Developments in the pharmacotherapeutic management of spontaneous preterm labor.
BACKGROUND
Preterm birth is the major cause of perinatal mortality and morbidity in the developed world.


OBJECTIVE
The aim of this study was to establish the importance of preterm birth and the huge healthcare costs involved and review the pathophysiology of preterm labor and the use of antepartum glucocorticoids, which are the main reason why tocolytics are used to prevent or delay preterm birth. The study also reviewed the range of tocolytics available, their mode of action and the evidence for their efficacy and fetomaternal safety.


METHODS
An extensive review of the literature using well-recognized and accepted scientific search engines was employed.


CONCLUSIONS
The perfect tocolytic does not exist. The evidence to support the use of magnesium sulfate as a tocolytic is poor. The use of beta-agonists is decreasing worldwide as clinicians move to nifedipine or atosiban, which are as effective but much safer. Although nifedipine is cheaper than atosiban and can be administered orally, the evidence to support atosiban is much superior to that of nifedipine and there have been recent safety concerns over nifedipine.
Kam
K Y Ronald
KY
Imperial College London, Department of Obstetrics and Gynaecology, Northwick Park and St Mark's NHS Trust, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
Lamont
Ronald F
RF
D005260:Female; D005333:Fetus / Q000187:drug effects; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use; D009543:Nifedipine / Q000494:pharmacology / Q000627:therapeutic use; D007752:Obstetric Labor, Premature / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics / Q000517:prevention & control*; D015149:Tocolytic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D014668:Vasotocin / Q000031:analogs & derivatives / Q000627:therapeutic use
D005938:Glucocorticoids; D015149:Tocolytic Agents; C047046:atosiban; D008278:Magnesium Sulfate; D009543:Nifedipine; D014668:Vasotocin