Acute tocolysis for uterine activity reduction in term labor: a review.
This review critically evaluates the efficacy of different tocolytics in reducing uterine pressure and contractions in term labor. The available evidence supports the use of beta-adrenergic-receptor agonists such as terbutaline or ritodrine; they appear to have an immediate and comparable profound effect on uterine activity in term labor. However, the preferred type of beta-adrenergic receptor agonist and dosage are unclear. The oxytocin receptor antagonist atosiban has a high specificity for the uterus with limited or no systemic effects and could therefore be an attractive alternative for use in term labor. The evidence on the tocolytic potency of a single bolus of atosiban for tocolysis in term labor is encouraging but limited and needs further research. Moreover, atosiban lacks United States Food and Drug Administration approval. Literature documenting efficacy and safety of nitroglycerin or magnesium sulfate in term labor is far from convincing. The theoretical basis for the use of tocolytics for nonreassuring intrapartum fetal heart rate patterns is to reduce the aggravating influence of uterine contractions. However, the clinical evidence that tocolytics in term active labor are actually beneficial in improving neonatal outcome is very limited.
de Heus
Roel
R
Department of Perinatology and Gynecology, University Medical Centre Utrecht, The Netherlands. roeldeheus@hotmail.com
Mulder
Eduard J H
EJ
Derks
Jan B
JB
Visser
Gerard H A
GH
D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000187:drug effects* / Q000502:physiology; D009569:Nitric Oxide / Q000378:metabolism; D005996:Nitroglycerin / Q000008:administration & dosage; D011247:Pregnancy; D012312:Ritodrine / Q000008:administration & dosage*; D013726:Terbutaline / Q000008:administration & dosage; D015149:Tocolytic Agents / Q000008:administration & dosage*; D014590:Uterine Contraction / Q000187:drug effects*; D014668:Vasotocin / Q000008:administration & dosage / Q000031:analogs & derivatives
D000318:Adrenergic beta-Agonists; D015149:Tocolytic Agents; C047046:atosiban; D009569:Nitric Oxide; D005996:Nitroglycerin; D012312:Ritodrine; D013726:Terbutaline; D014668:Vasotocin