Tocolysis in women with advanced preterm labor: a secondary analysis of a randomized clinical trial.
OBJECTIVE
To compare the efficacy of tocolytic treatment with indomethacin (I), magnesium sulfate (M) and nifedipine (N) for acute tocolysis in women with advanced cervical dilation (4-6 cm).


METHODS
A single center, randomized trial was carried out involving patients in preterm labor (cervix 1-6 cm). Secondary analysis of women with advanced cervical dilation (cervix 4-6 cm) at 24-32 weeks' gestation who received intravenous M, oral N or I suppositories comprised this study population.


RESULTS
Over 38 months, 92 women with advanced cervical dilation were randomized to one tocoloytic type. Days gained in utero (11.7) and percent remaining undelivered at 48 h (60.8%), 72 h (53.1%) and >7 days (38.3%) were similar regardless of tocolytic employed (p = 0.923, 0.968, 0.791, 0.802, respectively). Likewise, gestational age at delivery (30.7 ± 3.2) was similar between groups (p = 0.771). Finally, neonatal statistics were not different when stratified by tocolytic treatment.


CONCLUSIONS
There were no statistical differences between tocolytics in treating women with advanced cervical dilation. All offered significant days gained in utero after therapy, a high percentage remaining undelivered after 48 or 72 h and after 7 days. It would appear from data that there may be advantages to tocolytic treatment even in women with advanced cervical dilation.
a Departments of Obstetrics and Gynecology , The Mount Sinai Medical Center , New York City , NY , USA .
Chad K
CK
Klauser
b Departments of Obstetrics and Gynecology , Regional Perinatal Group , Shreveport , LA , USA .
Christian M
CM
Briery
c Departments of Obstetrics and Gynecology , University of Mississippi Medical Center , Jackson , MS , USA .
Ann R
AR
Tucker
c Departments of Obstetrics and Gynecology , University of Mississippi Medical Center , Jackson , MS , USA .
Rick W
RW
Martin
d Departments of Obstetrics and Gynecology , University of Arkansas for Medical Sciences , Little Rock , AR , USA , and.
Everett F
EF
Magann
e Departments of Obstetrics and Gynecology , Lyndon B. Johnson General Hospital , Houston , TX , USA.
Suneet P
SP
Chauhan
c Departments of Obstetrics and Gynecology , University of Mississippi Medical Center , Jackson , MS , USA .
John C
JC
Morrison
D061605:Administration, Intravenous; D000284:Administration, Oral; D000285:Administration, Rectal; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage; D007231:Infant, Newborn; D007747:Labor Stage, First / Q000187:drug effects / Q000502:physiology; D008278:Magnesium Sulfate / Q000008:administration & dosage; D009543:Nifedipine / Q000008:administration & dosage; D007752:Obstetric Labor, Premature / Q000188:drug therapy* / Q000628:therapy; D011247:Pregnancy; D013488:Suppositories; D015145:Tocolysis / Q000379:methods*; D015149:Tocolytic Agents / Q000008:administration & dosage; D055815:Young Adult
D013488:Suppositories; D015149:Tocolytic Agents; D008278:Magnesium Sulfate; D009543:Nifedipine; D007213:Indomethacin
Advanced cervical dilation; maternal–fetal medicine; pregnancy; preterm labor; tocolytic treatment