Tocolysis for preterm labor: Expert opinion

Abstract

Tocolysis is an important treatment in the improvement of outcome in preterm labor and preterm birth, provided that its use follows clear evidence-based recommendations. In this expert opinion, the most recent evidence about efficacy and side effects of different tocolytics is being reviewed and evidence-based recommendation about diagnosis and treatment of preterm labor is given. Further aspects such as progesterone administration or antibiotic treatment for the prevention of preterm birth are included. Our review demonstrates that an individualized choice of different tocolytics and additional treatments is necessary to improve short- and long-term neonatal outcome in preterm labor and preterm birth.

Tocolysis – update 2016

“…Einige Quellen spezifizieren die Zervixverkürzung mit einem Grenzwert von < 25 mm [6,7], auch die amerikanischen Leitlinien nennen < 25 mm als Grenzwert zur kurzen Zervix [8]. Andere dagegen geben einen unteren Grenzwert von < 15 mm Zervixlänge als Hinweis auf eine tatsächlich drohende Frühgeburt an [5].…”

“…Bei der vorliegenden medizinischen Evidenzlage kann bei den meisten Schwangeren für die Dauer der Lungenreife eine Tokolyse mit Kalziumantagonisten durchgeführt werden, wohingegen Atosiban nach Expertenmeinung bei Hochrisikoschwangeren mit z. B. kardiopulmonalen Erkrankungen oder Diabetes mellitus Typ I der Vorzug gegeben sollte [7].…”

Systematic review and meta‐analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor

“…Although 50% of PTL takes place after 35 completed weeks of gestation, 99% of associated morbidity and mortality occurs before this time . Therefore, to improve the outcomes of premature neonates, the most common approach is to provide tocolytics to women as labor‐inhibiting agents that postpone delivery by inducing myometrial relaxation or uterine quiescence of the uterus . For each day delayed, survival rate improves by 3% allowing the administration of alternative rescue treatments such as antenatal corticosteroids during the extended interval till delivery …”

“…9 Therefore, to improve the outcomes of premature neonates, the most common approach is to provide tocolytics to women as labor-inhibiting agents that postpone delivery by inducing myometrial relaxation or uterine quiescence of the uterus. 10 For each day delayed, survival rate improves by 3% allowing the administration of alternative rescue treatments such as antenatal corticosteroids during the extended interval till delivery. 5,11,12 Many different classes of tocolytics are commonly used including: the β adrenoceptor agonist ritodrine hydrochloride, prostaglandin inhibitors indomethacin and ketorolac, the calcium channel blocking agent nifedipine, the oxytocin receptor antagonist atosiban, magnesium sulfate, and others.…”

Outcomes of Admissions for Preterm Labor

“…Unfortunately, current strategies such as tocolytic agents have shown limited efficacy and are associated with undesirable side effects. 11 12 13 14 15 16 17 18 19 …”