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Preterm birth is associated with increased mortality and morbidity. Tocolytic drugs, such as indomethacin, are often used to postpone preterm delivery. Indomethacin has been proven to be more effective than other tocolytic agents in terms of delaying birth but is often prescribed with caution because of its potential association with adverse neonatal outcomes. We aim to study the effects of antenatal indomethacin on neonatal outcomes after controlling for potential confounders, as compared to nifedipine and/or atosiban.In this cohort study, we performed a retrospective analysis of maternal and neonatal data. Women were included if they received indomethacin, nifedipine or atosiban as a tocolytic drug for imminent preterm labor and gave birth at a gestational age (GA) between 23Four hundred seventy-four women, delivering 610 infants were investigated. The incidence of the following adverse neonatal outcomes were significantly higher after indomethacin use: neonatal death (The presumed association between antenatal indomethacin exposure and several adverse neonatal outcomes may be based upon indication bias. Taking important confounding factors, such as GA at birth and neonatal birth weight into account, antenatal indomethacin exposure does not result in a higher incidence of adverse neonatal outcomes. However, there may be a higher risk for spontaneous intestinal perforation.

Introduction The breech presentation represents 4,7% of deliveries at term. There is a method of external cephalic version (ECV) performed from 36 weeks of gestation. French guidelines for the clinical practice of ECV were published in 2020. Objective To evaluate the national practices of ECV in French maternity units, especially on the use of tocolysis, 1 year after publication of the French clinical recommendations guidelines by the French national college of obstetricians and gynecologists (CNGOF). Methods Data self-reported for this national descriptive study were collected from March to May 2021 by an online questionnaire distributed to all French maternities. The 25 items of the questionnaire collected information of maternity units, the general practice of ECV, use or not of tocolysis for ECV attempt and the relevance of a prospective study. Results Of the 517 French maternity units, 150 (29%) responded to the online survey. 95,3% systematically performed ECV. A Kleihauer test was routinely performed in 71 units (49.7%). A tocolysis was associated with ECV attempt in 52.4% of cases. The drugs used were intravenous atosiban (30,7%), mainly in levels 2b and 3 maternity units, intravenous salbutamol (24%), other mode of administration of salbutamol (14,7%) and oral nifedipine (22,6%) mainly in levels 1 and 2a maternity units. Adverse effects were described in 20%, mainly with the use of salbutamol (73,3%). Conclusions 52.4% of the French maternity units surveyed used tocolysis for the ECV attempt, although it is systematically recommended. The choice of tocolytic drug differed according to the maternity units.

Introduction: Preterm labour is a major healthcare problem throughout the world, it is a major cause of perinatal mortality and morbidity. Methods: Prospective comparative study conducted in the Department of Obstetrics & Gynaecology at Kamla Raja Hospital, Gwalior, M.P, from August 2011 to September 2012. Sample Size: 80. 50 patients were given H.C.G. and 30 were given Magnesium sulphate to suppress preterm labour. Statistical analysis done using Chi square test in SPSS software and p value < 0.05 was considered significant. Results: Mean duration between initiation of treatment & suppression of contractions was 3.1 hrs & 2.9 hrs in women receiving H.C.G. & Magnesium sulphate respectively (p value

Summary Background Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries. Methods WHOMCS is a facility-based, cross-sectional survey database of birth outcomes in 359 facilities in 29 countries, with data collected prospectively from May 1, 2010, to Dec 31, 2011. For this analysis, we included deliveries after 22 weeks' gestation and we excluded births that occurred outside a facility or quicker than 3 h after arrival. We calculated use of antenatal corticosteroids in women who gave birth between 26 and 34 weeks' gestation, when antenatal corticosteroids are known to be most beneficial. We also calculated use in women at 22–25 weeks' and 34–36 weeks' gestation. We assessed tocolytic drug use, with and without antenatal corticosteroids, in spontaneous, uncomplicated preterm deliveries at 26–34 weeks' gestation. Findings Of 303 842 recorded deliveries after 22 weeks' gestation, 17 705 (6%) were preterm. 3900 (52%) of 7547 women who gave birth at 26–34 weeks' gestation, 94 (19%) of 497 women who gave birth at 22–25 weeks' gestation, and 2276 (24%) of 9661 women who gave birth at 35–36 weeks' gestation received antenatal corticosteroids. Rates of antenatal corticosteroid use varied between countries (median 54%, range 16–91%; IQR 30–68%). Of 4677 women who were potentially eligible for tocolysis drugs, 1276 (27%) were treated with bed rest or hydration and 2248 (48%) received no treatment. β-agonists alone (n=346, 7%) were the most frequently used tocolytic drug. Only 848 (18%) of potentially eligible women received both a tocolytic drug and antenatal corticosteroids. Interpretation Use of interventions was generally poor, despite evidence for their benefit for newborn babies. A substantial proportion of antenatal corticosteroid use occurred at gestational ages at which benefit is controversial, and use of less effective or potentially harmful tocolytic drugs was common. Implementation research and contextualised health policies are needed to improve drug availability and increase compliance with best obstetric practice. Funding UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); WHO; USAID; Ministry of Health, Labour and Welfare of Japan; Gynuity Health Projects.

Tocolytic drugs are used widely in order to prevent preterm birth. Ritodrine, is the only food and drug administration (FDA) approved drug for tocolytic use. We estimated the cytogenetic effect of ritodrine administered as maternal therapy, alone or in combination with smoking, in women and their neonates.Lymphocyte and fibroblasts cultures were evaluated and three indices were analyzed; sister chromatid exchanges (SCEs), proliferation rate index (PRI) and mitotic index (MI) as well as average generation time (AGT) and population doubling time (PDT). Campothacin (CPT-11) was used as a positive control.Administration of ritodrine up to a month revealed significant reduction of SCEs/cell in neonates in the presence or absence of the mutagenic agent. A statistical significant increase on SCEs, for mothers and neonates, was noticed in neonate's lymphocytes when tocolytic therapy was over a month. Ritodrine revealed a cytoprotective action against smoking when the two factors were combined, but the synergistic action of ritodrine with smoking increased genotoxicity, cytostaticity and cytotoxicity of neonates after long administration (1-3 months).The time-depended genotoxic, cytostatic and cytotoxic action of ritodrine alone or in combination with smoking suggests that its administration should not exceed the time period of a month.

Evaluation of: Smith GN, Walker MC, Ohlsson A, O’Brien K, Windrim R; Canadian Preterm Labour Nitroglycerin Trial Group. Randomized double-blind placebo-controlled trial of transdermal nitroglycerin for preterm labor. Am. J. Obstet. Gynecol. 196(1), 37.e1–37.e8 (2007).The aim of finding a new tocolytic drug through the adaptation of a substance commonly utilized for other pathologies but that has been proven to have a tocolytic effect in vitro or in vivo deserves to be explored. However, care must be taken to avoid misleading results, especially when protocols are not carefully designed. On the basis that glyceril trinitrate (GTN) has been found in both animal and human studies to act as a tocolytic agent with unclear maternal–fetal side effects, a multicenter, randomized, placebo-controlled trial was set up by the Canadian Preterm Labour Nitroglycerin Trial Group and the results were recently published. The risk of developing neonatal morbidity was reduced by 79% if mothers were treated with GTN. Moreover...

To determine hypotensive effect of nifedipine in the treatment of preterm labor.A descriptive analytic study was conducted on pregnant women treated with nifedipine as tocolytic drug for preterm labor. Maternal blood pressure before and at 15, 30, 45 and 60 min after administration of nifedipine was evaluated and analyzed. Hypotension was defined as a decrease in systolic or diastolic blood pressure of 15 mmHg or more.A total of 157 pregnant women met the inclusion criteria. The mean systolic and diastolic blood pressure before treatment was 109.4 and 72.5 mmHg, respectively. The blood pressure following treatment with nifedipine was significantly decreased both systolic and diastolic blood pressure (p0.05) at 30, 45 and 60 min. Of 157 patients, 28 (17.8%) and 27 (17.2%) had systolic and diastolic hypotension, respectively. Of the patients with decreased blood pressure, the mean decrease of systolic and diastolic blood pressure was 16.3 and 14.5 mmHg, respectively.Nifedipine was associated with a minimal but significant decrease in blood pressure. 17% of cases have hypotension. However, hypotension secondary to nifedipine was not associated with significant clinical symptoms, suggesting that nifedipine is relatively safe in terms of hypotensive effect.

Administration of short-term tocolytic agents can prolong pregnancy for women in preterm labor. Prolonging pregnancy has many benefits because it allows for other proven interventions, such as antenatal corticosteroid administration, to be accomplished. This review provides an overview of currently utilized tocolytic agents and the evidence demonstrating their efficacy for prolonging pregnancy by at least 48 hours. General pharmacological principles for the clinician regarding drugs in pregnancy are also briefly discussed. In general, while the choice of the best first-line short-term tocolytic drug is not clear, it is evident that use of these agents has a clear place in current obstetric therapeutics.

Although tocolytic drugs are widely used to try to stop preterm labor, their actual contribution to preventing preterm deliveries is unknown. Since tocolytic drugs are not used at the University of Manitoba, it was possible to estimate the proportion of preterm deliveries that might have been eligible for tocolytic drug therapy. Of 364 consecutive preterm deliveries between 24 and 35 weeks, only 9% would have been eligible for, let alone prevented by, tocolytic drug therapy, and even a smaller percentage of babies would actually have benefitted from their use. The use of tocolytic drugs can, at best, benefit only a very small percentage of babies born preterm. Whether the risks of treatment justify this small benefit is arguable.

Objective: To evaluate nifedipine as a tocolytic agent and measure the side-effects Methods : Prospective randomized study of 89 singleton pregnancies with preterm labour between 30-34 weeks of gestation. The capacity to delay delivery 48 h,7 days, til 36 weeks were the outcome variable assessed. Results: Nifedipine could successfully prolong delivery in about 82 % of cases. There were fewer side-effects. Main side-effects were flushing and head-ache. Most of the patients complained of no side-effects. Conclusion : Nifedipine is a well tolerated tocolytic drug with fewer side-effects. Key word: Nifedipine; tocolysis; preterm labour DOI: 10.3329/bjog.v23i2.4961 Bangladesh J Obstet Gynaecol , 2008; Vol. 23(2) : 61-64

SUMMARY The tocolytic drug Clenbuterol was clinically tested as a means of producing relaxation of the myometrium to facilitate exteriorisation of the uterus during Caesarean operation in 17 cows. When myometrial tone was found to be high during surgery, the intravenous injection of 10 ml of Clenbuterol resulted in a lowering of tone in less than 3 min allowing easy exteriorisation of the uterus. Alternative methods of myometrial relaxation are compared.