The Evidence Regarding Maintenance Tocolysis

Abstract

Preterm delivery is a public health issue of major proportion. More than 12% of deliveries in the United States that occur at less than 37 weeks gestation preterm labor (PTL) represents the largest single reason for preterm birth (PTB). Attempts to prevent PTB have been unsuccessful. This paper of maintenance tocolytic therapy will examine the efficacy and safety of the drugs, both oral and subcutaneous, which have been utilized for prolongation of pregnancy following successful arrest of a documented episode of acute preterm labor. The evidence for oral tocolytics as maintenance therapy as well as parenteral medications for such patients is offered. Finally, the effects in the United States of the Food and Drug Administration (FDA) action on such medications are reported.

Tocolysis for in utero Surgery: Atosiban Performs Distinctly Better than Magnesium Sulfate

“…Thus, Klauser et al in 2014 [9] stated that clinicians in the US should use the medication that yielded the best results with the lowest rate of maternal or neonatal side effects. Elliot and Morrison in 2013 [10] explicitly criticize that the FDA has blocked the use of atosiban in the US although it remains available, and is routinely used, in the rest of the world.…”

17OHP‐C in patients with spontaneous preterm labor and intact membranes: is there an effect according to the presence of intra‐amniotic inflammation?

“…Because the FDA has not recommended the clinical use of ritodrine, 30 we used it carefully and with informed consent. The upper limit of ritodrine administration is 200 μg/min in Japan; however, it was set to 100 μg/min in our hospital.…”

“…The upper limit of ritodrine administration is 200 μg/min in Japan; however, it was set to 100 μg/min in our hospital. Because the FDA has not recommended the clinical use of ritodrine, 30 we used it carefully and with informed consent.…”

Risks and Benefits of Magnesium Sulfate Tocolysis in Preterm Labor (PTL)

“…Maintenance tocolysis would be the use of tocolytic drugs in appropriate candidates beyond 48 hours. Elliott and Morrison [24] published a review article on the evidence regarding maintenance tocolysis, which usually involves oral therapy with magnesium, beta-agonists, or calcium channel blockers after acute treatment for preterm labor in the hospital. Convincing evidence supporting oral maintenance tocolysis is lacking, but supports the use of other maintenance therapy.…”