Tocolysis and delayed delivery versus emergency delivery in cases of non‐reassuring fetal status during labor

Abstract

Tocolysis and delayed delivery renders better immediate neonatal results than emergency delivery when fetal distress is suspected because of a non-reassuring fetal heart pattern. In addition, it may decrease the need for emergency delivery without increasing maternal and fetal adverse side-effects.

Study of early perinatal outcome in lower segment caesarean section in severe foetal distress at tertiary care centre

“…Briozzo et al, conducted a prospective randomized study to determine whether FIR using tocolysis and delayed delivery was better for the fetus than emergency delivery when fetal hypoxia was suspected because of a nonreassuring FHR pattern using conventional heart rate monitoring. 20 They concluded that tocolysis and delayed delivery rendered better immediate neonatal results than emergency delivery when fetal distress was suspected because of a non-reassuring fetal heart pattern. In addition, it may decrease the need for emergency delivery without increasing maternal and fetal adverse sideeffects.…”

Acute tocolysis for uterine tachysystole or suspected fetal distress

“…There is a wide range of tocolytic agents used acutely during labour for correcting uterine tachysystole, with or without the presence of suspected fetal distress. While studies have predominantly evaluated beta 2 (ß 2 )-adrenergic receptor agonists (Afschar 2004;Arias 1978;Briozzo 2007;Buhimschi 2002;De Heus 2008;Gerris 1980;Ingemarsson 1985;Patriarco 1987;Pullen 2000;Sheybany 1982), some have also used magnesium sulphate Vigil-De Gracia 2000), nitric oxide donors (Buhimschi 2002;Pullen 2000), calcium channel blockers (Chao 2002), or oxytocin antagonists (Afschar 2004;De Heus 2008). Unfortunately, to date, no consistent recommendations on the indications for tocolytic therapy during labour, the preferred type of tocolytic agent, or the optimum dosage of these agents have been available.…”

Uterine contraction agents, tocolytics, vaginal therapeutics and local contraceptives

“…No protocol of (long-term) tocolysis has unequivocally contributed to improvement in neonatal outcome (Haas 2009(Haas , 2012. In one randomized controlled trial it has been found that the condition at birth of these infants was indeed better after acute intra-partum tocolysis (Briozzo 2007). There is no evidence that maintenance therapy with intravenous or oral tocolytic drugs, given after a period of acute preterm contractions, will prolong gestational age (Roos 2013, Dodd 2012.…”

“…The effectiveness of oral treatment with these agents has not been demonstrated. Maybe the only current and remaining indication for β-sympathomimetic agents is in its use during term labor to stop excessive contractions and improve the fetal condition (de Heus 2008a, 2008b, Briozzo 2007. Maybe the only current and remaining indication for β-sympathomimetic agents is in its use during term labor to stop excessive contractions and improve the fetal condition (de Heus 2008a, 2008b, Briozzo 2007.…”