[Tocolysis for preterm labor without premature preterm rupture of membranes]. 2016

M Doret, and G Kayem
Service de gynécologie obstétrique, hospices civils de Lyon, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Bron cedex, France. Electronic address: muriel.doret@chu-lyon.fr.

OBJECTIVE To propose guidelines for clinical practice for tocolysis in preterm labor without premature preterm rupture of the membranes (PPROM). METHODS Bibliographic searches were performed in the Medline and Cochrane databases and gynecologist and obstetricians' international society guidelines. It is important to note that most studies included women in preterm labour with and without PPROM. RESULTS Compared with placebo, tocolytics are not associated with a reduction in neonatal mortality or morbidity (LE2). Compared with betamimetics, nifedipine is associated with a reduction in necrotizing enterocolitis, intraventricular hemorrhage and respiratory distress syndrome (LE2). There is no difference between nifedipine and atosiban regarding neonatal prognosis, except a modest reduction in NICU transfer with nifedipine (LE2). Betamimetics, atosiban and nifedipine are equivalent to prolong pregnancy for more than 48hours (LE2). Compared with betamimetics, nifedipine reduces delivery before 34 WG and is associated with a longer pregnancy (LE2). Atosiban and nifedipine are equivalent to prolong the pregnancy over 7 days (LE2), but in women with spontaneous preterm labour without PPROM, nifedipine reduces deliveries before 37 WG and pregnancy prolongation is longer, without improving neonatal prognosis (LE2). Maternal severe adverse effects may occur with all tocolytics (LE4). Betamimetics cardiovascular adverse effects are frequents (LE2) and may be serious (maternal death) (LE4). Nifedipine and atosiban reduce maternal adverse effect compared with placebo (LE2). Cardiovascular adverse effects are moderately increased with nifedipine compared with atosiban (LE2), without increasing treatment discontinuation (LE2). Regarding their benefits on pregnancy prolongation and good maternal tolerance, atosiban and nifedipine can be used for tocolysis in spontaneous preterm labour without PPROM (Grade B), for singleton and multiple pregnancies (Professional Consensus). Advantageously, nifedipine is orally taken and is inexpensive (Professional Consensus). Nicardipine should not be used for tocolysis (Professional Consensus) and betamimetics should not be prescribed anymore for tocolysis (Grade C). All tocolytic treatment should be prescribed for up to 48hours (Grade B). In case of initial tocolysis failure, another treatment may be proposed with the other class of tocolytic (Professional Consensus). Different class of tocolytics should not be combined (Grade C). Scientific data are lacking to propose guidelines regarding a rescue tocolysis, after a first previous successful tocolysis with complete antenatal corticosteroid therapy (Professional Consensus). There is no scientific evidence to propose a tocolysis in women with advanced dilatation (GradeC), nor prescribe a tocolysis after 34 WG (Professional Consensus). There is no evidence to define a gestational age lower limit for tocolysis (Professional Consensus). CONCLUSIONS Nifedpine and atosiban can be used for tocolysis (Grade B), including for multiple pregnancies (Professional Consensus). Maintenance tocolysis is useless (Grade C) and potentially harmful (Grade C). Betamimetics should not be used for tocolysis (Professional Consensus).

UI MeSH Term Description Entries
D007752 Obstetric Labor, Premature Onset of OBSTETRIC LABOR before term (TERM BIRTH) but usually after the FETUS has become viable. In humans, it occurs sometime during the 29th through 38th week of PREGNANCY. TOCOLYSIS inhibits premature labor and can prevent the BIRTH of premature infants (INFANT, PREMATURE). Preterm Labor,Labor, Premature,Premature Labor,Premature Obstetric Labor,Labor, Premature Obstetric,Labor, Preterm
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D015145 Tocolysis Any drug treatment modality designed to inhibit UTERINE CONTRACTION. It is used in pregnant women to arrest PREMATURE LABOR. Tocolytic Therapy,Therapy, Tocolytic,Tocolytic Treatment,Therapies, Tocolytic,Tocolyses,Tocolytic Therapies,Tocolytic Treatments,Treatment, Tocolytic,Treatments, Tocolytic
D015149 Tocolytic Agents Drugs that prevent preterm labor and immature birth by suppressing uterine contractions (TOCOLYSIS). Agents used to delay premature uterine activity include magnesium sulfate, beta-mimetics, oxytocin antagonists, calcium channel inhibitors, and adrenergic beta-receptor agonists. The use of intravenous alcohol as a tocolytic is now obsolete. Tocolytic,Tocolytic Agent,Tocolytic Effect,Tocolytic Effects,Tocolytics,Agent, Tocolytic,Agents, Tocolytic,Effect, Tocolytic,Effects, Tocolytic

Related Publications

M Doret, and G Kayem
April 2021, European journal of obstetrics, gynecology, and reproductive biology,
M Doret, and G Kayem
March 2008, Gynecologie, obstetrique & fertilite,
M Doret, and G Kayem
January 1998, The Journal of maternal-fetal medicine,
M Doret, and G Kayem
September 2005, Clinics in perinatology,
M Doret, and G Kayem
January 1989, Gynakologische Rundschau,
M Doret, and G Kayem
October 2010, Journal of perinatology : official journal of the California Perinatal Association,
M Doret, and G Kayem
July 1984, Journal of the South Carolina Medical Association (1975),
M Doret, and G Kayem
February 1993, Current opinion in obstetrics & gynecology,
M Doret, and G Kayem
December 1986, Clinical obstetrics and gynecology,
Copied contents to your clipboard!