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ESSAY 151 - TOCOLYTICS

Posted by Sarwat F.
Available evidence suggests that tocolytics prevent preterm delivery upto only seven days after beginning treatment. There s insufficient evidence that they can prolong pregnancy for greater duration.

However this short time interval can be beneficial because of the fact that short term prolongation of pregnancy can be utilized for administration of steroids and in utero transfer of the baby to centres with facilities of SCBU.

Apart from benefit of time gained for administration of steroids and reducing the number of woman who deliver within seven days of commencing the drug, there is insufficient evidence for reliable conclusions to be made on perinatal and infant mortality or neonatal morbidity and it is therefore reasonable not to use them.

Among various tocolytics that are available, beta agonists were the ones most commonly used in the past. They are associated with significant maternal side effects including fluid overload, pulmonary edema. Myocardial ischemia, hyperglycemia and hypokalemia. Because of their side effect of hyperglycemia they interfere with glucose control in pregnancies complicated with gestational diabetes and preterm labour both. Studies have now shown that beta agonists are no longer the first choic in view of their side effects profile. Their effectiveness in prolonging pregnancy in the long term is unproven.

Another tocolytic is nifedipine which acts by blocking calcium channel in the smooth muscles. Their efficacy in suppressing preterm labour is as good as or even better than beta agonists. Like beta agonist they are also not associated with any improvement in PNMR. They also have the benefit of being able to be used orally and are very cheap and thus cost effective. A drawback in their usage is that the dosage and formulation are not clear for nifedipine as a tocolytic. Their side effects are tolerable as compared to beta agonists and include headaches and tachycardia. They are not associated with any deleterious effects on the fetus. One problem with their use is that they are not licensed for use for preterm labour.

Prostaglandin synthetase inhibitor indomethacin is also used as a tocolytic. It reduces preterm delivery within 48 hrs and is found to prolong pregnancy by 7 days in some studies. It is also shown in small studies to reduce respiratory distress in newborn and reduce perinatal deaths. However it is associated with significant adverse maternal and fetal side effects. Maternal side effects include peptic ulceration, gastrointestinal bleeding, thrombocytopenia and allergic reactions. Fetal side effects include pulmonary hypertension secondary to closure of ductus arteriosus, necrotizing enterocolitis, adverse effect on fetal renal function and intraventricular hemorrhage. This limit its use as a front line tocolytic.

Magnesuim sulphate is another tocolytic which acts by relaxing smooth muscle. There is however insufficient evidence to prove that it is effective in preventing preterm births. It is also associated with serious side effects which include adult respiratory distress syndrome, respiratory depression, cardiac arrest and low therapeutic ratio.

Atosiban is an oxytocin receptor antagonist and it is now proven to be an effective tocolytic, it is licensed for this indication as well as compared to nifedipine. It has a better side effect profile as related to beta agonist like ritodrine. Only problem associated with it is its high cost. Atosiban is effective over 28 weeks but efficacy under 23 weeks is inconclusive. It is administered by parenteral route.

Various other tocolytics like COX 2 inhibitors and nitric oxide donors have better side effect profile than other tocolytics but large clinical trials are awaited before they can be used.


Maintainence therapy of tocolytics is yet not proven to be of benefit and is therefore not recommended in routine practice. Further large scale studies are required to prove the benefit, if any of long term maintainence therapy.

As the available evidence about efficacy of tocolytice is limited, the current recommendation is to discuss the limited usefulness and side effect profile with the woman and informed decision is made regarding the administration of tocolytics.
Posted by SWATI M.
Preterm birth is a important cause for perinatal morbidity and mortality.The evidence suggest that the tocolysis in the treatment of preterm labour do not improve outcome.They prolong the preterm birth up to 7 days but this has not reflected in improvement on perinatal morbidity or mortality and so it is reasonable not to use them.But in selected women,who require in-utero transfer for better facilities of SCBU or time to complete a course of corticosteroids ,there may be benefit and should be recommended though not formally evaluated in trials.
The effectiveness of tocolytics is reduced in PPROM and there are contraindications for it?s use such as chorioamnionitis, imminent delivery or placental abruption.With placenta previa can be used in selected cases if uterine activity present as concern it may increase bleeding. The overall decrease in perinatal morbidity and mortality due to prematurity is mainly attributable to use of corticosteroids,antibiotics and improved neonatal facilities rather than effect of tocolytics.
Maintenance tocolysis is not recommended routinely as not beneficial.
If tocolytic drug is used,atosiban or nifedipine is preferable as have same effectivity and fewer side effects than ritodrine. Atosiban has no cardiac side effects like B-agonists, can be used in patients at risk of cardiac complications.It does not cause fetal tachycardia , licenced for use but expensive and available in injectable form. Adverse effects of atosiban are nausea ,vomiting ,headache.
Nifedipine can be used oral,cheap but not licensed as tocolytic use and woman should be consented before use.
B- agonists have adverse effects such as tachycardia,cardiac arrythmias,myocardial ischaemia ,hyperglycaemia,hypokalaemia,pulmonary edema hence precautions are needed in patients with cardiac disease,diabetes.
Indomethacin has fewer side effects than B agonists but increased risk of premature closure of ductus.Nitric oxide donars have fewer maternal side effects but needs further evaluation.There is insufficient evidence to support use of magnesium sulphate as tocolytic.
Prophylactic use of tocolytics for prevention of preterm labour in high risk women can not be recommended as not useful and difficulty in prediction of preterm labour.
Tocolytics use is indicated during external cephalic version at term particularly in primigravida as it increases success without adverse effects.
Intrapartum tocolysis is indicated if fetal distress with uterine hypercontractility not secondary to oxytocin use.Terbutalin injection subcutaneous 0.25 mg is recommended.
The role for tocolytics in obstetrics is in selected women with preterm labour ,management of intrapartum fetal distress and to fascilitate external cephalic version
Posted by narmin B.
In obstetrics tocolytics are used to inhibit uterine contractions in preterm labour and myometrial relaxation in external cephalic version and uterine hyperstimulation.

The most important use of tocolytics is in the prevention of preterm labour (gestational age less than 37 weeks). However still it is not clear that tocolytics improve fetal outcome in preterm labour in terms of perinatal mortality or morbidity .It is recommended that tocolytics to be used only to prevent delivery for a few days to allow the effect of steroids for lung maturity or intrauterine transfer( where special care facility for neonate is not available). Patient should be informed about the benefits and side effects of tocolytic and her choice should be respected. There is insufficient evidence about efficacy or safety of long term use of tocotytics for prolongation of pregnancy, and therefore currently it is not recommended.

Tocolytics are contraindicated in the presence of chorioamnionitis because prolongation of pregnancy is associated with increased maternal and perinatal mortality and morbidity due to sepsis. Also in the presence of fetal distress, severe intrauterine growth retardation and severe pre-eclampsia tocolytics are contraindicated.

The first choice of tocolytic in preterm labour is either calcium channel blockers such as nifedipine or atosiban. Compared to B agonists like ritodrine, which was the drug of choice in the past, both nifedipine and atosiban are similarly effective and have fewer side effects. Nifedipine is cheap and can be given orally but is not licensed for tocolytic use in the UK. Its side effects include headache and nausea and gastrointestinal symptoms and long term use of nifedipine may cause placental insufficiency and intrauterine growth retardation.

Atosiban is an oxitocin receptor antagonist and is licensed for tocolytic use in the UK. However atosiban is an expensive drug and is not routinely available in all obstetric units. Side effects are not severe and are in the form of hypotension, nausea and vomiting.

Non steroidal anti inflammatory drugs (NSAIDs) are also used as tocolytics in preterm labour. The mechanism of action is through inhibition of prostaglandin synthesis. Oral or rectal administration is possible and side effects include gastrointestinal symptoms. Long term use can cause premature closure of ductus arterious.

In the past, administration of a B agonist such as ritodrine infusion was the first choice for inhibition of contractions in preterm labour. However due to severe side effects of ritodrine such as pulmonary oedema, cardiac failure and maternal mortality, it is not recommended for tocolytic purposes.

Another use of tocolytics in obstetrics is in the treatment of uterine hyperstimulation which can cause uterine rupture or fetal distress. Uterine hyperstimulation can be seen following the use of prostaglandin for induction of labour or syntocinon for augmentation. B agonists such as salbutamol or terbutalin have been used successfully for myometrial relaxation. However side effects of B agonist agents such as palpitation and hypotension may be seen. In the presence of maternal cardio respiratory disease this drugs should not be used.

Tocolytics has been used to facilitate external cephalic version (ECV) routinely and in selected cases. It has been shown that tocolytic has significant effect in the success rate of ECV. However, still there is no recommendation with regard to the type and dose of tocolytic drug. Nitric oxide donors such as glyceryl nitrate (GTN) in the form of nasal spray or patch have been used successfully. Unwanted effects due to vasodilatation may be seen in the form of headache, flushing and hypotension.


Posted by Nibedita R.
Premature birth is the major cause of neonatal morbidity and mortality and complicates upto 10% of all pregnancies.
There is lack of clear evidence that tocolytic drugs can improve outcome in terms of perinatal mortality or serious morbidity in preterm labour. Therefore, the rationale is not to use them routinely.
However, systematic review of RCT shows that tocolytics can effectively prolong pregnancy upto 7 days. Delaying delivery upto 7 days may be beneficial for extreme preterm neonate where a survival gain of 3% per day and birthweight improvement by 100gms at lower gestational age (24-32weeks) would be expected.

RDS, IVH and necrotising enterocolitis are serious morbidities in preterm neonate. Tocolytics can effectively prolong pregnancy to complete a course of corticosteroids and promote fetal lung maturity in preterm neonate (<24-34> weeks), thus reduces long-term complications.
This time gain facilitates in-utero transfer to a centre with SCBU and advanced neonatal care would significantly improve survival in preterm neonate.
Short course of tocolytics and corticosteroids is also cost effective in terms of reduction of duration of hospital stay and neonatal intensive care treatment.

Attempting tocolysis in PTL may not be appropriate when the labour is too advanced and prolonging pregnancy may be detrimental for the fetus because of infection or placental abruption. Therefore, careful selection of patient is important before commencing treatment.

Its effectiveness may be reduced when used in PPROM.

It has also been advocated for the management of intrapartum fetal distress due to hypertonic uterine contractions and to improve success rate of ECV at term, especially in primigravida. Tocolytics for treatment of uterine activity in presence of bleeding due to placenta previa can be useful in selected cases. However, such use should be considered only in a tertiary setting.

Regarding choice of tocolytics, Atosiban or Nifedipine appear preferable to Ritodrine, as they have fewer adverse effects but similar effectiveness in delaying delivery at 48hrs and 7days with similar neonatal outcome.
B-mimetics have been the most commonly used drugs in UK. Although its use is associated with significant adverse effects, such as palpitation, tremor, chest pain, cardiac arrythmias, nausea, vomiting, headache, hyperglycaemia, hypokalaemia, pulmonary oedema (antidiuretic effect) and also maternal death. Great care to be taken in diabetics and patients with heart disease. Short-term fetal effects include tachycardia and increased cardiac output.

Atosiban- an oxytocin antagonist, has a better maternal cardiac adverse effect profile than B-mimetics. Although similar effectiveness over 28weeks, its effectiveness under 28weeks remains to be evaluated. Licensed for use as tocolytics, available as injections but is expensive when compared to Ritodrine and Nifedipine.

Nifedipine, a calcium channel blocker, is as good as, or better than B-mimetics for prevention of PTL, better side effect profile, relatively inexpensive, no adverse effect on fetus and administered orally. Nifedipine is not licensed for use as tocolytics and ideal dosage and formulations are unclear.

Indomethacin, a non selective cox-inhibitor, relatively few maternal adverse effects but its use has been limited by potential fetal adverse effects, such as, premature closure of ductus arteriosus, oligohydramnios, necrotising enterocolitis, IVH and impaired fetal renal function.
Magnesium sulphate has been tried, however, meta-analysis has shown it to be no better than placebo in delaying delivery.
Nitric oxide donor and COX-2 inhibitors are under clinical trial with better side effect profile than Indomethacin although there is no conclusive evidence to support their use.

The use of any tocolytic drug should be carefully considered in terms of available evidence on potential benefit and possible hazards and fully discussed with the mother and the partner before treatment is instigated.



Posted by Sonali G.


Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.




























































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in births <37 weeks and in low birth weight <2500 grams. Common side effects like palpitation, nausea, vomiting, chest pain or pulmonary edema are more than other tocolytic agents.
Atosiban is licensed in UK for use in threatened preterm labour but it is an expensive drug. It is similar in efficacy to Ritodrine but with fewer side effects. The only common side effect with it is nausea (~11%).
Nifedipine is not licenced in UK, but is cheaper and equally efficacious to atosiban in delaying delivery >48 hours and 7 days. There is some evidence of its benefit on risk of neonatal respiratory distress syndrome and neonatal jaundice compared with alternative agents.
There are insufficient evidence of nitric oxide, but it has fewer side effects. There are some evidences to show that it may cause cervical ripening which may restrict its use.
NSAIDS (indometthacine) is the only tocolytic agent which significantly reduces births before 37 wks and results in significant reduction of low birth weight babies <2500gms (OR0.07). There are minimal side effects and is cheap. But its use antenatally is associated with premature closure of ductus venosus, renal and cerebral vasoconstrictions , NEC and oligihydramnios.
Magnesium sulphate is not effective even in delaying delivery >48 hours or 7 days. Its use is not justified.
Maintenance tocolysis is not recommended for routine practice as there is insufficient evidence to show its benefit to prevent preterm birth.
Tocolysis has also been advocated during external cephalic version but it is not a must.
In cases of hypercontractility during labour s.c. terbutaline is given to counteract hypertonicity.
In absence of sufficient evidences it use should be discussed with the patient and her view taken into consideration with appropriate documentation.


































































Critically evaluate the use of tocolysis in obstetrics

Preterm delivery accounts for 6-10% of all deliveries and is a major cause of perinatal morbidity and mortality.
Evidence supports that tocolysis is associated with reduction in odds of delivery within 24 hours (O.R.0.47), 48 hours, and 7 days (OR 0.60). But there was no statistically significant reduction in births before 30 weeks, 32 weeks or 37 weeks of gestation. It is not proven to have an effect on perinatal mortality or morbidity. Therefore RCOG recommends its use only when the time gained can be used for administration of steroids or in utero transfer.
It a tocolytic drug is used for preterm labour, atosiban or Nifedepine appears preferable to ritodrine as they are associated with fewer side effects with comparable efficacy.
b-agonist (ritodine) is proven to be efficacious to delaying delivery for >48 hours (OR 0.57) and 7 days (0.65) but is not associated with significant reduction in b
Posted by Nibedita R.
Dear DR PAUL,

Please comment on my essay.

Nibedita
Posted by Nibedita R.
Thank you very much DR PAUL,

Nibedita.