PubMed
Cochrean library
RCOG Guidelines
ACOG Issues Guidelines
National Guideline Clearinghouse
MOH Sing. Guideline
Definition
Preterm labor is the presence of
contractions of sufficient strength
and frequency to effect
progressive effacement and
dilation of the cervix between 20
and 37 weeks' gestation
WHO
Preterm Labor
Incidence : 6- 10%
• Spontaneous : 40-50%
• PROM : 25-40%
Nifedipine = Epilate
Atosiban= Tractocile
Choice Of Tocolytic Drug
If a tocolytic drug is used, ritodrine no
longer seems the best choice.
Atosiban or nifedipine appear
preferable as they have fewer adverse
effects and seem to have comparable
effectiveness.
RCOG Guideline Grade A recommendation 2002 (Valid:2005)
B -Sympathomimetic Agents.
• Use of beta-agonists should be
restricted to the management of
preterm labour between 20 and
35 completed weeks, including
women with ruptured membranes.
(Grade A)
Duckitt& Thornton ,
(Cochrane Review) March 2002. In: The
Cochrane Library, Issue 1 2003. Oxford: Update Software.
Indomethacin
Compared with ritodrine there is
insufficient evidence for any
differential effect on delay in
delivery, but indomethacin does
seem to have fewer maternal
adverse effects than the beta-
agonists
RCOG Guideline Grade B Recommendation 2002 (Valid:2005)
Indomethacin
Fetal risk:
Premature closure of the ductus.
Renal and cerebral vasoconstriction.
Necrotising enterocolitis
Common with high dose and
prolonged exposure.
RCOG Guideline Grade B Recommendation 2002 (Valid:2005)
Indomethacin
Indomethacin therapy for
< 48 hours
< 30-32 weeks' gestation)
Not > 200mg/day.
appears to be a relatively safe and
effective tocolytic agent
Goldenberg , Obstetrics &Gynecology 11-2002
Indomethacin
Indomethacin can be
used as a second-line
tocolytic agent in early
gestational age preterm
labors.
Goldenberg , Obstetrics &Gynecology 11-2002
Indomethacin
Indomethacin may be a first-
line tocolytic in:
• Associated polyhydramnios :
( to have renal effects of
indomethacin)
Newton eMedicine 2002
Indomethacin
Capsule 25mg oral
Amp 50mg
Rectal Supp 100 mg
50 mg Loading dose
Then 25-50mg /6hs
Newton eMedicine 2002
Atosiban: Tractocil
Atosiban, a synthetic
peptide, is a competitive
antagonist of oxytocin at
uterine oxytocin
receptors.
Atosiban: Tractocil
Atosiban - compared with beta-agonists-
has:
Little difference in the effect of these agents on
delayed delivery
Fewer maternal adverse effects than beta-agonists,
such as chest pain, palpitations , tachycardia ,
hypotension , dyspnoea ,vomiting , and headache.