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Is tocolysis safe in the management of third-trimester bleeding?
C V Towers1, R A Pircon, M Heppard
1Department of Obstetrics and Gynecology, University of California, Long Beach, USA.
American Journal of Obstetrics and Gynecology
|June 16, 1999
Summary
Tocolytic agents used for preterm third-trimester bleeding did not increase maternal or neonatal harm in this large study. Neonatal deaths were linked to prematurity complications, not tocolysis itself.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Neonatology
Background:
- Third-trimester bleeding in pregnancies before 36 weeks' gestation often involves expectant management.
- The use of tocolytic agents to manage associated contractions remains controversial due to limited data.
Purpose of the Study:
- To evaluate the safety of tocolytic agent use in a large cohort of preterm pregnancies with third-trimester bleeding.
- To assess potential harm associated with tocolytic agents in this specific obstetric context.
Main Methods:
- A 6-year retrospective analysis of a perinatal database.
- Inclusion criteria: third-trimester bleeding onset between 23 and 36 weeks' gestation.
- Data collected: gestational age, tocolytic use, transfusion needs, maternal morbidity, and neonatal outcomes.
Main Results:
- 236 cases analyzed (131 abruptio placentae, 105 placenta previa); 72-73% received tocolytic agents.
- No increased need for transfusion or fetal distress incidence with tocolytic use.
- No maternal morbidity or stillbirths post-admission related to tocolytic agents; neonatal deaths were due to prematurity.
Conclusions:
- This study represents the largest evaluation of tocolytic agents in preterm third-trimester bleeding.
- Tocolytic agent use in a tertiary setting did not demonstrate increased maternal or neonatal morbidity/mortality.
- Further prospective randomized trials are needed to ascertain potential benefits of tocolytic use.