What is the future of tocolysis?

Use of the currently available tocolytics is controversial because it has not been associated with improved perinatal outcomes. New markers of preterm labour may come from gene-profiling studies, in as much as they may help in identifying novel genes regulating myometrial quiescence and in expanding our understanding of the pathologic process of uterine dysfunction. Study of certain transcripts in circulating white blood cells by RT-PCR could assist the obstetrician in evaluation of the risks. Uterine electromyography (EMG) also has the potential benefit of monitoring tocolytic treatment, although no standard method of clinical interpretation has yet been devised for the results yielded by this instrumentation. Recent functional genomic studies found that in the uterus at term there is a massive down-regulation of a large panel of developmental cell adhesion molecules and proliferation-related genes. Conversely, maintaining the developmental processes in an active state in patients at risk would help to prevent preterm delivery. It is too early to suggest any therapies with anticytokines in pregnant women. However, exploration of genetic polymorphisms, which may influence the balance of pro- and anti-inflammatory cytokines that are relevant to the course of preterm labour, seems to be a novel avenue that should be explored.