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Maintenance tocolysis.
1Division of Obstetrics and Gynaecology, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
BJOG : an International Journal of Obstetrics and Gynaecology
|February 18, 2005
Summary
Maintenance tocolysis, used to prolong pregnancy in preterm labor, shows limited effectiveness. Current evidence suggests beta-agonists and magnesium sulfate are ineffective, while atosiban shows promise but requires further study.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Pharmacology
Background:
- Women undelivered after 48 hours of tocolysis face continued preterm labor risk.
- The efficacy of extended tocolytic treatment remains uncertain.
Purpose of the Study:
- To systematically review existing evidence on the effectiveness of maintenance tocolysis.
Main Methods:
- Summary of findings from published systematic reviews.
- Inclusion of recently published trials not yet incorporated into reviews.
Main Results:
- Maintenance tocolysis with beta-agonists and magnesium sulfate did not prolong gestation or improve fetal outcomes.
- Nifedipine trials were underpowered; one trial suggested potential for prolonging gestation.
- Atosiban, an oxytocin receptor blocker, prolonged gestation in one trial, but the study was too small to assess fetal outcomes.
Conclusions:
- Insufficient evidence supports routine maintenance tocolysis for preterm labor.
- Prolonging gestation may benefit selected cases of very preterm labor if fetal compromise and infection are excluded.
- Atosiban is the only tocolytic demonstrated to prolong gestation as maintenance therapy.