Emerging tocolytics for maintenance therapy of preterm labour: oxytocin antagonists and calcium channel blockers

The incidence of spontaneous preterm labour and preterm birth has increased, and its management worldwide remains suboptimal. While considerable debate remains as to whether long-term maintenance tocolysis is appropriate after an episode of spontaneous preterm labour, many practitioners support its use. Several drugs have been used for maintenance tocolysis, but they differ in terms of safety and efficacy. Atosiban and nifedipine are preferable for maintenance tocolysis, as they have been shown to be as effective as ritodrine while being associated with fewer adverse effects. Nifedipine is not licensed for use as a tocolytic. An ideal tocolytic should be utero specific, with few fetomaternal and fetal adverse effects, and should significantly improve perinatal outcome. To warrant the use of maintenance therapy, larger trials in women at particular gestational age ranges may be needed, in which the primary endpoints are perinatal outcomes. The inclusion of cost-effectiveness analyses would also be of benefit.