[Indometacin: come back of a controversial tocolytic? Obstetrical point of view]

The main aim of tocolysis is to improve the health of newborns. Given the modest impact in terms of perinatal health of tocolysis we must emphasize the use of tocolytics which, equally effective, have fewer maternal side effects than beta-agonists and are devoid of potential complications for mother and the newborn. Inhibitors of prostaglandin synthesis and calcium antagonists of oxytocin seem to meet these criteria. The recent papers for the use of NSAIDs provide no fundamentally new scientific data. This therapy is potentially associated with severe neonatal complications and superiority to calcium channel blockers or antagonists of oxytocin in terms of prolongation of pregnancy is not established. It seems reasonable to reserve them for special situations by their severity, precocity of the age of gestation or by the ineffectiveness of other treatments. In practice, it is recommended not to use NSAIDs first line, beyond 32 weeks and treatment should be of short duration (less than 48 to 72 hours). Ideally, delivery should not occur within 48 hours after stopping treatment.