Published 5 March 2009, doi:10.1136/bmj.b195
Cite this as: BMJ 2009;338:b195

Editorials

Tocolytics and preterm labour

Whether to treat or not is the real dilemma, not which drug to use

The first 150 words of the full text of this article appear below.

Preterm labour is still the main cause of perinatal morbidity and mortality in the developed world. Despite a better understanding of the pathophysiology, and the recognition that it is a syndrome with multiple causes, rates continue to rise.1 In the linked cohort study (doi:10.1136/bmj.b744), de Heus and colleagues assess the incidence of serious maternal complications with the use of tocolytic drugs for the treatment of preterm labour.2

Corticosteroids given to women at risk of preterm birth increase fetal lung maturity and can reduce fetal death, intraventricular haemorrhage, and respiratory distress by up to 50%.3 In contrast, it is still unclear whether tocolysis improves neonatal or longer term outcomes.4 Thus, the Royal College of Obstetricians and Gynaecologists’ clinical guideline on tocolysis concludes that, "it is reasonable not to use tocolytic drugs."5

Despite the lack of evidence, several tocolytic drugs are commonly used worldwide. They are used primarily to delay . . . [Full text of this article]

Andrew Carlin, director of maternal fetal medicine1, Jane Norman, chair of maternal and fetal health2, Stephen Cole, consultant in maternal-fetal medicine3, Roger Smith, director of mothers and babies research centre4

1 Department of Obstetrics and Gynaecology, Mothers and Babies Research Centre, John Hunter Hospital, NSW 2310, Australia, 2 Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh EH16 4TY, 3 Maternal-Fetal Medicine, Royal Womens’ Hospital, Melbourne, Parkville VIC 3052, Australia, 4 Mothers and Babies Research Centre/Hunter Medical Research Institute, John Hunter Hospital

roger.smith@newcastle.edu.au


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Relevant Article

Adverse drug reactions to tocolytic treatment for preterm labour: prospective cohort study
Roel de Heus, Ben Willem Mol, Jan-Jaap H M Erwich, Herman P van Geijn, Wilfried J Gyselaers, Myriam Hanssens, Linda Härmark, Caroline D van Holsbeke, Johannes J Duvekot, Fred F A M Schobben, Hans Wolf, and Gerard H A Visser
BMJ 2009 338: b744. [Abstract] [Full Text] [PDF]

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