Editorials

Tocolytics and preterm labour

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b195 (Published 06 March 2009) Cite this as: BMJ 2009;338:b195
  1. Andrew Carlin, director of maternal fetal medicine1,
  2. Jane Norman, chair of maternal and fetal health2,
  3. Stephen Cole, consultant in maternal-fetal medicine3,
  4. Roger Smith, director of mothers and babies research centre4
  1. 1Department of Obstetrics and Gynaecology, Mothers and Babies Research Centre, John Hunter Hospital, NSW 2310, Australia
  2. 2Reproductive and Developmental Sciences, University of Edinburgh, Edinburgh EH16 4TY
  3. 3Maternal-Fetal Medicine, Royal Womens’ Hospital, Melbourne, Parkville VIC 3052, Australia
  4. 4Mothers and Babies Research Centre/Hunter Medical Research Institute, John Hunter Hospital
  1. roger.smith{at}newcastle.edu.au

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

    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 delivery for up to 48 hours to allow for administration of corticosteroids or transfer to a unit with neonatal intensive care facilities (or both). Little consensus exists as to which tocolytic agent …

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