Intended for healthcare professionals

Rapid response to:


Adverse drug reactions to tocolytic treatment for preterm labour: prospective cohort study

BMJ 2009; 338 doi: (Published 06 March 2009) Cite this as: BMJ 2009;338:b744

Rapid Response:

No indication for tocolysis by beta adrenoreceptor agonists

Roel de Heus et al. (1) report that the tocolysis by beta-adrenergic
agonists is associated with high incidence of serious adverse drug
reactions contrary to the atosiban and the indometacin.
Nevertheless, it is surprising that beta adrenoreceptor agonists were
still used for tocolysis in this recent study (2006-2007) given their
potentially serious side effects for the maternal cardiovascular functions
previously known. Indeed, the calcium channel blockers and the atosiban
are at least as effective as the beta-adrenergic agonists with fewer
severe side effects (2).
In addition, antenatal indometacin described in the study as having no
severe maternal side effects may be associated with severe neonatal
outcomes such as periventricular leukomalacia and necrotising
enterocolitis that limit its indications (3).


1. De Heus R, Mol BW, Erwich JJ, van Geijn HP, Gyselaers WJ, Hanssens
M, Härmark L, van Holsbeke CD, Duvekot JJ, Schobben FF, Wolf H, Visser GH.
Adverse drug reactions to tocolytic treatment for preterm labour:
prospective cohort study. BMJ. 2009;338:b744.

2. The Worldwide Atosiban versus Beta-agonists Study Group.
Effectiveness and safety of the oxytocin antagonist atosiban versus
beta-adrenergic agonists in the treatment of preterm labour. BJOG.

3. Amin SB, Sinkin RA, Glantz JC. Metaanalysis of the effect of
antenatal indomethacin on neonatal outcomes. Am J Obstet Gynecol.

Competing interests:
None declared

Competing interests: No competing interests

29 March 2009
Souhail Alouini
Obstetrician and Gynaecologist surgeon, M.D., Ph.D.
Centre Hospitalier Regional d'Orléans, 45000, France