II. Indications
III. Contraindications (See specific medications)
- Intrauterine Fetal Demise or lethal fetal anomaly
-
Nonreassuring Fetal Status
- Fetal Bradycardia <100
- Fetal Tachycardia >180
- Severe Preeclampsia or Eclampsia
- Maternal bleeding with hemodynamic instability
- Maternal Systolic Blood Pressure <90 mmHg
- Maternal cardiopulmonary symptoms (e.g. Shortness of Breath, Chest Pain)
- Chorioamnionitis
IV. Preparations: Preferred Tocolytics
-
General Indications
- Stops labor for 24-48 hours
- Allows maternal transport and Corticosteroid doses
-
Magnesium Sulfate
- Load: 6 grams bolus IV over 20 min (Very high dose!, some protocols use 4 g load)
- Maintenance: 2 grams/hour IV infusion (max: 3 g/h)
- Must follow protocols for patient safety
- Tocolytic and neuroprotective (with decreased risk of Cerebral Palsy in deliveries before 32 weeks)
- Does not prevent preterm birth
-
Indomethacin (Indocin)
- Load: 50-100 mg orally or rectally
- Maintenance: 25-50 mg orally every 4-6 hours for up to 48 hours
- Avoid use >48 hours (risk of oligohydramnios, premature closure ductus arteriosus)
- Not recommended after 32 weeks due to ductus arteriosus constriction
-
Nifedipine (Procardia)
- Load: 30 mg orally
- Maintenance: 10-20 mg every 4-6 hours (max: 180 mg/day)
- Higher risk of maternal adverse effects when combined with Magnesium Sulfate
V. Preparations: Other Tocolytics
-
Terbutaline
- Load: 0.25 mg SQ every 20-30 min for up to 4 doses
- Maintenance: 0.25 mg every 3-4 hours until Uterus quiet for 24 hours
- Effective at temporarily stopping contractions
- Results in shortest hospital triage stays
- Guinn (1997) Am J Obstet Gynecol 177:814-87 [PubMed]
- Oral Terbutaline is not effective in Preterm Labor
-
Ritodrine
- Not available in the United States as of 2013
- Curiously, was the only FDA approved Preterm Labor Tocolytic
- Not shown to be more effective than Placebo
- (1992) N Engl J Med 327:308-12 [PubMed]
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Related Studies
Definition (MSH) | Any drug treatment modality designed to inhibit UTERINE CONTRACTION. It is used in pregnant women to arrest PREMATURE LABOR. |
Concepts | Therapeutic or Preventive Procedure (T061) |
MSH | D015145 |
SnomedCT | 103747003 |
LNC | LA20008-1 |
English | Therapies, Tocolytic, Therapy, Tocolytic, Tocolyses, Tocolysis, Tocolytic Therapies, Tocolytic Therapy, Tocolytic Treatment, Tocolytic Treatments, Treatment, Tocolytic, Treatments, Tocolytic, THER TOCOLYTIC, TOCOLYTIC THER, tocolytic therapy, tocolyse, tocolysis, tocolytic treatment, Inhibition of uterine contractions, Tocolysis (procedure) |
Swedish | Tokolys |
Japanese | ジンツウヨクセイ, 子宮収縮抑制, 陣痛抑制, 子宮収縮抑制療法, 出産消散 |
Czech | tokolýza, Tokolýza |
Finnish | Tokolyysi |
Russian | RODOVOI DEIATEL'NOSTI SNIZHENIE, TOKOLIZ, TOKOLITICHESKAIA TERAPIIA, РОДОВОЙ ДЕЯТЕЛЬНОСТИ СНИЖЕНИЕ, ТОКОЛИЗ, ТОКОЛИТИЧЕСКАЯ ТЕРАПИЯ |
French | Thérapie tocolytique, Tocolyse, Traitement tocolytique |
Italian | Trattamento tocolitico, Terapia tocolitica, Tocolisi |
Polish | Leczenie tokolityczne, Tokoliza |
Hungarian | Tocolysis |
Norwegian | Tokolyse, Tokolytisk behandling, Tokolytisk terapi |
Spanish | inhibición de las contracciones uterinas, tocólisis (procedimiento), tocólisis, Tocolisis, Tocólisis, Terapia Tocolítica |
Portuguese | Tocolise, Terapia Tocolítica, Tocólise |
Dutch | tocolyse, Therapie, tocolytische, Tocolyse |
German | Tokolyse, Tokolytische Therapie |
Ontology: Tocolytic Agents (C0040349)
Definition (CSP) | class of drugs which inhibit premature labor. |
Definition (MSH) | Drugs that prevent preterm labor and immature birth by suppressing uterine contractions (TOCOLYSIS). Agents used to delay premature uterine activity include magnesium sulfate, beta-mimetics, oxytocin antagonists, calcium channel inhibitors, and adrenergic beta-receptor agonists. The use of intravenous alcohol as a tocolytic is now obsolete. |
Concepts | Pharmacologic Substance (T121) |
MSH | D015149 |
SnomedCT | 262212007 |
English | Agents, Tocolytic, Tocolytic Agents, Tocolytics, tocolytic agent, tocolytics, tocolytic, drugs tocolytic, tocolytic agents, Tocolytic drug, Tocolytic drug (product), Tocolytic drug (substance) |
German | Mittel zur Hemmung der Wehentätigkeit, Wehenhemmende Mittel, Wehenhemmer, Tokolysemittel, Tokolytika |
French | Médicaments tocolytiques, Agents tocolytiques, Tocolytiques |
Swedish | Tokolytika |
Czech | tokolytika |
Finnish | Tokolyytit |
Italian | Tocolitici, Agenti tocolitici |
Russian | TOKOLITICHESKIE SREDSTVA, RODOVUIU DEIATEL'NOST' SNIZHAIUSHCHIE SREDSTVA, РОДОВУЮ ДЕЯТЕЛЬНОСТЬ СНИЖАЮЩИЕ СРЕДСТВА, ТОКОЛИТИЧЕСКИЕ СРЕДСТВА |
Croatian | TOKOLITICI |
Polish | Leki przeciw skurczom macicy, Środki hamujące poród, Środki hamujące czynność skurczową macicy, Leki tokolityczne |
Japanese | 陣痛抑制剤, 子宮収縮抑制剤, 子宮収縮抑制薬, 陣痛抑制薬 |
Spanish | Tocolíticos, Efecto Tocolítico, Agentes Tocolíticos, Fármacos Tocolíticos, fármaco tocolítico (producto), fármaco tocolítico |
Portuguese | Efeito Tocolítico, Fármacos Tocolíticos, Agentes Tocolíticos, Tocolíticos |