Preterm labor: current pharmacotherapy options for tocolysis

Elvira OG van Vliet MD PhD*a, Elisabeth M Boormans MD PhDb, Thomas S de Lange MScc, Ben W Mol MD PhDd & Martijn A Oudijk MD PhDea UMC Utrecht, Department of Obstetrics and Gynaecology, WKZ, PO Box 85090, 3508 AB Utrecht, Netherlands b Academic Medical Centre, Department of Obstetrics and Gynaecology, Room H4-256, PO Box 22700, 1105 DE Amsterdam, The Netherlandsc Academic Medical Centre, Department of Obstetrics and Gynaecology, Room H4-226, PO Box 22700, 1105 DE Amsterdam, The Netherlandsd University of Adelaide, The Robinson Institute, School of Paediatrics and Reproductive Health, 5000 SA, Australiae UMC Utrecht, Department of Obstetrics and Gynaecology, WKZ, PO Box 85090, 3508 AB Utrecht, The Netherlands† Author for correspondence Introduction: In the developed world, preterm birth is in quantity and in severity the most important issue in obstetric care. Adverse neonatal outcome is strongly related to gestational age at delivery. Since the pathophysiological mechanism of preterm birth is not yet completely unraveled, the development of successful preventive strategies is hampered. When preterm labor is actually threatening, current pharmacological therapies focus on inhibition of preterm contractions. This allows for transportation of the mother to a center with a neonatal intensive care unit and administration of corticosteroids to enhance fetal lung maturation. Globally, however, large practice variation exists. Areas covered: The aim of this review is to provide an overview of current pharmacological therapies for preterm labor. Expert opinion: For the initial tocolysis, the use of atosiban or nifedipine for 48 h is recommended based on the largest effectiveness and most favorable side effect profile. However, since data that convincingly indicate the beneficial effect of tocolytics on neonatal outcome are lacking, it might well be that tocolytics are ineffective. The role of progesterone in treatment of acute tocolysis is limited, but it might play a role in the prevention of preterm labor or as sensitizer for other tocolytic agents.