Key result
Nifedipine, atosiban, and indomethacin showed no clinically important effect on fetal heart rate variability, whereas magnesium sulfate and ritodrine decreased variability.
Why the study?
Do tocolytic drugs affect fetal heart rate variability in pregnant women?
Systematic Review (n=169)
Do tocolytic drugs affect fetal heart rate variability in pregnant women?
Different tocolytic drugs have varying effects on fetal heart rate variability, which should be considered during fetal monitoring to prevent misinterpretation of fetal well-being.
Tocolytic-specific HRV changes warrant caution in fetal monitoring to avoid misinterpreting distress; extends limited evidence but leaves open need for outcome-focused trials.
INTRODUCTION: Tocolytics may cause changes in fetal heart rate (HR) pattern, while fetal heart rate variability (HRV) is an important marker of fetal well-being. We aim to systematically review the literature on how tocolytic drugs affect fetal HRV. MATERIALS AND METHODS: We searched CENTRAL, PubMed and EMBASE up to June 2016. Studies published in English, using computerized or visual analysis to describe the effect of tocolytics on HRV in human fetuses were included. Studies describing tocolytics during labor, external cephalic version, pre-eclampsia and infection were excluded. Eventually, we included six studies, describing 169 pregnant women. RESULTS: Nifedipine, atosiban and indomethacin administration show no clinically important effect on fetal HRV. Following administration of magnesium sulfate decreased variability and cases of bradycardia are described. Fenoterol administration results in a slight increase in fetal HR with no changes in variability. After ritodrine administration increased fetal HR and decreased variability is seen. The effect of co-administration of corticosteroids should be taken into account. CONCLUSION: In order to prevent iatrogenic preterm labor, the effects of tocolytic drugs on fetal HRV should be taken into account when monitoring these fetuses.
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Verdurmen et al. (2016) conducted a systematic review in Pregnancy (n=169). Tocolytic drugs was evaluated on Fetal heart rate variability. Nifedipine, atosiban, and indomethacin showed no clinically important effect on fetal heart rate variability, whereas magnesium sulfate and ritodrine decreased variability.
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