The safety of tocolytics used for the inhibition of preterm labour

@article{Lamont2016TheSO,
  title={The safety of tocolytics used for the inhibition of preterm labour},
  author={C. D. Lamont and Jan Stener J{\o}rgensen and Ronald F Lamont},
  journal={Expert Opinion on Drug Safety},
  year={2016},
  volume={15},
  pages={1163 - 1173}
}
ABSTRACT Introduction: Preterm birth is the major cause of neonatal mortality and morbidity worldwide and a huge cost burden on healthcare. Between 22 and 26 completed weeks of gestation, for every day that delivery is delayed, survival increases by 3%. Areas covered: Following a systematic review of the literature, we have provided an overview of the use of tocolytics for the prevention of preterm birth and have examined the fetal and maternal adverse effects of the various tocolytic agents… 
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Effectiveness and Safety of Isoxsuprine Hydrochloride as Tocolytic Agent in Arresting Active/Threatened Preterm Labor and Its Role in Maintenance Tocolysis-A Prospective, Open-Label Study.
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References

SHOWING 1-10 OF 112 REFERENCES
Developments in the pharmacotherapeutic management of spontaneous preterm labor
TLDR
The pathophysiology of preterm labor and the use of antepartum glucocorticoids are reviewed and the perfect tocolytic does not exist, and clinicians move to nifedipine or atosiban, which are as effective but much safer.
The choice of a tocolytic for the treatment of preterm labor: a critical evaluation of nifedipine versus atosiban
TLDR
Atosiban was developed specifically to treat preterm labor, so the cost is higher than nifedipine or ritodrine, but the balance of evidence indicates that atosiban is as effective as nifesiban and more effective than β-agonists and is significantly safer than both.
Atosiban as a tocolytic for the treatment of spontaneous preterm labor
TLDR
Atosiban (Tractocile®) is a vasopressin-oxytocin receptor antagonist, which is much more uterospecific than previous tocolytics, and, consequently has placebo-level side effects.
The pathophysiology of pulmonary oedema with the use of beta‐agonists
  • R. Lamont
  • Medicine, Biology
    BJOG : an international journal of obstetrics and gynaecology
  • 2000
TLDR
The anatomical, biochemical and physiological factors associated with the development of pulmonary oedema in association with beta-agonist therapy which has driven the search for better, safer tocolytic agents are reviewed.
TOCOLYTIC DRUGS FOR WOMEN IN PRETERM LABOUR
  • Medicine
  • 2003
Preterm birth is the most important single determinant of adverse infant outcome, in terms of both survival and quality of life. Although preterm birth is defined as being before 37 completed weeks,
Atosiban versus betamimetics in the treatment of preterm labour in Germany: an economic evaluation
TLDR
Compared to betamimetics, use of atosiban was associated with a significantly lower frequency of adverse events for tachycardia, palpitation, vomiting, headache, hyperglycaemia, tremor, dyspnoea, chest pain, hypocalemia and foetal tachycardsia.
Calcium channel blockers for inhibiting preterm labour and birth.
TLDR
Comparing CCBs (mainly nifedipine) with other tocolytics by type (including betamimetics, glyceryl trinitrate (GTN) patch, non-steriodal anti inflammatories (NSAID), magnesium sulphate and ORAs), no significant reductions were shown in primary outcome measures of birth within 48 hours of treatment or perinatal mortality.
Betamimetics for inhibiting preterm labour.
TLDR
Betamimetics help to delay delivery for women transferred to tertiary care or completed a course of antenatal corticosteroids and multiple adverse effects must be considered, but the data are too few to support the use of any particular betamimetic.
Comparison of nifedipine and progesterone for maintenance tocolysis after arrested preterm labour
  • S. Kamat, P. Veena, R. Rani
  • Medicine
    Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
  • 2014
TLDR
It is concluded that when compared with nifedipine, progesterone significantly prolongs pregnancy in women with arrested preterm labour with better neonatal outcomes and fewer side-effects.
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