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It’s not easy to summarize this session and the many data that has been brought up by the different speakers I believe that we have demonstrated three major new points. First the tocolysis should be applied only in cases that we are sure that as much as possible the patient is in true labour. To do this I think that we should apply new diagnostic tools, not just rely on the clinical visit but to have for instance, cervical length measurement by ultrasound, foetal fibronectin assay, vaginal ph and so on. I believe this is crucial to avoid as much as possible, a lot of patients being treated with tocolysis without any need. The second point is that we have a big armamentarium of tocolytic agents but we have to be very careful which one we use. First of all, some of them have been shown not to be really good agents, such as magnesium sulfate, and others being used off-label in their properties to be a tocolytic agent, such as nifedipine. Obviously nothing happens until we may have severe collateral of side-effects to the mother or to the foetus. Because as has been clearly shown by the lawyer, we have problems and we may face, as obstetricians, personal problems in giving these drugs so I think it is very important that the scientific societies and scientific groups get a consensus on the uses of many of these drugs that are used off-label.The third point has been demonstrated by the case-in-point of what is the need to give tocolysis in some cases and leave nature in control in another. I think nowadays that at gestational age past 28 weeks we may use tocolysis just to obtain some advantages in giving drugs which are well known to protect the foetus from complications like for instance corticosteroids or a combination of drugs that has been suggested recently like (inaudible). Before the gestational age of 28 weeks we clearly may gain advantages of survival in prolonging gestation so tocolysis can be given for more than 48 hours for weeks and to prove safe the new tocolytic agents like atosiban. I think that these are the crucial points that hopefully we depicted well and I think that you enjoyed the speeches and the take home messages are clear. The minimum to do is sometimes a big advantage and sometimes doing too much can do more harm, especially in the period when the neonatal outcome is crucial not only for the family but for the society.Thank you very much. |
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