Pathophysiology of adverse events with tocolytics
Pathophysiology of adverse events with tocolytics
 Professor Steve Caritis
Department of Obstetrics, Gynecology and Reproductive Sciences
University of Pittsburgh School of Medicine, USA
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Biography
Steve Caritis is a Professor of Obstetrics, Gynecology and Reproductive Sciences at the University of Pittsburgh School of Medicine, USA. Professor Caritis received his residency training in obstetrics and
gynaecology at the University of Pittsburgh, Magee-Women’s Hospital and his fellowship training at Columbia Presbyterian Medical Center in New York. He is currently the Director of the Division of Maternal-Fetal Medicine at the University of Pittsburgh, Magee-Women’s Hospital. His research focus has been on tocolytic drugs, particularly the pharmacological basis related to their use. Professor Caritis has been a member of the NICHD-sponsored Maternal-Fetal Medicine Units Network since 1986 and is also part of the NICHD-sponsored Obstetric-Fetal Pharmacology Research Units.
Abstract
The rationale for using tocolytics in preterm labour is to enable transfer of the mother to a tertiary centre and to prolong pregnancy sufficiently so that glucocorticoids can be administered to the mother. There is little question that these short-term objectives can be achieved with contemporary tocolytics. Whether tocolytics can maintain pregnancy for sufficient periods to enable in-utero maturation to occur remains an unresolved question. When a decision is made to use tocolytics, the clinician is faced with a multitude of choices with side effects, efficacy, and ease of administration generally the most important considerations. Placebo-controlled studies suggest that the beta-agonists, prostaglandin inhibitors and atosiban are effective in prolonging pregnancy for 24–48 hours. Of these three agents, atosiban has the best safety profile. There are no placebo-controlled studies with calcium channel blockers or nitric oxide donors. However, because of their ease of use and efficacy comparable with the beta agonists, calcium channel blockers are widely used. Calcium channel blockers appear to have a better safety profile than the beta agonists, but there are still significant cardiovascular side effects associated with their use. Indomethacin, although proven to be efficacious, has a safety profile that limits its utility to short courses. Magnesium sulfate is the most commonly used tocolytic in the USA, despite a lack of evidence on its efficacy. Although magnesium sulfate appears to have a good safety profile, serious side effects have been reported with its use. The choice of tocolytics is commonly based on personal preference. Whichever tocolytic is chosen, the fundamental parturitional process is not reversed by contemporary treatment; rather, uterine responsiveness to some uterine stimulant is reduced; thus, the expectations of tocolytic effectiveness need to be reconsidered.
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