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Multiples
Everything you want to know about tocolytics :)
Since this comes up quite often and we all have different doctors with varying opinions, here is a list of the different tocolytic medications used. The actual cause of preterm labor is still unknown, so the role of the tocolytic is to address the side effect (contractions) and not necessarily the cause. With that understanding, tocolytics are not proven effective or have demonstrated minimal benefit (makes sense since you aren't treating the actual cause of PTL). You will find in researching them that their use remains controversial. The bottom line of this is not to debate their usefulness but to understand what medications are available, pros/cons and other uses they might have. I hope this is helpful!! The most important thing is to have a dialogue with your physician regarding the medication of choice, his/her rationale for its use and to feel comfortable with the plan. Remember that side effects listed below are basically all of them - even worst case scenarios; it doesn't mean they can't be used safely.
The following information is from the ACOG Practice Bulletin "Management of Preterm Labor".
There is no clear first-line tocolytic drug. If tocolytic drugs are used, the choice of the drug should be individualized and based on maternal condition, potential drug side effects, and gestational age.
1. Beta-mimetics (Terbutaline): Contraindicated in patients with cardiac arrhythmias. Maternal side effects include cardiac arrhythmias, pulmonary edema, heart attack, hypotension, tachycardia. Fetal or neonatal side effect include fetal tachycardia, high insulin, high blood sugar, heart attack. When used for tocolysis long term, a patient typically wears a subcutaneous pump as a means of administering the medication. If used for short term tocolysis, it is usually administered as a subcutaneous injection.
*** Terbutaline is still commonly used in laboring patients experiencing too many contractions (called hyperstimulation or tachysystole) ***
2. Magnesium sulfate: Contraindicated in patients with myasthenia gravis. Maternal side effects include lethargy, flushing, headache, muscle weakness, double vision, dry mouth, pulmonary edema, cardiac arrest (in toxic levels). Fetal and neonatal side effects include lethargy, hypotonia (floppy baby), respiratory depression. It is administered intravenously. Due to the potential side effects in mom, patients are typically monitored on L&D very closely (urinary output, reflexes, lung exam)
**** Other important uses for magnesium sulfate include seizure prevention in pre-eclampsia/eclampsia (the standard of care) and neuroprotection for the baby if delivering prematurely (also becoming the standard of care). When used for neuroprotection, the magnesium should be administered within 24 hours of delivery for maximum benefit; this does not mean a patient needs to be on long-term mag therapy for this treatment ****
3. Calcium channel blocker (Nifedipine aka Procardia): Contraindicated in patients with heart disease, very low blood pressure. Maternal side effects include flushing, headache, dizziness, nausea, transient low blood pressure. There are no known side effects on the fetus or the neonate. It is administered as a pill taken every 4-6 hours.
4. Prostaglandin synthetase inhibitors (Indomethacin - motrin, ibuprofen): Contraindicated in patients with severe liver or kidney disease. Maternal side effects include nausea and heartburn. Fetal or neonatal side effects include constriction of the ductus arteriosus (thus the use of this medicine is typically stopped by about 32 weeks to prevent this), reversible decrease in kidney function, nectrotizing enterocolitis, and intraventricular hemorrhage. It is administered as a pill by mouth (the first dose may be administered rectally).
*** If a mom is experiencing too much amniotic fluid (polyhydramnios), indomethacin may be used as a means of reducing the amount of urine produced by the baby's kidneys and thus reducing the total fluid volume. This use is less likely to be seen in multiples since it will affect all babies. ***
This is a very basic run down. Hope it helps!!
Three losses in 2009;
Boy/Girl twins born in 2010
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Re: Everything you want to know about tocolytics :)
Great info E&R -- same with your mag post below. Greatly appreciated! I've bookmarked this!
Awesome! Thanks!!
Thank you!!
Beta-mimetics (Terbutaline): Contraindicated in patients with cardiac arrhythmias.
I can definitely see why! I thought I'd have a heart attack on that stuff.