Types of Agents
There is no clear first-line tocolytic agent.
Various types of agents are used, with varying success rates and side effects. Some medications are not specifically approved by the U.S. Food and Drug Administration (FDA) for use in stopping uterine contractions in preterm labor, instead being used off label.
|Maternal side effects||Fetal and neonatal side effects|
|Terbutaline (Brethine)||β2-agonist||Is often the drug given first, especially if there is only low risk of preterm birth.||Cardiac arrhythmias||Cardiac or cardiopulmonary arrhythmias, pulmonary edema, myocardial ischemia, hypotension, tachycardia, death||Fetal tachycardia, hyperinsulinemia, hypoglycemia, myocardial and septal hypertrophy, myocardial ischemia|
|Ritodrine (Yutopar)||β2-agonist||The only FDA approved tocolytic||Poorly controlled thyroid disease and diabetes||Metabolic hyperglycemia, hyperinsulinemia, hypokalemia, antidiuresis, altered thyroid function, physiologic tremor, palpitations, nervousness, nausea or vomiting, fever, hallucinations||Neonatal tachycardia, hypoglycemia, hypocalcemia, hyperbilirubinemia, hypotension, intraventricular hemorrhage|
|Nifedipine (Procardia, Adalat)||CCBs||Is one of the most commonly used tocolytic agents.||Cardiac disease. It should not be used concomitantly with magnesium sulfate.||Flushing, headache, dizziness, nausea, transient hypotension. Administration of calcium channel blockers should be used with care in patients with renal disease and hypotension. Concomitant use of calcium channel blockers and magnesium sulfate may result in cardiovascular collapse.||None noted as yet|
|Indomethacin||NSAIDs||late pregnancy (ductus arteriosus), significant renal or hepatic impairment||Nausea, heartburn||Constriction of ductus arteriosus, pulmonary hypertension, reversible decrease in renal function with oligohydramnios, intraventricular hemorrhage, hyperbilirubinemia, necrotizing enterocolitis|
|Sulindac||NSAIDs||Coagulation disorders or thrombocytopenia, nonsteroidal anti-inflammatory drug (NSAID)-sensitive asthma, other sensitivity to NSAIDs|
|IV Magnesium sulfate||myosin light chain inhibitor||Shown to be ineffective. Has been recommended for women at high risk. However, meta-analyses have failed to support it as a tocolytic agent.||myasthenia gravis||Flushing, lethargy, headache, muscle weakness, diplopia, dry mouth, pulmonary edema, cardiac arrest||Lethargy, hypotonia, respiratory depression, demineralization with prolonged use|
|Ethyl alcohol||?||Shown to be ineffective. Was frequently prescribed as a tocolytic in the mid-20th century, but later double-blind studies found it was not effective.|
Calcium-channel blockers and an oxytocin antagonist can delay delivery by 2–7 days. Otherwise, tocolysis is rarely successful beyond 24–48 hours because current medication do not alter the fundamentals of labor activation. However, just gaining 48 hours is sufficient to allow the pregnant women to be transferred to a center specialized for management of preterm deliveries and give administered corticosteroids the possibility to reduce neonatal organ immaturity.
The efficacy of beta-agonists, atosiban and indomethacin is a decreased odds ratio (OR) of delivery within 24 hours of 0.54 (95 percent confidence interval (CI): 0.32-0.91) and 0.47 within 48 hours (OR 0.47, 95 percent CI 0.30-0.75).
Antibiotics may delay the onset of labor in women with premature rupture of membranes, but this is not usually characterized as tocolysis.
Read more about this topic: Tocolytic
Other articles related to "types, types of agents, types of, of agent, agents, type":
... Claw-types set quickly in most seabeds and although not an articulated design, they have the reputation of not breaking out with tide or wind changes, instead slowly turning ... Claw types have difficulty penetrating weedy bottoms and grass ... ratio and generally have to be oversized to compete with other types ...
... but something as simple as observing the number and types of ships in a port ... diplomatic or nonofficial cover, handling two kinds of agent basic and supplementary ... Basic agents can be formed into groups with leaders, or report directly to the controller ...
... Arquilla and Ronfeldt point to three basic types of networks that may be used by netwar actors Chain network – typified by smuggling networks, where end-to-end ... Netwar actors may also take on hybrid forms as well, blending different types of networks and hierarchies ... group may be networked to each other through different types of network structures ...
... Attempts to introduce types date back to the 1980s, and as of 2008 there are still attempts to extend Prolog with types ... Type information is useful not only for type safety but also for reasoning about Prolog programs ...
... The principal types of graphemes are logograms, which represent words or morphemes (for example, Chinese characters, or the ampersand representing the English word ... For a full discussion of the different types, see Writing system Functional classification of writing systems ...
Famous quotes containing the words types of, agents and/or types:
“Our children evaluate themselves based on the opinions we have of them. When we use harsh words, biting comments, and a sarcastic tone of voice, we plant the seeds of self-doubt in their developing minds.... Children who receive a steady diet of these types of messages end up feeling powerless, inadequate, and unimportant. They start to believe that they are bad, and that they can never do enough.”
—Stephanie Martson (20th century)
“Modern mans capacity for destruction is quixotic evidence of humanitys capacity for reconstruction. The powerful technological agents we have unleashed against the environment include many of the agents we require for its reconstruction.”
—George F. Will (b. 1941)
“He types his laboured columnweary drudge!
Senile fudge and solemn:
Spare, editor, to condemn
These dry leaves of his autumn.”
—Robertson Davies (b. 1913)