Don't Go Overboard When Prescribing Tocolytics.

VAIL, COLO. -- The indications for to-colytic therapy have shrunk considerably in recognition of the drugs' lack of substantial benefit in preventing preterm birth coupled with their significant potential for harm, Dr. Debra Guinn said at a conference on obstetrics and gynecology sponsored by the University of Colorado.

"My take-home message is this: All of these drugs are dangerous. They're dangerous for the mom and potentially dangerous for the baby. I think that they do have some utility, but you need to use them safely and with common sense. It's not worth it to go overboard and potentially harm the mom to try and prolong pregnancy in some circumstances for 24-48 hours," said Dr. Guinn, a perinatologist at the University of Colorado in Denver.

Her current indications for tocolysis capitalize on the drugs' demonstrated modest ability to prolong pregnancy for 24-48 hours. One circumstance where this is worthwhile is to permit women at significant risk of preterm delivery to be transported from their community hospital to a tertiary care center, since it's clear that small preemies do much better when born at a tertiary center.

Another situation when tocolysis is of value is to buy time to administer a complete course of prenatal corticosteroids, a therapy which, unlike tocolytics, is of proven benefit. A third indication for tocolysis is to provide time to finish working up a suspected fetal anomaly.

She dismissed maintenance tocolytic therapy aimed at preventing recurrent preterm labor and preterm delivery, calling it "a dead issue." Many clinical trials have failed to show improved outcomes, including her own negative randomized placebo-controlled trial of terbutaline pump therapy.

She allowed for a very limited role for oral tocolytics in the occasional patient who becomes highly anxious in ...