Medline ® Abstract for Reference 7
of 'Anesthesia for the patient with peripartum hemorrhage'
Chandraharan E, Arulkumaran S
Curr Opin Obstet Gynecol. 2005 Apr;17(2):151-6.
PURPOSE OF REVIEW: Emergency uterine relaxation may decrease the morbidity and mortality of the mother and her fetus. Obstetricians need to be aware of the indications, pharmacological methods, efficacy and complications of acute tocolysis.
RECENT FINDINGS: A variety of pharmacological agents are used to suppress uterine contractions. Newer agents like cyclo-oxygenase-2 inhibitors (Celecoxib) and oxytocin antagonists (atosiban) have been introduced into clinical practice with the hope of reducing the complications of betasympathomimetic drugs. Calcium-channel blockers are used but there are recent case reports of acute pulmonary oedema with the use of these agents. Most of the trials on tocolytics have been for suppression of preterm labour. Nitroglycerin has been used successfully as an acute tocolytic during Caesarean sections and manual removal of placenta. A recent randomized trial has suggested that atosiban may be an option for acute intrapartum tocolysis. This article will review the recent literature on the use of pharmacological agents used to suppress uterine contractions in emergency obstetric situations.
SUMMARY: Acute tocolysis may be indicated in antepartum, intrapartum and postpartum periodsfor a variety of indications. It may help reduce maternal and fetal morbidity and mortality. The ideal tocolytic is yet to be developed. Research is needed to develop a drug which has a greater uterospecificity with no effect on other organs with a rapid onset and a short duration of action.
Division of Obstetrics and Gynaecology, St. George's Hospital Medical School, London SW17 0RE, UK.