Acute tocolysis sympathomimetics

The maximum benefit to the preterm neonate from antenatal corticosteroid administration is from 24 h to 7 days after the first dose of the course (Fig. 21.5). In utero transfer has also been shown to improve neonatal morbidity and mortality and clearly time would be required to move a mother in preterm labour from one hospital to another. Suppression of uterine contractions may therefore be an obvious solution to the problem of preterm labour. With the introduction of beta-sympethomitotics into obstetric practice in the 1970s accompanied by small clinical trials which suggested great efficacy in inhibiting preterm contractions, most obstetricians developed the impression that tocolysis with ritodrine or salbutamol was an effective therapy for acute preterm labour. This impression was strengthened because of the very high placebo response rate. More modern studies have shown that ritodrine will delay preterm delivery in a minority of patients for 24 and 48 h but that its use is not associated with any improvement of any marker of neonatal morbidity or in neonatal mortality rates. Ritodrine and salbutamol are associated with significant, potentially life-threatening maternal side effects (particularly if given in combination with corticosteroids) which include fluid overload, pulmonary oedema, myocardial ischaemia, hyperglycaemia and hypocalcaemia. Numerous maternal deaths have been reported in which tocolysis using sympathomimetic drugs has played a role. Sym-pathomimetic as tocolytics are now rarely used in the United Kingdom and, since safer, although not necessarily more effective tocolytic drugs are now available, their use should now be completely abandoned.

Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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