The NSAID most widely studied as an acute tocolytic is indomethacin. Randomized placebo-controlled studies suggest that indomethacin may significantly delay preterm delivery for 24 and 48 h and for 7 days. However, the total number of women enrolled in all of the three randomized placebo-controlled trials is only 90. As discussed above, indomethacin has a major effect upon fetal renal function and upon the fetal cardiovascular system, in particular on the fetal ductus arteriosus. Use of indomethacin for tocolysis has also been associated with higher incidences of necrotizing enterocolitis, intra-ventricular haemorrhage and abnormalities in neonatal haemostasis. In experimental animals the combination of a COX-2 specific NSAID and a tocolytic (either a calcium channel blocker or an oxytocin antagonist) appears to be superior to the use of a tocolytic alone. However, this type of combination therapy has not yet been properly evaluated in the human. At present there is no evidence that indomethacin or any other NSAID has any advantage as a first line tocolytic over calcium channel blockers or oxytocin antagonists, each of which has a much better maternal and fetal side-effect profile.
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The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.