Tocolytics, also known as anti-contraction medications or labor repressants, are used to suppress premature labor by relaxing the uterus and delaying delivery for 48 hours. This allows time for the administration of steroids to accelerate fetal lung maturity. The main tocolytic agents discussed are beta-agonists like terbutaline, NSAIDs like indomethacin, calcium channel blockers like nifedipine, and ethanol. While tocolytics can delay birth temporarily, their effects are often only partial and contractions may resume after a few days. Both mother and baby require monitoring during treatment due to potential side effects on cardiac, pulmonary, and circulatory functions.

1.  Click to add text
Tocolytics

2. Tocolytics
 also called anti-contraction medications or
labor repressant
 from the Greek
tokos – childbirth & lytic - capable of
dissolving
“They are medications used to suppress
premature labor”
 They are given when delivery would result in
premature birth.
 The therapy also buys time for the
administration of betamethasone, a
glucocorticoid drug which greatly accelerates
fetal lung maturity, but takes one to two days
to work.

3.  Delay labor for 48 hrs to administer steroids
 Transport mom and baby to facility able to
provide appropriate care
 The suppression of contractions is often only
partial and tocolytics can only be relied on to
delay birth for several days.
 Depending on the tocolytic used the mother or
fetus may require monitoring, as for instance
 blood pressure monitoring when nifedipine is
used as it reduces blood pressure.

4. There is no clear first-line tocolytic agent
β2-agonist
Terbutaline
Ritodrine
Fenoterol
Salbutamol
NSAIDs
Indomethacin
Sulindac
CCBs
Nifedipine
Ethyl alcohol

5. TERBUTALINE:
 Beta-2 agonists cause myometrium relaxation
 MOA- Inc Adenyl Cyclase and cAMP
Side Effects
Cardiac arrhythmias,
pulmonary edema,
myocardial ischemia,
hypertension,
Tachycardia & death
Fetal and neonatal side effects
Fetal tachycardia,
hyperinsulinemia,
hypoglycemia,
myocardial hypertrophy (thickening of hrt muscles)
myocardial ischemia

7. Indomethacin
Nonspecific COX inhibitor, prostaglandin synthetase
inhibitor
Prostaglandins increase myometrial gap junctions
Side Effects:
Primary Pulmonary Hypertension,
premature PDA closure (Patent ductus arteriosus)
predispose to bleeding (Hypocoagulability)
(decreased Thromboxane A2)

9. Nifedipine
 Is one of the most commonly used tocolytic
agents
 Belongs to CCB, act by blocking the calcium
channels
 Cardiac disease it should not be used
Side effects:
 Flushing, headache, dizziness,
 nausea, 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

10. ETHANOL:
 GABA-A receptor agonist
 Shown to be ineffective. Was a frequently used
tocolytic in the mid-20th century, but later
double-blind studies found it was not effective.

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