Randomized comparative trial of indomethacin and ritodrine for the long-term treatment of preterm labor

Article Abstract:

A comparison of two drugs was performed to assess their ability to inhibit preterm (premature) labor. The tocolytic drugs (drugs that are used to prevent preterm labor) ritodrine, which is the only drug currently approved for this purpose by the Food and Drug Administration, and indomethacin, an agent that may adversely affect neonates' (newborns) breathing were randomly administered to 40 women. The subjects were between 23 and 34 weeks gestation when they developed uterine contractions. Either intravenous ritodrine or oral indomethacin were administered for several hours while they were carefully observed and their contractions recorded. Side effects were evaluated by review of nursing notes and interviews with the women 48 hours after delivery (on average, several weeks later). Results showed that the two drugs delayed pregnancy the same amount of time (25 to 28 days). A greater proportion of women in the ritodrine than the indomethacin group reported symptoms such as heart palpitations, jitteriness, lightheadedness, headache, and difficulty in breathing. No differences in neonatal outcomes (measured by physical functioning at birth, days in intensive care, and need for ventilators) between the two drug groups were seen, although three infants developed pulmonary hypertension (increased pressure in the pulmonary artery, which carries blood to the lungs from the heart). A brief review is presented of the medical literature concerning the use of indomethacin as a tocolytic agent. It is considerably less expensive than ritodrine ($33 versus $560). The side effect of pulmonary hypertension in newborns was not seen in previous studies in which indomethacin was administered for fewer than 48 hours; in the current study, women received the drug on a long-term basis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Indomethacin, Ritodrine

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Does the use of a tocolytic agent affect the success rate of external cephalic version?

Article Abstract:

Giving an agent to relax the uterus before performing external cephalic version appears to increase the success rate in first time mothers but may have no effect in women with prior births. External cephalic version is turning a baby from buttocks to head downward from the outside. Researchers randomly assigned 283 women undergoing external cephalic version to receive either intravenous ritodrine or a placebo. The baby was successfully turned in 43% of first time mothers receiving ritodrine versus 25% of mothers receiving placebo, but in women with prior births, the percentages were similar: 66% versus 58%.

Management, Breech delivery, Breech birth, Version (Obstetrics)

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Double-blind, randomized, controlled trial of atosiban and ritodrine in the treatment of preterm labor: a multicenter effectiveness and safety study

Article Abstract:

Atosiban is as effective as ritodrine in preventing premature labor and has fewer side effects, according to a study of 247 women in premature labor. These drugs belong to a class of drugs called tocolytic drugs, which are used to stop premature labor.

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