Subscribe to RSS
DOI: 10.1055/s-0036-1579647
Perinatal Outcomes after Short versus Prolonged Indomethacin for Tocolysis in Women with Preterm Labor
Publication History
27 October 2015
01 February 2016
Publication Date:
09 March 2016 (online)
![](https://www.thieme-connect.de/media/ajp/201609/lookinside/thumbnails/10-1055-s-0036-1579647_150391-1.jpg)
Abstract
Objective Indomethacin tocolysis is generally limited to 48 hours. Indomethacin has been administered for longer durations to prolong gestation in extreme prematurity. Our aim is to compare perinatal outcomes after a prolonged course, > 48 hours versus ≤ 48 hours in preterm labor.
Methods A retrospective chart review of women admitted with preterm labor < 32 weeks gestation who received indomethacin for tocolysis. The primary maternal outcome was latency from admission until delivery. The primary neonatal outcome was a composite of severe neonatal morbidities.
Results A total of 73 women were included: 32 (43.8%) received indomethacin for > 48 hours (prolonged) and 41 (56.2%) for ≤ 48 hours (standard). Prolonged group started on indomethacin at an earlier gestational age compared with standard group (23.9 [23.1–27.3] vs. 25.7 [23.8–28.5] weeks, p = 0.03). Latency from admission until delivery was longer in the prolonged group versus the standard group (1.8 [1.1–3] vs. 0.4 [0.1–0.8] weeks, p < 0.001). Prolonged use was not associated with increased risk of the composite neonatal outcome; however, there was a trend for more necrotizing enterocolitis.
Conclusion A prolonged course of indomethacin may be an option for women with preterm labor at risk of extreme prematurity; it may also be associated with higher risks of some adverse neonatal outcomes.
Note
This study was presented as a poster at the 35th Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine; February 2–7, 2015; San Diego, CA.
-
References
- 1 Gerson A, Abbasi S, Johnson A, Kalchbrenner M, Ashmead G, Bolognese R. Safety and efficacy of long-term tocolysis with indomethacin. Am J Perinatol 1990; 7 (1) 71-74
- 2 Martin JA, Hamilton BE, Osterman MJ , et al. Births: final data for 2013. Natl Vital Stat Rep 2015; 64 (1) 1-65
- 3 Abramovici A, Cantu J, Jenkins SM. Tocolytic therapy for acute preterm labor. Obstet Gynecol Clin North Am 2012; 39 (1) 77-87
- 4 Savage AH, Anderson BL, Simhan HN. The safety of prolonged indomethacin therapy. Am J Perinatol 2007; 24 (4) 207-213
- 5 Loe SM, Sanchez-Ramos L, Kaunitz AM. Assessing the neonatal safety of indomethacin tocolysis: a systematic review with meta-analysis. Obstet Gynecol 2005; 106 (1) 173-179
- 6 Hammers AL, Sanchez-Ramos L, Kaunitz AM. Antenatal exposure to indomethacin increases the risk of severe intraventricular hemorrhage, necrotizing enterocolitis, and periventricular leukomalacia: a systematic review with metaanalysis. Am J Obstet Gynecol 2015; 212 (4) 505.e1-505.e13
- 7 Gomella T, Cunningham M. Neonatology, 7th ed. New York, NY: McGraw-Hill Education; 2013
- 8 Sood BG, Lulic-Botica M, Holzhausen KA , et al. The risk of necrotizing enterocolitis after indomethacin tocolysis. Pediatrics 2011; 128 (1) e54-e62
- 9 Amin SB, Sinkin RA, Glantz JC. Metaanalysis of the effect of antenatal indomethacin on neonatal outcomes. Am J Obstet Gynecol 2007; 197 (5) 486.e1-486.e10
- 10 Klauser CK, Briery CM, Keiser SD, Martin RW, Kosek MA, Morrison JC. Effect of antenatal tocolysis on neonatal outcomes. J Matern Fetal Neonatal Med 2012; 25 (12) 2778-2781
- 11 King J, Flenady V, Cole S, Thornton S. Cyclo-oxygenase (COX) inhibitors for treating preterm labour. Cochrane Database Syst Rev 2005; (2) CD001992
- 12 Besinger RE, Niebyl JR, Keyes WG, Johnson TR. Randomized comparative trial of indomethacin and ritodrine for the long-term treatment of preterm labor. Am J Obstet Gynecol 1991; 164 (4) 981-986 , discussion 986–988
- 13 Bivins Jr HA, Newman RB, Fyfe DA, Campbell BA, Stramm SL. Randomized trial of oral indomethacin and terbutaline sulfate for the long-term suppression of preterm labor. Am J Obstet Gynecol 1993; 169 (4) 1065-1070
- 14 Antonucci R, Zaffanello M, Puxeddu E , et al. Use of non-steroidal anti-inflammatory drugs in pregnancy: impact on the fetus and newborn. Curr Drug Metab 2012; 13 (4) 474-490
- 15 Block-Abraham D, Turan M, Crimmins S, Harman C. Effects of long-term indomethacin exposure on amniotic fluid volume. Am J Obstet Gynecol 2015; 212 (1, Supp): S234
- 16 Caritis S. Adverse effects of tocolytic therapy. BJOG 2005; 112 (Suppl. 01) 74-78
- 17 Pryde PG, Besinger RE, Gianopoulos JG, Mittendorf R. Adverse and beneficial effects of tocolytic therapy. Semin Perinatol 2001; 25 (5) 316-340
- 18 Tyson JE, Parikh NA, Langer J, Green C, Higgins RD ; National Institute of Child Health and Human Development Neonatal Research Network. Intensive care for extreme prematurity—moving beyond gestational age. N Engl J Med 2008; 358 (16) 1672-1681