Comparative values of tocolytic options

September 21, 2009

My name is Joachim Dudenhausen and I am Professor of Obstetrics and Head of the Department of Obstetrics of the Charity University Medical School in Berlin. The institution is the biggest obstetrical department in Germany with 6,000 deliveries per year with a high rate in high risk pregnancies like, diabetes, malformation, pre-term labor, multiples and so on.

 

My name is Joachim Dudenhausen and I am Professor of Obstetrics and Head of the Department of Obstetrics of the Charity University Medical School in Berlin. The institution is the biggest obstetrical department in Germany with 6,000 deliveries per year with a high rate in high risk pregnancies like, diabetes, malformation, pre-term labor, multiples and so on.

How would you compare current tocolytic options and their efficacy?

We use several drugs against contractions in pregnancy, pre-term contractions; the most common medical ones are the Nifedipine and Betamimetics. The side effects of Betamimetics are relatively high to the side effects of Nifedipine and therefore the use in Betamimetics decreased during the last decade, and the use of Nifedipine increased. The first choice in tocolytics, and maybe in Germany or in Europe, Atosiban, that's an oxytocin receptor antagonist and the side effects are relatively low. It is very expensive, that's a concern at this point. Therefore it will be used in such cases where the risk of lung edema is very high, for instance, multiples or in pregnant women with heart diseases. In these cases I think the first choice is Atosiban. In cases with singleton pregnancy and not more or less healthy young women with pre-term contractions we use Nifedipine as the first choice. The efficiency is proven. The evidence-based data are clear. It is possible with Atosiban and with Nifedipine and Betamimetics to prolong a pregnancy for two weeks. Evidence data on longer prolongation are not present.

What are the side effect profiles of the various tocolytic options?

I think that the Atosiban is the substance with the lowest side effect. The most important side effect for the mother is the lung edema of tocolytics. The lung edema with Betamimetics is one for 400 cases and in Atosiban is very much lower; therefore in cases where the risk of lung edema is high, multiples and heart diseases, the Atosiban is the first choice.