Most MFMs recommend tocolysis for preterm labor

Nearly all maternal-fetal medicine (MFM) specialists in the United States recommend tocolysis in the setting of acute preterm labor, and less so for a number of other obstetric complications, according to the July issue of Obstetrics and Gynecology.

Nathan S. Fox, MD, from the Weill Medical College of Cornell University in New York City, and colleagues surveyed 827 members of the Society for Maternal-Fetal Medicine using clinical scenarios to determine MFM specialists’ practice patterns with tocolytics.

The researchers report that 96% of maternal-fetal medicine specialists recommended tocolysis for acute preterm labor, and 56%, 56%, 32%, and 29% recommend tocolysis for repeat acute preterm labor, preterm premature rupture of membranes (PROM) with contractions, preterm PROM without contractions and maintenance tocolysis, respectively. The most common first-line agent for tocolysis was magnesium, and nifedipine was the most common agent for maintenance tocolysis. While more then 80% of MFM specialists believed tocolysis to be beneficial for acute preterm labor, less than 50% thought tocolysis was beneficial for the other indications, the report indicates.

While the benefit of tocolysis has been established with acute preterm labor, “there is a need for large, randomized trials evaluating the role of tocolysis in the setting of repeat acute preterm labor, maintenance tocolysis and preterm PROM,” the authors write. “There is a need for more contemporary studies because other factors that could improve neonatal outcome have changed, such as the prevalent use of corticosteroids and improved neonatal care.”

Fox NS, Gelber SE, Kalish RB, et al. Contemporary practice patterns and beliefs regarding tocolysis among U.S. maternal–fetal medicine specialists. Obstet Gynecol. 2008;112:42-47.