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Tocolytics are medicines that attempt to stop labor. They are
used if labor begins before term. Tocolytics can stop labor or delay labor to
give the baby's lungs time to mature. If started early in premature labor, they
may be effective. They are not as successful later in labor, if the membranes
have broken, or if your cervix is already dilated beyond 2 centimeters. When
taking this medication, you may need hospitalization or home therapy.
Terbutaline, ritodrine, nifedipine and magnesium
sulfate are all used as tocolytic drugs. Tocolytics are not used if the mother
has chorioamnionitis (an infection in the membranes around the baby), abruptio
placenta, severe preeclampsia or eclampsia, cardiac disease, or other severe
medical illnesses. Tocolytics are also not used if the fetus has died in the
uterus, or if the fetus is in acute distress. Some of these drugs are used in
combination with other medications.
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Terbutaline: This medicine is used to
stop preterm labor. It is also known as Brethine. It can be taken as a pill,
through an IV (through a catheter directly into your vein), as an injection,
or through a controlled infusion pump. A pump is used to give a continuous
low dose of the terbutaline. Additional amounts of the medication can be
administered if uterine activity increases. A subcutaneous (the medicine is
injected under your skin but not directly into a vein) infusion pump may be
used with home uterine monitoring. Some of the side effects can include
nervousness, restlessness, insomnia, headache, rapid heart rate, nausea,
hyperglycemia (high blood sugar) and hypokalemia (low blood potassium). A
rare but serious side effect is pulmonary edema. The baby may also
experience a fast heart rate and high or low blood sugar after birth. The
mother and baby should be monitored while taking this drug. Your doctor
should be informed if you have shortness of breath or chest pain while
taking this medicine, or if the contractions begin again while you are on
this medicine.
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Ritodrine: This medicine is used to stop
preterm labor. It acts in a similar way to terbutaline. You can take it
through an IV. The side effects are like those of terbutaline. If you have a
history of cardiac dysrhythmias (irregular heart rhythms) or cardiac
disease, hypertension or thyrotoxicosis (an excess of thyroid hormones), you
should discuss this with your doctor before taking terbutaline or ritodrine.
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Nifedipine: This medicine is used to
stop contractions. It is also called Adalat or Procardia and is taken as a
pill. It is used to stop contractions and delay labor, and may also be used
for occasional uterine irritability. Some of the side effects that may occur
include facial flushing, headache, nausea, palpitations, and
lightheadedness. No serious newborn side effects have been noted.
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Magnesium sulfate: This medicine can be
used to stop contractions as well as in the treatment and prevention of
seizures in a patient with preeclampsia. It can be taken as a pill or
through an IV. Side effects may include feelings of extreme warmth,
perspiration, flushing, nausea, vomiting, blurred vision, lightheadedness,
lethargy, nasal stuffiness and constipation. Magnesium sulfate can affect
your reflexes and slow your breathing. Some women report chest pain,
especially if they are taking this medicine with another of the tocolytics.
Women who have myasthenia gravis, a history of renal impairment (kidney
problems), heart block, or a history of a myocardial infarction (heart
attack) should discuss this with your doctor before using magnesium sulfate.
Side effects usually go away within a few days. The fetus may show a
decreased baseline heart rate. A newborn who has been exposed to magnesium
sulfate may seem drowsy, have a weak cry and a decreased sucking rate in the
early postpartum period. The mother and fetus should be monitored while on
this medication.
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Indomethacin: This medicine is used to
try to stop preterm labor, and is also called Indocin. It can be taken as a
pill or as a suppository (in the rectum). Side effects include abdominal
discomfort, nausea, vomiting, depression and dizzy spells for the mother.
Indocin can also have serious effects on the fetus if used long term or if
the gestational age is greater than 32-34 weeks. This drug may also be
dangerous for the mother is she has a history of bleeding disorders, aspirin
sensitivity, or kidney problems.
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Betamethasone: This medicine is a
steroid used to help the fetal lungs develop more quickly. It is also called
Celestone and is given as an injection into muscle tissue. The use of
betamethasone can decrease the chance that the baby will have respiratory
distress syndrome when born. It is usually used if preterm delivery is a
concern. Sometimes doctors use dexamethasone, which is a very similar
medicine. Side effects may include sleeplessness and higher blood sugar
levels for the mother and decreased fetal movement for the baby.
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