Tocolysis for Threatened Preterm Delivery: What to Use When No Particular Agent Seems Ideal

Although tocolytics have proved disappointing for preventing preterm delivery and improving neonatal outcomes, off-label use of these medications can be useful in delaying delivery long enough to allow maternal administration of glucocorticoids for promoting fetal lung maturation. However, which of the many agents to use is not clear because each one's efficacy has largely been measured against placebo or only one other agent. Now, researchers have performed a network meta-analysis of 95 trials to compare each class of tocolytics to another class, whether head to head or through a network of indirect comparisons.

All tocolytic classes were superior to placebo in delaying delivery by 48 hours, with prostaglandin inhibitors (e.g., indomethacin…