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Ultrasound Finding

Shape of Cervix on ultrasound

Seen in

T shaped

Normal

Y shaped

Suspicious of preterm labor

U shaped

Funneling of os-seen in incompetent os, preterm labor.


Tocolytic Agents

  1. Beta 2 agonist (e.g., isoxsuprine, ritodrine, terbutaline, etc.)
  2. Calcium channel blocker (nifedipine)
  3. Indomethacin – prostaglandin synthetase inhibitors (indomethacin, sulindac)
  4. Magnesium sulfate
  5. Atosiban (oxytocin antagonist)
  6. Progesterone
  7. Diazoxide

Ritodrine is the only tocolytic agent approved by US FDA.

  1. Most commonly used = beta 2 agonist (Maximum pulmonary edema)
  2. Maximum side effects = beta 2 agonist
  3. Least side effects = progesterone followed by atosiban
  4. Tocolytic of choice in heart disease patients; atosiban
  5. Best first line tocolytic – Nifedipine
  6. Best tocolysis for heart patients with preterm labour is magnesium sulphate.

Potential Complications of Tocolytic Agents

  1. Beta-adrenergic agents
    1. Hyperglycemia
    2. Hypokalemia
    3. Hypotension
    4. Pulmonary edema
    5. Cardiac insufficiency
    6. Arrhythmias
    7. Myocardial ischemia
    8. Maternal death
  2. Magnesium sulfate (toxicity)
    1. Pulmonary edema
    2. Respiratory depression
    3. Cardiac arrest
    4. Maternal tetany
    5. Muscular paralysis
  3. Indomethacin
    1. Oligohydramnios
    2. Premature closure of DA
    3. Renal failure
    4. Gastrointestinal bleeding
  4. Nifedipine
    1. Transient hypotension

Extra Edge:

 

Most of the tocolytics lead to tachycardia, hypotension, hyperglycemia, hypokalemia, pulmonary edema, respiratory depression & cardiac arrythmias.
 

Contraindications to Tocolysis

  1. Chorioamnionitis
  2. Preeclampsia/eclampsia
  3. Advanced labor
  4. Fetal distress
  5. Abruption
  6. IUFD
  7. Congenital anomalies not compatible with life
  8. Pregnancy >34 weeks





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