Uterine Relaxants : tocolytics

Topic:--Progesterone for preterm labor prophylaxis is indicated, from 16-36 weeks.  What is the list of tocolytic agents?? Tocolytics are ::--A) Atosiban (costly)  and  B) Ritodrine which is banned in  most countries &  not available in US, due to lack of studies, unproven benefits, and costs. On the other hand C) Nifedipine is a well studied useful tocolytic and inexpensive. D) vaginal progesterone –gaining importance .as affordable and cost effective .

Indications of tocolytics?? Who warrant tocolytics?? Who are Ideal candidates?? 1)  Patients with prior preterm delivery due to PTL or  2) PPROM, 3) Thr abortion 4) Uterine cramps  in midpregnancy with increased white discharge .

When progesterone ? How to  select the cases?? However, progesterone for preterm labor prophylaxis is indicated, from 16-36 weeks. In US, many  use 17 OHP 250 mg IM weekly from 16 to 36 weeks. In Europe, vaginal progesterone 200 mg daily, is used.

  How to follow up?? Who should undergo regular cervical length measurements from 16 to 23 6/7 weeks every 2 weeks.   Ans:- How to prevent preterm labour?? Patients with prior PTD or PPROM should undergo cervical length measurements from 16 to 23 6/7 weeks, every 2 weeks. If the cervical length is 3 cm or less, repeat every week. If cervical length is 2.5 cm or below, then cerclage is indicated, McDonald cerclage is better at that late gest age. < 10% of these prior PTD patients will have short cervix.  So 90+% will not require cerclage. If patient gets a cerclage, the progesterone needs to continue until 36 weeks. For routine cervical insufficiency patients, that have cerclage due to prior h/o insufficiency, progesterone can still be used if the diagnosis of cervical insufficiency is not definite