Document Detail

Is there justification for using indomethacin in preterm labor? An analysis of neonatal risks and benefits.
MedLine Citation:
PMID:  9369826     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Recent reports have suggested that the use of indomethacin for tocolysis may independently increase the risk for major adverse neonatal events such as intraventricular hemorrhage and necrotizing enterocolitis. The objective of this study was to determine whether this potential risk of indomethacin is outweighed by the benefit of delivery delay at gestational ages < 32 weeks. STUDY DESIGN: We constructed separate decision trees to compare strategies of tocolysis with indomethacin versus no tocolysis for hypothetic cohorts of patients with idiopathic preterm labor at 24, 26, 28, 30, and 32 weeks' gestation. Probabilities for these decision models, including estimates of indomethacin efficacy and the potential for increase in adverse neonatal events with indomethacin, were obtained from the medical literature. The primary outcome was the number of expected adverse neonatal events per 1000 women for each strategy at each gestational age. RESULTS: In the base case analysis tocolysis with indomethacin was a more favorable strategy than no tocolysis across all gestational ages that we studied. As expected, the difference in the number of events between the two strategies declined with advancing gestational age because of a decreasing baseline risk for adverse neonatal events as gestational age increased. The models at 26, 28, 30, or 32 weeks were not sensitive to our estimates of indomethacin efficacy, nor to our estimates of baseline neonatal morbidity or steroid efficacy, or to the relative increase in some neonatal morbidities with indomethacin use. CONCLUSIONS: On the basis of current estimates, the benefits of indomethacin outweigh the potential risks to the neonate at gestational ages < or = 32 weeks. Thus the use of indomethacin for tocolysis at these ages is a reasonable strategy.
G A Macones; C A Robinson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  177     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  1997 Oct 
Date Detail:
Created Date:  1997-12-05     Completed Date:  1997-12-05     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  819-24     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, USA.
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MeSH Terms
Cerebral Hemorrhage / chemically induced
Decision Support Techniques
Enterocolitis, Pseudomembranous / chemically induced
Gestational Age*
Indomethacin / adverse effects*,  therapeutic use*
Infant, Newborn
Obstetric Labor, Premature / drug therapy*
Risk Factors
Tocolytic Agents / adverse effects,  therapeutic use*
Treatment Outcome
Reg. No./Substance:
0/Tocolytic Agents; 53-86-1/Indomethacin
Comment In:
Am J Obstet Gynecol. 1998 Apr;178(4):873-4   [PMID:  9579464 ]

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