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NICE - tocolysis in premature labour

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Tocolysis

  • tocolysis is the suppression of uterine contractions
    • tocolytics are medications used to suppress premature labour
      • tocolytic therapy is provided when delivery would result in premature birth, postponing delivery long enough for the administration of glucocorticoids, which accelerate fetal lung maturity

  • the following factors should be taken into account when making a decision about whether to start tocolysis:
    • whether the woman is in suspected or diagnosed preterm labour
    • other clinical features (for example, bleeding or infection) that may suggest that stopping labour is contraindicated
    • gestational age at presentation
    • likely benefit of maternal corticosteroids
    • availability of neonatal care (need for transfer to another unit)
    • the preference of the woman
  • nifedipine* should be considered for tocolysis for women between 24+0 and 25+6 weeks of pregnancy who have intact membranes and are in suspected preterm labour
  • nifedipine* should be offered for tocolysis to women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour

  • if nifedipine is contraindicated, offer oxytocin receptor antagonists for tocolysis

  • do not offer betamimetics for tocolysis

* although this is common in UK clinical practice, at the time of publication (August 2019), nifedipine did not have a UK marketing authorisation for this indication

  • prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information
  • suggested dose of nifedipine is a loading dose of 20 mg nifedipine orally, followed by 10-20 mg 3 to 4 times daily, adjusted according to uterine activity
  • at the time of publication, some brands of nifedipine were specifically contraindicated in pregnancy by the manufacturer in their SPC. Refer to individual SPCs for each preparation of nifedipine for further details

Reference:

Last edited 08/2019

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