[Maintenance tocolysis with calcium channel blockers]

Abstract

Aim of the study: The objective of initial tocolysis is to prolong pregnancy for 48 hours, in order to allow fetal lung maturation with corticosteroids. Maintenance tocolysis is defined by the prolongation of tocolytic therapy beyond 48 h. Although the 2002 guidelines of the French College did not recommend to prolong tocolysis beyond 48 h, about 60% of obstetricians prescribe maintenance tocolysis.

Method: Nifedipine is the most frequently used treatment for maintenance tocolysis. Five randomised studies and two metaanalyses have compared maintenance tocolysis with nifedipine, with placebo or no treatment.

Results-conclusion: Maintenance tocolysis with calcium channel blockers does not reduce the risk of preterm birth and does not improve perinatal outcome. Tocolytic treatment after 48 hours of initial tocolysis has no beneficial effect (level of evidence 1).

Keywords: Accouchement prématuré; Calcium channel blockers; Inhibiteurs calciques; Maintenance tocolysis; Nicardipine; Nifedipine; Nifédipine; Preterm delivery; Tocolyse; Tocolyse d’entretien; Tocolysis.