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Medications for Preterm Labor and Delivery

If you are having preterm labor, you may be given medication. Drugs for preterm labor include:

  1. Tocolytics—to slow or stop preterm labor contractions
    1. Calcium channel blockers
    2. Betamimetics
    3. Prostaglandin synthetase inhibitors (cyclooxygenase inhibitors)
    4. Magnesium sulfate
  2. Corticosteroids—to help the baby’s lungs and brain mature
  3. Antibiotics—to prevent infection in the mother and baby

Tocolytics

Tocolytics are drugs that minimize the strength and number of contractions. Although an ideal goal would be to stop preterm labor completely, the most that can be reasonably expected from current tocolytics is a delay of 48 hours. This delay allows time for treatment with steroids and antibiotics. Steroids are given to speed the baby’s lung development. Even a few extra days in the uterus can be vital to the baby’s development.

Antibiotics may be given to treat a suspected infection. During this time, you may also be transferred to a better-equipped hospital.

These drugs can be given through an IV or by mouth between 24 and 34 weeks gestation.

Calcium Channel Blockers
  • Common name: Nifedipine

Calcium channel blockers reduce smooth muscle contractions, such as those in the uterus. In addition, statistically significant benefit has been seen for infants in terms of preventing respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and jaundice.

Prostaglandin Synthetase Inhibitors (Cyclooxygenase Inhibitors)

Common names include:

  • Ibuprofen
  • Indomethacin
  • Ketorolac
  • Sulindac

Prostaglandins cause uterine contractions, so these drugs are meant to block the production of prostaglandin and may be used in certain causes of preterm contractions.

Betamimetics

Common names include:

  • Terbutaline
  • Ritodrine

These drugs cause uterine muscles to relax.

Magnesium Sulfate

This is a muscle relaxant that is given intravenously. While this medication has not been proven to delay preterm birth, it is effective in treating pre-eclampsia and does offer protection against brain injury in the baby. It is used frequently in the presence of preterm labor.

Corticosteroids

Common names include:

  • Betamethasone
  • Dexamethasone

If you are between 24-34 weeks of pregnancy, your doctor may give corticosteroids. These drugs help your baby’s lungs mature. They also reduce the risk of respiratory distress syndrome and bleeding in the brain. With these drugs, your baby will breathe easier after delivery.

Antibiotics

Common names include:

  • Penicillin
  • Ampicillin
  • Clindamycin
  • Vancomycin
  • Cefazolin

Antibiotics help to treat and prevent infection in both the mother and the baby. Preterm babies are at increased risk of infection because their immune systems are immature.

Revision Information

  • ACOG Committee Opinion No. 291: Use of progesterone to reduce preterm birth. American College of Obstetricians and Gynecologists. 2003.

  • Berghella V, Klebanoff M, et al. National Institute for Child Health and Development Maternal Fetal Medicine Units Network. Sexual intercourse association with asymptomatic bacterial vaginosis and trichomonas vaginalis treatment in relationship to preterm birth Am J Obstet Gynecol. 2002;187:1277-1282.

  • da Fonseca EB, Bittar RE, et al. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study. Am J Obstet Gynecol. 2003;188:419-424.

  • Dodd JM, Crowther CA, et al. Progesterone supplementation for preventing preterm birth: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2005;84:526-533.

  • MacKenzie R, Walker M, et al. Progesterone for the prevention of preterm birth among women at increased risk: A systematic review and meta-analysis of randomized controlled trials. Am J Obst Gynecol. 2006;194:1234-1242.

  • McDonald H, Brocklehurst P, Parsons J. Antibiotics for treating bacterial vaginosis in pregnancy. The Cochrane Database of Systematic Reviews. 2005;(1):CD000262.

  • Ness A, Dias T, et al. Impact of the recent randomized trials on the use of progesterone to prevent preterm birth: a 2005 follow-up survey. Am J Obstet Gynecol. 2006;195:1174-1179.

  • Prematurity. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 30, 2013. Accessed March 18, 2014.

  • Preterm labor. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 2, 2014. Accessed March 18, 2014.

  • Stanley FJ, Crowther C. Antenatal magnesium sulfate for neuroprotection before preterm birth? N Engl J Med. 2008; 359:962-964.

  • What treatments can reduce the chances of preterm labor & birth? National Institute of Child Health & Human Development website. Available at: http://www.nichd.nih.gov/health/topics/preterm/Pages/default.aspx. Updated November 6, 2013. Accessed March 18, 2014.

  • Whitworth M, Quenby S; Cochrane Pregnancy and Childbirth Group. Prophylactic oral betamimetics for preventing preterm labour in singleton pregnancies. The Cochrane Database of Systematic Reviews. 2009; (1).

  • Yemini M, Borenstein R, et al. Prevention of premature labor by 17 alpha-hydroxyprogesterone caproate. Am J Obstet Gynecol. 1985;151:574-577.

  • Zhu BP, Haines KM, et al. Effect of the interval between pregnancies on perinatal outcomes among white and black women. Am J Obstet Gynecol. 2001;185:1403-1410.