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- W1978314017 abstract "Commonly used tocolytics show tachyphylaxis and are associated with potentially life-threatening maternal side-effects. Indometacin is the only drug that has been shown to delay delivery for more than 48 hours in randomised trials, 1 Keirse MJNC Indomethacin tocolysis in preterm labour. In: Cochrane Library [CDROM and online]: review no 04383. Cochrane Collection; issue 22. Update Software, Oxford1995 Google Scholar but fetal side-effects limit its usefulness. 2 Hendricks SK Smith JR Moore DE Brown ZA Oligohydramnios associated with prostaglandin synthetase inhibitors in preterm labour. Br J Obstet Gynaecol. 1990; 97: 312-316 Crossref PubMed Scopus (52) Google Scholar Indometacin inhibits the cyclo-oxygenase (COX) enzyme. Of the two COX isoforms, COX-1 is constitutively expressed in tissues with constant prostaglandin synthesis, and COX-2 is inducible and associated with inflammation. COX-2 is upregulated during labour in fetal membranes, 3 Slater D Berger L Moore GE Bennett PR Changes in the expression of types 1 and 2 cyclo-oxygenase in human fetal membranes at term. Am J Obstet Gynecol. 1995; 172: 77-82 Summary Full Text PDF PubMed Scopus (165) Google Scholar but constitutive fetal prostaglandin synthesis is probably mediated by COX-1. A COX-2-selective non-steroidal anti-inflammatory (NSAID) agent might have the efficacy of indometacin without side-effects. Several such drugs have been developed but there is no experience of their use in pregnancy. Nimesulide is an NSAID which shows 100-fold selectivity for COX-2 4 Vane JR Botting RM Mechanisms of action of anti-inflammatory drugs. in: Vane J Botting R Botting G Improved non-steroid anti-inflammatory drugs: COX-2 enzyme inhibitors. Kluwer Academic, UK1996: 1-27 Crossref Google Scholar and which has been in use in Europe for a decade with no reports of complications of its use in pregnancy, as far as we are aware." @default.
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- W1978314017 date "1997-07-01" @default.
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- W1978314017 title "Use of a cyclo-oxygenase type-2-selective non-steroidal anti-inflammatory agent to prevent preterm delivery" @default.
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- W1978314017 doi "https://doi.org/10.1016/s0140-6736(05)62229-5" @default.
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