nifedipine dose for tocolysis rcog

Acute tocolysis treatment was usually by nifedipine (the initial dose was 10 mg capsules orally renewable every 20 minutes up to 4 capsules per hour in the first hour, followed by 20 mg slow-release tablets three times daily for 48 hours) or atosiban (a bolus injection of 6.75 mg i.v. Dosage/Direction for Use. Tocolysis (Acute) – Administration of terbutaline Uncontrolled document when printed Published: 27/07/2020 Page 2 of 3 Presentation ampoule = 500microgram/mL Dose2 Single dose: 250micrograms IV or SC The volume to be administered is 0.5mL SC if no IV access OR 0.5mL by slow IV injection., OR. Maximum initial dose: 40 mg in the first 40-60 minutes. Do not allow crushing or chewing. orally, swallow Nifedipine XL 30 mg . Green-top Guidline No. Failure of acute tocolysis, defined as delivery within 48 h, was significantly more common with NTG (31.7%) as compared to nifedipine (11.6%) in the study conducted by Dhawle et al. Nifedipine trials: effectiveness and safety aspects. 668-674. An open, randomized clinical trial conducted between March 1, 2013, and April 31, 2014. An oxytocin receptor antagonist (such as atosiban) is an alternative if nifedipine is contra-indicated or unsuitable. The suggested dose of nifedipine is an initial oral dose of … We suggest that an underlying disorder is the more likely explanation. tocolisis If contractions persist, therapy can be continued with 20 mg orally every 3 … Tocolysis for Women in Preterm Labour Green-top Guideline RCOG, 2011 Prof Aboubakr Elnashar Aboubakr Elnashar ; Use of a tocolytic drug is associated with a prolongation of pregnancy for up to 7 days but with no significant effect on preterm birth and no clear effect on perinatal or … Bracero LA, Leikin E, Kirshenbaum N, Tejani N. Comparison of nifedipine and ritodrine for the treatment of preterm labor. Policy Nifedipine is the preferred method of tocolysis … Chronic anal fissure. trouble concentrating. SETTING: Department of Obstetrics at the Zurich University Hospital. Nifedipine was associated with the least length of hospital stay. Both lines of intervention was administered for 48 hours. … Generic Medicine Info. Calcium channel blockers in the management of chronic coronary syndrome. in (maximum: 40 mg in 2 hrs) PTL (at least 4 contractions 20 minutes) *Do not give grapefruit juice . Ritodrine remains widely RCOG Guideline No. However, information is lacking on their possible effects on the fetal biophysical profile. Nifedipine is started at 2 x 10 mg nifedipine capsules taken orally in the first hour, followed by 20 mg nifedipine retard every 6 hours for the next 47 hours. Once tocolysis was achieved, nifedipine 20 mg orally was administered every 8 hr for a period of 48 hr. ... first dose nifedipine 10 mg tablet chewed, followed by three further doses of nifedipine 10 mg every 15 minutes, followed by nifedipine slow release 20 mg every 3 or 4 hours depending on uterine activity. Nifedipine 10 mg immediate release tablet by mouth loading dose Nifedipine administered orally every 15-20 minutes for the first hour to a maximum loading dose of 30 mg, followed by a maintenance dose of 10-20 mg immediate release nifedipine administered orally every 6 hours Do not give indomethacin >31+6 weeks due to potential patent ductus arteriosus closure. It works by relaxing the muscles of your heart and blood vessels. Definition (MSH) Drugs that prevent preterm labor and immature birth by suppressing uterine contractions (TOCOLYSIS). Total two hundred patients were included in this study, 100 patients were in group A (Nifedipine) and 100 patients were in group B (Nitroglcerine) and we measured the prolongation of pregnancy for 48 hours in both groups. It is not licensed for use as a tocolytic and there is no consensus on the optimal treatment dose or regimen. NOTE: MAXIMAL DOSE IS 160 mg per day. Two Dose Regimens of Nifedipine for the Management of Preterm Labor. Nifedipine 20 mg sublingual, repeated after 30 minutes if contractions do not decrease in intensity. Maintenance of 120-160 mgs of slow-release nifedipine daily for 48 hours.Once contractions cease, nifedipine will be maintained at 80-120 mg daily in divided doses up to 36 weeks. Of the 520 doses administered, 24% and 43% resulted in a greater than 25% reduction in SBP and DBP respectively, and the degree of blood pressure reduction was weakly correlated to the mg/kg dose. (avoid in gestation >32 weeks for concern of premature narrowing or closure of the ductus arteriosus) Nifedipine 20mg x1, additional 20mg dose in 90min if ctx persist, followed by 20mg q3-8 hrs PRN ctx. Agents used to delay premature uterine activity include magnesium sulfate, beta-mimetics, oxytocin antagonists, calcium channel inhibitors, and … There was no correlation between nifedipine levels and body mass index (BMI), or between nifedipine levels and gestational age. Generally, dosage is increased gradually at 7- to 14-day intervals until optimum control of blood pressure is obtained. Atosiban or nifedipine appear preferable as they have fewer adverse effects and seem to have comparable effectiveness. venetoclax dose by at least 50%; resume previous venetoclax dose 2-3 days after nifedipine D/C: combo may incr. In November 2015, this was an off-label use of nifedipine. Therefore every woman who receives nifedipine tocolysis must be able to make an informed decision regarding its use. 19 Tocolytic treatment for women in preterm labour is the subject of RCOG Green-top Guideline No. In the atosiban group, a bolus injection of 6.75 mg i.v. The total dose administered during 48 hr was 120 mg. Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/44598 Download. In this post, MomJunction tells you if taking nifedipine during pregnancy is safe, when and how to use it, and its possible side-effects. METHODS: A prospective, randomized double-blind, multicenter study was conducted.After successful tocolysis, patients were randomly assigned to receive 20 mg nifedipine or an identical-appearing placebo every 4–6 hours until 37 weeks of gestation. OBJECTIVE: To determine nifedipine concentrations in maternal plasma at steady state, and maternal and umbilical cord plasma at delivery, after tocolysis with nifedipine gastrointestinal therapeutic system (GITS) tablets. OBJECTIVE: To study the direct fetal effects of tocolysis with atosiban or nifedipine combined with a course of betamethasone. Maximum dose of Nifedipine IR is 160mg/day.1 Onset of tocolysis is at 30 to 60 minutes and institution of a second line of tocolysis should not (1) 1.. Preterm labour of 15 Obstetrics & Gynaecology . Lamont CD, Jørgensen JS, Lamont RF. 0.25-0.5mg/kg PO q4-6h; Max: 10mg/dose up to 1-2mg/kg/day; Hypertrophic cardiomyopathy. nifedipine + venetoclax. Capsule nifedipine oral 4 doses each of 10 mg given 15 minutes apart for acute tocolysis, followed by Tablet Nicardia Retard (nifedipine sustained released) 20 mg twice daily for next 7 days as maintenance tocolysis. To evaluate the effect of a single 250-mg dose of 17 alpha-hydroxyprogesterone caproate (17-OHPC) intramuscularly as adjunct to nifedipine tocolysis in preterm labor. A comparison of tocolysis with nifedipine or ritodrine: analysis of efficacy and maternal, fetal, and neonatal outcome. View in Chinese. We compared two dose regimens of tocolytic oral nifedipine. Monitoring Maternal blood pressure and heart rate Nifedipine is a calcium channel blocker in the dihydropyridine subclass. ... for a total daily dose of 80 mg nifedipine… Effect of maintenance tocolysis with nifedipine in threatened preterm labor on perinatal outcomes: A randomized controlled trial Max. When nifedipine is administered as multiples of 30 mg tablets over a dose range of 30 mg to 90 mg, the area under the curve (AUC) is dose proportional: however, the peak plasma concentration for the 90 mg dose given as 3 x 30 mg is 29% greater than predicted from the 30 mg and 60 mg doses. Methods: The study included 73 patients with preterm labor with intact membranes. Regimen: Oral (not sublingual) loading dose of 10 mg (immediate release) Q 10 mins (for a total loading dose of 30 mg) then standard A loading dose of 4–6 g in 10%–20% solution over 30 minutes is followed by a continuous infusion of 2 g per hour. In vivo: Nifedipine (3 mg/kg) slightly lowers the level of systolic and/or diastolic blood pressure or increased the heart rate in rats. Magnesium Sulfate 4 gms IV as a single dose for neuroprotection 4. d. (5) i. The results showed that adverse events were the highest among women given more than 60 mg total dose of nifedipine [OR 3.78, 95% CI (1.27–11.2), ] and in reports from case series compared to controlled studies [OR 2.45, 95 CI (1.17–5.15), ] . Nifedipine may also be used for purposes not listed in this medication guide. 6 mg given intramuscularly every 12 hours for 4 doses. Dose of nifedipine: an initial oral dose of 20 mg followed by 10–20 mg three to four times daily, adjusted according to uterine activity for up to 48 hours. Usual Dosage. nifedipine/indomethacin combination therapy or nifedipine monotherapy. Am J Obstet Gynecol 1990; 163:105. Study medication was 20 mg of nifedipine slow-release tablets every 6 hours, resulting in a total daily dose of 80 mg of nifedipine or placebo tablets. ere were no signi cant di erences in interval from treatment o delivery, gestational age at delivery, or adverse e ects. Nifedipine versus Nifedipine and Progesterone Therapy in Acute Tocolysis in Preterm Labor and Their Effect on Maternal and Fetal blood flow', The Egyptian Journal of Hospital Medicine , 82(4), pp. The primary outcome was inhibition of preterm labor, … Apply 2–3 times a day until pain stops. FH Assessment during Tocolysis with Nifedipine (Adalat) a. Assess FH every 15-30 minutes before administration of nifedipine. Instructions. Consider Nifedipine for tocolysis for women between 24+0 and 25+6 weeks of pregnancy who have intact membranes and are in suspected preterm labour. Calcium-channel blockers (such as nifedipine) and oxytocin antagonists (such as atosiban) may delay delivery by 2 to 7 days, depending on how quickly the medication is administered. BJOG: an In-ternational Journal of Obstetrics & Gynaecology 112, 79-83. Start of study medication is 48 hours after start of the initial tocolysis. Corticosteroids were given for fetal pulmonary maturity. All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. As a guideline for defining the dose, the treatment regimes set out in the APOSTEL III study protocol can be used. Maintenance Therapy. All patients will receive one course of 12 mg betamethasone intramuscularly every 24 hours for 48 hours to promote fetal lung maturation and a rescue dose if they present in labor again at < 34 weeks of gestation. Nifedipine (Adalat®) 20 mg sublingual crushed, repeated after 30 minutes if contractions do not decrease in intensity. Nifedipine Tocolysis Regime Policy Hutt Maternity Policies provide guidance for the midwives and medical staff working in Hutt Maternity Services. Short-acting β2 agonists: restricted use for tocolysis in premature labour ... Consequentially, it is recommended that the minimum effective dose should be titrated for the individual. 3, pp. Elderly: Dose … dose q7-14 days; Max: 180 mg/day; Info: pts w/ coronary artery spasm may require 20-30 mg PO tid-qid; taper dose gradually to D/C. unable to sleep. For Adult. Otherwise, tocolysis is rarely successful beyond 24 to 48 hours because current medications do … Tocolysis for women in preterm labour. Studies comparing nifedipine with ritodrine report fewer maternal side effects. Nifedipine serum levels in pregnant women undergoing tocolysis with nifedipine. Objective: To compare the effectiveness and side effect of two different dosage regimes of oral Nifedipine in the treatment of preterm labour Methods: A double blinded randomized controlled trial in which 86 pregnant women with preterm labour were randomized to receive either the low or high dose regimen of Nifedipine for tocolysis. OBJECTIVE: To determine nifedipine plasma concentrations after a loading dose of nifedipine 10mg capsules, 40 mg over 1h followed by slow-release tablets (60 mg/d) versus gastrointestinal therapeutic system (GITS) tablets (90 mg/d) for tocolysis. Preterm Labour, Tocolytic Drugs (Green-top Guideline No. OBJECTIVE: To estimate whether maintenance nifedipine tocolysis after arrested preterm labor prolongs pregnancy and improves neonatal outcomes. Medications. There is no difference between all groups regarding the rate of preterm delivery before full steroid dose (p > 0.05). This is a prospective controlled randomized trial conducted in 92 women with singleton pregnancies in preterm labor. Indeed, most of the randomised controlled trials on nifedipine for tocolysis have started with immediate-release tablets or capsules up to a maximum dose of 40 mg during the first hour. The maintenance dose consisted of 20 mg orally every 6 h for 24 h up to a total of 100-120 mg nifedipine. Clinical severity justified hospitalization in intensive care unit (ICU) each time. When a woman goes into labor at 37 weeks or earlier, it’s … Commentary on : Flenady V, Wojcieszek AM, Papatsonis DN, et al. Nifedipine 5 mg is an unlicensed medication in New Zealand. • If contractions persist after 30 minutes further 20 mg orally may be given at 30 min intervals for a further two doses. nifedipine/indomethacin combination therapy or nifedipine monotherapy. Max. Adalat CC is to be taken by mouth on an empty stomach. The use of nifedipine for tocolysis is also unlicensed. Women with singleton pregnancies admitted in preterm labor (24 to 34 weeks) were randomized to high-dose (HD) nifedipine ( N = 49; 20 mg loading dose, repeated in 30 minutes, daily 120 to 160 mg slow-release nifedipine for 48 hours followed by 80 to 120 mg daily until 36 weeks) or low-dose (LD) nifedipine ( N = 53; 10 mg, up to four doses every 15 minutes, daily 60 to 80 mg slow-release nifedipine … Preterm labor/Tocolysis. Nifedipine is a calcium ion inhibitor which brings about a decrease in blood pressure. Nifedipine is in a group of drugs called calcium channel blockers. 668-674. To determine the effectiveness of an oral versus sublingual loading dose of nifedipine for tocolysis. Preterm labor and calcium channel blockers. to maximum dose (see below) Maximum daily dose Angina: 90mg Acute hypertension: 40mg per episode Hypertension, Tocolysis: 120mg Administration Oral: Immediate release tablets for tocolysis: The first 2 doses should be crushed or chewed to increase the rate of absorption Slow release tablets: Swallow tablet whole, do not crush or chew. latency or decrease neonatal morbidity compared with either limited tocolysis or no tocolysis at all. We compared two dose regimens of tocolytic oral nifedipine. There are no randomized, placebo-controlled studies demonstrating the benefit of nifedipine in preterm labor. The primary outcome is the number of women who do not deliver and do not need alternative tocolytic drug (terbutaline). If you notice any other effects, check with your healthcare professional. The study aimed to compare the efficacy and side effects of intravenous magnesium sulfate (MgSO4) and oral nifedipine for inhibition of preterm labor.This randomized controlled trial was performed on 220 women with preterm labor between 32 and 34 weeks of gestation who were randomly assigned to receive either MgSO4 or nifedipine. 20 mg twice daily until pain stops. (2007). In the first hour after starting nifedipine, blood pressure and heart rate will be measured every 15 minutes. Nifedipine should be used with caution in people with: Severe hypotension (systolic blood pressure less than 90 mmHg). This outcome of a retrospective cohort study covering a 5-year period was reported at the 2018 World Congress of the Royal College of Obstetricians and Gynaecologists… The mean nifedipine dose used was 0.23 mg/kg (range 0.04 to 0.69 mg/kg) PO. An extended-release tablet (30 mg), which lasts 24 hours and is known as nifedipine XL or CR or ER …. She was started on nifedipine for tocolysis and to facilitate administration of steroids. The side-effects were not dose-related. In fact, the Royal College of Obstetricians and Gynaecologists Guideline No 1b recommends that nifedipine or atosiban be used as preferred first-line tocoly- The herbal medicine Bryophyllum pinnatum has been used as a tocolytic agent in anthroposophic medicine and, recently, in conventional settings alone or as an add-on medication with tocolytic agents such as atosiban or nifedipine. Prinzmetal's angina. Of the 520 doses administered, 24% and 43% resulted in a greater than 25% reduction in SBP and DBP respectively, and the degree of blood pressure reduction was weakly correlated to the mg/kg dose. A recommended initial dosage of nifedipine is 20 mg orally, followed by 20 mg orally after 30 minutes. duration of use 8 weeks, apply to anal canal, using 0.2%–0.5% topical preparation. Initiation of study medication was 48 to 72 hours after the start of initial tocolysis. In 2006, preterm birth was associated with over 36% of the neonate deaths. She received a total of six doses of nifedipine during her admission before discontinuation of the medication. Whether continued tocolysis after 48 hours of rescue tocolysis improves neonatal outcome is unproven. 3 Choice of drug:. duration of use 8 weeks. STUDY DESIGN: Prospective study in 14 pregnant women treated for threatened preterm labor. Dose: 10-20 mg PO tid; Start: 10 mg PO tid, may incr. Nifedipine is used to treat hypertension (high blood pressure) and angina (chest pain). If contractions continue after 20 minutes, give 10 mg PO q 20 mins for a maximum of 2 doses. Tablet Nicardia retard was started 12 hours after last dose of capsule nifedipine. Dosage must be adjusted according to patient response. El-Sayed, MD OBJECTIVE: To compare the efficacy and side effects of The investigators found a reduced risk of delivery within 7 … Other side effects not listed may also occur in some patients. We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. To the Editor: Recent studies have suggested that nifedipine is … Nifedipine inhibits the transmembrane influx of extracellular calcium ions into myocardial and vascular smooth muscle cells, causing dilatation of the main coronary and systemic arteries and decreasing myocardial contractility. The half life of a 10‐mg nifedipine capsule is only 1.3 hours 2 and it has a low and transient side effect profile, 3 but their patient's blood pressure remained low for 6 hours after stopping the nifedipine despite intravenous colloid infusion. 22 The therapeutic effect does not rely on serum magnesium levels because mean serum levels have been found to be similar between patients with successful and failed tocolysis. b) Check blood pressure and pulse following each dose c) Initial nifedipine dose: 2 x 5 mg sublingual (pierce capsule prior to administration) Nifedipine 30 mg orally was given for acute tocolysis. Nifedipine (Procardia, Adalat) dose for the treatment of High altitude pulmonary edema in children and adolescents: Note: Treatment with Nifedipine should be considered for an unsatisfactory response to oxygen and/or altitude descent. Hypertension (Off-label) 0.25-0.5 mg/kg/day (extended release) PO in 1 or 2 daily doses initially; not to exceed 3 mg/kg/day (120 mg/day) Avoid conventional (ie, immediate-release) product; potential for hypotension and … Indicated for the reduction of neonatal mortality, (respiratory distress syndrome) RDS, and (intraventricular hemorrhage) IVH in women at for preterm delivery at less than 34 weeks. 89.1% for acute tocolysis of preterm labour as compared to oral nifedipine and should be used as first line tocolytic agent. Oral: Extended release: Initial: 30 or 60 mg once daily; increase as needed to effective antianginal dose over 1 to 2 weeks. …minutes with nifedipine and up to 10 minutes with verapamil . Calcium channel blockers for inhibiting preterm birth. OBJECTIVES: To evaluate the effectiveness of maintenance tocolytic therapy with oral nifedipine on the reduction of adverse neonatal outcomes and the prolongation of pregnancy by performing an individual patient data meta-analysis (IPDMA). The nifedipine tocolysis dosage regime: 20 mg orally, followed by 20 mg orally after 30 minutes if contractions persist, followed by 20 mg orally every 3–8 hours for 48 hours as indicated: Or 10 mg sublingually, followed by 10 mg every 10 minutes (maximum dose for the first hour 40 mg), followed by 20 mg every 4 hours for 48 hours. See NICE's information on prescribing medicines. Nifedipine serum levels spread between 6 and 101 ng/ml (17 – 292 nmol/l). FDA-approved indications include chronic stable angina, hypertension. Immediate-release formulation: 5 mg/kg/dose per oral every 8 … No clinically significant adverse events were noted. Nifedipine regime a) Check no contraindications to tocolysis (eg woman asthmatic, vaginal bleeding etc.) Effectiveness of nifedipine in threatened preterm labor: a randomized trial Srisuda Songthamwat, Chatchanawadee Na Nan, Metha Songthamwat Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand Objective: Threatened preterm labor is a condition in which regular uterine contractions occur at least 1 time in 10 minutes and persist for more than 30 … Tocolysis is an emergent procedure indicated to prolong gestation to decrease fetal morbidity and mortality. The primary outcome is the number of women who do not deliver and do not need alternative tocolytic drug (terbutaline). Because each individual trial has been small, this is the best evidence to date that nifedipine can be used for tocolysis. Preterm Labour. The secondary outcome is an estimated association with neonatal morbidity and mortality. Indomethacin 50-100mg loading dose, 25mg q4-6 hrs for 48 hrs. Whether continued tocolysis after 48 hours of rescue tocolysis improves neonatal outcome is unproven. -Maximum doe: 180 mg/day. Welcome to the RCOG. Potential toxic dose in children <6 years: 2 mg/kg. More than 40 studies have been published on nifedipine's effectiveness as a tocolytic. Several studies have addressed the effects of nifedipine on the uteroplacental flow in pregnant women inhibiting labor with nifedipine, but the results are quite controversial. For the first 48 hours thereafter, all attempts should … Nifedipine is often prescribed during pregnancy to manage hypertensive disorder. c. If there are no contractions 3 hours after first dose of nifedipine, decrease assessment to every 1 hour. 20 mg nifedipine capsule (do not crush) or slow-release tablet dispersed in water Observations BP every 15 min for first 2 hr after first dose and once 15 min after subsequent doses Nifedipine should not cause a drop in blood pressure in normotensive women Continuous electronic fetal monitoring for first 2 hr Maintenance tocolysis with nifedipine beyond 48 hours does not reduce adverse perinatal outcomes, according to a new randomized controlled trial. Evidence-based information on terbutaline in Systematic Reviews or Evidence Summaries from hundreds of trustworthy sources for health and social care. Immediate-release capsules: -Initial dose: 10 mg orally 3 times a day. 260-263. Use INDOMETHACIN 50-100mg PO/PR STAT followed by 25mg PO q4-6h. Conclusions: Nifedipine maintenance tocolysis is associated with a significant decline in uterine artery and middle cerebral artery Doppler indices 24 h after the first dose. 1(B): We wanted to compare the inhibitory effect of atosiban and nifedipine on human myometrial contractility in vitro in the absence and in the presence of B. • Maintenance 20-40 mg orally qid for up to 48 hours. Terbutaline 0.25mg sq q20-30 min up to 4 doses PRN ctx. The primary outcome was attainment of 37 weeks of gestation. The median curves for plasma nifedipine concentration (ng ml −1) vs. time (h) for the two groups were determined during the 12 h dose interval using the monocompartmental model (Figure 1). Nifedipine is a dihydropyridine calcium channel blocking agent. 15 Results of our study 3. Study medication consists of 20 milligrams nifedipine every six hours, administered orally, resulting in a total daily dose of 80 milligrams, or placebo. consider alternative, hold venetoclax or decr. • Initial dose 20 mg orally stat. Poor cardiac reserve. The extended-release doses have varied from 60 to 160 mg daily,,,,,,,,,,,,. Her informed consent must be obtained and documented in the clinical notes by obstetric team. We analyzed whether there was a time effect and compared values at the different time-points. Fetal cardiac diastolic function is unaffected and the significant redistribution observed after 24 h is likely to be attributable to altered cerebral blood flow. Offer nifedipine 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. Women between 24 and 33 weeks of gestation who have intact membranes and are in suspected or diagnosed premature labour can be given nifedipine [unlicensed indication] for tocolysis. In the nifedipine group, the initial dose was 20 mg nifedipine (two 10 mg capsules) orally in the first hour, followed by 20 mg slow-release nifedipine per 6 h for the next 47 h. In the first hour after the start of nifedipine administration, blood pressure and heart rate were measured every 15 min. This article has no abstract; the first 100 words appear below. van Geijn HP, Lenglet JE, Bolte AC (2005). The sample size will … Loading Dose orally, swallow Nifedipine 10 milligrams (mg) (5 mg capsules x 2) whole with clear fluids* every 30 minutes until contractions stop . Atosiban is licensed for this usage in the UK but nifedipine is not. ( 0.5 , 0.75 , 4 mg tablets, 4 mg/mL solution ) … Initially 1 tab once daily, may be increased in increments up to 120 mg once daily. Cochrane Database Syst Rev 2014;6:CD002255[OpenUrl][1][PubMed][2] Preterm birth remains as the leading cause of neonatal morbidity and mortality. Maintenance tocolysis, mostly defined as the continuation of tocolytic treatment beyond 48 h, is still a controversial issue.

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