Indomethacin for Slowing Preterm Labor
Examples
Indomethacin is sometimes used as a
tocolytic medicine to prolong pregnancy by slowing
preterm uterine contractions.
Indomethacin is given through a vein
(intravenously), by mouth as capsules or liquid
(orally), or in the rectum (anal suppository).
Use of
indomethacin for the treatment of preterm labor is an
unlabeled use of the drug. Indomethacin is usually
used as an anti-inflammatory medicine to treat arthritis and other conditions
that can affect joints and tissues around joints.
Why It Is Used
Indomethacin is used only:
- For short-term treatment of preterm
labor.
- Before 31 to 32 weeks of pregnancy.
Indomethacin can be used to treat preterm labor
when:
- Labor needs to be delayed for 24 to 48 hours
to:
- Let
corticosteroids given to the mother help fetal lungs
mature.
- Provide time to move a mother to a hospital that provides
neonatal intensive care, if her local hospital does not.
- Regular contractions of the uterus have thinned
the
cervix less than 80% and opened it less than
4 cm, and the mother's
amniotic sac has not
broken.
- Beta-sympathetic medicines (such as terbutaline) have
not stopped uterine contractions.
- Treatment with other tocolytic medicines was stopped because of
side effects.
How Well It Works
Indomethacin can be effective in
delaying preterm labor.1 More
research is needed before its harms and benefits are fully known.
Side Effects
Indomethacin appears to have fewer side
effects on the mother but potentially more serious effects on the fetus than
other tocolytic medicines used to treat preterm labor. But fetal side effects
are very unlikely when treatment lasts fewer than 7 days. Indomethacin may
cause:
- A fetus's kidneys to produce abnormally low
amounts of urine, resulting in a decrease in the amount of amniotic fluid
(oligohydramnios).
- Early changes in the heart that do not normally
occur until after birth. This may cause problems with fetal blood
circulation.
Maternal side effects are very rare. They include:
- Headaches.
- Dizziness.
- Nausea and/or
vomiting.
- Stomach upset or heartburn.
- Prolonged vaginal
bleeding.
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems.)
What To Think About
- Indomethacin is used with caution, particularly
for pregnant women with heart disease, asthma, a history of intestinal bleeding
or ulcers, kidney disease, problems with blood clotting, or a decreased amount
of amniotic fluid (oligohydramnios). It is also not used during the last 2
months of pregnancy because of possible effects on fetal heart
development.
- When indomethacin is used for more than 3 to 7 days,
fetal monitoring with an
echocardiogram and regular
ultrasound tests on the mother are used to check the
amount of amniotic fluid.
Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.
References
Citations
- Haas DM (2010). Preterm birth, search date June 2009.
Online version of BMJ Clinical Evidence:
http://www.clinicalevidence.com.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Sarah Marshall, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | William Gilbert, MD - Maternal and Fetal Medicine |
|---|
| Last Revised | January 10, 2011 |
|---|
Last Revised:
January 10, 2011
Haas DM (2010). Preterm birth, search date June 2009.
Online version of BMJ Clinical Evidence:
http://www.clinicalevidence.com.
