Tocolytic of choice in hea disease
Atosiban [Ref: Ian Donald practical problems in obstetrics 6h/e Most tocolytics are contraindicated in women with cardiac disease because of their potential to precipitate cardiac failure. - As there are no studies performed to look at the safety of tocolytic drugs in setting of existing hea failure the recommendations for their use can be best made on the basis of their side effect profile in normal women. "Atobisan, an oxytocin antagonist seems to be the drug of choice at present" -In an animal study it was shown to have no central hemodynamic effect although some concern has been expressed over increased infant moality rate. Indomethacin has minimal effect on hea rate and mean aerial pressure and may be used as an alternative for sho term tocolysis. None of the other tocolytics are considered safe for cardiac disease. Beta inimetics probably are the worst They are contraindicated in :? - Cardiac arrhythinias - Valvular disease - Cardiac ischemia Nifedipine It is contraindicated in :? - Conduction defects - Left ventricular failure Magnesium sulfate - Status of magnesium sulfate as regards it safety in cardiac disease in unceain.
Nifedepine
Atosiban
MgSo4
Salbutamol