Tocolytic therapies in development for preterm labour

Abstract

Management of threatened preterm birth is still the main problem in obstetrics. Increasing knowledge about semiselective β-2-mimetics as the main substances in clinical routine shows that they are a tool for the acute management of preterm labour rather than for substantial prolongation of pregnancy. Current investigational work is aimed at obtaining increased awareness of the pathophysiological/patho-biochemical peculiarities of pre-term labour. Thus, contraction triggered application or vaginal administration seem to be more appropriate application routes. Influencing intracellular calcium homeostasis by calcium channel-blockers, modulation of prostaglandin synthesis by prostaglandin precursors competing with the arachidonic acid pathway, or specific prostacyclin synthesis inductors, or inhibition of specifically acting functional peptides, such as oxytocin, are concepts that are still experimental but come closer to the mechanisms underlying preterm labour. In addition, important epidemiological contributors to preterm labour such as ascending genital infection have to be taken into consideration, eventually resulting in a more generous use of local and systemic bacteriosta-tics/antibiotics.