Effect of tocolytic drugs on fetal heart rate variability: a systematic review

K.M.J. Verdurmen (Corresponding author), A.D.J. Hulsenboom, J.O.E.H. van Laar, S.G. Oei

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Abstract

Introduction: Tocolytics may cause changes in fetal heart rate (HR) pattern, while fetal heart rate variability (HRV) is an important marker of fetal well-being. We aim to systematically review the literature on how tocolytic drugs affect fetal HRV.

Materials and methods: We searched CENTRAL, PubMed and EMBASE up to June 2016. Studies published in English, using computerized or visual analysis to describe the effect of tocolytics on HRV in human fetuses were included. Studies describing tocolytics during labor, external cephalic version, pre-eclampsia and infection were excluded. Eventually, we included six studies, describing 169 pregnant women.

Results: Nifedipine, atosiban and indomethacin administration show no clinically important effect on fetal HRV. Following administration of magnesium sulfate decreased variability and cases of bradycardia are described. Fenoterol administration results in a slight increase in fetal HR with no changes in variability. After ritodrine administration increased fetal HR and decreased variability is seen. The effect of co-administration of corticosteroids should be taken into account.

Conclusion: In order to prevent iatrogenic preterm labor, the effects of tocolytic drugs on fetal HRV should be taken into account when monitoring these fetuses.


Keywords: Tocolytic therapy, calcium channel blocker, oxytocin receptor antagonist, prostaglandin antagonist, beta-adrenergic agonist, fetal heart rate variability
Original languageEnglish
Pages (from-to)2387-2394
Number of pages8
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume30
Issue number20
Early online date8 Nov 2016
DOIs
Publication statusPublished - 18 Oct 2017

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Keywords

  • Tocolytic therapy
  • beta-adrenergic agonist
  • calcium channel blocker
  • fetal heart rate variability
  • oxytocin receptor antagonist
  • prostaglandin antagonist
  • Humans
  • Tocolytic Agents/adverse effects
  • Magnesium Sulfate/adverse effects
  • Pregnancy
  • Heart Rate, Fetal/drug effects
  • Calcium Channel Blockers/adverse effects
  • Female

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