Non-steroidal anti-inflammatory drugs/ prostaglandin inhibitors

Indomethacin is the most widely studied non-steroidal antiinflammatory tocolytic, a non-selective COX inhibitor. It acts by preventing prostaglandin production by inhibiting COX, the enzyme which converts arachidonic acid into prostaglandin.

There is concern that COX inhibitors cross the placenta and may interfere with fetal COX production resulting in kidney and cardiac abnormalities such as premature closure of the ductus arteriosus. Its use in clinical practice is typically limited to below 32 weeks' gestation due to fetal concerns. In a recent network meta-analysis of tocolytic agents (79), prostaglandin inhibitors were shown to be more efficacious in delaying delivery by 48 hours when compared with placebo and had a 96% probability of being ranked in the top three most efficacious tocolytics, whereas a Cochrane review (1509 women) showed no clear benefit for COX inhibitors over placebo or any other tocolytic agent. Limitations are recognized due to small numbers and the low quality of studies and there are insufficient data on short- and long-term benefits for COX inhibitors. A larger clinical trial of indomethacin against placebo is expected to finish in June 2018, and may provide a clearer role for indomethacin.

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Source: Arulkumaran S., Ledger W., Denny L., Doumouchtsis S. (eds.). Oxford Textbook of Obstetrics and Gynaecology. Oxford University Press,2020. — 928 p.. 2020

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Non-steroidal anti-inflammatory drugs/ prostaglandin inhibitors

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