Abstract
Commonly used tocolytics show tachyphylaxis and are associated with potentially life-threatening maternal side-effects. Indometacin is the only drug that has been shown to delay delivery for more than 48 hours in randomised trials,1 but fetal side-effects limit its usefulness.2 Indometacin inhibits the cyclo-oxygenase (COX) enzyme. Of the two COX isoforms, COX-1 is constitutively expressed in tissues with constant prostaglandin synthesis, and COX-2 is inducible and associated with inflammation. COX-2 is upregulated during labour in fetal membranes,3 but constitutive fetal prostaglandin synthesis is probably mediated by COX-1.
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