Role of isoxsuprine in acute and maintenance tocolysis

Preterm birth (PTB) continues to be a significant global health issue, with India reporting 3.02 million PTBs, accounting for nearly 23% of all PTBs worldwide. Over the past decade, the PTB rate has remained unchanged at 13 per 100 live births. Preterm labor (PTL), a leading cause of pregnancy-related hospitalizations, poses significant challenges for healthcare providers. Effective management is essential to mitigate the complications associated with PTB, which places a considerable burden on the healthcare system. Managing PTL is particularly challenging due to the difficulty in predicting its onset, as approximately 50% of PTB cases occur without identifiable risk factors. The current PTB detection methods, such as the transvaginal ultrasound (TVUS) examination, the fibronectin test, etc., fail to detect PTB accurately, which makes PTB a complicated condition. The primary goal of PTL management is to prolong pregnancy with tocolytics which provides an opportunity to administer antenatal corticosteroids and magnesium sulfate, if needed, as well as in utero transfer to higher care facilities, when necessary. This review delves into recommendation shared by expert gynecologists on the role of effective tocolysis in management of PTL. The experts shared insights that in India, isoxsuprine is preferred over other tocolytic agents in acute PTL management, allowing sufficient time for corticosteroids to act. However, they opined that there is a possibility of spontaneous recurrence of PTL after the cessation of active labour therapy, highlighting the importance of maintenance tocolysis. The use of oral isoxsuprine as maintenance tocolysis has been associated with improved perinatal outcomes, including lesser incidence of NICU admission, improved birth weight outcomes, and extended latency periods. Maintenance tocolysis can be given to patients of cervical cerclage, active and threatened PTL. In conclusion, while PTL remains a significant challenge, isoxsuprine use in both acute and maintenance phases of therapy can positively impact maternal and perinatal outcomes.