Why use Indocin for tocolytic?

Published

Does anyone know when Indocin would be used for a tocolytic?

We had a G5P3012, h/o pregnancy related UTI's and kidney stones, GA 25 wks. She had ARDS, was brought to ICU. Ctx's started and she was given Indocin. She was finally diagnosed with fluid overload related to pyelonephritis.

It was my first experience with indocin, and no one could tell me why this was given instead of nefidipine. Anyone has a clue?

Up Vote Up Vote ×

It's a prostaglandin inhibitor. Prostaglandins have several actions/effects in the body, including uterine contraction. A possible side effect is edema though.

In addition to the routine anti-inflammatory uses, prostaglandin inhibitors can be given to women with polyhydramnios to decrease fetal urine flow, as well as to neonates for closure of patent ductus arteriosus.

Up Vote Up Vote ×

Indocin was used more before we tried ibuprofen. It is an older method of tocolysis. It can be hard on the stomach, which is one of the reasons why it fell out of favor and ibuprofen replaced it.

None of the NSAIDS should be given after about 32-34 weeks in order to avoid premature closure of the ductus arteriosus. Although I have seen it given for poly, the PDA effect is serious and babies of this age need close monitoring. Your baby should be fine. Hope your mom is better!

Up Vote Up Vote ×
Specializes in Maternal - Child Health.

I suspect that the patient's diagnosis of ARDS may have prevented the use of terbutaline, which can have serious side-effects, including pulmonary edema.

Indocin can be safely used up to about 32 weeks gestation, and can be quite effective. As Eric mentioned, it can significantly decrease amniotic fluid production. Any patient on indocin must have amniotic fluid levels monitored by U/S to prevent oligohydramnios that could lead to a cord accident.

Up Vote Up Vote ×

Wow! I agree w/ everyone else's reasoning. I haven't seen this (indocin) used for many years. Nifedipine is going to inhibit uc's by inhibiting calcium uptake by the smooth muscle cells. The indocin will block prostaglandin synthesis and inhibit uc's as has been said. Can't chf/pulm. edema be worsened in some cases by nifedipine? It can also drop BP. I think I remember this stuff from way back in my life in telemetry. That was in B.O. times(before OB for me) when I was first out of school. Aren't NSAID's hard on the kidneys though?? Never used Motrin for PTL. It is interesting what you learn here.

Up Vote Up Vote ×

Wow - it's strange to hear people talking about indocin being an out-of-date treatment for PTL... on the antepartum unit I came from (not 6 mos ago) it was routinely used as well as terb and nifedipine. Never heard of ibuprofen use, although it makes sense I suppose...

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

where I worked in OK, we did indocin rectal for tocolysis. it sometimes worked, sometimes not. I do seem to remember them getting diarrhea.....

it is not used by any OBs where I am now, in any case. No NSAIDS are anymore.

Up Vote Up Vote ×
+ Join the Discussion