The controversy surrounding indomethacin for tocolysis

Indomethacin is a prostaglandin synthetase inhibitor sometimes used for toc olysis. Several placebo-controlled trials and trials comparing indomethacin to other potential first-line tocolytic agents support its efficacy for de laying delivery for >48 hours. Recent observational studies, however, have raised concerns about the safety of indomethacin, implicating it with incre ased rates of intraventricular hemorrhage and necrotizing enterocolitis. Ca reful analysis of these observational studies suggests that these results s hould be viewed with caution, because of uncontrolled confounding by indica tion. A recent decision analysis supports the risk/benefit analysis of indo methacin in this setting. Still, the future of indomethacin in preterm labo r should be guided by well-designed prospective clinical trials. Such studi es are underway.