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NSAIDs (such as indomethacin) and calcium channel blockers (such as nifedipine) are the most likely to delay delivery for 48 hours, with the least amount of maternal and neonatal side effects. [46] Otherwise, tocolysis is rarely successful beyond 24 to 48 hours because current medications do not alter the fundamentals of labor activation. [47]
Regarding adverse effects, selective COX-2 inhibitors have lower risk of gastrointestinal bleeding. [153] With the exception of naproxen, nonselective NSAIDs increase the risk of having a heart attack. [153] Some data also supports that the partially selective nabumetone is less likely to cause gastrointestinal events. [153]
Long-term use of NSAIDs can cause gastric erosions, which can become stomach ulcers and in extreme cases can cause severe haemorrhage, resulting in death. The risk of death as a result of GI bleeding caused by the use of NSAIDs is 1 in 12,000 for adults aged 16–45. [5] The risk increases almost twentyfold for those over 75. [5]
Prostaglandin inhibitors are drugs that inhibit the synthesis of prostaglandin in human body. [1] There are various types of prostaglandins responsible for different physiological reactions such as maintaining the blood flow in stomach and kidney, regulating the contraction of involuntary muscles and blood vessels, and act as a mediator of inflammation and pain.
Misoprostol is a synthetic prostaglandin medication used to prevent and treat stomach and duodenal ulcers, induce labor, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus. [10] [11] It is taken by mouth when used to prevent gastric ulcers in people taking nonsteroidal anti-inflammatory drugs (NSAID). [11]
Ibuprofen and naproxen have not frequently been studied during pregnancy, but recent studies do not show increased risk of spontaneous abortion within the first six weeks of pregnancy. [ 14 ] [ 12 ] However, all NSAIDs showed association with structural cardiac defects with usage during the early weeks of pregnancy.
While epidurals have been shown to prolong the second stage of labor — namely, pushing — by about 20 minutes, research shows that epidurals do not increase the chance of requiring a C-section ...
As with other NSAIDs, potential side effects include gastrointestinal bleeding. [10] Long-term use has been associated with kidney failure, and rarely liver failure, and it can exacerbate the condition of patients with heart failure. [8] At low doses, it does not appear to increase the risk of heart attack; however, at higher doses it may. [10]