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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]
One of the most common causes of increased bleeding risk is exposure to nonsteroidal anti-inflammatory drugs (NSAIDs). The prototype for these drugs is aspirin, which inhibits the production of thromboxane. NSAIDs (for example Ibuprofen) inhibit the activation of platelets, and thereby increase the risk of bleeding. The effect of aspirin is ...
Thus indometacin users have an elevated risk of lithium toxicity. For patients taking lithium (e.g. for treatment of depression or bipolar disorder), less toxic NSAIDs such as sulindac or aspirin are preferred. All NSAIDs, including indometacin, also increase plasma renin activity and aldosterone levels, and increase sodium and potassium retention.
Although Black women are affected more, a notable finding of the study is that both Black and white women are impacted by poor pain management in childbirth.
Risk of adverse advents such as bleeding or gastrointestinal side effects is relatively high with daily aspirin therapy. Even a 81 mg daily aspirin regimen for cardiovascular benefits has been shown to increase risk of long-term bleeding, [ 27 ] so the significantly higher aspirin doses used for maintenance therapy are of some concern. [ 19 ]
A normal menstrual cycle is 21–35 days in duration, with bleeding lasting an average of 5 days and total blood flow between 25 and 80 mL. Heavy menstrual bleeding is defined as total menstrual flow >80ml per cycle, soaking a pad/tampon at least every 2 hours, changing a pad/tampon in the middle of the night, or bleeding lasting for >7 days.