Original Article 175 Indomethacin in Pregnancy: Applications and Safety Gael Abou-Ghannam, M.D. 1 Ihab M. Usta, M.D. 1 Anwar H. Nassar, M.D. 1 1 Department of Obstetrics and Gynecology, American University of Address for correspondence and reprint requests Anwar H. Nassar, Beirut Medical Center, Hamra, Beirut, Lebanon M.D., American University of Beirut Medical Center, P.O. Box 113-6044/B36, Hamra 110 32090, Beirut, Lebanon (e-mail:
[email protected]). Am J Perinatol 2012;29:175–186. Abstract Preterm labor (PTL) is a major cause of neonatal morbidity and mortality worldwide. Among the available tocolytics, indomethacin, a prostaglandin synthetase inhibitor, has been in use since the 1970s. Recent studies have suggested that prostaglandin synthetase inhibitors are superior to other tocolytics in delaying delivery for 48 hours and 7 days. However, increased neonatal complications including oligohydramnios, Keywords renal failure, necrotizing enterocolitis, intraventricular hemorrhage, and closure of the ► indomethacin patent ductus arteriosus have been reported with the use of indomethacin. Indometh- ► tocolysis acin has been also used in women with short cervices as well as in those with idiopathic ► preterm labor polyhydramnios. This article describes the mechanism of action of indomethacin and its ► short cervix clinical applications as a tocolytic agent in women with PTL and cerclage and its use in ► polyhydramnios the context of polyhydramnios. The fetal and neonatal side effects of this drug are also ► fetal side effects summarized and guidelines for its use are proposed. Preterm labor (PTL) is a major cause of neonatal morbidity in women with PTL and cerclage and its use in the context of and mortality worldwide.1 Care of premature infants has polyhydramnios.