Which tocolytic is recommended for use before 32 weeks of gestation?

Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) that is particularly effective as a tocolytic for inhibiting premature labor, especially in cases where the gestational age is less than 32 weeks. Its mechanism of action involves the inhibition of prostaglandin synthesis, which plays a critical role in uterine contractions. By reducing prostaglandin levels, indomethacin can help relax the uterine smooth muscle and delay preterm labor.

In addition, indomethacin is often chosen for its ability to decrease the risk of neonatal complications associated with preterm birth, including reducing the likelihood of intraventricular hemorrhage and promoting fetal lung maturity. This makes it a valuable option in managing preterm labor in the specified gestational age range.

Other tocolytics, such as nifedipine and terbutaline, may be used but are not as specifically indicated for use before 32 weeks as indomethacin due to their respective profiles and potential side effects. Magnesium sulfate is primarily used for neuroprotection in preterm infants and for managing severe preeclampsia, but it is not primarily indicated for tocolysis. Therefore, when considering the best tocolytic option specifically