Indomethacin for Slowing Preterm Labor
Indomethacin is sometimes used as a
tocolytic medicine to prolong pregnancy by slowing
preterm uterine contractions.
Indomethacin is given through a vein
(intravenously), by mouth as capsules or liquid
(orally), or in the rectum (anal suppository).
How It Works
Indomethacin is a nonsteroidal
anti-inflammatory drug (NSAID) that blocks the production of certain substances
called prostaglandins, which contribute to uterine contractions.
Why It Is Used
Indomethacin is used only:
- For short-term treatment of preterm
- Before 31 to 32 weeks of pregnancy.
Indomethacin can be used to treat preterm labor
- Labor needs to be delayed for 24 to 48 hours
corticosteroids given to the mother help fetal lungs
- Provide time to move a mother to a hospital that provides
neonatal intensive care, if her local hospital does not.
- Regular contractions of the uterus have thinned
cervix less than 80% and opened it less than
4 cm, and the mother's
amniotic sac has not
- Beta-sympathetic medicines (such as terbutaline) have
not stopped uterine contractions.
- Treatment with other tocolytic medicines was stopped because of
How Well It Works
Indomethacin can be effective in
delaying preterm labor.1 More
research is needed before its harms and benefits are fully known.
Indomethacin appears to have fewer side
effects on the mother but potentially more serious effects on the fetus than
other tocolytic medicines used to treat preterm labor. But fetal side effects
are very unlikely when treatment lasts less than 7 days. Indomethacin may
- A fetus's kidneys to produce abnormally low
amounts of urine, resulting in a decrease in the amount of amniotic fluid
- Early changes in the heart that do not normally
occur until after birth. This may cause problems with fetal blood
Maternal side effects are very rare. They include:
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems.)
What To Think About
- Indomethacin is used with caution, particularly
for pregnant women with heart disease, asthma, a history of intestinal bleeding
or ulcers, kidney disease, problems with blood clotting, or a decreased amount
of amniotic fluid (oligohydramnios). It is also not used during the last 2
months of pregnancy because of possible effects on fetal heart
- When indomethacin is used for more than 3 to 7 days,
fetal monitoring with an
echocardiogram and regular
ultrasound tests on the mother are used to check the
amount of amniotic fluid.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Haas DM (2011). Preterm birth, search date June 2010.
BMJ Clinical Evidence. Available online:
Primary Medical Reviewer
||Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer
||William Gilbert, MD - Maternal and Fetal Medicine
||January 8, 2013