Safety and efficacy of combined ritodrine and magnesium sulfate for preterm labor: a method for reduction of complications.

Ritodrine hydrochloride and magnesium sulfate used in combination for preterm labor tocolysis have been cited for yielding excessively high complication rates. A retrospective chart review was performed to assess the frequency of these complications and to determine whether tocolysis can be continued despite complications. Of 95 patients managed with dual tocolytics, 61 had side effects sufficiently serious to warrant cessation of tocolytic therapy for an overall complication rate of 64%. After evaluation for objective evidence of pathologic conditions, 41 (67%) patients were restarted on dual tocolytics without further complication. It was deemed inappropriate to restart tocolysis in 20 patients, resulting in a 21% rate of complications. This allowed a significant increase in the number of patients delivering after 36 weeks (19.5% versus 50%, p less than 0.02) and a decrease in neonatal intensive care unit days per infant (3 versus 15.5 days, p less than 0.02). This suggests that aggressive continued tocolysis with multiple agents can be safe and efficacious with appropriate evaluation.