Verdurmen Kim M J, Hulsenboom Alexandra D J, van Laar Judith O E H, Oei S Guid
a Department of Obstetrics and Gynecology , Máxima Medical Center , Veldhoven , the Netherlands and.
b Faculty of Electrical Engineering , Eindhoven University of Technology , Eindhoven , the Netherlands.
J Matern Fetal Neonatal Med. 2017 Oct;30(20):2387-2394. doi: 10.1080/14767058.2016.1249844. Epub 2016 Nov 8.
Tocolytics may cause changes in fetal heart rate (HR) pattern, while fetal heart rate variability (HRV) is an important marker of fetal well-being. We aim to systematically review the literature on how tocolytic drugs affect fetal HRV.
We searched CENTRAL, PubMed and EMBASE up to June 2016. Studies published in English, using computerized or visual analysis to describe the effect of tocolytics on HRV in human fetuses were included. Studies describing tocolytics during labor, external cephalic version, pre-eclampsia and infection were excluded. Eventually, we included six studies, describing 169 pregnant women.
Nifedipine, atosiban and indomethacin administration show no clinically important effect on fetal HRV. Following administration of magnesium sulfate decreased variability and cases of bradycardia are described. Fenoterol administration results in a slight increase in fetal HR with no changes in variability. After ritodrine administration increased fetal HR and decreased variability is seen. The effect of co-administration of corticosteroids should be taken into account.
In order to prevent iatrogenic preterm labor, the effects of tocolytic drugs on fetal HRV should be taken into account when monitoring these fetuses.
宫缩抑制剂可能会导致胎儿心率（HR）模式发生变化，而胎儿心率变异性（HRV）是胎儿健康的重要指标。我们旨在系统回顾关于宫缩抑制剂如何影响胎儿HRV的文献。
我们检索了截至2016年6月的Cochrane系统评价数据库、PubMed和EMBASE。纳入了以英文发表的、使用计算机化或视觉分析来描述宫缩抑制剂对人类胎儿HRV影响的研究。排除了描述分娩期宫缩抑制剂、外倒转术、先兆子痫和感染的研究。最终，我们纳入了6项研究，涉及169名孕妇。
硝苯地平、阿托西班和吲哚美辛的使用对胎儿HRV无临床重要影响。硫酸镁给药后可降低变异性，并出现心动过缓病例。使用非诺特罗可使胎儿心率略有增加，变异性无变化。利托君给药后，胎儿心率增加，变异性降低。应考虑联合使用皮质类固醇的影响。
为预防医源性早产，在监测这些胎儿时应考虑宫缩抑制剂对胎儿HRV的影响。
