1. Indomethacin is a nonspecific cyclooxygenase inhibitor. Indomethacin is significantly more effective than placebo.

2. Maternal side effects include nausea, esophageal reflux, gastritis, and emesis.

3. Fetal side effects. The primary fetal concerns with use of indomethacin are constriction of the ductus arteriosus and oligohydramnios.

4. Contraindications. Maternal contraindications include platelet dysfunction or bleeding disorder, hepatic dysfunction, gastrointestinal ulcerative disease, renal dysfunction, and asthma (in women with hypersensitivity to aspirin).

E. Recommendations. Beta-adrenergic agonists are the first-line agents for treatment of preterm labor. Indomethacin is recommended for women in PTL with gestations less than 32 weeks in which beta-agonists cannot be administered.

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