survival and quality of life. Such an approach will have a
great impact on societal and long term public helath-care
costs. Unfortunately, an ideal tocolytic drug that is uterospecific
with minimal maternal and fetal side effects and that
significantly improves neonatal outcome still eludes us. At
the Canadian Tocolysis Consensus Conference it was
concluded that there is little evidence to support the use of
any of the currently available tocolytics and that tocolytic
use has not been associated with improved perinatal outcomes
and often has detrimental effects on the mother 63. There is
still much confusion regarding the ideal tocolytic and this
has been exemptified by a recent survey among the
obstetricians in Australia and New Zealand, which revealed a
wide range of opinions and uncertainty over the effectiveness
of tocolytic therapy in clinical management, the most
appropriate drug and side effects 64.
Future research is needed on cyclo-oxygenase selective
prostaglandin inhibitors, the use of multiple drugs with more
utero-selectivity and fewer side effects, and the development
of oxytocin antagonists with better efficacy. Prostglandin F2
alpha receptor antagonists should also be explored. Research
is also needed to develop technics to effectively predict
preterm labor. Mannan Binding Protein (MBP) is homologous
to surfactant protein and is found in fetal membranes. There
is a suggestion that a deficiency of this protein may be used
as a predictor of preterm births and further research is needed
to confirm this hypothesis. Recently, the role of potassium
channels in human myometrium has been analysed 65 and
down regulation of betasubunits of calcium-activated
potassium channel in human myometrium during preterm
labor has been demonstrated 66. These findings may generate
future research into the development of potassium channel
modulators to arrest preterm labor. The ultimate goal of
management of preterm labor should not be to merely prolong
pregnancy but to improve neonatal outcome and to reduce
morbidity and mortality.