James G Thornton1. 1. Division of Obstetrics and Gynaecology, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
Abstract
BACKGROUND: Women who are undelivered after 48 hours of tocolysis remain at increased risk of preterm labour, but it is not clear whether prolonged treatment is effective. OBJECTIVE: To review the current evidence for the effectiveness of maintenance tocolysis. METHODS: The results of published systematic reviews were summarised. RESULTS: Four systematic reviews and two trials published too recently for inclusion were identified. Maintenance tocolysis with beta-agonists and magnesium sulphate was ineffective in prolonging gestation or reducing any adverse fetal outcomes. One trial of maintenance tocolysis with nifedipine was underpowered to rule out an effect on prolonging gestation. One trial using the oxytocin receptor blocker, atosiban, showed that this drug used as maintenance tocolysis does prolong gestation, but the trial was too small to demonstrate any reduction in substantive fetal outcomes. CONCLUSIONS: There is insufficient evidence to justify the routine use of maintenance tocolysis in preterm labour. It remains plausible that prolongation of gestation might be beneficial in selected cases of very preterm labour where fetal compromise and infection have been ruled out. The only tocolytic that has been shown to prolong gestation when used as maintenance therapy is atosiban.
BACKGROUND:Women who are undelivered after 48 hours of tocolysis remain at increased risk of preterm labour, but it is not clear whether prolonged treatment is effective. OBJECTIVE: To review the current evidence for the effectiveness of maintenance tocolysis. METHODS: The results of published systematic reviews were summarised. RESULTS: Four systematic reviews and two trials published too recently for inclusion were identified. Maintenance tocolysis with beta-agonists and magnesium sulphate was ineffective in prolonging gestation or reducing any adverse fetal outcomes. One trial of maintenance tocolysis with nifedipine was underpowered to rule out an effect on prolonging gestation. One trial using the oxytocin receptor blocker, atosiban, showed that this drug used as maintenance tocolysis does prolong gestation, but the trial was too small to demonstrate any reduction in substantive fetal outcomes. CONCLUSIONS: There is insufficient evidence to justify the routine use of maintenance tocolysis in preterm labour. It remains plausible that prolongation of gestation might be beneficial in selected cases of very preterm labour where fetal compromise and infection have been ruled out. The only tocolytic that has been shown to prolong gestation when used as maintenance therapy is atosiban.
Authors: Catalin S Buhimschi; Vineet Bhandari; Yiping W Han; Antonette T Dulay; Margaret A Baumbusch; Joseph A Madri; Irina A Buhimschi Journal: Curr Opin Infect Dis Date: 2009-06 Impact factor: 4.915
Authors: Carolien Roos; Liesbeth Hcj Scheepers; Kitty Wm Bloemenkamp; Annemiek Bolte; Jerome Cornette; Jan B Derks; Hans Jj Duvekot; Jim van Eyck; Joke H Kok; Anneke Kwee; Ashley Merién; Brent C Opmeer; Mariëlle G van Pampus; Dimitri Nm Papatsonis; Martina M Porath; Joris Am van der Post; Sicco A Scherjon; Krystyne Sollie; Marc Ea Spaanderman; Sylvia Mc Vijgen; Christine Willekes; Ben Willem J Mol; Fred K Lotgering Journal: BMC Pregnancy Childbirth Date: 2009-09-09 Impact factor: 3.007