Document Detail


Tocolysis with nifedipine or beta-adrenergic agonists: a meta-analysis.
MedLine Citation:
PMID:  11336775     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To clarify the relative efficacy of nifedipine and beta-agonists for tocolysis. DATA SOURCES: The literature was searched in the following databases: MEDLINE 1965-1998, Embase 1988-1998, Current Contents 1997-1998, and the Cochrane Database for 1998. We also sought unpublished trials and abstracts submitted to major international congresses. Search terms were: "tocolysis," "nifedipine," "calcium channel blocker," "ritodrine," "terbutaline," and "salbutamol."Methods of Study Selection: Randomized controlled trials comparing tocolysis with nifedipine and beta-adrenergic agonists during preterm labor were reviewed. In cases with postrandomization exclusions, authors were contacted to obtain intent-to-treat results and to avoid analytical bias. We identified 11 published and two unpublished randomized trials. TABULATION, INTEGRATION, AND RESULTS: Data were extracted by two reviewers and analyzed by a blinded biostatistician with RevMan 3.1 software from the Cochrane Collaboration. We analyzed nine relevant randomized controlled trials that included 679 patients. Meta-analysis showed that nifedipine was more effective than the beta-agonists in delaying delivery at least 48 hours [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.03, 2.24], or over 34 weeks (OR 1.87, 95% CI 1.11, 3.15). The agents did not differ as to the incidence of deliveries after 37 weeks (OR 1.29, 95% CI 0.85, 1.96) or the neonatal mortality rate (OR 1.51, 95% CI 0.63, 3.65). Treatment with nifedipine was interrupted significantly less often because of side effects (OR 0.12, 95% CI 0.05, 0.29) and led to better neonatal outcomes (fewer infants with respiratory distress syndrome: OR 0.57, 95% CI 0.37, 0.89) or transferred to neonatal intensive care units (OR 0.65, 95% CI 0.43, 0.97). CONCLUSION: With respect to neonatal outcome, nifedipine appears to be more effective than beta-agonists for tocolysis and should be considered for use as a first-line tocolytic agent.
Authors:
V Tsatsaris; D Papatsonis; F Goffinet; G Dekker; B Carbonne
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  97     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2001 May 
Date Detail:
Created Date:  2001-05-04     Completed Date:  2001-05-24     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  840-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, Hôpital Saint-Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Agonists / therapeutic use*
Female
Humans
Nifedipine / therapeutic use*
Obstetric Labor, Premature*
Pregnancy
Randomized Controlled Trials as Topic
Tocolysis*
Tocolytic Agents / therapeutic use*
Chemical
Reg. No./Substance:
0/Adrenergic beta-Agonists; 0/Tocolytic Agents; 21829-25-4/Nifedipine
Comments/Corrections
Comment In:
Obstet Gynecol. 2002 Mar;99(3):518-9; author reply 519-20   [PMID:  11864692 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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