Document Detail

Tocolytic therapy for preterm delivery: systematic review and network meta-analysis.
MedLine Citation:
PMID:  23048010     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the most effective tocolytic agent at delaying delivery.
DESIGN: Systematic review and network meta-analysis.
DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, Medline In-Process, Embase, and CINAHL up to 17 February 2012.
STUDY SELECTION: Randomised controlled trials of tocolytic therapy in women at risk of preterm delivery.
DATA EXTRACTION: At least two reviewers extracted data on study design, characteristics, number of participants, and outcomes reported (neonatal and maternal). A network meta-analysis was done using a random effects model with drug class effect. Two sensitivity analyses were carried out for the primary outcome; restricted to studies at low risk of bias and restricted to studies excluding women at high risk of preterm delivery (those with multiple gestation and ruptured membranes).
RESULTS: Of the 3263 titles initially identified, 95 randomized controlled trials of tocolytic therapy were reviewed. Compared with placebo, the probability of delivery being delayed by 48 hours was highest with prostaglandin inhibitors (odds ratio 5.39, 95% credible interval 2.14 to 12.34) followed by magnesium sulfate (2.76, 1.58 to 4.94), calcium channel blockers (2.71, 1.17 to 5.91), beta mimetics (2.41, 1.27 to 4.55), and the oxytocin receptor blocker atosiban (2.02, 1.10 to 3.80). No class of tocolytic was significantly superior to placebo in reducing neonatal respiratory distress syndrome. Compared with placebo, side effects requiring a change of medication were significantly higher for beta mimetics (22.68, 7.51 to 73.67), magnesium sulfate (8.15, 2.47 to 27.70), and calcium channel blockers (3.80, 1.02 to 16.92). Prostaglandin inhibitors and calcium channel blockers were the tocolytics with the best probability of being ranked in the top three medication classes for the outcomes of 48 hour delay in delivery, respiratory distress syndrome, neonatal mortality, and maternal side effects (all cause).
CONCLUSIONS: Prostaglandin inhibitors and calcium channel blockers had the highest probability of delaying delivery and improving neonatal and maternal outcomes.
David M Haas; Deborah M Caldwell; Page Kirkpatrick; Jennifer J McIntosh; Nicky J Welton
Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review     Date:  2012-10-09
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  345     ISSN:  1756-1833     ISO Abbreviation:  BMJ     Publication Date:  2012  
Date Detail:
Created Date:  2012-10-10     Completed Date:  2012-12-17     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  England    
Other Details:
Languages:  eng     Pagination:  e6226     Citation Subset:  AIM; IM    
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MeSH Terms
Calcium Channel Blockers / therapeutic use
Magnesium Sulfate / therapeutic use
Obstetric Labor, Premature / prevention & control*
Pregnancy Complications / prevention & control
Pregnancy Outcome
Prostaglandin Antagonists / therapeutic use
Randomized Controlled Trials as Topic
Time Factors
Tocolysis / methods*
Tocolytic Agents / therapeutic use*
Treatment Outcome
Vasotocin / analogs & derivatives,  therapeutic use
Grant Support
G0800800//Medical Research Council; G0802413//Medical Research Council; G0902118//Medical Research Council; NIH-NICHD K23HD055305//PHS HHS
Reg. No./Substance:
0/Calcium Channel Blockers; 0/Prostaglandin Antagonists; 0/Tocolytic Agents; 7487-88-9/Magnesium Sulfate; 90779-69-4/atosiban; W6S6URY8OF/Vasotocin
Comment In:
Evid Based Med. 2013 Oct;18(5):182-3   [PMID:  23386705 ]
BMJ. 2012;345:e6531   [PMID:  23048012 ]

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

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