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Meta-Analysis
. 2002;2002(4):CD003933.
doi: 10.1002/14651858.CD003933.

Terbutaline pump maintenance therapy after threatened preterm labor for preventing preterm birth

K Nanda  1 , L A Cook, M F Gallo, D A Grimes
Affiliations
Meta-Analysis

Terbutaline pump maintenance therapy after threatened preterm labor for preventing preterm birth

K Nanda et al. Cochrane Database Syst Rev. 2002.

Abstract

Background: Women with preterm labor that is arrested with tocolytic therapy are at increased risk of recurrent preterm labor. Terbutaline pump maintenance therapy has been given to such women to decrease the risk of recurrent preterm labor, preterm birth, and its consequences.

Objectives: To determine the effectiveness and safety of terbutaline pump maintenance therapy after threatened preterm labor in preventing preterm birth and its complications.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (searched May 2002) and the Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2002).

Selection criteria: Randomized trials comparing terbutaline pump maintenance therapy with alternative therapy, placebo, or no therapy after threatened preterm labor.

Data collection and analysis: Two reviewers independently assessed the studies for inclusion and then extracted data from eligible studies.

Main results: We included two studies. Terbutaline pump maintenance therapy did not appear to offer any advantages over the saline placebo pump or oral terbutaline maintenance therapy in preventing preterm births by prolonging pregnancy or its complications among women with arrested preterm labor. The weighted mean difference (WMD) for gestational age at birth was -0.1 weeks (95% confidence interval (CI) -1.7 to 1.4) for terbutaline pump therapy compared with saline placebo pump for both trials combined and 1.4 weeks (95% CI -1.1 to 3.9) for terbutaline pump versus oral terbutaline therapy for the first trial. The second trial reported a relative risk (RR) of 1.17 (95% CI 0.79 to 1.73) of preterm birth (less than 37 completed weeks) and a RR of 0.97 (95% CI 0.51 to 1.84) of very preterm birth (less than 34 completed weeks) for terbutaline pump compared with saline placebo pump. Terbutaline pump therapy also did not result in a higher rate of therapy continuation or a lower rate of infant complications. No data were reported on long-term infant outcomes, costs, or maternal assessment of therapy.

Reviewer's conclusions: Terbutaline pump maintenance therapy has not been shown to decrease the risk of preterm birth by prolonging pregnancy. Furthermore, the lack of information on the safety of the therapy, as well as its substantial expense, argues against its role in the management of arrested preterm labor. Future use should only be in the context of well-conducted, adequately powered randomized controlled trials.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Terbutaline pump versus saline pump, Outcome 1 Neonatal intensive care unit admission > 24 hours.
1.2
1.2. Analysis
Comparison 1 Terbutaline pump versus saline pump, Outcome 2 Gestational age at delivery (in weeks).
1.3
1.3. Analysis
Comparison 1 Terbutaline pump versus saline pump, Outcome 3 Preterm birth (< 37 weeks).
1.4
1.4. Analysis
Comparison 1 Terbutaline pump versus saline pump, Outcome 4 Very preterm birth (< 34 weeks).
1.5
1.5. Analysis
Comparison 1 Terbutaline pump versus saline pump, Outcome 5 Early discontinuation.
1.6
1.6. Analysis
Comparison 1 Terbutaline pump versus saline pump, Outcome 6 Respiratory distress syndrome.
1.7
1.7. Analysis
Comparison 1 Terbutaline pump versus saline pump, Outcome 7 Birthweight.
2.1
2.1. Analysis
Comparison 2 Terbutaline pump versus oral terbutaline, Outcome 1 Birthweight.
2.2
2.2. Analysis
Comparison 2 Terbutaline pump versus oral terbutaline, Outcome 2 Gestational age at delivery (in weeks).
2.3
2.3. Analysis
Comparison 2 Terbutaline pump versus oral terbutaline, Outcome 3 Early discontinuation.
2.4
2.4. Analysis
Comparison 2 Terbutaline pump versus oral terbutaline, Outcome 4 Respiratory distress syndrome.
See this image and copyright information in PMC

References

References to studies included in this review

Guinn 1998 {published data only}
    1. Guinn DA, Goepfert AR, Owen J, Wenstrom KD, Hauth JC. Terbutaline pump maintenance therapy for prevention of preterm delivery: a double‐blind trial. American Journal of Obstetrics and Gynecology 1998 Oct;179(4):874‐8. - PubMed
Wenstrom 1997 {published data only}
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References to studies excluded from this review

Morales 1990 {unpublished data only}
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Morrison 1993 {unpublished data only}
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References to other published versions of this review

Chawanpaiboon 2014
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