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Meta-Analysis
. 2012 Dec 12;12(12):CD003927.
doi: 10.1002/14651858.CD003927.pub3.

Oral betamimetics for maintenance therapy after threatened preterm labour

Jodie M Dodd  1 , Caroline A Crowther, Philippa Middleton
Affiliations
Meta-Analysis

Oral betamimetics for maintenance therapy after threatened preterm labour

Jodie M Dodd et al. Cochrane Database Syst Rev. .

Abstract

Background: Some women who have threatened to give birth prematurely, subsequently settle. They may then take oral tocolytic maintenance therapy to prevent preterm birth and to prolong gestation.

Objectives: To assess the effects of oral betamimetic maintenance therapy after threatened preterm labour for preventing preterm birth.

Search methods: We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 9 November 2012.

Selection criteria: Randomised controlled trials comparing oral betamimetic with alternative tocolytic therapy, placebo or no therapy, for maintenance following treatment of threatened preterm labour.

Data collection and analysis: Two review authors independently applied the selection criteria and carried out data extraction and quality assessment of studies.

Main results: We did not identify any new trials from the updated search so the results remain unchanged as follows.We included 13 randomised controlled trials (RCTs) with a total of 1551 women. We found no differences for admission to the neonatal intensive care unit when betamimetics were compared with placebo (risk ratio (RR) 1.28, 95% confidence interval (CI) 0.68 to 2.41; two RCTs of terbutaline with 2600 women) or with magnesium (RR 0.80, 95% CI 0.43 to 1.46; one RCT of 137 women). The rate of preterm birth (less than 37 weeks) showed no significant difference in six RCTs, four comparing ritodrine with placebo/no treatment and two comparing terbutaline with placebo/no treatment (RR 1.11, 95% CI 0.91 to 1.35; 644 women). We observed no differences between betamimetics and placebo, no treatment or other tocolytics for perinatal mortality and morbidity outcomes. Some adverse effects such as tachycardia were more frequent in the betamimetics groups than the groups allocated to placebo, no treatment or another type of tocolytic.

Authors' conclusions: Available evidence does not support the use of oral betamimetics for maintenance therapy after threatened preterm labour.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Betamimetic versus placebo/no treatment (primary outcomes), Outcome 1 Very preterm birth (Less than 34 weeks' gestation).
1.2
1.2. Analysis
Comparison 1 Betamimetic versus placebo/no treatment (primary outcomes), Outcome 2 Low birthweight (< 2500 grams).
1.3
1.3. Analysis
Comparison 1 Betamimetic versus placebo/no treatment (primary outcomes), Outcome 3 Neonatal intensive care unit admission.
1.4
1.4. Analysis
Comparison 1 Betamimetic versus placebo/no treatment (primary outcomes), Outcome 4 Perinatal mortality.
2.1
2.1. Analysis
Comparison 2 Betamimetic versus placebo/no treatment (infant outcomes), Outcome 1 Preterm birth (< 37 weeks).
2.2
2.2. Analysis
Comparison 2 Betamimetic versus placebo/no treatment (infant outcomes), Outcome 2 Birthweight.
2.3
2.3. Analysis
Comparison 2 Betamimetic versus placebo/no treatment (infant outcomes), Outcome 3 Respiratory distress syndrome.
2.4
2.4. Analysis
Comparison 2 Betamimetic versus placebo/no treatment (infant outcomes), Outcome 4 Necrotising enterocolitis.
2.5
2.5. Analysis
Comparison 2 Betamimetic versus placebo/no treatment (infant outcomes), Outcome 5 Intraventricular haemorrhage.
2.6
2.6. Analysis
Comparison 2 Betamimetic versus placebo/no treatment (infant outcomes), Outcome 6 Neonatal jaundice.
2.7
2.7. Analysis
Comparison 2 Betamimetic versus placebo/no treatment (infant outcomes), Outcome 7 Apgar score < 7 at 5 minutes.
2.8
2.8. Analysis
Comparison 2 Betamimetic versus placebo/no treatment (infant outcomes), Outcome 8 Need for mechanical ventilation.
3.1
3.1. Analysis
Comparison 3 Betamimetic versus placebo/no treatment (maternal outcomes), Outcome 1 Side effects sufficient to stop therapy.
3.2
3.2. Analysis
Comparison 3 Betamimetic versus placebo/no treatment (maternal outcomes), Outcome 2 Tachycardia.
3.3
3.3. Analysis
Comparison 3 Betamimetic versus placebo/no treatment (maternal outcomes), Outcome 3 Tachypnoea.
3.4
3.4. Analysis
Comparison 3 Betamimetic versus placebo/no treatment (maternal outcomes), Outcome 4 Hypotension.
3.5
3.5. Analysis
Comparison 3 Betamimetic versus placebo/no treatment (maternal outcomes), Outcome 5 Nausea.
3.6
3.6. Analysis
Comparison 3 Betamimetic versus placebo/no treatment (maternal outcomes), Outcome 6 Vomiting.
3.7
3.7. Analysis
Comparison 3 Betamimetic versus placebo/no treatment (maternal outcomes), Outcome 7 Palpitations.
3.8
3.8. Analysis
Comparison 3 Betamimetic versus placebo/no treatment (maternal outcomes), Outcome 8 Headache.
4.1
4.1. Analysis
Comparison 4 Betamimetic versus placebo/no treatment (preterm birth and hospital admissions), Outcome 1 Preterm birth within 24 hours.
4.2
4.2. Analysis
Comparison 4 Betamimetic versus placebo/no treatment (preterm birth and hospital admissions), Outcome 2 Preterm birth within 48 hours.
4.3
4.3. Analysis
Comparison 4 Betamimetic versus placebo/no treatment (preterm birth and hospital admissions), Outcome 3 Preterm birth within 1 week.
4.4
4.4. Analysis
Comparison 4 Betamimetic versus placebo/no treatment (preterm birth and hospital admissions), Outcome 4 Maternal antenatal readmission to hospital.
5.1
5.1. Analysis
Comparison 5 Terbutaline versus indomethacin (primary outcomes), Outcome 1 Very preterm birth (< 34 weeks).
5.2
5.2. Analysis
Comparison 5 Terbutaline versus indomethacin (primary outcomes), Outcome 2 Neonatal mortality.
6.1
6.1. Analysis
Comparison 6 Terbutaline versus indomethacin (infant outcomes), Outcome 1 Birthweight.
6.2
6.2. Analysis
Comparison 6 Terbutaline versus indomethacin (infant outcomes), Outcome 2 Required mechanical ventilation.
6.3
6.3. Analysis
Comparison 6 Terbutaline versus indomethacin (infant outcomes), Outcome 3 Days stay in neonatal intensive care unit.
6.4
6.4. Analysis
Comparison 6 Terbutaline versus indomethacin (infant outcomes), Outcome 4 Intraventricular haemorrhage.
7.1
7.1. Analysis
Comparison 7 Terbutaline versus indomethacin (maternal outcomes), Outcome 1 Side effects sufficient to stop therapy.
8.1
8.1. Analysis
Comparison 8 Terbutaline versus indomethacin (preterm birth and hospital admissions), Outcome 1 Preterm birth.
8.2
8.2. Analysis
Comparison 8 Terbutaline versus indomethacin (preterm birth and hospital admissions), Outcome 2 Maternal antenatal readmission to hospital.
9.1
9.1. Analysis
Comparison 9 Terbutaline versus ritodrine (primary outcomes), Outcome 1 Very preterm birth (less than 34 weeks).
10.1
10.1. Analysis
Comparison 10 Terbutaline versus ritodrine (infant outcomes), Outcome 1 Preterm birth (< 37 weeks).
10.2
10.2. Analysis
Comparison 10 Terbutaline versus ritodrine (infant outcomes), Outcome 2 Mean birthweight.
10.3
10.3. Analysis
Comparison 10 Terbutaline versus ritodrine (infant outcomes), Outcome 3 Hyperbilirubinaemia (neonatal jaundice requiring phototherapy).
11.1
11.1. Analysis
Comparison 11 Terbutaline versus ritodrine (maternal outcomes), Outcome 1 Tachycardia.
11.2
11.2. Analysis
Comparison 11 Terbutaline versus ritodrine (maternal outcomes), Outcome 2 Tachypnoea.
11.3
11.3. Analysis
Comparison 11 Terbutaline versus ritodrine (maternal outcomes), Outcome 3 Nausea/vomiting.
12.1
12.1. Analysis
Comparison 12 Terbutaline versus ritodrine (preterm birth and hospital admissions), Outcome 1 Maternal antenatal readmission to hospital.
13.1
13.1. Analysis
Comparison 13 Betamimetic versus magnesium (primary outcomes), Outcome 1 Neonatal intensive care unit admission.
13.2
13.2. Analysis
Comparison 13 Betamimetic versus magnesium (primary outcomes), Outcome 2 Perinatal mortality.
14.1
14.1. Analysis
Comparison 14 Betamimetic versus magnesium (infant outcomes), Outcome 1 Preterm birth (< 37 weeks).
14.2
14.2. Analysis
Comparison 14 Betamimetic versus magnesium (infant outcomes), Outcome 2 Birthweight.
14.3
14.3. Analysis
Comparison 14 Betamimetic versus magnesium (infant outcomes), Outcome 3 Respiratory distress syndrome.
14.4
14.4. Analysis
Comparison 14 Betamimetic versus magnesium (infant outcomes), Outcome 4 Intraventricular haemorrhage.
14.5
14.5. Analysis
Comparison 14 Betamimetic versus magnesium (infant outcomes), Outcome 5 Neonatal jaundice.
15.1
15.1. Analysis
Comparison 15 Betamimetic versus magnesium (maternal outcomes), Outcome 1 Side effects sufficient to stop medication.
15.2
15.2. Analysis
Comparison 15 Betamimetic versus magnesium (maternal outcomes), Outcome 2 Tachycardia/palpitations.
15.3
15.3. Analysis
Comparison 15 Betamimetic versus magnesium (maternal outcomes), Outcome 3 Tachypnoea.
15.4
15.4. Analysis
Comparison 15 Betamimetic versus magnesium (maternal outcomes), Outcome 4 Nausea.
15.5
15.5. Analysis
Comparison 15 Betamimetic versus magnesium (maternal outcomes), Outcome 5 Vomiting.
15.6
15.6. Analysis
Comparison 15 Betamimetic versus magnesium (maternal outcomes), Outcome 6 Chest pain.
16.1
16.1. Analysis
Comparison 16 Betamimetic versus magnesium (preterm birth and hospital admissions), Outcome 1 Maternal antenatal readmission to hospital.
See this image and copyright information in PMC

Update of

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