Maintenance tocolysis
- 16 February 2005
- journal article
- research article
- Published by Wiley in BJOG: An International Journal of Obstetrics and Gynaecology
- Vol. 112 (s1), 118-121
- https://doi.org/10.1111/j.1471-0528.2005.00599.x
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 β‐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.Keywords
This publication has 23 references indexed in Scilit:
- Tocolysis with nifedipine or beta-adrenergic agonists: a meta-analysis1Published by Ovid Technologies (Wolters Kluwer Health) ,2001
- Maintenance treatment of preterm labor with the oxytocin antagonist atosibanAmerican Journal of Obstetrics and Gynecology, 2000
- Tocolytics for preterm labor: a systematic review*1Obstetrics & Gynecology, 1999
- Diltiazem for maintenance tocolysis of preterm labor: Comparison to rifedipine in a randomized trialThe Journal of Maternal-Fetal Medicine, 1998
- A Placebo-Controlled Randomized Trial of the Terbutaline Pump for Prevention of Preterm DeliveryAmerican Journal of Perinatology, 1997
- The clinical efficacy of oral tocolytic therapyAmerican Journal of Obstetrics and Gynecology, 1996
- Oral terbutaline after parenteral tocolysis: A randomized, double-blind, placebo-controlled trialAmerican Journal of Obstetrics and Gynecology, 1996
- Double‐blind evaluation of ritodrine sustained release for oral maintenance of tocolysis after active preterm labourBJOG: An International Journal of Obstetrics and Gynaecology, 1996
- Oral terbutaline in the outpatient management of preterm laborAmerican Journal of Obstetrics and Gynecology, 1995
- Beta‐mimetics in preterm labour: an overview of the randomized controlled trialsBJOG: An International Journal of Obstetrics and Gynaecology, 1988