A prospective randomized comparison of oral terbutaline and magnesium oxide for the maintenance of tocolysis

Ridgway, Louis E.; Muise, Kevin; Wright, Jeffrey W.; Patterson, Robert; Newton, Edward R.

doi:10.1016/0002-9378(90)91087-s

Cited by 31 publications

(8 citation statements)

References 3 publications

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“…These include β‐agonists, such as ritodrine and terbutaline; calcium channel blockers, such as nifedipine and diltiazem; ethanol; magnesium sulphate; the oxytocin receptor antagonist, atosiban; the nitric oxide donor, glyceryl trinitrate (GTN), in the form of patches; and the cyclooxygenase (COX) inhibitor, indomethacin. COX‐2 inhibitors have not yet been used for maintenance tocolysis although the other drugs listed above have been subjected to evaluation in at least 17 randomised controlled trials, 1–17 and these trials have provided source material for at least 15 systematic reviews 18–32 with the potential for six more 33–38 …”

Section: Introductionmentioning

confidence: 99%

Maintenance tocolysis

Thornton

2005

BJOG

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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. MethodsThe results of published systematic reviews were summarised.Results Four systematic reviews and two trials published too recently for inclusion were identified.Maintenance tocolysis with h-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. BACKGROUND

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Section: Introductionmentioning

confidence: 99%

Maintenance tocolysis

Thornton

2005

BJOG

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“…The review of magnesium maintenance therapy 633 for the prevention of spontaneous preterm birth included three randomised controlled trials (n = 303); [558][559][560] no further trials were identified. Further details of the review can be found in Appendix 6, Table 136.…”

Section: Magnesium Sulphate Maintenancementioning

confidence: 99%

Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling

Honest

Ca²,

Durée³

et al. 2009

Health Technol Assess

189

146

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For primary prevention, an effective, affordable and safe intervention applied to all mothers without preceding testing is likely to be the most cost-effective approach in asymptomatic women in early pregnancy. For secondary prevention among women at risk of preterm labour in later pregnancy, a management strategy based on the results of testing is likely to be more cost-effective. Implementation of a treat-all strategy with simple interventions, such as fish oils, would be premature for asymptomatic women. Universal provision of high-quality ultrasound machines in labour wards is more strongly indicated for predicting spontaneous preterm birth among symptomatic women than direct management, although staffing issues and the feasibility and acceptability to mothers and health providers of such strategies need to be explored. Further research should include investigations of low-cost and effective tests and treatments to reduce and delay spontaneous preterm birth and reduce the risk of perinatal mortality arising from preterm birth.

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“…The review of oral betamimetics for maintenance therapy after threatened preterm labour 549 included 11 RCTs (n = 1238); [550][551][552][553][554][555][556][557][558][559][560] no additional studies were found when the searches were updated. Further details of the review can be found in Appendix 6, Table 132.…”

Section: Oral Betamimetics Maintenancementioning

confidence: 99%

Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling

2010

Clinical Governance: An International Journal

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A prospective randomized comparison of oral terbutaline and magnesium oxide for the maintenance of tocolysis

Cited by 31 publications

References 3 publications

Maintenance tocolysis

Maintenance tocolysis

Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling

Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling

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