Pregnancy and Economic Outcomes in Patients Treated for Recurrent Preterm Labor

Fleming, Alfred; Bonebrake, Robert; Istwan, Niki; Rhea, Debbie; Coleman, Suzanne; Stanziano, Gary

doi:10.1038/sj.jp.7211058

Cited by 12 publications

(18 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When administered orally, terbutaline's efficacy is often greatly influenced by poor patient compliance and the development of myometrial desensitization related to long-term, high-dose exposure [3]. Continuous subcutaneous terbutaline therapy (SQT) has been reported to be more effective than oral tocolytics for pregnancy prolongation following acute preterm labor in both singleton and multiple gestations [4][5][6], and is safe from serious side effects when used appropriately [7].…”

Section: Introductionmentioning

confidence: 99%

The interval to spontaneous delivery following discontinuation of maintenance tocolysis

Jones

Morrison

Istwan³

et al. 2006

The Journal of Maternal-Fetal & Neonatal Medicine

Self Cite

View full text Add to dashboard Cite

Spontaneous preterm delivery occurred in 63.0% of singletons and 87.9% of twins. Although stable at SQT discontinuation, 32.5% of singletons and 59.9% of twins delivered within three days. The interval from discontinuation of SQT to delivery was less for twin than singleton gestations (5.1 +/- 6.5 vs. 11.0 +/- 10.5 days, respectively, p < 0.001). CONCLUSIONS. Preterm discontinuation of SQT should be avoided if additional pregnancy prolongation is desired.

show abstract

Section: Introductionmentioning

confidence: 99%

The interval to spontaneous delivery following discontinuation of maintenance tocolysis

Jones

Morrison

Istwan³

et al. 2006

The Journal of Maternal-Fetal & Neonatal Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…recurrent preterm labor) were eligible for inclusion [11], [13]–[20]. Some studies were conducted exclusively in women with singleton gestation [13], [15], [17], [18], [21], [22], while a few studies evaluated women with twins only [16], [19]. Some studies may have included women less than 24 weeks gestational age, but data for such participants could not be separated [11], [15]–[19], .…”

Section: Resultsmentioning

confidence: 99%

“…Three retrospective cohort studies reported non-significant differences in rate of stillbirth in women with recurrent preterm labor and single or twin gestation [17]–[19]. However, these studies were likely underpowered, given the small number of events (<1%).…”

Section: Resultsmentioning

confidence: 99%

“…Low strength of evidence favored SQ terbutaline pump compared with oral tocolytics or no treatment in women with recurrent preterm labor (Table 3). Four of five cohort studies with important risk of bias reported statistically significant reduction in the odds of delivery <37 weeks (OR 0.04 to 0.75; 95 percent CI, lower bound range 0.01 to 0.58; upper bound range 0.23 to 1.20) [11], [13], [15], [17], [18].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of Terbutaline Pump for the Prevention of Preterm Birth. A Systematic Review and Meta-Analysis

et al. 2012

View full text Add to dashboard Cite

BackgroundSubcutaneous terbutaline (SQ terbutaline) infusion by pump is used in pregnant women as a prolonged (beyond 48–72 h) maintenance tocolytic following acute treatment of preterm contractions. The effectiveness and safety of this maintenance tocolysis have not been clearly established. We aimed to systematically evaluate the effectiveness and safety of subcutaneous (SQ) terbutaline infusion by pump for maintenance tocolysis.Methodology/Principal FindingsMEDLINE, EMBASE, CINAHL, the Cochrane Library, the Centre for Reviews and Dissemination databases, post-marketing surveillance data and grey literature were searched up to April 2011 for relevant experimental and observational studies.Two randomized trials, one nonrandomized trial, and 11 observational studies met inclusion criteria. Non-comparative studies were considered only for pump-related harms. We excluded case-reports but sought FDA summaries of post-marketing surveillance data. Non-English records without an English abstract were excluded. Evidence of low strength from observational studies with risk of bias favored SQ terbutaline pump for the outcomes of delivery at <32 and <37 weeks, mean days of pregnancy prolongation, and neonatal death. Observational studies of medium to high risk of bias also demonstrated benefit for other surrogate outcomes, such as birthweight and neonatal intensive care unit (NICU) admission. Several cases of maternal deaths and maternal cardiovascular events have been reported in patients receiving terbutaline tocolysis.Conclusions/SignificanceAlthough evidence suggests that pump therapy may be beneficial as maintenance tocolysis, our confidence in its validity and reproducibility is low, suggesting that its use should be limited to the research setting. Concerns regarding safety of therapy persist.

show abstract

“…Matched pairs (142) of women hospitalised with recurrent preterm labour were randomised to nifedipine or subcutaneous terbutaline [64]. Subcutaneous terbutaline resulted in a later gestation age at delivery, higher birth weights and less nursery days [65].…”

Section: Calcium-channel Blockersmentioning

confidence: 99%

Recent pharmacological advances in the treatment of preterm membrane rupture, labour and delivery

Doggrell

2004

Expert Opinion on Pharmacotherapy

View full text Add to dashboard Cite

Preterm delivery (before 37 completed weeks of gestation) is the major determinant of infant mortality. In women with a previous preterm birth associated with bacterial vaginosis, prophylactic antibiotics (e.g., metronidazole) reduce the risk of preterm birth and low birth weight. Trichomonas vaginalis increases the risk of preterm delivery, but metronidazole is not beneficial for this and may even be detrimental. Antibiotic use (e.g., erythromycin) prolongs pregnancy in late premature rupture and has health benefits for the neonate. However, antibiotics are probably not useful in preterm labour. Intramuscular 17alpha-progesterone and vaginal progesterone reduce the rate of preterm labour in high-risk pregnancies, including previous spontaneous preterm delivery. Magnesium sulfate, beta2-adrenoceptor agonists and the oxytocin-receptor antagonist, atosiban, are effective in reducing uterine contractions short-term, but there is little evidence that this leads to improved outcomes for the neonate. However, tocolysis with calcium-channel blockers does seem to lead to better outcomes for the neonate. Fetal side effects, such as ductus arteriosus constriction and impaired renal function, are associated with the inhibition of prostaglandin synthesis with indomethacin. New approaches and more effective drugs are required in the treatment of preterm delivery.

show abstract

Pregnancy and Economic Outcomes in Patients Treated for Recurrent Preterm Labor

Abstract: Treating RPTL with SQT versus oral nifedipine resulted in a later GA at delivery, improved neonatal outcome, and increased cost-effectiveness.

Cited by 12 publications

References 27 publications

The interval to spontaneous delivery following discontinuation of maintenance tocolysis

The interval to spontaneous delivery following discontinuation of maintenance tocolysis

Effectiveness of Terbutaline Pump for the Prevention of Preterm Birth. A Systematic Review and Meta-Analysis

Recent pharmacological advances in the treatment of preterm membrane rupture, labour and delivery

Contact Info

Product

Resources

About