Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour

Papatsonis, Dimitri N. M., Flenady, Vicki and Liley, Helen G. (2013) Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour. Cochrane Database of Systematic Reviews, 10: . doi:10.1002/14651858.CD005938.pub3

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Author Papatsonis, Dimitri N. M.
Flenady, Vicki
Liley, Helen G.
Title Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2013-10-01
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD005938.pub3
Open Access Status File (Publisher version)
Issue 10
Total pages 24
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Formatted abstract
Background
In some women, an episode of preterm labour settles and does not result in immediate preterm birth. Subsequent treatment with tocolytic agents such as oxytocin receptor antagonists may then have the potential to prevent the recurrence of preterm labour, prolonging gestation, and preventing the adverse consequences of prematurity for the infant.

Objectives
To assess the effects of maintenance therapy with oxytocin antagonists administered by any route after an episode of preterm labour in order to delay or prevent preterm birth.

Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013), sought ongoing and unpublished trials by contacting experts in the field and searched the reference lists of relevant articles.

Selection criteria
Randomised controlled trials comparing oxytocin antagonists with any alternative tocolytic agent, placebo or no treatment, used for maintenance therapy after an episode of preterm labour.

Data collection and analysis
We used the standard methods of The Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group. Two review authors independently undertook evaluation of methodological quality and extracted trial data.

Main results
This review includes one trial of 513 women. When compared with placebo, atosiban did not reduce preterm birth before 37 weeks (risk ratio (RR) 0.89; 95% confidence intervals (CI) 0.71 to 1.12), 32 weeks (RR 0.85; 95% CI 0.47 to 1.55), or 28 weeks (RR 0.75; 95% CI 0.28 to 2.01). No difference was shown in neonatal morbidity, or perinatal mortality.

Authors' conclusions
There is insufficient evidence to support the use of oxytocin receptor antagonists to inhibit preterm birth after a period of threatened or actual preterm labour. Any future trials using oxytocin antagonists or other drugs as maintenance therapy for preventing preterm birth should examine a variety of important infant outcome measures, including reduction of neonatal morbidity and mortality, and long-term infant follow-up. Future research should also focus on the pathophysiological pathways that precede preterm labour.
Keyword Obstetric labor, premature [prevention & control]
Premature birth [prevention & control]
Randomized controlled trials as topic
Receptors, oxytocin [antagonists & inhibitors]
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Medicine Publications
 
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