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Hydration for treatment of preterm labour

  1. Catalin M Stan1,*,
  2. Michel Boulvain2,
  3. Riccardo Pfister3,
  4. Pascale Hirsbrunner-Almagbaly4

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 4 NOV 2013

Assessed as up-to-date: 3 OCT 2013

DOI: 10.1002/14651858.CD003096.pub2


How to Cite

Stan CM, Boulvain M, Pfister R, Hirsbrunner-Almagbaly P. Hydration for treatment of preterm labour. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD003096. DOI: 10.1002/14651858.CD003096.pub2.

Author Information

  1. 1

    Private Practice, Lausanne, Switzerland

  2. 2

    Maternité Hôpitaux Universitaires de Genève, Département de Gynécologie et d'Obstétrique, Unité de Développement en Obstétrique, Genève 14, Switzerland

  3. 3

    Hôpitaux Universitaires de Genève, Division de Neonatologie et Soins Intensifs, Departement de Pédiatrie, Geneva 14, Switzerland

  4. 4

    Hôpitaux Universitaires de Genève, Département de Gynécologie et d'Obstétrique, Geneva 14, Switzerland

*Catalin M Stan, Private Practice, Avenue Vinet 16, Lausanne, 1004, Switzerland. catalin.stan@hin.ch.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 4 NOV 2013

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Characteristics of included studies [ordered by study ID]
Guinn 1997

MethodsRandomised controlled trial with 3 arms and individual randomisation.


ParticipantsWomen at 20 to 34 weeks of gestation, with a singleton pregnancy, intact membranes at risk for preterm delivery. Risk of preterm delivery was defined as: 3 or more contractions per 30 minutes, cervical dilatation of 1 cm or less, cervical effacement less than 80%. Exclusion criteria were non-reassuring fetal status, suspicion of infection and maternal disease.


InterventionsControl group: bed rest alone (56 women).
Experimental group: IV hydration with 500 mL cristalloids over 20 minutes followed by 200 mL/hour (62 women).


OutcomesInterval from randomisation to delivery and to discharge, gestational age at delivery, delivery before 34 and 37 weeks, costs.


NotesA third group treated with terbutaline is not included in this review.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk“computer-generated randomization schedule”

Allocation concealment (selection bias)Low risk“Consenting women were assigned to one of three treatment groups by opening the next sealed, opaque envelope”

Blinding of participants and personnel (performance bias)
All outcomes
High riskThe treatment regimens were different, and clinical decisions (which may have had an impact on outcomes) were made by staff who knew which treatment women were receiving.

Blinding of outcome assessment (detection bias)
All outcomes
High riskBlinding of outcome assessors was not mentioned and treatment was likely to have been recorded in patient records “outcome data were abstracted from the medical record and the computerized perinatal database”.

Incomplete outcome data (attrition bias)
All outcomes
Low riskAll participants seem to be accounted for.

Selective reporting (reporting bias)Unclear riskAssessment from published study report.

Other biasLow riskGroups appeared similar at baseline, other bias not apparent.

Helfgott 1994

MethodsRandomised controlled trial. 3 arms with individual randomisation.


ParticipantsWomen at 24 to 37 weeks of gestation, with a singleton pregnancy, intact membranes at risk for preterm delivery. Risk of preterm delivery was defined as: regular painful contractions, cervical dilatation of 4 cm or less, cervical effacement less than 100%. Exclusion criteria were contraindication to tocolytics, obvious labour.


InterventionsControl group: bed rest alone (40 women).
Experimental groups:
IV hydration only: 500 mL lactate Ringer over 30 minutes (34 women).
IV hydration and morphine: hydration as above and 8-12 mg of morphine sulphate IM (42 women).


OutcomesInterval from randomisation to delivery, delivery before 32 and 37 weeks, need for additional treatment.


NotesHydration only and hydration + morphine groups were combined for the purpose of this review.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low risk“the assignments were computer generated".

Allocation concealment (selection bias)Low riskAllocations were “placed in sealed opaque envelopes, and opened at the time of entry”.

Blinding of participants and personnel (performance bias)
All outcomes
High riskWomen and clinicians were not blinded, which may have affected clinical decisions about their care.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskIt was stated that some outcome assessment was blinded, but for other outcomes it was no clear that assessors were blind to treatment group. “The monitor tracings were analysed by a blinded observer so as not to bias the information regarding uterine contractions upon entry and completion of the study”.

Incomplete outcome data (attrition bias)
All outcomes
Unclear risk5 out of 124 women were enrolled into the study but then excluded. Another 3 subsequently left the study. Delivery information was available for 110 women, (11.3% attrition).

Selective reporting (reporting bias)Unclear riskAssessment from published study report.

Other biasLow riskGroups appeared comparable at baseline. Other bias not apparent.

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Pircon 1989Inadequate method of concealment of the allocation (alternate date). Women in the control group were treated with hydration after 2 hours if contractions persisted. 3 women were readmitted after the initial treatment and included again in the study, with a cross-over of the intervention. Report of the results is unclear.

 
Comparison 1. Hydration versus no treatment/bed rest alone (all women)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

1 Perinatal death00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

2 Severe neonatal morbidity00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

3 Prolongation of pregnancy more than 48 hours00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

4 Prolongation of pregnancy more than seven days00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 5 Delivery before 37 weeks2228Risk Ratio (M-H, Fixed, 95% CI)1.09 [0.71, 1.68]

 6 Delivery before 34 weeks1118Risk Ratio (M-H, Fixed, 95% CI)0.72 [0.20, 2.56]

 7 Delivery before 32 weeks1110Risk Ratio (M-H, Fixed, 95% CI)0.76 [0.29, 1.97]

 8 Admission to neonatal intensive care unit1118Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.46, 2.16]

9 Low birthweight (less than 2500 g)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

10 Very low birthweight (less than 1500 g)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Maternal death00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Women's assessment of their treatment00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 13 Cost of treament (first 24 hours, in US$)1103Mean Difference (IV, Fixed, 95% CI)39.0 [-26.11, 104.11]

 14 Use of tocolytic drugs (not prespecified)2234Risk Ratio (M-H, Fixed, 95% CI)0.83 [0.57, 1.20]

 15 Time to delivery (days, not prespecified)2228Mean Difference (IV, Fixed, 95% CI)-0.99 [-7.85, 5.87]

 
Comparison 2. Hydration versus no treatment/bed rest alone (women included before 34 weeks)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

1 Prolongation of pregnancy more than 48 hours00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

2 Prolongation of pregnancy more than seven days00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

3 Delivery before 32 weeks00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 4 Delivery before 34 weeks1118Risk Ratio (M-H, Fixed, 95% CI)0.72 [0.20, 2.56]

 5 Delivery before 37 weeks1118Risk Ratio (M-H, Fixed, 95% CI)1.32 [0.72, 2.42]

6 Low birthweight (less than 2500 g)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

7 Very low birthweight (less than 1500 g)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Perinatal death00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Severe neonatal morbidity00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 10 Admission to neonatal intensive care unit1118Risk Ratio (M-H, Fixed, 95% CI)0.99 [0.46, 2.16]

11 Maternal death00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Women's assessment of their treatment00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 13 Cost of treament (first 24 hours, in US$)1103Mean Difference (IV, Fixed, 95% CI)39.0 [-26.11, 104.11]

 14 Use of tocolytic drugs (not prespecified)1118Risk Ratio (M-H, Fixed, 95% CI)0.72 [0.31, 1.70]

 15 Time to delivery (days, not prespecified)1118Mean Difference (IV, Fixed, 95% CI)-4.30 [-13.61, 5.01]