Intervention Review

Oral betamimetics for maintenance therapy after threatened preterm labour

  1. Jodie M Dodd1,*,
  2. Caroline A Crowther2,
  3. Marianna R Dare3,
  4. Philippa Middleton2

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 20 FEB 2011

DOI: 10.1002/14651858.CD003927.pub2

Database Title

Additional Information

How to Cite

Dodd JM, Crowther CA, Dare MR, Middleton P. Oral betamimetics for maintenance therapy after threatened preterm labour. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD003927. DOI: 10.1002/14651858.CD003927.pub2.

Author Information

  1. 1

    The University of Adelaide, School of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia

  2. 2

    The University of Adelaide, ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia

  3. 3

    The University of Adelaide, Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia

*Jodie M Dodd, School of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, 5006, Australia. jodie.dodd@adelaide.edu.au.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 JAN 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Some women who have threatened to give birth prematurely, subsequently settle. They may then take oral tocolytic maintenance therapy to prevent preterm birth and to prolong gestation.

Objectives

To assess the effects of oral betamimetic maintenance therapy after threatened preterm labour for preventing preterm birth.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (25 January 2011).

Selection criteria

Randomised controlled trials comparing oral betamimetic with alternative tocolytic therapy, placebo or no therapy, for maintenance following treatment of threatened preterm labour.

Data collection and analysis

Two review authors independently applied the selection criteria and carried out data extraction and quality assessment of studies.

Main results

We included 13 randomised controlled trials (RCTs) with a total of 1551 women. We found no differences for admission to the neonatal intensive care unit when betamimetics were compared with placebo (risk ratio (RR) 1.28, 95% confidence interval (CI) 0.68 to 2.41; two RCTs of terbutaline with 2600 women) or with magnesium (RR 0.80, 95% CI 0.43 to 1.46; one RCT of 137 women). The rate of preterm birth (less than 37 weeks) showed no significant difference in six RCTs, four comparing ritodrine with placebo/no treatment and two comparing terbutaline with placebo/no treatment (RR 1.11, 95% CI 0.91 to 1.35; 644 women). We observed no differences between betamimetics and placebo, no treatment or other tocolytics for perinatal mortality and morbidity outcomes. Some adverse effects such as tachycardia were more frequent in the betamimetics groups than the groups allocated to placebo, no treatment or another type of tocolytic.

Authors' conclusions

Available evidence does not support the use of oral betamimetics for maintenance therapy after threatened preterm labour.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Oral betamimetics for maintenance therapy after threatened preterm labour

A substantial proportion of women who have an episode of threatened preterm labour (before 37 weeks) are actively treated with agents that stop the uterine contractions (tocolytic therapy) and they do not progress to give birth. After being successfully treated for an episode of threatened preterm birth, women may then take medication (tocolytics) to prolong gestation so that their baby is not born too early. Medications used for this purpose include betamimetics, magnesium sulphate, calcium channel blockers and COX inhibitors.

Oral betamimetics for maintenance therapy after threatened preterm labour do not prevent preterm labour. This conclusion is based on 13 randomised controlled trials with a total of 1551 women. In this review, the betamimetics ritodrine and terbutaline did not reduce the rate of preterm birth (eight trials), or prevent problems with babies that required admission to the neonatal intensive care unit (two trials), when compared with placebo, no treatment or other tocolytic drugs. Betamimetics may cause pregnant women to have an increased heart rate (palpitations) and rate of breathing, low blood pressure, nausea and vomiting, and high blood sugar concentrations as side effects.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

脅迫性早產徵兆之後使用口服的betamimetics作為維持治療

有些已經出現早產徵兆的婦女，接下來又會恢復平靜，然後她們可能會接受口服的安胎藥作為維持治療以預防早產並延長孕期

目標

評估脅迫性早產後口服betamimetics作為維持治療以預防早產的效果

搜尋策略

我們搜尋了the Cochrane Pregnancy and Childbirth Trials Register(2005年6月) 以及MEDLINE(從1966年到2003年8月)

選擇標準

比較在脅迫性流產後口服betamimetics和其他安胎藥、安慰劑或無治療以作為維持治療的隨機控制試驗

資料收集與分析

2位回顧作者獨立採用了選擇的標準，並完成了研究的資料選用與品質評估

主要結論

共包含了11個隨機的對照試驗(RCTs)。將betamimetics與安慰劑(相對風險(RR)為 .29, 95% 信賴區間 (CI)為 0.64 – 2.60; 1個使用terbutaline 的隨機對照試驗共140名婦女)進行，或是與鎂劑(相對風險(RR)為 0.80, 95% 信賴區間為 0.43 to 1.46; 1個隨機對照試驗共137名婦女)比較可發現新生兒加護病房住房率沒有差異。在4個隨機的對照試驗2個比較ritodrine和安慰劑/無治療；另2個比較terbutaline和安慰劑/無治療中，早產(少於37周)的比例上並沒有顯著差異，(相對風險為 .08, 95% 信賴區間為 0.88 – 1.32, 384 名婦女)，比較使用betamimetics與安慰劑、無治療或其他安胎藥在周產期死亡率與罹病結果方面也沒有差異。比起安慰劑組、無治療組或其他安胎藥物組，許多副作用如心搏過速較常發生在betamimetics組

作者結論

可以取得的證據不支持使用口服的betamimetics作為脅迫性早產後的維持治療

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

口服betamimetics作為脅迫性早產後之維持治療不能預防早產發生。在成功的治療早產之後，婦女們可能會服用藥物(安胎藥)以延長孕期，讓她們的孩子不要太快出世，口服的betamimetics是其中一種用於維持治療的藥物。此文獻回顧發現當與安慰劑、不採取治療或是其他的安胎藥物相比時，betamimetics並沒有辦法降低早產的機率或是預防與嬰兒有關的問題。Betamimetics也可能會在婦女身上引起心悸與心跳速率過快

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