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Cochrane Update |
BACKGROUND: Preterm birth, defined as birth before 37 completed weeks, is the most important cause of perinatal mortality and morbidity in high-income countries. Oxytocin receptor antagonists have been proposed as effective tocolytic agents for women in preterm labor to postpone the birth, with fewer adverse effects than other tocolytic agents.
OBJECTIVES: To assess the effects on maternal, fetal, and neonatal outcomes of tocolysis with oxytocin receptor antagonists for women with preterm labor compared with placebo or no intervention and compared with any other tocolytic agent.
SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (September 2004), CENTRAL (The Cochrane Library, Issue 3, 2004), MEDLINE (1965 to June 2004), EMBASE (1988 to June 2004).
SELECTION CRITERIA: Randomized trials of oxytocin receptor antagonists for tocolysis in the management of women in labor between 20 and 36 weeks of gestation.
DATA COLLECTION AND ANALYSIS: Two authors independently evaluated methodological quality and extracted trial data. We sought additional information from trial authors.
MAIN RESULTS: Six trials (1,695 women) were included. Compared with placebo, atosiban did not reduce incidence of preterm birth or improve neonatal outcome. In one trial (583 infants), atosiban was associated with an increase in infant deaths at 12 months of age compared with placebo (relative risk [RR] 6.15, 95% confidence interval [CI] 1.39 to 27.22). However, this trial randomized significantly more women to atosiban before 26 weeks of gestation. Use of atosiban resulted in lower infant birth weight (weighted mean difference –138.31 g, 95% CI –248.76 to –27.86) and more maternal adverse drug reactions (RR 4.02, 95% CI 2.05 to 7.85, two trials, 613 women). Compared with betamimetics, atosiban increased the numbers of infants born under 1,500 g (RR 1.96, 95% CI 1.15 to 3.35, two trials, 575 infants). Atosiban was associated with fewer maternal drug reactions requiring treatment cessation (RR 0.04, 95% CI 0.02 to 0.11, number needed to treat 6, 95% CI 5 to 7, four trials, 1,035 women).
AUTHORS’ CONCLUSION: This review failed to demonstrate the superiority of atosiban over betamimetics or placebo in terms of tocolytic efficacy or infant outcomes. The finding of an increase in infant deaths in one placebo-controlled trial warrants caution. A recent Cochrane Review suggests that calcium channel blockers (mainly nifedipine) are associated with better neonatal outcome and fewer maternal adverse effects than betamimetics. However, a randomized comparison of nifedipine with placebo is not available. Further well-designed randomized controlled trials of tocolytic therapy are needed. Such trials should incorporate a placebo arm.
This article has been cited by other articles:
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  R. F. Lamont Oxytocin Receptor Antagonists for Inhibiting Preterm Labour Obstet. Gynecol., January 1, 2008; 111(1): 218 - 218. [Full Text] [PDF]
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