Cyclo-oxygenase (COX) inhibitors for preventing preterm labour

Area of Science:

• Obstetrics and Gynecology
• Pharmacology

Background:

• Preterm birth prevention is critical; prostaglandins influence labor.
• Cyclo-oxygenase (COX) inhibitors block prostaglandin production, potentially arresting uterine contractions.
• Previous reviews found insufficient data on COX inhibitors for preterm labor treatment.

Purpose of the Study:

• To evaluate the effectiveness and safety of COX inhibitors for preventing preterm labor in high-risk pregnancies.

Main Methods:

• Searched Cochrane Pregnancy and Childbirth Group's Trial Register (up to June 2012).
• Included randomized trials of any COX inhibitor for preterm labor prevention in women <36 weeks gestation at risk.
• Excluded quasi-randomized and cross-over trials; two authors assessed eligibility and quality.

Main Results:

• One trial (98 women) assessed rofecoxib; no data on preterm labor itself.
• Rofecoxib use increased risks of preterm birth and preterm premature rupture of membranes (PPROM).
• Associated with reversible oligohydramnios and low fetal urine production; no differences in treatment discontinuation, neonatal morbidities, or maternal/perinatal mortality.

Conclusions:

• Very limited evidence exists for using COX inhibitors to prevent preterm labor.
• Inadequate data prevents recommendations for clinical practice.
• Future research needs to assess short- and long-term infant effects.