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Published on: September 10, 2018
Four kinds of tocolytic therapy for preterm delivery: Systematic review and network meta-analysis
Zhihui Xiong1, Shuping Pei1, Zhen Zhu1
1Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China.
Insights
Indomethacin is most effective for preterm delivery, while nifedipine is safest. Ritodrine showed the most adverse reactions. Further research is needed for twin pregnancies and extreme preterm delivery cases.
Area of Science:
- Obstetrics and Gynecology
- Perinatology
- Pharmacology
Background:
- Premature birth affects millions globally, with rising concerns in China due to policy changes.
- Tocolysis is a key intervention for managing preterm delivery.
Purpose of the Study:
- To evaluate the efficacy and safety of various tocolytic agents for preterm delivery.
- To provide evidence for clinical practice and patient self-management.
Main Methods:
- A network meta-analysis of 44 randomized controlled trials (RCTs) involving 6939 patients.
- Searched four major English databases up to November 2021.
- Statistical analysis performed using R and Stata software.
Main Results:
- Indomethacin demonstrated the highest effectiveness in delaying delivery.
- Nifedipine was identified as the safest tocolytic agent.
- Ritodrine was associated with the highest incidence of adverse reactions.
Conclusions:
- Nifedipine appears to offer a favorable balance of efficacy and safety for preterm delivery.
- Indomethacin is effective but carries more safety concerns than nifedipine.
- High-quality studies are needed to confirm findings, especially for twin pregnancies and extreme preterm deliveries.
What Is Known And Objective:
Premature birth affects more than 15 million infants, as well as mothers and families around the world. With the relaxation of the two-child policy, the problem of premature birth has become relatively prominent in China. According to statistics, China had a birth population of 15.23 million in 2018, with a considerably large number of premature births. This study aims to evaluate the efficacy and safety of tocolysis in the treatment of preterm delivery, provide clinical evidence for medical staff and promote the self-management of patients with premature births.
Methods:
Four English databases (PubMed, Embase, Cochrane Library and Web of Science) were retrieved by computer, the retrieval time was from the establishment of each database to November 2021, and the randomized controlled trials for the treatment of preterm delivery were screened according to the pre-set natriuretic exclusion criteria. After literature screening, data selection and risk of bias evaluation were independently conducted by two researchers. R 4.1.1 and Stata 17.0 software were used for statistical analysis.
Results And Discussion:
A total of 44 RCTs were included, including 6939 patients. The results of network meta-analysis reveal that in terms of effectiveness, indomethacin was the most effective intervention measure, followed by nifedipine, and the difference was statistically significant; regarding safety, nifedipine was the safest intervention measure, followed by indomethacin, and the difference was statistically significant; and in respect of adverse reactions, ritodrine had the highest probability, and the difference was statistically significant.
What Is New And Conclusion:
Nifedipine may be better for delayed delivery and less likely to produce adverse pregnancy outcomes, followed by indomethacin. Limited by the number and quality of recipient studies, the aforementioned conclusions need to be verified through more high-quality studies. At the same time, the focus should be on patients with twin pregnancy and patients with clinical manifestations of extreme preterm delivery.
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