Tags

Type your tag names separated by a space and hit enter

Maintenance therapy with calcium channel blockers for preventing preterm birth after threatened preterm labour.

Abstract

BACKGROUND

Calcium channel blocker maintenance therapy is one of the types of tocolytic therapy that may be used after an episode of threatened preterm labour (and usually an initial dose of tocolytic therapy) in an attempt to prevent the onset of further preterm contractions.

OBJECTIVES

To assess the effects of calcium channel blockers as maintenance therapy on preventing preterm birth after threatened preterm labour.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013) and reference lists of retrieved studies.

SELECTION CRITERIA

Randomised controlled trials of calcium channel blockers used as maintenance therapy to prevent preterm birth after threatened preterm labour, compared with placebo or no treatment.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies.

MAIN RESULTS

We included six trials that enrolled 794 women and their babies and all assessed nifedipine as calcium channel blocker maintenance therapy. The six trials were judged to be at a moderate risk of bias overall. No differences in the incidence of preterm birth (risk ratio (RR) 0.97; 95% confidence interval (CI) 0.87 to 1.09; five trials, 681 women), birth within 48 hours of treatment (RR 0.46; 95% CI 0.07 to 3.00; two trials, 128 women) or neonatal mortality (average RR 0.75; 95% CI 0.05 to 11.76; two trials, 133 infants) were seen when nifedipine maintenance therapy was compared with placebo or no treatment. No stillbirths were reported in the one trial that provided data for this outcome. No trials reported on longer-term follow-up of infants.Women receiving nifedipine maintenance therapy were significantly more likely to have their pregnancy prolonged (mean difference (MD) 5.35 days; 95% CI 0.49 to 10.21; four trials, 275 women); however, no differences between groups were shown for birth at less than 34 weeks' gestation, birth at less than 28 weeks' gestation, birth within seven days of treatment, or gestational age at birth. No significant differences were shown between the nifedipine and control groups for any of the secondary neonatal morbidities reported. Similarly, no significant differences were seen for the outcomes relating to the use of health services, except for in one trial, where infants whose mothers received nifedipine were significantly more likely to have a longer length of hospital stay as compared with infants born to mothers who received a placebo (MD 14.00 days; 95% CI 4.21 to 23.79; 60 infants).

AUTHORS' CONCLUSIONS

Based on the current available evidence, maintenance treatment with a calcium channel blocker after threatened preterm labour does not prevent preterm birth or improve maternal or infant outcomes.

Authors+Show Affiliations

Suite 28, Mater Medical Centre, 76 Willetts Road, Mackay, Queensland, Australia, 4740.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

24173691

Citation

Naik Gaunekar, Naguesh, et al. "Maintenance Therapy With Calcium Channel Blockers for Preventing Preterm Birth After Threatened Preterm Labour." The Cochrane Database of Systematic Reviews, 2013, p. CD004071.
Naik Gaunekar N, Raman P, Bain E, et al. Maintenance therapy with calcium channel blockers for preventing preterm birth after threatened preterm labour. Cochrane Database Syst Rev. 2013.
Naik Gaunekar, N., Raman, P., Bain, E., & Crowther, C. A. (2013). Maintenance therapy with calcium channel blockers for preventing preterm birth after threatened preterm labour. The Cochrane Database of Systematic Reviews, (10), CD004071. https://doi.org/10.1002/14651858.CD004071.pub3
Naik Gaunekar N, et al. Maintenance Therapy With Calcium Channel Blockers for Preventing Preterm Birth After Threatened Preterm Labour. Cochrane Database Syst Rev. 2013 Oct 31;(10)CD004071. PubMed PMID: 24173691.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maintenance therapy with calcium channel blockers for preventing preterm birth after threatened preterm labour. AU - Naik Gaunekar,Naguesh, AU - Raman,Puvaneswary, AU - Bain,Emily, AU - Crowther,Caroline A, Y1 - 2013/10/31/ PY - 2013/11/1/entrez PY - 2013/11/1/pubmed PY - 2014/4/29/medline SP - CD004071 EP - CD004071 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 10 N2 - BACKGROUND: Calcium channel blocker maintenance therapy is one of the types of tocolytic therapy that may be used after an episode of threatened preterm labour (and usually an initial dose of tocolytic therapy) in an attempt to prevent the onset of further preterm contractions. OBJECTIVES: To assess the effects of calcium channel blockers as maintenance therapy on preventing preterm birth after threatened preterm labour. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials of calcium channel blockers used as maintenance therapy to prevent preterm birth after threatened preterm labour, compared with placebo or no treatment. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. MAIN RESULTS: We included six trials that enrolled 794 women and their babies and all assessed nifedipine as calcium channel blocker maintenance therapy. The six trials were judged to be at a moderate risk of bias overall. No differences in the incidence of preterm birth (risk ratio (RR) 0.97; 95% confidence interval (CI) 0.87 to 1.09; five trials, 681 women), birth within 48 hours of treatment (RR 0.46; 95% CI 0.07 to 3.00; two trials, 128 women) or neonatal mortality (average RR 0.75; 95% CI 0.05 to 11.76; two trials, 133 infants) were seen when nifedipine maintenance therapy was compared with placebo or no treatment. No stillbirths were reported in the one trial that provided data for this outcome. No trials reported on longer-term follow-up of infants.Women receiving nifedipine maintenance therapy were significantly more likely to have their pregnancy prolonged (mean difference (MD) 5.35 days; 95% CI 0.49 to 10.21; four trials, 275 women); however, no differences between groups were shown for birth at less than 34 weeks' gestation, birth at less than 28 weeks' gestation, birth within seven days of treatment, or gestational age at birth. No significant differences were shown between the nifedipine and control groups for any of the secondary neonatal morbidities reported. Similarly, no significant differences were seen for the outcomes relating to the use of health services, except for in one trial, where infants whose mothers received nifedipine were significantly more likely to have a longer length of hospital stay as compared with infants born to mothers who received a placebo (MD 14.00 days; 95% CI 4.21 to 23.79; 60 infants). AUTHORS' CONCLUSIONS: Based on the current available evidence, maintenance treatment with a calcium channel blocker after threatened preterm labour does not prevent preterm birth or improve maternal or infant outcomes. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/24173691/Maintenance_therapy_with_calcium_channel_blockers_for_preventing_preterm_birth_after_threatened_preterm_labour_ L2 - https://doi.org/10.1002/14651858.CD004071.pub3 DB - PRIME DP - Unbound Medicine ER -