Terbutaline pump maintenance therapy after threatened preterm labor for preventing preterm birth

Nanda K, Cook LA., Gallo MF, Grimes DA

Published Online:

March 17, 2010

Terbutaline pumps may not be able to prevent a woman who had preterm labor stopped with drugs going back into labor too soon.

Women who go into very early labor (before 34 weeks) and have their contractions stopped by intravenous drugs are at high risk of going back into preterm labor. Terbutaline is a drug that can relax the uterus and possibly stop contractions. Taken orally, though, it does not seem to prevent contractions returning. Another option is to use a small portable pump that feeds a continuous dose of terbutaline under the skin. The review found there are not enough large trials to show whether this is safe or effective. Some evidence suggests that terbutaline by pump does not prevent the return of preterm labor.

Abstract (click to read)

Background:

Women with preterm labor that is arrested with tocolytic therapy are at increased risk of recurrent preterm labor. Terbutaline pump maintenance therapy has been given to such women to decrease the risk of recurrent preterm labor, preterm birth, and its consequences.

Objectives:

To determine the effectiveness and safety of terbutaline pump maintenance therapy after threatened preterm labor in preventing preterm birth and its complications.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2007). We updated the search in January 2010 and added the results to the awaiting classification section.

Selection criteria:

Randomized trials comparing terbutaline pump maintenance therapy with alternative therapy, placebo, or no therapy after threatened preterm labor.

Data collection and analysis:

Two review authors independently assessed the studies for inclusion and then extracted data from eligible studies.

Main results:

We included two studies. Terbutaline pump maintenance therapy did not appear to offer any advantages over the saline placebo pump or oral terbutaline maintenance therapy in preventing preterm births by prolonging pregnancy or its complications among women with arrested preterm labor. The weighted mean difference (WMD) for gestational age at birth was -0.14 weeks (95% confidence interval (CI) -1.66 to 1.38) for terbutaline pump therapy compared with saline placebo pump for both trials combined and 1.40 weeks (95% CI -1.13 to 3.93) for terbutaline pump versus oral terbutaline therapy for the first trial. The second trial reported a relative risk (RR) of 1.17 (95% CI 0.79 to 1.73) of preterm birth (less than 37 completed weeks) and a RR of 0.97 (95% CI 0.51 to 1.84) of very preterm birth (less than 34 completed weeks) for terbutaline pump compared with saline placebo pump. Terbutaline pump therapy also did not result in a higher rate of therapy continuation or a lower rate of infant complications. No data were reported on long-term infant outcomes, costs, or maternal assessment of therapy.

Authors' conclusions:

Terbutaline pump maintenance therapy has not been shown to decrease the risk of preterm birth by prolonging pregnancy. Furthermore, the lack of information on the safety of the therapy, as well as its substantial expense, argues against its role in the management of arrested preterm labor. Future use should only be in the context of well-conducted, adequately powered randomized controlled trials.

[Note: The two citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

This record should be cited as:

Nanda K, Cook LA., Gallo MF, Grimes DA. Terbutaline pump maintenance therapy after threatened preterm labor for preventing preterm birth. Cochrane Database of Systematic Reviews 2002, Issue 4. Art. No.: CD003933. DOI: 10.1002/14651858.CD003933

Assessed as up to date:

April 30, 2007

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Preterm labour > Maintenance

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Terbutaline pump maintenance therapy after threatened preterm labor for preventing preterm birth

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