Tocolysis to relax the uterus and assist birth at difficult caesarean sections

Dodd JM, Reid K

Published Online:

June 15, 2011

Caesarean section involves making an incision in the woman's abdomen and cutting through the wall of the uterus. The baby is then born through these incisions. Medication to relax the uterus (tocolytic drugs) has been suggested to facilitate the birth of the baby at difficult caesarean section and reduce the risk of birth trauma, like fractures and nerve damage. There are risks associated with the use of medication to relax the uterus, including excessive bleeding and possible interference with the blood the baby receives from the placenta at birth. There is currently limited evidence available to help with informed decisions around the use of these drugs at difficult caesareans. Until there is evidence that these drugs do more good than harm, they should not be used.

Abstract (click to read)

Background:

Caesarean section involves making an incision in the woman's abdomen and cutting through the uterine muscle. The baby is then delivered through that incision. Difficult caesarean birth may result in injury for the infant. Medication that relaxes the uterus (tocolytic medication) may facilitate the birth of the baby at caesarean section.

Objectives:

To compare the use of tocolysis (routine or selective use) with no use of tocolysis or placebo at the time of caesarean section for outcomes of infant birth trauma, maternal complications (particularly postpartum haemorrhage requiring blood transfusion), and long-term measures of infant and childhood morbidity.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 1) and PubMed (1966 to January 2006). We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 5 May 2011 and added the results to the awaiting classification section.

Selection criteria:

Use of tocolytic agents (routine or selective) at caesarean section versus no use of tocolytic or placebo at caesarean section to facilitate the birth of the baby.

Data collection and analysis:

Two review authors independently assessed trial quality and extracted data.

Main results:

A single randomised trial involving 97 women was identified and included in the review. Maternal and infant health outcomes were not reported.

Authors' conclusions:

There is currently insufficient information available from randomised trials to support or refute the routine or selective use of tocolytic agents to facilitate infant birth at the time of caesarean section.

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

This record should be cited as:

Dodd JM, Reid K. Tocolysis for assisting delivery at caesarean section. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004944. DOI: 10.1002/14651858.CD004944.pub2

Assessed as up to date:

July 28, 2006

Find the research

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Caesarian section > Other interventions

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Tocolysis to relax the uterus and assist birth at difficult caesarean sections

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