title: Effectiveness of terbutaline pump for the prevention of preterm birth. A systematic review and meta-analysis.
abstract: BACKGROUND
  Subcutaneous terbutaline (SQ terbutaline) infusion by pump is used in pregnant women as a prolonged (beyond 48-72 h) maintenance tocolytic following acute treatment of preterm contractions. The effectiveness and safety of this maintenance tocolysis have not been clearly established. We aimed to systematically evaluate the effectiveness and safety of subcutaneous (SQ) terbutaline infusion by pump for maintenance tocolysis.
  
  
  RESULTS
  MEDLINE, EMBASE, CINAHL, the Cochrane Library, the Centre for Reviews and Dissemination databases, post-marketing surveillance data and grey literature were searched up to April 2011 for relevant experimental and observational studies. Two randomized trials, one nonrandomized trial, and 11 observational studies met inclusion criteria. Non-comparative studies were considered only for pump-related harms. We excluded case-reports but sought FDA summaries of post-marketing surveillance data. Non-English records without an English abstract were excluded. Evidence of low strength from observational studies with risk of bias favored SQ terbutaline pump for the outcomes of delivery at <32 and <37 weeks, mean days of pregnancy prolongation, and neonatal death. Observational studies of medium to high risk of bias also demonstrated benefit for other surrogate outcomes, such as birthweight and neonatal intensive care unit (NICU) admission. Several cases of maternal deaths and maternal cardiovascular events have been reported in patients receiving terbutaline tocolysis.
  
  
  CONCLUSIONS
  Although evidence suggests that pump therapy may be beneficial as maintenance tocolysis, our confidence in its validity and reproducibility is low, suggesting that its use should be limited to the research setting. Concerns regarding safety of therapy persist.
authors.affiliation: Evidence-Based Practice Center, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Gaudet
authors.forename: Kavita
authors.initials: K
authors.lastname: Singh
authors.forename: Laura
authors.initials: L
authors.lastname: Weeks
authors.forename: Becky
authors.initials: B
authors.lastname: Skidmore
authors.forename: Alexander
authors.initials: A
authors.lastname: Tsertsvadze
authors.forename: Mohammed T
authors.initials: MT
authors.lastname: Ansari
mesh_terms: D000328:Adult; D001724:Birth Weight / Q000187:drug effects; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007260:Infusion Pumps; D011247:Pregnancy; D047928:Premature Birth / Q000188:drug therapy* / Q000517:prevention & control*; D017594:Publication Bias; D013726:Terbutaline / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013726:Terbutaline