title: Tocolysis for inhibiting preterm birth in extremely preterm birth, multiple gestations and in growth-restricted fetuses: a systematic review and meta-analysis.
abstract: This systematic review was to identify available evidence on the effectiveness of tocolysis in inhibiting preterm delivery for women with threatened extremely preterm birth, multiple gestations, and growth-restricted babies, and their infants' outcomes. A comprehensive search using MEDLINE, Embase, the Cochrane Library, CINAHL, POPLINE and the WHO Global Health Library databases was conducted on 14 February 2014. For selection criteria, randomized controlled trials and non-randomized studies that compared tocolysis treatment to placebo or no treatment were considered. Selection of eligible studies, critical appraisal of the included studies, data collection, meta-analyses, and assessment of evidence quality were performed in accordance with the Cochrane Collaboration's guidance and validated assessment criteria. The search identified seven studies for extremely preterm birth, in which three were randomized controlled trials (RCTs) and four were non-randomized studies (non-RCTs). There were no eligible studies identified for women with multiple pregnancy and growth-restricted fetuses. Meta-analyses indicated no significant difference was found for the relative effectiveness of tocolytics versus placebo for prolonging pregnancy in women with extremely preterm birth (RR 1.04, 95% CI 0.83 to 1.31) or reducing the rate of perinatal deaths (RR 2.22, 95% CI 0.26 to 19.24). In summary, there is no evidence to draw conclusions on the effectiveness of tocolytic therapy for women with threatened extremely preterm birth, multiple gestations, and growth-restricted babies.
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan. celine-m@ncchd.go.jp.
authors.forename: Celine
authors.initials: C
authors.lastname: Miyazaki
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan. ralfmorenog@gmail.com.
authors.forename: Ralf
authors.initials: R
authors.lastname: Moreno Garcia
authors.forename: Ralfh Garcia
authors.initials: RG
authors.lastname: Moreno
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan. ota-e@ncchd.go.jp.
authors.forename: Erika
authors.initials: E
authors.lastname: Ota
authors.affiliation: Graduate School of Human Sciences, Osaka University, Osaka, Japan. mktb@tcct.zaq.ne.jp.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Swa
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. oladapoo@who.int.
authors.forename: Olufemi T
authors.initials: OT
authors.lastname: Oladapo
authors.affiliation: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan. mori-r@ncchd.go.jp.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mori
mesh_terms: D000328:Adult; D019317:Evidence-Based Medicine; D005260:Female; D005317:Fetal Growth Retardation / Q000503:physiopathology*; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D065228:Non-Randomized Controlled Trials as Topic; D007752:Obstetric Labor, Premature / Q000209:etiology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011272:Pregnancy, Multiple; D047928:Premature Birth / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D015145:Tocolysis / Q000009:adverse effects*; D014944:World Health Organization