Cochrane · systematic review · CD009770
Acute tocolysis for uterine tachysystole or suspected fetal distress
Leathersich, SJ, Vogel, JP, Tran, TS, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
49
current version
GRADE rated
30
No studies
19
Included studies
NR
No studies 19 · 38.8%Ungraded 0 · 0%Very low 6 · 12.2%Low 18 · 36.7%Moderate 6 · 12.2%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings for selective ß2‐adrenergic agonist versus no tocolytic agent, whilst awaiting emergency delivery
Population: women with fetal distress for whom the decision had been made to delivery by emergency caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perinatal death or severe morbidity Summary of findings for selective ß2‐adrenergic agonist vs no tocolytic agent, whilst awaiting emergency delivery | no estimate extracted | NR | No studies |
Fetal or neonatal mortality Summary of findings for selective ß2‐adrenergic agonist vs no tocolytic agent, whilst awaiting emergency delivery | RR 0.23 [0.01, 4.55] | 2 studies · 57 participants | Low Downgraded: imprecision |
Caesarean delivery Summary of findings for selective ß2‐adrenergic agonist vs no tocolytic agent, whilst awaiting emergency delivery | no estimate extracted | NR | No studies |
5‐minute Apgar score < 7 Summary of findings for selective ß2‐adrenergic agonist vs no tocolytic agent, whilst awaiting emergency delivery | RR 0.2 [0.02, 1.57] | 2 studies · 55 participants | Low Downgraded: imprecision |
Low umbilical artery pH (less than 7.0 or as defined by trial authors) Summary of findings for selective ß2‐adrenergic agonist vs no tocolytic agent, whilst awaiting emergency delivery | no estimate extracted | NR | No studies |
Abnormal FHR as defined by trial authors (FHR tracing not improved) Summary of findings for selective ß2‐adrenergic agonist vs no tocolytic agent, whilst awaiting emergency delivery | RR 0.28 [0.08, 0.95] | 2 studies · 43 participants | Moderate Downgraded: imprecision |
Summary of findings for IV atosiban versus IV hexoprenaline
Population: women with severe intrapartum fetal bradycardia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perinatal death or severe morbidity Summary of findings for IV atosiban vs IV hexoprenaline | RR 0.33 [0.01, 7.5] | 1 study · 26 participants | Low Downgraded: imprecision |
Fetal or neonatal mortality Summary of findings for IV atosiban vs IV hexoprenaline | no estimate extracted | 1 study · 26 participants | Low Downgraded: imprecision |
Caesarean delivery Summary of findings for IV atosiban vs IV hexoprenaline | RR 0.33 [0.01, 7.5] | 1 study · 26 participants | Low Downgraded: imprecision |
5‐minute Apgar score < 7 Summary of findings for IV atosiban vs IV hexoprenaline | no estimate extracted | 1 study · 26 participants | Low Downgraded: imprecision |
Umbilical artery pH Summary of findings for IV atosiban vs IV hexoprenaline | no estimate extracted | 1 study · 26 participants | Low Downgraded: imprecision |
Abnormal FHR tracing Summary of findings for IV atosiban vs IV hexoprenaline | RR 3 [0.13, 67.51] | 1 study · 26 participants | Very low Downgraded: imprecision |
Summary of findings for IV fenoterol bromhydrate versus emergency delivery
Population: women with a non‐reassuring fetal heart trace during labour but without uterine tachysystole
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perinatal death or severe morbidity Summary of findings for IV fenoterol bromhydrate vs emergency delivery | no estimate extracted | NR | No studies |
Fetal or neonatal mortality Summary of findings for IV fenoterol bromhydrate vs emergency delivery | no estimate extracted | NR | No studies |
Caesarean delivery Summary of findings for IV fenoterol bromhydrate vs emergency delivery | RR 1.12 [1.04, 1.22] | 1 study · 390 participants | Moderate Downgraded: risk of bias |
5‐minute Apgar score < 7 Summary of findings for IV fenoterol bromhydrate vs emergency delivery | RR 1.28 [0.35, 4.68] | 1 study · 390 participants | Low Downgraded: risk of bias, imprecision |
Umbilical artery pH < 7.1 Summary of findings for IV fenoterol bromhydrate vs emergency delivery | RR 0.68 [0.44, 1.05] | 1 study · 390 participants | Low Downgraded: risk of bias, imprecision |
Abnormal FHR tracing Summary of findings for IV fenoterol bromhydrate vs emergency delivery | no estimate extracted | NR | No studies |
Summary of findings for IV hexoprenaline versus no tocolytic agent, whilst awaiting emergency delivery
Population: women for whom a decision had been made to deliver by caesarean section for suspected fetal distress based on FHR monitoring
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perinatal death or severe morbidity Summary of findings for IV hexoprenaline vs no tocolytic agent, whilst awaiting emergency delivery | no estimate extracted | NR | No studies |
Fetal or neonatal mortality Summary of findings for IV hexoprenaline vs no tocolytic agent, whilst awaiting emergency delivery | RR 0.23 [0.01, 4.55] | 1 study · 37 participants | Low Downgraded: imprecision |
Caesarean delivery Summary of findings for IV hexoprenaline vs no tocolytic agent, whilst awaiting emergency delivery | no estimate extracted | NR | No studies |
5‐minute Apgar score < 7 Summary of findings for IV hexoprenaline vs no tocolytic agent, whilst awaiting emergency delivery | RR 0.24 [0.01, 4.57] | 1 study · 35 participants | Low Downgraded: imprecision |
Umbilical artery pH < 7.2 Summary of findings for IV hexoprenaline vs no tocolytic agent, whilst awaiting emergency delivery | RR 0.64 [0.3, 1.35] | 1 study · 33 participants | Low Downgraded: imprecision |
FHR tracing not improved Summary of findings for IV hexoprenaline vs no tocolytic agent, whilst awaiting emergency delivery | RR 0.43 [0.21, 0.88] | 1 study · 23 participants | Moderate Downgraded: imprecision |
Summary of findings for subcutaneous terbutaline versus IV magnesium sulphate
Population: women with intrapartum fetal distress for whom the decision had been made to deliver by caesarean section
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perinatal death or severe morbidity Summary of findings for subcutaneous terbutaline vs IV magnesium sulphate | no estimate extracted | NR | No studies |
Fetal or neonatal mortality Summary of findings for subcutaneous terbutaline vs IV magnesium sulphate | no estimate extracted | NR | No studies |
Caesarean delivery Summary of findings for subcutaneous terbutaline vs IV magnesium sulphate | no estimate extracted | NR | No studies |
5‐minute Apgar score < 7 Summary of findings for subcutaneous terbutaline vs IV magnesium sulphate | no estimate extracted | NR | No studies |
Umbilical artery pH < 7.2 Summary of findings for subcutaneous terbutaline vs IV magnesium sulphate | RR 0.29 [0.07, 1.23] | 1 study · 46 participants | Very low Downgraded: imprecision |
Resolution of fetal distress on FHR tracing Summary of findings for subcutaneous terbutaline vs IV magnesium sulphate | RR 1.31 [0.97, 1.77] | 1 study · 46 participants | Very low Downgraded: imprecision |
Summary of findings for subcutaneous terbutaline with continuation of oxytocic infusion versus cessation of oxytocic infusion without tocolytic agent
Population: women who developed uterine hyperstimulation in labour with oxytocin augmentation, but without signs of fetal distress
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perinatal death or severe morbidity Summary of findings for subcutaneous terbutaline with continuation of oxytocic infusion vs cessation of oxytocic infusion without tocolytic agent | no estimate extracted | NR | No studies |
Fetal or neonatal mortality Summary of findings for subcutaneous terbutaline with continuation of oxytocic infusion vs cessation of oxytocic infusion without tocolytic agent | no estimate extracted | NR | No studies |
Caesarean delivery Summary of findings for subcutaneous terbutaline with continuation of oxytocic infusion vs cessation of oxytocic infusion without tocolytic agent | RR 1.73 [0.68, 4.45] | 1 study · 28 participants | Low Downgraded: risk of bias, imprecision |
5‐minute Apgar score < 7 Summary of findings for subcutaneous terbutaline with continuation of oxytocic infusion vs cessation of oxytocic infusion without tocolytic agent | no estimate extracted | 1 study · 28 participants | Very low Downgraded: risk of bias, imprecision |
Umbilical artery pH < 7.0 Summary of findings for subcutaneous terbutaline with continuation of oxytocic infusion vs cessation of oxytocic infusion without tocolytic agent | no estimate extracted | 1 study · 28 participants | Very low Downgraded: risk of bias, imprecision |
Abnormal FHR tracing Summary of findings for subcutaneous terbutaline with continuation of oxytocic infusion vs cessation of oxytocic infusion without tocolytic agent | no estimate extracted | NR | No studies |
Summary of findings for subcutaneous terbutaline versus no tocolytic agent, whilst awaiting emergency delivery
Population: women in labour with signs of fetal distress and a fetal scalp pH < 7.25, for whom the decision had been made for emergency delivery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perinatal death or severe morbidity Summary of findings for subcutaneous terbutaline vs no tocolytic agent, whilst awaiting emergency delivery | no estimate extracted | NR | No studies |
Fetal or neonatal mortality Summary of findings for subcutaneous terbutaline vs no tocolytic agent, whilst awaiting emergency delivery | no estimate extracted | 1 study · 20 participants | Low Downgraded: imprecision |
Caesarean delivery Summary of findings for subcutaneous terbutaline vs no tocolytic agent, whilst awaiting emergency delivery | no estimate extracted | NR | No studies |
5‐minute Apgar score < 7 Summary of findings for subcutaneous terbutaline vs no tocolytic agent, whilst awaiting emergency delivery | RR 0.17 [0.01, 3.08] | 1 study · 20 participants | Low Downgraded: imprecision |
Umbilical artery pH Summary of findings for subcutaneous terbutaline vs no tocolytic agent, whilst awaiting emergency delivery | no estimate extracted | 1 study · 20 participants | Moderate Downgraded: imprecision |
Abnormal FHR tracing Summary of findings for subcutaneous terbutaline vs no tocolytic agent, whilst awaiting emergency delivery | RR 0.57 [0.33, 0.98] | 1 study · 20 participants | Moderate Downgraded: imprecision |
No improvement in FHR Summary of findings for subcutaneous terbutaline vs no tocolytic agent, whilst awaiting emergency delivery | RR 0.13 [0.03, 0.59] | 1 study · 20 participants | Moderate Downgraded: imprecision |
Summary of findings for IV terbutaline versus IV nitroglycerin
Population: women with non‐reassuring FHR tracing during labour or induction of labour
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perinatal death or severe morbidity Summary of findings for IV terbutaline vs IV nitroglycerin | no estimate extracted | NR | No studies |
Fetal or neonatal mortality Summary of findings for IV terbutaline vs IV nitroglycerin | no estimate extracted | NR | No studies |
Caesarean delivery Summary of findings for IV terbutaline vs IV nitroglycerin | RR 0.96 [0.68, 1.36] | 1 study · 110 participants | Low Downgraded: imprecision |
5‐minute Apgar score < 7 Summary of findings for IV terbutaline vs IV nitroglycerin | no estimate extracted | 1 study · 110 participants | Low Downgraded: imprecision |
Umbilical artery pH < 7.0 Summary of findings for IV terbutaline vs IV nitroglycerin | RR 4.87 [0.24, 98.18] | 1 study · 75 participants | Very low Downgraded: imprecision |
Successful intrauterine fetal resuscitation Summary of findings for IV terbutaline vs IV nitroglycerin | RR 1.12 [0.87, 1.45] | 1 study · 110 participants | Low Downgraded: imprecision |