Article

Cyclo-oxygenase (COX) inhibitors for preventing preterm labour

Department of Obstetrics and Gynaecology, Khon Kaen Hospital, Srichan Road, Khon Kaen, Thailand, 40000.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 01/2012; 10(10):CD007748. DOI: 10.1002/14651858.CD007748.pub2
Source: PubMed

ABSTRACT Preventing preterm labour is the most important step in preventing preterm birth. Prostaglandins play an important role in labour and birth. Prostaglandin production can be obstructed by inhibition of the cyclo-oxygenase (COX) enzyme and this may arrest uterine contraction. A Cochrane review on COX inhibitors for the treatment of preterm labour found insufficient data to draw conclusions about its effectiveness.
To assess the effectiveness and safety of COX inhibitors for preventing preterm labour in high-risk women.
We searched the Cochrane Pregnancy and Childbirth Group's Trial Register (30 June 2012).
All published and unpublished randomised trials evaluating administration of any COX inhibitor for prevention of preterm labour in pregnant women at gestational age less than 36 weeks at risk of, but not experiencing, preterm labour. Cluster-randomised trials were eligible for inclusion. Quasi-randomised trials and studies with cross-over designs were excluded.
Two review authors (T Khanprakob and U Sangkomkamhang) independently assessed all potential studies for inclusion. Disagreement was resolved by discussion and, where necessary, by consultation with a third review author. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy.
We included one randomised trial (involving 98 women) that evaluated the effectiveness of one type of COX inhibitor (rofecoxib) for preventing preterm birth. The included study did not report any data for one of our primary outcomes: preterm labour. Rofecoxib use was associated with an increased risk for preterm birth and preterm premature rupture of membranes (PPROM). Rofecoxib was associated with a higher risk of oligohydramnios and low fetal urine production but the effects were reversible after stopping treatment. There were no differences in the number of women who discontinued treatment before 32 weeks of gestation. There was no difference in neonatal morbidities and admission to neonatal intensive care unit. There were no maternal adverse effects or perinatal mortalities in either group.
There was very little evidence about using COX inhibitors for preventing preterm labour. There are inadequate data to make any recommendation about using COX inhibitor in practice to prevent preterm labour. Future research should include follow-up of the babies to examine the short-term and long-term effects of COX inhibitors.

0 Followers
 · 
98 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the efficacy and safety of transdermal nitroglycerin as tocolytic agent in women with preterm labor. Systematic review and meta-analysis of randomized controlled trials. Thirteen studies (1302 women) were included. Two studies evaluated transdermal nitroglycerin versus placebo (N=186), 9 evaluated transdermal nitroglycerin versus β2-adrenergic-receptor agonists (N=1024), and 1 each evaluated transdermal nitroglycerin versus nifedipine (N=50) and transdermal nitroglycerin versus magnesium sulfate (N=42). There were no significant differences between transdermal nitroglycerin and placebo for delivery within 48 hours of initiation of treatment or before 28, 34 or 37 weeks' gestation, adverse neonatal outcomes, and neurodevelopmental status at 24 months of age. Nevertheless, one study found a marginally significant reduction in the risk of a composite outcome of significant neonatal morbidity and perinatal mortality (3/74 [4.1%] versus 11/79 [13.9%]; relative risk 0.29, 95% confidence interval 0.08-1.00). When compared with β2-adrenergic-receptor agonists, transdermal nitroglycerin was associated with a significant reduction in the risk of preterm birth <34 and <37 weeks' gestation, admission to the neonatal intensive care unit, use of mechanical ventilation, and maternal side effects. There were no significant differences between transdermal nitroglycerin and nifedipine and magnesium sulfate in delivery within 48 hours of treatment and pregnancy prolongation, respectively. Overall, women receiving transdermal nitroglycerin had a higher risk of headache. Although transdermal nitroglycerin appears to be more effective than β2-adrenergic-receptor agonists, the current evidence does not support its routine use as tocolytic agent for the treatment of preterm labor. Further additional double-blind placebo-controlled trials are needed.
    American journal of obstetrics and gynecology 07/2013; 209(6). DOI:10.1016/j.ajog.2013.07.022 · 3.97 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: In developed countries, preterm birth is the major cause of perinatal morbidity, mortality and the most important public health problem in the obstetric field. In the past decades, an increasing trend has been observed regardless of the great efforts focussed on the improvement of our understanding of the physiopathological mechanisms behind preterm labour (PTL) and the improvement in the use of tocolytic drugs. Areas covered: In this review, the authors focus on some points of the physiopathology of labour in order to understand the rationality behind the different management approaches developed for the PTL syndrome. Expert opinion: There is a need to develop new tools for the treatment of patients with PTL. Research focussed on improving tocolysis, the physiology of labour and pathological processes involved in PTL would afford new approaches for the treatment of PTL, allowing clinicians to provide integrative solutions for this multifactorial disease. Recently, the prophylactic use of progesterone pessary and cerclage in women with high risk of premature labour has been reported to reduce the incidence of premature births and improve neonatal outcomes. These results highlight the importance of prediction models in order to establish preventative strategies early in pregnancy.
    Expert Opinion on Investigational Drugs 04/2014; 23(6). DOI:10.1517/13543784.2014.905541 · 5.43 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Preterm birth, defined as birth between 20 and 36 completed weeks, is a major contributor to perinatal morbidity and mortality globally. Oxytocin receptor antagonists (ORA), such as atosiban, have been specially developed for the treatment of preterm labour. ORA have been proposed as effective tocolytic agents for women in preterm labour to prolong pregnancy with fewer side effects than other tocolytic agents.
    Cochrane database of systematic reviews (Online) 06/2014; 6(6):CD004452. DOI:10.1002/14651858.CD004452.pub3 · 5.94 Impact Factor
Show more