Evidence map›Paper›PMID 23048010›Full record

SynthesisBMJ (Clinical research ed.)2012

Tocolytic therapy for preterm delivery: systematic review and network meta-analysis.

David M Haas, Deborah M Caldwell, Page Kirkpatrick, Jennifer J McIntosh, Nicky J Welton

Registry-linked trialOpen access · hybridAbstract readSystematic ReviewNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01869361 (Randomized, Placebo Controlled Trial of Indomethacin for Tocolysis), which is not on this map. Cited by 131 papers, 21 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
131citing papers in PubMed, 21 pooled it
21.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01869361 early_phase1withdrawnnot on this mapstarted 2020, after this paper: background citation

Randomized, Placebo Controlled Trial of Indomethacin for Tocolysis

TypeinterventionalSponsorMetroHealth Medical CenterRan2020 to 2021Enrolled0ConditionsPreterm LaborArmsIndomethacin, Placebo
3 · Its place in the literature

Who cites it

131 citing papers in PubMed, 21 syntheses or guidelines pooled it, 414 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Tocolytics for delaying preterm birth: a network meta-analysis (0924).The Cochrane database of systematic reviews · 2022
    Pooled it
  4. Guideline
  5. Pooled it
  6. Methods to induce labour: a systematic review, network meta-analysis and cost-effectiveness analysis.BJOG : an international journal of obstetrics and gynaecology · 2016
    Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Ethanol for preventing preterm birth in threatened preterm labor.The Cochrane database of systematic reviews · 2015
    Pooled it
  12. Cyclo-oxygenase (COX) inhibitors for treating preterm labour.The Cochrane database of systematic reviews · 2015
    Pooled it
  13. Pooled it
  14. Pooled it
  15. Pooled it
  16. Oxytocin receptor antagonists for inhibiting preterm labour.The Cochrane database of systematic reviews · 2014
    Pooled it
  17. Calcium channel blockers for inhibiting preterm labour and birth.The Cochrane database of systematic reviews · 2014
    Pooled it
  18. Nitric oxide donors for treating preterm labour.The Cochrane database of systematic reviews · 2014
    Pooled it
  19. Betamimetics for inhibiting preterm labour.The Cochrane database of systematic reviews · 2014
    Pooled it
  20. Pooled it

71 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 2 countries.

David M HaasDepartment of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA. dahaas@iupui.edu
Deborah M Caldwell
Page Kirkpatrick
Jennifer J McIntosh
Nicky J Welton
Indiana University – Purdue University Indianapolis · USUniversity of Bristol · GBIndiana University School of Medicine

Funding

Medical Research Council G0800800Medical Research Council G0802413Medical Research Council G0902118PHS HHS NIH-NICHD K23HD055305
6 · The paper itself

Abstract

objectiveTo determine the most effective tocolytic agent at delaying delivery.

designSystematic review and network meta-analysis. DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, Medline In-Process, Embase, and CINAHL up to 17 February 2012. STUDY SELECTION: Randomised controlled trials of tocolytic therapy in women at risk of preterm delivery. DATA EXTRACTION: At least two reviewers extracted data on study design, characteristics, number of participants, and outcomes reported (neonatal and maternal). A network meta-analysis was done using a random effects model with drug class effect. Two sensitivity analyses were carried out for the primary outcome; restricted to studies at low risk of bias and restricted to studies excluding women at high risk of preterm delivery (those with multiple gestation and ruptured membranes).

resultsOf the 3263 titles initially identified, 95 randomized controlled trials of tocolytic therapy were reviewed. Compared with placebo, the probability of delivery being delayed by 48 hours was highest with prostaglandin inhibitors (odds ratio 5.39, 95% credible interval 2.14 to 12.34) followed by magnesium sulfate (2.76, 1.58 to 4.94), calcium channel blockers (2.71, 1.17 to 5.91), beta mimetics (2.41, 1.27 to 4.55), and the oxytocin receptor blocker atosiban (2.02, 1.10 to 3.80). No class of tocolytic was significantly superior to placebo in reducing neonatal respiratory distress syndrome. Compared with placebo, side effects requiring a change of medication were significantly higher for beta mimetics (22.68, 7.51 to 73.67), magnesium sulfate (8.15, 2.47 to 27.70), and calcium channel blockers (3.80, 1.02 to 16.92). Prostaglandin inhibitors and calcium channel blockers were the tocolytics with the best probability of being ranked in the top three medication classes for the outcomes of 48 hour delay in delivery, respiratory distress syndrome, neonatal mortality, and maternal side effects (all cause).

conclusionsProstaglandin inhibitors and calcium channel blockers had the highest probability of delaying delivery and improving neonatal and maternal outcomes.

Indexed as

Calcium Channel BlockersFemaleHumansMagnesium SulfateObstetric Labor, PrematurePregnancyPregnancy ComplicationsPregnancy OutcomeProstaglandin AntagonistsRandomized Controlled Trials as TopicTime FactorsTocolysisTocolytic AgentsTreatment OutcomeVasotocinatosibanCalcium Channel BlockersMagnesium SulfateProstaglandin AntagonistsTocolytic AgentsVasotocin

Identifiers

PMID23048010
PMCPMC4688428
OpenAlexW2165265331

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.