Journal
COCHRANE DATABASE OF SYSTEMATIC REVIEWS
Volume -, Issue 5, Pages -Publisher
WILEY
DOI: 10.1002/14651858.CD000940.pub3
Keywords
Magnesium Chloride [therapeutic use]; Magnesium Compounds [therapeutic use]; Magnesium Oxide [therapeutic use]; Magnesium Sulfate [therapeutic use]; Obstetric Labor, Premature [drug therapy]; Premature Birth [prevention & control]; Randomized Controlled Trials as Topic; Ritodrine [therapeutic use]; Terbutaline [therapeutic use]; Tocolysis [methods]; Tocolytic Agents [therapeutic use]; Female; Humans; Pregnancy
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Funding
- Australian National Health and Medical Research Council
- Commonwealth Department of Health and Ageing, Australia
- National Institute for Health Research (NIHR)
- Australian Research Centre for Health of Women and Babies, Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Australia
- Discipline of Public Health, The University of Adelaide, Australia
- National Health and Medical Research Council, Australia
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Background Magnesium maintenance therapy is one of the types of tocolytic therapy used after an episode of threatened preterm labour (usually treated with an initial dose of tocolytic therapy) in an attempt to prevent the onset of further preterm contractions. Objectives To assess whether magnesium maintenance therapy is effective in preventing preterm birth after the initial threatened preterm labour is arrested. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013). Selection criteria Randomised controlled trials of magnesium therapy given to women after threatened preterm labour. Data collection and analysis The review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. We checked data entry. Main results We included four trials involving 422 women. Three trials had high risk of bias and none included any long-term follow-up of infants. No differences in the incidence of preterm birth or perinatal mortality were seen when magnesium maintenance therapy was compared with placebo or no treatment; or alternative therapies (ritodrine or terbutaline). The risk ratio (RR) for preterm birth (less than 37 weeks) for magnesium compared with placebo or no treatment was 1.05, 95% confidence interval (CI) 0.80 to 1.40 (two trials, 99 women); and 0.99, 95% CI 0.57 to 1.72 (two trials, 100 women) for magnesium compared with alternative therapies. The RR for perinatal mortality for magnesium compared with placebo or no treatment was 5.00, 95% CI 0.25 to 99.16 (one trial, 50 infants); and 5.00, 95% CI 0.25 to 99.16 (one trial, 50 infants) for magnesium compared with alternative treatments. Women taking magnesium preparations were less likely to report side effects (RR 0.67, 95% CI 0.47 to 0.96, three trials, 237 women), including palpitations or tachycardia (RR 0.26, 95% CI 0.13 to 0.52, three trials, 237 women) than women receiving alternative therapies. Women receiving magnesium were however, more likely to experience diarrhoea (RR 6.79, 95% CI 1.26 to 36.72, three trials, 237 women). Authors' conclusions There is not enough evidence to show any difference between magnesium maintenance therapy compared with either placebo or no treatment, or alternative therapies (ritodrine or terbutaline) in preventing preterm birth after an episode of threatened preterm labour.
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