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BJOG. 2003 Dec;110(12):1045-9.

Effectiveness of nifedipine versus atosiban for tocolysis in preterm labour: a meta-analysis with an indirect comparison of randomised trials.

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  • 1Education Resource Centre, Birmingham Women's Hospital, UK.

Abstract

OBJECTIVE:

To explore the effectiveness of nifedipine compared with atosiban for tocolysis in preterm labour.

DESIGN:

A systematic review of randomised controlled trials with meta-analysis using adjusted indirect comparison.

POPULATION:

Six hundred and seventy-nine women recruited in nine randomised trials evaluating the effectiveness of nifedipine versus beta-agonists, and 852 women recruited in four trials of atosiban versus beta-agonists. There were no trials comparing nifedipine directly with atosiban.

METHODS:

We performed meta-analysis with a technique involving an adjusted indirect comparison between nifedipine and atosiban using beta-agonists as the common comparator. This approach preserves the benefit accrued by randomisation in the original comparisons.

MAIN OUTCOME MEASURES:

Reduction in neonatal respiratory distress syndrome and delay in delivery by 48 hours.

RESULTS:

Nifedipine tocolysis was associated with a significant reduction in respiratory distress syndrome compared with atosiban (OR 0.55, 95% CI 0.32-0.97). It also increased the number of women whose delivery was delayed by 48 hours (OR 1.20, 95% CI 0.73-1.95), although this result was not statistically significant.

CONCLUSIONS:

When indirectly compared with atosiban, nifedipine tocolysis is more effective. In the absence of a direct comparison, our analysis provides a way to explore the potential benefits of nifedipine versus atosiban.

PMID:
14664874
[PubMed - indexed for MEDLINE]
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