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Terbutaline pump maintenance therapy after threatened preterm labor for preventing preterm birth

Chawanpaiboon S, Laopaiboon M, Lumbiganon P, Sangkomkamhang US, Dowswell T. Terbutaline pump maintenance therapy after threatened preterm labour for reducing adverse neonatal outcomes. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD010800. DOI: 10.1002/14651858.CD010800.pub2.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Terbutaline pump maintenance therapy after threatened preterm labour for reducing adverse neonatal outcomes

Babies born too early (preterm birth) are at high risk of poor outcomes, and the earlier they are born the greater their risk. Preterm babies are more likely to die or have serious disability as children, including cerebral palsy and other similar conditions. Women who go into very early labour (before 34 weeks) and have their contractions stopped by intravenous drugs are at high risk of going back into preterm labour. Terbutaline is a drug that can relax the uterus and possibly stop contractions. Taken orally, though, it does not seem to prevent contractions returning. Another option is to use a small portable pump that feeds a continuous dose of terbutaline under the skin. This has the advantage of using a lower daily dose with faster onset of action and good tolerability because of fewer side effects than when taken by mouth. We found four studies involving 234 women who had been in preterm labour and had their contractions stopped. We found no evidence of terbutaline maintenance therapy offering any advantages over saline placebo pump or oral terbutaline maintenance therapy in reducing adverse neonatal outcomes by prolonging pregnancy among women with arrested preterm labour. The review found there are not enough large trials to show whether terbutaline pump maintenance therapy is safe or effective.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Terbutaline Pump for the Prevention of Preterm Birth [Internet]

Tocolytic agents inhibit contractions during the labor process. Subcutaneous terbutaline (SQ terbutaline) infusion by pump is used as a prolonged (beyond 48–72 hours) maintenance tocolytic following acute treatment of preterm contractions. The effectiveness and safety of this maintenance tocolysis have not been clearly established.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: September 2011
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Formoterol and budesonide for the relief of asthma symptoms in adults and children

Combined formoterol and budesonide inhalers can be used for maintenance treatment of asthma and relief of symptoms. Three trials involving 5905 participants were included. We found very little evidence in relation to the use of formoterol and budesonide for relief of symptoms in people with mild asthma, but in people with more severe asthma who had suffered exacerbations in spite of regular treatment with inhaled corticosteroids, we found that reliever formoterol and budesonide compared favourably with terbutaline in reducing asthma exacerbations that required a course of oral corticosteroids. However only a small proportion of the 'severe asthma exacerbations' as defined in the trials led to hospital admissions, and no significant overall benefit has yet been shown for this outcome. In children with asthma that was not controlled with regular inhaled corticosteroids, there were fewer serious adverse events when formoterol and budesonide were used to relieve symptoms as well as for maintenance treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Beta2‐adrenoceptor agonists for primary dysmenorrhoea

As many as 50% of premenopausal women regularly suffer from menstrual pain. Many of these women may be incapacitated for one to three days during each menstrual cycle. Primary dysmenorrhoea (PD) is where women suffer from menstrual pain but lack any pathology in their pelvic anatomy. A wide range of treatments are available and some of these, such as beta2‐adrenoceptor agonists, have been used to treat women with primary dysmenorrhoea but their effects are unclear. Five studies involving 187 females with an age range of 15 to 40 years were included in this review. Oral isoxsuprine was examined in two studies; terbutaline oral spray, ritodrine chloride and oral hydroxyphenyl‐orciprenalin were compared with placebo in a further three studies. All of the studies were conducted over 30 years ago and none were of high quality. None of these medications, other than isoxsuprine combined with acetaminophen and caffeine, were reported to have any beneficial effect. Side effects with these medications were reported in up to a quarter of the participants and included nausea, vomiting, dizziness, quivering, tremor and palpitations. At present there is insufficient evidence to allow confident decision‐making about the use of beta2‐adrenoceptor agonists for dysmenorrhoea.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Formoterol versus short‐acting beta‐agonists as symptom relief for adults and children with asthma

Short‐acting beta‐agonists are traditionally used to ease symptoms when people experience wheezing and breathlessness during asthma exacerbations. Formoterol is a bronchodilator that works quickly to relieve symptoms and the effect lasts longer. We are interested in whether there are any benefits or disadvantages associated with using formoterol instead of more traditional treatments to relieve symptoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Betamimetics for inhibiting preterm labour

Preterm labour is when women go into labour before 37 weeks' gestation. Babies born before term (preterm birth) have poorer outcomes compared with babies who are born at term. The earlier the baby is born, the poorer the outcome. Most preterm births occur in low‐income countries where medical help is less readily available. Preterm birth is a major cause of infant deaths and serious illness worldwide. Preterm birth can result in respiratory distress syndrome and chronic lung disease, bleeding into the fluid spaces (ventricles) within the brain (intraventricular haemorrhage)), generalised infection or infection of the blood stream (sepsis), cerebral palsy and other neuro‐developmental impairments. Even short delays in preterm birth can enable women to reach specialist care and receive 'corticosteroid' drugs that are given to women before birth to improve their babies' lung function.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Does daily treatment with formoterol result in more serious adverse events compared to placebo or daily salbutamol?

Asthma is a common condition that affects the airways – the small tubes that carry air in and out of the lungs. When a person with asthma comes into contact with an irritant (an asthma trigger), the muscles around the walls of the airways tighten, the airways become narrower, and the lining of the airways becomes inflamed and starts to swell. This leads to the symptoms of asthma ‐ wheezing, coughing and difficulty in breathing. They can lead to an asthma attack or exacerbation. People can have underlying inflammation in their lungs and sticky mucus or phlegm may build up, which can further narrow the airways. There is no cure for asthma; however there are medications that allow most people to control their asthma so they can get on with daily life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Short‐acting beta2‐agonists for stable chronic obstructive pulmonary disease

This review has shown that regular use for at least seven days of inhaled beta‐2 medicines that relieve airways obstruction and can also improve the symptoms associated with chronic obstructive pulmonary disease (COPD) in most patients but not all. Patients are far more likely to prefer treatment with these type of medicines than with placebo, and less likely to fail or drop‐out from treatment when treated with such medicines. Regular treatment with such inhaled medicines should be reserved for those patients who report symptomatic and clinical benefit from their use. Newer, long acting bronchodilators are currently available, and they may be more practical and/or effective in these patients. However, this review indicates that these older inexpensive drugs are effective in the treatment of COPD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Addition of intravenous beta2‐agonists to inhaled beta2‐agonists for acute asthma

We found three trials involving 104 people (75 children and 29 adults) with acute asthma. There was no significant difference in adults receiving intravenous beta‐agonists as well as standard care in the one small trial considering this comparison. We also looked at length of stay in the emergency department. Two reported shorter recovery time or quicker discharge from the emergency department in patients also receiving intravenous beta‐agonists. One trial reported that more children experienced tremor if they had received injected beta‐agonists whereas another trial, with adults, reported no significant difference in adverse effects. As there are so few trials and so few included patients we cannot be sure about the reliability of these findings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

In people with asthma are single inhalers that contain both formoterol and budesonide better than current best practice?

‘Single inhaler therapy’ means that a single inhaler containing two drugs is used. One of these drugs acts quickly and is called the "reliever". The other works much more slowly and is called the "preventer". The reliever is a beta‐agonist bronchodilator, which help to open the airways and help people breathe more easily. The preventer is a steroid that controls the underlying inflammation in the lungs, which is caused by the asthma. People on 'single inhaler therapy' (SiT) have one inhaler for use every day to control their underlying inflammation and also for symptom relief. The idea behind SiT is that when people take their inhalers to reduce their shortness of breath or wheezing they will also be getting an increased dose of the steroid preventer.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Oral betamimetics for maintenance therapy after threatened preterm labour

A substantial proportion of women who have an episode of threatened preterm labour (before 37 weeks) are actively treated with agents that stop the uterine contractions (tocolytic therapy) and they do not progress to give birth. After being successfully treated for an episode of threatened preterm birth, women may then take medication (tocolytics) to prolong gestation so that their baby is not born too early. Medications used for this purpose include betamimetics, magnesium sulphate, calcium channel blockers and COX inhibitors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Giving magnesium maintenance therapy to women to prevent preterm birth after stopping threatened preterm labour

Magnesium does not reduce preterm birth or improve the outcome for the infant when given to women after contractions of preterm labour have been stopped.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Tocolytics for preterm premature rupture of membranes

Preterm premature rupture of membranes (PPROM) accounts for one‐third of preterm births. Infants who are born before 37 weeks may suffer from problems related to prematurity, including death. Medications that aim to stop labor are often given in an attempt to prevent preterm birth. It is unclear whether these medications should be used in women with PPROM. This review of eight studies (involving 408 women) found that these medications do not effect perinatal death, but do increase latency and may increase maternal (e.g., chorioamnionitis) and neonatal morbidity (e.g., five‐minute Apgar of less than seven and increased need for ventilation of the neonate).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Tocolytics for suspected intrapartum fetal distress

Tocolytic drugs to help babies who have a shortage of oxygen during labour.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Oral betamimetics for the prevention of preterm labour and birth for women with twin pregnancies

There is insufficient evidence from randomised controlled trials to support the routine use of oral betamimetics (drugs that reduce or prevent uterine contraction) to prevent preterm birth of twins.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Effectiveness of terbutaline pump for the prevention of preterm birth: a systematic review and meta-analysis

BACKGROUND: Subcutaneous terbutaline (SQ terbutaline) infusion by pump is used in pregnant women as a prolonged (beyond 48-72 h) maintenance tocolytic following acute treatment of preterm contractions. The effectiveness and safety of this maintenance tocolysis have not been clearly established. We aimed to systematically evaluate the effectiveness and safety of subcutaneous (SQ) terbutaline infusion by pump for maintenance tocolysis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Oxytocin receptor antagonists for inhibiting preterm labour

Tocolytic drugs suppress preterm labour and have the potential to postpone preterm birth long enough to, hopefully, improve infant outcome. This may be by allowing normal growth and maturation of the baby, or by allowing time for administration of magnesium sulphate to reduce risk of cerebral palsy and corticosteroids to help the baby's lungs and other organs to mature. They may also provide the opportunity, if necessary, for the mother to be transferred to a hospital that has facilities to provide neonatal intensive care. However, prolonging pregnancy may instead have adverse outcomes for the baby and so it is important to assess infant outcomes alongside duration of pregnancy. Oxytocin receptor antagonists (ORAs) are a group of tocolytic drugs, and we undertook this review to see if ORAs prolonged pregnancy and improved outcomes for infants compared with no treatment or with other tocolytic drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Use of dry powder inhalers in acute exacerbations of asthma and COPD

This review concluded that dry powder inhalers functioned equally as well as established therapies with other inhaler devices in patients with acute asthma or chronic obstructive pulmonary disease. Given poor reporting of the review process and uncertainty over the quality of the included studies, the authors' conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Tocolytic therapy: a meta-analysis and decision analysis

The review concluded that all current tocolytic agents were superior to no treatment at delaying delivery of newborns for both 48 hours and seven days. In light of the limited assessment of study quality, questionable statistical techniques used and an absence of any statistical investigation into variation between studies, the authors' conclusions are not likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

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