Tocolysis for assisting delivery at caesarean section
Abstract
Background
Caesarean section involves making an incision in the woman's abdomen and cutting through the uterine muscle. The baby is then delivered through that incision. Difficult caesarean birth may result in injury for the infant. Medication that relaxes the uterus (tocolytic medication) may facilitate the birth of the baby at caesarean section.
Objectives
To compare the use of tocolysis (routine or selective use) with no use of tocolysis or placebo at the time of caesarean section for outcomes of infant birth trauma, maternal complications (particularly postpartum haemorrhage requiring blood transfusion), and long‐term measures of infant and childhood morbidity.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 1) and PubMed (1966 to January 2006). We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 5 May 2011 and added the results to the awaiting classification section.
Selection criteria
Use of tocolytic agents (routine or selective) at caesarean section versus no use of tocolytic or placebo at caesarean section to facilitate the birth of the baby.
Data collection and analysis
Two review authors independently assessed trial quality and extracted data.
Main results
A single randomised trial involving 97 women was identified and included in the review. Maternal and infant health outcomes were not reported.
Authors' conclusions
There is currently insufficient information available from randomised trials to support or refute the routine or selective use of tocolytic agents to facilitate infant birth at the time of caesarean section.
[Note: The six citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
PICOs
Plain language summary
Tocolysis to relax the uterus and assist birth at difficult caesarean sections
Caesarean section involves making an incision in the woman's abdomen and cutting through the wall of the uterus. The baby is then born through these incisions. Medication to relax the uterus (tocolytic drugs) has been suggested to facilitate the birth of the baby at difficult caesarean section and reduce the risk of birth trauma, like fractures and nerve damage. There are risks associated with the use of medication to relax the uterus, including excessive bleeding and possible interference with the blood the baby receives from the placenta at birth. There is currently limited evidence available to help with informed decisions around the use of these drugs at difficult caesareans. Until there is evidence that these drugs do more good than harm, they should not be used.
