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Cochrane Database of Systematic Reviews

Profilaxis con betamiméticos orales para la prevención del parto prematuro en mujeres con embarazo gemelar

Información

DOI:
https://doi.org/10.1002/14651858.CD004733.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 08 diciembre 2015see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Embarazo y parto

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

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Autores

  • Waralak Yamasmit

    Correspondencia a: Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand

    [email protected]

  • Surasith Chaithongwongwatthana

    Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

  • Jorge E Tolosa

    Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, USA

  • Sompop Limpongsanurak

    Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

  • Leonardo Pereira

    Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, USA

  • Pisake Lumbiganon

    Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

Contributions of authors

For the 2015 update, Waralak Yamasmit and Surasith Chaithongwongwatthana contributed to assessment the of risk of bias in studies and updated the main text. The final version of the updated review was approved by all review authors.

Sources of support

Internal sources

  • Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand.

  • Chulalongkorn University, Thailand.

  • Khon Kaen University, Thailand.

  • Oregon Health & Sciences University, USA.

  • Global Network for Perinatal and Reproductive Health (GNPRH), USA.

External sources

  • United States Agency for International Development, Child Health Research (USAID‐CHR), USA.

  • The Rockefeller Foundation, USA.

  • National Institute for Health Research (NIHR), UKNIHR Cochrane Programme Grant Project: 13/89/05 – Pregnancy and childbirth systematic reviews to support clinical guidelines (2015 update), UK.

Declarations of interest

Waralak Yamasmit: none known.

Surasith Chaithongwongwatthana: none known.

Jorge E Tolosa: I am a consultant for NIH in the US and part of a scientific review committee of research proposals. This is not directly related to this review.

Sompop Limpongsanurak: none known.

Leonardo Pereira: Although I have grant funding and sources of income form educational and case reviews, these are not directly in the area of this topic review and I have no competing interest which affects my objectivity in this review.

Pisake Lumbiganon: none known.

Acknowledgements

This project was supported by the National Institute for Health Research, via Cochrane programme Grant funding (13/89/05) to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2015 Dec 08

Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy

Review

Waralak Yamasmit, Surasith Chaithongwongwatthana, Jorge E Tolosa, Sompop Limpongsanurak, Leonardo Pereira, Pisake Lumbiganon

https://doi.org/10.1002/14651858.CD004733.pub4

2012 Sep 12

Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy

Review

Waralak Yamasmit, Surasith Chaithongwongwatthana, Jorge E Tolosa, Sompop Limpongsanurak, Leonardo Pereira, Pisake Lumbiganon

https://doi.org/10.1002/14651858.CD004733.pub3

2005 Jul 20

Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy

Review

Waralak Yamasmit, Surasith Chaithongwongwatthana, Jorge E Tolosa, Sompop Limpongsanurak, Leonardo Pereira, Pisake Lumbiganon

https://doi.org/10.1002/14651858.CD004733.pub2

2004 Apr 19

Prophylactic oral betamimetics for preventing preterm birth in women with a twin pregnancy

Protocol

Waralak Yamasmit, Surasith Chaithongwongwatthana, Jorge E Tolosa, Sompop Limpongsanurak, Leonardo Pereira, Babu Cheku, Pisake Lumbiganon

https://doi.org/10.1002/14651858.CD004733

Differences between protocol and review

We have removed the following outcomes from our list of outcomes.

  1. Very preterm birth (less than 34 weeks' gestation)

  2. Extremely preterm birth (less than 28 weeks' gestation)

  3. Very low birthweight (less than 1500 g)

We have added the following outcome to our list of outcomes.

  1. Birthweight

We have removed the following planned subgroup from our methods.

  1. Dose

  2. Duration of therapy

A 'Summary of findings' table has been incorporated in the 2015 update.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adult; Female; Humans; Pregnancy;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 1

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Comparison 1 Oral betamimetic versus placebo, Outcome 1 Preterm labour.
Figuras y tablas -
Analysis 1.1

Comparison 1 Oral betamimetic versus placebo, Outcome 1 Preterm labour.

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Comparison 1 Oral betamimetic versus placebo, Outcome 2 Prelabour rupture of membranes.
Figuras y tablas -
Analysis 1.2

Comparison 1 Oral betamimetic versus placebo, Outcome 2 Prelabour rupture of membranes.

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Comparison 1 Oral betamimetic versus placebo, Outcome 3 Preterm birth (less than 37 weeks' gestation).
Figuras y tablas -
Analysis 1.3

Comparison 1 Oral betamimetic versus placebo, Outcome 3 Preterm birth (less than 37 weeks' gestation).

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Comparison 1 Oral betamimetic versus placebo, Outcome 4 Preterm birth (less than 34 weeks' gestation).
Figuras y tablas -
Analysis 1.4

Comparison 1 Oral betamimetic versus placebo, Outcome 4 Preterm birth (less than 34 weeks' gestation).

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Comparison 1 Oral betamimetic versus placebo, Outcome 5 Neonatal mortality.
Figuras y tablas -
Analysis 1.5

Comparison 1 Oral betamimetic versus placebo, Outcome 5 Neonatal mortality.

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Comparison 1 Oral betamimetic versus placebo, Outcome 6 Low birthweight (less than 2500 g).
Figuras y tablas -
Analysis 1.6

Comparison 1 Oral betamimetic versus placebo, Outcome 6 Low birthweight (less than 2500 g).

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Comparison 1 Oral betamimetic versus placebo, Outcome 7 Small‐for‐gestational age (birthweight less than 10th centile).
Figuras y tablas -
Analysis 1.7

Comparison 1 Oral betamimetic versus placebo, Outcome 7 Small‐for‐gestational age (birthweight less than 10th centile).

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Comparison 1 Oral betamimetic versus placebo, Outcome 8 Birthweight (not prespecified).
Figuras y tablas -
Analysis 1.8

Comparison 1 Oral betamimetic versus placebo, Outcome 8 Birthweight (not prespecified).

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Comparison 1 Oral betamimetic versus placebo, Outcome 9 Respiratory distress syndrome.
Figuras y tablas -
Analysis 1.9

Comparison 1 Oral betamimetic versus placebo, Outcome 9 Respiratory distress syndrome.

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Comparison 1 Oral betamimetic versus placebo, Outcome 10 Maternal death.
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Analysis 1.10

Comparison 1 Oral betamimetic versus placebo, Outcome 10 Maternal death.

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Summary of findings for the main comparison. Oral betamimetic versus placebo for pregnant women with a twin pregnancy to prevent preterm birth

Oral betamimetic versus placebo for pregnant women with a twin pregnancy to prevent preterm birth

Patient or population: pregnant women with a twin pregnancy
Settings: studies were located in England, Ireland, Sount Africa, Sweden and Zimbabwe
Intervention: oral betamimetic

Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Oral betamimetic versus placebo

Preterm labour
Follow‐up: 10‐16 weeks

Study population

RR 0.37
(0.17 to 0.78)

194
(2 studies)

⊕⊕⊝⊝
low1,2

179 per 1000

66 per 1000
(30 to 140)

Moderate

314 per 1000

116 per 1000
(53 to 245)

Prelabour rupture of membranes
Follow‐up: 8‐16 months

Study population

RR 1.42
(0.42 to 4.82)

144
(1 study)

⊕⊕⊝⊝
low3

57 per 1000

81 per 1000
(24 to 275)

Preterm birth (less than 37 weeks' gestation)
Follow‐up: 6‐20 weeks

Study population

RR 0.85
(0.65 to 1.10)

276
(4 studies)

⊕⊕⊝⊝
low3

478 per 1000

406 per 1000
(311 to 526)

Moderate

427 per 1000

363 per 1000
(278 to 470)

Very preterm birth (less than 34 weeks' gestation)
Follow‐up: 8‐16 months

Study population

RR 0.47
(0.15 to 1.50)

144
(1 study)

⊕⊕⊝⊝
low3

114 per 1000

54 per 1000
(17 to 171)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Unclear risk of selection bias (‐1).
2 Few events and small sample size (‐1).
3 Wide confidence interval crossing the line of no effect, few events and small sample size (‐2).

Figuras y tablas -
Summary of findings for the main comparison. Oral betamimetic versus placebo for pregnant women with a twin pregnancy to prevent preterm birth
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Comparison 1. Oral betamimetic versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Preterm labour Show forest plot

2

194

Risk Ratio (M‐H, Fixed, 95% CI)

0.37 [0.17, 0.78]

2 Prelabour rupture of membranes Show forest plot

1

144

Risk Ratio (M‐H, Fixed, 95% CI)

1.42 [0.42, 4.82]

3 Preterm birth (less than 37 weeks' gestation) Show forest plot

4

276

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.65, 1.10]

4 Preterm birth (less than 34 weeks' gestation) Show forest plot

1

144

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.15, 1.50]

5 Neonatal mortality Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 Assuming independence between twins

3

452

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.15, 5.37]

5.2 Assuming complete correlation between twins

3

226

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.23, 2.38]

6 Low birthweight (less than 2500 g) Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 Assuming independence between twins

2

366

Risk Ratio (M‐H, Random, 95% CI)

1.19 [0.77, 1.85]

6.2 Assuming complete correlation between twins

2

183

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.81, 1.47]

7 Small‐for‐gestational age (birthweight less than 10th centile) Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

7.1 Assuming independence between twins

2

178

Risk Ratio (M‐H, Random, 95% CI)

0.90 [0.41, 1.99]

7.2 Assuming complete correlation between twins

2

89

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.42, 2.13]

8 Birthweight (not prespecified) Show forest plot

3

478

Mean Difference (IV, Fixed, 95% CI)

111.22 [22.21, 200.24]

9 Respiratory distress syndrome Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 Assuming independence between twins

2

388

Risk Ratio (M‐H, Fixed, 95% CI)

0.30 [0.12, 0.77]

9.2 Assuming complete correlation between twins

2

194

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.11, 1.16]

10 Maternal death Show forest plot

1

144

Risk Ratio (M‐H, Fixed, 95% CI)

2.84 [0.12, 68.57]
Figuras y tablas -
Comparison 1. Oral betamimetic versus placebo
Ir a la tabla de la revisión