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Study flow diagram.
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Figure 1

Study flow diagram.

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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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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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

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

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Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 1 Fetal, neonatal and infant death.
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Analysis 1.1

Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 1 Fetal, neonatal and infant death.

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Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 2 Fetal death.
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Analysis 1.2

Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 2 Fetal death.

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Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 3 Neonatal death.
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Analysis 1.3

Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 3 Neonatal death.

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Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 4 Respiratory distress syndrome.
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Analysis 1.4

Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 4 Respiratory distress syndrome.

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Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 5 Hypocalcaemia, osteopenia or fracture.
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Analysis 1.5

Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 5 Hypocalcaemia, osteopenia or fracture.

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Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 6 Mode of birth.
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Analysis 1.6

Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 6 Mode of birth.

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Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 7 Pulmonary oedema.
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Analysis 1.7

Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 7 Pulmonary oedema.

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Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 8 Self‐reported adverse effects.
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Analysis 1.8

Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 8 Self‐reported adverse effects.

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Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 9 Admission to neonatal intensive care unit.
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Analysis 1.9

Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 9 Admission to neonatal intensive care unit.

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Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 10 Length of stay neonatal intensive care unit (days).
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Analysis 1.10

Comparison 1 Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials, Outcome 10 Length of stay neonatal intensive care unit (days).

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Summary of findings for the main comparison. Different treatment regimens of magnesium sulphate for tocolysis in women in preterm labour

Different treatment regimens of magnesium sulphate for tocolysis in women in preterm labour

Patient or population: Women in preterm labour
Intervention: High‐dose magnesium sulphate
Comparison: Low‐dose magnesium sulphate

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with low‐dose (as defined by the trialist) magnesium sulphate

Risk with high‐dose (as defined by the trialist) magnesium sulphate

Fetal, neonatal and infant death

Study population

RR 0.43
(0.12 to 1.56)

100
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1 2 3

140 per 1000

60 per 1000
(17 to 218)

Respiratory distress syndrome

Study population

RR 0.31
(0.11 to 0.88)

100
(1 RCT)

⊕⊕⊝⊝
LOW 1 3

260 per 1000

81 per 1000
(29 to 229)

*The risk in the intervention group (and its 95% CI) 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; RCT: Randomised controlled trial.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

1 Evidence is based on a single trial

2 Evidence of wide confidence intervals crossing the line of no effect

3 No evidence of blinding of participants, personnel or outcome assessors

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Summary of findings for the main comparison. Different treatment regimens of magnesium sulphate for tocolysis in women in preterm labour
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Comparison 1. Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fetal, neonatal and infant death Show forest plot

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.12, 1.56]

2 Fetal death Show forest plot

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.06, 15.55]

3 Neonatal death Show forest plot

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.07, 1.57]

4 Respiratory distress syndrome Show forest plot

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.31 [0.11, 0.88]

5 Hypocalcaemia, osteopenia or fracture Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Hypocalcaemia

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.99]

6 Mode of birth Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Caesarean birth

2

248

Risk Ratio (M‐H, Fixed, 95% CI)

0.90 [0.59, 1.37]

7 Pulmonary oedema Show forest plot

1

148

Risk Ratio (M‐H, Fixed, 95% CI)

4.49 [0.22, 92.03]

8 Self‐reported adverse effects Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

8.1 Flushing

2

248

Risk Ratio (M‐H, Random, 95% CI)

1.64 [0.89, 3.03]

8.2 Headache

2

248

Risk Ratio (M‐H, Random, 95% CI)

1.78 [0.95, 3.31]

8.3 Nausea

1

100

Risk Ratio (M‐H, Random, 95% CI)

1.27 [0.73, 2.20]

9 Admission to neonatal intensive care unit Show forest plot

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.19, 1.12]

10 Length of stay neonatal intensive care unit (days) Show forest plot

1

100

Mean Difference (IV, Fixed, 95% CI)

‐3.10 [‐5.48, ‐0.72]
Figuras y tablas -
Comparison 1. Magnesium sulphate high‐dose versus low‐dose regimen ‐ all included trials
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