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Tocolysis compared with no tocolysis in women with threatened preterm birth and ruptured membranes: a propensity score analysis

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dc.contributor.authorvan Winden, T.M.S.
dc.contributor.authorRoos, C.
dc.contributor.authorNijman, T.A.J.
dc.contributor.authorKleinrouweler, C.E.
dc.contributor.authorOlaru, A.
dc.contributor.authorMol, B.W.
dc.contributor.authorMcAuliffe, F.M.
dc.contributor.authorPajkrt, E.
dc.contributor.authorOudijk, M.A.
dc.date.issued2020
dc.description.abstractIntroduction: In women with preterm ruptured membranes and contractions, the administration of tocolysis is controversial. This study compares tocolysis with no tocolysis in women with threatened preterm birth and ruptured membranes. Objective: To compare tocolysis with no tocolysis in women with threatened preterm birth and ruptured membranes. Study design: Data from the APOSTEL III RCT was combined with data from the National Maternity Hospital, Dublin. In the APOSTEL III trial, women with threatened preterm birth were randomized to atosiban or nifedipine. Patient data from Ireland were obtained from a cohort of women with threatened preterm birth with ruptured membranes. The Irish women received no tocolytic treatment. Only women with ruptured membranes and contractions were selected. We studied women with singleton or twin pregnancies and a gestational age between 25+0 and 33+6 weeks. Propensity score matching was performed to create comparable groups. Primary outcome was a composite adverse neonatal outcome. Secondary outcomes were individual components of the primary outcome, as well as neonatal intensive care unit (NICU) admission, gestational age at delivery, prolongation of pregnancy and mode of delivery. Results: 153 women from the Apostel III trial were compared with 51 eligible women of the Irish cohort. We could match 46 women who received tocolysis and 46 women who received no tocolysis. All women had ruptured membranes. Maternal age, BMI, parity and gestational age at study entry were comparable between the groups after matching. There were no statistically significant differences in neonatal composite outcome (9.6 % in the tocolysis group versus 18 % in the control group, OR 0.46, 95 % CI 0.13−1.63). We found a lower incidence of NICU admission in the tocolysis group (63 %) than in the control group (94 %; OR 0.11, 95 % CI 0.03−0.41), which could be explained by differences in national admission policies. There were no statistically significant differences between tocolysis and no tocolysis in any of the other outcomes including sepsis, gestational age at delivery and time to delivery. Conclusion: In this propensity score analysis of women with threatened preterm birth and ruptured membranes, tocolytic therapy did not alter composite adverse neonatal outcome or time to delivery.
dc.description.statementofresponsibilityT.M.S. van Winden, C. Roos, T.A.J. Nijman, C.E. Kleinrouweler, Adriana Olaru, B.W. Mol, F.M. McAuliffe, E. Pajkrt, M.A. Oudijk
dc.identifier.citationEuropean Journal of Obstetrics and Gynecology and Reproductive Biology, 2020; 255:67-73
dc.identifier.doi10.1016/j.ejogrb.2020.10.015
dc.identifier.issn0301-2115
dc.identifier.issn1872-7654
dc.identifier.orcidMol, B.W. [0000-0001-6887-0262] [0000-0001-8337-550X]
dc.identifier.urihttps://hdl.handle.net/2440/132012
dc.language.isoen
dc.publisherElsevier BV
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/GNT1176437
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/GNT1082548
dc.rights© 2020 Elsevier B.V. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.ejogrb.2020.10.015
dc.subjectFetal membranes; premature rupture; preterm birth; propensity score; tocolysis; threatened preterm birth
dc.subject.meshHumans
dc.subject.meshPremature Birth
dc.subject.meshTocolytic Agents
dc.subject.meshTocolysis
dc.subject.meshPregnancy
dc.subject.meshInfant
dc.subject.meshInfant, Newborn
dc.subject.meshIreland
dc.subject.meshFemale
dc.subject.meshPropensity Score
dc.titleTocolysis compared with no tocolysis in women with threatened preterm birth and ruptured membranes: a propensity score analysis
dc.typeJournal article
pubs.publication-statusPublished

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