Is delaying premature delivery safe? Professor questions the use of drugs that delay premature birth

Professor Alfirevic from the Department of Women's and Children's Health at the University of Liverpool argues that although premature children tend to have lower cognitive ability than their peers and 14.9 million are born prematurely each year worldwide, is it really possible to stop spontaneous preterm labour?

In an accompanying research paper, Haas and colleagues carried out a review of several controlled trials to determine the most cost-effective tocolytic agent. Tocolytic drugs are used to delay delivery for up to 48 hours. This allows time for doctors to give steroids to speed up the baby's and to enable the mother to be transferred to a centre with a unit.

And while Professor Alfirevic appreciates that it is important to choose the right tocolytic drug, he argues that Haas and colleagues' study found no evidence that tocolytic drugs improve rates of newborn illness or death.

Furthermore, a separate study which looked at mothers who took antibiotics (erythromycin and co-amoxiclav) to prevent found an unexpected increase in cerebral palsy among the children.

Professor Alfirevic suggests that instead of focusing studies on the success of tocolytic drugs on delaying preterm birth, larger trials are needed to determine the clinically meaningful effects of the drugs. He says that clinicians "need proof of a sustained improvement in important health outcomes that matter to women" and the evidence, that tocolytics may allow mothers more time to be moved to specialist neonatal units, may not be enough.

Professor Alfirevic says that despite Haas and colleagues' "well done" meta-analysis, the Royal College of Obstetricians and Gynaecologists' 2011 recommendation that it is reasonable not to use tocolytics still stands.

He concludes that clinicians should be honest and tell women that they are giving them drugs that they hope will prolong pregnancy, but they may not make their babies healthier. And he hopes that "babies are not coming to greater harm by our attempts to keep them in utero."

More information:
www.bmj.com/cgi/doi/10.1136/bmj.e6226
www.bmj.com/cgi/doi/10.1136/bmj.e6531

Related Stories

Preterm birth: Magnesium sulphate cuts cerebral palsy risk

date Jan 21, 2009

Magnesium sulphate protects very premature babies from cerebral palsy, a new study shows. The findings of this Cochrane Review could help reduce incidence of the disabling condition, which currently affects around one in ...

Recommended for you

German woman, 65, gives birth to quadruplets

date 23 hours ago

A 65-year-old teacher from Berlin has given birth to quadruplets after a pregnancy that was widely criticized by medical professionals because of her age, RTL television said Saturday.

More evidence C-sections riskier for moms

date May 20, 2015

(HealthDay)—Women who deliver their first baby by cesarean section are more likely to need blood transfusions and be admitted to intensive care units than women who opt for a vaginal delivery, U.S. health ...

Meds offer slight symptom relief in overactive bladder

date May 20, 2015

(HealthDay)—For women with overactive bladder, medications delivered as a daily dose correlate with small reductions in urge incontinence episodes and voiding, according to a review published online May ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.