Strategies for preventing preterm labor

02_high_tech_med
Research areas: High tech medicine, Prevention and screening

Philipp Mad
Duration: October 2008 until Spring 2009

Literature search and -documentation: Tarquin Mittermayr
Initiated by: KAGES
Publication: HTA Project Report 30 - https://eprints.aihta.at/825


Background:
Preterm birth is associated with an increased risk of mortality and morbidity for the infant. Treatment strategies aim to delay labour to improve perinatal outcomes by allowing the fetus to mature further before birth, and to provide lung maturation by antenatal corticosteroid administration. Antenatal transfer of the mother to a tertiary care hospital may also be possible when preterm labour is delayed.
Bedrest is widely recommended in a hospital or at home for the prevention of preterm birth as first step treatment, however, evidence on its effectiveness is lacking. The most common tocolytic agent to delay preterm birth in Austria is the Betamimetic Hexoprenaline (Gynipral®, Nycomed Austria). Over the last years a new tocolytic agent, the Ocytocin Receptor Antagonist Atosiban (Tractocile ®, Ferring, Sweden) was introduced to medical practice. Cochrane reviews found similar effectiveness of both tocolytic agents. However, an increasing use of Atosiban causing additional costs has recentlybeen seen in Austrian hospitals.

Study Aim:

Synthesis of evidence based guidelines on tocolysis and usage of Atosiban and HexoprenalinSummary of Evidence on Effectiveness of Atosiban, Hexoprenaline and bedrest in women at risk of preterm labourSystematic review of cost-effectiveness of Atosiban and Hexoprenaline


Research Questions:

1) Usage of tocolytics:
a. When should tocolysis be initiated in women at risk of preterm labour?
b. What are the advantages/disadvantages of Atosiban and Hexoprenalin?
c. Which women should recieve Hexoprenalin, which Atosiban?

2) How effective are Atosiban, Hexoprenalin and bedrest in preventing preterm labour?

3) Is Hexoprenalin compared to Atosiban cost-effective in preventing preterm labour?


Methods:

Systematich review of evidence-based guidelines on tocolysis in preventing preterm labour.Update of Cochrane Reviews on Atosiban, Betamimetics and bed rest using a similar search strategy. Systematic review of cost-effectiveness analyses including Atosiban and Hexoprenalin