Using tocolysis in pregnant women with symptomatic placenta praevia does not significantly improve prenatal, perinatal, neonatal and maternal outcomes: a systematic review and meta-analysis

Frederick Morfaw, Mercy Fundoh, Jessica Bartoszko, Lawrence Mbuagbaw, Lehana Thabane, Frederick Morfaw, Mercy Fundoh, Jessica Bartoszko, Lawrence Mbuagbaw, Lehana Thabane

Abstract

Background: Placenta praevia refers to a placenta located in the lower segment of the uterus. This abnormal location predisposes the placenta to abnormal bleeding with an increased risk of premature labour. The merits of tocolytic drugs (tocolysis) to calm uterine contractions and prolong pregnancy in women with placenta praevia are uncertain.

Objectives: The primary objective is to determine the effects of tocolysis versus no tocolysis on pregnancy prolongation. Secondary objectives include to determining the effects of tocolysis versus no tocolysis on gestational age at delivery, maternal hospitalisations, recurrent vaginal bleeding, prematurity, admissions into neonatology, and perinatal deaths.

Methods: We searched MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, reference lists of pertinent articles and trial registries for randomised controlled trials comparing tocolysis to no tocolysis or placebo in patients with placenta praevia. Risk of bias and data extraction was done independently by two reviewers. We pooled data using a random-effects model. We used the GRADE system to assess the certainty of evidence for each outcome.

Main results: There is no significant difference in pregnancy prolongation with the use of tocolysis in cases of placenta praevia (mean difference [MD] 11.51 days; 95% CI, - 1.75, 24.76; 3 trials, 253 participants; low certainty evidence). Tocolysis has no significant effect on gestational age at delivery (MD 0.33 weeks [95% CI - 1.53, 2.19]: 2 trials, 169 participants, moderate certainty evidence), birthweight (MD 0.12 kg [95% CI - 0.26, 0.5 kg]: 2 trials, 169 participants, moderate certainty evidence), risk of premature delivery (risk ratio [RR] 1.04; 95% CI 0.56, 1.94): 2 trials, 169 participants, low certainty evidence), risk of repeat vaginal bleeding (RR 1.05 [95% CI 0.73, 1.51]: 2 trials, 169 participants, moderate certainty evidence). Tocolysis has no significant effect on the risk of perinatal death (risk difference [RD]: 0.00 [95% CI - 0.04, 0.03]: 2 trials, 169 women; low certainty evidence), number of days of maternal hospitalisation (MD 0.60 days [95% CI - 0.79, 1.99]: 1 trial, 109 women; low certainty evidence), risk of fetal admissions into neonatology (RR 1.30 [95% CI 0.80, 2.12]: 1 trial, 109 participants, low certainty evidence) and on the duration of stay in neonatology units (MD 0.70 days [95% CI - 5.26, 6.66]: 1 trial, 109 participants, low certainty evidence).

Conclusion: In women with symptomatic placenta praevia, there is no significant effect on pregnancy prolongation with the use of tocolysis. Tocolysis has no significant effect on other prenatal, perinatal, neonatal and maternal outcomes among women with symptomatic placenta praevia.

Systematic review registration: PROSPERO CRD42018091513.

Keywords: Antepartum haemorrhage; Placenta praevia; Tocolysis; Tocolytic agent.

Conflict of interest statement

Ethics approval and consent to participate

Being a systematic review of published literature, we did not need any ethical approval nor patient consent in order to conduct this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Risk of bias summary
Fig. 3
Fig. 3
Comparison: provision of tocolysis versus placebo. Outcome: mean difference in number of days of pregnancy prolongation
Fig. 4
Fig. 4
Comparison: provision of tocolysis versus placebo. Outcome: mean difference in gestational age at delivery
Fig. 5
Fig. 5
Comparison: provision of tocolysis versus placebo. Outcome: mean difference in birth weight
Fig. 6
Fig. 6
Comparison: provision of tocolysis versus placebo. Outcome: relative risk of premature delivery
Fig. 7
Fig. 7
Comparison: provision of tocolysis versus placebo. Outcome: relative risk of any repeat episode of vaginal bleeding
Fig. 8
Fig. 8
Comparison: provision of tocolysis versus placebo. Outcome: risk difference in perinatal deaths

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