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Evidence summaries

Nitric Oxide Donors for Delaying Preterm Birth

Nitric oxide donors appear to be effective for inhibiting preterm labour compared with placebo or no treatment. Level of evidence: "B"

The certainty of evidence is downgraded by indirectness of evidence.

Summary

A Cochrane review and network meta-analysis[Abstract] 1assessing different tocolytic drugs included 122 trials with a total of 13 697 women (table T1). Nitric oxide donors ranked highest for delaying preterm birth by 48 hours and 7 days followed by calcium channel blockers, oxytocin receptor antagonists and combinations of tocolytics. In direct comparison with placebo or no treatment nitric oxide donors showed a trend towards benefit (RR 1.18, 955 CI 0.76 to 1.84, low evidence).

Delay in birth by 48 hours with different tocolytics compared with placebo or no treatment

OutcomeNetwork evidenceAnticipated absolute effects for network estimate
RR (95% CI) CertaintyRisk with placebo or no treatmentRisk with tocolytic agentRisk difference with tocolytic agent
Betamimetics1.12(1.05 to 1.20) Low645 per 1000722 per 100077 more per 1000(from 32 to 129 more)
Calcium channel blockers1.16(1.07 to 1.24)Low645 per 1000748 per 1000103 per 1000(from 45 to 155 more)
Magnesium sulphate1.12(1.02 to 1.23) Moderate645 per 1000722 per 100077 more per 1000(from 13 to 148 more)
Oxytocin receptor antagonists1.13(1.05 to 1.22) Moderate645 per 1000729 per 100084 more per 1000(from 32 to 142 more)
Nitric oxide donors1.17(1.05 to 1.31) Moderate645 per 1000755 per 1000110 per 1000(from 32 to 200 more)

Clinical comments

Note

Date of latest search: 2022-11-08

References

  • Wilson A, Hodgetts-Morton VA, Marson EJ et al. Tocolytics for delaying preterm birth: a network meta-analysis (0924). Cochrane Database Syst Rev 2022;(8):CD014978. [PubMed]

Primary/Secondary Keywords