Nitric oxide donors for the treatment of preterm labour

BACKGROUND: A number of tocolytics have been advocated for the treatment of threatened preterm labour in order to delay delivery. The rationale is that a delay in delivery may be associated with improved neonatal morbidity or mortality. Nitric oxide donors, such as nitroglycerin, have been used to relax the uterus. This review addresses their efficacy, side effects and influence on neonatal outcome. OBJECTIVES: To determine whether nitric oxide donors administered in threatened preterm labour are associated with a delay in delivery, adverse side effects or improved neonatal outcome. SEARCH STRATEGY: A comprehensive search of the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002) was undertaken. We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 1 October 2009 and added the results to the awaiting classification section. SELECTION CRITERIA: Randomised controlled trials of nitric oxide donors administered for tocolysis. DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were done independently by two reviewers. MAIN RESULTS: Five randomised controlled trials (466 women) were included. Nitroglycerine was the NO donor used in all these trials. Nitric oxide donors did not delay delivery nor improve neonatal outcome when compared with placebo, no treatment or alternative tocolytics such as ritodrine, albuterol and magnesium sulphate. There was, however, a reduction in number of deliveries less than 37 weeks when compared with alternative tocolytics but the numbers of deliveries before 32 and 34 weeks were not influenced. Side effects (other than headache) were reduced in women who received nitric oxide donors rather than other tocolytics. However, women were significantly more likely to experience headache when NO donors had been used. AUTHORS' CONCLUSIONS: There is currently insufficient evidence to support the routine administration of nitric oxide donors in the treatment of threatened preterm labour. [Note: The 21 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]