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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2024

Open Access 01-12-2024 | Nifedipine | Research

Comparison of the efficacy of nifedipine with ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor: a systematic review and meta-analysis

Authors: Maryam Zamani, Rasoul Alimi, Seyyed Mostafa Arabi, Maryam Moradi, Elham Azmoude

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

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Abstract

Background

Some studies have compared the efficacy of nifedipine with that of other tocolytic drugs in the treatment of preterm labor, but the reported results are conflicting.

Objective

To compare the efficacy of nifedipine with that of ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor.

Methods

In this systematic review and meta-analysis, PubMed/MEDLINE, Scopus, Clarivate Analytics Web of Science, and Google Scholar were searched until April 3,2024 using predefined keywords. Randomized controlled trials (RCTs) and clinical trials that compared the efficacy of nifedipine with that of ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor were included. Two authors independently reviewed the articles, assessed their quality and extracted the data. The quality of the included RCTs based on the Cochrane Risk of Bias Tool 1 for clinical trial studies. The risk difference (RD) with the associated 95% confidence interval (CI) was calculated. A forest plot diagram was used to show the comparative point estimates of nifedipine and other tocolytic drugs on the prevention of preterm labor and their associated 95% confidence intervals based on the duration of pregnancy prolongation. Study heterogeneity was evaluated by the I2 index, and publication bias was evaluated by Egger’s test.

Results

Forty studies enrolling 4336 women were included. According to our meta-analysis, there was a significant difference in the prolongation of preterm labor within the first 48 h between the nifedipine group and the nitroglycerine group (RD, -0.04; 95% CI, -0.08 to -0.00; I2: 32.3%). Additionally, there were significant differences between nifedipine and ritodrine (RD, 0.11; 95% CI, 0.02 to 0.21; I2, 51.2%) for more than one week RD, 0.10; 95% CI, 0.03 to 0.19; I2, 33.2%) and for 34 weeks and more. The difference between nifedipine and magnesium sulfate was not significant in any of the four time points.

Conclusions

Considering the superiority of nifedipine over ritodrine and nitroglycerine and its similar efficacy to magnesium sulfate for tocolysis, it seems that the side effects of these options determine the first drug line.
Appendix
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Literature
1.
Hosny AEMS, Fakhry MN, El-Khayat W, Kashef MT. Risk factors associated with preterm labor, with special emphasis on preterm premature rupture of membranes and severe preterm labor. J Chin Med Assoc. 2020;83:280–7.PubMedCrossRef
2.
Vogel JP, Chawanpaiboon S, Moller AB, Watananirun K, Bonet M, Lumbiganon P. The global epidemiology of preterm birth. Best Pract Res Clin Obstet Gynaecol. 2018;52:3–12.PubMedCrossRef
3.
4.
Tuji TS, Wake AD, Adere GB, Wedajo AB, Obole BD, Jenka DT, Gebriye ST. Magnitude of spontaneous preterm birth and its associated factors among preterm birth in NICU wards in Asella Teaching and Referral Hospital, Asella, Oromia, Ethiopia. J Int Med Res. 2021;49:3000605211034693.PubMedCrossRef
5.
Govindaswami B, Jegatheesan P, Nudelman M, Narasimhan SR. Prevention of Prematurity: advances and opportunities. Clin Perinatol. 2018;45:579–95.PubMedCrossRef
6.
Triggs T, Kumar S, Mitchell M. Experimental drugs for the inhibition of preterm labor. Expert Opin Investig Drugs 2020;:507–23.
7.
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 171: Management of Preterm Labor. Obstet Gynecol. 2016;128:e155-64.
8.
Morhart P, Gärtner J, Weiss C, Stumpfe FM, Dammer U, Faschingbauer F, Fahlbusch FB, Beckmann MW, Kehl S. Influence of Timing of Antenatal Corticosteroid Administration on Morbidity of Preterm neonates. Vivo. 2022;36:1777–84.CrossRef
9.
Navathe R, Berghella V. Tocolysis for Acute Preterm Labor: where have we been, where are we now, and where are we going? Am J Perinatol. 2016;33:229–35.PubMedCrossRef
10.
Cunningham FG. Williams Obstetrics. 25th ed. New York: McGraw-Hill Education; 2018.
11.
Ferguson JE, Dyson DC, Schutz T, Stevenson DK. A comparison of tocolysis with nifedipine or ritodrine: analysis of efficacy and maternal, fetal, and neonatal outcome. Am J Obstet Gynecol. 1990;163:105–11.PubMedCrossRef
12.
Mousa AAA, Mohamed MA, Radwan MS, El Sayed KF. A comparative study between Nifedipine, Ritodrine and Magnesium Sulfate as Tocolytics in cases of Preterm Labor and their effect on Utero placental perfusion. Egypt J Hosp Med. 2019;75:2878–87.CrossRef
13.
Van De Water M, Kessel ET, De Kleine MJ, Oei SG. Tocolytic effectiveness of nifedipine versus ritodrine and follow-up of newborns: a randomized controlled trial. Acta Obstet Gynecol Scand. 2008;87:340–5.PubMedCrossRef
14.
Maitra N, Christian V, Kavishvar A. Tocolytic efficacy of nifedipine versus ritodrine in preterm labor. Int J Gynaecol Obstet. 2007;97:147–8.PubMedCrossRef
15.
Ali M, Hussain MA, Qaisrani HG, Chohan MA. To compare the efficacy of beta agonist ritodrine and calcium channel blocker nifedipine in the management of preterm labour. Pakistan J Med Health Sci. 2013;7:1167–9.
16.
Al-Qattan F, Omu AE, Labeeb L. A prospective randomized study comparing nifedipine versus ritodrine for the suppression of preterm labour. Med Principles Pract. 2000;9:164–73.CrossRef
17.
Cararach V, Palacio M, Martínez S, Deulofeu P, Sánchez M, Cobo T, Coll O. Nifedipine versus Ritodrine for suppression of preterm labor. Comparison of their efficacy and secondary effects. Eur J Obstet Gynecol Reprod Biol. 2006;127:204–8.PubMedCrossRef
18.
Levin G, Ezra Y, Weill Y, Kabiri D, Pollack RN, Rottenstreich A. Nifedipine versus Ritodrine during external cephalic version procedure: a case control study. J Matern Fetal Neonatal Med. 2021;34:3008–13.PubMedCrossRef
19.
Jamil M, Abid R, Basharat A. Transdermal nitro-glycerine Versus oral nifedipine for Acute Tocolysis in Preterm Labour: a randomized controlled trial. J Soc Obstetricians Gynaecologists Pakistan. 2020;10:26–9.
20.
Amorim MM, Lippo LA, Costa AA, Coutinho IC, Souza AS. Nitroglicerina transdérmica versus Nifedipina oral para inibição do trabalho de parto prematuro: ensaio clínico randomizado [Transdermal nitroglycerin versus oral nifedipine administration for tocolysis: a randomized clinical trial]. Rev Bras Ginecol Obstet. 2009;31:552–8.PubMed
21.
Salman S, Habib D, Atef M, Abbas A. The effect of oral Nifedipine versus Parenteral Magnesium Sulfate and Ritodrine for Tocolysis in patients with threatened Preterm Labor: a Randomized Controlled Trial. Open J Obstet Gynecol. 2019;9:1142–50.CrossRef
22.
Klauser CK, Briery CM, Tucker AR, Martin RW, Magann EF, Chauhan SP, Morrison JC. Tocolysis in women with advanced preterm labor: a secondary analysis of a randomized clinical trial. J Matern Fetal Neonatal Med. 2016;29:696–700.PubMedCrossRef
23.
Kamel H, HosamEldin N, Soltan M. Comparative study between the Effect of Nifedipine, Ritodrine and Magnesium Sulfate Therapy on Doppler indices of fetal umbilical and middle cerebral arteries in patients with Preterm Labour. Egypt J Hosp Med. 2019;74:364–74.CrossRef
24.
Houtzager BA, Hogendoorn SM, Papatsonis DN, Samsom JF, van Geijn HP, Bleker OP, van Wassenaer AG. Long-term follow up of children exposed in utero to nifedipine or ritodrine for the management of preterm labour. BJOG. 2006;113:324–31.PubMedCrossRef
25.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;15:264–9.CrossRef
26.
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane collaboration’s tool for assessing risk of bias in randomized trials. BMJ. 2011;343:d5928.PubMedPubMedCentralCrossRef
27.
Balasubramani SR, Kamatchi K. Transdermal nitroglycerin versus oral nifedipine administration for tocolysis in preterm labour. J Evol Med Dent Sci. 2017;6:3967–74.CrossRef
28.
Baykal BÖ, Avcıoğlu SN. Comparison of effects of nifedipine and ritodrine on maternal and fetal blood flow patterns in preterm labor. J Turk Ger Gynecol Assoc. 2015;16:80–5.PubMedPubMedCentralCrossRef
29.
Bracero LA, Leikin E, Kirshenbaum N, Tejani N. Comparison of nifedipine and ritodrine for the treatment of preterm labor. Am J Perinatol. 1991;8:365–9.PubMedCrossRef
30.
Ceyhan ST, Güngör S, Göktolga U, Keskin U, Ergün A, Baþer I. Erken doğumun önlenmesinde nifedipin ve ritodrinin karşılaştırılması. Gülhane Tıp Dergisi. 2007;49:87–90.
31.
Dhawle A, Kalra J, Bagga R, Aggarwal N. Nifedipine versus nitroglycerin for acute tocolysis in preterm labour: a randomized controlled trial. Int J Reprod Contracept Obstet Gynecol. 2013;2:61–7.CrossRef
32.
Faraji R, Asgharnia M, Dalil Heirati F, Nemati F. A comparison between Magnesium Sulfate and Nifedipine for Preterm Labor Prevention. J Babol Univ Med Sci. 2013;15:88–92.
33.
García-Velasco JA, González González A. A prospective, randomized trial of nifedipine vs. ritodrine in threatened preterm labor. Int J Gynaecol Obstet. 1998;61:239–44.PubMedCrossRef
34.
Glock JL, Morales WJ. Efficacy and safety of nifedipine versus magnesium sulfate in the management of preterm labor: a randomized study. Am J Obstet Gynecol. 1993;169:960–4.PubMedCrossRef
35.
Gurjar B, Sony, Rawat RP, Bala S. A Comparative Evaluation of Nifedipine, Ritodrine & Isoxsuprine as a tocolytic. J Med Sci Clin Res. 2017;5:22004–12.CrossRef
36.
Iftikhar P, Kanwal M. Role of nitroglycerin verses nifedipine in preterm labor. Isra Med J. 2017;9:277–9.
37.
38.
Kashanian M, Zamen Z, Sheikhansari N. Comparison between nitroglycerin dermal patch and nifedipine for treatment of preterm labor: a randomized clinical trial. J Perinatol. 2014;34:683–7.PubMedCrossRef
39.
40.
Nikbakht R, Taheri Moghadam M, Ghane’ee H. Nifedipine compared to magnesium sulfate for treating preterm labor: a randomized clinical trial. Iran J Reprod Med. 2014;12:145–50.PubMedPubMedCentral
41.
Niroomanesh S, Abedi F. Efficacy of nifedipine versus magnesium sulfate in the management of preterm labor. J Urmia Univ Med Sci. 2001. 12.
42.
Padmini P, Dharshini P. Comparison of oral nifedipine and transdermal nitroglycerine as a tocolytic for preterm labour. Chennai: Stanley Medical College; 2015.
43.
Sharma N, Rani S, Huria A, Chawla D. Oral nifedipine versus nitroglycerine patch for tocolysis in preterm labour. Int J Reprod Contracept Obstet Gynecol. 2019;8:174–9.CrossRef
44.
Vinodhini C. A Comparitive Study of Efficacy of Transdermal Nitroglycerine/Intravenous Magnesium Sulfate/Oral Nifedipine in Prevention of Preterm Labour: a Randomized controlled study. Salem: Government Mohan Kumaramangalam Medical College; 2019.
45.
Yasmin S, Sabir S, Zahoor F. To compare the effectiveness of nifedipine and glyceryl trinitrate patch in prevention of preterm labour. J Postgrad Med Inst. 2016;30:92–6.
46.
Zulfiqar S, Zulfiqar S, Khan SM. Comparison of nitroglycerine patch and nifedipine in treatment of preterm labour. J Sheikh Zayed Med Coll. 2016;7:965–7.
47.
Khan AA, Urooj S, Ahsen S. Comparing use of nitroglycerine and nifedipine for preterm labour patients. Asian J Multidisciplinary Stud. 2019;7:11.
48.
Khan Z, Shams G, Bashar H, Atiq S. Rehana. Preterm Labor and the efficacy of Magnesium Sulfate and Nifedipine in Management. Khyber J Med Sci. 2021;14:31–5.
49.
Klauser CK, Briery CM, Martin RW, Langston L, Magann EF, Morrison JC. A comparison of three tocolytics for preterm labor: a randomized clinical trial. J Matern Fetal Neonatal Med. 2014;27:801–6.PubMedCrossRef
50.
Kupferminc M, Lessing JB, Yaron Y, Peyser MR. Nifedipine versus Ritodrine for suppression of preterm labour. Br J Obstet Gynaecol. 1993;100:1090–4.PubMedCrossRef
51.
Subhashini K. Comparison of safety and efficacy of intravenous magnesium sulfate and oral nifedipine in treatment of preterm labour. Tiruchirappalli: KAP Viswanathan Government Medical College; 2013.
52.
Akhtar Z, Amna B, Qamar S, Saddiqua A, Bibi N, Bibi S. Compare the effectiveness of Transdermal Nitro-Glycerine Versus oral nifedipine for Acute Tocolysis in Preterm Labour. Pakistan J Med Health Sci. 2020;14:2030–2.
53.
Maryam Khan Badshah, Ara nUJ, Shahab T. Rubina Akhtar, comparison of Nitroglycerine vs Nifedipine for Preterm Labour. Med Forum Monthly. 2019;30:25–8.
54.
Alavi A, Moallemi N, Zolfaghari G, Amjadi N. A comparison between tocolytic effect of Nifedipine and Magnesium sulfate in preterm labor pain.
55.
Kara M, Yılmaz E, Avcı İ, Öge T. Comparison of nifedipine with magnesium sulfate plus terbutaline for the treatment of preterm labor. J Turk Soc Obstet Gynecol. 2009;6:250–6.
56.
Papatsonis DN, Van Geijn HP, Adèr HJ, Lange FM, Bleker OP, Dekker GA. Nifedipine and Ritodrine in the management of preterm labor: a randomized multicenter trial. Obstet Gynecol. 1997;90:230–4.PubMedCrossRef
57.
Ambedkar D, Kushwaha V. A comparative study between nifedipine and magnesium sulfate for treatment of preterm labor. Eur J Mol Clin Med. 2022;9:123–9.
58.
Goyal N, Agrawal M, Dewani D, Reddy Eleti M. A comparative study of the effectiveness of Transdermal Nitroglycerine patches and oral nifedipine in prolongation of pregnancy in Women with Preterm Labour. Cureus. 2023;15:e39106.PubMedPubMedCentral
59.
Bhat S, Jain A, Sunil KS. Nifedipine versus magnesium sulfate in the management of preterm labour- A randomized controlled trial. Indian J Obstet Gynecol Res. 2023;10:460–8.CrossRef
60.
Kalburgi AP, Kshirsagar N. Which one is better for Tocolysis in Preterm Labor? Oral nifedipine vs Transdermal Nitroglycerin Patch. Natl J Med Res. 2023;13:50–8.CrossRef
61.
Saleem R, Akram S, Sabir F, Salam S, Akhtar N, Bashir N, et al. Comparison of efficacy and safety of Magnesium Sulfate Versus oral nifedipine in Acute Tocolysis of Preterm Labour. Pakistan J Med Health Sci. 2023;17:168–70.
62.
Tavassoli F. Effectiveness of Nifedipine and Transdermal nitroglycerin in treatment of Preterm Labor. Asian Res J Gynecol Obstet. 2020;3:10–8.
63.
Crowley C. P. Prophylactic corticosteroids for preterm birth. Cochrane Database Syst Rev. 2000:CD000065.
64.
Sebastian E, Bykersma C, Eggleston A, Eddy KE, Chim ST, Zahroh RI, Scott N, Chou D, Oladapo OT, Vogel JP. Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: a systematic review. EClinicalMedicine. 2022;49:101496.PubMedPubMedCentralCrossRef
65.
Conde-Agudelo A, Romero R. Transdermal nitroglycerin for the treatment of preterm labor: a systematic review and metaanalysis. Am J Obstet Gynecol. 2013;209:e5511–55118.CrossRef
66.
Flenady V, Wojcieszek AM, Papatsonis DN, Stock OM, Murray L, Jardine LA, Carbonne B. Calcium channel blockers for inhibiting preterm labour and birth. Cochrane Database Syst Rev. 2014;2014:CD002255.PubMedPubMedCentral
67.
Duckitt K, Thornton S, O’Donovan OP, Dowswell T. Nitric oxide donors for treating preterm labour. Cochrane Database Syst Rev. 2014;2014:CD002860.PubMedPubMedCentral
68.
Conde-Agudelo A, Romero R, Kusanovic JP. Nifedipine in the management of preterm labor: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011;204:e1341–20.CrossRef
69.
Oei SG, Mol BW, de Kleine MJ, Brölmann HA. Nifedipine versus Ritodrine for suppression of preterm labor; a meta-analysis. Acta Obstet Gynecol Scand. 1999;78:783–8.PubMed
70.
Tsatsaris V, Papatsonis D, Goffinet F, Dekker G, Carbonne B. Tocolysis with nifedipine or beta-adrenergic agonists: a meta-analysis. Obstet Gynecol. 2001;97:840–7.PubMed
71.
King JF, Flenady VJ, Papatsonis DN, Dekker GA, Carbonne B. Calcium channel blockers for inhibiting preterm labour. Cochrane Database Syst Rev. 2003:CD002255.
72.
Haas DM, Caldwell DM, Kirkpatrick P, McIntosh JJ, Welton NJ. Tocolytic therapy for preterm delivery: systematic review and network meta-analysis. BMJ. 2012;345:e6226.PubMedPubMedCentralCrossRef
Metadata
Title
Comparison of the efficacy of nifedipine with ritodrine, nitroglycerine and magnesium sulfate for the management of preterm labor: a systematic review and meta-analysis
Authors
Maryam Zamani
Rasoul Alimi
Seyyed Mostafa Arabi
Maryam Moradi
Elham Azmoude
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-024-06497-w

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