The quality of nifedipine studies used to assess tocolytic efficacy: a systematic review
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Ronnie F. Lamont
Abstract
Objective: To assess the quality of studies of nifedipine used to treat spontaneous preterm labor.
Design: A systematic review of study quality using a novel validity assessment tool, examining method-specific and topic-specific items in the domains of selection, performance and measurement biases.
Data Sources: Medline (1996–2003), EMBASE (1996–2003), BIOSIS (1993–2003), Current Contents (1995–2003), DERWENT DRUGFILE (1983–2003), Cochrane Database of Systematic Reviews. Bibliographies of existing meta-analyses and systematic reviews of nifedipine as a tocolytic.
Methods of Study Selection: Forty-five studies evaluating the effectiveness of nifedipine were identified.
Data Extraction: Each study was assessed for 40 method-specific and topic-specific items of quality in duplicate using piloted data extraction forms. Disagreements between assessors were settled by consensus/arbitration.
Data Synthesis: Very few of the studies complied with adequacy criteria of quality for either method-specific or topic-specific items. There was no improvement in quality over time. The quality of method-specific items was significantly poorer when compared with topic-specific items of quality overall (P<0.0001) and in the domains of selection bias (P<0.0001) and performance bias (P<0.0001).
Conclusion: Studies of the effectiveness of nifedipine as a tocolytic are of poorer quality with respect to method-specific items than topic-specific items. These deficiencies should be highlighted in meta-analyses or systematic reviews which measure efficacy and should influence the generation of guideline statements or recommendations for the use of nifedipine as a tocolytic. A large randomized trial fulfilling the quality items is necessary to assess the real efficacy of nifedipine in preterm labor.
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© Walter de Gruyter
Articles in the same Issue
- The epidemiology of preterm labor – a global perspective
- Erythropoietin and prematurity – where do we stand?
- The quality of nifedipine studies used to assess tocolytic efficacy: a systematic review
- Unexplained intrauterine fetal death is accompanied by activation of complement
- Anaphylatoxins in preterm and term labor
- The transcription factor Ets-1 is expressed in human amniochorionic membranes and is up-regulated in term and preterm premature rupture of membranes
- Recombinant human lactoferrin has preventive effects on lipopolysaccharide-induced preterm delivery and production of inflammatory cytokines in mice
- Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound
- Cerebral ventricular volume assessment by three-dimensional ultrasonography
- Nomogram of the fetal gastric size development in normal pregnancy
- Therapeutic hypothermia: from lab to NICU
- Alveolar capillary dysplasia: a six-year single center experience
- Spina bifida – a follow-up study of neonates born from 1991 to 2001
- Concordant occipital encephalocele in monoamniotic twins
- Changes of lactate, glucose, ionized calcium and glutamate concentrations in cephalic vein blood during brain hypothermia using extracorporeal membrane oxygenation (ECMO) in a newborn infant with hypoxic-ischemic encephalopathy
- Treatment of symptomatic congenital cytomegalovirus infection with valganciclovir
- A coiled nasogastric tube in a newborn
Articles in the same Issue
- The epidemiology of preterm labor – a global perspective
- Erythropoietin and prematurity – where do we stand?
- The quality of nifedipine studies used to assess tocolytic efficacy: a systematic review
- Unexplained intrauterine fetal death is accompanied by activation of complement
- Anaphylatoxins in preterm and term labor
- The transcription factor Ets-1 is expressed in human amniochorionic membranes and is up-regulated in term and preterm premature rupture of membranes
- Recombinant human lactoferrin has preventive effects on lipopolysaccharide-induced preterm delivery and production of inflammatory cytokines in mice
- Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound
- Cerebral ventricular volume assessment by three-dimensional ultrasonography
- Nomogram of the fetal gastric size development in normal pregnancy
- Therapeutic hypothermia: from lab to NICU
- Alveolar capillary dysplasia: a six-year single center experience
- Spina bifida – a follow-up study of neonates born from 1991 to 2001
- Concordant occipital encephalocele in monoamniotic twins
- Changes of lactate, glucose, ionized calcium and glutamate concentrations in cephalic vein blood during brain hypothermia using extracorporeal membrane oxygenation (ECMO) in a newborn infant with hypoxic-ischemic encephalopathy
- Treatment of symptomatic congenital cytomegalovirus infection with valganciclovir
- A coiled nasogastric tube in a newborn
