74870
document
The therapeutic efficacy and cost-effectiveness of aggressive tocolysis for premature labor associated with premature rupture of the membranes . We conducted a randomized trial comparing bed rest with tocolysis to determine the therapeutic efficacy , safety , and cost-effectiveness of tocolysis for the treatment of preterm labor after membrane rupture . One hundred nine women participated over a 26-month interval . Treatment groups did not differ significantly in terms of gestational age at membrane rupture , gestational age at delivery , birth weight , maternal or fetal infectious morbidity , respiratory distress syndrome , necrotizing enterocolitis , or perinatal mortality . Prolongation of intrauterine time after the onset of uterine contractions was seen in women receiving tocolysis ( 105.2 +/- 157 hours versus 62.1 +/- 77 hours , p = 0.06 ) . This prolongation was not associated with a significant reduction in the total cost per surviving infant ( tocolysis , $ 38,593 +/- $ 40,887 versus bed rest , $ 43,158 +/- $ 37,116 ; p = 0.445 ) . The cost difference was artifactual . The number of very premature infants born ( less than 28 weeks ' gestation ) was unequal in the two groups ( 12 in the bed rest group and 5 in the tocolysis group ) and skewed the results . Before 28 weeks ' gestation tocolysis was associated with a significant increase in intrauterine time after the onset of regular contractions ( p = 0.05 ) . However , there was no identifiable perinatal benefit garnered from the additional 5 days . After 28 weeks there were no significant differences between treatment groups in terms of intrauterine time after the onset of regular contractions and total cost per surviving infant . Because tocolysis does not improve perinatal outcome and can itself be associated with major maternal morbidity , it should be avoided after 28 weeks ' gestation . Before 28 weeks ' gestation tocolysis may greatly increase intrauterine time , but the benefit of this prolongation is not clear .
74871
Intervention_Pharmacological
bed rest with tocolysis
74872
Intervention_Pharmacological
tocolysis
74873
Intervention_Pharmacological
tocolysis
74874
Intervention_Pharmacological
tocolysis
74875
Intervention_Pharmacological
tocolysis
74876
Outcome_Other
therapeutic efficacy
74877
Outcome_Other
cost-effectiveness
74878
Outcome_Other
therapeutic efficacy
74879
Outcome_Other
safety
74880
Outcome_Other
cost-effectiveness
74881
Outcome_Physical
gestational age at membrane rupture
74882
Outcome_Physical
gestational age at delivery
74883
Outcome_Physical
birth weight
74884
Outcome_Adverse-effects
maternal or fetal infectious morbidity , respiratory distress syndrome , necrotizing enterocolitis
74885
Outcome_Mortality
perinatal mortality
74886
Outcome_Other
total cost
74887
Outcome_Other
cost difference
74888
Outcome_Physical
very premature infants born
74889
Outcome_Physical
increase in intrauterine time
74890
Outcome_Physical
regular contractions
74891
Outcome_Physical
intrauterine time
74892
Outcome_Physical
regular contractions
74893
Participant_Condition
premature labor associated with premature rupture of the membranes
74894
Participant_Condition
preterm labor after membrane rupture
74895
Participant_Sample-size
One hundred nine women