Condition
Preterm Labor
Preterm labor is when regular contractions begin to open the cervix before 37 weeks of pregnancy, as the body starts preparing for birth too early. The evidence is strongest for atosiban, and a placebo-controlled trial found more women had not yet delivered after 24 hours, 48 hours and 7 days. Those gains were seen from 28 weeks onward, while it was less effective earlier in pregnancy.
Sources: PMID 35947046; PMID 14664874
- Updated
- How we grade
- 34 studies cited
- Supplements studied
- 0
- Medicines and peptides
- 1
- Graded outcomes
- 5
Prescription medicines and peptides studied, for context
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Tocolytic Efficacy vs Beta-Agonists vs Salbutamol: 48h efficacy 93.3% vs 95.0% (P=0.67). vs Terbutaline: 48h efficacy 86.1% vs 85.3% (P=0.78). Comparable tocolytic effectiveness with better safety profile. Some trials suggest slightly lower initial success rate. | NoneNo effect | 18 studies | ||||
Studies that measured tocolytic efficacy vs beta-agonists | ||||||
| Pregnancy Prolongation (48h-7 days) Romero Phase 3 (n=501): Significantly more undelivered at 24h, 48h, and 7 days vs placebo (all P≤0.008) at ≥28 weeks. Allows time for corticosteroid administration. Less effective at <28 weeks gestational age. | Improves (the measure goes up) | Moderate effect | 17 studies | |||
Studies that measured pregnancy prolongation (48h-7 days)
| ||||||
| Maternal Tolerability vs Beta-Agonists vs Ritodrine: Adverse events 7.9% vs 70.8%, early termination 0% vs 20%. vs Salbutamol: Better tolerated with comparable efficacy. vs Terbutaline: Fewer clinically important adverse events. No cardiovascular side effects seen with beta-agonists. | Improves (the measure goes up) | Large effect | 14 studies | |||
Studies that measured maternal tolerability vs beta-agonists
| ||||||
| Neonatal Outcomes Cochrane 2014: No superiority vs placebo, beta-agonists, or CCBs for neonatal outcomes. Similar neonatal morbidity across comparators. One trial noted increased fetal deaths at <24 weeks - use caution at early gestational ages. | NoneNo effect | 14 studies | ||||
Studies that measured neonatal outcomes
| ||||||
| Maternal Side Effects Most common: Nausea (mild). No tachycardia, hypotension, or hyperglycemia seen with beta-agonists. No pulmonary edema risk. Fewer treatment discontinuations. Generally well-tolerated by mother and fetus. | Improves (the measure goes down) | Large effect | 14 studies | |||
Studies that measured maternal side effects
| ||||||
Key findings
- Tocolytic Efficacy vs Beta-Agonists
- Pregnancy Prolongation (48h-7 days)Improves (the measure goes up)
- Maternal Tolerability vs Beta-AgonistsImproves (the measure goes up)
Safety notes in the studies
- vs Ritodrine: Adverse events 7.9% vs 70.8%, early termination 0% vs 20%.
- vs Terbutaline: Fewer clinically important adverse events.
- One trial noted increased fetal deaths at <24 weeks - use caution at early gestational ages.
Studies cited
34 studies from PubMed
- Safety and efficacy of atosiban for fetomaternal resuscitation following severe placental abruption in preparation for an emergency cesarean section: a narrative review.
- The biased OTR ligands -atosiban and carbetocin- differentially inhibit early or late formalin-induced nociception in rats.
- Atosiban as a potential treatment for endometriosis-related pain: results from the ENDOBAN pilot study.
- Effect of atosiban on in vitro fertilization pregnancy outcome among women with endometriosis in presence or absence of adenomyosis.
- A multicenter, retrospective comparison of pregnancy outcomes between groups of preterm labor nulliparous mothers treated with atosiban vs. ritodrine in singleton and multiple pregnancies.
- Non-Cardiogenic Pulmonary Edema Due to Administration of Atosiban.
- Atosiban-induced acute pulmonary edema: A rare but severe complication of tocolysis.
- Efficacy of atosiban for repeated embryo implantation failure: A systematic review and meta-analysis.
- Tocolytics for delaying preterm birth: a network meta-analysis
- Efficacy of atosiban combined with ritodrine in the treatment of threatened preterm labor and related risk factors of different pregnancy outcomes.
- Tocolysis with nifedipine versus atosiban and perinatal outcome: an individual participant data meta-analysis.
- Short-Term Outcomes of Atosiban in the Treatment of Preterm Labour at the Sultan Qaboos University Hospital, Muscat, Oman: A tertiary care experience
- Usefulness of atosiban for tocolysis during external cephalic version: Systematic review and meta-analysis.
- Atosiban Combined with Ritodrine for Late Threatened Abortion or Threatened Premature Labor Patients with No Response to Ritodrine: A Clinical Trial.
- Atosiban and Pregnancy Outcomes Following In Vitro Fertilization Treatment for Infertile Women Requiring One, Two, or More Embryo Transfer Cycles: A Longitudinal Cohort Study.
- Effectiveness and safety of atosiban versus conventional treatment in the management of preterm labor.
- Atosiban improves the outcome of embryo transfer. A systematic review and meta-analysis of randomized and non-randomized trials.
- The use of atosiban prolongs pregnancy in patients treated with fetoscopic endotracheal occlusion (FETO).
- Systematic review and meta-analysis of randomized controlled trials of atosiban versus nifedipine for inhibition of preterm labor.
- Steroids, atosiban and pulmonary oedema: are or may be a cause?
- Evaluation of the efficacy of atosiban in pregnant women with threatened preterm labor associated with assisted reproductive technology
- The impact of atosiban on pregnancy outcomes in women undergoing in vitro fertilization-embryo transfer: A meta-analysis.
- A meta-analysis of atosiban supplementation among patients undergoing assisted reproduction.
- Oxytocin receptor antagonists for inhibiting preterm labour
- Atosiban improves implantation and pregnancy rates in patients with repeated implantation failure.
- Atosiban and non-cardiogenic pulmonary oedema.
- Use of atosiban in a twin pregnancy with extremely preterm premature rupture in the membrane of one twin: a case report and literature review.
- Atosiban versus usual care for the management of preterm labor
- Effectiveness of nifedipine versus atosiban for tocolysis in preterm labour: a meta-analysis with an indirect comparison of randomised trials.
- Treatment of preterm labor with the oxytocin antagonist atosiban: a double-blind, randomized, controlled comparison with salbutamol
- The oxytocin antagonist atosiban versus the beta-agonist terbutaline in the treatment of preterm labor. A randomized, double-blind, controlled study
- An oxytocin receptor antagonist (atosiban) in the treatment of preterm labor: a randomized, double-blind, placebo-controlled trial with tocolytic rescue
- Double-blind, randomized, controlled trial of atosiban and ritodrine in the treatment of preterm labor: a multicenter effectiveness and safety study
- Maintenance treatment of preterm labor with the oxytocin antagonist atosiban