Assessment of perinatal outcome after sustained tocolysis in early labour (APOSTEL-II trial)

Carolien Roos*, Liesbeth H. C. J. Scheepers, Kitty W. M. Bloemenkamp, Annemiek Bolte, Jerome Cornette, Jan B. Derks, Hans J. J. Duvekot, Jim van Eyck, Joke H. Kok, Anneke Kwee, Ashley Merien, Brent C. Opmeer, Marielle G. van Pampus, Dimitri N. M. Papatsonis, Martina M. Porath, Joris A. M. van der Post, Sicco A. Scherjon, Krystyne Sollie, Marc E. A. Spaanderman, Sylvia M. C. VijgenChristine Willekes, Ben Willem J. Mol, Fred K. Lotgering

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

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Background: Preterm labour is the main cause of perinatal morbidity and mortality in the Western world. At present, there is evidence that tocolysis for 48 hours is useful in women with threatened preterm labour at least before 32 weeks. This allows transfer of the patient to a perinatal centre, and maximizes the effect of corticosteroids for improved neonatal survival. It is questionable whether treatment with tocolytics should be maintained after 48 hours.

Methods/Design: The APOSTEL II trial is a multicentre placebo-controlled study. Pregnant women admitted for threatened preterm labour who have been treated with 48 hours corticosteroids and tocolysis will be eligible to participate in the trial between 26(+0) and 32(+2) weeks gestational age. They will be randomly allocated to nifedipine (intervention) or placebo (control) for twelve days or until delivery, whatever comes first.

Primary outcome is a composite of perinatal death, and severe neonatal morbidity up to evaluation at 6 months after birth. Secondary outcomes are gestational age at delivery, number of days in neonatal intensive care and total days of the first 6 months out of hospital. In addition a cost-effectiveness analysis will be performed. Analysis will be by intention to treat. The power calculation is based on an expected 11% difference in adverse neonatal outcome. This implies that 406 women have to be randomised (two sided test, beta 0.2 at alpha 0.05).

Discussion: This trial will provide evidence as to whether maintenance tocolysis reduces severe perinatal morbidity and mortality in women with threatened preterm labour before 32 weeks.

Originele taal-2English
Aantal pagina's5
TijdschriftBMC Pregnancy and Childbirth
StatusPublished - 2009

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