• R Lede and L Duley.
• Obstetrics and Gynecology, University of Buenos Aires, Argentinian Institute for Evidence Based Medicine, Av. Roque Saenz Peña 825, Buenos Aires, Argentina, 1035. rlede@anmat.gov.ar
• Cochrane Db Syst Rev. 2005 Jul 20 (3): CD002857.

BackgroundMiscarriage is the spontaneous loss of a pregnancy before the fetus is viable. Uterine muscle relaxant drugs have been used for women at risk of miscarriage in the belief they relax uterine muscle, and hence reduce the risk of miscarriage.ObjectivesTo assess the effects for the woman and her baby of uterine muscle relaxant drugs when used for threatened miscarriage.Search StrategyWe searched the Cochrane Pregnancy and Childbirth Group Trials Register (4 May 2004), and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2004).Selection CriteriaRandomised trials were included, and quasi-randomised trials were excluded. The participants were women with a pregnancy of less than 20 weeks' gestation having a threatened miscarriage. The interventions were any uterine muscle relaxing drugs (including tocolytic and antispasmodic agents) compared with either placebo or no drug. Primary outcomes for the review were miscarriage: defined as spontaneous pregnancy loss before fetal viability, baby death (stillbirth or neonatal death) and maternal death.Data Collection And AnalysisBoth review authors independently assessed studies for eligibility and trial quality, and extracted data.Main ResultsOne poor quality trial (170 women) was included. This compared a beta-agonist with placebo. There was a lower risk of intrauterine death associated with the use of a beta-agonist (relative risk (RR) 0.25, 95% confidence interval (CI) 0.12 to 0.51). Preterm birth was the only other outcome reported (RR 1.67, 95% CI 0.63 to 4.38).Authors' ConclusionsThere is insufficient evidence to support the use of uterine muscle relaxant drugs for women with threatened miscarriage. Any such use should be restricted to the context of randomised trials.

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