This systematic review aimed to identify the benefits and possible harms of tocolytic therapy for preterm labour management in the context of pregnant women with extremely preterm birth, multiple gestations, or growth-restricted foetuses. A comprehensive search using MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, CINAHL, and the WHO Global Index Medicus databases was conducted from 10 to 15 July 2021. We included randomized controlled trials and non-randomized studies that assessed the effects of tocolysis compared with placebo or no treatment. We found 744 reports and, finally, nine studies (three randomized controlled trials and six cohort studies) pertaining to women with <28 weeks of gestation were included. No eligible studies were identified among women with a multiple pregnancy or a growth-restricted foetus. A meta-analysis of the trial data showed that there were no clear differences in perinatal death nor for a delay in birth. Non-randomized evidence showed that tocolysis delayed birth by 7 days, though there was no clear difference for preterm birth. In summary, it remains unclear whether tocolytic therapy for inhibiting preterm labour is beneficial for these subgroups of women and their newborns. Further well-designed randomized controlled trials and observational studies are needed to address the lack of evidence regarding tocolytic agents in these populations.

Background Clinical practice with aromatherapy has become an expanding area for nursing, and is considered one of the most popularly used complementary treatments. However, there is insufficient evidence about the benefits of aromatherapy for pain management and other related discomforts in labor. We aimed to evaluate the effects of aromatherapy for women during delivery particularly for pain relief. Methods AMED, ClinicalTrials.Gov, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, and WHO ICTRP were searched in August 2017. For updates, these databases were searched from July 2017 to July 2018. This study included randomized controlled trials (RCTs) and quasi-RCTs for normal pregnancy women who were experiencing labor onset, and compared aromatherapy with standard care or control. Results Six RCTs from six reports, and four quasi-RCTs from five reports were included (1238 pregnant women). The trials found significant difference between groups for the primary outcomes of pain relief on the latent (MD -1.56, 95%CI: -2.45 to -0.67, low certainty of evidence) and early active phase (MD -1.69, 95%CI: -2.50 to -0.89, low certainty of evidence). However, there were no significant differences for the primary outcomes of pain relief on the late active phase, and anxiety relief on the early and late active phases. Conclusions This meta-analysis found evidence that the use of inhalation aromatherapy for term pregnancy women is associated with reduction of labor pain. However, there is insufficient evidence to confirm pain relief on the late active phase, anxiety relief, and other outcomes following aromatherapy. Trial registration We registered the study protocol with PROSPERO (CRD42017077617).