Do obstetric units adhere to the evidence-based national guideline? A Germany-wide survey on the current practice of initial tocolysis

Stelzl, Patrick; Kehl, Sven; Oppelt, Peter; Maul, Holger; Enengl, Sabine; Kyvernitakis, Ioannis; Rath, Werner

doi:10.1016/j.ejogrb.2022.01.006

Cited by 7 publications

(11 citation statements)

References 37 publications

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“…There have been many similar studies conducted in countries around the world [ 22 ], including in Australia [ 41 ], Austria [ 30 ], Canada [ 42 ], France [ 18 , 43 ], New Zealand [ 41 ], UK [ 44 ], Germany [ 4 ], and USA [ 45 ]. All of these studies found that tocolysis practice patterns varied widely between practitioners and that not all obstetricians prescribed according to scientific evidence, as is the case in Taiwan, and this study attempted to address this concern.…”

Section: Discussionmentioning

confidence: 99%

“…Preterm birth is still a major challenge for obstetricians worldwide and is associated with neonatal complications, such as respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NE), and retinopathy of prematurity [ 1 , 2 , 3 , 4 , 5 ]. According to the Global Health Observatory by the World Health Organization, complications of prematurity are a leading cause of death under 5 years of age, with 964,366 deaths in 2017 alone, accounting for 17.8% of the under-5-mortality globally [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…To emphasize, preterm birth is still a challenge to researchers studying its basic mechanisms, and though there have been some recent headways into its molecular pathways and prediction models [ 15 ], the question of when to start tocolytic therapy and for how long remains a common but difficult decision for clinicians. Currently, it is generally recommended that tocolysis be limited to the occurrence of preterm labor between the gestational ages (GA) of 24 weeks and 30 weeks or to those over 30 weeks of GA accompanied with cervical length <15 mm or 20 mm [ 4 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. The most acceptable strategy is acute tocolysis or 48 h of tocolytic agent use for steroid and magnesium sulphate (MgSO4) administration, as well as to gain time for maternal–fetal transfer [ 25 , 26 , 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Tocolytic Treatment for the Prevention of Preterm Birth from a Taiwanese Perspective: A Survey of Taiwanese Obstetric Specialists

Lee

Yeh

Yang

et al. 2022

IJERPH

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Preterm birth represents a great burden to the healthcare system, resulting in the consideration for the use of tocolytic therapy to provide a “better time” for delivery in order to buy time to accelerate fetal lung maturity, thereby minimizing prematurity-related morbidity and mortality. However, the benefits and potential side effects and risks of tocolytic treatment for preterm birth should be carefully balanced. Although many countries and societies provide guidelines or consensuses for the management for preterm birth, there is no standardized national guideline or consensus in Taiwan. As such, great heterogeneity is suspected in preterm labor management, contributing to the uncertainty of attitudes and practice patterns of obstetric specialists in Taiwan. This study attempts to understand the attitudes and practice patterns regarding tocolytic therapy in Taiwan. A paper-based survey was conducted at the 2020 Taiwan Society of Perinatology Conference on 8 December 2020, exploring how obstetric specialists would use tocolytics under nine different clinical scenarios, such as a short cervix, preterm labor, maintenance tocolysis, preterm premature rupture of membranes, etc. Three hundred ten specialists attended the conference, and 77 responded to the survey with a response rate of 24.8%. According to the survey, many of these specialists would prescribe tocolytics for less evidence-based indications, including 22% for abdominal tightness, 46% for a short cervix, 60% for maintenance tocolysis, and 89% for repeat tocolysis, with the preferred first line medication being ritodrine and nifedipine. We concluded that tocolysis is widely accepted and practiced in Taiwan. More research is needed to include Taiwan-specific economic and cultural factors as well as associated adverse effects and patients’ outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tocolytic Treatment for the Prevention of Preterm Birth from a Taiwanese Perspective: A Survey of Taiwanese Obstetric Specialists

Lee

Yeh

Yang

et al. 2022

IJERPH

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“…Currently, the most widely used tocolytic is the CCB group, which is nifedipine. It is said that this drug is quite effective in inhibiting the process of preterm labor, with minimal side effects [18] Previous studies have shown the success of nifedipine in preventing preterm labor and relieving contractions in contractile uterine patients reaching 86.4% and reducing pain scale to 74.28% [19]. Other studies have shown that the success rate of nifedipine therapy as a tocolytic in patients with postpartum prematurus imminens at the Prof. Dr. I.G.N.G.…”

Section: The Role Of Mgso4 and Nifedipine As Management Of Prom In Pr...mentioning

confidence: 99%

Magnesium Sulphate and Nifedipine in Management of Preterm Premature Rupture of Membranes

Aryana

Winata

Setiawan

2022

EJMED

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Premature rupture of membranes (PROM) is defined as rupture before delivery that can occur at any gestational age. If it occurs before 37 weeks of gestation, it’s called Preterm Premature Rupture of Membrane (PPROM). PROM is a condition that still occurs in both developed and developing countries and cause a serious threat to the fetal and maternal well-being if not managed properly. Conservative management is chosen in PPROM until the fetus is viable, consist of hospitalization, assessment of sign of infection, well-being of the fetal and maternal. Spesific treatment includes the administration of corticosteroid, antibiotics, and tocolytics. Tocolytic agents that are widely used as first-line agents are magnesium sulphate (MgSO4) and nifedipine, one of the Calcium Channel Blocker (CCB) groups. MgSO4 and nifedipine both have an effect in reducing myometrial contractility. MgSo4 also has a neuroprotective effect in PPROM less than 31 weeks if there is a threat of delivery within 24 hours. Meta-analysis related to the use of these two agents in PPROM is still subject to differing result. Some studies have shown nifedipine is considered to have milder side effect than MgSO4, more easily tolerated by oral administration, and more affordable. However, some studies have shown that the two agents have the same efficacy. Other studies have shown no significant benefit in administering nifedipine to neonates or prolong pregnancy in women with PPROM without contractions.

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“…The ACS coverage, for instance, ranges from 16-91% across the world. Moreover, prescribing tocolytics in the clinical setting is often symptom-based rather than strictly conforming to the guideline recommendations [14][15][16][17]. Taken together, the highly heterogeneous pathogenesis and clinical presentation of preterm labor require more exploration into variations of clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Use of Medication for Preterm Labor: Retrospective Cohort Study in a Single Tertiary Center in Wuhan, China

Liu¹,

Zhang²,

Zhang³

et al. 2023

Preprint

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Background Prevention and treatment in preterm birth are still under intensive investigation. A gap exists between evidence-based recommendations and clinical practice. A deeper understanding of the prevalence of medication use is an essential step toward improving the care of pregnant women. This study aimed to address this issue.Methods A retrospective cohort was conducted between December 2018 and November 2019 in Tongji Hospital (Wuhan). In total, 878 pregnant women were enrolled. Information on maternal characteristics, medication prescription, maternal outcomes (including post-partum hemorrhage), and neonatal outcomes (including APGAR score, birthweight, neonatal intensive care unit (NICU) admission, cardiopulmonary and neurological diseases) in the linking system were retrieved.Results The overall coverage of the common medications, including antenatal corticosteroids (ACS), magnesium sulfate, tocolytics, and progesterone, was 84.5%, 52.8%, 24.9%, and 13.3%, respectively. The treatment plan varied widely regarding the regimen, dosing, duration, and combination of these drugs. Specifically, tocolytic maintenance, which means the administration duration of more than 48 hours in this study, increased the risk of post-partum hemorrhage; it also significantly increased birthweight, but was not a risk factor of large-for-gestational-age (LGA).Conclusions This retrospective study in a single tertiary center disclosed that obstetric medications for preterm labor are highly individualized and do not strictly conform to current guidelines. This phenomenon is not uncommon in other countries. Clinical practice and evidence-based recommendations need to be carefully balanced; more studies are warranted to provide high-quality evidence to aid clinical decisions.

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Do obstetric units adhere to the evidence-based national guideline? A Germany-wide survey on the current practice of initial tocolysis

Cited by 7 publications

References 37 publications

Tocolytic Treatment for the Prevention of Preterm Birth from a Taiwanese Perspective: A Survey of Taiwanese Obstetric Specialists

Tocolytic Treatment for the Prevention of Preterm Birth from a Taiwanese Perspective: A Survey of Taiwanese Obstetric Specialists

Magnesium Sulphate and Nifedipine in Management of Preterm Premature Rupture of Membranes

Use of Medication for Preterm Labor: Retrospective Cohort Study in a Single Tertiary Center in Wuhan, China

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