Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth

Abstract

Objective To describe spontaneous preterm birth prevention practices self‐reported before and after the dissemination of relevant guidelines, and to identify personal and organisational factors associated with adherence. Design A repeated cross‐sectional vignette‐based survey study. Setting French obstetricians. Population French obstetricians practicing in public or private maternity units. Methods Before and after the dissemination of the 2017 French guidelines on the prevention of spontaneous preterm birth, participants were asked to complete a web‐based self‐administered questionnaire based on two clinical vignettes. Vignette 1 focused on respondents’ attitudes towards strict bed rest, cerclage, and progesterone treatment for women with a short cervix in mid‐trimester; vignette 2 focused on attitudes towards strict bed rest and maintenance tocolysis after successful tocolysis for preterm labour. A mixed quantitative and qualitative analysis was conducted. Main outcome measures Non‐adherence to guidelines for the prevention of spontaneous preterm birth in responses to each vignette. Results We obtained complete responses from 286 obstetricians before and 282 obstetricians after guideline dissemination, including 145 obstetricians participating in both. After dissemination, 51.4% of obstetricians self‐reported non‐adherent practices for vignette 1 and 22.3% of obstetricians self‐reported non‐adherent practices for vignette 2. No improvement was observed after dissemination. The quantitative analysis identified factors associated with non‐adherence, including older age and practice in non‐university or small hospitals, whereas the qualitative analysis highlighted barriers to implementation, including fear of change, habits, work overload, and lack of time. Conclusions Adherence to guidelines was generally low, with practices unmodified by their dissemination. Improvement is required, especially regarding applicability. Tweetable abstract Adherence to guidelines to prevent spontaneous preterm birth was generally low and remained unmodified after guideline dissemination.

How common is substandard obstetric care in adverse events of birth asphyxia, shoulder dystocia and postpartum hemorrhage? Findings from an external inspection of Norwegian maternity units

“…However, it is an important administrative responsibility to ensure that health personnel have the qualifications required, are familiar with the guidelines and follow the recommendations. More time and funding should probably be spent on implementation of guidelines and training the staff to use them more effectively 6,22‐24 …”

“…However, breaches of the standard of care are still common. This may imply that not all obstetric health personnel are familiar with the guidelines and their competence levels need to be improved 22,28,29 …”

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

“…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.…”

“…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 ].…”

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“…Furthermore, bed‐rest increases the risk of significant physical, psychological, emotional and economic harm to the woman and her family. Despite this, clinicians continue to recommend this treatment modality, 6,14 often under duress from the high‐risk patient who wants to believe ‘she has done everything she can’ to prevent another preterm birth.…”