Hospitalization and Infant Outcomes among Women Exposed and Unexposed to Tocolysis

Abstract

OBJECTIVE:To examine whether infants exposed to tocolytics are at increased risk for selected adverse clinical and hospitalization outcomes. STUDY DESIGN:We conducted a population-based cohort study of women with preterm labor, in Washington State from 1989 to 2001 (N ¼ 79,679), using linked hospitalization records. Relative risks for infant outcomes were estimated using multivariate logistic regression. RESULTS:Adjusted risk estimates for infants exposed to tocolysis were greater for respiratory distress (RR ¼ 1.5, 95% CI 1.4 to 1.6), intubation (RR ¼ 1.4, 95% CI 1.2 to 1.5), and bacterial infection (RR ¼ 1.6, 95% CI 1.4 to 1.8). Exposed infants were also more likely to have birth hospitalizations >2 days (RR ¼ 1.4, 95% CI 1.3 to 1.4), require transfer (RR ¼ 1.5, 95% CI 1.3 to 1.8), have increased hospital costs (RR ¼ 2.3, 95% CI 2.2 to 2.4), and require readmisssion within the first year of life (RR ¼ 1.2, 95% CI 1.1 to 1.3). CONCLUSION:Infants exposed to tocolytics appeared to have relatively poorer hospitalization and clinical outcomes; significant benefits were not observed.

Factors associated with tocolytic hospitalizations in Taiwan: evidence from a population-based and longitudinal study from 1997 to 2004

“…Because our focus was on tocolytic hospitalizations, defined as ICD-9-CM codes 644.0 to 644.4 listed in the diagnosis field, women contraindicated for tocolysis according to the current standard of care and women noted to have additional medical conditions that could have been treated with medications misclassified with tocolysis were also excluded [26]. Those exclusion conditions included hypertension/eclampsia/pre-eclampsia (ICD-9-CM 642), excessive maternal bleeding/abrupted placenta/placenta previa (ICD-9-CM 762.0, 762.1, 762.2), premature rupture of membrances/incompetent cervix (ICD-9-CM 761), fetal distress (ICD-9-CM 656.3, 663.0, 768.3 and 768.4), maternal infection/chorioamnionitis (ICD-9-CM 762.7), and congenital abnormalities (ICD-9-CM 740-759).…”

Mind the information gap: fertility rate and use of cesarean delivery and tocolytic hospitalizations in Taiwan

“…One of the most common causes for antenatal hospitalizations is symptoms due to preterm labor and is often treated with tocolytic therapy [19]. However, the effectiveness of inpatient tocolysis for preterm labor remains unclear and no guideline for the appropriate use exists, leaving the treatment at the physician's discretion [19-21]. An interesting fact to note in Taiwan is that the use of inpatient tocolysis has remained relatively stable while the number of newborns has declined significantly.…”

“…We then followed a recent study by Coleman et al [21] to define inpatient tocolytic hospitalization as having one of the following ICD-9-CM codes: 644.00, 644.03, 644.10, and 644.13. In the hospital discharge file, each patient record had one principal diagnosis, as listed in the ICD-9-CM, and up to four secondary diagnoses.…”

“…We identified tocolytic hospitalization from the primary and secondary diagnosis. Following Coleman et al's approach,[21] we further excluded women contraindicated for tocolysis according to the current standard of care and women noted to have additional medical conditions that could have been treated with medications misclassified with tocolysis, because these conditions required either immediate c-section or termination of pregnancy, including ICD-9-CM codes 642, 762.0, 762.1, 762.2, 761, 656.3, 663.0, 768.3, 768.4, 762.7, and 740-759. Based on these definitions, a total of 96,838 tocolytic hospitalizations were identified.…”