Abstract
BackgroundInternational guidelines recommend that tocolytic therapy be restricted to a single 48-h application. However, multiple cycles of tocolytic therapy and maintenance therapy that exceeds 48 h appear to play a role in daily clinical practice. We aimed to evaluate current trends in clinical practice with respect to treatment with tocolytic agents and to identify differences between evidence-based recommendations and daily clinical practice in Austria.MethodsA prospective multicenter registry study was conducted from October 2013 through April 2015 in ten obstetrical departments in Austria. Women ≥18 years of age who received tocolytic therapy following a diagnosis of threatened preterm birth were included, and details were obtained regarding clinical characteristics, tocolytic therapy, and pregnancy outcome.ResultsA total of 309 women were included. We observed a median of 2 cycles of tocolytic therapy per patient (IQR 1–3) with a median duration of 2 days per cycle (IQR 2–5). Repeat tocolysis was administered in 41.7% of women, resulting in up to six tocolysis cycles; moreover, 40.8% of the first tocolysis cycles were maintenance tocolysis (i.e., longer than 48 h). Only 25.6% of women received one single 48-h tocolysis cycle in which they received antenatal corticosteroids for fetal lung maturation in accordance evidence-based recommendations.ConclusionsHere, we report a clear disparity between evidence-based recommendations and daily practice with respect to tocolysis. We believe that the general practice of prescribing tocolytic therapy must be revisited. Furthermore, our findings highlight the need for contemporary studies designed to investigate the effectiveness of performing maintenance and/or repetitive tocolysis treatment.
Highlights
Gestational age and birth weight are major contributors to neonatal morbidity and mortality [1, 2]
Tocolytic agents have been shown to slightly prolong pregnancy in the setting of preterm labor (PTL), evidence regarding a general improvement in neonatal outcome is currently lacking [5, 9, 10]; a positive effect of tocolysis on neonatal outcome is evident only when Preterm birth (PTB) is delayed long enough to allow the use of antenatal corticosteroids for promoting fetal lung maturation [11]
With respect to neonatal outcomes, we found that women in the non-Evidence based (EVB) group delivered babies (i) at earlier gestational age (GA) (ii) with lower weight, who (iii) had to be transferred to a neonatal intensive care unit more often when compared to women in the EVB group
Summary
Gestational age and birth weight are major contributors to neonatal morbidity and mortality [1, 2]. Nazifovic et al BMC Pregnancy and Childbirth (2018) 18:446 morbidity or mortality, as well as long-term outcome, is still a matter of debate. Tocolytic agents have been shown to slightly prolong pregnancy in the setting of PTL, evidence regarding a general improvement in neonatal outcome is currently lacking [5, 9, 10]; a positive effect of tocolysis on neonatal outcome is evident only when PTB is delayed long enough to allow the use of antenatal corticosteroids for promoting fetal lung maturation [11].
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