Use of steroids, tocolytics and antibiotics in the management of preterm labour in Wales

Abstract

Summary The management of preterm labour (PTL) remains contentious. Many regimes are used for the management of this common condition and in utero transfer of pregnant women to another unit is not unusual in British practice. Medical staff in the accepting unit may have little or no experience with one or more drug regimes used in this condition which used in isolation and in combination with others may have disastrous consequences for the mother. We have assessed the variation in practice for the management of preterm labour in all consultant-led obstetric units in Wales using a postal questionnaire. The percentage of units with written guidelines for the management of PTL was 40%. All units used corticosteroids although the regimes used varied. Fourteen of the 15 units used tocolytics. Ritodrine and nifedipine were the most frequently used tocolytics but there was much variation in practice. Only seven (46.7%) units used antibiotics and five of these were randomising women in PTL to the ORACLE study. Postal surveys may not reflect accurately what actually happens in clinical practice. These data demonstrate that there is no common policy for the management of PTL even in a relatively small region such as Wales. We would suggest that the development of a regional policy for the management of preterm labour would be a significant step forward in the management of this controversial, but important cause of neonatal morbidity and mortality.