Fox Nathan S, Gelber Shari E, Kalish Robin B, Chasen Stephen T
Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA.
Obstet Gynecol. 2008 Jul;112(1):42-7. doi: 10.1097/AOG.0b013e318176158e.
To estimate maternal-fetal medicine specialists' practice patterns and perceived risks and benefits to tocolysis.
We performed a mail-based survey of all Society for Maternal-Fetal Medicine (SMFM) members in the United States. Subjects were asked whether they would recommend tocolysis and what would be their first-line tocolytic in five scenarios: 1) acute preterm labor; 2) maintenance tocolysis after arrested preterm labor; 3) repeat acute preterm labor; 4) preterm premature rupture of membranes (PROM) without contractions; and 5) preterm PROM with contractions.
A total of 827 (46%) SMFM members responded. Ninety-six percent, 56%, 56%, 32%, and 29% would recommend tocolysis for acute preterm labor, repeat acute preterm labor, preterm PROM with contractions, preterm PROM without contractions, and maintenance tocolysis, respectively. The most common first-line tocolytic was magnesium for acute preterm labor (45%) and repeat acute preterm labor (41%); nifedipine was the most common maintenance tocolysis (79%). Eighty percent believed tocolysis was associated with moderate or significant benefit in the setting of acute preterm labor; however, fewer than 50% responded similarly for the other four scenarios. In all five scenarios, more than 50% of respondents indicated there was minimal or no risk associated with tocolysis. Having a nonacademic practice was independently associated with the recommendation for tocolysis.
Almost all maternal-fetal medicine specialists recommend tocolysis in the setting of acute preterm labor, and many recommend tocolysis for other indications. Magnesium and nifedipine are the most commonly prescribed first-line tocolytics.
III.
评估母胎医学专家的治疗模式以及对宫缩抑制剂的潜在风险和益处的认知。
我们对美国母胎医学协会（SMFM）的所有成员进行了一项基于邮件的调查。受试者被问及在以下五种情况下是否会推荐使用宫缩抑制剂以及他们的一线宫缩抑制剂是什么：1）急性早产；2）早产宫缩停止后的维持性宫缩抑制；3）复发性急性早产；4）无宫缩的早产胎膜早破（PROM）；5）有宫缩的早产胎膜早破。
共有827名（46%）SMFM成员回复。对于急性早产、复发性急性早产、有宫缩的早产胎膜早破、无宫缩的早产胎膜早破以及维持性宫缩抑制，分别有96%、56%、56%、32%和29%的成员会推荐使用宫缩抑制剂。急性早产（45%）和复发性急性早产（41%）最常用的一线宫缩抑制剂是硫酸镁；硝苯地平是最常用的维持性宫缩抑制剂（79%）。80%的人认为宫缩抑制剂在急性早产情况下有中度或显著益处；然而，在其他四种情况下，只有不到50%的人有类似的回答。在所有五种情况下，超过50%的受访者表示宫缩抑制剂的风险极小或没有风险。拥有非学术性的临床实践与推荐使用宫缩抑制剂独立相关。
几乎所有母胎医学专家都推荐在急性早产情况下使用宫缩抑制剂，许多人也推荐将宫缩抑制剂用于其他适应症。硫酸镁和硝苯地平是最常用的一线宫缩抑制剂。
III级
