Department of Gynecology and Obstetrics, Semmelweis Frauenklinik, Bastiengasse 36-38, A-, 1180, Vienna, Austria.
Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel 18-20, A-, 1090, Vienna, Austria.
BMC Pregnancy Childbirth. 2018 Nov 16;18(1):446. doi: 10.1186/s12884-018-2078-5.
International 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.
A 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.
A 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.
Here, 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.
国际指南建议将保胎治疗限制在单次 48 小时应用。然而，在日常临床实践中，似乎多次保胎治疗和超过 48 小时的维持治疗发挥了作用。我们旨在评估奥地利保胎药物治疗的当前临床实践趋势，并确定循证建议与日常临床实践之间的差异。
本前瞻性多中心注册研究于 2013 年 10 月至 2015 年 4 月在奥地利的 10 个产科部门进行。纳入诊断为先兆早产后接受保胎治疗的年龄≥18 岁的女性，详细记录其临床特征、保胎治疗和妊娠结局。
共纳入 309 名女性。我们观察到每位患者的保胎治疗中位数为 2 个周期（IQR 1-3），每个周期的中位数持续时间为 2 天（IQR 2-5）。41.7%的女性再次接受保胎治疗，导致多达 6 个保胎治疗周期；此外，40.8%的首次保胎治疗周期为维持保胎治疗（即超过 48 小时）。仅 25.6%的女性接受了符合循证建议的单次 48 小时保胎治疗，即接受产前皮质激素促进胎儿肺成熟。
本研究报告了保胎治疗的循证建议与日常实践之间存在明显差异。我们认为，必须重新审视保胎治疗的普遍做法。此外，我们的研究结果强调了需要进行当代研究，以调查维持和/或重复保胎治疗的效果。
