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Differences between evidence-based recommendations and actual clinical practice regarding tocolysis: a prospective

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International guidelines suggest a single 48-hour tocolytic therapy cycle. However, Austrian clinical practice frequently involves multiple tocolysis cycles exceeding 48 hours, indicating a significant gap between recommendations and real-world application.

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Area of Science:

  • Obstetrics and Gynecology
  • Pharmacology
  • Clinical Practice Research

Background:

  • International guidelines recommend a single 48-hour course of tocolytic therapy.
  • Current clinical practice may involve multiple cycles and extended maintenance therapy.
  • Discrepancies between guidelines and practice warrant investigation.

Purpose of the Study:

  • To evaluate current trends in tocolytic therapy administration in Austria.
  • To identify differences between evidence-based recommendations and clinical practice.
  • To assess the utilization of repeat and maintenance tocolysis.

Main Methods:

  • Prospective, multicenter registry study conducted in ten Austrian obstetrical departments.
  • Inclusion of women aged 18 years or older diagnosed with threatened preterm birth.
  • Data collection on clinical characteristics, tocolytic therapy details, and pregnancy outcomes.

Main Results:

  • 309 women were included in the study.
  • A median of 2 tocolysis cycles (IQR 1-3) were administered per patient, with a median duration of 2 days per cycle.
  • Repeat tocolysis occurred in 41.7% of women, and 40.8% of initial cycles were maintenance tocolysis (>48 hours). Only 25.6% received a single 48-hour cycle with antenatal corticosteroids.

Conclusions:

  • A clear disparity exists between evidence-based recommendations and current Austrian clinical practice regarding tocolysis.
  • The general practice of prescribing tocolytic therapy requires re-evaluation.
  • Further studies are needed to investigate the effectiveness of maintenance and repetitive tocolysis treatments.