Differences between Current Clinical Practice and Evidence-Based Guideline Recommendations Regarding Tocolysis - an...

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Clinical Practice Guidelines

Background:

• National guidelines for preterm birth prevention and therapy (AWMF Guideline 015-025) were implemented in Austria.
• Understanding current clinical practices in tocolysis is crucial for improving maternal and neonatal outcomes.

Purpose of the Study:

• To evaluate the adherence of Austrian obstetricians to national guideline recommendations for tocolysis.
• To investigate current practices regarding tocolysis indications, timing, monitoring, drug choice, side effects, and patient discharge recommendations.

Main Methods:

• A nationwide web-based survey was conducted among 78 Austrian obstetric departments between June 5th and August 31st, 2023.
• Data were analyzed descriptively, with Fisher's exact test used for group comparisons.
• The survey focused on practices approximately one year after the guideline's implementation.

Main Results:

• The response rate was 69.2%. Key indications for tocolysis included ≥4 contractions within 20 minutes (48.1%).
• The AWMF Guideline was the primary decision-making support (61.1%). Tocolysis initiation occurred earliest at 23+0 weeks gestation in 35.2% of units.
• Atosiban was the first-line agent (79.6%), followed by nifedipine (13.0%). Maintenance tocolysis was common (90.7%), often based on specific indications.
• Serious side effects were reported by 77.8%, primarily with hexoprenaline use.

Conclusions:

• Significant discrepancies exist between evidence-based tocolysis guidelines and current clinical practice in Austrian hospitals.
• These findings underscore the need for improved guideline implementation and adherence in obstetric care.
• Further research may be warranted to explore reasons for these discrepancies and develop targeted interventions.