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Optimising maternal-fetal outcomes in preterm labour: a decision analysis
G A Macones1, T J Bader, D A Asch
1Department of Obstetrics and Gynaecology, University of Pennsylvania School of Medicine, Philadelphia, USA.
British Journal of Obstetrics and Gynaecology
|June 24, 1998
Summary
For preterm labor after 32 weeks, empiric tocolysis is best at 32 weeks. At 34 weeks, tocolysis or no tocolysis are similar, while at 36 weeks, no tocolysis is preferred. Amniocentesis is not recommended.
Area of Science:
- Maternal-Fetal Medicine
- Decision Analysis
- Obstetrics
Background:
- Preterm labor management strategies vary, impacting maternal and fetal outcomes.
- Decision analytic techniques can model risks and benefits of different interventions.
- Fetal maturity testing via amniocentesis is one potential management component.
Purpose of the Study:
- To compare maternal and fetal risks and benefits of three preterm labor management strategies after 32 weeks gestation.
- Strategies evaluated: empiric tocolysis, no tocolysis, and amniocentesis for fetal maturity testing.
- To determine optimal management based on gestational age.
Main Methods:
- Decision trees were constructed for hypothetical patient cohorts at 32, 34, and 36 weeks gestation.
- Probabilities for tocolysis efficacy, maternal/neonatal outcomes, and steroid efficacy were derived from published literature.
- Primary outcome: total expected adverse maternal and neonatal events per strategy and gestational age.
Main Results:
- At 32 weeks gestation, empiric tocolysis resulted in the fewest adverse maternal and neonatal events.
- At 34 weeks gestation, tocolysis and no tocolysis demonstrated comparable overall outcomes.
- At 36 weeks gestation, outcomes were generally favorable irrespective of the management strategy employed.
Conclusions:
- Empiric tocolysis is supported for preterm labor at 32 weeks gestation.
- At 34 weeks, both tocolysis and no tocolysis represent reasonable management alternatives.
- No tocolysis appears preferable at 36 weeks; amniocentesis is not advised for preterm labor management at these gestations.