Maintenance tocolysis, tocolysis in preterm premature rupture of membranes and in cervical cerclage – a Germany-wide survey on the current practice after dissemination of the German guideline

Author:

Stelzl Patrick12ORCID,Kehl Sven2,Oppelt Peter1,Mayr Andreas3,Fleckenstein Tobias3,Maul Holger4,Enengl Sabine1,Berger Richard5,Rath Werner6

Affiliation:

1. Universitätsklinik für Gynäkologie, Geburtshilfe und gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz , Austria

2. Frauenklinik, Universitätsklinikum Erlangen , Erlangen , Germany

3. Institut für Medizinische Biometrie, Informatik und Epidemiologie, Medizinische Fakultät, Universität Bonn , Bonn , Germany

4. Frauenkliniken der Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, c/o. Asklepios Klinik Barmbek , Hamburg , Germany

5. Marienhaus Klinikum St. Elisabeth, Klinik für Gynäkologie und Geburtshilfe , Neuwied , Germany

6. Medizinische Fakultät Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel , Kiel , Germany

Abstract

Abstract Objectives To investigate the adherence of German perinatal specialist units and those of basic obstetric care to the national guideline we compared data from a nation-wide survey on the practice of maintenance tocolysis, tocolysis in preterm premature rupture of membranes and in the perioperative setting of cervical cerclage, and bedrest during and after tocolysis with recommendations from the current German Guideline 015/025 “Prevention and Treatment of Preterm Birth”. Methods A total of 632 obstetric clinics in Germany were approached and received a link to an online questionnaire. Data were descriptively analyzed by performing measures of frequency. To compare two or more groups Fisherʼs exact test was used. Results The response rate was 19%; 23 (19.2%) of respondents did not perform maintenance tocolysis, while 97 (80.8%) conducted maintenance tocolysis; 30 (25.0%) of obstetric units performed cervical cerclage without tocolysis and 90 (75.0%) combined cervical cerclage with tocolysis; 11 (9.2%) of respondents did not use tocolytics in patients with preterm premature rupture of membranes, while 109 (90.8%) conducted tocolysis in these patients; 69 (57.5%) of obstetric units did not recommend bed rest during tocolysis, whereas 51 (42.5%) favored bedrest. Perinatal care centers of basic obstetric care recommend bed arrest during tocolysis statistically significant more often to their patients than those of higher perinatal care levels (53.6 vs. 32.8%, p=0.0269). Conclusions The results of our survey are in accordance to others from different countries and reveal considerable discrepancies between evidence-based guideline recommendations and daily clinical practice.

Publisher

Walter de Gruyter GmbH

Subject

Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health

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