Differences between Current Clinical Practice and Evidence-Based Guideline Recommendations Regarding Tocolysis – an Austria-wide Survey

Abstract

Introduction

To evaluate the adherence of Austrian obstetricians to national guideline recommendations by investigating data on the current practice of tocolysis regarding indications, timing and monitoring of tocolysis, choice of tocolytics and serious side effects, maintenance tocolysis, support of decision-making and recommendations at patient’s discharge from the hospital.

Materials and Methods

78 obstetric departments in Austria were invited to participate in a nationwide survey between June 5^th and August 31^st 2023 by answering a web-based questionnaire about clinical standards. The survey was conducted approximately one year after implementation of the AWMF Guideline “Prevention and Therapy of Preterm Birth” 015‑025. Collected data were analyzed descriptively by performing measures of frequency. Fisher’s exact test was used for group comparison.

Results

The response rate was 69.2% (33.3% perinatal centers, 66.7% standard care). The most important indication of tocolysis were ≥ 4 contractions within 20 minutes of CTG tracing, as stated by 26 (48.1%) of the respondents; the AWMF Guideline 015‑025 (2022) was the most important decision-making support for tocolytic treatment (61.1%). 19 (35.2%) of obstetric units started tocolysis earliest at 23 + 0 weeks of gestation. Atosiban was the first-line tocolytic drug used by 43 (79.6%) of obstetric units, followed by nifedipine (n = 7, 13.0%); 49 of 54 obstetric units (90.7%) stated to perform maintenance tocolysis, among these 46 (93.9%) not routinely but on special indications (e.g. placenta previa). Serious side effects were observed by 77.8% of the respondents, mostly associated with the use of hexoprenaline.

Conclusions

Our survey revealed considerable discrepancies between evidence-based guideline recommendations and daily clinical practice in Austrian hospitals.

Zusammenfassung

Einleitung

Ziel dieser Studie war es, die Einhaltung von Empfehlungen in nationalen Leitlinien durch Geburtshelfer*innen in Österreich zu bewerten. Dazu wurden Daten zur aktuellen Praxis der Tokolyse hinsichtlich Indikation, Zeitpunkt und Überwachung der Tokolyse, Wahl des Tokolytikums und schwerwiegende Nebenwirkungen, Erhaltungstokolyse, Entscheidungshilfe und Empfehlungen bei Entlassung der Patientin aus dem Krankenhaus untersucht.

Material und Methoden

Zwischen dem 5. Juni und dem 31. August 2023 wurden 78 geburtshilfliche Abteilungen in Österreich zur Teilnahme an einer landesweiten Erhebung aufgefordert, indem sie einen Online-Fragebogen über klinische Standards beantworten sollten. Die Erhebung wurde ungefähr 1 Jahr nach Einführung der AWMF-Leitlinie „Prävention und Therapie der Frühgeburt“ 015‑025 durchgeführt. Die deskriptive Analyse der erhobenen Daten erfolgte mittels Häufigkeitsanalysen. Der Exakte Fisher-Test wurde für Gruppenvergleiche eingesetzt.

Ergebnisse

Die Rücklaufquote betrug 69,2% (33,3% Perinatalzentren, 66,7% Zentren der Grund- und Regelversorgung). Laut 26 (48,1%) der Befragten war die wichtigste Indikation zur Einleitung einer Tokolyse eine CTG-Aufzeichnung von ≥ 4 Wehen/20 Minuten; die AWMF-Leitlinie 015‑025 (2022) stellte die wichtigste Entscheidungshilfe für eine tokolytische Behandlung dar (61,1%). 19 (35,2%) der geburtshilflichen Abteilungen haben frühestens in der 23 + 0 Schwangerschaftswoche mit einer Tokolyse begonnen. Tokolytikum der ersten Wahl war das Mittel Atosiban, das von 43 (79,6%) geburtshilflichen Abteilungen eingesetzt wurde, gefolgt von Nifedipin (n = 7, 13,0%); 49 von 54 geburtshilflichen Abteilungen (90,7%) gaben an, dass sie eine Erhaltungstokolyse verabreichen, wobei 46 (93,9%) diese nicht routinemäßig, sondern nur bei besonderen Indikationen (z. B. Placenta praevia) einsetzen. Schwerwiegende Nebenwirkungen wurden von 77,8% der Umfrageteilnehmer*innen beobachtet, meist in Verbindung mit dem Einsatz von Hexoprenalin.

Schlussfolgerungen

Unsere Erhebung zeigte beträchtliche Diskrepanzen zwischen den evidenzbasierten Empfehlungen der Leitlinie und der täglichen klinischen Praxis in österreichischen Krankenhäusern auf.

Keywords

preterm birth - tocolysis - survey - clinical practice - guideline recommendations

Schlüsselwörter

Frühgeburt - Tokolyse - Erhebung - klinische Praxis - Leitlinienempfehlungen

Publikationsverlauf

Eingereicht: 16. September 2024

Angenommen nach Revision: 19. Oktober 2024

Artikel online veröffentlicht:
28. November 2024

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