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

Patrick Stelzl; Sven Kehl; Peter Oppelt; Andreas Mayr; Tobias Fleckenstein; Holger Maul; Sabine Enengl; Richard Berger; Werner Rath

doi:10.1515/jpm-2022-0572

Artikel

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

Patrick Stelzl , Sven Kehl , Peter Oppelt , Andreas Mayr , Tobias Fleckenstein , Holger Maul , Sabine Enengl , Richard Berger und Werner Rath

Veröffentlicht/Copyright: 28. März 2023

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Aus der Zeitschrift Journal of Perinatal Medicine Band 51 Heft 6

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.

Keywords: bed rest; cervical cerclage; German-wide survey; maintenance tocolysis; preterm premature rupture of membranes

Corresponding author: Dr. Patrick Stelzl, Universitätsklinik für Gynäkologie, Geburtshilfe und gynäkologische Endokrinologie, Kepler Universitätsklinikum Johannes Kepler Universität Linz, Altenberger Str. 69, 4040 Linz, Austria; and Frauenklinik, Universitätsklinikum Erlangen, Universitätsstrasse 21 – 23, 91054 Erlangen, Germany, E-mail: patrick.stelzl@kepleruniklinikum.at

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: Not applicable.

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Received: 2022-11-25

Accepted: 2023-02-26

Published Online: 2023-03-28

Published in Print: 2023-07-26

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Artikel in diesem Heft

https://doi.org/10.1515/jpm-2022-0572

Schlagwörter für diesen Artikel

bed rest; cervical cerclage; German-wide survey; maintenance tocolysis; preterm premature rupture of membranes