目的:目前的国际指南建议先兆早产患者在妊娠34周前进行宫内保胎治疗至少48小时以完成胎儿肺成熟,并确保宫内转移到围产期中心。根据以前的调查结果,关于保胎治疗的日常临床实践模式和循证指南建议之间存在显著差异.我们比较了一项全国范围内关于初次分娩的调查数据与当前德国指南015/025“早产的预防和治疗”的建议。
方法:德国的632个产科单位在2020年1月20日至3月31日之间收到了一个在线问卷的链接,该问卷是根据国家和国际建议和指南开发的。通过执行频率测量对收集的数据进行描述性分析。
结果:反应率为19%;51(42.5%)的受访者认为CTG追踪在20分钟内出现≥4次收缩,49(40.8%)宫颈长度测量≤25mm,13(10.9%)主观收缩是最重要的宫缩决策标准;47(39.2%)个产科单元最早在230开始宫缩,34(28.3%)在220开始,26(21.7%)在235和13(10.8%)在240周开始妊娠;妊娠的104(86.7%)42个(35.0%)产科单位在妊娠23周5周给予产前皮质类固醇,在220周给予16个(13.3%),在240周给予13个(10.8%)。钙通道阻滞剂是59个(49.1%)产科单位使用的一线保胎药物,其次是静脉内注射β-类似物(n=26,21.7%)和阿托西班(n=20,16.7%)。105名(70%)的受访者观察到严重的副作用,14(9.3%)使用硝苯地平和30(20.0%)使用硝化甘油贴剂。德国指南被78(65%)的产科单位认为是最重要的决策支持,其次是医院特定的SOP/算法(n=31,25.8%)。
结论:我们的调查强调了循证指南建议与日常临床实践之间的巨大差异。
OBJECTIVE: Current international guidelines recommend tocolytic treatment by at least 48 h to complete fetal lung maturation and to ensure in-utero transfer to a perinatal center before 34 weeks of gestation in patients with threatened preterm birth. According to the results of former surveys, significant differences between daily clinical practice patterns and evidence-based guideline recommendations regarding tocolytic treatment have been demonstrated. We compared data from a nation-wide survey on the practice of initial tocolysis with recommendations from the current German Guideline 015/025 \"Prevention and Treatment of Preterm Birth\".
METHODS: 632 obstetric units in Germany received a link to an online questionnaire between January 20th and March 31st 2020, which was developed according to national and international recommendations and guidelines. Collected data was descriptively analyzed by performing measures of frequency.
RESULTS: The response rate was 19%; 51 (42.5%) of the respondents consider CTG tracing with ≥ 4 contractions within 20 min, 49 (40.8%) cervical length measurement of ≤ 25 mm and 13 (10.9%) subjective contractions as the most significant decision-making criteria for tocolysis; 47 (39.2%) of obstetric units initiate tocolysis earliest at 23 + 0, 34 (28.3%) at 22 + 0, 26 (21.7%) at 23 + 5 and 13 (10.8%) at 24 + 0 weeks of gestation; 104 (86.7%) stop tocolysis latest at the 34 + 0 weeks of gestation, 42 (35.0%) obstetric units administer antenatal corticosteroids at 23 + 5, 16 (13.3%) at 22 + 0, and 13 (10.8%) at 24 + 0 weeks of gestation. Calcium channel blockers are the first-line tocolytic drug used by 59 (49.1%) of the obstetric units, followed by intravenous betamimetics as bolus (n = 26, 21.7%) and atosiban (n = 20, 16.7%). Severe side-effects were observed by 105 (70%) of the respondents in association with the use of betamimetics, 14 (9.3%) with the use of nifedipine and 30 (20.0%) with nitroglycerine patches. The German guideline was considered the most important decision-making support by 78 (65%) of the obstetric units, followed by hospital specific SOPs/algorithms (n = 31, 25.8%).
CONCLUSIONS: Our survey highlights a considerable discrepancy between evidence-based guideline recommendations and daily clinical practice.