Tocolytic Treatment for the Prevention of Preterm Birth from a Taiwanese Perspective: A Survey of Taiwanese Obstetric Specialists

Abstract

Preterm birth represents a great burden to the healthcare system, resulting in the consideration for the use of tocolytic therapy to provide a “better time” for delivery in order to buy time to accelerate fetal lung maturity, thereby minimizing prematurity-related morbidity and mortality. However, the benefits and potential side effects and risks of tocolytic treatment for preterm birth should be carefully balanced. Although many countries and societies provide guidelines or consensuses for the management for preterm birth, there is no standardized national guideline or consensus in Taiwan. As such, great heterogeneity is suspected in preterm labor management, contributing to the uncertainty of attitudes and practice patterns of obstetric specialists in Taiwan. This study attempts to understand the attitudes and practice patterns regarding tocolytic therapy in Taiwan. A paper-based survey was conducted at the 2020 Taiwan Society of Perinatology Conference on 8 December 2020, exploring how obstetric specialists would use tocolytics under nine different clinical scenarios, such as a short cervix, preterm labor, maintenance tocolysis, preterm premature rupture of membranes, etc. Three hundred ten specialists attended the conference, and 77 responded to the survey with a response rate of 24.8%. According to the survey, many of these specialists would prescribe tocolytics for less evidence-based indications, including 22% for abdominal tightness, 46% for a short cervix, 60% for maintenance tocolysis, and 89% for repeat tocolysis, with the preferred first line medication being ritodrine and nifedipine. We concluded that tocolysis is widely accepted and practiced in Taiwan. More research is needed to include Taiwan-specific economic and cultural factors as well as associated adverse effects and patients’ outcomes.

Is antibiotic exposure associated with an increased risk of developing necrotizing enterocolitis and bronchopulmonary dysplasia in very low birth weight infants?

“…In our limited knowledge, at least two conventional key factors, such as gestational weeks and birth weight are reported to be a strongly independent risk factor associated with worse outcomes of newborns. 4,5 We are wondering to know why the authors did not include two factors for adjusting their targeted item (antibiotics exposure) in their study. Although we do not know the results if the authors would like to re-analyze their data, we supposed that both (gestational weeks and birth weight) may be an important and independent risk factor associated with the development of NEC and BPD.…”

Magnesium Sulphate and Nifedipine in Management of Preterm Premature Rupture of Membranes

“…The goal of low doses is to achieve a reduction in uterine contractions while minimizing the side effects of nifedipine such as headache (most commonly) and hypotension as a result of vasodilation. The maintenance dose is 20 mg every 6-8 hours given orally [17].…”

Use of Medication for Preterm Labor: Retrospective Cohort Study in a Single Tertiary Center in Wuhan, China

“…The ACS coverage, for instance, ranges from 16-91% across the world. Moreover, prescribing tocolytics in the clinical setting is often symptom-based rather than strictly conforming to the guideline recommendations [14][15][16][17]. Taken together, the highly heterogeneous pathogenesis and clinical presentation of preterm labor require more exploration into variations of clinical practice.…”