Insights into tocolytic use and preterm birth management: a Swiss cross-sectional survey

Summary

STUDY AIMS: Premature birth is the leading cause of neonatal morbidity and mortality. Tocolytics aim to temporarily inhibit preterm contractions, allowing time for lung maturation induction, which reduces neonatal complications. Guidelines recommend limiting tocolysis to 48 hours and avoiding its use beyond 34 weeks of gestation. However, international surveys indicate that clinical practice often deviates from guidelines, revealing a gap between evidence-based recommendations and real-world practice. We aimed to evaluate current practices in the use of tocolysis and antenatal corticosteroid treatment in Switzerland and their alignment with international and national guidelines for preterm birth management.

METHODS: This national cross-sectional survey (15 February to 30 May 2024) used an anonymous online questionnaire distributed to 94 chief physicians of obstetric departments and 481 private-practice gynaecologists via e-mail, as well as through newsletters and social media channels of the Swiss Society of Gynaecology and Obstetrics in German, French and Italian. Chief physicians were contacted through the Chief Physicians’ Conference e-mail list and asked to share the survey with their medical teams. Private-practice gynaecologists were reached via practice e-mail addresses obtained through the authors’ personal networks and a clinic internal directory, as no centralised registry exists. Eligible participants were those actively involved in obstetrics or pregnancy care. The primary outcomes were duration and timing of tocolysis. Data is shown for the overall cohort and stratified by physician group (hospital, private-practice and attending physicians). The estimated response rate among specialists was 13% overall, with higher participation by hospital physicians (25%) and lower participation by private-practice physicians (8%).

RESULTS: A total of 319 obstetricians participated in the survey (201 hospital, 68 private-practice and 50 attending physicians). Maintenance tocolysis was still practiced by 54% of survey participants. While 80% of the respondents adhered to international/national guidelines by limiting tocolysis to 34 weeks of gestation, 20% reported administering tocolytics beyond this point. Tocolysis was primarily used in cases of preterm labour; in contrast, its use in premature preterm rupture of membranes without contractions was limited, with most physicians administering it only during antenatal corticosteroid treatment administration. Furthermore, similarities were observed among physician groups in prioritising indications and contraindications for tocolysis, but variations existed in the use of tocolytics in special situations (e.g. high-risk pregnancies or cervical cerclage).

CONCLUSION: Most participating Swiss obstetricians adhere to existing guidelines for preterm birth management, but discrepancies remain – particularly regarding tocolysis for longer than 48 hours and after 34 weeks of gestation. Enhanced education and improved implementation strategies are needed to bridge gaps and promote a more unified approach in line with current evidence.