European survey reveals widespread, varied intrapartum tocolysis practices, favoring betamimetics and oxytocin receptor antagonists.
Background
Intrapartum acute tocolysis is a critical intervention used to temporarily reduce uterine activity during labor, primarily in situations like uterine tachysystole or suspected intrapartum fetal hypoxia. Despite its frequent clinical application, there is a notable lack of robust evidence supporting its effectiveness and safety. This gap contributes to inconsistent guidance regarding appropriate indications, the optimal choice of tocolytic agents, and their administration protocols, leading to significant variability in practice across healthcare settings.
Study Design
A cross-sectional, questionnaire-based survey was conducted among European obstetricians and midwives involved in intrapartum care between March and April 2023. The survey comprised 15 questions across two sections, covering respondent demographics, institutional characteristics, and detailed practices of intrapartum acute tocolysis. Key areas explored included first- and second-line tocolytic agents, frequency of use, clinical indications, routes of administration, contraindications, and the availability of local protocols. The online questionnaire was disseminated through professional obstetric and midwifery networks, gathering 217 responses for analysis.
Results
A total of 217 responses were analyzed, predominantly from healthcare professionals in hospital settings (96.8%). Intrapartum acute tocolysis was reported by a significant 85.7% (186/217) of respondents. The primary indications for its use were consistently identified as suspected intrapartum fetal hypoxia and uterine tachysystole. Regarding agents, betamimetics were the most frequently reported (63.4%), followed by oxytocin receptor antagonists (42.1%), though substantial regional variations were observed in agent preference. Most respondents administered tocolysis intravenously (90.8%).
Key Findings
- 85.7% of European healthcare professionals use intrapartum acute tocolysis.
- Main indications are suspected intrapartum fetal hypoxia and uterine tachysystole.
- Betamimetics are the most common agents (63.4%), followed by oxytocin receptor antagonists (42.1%).
- Most tocolysis is administered intravenously (90.8%), with 62.7% using bolus and 37.3% continuous infusion.
- Significant regional variations exist in the choice of tocolytic agents and contraindications.
Why It Matters
The survey highlights a significant reliance on intrapartum tocolysis across Europe, yet reveals considerable heterogeneity in practice, particularly concerning agent choice and administration. Standardizing protocols for intrapartum tocolysis is crucial to improve patient safety and outcomes. The widespread use of betamimetics and oxytocin receptor antagonists, like atosiban, underscores the need for more evidence-based guidelines to inform their optimal application. This variability suggests that current clinical translation is inconsistent, indicating a need for clearer, universally adopted protocols to ensure consistent, high-quality care for women experiencing complications during labor.
tocolysis
intrapartum-care
obstetrics
survey
betamimetics
oxytocin-receptor-antagonists