Obstet Gynecol Sci.  2015 May;58(3):203-209. 10.5468/ogs.2015.58.3.203.

Practice patterns in the management of threatened preterm labor in Korea: A multicenter retrospective study

• Hwang HS
• Na SH
• Hur SE
• Lee SA
• Lee KA
• Cho GJ
• Oh KY
• Jin CH
• Lee SM
• Shin JE
• Park KH
• Lim JY
• Choi SJ
• Lee JH
• Choi SK
• Shim JY
• Jo YS
• Choi GY
• Kim YH
• Kil KC
• Kim JW
• Kwak DW
• Kang YD
• Kim YJ

• KMID: 2148932
• DOI: http://doi.org/10.5468/ogs.2015.58.3.203

Abstract

OBJECTIVE
This study aimed to examine clinical practice patterns in the management of pregnant women admitted with threatened preterm labor (TPL) in Korea.
METHODS
Data from women admitted with a diagnosis of TPL were collected from 22 hospitals. TPL was defined as regular uterine contractions with or without other symptoms such as pelvic pressure, backache, increased vaginal discharge, menstrual-like cramps, bleeding/show and cervical changes. Data on general patient information, clinical characteristics at admission, use of tocolytics, antibiotics, and corticosteroids, and pregnancy outcomes were collected using an online data collections system.
RESULTS
A total of 947 women with TPL were enrolled. First-line tocolysis was administered to 822 (86.8%) patients. As a first-line tocolysis, beta-agonists were used most frequently (510/822, 62.0%), followed by magnesium sulfate (183/822, 22.3%), calcium channel blockers (91/822, 11.1%), and atosiban (38/822, 4.6%). Of the 822 women with first-line tocolysis, second-line tocolysis were required in 364 (44.3%). Of 364 with second-line, 199 had third-line tocolysis (37.4%). Antibiotics were administered to 29.9% of patients (284/947) with single (215, 22.7%), dual (26, 2.7%), and triple combinations (43, 4.5%). Corticosteroids were administered to 420 (44.4%) patients. Betamethasone was administered to 298 patients (71.0%), and dexamethasone was administered to 122 patients (29.0%).
CONCLUSION
Practice patterns in the management of TPL in Korea were quite various. It is needed to develop standardized practice guidelines for TPL management.

Keyword

Clinical practical pattern; Pregnancy outcome; Premature birth; Threatened preterm labor

MeSH Terms

Adrenal Cortex Hormones
Anti-Bacterial Agents
Back Pain
Betamethasone
Calcium Channel Blockers
Dexamethasone
Diagnosis
Female
Humans
Korea
Magnesium Sulfate
Muscle Cramp
Obstetric Labor, Premature*
Physician's Practice Patterns
Pregnancy
Pregnancy Outcome
Pregnant Women
Premature Birth
Retrospective Studies*
Tocolysis
Tocolytic Agents
Uterine Contraction
Vaginal Discharge
Adrenal Cortex Hormones
Anti-Bacterial Agents
Betamethasone
Calcium Channel Blockers
Dexamethasone
Magnesium Sulfate
Tocolytic Agents

Figure

• 

  Fig. 1 Frequency of hospital admission according to gestational age in women with threatened preterm labor. A trend shows that the number of hospital admission increased in proportion to gestational age.

• 

  Fig. 2 Betamethasone was more frequently used than the dexamethasone (71.0% vs. 29.0%) (A). The completion rate of betamethasone treatment was higher than that of dexamethasone (B,C).

Reference

1. Meloni A, Melis M, Alba E, Deiana S, Atzei A, Paoletti AM, et al. Medical therapy in the management of preterm birth. J Matern Fetal Neonatal Med. 2009; 22:Suppl 3. 72–76.

2. Haas DM, Imperiale TF, Kirkpatrick PR, Klein RW, Zollinger TW, Golichowski AM. Tocolytic therapy: a meta-analysis and decision analysis. Obstet Gynecol. 2009; 113:585–594.

3. Han S, Crowther CA, Moore V. Magnesium maintenance therapy for preventing preterm birth after threatened preterm labour. Cochrane Database Syst Rev. 2013; 5:CD000940.

4. Diguisto C, Le Ray C, Maillard F, Khoshnood B, Verspyck E, Perrotin F, et al. Individual and organisational determinants associated with maintenance tocolysis in the management of preterm labour: a multilevel analysis. PLoS One. 2012; 7:e50788.

5. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008; 371:75–84.

6. Tucker JM, Goldenberg RL, Davis RO, Copper RL, Winkler CL, Hauth JC. Etiologies of preterm birth in an indigent population: is prevention a logical expectation. Obstet Gynecol. 1991; 77:343–347.

7. Savitz DA, Blackmore CA, Thorp JM. Epidemiologic characteristics of preterm delivery: etiologic heterogeneity. Am J Obstet Gynecol. 1991; 164:467–471.

8. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJ. Births: final data for 2008. Natl Vital Stat Rep. 2010; 59:13–71.

9. Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science. 2014; 345:760–765.

10. American College of Obstetricians and Gynecologists. Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 127: management of preterm labor. Obstet Gynecol. 2012; 119:1308–1317.

11. DeFranco EA, Lewis DF, Odibo AO. Improving the screening accuracy for preterm labor: is the combination of fetal fibronectin and cervical length in symptomatic patients a useful predictor of preterm birth? A systematic review. Am J Obstet Gynecol. 2013; 208:233.e1–233.e6.

12. Katz M, Goodyear K, Creasy RK. Early signs and symptoms of preterm labor. Am J Obstet Gynecol. 1990; 162:1150–1153.

13. Copper RL, Goldenberg RL, Davis RO, Cutter GR, DuBard MB, Corliss DK, et al. Warning symptoms, uterine contractions, and cervical examination findings in women at risk of preterm delivery. Am J Obstet Gynecol. 1990; 162:748–754.

14. Brownfoot FC, Gagliardi DI, Bain E, Middleton P, Crowther CA. Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2013; 8:CD006764.

15. Hiersch L, Yogev Y, Domniz N, Meizner I, Bardin R, Melamed N. The role of cervical length in women with threatened preterm labor: is it a valid predictor at any gestational age. Am J Obstet Gynecol. 2014; 211:532.e1–532.e9.

16. Keskin U, Ulubay M, Kurt YG, Fidan U, Kocyigit YK, Honca T, et al. Increased neopterin level and chitotriosidase activity in pregnant women with threatened preterm labor. J Matern Fetal Neonatal Med. 2014; 28:1–5.

17. Heng YJ, Pennell CE, Chua HN, Perkins JE, Lye SJ. Whole blood gene expression profile associated with spontaneous preterm birth in women with threatened preterm labor. PLoS One. 2014; 9:e96901.

18. Van Vliet EO, Boormans EM, de Lange TS, Mol BW, Oudijk MA. Preterm labor: current pharmacotherapy options for tocolysis. Expert Opin Pharmacother. 2014; 15:787–797.

19. Flenady V, Hawley G, Stock OM, Kenyon S, Badawi N. Prophylactic antibiotics for inhibiting preterm labour with intact membranes. Cochrane Database Syst Rev. 2013; 12:CD000246.