Management of threatened preterm delivery in France: a national practice survey (the EVAPRIMA study)

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 115; no. 12; pp. 1538 - 1546
• Main Authors: Parant, O, Maillard, F, Tsatsaris, V, Delattre, M, Subtil, D, Goffinet, F
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-11-2008; Blackwell; Wiley Subscription Services, Inc
• Subjects: Abortion, Threatened - diagnosis; Abortion, Threatened - prevention & control; Adrenal Cortex Hormones - therapeutic use; Biological and medical sciences; Corticosteroid therapy; Cross-Sectional Studies; Diseases of mother, fetus and pregnancy; Female; France; guidelines; Gynecology. Andrology. Obstetrics; Hospitalization - statistics & numerical data; Hospitals, Maternity - statistics & numerical data; Humans; Maternal Age; Medical sciences; Medical treatment; Obstetric Labor, Premature - diagnosis; Obstetric Labor, Premature - prevention & control; Obstetrics; Parity; Perinatal Care - standards; Physical Examination; practice survey; Pregnancy; Pregnancy Trimesters; Pregnancy. Fetus. Placenta; Premature labor; Professional Practice - standards; Random Allocation; threatened preterm delivery; tocolysis; Tocolytic Agents - therapeutic use; France; Clinical management; Treatment; Pregnancy disorders; Gynecology; Premature delivery; Obstetrics; Public health
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2008.01929.x

Objectives  To describe the management of threatened preterm delivery (TPD) in France 3 years after publication of the French guidelines and to analyse the factors of variation of the practices observed.
Design  Population‐based study.
Setting  Representative sample of French maternity units. The study included 107 hospitals, accounting for 20% of all French maternity units.
Population  Women hospitalised for TPD during May 2005.
Methods  Cross‐sectional national practice survey.
Results  Of the 734 admissions for TPD, 12.1% involved premature rupture of membranes and 12.9% were in utero transfers. Women admitted for TPD accounted for roughly 6% of all annual deliveries, regardless of the unit’s level of care, and 42.4% of these women delivered preterm: none delivered before 32 weeks in level 1 maternity units, 11.6% in level 2 and 88.4% in level 3. Transvaginal cervical ultrasound was performed for 54.5% of the women with intact membranes. Tocolysis was administered in 87.1% of women with intact membranes, with 45.6% of such women receiving this intervention for longer than 48 hours. First‐line tocolytics used were calcium channel blockers (53.7%), beta‐agonists (34.7%) or atosiban (8.8%), but their distribution differed substantially according to level of care. Maintenance tocolysis was administered to 385 women (59.8%) with intact membranes. Of the women admitted before 34 weeks, 21.1% did not receive corticosteroids.
Conclusions  Practices for the management of TPD vary widely and appear to depend on the level of care. Some practices appear less than optimal, especially those related to duration of tocolysis, maintenance tocolysis, antenatal corticosteroid and use of cervical ultrasound.