Abstract

ALVES, Maria; BERNARDES, João; REYNOLDS, Ana  and  SANTOS, Ricardo. Guidelines for preterm labour management: a comparative analysis of the Portuguese national reality. Acta Obstet Ginecol Port [online]. 2018, vol.12, n.2, pp.106-117. ISSN 1646-5830.

Overview and Aims: Preterm labour (PTL) represents 7-8% of all Portuguese labours. Its management is marked by ongoing controversies, resulting in systematic variability in management in different institutions. We present an assessment of agreement among national and international PTL management guidelines. Methods: A search for PTL management guidelines was performed. The following contents were extracted: Definition of Threatened PTL (TPTL) or Established (EPTL), Prevention, Diagnosis, Tocolysis, Fetal Lung Maturation and Neuroprotection. An interguideline agreement analysis was performed using a consensus obtained through a modified Delphi approach. A score of 1, 0.5 or 0 was given, for "agreement" (similar clinical significance), "partial disagreement" (differences with possible clinical significance) and "disagreement" (differences with clinical significance), respectively. Median inter-guideline agreement scores (MCct) and inter-observer Proportions of Agreement were calculated. Results: Five national protocols fulfilled selection criteria. Four international guidelines were also considered: WHO, ACOG, NICE and European Association of Perinatal Medicine. Nationwide, more significant inter-guideline disagreements related to definition of EPTL, Prevention and Diagnosis, with MCct of 0,25. TPTL, Tocolysis, Fetal Pulmonary Maturation and Neuroprotection were similarly agreeing, with MCct of 0,5. In international guidelines only four clinical categories were analyzed, with Neuroprotection achieving a MCct of 0,75; EPTL and Pulmonary Maturation reaching a MCct of 0,25; and Tocolysis presenting the lowest MCct of 0,00. Discussion: There are differences among the PTL management guidelines published internationally and in Portugal that may have clinical significance. Further research is warranted to evaluate the potential for assembling a wider national consensus through more explicit health policies.

Keywords : Child mortality; Obstetric labor; Premature; Neuroprotective agents; Tocolysis.

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