Unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort)

Abstract After preterm premature rupture of membranes (PPROM), antibiotics and antenatal steroids are effective evidence-based interventions, but the use of tocolysis is controversial. We investigated whether a unit policy of tocolysis use after PPROM is associated with prolonged gestation and impro...

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Autores principales:	Elsa Lorthe, Carla Moreira, Tom Weber, Lene D. Huusom, Stephan Schmidt, Rolf F. Maier, Pierre-Henri Jarreau, Marina Cuttini, Elizabeth S. Draper, Jennifer Zeitlin, Henrique Barros, The EPICE research group
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4bb321d5eb644f26bde18eca9e025d87
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spelling	oai:doaj.org-article:4bb321d5eb644f26bde18eca9e025d872021-12-02T17:52:33ZUnit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort)10.1038/s41598-020-65201-y2045-2322https://doaj.org/article/4bb321d5eb644f26bde18eca9e025d872020-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-65201-yhttps://doaj.org/toc/2045-2322Abstract After preterm premature rupture of membranes (PPROM), antibiotics and antenatal steroids are effective evidence-based interventions, but the use of tocolysis is controversial. We investigated whether a unit policy of tocolysis use after PPROM is associated with prolonged gestation and improved outcomes for very preterm infants in units that systematically use these other evidence-based treatments. From the prospective, observational, population-based EPICE cohort study (all very preterm births in 19 regions from 11 European countries, 2011–2012), we included 607 women with a singleton pregnancy and PPROM at 24–29 weeks’ gestation, of whom 101, 195 and 311 were respectively managed in 17, 32 and 45 units with no-use, restricted and liberal tocolysis policies for PPROM. The association between unit policies and outcomes (early-onset sepsis, survival at discharge, survival at discharge without severe morbidity and survival at two years without gross motor impairment) was investigated using three-level random-intercept logistic regression models, showing no differences in neonatal or two-year outcomes by unit policy. Moreover, there was no association between unit policies and prolongation of gestation in a multilevel survival analysis. Compared to a unit policy of no-use of tocolysis after PPROM, a liberal or restricted policy is not associated with improved obstetric, neonatal or two-year outcomes.Elsa LortheCarla MoreiraTom WeberLene D. HuusomStephan SchmidtRolf F. MaierPierre-Henri JarreauMarina CuttiniElizabeth S. DraperJennifer ZeitlinHenrique BarrosThe EPICE research groupNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 10, Iss 1, Pp 1-12 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Elsa Lorthe Carla Moreira Tom Weber Lene D. Huusom Stephan Schmidt Rolf F. Maier Pierre-Henri Jarreau Marina Cuttini Elizabeth S. Draper Jennifer Zeitlin Henrique Barros The EPICE research group Unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort)
description	Abstract After preterm premature rupture of membranes (PPROM), antibiotics and antenatal steroids are effective evidence-based interventions, but the use of tocolysis is controversial. We investigated whether a unit policy of tocolysis use after PPROM is associated with prolonged gestation and improved outcomes for very preterm infants in units that systematically use these other evidence-based treatments. From the prospective, observational, population-based EPICE cohort study (all very preterm births in 19 regions from 11 European countries, 2011–2012), we included 607 women with a singleton pregnancy and PPROM at 24–29 weeks’ gestation, of whom 101, 195 and 311 were respectively managed in 17, 32 and 45 units with no-use, restricted and liberal tocolysis policies for PPROM. The association between unit policies and outcomes (early-onset sepsis, survival at discharge, survival at discharge without severe morbidity and survival at two years without gross motor impairment) was investigated using three-level random-intercept logistic regression models, showing no differences in neonatal or two-year outcomes by unit policy. Moreover, there was no association between unit policies and prolongation of gestation in a multilevel survival analysis. Compared to a unit policy of no-use of tocolysis after PPROM, a liberal or restricted policy is not associated with improved obstetric, neonatal or two-year outcomes.
format	article
author	Elsa Lorthe Carla Moreira Tom Weber Lene D. Huusom Stephan Schmidt Rolf F. Maier Pierre-Henri Jarreau Marina Cuttini Elizabeth S. Draper Jennifer Zeitlin Henrique Barros The EPICE research group
author_facet	Elsa Lorthe Carla Moreira Tom Weber Lene D. Huusom Stephan Schmidt Rolf F. Maier Pierre-Henri Jarreau Marina Cuttini Elizabeth S. Draper Jennifer Zeitlin Henrique Barros The EPICE research group
author_sort	Elsa Lorthe
title	Unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort)
title_short	Unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort)
title_full	Unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort)
title_fullStr	Unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort)
title_full_unstemmed	Unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort)
title_sort	unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (epice cohort)
publisher	Nature Portfolio
publishDate	2020
url	https://doaj.org/article/4bb321d5eb644f26bde18eca9e025d87
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Unit policies regarding tocolysis after preterm premature rupture of membranes: association with latency, neonatal and 2-year outcomes (EPICE cohort)

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