Interfacility Variation in Diagnosis and Tocolysis for Threatened Preterm Labor and Its Association With Gestational Age Threshold for Neonatal Intensive Care Unit Admission: A Cross‐Sectional Survey of Perinatal Centers in the Chugoku–Shikoku Region
Naofumi Yamane, Yuko Teraoka, Yurika Mukai, Kousuke Nakamoto, Yusuke Matoba, Yuriko Oomori, Katsuyuki Tomono, Tomomi Yamazaki, Kouji Banno, Ken YamaguchiABSTRACT
Aim
To describe interfacility variation in threatened preterm labor (TPL) management in a perinatal care network in western Japan and the association between the neonatal intensive care unit (NICU) admission threshold and the long‐term tocolysis policy.
Methods
A cross‐sectional, facility‐level questionnaire survey was conducted for all 43 perinatal maternal and child health centers in the Chugoku–Shikoku region of western Japan in 2024. Centers reported diagnostic criteria for TPL, use of objective scoring systems, first‐line intravenous tocolytic drugs, NICU admission gestational age threshold, and institutional policies regarding planned duration of intravenous tocolysis (short‐term, ≤ 48 h; long‐term, > 48 h). Factors related to the adoption of long‐term tocolysis were evaluated using logistic regression.
Results
Valid responses were obtained from 32 centers (74.4%). A long‐term‐only tocolysis policy was reported by 65.6% (21/32) of centers. Diagnostic criteria and thresholds for intervention varied widely, and only three centers (9.4%) used an objective severity score, such as the preterm labor index or tocolysis index. Ritodrine hydrochloride was used as the first‐line intravenous tocolytic drug in 93.8% (30/32) of centers. The NICU admission threshold differed among centers. In multivariable analysis, centers with a higher NICU admission threshold were more likely to report a long‐term‐only policy (adjusted odds ratio, 1.38 per 1‐week increase; 95% confidence interval, 1.04–1.83; p = 0.028).
Conclusions
Management of TPL showed marked interfacility variation in the regional perinatal care network. The NICU admission threshold was associated with the institutional tocolysis‐duration policy, suggesting that regional perinatal system structure should be considered when discussing optimal tocolysis duration.