Use of intrapartum tocolysis in Europe: results from a cross-sectional survey

BACKGROUND: Intrapartum acute tocolysis is used to temporarily reduce uterine activity in situations such as uterine tachysystole or suspected intrapartum fetal hypoxia. Despite its frequent use in clinical practice, evidence supporting its effectiveness and safety remains limited, and guidance on indications, choice of agent, and administration is inconsistent. OBJECTIVE: To describe current practices of intrapartum acute tocolysis among European specialists in intrapartum care, focusing on indications, agents used, frequency, route of administration, and availability of local protocols. METHODS: A cross-sectional, questionnaire-based survey was conducted among European obstetricians and midwives involved in intrapartum care, between March and April 2023. The survey contained 15 questions divided into two sections. The first section covered respondent and institutional characteristics, including professional role, type of institution, annual number of births, and caesarean delivery rate. The second section addressed the use of intrapartum acute tocolysis, including first- and second-line tocolytic agents, frequency of use, clinical indications, routes of administration, contraindications, and availability of local protocols. The online questionnaire was disseminated through professional obstetric and midwifery networks. RESULTS: A total of 217 responses were analysed, mostly from healthcare professionals working in hospital settings (96.8 %). Use of intrapartum acute tocolysis was reported by 85.7 % (186/217) of respondents. The main indications were suspected intrapartum fetal hypoxia and uterine tachysystole. Betamimetics were the most frequently reported agents (63.4 %), followed by oxytocin receptor antagonists (42.1 %), but there were marked regional variations. Most respondents administered tocolysis intravenously (90.8 %). Of these, 62.7 % used bolus administration and 37.3 % continuous infusion. Contraindications varied widely, with maternal cardiovascular disease being the most common, and only 66.1 % of respondents reported the availability of local protocols. CONCLUSION: Intrapartum acute tocolysis is widely practiced across Europe, yet there is wide variation in indications, choice of agent, route of administration, and institutional guidance. These findings highlight the need for harmonized, evidence-based guidelines to support safe and consistent clinical practice.