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 of Western Japan.
4 affiliations
- 1Department of Obstetrics and Gynecology, Hiroshima University Hospital, Hiroshima, Japan.
- 2Department of Obstetrics and Gynecology, Miyoshi Central Hospital, Hiroshima, Japan.
- 3Department of Obstetrics and Gynecology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
- 4Department of Obstetrics and Gynecology, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Abstract
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.
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BibTeX
@article{yamane2026interfacility,
title = {{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 of Western Japan.}},
author = {Naofumi Yamane and Yuko Teraoka and Yurika Mukai and Kousuke Nakamoto and Yusuke Matoba and Yuriko Oomori and Katsuyuki Tomono and Tomomi Yamazaki and Kouji Banno and Ken Yamaguchi},
journal = {The journal of obstetrics and gynaecology research},
year = {2026},
month = oct,
doi = {10.1111/jog.70547},
url = {https://europepmc.org/article/MED/42950798},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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 of Western Japan.
AU - Naofumi Yamane
AU - Yuko Teraoka
AU - Yurika Mukai
AU - Kousuke Nakamoto
AU - Yusuke Matoba
AU - Yuriko Oomori
AU - Katsuyuki Tomono
AU - Tomomi Yamazaki
AU - Kouji Banno
AU - Ken Yamaguchi
PY - 2026
DA - 2026/10/28
JO - The journal of obstetrics and gynaecology research
DO - 10.1111/jog.70547
UR - https://europepmc.org/article/MED/42950798
AB - 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.
SN - 1341-8076
SN - 1447-0756
ER -