Do obstetricians apply the national guidelines? A vignette-based study assessing practices for the prevention of preterm birth

Objective: To describe spontaneous preterm birth prevention practices self-reported before and after the dissemination of relevant guidelines, and to identify personal and organisational factors associated with adherence.

Design: A repeated cross-sectional vignette-based survey study.

Setting: French obstetricians.

Population: French obstetricians practicing in public or private maternity units.

Methods: Before and after the dissemination of the 2017 French guidelines on the prevention of spontaneous preterm birth, participants were asked to complete a web-based self-administered questionnaire based on two clinical vignettes. Vignette 1 focused on respondents' attitudes towards strict bed rest, cerclage, and progesterone treatment for women with a short cervix in mid-trimester; vignette 2 focused on attitudes towards strict bed rest and maintenance tocolysis after successful tocolysis for preterm labour. A mixed quantitative and qualitative analysis was conducted.

Main outcome measures: Non-adherence to guidelines for the prevention of spontaneous preterm birth in responses to each vignette.

Results: We obtained complete responses from 286 obstetricians before and 282 obstetricians after guideline dissemination, including 145 obstetricians participating in both. After dissemination, 51.4% of obstetricians self-reported non-adherent practices for vignette 1 and 22.3% of obstetricians self-reported non-adherent practices for vignette 2. No improvement was observed after dissemination. The quantitative analysis identified factors associated with non-adherence, including older age and practice in non-university or small hospitals, whereas the qualitative analysis highlighted barriers to implementation, including fear of change, habits, work overload, and lack of time.

Conclusions: Adherence to guidelines was generally low, with practices unmodified by their dissemination. Improvement is required, especially regarding applicability.

Tweetable abstract: Adherence to guidelines to prevent spontaneous preterm birth was generally low and remained unmodified after guideline dissemination.