Zusammenfassung
Frühgeburten haben mit über 70% einen erheblichen Anteil an der perinatalen Sterblichkeit sowie an der Morbidität von Neugeborenen. Die Ursachen der nichtiatrogenen Frühgeburtlichkeit sind mannigfaltig und umfassen aszendierende Infektionen, Mehrlingsschwangerschaften und Uterusfehlbildungen. Eine monokausale Therapie der drohenden Frühgeburtlichkeit kann es nicht geben. Es gibt auch kein Tokolytikum, das eindeutig die erste Wahl darstellt: Atosiban, Nifedipin, β-Mimetika und Indometacin sind vermutlich äquieffektiv. Atosiban ist nebenwirkungsarm, aber sehr teuer. Nifedipin ist für die Behandlung in der Schwangerschaft nicht zugelassen. β-Mimetika sind nebenwirkungsreich, es besteht allerdings die größte Erfahrung mit dieser Stoffgruppe für die Tokolyse. Nifedipin kann oral gegeben werden, während Fenoterol und Atosiban parenteral verabreicht werden müssen, um tokolytisch wirksame Konzentrationen zu erreichen. Intravenöses Magnesiumsulfat und Indometacin sollten in der klinischen Routine nur in besonderen Situationen für die Tokolyse eingesetzt werden. Andere Maßnahmen, wie die Verabreichung von Gestagenen, sind noch unzureichend erforscht oder – wie die Notfallcerclage – nur in ausgewählten Einzelfällen wirksam. Es gibt keine Evidenz dafür, dass additive Maßnahmen wie absolute Bettruhe, Hydratation und Sedation die drohende Frühgeburtlichkeit verbessern, sie sind deshalb im Regelfall nicht angezeigt
Abstract
Preterm delivery contributes significantly to perinatal mortality and morbidity. Despite advances in obstetric care, the rate of such deliveries has increased over the past decade. The use of tocolysis, however, has only a minor impact on the prevention of preterm delivery because contractions do not necessarily induce delivery and prolongation of pregnancy is not desired in many cases for maternal or fetal reasons.
A clear first line tocolytic drug does not exist: nifedipine, atosiban, β-mimetics and indomethacin are equally effective. Atosiban has the lowest rate of maternal side effects but is expensive. According to the Cochrane Database, nifedipine is preferable to other tocolytics, however, it is not licensed for use in pregnancy. Most experience has been gained with β-mimetics which have several side-effects. Magnesium and indomethacin should not be used for routine tocolysis. The effectiveness for magnesium has not been demonstrated in randomized trials, and both of these substances have severe side-effects for the mother and/or fetus. There is no evidence in the literature that bed rest, hydration or the use of sedative drugs improve the rate of premature delivery.
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Beinder, E. Drohende Frühgeburt. Gynäkologe 39, 299–310 (2006). https://doi.org/10.1007/s00129-006-1813-6
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DOI: https://doi.org/10.1007/s00129-006-1813-6