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Frühgeburt: Epidemiologie, Prädiktion und Prävention

Premature birth: epidemiology, prediction and prevention

  • Gynäkologie aktuell
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Zusammenfassung

Die Frühgeburt trägt wesentlich zur perinatalen Morbidität und Mortalität bei und gilt als einer der Hauptrisikofaktoren für „disability-adjusted life years“ (DALYs). Ihre Inzidenz liegt in Deutschland seit 2008 stabil bei etwas über 8 %. Deutschland nimmt damit in Europa einen der hinteren Plätze ein. Der Zustand nach Frühgeburt ist der gewichtigste individuelle Risikofaktor für eine erneute Frühgeburt. Für die Bitte ersetzen durch Gesamtfrühgeborenenrate einer Population sind allerdings die Nulliparität und das männliche fetale Geschlecht von deutlich größerer Bedeutung. Die Ursachen für die erheblichen Unterschiede in der Frühgeborenenrate zwischen einzelnen Ländern gleicher Entwicklungsstufe sind zu großen Teilen unklar. Durch den Einsatz verschiedener präventiver Maßnahmen, z. B. Progesteron, Cerclage und Zervixpessar, lässt sich im individuellen Fall das Frühgeburtsrisiko senken.

Abstract

Premature birth makes a substantial contribution to the perinatal morbidity and mortality and is one of the main risk factors for disability-adjusted life years (DALYs). Since 2008 the incidence in Germany has been stable at slightly over 8 %. Germany therefore occupies one of the lowest places in Europe. The condition after premature birth is the weightiest individual risk factor for recurrence of a premature birth; however, the nulliparity and male sex of the fetus are of much greater importance for the total rate of premature births in a population. The reasons for the substantial differences in the premature birth rate between individual countries with the same level of development are mostly unclear. In individual cases the risk of premature birth can be reduced through the use of various preventive measures, e.g. progesterone, cervical cerclage and cervical pessaries.

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Literatur

  1. TEHR The European Health Report 2010

  2. Bellad MB, Hoffman MK, Mallapur AA et al (2018) Clindamycin to reduce preterm birth in a low resource setting: a randomised placebo-controlled clinical trial. BJOG 125:1601–1609

    Article  CAS  Google Scholar 

  3. Berger R, Abele H, Bahlmann F et al (2019) Prevention and therapy of Preterm birth. Guideline of the DGGG, OEGGG and SGGG (S2k level, AWMF registry number 015/025, february 2019)—part 1 with recommendations on the epidemiology, etiology, prediction, primary and secondary prevention of Preterm birth. Geburtshilfe Frauenheilkd 79:800–812

    Article  Google Scholar 

  4. Berghella V, Mackeen AD (2011) Cervical length screening with ultrasound-indicated cerclage compared with history-indicated cerclage for prevention of preterm birth: a meta-analysis. Obstet Gynecol 118:148–155

    Article  Google Scholar 

  5. Berghella V, Rafael TJ, Szychowski JM et al (2011) Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis. Obstet Gynecol 117:663–671

    Article  Google Scholar 

  6. Brocklehurst P, Gordon A, Heatley E et al (2013) Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000262.pub4

    Article  PubMed  PubMed Central  Google Scholar 

  7. Crowther CA, Ashwood P, Mcphee AJ et al (2017) Vaginal progesterone pessaries for pregnant women with a previous preterm birth to prevent neonatal respiratory distress syndrome (the PROGRESS Study): A multicentre, randomised, placebo-controlled trial. PLoS Med 14:e1002390

    Article  Google Scholar 

  8. Cruz-Melguizo S, San-Frutos L, Martinez-Payo C et al (2018) Cervical Pessary compared with vaginal progesterone for preventing early preterm birth: a randomized controlled tria. Obstet Gynecol 132:907–915

    Article  CAS  Google Scholar 

  9. Dodd JM, Grivell RM, Cm OB et al (2017) Prenatal administration of progestogens for preventing spontaneous preterm birth in women with a multiple pregnancy. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD012024.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dugoff L, Berghella V, Sehdev H et al (2018) Prevention of preterm birth with pessary in singletons (PoPPS): randomized controlled trial. Ultrasound Obstet Gynecol 51:573–579

    Article  CAS  Google Scholar 

  11. Ferrero DM, Larson J, Jacobsson B et al (2016) Cross-country individual participant analysis of 4.1 Mio. Singleton births in 5 countries with very high human development index confirms known associations but provides no biologic explanation for 2/3 of all Preterm births. PLoS ONE 11:e162506

    Article  Google Scholar 

  12. Friese K, Kirschner W (2003) Das BabyCare-Projekt. Konzept, erste Ergebnisse und Erfolgskriterien. Gynäkologe 36:403–412

    Article  Google Scholar 

  13. Goya M, Pratcorona L, Merced C et al (2012) Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. Lancet 379:1800–1806

    Article  Google Scholar 

  14. Hollowell J, Oakley L, Kurinczuk JJ et al (2011) The effectiveness of antenatal care programmes to reduce infant mortality and preterm birth in socially disadvantaged and vulnerable women in high-income countries: a systematic review. BMC Pregnancy Childbirth 11:13

    Article  Google Scholar 

  15. Hui SY, Chor CM, Lau TK et al (2013) Cerclage pessary for preventing preterm birth in women with a singleton pregnancy and a short cervix at 20 to 24 weeks: a randomized controlled trial. Am J Perinatol 30:283–288

    PubMed  Google Scholar 

  16. Iams JD, Goldenberg RL, Meis PJ et al (1996) The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med 334:567–572

    Article  CAS  Google Scholar 

  17. Iqtig IQTIG (2017) Bundesauswertung zum Erfassungsjahr 2017 – Geburtshilfe Qualitätsindikatoren

    Google Scholar 

  18. Iqwig IQWIG (2015) Abschlußbericht S13-02 Bakteriuriescreening bei Schwangeren

    Google Scholar 

  19. Jarde A, Lutsiv O, Beyene J et al (2019) Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: an updated systematic review and network meta-analysis. BJOG 126:556–567

    Article  CAS  Google Scholar 

  20. Kazemier BM, Koningstein FN, Schneeberger C et al (2015) Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomised controlled trial. Lancet Infect Dis 15:1324–1333

    Article  Google Scholar 

  21. Makrides M, Best K, Yelland L et al (2019) A randomized trial of prenatal n‑3 fatty acid supplementation and preterm delivery. N Engl J Med 381:1035–1045

    Article  CAS  Google Scholar 

  22. Middleton P, Gomersall JC, Gould JF et al (2018) Omega‑3 fatty acid addition during pregnancy. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003402.pub3

    Article  PubMed  PubMed Central  Google Scholar 

  23. Moore E, Blatt K, Chen A et al (2016) Relationship of trimester-specific smoking patterns and risk of preterm birth. Am J Obstet Gynecol 215:109.e1–109.e6

    Article  Google Scholar 

  24. Murphy DJ (2007) Epidemiology and environmental factors in preterm labour. Best Pract Res Clin Obstet Gynaecol 21:773–789

    Article  Google Scholar 

  25. Newnham JP, White SW, Meharry S et al (2017) Reducing preterm birth by a statewide multifaceted program: an implementation study. Am J Obstet Gynecol 216:434–442

    Article  Google Scholar 

  26. Newton JN, Briggs AD, Murray CJ et al (2015) Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386:2257–2274

    Article  Google Scholar 

  27. Nicolaides KH, Syngelaki A, Poon LC et al (2016) A randomized trial of a cervical pessary to prevent preterm singleton birth. N Engl J Med 374:1044–1052

    Article  CAS  Google Scholar 

  28. Norberg H, Kowalski J, Marsal K et al (2017) Timing of antenatal corticosteroid administration and survival in extremely preterm infants: a national population-based cohort study. BJOG 124:1567–1574

    Article  CAS  Google Scholar 

  29. Norman JE, Marlow N, Messow CM et al (2016) Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet 387:2106–2116

    Article  CAS  Google Scholar 

  30. Palmer KT, Bonzini M, Bonde JP et al (2013) Pregnancy: occupational aspects of management: concise guidance. Clin Med 13:75–79

    Article  Google Scholar 

  31. Perez-Lopez FR, Chedraui P, Perez-Roncero GR et al (2019) Effectiveness of the cervical pessary for the prevention of preterm birth in singleton pregnancies with a short cervix: a meta-analysis of randomized trials. Arch Gynecol Obstet 299:1215–1231

    Article  Google Scholar 

  32. Romero R, Conde-Agudelo A, Da Fonseca E et al (2018) Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data. Am J Obstet Gynecol 218:161–180

    Article  CAS  Google Scholar 

  33. Saccone G, Ciardulli A, Xodo S et al (2017) Cervical pessary for preventing preterm birth in singleton pregnancies with short cervical length: a systematic review and meta-analysis. J Ultrasound Med 36:1535–1543

    Article  Google Scholar 

  34. Smaill FM, Vazquez JC (2015) Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000490.pub3

    Article  PubMed  Google Scholar 

  35. Subtil D, Brabant G, Tilloy E et al (2018) Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. Lancet 392:2171–2179

    Article  CAS  Google Scholar 

  36. Thinkhamrop J, Hofmeyr GJ, Adetoro O et al (2015) Antibiotic prophylaxis during the second and third trimester to reduce adverse pregnancy outcomes and morbidity. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD002250.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  37. Van Baaren GJ, Vis JY, Wilms FF et al (2014) Predictive value of cervical length measurement and fibronectin testing in threatened preterm labor. Obstet Gynecol 123:1185–1192

    Article  Google Scholar 

  38. Voss W, Hobbiebrunken E, Ungermann U et al (2016) The Development of Extremely Premature Infants. Dtsch Arztebl Int 113:871–878

    PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Marienhaus Klinikum St. Elisabeth, Klinik für Gynäkologie und Geburtshilfe, Akademisches Lehrkrankenhaus der Universitäten Mainz und Maastricht, Friedrich-Ebert-Str. 59, 56564, Neuwied, Deutschland

    R. Berger

  2. Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Deutschland

    H. Abele

  3. Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Osnabrück GmbH, Osnabrück, Deutschland

    Y. Garnier

  4. Frauenklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    R. Kuon

  5. Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland

    W. Rath

  6. Frauenkliniken, Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Deutschland

    H. Maul

Authors
  1. R. Berger
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  2. H. Abele
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  3. Y. Garnier
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  4. R. Kuon
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  5. W. Rath
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  6. H. Maul
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Corresponding author

Correspondence to R. Berger.

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Interessenkonflikt

R. Berger bekam Kongressgebühren- und Reisekostenerstattung sowie Vortragshonorare von der Firma Eickeler. R. Kuon erhielt Kongressgebühren- und Reisekostenerstattung sowie Vortragshonorare von der Dr. Kade/Besins GmbH. H. Maul wurde honoriert für Beratertätigkeit der Firma Hologic. Er bekam Reisekostenerstattung sowie Vortragshonorare von der Firma Kade. H. Abele, Y. Garnier und W. Rath geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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T. Fehm, Düsseldorf

L. Kiesel, Münster

R. Kimmig, Essen

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Berger, R., Abele, H., Garnier, Y. et al. Frühgeburt: Epidemiologie, Prädiktion und Prävention . Gynäkologe 53, 331–337 (2020). https://doi.org/10.1007/s00129-020-04584-5

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  • DOI: https://doi.org/10.1007/s00129-020-04584-5

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