Akuttokolyse – eine kritische Analyse evidenzbasierter Daten

Zusammenfassung

Die Tokolyse gehört zu den häufigsten geburtshilflichen Maßnahmen. Ziel ist die Verlängerung der Schwangerschaft um mindestens 48 Stunden zum Abschluss der fetalen Lungenreifung und zum In-utero-Transfer der Schwangeren in ein Perinatalzentrum. Die Indikation zur Tokolyse sind regelmäßige, vorzeitige Wehen (≥ 4/20 min) und eine dynamische Verkürzung der Zervixlänge/Zervixeröffnung zwischen 22 + 0 bis 33 + 6 SSW. In diesem Zusammenhang können die sonografisch gemessene Zervixlänge und die Bestimmung von Biomarkern im Zervikovaginalsekret wichtige Entscheidungshilfen sein. Betasympathomimetika sollten aufgrund der hohen Rate schwerer maternaler Nebenwirkungen nicht mehr eingesetzt werden. Bei kontroverser Datenlage wird Magnesiumsulfat in aktuellen Leitlinien nicht mehr zur Tokolyse empfohlen. Atosiban ist zur Schwangerschaftsverlängerung äquieffektiv zu Betasympathomimetika und Nifedipin, weist die geringste Rate maternaler Nebenwirkungen, aber auch die höchsten Arzneimittelkosten auf. Nifedipin und Indometacin werden in internationalen Leitlinien zur Akuttokolyse empfohlen, allerdings bestehen Hinweise für eine erhöhte neonatale Morbidität nach Indometacin. Derzeitige Probleme sind vor allem das Fehlen randomisierter, kontrollierter Vergleichs- und placebokontrollierter Studien, die z. T. kontroverse Datenlage und die unzureichende Evidenz von Tokolytika, das neonatale Outcome signifikant zu verbessern.

Schlüsselwörter

vorzeitige Wehen - Tokolyse - Indikation und Ziele - Tokolytika - Evidenz - Sicherheitsprofil

• References/Literatur

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