Rath Werner, Kehl Sven
Medizinische Fakultät Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany.
Geburtshilfe Frauenheilkd. 2018 Dec;78(12):1245-1255. doi: 10.1055/a-0717-5329. Epub 2018 Dec 14.
Tocolysis is among the most common obstetric measures. The objective is to prolong the pregnancy by at least 48 hours to complete foetal lung maturation and for the in-utero transfer of the pregnant woman to a perinatal centre. The indication for tocolysis is regular, premature contractions (≥ 4/20 min) and a dynamic shortening of the cervical length/cervical opening between 22 + 0 to 33 + 6 weeks of pregnancy. In this connection, the cervical length measured on ultrasound and the determination of biomarkers in the cervicovaginal secretions can be important decision-making aids. Beta sympathomimetics should no longer be used due to the high rate of severe maternal adverse effects. Given controversial data, magnesium sulphate is no longer recommended for tocolysis in current guidelines. Atosiban is as effective for prolonging pregnancy as beta sympathomimetics and nifedipine, has the lowest rate of maternal adverse effects, but also the highest drug costs. Nifedipine and indomethacin are recommended in international guidelines for acute tocolysis, however there are indications of increased neonatal morbidity following indomethacin. Current problems are, above all, the lack of randomised, controlled comparative and placebo-controlled studies, the data which are controversial to some extent, and the insufficient evidence of tocolytics to significantly improve the neonatal outcome.
宫缩抑制是最常见的产科措施之一。其目的是将孕周延长至少48小时，以完成胎儿肺成熟，并将孕妇宫内转运至围产期中心。宫缩抑制的指征是规律的早产宫缩（≥4次/20分钟）以及妊娠22 + 0至33 + 6周期间宫颈长度/宫颈口动态缩短。在此方面，超声测量的宫颈长度以及宫颈阴道分泌物中生物标志物的测定可能是重要的决策辅助手段。由于严重母体不良反应发生率高，β-拟交感神经药不应再使用。鉴于数据存在争议，当前指南不再推荐硫酸镁用于宫缩抑制。阿托西班在延长孕周方面与β-拟交感神经药和硝苯地平效果相同，母体不良反应发生率最低，但药物成本也最高。国际指南推荐硝苯地平和吲哚美辛用于急性宫缩抑制，然而有迹象表明吲哚美辛会增加新生儿发病率。当前的问题首先是缺乏随机对照比较研究和安慰剂对照研究，部分数据存在争议，且宫缩抑制药物显著改善新生儿结局的证据不足。
