Abstract
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.
Highlights
Drug-based inhibition of contractions has been a part of the treatment concept for preterm delivery whose rate in Europe, at 5–18 %, remains high [1]; in Germany, it was 8.6 % in 2017 [2].As the perinatal statistics from 2017 show [2], approximately 18 800 cases of tocolysis are performed in Germany annually in the case of threatened preterm delivery, with a median duration of 3 days.For demonstrable reasons, tocolytics are used too frequently and too long
Beta sympathomimetics are no longer recommended for tocolysis [18, 22, 24]
A meta-analysis from 2013 (13 randomised, controlled studies, n = 1302) was not able to show any significant differences in two studies with a small number of cases between transdermal nitroglycerin and placebo with regard to prolongation of pregnancy by 48 hours [34]
Summary
Drug-based inhibition of contractions has been a part of the treatment concept for preterm delivery whose rate in Europe, at 5–18 %, remains high [1]; in Germany, it was 8.6 % in 2017 [2].As the perinatal statistics from 2017 show [2], approximately 18 800 cases of tocolysis are performed in Germany annually in the case of threatened preterm delivery, with a median duration of 3 days (up to 106 days).For demonstrable reasons (for example, the pregnant womans desire for “treatment”, concerns about medical-legal disputes in the event of damage), tocolytics are used too frequently and too long. Drug-based inhibition of contractions has been a part of the treatment concept for preterm delivery whose rate in Europe, at 5–18 %, remains high [1]; in Germany, it was 8.6 % in 2017 [2]. As the perinatal statistics from 2017 show [2], approximately 18 800 cases of tocolysis are performed in Germany annually in the case of threatened preterm delivery, with a median duration of 3 days (up to 106 days). In approximately 30 % of pregnant women with preterm contractions, these stop spontaneously [3]; about 50 % of pregnant women deliver without tocolysis near term [4] and only 12–17 % within one week [5]. A differentiated indication is a precondition for performing tocolysis
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