Applikation antenataler Kortikosteroide: optimales Timing

Zusammenfassung

Die Effektivität antenataler Kortikosteroide (ACS), das Respiratory Distress Syndrome (RDS) signifikant zu senken, hängt entscheidend vom Timing ab. Dies gelingt bei einer Entbindung > 24 Stunden bis 7 Tage nach Applikation, nach dieser Zeit scheinen eher die Nebenwirkungen zu überwiegen. Darüber hinaus werden bei Kindern, die nach ACS-Applikation reif geboren werden, vermehrt mentale Beeinträchtigungen und Verhaltensstörungen beobachtet. Das optimale Timing der ACS-Gabe hängt entscheidend von der jeweiligen Indikation ab und gelingt bisher in lediglich 25–40% der Fälle. Die ACS-Applikation ist immer indiziert bei PPROM, bei schwerer, früher Präeklampsie, bei fetaler IUGR mit Null- oder Reverse-Flow in der A. umbilicalis, bei einer blutenden Placenta praevia und bei Patientinnen mit vorzeitiger Wehentätigkeit und einer Zervixlänge < 15 mm. Das Risiko von Frauen mit einer asymptomatischen Zervixinsuffizienz, innerhalb von 7 Tagen zu gebären, ist sehr gering. Hier sollte auf die ACS-Gabe auch bei einer Zervixlänge von unter 15 mm verzichtet werden, wenn der Muttermund geschlossen ist und keine weiteren Risikofaktoren für eine Frühgeburt vorliegen. Die Entwicklung weiterer diagnostischer Methoden mit verbesserter Prädiktion für eine Frühgeburt ist dringend notwendig, um das Timing der ACS-Gabe in diesem Patientenkollektiv zu optimieren. Zurückhaltung bei der ACS-Gabe ist ebenso angezeigt bei Frauen mit vorzeitiger Wehentätigkeit und einer Zervixlänge ≥ 15 mm. Hier gilt es, in weiteren Studien mittels Amniozentese das Patientenkollektiv zu identifizieren, bei dem eine intraamniale, mikrobielle Infektion/Inflammation (MIAC/IAI) vorliegt, und Schwellenwerte für die Indikation zur Entbindung zu definieren. Die ACS-Gabe ist keine Notfallmaßnahme, in der Regel auch nicht vor Verlegung in ein Perinatalzentrum. Deshalb sollte, wenn immer möglich, die Indikation zur ACS-Applikation von einem/einer in der Perinatologie sehr erfahrenen Kollegen/Kollegin gestellt werden.

Schlüsselwörter

antenatale Kortikosteroide - Frühgeburt - Timing - Zeitintervall

Publication History

Received: 31 July 2023

Accepted after revision: 31 October 2023

Article published online:
03 January 2024

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