CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2018; 78(12): 1245-1255
DOI: 10.1055/a-0717-5329
GebFra Science
Review/Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Acute Tocolysis – a Critical Analysis of Evidence-Based Data

Article in several languages: English | deutsch
Werner Rath
1   Medizinische Fakultät Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
,
Sven Kehl
2   Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
› Author Affiliations
Further Information

Publication History

received 11 June 2018
revised 24 August 2018

accepted 26 August 2018

Publication Date:
14 December 2018 (online)

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.

 
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