Progesteron – effektiv zur Wehenhemmung und zur Erhaltungstherapie nach Wehenstopp?

Zusammenfassung

Zahlreiche experimentelle Studien weisen darauf hin, dass natürliches Progesteron über verschiedene Mechanismen einen inhibitorischen Effekt auf die uterine Kontraktilität ausübt und das Myometrium für Tokolytika sensibilisiert. Daher war es sinnvoll, die möglichen Vorteile von oralem/vaginalem Progesteron und des intramuskulär applizierten synthetischen Progesteronderivats 17-α-Hydroxyprogesteroncaproat in klinischen Studien zur primären Tokolyse, additiv zu etablierten Tokolytika („adjunktive Tokolyse“) und zur Erhaltungstherapie nach erfolgreicher Wehenhemmung bei drohender Frühgeburt zu untersuchen. Aus drei Studien mit kleiner Fallzahl ergibt sich keine ausreichende Evidenz, Progesteron/17-α-Hydroxyprogesteroncaproat zur primären Tokolyse bei Frauen mit vorzeitiger Wehentätigkeit zu empfehlen. Es gibt ebenfalls keine Evidenz dafür, dass Progesteron oder 17-α-Hydroxyprogesteroncaproat in Kombination mit gebräuchlichen Tokolytika zu einer Verlängerung der Schwangerschaft und zu einer signifikanten Senkung der Rate an Frühgeburten führt. Die Datenlage zur Anwendung von Progesteron zur Erhaltungstherapie ist kontrovers. Während randomisierte, kontrollierte Studien mit niedriger Qualität vielversprechende Ergebnisse zeigten, ergaben sich aus Studien mit hoher Qualität keine signifikanten Unterschiede hinsichtlich der Frühgeburtenrate < 37 SSW, der Latenzzeit bis zur Geburt und im neonatalen Outcome zwischen Progesteron/17-α-Hydroxyprogesteroncaproat und Placebo oder keiner Behandlung. Erhebliche Unterschiede in der Methodologie, den Einschluss- und Zielkriterien, dem Applikationsmodus und den Dosierungen der Substanzen sowie die inadäquate statistische Power infolge niedriger Fallzahlen macht eine Interpretation und Vergleichbarkeit der Studien schwierig. Daher sind gut konzipierte, randomisierte, placebokontrollierte Doppelblindstudien mit einheitlichen primären Zielkriterien notwendig, um zu klären, ob Progesteron und auf welchem Applikationsweg und mit welcher Dosierung bei Patientinnen mit manifesten vorzeitigen Wehen und zur Erhaltungstherapie nach initialer Wehenhemmung von klinischem Nutzen ist.

Schlüsselwörter

vorzeitige Wehen - Progesteron - 17-α-Hydroxyprogesteroncaproat - Tokolyse - Erhaltungstherapie/-tokolyse

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