Vorzeitige Immobilisierung bei drohender Frühgeburt – Reflexion aus der Praxis

Häufig wird Schwangeren zum Zweck der Schonung empfohlen, eine liegende Position – zusätzlich zu den Schlafenszeiten – über mehrere Tage und Wochen hinweg einzuhalten. Die Auswirkungen einer solchen Maßnahme sind erheblich und trotz zahlreicher wissenschaftlicher Belege sind Veränderungen in der täglichen Praxis kaum zu bemerken. Ist die Immobilisierung bei „drohender Frühgeburt“ Allheilmittel oder ein notwendiges Übel? Gibt es Alternativen?

• Literatur

• 1 Ahlers CJ. Vom Himmel auf Erden und Hölle im Kopf. Was Sexualität für uns bedeutet. München: Goldmann; 2016
• 2 Allen C. et al. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet 1999 (354) : 1229
• 3 AWMF. Prävention und Therapie der Frühgeburt. Leitlinienklasse S2k. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften AWMF (015–025); 2019
• 4 Bigelow CA. et al. Pilot Randomized Controlled Trial to Evaluate the Impact of Bed Rest on Maternal and Fetal Outcomes in Woman with Preterm Premature Rupture of the Membranes. Am J Perinatol 2016; 33 (04) : 356-363
• 5 Biggio JR Jr. Bed rest in pregnancy: time to put the issue to rest. Obstet Gynecol. 2013; 121: 1158
• 6 Brisch KH. et al. Psychotherapeutische Intensivbehandlung von Risikoschwangeren mit drohender Frühgeburt. Zeitschrift für Geburtshilfe und Neonatologie 1997; 23: 186
• 7 Bundesverband „Das frühgeborene Kind” e. V. (Hg.). ( 2014 ): Elternberatung in der Neonatologie. Ein Praxis-Leitfaden des Bundesverbandes „Das frühgeborene Kind“ e. V. Online verfügbar unter https://www.fruehgeborene.de/sites/default/files/field_pblctn_file/leitfaden_elternberatung_a_5_web.pdf
• 8 Churchill F. On the Theory and Practice of Midwifery. Philadelphia: Henry C. Lea; 1866
• 9 da Silva Lopes K. et al. Bed rest with and without hospitalisation in multiple pregnancy for improving perinatal outcomes. Cochrane Database Syst Rev 2017; 6 ; (03) : CD012031 . doi: 10.1002 / 14651858.CD012031.pub2.
• 10 Domingues MR. et al. Physical activity and preterm birth: a literature review. Sports Med 2009; 39 (11) : 961-975
• 11 Elliott JP. et al. A randomized multicenter study to determine the efficacy of activity restriction for preterm labor management in patients testing negative for fetal fibronectin. J Perinatol 2005; 25 (10) : 626-630
• 12 Fox NS. et al. The recommendation for bed rest in the setting of arrested preterm labor and premature rupture of membranes. Am J Obstet Gynecol. 2009; 200 (02) : 165 .e1-6
• 13 Goldenberg RL. et al. Bed rest in pregnancy. Obstet Gynecol. 1994; 84 (01) : 131-136
• 14 Grobman WA. et al. Activity restriction among women with a short cervix. Obstet Gynecol. 2013; 121 (06) : 1181-1186
• 15 Hobel CJ. et al. Psychosocial stress and pregnancy outcome. Clin Obstet Gynecol 2008; 51 (02) : 333-348 .
• 16 Hobel CJ. et al. The West Los Angeles Preterm Birth Prevention Project. I. Program impact on high-risk woman. Am J Obstet Gynecol 1994; 170 (1 Pt 1): 54-62 .
• 17 Hegaard HK. et al. Leisure time physical activity during pregnancy and impact on gestational diabetes mellitus, pre-eclampsia, preterm delivery and birth weight: a review. Acta Obstet Gynecol Scand 2007; 86 (11) : 1290-1296
• 18 Helle N. et al. Postpartum posttraumatic and acute stress in mothers and fathers of infants with very low birth weight: Cross-sectional results from a controlled multicenter cohort study. J Affect Disord 2008; (235) : 467-473
• 19 Howson CP, Kinney MV, Lawn JE. (Editors)/March of Dimes, PMNCH, Save the Children, WHO. Born Too Soon: The Global Action Report on Preterm Birth. World Health Organization. Born Too Soon - The Global Action Report on Preterm Birth. Geneva: World Health Organization; 2012
• 20 Kaji T. et al. Effect of bed rest during pregnancy on bone turnover markers in pregnant and postpartum women. Bone 2007; 40: 1088-1094
• 21 Kovacevich GJ. et al. The prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment for premature labor or preterm premature rupture of membranes. Am J Obstet Gynecol 2000; 182 (05) : 1089-1092
• 22 Lamprecht BE. Drohende Frühgeburt und Immobilisierung. Notwendiges Übel oder einfach nur Übel? Geburtshilfe im Dialog 2019. Pro Medico. Geburtshilfe im Dialog 2019. Mannheim, 23. 03.2019
• 23 Lederman RP. Boyd E. Pitts K. et al. Maternal development experiences of women hospitalized to prevent preterm birth. Sex Reprod Healthc 2013; 4 (04) : 133-138 . DOI: 10.1016 / j.srhc.2013.10.004
• 24 Lookwood CJ. Magriples U. Prenatal care: Patient education, health promotion, and safety of commonly used drugs. UpToDate. 2019 . https://www.uptodate.com/contents/prenatal-care-patient-education-health-promotion-and-safety-of-commonly-used-drugs/print
• 25 Maloni JA. : Antepartum bed rest for pregnancy complications: efficacy and safety for preventing preterm birth. Biol Res Nurs 2010; 12 (02) : 106-124
• 26 Maloni JA. : Lack of evidence for prescription of antepartum bed rest. Expert Rev Obstet Gynecol 2011; 6 (04) : 385-393
• 27 Maloni JA. et al. Antepartum bed rest: maternal weight change and infant birth weight. Biol Res Nurs 2004; 5 (03) : 177-186
• 28 Maloni JA, Park S. Postpartum symptoms after antepartum bed rest. J Obstet Gynecol Neonatal Nurs 2005; 34 (02) : 163-171
• 29 Maloni JA, Schneider BS. : Inactivity: symptoms associated with gastrocnemius muscle disuse during pregnancy. AACN Clin Issues 2002; 13: 248-262
• 30 Maloni JA. et al. Antepartum bed rest: effect upon the family. J Obstet Gynecol Neonatal Nurs 2001; 30 , S.  165-173
• 31 Maloni JA. et al. Dysphoria among high-risk pregnant hospitalized women on bed rest: a longitudinal study. Nurs Res 2002; 51 (02) : 92
• 32 McCall CA. et al. “Therapeutic” bed rest in pregnancy: unethical and unsupported by data. Obstet Gynecol 2013; 121: 1305
• 33 Melzer K. et al. Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes. Sports Med 2010; 40 (06) : 493-507
• 34 National Library of Medicine. : https://medlineplus.gov/ency/patientinstructions/000581.htm
• 35 Noeker M. Keller KM. Münchhausen-by-proxy-Syndrom als Kindesmisshandlung. Monatsschrift Kinderheilkunde 2002; 150 (11) : 1357-1369
• 36 Omar A. The Effect of Activity Restriction on Infant’s Birth Weight and Gestational Age at Birth: PRAMS Data Analysis. Can J Nurs Res; 2018. . doi: 10.1177 / 0844562118778976. Epub 2018 Jun 9.
• 37 Promislow JHE. et al.: Bed rest and other determinants of bone loss during pregnancy. Am J Obstet Gynecol 2004; 191 (04) : 1077-1083
• 38 Rose MS. et al. (2016): Prenatal Maternal Anxiety as a Risk Factor for Preterm Birth and the Effects of Heterogeneity on This Relationsship: A Systematic Review and Meta-Analysis. Biomed Res Int. 2016; 8312158 . doi: 10.1155 / 2016 / 8312158
• 39 Saccone G. et al. Effects of exercise during pregnancy in women with short cervix: Secondary analysis from the Italian Pessary Trial in singletons. Eur J Obstet Gynecol Reprod Biol . 2018; 229: 132-136
• 40 Saltuari P. Funktionelle Entspannung und Kunsttherapie mit Risikoschwangeren. In: Harms T (Hg.): Körperpsychotherapie mit Säuglingen und Eltern. Grundlagen und Praxis. Baden-Baden: Nomos ; 2017; 353-376
• 41 Sciscione AC. Maternal activity restriction and the prevention of preterm birth. Am J Obstet Gynecol 2010; 202 (03) : 232 .e1-5
• 42 Shapiro GD. et al. Psychosocial stress in pregnancy and preterm birth: associations and mechanisms. J Perinat Med 2013; 41 (06) : 631-645
• 43 Sommerlad S. et al. Was triggert posttraumatische Belastungssymptome bei Patientinnen mit und ohne drohende Frühgeburt?. Geburtshilfe Frauenheilkd 2018; 78 (10) : 229
• 44 Sosa CG. et al. Bed rest in singleton pregnancies for preventing preterm birth. Cochrane Database Syst Rev. 2015; (03) : CD003581 . doi: 10.1002 / 14651858
• 45 Sprague AE. The Evolution of Bed Rest as a Clinical Intervention. J Obstet Gynecol Neonatal Nurs 2004; 33 (05) : 542-549
• 46 Steiner H. Aktuelle Aspekte der Frühgeburt und der Tokolyse. Bremen: Uni-Med; 2008
• 47 Weissgerber TL. Wolfe LA, Davies GA et al. Exercise in the prevention and treatment of maternal-fetal disease: a review of the literature. Appl Physiol Nutr Metab 2006; 31 (06) : 661-74
• 48 Zemet R. et al. Quantitative assessment of physical activity in pregnant women with sonographic short cervix and the risk for preterm delivery: A prospective pilot study. PLoS One 2018; 13 (06) : e0198949 . doi: 10.1371 / journal.pone.0198949