In cooperation with

Abstract

Preterm labor: Diagnosis and evidence based therapy

Prematurity significantly contributes to perinatal mortality and morbidity, and despite of advances in obstetric care, the rate of prematurity increased over the past decade. The use of tocolysis,however, has only a minor impact on prevention of prematurity because contractions do not necessarily induce preterm delivery and prolongation of pregnancy is not desired in many cases due to maternal or fetal reasons. A clear first line tocolytic drug does not exist: Nifedipin,Atosiban, ?-mimetics and Indomethacin seem to be equi-effective.Atosiban has the lowest rate of maternal side effects but it is expensive. According to the Cochrane Database, Nifedipin is preferable to other tocolytics,however it is not licensed for use in pregnancy. ?-mimetics have several side-effects, but the medical experience is greatest with these substances. Magnesium and Indomethacin should not be used for routine tocolysis. Effectiveness for Magnesium is not shown in randomized trials, and Indomethacin should not be used after 30–32 weeks of pregnancy. Both substances have severe fetal side-effects.NO donors cannot be recommended until further data from larger trials are available.

Ernst Beinder

Reviewer: Ulrike Friebe-Hoffmann, Düsseldorf,
und Klaus Vetter, Berlin

CME Praktische Fortbildung Gynäkologie, Geburtsmedizin und Gynäkologische Endokrinologie 3/2005: 26-35