Tocolysis

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Under tocolysis (of tokos (gr), birth ', lyein (gr), dissolve') refers to the inhibition of the contractions by tocolytics . By inhibiting the contraction of the womb ( uterus ), labor is inhibited. In addition to prolonging the pregnancy, labor-induced complications during childbirth are indicated. Often these are ascending infections of the vagina.

After the 34th week of pregnancy, there is usually no longer any medical indication for the inhibition of labor, since the unborn child is usually sufficiently mature to have a good chance of survival. The only exceptions are special situations, for example placenta previa or amniotic sac prolapse . The following drugs are used for drug tocolysis:

  • Beta-2 sympathomimetics , such as fenoterol . For intravenous administration, a maternal heart rate of 130 / min is the upper tolerable limit; Due to the considerable side effects, only pulsatile bolustocolysis is recommended.
  • Oxytocin antagonists, such as atosiban . With an effectiveness comparable to the beta-2 sympathomimetics, atosiban has a reduced potential for cardiovascular side effects.
  • Calcium channel blockers such as nifedipine . These are recommended in international guidelines because of their good tolerability and effectiveness.
  • High-dose magnesium is not recommended because of the common side effects on mother and child.
  • NO donors , such as glycerol trinitrate transdermally . In 11 randomized comparative studies, these showed a comparable or better effectiveness than beta-2 sympathomimetics with significantly fewer side effects. An important side effect is, for example, the frequently occurring "nitrate headache".
  • Prostaglandin synthesis inhibitors such as indomethacin or selective COX-2 inhibitors . These are very effective and have few side effects, but contraindications must be observed ( ulcer disease , bronchial asthma , coronary heart disease ). In addition, the application must not exceed 48 hours and no longer take place after the 32nd week of pregnancy, as the medication crosses the placenta (risk of constriction of the ductus botalli , reduction in amniotic fluid, etc.).

In Germany and Austria, only fenoterol and atosiban have a formal drug approval for tocolysis (as of April 2013). Fenoterol is used in around 95% of maternity hospitals. However, due to the considerable side effects, this no longer appears to be the first choice, so other off-label products are used.

Clinical studies test the effectiveness of Kalanchoe pinnatum ( Bryophyllum ). Clinical effectiveness has not yet been proven.

literature

  • Thomas Karow: Pharmacology and Toxicology . 2009.

Individual evidence

  1. ↑ a b c d e Eckehard Schleußner: Threatening premature birth: prevention, diagnosis and therapy. Deutsches Ärzteblatt 2013; 110 (13): 227–36
  2. ↑ Simões-Wüst, Rist: Bryophyllum in preclinical and clinical research . In: Der Merkurstab , Heft 5, 2007, 415–420, accessed on December 10, 2010 ( online ( Memento from January 22, 2015 in the Internet Archive ); PDF; 78 kB)