Prävention und Therapie der vorzeitigen Wehentätigkeit

Objective: The incidence of preterm birth has remained unchanged for years at about 8-10%. Prematurity remains the leading cause of neonatal mortality, accounting for 70-85% of all neonatal deaths, so that the prevention and treatment of preterm labor is a central issue in pregnancy care. Methods: We review possible risk factors for preterm labor and strategies for prevention and treatment. Results: Although infections play an important role in the etiology of preterm labor, antibiotics should not be used prophylactically without evidence of infection in patients with intact membranes. In contrast, a beneficial effect for antibiotics has been proved for preterm premature rupture of the membranes. Only 10-20% of women with preterm labor have an indication for tocolytic treatment. The use of tocolytics before 24 and after 36 weeks' gestation should be limited to special situations. Tocolytic treatment with intravenous β 2 -sympatheticomimetic agents can significantly reduce the rate of delivery within 48 hours, a period sufficient to reduce the risk for the respiratory distress syndrome with corticosteroids. In contrast, the efficacy of longterm parenteral tocolysis or oral tocolysis is unproved. In certain situations tocolysis can be achieved with intravenous magnesium, nifedipine, or inhibitors of prostaglandin synthesis. The psychosocial situation should also be taken into account because there is evidence that psychologic aspects play a role in the etiology of preterm labor.