Abstract
Tocolysis is among the most common obstetric measures. The objective is to prolong
the pregnancy by at least 48 hours to complete foetal lung maturation and for the
in-utero transfer of the pregnant woman to a perinatal centre. The indication for
tocolysis is regular, premature contractions (≥ 4/20 min) and a dynamic shortening
of the cervical length/cervical opening between 22 + 0 to 33 + 6 weeks of pregnancy.
In this connection, the cervical length measured on ultrasound and the determination
of biomarkers in the cervicovaginal secretions can be important decision-making aids.
Beta sympathomimetics should no longer be used due to the high rate of severe maternal
adverse effects. Given controversial data, magnesium sulphate is no longer recommended
for tocolysis in current guidelines. Atosiban is as effective for prolonging pregnancy
as beta sympathomimetics and nifedipine, has the lowest rate of maternal adverse effects,
but also the highest drug costs. Nifedipine and indomethacin are recommended in international
guidelines for acute tocolysis, however there are indications of increased neonatal
morbidity following indomethacin. Current problems are, above all, the lack of randomised,
controlled comparative and placebo-controlled studies, the data which are controversial
to some extent, and the insufficient evidence of tocolytics to significantly improve
the neonatal outcome.
Key words
preterm contractions - tocolysis - indication and objectives - tocolytics - evidence
- safety profile
