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Frauenheilkunde up2date 2021; 15(02): 119-137
DOI: 10.1055/a-1068-7370
Geburtshilfe und Perinatalmedizin

Tokolyse

Werner Rath
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Die medikamentöse Wehenhemmung (Tokolyse) gehört nach der Geburtseinleitung zu den häufigsten Maßnahmen in der Geburtshilfe. Unsicherheiten bestehen vor allem hinsichtlich der Indikation zur Tokolyse. Bisher gibt es nicht das für Mutter und Kind „ideale“ Tokolytikum. Die Erhaltungstokolyse ist eine Einzelfallentscheidung im Spannungsfeld zwischen Evidenz und klinischer Praxis.
Kernaussagen

  • Die Tokolyse gehört zu den häufigsten Maßnahmen in der Geburtshilfe.

  • Die Indikationen sind regelmäßige, vorzeitige Wehen ≥ 4/20 min in Verbindung mit einer Verkürzung/Eröffnung der Zervix zwischen 22 + 0 und 33 + 6 SSW.

  • Ziel ist die Schwangerschaftsverlängerung um 48 Stunden zum Abschluss der fetalen Lungenreifeinduktion und zum In-utero-Transfer der Schwangeren in ein Perinatalzentrum.

  • Geeignete Tokolytika sind vor allem Indometacin, Nifedipin und Atosiban.

  • Die Erhaltungstokolyse (> 48 h) ist eine Einzelfallentscheidung, aber keine evidenzbasierte Maßnahme zur Senkung der Frühgeburtenrate.

  • Vaginales/orales Progesteron wird derzeit weder in Kombination mit einem Tokolytikum noch zur Erhaltungstherapie empfohlen.

Schlüsselwörter

Pathophysiologie - Indikation - Kontraindikation - Evidenz - Tokolytika


Publication History

Article published online:
07 April 2021

© 2021. Thieme. All rights reserved.

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