Advertisement

Vorzeitige Wehentätigkeit

  • Holger MaulEmail author
Chapter

Zusammenfassung

Weltweit kommen ca. 15 Mio. Kinder vor Abschluss der 37. Schwangerschaftswoche zur Welt und 2,8 Mio. vor Abschluss der 32. Schwangerschaftswoche. Frühgeburten stellen eine der Hauptursachen der neonatalen (35% ≙ 2,8 Mio. Kinder/Jahr) und kindlichen Mortalität (17% ≙ 6,2 Mio. Kinder/Jahr) dar. Frühgeburten sind verantwortlich für 25–50% schwerer neurologischer Langzeitmorbidität von Kindern mit z. T. lebenslang belastenden Einzelschicksalen und stellen eine massive Belastung des Gesundheitssystems dar. Alleine in Deutschland wurden im Jahr 2014 63.300 tokolytische Therapien (9,2% der Geburten) mit im Mittel 3 bis maximal 114 Tagen Dauer durchgeführt. Der vorliegende Fall handelt von einer 29-jährigen Schwangeren, die sich in der 27. Schwangerschaftswoche mit Wehen in der Klinik vorstellt.

Weiterführende Literatur

  1. Celik E, To M, Gajewska K et al; (2008) Fetal Medicine Foundation Second Trimester Screening Group Cervical length and obstetric history predict spontaneous preterm birth: development and validation of a model to provide individualized risk assessment. Ultrasound Obstet Gynecol 31(5): 549–554CrossRefPubMedGoogle Scholar
  2. Chang HH, Larson J, Blencowe H et al (2013) Born Too Soon preterm prevention analysis group. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with Very High Human Development Index. Lancet 381(9862): 223–234CrossRefPubMedGoogle Scholar
  3. Doyle LW, Crowther CA, Middleton P et al (2009) Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev (1): CD004661Google Scholar
  4. Fonseca EB, Celik E, Parra M et al;(2007) Fetal Medicine Foundation Second Trimester Screening Group Progesterone and the risk of preterm birth among women with a short cervix. N Engl J Med 357(5): 462–469CrossRefPubMedGoogle Scholar
  5. Goya M, Pratcorona L, Merced C et al; Pesario Cervical para Evitar Prematuridad (PECEP) Trial Group (2012) Cervical pessary in pregnant women with a short cervix (PECEP): an open-label randomized controlled trial. Lancet 379(9828): 1800–1806CrossRefPubMedGoogle Scholar
  6. Hammers AL, Sanchez-Ramos L, Kaunitz AM (2015) Antenatal exposure to indomethacin increases the risk of severe intraventricular hemorrhage, necrotizing enterocolitis, and periventricular leukomalacia: a systematic review with metaanalysis. Am J Obstet Gynecol 212(4): 505.e1–13CrossRefPubMedGoogle Scholar
  7. Heath VC, Southall TR, Souka AP et al (1998) Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery. Ultrasound Obstet Gynecol 12(5): 312–317CrossRefPubMedGoogle Scholar
  8. Kuhrt K, Smout E, Hezelgrave N et al (2016a) Development and validation of a tool incorporating cervical length and quantitative fetal fibronectin to predict spontaneous preterm birth in asymptomatic high-risk women. Ultrasound Obstet Gynecol 47(1): 104–109CrossRefPubMedGoogle Scholar
  9. Kuhrt K, Hezelgrave N, Foster C et al (2016b) Development and validation of a tool incorporating quantitative fetal fibronectin to predict spontaneous preterm birth in symptomatic women. Ultrasound Obstet Gynecol 47(2): 210–216CrossRefPubMedGoogle Scholar
  10. McCabe ER, Carrino GE, Russell RB, Howse JL (2014) Fighting for the next generation: US Prematurity in 2030. Pediatrics 134(6): 1193–1199CrossRefPubMedGoogle Scholar
  11. Mercer BM (2003) Preterm premature rupture of the membranes. Obstet Gynecol 101(1): 178–193PubMedGoogle Scholar
  12. Mercer JS, Vohr BR, McGrath MM et al (2006) Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics 117(4): 1235–1242PubMedGoogle Scholar
  13. Meis PJ, Klebanoff M, Thom E et al; (2003)National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med 348(24): 2379–2385; erratum in: N Engl J Med (2003) 349(13): 1299CrossRefPubMedGoogle Scholar
  14. Norman JE, Marlow N, Messow CM et al;(2016) OPPTIMUM Study Group Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet 387(10033): 2106–1216CrossRefGoogle Scholar
  15. Önderoglu LS (1997) Digital examination and transperineal ultrasonographic measurement of cervical length to assess risk of preterm delivery. Int J Gynecol Obstet 59(3): 223–228CrossRefGoogle Scholar
  16. Owen J, Hankins G, Iams JD et al (2009) Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol 201(4): 375.e1–8CrossRefPubMedPubMedCentralGoogle Scholar
  17. Suhag A, Saccone G, Berghella V (2015) Vaginal progesterone for maintenance tocolysis: a systematic review and metaanalysis of randomized trials. Am J Obstet Gynecol 213(4): 479–487CrossRefPubMedGoogle Scholar
  18. van Baaren GJ, Vis JY, Wilms FF et al (2014) Predictive value of cervical length measurement and fibronectin testing in threatened preterm labor. Obstet Gynecol 123(6): 1185–1192CrossRefPubMedGoogle Scholar
  19. Vis JY, van Baaren GJ, Wilms FF et al (2015) Randomized comparison of nifedipine and placebo in fibronectin-negative women with symptoms of preterm labor and a short cervix (APOSTEL-I Trial). Am J Perinatol 32(5): 451–460PubMedGoogle Scholar
  20. Zephyrin LC, Hong KN, Wapner RJ et al;(2013) Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units (MFMU) Network Gestational age-specific risks vs benefits of multicourse antenatal corticosteroids for preterm labor. Am J Obstet Gynecol 209(4): 330.e1–7CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland 2018

Authors and Affiliations

  1. 1.Chefarzt der Abt. GeburtshilfeMarienkrankenhausHamburgDeutschland

Personalised recommendations