Guideline for the treatment of premature labor
Medical guidelines represent a kind of red thread that is intended to support medical personnel in making decisions in specific clinical situations. If a pregnant woman experiences premature contractions (preterm labor) from the 24th week of pregnancy onwards, it is recommended that tocolysis (contraction inhibition) be performed. This should stop the contractions for at least 48 hours in order to allow the child to mature in the lungs.
Lung maturation is achieved by a single administration of betamethasone injections into the muscles. The aim is to prepare the still immature lungs of the unborn child for a possible premature birth. If the premature contractions occur before the 24th or after the 33rd week of pregnancy, tocolysis is not recommended according to the guideline.
Therapy
Depending on the findings, the therapy of preterm labor is divided into outpatient care, inpatient care and delivery indication. This is provided if the mother and/or child is at risk. This would be appropriate in cases of clinical pictures such as placental insufficiency or dissolution, (pre-)eclampsia or amniotic infection.
If an infection has been diagnosed, the focus is on clearing up the infection (e.g. with an antibiotic) to eliminate the cause of the contractions (premature labor). Outpatient care can be provided under the following conditions: After clarification of the symptoms of premature labor of an imminent premature birth (hardening of the abdomen, pulling in the back or in the groin region) the patient can be discharged to the home environment.Then there is an incapacity to work with a lot of (bed) rest, possibly a domestic help can be provided by the health insurance. 3 times daily 2 tablets of Magnesium 5-Longoral/per day (=30mmol Mg) should be taken, because Magnesium has a relaxing (=relaxing) effect on the muscles.
The check-ups are more closely monitored than in normal pregnancy.
- Less than 6 contractions per hour in CTG
- No change in cervical length
- No evidence of a bubble burst
An inpatient admission for the treatment of premature labor is necessary in the following cases: It is important to eliminate possible stress factors in order to eliminate the possible cause. In addition, between the 24th and 34th week of pregnancy, the fetus is treated with medication to prevent RDS in order to improve the chances of survival of the newborn child in the event of premature birth.
Under these circumstances, attempts are made to inhibit the activity of labour (premature contractions) with various drugs (=tocolysis). However, this does not reduce the rate of preterm birth, but leads to an extension of the gestation period of about 2-7 days (preterm labor) through short-term inhibition.
- Cervix length shortened (less than 2.5cm)
- Regular, painful contractions
- Occurrence of symptoms before the 32nd week of pregnancy or an estimated child weight < 1500g (admission to a neonatal center)
- Betamimetics: These are the best studied and most widely used.
An example is Fenoterol or the trade name Partusisten. This must not be used in cases of heart, liver or kidney disease, pneumonia, hyperthyroidism or high potassium levels in the blood count. Therefore, blood and blood pressure must be checked daily during therapy.
- Magnesium: Magnesium is now controversial in use, an effect compared to placebos could not be shown in studies.
A general dilatation of the blood vessels leads to a drop in blood pressure, headaches, blushing and dizziness. If high doses accumulate in the unborn child, hypermagnesemia can occur, affecting respiratory movement and heart action.
- Calcium antagonists: Calcium causes the phosphorylation of myosin chains (= microscopic structure of a muscle) and thus causes muscle contraction. Calcium antagonists reduce the calcium concentration in the cell and cause fewer contractions.
However, it is not approved as tocolysis, yet it produces effects equivalent to those of the other drugs. Side effects are caused by a reduction in blood pressure due to dilation of the blood vessels, which can lead to an acceleration of the heart rate (= tachycardia), headaches, dizziness or nausea (premature labor).
- Oxytocin antagonists: The mechanism of action is that the drug attaches itself to the receptors of oxytocin and thus the oxytocin itself has no place and no effect (premature labor). The drug used is called Tractocile.
Indications are generally diabetes mellitus or also gestational diabetes, twin pregnancy, hypertension or premature rupture of the bladder. The effectiveness is not better than with fenoterol, but it is better tolerated (no observation of cardiovascular side effects) and also significantly more expensive. To be used instead of betamimetics, the cervix must have an opening of 1-3 cm, regular uterine contractions of longer than 30sec and at least 4 times/30min, cervical dilation of more than 50%, age > 18 years, pregnancy must be in the 24th – 33rd week of pregnancy and the fetus must have a normal heart rate.
