To prolong gestation, even for only the few days required to achieve pulmonary maturity, tocolysis must be initiated at the earliest possible stage after the onset of labour. Unfortunately, it is difficult to make the diagnosis of preterm labour. In theory, this diagnosis should be based on the detection of changes in cervical length, dilatation and/or consistency brought about by an increase in myometrial activity rather than by the patient’s subjective perception of the strength of her contractions. It is particularly important to distinguish cervical dilatation resulting from isthmic (cervical) incompetence from genuine preterm labour, as these two entities call for very different treatments. Moreover, whenever chronic tocolysis is considered, membranes should be intact and subclinical intrauterine infection should not be present, as both adversely affect the efficacy of tocolysis1. When present, intrauterine infection is a threat to both the fetus and the mother, which requires delivery without delay. Potent tocolytic (uterorelaxant) drugs are now available for chronic treatment of preterm labour, as well as for acute short-term suppression of uterine activity.

Inhibition of labour

Die perinatale Mortalitat und Morbiditat ist vorrangig abhangig von der erfolgreichen Behandlung der niedriggewichtigen Neugeborenen < 1200 g. Die hauptsachlichen Erkrankungsursachen sind das neonatale Atemnotsyndrom mit seinen Folgen wie Hirnblutungen, Asphyxie und Sepsis. Bei der Analyse neonataler Todesursachen Fruhgeborener sterben nach Ausschlus schwerer Misbildungen und fetaler Grunderkrankungen 90% aller Kinder am Membransyndrom und seinen Folgen (9).

Interaktion von Lungenreifung und Tokolyse

Die Verwendung wehenhemmender Substanzen zielt darauf ab, die Geburt eines noch unreifen, fur das extrauterine Leben noch nicht ausreichend entwickelten Kinds zu verhindern. Einer der wichtigsten Faktoren, welche das Uberleben Fruhgeborener bestimmen, ist die Lungenreife (5, 51). Ziel der Therapie vorzeitiger Wehentatigkeit mus es deshalb sein, die Geburt aufzuhalten, bis eine ausreichende Lungenreifung eingetreten ist oder die Lungenreifung so zu beschleunigen, das ein Respiratory-distress-Syndrom (RDS) bzw. Beluftungsstorungen durch hyaline Membranen auch bei vorzeitiger Geburt vermieden werden.

Nebenwirkungen der Glukokortikoidgabe zur Beschleunigung der fetalen Lungenreife unter Tokolyse

Particle electrophoresis has been used to investigate particles obtained from amniotic fluid. These particles are defined mainly as unilamellar and multilamellar liposomes by electron microscopy. A total of 172 samples of amniotic fluids from 132 pregnancies were included in this study. The electrophoretic results were compared to the total phospholipids and to neonatal outcomes in 42 cases. At least two kinds of particles from amniotic fluids with different electrophoretic mobilities (EPM) are evident. With a ratio of F greater than 1.0, the presence of electrophoretically faster particles was found to be associated with apparent fetal lung maturity. On the other hand when the ratio was F less than 1.0, this seems to indicate an immature fetal lung. Seventy-seven per cent of F values correspond to the total phospholipid content P regarding the prediction of fetal pulmonary maturity resp. immaturity. The correct prediction of fetal lung maturity was demonstrated in 42 patients delivered within 48 hours of amniotic fluid sampling. In 28 cases with a mature F value (greater than 1.0) the correct prediction of respiratory distress syndrome (RDS) was 100 per cent. Eight out of 14 patients with immature F values (less than 1.0) developed RDS. The F values were found to increase as pregnancy progressed. The electrophoretically differentiated amniotic fluid particles behave differently at low pH. Selection and electrophoretic measurement of particles were made in a subjective manner. This preliminary investigation suggests that the results correspond to those obtained by objective cell electrophoretic measurements.

/pdf/fetal-pulmonary-maturity-as-determined-by-particle-3eaqoeky88.pdf

Fetal pulmonary maturity as determined by particle electrophoresis.

The respiratory distress syndrome (RDS) and its consequences are one of the principal causes of death in early childhood [15, 60]. An important pathogenetic factor in the development of RDS in neonates in disturbance of the functioning of the pulmonary surfactant, possibly due to a deficiency (or a defect) in its biosynthesis, inactivation or accelerated degradation of the surfactant as a result of pulmonary immaturity, or as a result of the influ~ ence of a range of unfavorable factors (pulmonary hypoperfusion, and pulmonary edema, acidosis, and hypoxemia).

Correction of surfactant deficiency in respiratory distress syndrome by lipid preparations (review)

From January 1978 to December 1979 cortico-steroids to improve prenatal pulmonary maturity were administered to 174 patients. Patients with additional factors to accelerate pulmonary maturity or patients with additional factors to pre-dispose to pulmonary asphyxia during labor were not evaluated. 43 patients who delivered 47 children were studied. The cortico-steroid treatment and delay of delivery for over 48 hours improved the survival chances of the pre-mature infants. Following the administration of 4 times 2 mg beta-methasone-phosphate 26.7% of the infants had respiratory distress syndrome whereas no respiratory distress syndrome was found after 4 times 4 mg of beta-methasone-phosphate.

Erfolg und Komplikationen bei pränataler Lungenreifeförderung mit Kortikosteroiden; eine Frage der Dosierung?

The samples of amniotic fluid from 55 transabdominal amniocenteses were examined with a simple spectrophotometric test for the predictive value on the risk of respiratory distress syndrome. There was a highly significant correlation between the lecithin content and the optical density of the amniotic fluid at 650 nm (r = 0.065 at p <0.001). No infant with an extinction threshold value of less than 0.15 had neonatal respiratory distress syndrome.

[Is spectrophotometric analysis of the amniotic fluid a simple method for the determination of fetal pulmonary maturity? (author's transl)].

Einfluß der Langzeittokolyse auf die Lungenreifung von Zwillingen

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Erfolg und Komplikationen bei pränataler Lungenreifeförderung mit Kortikosteroiden; eine Frage der Dosierung?

[Is spectrophotometric analysis of the amniotic fluid a simple method for the determination of fetal pulmonary maturity? (author's transl)].

Einfluß der Langzeittokolyse auf die Lungenreifung von Zwillingen