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Intrauterine minimalinvasive Therapie

Möglichkeiten und Risikoabwägung für das ungeborene Kind

Intrauterine minimally invasive therapy

Options and risk evaluation for the unborn child

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  • Published:
Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Methoden

Die transplazentare Therapie fetaler Tachyarrhythmien und die intrauterine Erythrozytentransfusion bei fetaler Anämie werden seit Jahren erfolgreich eingesetzt. Minimalinvasive Eingriffe unter sonographischer Sicht sind Shuntapplikationen bei fetalem Hydrothorax und zur Harnableitung bei Urethraobstruktion, aber auch kardiale Interventionen, wie Ballonvalvuloplastien, Atrioseptoplastie und Stenteinlage. Unter fetoskopischer Sicht erfolgen Laserkoagulation plazentarer Anastomosen bei fetofetalem Transfusionssyndrom und Ballonokklusion der Trachea bei fetaler Zwerchfellhernie.

Ergebnisse

Für den Erfolg der Eingriffe sind die richtige Auswahl der hiervon profitierenden Feten, die entsprechende Erfahrung der Durchführenden, ein multidisziplinäres Vorgehen teilweise beim Eingriff selbst, immer aber bei der Beratung und beim weiteren perinatalen Management entscheidend.

Schlussfolgerung

Diese komplexen Eingriffe sollten an nur wenigen Zentren durchgeführt werden und möglichst in Studien einfließen, um bei diesen seltenen Krankheitsbildern weitere Erfahrung sammeln zu können.

Abstract

Methods

The transplacental treatment of fetal tachyarrhythmia and intrauterine erythrocyte transfusion for fetal anemia have been successfully performed for more than 30 years. Minimally invasive fetal interventions can be performed under (1) sonographic guidance as pleuroamniotic shunt for hydrothorax or vesico-amniotic shunt for urethral obstruction and as cardiac interventions (e.g. balloon valvuloplasty, atrioseptoplasty and stenting) or (2) fetoscopically guided as laser coagulation of chorionic plate vessels for twin-twin transfusion syndrome and balloon occlusion of the trachea for severe diaphragmatic hernia.

Results

Correct selection of fetuses which profit from the intervention, great experience and training of the practitioners, multidisciplinary counselling and perinatal management are some important steps for the success of fetal treatment procedures.

Conclusion

Restriction of these complex interventions to a few centers allows technical and structural competence to be achieved and the acquisition of more knowledge by participating in multicenter studies.

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Authors and Affiliations

  1. Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland

    U. Gembruch, A. Geipel & C. Berg

  2. Abteilung für Neonatologie, Universitätsklinikum Bonn, Bonn, Deutschland

    A. Müller & P. Bartmann

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  1. U. Gembruch
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  2. A. Geipel
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  3. A. Müller
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  4. P. Bartmann
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  5. C. Berg
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Correspondence to U. Gembruch.

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Gembruch, U., Geipel, A., Müller, A. et al. Intrauterine minimalinvasive Therapie. Monatsschr Kinderheilkd 160, 1221–1228 (2012). https://doi.org/10.1007/s00112-012-2729-y

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