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Vorgehen bei plazentaren Blutungen

Vorzeitige Plazentalösung, Vasa praevia

Approach to placental hemorrhage

Premature placental detachment, vasa previa

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Zusammenfassung

Peripartale Blutungen gehen mit einer hohen maternalen wie fetalen Morbidität und Mortalität einher. Sie zählen zu den häufigsten Ursachen für Müttersterblichkeit (25%) weltweit. Im Vordergrund steht neben der Plazenta praevia und der vorzeitigen Plazentalösung die Uterusatonie. Beim Auftreten einer vorzeitigen Plazentalösung oder einer Blutung aufgrund von Vasa praevia besteht neben maternalen Risiken eine extrem hohe Gefährdung des Feten. Neben den klinischen Symptomen spielt in der Diagnostik die Ultraschalluntersuchung eine entscheidende Rolle. Die Prognose für Mutter und Kind kann substanziell verbessert werden, wenn Risikofaktoren frühzeitig erkannt werden und die Erkrankung rasch und fachgerecht behandelt wird.

Abstract

Peripartum hemorrhage is associated with a high maternal and fetal morbidity and mortality and is one of the leading causes of maternal death worldwide (25%). The major causes of hemorrhage are placenta previa, premature abruption of the placenta and uterine atony. In cases with placental abruption or bleeding from the vasa previa there is an extremely high risk for the fetus as well as for the mother. The diagnosis of hemorrhage is suspected from the clinical manifestations and confirmed by ultrasonography. The prognosis for both mother and child can be markedly improved if the risk factors for hemorrhage are recognized early and the problem is treated rapidly and appropriately.

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Literatur

  1. Deneux-Tharaux C, Camora E, Bouvier-Colle MH et al (2006) Postpartum maternal mortality and cesarean delivery. Obstet Gynecol 108:541–548

    Article  PubMed  Google Scholar 

  2. UNFPA (2003) Maternal mortality update 2002: a focus on emergency obstetric care. United Nations Population Fund. New York

  3. Royal College of Obstetricians and Gynaecologists (RCOG) Guideline No 27; Placenta previa and placenta accreta: Diagnosis and management 2005

  4. Tikannen M (2011) Placental abruption: epidemiology risk factors and consequences. Acta Obstet Gynecol Scand 90 140–149

    Google Scholar 

  5. Tikkanen M, Nuutila M, Hiilesmaa V et al (2006) Clinical presentation and risk factors of placental abruption. Acta Obstet Gynecol Scand 85:700–705

    Article  PubMed  Google Scholar 

  6. James AH, McLintock C, Lockhart E (2012) Postpartum hemorrhage: when uterotonics and sutures fail. Am J Hematol (Suppl 1):S16–S22

    Google Scholar 

  7. Cortet M (2012) Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. Br J Anaesth 108(6):984–989

    Article  PubMed  CAS  Google Scholar 

  8. Ducloy-Bouthors AS et al (2011) High-dose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care. 15(2):R117

    Google Scholar 

  9. Oyelese Y, Catanzarite V, Prefumo F et al (2004) Vasa previa: the impact of prenatal diagnosis on outcomes. Obstet Gynecol 03:937–942

    Article  Google Scholar 

  10. Fung TY, Lau TK (1998) Poor perinatal outcome associated with vasa previa: is it preventable? A report of three cases and review of the literature. Ultrasound Obstet Gynecol 12:430–433

    Article  PubMed  CAS  Google Scholar 

  11. Oyelese KO, Turner M, Lees C, Campbell S (1999) Vasa previa: an avoidable obstetric tragedy. Obstet Gynecol Surv 54:138–145

    Article  PubMed  CAS  Google Scholar 

  12. Paavonen J, Jouttunpaa K, Kangasluoma P et al (1984) Velamentous insertion of the umbilical cord and vasa previa. Int J Gynaecol Obstet 22:207–211

    Article  PubMed  CAS  Google Scholar 

  13. Al-Khaduri M, Kadoch IJ, Couturier B et al (2007) F. Vasa praevia after IVF: should there be guidelines? Report of two cases and literature review. Reprod Biomed Online 14:372–374

    Article  PubMed  Google Scholar 

  14. Oyelese Y, Spong C, Fernandez MA, McLaren RA (2000) Second trimester low-lying placenta and in-vitro fertilization? Exclude vasa previa. J Matern Fetal Med 9:370–372

    Article  PubMed  CAS  Google Scholar 

  15. Baulies S, Maiz N, Munoz A et al (2007) Prenatal ultrasound diagnosis of vasa praevia and analysis of risk factors. Prenat Diagn 27:595–599

    Article  PubMed  CAS  Google Scholar 

  16. Sepulveda W, Rojas I, Robert JA et al (2003) Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study. Ultrasound Obstet Gynecol 21:564–569

    Article  PubMed  CAS  Google Scholar 

  17. Odunsi K, Bullough CH, Henzel J, Polanska A (1996) Evaluation of chemical tests for fetal bleeding from vasa previa. Int J Gynaecol Obstet 55

  18. Lijoi A.F. Brady J (2003) Vasa previa diagnosis and management. J Am Board Fam Pract 16:543–548

    Article  PubMed  Google Scholar 

  19. Oyelese KO, Turner M, Lees C, Campbell S (1999) Vasa previa: an avoidable obstetric tragedy. Obstet Gynecol Surv 54:138–145

    Article  PubMed  CAS  Google Scholar 

  20. Catanzarite V, Maida C, Thomas W, Mendoza A (2001) Prenatal sonographic diagnosis of vasa previa: ultrasound findings and obstetric outcome in ten cases. Ultrasound Obstet Gynecol 18(2):109–115

    Article  PubMed  CAS  Google Scholar 

  21. Stanco L, Piacquadio KM (2001) Prenatal sonographic diagnosis of vasa previa: ultrasound findings and obstetric outcome in ten cases. Ultrasound Obstet Gynecol 18:109–115

    Article  PubMed  Google Scholar 

  22. Lee W, Lee VL, Kirk JS et al (2000) Vasa previa: prenatal diagnosis, natural evolution and clinical outcome. Obstet Gynecol 95:572–576

    Article  PubMed  CAS  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Kainer gibt an, dass kein Interessenkonflikt besteht.

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  1. Klinikum Hallerwiese der Diakonie Neuendettelsau, Abteilung für Geburtshilfe und Pränatalmedizin, St. Johannis - Mühlgasse 10, 90419 , Nürnberg, Deutschland

    F. Kainer

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Kainer, F. Vorgehen bei plazentaren Blutungen. Gynäkologe 46, 803–807 (2013). https://doi.org/10.1007/s00129-013-3164-4

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  • DOI: https://doi.org/10.1007/s00129-013-3164-4

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