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Der Anaesthesist

, Volume 56, Issue 10, pp 1075–1090 | Cite as

Blutungen während der Schwangerschaft

  • S. Hofer
  • R. Schreckenberger
  • B. Heindl
  • K. Görlinger
  • H. Lier
  • H. Maul
  • E. Martin
  • M.A. Weigand
CME Weiterbildung • Zertifizierte Fortbildung

Zusammenfassung

Blutungen während der Schwangerschaft sind oft fulminant und für Mutter und Kind vital bedrohlich. Sie sind für etwa 25% aller peripartalen maternen Sterbefälle verantwortlich. Die besondere Pathophysiologie der schwangerschaftsbedingten hämostaseologischen Veränderungen, wie das erhöhte Gerinnungspotenzial, eine verminderte antikoagulatorische Aktivität und starke Alterationen des fibrinolytischen Systems, müssen dem Behandlungsteam bekannt sein, um eine zielgerichtete, konsequente und interdisziplinäre Therapie durchführen zu können. Zu den wichtigsten therapeutischen Eckpfeilern bei peripartalen Blutungen zählen neben der kausalen gynäkologischen Therapie die frühzeitige Detektion und Durchbrechung einer Hyperfibrinolyse, die Optimierung von Fibrinogen und Thrombozyten als Endstrecke der Gerinnung und die Kenntnis der Möglichkeiten einer erweiterten Gerinnungstherapie.

Schlüsselwörter

Schwangerschaftshämostase Blutungen während Schwangerschaft Hyperfibrinolyse Uterusatonie Gerinnungstherapie 

Hemorrhaging during pregnancy

Abstract

Hemorrhaging during pregnancy is often fulminant and life-threatening for mother and child. Of maternal deaths occurring during pregnancy, 25% are caused by hemorrhaging. All physicians involved in the interdisciplinary treatment of hemorrhaging during pregnancy need to be familiar with the specific pathophysiology of hemostatic changes during pregnancy, e.g. elevated hemostatic capacity, reduced anti-coagulation activity and severe alterations of the fibrinolysis system. Therapists must be able to perform a consequent, goal-directed interdisciplinary approach to prevent adverse maternal and fetal outcomes. The major issues of therapy are causal obstetric treatment of the bleeding, early detection and therapy of hyperfibrinolysis, optimization of fibrinogen and platelet levels and knowledge of the possibilities of a targeted coagulation therapy.

Keywords

Hemostasis during pregnancy Hemorrhage during pregnancy Hyperfibrinolysis Uterine atony Coagulation therapy 

Notes

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin:

Vorträge bei Veranstaltungen von CSL Behring.

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • S. Hofer
    • 1
  • R. Schreckenberger
    • 1
  • B. Heindl
    • 2
  • K. Görlinger
    • 3
  • H. Lier
    • 4
  • H. Maul
    • 5
  • E. Martin
    • 1
  • M.A. Weigand
    • 1
  1. 1.Klinik für AnästhesiologieUniversitätsklinikum HeidelbergHeidelbergDeutschland
  2. 2.Klinik für AnästhesiologieLudwig-Maximilians-Universität MünchenMünchenDeutschland
  3. 3.Klinik für Anästhesiologie und IntensivmedizinUniversitätsklinikum EssenEssenDeutschland
  4. 4.Klinik und Poliklinik für Anästhesiologie und Operative IntensivmedizinUniversitätsklinikum KölnKölnDeutschland
  5. 5.UniversitätsfrauenklinikUniversitätsklinikum HeidelbergHeidelbergDeutschland

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