Der Gynäkologe

, Volume 41, Issue 10, pp 772–780 | Cite as

Betreuungsbedarf für Mehrlingsschwangere

Leitthema
First Online:

Zusammenfassung

Eine Mehrlingsschwangerschaft erfordert spezielle perinatalmedizinische Kenntnisse von der/dem betreuende/n Frauenärztin/arzt. Mit im Vergleich zu Einlingsschwangerschaften mehr und höheren fetalen wie maternalen Risiken muss gerechnet werden. Dies spiegelt die erhöhte perinatale Morbidität und Mortalität wieder, welche durch die hohe Prävalenz an Frühgeburten, Wachstumsverzögerungen und Fehlbildungen bedingt ist. Diese Risiken sind besonders bei monochorialen Zwillingen ausgeprägt. Hinzu kommt hier die Gefahr des fetofetalen Transfusionssyndroms, das unbehandelt zum drastischen Anstieg der Spätabort- und Frühgeburtenrate beiträgt.

Mithilfe der Ultraschalldiagnostik muss die Chorionizität im ersten Trimenon im Mutterpass dokumentiert werden. Detaillierte Ultraschalluntersuchungen im 2. Screening erlauben die Detektion möglicher Fehlbildungen sowie im zweiten und dritten Trimenon die Überwachung eventuell auftretender plazentarer Durchblutungsstörungen. Mithilfe der transvaginalen sonographischen Zervixlängenmessung kann das Frühgeburtsrisiko eingeschätzt werden. Aus maternaler Sicht ist die erhöhte Prävalenz einer Präeklampsie und einer Anämie von Bedeutung, peripartal sind die Frühgeburtrate und die damit verbundenen Risiken signifikant erhöht (z. B. Infektionen, erhöhte Sectiorate, postpartale Atonie). Aus diesen Gründen ergibt sich die Empfehlung zur antepartalen Vorstellung und Geburt in einem Perinatalzentrum.

Schlüsselwörter

Mehrlinge Schwangerschaftsüberwachung Frühgeburt Wachstumsrestriktion Ultraschall 

Antepartum in management of multiple gestations

Abstract

Multiple gestations require special perinatal medical knowledge by the attending physician. In contrast to singleton pregnancies, increased maternal and fetal risks must be expected. This is reflected in the increased perinatal morbidity and mortality, which are caused by the high prevalence of premature births, growth restriction and congenital abnormalities. These risks are especially high for monochorionic twins. In addition, there is the danger of the twin-twin transfusion syndrome, which when untreated can contribute to a drastic increase in the late abortion and premature birth rates. The chorionicity must be documented in the 1st trimester by ultrasound and entered in the prenatal records. A detailed ultrasound examination in the 2nd screening can detect possible malformations and in the 2nd and 3rd trimesters the monitoring of possible disturbances in placental blood circulation. The risk of preterm birth can be estimated using transvaginal sonographic measurement of cervical length. From the maternal aspect the increased prevalence of preeclampsia and anemia are significant, the premature birth rate and the accompanying risks (e.g. infections, increased rate of caesarian sections and postpartum atony) are significantly increased in the peripartal period. For these reasons antenatal examination and birth in a perinatal center are recommended.

Keywords

Multiple gestation Antepartum monitoring Preterm birth Intrauterine growth restriction Ultrasound 
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Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Klinik für GeburtsmedizinCampus Virchow KlinikumBerlinDeutschland

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