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Der Gynäkologe

, Volume 52, Issue 1, pp 39–51 | Cite as

Mehrlingsschwangerschaften

  • Nicole Ochsenbein-KölbleEmail author
CME
  • 268 Downloads

Zusammenfassung

Mehrlingsschwangerschaften, ein Hochrisikokollektiv, haben in den letzten 20 Jahren aufgrund des steigenden mütterlichen Alters und des Einsatzes sterilitätsmedizinischer Maßnahmen weiter zugenommen. Das korrekte Datieren der Schwangerschaft, die Bestimmung der Anzahl Feten (ab 7 Schwangerschaftswochen [SSW]) und der Chorionizität/Amnionizität im ersten Trimester (idealerweise zwischen 8 und 10 SSW) sind Grundvoraussetzungen für die Betreuung von Mehrlingsschwangeren, die in Zusammenarbeit mit oder an einem Perinatalzentrum stattfinden sollte. Nackentransparenzmessungen (11–13 SSW) und fetale DNA-Tests sind mögliche pränatale nichtinvasive Screeningmethoden. Die Einnahme von niedrigdosierter Acetylsalicylsäure ab 12 SSW kann das Präeklampsierisiko reduzieren. Um 20 SSW sollte ein Fehlbildungsscreening angeboten werden. Eine Zervixlängenmessung bei 22–24 SSW hilft, das Frühgeburtsrisiko abzuschätzen und eine Progesterontherapie einzuleiten. Bei monochorialen Mehrlingen sind Ultraschallkontrollen ab 16 SSW mindestens alle 2 Wochen durchzuführen, bei dichorialen alle 3–4 Wochen zur Wachstumskontrolle.

Schlüsselwörter

Nackentransparenzmessung Frühgeburt Präeklampsie Aneuploidie Fetale Entwicklung 

Multiple pregnancies

Abstract

During the last two decades there has been a considerable rise in multiple pregnancies, a high-risk collective, due to increased maternal age and the use of medical fertility treatment measures. A correct dating of pregnancy, determination of the number of fetuses (upwards from 7 gestational weeks, GW) and assessment of the chorionicity/amnionicity in the first trimester (ideally between 8 and 10 GW) are essential for further monitoring of multiple pregnancies in collaboration with or at a perinatal center. Nuchal translucency measurement by ultrasound (US, 11–13 GW) and the analysis of cell-free DNA in maternal blood should be performed to screen for fetal aneuploidy. A low-dose treatment with acetylsalicylic acid initiated from 12 GW onwards should be considered to reduce the risk for preeclampsia. A screening for fetal malformations should be offered at approximately 20 GW. Measurement of the length of the cervix between 22–24 GW helps to assess the risk for preterm birth and to initiate a treatment with progesterone. In a monochorionic multiple pregnancy US control examinations should be performed at least every 2 weeks after 16 GW and in uncomplicated dichorionic pregnancies at least every 3–4 weeks to check fetal growth.

Keywords

Nuchal translucency measurement Premature birth Preeclampsia Aneuploidy Fetal development 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

N. Ochsenbein-Kölble gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für GeburtshilfeUniversitätsSpital ZürichZürichSchweiz

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