gynäkologie + geburtshilfe

, Volume 19, Issue 5, pp 34–42

Was muss der Niedergelassene in der Betreuung beachten?

Mehrlingsschwangerschaften
Zertifizierte Fortbildung

Zusammenfassung

Mehrlingsschwangerschaften gehen häufiger mit Komplikationen für Mutter und Kinder einher als Einlingsschwangerschaften. Niedergelassene Frauenärzte und in der Klinik tätige Geburtshelfer sollten daher alles Notwendige für ein gutes Outcome von Müttern und Kindern veranlassen. Dieses Ziel können wir nur erreichen, wenn wir zusammenarbeiten. Wichtige Weichen werden im Rahmen der ersten Untersuchungen in der Praxis während der Frühschwangerschaft gestellt. Auf höhergradige Mehrlingsschwangerschaften wird in diesem Beitrag nur punktuell eingegangen; sie sollten frühzeitig in pränataldiagnostisch und perinatologisch erfahrenen Schwerpunktambulanzen betreut werden.

Literatur

  1. 1.
    Sebire NJ et al. Intertwin disparity in fetal size in monochorionic and dichorionic pregnancies. Obstet Gynecol. 1998 Jan;91(1):82–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Spencer K, Nicolaides KH. Screening for trisomy 21 in twins using first trimester ultra-sound and maternal serum biochemistry in a one-stop clinic: a review of three years experience. BJOG 2003; 110: 276–80.PubMedCrossRefGoogle Scholar
  3. 3.
  4. 4.
    Weber MA, Sebire NJ. Genetics and developmental pathology of twinning. Semin Fetal Neonatal Med. 2010 Dec;15(6): 313–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Glinianaia SV, Rankin J, Wright C. Congenital anomalies in twins: a register-based study. Hum Reprod. 2008 Jun;23(6):1306–11.PubMedCrossRefGoogle Scholar
  6. 6.
    Buhling KJ, Henrich W, Starr E, Lubke M, Bertram S, Siebert G, Dudenhausen JW: Risk for gestational diabetes and hypertension for women with twin pregnancy compared to singleton pregnancy. Arch Gynecol Obstet. 2003;269(1):33.PubMedCrossRefGoogle Scholar
  7. 7.
    Liem S et al. Cervical pessaries for prevention of preterm birth in women with a multiple pregnancy (ProTWIN): a multicentre, open-label randomised controlled trial. Lancet. 2013 Oct 19;382(9901):1341–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Luke B. The ideal twin pregnancy: patterns of weight gain, discordancy, and length of gestation. Am J Obstet Gynecol. 1993 Sep;169(3):588–97.PubMedCrossRefGoogle Scholar
  9. 9.
    Sebire NJ et al. Intertwin disparity in fetal size in monochorionic and dichorionic pregnancies. Obstet Gynecol. 1998 Jan;91(1):82–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Quintero RA et al. Staging of twin-twin transfusion syndrome. J Perinatol. 1999;19:550–555.PubMedCrossRefGoogle Scholar
  11. 11.
    Simpson LL. Society for Maternal-Fetal Medicine. Am J Obstet Gynecol. 2013 Jan;208(1):3–18. Erratum in: Am J Obstet Gynecol. 2013 May;208(5):392.PubMedCrossRefGoogle Scholar
  12. 12.
    Heyborne KD et al. Improved perinatal survival of monoamniotic twins with intensive inpatient monitoring. Am J Obstet Gynecol. 2005;192(1):96.PubMedCrossRefGoogle Scholar
  13. 13.
  14. 14.
    Poon LC, Nicolaides KH. First-trimester maternal factors and biomarker screening for preeclampsia. Prenat Diagn. 2014 Apr 25.Google Scholar
  15. 15.
    Goldenberg, RL, Iams, JD, Miodovnik, M, et al. The preterm prediction study: risk factors in twin gestations. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 1996; 175:1047.PubMedCrossRefGoogle Scholar
  16. 16.
    Guzman, ER, Walters, C, O’Reilly-Green, C, et al. Use of cervical ultrasonography in prediction of spontaneous preterm birth in twin gestations. Am J Obstet Gynecol 2000; 183:1103.PubMedCrossRefGoogle Scholar
  17. 17.
    Vayssiere, C, Favre, R, Audibert, F, et al. Cervical length and funneling at 22 and 27 weeks to predict spontaneous birth before 32 weeks in twin pregnancies: a French prospective multicenter study. Am J Obstet Gynecol 2002; 187:1596.PubMedCrossRefGoogle Scholar
  18. 18.
    Goldenberg RL et al. The preterm prediction study: risk factors in twin gestations. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol. 1996 Oct;175(4 Pt 1):1047–53.PubMedCrossRefGoogle Scholar
  19. 19.
    Dor J et al. Elective cervical suture of twin pregnancies diagnosed ultrasonically in the first trimester following induced ovulation. Gynecol Obstet Invest. 1982;13(1):55–60.PubMedCrossRefGoogle Scholar
  20. 20.
    Senat MV, Deprest J et al. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004 Jul 8;351(2):136–44.PubMedCrossRefGoogle Scholar
  21. 21.
    Hillman SC, Morris RK, Kilby MD: Co-twin prognosis after single fetal death: a systematic review and meta-analysis. Obstet Gynecol. 2011;118(4):928PubMedCrossRefGoogle Scholar
  22. 22.
    Yamasmit W, et al. Prophylactic oral betamimetics for reducing preterm birth in women with a twin pregnancy. Cochrane Database Syst Rev. 2012;9:CD004733.PubMedGoogle Scholar
  23. 23.
    Barrett JF, Hannah ME et al. (Twin Birth Study Collaborative Group) A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med. 2013 Oct 3;369(14):1295–305.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Kahn B et al. Prospective risk of fetal death in singleton, twin, and triplet gestations: implications for practice. Obstet Gynecol. 2003;102(4):685.PubMedCrossRefGoogle Scholar
  25. 25.

Copyright information

© Urban & Vogel 2014

Authors and Affiliations

  1. 1.Klinik für Frauenheilkunde und GeburtshilfeKrankenhaus St. Elisabeth u. St. BarbaraHalle (Saale)Deutschland
  2. 2.HalleDeutschland

Personalised recommendations