Skip to main content
SpringerLink
Log in

Update 2018 der ESC-Leitlinie zu kardiovaskulären Erkrankungen in der Schwangerschaft

Die wichtigsten Fakten

Update of the ESC guidelines 2018 on cardiovascular diseases during pregnancy

Most important facts

  • Schwerpunkt
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Herzerkrankungen sind in den westlichen Ländern die häufigste Ursache für den Tod der Mutter während einer Schwangerschaft. Die aktuelle ESC-Leitlinie 2018 zu Herz-Kreislauf-Erkrankungen in der Schwangerschaft ist ein Handlungsleitfaden für jede Ärztin und jeden Arzt, die vor der Herausforderung stehen, schwangere Frauen mit kardiovaskulären Erkrankungen zu betreuen. Zu den neuen Konzepten gegenüber 2011 gehören die Empfehlungen, das mütterliche Risiko aufgrund der modifizierten Klassifikation der Weltgesundheitsorganisation (mWHO) einzustufen, die Einführung des „Schwangerschafts-Herz-Teams“, Hinweise zur assistierten Fertilitätstherapie, differenzierte Empfehlungen zur Antikoagulation für Frauen mit niedrigem und hohem Dosisbedarf an Vitamin-K-Antagonisten sowie die mögliche Verwendung von Bromocriptin bei der peripartalen Kardiomyopathie. Die FDA(Food and Drug Administration)-Kategorien A bis D und X sollen nicht mehr verwendet werden. Daher wurde die Tabelle zu den Arzneimitteln durch detaillierte Informationen aus tierexperimentellen und humanen Studien zum Risiko für Mutter und Fetus ergänzt. Die neuen Erkenntnisse zu den spezifischen Herzerkrankungen werden in den jeweiligen Kapiteln ausführlich dargestellt.

Abstract

Heart diseases are the most common cause of maternal death during pregnancy in Western countries. The current ESC guidelines 2018 for the management of cardiovascular diseases during pregnancy is a guide for any physician facing the challenge of caring for pregnant women with cardiovascular diseases. Among the new concepts compared to 2011, are recommendations to classify maternal risk due to the modified World Health Organization (mWHO) classification, introduction of the pregnancy heart team, guidance on assisted reproductive therapy, specific recommendations on anticoagulation for low-dose and high-dose requirements of vitamin K antagonists and the potential use of bromocriptine in peripartum cardiomyopathy. The Food and Drug Administration (FDA) categories A–D and X should no longer be used. Therefore, the table of drugs was completed with detailed information from animal and human studies on maternal and fetal risks. The new findings on specific heart diseases are presented in detail in the respective chapters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J et al (2018) 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 39:3165–3241

    Article  PubMed  Google Scholar 

  2. Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C et al (2011) ESC Guidelines on the management of cardiovascular diseases during pregnancy. Eur Heart J 32:3147–3197

    Article  PubMed  Google Scholar 

  3. Drenthen W, Boersma E, Balci A et al (2010) Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J 31:2124–2132

    Article  PubMed  Google Scholar 

  4. Ruys TP, Roos-Hesselink JW, Hall R et al (2014) Heart failure in pregnant women with cardiac disease: data from the ropac. Heart 100:231–238

    Article  PubMed  Google Scholar 

  5. Cantwell R, Clutton-Brock T, Cooper G et al (2011) Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The eighth report of the confidential enquiries into maternal deaths in the united kingdom. BJOG 118:1–203

    PubMed  Google Scholar 

  6. Pijuan-Domenech A, Galian L, Goya M et al (2015) Cardiac complications during pregnancy are better predicted with the modified who risk score. Int J Cardiol 195:149–154

    Article  CAS  PubMed  Google Scholar 

  7. Elkayam U, Goland S, Pieper PG, Silverside CK (2016) High-risk cardiac disease in pregnancy: Part i. J Am Coll Cardiol 68:396–410

    Article  PubMed  Google Scholar 

  8. Fetal Echocardiography Task Force, American Institute of Ultrasound in Medicine Clinical Standards Committee, American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine (2011) AIUM practice guideline for the performance of fetal echocardiography. J Ultrasound Med 30:127–136

    Article  Google Scholar 

  9. Tweet MS, Hayes SN, Gulati R, Rose CH, Best PJ (2015) Pregnancy after spontaneous coronary artery dissection: a case series. Ann Intern Med 162:598–600

    Article  PubMed  Google Scholar 

  10. Zeisler H, Llurba E, Chantraine F, Vatish M (2016) Predictive value of the sFlt-1:PIGF ratio in women with suspected preeclampsia. N Engl J Med 374:13–22

    Article  CAS  PubMed  Google Scholar 

  11. Schmella MJ, Clifton RG, Althouse AD, Roberts JM (2015) Uric acid determination in gestational hypertension: Is it as effective a delineator of risk as proteinuria in high-risk women? Reprod Sci 22:1212–1219

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Rolnik DL, Wright D, Poon LC, O’Gorman N (2017) Aspirin versus placebo in pregnancies at high-risk for preterm preeclampsia. N Engl J Med 377:613–622

    Article  CAS  PubMed  Google Scholar 

  13. Gutin LS, Merz AE, Bakalov VK et al (2013) Parity and aortic dimensions in healthy women. Int J Cardiol 165:383–384

    Article  PubMed  Google Scholar 

  14. Bauersachs J, Arrigo M, Hilfiker-Kleiner D et al (2016) Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the heart failure association of the European society of cardiology study group on peripartum cardiomyopathy. Eur J Heart Fail 18:1096–1105

    Article  PubMed  Google Scholar 

  15. Sliwa K, Mebazaa A, Hilfiker-Kleiner D et al (2017) Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on PPCM. Eur J Heart Fail 19:1131–1141

    Article  CAS  PubMed  Google Scholar 

  16. Vaidya VR, Arora S, Patel N et al (2017) Burden of arrhythmia in pregnancy. Circulation 135:619–621

    Article  PubMed  Google Scholar 

  17. Driver K, Chisholm CA, Darby AE et al (2015) Catheter ablation of arrhythmia during pregnancy. J Cardiovasc Electrophysiol 26:698–702

    Article  PubMed  Google Scholar 

  18. Ahmed N, Kausar H, Ali L, Rakhshinda (2015) Fetomaternal outcome of pregnancy with mitral stenosis. Pak J Med Sci 31:643–647

    Article  PubMed Central  PubMed  Google Scholar 

  19. Xu Z, Fan J, Luo X et al (2016) Anticoagulation regimens during pregnancy in patients with mechanical heart valves: a systematic review and meta-analysis. Can J Cardiol 32:1248.e1–1248.e9

    Article  Google Scholar 

  20. U.S. Food & Drug Administration Pregnancy and lactation labeling (drugs) final rule. https://www.fda.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/Labeling/ucm093307.htm. Zugegriffen: 27.10.2018

Download references

Author information

Authors and Affiliations

  1. Institut für Geschlechterforschung in der Medizin (GiM) und Center for Cardiovascular Research (CCR), Charité – Universitätsmedizin Berlin, Hessische Str. 3–4, 10115, Berlin, Deutschland

    U. Seeland & V. Regitz-Zagrosek

  2. DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partnerseite Berlin, Berlin, Deutschland

    U. Seeland & V. Regitz-Zagrosek

  3. Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    J. Bauersachs

  4. Klinik für Kardiologie, Universitair Medisch Centrum Rotterdam, Rotterdam, Niederlande

    J. Roos-Hesselink

Authors
  1. U. Seeland
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Bauersachs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Roos-Hesselink
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Regitz-Zagrosek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. Seeland.

Ethics declarations

Interessenkonflikt

U. Seeland, J. Bauersachs, J. Roos-Hesselink und V. Regitz-Zagrosek geben an, dass kein Interessenkonflikt besteht.

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seeland, U., Bauersachs, J., Roos-Hesselink, J. et al. Update 2018 der ESC-Leitlinie zu kardiovaskulären Erkrankungen in der Schwangerschaft. Herz 43, 710–718 (2018). https://doi.org/10.1007/s00059-018-4765-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-018-4765-4

Schlüsselwörter

Keywords

Search

Navigation