Zusammenfassung
Vergiftungen bei Schwangeren, v. a. in suizidaler Absicht, verursachen große Unsicherheit hinsichtlich der Auswirkungen der Intoxikation und deren Behandlung auf das Ungeborene. Häufig wird das Fehlbildungsrisiko nach Überdosis überschätzt. Wenn die Mutter nicht vital bedroht ist und es sich nicht um Medikamente handelt, die in therapeutischer Dosis als teratogen angesehen werden, ist nach heutigem Wissensstand kein erhebliches Risiko für den Embryo anzunehmen. Dies gilt für die bei Suizidversuchen relativ häufig verwendeten Mittel wie Paracetamol und Eisenpräparate, Mischintoxikationen mit Psychopharmaka sowie für Schlangenbisse und Knollenblätterpilzingestion. Entscheidend ist, dass die Schwangere so behandelt wird wie eine Nichtschwangere, d. h. dass therapeutische Maßnahmen, die aus aktueller klinisch-toxikologischer Sicht indiziert sind, eingesetzt werden. Die Entwicklung des Feten muss bei relevanten Vergiftungen mit weiterführender Ultraschalldiagnostik kontrolliert werden; dies betrifft unmittelbare Auswirkungen auf Vitalität, Herzfrequenz und Bewegungsmuster sowie Organfehlbildungen und Wachstumsstörungen im weiteren Verlauf. Ein Schwangerschaftsabbruch aus Furcht vor einer Schädigung der Frucht ist im Allgemeinen nicht gerechtfertigt.
Abstract
Attempted suicides and poisonings in pregnancy are a challenge for health care professionals because of the unknown effects of the toxic agent and the antidote therapy on the unborn. In case of intoxication, the malformation risk is often overestimated. In contrast, pertinent data show that the risk is not very high as long as the drug is not known as a teratogen and the mother’s health is not substantially impaired. This applies to suicide attempts with acetaminophen, iron-containing products, and multidrug overdoses with psychopharmaceuticals as well as snake and spider bites and the ingestion of poisonous mushrooms. It is of utmost importance that the pregnant patient receives the same detoxification and supportive therapy following pertinent guidelines as a non-pregnant patient. The fetus should be followed-up by ultrasound with special focus on its vital parameters, movement pattern, and normal growth and organ differentiation. As long as the maternal health status is not substantially impaired, there is no indication to discuss elective termination of pregnancy “for toxicological reasons”.
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Schaefer, C., Hoffmann-Walbeck, P. Intoxikationen bei Schwangeren. Med Klin Intensivmed Notfmed 107, 118–122 (2012). https://doi.org/10.1007/s00063-011-0036-3
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DOI: https://doi.org/10.1007/s00063-011-0036-3