Skip to main content
SpringerLink
Log in

Kardiopulmonale Notfälle in Schwangerschaft und Postpartalperiode

Cardiopulmonary emergencies during pregnancy and the postpartum period

  • Leitthema
  • Published:
Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Die Zahl kardiovaskulärer Komplikationen während der Schwangerschaft hat in der Vergangenheit stetig zugenommen und stellt derzeit in westlichen Ländern die häufigste mütterliche Todesursache dar. Während der Schwangerschaft kommt es zu verschiedenen hämodynamischen und hämostaseologischen Veränderungen, die in ihrer Summe eine signifikante Mehrbelastung des Herz-Kreislauf-Systems sowie einen Zustand der Hyperkoagulabilität zur Folge haben. Dementsprechend können latente oder manifeste Herzerkrankungen während einer Schwangerschaft akut exazerbieren. Am häufigsten kann es dabei zur Ausbildung akuter Koronarsyndrome, einer peripartalen Kardiomyopathie, Arrhythmien bzw. zu einer akuten Lungenarterienembolie kommen. Aufgrund einer potenziellen kindlichen Gefährdung sind Diagnostik- und Therapiepfade eingeschränkt, insbesondere bezüglich radiologischen Bildgebungsverfahren und limitierter medikamentöser Möglichkeiten. Umso wichtiger sind Kenntnisse über die zur Verfügung stehenden Methoden, da Leitlinienempfehlungen nachweislich zur Reduktion von Morbidität und Mortalität bei akut kardial erkrankten Patientinnen während der Schwangerschaft beitragen konnten.

Abstract

The number of patients who develop cardiac problems during pregnancy are increasing and represent to date the major cause of maternal death in western countries. Pregnancy induces several changes which together increase the hemodynamic burden on the cardiovascular system and can also cause a prothrombotic state. Hence, latent or apparent cardiac disease can acutely decompensate during pregnancy. From a cardiovascular perspective, pregnancies are most often complicated by acute coronary syndromes, peripartum cardiomyopathy, arrhythmias, or pulmonary embolism. Due to potential fetal harm conventional diagnostic and therapeutic approaches are limited by the restricted use of radiogenic cardiac imaging and applicable medications. Therefore, knowledge about available therapeutic options is of greatest importance, since guideline recommendations have clearly been demonstrated to reduce morbidity and mortality in acute cardiac emergencies during pregnancy.

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
Abb. 5

Literatur

  1. Weiss BM, Segesser LK von, Alon E et al (1998) Outcome of cardiovascular surgery and pregnancy: a systematic review of the period 1984–1996. Am J Obstet Gynecol 179:1643–1653

    Article  PubMed  CAS  Google Scholar 

  2. Siu SC, Sermer M, Colman JM et al (2001) Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 104:515–521

    Article  PubMed  CAS  Google Scholar 

  3. Khairy P, Ionescu-Ittu R, Mackie AS et al (2010) Changing mortality in congenital heart disease. J Am Coll Cardiol 56:1149–1157

    Article  PubMed  Google Scholar 

  4. Gohlke-Bärwolf CE, Eichstädt H (2004) Herzerkrankungen und Schwangerschaft. In: Roskamm N, Neumann FJ, Kalusche D, Bestehorn HP (Hrsg) Herzkrankheiten, 5. Aufl. Springer, Berlin

  5. Klein HH, Pich S (2003) Cardiovascular changes during pregnancy. Herz 28:173–174

    Article  PubMed  Google Scholar 

  6. ESC Guidelines on the management of cardiovascular disease during pregnancy. Eur Heart J doi:10.1093/eurheartj/ehr218

  7. Department of Health and Social Security (1989) Report on confidential enquiries into maternal deaths in England and Wales, 1982–84. Reports on Health and Social Subjects No. 34. HMSO, London

  8. The Confidential Enquiry into Maternal and Child Health (CEMACH) (2007) Saving mothers‘ lives: Reviewing maternal deaths to make motherhood safer 2003–2005. The seventh report on Confidential Enquiries into Maternal Deaths in the United Kingdom. CEMACH, London

  9. James AH, Jamison MG, Biswas MS et al (2006) Acute myocardial infarction in pregnancy: a United States population-based study. Circulation 113:1564–1571

    Article  PubMed  Google Scholar 

  10. Ladner HE, Danielson B, Gilbert WM (2005) Acute myocardial infarction in pregnancy and the puerperium: a population-based study. Obstet Gynecol 105:480–484

    Article  PubMed  Google Scholar 

  11. Joyal D, Leya F, Koh M et al (2007) Troponin I levels in patients with preeclampsia. Am J Med 120:819.e13–e14

    Article  PubMed  Google Scholar 

  12. Roth A, Elkayam U (2008) Acute myocardial infarction associated with pregnancy. J Am Coll Cardiol 52:171–180

    Article  PubMed  Google Scholar 

  13. George D, Erkan D (2009) Antiphospholipid syndrome. Prog Cardiovasc Dis 52:115–125

    Article  PubMed  CAS  Google Scholar 

  14. Roth A, Elkayam U (1996) Acute myocardial infarction associated with pregnancy-an update. Ann Intern Med 125:751–762

    PubMed  CAS  Google Scholar 

  15. Koul AK, Hollander G, Moskovits N et al (2001) Coronary artery dissection during pregnancy and the postpartum period: two case reports and review of literature. Catheter Cardiovasc Interv 52:88–94

    Article  PubMed  CAS  Google Scholar 

  16. Manalo-Estrella P, Barker AE (1967) Histopathologic findings in human aortic media associated with pregnancy. Arch Pathol 83:336–341

    PubMed  CAS  Google Scholar 

  17. Bonnet J, Aumailley M, Thomas D et al (1986) Spontaneous coronary artery dissection: case report and evidence for a defect in collagen metabolism. Eur Heart J 7:904–909

    PubMed  CAS  Google Scholar 

  18. Mathew JP, Fleisher LA, Rinehouse JA et al (1993) ST segment depression during labor and delivery. Anesthesiology 78:997–998

    Article  Google Scholar 

  19. Moran C, Ni Bhuinnedin M, Geary M et al (2001) Myocardial ischemia in normal patients undergoing elective cesarean section: a peripartum assessment. Anaesthesia 56:1051–1058

    Article  PubMed  CAS  Google Scholar 

  20. Shivvers SA, Wians FH, Keffer JH, Ramin SM (1999) Maternal cardiac troponin I levels during normal labor and delivery. Am J Obstet Gynecol 180:122–127

    Article  PubMed  CAS  Google Scholar 

  21. O’Donoghue M, Boden WE, Braunwald E et al (2008) Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA 300:71–80

    Article  Google Scholar 

  22. Thorne SA (2004) Pregnancy in heart disease. Heart 90:450–456

    Article  PubMed  CAS  Google Scholar 

  23. Beus E de, Mook WN van, Ramsay G et al (2003) Peripartum cardiomyopathy: a condition intensivists should be aware of. Intensive Care Med 29:167–174

    PubMed  Google Scholar 

  24. Pearson GD, Veille JC, Rahimtoola S et al (2000) Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 283:1183–1188

    Article  PubMed  CAS  Google Scholar 

  25. Regitz-Zagrosek V, Gohlke-Bärwolf C, Geibel-Zehender A et al (2008) Herzerkrankung in der Schwangerschaft. Clin Res Cardiol 97:1–36

    Article  Google Scholar 

  26. Sliwa K, Hilfiker-Kleiner D, Petrie MC et al (2010) Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 12:767–778

    Article  PubMed  Google Scholar 

  27. Sliwa K, Fett J, Elkayam U (2006) Peripartum cardiomyopathy. Lancet 368:687–693

    Article  PubMed  Google Scholar 

  28. Hilfiker-Kleiner D, Kaminski K, Podewski E et al (2007) A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell 128:589–600

    Article  PubMed  CAS  Google Scholar 

  29. Rokey R, Belfort M (2002) Peripartum cardiomyopathy. In: Wilansky S, Willerson JT (Hrsg) Heart disease in women. Churchill Livingstone, New York, S 487–495

  30. Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 10:933–989

    Article  PubMed  Google Scholar 

  31. Rasmusson KD, Stehlik J, Brown RN et al (2007) Long-term outcomes of cardiac transplantation for peri-partum cardiomyopathy: a multiinstitutional analysis. J Heart Lung Transplant 26:1097–1104

    Article  PubMed  Google Scholar 

  32. Sliwa K, Blauwet L, Tibazarwa K et al (2010) Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation 121:1465–1473

    Article  PubMed  CAS  Google Scholar 

  33. Gowda RM, Khan IA, Mehta NJ et al (2003) Cardiac arrhythmias in pregnancy: clinical and therapeutic considerations. Int J Cardiol 88:129–133

    Article  PubMed  Google Scholar 

  34. Joglar JA, Page RL (1999) Treatment of cardiac arrhythmias during pregnancy:safety considerations. Drug Saf 20:85–94

    Article  PubMed  CAS  Google Scholar 

  35. Blomström-Lundqvist C, Scheinman MM, Aliot EM et al (2003) ACC/AHA/ESC Guidelines for the management of patients with supraventricular arrhythmias 2003. Circulation 108:1871–1909

    Article  PubMed  Google Scholar 

  36. Elkayam U, Goodwin TM (1995) Adenosine therapy for supraventricular tachycardia during pregnancy. Am J Cardiol 75:521–523

    Article  PubMed  CAS  Google Scholar 

  37. Fuster V, Ryden LE, Cannom DS et al (2006) ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). Eur Heart J 27:1979–2030

    Article  PubMed  Google Scholar 

  38. Camm AJ, Kirchhof P, Lip GY et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429

    Article  PubMed  Google Scholar 

  39. Rogge C, Geibel A, Bode C, Zehender M (2004) Cardiac arrhythmias and sudden cardiac death in women. Z Kardiol 93:427–438

    Article  PubMed  CAS  Google Scholar 

  40. Natale A, Davidson T, Geiger MJ, Newby K (1997) Implantable cardioverter-defibrillators and pregnancy: a safe combination? Circulation 96:2808–2812

    PubMed  CAS  Google Scholar 

  41. Heit JA, Kobbervig CE, James AH et al (2005) Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 143:697–706

    PubMed  Google Scholar 

  42. Kline JA, Williams GW, Hernandez-Nino J (2005) D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed. Clin Chem 51:825–829

    Article  PubMed  CAS  Google Scholar 

  43. Turrentine MA, Braems G, Ramirez MM (1995) Use of thrombolytics for the treatment of thromboembolic disease during pregnancy. Obstet Gynecol Surv 50:534–541

    Article  PubMed  CAS  Google Scholar 

  44. Ahearn GS, Hadjiliadis D, Govert JA, Tapson VF (2002) Massive pulmonary embolism during pregnancy successfully treated with recombinant tissue plasminogen activator: a case report and review of treatment options. Arch Intern Med 162:1221–1227

    Article  PubMed  Google Scholar 

  45. Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29:2276–2315

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Innere Medizin III, Schwerpunkt Kardiologie und Angiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schittenhelmstr.12, 24105, Kiel, Deutschland

    M. Rosenberg &  N. Frey

Authors
  1. M. Rosenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Frey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Frey.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rosenberg, M., Frey, N. Kardiopulmonale Notfälle in Schwangerschaft und Postpartalperiode. Med Klin Intensivmed Notfmed 107, 101–109 (2012). https://doi.org/10.1007/s00063-011-0039-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-011-0039-0

Schlüsselwörter

Keywords

Search

Navigation