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Chirurgie in der Schwangerschaft

Surgery during pregnancy

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Zusammenfassung

Die Entscheidung zu operativen Eingriffen in der Schwangerschaft sollte wegen der Gefahr für Mutter und Kind nach Möglichkeit interdisziplinär unter Koordination durch die Geburtshilfe vorgenommen werden. Hierbei müssen die Risiken des operativen Eingriffes für die Mutter und den Fetus kalkuliert und gegen die Nachteile einer nicht operativen Therapie abgewogen werden. Sollte keine vitale Bedrohung für die Mutter vorliegt, besitzt die Entwicklung des Fetus höchste Priorität bei therapeutischen Überlegungen. Die größte Gefährdung des Fetus besteht im 1. Schwangerschaftstrimenon. Operationen mit aufgeschobener Dringlichkeit sollten daher, sofern sie nicht bis nach der Gravidität verschoben werden können, möglichst nicht in den ersten 3, sondern zwischen dem 4. und 6. Schwangerschaftsmonat ausgeführt werden. Wenn maternal nötig, müssen operative Eingriffe aber zu jedem Zeitpunkt in der Gravidität ausgeführt werden. Ab Erreichen der extrauterinen Lebensfähigkeit (ca. 24./25. Schwangerschaftswoche) ist dabei in Abwägung zwischen maternaler Gefährdung und kindlicher Morbidität und Mortalität immer zwischen jeweiliger operativer Option inklusive vorzeitiger Entbindung oder postoperativer Fortführung der Schwangerschaft zu wählen. Vor dem Hintergrund der potenziellen Frühgeburtlichkeit sollten operative Eingriffe in der Schwangerschaft nur an perinatologischen Zentren mit neonatologischer Intensivstation vorgenommen werden.

Abstract

The decision for surgical intervention during pregnancy should be interdisciplinary and include all aspects of prenatal care. The risk of surgery to mother and fetus must be calculated and weighed against the disadvantages of other, nonradical methods. If there is no danger to the mother, the highest priority in all therapeutic considerations is the fetus and its development. The greatest threat to the fetus exists during the first trimester. In case surgery cannot be postponed till after birth, they should be done if possible during the 4th to 6th months of pregnancy, not the first trimester. In case of danger to the mother, necessary surgery must be performed any time during the pregnancy. Once extrauterine fetal survival is possible (the 24th or 25th week of pregnancy), danger to the mother and the child’s mortality and morbidity of the various options must be carefully weighed for both premature delivery and continued pregnancy. Due to the problems of prematurity, any surgery during pregnancy should be carried out only in perinatal clinics outfitted with neonatologic intensive care units.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen

    H. Lang

  2. Geburtshilflich-Gynäkologische Universitätsklinik Graz, Österreich

    U. Lang

  3. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45122 , Essen

    H. Lang

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  1. H. Lang
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  2. U. Lang
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Lang, H., Lang, U. Chirurgie in der Schwangerschaft. Chirurg 76, 744–752 (2005). https://doi.org/10.1007/s00104-005-1075-1

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