Zusammenfassung
Die Zahl der Mehrgebärenden, bei denen eine Uterotomie vorausgeht, steigt ständig an. Das liegt v. a. an der weiterhin zunehmenden Anzahl von Sectiones, die Sectiorate liegt derzeit in Niedersachsen bei 27%. Auch der Anteil der Schwangeren, bei denen bereits eine Myomenukleation durchgeführt wurde, nimmt zu, da der Altersdurchschnitt der Schwangeren steigt. In beiden Settings stellt sich die Frage des anzustrebenden Entbindungsmodus, bei der neben der größtmöglichen Sicherheit für Mutter und Kind auch psychologische Faktoren und gesellschaftliche Trends in die Entscheidung einfließen. Risiken und Entscheidungshilfen werden dargestellt. In 0,1–1% der Schwangeren ist mit einer Uterusfehlbildung zu rechnen, die sich in der Ausprägung von einem angedeuteten Septum bis zur komplexen Fehlbildung wie beim Uterus didelphys erstrecken kann. Eine gefürchtete Komplikation stellt die Uterusruptur dar, allerdings bestehen auch noch andere Risiken für Schwangerschaft und Geburt. Dennoch kann nach Sichtung der Datenlage außer beim Vorliegen bestimmter weiterer Faktoren zum Versuch des Spontanpartus geraten werden.
Abstract
The number of multiparous women with a uterine scar is rising constantly. This is mostly due to the increasing number of cesarean sections. At present cesarean sections account for 27% of all births in the German State of Lower Saxony. Besides cesarean sections, there is also an increased number of pregnant women in whom enucleation of fibroids has been performed, mostly due to constantly rising maternal age. In both situations, it is difficult to decide on the mode of delivery. Besides safety concerns for mother and fetus, psychological factors and trends in society may also play a role. This article evaluates the risks involved and provides guidelines for decision making. Uterine malformations occur in 0.1–1% of all pregnancies ranging from an incomplete septum up to complex malformations such as uterus didelphys. Besides other possible events, uterine rupture is the most dangerous and feared complication in these situations. However, a review of the available data and current literature shows that spontaneous delivery can be advised after exclusion of certain risk factors.
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Fischer, D., Axt-Fliedner, R., Hornung, D. et al. Entbindung nach Uterotomie oder bei Uterusanomalien. Gynäkologe 38, 514–521 (2005). https://doi.org/10.1007/s00129-005-1697-x
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DOI: https://doi.org/10.1007/s00129-005-1697-x