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Fruchtwasserembolie

Übersicht und Darstellung von Fällen mit gutem Outcome

Amniotic fluid embolism

Overview and case reports with good outcome

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Die Fruchtwasserembolie ist eine seltene Erkrankung mit hoher Mortalität. Das Fruchtwasser und korpuskuläre Bestandteile können über die uterinen Venen in den mütterlichen Kreislauf (Amnioninfusion) gelangen. In der ersten Phase einer Fruchtwasserembolie verlegen die Fremdagenzien das pulmonale Gefäßbett, sodass es zur pulmonalen Hypertonie, zum akuten Cor pulmonale und kardiogenen Schock kommt. Die zweite Phase des Krankheitsbildes ist durch die disseminierte intravasale Koagulopathie mit reaktiver Hyperfibrinolyse und Verbrauchskoagulopathie gekennzeichnet. Kommt es während oder kurz nach der Geburt zu Dyspnoe, Zyanose, Angstgefühl und Bewusstseinsverlust, muss sofort an eine Fruchtwasserembolie gedacht werden. Vorrangig ist dann die intensivmedizinische Behandlung der kardiopulmonalen Insuffizienz und die Bekämpfung der Gerinnungsstörung. Nach ausreichender Stabilisierung des mütterlichen Zustands sollte die Geburt möglichst rasch vaginal beendet werden. Ist dies es nicht möglich, kommt zur Rettung des Kindes nur die Notsectio infrage. Post partum ist mit einer vaginalen Massivblutung wegen Uterusatonie und Verbrauchskoagulopathie zu rechnen. Dementsprechend müssen Uterotonika (Oxytocin, Mutterkornalkaloide) verabreicht werden, Prostaglandine sind kontraindiziert.

Abstract

Amniotic fluid embolism is a rare disorder with a high mortality rate. The amniotic fluid and corpuscular components can enter the maternal circulation via uterine veins (amnioninfusion). During the first stage of amniotic fluid embolism foreign substances are deposited in the pulmonary vascular bed leading to pulmonary hypertension, acute cor pulmonale, and cardiogenic shock. The second phase of the clinical picture is characterized by disseminated intravascular coagulation (DIC) with reactive hyperfibrinolysis. If dyspnea, cyanosis, anxiety, or loss of consciousness occur during or shortly after birth, amniotic fluid embolism must be considered immediately. Priority is given to medical intensive care of cardiopulmonary insufficiency and control of coagulopathy. After the mother’s condition has been adequately stabilized, vaginal delivery should be finished as quickly as possible. If this is not feasible, the only recourse to save the child is emergency cesarean section. Massive vaginal hemorrhage due to uterine atony and DIC can be expected postpartum. For that reason uterotonic medication (oxytocin, ergot alkaloids) must be administered, but prostaglandins are contraindicated.

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Authors and Affiliations

  1. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden, Deutschland

    R. Lachmann, G. Kamin, M. Jaekel & W. Distler

  2. Zentrum für Geburtshilfe und Frauenheilkunde, Abteilung für Pränatale Medizin und Geburtshilfe, Universitätsklinikum Bonn, Bonn, Deutschland

    F. Bender

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  1. R. Lachmann
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  2. G. Kamin
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  3. F. Bender
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  4. M. Jaekel
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  5. W. Distler
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Correspondence to R. Lachmann.

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Lachmann, R., Kamin, G., Bender, F. et al. Fruchtwasserembolie. Gynäkologe 41, 420–426 (2008). https://doi.org/10.1007/s00129-008-2136-6

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  • DOI: https://doi.org/10.1007/s00129-008-2136-6

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