Zusammenfassung
Hintergrund
Klinisch relevante Störungen der Blutgerinnung in der Gravidität sowohl in Richtung Blutungsneigung als auch im Sinne einer pathologischen Hyperkoagulation sind relativ selten, aber potenziell lebensbedrohlich für Mutter und Fetus.
Ziel der Arbeit
Darstellung der häufigsten in der Schwangerschaft zu erwartenden internistischen Störungen der Hämostase, der entsprechenden Diagnostik und des Managements.
Methoden
Auswertung von aktueller Literatur, Leitlinien und Expertenmeinungen.
Ergebnisse
Die häufigste angeborene Hämostasestörung ist das Von-Willebrand-Syndrom. Bei Auftreten einer Thrombozytopenie ist die Unterscheidung zwischen benigner Gestationsthrombozytopenie und potenziell bedrohlichen Erkrankungen wie autoimmuner und mikroangiopathischer Thrombozytopenie wichtig. Der Geburtsmodus wird in aller Regel nicht durch diese Erkrankungen, sondern durch die geburtshilfliche Situation bestimmt. Die Entscheidung hinsichtlich einer prophylaktischen bzw. therapeutischen Antikoagulation richtet sich vor allem nach klinischen Kriterien, weniger nach dem Nachweis angeborener thrombophiler Risikofaktoren.
Schlussfolgerung
Durch adäquates interdisziplinäres Management ist der Ausgang dieser Schwangerschaften für Mutter und Kind in der Regel günstig. Wesentlich ist eine frühzeitige Diagnosestellung, die in der Gravidität durch die physiologisch veränderten Laborindizes häufig erschwert ist.
Abstract
Background
Clinically relevant coagulation disorders during pregnancy leading to enhanced bleeding as well as pathological hypercoagulation are relatively rare, however, potentially life-threatening for the mother and the fetus.
Objectives
Presentation of the most common non-obstetrical coagulation disorders as well as of the respective diagnostic and therapeutic management.
Methods
Analysis of the recent literature as well as of current guidelines and expert opinions.
Results
Von-Willebrand syndrome is the most frequent congenital coagulation disorder. Upon diagnosis of thrombocytopenia, it is critical to discriminate between benign gestational thrombocytopenia and potentially serious diseases, such as autoimmune and microangiopathic thrombopenia. Delivery modalities are usually not determined by these diseases, but by obstetrical aspects. The decision on prophylactic as well as therapeutic anticoagulation is influenced predominantly by clinical criteria, not so much by the presence of congenital thrombophilic risk factors.
Conclusion
The outcome of these pregnancies is generally favorable for both the mother and the infant, provided there is adequate interdisciplinary management. An early diagnosis is crucial, although often hampered by the physiologically altered laboratory indices during gravidity.
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Interessenkonflikt. C. Binder und C. Aschka geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Binder, C., Aschka, C. Störungen der Blutgerinnung in der Schwangerschaft. Gynäkologe 48, 94–100 (2015). https://doi.org/10.1007/s00129-014-3412-2
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DOI: https://doi.org/10.1007/s00129-014-3412-2