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Intrauterine Therapie – wie ist der Stand der Dinge?

Intrauterine therapy—where do we stand?

  • Leitthema
  • Published:
Die Gynäkologie Aims and scope

Zusammenfassung

Die Fortschritte in der pränatalen Ultraschalldiagnostik der letzten 40 Jahre haben einerseits zu einer deutlichen Steigerung der Entdeckungsrate vorgeburtlicher Erkrankungen geführt, andererseits aber auch die Grundlage für die intrauterine Therapie einiger ausgewählter Erkrankungen geschaffen. Da die meisten vorgeburtlichen Interventionen mit Risiken sowohl für den Fetus als auch für die werdende Mutter verbunden sind, bleiben sie Erkrankungen vorbehalten, die unbehandelt eine tödliche Prognose haben oder im Laufe der intrauterinen Entwicklung eine deutliche Verschlechterung der Prognose erfahren. Bisher haben nur wenige dieser therapeutischen Konzepte ihren Wert im Rahmen kontrollierter Studien bewiesen. Dies sind insbesondere die Lasertherapie des fetofetalen Transfusionssyndroms, der intrauterine Verschluss der Spina bifida und die Trachealokklusion bei Zwerchfellhernien mit schwerer pulmonaler Hypoplasie. Andere intrauterine Therapieansätze sind weniger gut belegt, entweder aufgrund der Seltenheit der Erkrankung oder der mangelnden Verfügbarkeit des Instrumentariums und der entsprechend erfahrenen Therapeuten. Der Beitrag soll dem primär beratenden Gynäkologen einen Überblick über die etablierten Verfahren und die neueren Entwicklungen geben.

Abstract

Advances in prenatal ultrasound over the past 40 years have led to a significant increase in the detection rate of prenatal diseases but have also created the basis for intrauterine treatment in a subset of cases. As most prenatal interventions are associated with risks for both the fetus and the mother, they are reserved for diseases that have a fatal prognosis if left untreated, or face a significant deterioration during intrauterine development. To date, only a few of these therapeutic concepts have proven their value in controlled studies. These are, in particular, laser therapy for twin-to-twin transfusion syndrome, intrauterine closure of spina bifida, and tracheal occlusion for diaphragmatic hernia associated with severe pulmonary hypoplasia. Other intrauterine therapeutic approaches are less well documented, either due to the rarity of the condition or the lack of availability of instruments and appropriately experienced therapists. This article is intended to provide the primary consultant gynecologist with an overview of established procedures and recent developments.

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Authors and Affiliations

  1. Schwerpunkt Pränatalmedizin, Gynäkologische Sonographie und Fetalchirurgie, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Köln, Kerpener Str. 34, 50931, Köln, Deutschland

    Eva Christin Weber,  Ingo Gottschalk &  Christoph Berg

  2. Abteilung für Pränataldiagnostik und fetale Therapie, Justus-Liebig-Universität Gießen, Gießen, Deutschland

    Ivonne Bedei

  3. Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Deutschland

    Christoph Berg

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  1. Eva Christin Weber
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Correspondence to Christoph Berg.

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E.C. Weber, I. Gottschalk, I. Bedei und C. Berg geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Andreas Schröer, Berlin

Jan Weichert, Lübeck

Ulrich Gembruch, Bonn

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Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

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Weber, E.C., Gottschalk, I., Bedei, I. et al. Intrauterine Therapie – wie ist der Stand der Dinge?. Gynäkologie (2024). https://doi.org/10.1007/s00129-024-05231-z

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