Zusammenfassung
Angeborene Fehlbildungen
Die häufigsten Anomalien des Uterus bei habituellen Aborten sind angeborene Fehlbildungen mit einer Inzidenz von etwa 13 %. Eine frühe, möglichst 3-D-sonographische Diagnostik sollte immer angeboten werden. Der Uterus septus oder subseptus entsteht durch eine fehlende oder mangelnde Resorption des Septums während der Entwicklung. Die Aborte treten meist im späten ersten Trimenon auf. Eine hysteroskopische Septumresektion (Metroplastik) ist angezeigt, da die Geburtenrate auf > 80 % erhöht werden kann. Bei komplizierten Fehlbildungen (Uterus unicornis, bicornis, didelphys) ist eine erweiterte Diagnostik (MRT) sinnvoll, eine operative Korrektur meist aber nicht notwendig, obwohl die Komplikationsrate in der Spätschwangerschaft auf einem hohen Niveau verbleibt. Eine begleitende Nierenfehlbildung sollte stets sonographisch oder MR-diagnostisch ausgeschlossen werden.
Erworbene Pathologien
Ob die Diagnose und Behandlung erworbener uteriner Pathologien, z. B. von Myomen, Polypen oder Synechien, das Abortrisiko reduzieren kann, ist noch unklar. Eine operative Behandlung empfiehlt sich dennoch in den meisten Fällen.
Abstract
Congenital malformations
The incidence of congenital uterine malformations in women with recurrent pregnancy loss is 13 %. An accurate and objective estimation of the uterus should be offered as soon as possible (particularly using a 3D sonography). The uterus septus or subseptus are the consequence of a defect in the absorption of the uterine septum. Pregnancy loss usually occurs in the late first trimester. A septum resection (metroplasty) by hysteroscopy is indicated, because the birth rate can be improved (> 80 %). In complicated malformations (unicornuate uterus, bicornuate, didelphys), advanced diagnostic imaging (MRI) is useful but surgical correction is normally not necessary, although the complication rate in late pregnancy remains high. Concomitant renal malformation should always be excluded (by ultrasound or MRI).
Acquired pathologies
Whether the diagnosis and treatment of other uterine diseases (as fibroids, polyps, and adhesions) can reduce the risk of miscarriage is still controversial: surgical treatment is usually recommended.
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Santi, A., Rohner, S. Anatomische Ursachen bei habituellen Aborten. Gynäkologische Endokrinologie 11, 89–94 (2013). https://doi.org/10.1007/s10304-012-0517-3
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DOI: https://doi.org/10.1007/s10304-012-0517-3