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Aortokavales Kompressionssyndrom

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Zusammenfassung

Das aortokavale Kompressionssyndrom (AKK) ist eine typische Komplikation der Spätschwangerschaft, obwohl ein Auftreten ab der 16. SSW möglich ist. Spannbreite und Schweregrad der auftretenden Symptome reichen von unspezifischen Beschwerden bis zu ausgeprägter mütterlicher Hypotonie, Bewusstlosigkeit, Kreislaufzusammenbruch und konsekutiver vitaler Gefährdung des Kindes. Ein AKK wird meist durch Einnahme der Rückenlage ausgelöst. Dadurch sind viele diagnostische und therapeutische Maßnahmen der modernen Geburtshilfe mit einem hohen Risiko behaftet. Für den Anästhesisten wird das AKK bei der Sectio caesarea besonders relevant, da in dieser Situation mehrere Risikofaktoren aufeinander treffen. Ziel dieses Artikels ist, einen Überblick über diese schwangerschaftstypische Komplikation zu geben. Neben der Pathophysiologie werden Risikofaktoren und anästhesiologische Maßnahmen dargestellt, die das Auftreten des AKK begünstigen können. Im 2. Teil des Artikels werden prophylaktischen Maßnahmen und therapeutische Optionen erörtert und ein klinisch praktikabler Entscheidungsalgorithmus vorgestellt.

Abstract

Aortocaval compression syndrome (supine hypotensive syndrome) represents a common complication mainly of late pregnancy, although the syndrome has been described to occur as early as 16 weeks of gestation. The nature and severity of symptoms range from unspecific complaints to severe maternal hypotension, loss of consciousness, cardiovascular collapse, and consecutive fetal depression. Predominantly, the syndrome is provoked by placing the parturient supine. Since supine positioning is required for diverse diagnostic and therapeutic procedures in obstetrics, these involve increased risk of aortocaval compression. For the anesthetist, cesarean section is most relevant, because of the coincidence of several risk factors. The following article begins by reviewing the pathophysiology of the syndrome, known risk factors and anesthesiological procedures that predispose to the syndrome. The second part is concerned with prophylactic measures and therapeutic options, together with the discussion of a clinically practicable algorithm.

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Authors and Affiliations

  1. Abteilung für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen

    R.-T. Kiefer, A. Ploppa & H.-J. Dieterich

  2. Abteilung für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 , Tübingen

    R.-T. Kiefer

Authors
  1. R.-T. Kiefer
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  2. A. Ploppa
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  3. H.-J. Dieterich
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Correspondence to R.-T. Kiefer.

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Kiefer, RT., Ploppa, A. & Dieterich, HJ. Aortokavales Kompressionssyndrom. Anaesthesist 52, 1073–1084 (2003). https://doi.org/10.1007/s00101-003-0596-6

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  • DOI: https://doi.org/10.1007/s00101-003-0596-6

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