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Hypertensive Schwangerschaftserkrankungen und Präeklampsie

Pregnancy hypertension and pre-eclampsia

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Zusammenfassung

Hypertensive Schwangerschaftserkrankungen und Präeklampsie zählen zu den häufigsten Schwangerschaftskomplikationen, die durch eine neu auftretende Hypertonie und/oder Proteinurie in der Schwangerschaft definiert und mit zahlreichen mütterlichen und fetalen Komplikationen assoziiert sind. Die Präeklampsie ist eine Drei-Stufen-Erkrankung, bei der sich auf der Basis einer gestörten frühen Plazentaentwicklung eine plazentare Mangelversorgung und Hypoxie entwickeln, die letztlich zu einer generalisierten mütterlichen Endotheldysfunktion mit organspezifisch unterschiedlichen klinischen Symptomen führt. Präventive Strategien mit Acetylsalicylsäure erreichen nur eine moderate Risikoreduktion, während die medikamentöse Therapie letztlich nur symptomatisch bleiben kann. Die einzige kausale Therapie ist die Beendigung der Schwangerschaft unter Berücksichtigung der Chancen für ein gesundes kindliches Überleben in Abwägung zu den mütterlichen Risiken. Eine Präeklampsie ist mit einem lebenslang erhöhten Risiko für renale, kardiovaskuläre und metabolische Erkrankungen sowohl für die betroffene Frau als auch deren Kinder verbunden.

Abstract

Pregnancy-induced hypertension and pre-eclampsia are common disorders during pregnancy defined by the de novo onset of hypertension and/or proteinuria and cause a variety of maternal and fetal problems. Pre-eclampsia is characterised as a three-stage disease that originates from poor early placental development, followed by placental malperfusion and hypoxia leading to generalised dysfunction of the maternal endothelium with organ-specific clinical symptoms. Prevention with acetylsalicylic acid results in a moderate risk reduction, whereas antihypertensive therapy works only symptomatically. The only causal therapy is the termination of pregnancy in respect of the chances for an acceptable fetal outcome balanced to the maternal risks. A history of pre-eclampsia is combined with long-lasting risks for renal, cardiovascular and metabolic diseases for the women as well as their offspring in later life.

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  1. Abteilung Geburtshilfe, Klinik für Frauenheilkunde und Geburtshilfe, Klinikum der Friedrich-Schiller-Universität Jena, Bachstr. 18, 07743 , Jena, Deutschland

    E. Schleußner

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Schleußner, E. Hypertensive Schwangerschaftserkrankungen und Präeklampsie. Nephrologe 4, 312–320 (2009). https://doi.org/10.1007/s11560-008-0259-3

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