Zusammenfassung
Die neuen deutschen Leitlinien zu hypertensiven Schwangerschaftserkrankungen stehen im internationalen Kontext und haben einige Neuerungen. Ziel der Änderungen ist die Prolongation der Schwangerschaft mit konsekutiver Senkung der fetalen und maternalen Morbidität und Mortalität. Zum ersten Mal wird die Möglichkeit sowie die Empfehlung zu Schwangerschaftsverlängerung behandelt. Konkret bedeutet das, dass die antihypertensive Therapie erst ab Blutdruckwerten von ≥170/110 mmHg empfohlen wird; dadurch soll die fetale Versorgung verbessert werden und plazentare Minderperfusion vermieden werden. Des Weiteren hat sich die Verwendung der Antihypertensiva insbesondere in der Akuttherapie verändert: das antihypertensive Mittel der Wahl ist nicht mehr Dihydralazin (Nepresol®) sondern Nifedipin (Adalat®). In der Behandlung des HELLP-Syndroms gibt es nur noch den Unterschied im Vergleich zur Präeklampsie, dass zusätzlich der Gebrauch von Glukokortikosteroiden empfohlen wird. Bei beiden Erkrankungen ist das Ziel, vor Beendigung der Schwangerschaft die fetale Lungenreifeinduktion mit plazentagängigen Glukokortikosteroiden durchgeführt zu haben. Ein weiterer neuer Punkt in den deutschen Leitlinien ist der Hinweis auf die Möglichkeiten der Prädiktion und Prävention der hypertensiven Schwangerschaftserkrankungen: bei Risikopatientinnen mit Zustand nach Präeklampsie oder bei Schwangeren mit pathologische Flussmuster der Art. Uterinae erhöht sich das Risiko für eine Präeklampsie signifikant, sodass eine präventive Therapie mit ASS durchgeführt werden sollte. Diese Änderungen der deutschen Leitlinie bewirken hauptsächlich eine mögliche Schwangerschaftsprolongation und damit die Senkung der neonatalen Mortalität und Morbidität.
Abstract
The new german guidelines for the treatment of hypertensive disorders in pregnancy have some important differentiations. The aim of the new guidelines is to avoid the early premature birth and to reduce the fetal and maternal morbidity and mortality. For the first time there ist the possibility and the recommendation for the prolongation of pregnancy. This means that the treatment of hypertensive disorders should start not before a blood pressure of ≥170/110 mmHg; thus the nutrition of the fetus will not be worsened and the worse perfusion of the placenta will be avoided. Further more the selection of antihypertensive treatment has changed: the first choice is not longer Dihydralazin (Nepresol®) but Nifedipin (Adalat®). In the treatment of HELLP-Syndrom there ist only one difference to the treatment of preeclampsia: the use of glucocorticosteroids. In the treatment of both hypertensive disorders in pregnancy there is the aim to finish the fetal lungmatureinduction before the delivery is planned or necessary. A new point of view in the german guidelines is the possibility of prediction and prevention of hypertensive disorders in pregnancy: patients who had already a hypertensive disorder in the pregnancy before or patients who have a pathologic flow in the Art. uterinae have a significant higher risk for a preeclampsia in this pregnancy. They should receive a preventive therapy with ASS. Because of these changes in the german guidelines the prolongation of pregnancy and the reduced rate of premature birth becomes more importance and helps to avoid a high rate of neonatal mortality and morbidity.
Schlüsselwörter
Präeklampsie - HELLP-Syndrom - Frühgeburtlichkeit - antihypertensive Therapie
Key words
Preeclampsia - HELLP syndrome - premature birth - antihypertensive treatment
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Korrespondenzadresse
Prof. Dr. med. Thorsten Fischer
Frauenklinik, Krankenhaus Landshut-Achdorf
Achdorfer Weg 3
84036 Landshut
eMail: frauenklinik@kh-landshut-achdorf.de
