Schwangerschaft und neonatologisches outcome der Kinder bei Patientinnen nach radikaler vaginaler Trachelektomie

Ziel: Die radikale vaginale Trachelektomie (RVT) als fertilitätserhaltende Therapie bei Patientinnen mit Zervixkarzinom und prospektivem Kinderwunsch ist eine onkologisch sichere Methode. Die in der Literatur beschriebenen Schwangerschaftsraten nach der Operation liegen zwischen 40–80%. Schwangerschaften nach RVT sind durch eine Frühgeburtsrate von 30% verkompliziert. Ziel dieser prospektiven Studie ist es, das neonatologische outcome der Kinder von Patientinnen nach RVT zu beurteilen.

Methodik: 154 Patientinnen mit Zervixkarzinom, die zwischen 03/95 und 02/08 eine radikale vaginale Trachelektomie erhalten hatten, sowie deren behandelnde Ärzte wurden zu Kinderwunsch, Schwangerschaft und kindlichem outcome befragt. Mutterpässe, Kinderhefte und Arztbriefe zu stationären Aufenthalten sowie Verläufe aus den jeweiligen Sozialpädiatrischen Zentren wurden eingesehen und ausgewertet. Es handelt sich um eine Fallkontrollstudie. Daten der Kontrollkinder wurden entsprechend der SSW gematcht.

Ergebnis: 55 Schwangere mit Z.n. RVT wurden von 58 Kindern entbunden. 43% aller Schwangeren hatten einen vorzeitigen Blasensprung. 30 Frühgeborene wurden geboren (51,7%), davon 17 (29%) < 32 SSW und 7 (12%) < 28 SSW. Bei Frühgeborenen < 32 SSW fanden sich signifikant häufiger vorzeitige Blasensprünge (p=0,008). Es zeigte sich ebenso eine Tendenz zu häufigerem Auftreten einer frühen Neugeborenensepsis bei Neugeborenen nach RVT (p=0,07). Hinsichtlich des Auftretens der gesamten postpartalen Komplikationen zeigt sich eine Tendenz für ein geringeres Auftreten bei Kindern der Trachelektomiepatientinnen (p=0,06).

Schlussfolgerung: Die postpartale Morbidität ist bei den Kindern nach RVT tendenziell geringer, denn die Frauen werden schon während der Schwangerschaft intensiver überwacht und es wird die Versorgung der Kinder in Perinatalzentren Level–1 gewährt.

Neugeborene von Patientinnen nach RVT zeigen kein zusätzliches Risiko durch den mütterlichen Eingriff, ihr neonatologisches outcome ist nicht beeinträchtigt.

Abb. 1: Häufigkeiten der Hirnblutung bei Kontrollpatienten ohne RVT (keine IVH = 0, leichte IVH = 1-2, schwere IVH = 3-4; n=44)

Tabelle 1: Kenngrößen der Frühgeborenen nach RVT

	N	MIN	MAX	ME	Interquartil
Körpergewicht Neugeborenes in g	24	600	3100	1450	818–2534
Körperlänge in cm	23	29,0	50,0	42,0	35–48
Kopfumfang in cm	23	20,0	35,0	28,4	23–33
APGAR nach 1min.	23	2	9	7	5–9
APGAR nach 5min.	23	4	10	9	7–9
APGAR nach 10min.	22	5	10	9	8–10
NapH	22	7,06	7,41	7,30	7,25–7,33

Abb. 3: Häufigkeiten der Hirnblutung nach RVT (keine IVH = 0, leichte IVH = 1-2, schwere IVH = 3-4; n=44)

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Frühgeburt - Zervixkarzinom - neonatologisches outcome - radikale vaginale Trachelektomie