Habitueller Abort - ein aktueller Überblick über Ursachen und therapeutische Möglichkeiten

Zusammenfassung

Der habituelle Abort (HA) wird als die Abfolge von drei spontanen Fehlgeburten vor der 20. Schwangerschaftswoche mit demselben Partner definiert. Eine Ursache oder assoziierte Pathologie wird in etwa 40 - 60 % der Fälle gefunden, darunter Antiphospholipidsyndrom, Thrombophilie, Uterusanomalien, hormonelle, infektiöse und genetische Faktoren. In Fällen von idiopathischem HA wird eine immunologische Ursache postuliert. Die therapeutischen Optionen richten sich nach den Ergebnissen der diagnostischen Abklärung und reichen von der chirurgischen Therapie von Uterusanomalien über die Korrektur von Endokrinopathien, lokale Sanierung von Infektionen, Unterstützung mit Progesteron und Folsäure bis zu immunologischen Therapien wie intravenöser Immunglobulingabe, Kortison und Impfung mit paternalen Leukozyten sowie antithrombotischen Therapien mit Aspirin und niedrigmolekularem Heparin. Alle diese Therapieansätze sind durch Studien sehr unterschiedlicher Qualität in ihrer Effizienz belegt. Die höchste Qualität der Studiendaten besteht für die Behandlung von Frauen mit HA und Antiphospholipidsyndrom mit einer Kombinationstherapie aus Aspirin und niedrigmolekularem Heparin.

Abstract

Recurrent spontaneous abortion (RSA) is defined as three consecutive abortions before 20 weeks' gestation with the same partner. A series of associated pathologies and etiologic factors of RSA have been identified, among them thrombophilia, antiphospholipid syndrome, uterine anomalies, luteal phase defect, hyperprolactinemia, hyperandrogenemia, genital infections, and maternal/paternal balanced translocations. In cases of idiopathic RSA, an immunologic cause has been postulated. All of the above mentioned factors should be included in the diagnostic work-up of affected women. Therapeutic options of women with RSA include surgical resection of uterine anomalies, correction of endocrinologic pathologies, treatment of genital infections, luteal support, folate, as well as immunologic therapies such as i.v. immunoglobulins, cortisone, immunization with paternal leucocytes, and anti-thrombotic therapies with aspirin and low molecular weight heparin. All of these therapies are based on studies of greatly varying quality. The highest degree of evidence exists for the treatment of women with antiphospholipid syndrome and RSA with a combination of aspirin and low molecular weight heparin.

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