Überwachung und Betreuung von Zwillingsschwangerschaften (AWMF 015-087 S2e-Leitlinie)

Zusammenfassung

In der folgenden AWMF-Leitlinie (DGGG/AGG & DEGUM federführend) werden die Diagnostik, das Screening und Management von Zwillingen sowie Zeitpunkt und Modus der Geburt behandelt.

Zwillingsschwangerschaften können in dichorial-diamniale (DC DA), monochorial-diamniale (MC DA) und monoamniale (MC MA) – welche immer monochorial sind – unterteilt werden.

Zwillingsschwangerschaften können für Chromosomenstörungen, Fehlbildungen, Wachstumsretardierung und hämodynamische Störungen konkordant (beide sind betroffen) oder diskordant sein (hier ist nur einer von beiden betroffen).

Der prognostisch bedeutsamste Parameter ist die Chorionizität. Monochoriale Zwillinge weisen deutlich höhere Risiken für eine intrauterine Morbidität und Mortalität auf als dichoriale Zwillinge.

Im Einzelnen wird Allgemeines zu Zwillingsschwangerschaften wie Datierung, Bestimmung der Chorionizität und Amnionizität, die Bezeichnung von Zwillingsfeten und das perinatale Switch-Phänomen diskutiert.

Das Routine-Monitoring von MC- und DC-Zwillingsschwangerschaften mit Ultraschall zwischen 11 und 13^+ 6 Schwangerschaftswochen auf Chromosomenstörungen, die invasive Pränataldiagnostik, Diskordanzen der NT oder SSL im ersten Trimenon, die frühe strukturierte Fehlbildungsdiagnostik sowie das Management bei für fetale Fehlbildungen diskordanten Zwillingen einschließlich des selektiven Fetozids werden beschrieben.

Das Zweittrimester-Screening und Management auf Frühgeburt und auf intrauterine selektive Wachstumsrestriktion (sFGR), die Klassifikation monochorialer Zwillinge mit sFGR und das Management des überlebenden Zwillings nach Fruchttod des Co-Zwillings werden behandelt.

Ausschließlich MC-Zwillinge betreffende Komplikationen sind das Zwillingstransfusionssyndrom (TTTS) mit den wichtigen Themen Screening, Prognose, Komplikationen der Lasertherapie, Entbindungszeitpunkt, Risiken für Gehirnanomalien und neurologische Entwicklungsverzögerung, die Twin Anemia–Polycythemia Sequence (TAPS) und die Twin Reversed Arterial Perfusion (TRAP) Sequence. Hierzu gehören auch die MC-MA-Zwillinge einschließlich der siamesischen Zwillinge.

Zuletzt werden der Geburtsmodus und -zeitpunkt von DC- und MC-Zwillingsschwangerschaften beschrieben.

Die Informationen sind in 62 Handlungsempfehlungen, 4 Tabellen und 8 Abbildungen mit umfassenden Hintergrundtexten zusammengefasst.

Die Leitlinie ist eine internationale LL-Adaptation (ISUOG, NICE) sowie eine systematische Literaturrecherche und ist up to date.

Key words

twins - monochorionic - dichorionic - monoamniotic - TTTS

^* Constantin von Kaisenberg and Philipp Klaritsch share first authorship.

Publication History

Received: 29 May 2020

Accepted: 09 August 2020

Article published online:
05 October 2020

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