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DOI: 10.1055/a-1380-3657
Rezidivierende Spontanaborte: ein Vergleich internationaler Leitlinien
Artikel in mehreren Sprachen: English | deutsch![](https://www.thieme-connect.de/media/gebfra/202107/lookinside/thumbnails/10-1055-a-1380-3657_gf_de-1.jpg)
Zusammenfassung
Während etwa 30% aller Frauen in ihrem Leben einen Spontanabort erleben, beträgt die Inzidenz für rezidivierende (habituelle) Spontanaborte 1 – 3% abhängig von der angewandten Definition. Zu den etablierten Risikofaktoren zählen endokrine, anatomische, infektiologische, genetische, hämostaseologische und immunologische Faktoren. Die Diagnostik ist jedoch durch teilweise divergierende Empfehlungen der jeweiligen internationalen Fachgesellschaften erschwert. Der vorliegende Artikel soll daher einen Vergleich der bestehenden internationalen Leitlinienempfehlungen geben. Hierzu werden die Leitlinien der ESHRE, ASRM, der DGGG/OEGGG/SGGG sowie die Empfehlungen des RCOG analysiert. Es zeigt sich, dass eine Abklärung bereits nach 2 klinischen Schwangerschaften indiziert ist und die Diagnostik anhand eines standardisierten Fahrplans erfolgen sollte, der die häufigsten Ursachen für wiederholte Spontanaborte umfasst. Die Leitlinien sind sich einig, dass der Ausschluss anatomischer Malformationen, eines Antiphospholipidsyndroms sowie von Schilddrüsendysfunktionen erfolgen sollte. Darüber hinaus empfehlen die Leitlinien die Durchführung einer Chromosomenanalyse beider Partner präkonzeptionell (oder aus dem Abortmaterial). Andere Risikofaktoren sind zum einen aufgrund fehlender diagnostischer Kriterien (Lutealphaseninsuffizienz), zum anderen aufgrund des unterschiedlichen Alters der Leitlinien (chronische Endometritis) nicht von allen Fachgesellschaften in die Empfehlungen aufgenommen. Zusätzlich haben unterschiedliche gesundheitsökonomische und Konsensusaspekte im Rahmen der Leitlinienerstellung Einfluss auf die einzelnen Empfehlungen. Das Verständnis der zugrunde liegenden Entscheidungsprozesse sollte in der Praxis dazu führen, dass für das jeweilige Paar die individuell beste Diagnostik und die sich daraus ableitende Therapie angeboten wird.
Publikationsverlauf
Eingereicht: 08. Dezember 2020
Angenommen nach Revision: 01. Februar 2021
Artikel online veröffentlicht:
23. April 2021
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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