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DOI: 10.1055/s-0029-1240719
© Georg Thieme Verlag KG Stuttgart · New York
Definitionen und Diagnostik postpartaler Blutungen (PPH): Unterschätzte Probleme![*]
Definitions and Diagnosis of Postpartum Haemorrhage (PPH): Underestimated Problems!Publikationsverlauf
eingereicht 25.6.2009
revidiert 28.9.2009
akzeptiert 10.11.2009
Publikationsdatum:
14. Januar 2010 (online)
![](https://www.thieme-connect.de/media/gebfra/201001/lookinside/thumbnails/10.1055-s-0029-1240719-1.jpg)
Zusammenfassung
Post-(peri-)partale Blutungen (PPH) gehören weltweit zu den häufigsten mütterlichen Todesursachen. Der WHO-Definition der PPH liegen Studien zur Messung des Blutverlusts aus den 50er-Jahren zugrunde. Dabei besteht eine PPH bei einem Blutverlust > 500 ml bis 24 Stunden post partum nach vaginaler Geburt und > 1000 ml nach Sectio caesarea. Andere Definitionen berücksichtigen den Abfall des Hämatokritwerts, die Notwendigkeit zur Bluttransfusion oder die Zeichen des hämorrhagischen Schocks. Auch zur Definition der schweren PPH liegen unterschiedliche Angaben vor. Bei der Bewertung dieser Definitionen sind zahlreiche klinische und laborchemische Probleme zu berücksichtigen. Bei einem Blutverlust > 1500 ml besteht ein signifikant erhöhtes Risiko für einen hämorrhagischen Schock, Gerinnungsstörung, Minderperfusion der Organe (z. B. myokardiale Ischämie) und Multiorganversagen. Die visuelle Beurteilung unterschätzt den Blutverlust um 30–50 % und erhöht das Risiko für ein verspätetes und inadäquates Management der PPH. Zumindest bei Risikofaktoren für eine PPH und/oder ersten Hinweisen auf eine verstärkte postpartale Blutung sollte der Blutverlust gemessen werden! Der Abfall des systolischen Blutdrucks, der Anstieg der Herzfrequenz sowie die Verminderung des Hämoglobin-/Hämatokritwerts sind späte Indikatoren für ein Versagen mütterlicher Kompensationsmechanismen.
Abstract
Primary postpartum haemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. The internationally accepted WHO definition has its origin in studies measuring blood loss after delivery which are more than 50 years old. PPH was defined as blood loss of 500 ml or more within 24 hours after vaginal delivery, and blood loss of 1000 ml or more after caesarean section. Other definitions refer to decreased haematocrit, the need for blood transfusions or signs of haemorrhagic shock. The definition of massive PPH also remains controversial. To evaluate these definitions numerous clinical and laboratory findings must be taken into account. Blood loss exceeding 1500 ml is associated with a significantly increased risk of haemorrhagic shock, coagulopathy, organ hypoperfusion (e. g. myocardial ischaemia) and multiple organ failure. Visual estimation of blood loss is notoriously inaccurate, the volume being underestimated by 30–50 %. This underestimation of blood loss increases the risk of delayed and inadequate management of PPH. In patients at increased risk of PPH and/or if there is evidence of increased blood loss, measurement of blood loss is mandatory. The obstetrician must be aware that the decrease in systolic blood pressure, rise in heart rate, and drop in haemoglobin/haematocrit levels are late symptoms reflecting failure of maternal compensatory mechanisms.
Schlüsselwörter
postpartale Blutung - Definitionen - kritische Beurteilung der Definitionen - klinische Symptome - Messung des Blutverlusts
Key words
postpartum haemorrhage - definitions - critical evaluation of definitions - clinical symptoms and diagnosis - measurement of blood loss
1 auszugsweise vorgetragen auf dem Intensivworkshop „Postpartal Hemorrhage“ Velden (Österreich): 14. – 16. 5. 2009
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1 auszugsweise vorgetragen auf dem Intensivworkshop „Postpartal Hemorrhage“ Velden (Österreich): 14. – 16. 5. 2009
Univ.-Prof. Dr. Werner Rath
Medizinische Fakultät des Universitätsklinikums Aachen (RWTH)
Gynäkologie und Geburtshilfe
Wendlingweg 2
52074 Aachen
eMail: wrath@ukaachen.de