Kernaussagen
Nistet sich die Blastozyste nicht im Bereich des Endometriums des Corpus uteri ein, sondern an anderen Stellen, so liegt eine Extrauteringravidität (EUG) vor. Die Einnistung kann erfolgen in der Tube (96 %–98 %), dem Tubenwinkel, dem Ovar, dem Myometrium, der Zervix oder im Abdomen. Bei 6–16 % der Frauen, die im 1. Trimester der Schwangerschaft notfallmäßig mit vaginaler Blutung und/oder Unterbauchschmerzen untersucht werden, wird eine EUG diagnostiziert. Insgesamt rechnet man mit 20 ektopen auf 1 000 Schwangerschaften. Die bekannten Risikofaktoren für die Entstehung einer EUG stören die normale Funktion und Architektur der Tube. Dies geschieht v. a. durch hormonelle Einflüsse bzw. durch eine mechanische Störung infolge entzündlicher Prozesse im kleinen Becken.
Diagnostik
Anamnestisch ist die klassische Trias der EUG eine leichte vaginale Schmierblutung, ziehende Unterbauchschmerzen und die sekundäre Amenorrhö. Der hCG-Wert kann nur in Verbindung mit dem transvaginalen Ultraschall die ektope Gravidität diagnostizieren. Kann bei hCG-Werten über 1 500–2 000 mlU / ml keine intrauterine Fruchtanlage gesehen werden, so ist von einer EUG auszugehen. Differenzialdiagnostisch kommt ein abgelaufener Abort infrage.
Therapie
Die Therapie der EUG richtet sich nach Klinik, sonografischem Befund und Höhe des hCG-Wertes. Therapieoptionen sind das exspektative Vorgehen, operative Verfahren und die medikamentöse Behandlung mit Methotrexat. Allerdings sind das exspektative Verfahren und die medikamentöse Therapie nur indiziert bei sehr engen Einschlusskriterien. Operative Verfahren umfassen die Salpingotomie, Salpingektomie und die Segmentteilresektionen. Wegen zahlreicher Vorteile kommt bei den operativen Verfahren die Laparoskopie zum Einsatz.
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Dr. med. J. Lermann
Frauenklinik Universitätsklinikum Erlangen
Universitätsstraße 21–23
91054 Erlangen
eMail: Johannes.Lermann@uk-erlangen.de
