Zusammenfassung
Wir berichten über eine 31-jährige schwangere Patientin (II Gravida/0 Para) mit primärem Antiphospholipid-Syndrom (APS) und schweren Komplikationen in der Anamnese: einer tiefen Beinvenenthrombose ohne Assoziation zu einer Schwangerschaft, einem intrauterinen Fruchttod (IUFT) in der ersten Schwangerschaft mit nachfolgender Lungenembolie. Die jetzige zweite Schwangerschaft verlief unter Therapie mit niedermolekularem Heparin (NMH) und Acetylsalicylsäure (ASS) einschließlich Geburt komplikationslos. Im Wochenbett entwickelte die Patientin eine Vaskulitis der Akren, die mit Steroiden (Prednisolon) behandelt wurde. Die Empfehlungen in der Literatur zur Behandlung solcher Patientinnen beziehen sich im Allgemeinen nur auf die medikamentöse Therapie in der Schwangerschaft. Empfehlungen hinsichtlich des geburtshilflichen Managements und der peripartalen Antikoagulation sind rar. Die Fragen nach dem optimalen Geburtsmodus und der peripartalen Heparin-Medikation sind unbeantwortet. Die Behandlung des primären APS in der Schwangerschaft sollte auch eine kontinuierliche und suffiziente peripartale Antikoagulation mit einem möglichst kleinen Zeitfenster ohne Antikoagulation um den Zeitraum der Geburt beinhalten. Eine Sectio caesarea erscheint für die Patientinnen nicht von Vorteil. Die intensivierte Überwachung der Patientinnen sollte auch postpartal weitergeführt werden.
Abstract
We report a case of a 31-year-old patient with primary antiphospholipid syndrome (APS) and a past medical history of deep vein thrombosis and intrauterine fetal death followed by pulmonary embolism in her first pregnancy. In this pregnancy treatment with low molecular weight heparin (LMWH) and aspirin was instituted and pregnancy outcome was uneventful. In the immediate post partum period a vascular inflammation of the finger and toe pulps made a steroid therapy necessary. Although there is general consensus on how to manage APS during pregnancy, no guidelines exist for the immediate peripartum period. Management plans should be individualized and aim for continuous anticoagulation in pregnancy. Time around delivery without anticoagulation should be kept to a minimum. The decision respecting the route of delivery should be guided by obstetric indications only. After delivery intensive monitoring of affected patients should be instituted to diagnose complications without undue delay.
Schlüsselwörter
Antiphospholipid-Syndrom - APS - Schwangerschaft - Geburt
Key words
Antiphospholipid syndrome - APS - pregnancy - delivery
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Dr. med. A. Müller
Frauenklinik Universitätsklinikum Erlangen
Universitätsstraße 21 - 23
91054 Erlangen
Email: andreas.mueller@gyn.imed.uni-erlangen.de