Die uterine Perfusionsstörung im zweiten Trimenon - aktuelle pathophysiologische, diagnostische und therapeutische Aspekte

Zusammenfassung

Die dopplersonographische Messung der uterinen Perfusion ist eine etablierte und nicht-invasive Methode zur Einschätzung des uteroplazentaren Blutflusses und der Impedanz im nachgeschalteten Gefäßbett. Diese Methode ist heute als einzige in der Lage, im 2. Trimenon mit hoher Sensitivität ein Risikokollektiv für spätere Schwangerschaftserkrankungen wie Präeklampsie oder intrauterine Wachstumsretardierung zu erkennen. Die Spezifität ist dagegen gering, da ein großer Teil der Schwangeren mit uteriner Perfusionsstörung trotz dieses Befundes einen normalen Schwangerschaftsverlauf hat. Gegenwärtig fehlt ein zur Dopplersonographie zusätzlicher und unabhängiger Marker, der in Kombination mit der uterinen Perfusionsmessung eine mögliche Schwangerschaftskomplikation besser vorhersagt. Therapeutische Optionen sind bislang gegenwärtig nur in der Lage, den klinischen Verlauf dieser Schwangerschaften etwas zu verbessern. Eine kausale Behandlung dieser Schwangerschaftserkrankungen auf Grundlage einer gestörten Plazentaentwicklung gibt es derzeit noch nicht.

Abstract

Doppler sonographic measurement of uterine perfusion in second trimester pregnancies is nowadays an established, non-invasive method to assess uteroplacental blood supply and down-stream vascular resistance. This method is able to identify women at risk for subsequent pregnancy complications like preeclampsia and intrauterine growth retardation. However, its specificity is limited since not all pregnancies with pathological perfusion develop later complications. At present, there is no additional and independent marker available that could increase the predictive value of uterine Doppler sonography. Therapeutic approaches may improve clinical course and outcome of those high-risk pregnancies but do not target the cause of the disturbed placental development.

Schlüsselwörter

uterine Perfusion - Dopplersonographie - Präeklampsie - intrauterine Wachstumsretardierung

Key words

Uterine perfusion - Doppler sonography - preeclampsia - intrauterine growth retardation

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