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Screening auf Frühgeburtlichkeit und Präeklampsie

Was ist evidenzbasiert – wohin kann der Weg führen?

Screening for preterm delivery and preeclampsia

What is evidence based and where can it lead?

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Frühgeburtlichkeit und Präeklampsie sind weiterhin große Herausforderungen, da es trotz intensiver Bemühungen in der Primär- und Sekundärprävention zu keiner wesentlichen Senkung der Prävalenz und der damit verbundenen maternalen wie fetalen Morbidität und Mortalität gekommen ist.

Fragestellung

Ist ein Screening zur Senkung der Frühgeburten- und Präeklampsierate angezeigt, und wie könnte es künftig aussehen, um diese Rate dauerhaft zu senken?

Ergebnisse

Die Literatur zeigt, dass aktuell ein Screening auf Präeklampsie, sei es mittels Biomarkern oder in Kombination mit dem Dopplerultraschall, die Richtlinien eines Screenings weder im ersten noch im zweiten Trimenon erfüllen. Auch im Hinblick auf Frühgeburtlichkeit kann kein allgemeines Screening mittels transvaginaler Zervixsonographie und/oder Testung auf fFN (fetales Fibronektin) empfohlen werden.

Diskussion

Wegen fehlender evidenzbasierter Daten zum Screening auf Frühgeburtlichkeit und Präeklampsie wird weitere Forschung angemahnt. Die o.g. Prädiktionsmarker sind jedoch weiterhin sehr wirksam einzusetzen bei Risiko- bzw. symptomatischen Patientinnen.

Abstract

Background

Preterm delivery and preeclampsia continue to present major challenges in obstetrics. Despite all efforts and progress in primary and secondary prevention, the prevalence and thus associated infant and maternal morbidity and mortality have not decreased.

Purpose

Does screening help to decrease the rate of preterm delivery and preeclampsia effectively?

Results

A review of the literature shows that screening for preeclampsia using biomarkers—alone or in combination with Doppler ultrasound—does not comply with guidelines for screening in the first or second trimester. In addition, with regard to preterm birth, neither a general screening using transvaginal ultrasonography and/or the fetal fibronectin test (fFNT) can be recommended.

Discussion

Due to lack of evidence-based data, further research regarding screening for preterm delivery and preeclampsia is necessary. However, the above mentioned predictive markers are effective in women with a history of preterm birth or patients who show signs and symptoms for a preterm delivery.

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Authors and Affiliations

  1. Universitätsfrauenklinik Basel, Spitalstrasse 21, 4031, Basel, Schweiz

    G. Vetter, A. Seidenfuss, I. Hösli &  O. Lapaire

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  1. G. Vetter
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  2. A. Seidenfuss
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  3. I. Hösli
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  4. O. Lapaire
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Correspondence to O. Lapaire.

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O. Lapaire, G. Vetter, A. Seidenfuss und I. Hösli geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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R. Zimmermann, Zürich

U. Gembruch, Bonn

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Vetter, G., Seidenfuss, A., Hösli, I. et al. Screening auf Frühgeburtlichkeit und Präeklampsie. Gynäkologe 48, 711–716 (2015). https://doi.org/10.1007/s00129-015-3778-9

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  • DOI: https://doi.org/10.1007/s00129-015-3778-9

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