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Mehrlingsschwangerschaft

  • W. Diehl
  • K. Hecher

Zusammenfassung

Durch die plazentaren Gefäßanastomosen hängt das Schicksal monochorialer Gemini voneinander ab. Daher hat die Feststellung der Chorion- und Amnionverhältnisse bei der Diagnose einer jeden Mehrlingsgravidität eine fundamentale Bedeutung und sollte bereits in der Frühgravidität, aber spätestens zum Zeitpunkt des Ersttrimesterscreenings erfolgen. Liegt eine monochoriale Plazenta vor, so ist eine engmaschige sonographische Überwachung der Schwangerschaft indiziert. Die monochorialen Zwillinge und ihre spezifischen Komplikationen (schweres Zwillingstransfusionssyndrom [FFTS], selektive Wachstumsrestriktion [sIUGR], Anämie-Polyzythämie-Sequenz [TAPS] im III. Trimester) sowie deren Therapie werden ausführlich dargestellt. Monoamniale Zwillinge sollten ab der 26.–28. SSW engmaschig sonographisch kontrolliert und aufgrund des erhöhten Risikos für einen intrauterinen Tod nach Lungenreifeinduktion ab der 33. SSW per elektiver Sektio entbunden werden. Eine Reduktion von höhergradigen Mehrlingen oder von Drillingen zu Zwillingen ist in Anbetracht der hohen Risiken einer extremen Prämaturität bei abwartendem Verhalten vertretbar und erfolgt bei dichorialen Verhältnissen durch eine intrakardiale Gabe von Kaliumchlorid. Bei monochorialen Verhältnissen kommt nur eine Nabelschnurkoagulation infrage. Eine Reduktion sollte in der 14. SSW erfolgen, und eine adäquate psychologische Evaluation und Betreuung sollte sichergestellt werden.

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© Springer-Verlag GmbH Deutschland 2018

Authors and Affiliations

  1. 1.Universitätsklinikum Hamburg-EppendorfKlinik und Poliklinik für GeburtshilfeHamburgDeutschland

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