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Mehrlinge

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Zusammenfassung

In den letzten 15–20 Jahren war in allen Industrieländern eine steigende Anzahl an Mehrlingsgeburten zu verzeichnen. Dieser Trend wird auf die zunehmende Anwendung der Methoden der assistierten Reproduktion und das steigende Lebensalter der Gebärenden zurückgeführt. In Mitteleuropa finden sich rund 110 Zwillings- und 2 Drillingsgeburten auf 10000 Lebendgeburten.

Von besonderer klinischer Bedeutung ist einerseits die Unterscheidung in dizygote und monozygote und andererseits in dichorial-diamniale, monochorialdiamniale und monochorial-monoamniale Zwillingsschwangerschaften, da sie mit einer unterschiedlichen Morbididät und Mortalität der Mutter und des Kindes einhergehen. In diesem Zusammenhang kommt der möglichst frühen Ultraschalldifferenzierung besondere Bedeutung zu.

Neben dem besonderen Risiko durch mehrlingsassoziierte Syndrome besteht die klinische Problematik der Mehrlingsschwangerschaft vor allem in der erhöhten Rate an Frühgeburten und intrauteriner Wachstumretardierung, die wesentlich die erhöhte Morbidität und Mortalität dieser Schwangerschaften bedingen.

Die Problematik der speziellen Betreuung der Mehrlingsschwangeren liegt im Fehlen relevanter prospektiver Studien, so daß derzeit weder beim unauffälligen noch beim pathologischen Verlauf Konsens über die verbindliche Auswahl von Überwachungsmethoden und die Häufigkeit ihrer Anwendung besteht.

Der Geburtsmodus wird hauptsächlich durch die Lage der Feten und durch das zu erwartende Geburtsgewicht bestimmt. Während bei Schädellage beider Zwillinge prinzipiell die vaginale Geburt angestrebt wird, besteht bei allen anderen Varianten der Kindslagen ein zunehmender Trend, die primäre Sectio zu indizieren. Dies zeigt sich um so mehr für höhergradige Mehrlingsgeburten.

In Anbetracht der hohen Morbidität und Mortalität von höhergradigen Mehrlingen stellt die selektive Reduktion eine Alternative dar. In diesem Fall und bei Mehrlingsschwangeren insgesamt und den oftmals beobachteten mehrlingsassoziierten Pathologien ist die psychische Betreuung von besonderer Bedeutung.

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  1. H. Strohmer
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Editors and Affiliations

  1. Universitäts-Frauenklinik, Inselspital, Schanzeneckstr. 1, CH-3012, Bern, Switzerland

    Henning Schneider

  2. Universitätsklinik für Frauenheilkunde Abteilung für Geburtshilfe und Gynäkologie, AKH, Währinger Gürtel 18-20, A-1090, Wien, Austria

    Peter Husslein

  3. Frauenklinik und Poliklinik, Technischen Universität München Klinikum rechts der Isar, Ismaninger Str. 22, D-81675, München, Deutschland

    Karl Theo M. Schneider

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Strohmer, H. (2000). Mehrlinge. In: Schneider, H., Husslein, P., Schneider, K.T.M. (eds) Geburtshilfe. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-98004-6_40

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