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Blutungen im 3. Trimenon

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Die Geburtshilfe

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Zusammenfassung

Grundsätzlich muss zwischen schwangerschaftsbedingten und nicht schwangerschaftsbedingten Ursachen für Blutungen in der Spätschwangerschaft unterschieden werden. Erstere gehen meist mit einem geringeren Risiko für Mutter und Kind einher. Schwere schwangerschaftsbedingte Blutungen führen meist zu einem Blutverlust von >1000 ml und sind zu 40–70 % durch eine Placenta praevia oder eine vorzeitige Plazentalösung hervorgerufen. Ausschließlich fetale Blutungen – z. B. durch Ruptur der Vasa praevia – sind selten.

Da die Prognose für den weiteren Schwangerschaftsverlauf schwer eingeschätzt werden kann, ist auch bei leichten Blutungen primär eine stationäre Überwachung angezeigt. Die klinische Untersuchung und die Sonographie ermöglichen in den meisten Fällen sehr rasch eine Beurteilung, ob die Beendigung der Schwangerschaft erforderlich ist. Bei schweren Blutungen steht – neben den allgemeinen Richtlinien der Notfallmedizin – die unverzügliche Beendigung der Schwangerschaft im Vordergrund.

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Literatur

  • Ananth CV, Savitz DA, Williams MA (1996) Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis. Obstet Gynecol 88:309–318

    Article  CAS  PubMed  Google Scholar 

  • Ananth CV, Smulin JC, Vintzileos AM (1997) The association of placenta praevia with history of cesarean delivery and abortion: a meta-analysis. Am J Obstet Gynecol 176:144

    Article  Google Scholar 

  • Bhide A, Prefumo F, Moore J et al (2004) Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia. Br J Obstet Gynaecol 110:860

    Article  Google Scholar 

  • Bujold E, RobergeS LY, Bureau M, Audibert F, Marcoux S, Forest JC, Giguere Y (2010) Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 116:402–414

    Article  PubMed  Google Scholar 

  • Chapman MG, Furness ET, Jones WR, Sheat JH (1989) Significance of the location of placenta site in early pregnancy. Br J Obstet Gynaecol 86:846–848

    Article  Google Scholar 

  • Clark SL (1999) Placentae praevia and abruption placentae. In: Creasy RK, Resnik R (Hrsg) Maternal fetal medicine. 4. Aufl. Saunders, Philadelphia, S 624

    Google Scholar 

  • Combs CA, Njberg DA, Mack LA, Smith JR, Benedetti CJ (1992) Expectant management after sonographic diagnosis of placenta abruptio. Am J Perinatol 9:170–174

    Article  CAS  PubMed  Google Scholar 

  • Cotton DB, Read JA, Paul RH, Quilligan EJ (1980) The conservative aggressive management of placenta praevia. Am J Obstet Gynecol 137:687–695

    Article  CAS  PubMed  Google Scholar 

  • Crenshaw C (1973) Placenta previa: a survey of twenty years’ experience with improved perinatal survival by expectant therapy and cesarean delivery. Obstet Gynecol Surv 28:461

    Article  PubMed  Google Scholar 

  • D’Angelo LJ, Irwin LF (1984) Conservative management of placenta praevia: a cost benefit analysis. Am J Obstet Gynecol 149:320–323

    Article  PubMed  Google Scholar 

  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) AWMF-Leitlinie 015/063 „Diagnostik und Therapie peripartaler Blutungen“ der DGGG (abgelaufen, wird derzeit überprüft). http://www.awmf.org/leitlinien/detail/ll/015-063.html. Zugegriffen am 07.06.2015

  • Faiz AS, Ananth CV (2003) Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 13:175

    Article  CAS  PubMed  Google Scholar 

  • Farine D, Fox HE, Jacobson S, Timor-Tritsch IE (1989) Is it really placenta previa? Eur J Obstet Gynecol Reprod Biol 331:103–108

    Article  Google Scholar 

  • Feinkind L, Nanda D, Delke I, Minkoff H (1990) Abruptio placentae after percutaneous umbilical cord sampling: a case report. Am J Obstet Gynecol 162:1203

    Article  CAS  PubMed  Google Scholar 

  • Golditch IM, Boyce NE (1970) Management of abruptio placentae. JAMA 212:2888

    Article  Google Scholar 

  • Green JR (1989) Placenta abnormalities: placenta praevia and abruptio placentae. In: Creasy RK, Resnik R (Hrsg) Maternal-fetal medicine: principles and practise. Saunders, Philadelphia

    Google Scholar 

  • Hänggi W, Schwaller K, Mueller MD (1997) Intra- und postoperative Komplikationen bei Sectio caesarea. Gynakologe 10:762–768

    Article  Google Scholar 

  • Heindl B, Delorenzo C, Spannagl M (2005) High dose fibrinogen administration for acute therapy of coagulopathy during massive perioperative transfusion. Anaesthesist 54:787–790

    Article  CAS  PubMed  Google Scholar 

  • Hibbard BM (1988) Bleeding in late pregnancy. In: Hibbard BM (Hrsg) Principles of obstetrics. Butterworth, London

    Google Scholar 

  • Hofer S, Schreckenberger R, Heindl B, Görlinger K et al (2007) Blutungen während der Schwangerschaft. Anästhesist 10:1261–1262

    Google Scholar 

  • Hoffmann-Tretin JC, Koenigsberg M, Rabin A, Anyaegbunam A (1992) Placenta accreta. Additional sonographic observations. J Ultrasound Med 11:29–34

    Google Scholar 

  • Kelly JV, Iffy L (1981) Placenta praevia. In: Iffy L, Kaminetzky HA (Hrsg) Principles and practise of obstetrics and perinatology, Bd 2. Wiley, New York

    Google Scholar 

  • Kramer MS, Berg C, Abenhaim H, Dahhou M, Rouleau J, Mehrabadi A, Joseph KS (2013) Incidence, risk factors and temoral trends in severe postpartum hemorrhage. Am J Obstet Gynecol 209(5):449.e1–449.e7

    Article  Google Scholar 

  • Mabie WC (1992) Placenta praevia. Clin Perinatol 19:425–435

    CAS  PubMed  Google Scholar 

  • Macones GA, Sehdev HM, Parry S, Jackson GM, Morgan MA (1997) The association between maternal cocaine use and placenta praevia. Am J Obstet Gynecol 176:S159 (SPO Abstract 557)

    Article  Google Scholar 

  • Mehrabadi A, Hutcheon JA, Lee L, Kramer MS, Liston RM, Josef KS (2013) Epidemiological investigation of a temporal increase in atonic postpartum haemorrhage: a population-based retrospective chort study. BJOG 120(7):853–862

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mukherjee S, Ak B, Sharma S, Nandanwar YS, Gadam M (2014) Retrospective study of risk factors and maternal and fetal outcome in patients with abruptio placentae. J Nat Sci Biol Med 5(2):425–428

    Article  PubMed  PubMed Central  Google Scholar 

  • Myerscough PR (1982) Munro Kerr’s operative obstetrics. 10. Aufl. Bailliere Tindall, London

    Google Scholar 

  • Naeye RL (1980) Abruptio placentae and placenta previa: frequency, perinatal mortality and cigarette smoking. Obstet Gynecol 55:701

    CAS  PubMed  Google Scholar 

  • Okonofua FE, Olatubosun OA (1985) Caesarean versus vaginal delivery in abruptio placentae associated with live fetuses. Int J Gynecol Obstet 23:471–474

    Article  CAS  Google Scholar 

  • Page EW, King EB, Merrill JA (1954) Abruptio placentae; dangers of delay in delivery. Obstet Gynecol 3:385

    CAS  PubMed  Google Scholar 

  • Paterson M (1979) The aetiology and outcome of abruptio placentae. Acta Obstet Gynecol Scand 58:31

    Article  CAS  PubMed  Google Scholar 

  • Pearlman MD, Tintinalli JE, Lorenz RP (1990) A prospective controlled trial of outcome after trauma during pregnancy. Am J Obstet Gynecol 162:1502–1510

    Article  CAS  PubMed  Google Scholar 

  • Pernoll ML (1991) Third-trimester hemorrhage. In: Pernoll ML (Hrsg) Current obstetric and gynecologic diagnosis and treatment. Appleton & Lange, Stamford, S 388

    Google Scholar 

  • Rasmussen S, Irgens LM, Dalaker K (1970) Outcome of pregnancies subsequent to placental abruption. Am J Obstet Gynecol 108:22

    Article  Google Scholar 

  • Rizos N, Doran T, Miskin M (1979) Natural history of placenta previa ascertained by diagnostic ultrasound. Am J Obstet Gynecol 133:287–293

    Article  CAS  PubMed  Google Scholar 

  • Schlenkser KH (1976) Ultraschallplazentographie. Gynakologe 9:156–165

    Google Scholar 

  • Schmid BC, Resniczek Gym Rolf N, Saade G, Gebauer G, Maul H (2013) Uterine packing with chitosan-covered gauze for control of postpartum haemorrhage. Am J Obstet Gynecol 209(3):225

    Article  PubMed  Google Scholar 

  • Sinah P, Kuruba N (2008) Ante-partum haemorrhage: an update. J Obstet Gynaecol 28(4):377–381

    Article  Google Scholar 

  • Sliver R, Depp R, Sabbagha RE, Dooley SL, Socol ML, Tamura RK (1984) Placenta previa: aggressive expectant management. Am J Obstet Gynecol 150:15–22

    Article  Google Scholar 

  • Varma TR (1973) Fetal growth and placental function in patients with placenta praevia. J Obstet Gynaecol Br Commonw 80:311–315

    Article  CAS  PubMed  Google Scholar 

  • Wilson JR (1983) Bleeding during late pregnancy. In: Wilson JR et al (Hrsg) Obstetrics and gynecology. Mosby, St. Louis

    Google Scholar 

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Authors and Affiliations

  1. Abteilung für Geburtshilfe und Pränatalmedizin Klinik Hallerwiese, Klinik Hallerwiese, St.Johannis-Mühlgasse 19, 90419, Nürnberg, Deutschland

    Franz Kainer

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Correspondence to Franz Kainer .

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Editors and Affiliations

  1. Frauenklinik, Universitätsklinikum, Bern, Switzerland

    Henning Schneider

  2. Frauenklinik, Medizinische Universität Wien, Wien, Austria

    Peter Husslein

  3. Frauenklinik u. Poliklinik, TU, Klinikum Rechts d. Isar, München, Germany

    Karl-Theo M. Schneider

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Kainer, F. (2016). Blutungen im 3. Trimenon. In: Schneider, H., Husslein, P., Schneider, KT. (eds) Die Geburtshilfe. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45064-2_20

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  • DOI: https://doi.org/10.1007/978-3-662-45064-2_20

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