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Reanimation der Schwangeren

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Geburtshilfliche Anästhesie und Intensivmedizin

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Zusammenfassung

Bei der Reanimation der Schwangeren müssen die physiologischen-anatomischen Veränderungen der Schwangerschaft berücksichtigt werden. Das Herzzeitvolumen steigt um 50%. Ebenfalls erhöht sind Pulsfrequenz, Atemminutenvolumen und Sauerstoffverbrauch. Die funktionelle Residualkapazität der Lunge und der kolloidosmotische Druck sinken (78). Durch diese Veränderungen reagiert die Schwangere empfindlicher auf kardiovaskuläre und respiratorische Insulte. Ferner kann der Uterus durch Kompression der Vena cava in Rückenlage der Patientin den venösen Rückstrom wesentlich beeinträchtigen (79). Auslösende Ereignisse für einen Herz-Kreislauf-Stillstand während der Schwangerschaft sind die Pulmonalembolie, Trauma, Peripartale Blutungen mit Hypovolämie, Fruchtwasserembolie, Herzvitien und Komplikationen einer tokolytischen Therapie wie Arrhythmie, Herzinsuffizienz oder Myokardischiämie (80). Beim Herz-Kreislauf-Stillstand der Schwangeren sollten alle Wiederbelebungsmaßnahmen des Erwachsenen durchgeführt werden. Um eine aortokavale Kompression des graviden Uterus zu vermeiden, sollte zusätzlich die Reanimation in Halbseitenlage versucht werden. Eine praktische Empfehlung für die reanimation der Schwangeren im Rahmen eines Notarzt-Einsatzes ist die Einbeziehung einer Hilfsperson, welche sich seitlich unter die Patientin legt und somit die Halbseitenlage ermöglicht. Vasopressoren sollten bei vitaler Indikation vorbehaltlos verabreicht werden. Bei erfolglosen initialen Reanimationsmaßnahmen ist eine sogenannte „peri-mortale Kaiserschnittentbindung“ angezeigt. Durch diesen

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  1. University of Florida, Gainesville, FL, USA

    Michael A. Frölich

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© 2000 Springer-Verlag Wien

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Frölich, M.A. (2000). Reanimation der Schwangeren. In: Geburtshilfliche Anästhesie und Intensivmedizin. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6317-7_41

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  • DOI: https://doi.org/10.1007/978-3-7091-6317-7_41

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-83172-4

  • Online ISBN: 978-3-7091-6317-7

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