Skip to main content

2016 | OriginalPaper | Buchkapitel

16. Früher vorzeitiger Blasensprung

verfasst von : Herbert Kiss, Klaus Reisenberger

Erschienen in: Die Geburtshilfe

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Der frühe vorzeitige Blasensprung (PPROM, „preterm premature rupture of membranes“) wird als Abgang von Fruchtwasser vor der vollendeten 37. SSW definiert. 2–5 % aller Schwangerschaften sind betroffen. Vaginale Infektionen sind ein eindeutiger identifizierbarer Risikofaktor; weitere beschriebene Risikofaktoren sind Blutungen und Rauchen in der Schwangerschaft sowie Amniozenthese. Die Diagnostik erfolgt in erster Linie klinisch durch den Nachweis von Flüssigkeitsabgang aus der Zervix. Für das Management ist das Gestationsalter entscheidend. Zwischen der 22. SSW und der 34. SSW bedarf es der intensiven Zusammenarbeit zwischen Geburtshelfer und Neonatologen, sodass ein intrauteriner Transport in ein Perinatalzentrum erfolgen sollte. Vor 34 SSW sollte ein individuelles Vorgehen geplant, nach der 34. SSW ein aktives Management im Sinne einer Schwangerschaftsbeendigung gewählt werden.
Literatur
Zurück zum Zitat Aagard-Tillery KM, Methalapaty FS, Ramsex PS, Ramin KD (2005) PROM: perspectives surrounding controversies in management. Am J Perinatol 22:287–297CrossRef Aagard-Tillery KM, Methalapaty FS, Ramsex PS, Ramin KD (2005) PROM: perspectives surrounding controversies in management. Am J Perinatol 22:287–297CrossRef
Zurück zum Zitat Alexander JM, Cox SM (1996) Clinical course of premature rupture of the membranes. Semin Perinatol 20(5):369–374CrossRefPubMed Alexander JM, Cox SM (1996) Clinical course of premature rupture of the membranes. Semin Perinatol 20(5):369–374CrossRefPubMed
Zurück zum Zitat Caughey AB, Robinson JN, Norwitz ER (2008) Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol 1:11–22PubMedPubMedCentral Caughey AB, Robinson JN, Norwitz ER (2008) Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol 1:11–22PubMedPubMedCentral
Zurück zum Zitat Cousins LM, Smok DP, Lovett SM, Poetler DM (2005) AmniSure placental alpha microglobulin-1 rapid immunoassay versus standard diagnostic methods for detection of rupture of membranes. Am J Perinatol 22:317CrossRefPubMed Cousins LM, Smok DP, Lovett SM, Poetler DM (2005) AmniSure placental alpha microglobulin-1 rapid immunoassay versus standard diagnostic methods for detection of rupture of membranes. Am J Perinatol 22:317CrossRefPubMed
Zurück zum Zitat Crowley P (1995) Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972–1994. Am J Obstet Gynecol 173:322–335CrossRefPubMed Crowley P (1995) Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972–1994. Am J Obstet Gynecol 173:322–335CrossRefPubMed
Zurück zum Zitat Crowther CA, Hiller JE, Doyle LW (2002) Magnesium sulphate for preventing preterm birth in threatened preterm labour (Cochrane Review). The Cochrane Libr (4): CD001060 Crowther CA, Hiller JE, Doyle LW (2002) Magnesium sulphate for preventing preterm birth in threatened preterm labour (Cochrane Review). The Cochrane Libr (4): CD001060
Zurück zum Zitat Deutsch A, Deutsch E, Totten C, Downes K, Haubner L, Belogolvkin V (2010) Maternal and neonatal outcomes based on gestational age of midtrimester preterm pramature rupture of membranes. J Matern Fetal Neonatal Med 23(12):1429–1434CrossRefPubMed Deutsch A, Deutsch E, Totten C, Downes K, Haubner L, Belogolvkin V (2010) Maternal and neonatal outcomes based on gestational age of midtrimester preterm pramature rupture of membranes. J Matern Fetal Neonatal Med 23(12):1429–1434CrossRefPubMed
Zurück zum Zitat Egarter CH, Leitich H, Karas H et al (1996) Antibiotic treatment in preterm premature rupture of membranes and neonatal morbidity: a metaanalysis. Am J Obstet Gynecol 174:589–597CrossRefPubMed Egarter CH, Leitich H, Karas H et al (1996) Antibiotic treatment in preterm premature rupture of membranes and neonatal morbidity: a metaanalysis. Am J Obstet Gynecol 174:589–597CrossRefPubMed
Zurück zum Zitat Ehsanipoor RM, Chung JH, Clock CA et al (2008) A retrospective review of ampicillin-sulbactam and amoxicillin + clavulanate vs cefazolin/cephalexin and erythromycin in the setting of preterm premature rupture of membranes: maternal and neonatal outcomes. Am J Obstet Gynecol 198:e54–e56CrossRefPubMed Ehsanipoor RM, Chung JH, Clock CA et al (2008) A retrospective review of ampicillin-sulbactam and amoxicillin + clavulanate vs cefazolin/cephalexin and erythromycin in the setting of preterm premature rupture of membranes: maternal and neonatal outcomes. Am J Obstet Gynecol 198:e54–e56CrossRefPubMed
Zurück zum Zitat Ekwo EE, Gosselink CA, Moawad A (1992) Unfavorable outcome in penultimate pregnancy and premature rupture of membranes in successive pregnancy. Obstet Gynecol 80(2):166PubMed Ekwo EE, Gosselink CA, Moawad A (1992) Unfavorable outcome in penultimate pregnancy and premature rupture of membranes in successive pregnancy. Obstet Gynecol 80(2):166PubMed
Zurück zum Zitat Garzetti GG, De Cristofaro F, La marca N, Arduini D (1997) Prophylactic transabdominal amnioinfusion in oligohydramnios for preterm premature rupture of membranes: increase of amniotic fluid index during latency period. Gynecol Obstet Invest 44:249–254CrossRefPubMed Garzetti GG, De Cristofaro F, La marca N, Arduini D (1997) Prophylactic transabdominal amnioinfusion in oligohydramnios for preterm premature rupture of membranes: increase of amniotic fluid index during latency period. Gynecol Obstet Invest 44:249–254CrossRefPubMed
Zurück zum Zitat Georgakopoulos PA, Dodos D, Mechleris D (1984) Sexuality in pregnancy and premature labor. Br J Obstet Gynaecol 91:891–893CrossRefPubMed Georgakopoulos PA, Dodos D, Mechleris D (1984) Sexuality in pregnancy and premature labor. Br J Obstet Gynaecol 91:891–893CrossRefPubMed
Zurück zum Zitat Harger JH, Hsing AW, Tuomala RE et al (1990) Risk factors for preterm premature ruputure of fetal membranes: a multicenter case-control study. Am J Obstet Gynecol 163:130–137CrossRefPubMed Harger JH, Hsing AW, Tuomala RE et al (1990) Risk factors for preterm premature ruputure of fetal membranes: a multicenter case-control study. Am J Obstet Gynecol 163:130–137CrossRefPubMed
Zurück zum Zitat Holmgren PA, Olofsson JI (1997) Preterm premature rupture of membranes and the associated risk for placental abruption. Inverse correlation to gestational age. Acta Obstet Gynecol Scand 76:743, ageCrossRefPubMed Holmgren PA, Olofsson JI (1997) Preterm premature rupture of membranes and the associated risk for placental abruption. Inverse correlation to gestational age. Acta Obstet Gynecol Scand 76:743, ageCrossRefPubMed
Zurück zum Zitat Jenkins TM, Berghella V, Shlossman PA, McIntyre CJ, Maas BD, Pollock MA, Wapner RJ (2000) Timing of cerclage removal after preterm premature rupture of membranes: maternal and neonatal outcomes. Am J Obstet Gynecol 183:847–852CrossRefPubMed Jenkins TM, Berghella V, Shlossman PA, McIntyre CJ, Maas BD, Pollock MA, Wapner RJ (2000) Timing of cerclage removal after preterm premature rupture of membranes: maternal and neonatal outcomes. Am J Obstet Gynecol 183:847–852CrossRefPubMed
Zurück zum Zitat Kenyon SL, Taylor DJ, Tarnow-Mordi W (2001) Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. ORACLE Collaborative Group. Lancet 31(357):979–988CrossRef Kenyon SL, Taylor DJ, Tarnow-Mordi W (2001) Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. ORACLE Collaborative Group. Lancet 31(357):979–988CrossRef
Zurück zum Zitat Kenyon S, Boulvain M, Neilson JP (2010) Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev 8, CD001058. doi:10.1002/14651858.CD001058.pub2PubMed Kenyon S, Boulvain M, Neilson JP (2010) Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev 8, CD001058. doi:10.1002/14651858.CD001058.pub2PubMed
Zurück zum Zitat Klebanoff MA, Nugent RP, Rhoads GG (1984) Coitus during pregnancy: is it safe? Lancet ii:914–917 Klebanoff MA, Nugent RP, Rhoads GG (1984) Coitus during pregnancy: is it safe? Lancet ii:914–917
Zurück zum Zitat Kurkinen-Raty M, Koivisto M, Jouppila P (1998) Perinatal and neonatal outcome and late pulmonary sequelae in infants born after preterm premature rupture of membranes. Obstet Gynecol 92:408, stoPubMed Kurkinen-Raty M, Koivisto M, Jouppila P (1998) Perinatal and neonatal outcome and late pulmonary sequelae in infants born after preterm premature rupture of membranes. Obstet Gynecol 92:408, stoPubMed
Zurück zum Zitat Lee T, Carpenter MW, Heber WW, Silver HM (2003) Preterm premature rupture of membranes: risks of recurrent complications in the next pregnancy among a population-based sample of gravid women. Am J Obstet Gynecol 188(1):209CrossRefPubMed Lee T, Carpenter MW, Heber WW, Silver HM (2003) Preterm premature rupture of membranes: risks of recurrent complications in the next pregnancy among a population-based sample of gravid women. Am J Obstet Gynecol 188(1):209CrossRefPubMed
Zurück zum Zitat Lee SE, Park JS, Norowitz ER et al (2007) Measurement of placental alpha-microglobulin-1 in cervicovaginal discharge to diagnose rupture of membranes. Obstet Gynecol 109:634CrossRefPubMed Lee SE, Park JS, Norowitz ER et al (2007) Measurement of placental alpha-microglobulin-1 in cervicovaginal discharge to diagnose rupture of membranes. Obstet Gynecol 109:634CrossRefPubMed
Zurück zum Zitat Lee SM, Lee J, Seong HS et al (2009) The clinical significance of a positive Amnisure test in women with term labor with intact membranes. J Matern Fetal Neonatal Med 22:305–310CrossRefPubMedPubMedCentral Lee SM, Lee J, Seong HS et al (2009) The clinical significance of a positive Amnisure test in women with term labor with intact membranes. J Matern Fetal Neonatal Med 22:305–310CrossRefPubMedPubMedCentral
Zurück zum Zitat Leeners B, Brandenburg U, Rath W (2000) Sexualität in der Schwangerschaft: Risiko- oder Schutzfaktor? Geburtshilfe Frauenheilkd 60:536–543CrossRef Leeners B, Brandenburg U, Rath W (2000) Sexualität in der Schwangerschaft: Risiko- oder Schutzfaktor? Geburtshilfe Frauenheilkd 60:536–543CrossRef
Zurück zum Zitat Mercer BM (2005) Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 32:411–428CrossRefPubMed Mercer BM (2005) Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 32:411–428CrossRefPubMed
Zurück zum Zitat NIH Consensus Development Panel, National Institutes of Health (1995) Effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 273:413–418CrossRef NIH Consensus Development Panel, National Institutes of Health (1995) Effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 273:413–418CrossRef
Zurück zum Zitat Porat S, Amsalem H, Shah PS, Murphy KE (2012) Transabdominal amnioninfusion for preterm rupture of membranes: a systematic review and metaanalysis of randomized and observational studies. Am J Obstet Gynecol 207:393.e1CrossRef Porat S, Amsalem H, Shah PS, Murphy KE (2012) Transabdominal amnioninfusion for preterm rupture of membranes: a systematic review and metaanalysis of randomized and observational studies. Am J Obstet Gynecol 207:393.e1CrossRef
Zurück zum Zitat Quintero RA, Romero R, Dzieczkowski J, Mammen E, Evans MI (1996) Sealing of ruptured amniotic membranes with intraamniotic platelet-cryoprecipitate plug [letter]. Lancet 347:1117CrossRefPubMed Quintero RA, Romero R, Dzieczkowski J, Mammen E, Evans MI (1996) Sealing of ruptured amniotic membranes with intraamniotic platelet-cryoprecipitate plug [letter]. Lancet 347:1117CrossRefPubMed
Zurück zum Zitat Romero R, Ghidini A, Mazor M et al (1991) Microbial invasion of the amniotic cavity in premature rupture of the membranes. Clin Obstet Gynecol 34:769–778CrossRefPubMed Romero R, Ghidini A, Mazor M et al (1991) Microbial invasion of the amniotic cavity in premature rupture of the membranes. Clin Obstet Gynecol 34:769–778CrossRefPubMed
Zurück zum Zitat Romero R, Yoon BH, Mazor M et al (1993) The diagnostic and prognostic value of amniotic fluid white blood cell count, glucose, interleukin-6, and gram stain in patients with preterm labor and intact membranes. Am J Obstet Gynecol 169:805–816CrossRefPubMed Romero R, Yoon BH, Mazor M et al (1993) The diagnostic and prognostic value of amniotic fluid white blood cell count, glucose, interleukin-6, and gram stain in patients with preterm labor and intact membranes. Am J Obstet Gynecol 169:805–816CrossRefPubMed
Zurück zum Zitat Schucker JL, Mercer BM (1996) Midtrimester premature rupture of the membranes. Semin Perinatol 20:389–400CrossRefPubMed Schucker JL, Mercer BM (1996) Midtrimester premature rupture of the membranes. Semin Perinatol 20:389–400CrossRefPubMed
Zurück zum Zitat Schutte MF, Treffers PE, Kloosterman GJ, Soepatmi S (1983) Management of premature rupture of membranes: the risk of vaginal examination of the infant. Am J Obstet Gynecol 146(4):395, termaCrossRefPubMed Schutte MF, Treffers PE, Kloosterman GJ, Soepatmi S (1983) Management of premature rupture of membranes: the risk of vaginal examination of the infant. Am J Obstet Gynecol 146(4):395, termaCrossRefPubMed
Zurück zum Zitat Spinillo A, Nicola S, Piazzi G et al (1994) Epidemiological correlates of preterm premature rupture of membranes. Int J Gynecol Obstet 47:7–15CrossRef Spinillo A, Nicola S, Piazzi G et al (1994) Epidemiological correlates of preterm premature rupture of membranes. Int J Gynecol Obstet 47:7–15CrossRef
Zurück zum Zitat The Worldwide Atosiban versus Beta-agonists Study Group (2001) Effectiveness and safety of the oxytocin antagonist atosiban versus beta-adrenergic agonists in the treatment of preterm labour. Br J Obstet Gynaecol 108:133–142CrossRef The Worldwide Atosiban versus Beta-agonists Study Group (2001) Effectiveness and safety of the oxytocin antagonist atosiban versus beta-adrenergic agonists in the treatment of preterm labour. Br J Obstet Gynaecol 108:133–142CrossRef
Zurück zum Zitat Van Teeffelen S, Pajkrt E, Willekes C, Van Kuijk SM, Mol BW (2013) Transabdominal amnioinfusion for improving fetal outcomes after oligohydramnios secondary to preterm prelabour rupture of membranes before 26 weeks. Cochrane Database Syst Rev 8, CD009952. doi:10.1002/14651858.CD009952.pub2PubMed Van Teeffelen S, Pajkrt E, Willekes C, Van Kuijk SM, Mol BW (2013) Transabdominal amnioinfusion for improving fetal outcomes after oligohydramnios secondary to preterm prelabour rupture of membranes before 26 weeks. Cochrane Database Syst Rev 8, CD009952. doi:10.1002/14651858.CD009952.pub2PubMed
Zurück zum Zitat Yoon BH, Romero R, Kim KS, Park JS, Ki SH, Kim BI, Jun JK (1999) A systemic fetal inflammatory response and the development of bronchopulmonary dysplasia. Am J Obstet Gynecol 181:773–779CrossRefPubMed Yoon BH, Romero R, Kim KS, Park JS, Ki SH, Kim BI, Jun JK (1999) A systemic fetal inflammatory response and the development of bronchopulmonary dysplasia. Am J Obstet Gynecol 181:773–779CrossRefPubMed
Metadaten
Titel
Früher vorzeitiger Blasensprung
verfasst von
Herbert Kiss
Klaus Reisenberger
Copyright-Jahr
2016
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-45064-2_16