Skip to main content
SpringerLink
Log in

Entbindung nach Uterotomie oder bei Uterusanomalien

Spontaneous birth and uterine anomalies

  • Zum Thema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Die Zahl der Mehrgebärenden, bei denen eine Uterotomie vorausgeht, steigt ständig an. Das liegt v. a. an der weiterhin zunehmenden Anzahl von Sectiones, die Sectiorate liegt derzeit in Niedersachsen bei 27%. Auch der Anteil der Schwangeren, bei denen bereits eine Myomenukleation durchgeführt wurde, nimmt zu, da der Altersdurchschnitt der Schwangeren steigt. In beiden Settings stellt sich die Frage des anzustrebenden Entbindungsmodus, bei der neben der größtmöglichen Sicherheit für Mutter und Kind auch psychologische Faktoren und gesellschaftliche Trends in die Entscheidung einfließen. Risiken und Entscheidungshilfen werden dargestellt. In 0,1–1% der Schwangeren ist mit einer Uterusfehlbildung zu rechnen, die sich in der Ausprägung von einem angedeuteten Septum bis zur komplexen Fehlbildung wie beim Uterus didelphys erstrecken kann. Eine gefürchtete Komplikation stellt die Uterusruptur dar, allerdings bestehen auch noch andere Risiken für Schwangerschaft und Geburt. Dennoch kann nach Sichtung der Datenlage außer beim Vorliegen bestimmter weiterer Faktoren zum Versuch des Spontanpartus geraten werden.

Abstract

The number of multiparous women with a uterine scar is rising constantly. This is mostly due to the increasing number of cesarean sections. At present cesarean sections account for 27% of all births in the German State of Lower Saxony. Besides cesarean sections, there is also an increased number of pregnant women in whom enucleation of fibroids has been performed, mostly due to constantly rising maternal age. In both situations, it is difficult to decide on the mode of delivery. Besides safety concerns for mother and fetus, psychological factors and trends in society may also play a role. This article evaluates the risks involved and provides guidelines for decision making. Uterine malformations occur in 0.1–1% of all pregnancies ranging from an incomplete septum up to complex malformations such as uterus didelphys. Besides other possible events, uterine rupture is the most dangerous and feared complication in these situations. However, a review of the available data and current literature shows that spontaneous delivery can be advised after exclusion of certain risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Acien P (1993) Reproductive performance of women with uterine malformations. Hum Reprod 8: 122–126

    CAS  PubMed  Google Scholar 

  2. Angell NF, Tan Domingo J (2002) Uterine rupture at term after uncomplicated hysteroscopic metroplasty. Obstet Gynecol 100: 1089–1099

    Article  PubMed  Google Scholar 

  3. Brown JM, Malkasian GD, Symmonds RE (1967) Abdominal myomectomy. Am J Obstet Gynecol 99: 126

    CAS  PubMed  Google Scholar 

  4. Bujold E, Mehta SH, Bujold C, Gauthier RJ (2002) Interdelivery interval and uterin rupture. Am J Obstet Gynecol 187: 1199–1202

    Article  PubMed  Google Scholar 

  5. Chauhan S, Martin JN, Henrichs CHE, Morrison JC, Magann EF (2003) Maternal and perinatal complications with uterine rupture in 142.075 patients who attempted vaginal birth after cesarean delivery: a review of the literature. Am J Obstet Gynecol 189: 408–417

    Article  PubMed  Google Scholar 

  6. Davids AM (1975) Myomektomie in the relief of infertility and sterility and in pregnancy. Surg Clin North Am 37: 563

    Google Scholar 

  7. Dubuisson JB, Fauconnier A, Deffarges JV et al. (2000) Pregnancy outcome and deliveries following laparoscopic myomectomy. Hum Reprod 15: 869–873

    Article  CAS  PubMed  Google Scholar 

  8. Düring P, Schneider H (2001) Einmal Sectio caesarea immer Sectio caesarea: Wieder zutreffend? In: Huch A, Chaoui R, Huch R (Hrsg) Sectio caesarea. Unimed, Bremen

  9. Fayez JA (1986) Comparison between abdominal and hysteroscopic metroplasty. Obstet Gynecol 68: 399–403

    CAS  PubMed  Google Scholar 

  10. Feige A (1997) Myomektomie. In: Feige A, Rempen A, Würfel W, Jawny J, Caffier H (Hrsg) Frauenheilkunde. Urban & Fischer, München, S 615–616

  11. Flamm BL (2001) Vaginal birth after cesarean (VBAC). Best practice & research. Clin Obstet Gynecol 15: 81–92

    CAS  Google Scholar 

  12. Goetzl L, Shipp TD, Cohen A, Zelop CM (2001) Oxytocin dose and the risk of uterine rupture in trial of labor after cesarean. Obstet Gynecol 97: 381–384

    Article  CAS  PubMed  Google Scholar 

  13. Golan D, Aharoni A, Gonen R et al. (1990) Early spontaneous ruptur of the myomectomy gravid uterus. Int J Gynaecol Obstet 31: 167

    Article  CAS  PubMed  Google Scholar 

  14. Greene FM (2001) Vaginal delivery after cesarean section. Is the risk acceptable? N Engl J Med 345: 54–55

    Article  CAS  PubMed  Google Scholar 

  15. Heinonen P, Saarikoski S, Pystynen P (1982) Reproductive performance of women with uterine anomalies: an evaluation of 182 cases. Acta Obstet Gynecol Scand 61: 157

    CAS  PubMed  Google Scholar 

  16. Hook B, Kiwi R, Amini SB, Fanaroff A, Hack M (1997) Neonatal morbidity after elective repeat cesarean section and trial of labor. Pediatrics 100: 348–353

    Article  CAS  PubMed  Google Scholar 

  17. Kobelin CG (2001) Intrapartum management of vaginal birth after cesarean section. Clin Obstet Gynecol 44: 588–593

    Article  CAS  PubMed  Google Scholar 

  18. Kolben M, Vetter K, Schneider KTM, Ratzel R (1999) Empfehlung zur Geburtsleitung bei Zustand nach Kaiserschnitt (Arbeitsgemeinschaft für maternofetale Medizin). Frauenarzt 40: 1003–1004

    Google Scholar 

  19. Leghart J, Hansen B (1982) Uterus didelphys. Report of a case with torsion of the uterus occuring during labor. Acta Obstet Gynecol Scand 61: 517–518

    PubMed  Google Scholar 

  20. Liebermann E (2001) Risk factors of uterine rupture during a trial of labor after cesarean. Clin Obstet Gynecol 44: 609–621

    Article  PubMed  Google Scholar 

  21. Ludmir J, Samuels P, Brooks S et al. (1990) Pregnancy outcome of patients with uncorrected uterine anomalies managed in a high-risk obstetric setting. Obstet Gynecol 75: 906–910

    CAS  PubMed  Google Scholar 

  22. Lydon-Rochelle M, Holt VL, Easterling TR, Martin DP (2001) Risk of uterine rupture during labor among woman with a prior cesarean delivery. N Engl J Med 345: 3–8

    Article  CAS  PubMed  Google Scholar 

  23. Lynch CM, Kearney R, Turner MJ (2002) Maternal morbidity after elective repeat cesarean section after two or more previous procedures. Eur J Obstet Gynecol 106: 10–13

    Article  Google Scholar 

  24. Maneschi I, Maneschi F, Parlato M, Fuca G, Incandela S (1989) Reproductive performance in women with uterus didelphys. Acta Eur Fertil 20: 121–124

    CAS  PubMed  Google Scholar 

  25. March CM, Israel R (1987) Hysteroscopic management of recurrent abortion caused by septate uterus. Am J Obstet Gynecol 156: 834

    CAS  PubMed  Google Scholar 

  26. Martel MJ, Mac Kinnon CJ (2004) Guidelines for vaginal birth after previous cesarean birth. J Obstet Gynecol 26: 660–670

    Google Scholar 

  27. McKenzie IZ, Bradley S, Embrey MR (1984) Vaginal PG and labour induction for patients previosly delivered by cesarean section. Br J Obstet Gynecol 91: 7

    Google Scholar 

  28. McMahon M, Luther ER, Bowes WA, Olshan AF (1996) Comparison of a trial of labor with an elective second cesarean section. N Engl J Med 335: 689–695

    Article  CAS  PubMed  Google Scholar 

  29. NN (2004) ACOG practice bulletin. Vaginal birth after previous cesarean. Obstet Gynecol 104: 203–212

    PubMed  Google Scholar 

  30. Patton PE, Novy MJ (2004) The diagnosis and reproductibe outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum. Am J Obstet Gynecol 190: 1669–1675

    Article  PubMed  Google Scholar 

  31. Pridjian G (1992) Labor after prior cesarean section. Clin Obstet Gynecol 35: 445–456

    CAS  PubMed  Google Scholar 

  32. Rageth JC, Juzi C, Großenbacher H (1999) Delivery after previous cesarean: a risk evaluation. Swiss working group of Obstetric and Gynecologic Institutions. Obstet Gynecol 93: 332–337

    Article  CAS  PubMed  Google Scholar 

  33. Rock J, Jones H Jr (1979) The clinical management of the double uterus. Fertil Steril 28: 789

    Google Scholar 

  34. Rosen MG, DickinsonJC, Westhoff CL (1991) Vaginal birth after cesarean: a metanalysis of morbidity and mortality. Obstet Gynecol 77: 465–470

    CAS  PubMed  Google Scholar 

  35. Schneider H (2000) Geburtshilfliches Management bei Status nach Sectio. Speculum 18: 9–13

    Google Scholar 

  36. Shuiqing M, Xuming B, Jinghe L (2002) Pregnancy and its outcome in women with malformed uterus. Chin Med Sci J 17: 242–245

    PubMed  Google Scholar 

  37. Strassmann EO (1952) Surgical unification of double uterus; technic, indications and results. South Med J 45: 818–827

    CAS  PubMed  Google Scholar 

  38. The Amercan Fertility Society (1988) The American Fertility Society classification of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril 49: 944

    PubMed  Google Scholar 

  39. Wing DA, Paul RH (1999) Vaginal birth after cesarean section: selection and management. Clin Obstet Gynecol 42: 436–448

    Article  PubMed  Google Scholar 

  40. Zentrum für Qualitätsmanagement im Gesundheitswesen (2003) Qualitätsbericht Geburtshilfe, Jahresauswertung 2003. Zentrum für Qualitätsmanagement im Gesundheitswesen, Hannover

  41. Zinberg S (2001) Vaginal delivery after previous cesarean delivery: a continuing controversy. Clin Obstet Gynecol 44: 561–570

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Universitätsfrauenklinik, Universität Schleswig-Holstein, Campus Lübeck

    D. Fischer, R. Axt-Fliedner, D. Hornung, D. Finas & M. Friedrich

  2. Universitätsfrauenklinik, Universität Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck

    D. Fischer

Authors
  1. D. Fischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Axt-Fliedner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Hornung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Finas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Friedrich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Fischer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fischer, D., Axt-Fliedner, R., Hornung, D. et al. Entbindung nach Uterotomie oder bei Uterusanomalien. Gynäkologe 38, 514–521 (2005). https://doi.org/10.1007/s00129-005-1697-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00129-005-1697-x

Schlüsselwörter

Keywords

Search

Navigation