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Postpartale Hämorrhagie

Prävention und Therapie

Postpartum hemorrhage

Prevention and therapy

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Früherkennung von Risikofaktoren, aktive Leitung der Nachgeburtsperiode und prophylaktische Gabe von Oxytocin sind wichtige Präventionsmaßnahmen. Mehr als 70% aller mütterlichen Todesfälle infolge postpartaler Hämorrhagien (PPH) gelten als vermeidbar. Die Therapie besteht in der Beseitigung der Blutungsursache, der Kreislaufstabilisierung und der rechtzeitigen Behandlung einer Gerinnungsstörung. Versagen medikamentöse Maßnahmen, führen die uterine Tamponade mittels Ballonkatheter, bei persistierenden Blutungen uteruserhaltende Kompressionsnähte bei über 80% zum Erfolg. Bei Versagen aller Maßnahmen ist die Hysterektomie indiziert. Die arterielle Embolisation der Aa. uterinae kann bei Plazentaimplantationsstörungen oder persistierenden Blutungen nach operativer Intervention hilfreich sein. Eine manuelle Lösung ist indiziert, wenn sich die Plazenta nicht innerhalb von 30 Minuten nach der Geburt gelöst hat. Bei Verdacht auf Gerinnungsstörung sollten Tranexamsäure und Fibrinogen rechtzeitig gegeben werden, rekombinanter Faktor VIIa darf nur nach Ausschöpfen aller chirurgischen und die Hämostase stabilisierenden Maßnahmen eingesetzt werden.

Abstract

Important proactive strategies are anticipating risk factors, active management of third stage labour and prophylactic oxytocin. Nearly 70% of maternal deaths caused by obstetric hemorrhage are considered preventable. Immediate treatment of the cause by drugs or surgery, resuscitation and timely correction of coagulopathy is the key to the management of postpartum hemorrhages (PPH). If medical therapy (oxytocin, sulprostone) fails uterine balloon tamponade and, if bleeding persists, uterine compression sutures successfully arrest bleeding in more than 80% of cases. Failure of all the procedures is an indication for hysterectomy. Uterine artery embolization may be useful in patients with placenta accreta/increta or ongoing bleeding after surgery. Manual removal of the placenta is mandatory, if the placenta is not separated within 30 min after birth. If coagulopathy is suspected clinically, intravenous tranexamic acid and fibrinogen should be given in a timely fashion. Activated recombinant factor VIIa should only be considered in patients refractory to adequate surgical and hemostasis-stabilizing procedures.

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  1. Gynäkologie und Geburtshilfe, Medizinische Fakultät des Universitätsklinikum (RWTH) Aachen, Wendlingweg 2, 52074, Aachen, Deutschland

    W. Rath

  2. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    M.K. Bohlmann

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Correspondence to W. Rath.

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Rath, W., Bohlmann, M. Postpartale Hämorrhagie. Gynäkologe 44, 538–548 (2011). https://doi.org/10.1007/s00129-010-2739-6

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