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Klinisches Management bei Placenta praevia und pathologischer Plazentainvasion

Clinical management of placenta previa and abnormally invasive placenta

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

In der Schwangerenvorsorge muss der Befund einer Placenta praevia (PP) und die Implantationstiefe besonders nach vorausgegangener Sectio und der Nabelschnuransatz sonographisch beurteilt werden. Die Schwangere mit einer PP sollte sich frühzeitig in einem Perinatalzentrum vorstellen. Der Entbindungszeitpunkt richtet sich nach geburtshilflicher Anamnese, klinischer Symptomatik und sollte bei unkomplizierter Vorgeschichte und Verlauf zwischen 36 und 37 vollendeten SSW sein. Bei einer Vorderwand-PP empfiehlt sich die präoperative sonographische Kontrolle, da Lageanomalien vorkommen und eine transplazentare Extraktion unvermeidbar sein kann. Bei einer abnorm invasiven Plazenta (AIP) sind eine interdisziplinäre Vorstellung sowie eine ausführliche Operationsvorbereitung erforderlich. Im Falle einer ausgedehnten AIP sollte die Plazenta umgangen werden und eine Sectio/Hysterektomie en bloc ohne Plazentalösung oder in ausgewählten Fällen das konservative Vorgehen mit Belassen der Plazenta und späterer spontaner Plazentageburt oder zweizeitiger Hysterektomie erwogen werden. Die Entscheidung dazu ist individuell sowie befund- und patientinnenabhängig.

Abstract

In the antenatal care of pregnant women with a diagnosis of placenta praevia (PP), the parameters of placental implantation depth and cord insertion must be evaluated sonographically, especially in patients with a history of cesarean section. Pregnant women with a PP should attend a high level perinatal center in the early stages of pregnancy. The timing of delivery depends on the obstetric history and clinical symptoms. In uncomplicated cases delivery should be between 36 and 37 weeks of gestation. Anterior wall PP requires preoperative sonographic monitoring as fetal position anomalies can occur and a transplacental delivery may be unavoidable. The diagnosis of an abnormally invasive placenta (AIP) requires a multidisciplinary approach and detailed surgical preparation. In the case of an extensive AIP removal of the placenta should be avoided and a cesarean section with an en bloc hysterectomy performed. In selective cases a conservative approach of leaving the placenta in place and subsequent spontaneous placental delivery without placental abruption, may be considered. The management approach is individual, diagnosis specific and patient-dependent.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. W. Henrich und T. Braun geben an, dass kein Interessenkonflikt besteht.

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  1. Kliniken für Geburtsmedizin, Charitè Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    W. Henrich & T. Braun

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  1. W. Henrich
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  2. T. Braun
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Correspondence to W. Henrich.

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Henrich, W., Braun, T. Klinisches Management bei Placenta praevia und pathologischer Plazentainvasion. Gynäkologe 46, 808–816 (2013). https://doi.org/10.1007/s00129-013-3165-3

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  • DOI: https://doi.org/10.1007/s00129-013-3165-3

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