Tauchmedizinische Beratung in der gynäkologischen Praxis

 

 Buy Article Permissions and Reprints

Zusammenfassung

Inzwischen ist Tauchen eine sehr beliebte und verbreitete Sportart und wird zunehmend auch von Frauen in fast allen Altersstufen ausgeübt. Es ist deshalb wahrscheinlich, im gynäkologischen Alltag mit tauchmedizinischen Fragestellungen konfrontiert zu werden. Um nun gynäkologischen Kollegen eine adäquate Beratung ihrer tauchenden Patientinnen zu ermöglichen, diskutieren wir in dieser Übersicht die gynäkologischen Aspekte des Tauchsports. Neben den physiologischen Grundlagen des Tauchens wird das Dekompressionsrisiko der Taucherin, das Tauchen mit Brustimplantaten, Verhaltensregeln in Schwangerschaft und Stillzeit, Besonderheiten nach Operation oder Tumorerkrankung sowie bei Einnahme oraler Kontrazeptiva thematisiert.

Abstract

Increasingly, women of all ages are enjoying scuba diving. Therefore gynaecological issues involved diving medicine need to be considered in order be able to give suitable advice. Here we describe the effects of diving on body functions, and comment on the special aspects of decompression sickness in female divers, diving with breast implants, diving when taking oral contraceptives or during pregnancy and lactation, and after gynaecological surgery or tumour disease.

Literatur

• 1 Wenzel J, Muth C M. Physikalische und physiologische Grundlagen des Tauchens.  Dtsch Z Sportmed. 2002;  53 162-169
  PubMedGoogle Scholar
• 2 Arborelius Jr. M, Ballidin U I, Lilja B et al. Hemodynamic changes in man during immersion with the head above water.  Aerosp Med. 1972;  43 592-598
  PubMedGoogle Scholar
• 3 Lin Y C. Circulatory functions during immersion and breath-hold dives in humans.  Undersea Biomed Res. 1984;  11 123-138
  PubMedGoogle Scholar
• 4 Hartmann S, Kölble N, Rake A et al. „Aqua-fit“ in der Schwangerschaft: Maternale und fetale hämodynamische Reaktionen bei einem Trainingsprogramm im Wasser.  Geburtsh Frauenheilk. 2001;  61 977-982
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Epstein M, Levinson R, Loutzenhiser R. Effects of water immersion on renal hemodynamics in normal man.  J Appl Physiol. 1976;  41 230-233
  PubMedGoogle Scholar
• 6 Flook V. Physics and physiology in the hyperbaric environment.  Clin Phys Physil Meas. 1987;  8 197-230
  PubMedGoogle Scholar
• 7 Carturan D, Boussuges A, Burnet H et al. Circulating venous bubbles in recreational diving: relationships with age, weight, maximal oxygen uptake and body fat percentage.  Int J Sports Med. 1999;  20 410-414
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Carturan D, Boussuges A, Vanuxem P et al. Ascent rate, age, maximal oxygen uptake, adiposity and circulating venous bubbles after diving.  J Appl Physiol. 2002;  93 1349-1356
  PubMedGoogle Scholar
• 9 Eckenhoff R G, Olstad C S, Carrod G. Human dose-response relationship for decompression and endogenous bubble formation.  J Appl Physiol. 1990;  69 914-918
  PubMedGoogle Scholar
• 10 Gerriets T, Tetzlaff K, Liceni T et al. Arteriovenous bubbles following cold water sport dives: relation to left-to-right shunting.  Neurology. 2000;  55 1741-1743
  PubMedGoogle Scholar
• 11 Melamed Y, Shupak A, Bitterman H. Medical problems associated with underwater diving.  N Engl J Med. 1992;  326 30-34
  CrossrefPubMedGoogle Scholar
• 12 Muth C M, Shank E S, Larsen B. Der schwere Tauchunfall: Pathophysiologie – Symptomatik – Therapie.  Anaesthesist. 2000;  49 302-316
  CrossrefPubMedGoogle Scholar
• 13 Butler B D, Hills B A. The lung as a filter for microbubbles.  J Appl Physiol. 1979;  47 537-543
  PubMedGoogle Scholar
• 14 Muth C M, Shank E S. Gas embolism.  N Engl J Med. 2000;  342 476-482
  CrossrefPubMedGoogle Scholar
• 15 Shank E S, Muth C M. Decompression illness, iatrogenic gas embolism, and carbon monoxide poisoning: the role of hyperbaric oxygen therapy.  Int Anesthesiol Clin. 2000;  38 111-138
  PubMedGoogle Scholar
• 16 Bassett B E. Twelve year survey of susceptibility of women to altitude decompression sickness. Preprints of Aerospace Medical Association Annual Scientific Meeting. Alexandria; Aerospace Medical Association 1980: 12-13
  PubMedGoogle Scholar
• 17 Bangasser S. Medical profile of the woman scuba diver. Proceedings of the 10th National Association of Underwater Instructors international conference on underwater education. Montclair, California; NAUI 1978: 31-40
  PubMedGoogle Scholar
• 18 Zwingelberg K M, Knight M A, Biles J B. Decompression sickness in women divers.  Undersea Biomed Res. 1987;  14 311-317
  PubMedGoogle Scholar
• 19 St Leger Dowse M, Bryson P, Gunby A et al. Comparative data from 2250 male and female sports divers: diving patterns and decompression sickness.  Aviat Space Environ Med. 2002;  73 743-749
  PubMedGoogle Scholar
• 20 Lee V, St Leger Dowse M, Edge C et al. Decompression sickness in women: a possible relationship with the menstrual cycle.  Aviat Space Environ Med. 2003;  74 1177-1182
  PubMedGoogle Scholar
• 21 International shark attack file, statistics of shark attacks on divers. Florida Museum of Natural History, University of Florida, USA. http://www.flmnh.ufl.edu/fish/Sharks/Statistics/statistics.htm
  Google Scholar
• 22 Trevett A J, Sheehan C, Forbes R. Decompression illness presenting as breast pain.  Undersea Hyperb Med. 2006;  33 77-79
  PubMedGoogle Scholar
• 23 Muth C M, Piepho T, Tetzlaff K. Decompression sickness – the female style? An observational study. 32nd Annual Meeting of the European Underwater and Baromedical Society (EUBS) on Diving and Hyperbaric Medicine, 23. – 26.6.2006, Bergen, Norwegen. 
  PubMedGoogle Scholar
• 24 American College of Obstetricians and Gynecologists . Exercise during pregnancy and the postpartum period.  Clin Obstet Gynecol. 2003;  46 496-499
  CrossrefPubMedGoogle Scholar
• 25 Powell M R, Smith M T. Fetal and maternal bubbles detected noninvasively in sheep and goats following hyperbaric decompression.  Undersea Biomed Res. 1985;  12 59-67
  PubMedGoogle Scholar
• 26 Bolton-Klug M E, Lehner C E, Lanphier E H et al. Lack of harmful effects from simulated dives in pregnant sheep.  Am J Obstet Gynecol. 1983;  146 48-51
  PubMedGoogle Scholar
• 27 St Leger Dowse M, Gunby A, Moncad R et al. Scuba diving and pregnancy: can we determine safe limits?.  J Obstet Gynaecol. 2006;  26 509-513
  CrossrefPubMedGoogle Scholar
• 28 Bolton M E. Scuba diving and fetal well-being: a survey of 208 women.  Undersea Biomed Res. 1980;  7 183-189
  PubMedGoogle Scholar
• 29 Betts J. Diving and the unborn child.  Diver. 1985;  30 14-15
  PubMedGoogle Scholar
• 30 Vann R D, Riefkohl R, Georgiade G S et al. Mammary implants, diving, and altitude exposure.  Plast Reconstr Surg. 1988;  81 200-203
  CrossrefPubMedGoogle Scholar
• 31 Grippaudo F R, Minasi P, Rocco M et al. Mammary implants: laboratory simulation of recreational diving conditions.  Br J Plast Surg. 2002;  55 120-123
  CrossrefPubMedGoogle Scholar
• 32 Tetzlaff K, Klingmann C, Muth C M et al. Checkliste Tauchtauglichkeit – Untersuchungsstandards und Empfehlungen der Gesellschaft für Tauch- und Überdruckmedizin (GTÜM). Stuttgart; Gentner Verlag 2009
  PubMedGoogle Scholar
• 33 Bolstad G. Women and diving.  Tidsskr Nor Laegeforen. 1986;  106 1571-1573
  PubMedGoogle Scholar

Dr. med. Andreas Reich

Universitätsfrauenklinik Ulm

Prittwitzstraße 43

89073 Ulm

Email: andreas.reich@uniklinik-ulm.de