Einführung der S3 Leitlinie „Vaginale Geburt am Termin“ – Wie hat sich die subpartuale fetale Überwachung verändert?

Zusammenfassung

Hintergrund

Hintergrund Die subpartuale fetale Überwachung wird in der Geburtsmedizin intensiv diskutiert. Studien haben gezeigt, dass das CTG zu nicht immer notwendigen Interventionen wie operativen und vaginal-operativen Eingriffen führen kann. Darum wird in der 2021 erschienenen AWMF-S3-Leitlinie „Vaginale Geburt am Termin“ erstmals die strukturierte intermittierende Auskultation im Niedrigrisikokollektiv empfohlen.

Material und Methoden

In einer retrospektiven Querschnittsstudie wurden alle deutschen Geburtskliniken (n=616) mithilfe eines Online-Fragebogens befragt, ob sie die intermittierende Auskultation bei Niedrigrisikoschwangeren einsetzen, sowie Gründe dafür und dagegen. Die Antwortrate lag bei 16% (n=96). Ergebnisse  22% (n=21) der Kliniken gaben an, die intermittierende Auskultation immer oder manchmal zu nutzen. Es zeigte sich ein signifikanter Zusammenhang zwischen einer durch die S3-Leitlinie bewirkten Veränderung in den Kliniken und der Anwendung der intermittierenden Auskultation (X2=12,95, df=2, p=0,001). Faktoren wie die 1-zu-1 Betreuung zu>95%, der hebammengeleitete Kreißsaal und die Differenzierung des Risikostatus beeinflussten die Anwendung der intermittierenden Auskultation nicht signifikant.

Schlussfolgerung

Die Leitlinie hat nicht dazu geführt, dass die intermittierende Auskultation als Überwachung im Niedrigrisikokollektiv eingesetzt wird. Erforderlich sind die klare Niedrigrisiko-Definition, die Sicherstellung der 1-zu-1 Betreuung, Qualifikation des Personals und eine rechtlich sichere Dokumentation sowie aktuelle Studien zum Vergleich der Vor- und Nachteile der intermittierenden Auskultation vs. CTG-Überwachung.

Abstract

Background

Subpartum fetal monitoring is a debated topic in obstetrics. Studies have shown that CTG monitoring can lead to not always necessary interventions such as C-sections and vaginal-operative deliveries. Therefore, the 2021 AWMF S3 guideline “Vaginal Birth at Term” recommends structured intermittent auscultation instead of CTG monitoring in low-risk pregnancies for the first time.

Materials and Methods

In a retrospective cross-sectional study, all German maternity clinics (n=616) were asked using an online questionnaire whether they use intermittent auscultation for low-risk pregnancies as well as reasons for and against it. The response rate was 16% (n=96). Results 22% (n=21) of clinics reported using intermittent auscultation always or sometimes. A significant correlation was found if changes had occurred and the application of intermittent auscultation (X2=12.95, df=2, p=0.001). Other factors such as the availability of one-to-one care (>95%), midwife-led delivery rooms, and differentiation between high- and low-risk pregnancies had no significant influence on the use of intermittent auscultation.

Summary

The guideline has not led to the use of intermittent auscultation for monitoring in low-risk pregnancies. Clear low-risk definition, one-to-one care, qualified staff and updated studies on intermittent auscultation vs. CTG are needed.

Schlüsselwörter

Kardiotokogramm (CTG) - Geburtshilfe - intermittierende Auskultation - Fetale Überwachung

Keywords

cardiotocogram (CTG) - obstetrics - intermittent auscultation - fetal surveillance

Publikationsverlauf

Eingereicht: 28. Mai 2025

Angenommen: 29. Juli 2025

Artikel online veröffentlicht:
12. September 2025

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