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DOI: 10.1055/s-0037-1616991
Geburtshilfliche Blutungskomplikationen
Haemorrhagic complications in obstetricsPublication History
Publication Date:
27 December 2017 (online)
Zusammenfassung
Die Labilität des Hämostasegleichgewichts in Schwangerschaft und Wochenbett ist einerseits geprägt durch eine Verschiebung der primären und der plasmatischen Hämostase in Richtung Prokoagulation. Andererseits kommt es durch den Regulierungsmechanismus des Fibrinolysesystems peri- und postpartal leicht zu einer überschießenden Reaktion, die massive Blutungskomplikationen zur Folge haben kann. Es kann im Rahmen von Geburtsverletzungen oder Uterusatonie zu massiven Blutungen und damit zu einer klassischen Verlustkoagulopathie kommen. Ebenso können Komplikationen (z. B. Fruchtwasserembolie, Puerperalsepsis, Eklampsie oder HELLP) auf dem Weg einer DIC zu einer sich schnell entwickelnden und u. U. fulminant verlaufenden Hyperfibrinolyse führen.
Hier werden die grundlegenden Veränderungen des Gerinnungssystems während der Schwangerschaft bis zum Wochenbett beschrieben und die verschiedenen Blutungsformen in der geburtshilflichen Situation mit ihrer speziellen Pathologie und spezifischen Korrekturmöglichkeiten erläutert. Ein Fallbeispiel zeigt die diagnostischen und therapeutischen Möglichkeiten im Falle einer Eklampsie mit vorzeitiger Plazentalösung.
Summary
The instability of the gestational and puerperal equilibrium of haemostasis is affected by a shift of primary and plasmatic haemostasis in a procoagulatory direction, whereas the regulation mechanism of the fibrinolytic system can easily cause disproportional peri- and postpartal reaction leading to massive haemorrhage. Peripartal injuries or an atonic uterus can lead to massive haemorrhage and cause a classic haemorrhagic coagulopathy. Complications like amniotic fluid embolism, puerperal sepsis, eclampsia or HELLP syndrom can lead through DIC to rapidly developing and possibly fulminant hyperfibrinolysis. This article depicts different forms of haemorrhage in the peripartal situation, their particular pathologies and specific possibilities for management. A case study demonstrates the diagnostic and therapeutic options in the case of eclampsia with early abruption of placenta.
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