Interdisziplinäre Betreuung von schwangeren Patientinnen mit Kollagenosen

Zusammenfassung

Kollagenosen sind neben der rheumatoiden Arthritis die häufigsten entzündlich-rheumatischen Erkrankungen. Da die Kollagenosen die Fertilität weit gehend unbeeinträchtigt lassen, stellt die Betreuung von schwangeren Patientinnen mit einer Kollagenose ein komplexes klinisches Problem dar, welches eine enge Kooperation der Gynäkologie, der Rheumatologie und der Pädiatrie erfordert. In diesem Artikel wird ein 4-Punkte-Programm vorgestellt, welches sich für die interdisziplinäre Betreuung von Patientinnen mit Kollagenosen in der Praxis bewährt hat, soweit als möglich auf evidenzbasierte Studien zurückgreift und sich den jeweiligen Gegebenheiten der behandelnden Praxen und Kliniken anpassen lässt. Das Programm umfasst das Erkennen von Risikopatientinnen, die präkonzeptionelle Diagnostik und Beratung, die Betreuung während der Schwangerschaft sowie die postpartale Risikominimierung. Klinische Schwerpunkte sind die immunsuppressive Therapie, die Antiphospholipid-Antikörper und der kongenitale Herzblock.

Abkürzungen

Ak:Antikörper

ANA:Antinukleäre Antikörper

APL:Antiphospholipid-Antikörper

APS:Antiphospholipid-Antikörpersyndrom

ASS:Acetylsalicylsäure

PSS:progressiv systemische Sklerodermie

SLE:systemischer Lupus erythematodes

SS:Schwangerschaft

Abstract

Connective tissue diseases affect frequently women during the childbearing period. As fertility is not considerably reduced in these patients, monitoring and treatment of a pregnant patient is a complex clinical setting that requires an intensive cooperation between gynecologists, rheumatologists and pediatricians. In this article, a 4-point-program for the clinical management of these patients is presented that addresses specifically the problems inherent with the identification of patients with connective tissue diseases, preconceptional diagnostics as well as monitoring and treatment during pregnancy and the postpartal period. Clinical aspects that are intensively discussed include immunosuppressive therapy during pregnancy, the management of antiphospholipid antibody-dependent problems and the prophylaxis and treatment options for congenital heart block.

Kollagenosen - systemischer Lupus erythematodes - Antiphospholipid-Antikörpersyndrom - kongenitaler Herzblock - Immunsuppressiva - Schwangerschaft

Connective tissue diseases - systemic lupus erythematosus - antiphospholipid antibodies syndrome - congenital heart block - immunosuppressants - pregnancy

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