Uterusruptur

Die Uterusruptur ist ein geburtshilflicher Notfall, der ein sofortiges Handeln des betreuenden Teams notwendig macht, um möglichst schwerwiegende Schäden für Mutter und Kind abzuwenden. Die Symptome entwickeln sich in den meisten Fällen plötzlich und intrapartal und sollten Geburtshelfern bekannt sein.

Kernaussagen

• Eine komplette Uterusruptur ist ein Notfall für das betreuende Geburtshilfeteam. Sie geht mit einer hohen maternalen und fetalen Morbidität und perinatalen Mortalität einher.

• Die häufigsten Uterusrupturen treten im Zustand nach Sectio nach Einsetzen der Wehentätigkeit in einer der Folgeschwangerschaften auf. Die größten Risikofaktoren sind hierbei Z. n. Uterusruptur, Z. n. uteriner Längs- oder T-Inzision im Rahmen der Voroperation und die Geburtseinleitung.

• Die klinischen Symptome einer peripartalen Uterusruptur sind heterogen (z. B. Narbenschmerzen, vaginale Blutungen, maternale Kreislaufinstabilität, fetaler Herztonabfall), diese können unabhängig voneinander und klinisch wenig apparent auftreten.

• Besteht während des Geburtsverlaufs der Verdacht auf eine Uterusruptur, ist die Fortführung eines vaginalen/vaginal-operativen Entbindungsversuchs kontraindiziert. Eine Sonografie des Myometriums kann hilfreich sein, ermöglicht jedoch nicht immer eine finale Diagnose.

• Es gibt keinen Cut-off-Wert einer Myometriumdicke, mit dem das Auftreten einer UR sicher ausgeschlossen werden kann. Bei einer Myometriumstärke < 2–3 mm scheint ein höheres Risiko zu bestehen.

• Im Fall einer Defektheilung (Nischenbildung) des Myometriums nach Sectio kann präventiv ein hysteroskopischer, laparoskopischer, laparoskopisch assistierter oder robotisch-assoziierter Nischenrepair durchgeführt werden.

• Im Zustand nach Sectio ist in der Folgeschwangerschaft eine fundierte Geburtsplanung mit Berücksichtigung aller Risikofaktoren und Aufklärung der Schwangeren obligat.

Schlüsselwörter

Uterusruptur - peripartale Komplikation - Nische - gedeckte Ruptur - Nischenrepair

Publication History

Article published online:
28 October 2022

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