Mehrlingsschwangerschaften

Mehrlingsschwangerschaften sind mit etwas über 1% keine Seltenheit. Am häufigsten sind Zwillinge, während höhergradige Mehrlinge deutlich seltener vorkommen. Für im Kreißsaal tätige Anästhesisten ist es wichtig, grundlegende Merkmale und Risiken von Zwillingsschwangerschaften zu kennen – ebenso den Ablauf und die Eskalationsmöglichkeiten einer vaginalen Zwillingsgeburt. So kann zeitnah korrekt reagiert werden, wie in diesem Beitrag dargestellt.

• Literatur

• 1 Hawkins AT, Koffel B. Abnormal Presentation and multiple Gestations. In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y, Mhyre J. eds. Chestnutʼs Obstetric Anesthesia: Principles and Practice. 5th ed. Philadelphia: Saunders; 2014: 809-824
• 2 Bateman BT, Simpson LL. Higher rate of stillbirth at the extremes of reproductive age: a large nationwide sample of deliveries in the United States. Am J Obstet Gynecol 2006; 194: 840-845 doi:10.1016/j.ajog.2005.08.038
• 3 American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 169: Multifetal Gestations: Twin, Triplet, and Higher-Order Multifetal Pregnancies. Obstet Gynecol 2016; 128: e131-e146 doi:10.1097/AOG.0000000000001709
• 4 Chapter 46: Multifetal Pregnancy. In: Leveno KJ, Spong CY, Casey BM, Hoffman BL, Cunningham FG, Bloom SL, Dashe JS. Williams Obstetrics. 25th ed.. New York: McGraw-Hill Education/Medical; 2018
• 5 von Kaisenberg CS, Klaritsch P, Ochsenbein-Kölble N. et al. S2e-Leitlinie: Überwachung und Betreuung von Zwillingsschwangerschaften. AWMF-Register-Nr. LL015–087. Im Internet (Stand: 08.08.2020): http://www.awmf.org/leitlinien/detail/ll/015-087.html
• 6 National Institute for Health and Care Excellence (NICE). Twin and triplet pregnancy. NICE guideline (NG137). September 2019. Im Internet (Stand: 08.08.2020): http://www.nice.org.uk/guidance/ng137
• 7 Kuleva M, Youssef A, Maroni E. et al. Maternal cardiac function in normal twin pregnancy: a longitudinal study. Ultrasound Obstet Gynecol 2011; 38: 575-580 doi:10.1002/uog.8936
• 8 Adank MC, Broere-Brown ZA, Gonçalves R. et al. Maternal cardiovascular adaptation to twin pregnancy: a population-based prospective cohort study. BMC Pregnancy Childbirth 2020; 20: 327 doi:10.1186/s12884-020-02994-w
• 9 American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 171: Management of Preterm Labor. Obstet Gynecol 2016; 128: e155 doi:10.1002/14651858.CD003096
• 10 Martin JA, Hamilton BE, Sutton PD. et al. Births: final data for 2004. Natl Vital Stat Rep 2006; 55: 1-101
• 11 Roberts D, Brown J, Medley N. et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; (03) CD004454
• 12 MacDorman MF, Gregory ECW. Fetal and perinatal mortality: United States, 2013. Natl Vital Stat Rep 2015; 64: 1-24
• 13 Lewi L, Deprest J, Hecher K. The vascular anastomoses in monochorionic twin pregnancies and their clinical consequences. Am J Obstet Gynecol 2013; 208: 19-30 doi:10.1016/j.ajog.2012.09.025
• 14 Rossi AC, DʼAddario V. Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature. Am J Obstet Gynecol 2008; 198: 147-152 doi:10.1016/j.ajog.2007.09.043
• 15 Vayssière C, Benoist G, Blondel B. et al. Twin pregnancies: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2011; 156: 12-17 doi:10.1016/j.ejogrb.2010.12.045
• 16 Barrett JFR, Hannah ME, Hutton EK. et al. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med 2013; 369: 1295-1305
• 17 Schmitz T, Korb D, Battie C. et al. Neonatal morbidity associated with vaginal delivery of noncephalic second twins. Am J Obstet Gynecol 2018; 218: 449.e1-449.e13 doi:10.1016/j.ajog.2018.01.023
• 18 Schmitz T, Prunet C, Azria E. et al. Association between planned cesarean delivery and neonatal mortality and morbidity in twin pregnancies. Obstet Gynecol 2017; 129: 986-995 doi:10.1097/AOG.0000000000002048
• 19 Rossi AC, Mullin PM, Chmait RH. Neonatal outcomes of twins according to birth order, presentation and mode of delivery: a systematic review and meta-analysis. BJOG 2011; 118: 523-532 doi:10.1111/j.1471-0528.2010.02836.x
• 20 Schmitz T. Prise en charge de lʼaccouchement du deuxième jumeau. J Gynecol Obstet Biol Reprod (Paris) 2009; 38 (8 Suppl): S114-S121 doi:10.1016/s0368-2315(09)73568-9
• 21 Stein W, Misselwitz B, Schmidt S. Twin-to-twin delivery time interval: influencing factors and effect on short-term outcome of the second twin. Acta Obstet Gynecol Scand 2008; 87: 346-353 doi:10.1080/00016340801934276
• 22 Reschke MM, Monks DT, Varaday SS. et al. Choice of local anaesthetic for epidural caesarean section: a Bayesian network meta-analysis. Anaesthesia 2020; 75: 674-682 doi:10.1111/anae.14966
• 23 Kee WDN, Khaw KS, Ng FF. et al. A prospective comparison of vasopressor requirement and hemodynamic changes during spinal anesthesia for cesarean delivery in patients with multiple gestation versus singleton pregnancy. Anesth Analg 2007; 104: 407-411
• 24 Becke K, Jöhr M, Girard T. Einleitung von nicht nüchternen Patienten am Beispiel von Schwangeren und Kindern. Anasthesiol Intensivmed Notfallmed Schmerzther 2019; 54: 617-628 doi:10.1055/a-0720-3936