Fetal Growth Restriction – Diagnostic Work-up, Management and Delivery

Dietmar Schlembach

doi:10.1055/a-1232-1418

Geburtshilfe und Frauenheilkunde, Table of Contents

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2020; 80(10): 1016-1025
DOI: 10.1055/a-1232-1418

GebFra Science

Review/Übersicht

Fetale Wachstumsrestriktion – Diagnostik, Betreuung und Entbindung

Article in several languages: English | deutsch

Authors

Dietmar Schlembach

Vivantes – Netzwerk für Gesundheit GmbH, Klinikum Neukölln, Klinik für Geburtsmedizin, Berlin, Germany

Abstract

Zusammenfassung

Die fetale oder intrauterine Wachstumsrestriktion (FGR/IUGR) tritt in ca. 5 – 8% aller Schwangerschaften auf und definiert einen Fetus, der sein genetisch vorgegebenes Wachstumspotenzial nicht ausschöpft. Sie stellt einen Hauptgrund der perinatalen Morbidität und Mortalität dar und ist zudem mit einer Prädisposition für die Entwicklung chronischer Erkrankungen im weiteren Leben assoziiert. Die geburtshilfliche Herausforderung stellt neben der rechtzeitigen Diagnose und der Ursachenklärung einer FGR vor allem die weitere Schwangerschaftsbetreuung mit der Wahl des optimalen Entbindungszeitpunkts dar. Ziel einer intensiven fetalen Überwachung ist es, eine Schwangerschaftsprolongation zur Minimierung der Frühgeburtsmorbidität zu erreichen, aber rechtzeitig vor einer fetalen Bedrohung oder Schädigung zu intervenieren, d. h. zu entbinden. Zu beachten ist, dass eine frühe FGR (< 32 + 0 SSW) und eine späte FGR (≥ 32 + 0 SSW) unterschiedlich beurteilt werden sollen. Eine zunehmende Verschlechterung spiegelt sich bei einer frühen FGR in Auffälligkeiten venöser Doppler-Parameter wider, bei einer späten FGR vor allem in der zerebralen Doppler-Sonografie. Die „optimale“ Methode zur Überwachung und Entscheidung zur Entbindung stellt bei einer frühen FGR nach derzeitigem Kenntnisstand die Kombination von computerisiertem CTG und Ductus venosus dar, bei einer späten FGR tritt die Beurteilung der zerebralen Doppler-Parameter in den Vordergrund.

Schlüsselwörter

fetale Wachstumsrestriktion - intrauterine Wachstumsrestriktion - Small for gestational Age - Doppler-Sonografie - computergestützte CTG-Analyse

Full Text

References

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