Intrauterine Therapie

Zusammenfassung

Seitdem in den 70er-Jahren des letzten Jahrhunderts die ersten intrauterinen Eingriffe unter aus heutiger Sicht sehr einfachen Rahmenbedingungen durchgeführt wurden, hat sich das Spektrum der vorgeburtlichen Eingriffe stetig erweitert – und auch die Frequenz, mit der diese Eingriffe an spezialisierten Zentren durchgeführt werden. Zwar erfolgen die meisten dieser Eingriffe minimalinvasiv, dennoch sind sie ausnahmslos mit erheblichen Risiken für den Fetus und, in Abhängigkeit von der Operationsmethode, auch für die werdende Mutter verbunden. Daher beschränken sich die meisten Zentren weltweit auf Interventionen bei fetalen Erkrankungen, die unbehandelt einen tödlichen Verlauf haben oder im Laufe der intrauterinen Entwicklung eine deutliche Verschlechterung der postnatalen Prognose erfahren. Dies ist umso bedeutender, als nur ein kleiner Teil der vorgeburtlichen Eingriffe erfolgreich im Rahmen kontrollierter klinischer Studien untersucht wurde. Ausnahmen sind lediglich die Lasertherapie des fetofetalen Transfusionssyndroms, der intrauterine Verschluss der Spina bifida und die Trachealokklusion bei Zwerchfell-Hernien mit schwerer pulmonaler Hypoplasie. Dieser Artikel soll einen Überblick über diejenigen fetalen Erkrankungen geben, die Kandidaten für eine intrauterine Therapie sind, sowie über die Evidenz der einzelnen Eingriffe.

Publication History

Received: 11 October 2024

Accepted after revision: 02 January 2025

Article published online:
14 March 2025

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