Der vorzeitige Blasensprung am Termin: Folgen des abwartenden VorgehensEine Analyse des eigenen Krankengutes

Zusammenfassung

Kaum ein Vorgehen ist sowenig standardisiert wie das Vorgehen beim vorzeitigen Blasensprung am Termin (PROM). Nach unseren Vorstellungen sollte daher das eigene Management immer wieder anhand eigener Daten überprüft und ggf. modifiziert werden. Zur Feststellung des Ist-Zustands haben wir über drei Monate 400 Schwangerschaften retrospektiv analysiert. Die Patientinnen mit vorzeitigem Blasensprung am Termin (> 36 + 0 SSW) wurden zunächst 24 h lang abwartend beobachtet und dann bei Fehlen eigener Wehen abhängig vom Zervixbefund eingeleitet. Sie wurden hinsichtlich Parität, Zervixbefund bei Aufnahme, Anzahl der vaginalen Untersuchungen, Geburtsmodus, Amnioninfektionssyndrom und Neugeboreneninfektion aufgeschlüsselt. Ein vorzeitiger Blasensprung fand sich in 10 %. Erstgebärende waren mit 73 % überdurchschnittlich häufig vertreten. Erwartungsgemäß fand sich bei 73 % ein unreifer Muttermundbefund. Das Intervall zwischen Blasensprung und Geburt betrug im Mittel 27 h. Die Hälfte der Kinder kam erst 24 h nach PROM zur Welt. Lag der Blasensprung länger als 24 h zurück, so verdoppelte sich die Rate der Kaiserschnitte (15 vs. 30 %), die Rate der vaginal-operativen Entbindungen (11 vs. 20 %), die Anzahl der Amnioninfektionssyndrome (16 vs. 35 %) und die Verlegung auf die Neugeborenenintensivstation (16 vs. 25 %). Bis zur Geburt wurden die Patientinnen vergleichsweise häufig vaginal untersucht (bis zu 18-mal; im Mittel 8-mal). Aufgrund der dargelegten Resultate halten wir ein aktiveres Vorgehen 6 - 8 h nach Blasensprung und Ausbleiben eigener regelmäßiger Wehentätigkeit für indiziert. Insbesondere Erstgebärende mit unreifer Zervix können davon profitieren. Die Häufigkeit vaginaler Untersuchungen sollte reduziert werden.

Few procedures are less standardised than the procedure in case of prelabour rupture of the membranes at term (PROM). We propose that management should be reviewed regularly on the basis of one's own data and be modified accordingly if necessary. For the duration of three months we analysed 400 pregnancies retrospectively. Patients with PROM were observed expectantly for 24 hours. If there were no spontaneous uterine contractions, labour was induced, depending on the degree of cervical dilatation. 10 percent of the cases studied had PROM. Of these a high proportion of 73 percent were primigravida, likewise 73 percent had an unripe cervix. The average time between PROM and delivery was 27 h. 50 percent of the babys were born 24 h after PROM. If delivery occurred more than 24 h after PROM, the rate of caesarean section (15 vs. 30 percent), the rate of forceps deliveries (11 vs. 20 percent), the rate of amnionitis (16 vs. 35 percent) and the number of admissions to the newborn-ICU (16 vs. 25 percent) almost doubled. The patients were examined vaginally relatively often prior to delivery (up to 18 times, with a mean of 8 times). We therefore recommend active management 6 - 8 h after PROM, should there be no onset of spontaneous uterine contractions. This is particularly beneficial to primigravida with an unripe cervix.

Schlüsselwörter

vorzeitiger Blasensprung am Termin - Geburtseinleitung - Erstgebärende - unreife Zervix

Key words

Prelabor rupture of the membranes at term - induction of labor - nulliparous women - unripe cervix

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