Fetale Wachstumsrestriktion: Prädiktion mittels Doppler-Sonografie und angiogene Faktoren zur Vorhersage

Die fetale Wachstumsrestriktion (oder intrauterine Wachstumsrestriktion) ist ein bedeutendes geburtshilfliches Problem mit hoher Morbidität und Mortalität, das circa 5 – 10% aller Schwangerschaften betrifft [1], [2]. Auch wenn die zugrunde liegenden Ursachen verschieden sind, so endet die fetale Wachstumsrestriktion häufig in einer suboptimalen uteroplazentaren Perfusion und fetalen Versorgung. Dies resultiert beispielsweise in einem erhöhten Risiko für Frühgeburtlichkeit, infantiler Zerebralparese, Hirnblutung, Hypoglykämie und Hyperbilirubinämie [3], [4]. Zudem sind Entwicklungsverzögerungen in der Kindheit und Erkrankungen im Erwachsenenalter (z. B. Diabetes mellitus) häufiger [5], [6]. Es sind vor allem 10% der perinatalen Mortalität durch eine nicht entdeckte fetale Wachstumsrestriktion verursacht und etwa 50% der Totgeburten hiermit assoziiert [7], [8].

• Literatur

• 1 Albu AR, Anca AF, Horhoianu VV. et al. Predictive factors for intrauterine growth restriction. J Med Life 2014; 7: 165-171
• 2 Parker SE, Werler MM. Epidemiology of ischemic placental disease: a focus on preterm gestations. Semin Perinatol 2014; 38: 133-138
• 3 McIntire DD, Bloom SL, Casey BM. et al. Birth weight in relation to morbidity and mortality among newborn infants. N Engl J Med 1999; 340: 1234-1238
• 4 Alkalay AL, Graham jr. JM, Pomerance JJ. Evaluation of neonates born with intrauterine growth retardation: review and practice guidelines. J Perinatol 1998; 18: 142-151
• 5 Pallotto EK, Kilbride HW. Perinatal outcome and later implications of intrauterine growth restriction. Clin Obstet Gynecol 2006; 49: 257-269
• 6 Barker DJ. Adult consequences of fetal growth restriction. Clin Obstet Gynecol 2006; 49: 270-283
• 7 Froen JF, Gardosi JO, Thurmann A. et al. Restricted fetal growth in sudden intrauterine unexplained death. Acta Obstet Gynecol Scand 2004; 83: 801-807
• 8 Richardus JH, Graafmans WC, Verloove-Vanhorick SP. et al. Differences in perinatal mortality and suboptimal care between 10 European regions: results of an international audit. BJOG 2003; 110: 97-105
• 9 Akolekar R, Syngelaki A, Sarquis R. et al. Prediction of early, intermediate and late pre-eclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks. Prenat Diagn 2011; 31: 66-74
• 10 Karagiannis G, Akolekar R, Sarquis R. et al. Prediction of small-for-gestation neonates from biophysical and biochemical markers at 11–13 weeks. Fetal Diagn Ther 2011; 29: 148-154
• 11 Beaufils M, Uzan S, Donsimoni R. et al. Prevention of pre-eclampsia by early antiplatelet therapy. Lancet 1985; 1: 840-842
• 12 Bujold E, Roberge S, Lacasse Y. et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010; 116: 402-414
• 13 Henderson JT, Whitlock EP, OʼConnor E. et al. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 160: 695-703
• 14 Askie LM, Duley L, Henderson-Smart DJ. et al. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet 2007; 369: 1791-1798
• 15 Roberge S, Nicolaides KH, Demers S. et al. Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound Obstet Gynecol 2013; 41: 491-499
• 16 Caron N, Rivard GE, Michon N. et al. Low-dose ASA response using the PFA-100 in women with high-risk pregnancy. J Obstet Gynaecol Can 2009; 31: 1022-1027
• 17 Rey E, Rivard GE. Is testing for aspirin response worthwhile in high-risk pregnancy?. Eur J Obstet Gynecol Reprod Biol 2011; 157: 38-42
• 18 Ayala DE, Ucieda R, Hermida RC. Chronotherapy with low-dose aspirin for prevention of complications in pregnancy. Chronobiol Int 2013; 30: 260-279
• 19 Norgard B, Puho E, Czeizel AE. et al. Aspirin use during early pregnancy and the risk of congenital abnormalities: a population-based case-control study. Am J Obstet Gynecol 2005; 192: 922-923
• 20 Werler MM, Mitchell AA, Shapiro S. The relation of aspirin use during the first trimester of pregnancy to congenital cardiac defects. N Engl J Med 1989; 321: 1639-1642
• 21 Rotchell YE, Cruickshank JK, Gay MP. et al. Barbados Low Dose Aspirin Study in Pregnancy (BLASP): a randomised trial for the prevention of pre-eclampsia and its complications. Br J Obstet Gynaecol 1998; 105: 286-292
• 22 Caritis S, Sibai B, Hauth J. et al. Low-dose aspirin to prevent preeclampsia in women at high risk. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med 1998; 338: 701-705
• 23 Sibai BM, Caritis SN, Thom E. et al. Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous pregnant women. The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med 1993; 329: 1213-1218
• 24 Duley L, Henderson-Smart DJ, Meher S. et al. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev 2007; (02) CD004659
• 25 Schiessl B, Schneider KT, Zimmermann A. et al. Prenatal constriction of the fetal ductus arteriosus–related to maternal pain medication?. Z Geburtshilfe Neonatol 2005; 209: 65-68
• 26 Wyatt-Ashmead J. Antenatal closure of the ductus arteriosus and hydrops fetalis. Pediatr Dev Pathol 2011; 14: 469-474
• 27 Intrauterine growth restriction. Guideline of the German Society of Gynecology and Obstetrics (S2k, AWMF-Registry-No.: 015/080, October 2016). Online: http://www.awmf.org/leitlinien/detail/ll/015-080.html Stand: 01.07.2017
• 28 Rolnik DL, Wright D, Poon LC. et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017; DOI: 10.1056/NEJMoa1704559.