Wochenbett – evidenz- und eminenzbasierte Empfehlungen

Die Postpartalphase des Wochenbetts ist charakterisiert durch Rückbildung der schwangerschaftsbedingten physiologischen Körperveränderungen. Sie wird durch Hebammen und Ärzte medizinisch überwacht und begleitet. So lassen sich Blutverlust, Wundheilung, der Beginn der Stillbeziehung und eventuell auftretende pathologische Prozesse durch Entzündungsvorgänge, Infektionen oder psychische Störungen rechtzeitig erkennen und behandeln.

Schlüsselwörter

Physiologie - Betreuung - Hämorrhagie - Entzündungen - Sepsis - Infektionen - psychische Erkrankungen

• Literatur

• 1 Jackson E, Glasier A. Return of ovulation and menses in postpartum nonlactating women: a systematic review. Obstet Gynecol 2011; 117: 657-662
• 2 Van der Wijden C, Manion C. Lactational amenorrhoea method for family planning. Cochrane Database Syst Rev 2015; (10) CD001329
• 3 Grattan DR, Ladyman SR. Chapter 2 – Neurophysiological and cognitive changes in pregnancy. In: Steegers EAP, Cipolla MJ, Miller EC. Handbook of Clinical Neurology. Amsterdam: Elsevier; 2020: 25-55
• 4 Bergström S, Lïbombo A. Puerperal measurement of the symphysis-fundus distance. Gynecol Obstet Invest 1992; 34: 76-78
• 5 Oppenheimer LW, Sherriff EA, Goodman JD. et al. The duration of lochia. Br J Obstet Gynaecol 1986; 93: 754-757
• 6 Harder U. Wochenbettbetreuung in der Klinik und zu Hause. Stuttgart: Thieme; 2015
• 7 Woodley SJ, Lawrenson P, Boyle R. et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2020; (05) CD007471
• 8 AOK. Rückbildungskurse | AOK – Die Gesundheitskasse. Accessed July 13, 2022 at: https://www.aok.de/pk/uni/inhalt/rueckbildungskurse/
• 9 Gluppe SL, Hilde G, Tennfjord MK. et al. Effect of a postpartum training program on the prevalence of Diastasis Recti Abdominis in postpartum primiparous women: A randomized controlled trial. Phys Ther 2018; 98: 260-268
• 10 McLintock C. Thromboembolism in pregnancy: challenges and controversies in the prevention of pregnancy-associated venous thromboembolism and management of anticoagulation in women with mechanical prosthetic heart valves. Best Pract Res Clin Obstet Gynaecol 2014; 28: 519-536
• 11 Blondon M, Skeith L. Preventing postpartum venous thromboembolism in 2022: A narrative review. Front Cardiovasc Med 2022; 9: 886416
• 12 Kamel H, Navi BB, Sriram N. et al. Risk of a thrombotic event after the 6-week postpartum period. N Engl J Med 2014; 370: 1307-1315
• 13 Haas S, Encke A, Kopp I. German S3 practice guidelines on prevention of venous thromboembolism--New and established evidence. Dtsch Med Wochenschr 2016; 141: 453-456
• 14 Royal College of Obstetricians and Gynaecologists (RCOG). Reducing the Risk of Thrombosis and Embolism during Pregnancy and the Puerperium (Green-top Guideline No. 37a). 2015 Accessed July 13, 2022 at: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/reducing-the-risk-of-thrombosis-and-embolism-during-pregnancy-and-the-puerperium-green-top-guideline-no-37a/
• 15 Bayer CM, Bani MR, Schneider M. et al. Assessment of breast volume changes during human pregnancy using a three-dimensional surface assessment technique in the prospective CGATE study. Eur J Cancer Prev 2014; 23: 151-157
• 16 Wunderle M, Ruebner M, Häberle L. et al. RANKL and OPG and their influence on breast volume changes during pregnancy in healthy women. Sci Rep 2020; 10: 5171
• 17 Hanson LA. Session 1: Feeding and infant development breast-feeding and immune function. Proc Nutr Soc 2007; 66: 384-396
• 18 Jorgensen SCJ, Burry L, Tabbara N. Role of maternal COVID-19 vaccination in providing immunological protection to the newborn. Pharmacotherapy 2022; 42: 58-70
• 19 Dorsch V, Rohde A. Postpartale psychische Störungen – Update 2016. Frauenheilkunde up2date 2016; 10: 355-374
• 20 DGGG/DGHW. Vaginale Geburt am Termin (S3-Leitlinie, AWMF Registry No. 015–083). Accessed July 13, 2022 at: https://www.awmf.org/leitlinien/detail/ll/015–083.html
• 21 Hebammenkunde: Lehrbuch für Schwangerschaft, Geburt, Wochenbett und Beruf. Stiefel A, Brendel K, Bauer NH. Stuttgart: Thieme; 2020.
• 22 Haeri S, Dildy GA. Maternal mortality from hemorrhage. Semin Perinatol 2012; 36: 48-55
• 23 Bergmann RL, Richter R, Bergmann KE. et al. Prevalence and risk factors for early postpartum anemia. Eur J Obstet Gynecol Reprod Biol 2010; 150: 126-131
• 24 Bundesärztekammer. Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten – Gesamtnovelle 2020. Accessed July 13, 2022 at: https://www.bundesaerztekammer.de/fileadmin/user_upload/_old-files/downloads/pdf-Ordner/MuE/Querschnitts-Leitlinien_BAEK_zur_Therapie_mit_Blutkomponenten_und_Plasmaderivaten-Gesamtnovelle_2020.pdf
• 25 Axelsson D, Brynhildsen J, Blomberg M. Postpartum infection in relation to maternal characteristics, obstetric interventions and complications. J Perinat Med 2018; 46: 271-278
• 26 Ayzac L, Caillat-Vallet E, Girard R. et al. Decreased rates of nosocomial endometritis and urinary tract infection after vaginal delivery in a French surveillance network, 1997–2003. Infect Control Hosp Epidemiol 2008; 29: 487-495
• 27 Burrows LJ, Meyn LA, Weber AM. Maternal morbidity associated with vaginal versus cesarean delivery. Obstet Gynecol 2004; 103: 907-912
• 28 Mackeen AD, Packard RE, Ota E. et al. Antibiotic regimens for postpartum endometritis. Cochrane Database Syst Rev 2015; (02) CD001067
• 29 Baksu A, Kalan A, Ozkan A. et al. The effect of placental removal method and site of uterine repair on postcesarean endometritis and operative blood loss. Acta Obstet Gynecol Scand 2005; 84: 266-269
• 30 Donders G, Greenhouse P, Donders F. et al. Genital Tract GAS Infection ISIDOG Guidelines. J Clin Med 2021; 10: 2043
• 31 Parks T, Wilson C, Curtis N. et al. Polyspecific intravenous immunoglobulin in clindamycin-treated patients with streptococcal toxic shock syndrome: A systematic review and meta-analysis. Clin Infect Dis 2018; 67: 1434-1436
• 32 Rottenstreich A, Da’as N, Kleinstern G. et al. Pregnancy and non-pregnancy related ovarian vein thrombosis: Clinical course and outcome. Thromb Res 2016; 146: 84-88
• 33 Salomon O, Dulitzky M, Apter S. New observations in postpartum ovarian vein thrombosis: experience of single center. Blood Coagul Fibrinolysis 2010; 21: 16-19
• 34 Collins CG, MacCallum EA, Nelson EW. et al. Suppurative pelvic thrombophlebitis. I. Incidence, pathology, and etiology; a study of 70 patients treated by ligation of the inferior vena cava and ovarian vessels. Surgery 1951; 30: 298-310
• 35 Mohrbacher N, Stock J, Koppitz C. et al. Handbuch für die Stillberatung – The Breastfeeding Answer Book: Stillende Mütter fachlich kompetent und einfühlsam beraten. Falkensee: La Leche Liga Deutschland e.V.; 2002
• 36 Gundersen TD, Krebs L, Loekkegaard ECL. et al. Postpartum urinary tract infection by mode of delivery: a Danish nationwide cohort study. BMJ Open 2018; 8: e018479
• 37 Grube M. Postpartale Psychosen. Psychoneuro 2005; 31: 441-444
• 38 DGGG/OEGGG/SGGG. Peripartale Blutungen, Diagnostik und Therapie (S2k-Leitlinie, AWMF Registry No. 015/063). 2016 Accessed July 13, 2022 at: https://www.awmf.org/uploads/tx_szleitlinien/015-063l_S2k_Peripartale_Blutungen_Diagnostik_Therapie_PPH_2016-04.pdf
• 39 Bose P, Regan F, Paterson-Brown S. Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions. Br J Obstet Gynaecol 2006; 113: 919-924