Mütterliche Risiken bei Schwangerschaft mit Fetalchirurgie von TTTS und fetalen Fehlbildungen

Zusammenfassung

Die Weiterentwicklung pränataler Diagnostik, der anästhesiologischen Methoden für Schwangere und Fet sowie spezieller Instrumente haben in den vergangenen Jahren dazu geführt, dass fetalchirurgische Maßnahmen an einer zunehmenden Zahl spezieller Zentren angewandt werden, um fetale Patienten zu behandeln und dabei nicht nur das Überleben der Kinder, sondern auch deren Lebensqualität zu sichern.

Für Entscheidungen in der Schwangerschaft muss jedoch auch berücksichtigt werden, welchen Risiken die Mütter während und nach diesen Eingriffen ausgesetzt sind. Dabei können sich Auswirkungen des plazentaren oder fetalen Krankheitsbildes mit den Folgen der Operationen überlagern. Eine fetalchirurgische Operation kann sogar mütterliche Risiken reduzieren. In diesem Artikel werden die bisher bekannten mütterlichen Kurz- und Langzeit-Risiken bei einer Anzahl plazentarer und fetaler Erkrankungen und deren Therapie beleuchtet. Durch interdisziplinäre Teambesprechungen sollten gemeinsam mit den Eltern die oft differenzierten Abwägungen der fetalen, neonatalen und mütterlichen Konsequenzen diskutiert und hierdurch Entscheidungsprozesse unterstützt werden.

Abstract

The improvements in fetal diagnosis or imaging, maternal-fetal anaesthesia, and instrumenta­tion have resulted in a wider application of fetal surgery for complex fetal diseases of the fetal patient in order to prevent death and to improve the quality of life for long-term survivors. However, for all decisions the maternal risks have to be balanced and considered in the informed consent process. Sometimes symptoms of the fetal disease may overlap with risks of the procedures. Maternal symptoms may even improve after fetal surgery in some cases. Here we aim at illustrating the short- and long-term consequences of different procedures of fetal surgery in order to improve the indication and informed consent process with the parents. Interdisciplinary team approaches help to illustrate the fetal, neonatal and maternal consequences when discussing and indicating fetal surgery and hopefully facilitate a long-term support for the family.

Schlüsselwörter

fetale Chirurgie - mütterliche Morbidität - komplexe fetale Fehlbildungen - Ethik in der Geburtsmedizin

Key words

fetal surgery - maternal morbidity - complex fetal malformations - ethics in obstetrics

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