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16.05.2024 | Totgeburt | Leitthema

Brauchen wir ein Ultraschallscreening im späten dritten Trimenon zur besseren Detektion wachstumsrestringierter Feten?

verfasst von: Prof. Dr. med. Ulrich Gembruch

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Zusammenfassung

Die Rate von Totgeburten und anderweitig adversem perinatalen Outcome korreliert invers mit den Perzentilen des Geburtsgewichtes. Im allgemeinen werden Feten mit einem sonographisch ermittelten Geburtsgewicht unterhalb der 10. Perzentile ultraschallbasierter Standardkurven, sog. SGA(„small-for-gestational age“)-Feten, einer intensivierten Überwachung unterzogen, ebenso wie Feten in Schwangerschaften mit vorbestehenden Risikofaktoren oder entsprechenden Auffälligkeiten während der Vorsorgeuntersuchungen. Nicht in diese Gruppe fallen derzeit Niedrigrisikoschwangere, hierunter auch nullipare Schwangere, bei denen das Risiko plazentar bedingter Komplikationen ebenfalls erhöht ist. Da die Mehrzahl der wachstumsrestringierten Feten („fetal growth restriction“, FGR) erst spät im dritten Trimenon ihr Wachstum einschränkt, erfolgt das derzeitige Ultraschallscreening mit 28 + 0–31 + 6 SSW (Schwangerschaftswochen) zu früh, um die große Mehrzahl der SGA- und FGR-Neonaten zu detektieren. Es ist evident, dass ein weiteres Screening mit 35 + 0–36 + 6 SSW erforderlich wäre, um die Entdeckungsrate für SGA- und FGR-Feten zu erhöhen. Vor- und Nachteile eines Ultraschallscreenings werden in diesem Kontext aufgezeigt, alternative Modelle werden diskutiert.

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Titel: Brauchen wir ein Ultraschallscreening im späten dritten Trimenon zur besseren Detektion wachstumsrestringierter Feten?
verfasst von: Prof. Dr. med. Ulrich Gembruch
Publikationsdatum: 16.05.2024
Verlag: Springer Medizin
Schlagwörter: Totgeburt
Schwangerenvorsorge
Erschienen in: Die Gynäkologie
Print ISSN: 2731-7102
Elektronische ISSN: 2731-7110
DOI: https://doi.org/10.1007/s00129-024-05227-9

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