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Die Unfallchirurgie

Erschienen in:

21.09.2020 | Schwangerenvorsorge | Leitthema

Die (schwer) verletzte schwangere Patientin aus Sicht der Unfallchirurgie

verfasst von: Dr. Dr. Vera Pedersen

Erschienen in: Die Unfallchirurgie | Ausgabe 12/2020

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Zusammenfassung

Hintergrund

Das Trauma ist die führende, nichtschwangerschaftsbedingte Mortalitätsursache bei schwangeren Frauen, auch wenn die genaue Inzidenz für Unfälle in der Schwangerschaft nicht bekannt ist. Die Versorgung der verletzten Schwangeren muss neben Traumaversorgungskonzepten, wie sie für nichtschwangere Erwachsene gelten, die besonderen physiologischen Bedingungen in der Schwangerschaft für Mutter und Fetus berücksichtigen.

Ziel der Arbeit

Übersicht zur aktuellen Datenlage über Epidemiologie, Verletzungsmechanismen, mütterliches und fetales Outcome sowie Empfehlungen zum Management der verletzten Schwangeren, basierend auf einer systematischen Literaturrecherche.

Ergebnisse

Es gibt keinen sicher erwiesenen Zusammenhang zwischen der mütterlichen Verletzungsschwere, ihrem physiologischen Zustand und dem fetalen Outcome. Praxisleitlinien empfehlen, die Behandlung und Stabilisierung der verletzten Schwangeren zu priorisieren, für die optimale initiale Behandlung des Fetus. Gegenwärtig leiten sich Empfehlungen für das Schockraummanagement sowie für das (unfall)chirurgische operative Vorgehen, einschließlich „damage control surgery“, aus einer schwachen Evidenzlage ab.

Schlussfolgerung

Untersuchung, Stabilisierung und Behandlung der verletzten Schwangeren haben Priorität für das Überleben des Ungeborenen. Die Behandlung von schwer verletzten Schwangeren erfordert die Expertise multidisziplinärer Teams aus Unfallchirurgen, Chirurgen, Anästhesisten, Radiologen, Geburtsmedizinern und Neonatologen, sodass für die schwer verletzten Schwangeren bereits präklinisch die Entscheidung für entsprechend ausgestattete Traumazentren gestellt werden sollte. Prinzipiell sollten sich die Behandlungskonzepte bei schwer verletzten Schwangeren nicht von denen bei nichtschwangeren Schwerverletzten unterscheiden.

Nur mit Berechtigung zugänglich

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Titel: Die (schwer) verletzte schwangere Patientin aus Sicht der Unfallchirurgie
verfasst von: Dr. Dr. Vera Pedersen
Publikationsdatum: 21.09.2020
Verlag: Springer Medizin
Schlagwörter: Schwangerenvorsorge
Polytrauma
Polytrauma
Erschienen in: Die Unfallchirurgie / Ausgabe 12/2020
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI: https://doi.org/10.1007/s00113-020-00868-6

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