Prävention der Präeklampsie

 

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Zusammenfassung

Die Präeklampsie zeichnet sich durch eine hohe fetale und maternale Morbidität und Mortalität aus und ist in hohem Maße für die Frühgeburtlichkeit verantwortlich. Trotz der klinischen Bedeutung konnten die pathophysiologischen Mechanismen bis heute nicht abschließend geklärt werden. Demzufolge sind auch kausale bzw. präventive Therapiestrategien nicht ausreichend bekannt. Eine zufriedenstellende Erfahrung in der Prävention einer Präeklampsie liegt bisher nur für die Anwendung von Acetylsalicylsäure (ASS) in Risikokollektiven vor. ASS greift direkt in die Dysbalance des vasodilatierenden Prostazyklins und des vasokonstringierenden Thromboxans ein. Erste Studien beweisen darüber hinaus auch einen präventiven Effekt der Antioxidanzien Vitamin C und E. Eine frühzeitige antihypertensive Therapie kann dagegen eine spätere Progression der Erkrankung nicht positiv beeinflussen. Eine Natriumrestriktion, eine Kalzium- und Magnesiumsubstitution, die Gabe von Fischöl oder eine Steroidtherapie sind in der Prävention einer Präeklampsie unwirksam. Die zukünftige Klärung der pathophysiologischen Zusammenhänge der Präeklampsie könnte helfen, die Akuttherapie zu verbessern und gleichzeitig wirksame präventive Strategien zu entwickeln.

Abstract

Preeclampsia is accompanied by high fetal and maternal morbidity and mortality and to a high degree responsible for preterm delivery. The pathophysiologic mechanisms underlying this disease remain poorly understood. Accordingly, only few causative or preventive therapeutical strategies are known. One such example for a preventive strategy is the use of aspirin (ASA) which directly affects the imbalance of vasodilative prostacycline and vasoconstrictive thromboxane. Recently, some studies are indicating a preventive effect of vitamin C and E substitution. In contrast, early antihypertensive therapy did not prevent later progression of the disease. Furthermore, sodium restriction, calcium and magnesium substitution, fish oil substitution, or steroid therapy are without any effect regarding the later development of preeclampsia. It is of utmost importance to further elucidate underlying pathophysiological mechanisms to improve therapeutical and preventive strategies.

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Für die Autoren der Projektgruppe Präeklampsie der Technischen Universität München:

Priv.-Doz. Dr. med. Thorsten FischerLtd. Oberarzt und stellvertretender Abteilungsleiter Perinatalmedizin 

Frauenklinik der Technischen Universität München · Klinikum rechts der Isar

Ismaninger Str. 22

81675 München

Phone: 0 89/41 40/24 30

Fax: 0 89/41 40/24 47