Skip to main content

2020 | Präeklampsie | OriginalPaper | Buchkapitel

9. Präeklampsie und hypertensive Schwangerschaftserkrankungen

verfasst von : Jürgen Wacker

Erschienen in: Therapiehandbuch Gynäkologie und Geburtshilfe

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Eine Definition der Hypertonie in der Schwangerschaft wurde von verschiedenen internationalen Gesellschaften (ISSHP, European Society of Hypertension (ESH) und der European Society of Cardiology (ESC) vorgeschlagen. Im deutschen Sprachraum hat sich die in der Übersicht aufgeführte Terminologie durchgesetzt.
Literatur
Zurück zum Zitat Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM (2001) The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 20(1):IX–XIV Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM (2001) The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 20(1):IX–XIV
Zurück zum Zitat Duley L (1995) Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. The Eclampsia Trial Collaborative Group. Lancet 345:1455–1463 Duley L (1995) Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. The Eclampsia Trial Collaborative Group. Lancet 345:1455–1463
Zurück zum Zitat Duley L, Henderson-Smart D (2002) Drugs for rapid treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev 4:CD001449 Duley L, Henderson-Smart D (2002) Drugs for rapid treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev 4:CD001449
Zurück zum Zitat Fenakel K, Fenakel G, Appelman Z, Lurie S, Katz Z, Shoham Z (1991) Nifedipine in the treatment of severe preeclampsia. ObstetGynecol 77:331–337 Fenakel K, Fenakel G, Appelman Z, Lurie S, Katz Z, Shoham Z (1991) Nifedipine in the treatment of severe preeclampsia. ObstetGynecol 77:331–337
Zurück zum Zitat Heilmann L, Rath W, Wacker J (1998) Diagnostik, Therapie und geburtshilfliches Vorgehen bei schweren hypertensiven Schwangerschaftserkrankungen. Frauenarzt 39:1706–1716 Heilmann L, Rath W, Wacker J (1998) Diagnostik, Therapie und geburtshilfliches Vorgehen bei schweren hypertensiven Schwangerschaftserkrankungen. Frauenarzt 39:1706–1716
Zurück zum Zitat Heilmann L, Wacker J, Rath W (2004) Die Diagnostik und Therapie des Schwangerschaftshochdruckes in Deutschland: Ergebnisse einer Umfrage an deutschen Frauenkliniken. GeburtshFrauenheilkd 64:589–599 Heilmann L, Wacker J, Rath W (2004) Die Diagnostik und Therapie des Schwangerschaftshochdruckes in Deutschland: Ergebnisse einer Umfrage an deutschen Frauenkliniken. GeburtshFrauenheilkd 64:589–599
Zurück zum Zitat Levin AC, Doering PL, Hutton RC (1994) Use of Nifedipine in the hypertensive disease of pregnancy. Ann Pharmacol 28:1371–1378CrossRef Levin AC, Doering PL, Hutton RC (1994) Use of Nifedipine in the hypertensive disease of pregnancy. Ann Pharmacol 28:1371–1378CrossRef
Zurück zum Zitat Magann EF, Chauhann SP, Kinsella MJ, McNamara MF et al (1999) Antenatal testing among 1001 patients at high risk: the role of ultrasonographic estimate of amniotic fluid volume. Am J Obstet Gynecol 41(4):349–353 Magann EF, Chauhann SP, Kinsella MJ, McNamara MF et al (1999) Antenatal testing among 1001 patients at high risk: the role of ultrasonographic estimate of amniotic fluid volume. Am J Obstet Gynecol 41(4):349–353
Zurück zum Zitat Maggee LA, Cham C, Waterman EJ, Ohlsson A, Dadelszen P (2003) Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ 327:955–965CrossRef Maggee LA, Cham C, Waterman EJ, Ohlsson A, Dadelszen P (2003) Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ 327:955–965CrossRef
Zurück zum Zitat Magpie Trial Collaborative Group (2002) Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 359:1877–1890CrossRef Magpie Trial Collaborative Group (2002) Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 359:1877–1890CrossRef
Zurück zum Zitat Martin JN, Thigpen BD, Moore RC et al (2005) Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol 105:246CrossRefPubMed Martin JN, Thigpen BD, Moore RC et al (2005) Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure. Obstet Gynecol 105:246CrossRefPubMed
Zurück zum Zitat Meher S, Abalos E, Carroli G (2005) Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database Syst Rev 4: CD003514 Meher S, Abalos E, Carroli G (2005) Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database Syst Rev 4: CD003514
Zurück zum Zitat National High Blood Pressure Education Program (1990) Working Group Report on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 163:1689–1712CrossRef National High Blood Pressure Education Program (1990) Working Group Report on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 163:1689–1712CrossRef
Zurück zum Zitat O’Gormann N, Nicolaides KH, Poon LC (2016) The use of ultrasound and other markers for early detection of preeclampsia. Womens Health (Lond). 12(2):199–207CrossRef O’Gormann N, Nicolaides KH, Poon LC (2016) The use of ultrasound and other markers for early detection of preeclampsia. Womens Health (Lond). 12(2):199–207CrossRef
Zurück zum Zitat Prevost RR, Akl SA, Whybrew WD, Sibai BM (1992) Oral nifedipine pharmacokinetics in pregnancy-induced hypertension. Pharmacotherapy 12:174–177PubMed Prevost RR, Akl SA, Whybrew WD, Sibai BM (1992) Oral nifedipine pharmacokinetics in pregnancy-induced hypertension. Pharmacotherapy 12:174–177PubMed
Zurück zum Zitat Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de PacoMatallana C. et al (2017a) Aspririn versus Placebo in Pregnancies at high risk for preterm preeclampsia. N Engl J Med 377(7):613–622 Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de PacoMatallana C. et al (2017a) Aspririn versus Placebo in Pregnancies at high risk for preterm preeclampsia. N Engl J Med 377(7):613–622
Zurück zum Zitat Rolnik DL, Wright D, Poon LC, Syyngelaki A, O’Gorman N et al (2017b) ASPRE trial: performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol 50(4):492–495 Rolnik DL, Wright D, Poon LC, Syyngelaki A, O’Gorman N et al (2017b) ASPRE trial: performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol 50(4):492–495
Zurück zum Zitat Schlembach D (2012) Intrauterine Wachstumsrestriktion – Diagnostik und Management. Geburtshilfe Frauenheilkd 72(5):373–375CrossRef Schlembach D (2012) Intrauterine Wachstumsrestriktion – Diagnostik und Management. Geburtshilfe Frauenheilkd 72(5):373–375CrossRef
Zurück zum Zitat Trogstad L, Magnus P, Stoltenberg C (2011) Pre-eclampsia: risk factors and causal models. Best Pract Clin Obstet Gynaecol. 25(3):329–342CrossRef Trogstad L, Magnus P, Stoltenberg C (2011) Pre-eclampsia: risk factors and causal models. Best Pract Clin Obstet Gynaecol. 25(3):329–342CrossRef
Zurück zum Zitat Wacker J, Schild R, Homuth V (2005) Präeklampsie und Evidence based Medicine (EbM). Geburtsh Frauenheilkd 65:530‒533 Wacker J, Schild R, Homuth V (2005) Präeklampsie und Evidence based Medicine (EbM). Geburtsh Frauenheilkd 65:530‒533
Zurück zum Zitat Wacker JR, Wagner BK, Briese V, Schauff B, Heilmann L, Bartz C, Hopp H (2006) Antihypertensive therapy in patients with pre-eclampsia: A prospective randomised multicentre study comparing dihydralazine with urapidil. Eur J Obstet Gynecol Reprod Biol 127:160–165CrossRefPubMed Wacker JR, Wagner BK, Briese V, Schauff B, Heilmann L, Bartz C, Hopp H (2006) Antihypertensive therapy in patients with pre-eclampsia: A prospective randomised multicentre study comparing dihydralazine with urapidil. Eur J Obstet Gynecol Reprod Biol 127:160–165CrossRefPubMed
Zurück zum Zitat American College of Obstetricians and Gynecology (ACOG) (1996) Hypertension in pregnancy. Technical Bulletin No. 219. Int J GynecolObstet 53:175–183 American College of Obstetricians and Gynecology (ACOG) (1996) Hypertension in pregnancy. Technical Bulletin No. 219. Int J GynecolObstet 53:175–183
Zurück zum Zitat Anonymous (1994) CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. Clasp (Collaboration Low-dose Aspirin Study in Pregnancy) Collaboration Group. Lancet 343:619–629 Anonymous (1994) CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. Clasp (Collaboration Low-dose Aspirin Study in Pregnancy) Collaboration Group. Lancet 343:619–629
Zurück zum Zitat Australian Society for the Study of Hypertension in Pregnancy (1993) Management of hypertension in pregnancy: executive summary. Med J Austr 158:700–702CrossRef Australian Society for the Study of Hypertension in Pregnancy (1993) Management of hypertension in pregnancy: executive summary. Med J Austr 158:700–702CrossRef
Zurück zum Zitat Brown MA, Mangos G, Davis G, Homer C (2005) The natural history of white coat hypertension during pregnancy. BJOG 112(5):601–606CrossRefPubMed Brown MA, Mangos G, Davis G, Homer C (2005) The natural history of white coat hypertension during pregnancy. BJOG 112(5):601–606CrossRefPubMed
Zurück zum Zitat Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S et al (2010) Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 116(2 Pt 1):402–414 Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S et al (2010) Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 116(2 Pt 1):402–414
Zurück zum Zitat Dubois D, Petitcolas J, Temperville B (1982) Treatment of hypertension in pregnancy with beta-adrenoceptor antagonists. Br J Clin Pharmacol 13:3375–3379CrossRef Dubois D, Petitcolas J, Temperville B (1982) Treatment of hypertension in pregnancy with beta-adrenoceptor antagonists. Br J Clin Pharmacol 13:3375–3379CrossRef
Zurück zum Zitat Hashimoto K, Kasdaglis T, Jain S et al (2013) Isolated low-normal amniotic fluid volume in the early third trimester: association with adverse perinatal outcome. J. Perina Med 41(4):349–353CrossRef Hashimoto K, Kasdaglis T, Jain S et al (2013) Isolated low-normal amniotic fluid volume in the early third trimester: association with adverse perinatal outcome. J. Perina Med 41(4):349–353CrossRef
Zurück zum Zitat Hermer M, von Bruchhausen V (1988) Clonidin bei Hypertonie in der Schwangerschaft. GeburtsFrauenheilkd 48:904 Hermer M, von Bruchhausen V (1988) Clonidin bei Hypertonie in der Schwangerschaft. GeburtsFrauenheilkd 48:904
Zurück zum Zitat Howarth GR, Seris A, Venter C, Pattinson RC (1997) A randomized controlled pilot study comparing urapidil to dihydralazine in the management of severe hypertension in pregnancy. Hypertension Pregn 16:213–221CrossRef Howarth GR, Seris A, Venter C, Pattinson RC (1997) A randomized controlled pilot study comparing urapidil to dihydralazine in the management of severe hypertension in pregnancy. Hypertension Pregn 16:213–221CrossRef
Zurück zum Zitat Kaaja R, Hiilemaa V, Holma K, Jarvenpaa AL (1992) Maternal antihypertensive therapy with betablockers associated with poor outcome in very-low birthweight infants. Int J GynecolObstet 38:195–199CrossRef Kaaja R, Hiilemaa V, Holma K, Jarvenpaa AL (1992) Maternal antihypertensive therapy with betablockers associated with poor outcome in very-low birthweight infants. Int J GynecolObstet 38:195–199CrossRef
Zurück zum Zitat Kehl S, Dotsch J, Hecher K, Schlembach D et al (2017) Intrauterine Growth Restriction. Guideline of the German Society of Gynecology and Obstetrics (S2k-Level, AWMF Registry No 015/080; October 2016. Geburtshilfe und Frauenheilkunde 77(11):1157–73 Kehl S, Dotsch J, Hecher K, Schlembach D et al (2017) Intrauterine Growth Restriction. Guideline of the German Society of Gynecology and Obstetrics (S2k-Level, AWMF Registry No 015/080; October 2016. Geburtshilfe und Frauenheilkunde 77(11):1157–73
Zurück zum Zitat Knuist M, Bonsel GJ, Zondervan HA, Treffers P (2018) Low sodium diet and pregnancy-induced hypertension: a multi-centre randomised controlled trial. Br J ObstetGynaecol 105:430‒434 (Erstveröffentlichung 1998) Knuist M, Bonsel GJ, Zondervan HA, Treffers P (2018) Low sodium diet and pregnancy-induced hypertension: a multi-centre randomised controlled trial. Br J ObstetGynaecol 105:430‒434 (Erstveröffentlichung 1998)
Zurück zum Zitat Kyle PM, Redman CWG (1992) Comparative risk-benefit assessment of drugs used in the management of hypertension in pregnancy. Drug Saf 7:223–234CrossRefPubMed Kyle PM, Redman CWG (1992) Comparative risk-benefit assessment of drugs used in the management of hypertension in pregnancy. Drug Saf 7:223–234CrossRefPubMed
Zurück zum Zitat AWMF Leitlinie zur Diagnostik und Therapie hypertensiver Schwangerschaftserkrankungen 2018 AWMF Leitlinie zur Diagnostik und Therapie hypertensiver Schwangerschaftserkrankungen 2018
Zurück zum Zitat Leveno KJ, Cunningham FG (1999) Management of preeclampsia. In: Lindheimer MD, Roberts JM, Cunningham FG (Hrsg) Hypertension in pregnancy. Appleton & Lange, Stanford, S 543–580 Leveno KJ, Cunningham FG (1999) Management of preeclampsia. In: Lindheimer MD, Roberts JM, Cunningham FG (Hrsg) Hypertension in pregnancy. Appleton & Lange, Stanford, S 543–580
Zurück zum Zitat Mabie WC (1999) Management of acute severe hypertension and encephalopathy. Clin Obstet Gynecol 42:519–531CrossRefPubMed Mabie WC (1999) Management of acute severe hypertension and encephalopathy. Clin Obstet Gynecol 42:519–531CrossRefPubMed
Zurück zum Zitat Millar JA (1988) Salt and pregnancy-induced hypertension. Lancet 27:514CrossRef Millar JA (1988) Salt and pregnancy-induced hypertension. Lancet 27:514CrossRef
Zurück zum Zitat Report of the Canadian Society Consensus Conference (1997) CMAJ 157:715‒725; 907‒919; 1245‒1254 Report of the Canadian Society Consensus Conference (1997) CMAJ 157:715‒725; 907‒919; 1245‒1254
Zurück zum Zitat Robinson M (1958) Salt in pregnancy. Lancet 1:178‒181 Robinson M (1958) Salt in pregnancy. Lancet 1:178‒181
Zurück zum Zitat Ruppert M, Diehl K, Kolloch R et al. (1991) Short-term dietary sodium restriction increase serum lipids and insulin in salt-sensitive and salt-resistant normotensive adults. Klin Wochenschr 69(25):51‒57 Ruppert M, Diehl K, Kolloch R et al. (1991) Short-term dietary sodium restriction increase serum lipids and insulin in salt-sensitive and salt-resistant normotensive adults. Klin Wochenschr 69(25):51‒57
Zurück zum Zitat Seabe SJ, Moodley J, Becker P (1989) Nifedipine in acute hypertensive emergencies in pregnancy. SAMJ 76:248–250PubMed Seabe SJ, Moodley J, Becker P (1989) Nifedipine in acute hypertensive emergencies in pregnancy. SAMJ 76:248–250PubMed
Zurück zum Zitat Sibai BM, Abdella TN, Anderson GD (1983) Pregnancy outcome in 211 patients with mild chronic hypertension. Obstet Gynecol 61:571–576PubMed Sibai BM, Abdella TN, Anderson GD (1983) Pregnancy outcome in 211 patients with mild chronic hypertension. Obstet Gynecol 61:571–576PubMed
Zurück zum Zitat Sibai BM, Villar MA, Bray E (1989) Magnesium supplementation during pregnancy: a double-blind randomized controlled trial. Am J Obstet Gynecol 161:115–119CrossRefPubMed Sibai BM, Villar MA, Bray E (1989) Magnesium supplementation during pregnancy: a double-blind randomized controlled trial. Am J Obstet Gynecol 161:115–119CrossRefPubMed
Zurück zum Zitat Spätling L, Spätling G (1988) Magnesium supplementation in pregnancy. A double-blind study. Br J ObstetGynaecol 95:120–125CrossRef Spätling L, Spätling G (1988) Magnesium supplementation in pregnancy. A double-blind study. Br J ObstetGynaecol 95:120–125CrossRef
Zurück zum Zitat The Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of European Society of Cardiology (ESC). Eur Heart J. 2013; 34 (28): 215–219. The Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of European Society of Cardiology (ESC). Eur Heart J. 2013; 34 (28): 215–219.
Zurück zum Zitat van der Maten GD, van Raaij JMA, Visman L et al (1997) Low sodium diet in pregnancy: effects on blood pressure and maternal nutritional status. Br J Nutrit 77:703–720CrossRef van der Maten GD, van Raaij JMA, Visman L et al (1997) Low sodium diet in pregnancy: effects on blood pressure and maternal nutritional status. Br J Nutrit 77:703–720CrossRef
Zurück zum Zitat Vink GJ, Moodley J, Philpott RH (1980) Effect of dihydralazine on the fetus in the treatment of maternal hypertension. Obstet Gynecol 55:519–522PubMed Vink GJ, Moodley J, Philpott RH (1980) Effect of dihydralazine on the fetus in the treatment of maternal hypertension. Obstet Gynecol 55:519–522PubMed
Zurück zum Zitat Wacker J, Werner P, Walter-Sack I, Bastert G (1998) Treatment of hypertension in patients with pre-eclampsia: a prospective parallel-group study comparing dihydralazine with urapidil. Nephrol Dial Transplant 13:318–325CrossRefPubMed Wacker J, Werner P, Walter-Sack I, Bastert G (1998) Treatment of hypertension in patients with pre-eclampsia: a prospective parallel-group study comparing dihydralazine with urapidil. Nephrol Dial Transplant 13:318–325CrossRefPubMed
Zurück zum Zitat Wacker J, Werner P, Schulz M, Henschel B, Bastert G (1999) Aktuelle Aspekte in der antihypertensiven Therapie bei Schwangeren mit Präeklampsie. Zentralbl Gynäkol 121:631–636PubMed Wacker J, Werner P, Schulz M, Henschel B, Bastert G (1999) Aktuelle Aspekte in der antihypertensiven Therapie bei Schwangeren mit Präeklampsie. Zentralbl Gynäkol 121:631–636PubMed
Zurück zum Zitat Wacker J, Frühauf J, Schulz M, Chiwora FM, Bastert G (2000) Riboflavin deficiencyandpreeclampsia. Obstet Gynecol 96:38–44PubMed Wacker J, Frühauf J, Schulz M, Chiwora FM, Bastert G (2000) Riboflavin deficiencyandpreeclampsia. Obstet Gynecol 96:38–44PubMed
Zurück zum Zitat Weder AB, Egan BM (1991) Potential deleterious impact of dietary salt restriction on cardiovascular risk factors. Klin Wochenschr 25:45–50 Weder AB, Egan BM (1991) Potential deleterious impact of dietary salt restriction on cardiovascular risk factors. Klin Wochenschr 25:45–50
Zurück zum Zitat Yu CK, Khouri O, Onwurdiwe N, Spiliopoulos Y, Nicolaides KH (2008) Fetal Medicine Foundation Second Trimester Screening: prediction of pre-eclampsia by uterine artery Doppler-Imaging: relationship to gestational age at delivery and small-for-gestational age. Ultrasound Obstet Gynecol 31(3):310–313CrossRefPubMed Yu CK, Khouri O, Onwurdiwe N, Spiliopoulos Y, Nicolaides KH (2008) Fetal Medicine Foundation Second Trimester Screening: prediction of pre-eclampsia by uterine artery Doppler-Imaging: relationship to gestational age at delivery and small-for-gestational age. Ultrasound Obstet Gynecol 31(3):310–313CrossRefPubMed
Zurück zum Zitat Zeisler, H, Llurba E, Chantraine F et al (2016) Predective Value of the sFlt-1/PIGF Ratio in women with suspected preeclampsia. N Engl J Med 374(1):13–22.N e Zeisler, H, Llurba E, Chantraine F et al (2016) Predective Value of the sFlt-1/PIGF Ratio in women with suspected preeclampsia. N Engl J Med 374(1):13–22.N e
Metadaten
Titel
Präeklampsie und hypertensive Schwangerschaftserkrankungen
verfasst von
Jürgen Wacker
Copyright-Jahr
2020
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-59809-2_9

Nodal-negativ nach neoadjuvanter Chemo: Axilladissektion verzichtbar?

03.05.2024 Mammakarzinom Nachrichten

Wenn bei Mammakarzinomen durch eine neoadjuvante Chemotherapie ein Downstaging von nodal-positiv zu nodal-negativ gelingt, scheint es auch ohne Axilladissektion nur selten zu axillären Rezidiven zu kommen.

Rezidivierender Peritonsillarabszess nach Oralsex

02.05.2024 Peritonsillarabszess Kasuistik

Die erotischen Dimensionen von Peritonsillarabszessen scheinen eng begrenzt zu sein. Das heißt aber nicht, solche Abszesse und Erotik hätten nichts miteinander gemein, wie ein Fallbericht verdeutlicht.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärzte und Psychotherapeuten.

Ambulantisierung: Erste Erfahrungen mit dem Hybrid-DRG

02.05.2024 DCK 2024 Kongressbericht

Die Hybrid-DRG-Verordnung soll dazu führen, dass mehr chirurgische Eingriffe ambulant durchgeführt werden, wie es in anderen Ländern schon länger üblich ist. Die gleiche Vergütung im ambulanten und stationären Sektor hatten Niedergelassene schon lange gefordert. Aber die Umsetzung bereitet ihnen doch Kopfzerbrechen.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.