Untersuchungen des perinatalen Zustandes bei frühgeborenen Kindern mit weniger als 1500 g

 

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Zusammenfassung

Fragestellung: Die Frühgeburtlichkeit stellt trotz größter Anstrengungen ein zentrales Thema in der modernen Geburtsmedizin dar. Fragestellung der vorliegenden Arbeit war, ob Unterschiede in Bezug auf den perinatalen Zustand bei Kindern mit weniger als 1500 g nach unterschiedlichem Geburtsmodus vorliegen. Patientinnen und Methodik: Im Rahmen dieser retrospektiven Studie wurden 122 Patientinnen mit einem Gestationsalter bis zur vollendeten 32. Schwangerschaftswoche untersucht, deren Kinder ein Geburtsgewicht unter 1500 g aufwiesen. Der perinatale Zustand bei den spontan geborenen Kindern (n = 26) wurde mit den per sectionem geborenen Kindern (n = 96) verglichen. Ergebnisse: Es waren, was die maternale Situation anbetrifft, bei den Spontangebärenden statistisch auffällige Werte bei Blasensprung, vorzeitigen Wehen und intravenöser Tokolyse feststellbar. Die Sectiopatientinnen wiesen in Bezug auf Präeklampsie und pathologisches Cardiotokogramm bei Aufnahme statistisch auffällige Werte auf. Hinsichtlich des perinatalen Zustandes waren bei einem p-Wert < 0.05 bei den Spontangebärenden folgende Parameter statistisch auffällig: C-reaktives Protein 24 Stunden postpartum, peri- und intraventrikuläre Hirnblutung Grad III, periventrikuläre Leukomalazie und Mortalitätsrate bis zum 7. Lebenstag. Die Rate an bronchopulmonaler Dysplasie war bei den Sectiopatientinnen statistisch auffällig höher (p < 0.05). Schlussfolgerung: Die vorliegenden Ergebnisse machen deutlich, dass der Geburtsmodus bei Kindern unter 1500 g den perinatalen Zustand beeinflusst. Jedoch kann keine Aussage darüber getroffen werden, welcher Geburtsmodus unter bestimmten maternalen und fetalen Bedingungen bevorzugt werden sollte.

Abstract

Background: Prematurity is a main issue in modern obstetrical care. The purpose of the present study was to evaluate the perinatal outcome of premature infants weighing less than 1500 g according to the mode of delivery. Patients and Methods: 122 patients with infants weighing less than 1500 g were enrolled in this retrospective study (26 to 32 weeks of gestation). The perinatal outcomes of 26 infants born by vaginal delivery were compared to 96 infants delivered by caesarean section. Results: The rates of rupture of membranes, preterm labour and intravenous tocolysis were significantly increased in patients after vaginal delivery. Preeclampsia and pathological cardiotocograms were increased in patients after caesarean section. Infants born by vaginal delivery showed a significant increase of peri- and intraventricular haemorrhage grade III, periventricular leukomalacia, C-reactive protein 24 hours postpartum and mortality until the seventh day of life. However, the rate of bronchopulmonary dysplasia was significantly increased in infants born by caesarean section (p < 0.05). Conclusions: These data suggest that the mode of delivery affects the perinatal outcome of infants weighing less than 1500 g. Based on the results of the present study, it appears unclear which mode of delivery should be preferred, depending on particular material and fetal factors.

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OA Dr. med. Winfried Munz

Universitäts-Frauenklinik

Universität des Saarlandes

Kirrberger Straße

66421 Homburg/Saar

Phone: 06841-1628118

Fax: 06841-1628079

Email: frwmun@uniklinik-saarland.de