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Erschienen in: Der Gynäkologe 4/2018

19.03.2018 | Uterus myomatosus | Leitthema

Therapeutische Konzepte bei habitueller Abortneigung

Viel hilft viel?

verfasst von: Dr. med. Kilian Vomstein, Katharina Feil, Ruben-J. Kuon, Bettina Toth

Erschienen in: Die Gynäkologie | Ausgabe 4/2018

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Zusammenfassung

Hintergrund

Nach der standardisierten diagnostischen Abklärung von Frauen mit habituellen Aborten (wiederkehrende Spontanaborte, WSA) sollte eine spezifische risikofaktoradaptierte Therapie eingeleitet werden. Bislang gibt es jedoch wenige evidenzbasierte Daten, welche eine klare Indikationsstellung für eine Therapieeinleitung bedingen.

Ziel der Arbeit

Welche therapeutischen Konzepte gibt es derzeit zur Behandlung von Frauen mit WSA?

Material und Methoden

Anhand der bestehenden Literatur, der aktuellen ESHRE(European Society of Human Reproduction and Embryology)-Leitlinie, „Guideline on the management of recurrent pregnancy loss“, und der S2k-Leitlinie der AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften), „Diagnostik und Therapie beim wiederholten Spontanabort“ (015/50), werden mögliche therapeutische Konzepte bei WSA dargelegt.

Ergebnisse

Eine Septumresektion sollte ebenso wie die Optimierung der Schilddrüsenfunktion (Zielwert TSH, Thyreoidea-stimulierendes Hormon, <2,5 mU/l) angeraten werden. Bei einem Antiphospholipidsyndrom (APLS) bzw. einem „non-criteria“ APLS ist eine Behandlung mit niedermolekularem Heparin und Acetylsalicylsäure indiziert, eine generelle prophylaktische Heparinisierung dagegen scheint obsolet. Immunologische Behandlungsoptionen werden derzeit nur unter Studienbedingungen empfohlen.

Diskussion

Die Betreuung von Paaren mit WSA stellt für jeden Frauenarzt eine besondere Herausforderung dar und bedarf einer intensiven Betreuung. Die aufgeführten Therapieoptionen orientieren sich an den Empfehlungen der nationalen und internationalen Leitlinien.
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Metadaten
Titel
Therapeutische Konzepte bei habitueller Abortneigung
Viel hilft viel?
verfasst von
Dr. med. Kilian Vomstein
Katharina Feil
Ruben-J. Kuon
Bettina Toth
Publikationsdatum
19.03.2018
Verlag
Springer Medizin
Erschienen in
Die Gynäkologie / Ausgabe 4/2018
Print ISSN: 2731-7102
Elektronische ISSN: 2731-7110
DOI
https://doi.org/10.1007/s00129-018-4226-4

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