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Schwangere in der Intensivmedizin

Die Intensivmedizin

Part of the book series: Springer Reference Medizin ((SRM))

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Zusammenfassung

Auf Intensivstationen zu behandelnde Schwangere stellen eine besondere Risikogruppe dar, da hier grundsätzlich sowohl den medizinischen Bedürfnissen der Mutter als auch des in utero befindlichen Kindes Rechnung getragen werden muss. Daher gilt hier der Fokus Schwangeren, bei denen die besonderen Veränderungen des maternalen Organismus in der Schwangerschaft, der Einfluss des Kindes auf die Mutter sowie Sicherheitsbedenken für Mutter und Kind in einer potenziell lebensbedrohlichen Situation zu berücksichtigen sind. Die Diagnostik in der Schwangerschaft berücksichtigt zunächst die Bestimmung des Gestationsalters des Embryos/Fetus und ggf. Management der Frühgeburtlichkeit. Physiologische Besonderheiten wie erhöhtes thromboembolische Risiko, Strahlenschutz und Spezifika einer ggf. notwendigen medikamentösen Therapie bzw. deren Toxizität für das ungeborene Kind sind ebenso thematisiert wie spezielle peri- und postpartale Krankheitsbilder.

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Literatur

  • Al-Aqeedi RF, Al-Nabti AD (2008) Drug-eluting stent implantation for acute myocardial infarction during pregnancy with use of glycoprotein IIb/IIIa inhibitor, aspirin and clopidogrel. J Invasive Cardiol 20:E146–E149

    PubMed  Google Scholar 

  • Albarzanchi AM, Sayes CM, Ridha Albarzanchi MT, Fajt VR, Dees WL, Kraemer DC (2012) Cilostazol blocks pregnancy in naturally cycling mice. Contraception 87(4):443–448. doi:10.1016/j.contraception.2012.09.008, pii: S0010-7824(12)00818-9

    Article  PubMed  Google Scholar 

  • Bar-Oz B, Bulkowstein M, Benyamini L, Greenberg R, Soriano I, Zimmerman D, Bortnik O, Berkovitch M (2003) Use of antibiotic and analgesic drugs during lactation. Drug Saf 26:925–935

    Article  CAS  PubMed  Google Scholar 

  • Bates SM, Weitz JI (2003) Emerging anticoagulant drugs. Arterioscler Thromb Vasc Biol 23:1491–1500

    Article  CAS  PubMed  Google Scholar 

  • Bates S, Greer IA, Middeldorp S, Vennstra DL, Prabulos AM, Vandvik PO (2012) VTE, thrombophilia, antithrombotic therapy, and pregnancy. Antithrombotic therapy and prevention of thrombosis. 9th ed American College of Chest Physicians. Evidence-based clinical practice guidelines. Chest 142:e691S–e736S

    Article  Google Scholar 

  • Bauer ME, Bauer ST, Rabbani AB, Mhyre JM (2012) Peripartum management of dual antiplatelet therapy and neuraxial labor analgesia after bare metal stent insertion for acute myocardial infarction. Anesth Analg 115:613–615

    PubMed  Google Scholar 

  • Bauersachs RM, Dudenhausen J, Faridi A, Fischer T, Fung S, Geisen U, Harenberg J, Herchenhan E, Keller F, Kemkes-Matthes B, Schinzel H, Spannagl M, Thaler CJ (2007) Risk stratification and heparin prophylaxis to prevent venous thromboembolism in pregnant women. Thromb Haemost 98:1237–1245

    CAS  PubMed  Google Scholar 

  • Bhatt DL, Topol EJ (2000) Antiplatelet and anticoagulant therapy in the secondary prevention of ischemic heart disease. Med Clin North Am 84:163–179

    Article  CAS  PubMed  Google Scholar 

  • Bohlmann MK (2010) Thrombophilie und Antikoagulation in der Schwangerschaft. Gynacol Geburtsmed Gynacol Endokrinol 6:30–42

    Google Scholar 

  • Bohlmann MK, Luedders DW, Baumann K, Thill M, Hornemann A (2009) Indikationen zur Antikoagulation in der Schwangerschaft. Geburtsh Frauenheilk 69:730–732

    Article  Google Scholar 

  • Boztosun B, Olcay A, Avci A, Kirma C (2008) Treatment of acute myocardial infarction in pregnancy with coronary artery balloon angioplasty and stenting: use of tirofiban and clopidogrel. Int J Cardiol 127:413–416

    Article  PubMed  Google Scholar 

  • Burdan F, Szumilo J, Dudka J, Korobowicz A, Klepacz R (2006) Congenital ventricular septal defects and prenatal exposure to cyclooxygenase inhibitors. Braz J Med Biol Res 39:925–934

    Article  CAS  PubMed  Google Scholar 

  • Chapman ML, Martinez-Borges AR, Mertz HL (2008) Lepirudin for treatment of acute thrombosis during pregnancy. Obstet Gynecol 112:432–433

    Article  PubMed  Google Scholar 

  • De Santis M, De Luca C, Mappa I, Cesari E, Mazza A, Quattrocchi T, Caruso A (2011) Clopidogrel treatment during pregnancy: a case report and a review of literature. Intern Med 50:1769–1773

    Article  PubMed  Google Scholar 

  • Dempfle CE (2004) Minor transplacental passage of fondaparinux in vivo. N Engl J Med 350:1914–1915

    Article  CAS  PubMed  Google Scholar 

  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe – DGGG (2008) Anwendung des CTG während Schwangerschaft und Geburt www.dggg.de/fileadmin/public_docs/Dokumente/Leitlinien/3–4-2_ctg_schwangerschaft_geburt_2009.pdf http://www.awmf.org/uploads/tx_szleitlinien/015-069_S1_Antenatale_Kortikosteroide_zur_Lungenreifung__ACS__07-2009_07-2014.pdf. Zugegriffen in Feb 2014

  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe – DGGG (2009) Antenatale Kortikosteroide zur Lungenreifung (ACS) http://www.awmf.org/uploads/tx_szleitlinien/015-069_S1_Antenatale_Kortikosteroide_zur_Lungenreifung__ACS__07-2009_07-2014.pdf. Zugegriffen in Feb 2014

  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe – DGGG (2010) S3-Leitlinie Prophylaxe der venösen Thromboembolie (VTE). http://www.awmf.org/uploads/tx_szleitlinien/003-001l_S3_Thromboembolie-Prophylaxe_2010_01.pdf. Zugegriffen in Feb 2014

  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe – DGGG (2011a) HIV-Therapie in der Schwangerschaft und bei HIV-exponierten Neugeborenen. (AWMF-Leitlinie; abgelaufen)

    Google Scholar 

  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe – DGGG (2011b) Leitlinie: Empfehlungen für die strukturellen Voraussetzungen der perinatologischen Versorgung in Deutschland www.dggg.de/fileadmin/public_docs/Dokumente/Leitlinien/g_03_05_01_empfehlungen_strukturellen_perinatolog-ischen.pdf. Zugegriffen in Feb 2014

  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe – DGGG (2013) Off-Label-Use in Gynäkologie und Geburtshilfe http://www.awmf.org/uploads/tx_szleitlinien/015-057l_S1_Off-Label-Use_in_Gynäkologie_und_Geburtshilfe_2013-03.pdf. Zugegriffen in Feb 2014

  • Dupont C, Touzet S, Colin C, Deneux-Tharaux C, Rabilloud M, Clement HJ, Lansac J, Colle MH, Rudigoz RC (2009) Incidence and management of postpartum haemorrhage following the dissemination of guidelines in a network of 16 maternity units in France. Int J Obstet Anesth 18:320–327

    Article  CAS  PubMed  Google Scholar 

  • El-Deeb M, El-Menyar A, Gehani A, Sulaiman K (2011) Acute coronary syndrome in pregnant women. Expert Rev Cardiovasc Ther 9:505–515

    Article  PubMed  Google Scholar 

  • Fachinformation Abciximab. Janssen Lilly, Stand Juni 2012

    Google Scholar 

  • Fachinformation Aggrenox. Boehringer Ingelheim, Stand Februar 2012

    Google Scholar 

  • Fachinformation Apixaban. Bristol-Myers Squibb & Pfizer Pharma, Stand Mai 2011

    Google Scholar 

  • Fachinformation Bivalirudin. The Medicines Company, Stand Februar 2012

    Google Scholar 

  • Fachinformation Cilostazol. Otsuka Phrameuceutical Europe, Stand Dezember 2010

    Google Scholar 

  • Fachinformation Clopidogrel. Sanofi, Stand April 2012

    Google Scholar 

  • Fachinformation Dabigatran. Boehringer Ingelheim, Stand August 2012

    Google Scholar 

  • Fachinformation Danaparoid. MSD, Stand August 2012

    Google Scholar 

  • Fachinformation Eptifibatid. Glaxo Smith Kline, Stand März 2012

    Google Scholar 

  • Fachinformation Lepirudin. Celgene, Stand August 2011

    Google Scholar 

  • Fachinformation Rivaroxaban. Bayer Schering Pharma AG, Stand Dezember 2011

    Google Scholar 

  • Fachinformation Ticagrelor. Astra Zeneca, Stand Oktober 2011

    Google Scholar 

  • Fachinformation Tirofiban. Iroko Cardio, Stand Oktober 2010

    Google Scholar 

  • Foxman B (2002) Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med 113(Suppl 1A):5S–13S

    Article  PubMed  Google Scholar 

  • Furlan A, Vianello F, Clementi M, Prandoni P (2006) Heparin- induced thrombocytopenia occurring in the first trimester of pregnancy: successful treatment with lepirudin. A case report. Haematologica 91(8 Suppl):ECR40

    PubMed  Google Scholar 

  • Gatt S (2003) Pregnancy, delivery and the intensive care unit: need, outcome and management. Curr Opin Anaesthesiol 16:263–267

    Article  PubMed  Google Scholar 

  • Gemeinsamer Bundesausschuss (2009) Richtlinien des Bundesausschusses der Ärzte und Krankenkassen über die ärztliche Betreuung während der Schwangerschaft und nach der Entbindung („Mutterschafts-Richtlinien“) www.g-ba.de/downloads/62–492–358/RL_Mutter-2009–06–18.pdf. Zugegriffen in Feb 2014

  • Hajj-Chahine J, Jayle C, Tomasi J, Corbi P (2010) Successful surgical management of massive pulmonary embolism during the second trimester in a parturient with heparin-induced thrombocytopenia. Interact Cardiovasc Thorac Surg 11:679–681

    Article  PubMed  Google Scholar 

  • Hazelgrove JF, Price C, Pappachan VJ, Smith GB (2001) Multicenter study of obstetric admissions to 14 intensive care units in southern England. Crit Care Med 29:770–775

    Article  CAS  PubMed  Google Scholar 

  • Hernandez RK, Werler MM, Romitti P, Sun L, Anderka M (2012) Nonsteroidal antiinflammatory drug use among women and the risk of birth defects. Am J Obstet Gynecol 206:228.e1–228.e8

    Article  CAS  Google Scholar 

  • Karsten J, Bohlmann MK, Sedemund-Adib B, Wnent J, Paarmann H, Iblher P, Meier T, Heinze H (2012) Electrical impedance tomography may optimize ventilation in a postpartum woman with respiratory failure. Int J Obstet Anesth. doi:10.1016/j.ijoa.2012.09.002, pii: S0959-289X(12)00123-9

    PubMed  Google Scholar 

  • Kealey A (2010) Coronary artery disease and myocardial infarction in pregnancy: a review of epidemiology, diagnosis, and medical and surgical management. Can J Cardiol 26:185–189

    Article  PubMed  Google Scholar 

  • Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF (2006) WHO analysis of causes of maternal death: a systematic review. Lancet 367:1066–1074

    Article  PubMed  Google Scholar 

  • Knight M, Berg C, Brocklehurst P, Kramer M, Lewis G, Oats J, Roberts CL, Spong C, Sullivan E, van Roosmalen J, Zwart J (2012) Amniotic fluid embolism incidence, risk factors and outcomes: a review and recommendations. BMC Pregnancy Childbirth 12:7

    Article  PubMed Central  PubMed  Google Scholar 

  • Kozer E, Nikfar S, Costei A, Boskovic R, Nulman I, Koren G (2002) Aspirin consumption during the first trimester of pregnancy and congenital anomalies: a meta-analysis. Am J Obstet Gynecol 187:1623–1630

    Article  PubMed  Google Scholar 

  • Lapinsky SE, Posadas-Calleja JG, McCullagh I (2009) Clinical review: ventilatory strategies for obstetric, brain-injured and obese patients. Crit Care 13:206

    Article  PubMed Central  PubMed  Google Scholar 

  • Lucas DN, Robinson PN, Nel MR (2012) Sepsis in obstetrics and the role of the anaesthetist. Int J Obstet Anesth 21:56–67

    Article  CAS  PubMed  Google Scholar 

  • Magnani HN (2010) An analysis of clinical outcomes of 91 pregnancies in 83 women treated with danaparoid (Orgaran). Thromb Res 125:297–302

    Article  CAS  PubMed  Google Scholar 

  • Markestad T, Kaaresen PI, Ronnestad A, Reigstad H, Lossius K, Medbo S, Zanussi G, Engelund IE, Skjaerven R, Irgens LM, Norwegian Extreme Prematurity Study Group (2005) Early death, morbidity, and need of treatment among extremely premature infants. Pediatrics 115:1289–1298

    Article  PubMed  Google Scholar 

  • Millar LK, Cox SM (1997) Urinary tract infections complicating pregnancy. Infect Dis Clin North Am 11:13–26

    Article  CAS  PubMed  Google Scholar 

  • Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK (2007) Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics 27:1705–1722

    Article  PubMed  Google Scholar 

  • Pettiti D, Sidney S, Quesenberry CP, Bernstein A (1997) Incidence of stroke and myocardial infarction in women of reproductive age. Stroke 28:280–283

    Article  Google Scholar 

  • Rath W, Hackethal A, Bohlmann MK (2012) Second-line treatment of postpartum haemorrhage (PPH). Arch Gynecol Obstet 286:549–561

    Article  CAS  PubMed  Google Scholar 

  • RCOG (2009) Green – top Guideline No. 52: prevention and management of post partum haemorrhage. RCOG, London

    Google Scholar 

  • Salomon J, Schnitzler A, Ville Y, Laffont I, Perronne C, Denys P, Bernard L (2009) Prevention of urinary tract infection in six spinal cord-injured pregnant women who gave birth to seven children under a weekly oral cyclic antibiotic program. Int J Infect Dis 13:399–402

    Article  PubMed  Google Scholar 

  • Santiago-Diaz P, Arrebola-Moreno AL, Ramirez-Hernandez JA, Melgares-Moreno R (2009) Platelet antiaggregants in pregnancy. Rev Esp Cardiol 62:1193–1205

    Article  Google Scholar 

  • Schaefer C, Spielmann H, Vetter K (2006) Arzneiverordnung in Schwangerschaft und Stillzeit. 7. Aufl. Elsevier, Urban & Fischer, München

    Google Scholar 

  • Sebastian C, Scherlag M, Kugelmass A, Schechter E (1998) Primary stent implantation for acute myocardial infarction during pregnancy: use of abciximab, ticlopidine, and aspirin. Cathet Cardiovasc Diagn 45:275–279

    Article  CAS  PubMed  Google Scholar 

  • Tanimura K, Ebina Y, Sonoyama A, Morita H, Miyata S, Yamada H (2012) Argatroban therapy for heparin-induced thrombocytopenia during pregnancy in a woman with hereditary antithrombin deficiency. J Obstet Gynaecol Res 38:749–752

    Article  PubMed  Google Scholar 

  • Tello-Montoliu A, Seecheran NA, Angiolillo DJ (2012) Successful pregnancy and delivery on prasugrel treatment: considerations for the use of dual antiplatelet therapy during pregnancy in clinical practice. J Thromb Thrombolysis [Epub vor Druck]

    Google Scholar 

  • Tröger B, Härtel C, Manner D, Eckey T, Bohlmann MK (2012) Kongenitale Gerinnungsstörungen – gynäkologische und neonatologische Aspekte. Gynakologe 45:383–390

    Article  Google Scholar 

  • Van Bogaert LJ, Dhai A (2008) Ethical challenges of treating the critically ill pregnant patient. Best Pract Res Clin Obstet Gynaecol 22:983–996

    Article  PubMed  Google Scholar 

  • Vasquez DN, Estenssoro E, Canales HS, Reina R, Saenz MG, Das Neves AV, Toro MA, Loudet CI (2007) Clinical characteristics and outcomes of obstetric patients requiring ICU admission. Chest 131:718–724

    Article  PubMed  Google Scholar 

  • Wang L, He K, Maxwell B, Grossman SJ, Tremaine LM, Humphreys WG, Zhang D (2011) Tissue distribution and elimination of [14C]apixaban in rats. Drug Metab Dispos 39:256–264

    Article  CAS  PubMed  Google Scholar 

  • WHO (2008) Managing puerpural sepsis. http://whqlibdoc.who.int/publications/2008/9789241546669_6_eng.pdf. Zugegriffen in Feb 2014

  • Young SK, Al-Mondhiry HA, Vaida SJ, Ambrose A, Botti JJ (2008) Successful use of arbatroban during the third trimester of pregnancy: case report and review of the literature. Pharmacotherapy 28:1531–1536

    Article  PubMed  Google Scholar 

  • Zhao M, Chang C, Liu Z, Chen LM, Chen Q (2010) Treatment with low-dose aspirin increased the level LIF and integrin β3 expression in mice during the implantation window. Placenta 31:1101–1105

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein – Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    Michael Bohlmann

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  1. Michael Bohlmann
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Correspondence to Michael Bohlmann .

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Editors and Affiliations

  1. Klinik für Anästhesiologie, RWTH Aachen Universitätsklinikum Aachen, Aachen, Germany

    Gernot Marx

  2. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany

    Elke Muhl

  3. Dir. der Klinik fuer Anaesthesie Intensivmed. und Schmerzther., Frankfurt, Hessen, Germany

    Kai Zacharowski

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Bohlmann, M. (2015). Schwangere in der Intensivmedizin. In: Marx, G., Muhl, E., Zacharowski, K. (eds) Die Intensivmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54675-4_103-1

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  • DOI: https://doi.org/10.1007/978-3-642-54675-4_103-1

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  • Online ISBN: 978-3-642-54675-4

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  1. Latest

    Schwangere in der Intensivmedizin
    Published:
    11 November 2022

    DOI: https://doi.org/10.1007/978-3-642-54675-4_103-2

  2. Original

    Schwangere in der Intensivmedizin
    Published:
    29 May 2015

    DOI: https://doi.org/10.1007/978-3-642-54675-4_103-1

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