Skip to main content
SpringerLink
Log in

Schwangere in der Intensivmedizin

  • Living reference work entry
  • Latest version View entry history
  • First Online:
Die Intensivmedizin

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

  • 82 Accesses

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 es hier die besonderen Veränderungen des maternalen Organismus in der Schwangerschaft, den Einfluss des Kindes auf die Mutter sowie Sicherheitsbedenken für Mutter und Kind in einer potenziell lebensbedrohlichen Situation zu beachten Die Diagnostik in der Schwangerschaft berücksichtigt zunächst die Bestimmung des Gestationsalters des Embryos/Fetus und ggf. Management einer eventuell drohenden 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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

Literatur

  • Aabakke et al (2021) SARS-CoV-2 infection in pregnancy in Denmark-characteristics and outcomes after confirmed infection in pregnancy: a nationwide, prospective, population-based cohort study – PubMed (nih.gov)

    Google Scholar 

  • 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. https://doi.org/10.1016/j.contraception.2012.09.008, pii: S0010-7824(12)00818-9

    Article  CAS  PubMed  Google Scholar 

  • Argentiero et al (2020) https://pubmed.ncbi.nlm.nih.gov/31471774/

  • 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 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 

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

    Article  CAS  PubMed  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

    Article  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

    Article  CAS  PubMed  Google Scholar 

  • Beyer-Westendorf et al (2020) Safety of direct oral anticoagulant exposure during pregnancy: a retrospective cohort study – PubMed (nih.gov)

    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. Geburtshilfe Frauenheilkd 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 

  • Burrows et al (2013) Pregnancy and short-coupled torsades de pointes – PubMed (nih.gov)

    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 

  • Chaudhary et al (2015) Management and outcome of heparin-induced thrombocytopenia in pregnancy: a systematic review – PubMed (nih.gov)

    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 (2010) S3-Leitlinie Prophylaxe der venösen Thromboembolie (VTE). Zugegriffen in Feb 2018

    Google Scholar 

  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe – DGGG (2013) Anwendung des CTG während Schwangerschaft und Geburt Microsoft Word – 015-036l_S1_CTG_Schwangerschaft_Geburt_2014-06.docx (greenbirth.de)

    Google Scholar 

  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe – DGGG (2019) Prävention und Therapie der Frühgeburt (awmf.org). Zugegriffen im August 2021

    Google Scholar 

  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe – DGGG (2021a) HIV-Therapie in der Schwangerschaft und bei HIV-exponierten Neugeborenen. AWMF: Detail

    Google Scholar 

  • Deutsche Gesellschaft für Gynäkologie und Geburtshilfe – DGGG (2021b) Leitlinie: Empfehlungen für die strukturellen Voraussetzungen der perinatologischen Versorgung in Deutschland. Zugegriffen im August 2021

    Google Scholar 

  • 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 Juli 2016

    Google Scholar 

  • Fachinformation Aggrenox. Boehringer Ingelheim, Stand Juni 2015

    Google Scholar 

  • Fachinformation Apixaban. Bristol-Myers Squibb & Pfizer Pharma, Stand April 2021

    Google Scholar 

  • Fachinformation Argatroban. Accord Healthcare, Stand November 2017

    Google Scholar 

  • Fachinformation Bivalirudin. Accord Healthcare, Stand Oktober 2016

    Google Scholar 

  • Fachinformation Cilostazol. Hexal, Stand August 2018

    Google Scholar 

  • Fachinformation Clopidogrel. Sanofi, Stand Mai 2021

    Google Scholar 

  • Fachinformation Dabigatran. Boehringer Ingelheim, Stand Januar 2021

    Google Scholar 

  • Fachinformation Danaparoid. Aspen, Stand November 2019

    Google Scholar 

  • Fachinformation Eptifibatid. Glaxo Smith Kline, Stand September 2020

    Google Scholar 

  • Fachinformation Fondaparinux. Glaxo Smith Kline, Stand April 2013

    Google Scholar 

  • Fachinformation Lepirudin. Celgene, Stand August 2011

    Google Scholar 

  • Fachinformation Prasugrel. Aliud Pharma, Stand März 2020

    Google Scholar 

  • Fachinformation Rivaroxaban. Bayer Pharma AG, Stand Juli 2021

    Google Scholar 

  • Fachinformation Ticagrelor. Astra Zeneca, Stand September 2019

    Google Scholar 

  • Fachinformation Tirofiban. Hexal, Stand März 2016

    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“) https://www.g-ba.de/downloads/62-492-2676/Mu-RL_2021-09-16_iK-2022-01-01.pdf. Zugegriffen im Feb 2014

  • Gupta et al (2020) https://pubmed.ncbi.nlm.nih.gov/32663542/

  • 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. https://doi.org/10.1016/j.ijoa.2012.09.002, pii: S0959-289X(12)00123-9

  • 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 

  • Kleinwechter et al (2021) [COVID-19 and pregnancy] – PubMed (nih.gov)

    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  PubMed Central  Google Scholar 

  • Komori et al (2020) Apixaban therapy in a pregnant woman with heparin-induced thrombocytopenia and venous thromboembolic events caused by congenital antithrombin deficiency: a case report – PubMed (nih.gov)

    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  PubMed Central  Google Scholar 

  • Limaye et al (2021) Predictors of severe and critical disease in pregnant women with SARS-CoV-2 – PubMed (nih.gov)

    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 

  • Nana et al (2021) Antiplatelet therapy in pregnancy: a systematic review – PubMed (nih.gov)

    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 

  • Plesinac et al (2013) Successful pregnancy after pulmonary embolism and heparin-induced thrombocytopenia – case report – PubMed (nih.gov)

    Google Scholar 

  • Pop et al (2020) Treatment with flow diverter stent during pregnancy – PubMed (nih.gov)

    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 (2016) 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

    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 

  • Serna Candel et al (2019) Management of a decompensated acute-on-chronic intracranial venous sinus thrombosis – PubMed (nih.gov)

    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 36:348–51

    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 

  • Verbruggen et al (2015) Use of ticagrelor in human pregnancy, the first experience – PubMed (nih.gov)

    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 im 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 

  • Zöllkau et al (2020) Aktualisierte Empfehlungen zu SARS-CoV-2/COVID-19 und Schwangerschaft, Geburt und Wochenbett (nih.gov)

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Zentrum für Gynäkologie & Geburtshilfe, St. Elisabethen-Krankenhaus GmbH, Lörrach, Deutschland

    Michael K. Bohlmann

Authors
  1. Michael K. Bohlmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael K. Bohlmann .

Editor information

Editors and Affiliations

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

    Gernot Marx

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

    Elke Muhl

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

    Kai Zacharowski

  4. Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main, Hessen, Deutschland

    Stefan Zeuzem

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Bohlmann, M.K. (2022). Schwangere in der Intensivmedizin. In: Marx, G., Muhl, E., Zacharowski, K., Zeuzem, S. (eds) Die Intensivmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54675-4_103-2

Download citation

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

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54675-4

  • Online ISBN: 978-3-642-54675-4

  • eBook Packages: Springer Referenz Medizin

Publish with us

Policies and ethics

Chapter history

  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

Search

Navigation