Nierenerkrankungen in der Schwangerschaft

Zusammenfassung In einer Schwangerschaft können Nierenkrankheiten neu auftreten oder bereits zu Beginn der Schwangerschaft vorhanden sein. Das Vorliegen einer arteriellen Hypertonie ist ein positiv prädiktiver Faktor für das Auftreten einer Präeklampsie, einer Erkrankung mit renaler Beeinträchtigung. Eine arterielle Hypertonie, eine Proteinurie und eine reduzierte Nierenfunktion sind ein erhöhtes Risiko für den Fetus und die Mutter, da sich deren Nierenfunktion verschlechtern kann und gehäuft Präeklampsien auftreten.Aktive, immunologisch vermittelte Systemerkrankungen stellen ebenfalls ein hohes Risiko für den Verlauf einer Schwangerschaft dar. Ein Diabetes mellitus sollte gut kontrolliert und die Nierenfunktion möglichst normal sein. Schwangerschaften bei Hämodialysepatientinnen sind selten und mit einer hohen fetalen Mortalität assoziiert. Eine Schwangerschaft nach Nierentransplantation ist möglich, sollte jedoch bei stabiler Nierenfunktion nicht im frühen Zeitraum nach der Transplantation erfolgen.Eine sorgfältige Präkonzeptionsberatung muss bei einer hypertensiven oder renalen Erkrankung erfolgen. Besondere genetische Aspekte einer vorliegenden Erkrankung, z. B. der Vererbungsmodus, sollten hierbei berücksichtigt und die Betreuung interdisziplinär geplant werden (Geburtshelfer, Nephrologe).     

Beschwerden in der Schwangerschaft

Ohne Zusammenfassung     

Tumorerkrankungen in der Schwangerschaft

The most frequent malignancy during pregnancy is cervical cancer, followed by Hodgkin’s lymphoma, breast cancer, and melanoma. Because of the older age of woman at pregnancy there has been an increase in the incidence. The diagnosis of a malignant tumor affects both the mother and her child; different therapy regimens have opposite effects on the prognosis of each one. The interdisciplinary dialogue with the mother attempts to find the optimal therapeutic modalities. Despite potentially negative effects of radiologic diagnostics, no time should be lost in finding the diagnosis. Gold standard methods are ultrasound and MRI. There is a lack of data regarding the different therapies. Surgery seems to be safe. Radiotherapy as well as endocrine therapy should not be done during pregnancy. Chemotherapy is regarded to be safe during the second and third trimesters, but it should not be applied earlier because of the teratogenic effects. Therapy with antibodies seems to be a promising treatment; long-term follow-up results are not available. In order to improve the knowledge about cancer in pregnancy, it is important to record case reports in http://www.germanbreastgroup.de/pregnancy.     

HIV-Infektion in der Schwangerschaft

Due to modern antiretroviral therapy vertical transmission of HIV-1 has been reduced to less than 1%. An interdisciplinary care in a centre experienced in HIV by HIV specialists, gynecologists and pediatricians is required for HIV-positive pregnant women. If the viral load of the mother is fully suppressed the mode of delivery in cases of HIV infection can be selected based only on obstetric criteria. Furthermore, these women should not breast feed if they live in resource-rich countries..     

Lifestyle in der Schwangerschaft

Apart from obstetric examinations a gynecologist has to advise patients concerning questions of life style. Due to perinatal and physiological research and a resultant change in paradigms this refers to physical and leisure activities as well as to nutritional facts and modern habits, such as smoking and alcohol. Life style during pregnancy does not only influence gestation and maternal and fetal well-being but may also subsequently lead to life-long consequences. The paper gives an overview on the current knowledge.     

Chemotherapie in der Schwangerschaft

In the majority of women diagnosed with breast cancer in pregnancy adjuvant or neoadjuvant chemotherapy is indicated. Administration of chemotherapy should not start before 14 weeks of gestation when fertilization, implantation and organogenesis have been completed. An earlier start with cytotoxic drugs results in a higher rate of miscarriage, fetal death and major malformations. The use of anthracyclines and taxanes is possible in the second and third trimester. These substances seem to have a good safety profile but there is a need for more data about the long-term outcome in children with prenatal exposure to chemotherapy, particularly about a higher risk for malignancies, sterility and cardiotoxicity. Trastuzumab is currently not recommended in any trimester during pregnancy.     

Lebererkrankungen in der Schwangerschaft

Liver diseases in pregnancy can result in maternal as well as fetal complications. Intrahepatic cholestasis in pregnancy may lead to a high fetal risk of IUD, meconium-stained amniotic fluid, premature delivery, asphyxia and arrhythmia. Concerning a good fetal outcome there is no evidence-based therapy. Pruritus and elevated cholic acid can be treated and controlled well by ursodeoxycholic acid. Since there is a higher risk of intrauterine death, most common at 37+ weeks of gestation, delivery is recommended starting at 36+ weeks, even earlier when excessively high cholic acid levels occur. Acute fatty liver of pregnancy is linked to higher maternal and fetal mortality. There are regular crossovers to the HELLP syndrome. Cholelithiasis causes 6% of all jaundice in pregnancy and thus has to be considered as another differential diagnosis particularly in multiparity. If operative treatment is required for cholecystolithiasis during pregnancy the best fetal outcome is achieved in the second trimester. It is likely that in the future chronic liver diseases such as Wilson??s disease and autoimmune hepatitis will be seen more often during pregnancy since there are increasingly better options for treatment. The same applies to pregnant women who have already undergone liver transplantation. An interdisciplinary approach with hepatologists in these high-risk pregnancies is mandatory.     

Reiten in der Schwangerschaft

In healthy and experienced female riders horseback riding does not influence the duration of pregnancy. The analysis of a retrospective survey with 1,851 participants after childbirth or miscarriage who had partially continued riding during pregnancy showed no evidence for an increased rate of miscarriages or preterm delivery, not even in show jumping or professional daily riding. Prolonged labor could also not be found. Women with preterm delivery stopped riding activities earlier than women with term delivery. Self-assessment by pregnant women could therefore be an important indicator in medical care. Accidents while riding or having contact to horses occurred in 9.7 % of participants. When counselling pregnant riders, accidents resulting from horseback riding or other equestrian activities therefore represent a considerable risk and should be taken into account.     

Malignome in der Schwangerschaft

Ovarian and placental cancers are rare complications of pregnancy. Nevertheless when they occur they are a real challenge for the perinatologist involved. Clinicians as well as the mother and their relatives have to cope with a special conflict situation. Early diagnosis and induction of the adequate therapy are crucial in these cases. Treatment depends on many different factors including gestational age, the stage and prognosis of the disease, as well as the parents wishes concerning the pregnancy. For appropriate decision-making a multidisciplinary approach including perinatologists, gynecologic oncologists, neonatologists and mental health professionals as well as extensive patient counseling is of main importance. This article gives an overview of ovarian cancer and gestational trophoblastic diseases complicating pregnancy including the main therapeutic options.     

Toxoplasmose-Infektion in der Schwangerschaft

Ohne Zusammenfassung     

Magen-Darm-Beschwerden in der Schwangerschaft

Zusammenfassung Magen- und Darmbeschwerden gehören zu den häufigsten Problemen in der Schwangerschaft. Der gastroösophageale Reflux, Übelkeit und Erbrechen kommen in 80% der Fälle vor, eine leichte Emesis in bis zu 30%. Die Hyperemesis tritt bei jeder 200. schwangeren Frau auf kann zu erheblichen Elektrolytverschiebungen führen. Differenzialdiagnostisch müssen eine Hyperthyreose, gastrointestinale und urogenitale Erkrankungen ausgeschlossen werden. Gastritiden bzw. Ulzera des Magens und des Dünndarms sind selten in der Schwangerschaft, das Magenkarzinom ist sehr selten, wenn es vorkommt aber von schlechter Prognose. Chronisch-entzündliche Darmerkrankungen wie Morbus Crohn und Colitis ulcerosa sind Erkrankungen der jungen Frau; das Zusammentreffen mit einer Schwangerschaft ist deshalb nicht ungewöhnlich. Der Krankheitsverlauf ist abhängig von Aktivität und Schwere der Erkrankung. In dem vorliegenden Artikel werden Symptome, Diagnostik und Therapieoptionen gastrointestinaler Erkrankungen in der Schwangerschaft diskutiert.