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Diagnostik und Therapie fetaler Arrhythmien

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Die Geburtshilfe

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Zusammenfassung

Bei 1–2 % der Feten treten länger anhaltende fetale Arrhythmien auf. Sie werden mittels M-mode- und Doppler-Echokardiografie differenziert. Überwachung und Therapie sind der vorliegenden Arrhythmie anzupassen. Supraventrikuläre Extrasystolen bedürfen keiner antiarrhythmischen Therapie. Tachyarrhythmien werden transplazentar mit Digoxin, Flecainid, Sotalol und Amiodaron behandelt, wobei Flecainid bei atrioventrikulären Reentry-Tachykardien immer häufiger als „First-line-Therapie“ eingesetzt wird. Beim durch maternale Anti-SSA/Ro-Autoantikörper bedingten kongenitalen kompletten AV-Block (CCHB) ist aufgrund des Nebenwirkungsprofils eine generelle transplazentare Behandlung mit hochdosierten fluorierten Kortikosteroiden nicht indiziert, sondern nur bei Zeichen einer kardialen Verschlechterung, wie ventrikuläre Dysfunktion und Fibrose sowie Hydrops. Im Hochrisikokollektiv (Wiederholungsrisiko bei vorherigem Kind mit CCHB 16–19 %) senkt die tägliche Gabe von 400 mg Hydroxychloroquin, beginnend bereits vor der 10. SSW, das Risiko eines erneuten CCHB auf 7–8 %.

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Authors and Affiliations

  1. Klinik für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Bonn, Deutschland

    Ulrich Gembruch & Annegret Geipel

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  1. Ulrich Gembruch
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  2. Annegret Geipel
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Correspondence to Ulrich Gembruch .

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Editors and Affiliations

  1. Frauenklinik, Medizinische Hochschule Hannover, Hannover, Niedersachsen, Deutschland

    Constantin von Kaisenberg

  2. Klinische Abteilung für Geburtshilfe, Medizinische Universität Graz, Graz, Steiermark, Österreich

    Philipp Klaritsch

  3. Geburtshilfe, Universitätsspital Basel, Basel Universitätsspital, Basel Stadt, Schweiz

    Irene Hösli-Krais

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Gembruch, U., Geipel, A. (2022). Diagnostik und Therapie fetaler Arrhythmien. In: von Kaisenberg, C., Klaritsch, P., Hösli-Krais, I. (eds) Die Geburtshilfe. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44369-9_61-1

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  • DOI: https://doi.org/10.1007/978-3-662-44369-9_61-1

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