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Therapeutische Konzepte bei habitueller Abortneigung

Viel hilft viel?

Therapeutic concepts for recurrent miscarriage

The more, the better?

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Der Gynäkologe Aims and scope

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.

Abstract

Background

A risk factor-specific individualized treatment strategy to prevent recurrent miscarriage should be started after a standardized diagnostic work-up. There are few evidence-based data indicating which treatment should be chosen.

Objective

What are the therapeutic options in recurrent miscarriage and what is the evidence?

Material and methods

This review evaluates the most recent recommendations concerning therapeutic options for recurrent miscarriage based on the European Society of Human Reproduction and Embryology (ESHRE) guidelines on the management of recurrent pregnancy loss as well as the S2k guidelines of the Association of the Scientific Medical Societies in Germany (AWMF) on the diagnostics and therapy of recurrent miscarriage (015/50).

Results

A septum resection as well as optimization of the thyroid gland function with a target value for thyroid-stimulating hormone (TSH) of >2.5mU/l should be performed. While treatment of antiphospholipid syndrome (APLS) and the “non-criteria” APLS with low molecular weight heparin (LMWH) and acetylsalicylic acid is recommended, a general treatment with LMWH should not be performed. Immunomodulatory treatment options should currently only be carried out in clinical trials.

Conclusion

Counseling patients with recurrent miscarriage has become more challenging with many different therapeutic options evolving in recent years. Therapeutic strategies need scientific evidence and new treatment options should be performed in clinical trials. This review outlines the treatment options recommended by national and international guidelines.

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Authors and Affiliations

  1. Gynäkologische Endokrinologie und Reproduktionsmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich

    Kilian Vomstein, Katharina Feil & Bettina Toth

  2. Abteilung für Gynäkologische Endokrinologie und Fertilitätsstörungen, Universitätsfrauenklinik Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland

    Ruben-J. Kuon

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  1. Kilian Vomstein
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  2. Katharina Feil
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Correspondence to Kilian Vomstein.

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Interessenkonflikt

R.-J. Kuon und B. Toth sind Gesellschafter der Reprognostics GbR. K. Vomstein und K. Feil geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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T. Strowitzki, Heidelberg

R. Kuon, Heidelberg

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Vomstein, K., Feil, K., Kuon, RJ. et al. Therapeutische Konzepte bei habitueller Abortneigung. Gynäkologe 51, 312–318 (2018). https://doi.org/10.1007/s00129-018-4226-4

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