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Präeklampsie und Eklampsie

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Definition:
Die Präeklampsie ist eine Plazentaerkrankung, die zu vielfältigen Organschädigungen führen kann und durch neu auftretende Hypertonie (2.–3. Trimenon; > 140/90) und Proteinurie gekennzeichnet ist. Die Eklampsie ist durch Krampfanfälle gekennzeichnet und das HELLP-Syndrom durch Hämolyse, erhöhte Transaminasen und Thrombozytopenie. Sowohl Eklampsie als auch HELLP-Syndrom gehen häufig mit einer Präeklampsie einher.
Häufigkeit:
Die Präeklampsie tritt in etwa 40 von 1.000 Schwangerschaften auf.
Symptome:
Oftmals asymptomatisch. In komplizierten Fällen zählen zu den häufigsten Symptomen Kopfschmerzen, Sehstörungen, Übelkeit und Oberbauchschmerzen.
Befunde:
Erhöhter Blutdruck (in 2 Messungen über 140/90) und evtl. starke Gewichtszunahme, geringer Symphysen-Fundus-Abstand oder Ödeme.
Diagnostik:
Es existiert kein zuverlässiger Screeningtest. Zur Risikoabschätzung im 1. oder 2. Trimenon dienen: Anamnestische Angaben (Mutterpass), Risikofaktoren, mittlerer arterieller Blutdruck, ggf. biochemische Marker und Dopplersonografie der Aa. uterinae.
Therapie:
Nur die Geburt führt zu einem Abklingen der Präeklampsie/Eklampsie, sodass u. U. eine Einleitung der Geburt vor dem Termin indiziert sein kann. Bei einem Blutdruck von über 160/110 mmHg erfolgt eine stationäre antihypertensive Therapieeinstellung.
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  • Thomas M. Heim, Dr. med. Wissenschaftsjournalist, Freiburg