Geburtshilfe Und Frauenheilkunde最新文献

Background: Endometriosis is a disease which affects the quality of life and fertility of many young women. Choosing the right time for surgery is important for the outcome of patients. We evaluated the surgical variables affecting postoperative pregnancy rates.

Method: This study is a retrospective analysis of women treated for endometriosis in Frankfurt University Hospital between 2007 and 2017. A total of 695 patients underwent laparoscopic surgery, of whom 125 patients fulfilled the inclusion criteria of wanting to have a child for more than one year. Finally, 102 patients (82%) with surgery and infertility were followed up for 70 months.

Results: We found a cumulative pregnancy rate of 69.6% after 38 months in our patients. The duration of infertility before surgery had a significant effect on postoperative pregnancy rates. There was no significant difference between the different kinds of surgical techniques, but complete treatment of all visible lesions significantly increased the chance of pregnancy (hazard ratio 2.2). Repeated abdominal operations reduced the chance of postoperative pregnancy and prolonged the time to pregnancy.

Conclusions: In patients with endometriosis and infertility, both laparoscopic surgery with complete resection of all visible lesions and the timing of surgery are important to achieve pregnancy. Early intervention with careful planning of the operation is critical. It is important to avoid repeated operations to achieve the best results regarding pregnancy.

Introduction: Preconception obesity is a risk factor for pregnancy and delivery, which is why giving birth in a perinatal center (care levels I and II) is recommended. There are currently no studies which have investigated the birth outcomes of obese patients based on the care level of the maternity hospital. This study aims to assess the effect of a higher body mass index prior to conception on maternal and fetal outcomes in a maternity hospital (care level IV).

Patients and methods: A total of 5616 pregnant women who gave birth between 2016 and 2023 were investigated in this retrospective cohort study, after taking the inclusion and exclusion criteria into account. Primary outcome parameter of this study was the transfer of the neonate to a neonatal intensive care unit. Other target parameters were the need to induce labor, delivery mode, Apgar score and pH value, and the incidence of complications (shoulder dystocia, higher-degree perineal tears, or peripartum hemorrhage).

Results: Overweight and obesity were associated with a higher rate of hypertensive disorders of pregnancy and gestational diabetes and were accompanied by higher rates of induction of labor and elective and secondary caesarean sections. Maternal outcome parameters such as intrapartum fever, preterm placental abruption, uterine rupture, higher-degree birth injuries and peripartum hemorrhage did not occur significantly more often in obese pregnant women. Fetal outcome parameters such as Apgar score and pH value did not differ from those reported for normal-weight pregnant women. Multivariate regression analysis showed a high risk of transfer to a neonatal intensive care unit (OR = 1.97; p = 0.035) for neonates born to women in obesity class II (BMI 35-39.9 kg/m ² ), women with gestational diabetes (OR = 1.71; p = 0.033), and nulliparous women (OR = 1.59; p = 0.005).

Conclusion: Obesity class II is associated with a slightly higher risk of transfer of the neonate to a pediatric intensive care unit but is not associated with worse Apgar scores or pH values. Pregnant women with a body mass index between 35 and 40 kg/m ² should be informed of this and should consider giving birth in a facility with a neonatal department (care level I-III).

Introduction: In Germany, 0.25% of the total population are persons with a Vietnamese migration background. There are almost no studies on this particular group of immigrants. We compared the perinatal data of women with a Vietnamese migration background with the pregnancy outcomes of non-Vietnamese women also living in Germany.

Methods: After using name analysis to allocate women into different groups, the perinatal data of women with a Vietnamese migration background who gave birth between 1.1.2016 and 31.12.2019 in Campus Charité Mitte in Berlin were retrospectively evaluated. These data were compared in a 3:1 ratio with the data of women of non-Vietnamese origin and the same age and parity. Multivariate regression analysis was used to determine factors which influenced caesarean section rates, the transfer rates of neonates to the neonatal department, and the rates of higher degree perineal tears.

Results: The perinatal data of 470 women with a Vietnamese migration background, 209 (44.5%) of whom were registered as living in a refugee shelter, were compared with those of 1410 controls. An "ideal pregnancy outcome," which included giving birth after 37 + 0 weeks of gestation, a 5-minute Apgar score ≥ 8, arterial cord blood pH ≥ 7.20, no transfer of the newborn to the neonatal department, and spontaneous birth or vacuum extraction without a higher degree perineal tear, was recorded for 44.5% of women with and 38.1% of women without a Vietnamese migration background (p = 0.1), despite the lower attendance rates at antenatal screening appointments of Vietnamese women. Accommodation in a shelter for refugees was a protective factor against caesarean section (OR 0.5, 95% CI: 0.36-0.73) and transfer of the newborn to the neonatal department (OR 0.45, 95% CI: 0.23-0.89). A Vietnamese migration background was a risk factor for a third-degree perineal tear (OR 5.4, 95% CI: 1.4-21.30).

Conclusion: Despite lower levels of antenatal care, women with a Vietnamese migration background did not have poorer pregnancy outcomes.

Artificial intelligence (AI) has become an omnipresent topic in the media. Lively discussions are being held on how AI could revolutionize the global healthcare landscape. The development of innovative AI models, including in the medical sector, is increasingly dominated by large high-tech companies. As a global technology epicenter, Silicon Valley hosts many of these technological giants which are muscling their way into healthcare provision with their advanced technologies. The annual conference of the American College of Obstetrics and Gynecology (ACOG) was held in San Francisco from 17 - 19 May 2024. ACOG celebrated its AI premier, hosting two sessions on current AI topics in gynecology at their annual conference. This paper provides an overview of the topics discussed and permits an insight into the thinking in Silicon Valley, showing how technology companies grow and fail there and examining how our American colleagues perceive increased integration of AI in gynecological and obstetric care. In addition to the classification of various, currently popular AI terms, the article also presents three areas where artificial intelligence is being used in gynecology and looks at the current developmental status in the context of existing obstacles to implementation and the current digitalization status of the German healthcare system.

Introduction: Minimally invasive surgery is increasing in all fields of surgery. It is currently unknown whether structured training is superior to self-directed training. The aim of this study is to analyze the enhancement of surgical skills in laparoscopy box trainers in a systematically guided training program compared to self-directed training.

Material and methods: Two groups of 40 medical students were included in the study between 04/2021 and 01/2023. Each training session on the laparoscopic box trainer (Medishield BV, NL) was automatically protocolled, including time, force, and path length. The structured group consisted of 21 students working in peer tandem, while the self-directed group consisted of 19 last-year students in their four-month elective. The observational study was conducted in an ecological study design.

Results: The self-directed cohort completed an average of 15 training sessions compared to the structured cohort's 10 sessions. All participants in both groups improved in time, path length, and force. The structured cohort showed nearly linear improvement, while the self-directed cohort had high deviation in results.

Conclusion: Supervision and collaborative work positively influence laparoscopic training success. Mere availability of training does not exploit the potential of laparoscopic box trainers. Curriculums for young surgeons or medical students should include institutionalized training with a structured schedule and a training partner for improved outcomes.

Introduction: To evaluate the adherence of Austrian obstetricians to national guideline recommendations by investigating data on the current practice of tocolysis regarding indications, timing and monitoring of tocolysis, choice of tocolytics and serious side effects, maintenance tocolysis, support of decision-making and recommendations at patient's discharge from the hospital.

Materials and methods: 78 obstetric departments in Austria were invited to participate in a nationwide survey between June 5 ^th and August 31 ^st 2023 by answering a web-based questionnaire about clinical standards. The survey was conducted approximately one year after implementation of the AWMF Guideline "Prevention and Therapy of Preterm Birth" 015‑025. Collected data were analyzed descriptively by performing measures of frequency. Fisher's exact test was used for group comparison.

Results: The response rate was 69.2% (33.3% perinatal centers, 66.7% standard care). The most important indication of tocolysis were ≥ 4 contractions within 20 minutes of CTG tracing, as stated by 26 (48.1%) of the respondents; the AWMF Guideline 015‑025 (2022) was the most important decision-making support for tocolytic treatment (61.1%). 19 (35.2%) of obstetric units started tocolysis earliest at 23 + 0 weeks of gestation. Atosiban was the first-line tocolytic drug used by 43 (79.6%) of obstetric units, followed by nifedipine (n = 7, 13.0%); 49 of 54 obstetric units (90.7%) stated to perform maintenance tocolysis, among these 46 (93.9%) not routinely but on special indications (e.g. placenta previa). Serious side effects were observed by 77.8% of the respondents, mostly associated with the use of hexoprenaline.

Conclusions: Our survey revealed considerable discrepancies between evidence-based guideline recommendations and daily clinical practice in Austrian hospitals.

Introduction: Infection after cesarean section is a major contributor to maternal morbidity. Measurement of C-reactive protein (CRP) is a laboratory test frequently conducted to rule out or confirm postoperative infection. The present study aimed to evaluate whether CRP is a suitable tool for ruling out infection after cesarean section and whether there are any reliable cut-off values.

Materials and methods: 2056 patients with cesarean section (CS) over a 3-year period were included in a retrospective analysis. Outcome parameters and risk factors for postoperative infection were collected. CRP values from preoperative and postoperative tests were compared. Cut-offs for ruling out infection were assessed.

Results: Among 2056 CSs, postoperative infection occurred in 78 cases (3.8%). The prevalence of infection in emergency CS was lowest, at four out of 134 (2.9%), and the highest prevalence was seen in secondary CS, at 42 of 903 (4.6%; p = 0.35). CRP values in the infection group were significantly higher (preoperative, 1.01 mg/dl vs. 0.62 mg/dl; day 1 postoperative, 7.91 mg/dl vs. 6.44 mg/dl; day 4 postoperative, 8.44 mg/dl vs. 4.09 mg/dl; p = 0.01). A suitable cut-off value for ruling out infection was not identified.

Conclusions: Although CRP values were significantly higher in the infection group, the clinical relevance of this appears to be negligible. CRP testing does not appear to be a reliable tool for diagnosing or ruling out postoperative infection.

This extensive AWMF 085-002 S2e-guideline "First Trimester Diagnosis and Therapy @ 11 - 13 ⁺⁶ of Gestation" has systematically analyzed high-quality studies and publications and the existing evidence (evidence tables) and produced recommendations (level of recommendation, level of evidence, strength of consensus). This guideline deals with the following topics in the context of the 11 - 13 ⁺⁶ weeks scan: the legal basis, screening for anatomical malformations, screening for chromosomal defects, quality assessment and audit, screening for preeclampsia and FGR, screening for preterm birth, screening for abnormally invasive placenta (AIP) and placenta accreta spectrum (PAS), screening for velamentous cord insertion and vasa praevia, screening for diabetes mellitus and LGA. Screening for complications of pregnancy can best be carried out @ 11 - 13 ⁺⁶ weeks of gestation. The issues of how to identify malformations, chromosomal abnormalities and certain disorders of placentation (high blood pressure and proteinuria, intrauterine growth retardation) have been solved. The problem of how to identify placenta percreta and vasa previa has been partially solved. What is still unsolved is how to identify disorders of glucose metabolism and preterm birth. In the first trimester, solutions to some of these problems are available: parents can be given extensive counselling and the risk that a pregnancy complication will manifest at a later stage can be delayed and reduced. This means that screening is critically important as it helps in decision-making about the best way to manage pregnancy complications (prevention and intervals between follow-up examinations). If no treatment is available and if a termination of pregnancy is considered, the intervention can be carried out with far lower complications compared to the second trimester of pregnancy. In most cases, further examinations are not required and the parents can be reassured. A repeat examination at around week 20 of gestation to complete the screening for malformations is recommended. Note: The guideline will be published simultaneously in the official journals of both professional societies (i.e. Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM and Geburtshilfe und Frauenheilkunde for the DGGG).

In many cases, outpatient surgical treatment of benign diseases of the uterus has advantages over inpatient care. This has been demonstrated by the healthcare situation in other countries. However, the prerequisite for the provision of outpatient services is that this does not lead to any impairment in the quality of care or of patient safety. The ultimate goal should not be to reduce costs but rather to maintain and, ideally, improve the quality of care. This requires that services are not just defined by the surgical procedure but also by the entire treatment chain, including, for example, psychosocial support, and are remunerated accordingly. It is particularly worrying that the final decision as to whether an outpatient operation is possible is not the responsibility of the operating unit, but of the "Medizinischer Dienst," with the corresponding options and threats of sanctions. This situation is unique internationally and requires a paradigm shift. Furthermore, structural prerequisites must be maintained which currently only exist inadequately in Germany. Since a substantial proportion of planned outpatient operations require immediate or secondary inpatient treatment, there must be a barrier-free transition between the outpatient and inpatient sectors. This will require the creation of networks between outpatient service providers and one or more hospitals that are equipped and competent to manage even complex complications. It is important to create structures that, with intensive involvement of the operating unit, include adequate preoperative evaluation and patient education as well as needs-oriented postoperative care at home. The current separation of sectors is a significant hinderance. Moreover, when expanding and promoting outpatient surgery, the aspect of training and further education of specialist staff must be taken into account, as well as cross-sectoral quality assurance. Based on a review of the international literature, this article presents 13 recommendations for adequate structures when providing outpatient services which should serve as a prerequisite for the greatest possible guarantee of patient safety.

This extensive AWMF 085-002 S2e-guideline "First Trimester Diagnosis and Therapy @ 11 - 13 ⁺⁶ Weeks of Gestation" has systematically analyzed high-quality studies and publications and the existing evidence (evidence tables) and produced recommendations (level of recommendation, level of evidence, strength of consensus). This guideline deals with the following topics in the context of the 11 - 13 ⁺⁶ weeks scan: the legal basis, screening for anatomical malformations, screening for chromosomal defects, quality assessment and audit, screening for preeclampsia and FGR, screening for preterm birth, screening for abnormally invasive placenta (AIP) and placenta accreta spectrum (PAS), screening for velamentous cord insertion and vasa praevia, screening for diabetes mellitus and LGA. Screening for complications of pregnancy can best be carried out @ 11 - 13 ⁺⁶ weeks of gestation. The issues of how to identify malformations, chromosomal abnormalities and certain disorders of placentation (high blood pressure and proteinuria, intrauterine growth retardation) have been solved. The problem of how to identify placenta percreta and vasa previa has been partially solved. What is still unsolved is how to identify disorders of glucose metabolism and preterm birth. In the first trimester, solutions to some of these problems are available: parents can be given extensive counselling and the risk that a pregnancy complication will manifest at a later stage can be delayed and reduced. This means that screening is critically important as it helps in decision-making about the best way to manage pregnancy complications (prevention and intervals between follow-up examinations). If no treatment is available and if a termination of pregnancy is considered, the intervention can be carried out with far lower complications compared to the second trimester of pregnancy. In most cases, further examinations are not required and the parents can be reassured. A repeat examination at around week 20 of gestation to complete the screening for malformations is recommended. Note: The guideline will be published simultaneously in the official journals of both professional societies (i.e. Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM and Geburtshilfe und Frauenheilkunde for the DGGG).