Geburtshilfe Und Frauenheilkunde最新文献

Introduction: Families with pathogenic germline variants (pv) in BRCA1/2 may have besides breast and ovarian cancer an elevated lifetime risk for other cancer types.

Material and methods: Data and pedigree information from 1852 family members of 286 BRCA1/2 positive families were analyzed. Genetic testing was conducted between 2015 and 2017 at the HBOC center at Charité - Universitätsmedizin Berlin. Relative cancer risk (RR) was calculated by comparing observed cancer incidence with the expected incidence in the German population.

Results: BRCA1/2 positive families showed an elevated cancer risk for gastric and cervical cancer regardless of BRCA status. The relative risk of gastric cancer was higher in BRCA2 carriers compared to BRCA1 carriers (gBRCA1 RR 1.42; 95% CI: 0.65-2.69 vs. gBRCA2 RR 1.88; 95% CI: 0.75-3.87). Similarly, the relative risk for cervical cancer was also greater in BRCA2 carriers than in BRCA1 carriers (gBRCA1 RR 1.88; 95% CI: 0.69-4.09 vs. gBRCA2 RR 2.09; 95% CI: 0.56-5.35). Additionally, BRCA2 families showed an increased risk of pancreatic cancer (RR 1.56; 95% CI, 0.50 to 3.63). No significant associations were found for other cancer entities.

Conclusion: In the present study, an increased risk of gastrointestinal cancer was observed in German families with pathogenic BRCA1/2 variants, consistent with findings from previous research. Potential new associations with cervical cancer were also identified, warranting confirmation through large prospective studies. These findings highlight the importance of developing additional screening programs or preventive strategies for BRCA carriers, especially with regard to upper gastrointestinal tract malignancies.

Background: Mistreatment and discrimination during childbirth are a global public health concern. Such experiences can adversely affect the subjective birth experience and increase the likelihood of compromised postpartum mental health, including symptoms of childbirth-related posttraumatic stress disorder (CB-PTSD) not only in mothers/birthing parents, but also in partners. This study examines instances of mistreatment and discrimination during childbirth, their association with CB-PTSD symptoms, and the potential mediating role of the subjective birth experience in both parents.

Methods: Data were retrieved from the prospective RESPECT _PARENTS cohort, a German community sample. For the current study, data from n = 1075 mothers/birthing parents and n = 454 partners, collected at two assessment points, i.e., during pregnancy and eight weeks after birth, were included. Regression and mediation models were used to analyze the associations separately for mothers/birthing parents and partners.

Results: Mistreatment during childbirth was reported by 25.8% of mothers/birthing parents and 6.8% of partners, whereas perceived discrimination was reported by 3.9% of mothers/birthing parents and 3.5% of partners. These experiences predicted more severe CB-PTSD symptoms among mothers/birthing parents. For both parents, experiencing more mistreatment and more discrimination was associated with a more negative subjective birth experience, which in turn was associated with more severe CB-PTSD symptoms, demonstrating a significant mediation effect.

Conclusion: The current study indicates that mistreatment and discrimination during childbirth exist in Germany among both mothers/birthing parents and partners, potentially contributing to a more negative subjective birth experience and more severe CB-PTSD symptoms. The findings emphasize the need to address mistreatment and discrimination during childbirth for both parents, in general and as potential risk factors for adverse outcomes.

Background: Before the market launch of low-dose misoprostol (LDM) in the form of 25 µg tablets, high-dose misoprostol (HDM) was used off-label for labor induction in Germany. The differences between the effectiveness and safety of both dosage forms were investigated.

Method: This retrospective cohort study included all pregnant women who were induced with misoprostol between 2019 and 2023. Until September 2021, misoprostol was available in the form of a 200 µg tablet which was divided manually and administered orally at an initial dose of 50 µg, followed by 100 µg every four hours. This was compared with the current administration regimen of an initial dose of 25 µg followed by 50 µg in terms of vaginal birth rate, duration of induction, and maternal and neonatal outcomes.

Results: A total of 1941 patients were analyzed; 1397 received HDM and 544 received LDM. Vaginal delivery was achieved with equal frequency (87% HDM vs. 88% LDM, p = 0.95). The duration of induction was shorter in the HDM group (20.7 hours vs. LDM 22.7 hours, p = 0.028), and opioid requirements were higher (HDM 74% vs. LDM 69%, p = 0.036). Maternal complications and neonatal outcomes did not differ. Regression analysis found that high BMI was an independent factor for a failed first induction attempt (B 0.002, SEM 0.0004, p < 0.001).

Conclusion: Both dosing regimens achieved high vaginal birth rates with comparable safety. Inductions with HDM were two hours shorter but were associated with higher opioid use.

Adjuvant endocrine therapy with CDK4/6 inhibitors necessitates regular visits, lab assessments and side effect management, currently conducted primarily at breast cancer centers in Germany. This retrospective analysis estimates the potential travel distances, times and CO ₂ emissions associated with centralized therapy management of adjuvant CDK 4/6 inhibitor application. Eligible patients for ribociclib or abemaciclib therapy were retrospectively identified from 5053 early breast cancer cases at the university hospitals of Ulm, Lübeck and Tübingen, using the monarchE and NATALEE criteria. Travel times were calculated assuming 24 visits over three years for ribociclib and 18 visits over two years for abemaciclib. Of the HR+/HER2- cohort, 1432 (38%) were potentially eligible for adjuvant CDK4/6 inhibitors, with 1080 patients included, based on available postal codes. Median travel distances and times for Ribociclib (3 years) were 1200 km (24.0 hours driving; 176.0 kg CO ₂ emissions; 50.4 hours by public transport; 72.0 kg CO ₂ emissions) and 900 km (18.0 hours driving; 132.3 kg CO ₂ emissions; 37.8 hours by public transport; 54.0 kg CO ₂ emissions) for abemaciclib (2 years). Despite its retrospective limitations, this analysis provides valuable insight into the impact of centralized care on travel time and CO ₂ emissions for oral cancer therapies in Germany. As the use of oral therapies increases, clinicians, patients, policymakers and the pharmaceutical industry should jointly develop strategies to optimize the safety, feasibility, and efficacy of oral therapies.

Introduction: Local perforator flaps have become an increasingly important option in oncoplastic breast surgery. Despite their long-standing use, their application in clinical practice remains limited. This study evaluates the use of thoracic wall perforator flaps, specifically the intercostal artery perforator (ICAP) and thoracodorsal artery perforator (TDAP) flaps, for volume and skin replacement after breast-conserving therapy and in the management of complications following reconstructive procedures.

Materials and methods: We performed a retrospective analysis of 50 patients treated with local perforator flaps between March 2022 and March 2025 at the Interdisciplinary Breast Center, Klinikum rechts der Isar. Follow-up examinations were conducted in a standardized manner by the primary surgeon and included clinical and ultrasound assessments of the flap, as well as documentation of complications, perfusion, and patient-reported outcomes.

Results: ICAP flaps were used in 39 cases and TDAP flaps in 11 cases. The majority of reconstructions (72%) were immediate. ICAP flaps were mainly used for lower and central defects, whereas TDAP flaps were used for upper outer quadrant and complex cases. The mean operative time was 109 minutes, longer for TDAP flaps (153 minutes). There was no total flap loss and complications were rare (one partial necrosis, three seromas). Radiotherapy was administered in 72% of cases without flap compromise. Flaps were also effective in the management of implant-related or autologous reconstruction complications.

Discussion: Perforator flaps offer reliable, low morbidity reconstruction options with good aesthetic outcomes and low complication rates, even after radiotherapy. They are also suitable for secondary reconstruction and management of complications.

Conclusion: Local perforator flaps, particularly ICAP and TDAP, are safe, versatile tools in oncoplastic breast surgery and should be more widely considered in clinical practice.

Introduction: The prevalence of gestational diabetes mellitus in Germany is approximately 10%. One third of affected women require insulin therapy when conservative measures such as dietary changes and physical activity are insufficient to achieve target glucose levels. Timely initiation of insulin therapy is crucial for optimising obstetric outcomes. Early identification of high-risk patients at the time of diagnosis would facilitate prompt and individualised treatment adjustments.

Materials and methods: A risk calculator was developed based on clinical parameters and medical history information to estimate the individual risk for insulin therapy. The models were derived from real-world data of the GestDiab registry, comprising 14157 pregnancies between 2018 and 2020, of which 4319 (30.5%) required insulin therapy.

Results: Various models incorporating maternal age, gestational age at diagnosis, parity, gravidity, body mass index, 75 g oral glucose tolerance test values, HbA1c levels, history of gestational diabetes mellitus, and family history of diabetes were developed. Validation using the GestDiab cohort from 2021 demonstrated that the model including all variables exhibited the highest predictive power (AUC 0.740).

Conclusions: The risk calculator is provided online to support both patients and physicians in making informed decisions. Individualised counselling based on personal risk assessments may enhance therapy adherence and potentially reduce the necessity for insulin therapy.

[This corrects the article DOI: 10.1055/a-1860-0419.].