Geburtshilfe Und Frauenheilkunde最新文献

This guideline on pregnancy, childbirth and puerperium for women with spinal cord injury (SCI) presents general issues relating to the wish to have children and pregnancy in the context of SCI. The guideline was developed by the German-speaking Medical Society for Paraplegia ( Deutschsprachige Medizinische Gesellschaft für Paraplegiologie , DMGP) and the German Society for Gynecology and Obstetrics ( Deutsche Gesellschaft für Gynäkologie und Geburtshilfe , DGGG). As there were no generally available evidence-based guidelines about this complex set of problems, this new guideline aims to standardize procedures using a structured consensus-of-experts approach. The aim is to establish general interdisciplinary standards and provide practical assistance for the care and counseling of women with SCI who wish to have children/are pregnant and thereby close the identified gaps in medical care, information, interdisciplinary cooperation and research.

Introduction: There is a global shortage of obstetricians and gynecologists (OB/GYN), raising concerns about patient care and workforce sustainability. Germany faces a particularly acute shortage, exacerbated by the impending retirement of many senior consultants. This study explores the career perceptions of graduate-entry medical students at the University of Bonn, focusing on their attitudes toward a career in OB/GYN.

Methods: A cohort of fifth year medical students (n = 213) participated in this study. Surveys were administered directly via QR codes at two points in the 10th semester: pre-rotation (pre-clerkship) and post-rotation, at the time of the OSCE (OSCE = objective structured clinical examination) in OB/GYN. The questionnaires assessed multiple dimensions of students' career preferences, understanding of the specialty, and the impact of clinical exposure on their perceptions. Statistical analyses, including McNemar's test, were performed to evaluate changes in students' perspectives.

Results: The findings revealed that prior to clinical exposure, only 32% of students expressed interest in a career in OB/GYN. After completing the rotation, this interest remained unchanged. Notably, concerns about night shifts increased significantly post-rotation, with 75% of students citing it as a key deterrent. Furthermore, financial considerations gained importance, with 54% of students highlighting future income as a critical factor post-rotation compared to 43% pre-rotation. Despite improved understanding of OB/GYN following hands-on experience, concerns about workload and stress persisted.

Discussion: While clinical exposure increased students' knowledge of OB/GYN, it did not significantly affect their interest in the specialty, likely due to concerns about work-life balance and the demanding nature of the field. The study underscores the need for reforms in OB/GYN training and practice environments to address these deterrents and improve recruitment into this essential specialty.

Purpose This guideline aims to improve and standardize the diagnostic and therapeutic approaches for different types of miscarriages, pregnancies of unclear localization, and ectopic pregnancies in the 1st trimester. Methods In accordance with the requirements for an S2k-guideline, this guideline was compiled following a search of the literature, and the various recommendations and statements were formally agreed upon by an interdisciplinary group of representative experts from Germany (DGGG, etc.), Austria (OEGGG) and Switzerland (SGGG) who met up several times under the aegis of the German Society for Gynecology and Obstetrics ( Deutsche Gesellschaft für Gynäkologie und Geburtshilfe , DGGG). Recommendations The guideline provides 129 recommendations on clinical, laboratory-based, ultrasonographical, pathomorphological and genetic diagnostics and describes and assesses different therapeutic options in terms of their success and complication rates and the continued fertility of the patient as well as aspects of the grieving process and coming to terms with the loss after an early loss of pregnancy.

Introduction: The trinational survey project conducted by the Young Forums of the German, Austrian, and Swiss Societies for Gynecology and Obstetrics aims to assess the preferences of prospective and practicing gynecologists regarding various work-time models, the compatibility of family and career, as well as parental leave.

Materials and methods: Between October 2023 and May 2024, a total of 1364 participants took part in the survey. The questionnaire consisted of 62 questions covering topics such as the workplace in general, work-time models, training priorities, team compositions, and professional goals. Participation was voluntary and anonymous.

Results: Of the 1364 participants, 75.3% were employed in Germany, 12.9% in Austria, and 11.8% in Switzerland. Men were significantly more likely to aspire to a chief physician position compared to women (26.5% vs. 3.6%; p < 0.001). Only 12.5% of participants overall preferred full-time employment, although 63.0% of residents worked full-time. Additionally, 65.4% of respondents stated that their workplace did not provide childcare with flexible hours. At the same time, 76.0% valued workplace-proximate childcare as an important factor in choosing an employer.

Conclusions: The results highlight heterogeneous and individual needs and priorities among all (prospective) gynecologists. At a time when individuality and equality are becoming increasingly significant, it is essential to promote work environments that meet the demands and needs of all physicians. The results should therefore be critically discussed to implement potential adjustments and improvements in practice.

Purpose: Misoprostol is used in low doses for the induction of labor. It is still not clear, however, which of the approved doses (25 µg or 50 µg) is more beneficial. The aim of this study was to investigate whether oral misoprostol at a dose of 25 µg or at a dose of 50 µg should be preferred to induce labor after cervical ripening with a double-balloon catheter.

Material and methods: This retrospective cohort study analyzed full-term pregnancies (≥ 37 + 0 GW) in which sequential induction of labor was carried out using a double-balloon catheter followed by oral administration of misoprostol. The patients were divided into two groups: Group 1 received 50 µg misoprostol every four hours and Group 2 received 25 µg misoprostol every two hours. The primary target parameter was the rate of caesarean sections. Secondary target parameters included the interval from induction to delivery, the rate of spontaneous births, vaginal operative deliveries, and neonatal outcomes.

Results: 967 patients were included in the study: 514 in Group 1 and 453 in Group 2. There was no significant difference in the rate of caesarean sections between the two groups (p = 0.688). However, significantly more women in Group 2 had unsuccessful induction of labor, defined as a vaginal birth after 72 hours (15.8% vs. 8.1%, p = 0.001). But fewer neonates from Group 2 required transfer to the neonatal department (10.6% vs. 18.5%, p < 0.001).

Conclusion: The study found no difference in the rate of caesarean sections for the different doses of misoprostol. However the rate of vaginal deliveries only occurring after 72 hours was higher in the group treated with 25 µg misoprostol, while more neonates required transfer to the neonatal department in the group receiving 50 µg misoprostol.

Introduction: It is still difficult to predict the outcome of preeclampsia and determine the individual procedure with regards to the time of birth. Cut-offs of the sFlt-1/PlGF ratio with a high risk for imminent delivery have been previously published and analyzed by our study group, but could not be confirmed. The aim of the current study is to re-evaluate the described cut-off values again in a new period of time.

Materials and methods: We performed a retrospective analysis (IRB 1279/2020) including all preeclampsia patients delivering in our department over a 3-year period. Patients were divided into 2 groups - gestational week 24+0-33+6 with an s-Flt1/PlGF > 655.2 and 34+0-37+0 weeks with an sFlt-1/PlGF > 201 and were compared with preeclampsia patients of the same weeks with sFlt-1/PlGF values below the described cut-offs. Correlation between sFlt-1/PlGF ratio and time to delivery was assessed.

Results: The association between sFlt-1/PlGF above the threshold and delivery within 48 h is significant for the high ratio early group (p < 0.01) but not for the high ratio late group (p = 0.62). In the early group, 60% of patients with sFlt-1/PlGF > 655.2 but only 8% in the low ratio group delivered within 48 h. In both the early and the late preeclampsia group, a high number of patients remained pregnant even though they showed elevated ratios.

Conclusion: High sFlt-1/PlGF ratios seem to correlate with a shorter pregnancy duration to some extent. Nevertheless, not all patients need to be delivered within 48 h, so the decision should never be based on the laboratory test alone.

Purpose This is an official guideline of the German Society for Gynecology and Obstetrics ( Deutsche Gesellschaft für Gynäkologie und Geburtshilfe , DGGG), the Austrian Society for Gynecology and Obstetrics ( Österreichische Gesellschaft für Gynäkologie und Geburtshilfe , ÖGGG) and the Swiss Society for Gynecology and Obstetrics ( Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe , SGGG). Shoulder dystocia is a rare but feared obstetric complication with potentially far-reaching medical consequences for mother and child. The purpose of this guideline is to standardize the processes which provide individual obstetric solutions for shoulder dystocia in accordance with current scientific knowledge and current clinical practice. The aim is also to emphasize that no matter how good the medical care, shoulder dystocia and its associated complications cannot be entirely prevented and are not fully controllable. Methods Representative members from different medical specialties were commissioned by the guidelines programm of the DGGG, OEGGG and SGGG to develop this S2k-guideline using a structured consensus process. Recommendations The guideline provides recommendations about the definition, diagnosis, epidemiology, risk factors and prevention, logistics, and measures to treat shoulder dystocia including an algorithm for action, and the associated complications, documentation requirements, debriefing, forensic aspects, education, training and simulation as well as follow-up discussions on the shoulder dystocia event.

Purpose This is an official guideline issued by the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The guideline aims to provide guidance and support for indication-based decisions in the context of vaginal-operative deliveries and the performance of these procedures. The intention is not to provide rigid standards for vaginal-operative deliveries but to show the range within which obstetric activities correspond to the current state of scientific knowledge and current clinical practice. Methods This S2k-guideline was developed based on the structured consensus of representative members from different medical professions who were commissioned by the guidelines program of the DGGG, OEGGG and SGGG. Recommendations The guideline provides recommendations on measures to avoid vaginal-operative births, the conditions in which these births should be carried out, the information provided to patients, the indications, contraindications, classifications, and choice of instruments, the procedure, antibiotic prophylaxis, complications, postnatal examinations, documentation and legal aspects, debriefing, and training and simulations.

Background: Infectious diseases during pregnancy can pose a serious health risk for mother and child. Employees with an occupational risk of infection are especially at risk. We investigated the immune status of pregnant employees working in the health service to determine the percentage of women who were adequately protected during pregnancy and the percentage of cases with a pregnancy-relevant risk.

Methods: This retrospective data collection was done using the standard records of the Occupational Health Department ( Betriebsärztliche Dienststelle ) of Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany. The data of employees with a pregnancy reported between 1 May 2018 and 31 May 2020 were collected. This resulted in a total study population of 406 cases. We collected data on the respective occupational groups, occupational risk profile, employment bans for expectant mothers, occupational-medical consultations, and immunity status with regards to measles, mumps, rubella, varicella zoster virus, parvovirus B19, CMV, hepatitis A and B, tetanus, diphtheria, pertussis, and poliomyelitis.

Results: The investigated employees had attended a mean of three previous occupational-medical consultations; 45.8% had received advice about maternity protection from the occupational physician's office. The immunity rates of the total study population at the time of their last medical consultation prior to their due date varied, depending on the respective disease, from 77.3% (mumps) to 90.9% (varicella zoster virus). 182 cases (44.8%) were prohibited from working during their further pregnancy.

Conclusion: Medical advice on infection risks and immunization combined with the offer of vaccinations are decisive in determining the immune status and ensure that immunizations can be carried out in good time. To achieve full immunization before becoming pregnant, girls and women should be advised early on about preventive maternity protection measures.