Geburtshilfe Und Frauenheilkunde最新文献

In hormone-receptor positive (HR+) early breast cancer (EBC), adjuvant endocrine therapy (ET) significantly reduces recurrence and mortality. A common means of estimating therapy adherence is to use patient-reported outcome measures. Yet, this method is inaccurate due to social-desirability bias. We therefore aimed to analyze adherence to ET over the first five years of treatment by using claims data from a large health insurance provider in Germany (AOK Baden-Wuerttemberg). Female patients diagnosed with HR+ EBC who received inpatient treatment and breast cancer surgery between 1 July 2010 and 31 December 2019 were included in the analysis. Adherence to ET was defined as the ratio between the sum of the number of pills from filled prescriptions and the duration of ET in days (from the start of the first prescription after completing surgery and chemotherapy). ET use was observed over five years. Low adherence was defined as a ratio smaller than 0.8 and high adherence as a ratio larger than or equal to 0.8. Distant recurrence-free survival (DRFS) was calculated from the day of the first diagnosis of EBC until onset of distant recurrence. Overall survival (OS) was defined as the period between first diagnosis of EBC until death of any cause. In total, 16642 patients with EBC were included. Of these patients, 4303 (86%) showed high adherence to ET in the first year after initiating treatment. After five years, high adherence persisted in 68% of patients. Continuous high adherence to ET had a significant impact on DRFS (HR: 0.66; 95% CI: 0.58-0.76, p > 0.0001) and OS (HR 0.52, 95% CI: 0.47-0.57, p < 0.0001). In conclusion, adherence to ET is an independent risk factor that significantly influences DRFS and OS. Further real-world studies should explore the factors contributing to treatment discontinuation and evaluate prospective strategies to enhance adherence.

Objective The recommendations of the Shock Section of the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) and the Maternal Disorders Section of the Working Group on Obstetrics and Prenatal Medicine (AGG) aim to improve the diagnosis and management of pregnant patients in shock. In 2018, the DIVI Shock Section published a revised classification of shock types. Given that pregnancy involves extensive physiological changes affecting all organ systems - with direct implications for the development and progression of shock - specific characteristics of shock in pregnancy were analyzed. Methods A selective literature review and iterative consensus process were conducted within the DIVI Shock Section and the Maternal Disorders Section of the AGG. Results Shock, defined as a state of circulatory failure characterized by a critical mismatch between oxygen delivery (DO ₂ ) and consumption (VO ₂ ), is common to all shock types, including in pregnant women. Unique features of pregnancy include altered sensitivity to triggering factors, modified classical shock symptoms, and specific diagnostic and therapeutic approaches to optimize outcomes for both mother and child. Conclusions The statements and recommendations facilitate the identification of underlying causes across the different forms of shock (hypovolemic, distributive, cardiogenic, and obstructive) and support the initiation of appropriate management strategies.

Background: Patients with a history of late miscarriage or preterm birth in a previous pregnancy may have a cerclage with total cervical closure (TCC) in a subsequent pregnancy to increase the likelihood of term delivery. This analysis investigates whether the interpregnancy interval influences the outcome of the subsequent pregnancy.

Methods: In a retrospective cohort of 131 women who received a prophylactic cerclage with TCC following late miscarriage or preterm birth, the impact of the interpregnancy interval on pregnancy outcome was evaluated. Women were divided into three interpregnancy interval groups (0-6, 6-12, and > 12 months). Outcomes assessed included late miscarriage, preterm birth (stratified by gestational age), term birth (≥ 37+0 weeks of gestation), and neonatal parameters (Apgar scores, umbilical cord pH, birth weight, and admission to the neonatal intensive care unit [NICU]).

Results: An interpregnancy interval of more than 12 months was associated with the highest rate of term deliveries (85.4%) and the best neonatal outcomes overall. This group had the lowest NICU admission rates, the highest birth weights, and the best Apgar scores. Very early preterm births (< 28+0 weeks) were observed more frequently in the shorter interval groups. Umbilical artery pH showed no correlation with the interpregnancy interval.

Conclusion: A longer interpregnancy interval of more than 12 months was associated with a higher rate of deliveries ≥ 37+0 weeks and improved fetal outcomes in women with prophylactic cerclage and TCC after prior preterm birth or late miscarriage. In contrast, very early preterm births (< 28+0 weeks) occurred more often with shorter intervals.

Objective: These recommendations by the AGG (Committee for Obstetrics, Department of Maternal Diseases) on how to treat iron-deficiency anemia during pregnancy aim to improve the diagnosis and management of iron-deficiency anemia in pregnancy.

Methods: The task force members developed the following recommendations and statements based on the current literature. Recommendations were adopted after the members of the working group achieved consensus.

Recommendations: This article gives an insight into the diagnosis and management of iron-deficiency anemia in pregnancy and provides recommendations on its treatment.

For up to eight years after menarche, adolescents are in a developmental stage where PCOS (polycystic ovary syndrome) symptoms are physiological. The diagnostic criteria for PCOS in adult women therefore only partially apply. A new German S2k guideline and the international PCOS guideline of 2023 provide standardized diagnostic criteria for hyperandrogenemia and menstrual disorders in adolescence. The provisional diagnosis of PCOS at risk has been introduced for adolescents who only partially meet the criteria and this diagnosis must be revisited three and eight years after menarche. Recommendations for therapy focus on providing information and lifestyle advice to adolescents and on the prevention and treatment of possible comorbidities such as obesity, insulin resistance and hypertension. This paper presents an overview of a structured diagnostic workup and therapeutic approaches to support adolescents with PCOS.

Aim: Endometriosis is a gynecological disorder characterized by endometrial-like tissue outside the uterus. This study evaluates the vascularization and proliferation of human endometriosis and endometrium tissues engrafted onto the chorioallantoic membrane of chicken embryos using immunohistochemistry and laser speckle contrast analysis imaging. For the assessment of clinical relevance, a comparison between laboratory and clinical data was performed.

Material and methods: Tissue samples from 10 patients categorized by #Enzian scores and undergoing endometriosis surgery were investigated in the chorioallantoic membrane model. Hematoxylin-eosin staining and immunohistochemical markers, including CD10, cytokeratin, Ki67, and Caspase-3, assessed cellular structures, proliferation, and apoptosis. Changes in blood perfusion, implemented as a surrogate marker for angiogenesis and vascularization, were analyzed over three days using laser speckle contrast analysis. The fertilized chicken eggs used for the chorioallantoic membrane model were stratified for their gender utilizing an in ovo sexing technique.

Results: Immunohistochemistry confirmed stromal and glandular cells in transplanted tissues. Ki67 indicated variable proliferation, while Caspase-3 identified apoptosis. Perfusion increased significantly in 75% of endometriosis samples. Endometrium from a patient with endometriosis showed increased perfusion, contrasting with stable perfusion in healthy endometrium. Higher #Enzian scores partly correlated with increased vascularization.

Summary: The chorioallantoic membrane model is a viable platform for studying endometriosis vascularization and angiogenesis. Endometriosis tissue showed enhanced vascularization influenced by lesion size and anatomical location, offering insights into disease progression and therapeutic strategies.

Background: The dynamic advances in robot-assisted surgery have particularly affected gynecological surgery. An analysis of the surgical data of robot-assisted procedures, starting when the procedure is first introduced into a surgical center, provides valuable insights into the initial use and integration of the da Vinci system in routine clinical practice and the impact on patient care. This article aims to investigate the learning curve and show the increased proficiency with this approach. This analysis focuses on the most common procedure performed during the introductory phase: benign total hysterectomy with salpingectomy.

Material and method: A retrospective data analysis was carried out of the first 250 patients operated on between February 2020 and June 2022 by five different surgeons in Freiburg University Hospital using the da Vinci surgical system. The evaluation includes classic surgical parameters such as preparation times, incision-to-suture times, and console times as well as the learning curves of the surgeons and the surgical team (incl. CUSUM analysis). Perioperative patient characteristics (e.g., blood loss, hospitalization times, conversion rate) are also presented.

Results: Most procedures (30%) were carried out for uterine fibroids. Operating times decreased significantly over time as more and more robot-assisted procedures were carried out: the surgical preparation time decreased over the first 30 procedures from 28.1 ± 8.6 min to 23.8 ± 7.2 min. The initial incision-to-suture time for benign total hysterectomies with salpingectomy was 94.0 ± 42.2 min and had decreased significantly by the end of the first 20 procedures. The average console time was 66.8 ± 36.1 min, and the decrease was particularly visible over the first 20 procedures. The individual learning curves of the surgeons showed significant decreases in time. For example, the average console time of surgeon A decreased over the first ten procedures from 70.5 ± 23.0 min to 46.9 ± 13.5 min. The conversion rate for the whole cohort was 0.8%.

Discussion: The evaluation of the first 250 da Vinci surgeries demonstrates the easy learnability of robot-assisted surgery. The conversion rate was very low, coming in at just 0.8%. A positive effect on the learning curve of individual surgeons was found after about 20 procedures. Both the preparation times and the incision-to-suture times decreased rapidly, meaning that there were no problems integrating the new approach into routine clinical practice.

Prenatal diagnostics are used to identify the causes of fetal anomalies detected on ultrasound. If ultrasound findings appear to indicate a genetic disorder, sequencing methods offer the opportunity to safely diagnose numerous genetic disorders prenatally with the help of diagnostic puncture and aspiration. Depending on the type of ultrasound abnormality, massive parallel sequencing (MPS) (the terms "high throughput sequencing" and "next generation sequencing" [NGS] are often used synonymously) can identify up to 50% of the causes of fetal malformations (skeletal abnormalities). Confirmation of a genetic disorder makes it possible to inform and advise pregnant women or parents who are looking for advice about the expected development of their unborn child and provides a science-based assessment of the risk of recurrence. This review article describes the benefits and special features of prenatal diagnostic tests using next generation sequencing and looks ahead at the developments in molecular genetic diagnostic procedures which may be used for the prenatal confirmation of genetic disorders in the future.

Purpose The purpose of this official guideline, updated and published by the German Society for Gynecology ( Deutsche Gesellschaft für Gynäkologie und Geburtshilfe , DGGG) and coordinated by the joint guidelines program of the DGGG, Austrian Society for Gynecology and Obstetrics ( Österreichische Gesellschaft für Gynäkologie und Geburtshilfe, OEGGG) and Swiss Society for Gynecology and Obstetrics ( Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe , SGGG) is to provide a consensus-based overview of the diagnosis and management of intrauterine growth restriction based on an evaluation of the relevant literature. Methods This S2k-guideline is the result of a structured consensus of representative members from various medical professions. It was compiled at the request of the guidelines commission of the DGGG. Recommendations The guideline provides recommendations on the diagnosis, management, counseling, prophylaxis, and screening of fetal growth restriction.