Geburtshilfe Und Frauenheilkunde最新文献

Preterm birth is one of the main causes of perinatal morbidity and mortality. The rate of grade III and IV cerebral hemorrhages in infants with a birth weight of less than 1500 g in Germany in 2022 was 2.97% and the periventricular leukomalacia rate was 1.07%. In addition to these severe forms of brain damage which are visible on sonography, recent MRI studies carried out at the calculated due date of affected children also showed diffuse white and grey matter injuries, especially of the basal ganglia and the cerebellum, indicating impaired brain development and function. To offer these children the best possible start in life it is essential that they are cared for in a level I perinatal center right from the start. In addition, a number of perinatal measures are available which may significantly improve the neuronal development in preterm infants. They include the use of antenatal corticosteroids and magnesium as well as deferred cutting of the umbilical cord. Recent studies have shown that in contrast to term-born infants, hypothermia treatment is unsuitable for neuroprotection in premature babies. As secondary and tertiary cell damage may occur days or even weeks after the primary insult due to persistent inflammation and the lack of trophic stimulation, in addition to providing premature infants with the best possible initial care, it is also necessary to optimize subsequent care in the intensive care unit in terms of providing a neuronal-positive stimulating environment. Breastfeeding and supply of breast milk are particularly important in this context.

There have been major changes in the understanding of gynecologic malignancies in recent years, leading to new therapy options and subsequently to greater responsibilities for every professional treating those patients. The most significant therapeutic advances were achieved with checkpoint inhibitors (CPI), especially for endometrial and cervical cancer. In ovarian cancer the dominant and most important new substances are poly (ADP-ribose) polymerase inhibitors (PARPi). This review aims to summarize the latest studies and developments in the therapeutic landscape of endometrial, ovarian, and cervical cancer. The treatment of advanced endometrial cancer has changed significantly with the introduction of CPI such as dostarlimab (RUBY trial), durvalumab (DUO-E trial) and pembrolizumab (Keynote-868 trial). For ovarian cancer PARPi have shown substantial PFS benefits in key approval trials, including PRIMA for niraparib, PAOLA for olaparib, and ATHENA-MONO for rucaparib. These findings have established PARPi as the standard of care in maintenance therapy. Overall survival (OS) data for PRIMA and PAOLA are now available and are analyzed and placed into context in this article. Furthermore, mirvetuximab soravtansine is the first antibody-drug conjugate (ADC) approved in Germany for platinum-resistant ovarian cancer for patients with folate receptor alpha expression. The Keynote-A18 and BEATcc trials have opened new options for the utilization of immuno-oncology in cervical cancer treatment. Along with new therapeutic options, new biomarkers have also become part of daily clinical practice as predictive and prognostic factors as well as forming the basis for targeted personalized medicine. The use of CPI is revolutionizing the treatment of all gynecologic cancers and offers significant benefits for progression-free survival (PFS) and OS in most therapy regimens. With the increased use of ADCs, this is not the end of these developments. Therapy algorithms from a certified German oncology center are developed and presented in this article.

This year's 19th St. Gallen (SG) consensus conference on the treatment of patients with early breast cancer (SGBCC: St. Gallen Breast Cancer Conference) is based on numerous patient examples, each with different variables, to reflect the increasingly personalized treatment decision for early breast cancer. More than ever, not only breast cancer subtype, performance status, age and life expectancy are considered as individual factors, but various molecular and genetic variables are also part of the treatment decision. In this manuscript, the SGBCC voting results are discussed by a German group of breast cancer specialists in the context of the recently (2025) updated treatment recommendations of the Commission of the Gynecological Oncology Working Group (AGO Mamma). The German treatment recommendations are based on current evidence. As the international panel of the SGBCC consists of experts from different countries and disciplines, the votes represent an international cross-section of opinions. Therefore, it is useful to discuss the voting results with respect to current German treatment guidelines.

Introduction: Postpartum depression is the most common mental health disorder associated with the birth of a child. However, postpartum depression often remains untreated because there are not enough prevention and treatment options. Barriers such as lack of knowledge and fear of stigmatization also make it more difficult for affected women to start treatment. Digital interventions could be an option which might circumvent many of these barriers. This study describes the development process of the smartphone-based intervention Smart-e-Moms which aims to reduce postpartum depressive symptoms.

Material and methods: The app was developed using a participatory and iterative approach. The three steps used for the formative evaluation were: (1) an analysis of needs and preferences (focus groups with 9 formerly affected women and 11 midwives), (2) an analysis of the barriers and facilitating factors to use the app (online survey of 37 mothers), and (3) testing of the app (online interviews with 10 acutely affected women). Qualitative data was analyzed with MAXQDA for content analysis.

Results: Step 1 identified numerous challenges after giving birth such as stress, negative thoughts and feelings, and lack of support, all of which flowed into the contents of the app. Ensuring that the units were short and the topics "self-care" and "relationship to the child" were also considered important. In step 2, barriers and facilitating factors were identified and incorporated into the design of the app. Step 3 consisted of a positive assessment of the first version of the app in terms of content and formal design as well as usability. The final app consisted of 10 behavioral units with written psychological guidance, constantly accessible exercises on self-care and the relationship to the child and permanently available information on common challenges after giving birth.

Conclusion: We present a new and innovative approach which aims to reach out more easily to women with postpartum depressive symptoms. The most important insights from the development process, the final design, and the elements of the program are described here.

Introduction: Because of fetal programming, neonatal macrosomia is associated with a higher long-term risk of metabolic disease. In 2020, the overall macrosomia rate of term-born singletons born to overweight or obese mothers in our center was approximately 30%. The aim of our study was to reduce the macrosomia rate with pregnancy-related nutrition counseling.

Methods: This is a single center, one-arm, interventional pilot study of 99 singleton pregnancies. The intervention took the form of three individual and group education sessions on pregnancy-relevant nutritional topics and exercise in the 10th to 14th, 20th to 24th and 30th to 34th weeks of gestation. The primary endpoint was the overall macrosomia rate born to overweight/obese mothers and birth ≥ 37 weeks of gestation. Macrosomia was defined as the presence of at least one of the following criteria: birth weight ≥ 4000 g, birth weight > 90th percentile, length-related birth weight > 90th percentile, birth weight > 90th percentile after adjustment for initial maternal weight and height. The results were compared with those of a non-interventional cohort from the same center.

Results: Ninety-one percent of pregnant women with a pre-pregnancy BMI ≥ 25 kg/m ² had a delivery at term (n = 77/85). The overall macrosomia rate of these children was 19.5% (95% CI: 11.3% to 30.1%, n = 15/77) and therefore lower than the expected BMI-corrected macrosomia rate of the comparison group of 31.3% (p = 0.026). In the total cohort, which included normal-weight women, a trend toward normalization of birth weights was observed (p = 0.083).

Conclusion: Professional nutrition counseling during pregnancy can reduce the neonatal macrosomia rate of infants born to women with a BMI ≥ 25 kg/m ² . Relevant provision of counseling services in the context of antenatal care would be useful for affected women.

High-grade serous tubo-ovarian cancer is the most common and aggressive type of ovarian cancer characterized by extensive genomic instability and marked inter- and intra-patient tumor heterogeneity. Tumor-site specific signaling crosstalk between cancer cells and the tumor microenvironment influences different tumor ecosystems that drive therapy response and disease progression. Cancer cell-intrinsic genomic aberrations further contribute to the diversity of the tumor immune landscape. Homologous recombination deficiency is considered a key oncogenic driver in 50% of the cases underlying distinctive mechanisms of tumor evolution. The heterogenous character of the tumor microenvironment represents a major challenge to identify predictive biomarkers of therapy response and to stratify subgroups amenable to immunotherapies.

Background: The interdisciplinary research project RESPECT (A Prospective Mixed-Methods- RE search Project on S ubjective Birth Experience and PE rson-centred C are in Paren T s and Obstetric Health Care Staff) aims to investigate the subjective birth experience of (expectant) parents in Germany and associated factors before, during, and after childbirth, including care-related aspects such as person-centred care and mistreatment during childbirth. In addition, the perspective of obstetric health care staff regarding their role in parents' subjective birth experience and person-centred care in obstetrics are explored.

Methods: RESPECT _PARENTS is a prospective cohort study targeting a community sample of expectant parents in the Dresden area with four assessment points from pregnancy to 24 months postpartum using online questionnaires and a structured telephone interview. Applying a mixed-methods approach, the main study is complemented by a sub-study with parents (RESPECT _PARENTS-TALK ) and an additional study branch with obstetric health care staff (RESPECT _STAFF ), both using qualitative interviews.

Results: In this study protocol, the theoretical background, methods, and first results regarding sociodemographic and birth-related variables of the sample (N = 2424 participants including n = 1693 expectant mothers/birthing parents and n = 731 partners) are presented and discussed.

Conclusion: The data will provide meaningful insights into parents' subjective birth experience and health-related effects over time, considering the perspectives of both parents and the obstetric health care staff. The findings can contribute to the development of strategies to improve obstetric health care according to the latest WHO recommendations and the German national health goal "Health around childbirth", and thus to prevent traumatic birth experiences.

Aim This S2k guideline of the German Society of Gynecology and Obstetrics (DGGG) contains consensus-based recommendations for the care and treatment of women with hypertension in pregnancy. It aims to serve as a guide for all professions involved in the care of pregnant women and to improve interprofessional and interdisciplinary cooperation. A new focus was placed on patients' long-term health beyond the postpartum period. Methods The existing S2k guideline was revised and the relevant literature reviewed. Where new questions arose, they were formulated and developed in PICO format. A targeted systematic literature search was carried out using PubMed. Other international guidelines were also consulted. After summarizing and presenting the available data, recommendations and statements were developed, discussed, and agreed on by the guideline group. Recommendations The recommendations cover prediction, prevention, diagnosis, and treatment from the moment hypertensive disease is detected in pregnancy as well as postpartum, in the puerperium, and during breastfeeding. A major change from the previous version of the guideline is the reduction in blood pressure levels that should be achieved during pregnancy. Suggestions are made on how to proceed with regards to the long-term health of mother and child, which the guideline group believes is currently regulated inadequately in the German healthcare system.

[This corrects the article DOI: 10.1055/a-2562-8469.].

Background: Nuchal cord, the situation when the umbilical cord is wrapped around the neck of the fetus, is a common occurrence during pregnancy and intrapartum. Abnormal cardiotocography patterns (CTG patterns) during nuchal cord are usually not associated with increased perinatal morbidity. This retrospective data analysis aimed to investigate the occurrence of specific CTG patterns with nuchal cord.

Methods: 150 CTGs with and 150 CTGs without nuchal cord at 60 and 30 minutes prior to delivery were randomly selected from the obstetric database of Hanover Medical School out of a total cohort of 7573 births (spontaneous delivery, vaginal-operative delivery, secondary caesarean section) between 2014 and 2017. After anonymization in accordance with the 2015 FIGO criteria, CTG patterns were interpreted by three physicians with varying levels of professional experience. The physicians were also asked to assess whether nuchal cord was present or not. The interrater variability between investigators regarding the interpretation of the CTG patterns was also investigated using proportion of agreement and kappa statistics.

Results: Nuchal cord was present in 11% of the total cohort. The study cohort and the total cohort were equivalent in terms of patient characteristics. No significant differences were found in the assessments of the three physicians with regard to CTGs with and without nuchal cord. Likewise, logistic regression analysis was unable to identify a specific CTG pattern in cases with nuchal cord intrapartum. High interpretation variability between physicians was found regarding CTG interpretations (PoA > 0.5).

Conclusion: CTG interpretation just before delivery of the infant is not useful to detect nuchal cord. Moreover, despite the existence of defined criteria, the variability between the CTG interpretations of the three physicians was high.