Geburtshilfe Und Frauenheilkunde最新文献

Introduction: The third-generation antibody-drug conjugates (ADC), trastuzumab deruxtecan (T-DXd) and sacituzumab govitecan (SG), recently obtained approval for metastatic breast cancer treatment across various subtypes and therapeutic contexts.

Materials and methods: This retrospective, multicentric study evaluated real-world tolerability, feasibility and efficacy in a pre-treated, real-world cohort at three major German breast cancer centers.

Results: 125 patients treated with T-DXd or SG from November 2020 to June 2023 were included (T-DXd: 77 patients; SG: 48 patients). The median treatment duration was 6.0 months for T-DXd and 3.5 months for SG therapy, with a median follow-up duration of 10.4 months for T-DXd (95% CI: 8.4-11.6) and 11.8 months for SG (95% CI: 8.0-14.4). Severe neutropenia (CTC ≥ III°) occurred in 33.3% during SG therapy, with a numerical reduction observed following primary, prophylactic use of G-CSF. T-DXd-associated pneumonitis occurred in 8 out of 77 patients (10.4 %). Median progression-free survival (mPFS) was 8.6 months (95% CI: 5.8-12.4) with T-DXd (HER2+: 10.8; HER2-low: 4.7) and 4.9 months (95% CI: 2.8-6.3) with SG (TNBC 4.9; HR+/HER2-: not reached). Median overall survival (OS) was 23.8 months (95% CI: 16.1-not estimable) with T-DXd (HER2+: 27.1; HER2-low: not reached), and 12.4 months (95% CI: 8.7-not estimable) with SG therapy (TNBC: 12.4, HR+/HER2-: not reached). 95.7% of the protocol-specified, therapeutic dose was administered for T-DXd and 89.6% for SG.

Conclusion: Overall, this indicates good feasibility, tolerability, and effectiveness of ADC therapies in the real-world setting.

Introduction: The impact of surgical margins on the prognosis of early breast cancer remains uncertain, particularly in the context of modern treatment approaches. This study aimed to investigate whether involved margins after surgery for early breast cancer affect overall survival.

Methods: We conducted a retrospective analysis of 3767 patients who underwent surgery for primary breast cancer or carcinoma in situ between 2006 and 2022 at Charité - University Hospital Berlin. Survival analysis based on margin status and a subsequent multivariate Cox regression analysis were conducted.

Results: With a median follow-up of 72.2 months, clear margins were achieved in 81.4% of patients (n = 3068) after primary surgery, while 16.2% (n = 610) required re-excision. Only 2.4% of patients (n = 89) had definitively involved margins. Margin involvement was more common in hormone receptor-positive disease, lobular subtype, carcinoma in situ, or locally advanced tumors, but less frequent in patients with previous neoadjuvant chemotherapy or triple-negative breast cancer. The Kaplan-Meier survival curves showed a significant separation with worse outcomes for patients with definitive R1 resections. However, the multivariate Cox regression analysis detected no statistically significant difference in overall survival based on margin status. Breast conserving surgery (HR 0.66; 95% CI 0.54-0.81) and HER2 overexpression (HR 0.65; 95% CI 0.48-0.89) were associated with improved survival.

Conclusion: Patients who underwent breast-conserving surgery in our study demonstrated favorable outcomes compared to patients after mastectomy. Although margin status did not significantly affect overall survival, larger multicenter studies are needed to evaluate the prognostic implications of margin involvement in breast cancer treatment in different tumor stages, tumor subtypes and local and systemic treatments.

Endocrine-based combination therapy with an inhibitor of the cyclin-dependent kinases 4 and 6 (CDK4/6 inhibitors) is currently the first-line therapy of choice for patients with hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-), locally advanced or metastatic breast cancer (mBC). The efficacy and safety of the treatment with palbociclib, the first CDK4/6 inhibitor approved for this indication, have been confirmed in large randomized controlled clinical trials (RCTs) with strictly defined patient cohorts. Since then, many relevant questions about CDK4/6 inhibition with palbociclib for mBC have been investigated in RCTs and real-world studies. Based on this evidence, palbociclib is widely used in clinical practice since many years because of its efficacy and good tolerability. The aim of this review is to summarize findings from RCTs and RWE considering clinically relevant aspects such as safety, tolerability, quality of life and efficacy with a focus on specific questions and patient characteristics. A critical discussion and review of the overall evidence for endocrine-based therapy with the CDK4/6 inhibitor palbociclib can contribute to support therapy decisions in daily clinical practice.

Background: Effective healthcare relies on well-trained professionals, and the quality of their training is dependent on appropriate learning methods and assessment techniques. Gamification, the use of game mechanics in non-game environments, has emerged as a promising strategy in medical education. This review explores the applicability and effectiveness of gamification in obstetrics and gynecology education.

Methods: Adhering to PRISMA guidelines, a comprehensive search was conducted on PubMed, Google Scholar, Embase, and Medline databases from January to March 2023. The search terms included "medical students OR residents OR physicians OR midwives AND games OR educational games OR serious games AND gynecology OR obstetrics". The inclusion criteria encompassed studies published in English or German from 1990 to March 2023, focusing on gamification in gynecology and obstetrics education. Data extraction and analysis were structured using the PICOS framework.

Results: The review identified various studies demonstrating the effectiveness of gamification in obstetrics and gynecology education. Gaming shows like Jeopardy significantly boosted knowledge retention and engagement. VR technologies, such as Second Life, enhanced emergency and surgical training. Improvisational games improved empathy skills, though requiring reinforcement. Video games and laparoscopy trainers showed promise in enhancing surgical skills, with gamers performing better in initial tasks. Custom-developed games like Play and Learn for Surgeons significantly improved procedural skills.

Discussion: Gamification in obstetrics and gynecology education boosts learner engagement, knowledge retention, and practical skills. VR technologies and video games are effective for surgical training, while custom games can enhance specific procedural skills. Further research is needed to optimize and integrate gamification strategies into standard curricula, offering a modern approach to equip healthcare professionals with essential skills and knowledge.

Objectives: To evaluate the performance of cerebroplacental ratio (CPR) in predicting composite adverse perinatal outcome (CAPO) in women with obesity compared to non-obese women at term.

Methods: This is a retrospective cohort study in a single tertiary referral centre over a 3-year period. All singleton pregnancies with CPR measurements ≥ 37 + 0 weeks and estimated fetal weight ≥ 10 ^th centile and attempted vaginal delivery were included and divided into two groups defined by pre-pregnancy body mass index (BMI) 2 . The presence of at least one of the following outcome parameters was defined as CAPO: operative delivery (OD) due to intrapartum fetal compromise (IFC), admission to the neonatal intensive care unit, umbilical cord arterial pH ≤ 7.15, 5 min Apgar < 7. The prognostic performance of CPR MoM was evaluated using receiver operating characteristic (ROC) analysis.

Results: The study cohort included 1207 pregnancies, of which 112 were women with a BMI ≥ 30 kg/m ² . In obese women, CAPO occurred in 21 cases (18.8%) compared to 247 (22.6%) cases in women with BMI < 30 kg/m ² (p = 0.404). In the entire study cohort, CPR MoM was significantly lower in the CAPO and OD for IFC group. ROC analyses revealed a significant predictive value of low CPR MoM for CAPO in obese women (AUC = 0.64, p = 0.024). Furthermore, CPR was predictive for OD for IFC not only in obese (AUC = 0.72, p = 0.023) but also in non-obese (AUC = 0.61, p = 0.003) women.

Conclusions: Low CPR MoM was predictive for CAPO and OD for IFC in obese women without additional risk factors. However, the overall predictive performance of CPR for CAPO in obese women was poor.

Introduction: Endometriosis is a chronic disease associated with pain that affects at least 10% of all women of reproductive age. The symptoms of endometriosis have a negative impact on quality of life; they limit the patient physically and psychologically and are the cause of significant anxiety. The aim of our study was to investigate the anxiety levels of women presenting to our specialized endometriosis outpatient clinic at the RWTH Aachen University Hospital. We sought to record their anxiety symptoms and investigate the effect of extensive counseling on anxiety in patients with endometriosis. We hypothesized that detailed counseling and the planning of multimodal endometriosis therapy would reduce anxiety.

Material and methods: Data from 183 patients with lower abdominal pain or suspected endometriosis were analyzed. Prior to the examination, the patients completed a standardized anamnesis form including the German version of the STAI (State Trait Anxiety Inventory). The diagnosis of endometriosis was made in accordance with the recent ESHRE guideline and was based on anamnesis, gynecological examination, and ultrasound by a specialist senior physician with many years of experience in treating endometriosis.

Results: Prior to the medical examination, we observed a mean STAI-State score of 48.44 ± 11.56 and STAI-Trait score 45.68 ± 11.27. Following medical examination and planning of multimodal therapy, there was a significant decrease in the mean STAI-State score from 48.44 ± 11.56 to 42.43 ± 10.01 (p < 0.0001) and a minimal but significant decrease in the mean STAI-Trait score from 45.68 ± 11.27 to 45.01 ± 11.57 (p < 0.05).

Conclusion: Our study showed that endometriosis is associated with high levels of anxiety. Detailed counseling and the planning of a multimodal therapy led to a significant improvement in anxiety levels.

Women often face sleep disturbances during key life stages such as adolescence, pregnancy, postpartum period, and perimenopause, influenced by hormonal fluctuations and conditions like polycystic ovary syndrome (PCOS) and premenstrual syndrome (PMS). The goal is to explore women's sleep disorders as classified in the International Classification of Sleep Disorders-3 (ICSD-3). Through a literature review, this study assesses the management of sleep disorders in women, particularly focusing on the link between gynecological disease and sleep disorders. It scrutinizes landmark research in diagnosing and treating women's sleep disorders. Observations indicate that physiological changes during adolescence, pregnancy, postpartum, and perimenopause can cause sleep issues, commonly addressed by gynecologists. Conditions like PCOS and PMS are notably linked to increased sleep disorder occurrences. The conclusion underscores the importance of gynecologists' awareness of the heightened risk of sleep disturbances in women, who often present these issues during consultations.

Introduction: After caesarean section a uterine niche can be detected in 42-84% of all women and in 11-45% large defects with a residual myometrium < 2.2 mm occur. If the niche compromises > 50% of myometrial thickness, risk of uterine rupture during birth increases. The suturing technique might contribute substantially on pathogenesis of niches. The objective of this study is to investigate the effect of the suturing technique on niche prevalence by using a standardized two-layer surgical technique.

Methods: Women with one previous caesarean section were examined within 6-23 months after caesarean section using contrast medium-supported transvaginal sonography regarding the prevalence, sonomorphological aspect and clinical symptoms of a uterine niche. The surgical technique used was: dilatation of the cervix, interrupted suture of the first layer (excluding the endometrium), continuous closure of the visceral and parietal peritoneum.

Results: Using native vaginal sonography, no niches were visible in the whole cohort. In three cases, there was a small niche detectable with a depth between 2.3 and 3.9 mm by contrast hysterosonography. Regarding the total myometrial thickness, the niche depth compromised less than 50%. All patients were symptom-free.

Conclusion: In our study population, there were only three cases (9.1%) with a small uterine niche. Residual myometrium and niche percentage on myometrial thickness were excellent in all three cases. Thus, our results show that the uterotomy closure technique used in the study cohort might be superior with respect to the development of uterine niches compared with the expected prevalence.