Geburtshilfe Und Frauenheilkunde最新文献

Introduction: Endometriosis is a very common benign condition in women. In recent years certification of health care institutions has led to a more standardized care for endometriosis patients, aiming at improving the quality of diagnosis and treatment. The introduction of a common classification system facilitates quantification of disease extent. This study investigated whether certification of a rural endometriosis clinic ameliorated care in endometriosis patients.

Methods and material: A single-center retrospective data analysis was performed of all endometriosis patients that underwent surgery at the investigated institution, certified in 2019, for the years 2018-2022.

Results: Between 2018 and 2022, a total of 812 surgeries were performed, with certification significantly improving diagnostic and surgical outcomes. Post-certification, there was an increase in ultrasound utilization (47.7% vs. 35.6%, p = 0.007), greater recognition of adenomyosis (65.8% vs. 57.0%, p = 0.035), and higher rates of complete lesion removal (92.5% vs. 87.8%, p = 0.011). Pain outcomes also improved, with more patients achieving pain relief 12 months postoperatively (40.5% vs. 34.5%, p = 0.196 vs. < 0.001). Additionally, certification enhanced follow-up assessments (64.1% vs. 40.7%, p < 0.001) and documentation of rectal lesions in patients with dyschezia (p < 0.001), indicating a positive impact on overall care quality.

Conclusion: This study shows that certification significantly improved care for endometriosis patients. Certification enhanced diagnostic precision, increased the use of ultrasound, improved surgical outcomes, and enabled more nuanced application of the #Enzian scoring system. Follow-up assessments became more consistent, reflecting stronger quality control. Despite remaining challenges, certification elevated the clinic's standard of care and emphasized patient-centered management.

Introduction: The aim of this single center cohort study was to examine the possible effects of SARS-CoV-2 infection, especially the Omicron variant, on outcome of pregnancy and birth after infertility treatment with assisted reproduction.

Material and methods: A total of 51 pregnancies and births after assisted reproduction were investigated in the period from 01/2022 to 12/2022 in a university fertility center with regards to SARS-CoV-2 infections and vaccination status. Eight multiple pregnancies were assessed separately. 20 women with singleton pregnancy had a confirmed SARS-CoV-2 infection in the six months prior to or during the pregnancy. This group was compared to 23 singleton pregnancies without SARS-CoV-2 infection or with infection had occurred more than six months before assisted reproduction.

Results: The comparison of single pregnancy with or without SARS-CoV-2 showed no differences considering age or body mass index. Complications of pregnancy such as preeclampsia, pregnancy-induced hypertension, placenta previa, placental insufficiency, and preterm labor were also comparable for both groups. There were no significant differences between the two groups with regards to gestational age at delivery, birth weight, birth mode, and APGAR scores. A comparison of the course of pregnancy in women with and women without basic immunization also showed no significant differences.

Conclusion: In the study period of 2022, infection with SARS-CoV-2, in most cases with the Omicron variant, during or up to six months prior to a pregnancy following assisted reproduction did not significantly affect the risk of maternal and fetal complications of pregnancy from the 2nd trimester of pregnancy or the fetoneonatal outcome.

Objective: Minimally invasive surgery (MIS) to treat endometrial cancer offers advantages over laparotomy, although concerns about its oncological safety for high-risk tumors and feasibility in patients with significant comorbidities remain. This study evaluates perioperative and long-term outcomes of MIS versus open surgery in a tertiary referral center cohort, using FIGO 2010 and 2023 classifications.

Methods: This is a retrospective analysis of perioperative outcomes, recurrence rates, and survival after endometrial cancer surgery (2000-2021) at an ESGO training center and tertiary referral center in Germany. 760 patients underwent hysterectomy, and adequate data for risk classification (without molecular diagnostics) was available for 330 of them.

Results: More than one third of the patients were aged 70 years or older and approximately half of the patients were obese. A high proportion presented with comorbidities such as hypertension or diabetes. MIS demonstrated favorable perioperative results in both low-risk and high-risk patients. Survival analysis showed a superior outcome with MIS for low-risk (5-year RFS rate: 79.8% vs. 59.2%, p = 0.035; OS rate: 83.8% vs. 58.0%, p = 0.010) and FIGO 2023 stage I disease (OS: p = 0.014). The oncological safety of MIS was equivalent to that of open surgery for high-risk tumors (5-year RFS rate: 60.5% vs. 54.3%, p = 0.506; OS rate: 67.5% vs. 58.3%, p = 0.416) and FIGO 2023 stages II (RFS, p = 0.453; OS, p = 0.378) and III (RFS, p = 0.419; OS, p = 0.850).

Conclusion: MIS was found to have superior outcomes for low-risk endometrial cancer and a comparable safety for high-risk patients, including those with older age or significant comorbidities. These findings support the use of MIS approaches as viable options across diverse risk groups, in line with FIGO 2023.

Introduction: Real-world data on treatment patterns and outcomes in recurrent or metastatic cervical cancer (r/mCC) are lacking.

Methods: This first national quality assurance initiative was a retrospective analysis of patients with r/mCC diagnosed between 2018 and 2022, who were identified from medical records of 31 gynecologic cancer centers in Germany. Patient demographic and clinical characteristics, treatment patterns, and clinical outcomes were assessed descriptively. Progression-free (PFS) and overall survival (OS) were calculated using Kaplan-Meier analysis.

Results: A total of 503 eligible patients (median age 55 years) were analyzed for r/mCC. 276/503 patients (55%) received first-line (1L) chemotherapy (platinum combination: 247/276; 79%) followed by targeted antibody therapy with bevacizumab (177/247; 72%), immunotherapy (19/247; 8%), or both combined (50/247; 20%). 111/503 (22%) received chemotherapy only (platinum combination: 64/111; 58%, platinum mono: 35/111; 31%, or platinum-free: 12/111; 11%), and 110/503 (22%) did not receive any systemic treatment (the remaining 6/503 patients received immunotherapy only). For these subgroups after a median follow-up of 16 months, the PFS was 12 months (95% CI 11-14), 8.8 months (95% CI 7.1-11), and 3 months (95% CI 2.3-4.8), and OS was 25 months (95% CI 21-31), 17 months (95% CI 14-22), and 3.6 months (95% CI 2.8-5.3), respectively. 176/283 (62%) patients who developed progressive disease (PD) were treated with second-line (2L) therapy.

Conclusion: Only half of the patients with r/mCC were treated 1L with platinum-combination therapy including antibody therapy according to national guidelines. Moreover, 22% at initial diagnosis and 38% of patients at PD were not treated with systemic therapy at all. This might reflect poor general performance status, patients' preference, and/or lack of effective therapies especially in 2L treatment.

The use of CDK4/6 inhibitors, the new PI3K/AKT-kinase inhibitors, selective estrogen receptor-degraders (SERDs), antibody-drug conjugates, immune therapies and PARP inhibitors in recent years has resulted in a marked change in the therapy landscape for patients with advanced stage breast cancer. CDK4/6 inhibitors, trastuzumab deruxtecan, and sacituzumab govitecan have all been shown to provide significant overall survival benefits compared to conventional chemotherapy. Other substances are also showing promising results and hold out the hope that further analysis of the overall survival benefits will be available in the near future. The speed at which studies are now being carried out has markedly increased, and conferences and specialist journals are now constant sources of new information. This review summarizes the most recent publications and conference presentations on the treatment of patients with advanced stage breast cancer.

Introduction: Serous tubal intraepithelial carcinomas (STIC) are classified as precursor lesions of high-grade serous carcinomas (HGSC) in women. STIC are rare and their incidence, prognosis and therapy remain unclear. Since 2021, all cases of isolated STIC in Germany must be reported, which means that all STICs in the German federal state of the Rhineland-Palatine (RLP) are available for evaluation.

Material and methods: A systematic search of the pathology reports in the RLP cancer registry was carried out for the period 01/2016-12/2023 using keywords related to STIC, and the results of the search were evaluated.

Results: 382 pathology reports were identified as relevant and screened. A total of seven patients with isolated STIC were reported to the RLP registry in the years 2020-2022. This corresponds to 0.014% of all reported cases of cancer in women in RLP in this period. Six patients had a diagnosis of isolated STIC, identified during risk-reducing salpingo-oophorectomy (RRSO). The mean patient age at the time of RRSO was 60.29 (± 7.09) years. RRSO was carried out on average 9.38 (± 6.75) years after a primary diagnosis of breast cancer/DCIS in five patients. No HGSC was reported for any of the patients with isolated STIC in the follow-up period until 01/2024. 43 synchronous STICs were reported for the period from 01/2016 to 12/2023.

Conclusion: 2-3 diagnoses of isolated STIC were recorded annually in RLP in the years 2020-2022. To date, there have been no reports of HGSC in these patients. In the future, the systematic recording of STICs will be expanded to include the cancer registries of other federal states of Germany and it will be possible to obtain valid data on the incidence of STIC in Germany. The collected data will also provide the basic information for a national STIC registry.

This review summarizes the latest developments for the treatment of patients with early-stage breast cancer. Most of the clinically relevant changes were the result of using immune checkpoint inhibitors to treat patients with triple-negative breast cancer (TNBC) and CDK4/6 inhibitors to treat patients with hormone receptor-positive, HER2-negative (HRpos/HER2neg) tumors and a high risk of recurrence. Recent studies are presenting more and more data with long follow-up times and integrating translational analyses to evaluate new biomarkers such as circulating tumor DNA (ctDNA). This review article summarizes the latest developments published in recent months and puts the findings in context.

[This corrects the article DOI: 10.1055/a-2576-6293.].

Introduction COVID-19 in pregnancy is associated with increased maternal and neonatal morbidity and mortality. The aim of our study was to investigate the effectiveness of COVID-19 vaccination in SARS-CoV-2-infected pregnant women with focus on women with gestational diabetes mellitus on pregnancy outcomes. Patients and Methods COVID-19 Obstetric and Neonatal Outcome study is a multicenter prospective observational study which registered SARS-CoV-2-infected pregnant women from April 2020 to December 2022. In March 2021, the study was complemented by the SATELLITES study which recruited vaccinated women until September 2023. Primary composite maternal and neonatal endpoints were defined. Multivariate adjusted logistic regression analysis was performed to evaluate the impact of vaccination on pregnancy outcomes. Vaccine effectiveness was defined as (1-adjusted odds ratio)*100. Results We registered 10 386 pregnant women, 6112 of whom were analyzed. 30% of women were vaccinated against COVID-19. Vaccination in women with gestational diabetes mellitus was associated with a vaccine effectiveness of 75% (95% CI: 16 - 93), depending on the predominant virus variant, and of 67% in the total cohort (95% CI: 36 - 83). No statistically significant difference was found in vaccine effectiveness with regards to perinatal outcomes of women with gestational diabetes mellitus (16%; 95% CI -58 - 55) but there was an impact in the total cohort (26%; 95% CI 8 - 94). Conclusion For pregnant women with gestational diabetes mellitus who were infected with SARS-CoV-2, at least one vaccination against COVID-19 before or during pregnancy was independently associated with a milder course of COVID-19 in mothers compared to no vaccination. We found no evidence of improved perinatal outcomes. The data emphasize the benefits of vaccination before or during pregnancy.