Geburtshilfe Und Frauenheilkunde最新文献

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.

Background: Ductal carcinoma in situ (DCIS) of the female breast is treated with surgery possibly followed by radiotherapy (RT) and/or adjuvant hormonal therapy despite their known long-term side effects. Since not every DCIS will progress into an invasive breast cancer (IBC), disease progression and de-escalation of treatment is an important topic of current research.

Methods: During 2007-2020, 3905 individuals with a DCIS diagnosis were reported to the cancer registry of Brandenburg and Berlin. We selected 3424 women who were cancer-free prior to DCIS diagnosis and without synchronous diagnoses of DCIS or ipsilateral IBC (iIBC). The objective was to describe changes over time in DCIS treatment and risk of developing iIBC by treatment.

Results: We observed decreasing proportions of mastectomy, breast-conserving surgery (BCS) with RT, and standard versus hypofractionated RT over time. During a median follow-up of 3.8 years, 105 women developed iIBC. Compared with BCS + RT with standard fractionation (54.9%, 1878/3424, 53 iIBC events), hazard ratios (HR) for ilBC were 0.72 (95% confidence interval [CI] 0.26, 1.99; 4 events) for BCS + hypofractionated RT, 0.70 (95% CI 0.33, 1.41; 11 events) for BCS alone, and 0.83 (95% CI 0.50, 1.37; 26 events) for mastectomy. Analyses were adjusted for DCIS size, grade, residual tumor status and ECOG score.

Conclusion: We observed a de-escalation of treatment over time, with fewer mastectomies, less RT, and more hypofractionation of RT. No substantial differences in risk of iIBC were observed between these treatments. There is a need to evaluate DCIS treatment de-escalation in larger cohorts with longer follow-up.

Background: A dignified final phase of life spent at home is what many people with terminal cancer wish for. There are currently no studies with large datasets on the palliative care of patients with gynecological tumors in the home environment.

Material and methods: Data from 5487 patients with gynecological-oncological disease who received specialized outpatient palliative care (SAPV) between 2017 and 2021 were included in the analysis.

Results: The analysis showed that 88.8% of the patients died in a home environment and that their symptom burden remained stable or even decreased slightly during treatment. The median duration of active SAPV was 23 days. Factors such as age, comorbidities, and symptom burden at the start of treatment influenced the survival time of patients. The SAPV team and relatives who provided care in the home environment were mostly very satisfied with the care provided.

Conclusion: The study provides important insights into the palliative care of patients with gynecological tumors and underscores the importance of SAPV for dignified end-of-life care.

The International Federation of Gynaecology and Obstetrics (FIGO) introduced a new staging system for endometrial carcinoma FIGO 2023 in June 2023. The new staging system differs significantly from previous versions by incorporating other non-anatomical parameters (histological type of tumour, tumour grade and the presence of massive lymphovascular space involvement as well as the molecular classification of the tumour). The FIGO 2023 staging system enhances the accuracy of prognostic assessments for patients at a specific stage with better options for targeted treatment. Another objective was to synchronise staging as much as possible with the European oncogynaecological ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma established in 2021. However, several changes are controversial. Routine molecular classification of endometrial carcinomas is not yet commonly available in most countries of the world. Another limitation of the FIGO 2023 staging system of endometrial cancer is the inclusion of variables whose definitions are still evolving, as well as variables that are subject to considerable interobserver variability in their assessment. Advantages, controversies, and limitations for clinical practice of the new FIGO 2023 endometrial cancer staging system are discussed.

Background: Endometriosis is a disease which affects the quality of life and fertility of many young women. Choosing the right time for surgery is important for the outcome of patients. We evaluated the surgical variables affecting postoperative pregnancy rates.

Method: This study is a retrospective analysis of women treated for endometriosis in Frankfurt University Hospital between 2007 and 2017. A total of 695 patients underwent laparoscopic surgery, of whom 125 patients fulfilled the inclusion criteria of wanting to have a child for more than one year. Finally, 102 patients (82%) with surgery and infertility were followed up for 70 months.

Results: We found a cumulative pregnancy rate of 69.6% after 38 months in our patients. The duration of infertility before surgery had a significant effect on postoperative pregnancy rates. There was no significant difference between the different kinds of surgical techniques, but complete treatment of all visible lesions significantly increased the chance of pregnancy (hazard ratio 2.2). Repeated abdominal operations reduced the chance of postoperative pregnancy and prolonged the time to pregnancy.

Conclusions: In patients with endometriosis and infertility, both laparoscopic surgery with complete resection of all visible lesions and the timing of surgery are important to achieve pregnancy. Early intervention with careful planning of the operation is critical. It is important to avoid repeated operations to achieve the best results regarding pregnancy.

Introduction: Preconception obesity is a risk factor for pregnancy and delivery, which is why giving birth in a perinatal center (care levels I and II) is recommended. There are currently no studies which have investigated the birth outcomes of obese patients based on the care level of the maternity hospital. This study aims to assess the effect of a higher body mass index prior to conception on maternal and fetal outcomes in a maternity hospital (care level IV).

Patients and methods: A total of 5616 pregnant women who gave birth between 2016 and 2023 were investigated in this retrospective cohort study, after taking the inclusion and exclusion criteria into account. Primary outcome parameter of this study was the transfer of the neonate to a neonatal intensive care unit. Other target parameters were the need to induce labor, delivery mode, Apgar score and pH value, and the incidence of complications (shoulder dystocia, higher-degree perineal tears, or peripartum hemorrhage).

Results: Overweight and obesity were associated with a higher rate of hypertensive disorders of pregnancy and gestational diabetes and were accompanied by higher rates of induction of labor and elective and secondary caesarean sections. Maternal outcome parameters such as intrapartum fever, preterm placental abruption, uterine rupture, higher-degree birth injuries and peripartum hemorrhage did not occur significantly more often in obese pregnant women. Fetal outcome parameters such as Apgar score and pH value did not differ from those reported for normal-weight pregnant women. Multivariate regression analysis showed a high risk of transfer to a neonatal intensive care unit (OR = 1.97; p = 0.035) for neonates born to women in obesity class II (BMI 35-39.9 kg/m ² ), women with gestational diabetes (OR = 1.71; p = 0.033), and nulliparous women (OR = 1.59; p = 0.005).

Conclusion: Obesity class II is associated with a slightly higher risk of transfer of the neonate to a pediatric intensive care unit but is not associated with worse Apgar scores or pH values. Pregnant women with a body mass index between 35 and 40 kg/m ² should be informed of this and should consider giving birth in a facility with a neonatal department (care level I-III).

Introduction: In Germany, 0.25% of the total population are persons with a Vietnamese migration background. There are almost no studies on this particular group of immigrants. We compared the perinatal data of women with a Vietnamese migration background with the pregnancy outcomes of non-Vietnamese women also living in Germany.

Methods: After using name analysis to allocate women into different groups, the perinatal data of women with a Vietnamese migration background who gave birth between 1.1.2016 and 31.12.2019 in Campus Charité Mitte in Berlin were retrospectively evaluated. These data were compared in a 3:1 ratio with the data of women of non-Vietnamese origin and the same age and parity. Multivariate regression analysis was used to determine factors which influenced caesarean section rates, the transfer rates of neonates to the neonatal department, and the rates of higher degree perineal tears.

Results: The perinatal data of 470 women with a Vietnamese migration background, 209 (44.5%) of whom were registered as living in a refugee shelter, were compared with those of 1410 controls. An "ideal pregnancy outcome," which included giving birth after 37 + 0 weeks of gestation, a 5-minute Apgar score ≥ 8, arterial cord blood pH ≥ 7.20, no transfer of the newborn to the neonatal department, and spontaneous birth or vacuum extraction without a higher degree perineal tear, was recorded for 44.5% of women with and 38.1% of women without a Vietnamese migration background (p = 0.1), despite the lower attendance rates at antenatal screening appointments of Vietnamese women. Accommodation in a shelter for refugees was a protective factor against caesarean section (OR 0.5, 95% CI: 0.36-0.73) and transfer of the newborn to the neonatal department (OR 0.45, 95% CI: 0.23-0.89). A Vietnamese migration background was a risk factor for a third-degree perineal tear (OR 5.4, 95% CI: 1.4-21.30).

Conclusion: Despite lower levels of antenatal care, women with a Vietnamese migration background did not have poorer pregnancy outcomes.