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Kehl S. Obesity at term: What to consider? How to deliver? Arch Gynecol Obstet 2024; 309:1725-1733. [PMID: 38326633 DOI: 10.1007/s00404-023-07354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
Obesity presents significant challenges during pregnancy, increasing the risk of complications and adverse outcomes for both mother and baby. With the rising prevalence of obesity among pregnant women, questions arise regarding optimal management, including timing of delivery and choice of delivery mode. Labour induction in obese women may require a combination of mechanical and pharmacological methods due to increased risk of failed induction. Caesarean section in obese women presents unique challenges, requiring comprehensive perioperative planning and specialized care to optimize outcomes. However, specific guidelines tailored to obese patients undergoing caesarean sections are lacking. Postpartum care should include vigilant monitoring for complications. Addressing obesity in pregnancy necessitates a multidisciplinary approach and specialized care to ensure the best outcomes.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Universitätsstr. 21-23, 91054, Erlangen, Germany.
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2
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Psilopatis I, Emons J, Levidou G, Hildebrandt T, Pretscher J, Kehl S. Feasibility and Satisfaction With the Word Catheter in Treatment of Bartholin's Cyst and Abscess. In Vivo 2024; 38:1292-1299. [PMID: 38688643 PMCID: PMC11059863 DOI: 10.21873/invivo.13568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND/AIM The Word catheter is a silicone device with a balloon system that may be inserted into a Bartholin's cyst or abscess in order to provide drainage and epithelization. The aim of this study was to evaluate the Word catheter as a therapy for Bartholin's cyst and abscess. Both patient and physician satisfaction, as well as the feasibility in an outpatient setting, were examined. PATIENTS AND METHODS A total of 51 women with a Bartholin's cyst or abscess were given the option of Word catheter insertion in an outpatient setting between August 2013 and March 2018. Both the patients and the consulting physicians were asked to complete two questionnaires, before, during and after treatment, with a view to evaluating the overall pain level, any discomfort symptoms and sexual activity, as well as satisfaction levels. RESULTS The insertion procedure seemed to constitute a short yet quite painful procedure. In most cases, the consulting physicians and the patients were content with the results. Nevertheless, dislodgement of the catheter or abscess recurrence were common. The removal of the Word catheter seemed to be short, painless, and uncomplicated. Most patients experienced pain and discomfort after catheter placement over the first days, with the symptoms fading over time. Sexual intercourse appeared to be negatively influenced. CONCLUSION The Word catheter was frequently well tolerated for the treatment of Bartholin's cysts and abscesses, with few non-serious side-effects, however, it did interfere with sexual health. Nonetheless, it may not be possible to make general recommendations based on this exploratory study.
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Affiliation(s)
- Iason Psilopatis
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Georgia Levidou
- Department of Pathology, Medical School, Klinikum Nuremberg, Paracelsus University, Nuremberg, Germany
| | - Thomas Hildebrandt
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jutta Pretscher
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sven Kehl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany;
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3
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Schiermeier S, von Kaisenberg CS, Kehl S, Reister F, Mosimann B, Reif P, Harlfinger W, König K, Schwarz C, Matern E, Kühnert M, Schmitz R, Hoopmann M, Ramsell A, Kalberer BS, Heule PG, Heinzl S, Kayer B, Gruber P, Steiner H, Schäffer L. Fetal Assessment in Pregnancy (Indication and Methodology for Fetal Monitoring in a low-risk Population). Guideline of the DGGG, DEGUM, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/089, February 2023). Ultraschall Med 2024; 45:147-167. [PMID: 37582399 DOI: 10.1055/a-2113-7638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
PURPOSE The aim of this guideline was to find evidence on whether carrying out Doppler examinations and CTGs in low-risk cohorts of pregnant women improves outcomes. METHODS First, a systematic search for guidelines was carried out. Identified guidelines were evaluated using the DELPHI instrument of the AWMF. Three guidelines were found to be suitable to evaluate CTG. Two DEGUM best practice guidelines were judged suitable to describe the methods. All studies on this issue were additionally analyzed using 8 PICO questions. A structured consensus of the participating professional societies was achieved using a nominal group process and a structured consensus conference moderated by an independent moderator. RECOMMENDATIONS No antepartum Doppler sonography examinations should be carried out in low-risk cohorts in the context of antenatal care. No antepartum CTG should be carried out in low-risk cohorts. NOTE: The guideline will be published simultaneously in the official journals of both professional societies (i. e., Geburtshilfe und Frauenheilkunde for the DGGG and Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM).
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Affiliation(s)
- Sven Schiermeier
- Lehrstuhl für Frauenheilkunde und Geburtshilfe der Universität Witten/Herdecke, Marien-Hospital Witten, Witten, Germany
| | | | - Sven Kehl
- Gynecology and Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Frank Reister
- Sektion Geburtshilfe, Univ.-Frauenklinik, Univ.-Klinikum Ulm, Ulm, Germany
| | - Beatrice Mosimann
- University Women's Hospital, Department of Obstetrics, Inselspital, Bern, Switzerland
| | - Philipp Reif
- Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Klaus König
- Berufsverband der Frauenärzte, Eschborn, Germany
| | - Christiane Schwarz
- Institute of Health Sciences, Department of Midwifery Science, Universität zu Lübeck, Lübeck, Germany
| | - Elke Matern
- Medical Department, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Maritta Kühnert
- Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany
| | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Beate Kayer
- Österreichisches Hebammengremium, Wien, Austria
| | | | - Horst Steiner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Landeskrankenhaus Salzburg, Paracelsus, Salzburg, Austria
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Dammer U, Pretscher J, Weiss C, Schneider M, Faschingbauer F, Beckmann MW, Kehl S. Perinatal Outcome in Pregnant Women With Isolated Oligohydramnios Diagnosed With the Single Deepest Pocket Method. In Vivo 2024; 38:754-760. [PMID: 38418104 PMCID: PMC10905473 DOI: 10.21873/invivo.13498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 03/01/2024]
Abstract
AIM The aim of this study was to investigate perinatal outcome in singleton pregnancies at term with isolated oligohydramnios, diagnosed by using the single deepest pocket method. PATIENTS AND METHODS In this historic cohort study, the perinatal outcomes of 196 women with isolated oligohydramnios at term, diagnosed by using the single deepest pocket method, were compared to 8,676 women with normal amniotic fluid volume. The primary outcome measure was the Cesarean section rate. Further outcome parameters included the rate of induction of labor, abnormal cardiotocography, umbilical cord pH and base excess, Apgar, meconium-stained liquor and admission to neonatal intensive care unit. RESULTS In the group with isolated oligohydramnios, there were significantly more Cesarean sections (p=0.0081) and more abnormal cardiotocographies (p=0.0005). Univariate and multivariate analyses showed that this difference was seen particularly in nulliparous women (p=0.0025 for Cesarean section and 0.0368 for abnormal cardiotocography). Peripartal and perinatal outcome parameters were not different between the two groups. CONCLUSION In women with isolated oligohydramnios at term, there is no impact on fetal outcome. The influence of isolated oligohydramnios on the rate of cesarean section and abnormal cardiotocography is considered to be less than that of parity.
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Affiliation(s)
- Ulf Dammer
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
- Department of Obstetrics and Gynaecology, St. Theresien Hospital, Nürnberg, Germany
| | - Jutta Pretscher
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim of Heidelberg University, Heidelberg, Germany
| | - Michael Schneider
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany
| | - Sven Kehl
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Erlangen, Germany;
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Kehl S. Zum 228. Jahrgang ein Themenschwerpunkt und neue
Beiräte. Z Geburtshilfe Neonatol 2024; 228:5-6. [PMID: 38330956 DOI: 10.1055/a-2165-7400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Liebe Leserinnen und Leser,ich möchte Ihnen allen im Namen der Herausgeber der Zeitschrift für
Geburtshilfe und Neonatologie (ZGN) und des Thieme Verlags die besten
Wünsche für das neue Jahr übermitteln. Das Jahr 2023 stand
perinatologisch zweifellos im Zeichen der Mindestmengen in der perinatologischen
Versorgung. Die Stellungnahme der Deutschen Gesellschaft für Perinatale
Medizin e. V. (DGPM) zu diesem teils kontrovers diskutierten Thema finden Sie in
dieser ersten Ausgabe im Jahr 2024.
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Affiliation(s)
- Sven Kehl
- Geburtshilfe/Pränatalmedizin, Klinik Hallerwiese, Nürnberg, Deutschland
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6
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Hofbauer A, Schneider H, Kehl S, Reutter H, Pecks U, Andresen K, Morhart P. [SARS-CoV-2 Infection in Pregnancy and Incidence of Congenital Malformations - is there a Correlation? Analysis of 8032 Pregnancies from the CRONOS Registry]. Z Geburtshilfe Neonatol 2024; 228:65-73. [PMID: 38330961 DOI: 10.1055/a-2213-1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Based on single case reports, the COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS) registry, sponsored by the German Society for Perinatal Medicine (DGPM), investigated the likelihood that SARS-CoV-2 infections of the mother in (early) pregnancy cause embryopathies and/or fetopathies. MATERIAL/METHODS The CRONOS registry enrolled a total of 8032 women with confirmed SARS-CoV-2 infection during pregnancy at more than 130 participating hospitals from April 2020 to February 2023. Both maternal and fetal data were documented and the anonymized multicenter data were analyzed. RESULTS Of 7142 fully documented pregnancies (including postnatal data), 140 showed congenital malformations. 8.57% of the mothers had had a SARS-CoV-2-infection in the 1st trimester and 36.43% in the 2nd trimester. In 66 cases with congenital malformations (47.14%), the malformation was only detected after the diagnosis of a maternal SARS-CoV-2 infection. The overall prevalence of congenital malformations in this cohort was 1.96%, compared to a prevalence of 2.39% reported in the EUROCAT (European network of population-based registries for the epidemiological surveillance of congenital anomalies) pre-pandemic registry between 2017-2019. DISCUSSION Our multicenter data argue against a link between maternal SARS-CoV-2 infection in early pregnancy and congenital malformation.
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Affiliation(s)
- Anna Hofbauer
- Neonatologie, Kinder- und Jugendklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Holm Schneider
- Neonatologie, Kinder- und Jugendklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sven Kehl
- Fachbereich Geburtshilfe, Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Heiko Reutter
- Neonatologie, Kinder- und Jugendklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Ulrich Pecks
- Geburtshilfe, Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Kristin Andresen
- Geburtshilfe, Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Patrick Morhart
- Neonatologie, Kinder- und Jugendklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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7
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Wright N, Hill J, Sharp H, Refberg-Brown M, Crook D, Kehl S, Pickles A. COVID-19 pandemic impact on adolescent mental health: a reassessment accounting for development. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-023-02337-y. [PMID: 38170282 DOI: 10.1007/s00787-023-02337-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
Current prospective reports suggest a pandemic-related increase in adolescent mental health problems. We examine whether age-related change over 11-14 years accounts for this increase. Mothers and adolescents in a UK-based birth cohort (Wirral Child Health and Development Study; WCHADS; N = 737) reported on adolescent depression and behavioural problems pre-pandemic (December 2019-March 2020), mid-pandemic (June 2020-March 2021) and late pandemic (July 2021-March 2022). Analysis used repeated measures models for over-dispersed Poisson counts with an adolescent-specific intercept with age as a time-varying covariate. Maturational curves for girls, but not for boys, showed a significant increase in self-reported depression symptoms over ages 11-14 years. Behavioural problems decreased for both. After adjusting for age-related change, girls' depression increased by only 13% at mid-pandemic and returned to near pre-pandemic level at late pandemic (mid versus late - 12%), whereas boys' depression increased by 31% and remained elevated (mid versus late 1%). Age-adjusted behavioural problems increased for both (girls 40%, boys 41%) and worsened from mid- to late pandemic (girls 33%, boys 18%). Initial reports of a pandemic-related increase in depression in young adolescent girls could be explained by a natural maturational rise. In contrast, maturational decreases in boys' depression and both boys' and girls' behavioural problems may mask an effect of the pandemic.
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Affiliation(s)
- N Wright
- Department of Psychology, Manchester Metropolitan University, Manchester, UK.
| | - J Hill
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - H Sharp
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
| | - M Refberg-Brown
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
| | - D Crook
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - S Kehl
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
| | - A Pickles
- Department of Biostatics & Health Informatics, King's College London, London, UK
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8
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Schleier M, Lubig J, Kehl S, Hébert S, Woelfle J, van der Donk A, Bär A, Reutter H, Hepp T, Morhart P. Diagnostic Utility of Interleukin-6 in Early-Onset Sepsis among Term Newborns: Impact of Maternal Risk Factors and CRP Evaluation. Children (Basel) 2023; 11:53. [PMID: 38255366 PMCID: PMC10813840 DOI: 10.3390/children11010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
(1) Background: Interleukin-6 (IL-6) levels act as an early infection marker preceding C-reactive protein (CRP) elevation. This study seeks to analyze IL-6 behavior in suspected early-onset sepsis (EOS) cases among term newborns, comparing it to that of CRP and evaluating IL-6's diagnostic utility. We also aim to assess the impact of maternal risk factors on EOS in term newborns, quantifying their influence for informed decision making. (2) Methods: The retrospective data analysis included 533 term newborns who were admitted to our hospital because of suspected EOS. IL-6, CRP, and the impact of maternal risk factors were analyzed in the context of EOS using binomial test, Chi-squared test, logistic and linear regression. (3) Results: In the cases of EOS, both IL-6 and CRP were elevated. The increase in CRP can be predicted by the initial increase in IL-6 levels. Among the assessed risk factors, intrapartum maternal fever (adjusted odds ratio 18.1; 95% CI (1.7-4.1)) was identified as the only risk factor significantly associated with EOS. (4) Conclusions: Employing IL-6 as an early infection marker enhanced EOS diagnostic precision due to its detectable early rise. However, caution is required, as elevations in IL-6 and CRP levels do not exclusively indicate EOS. Increased CRP levels in healthy newborns with maternal risk factors may be attributed to dynamics of vaginal labor.
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Affiliation(s)
- Maria Schleier
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Julia Lubig
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Sven Kehl
- Department of Gynecology and Obstetrics Medicine, Division of Obstetrics, Friedrich-Alexander-University of Erlangen-Nürnberg, Universitätsstraße 21/23, 91054 Erlangen, Germany;
| | - Steven Hébert
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Adriana van der Donk
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Alisa Bär
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
| | - Heiko Reutter
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
- Institute of Human Genetics, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Tobias Hepp
- Institute for Medical Informatics, Biometry and Epidemiology (IMBE), Friedrich-Alexander-University Erlangen-Nürnberg, Waldstraße 6, 91054 Erlangen, Germany;
| | - Patrick Morhart
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Loschgestraße 15, 91054 Erlangen, Germany; (M.S.); (J.L.); (S.H.); (J.W.); (A.v.d.D.); (A.B.); (H.R.)
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9
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Sourouni M, Germeyer A, Feißt M, Balzer A, Köster H, Minte A, Brüggmann D, Kohll C, Reinhardt K, Möginger M, Leonhardt A, Banz-Jansen C, Bohlmann M, Fröhlich C, Backes C, Hager D, Kaup L, Hollatz-Galuschki E, Engelbrecht C, Markfeld-Erol F, Hagenbeck C, Schäffler H, Winkler J, Stubert J, Rathberger K, Lüber L, Hertlein L, Machill A, Richter M, Berghäuser M, Weigel M, Morgen M, Horn N, Jakubowski P, Riebe B, Ramsauer B, Sczesny R, Schäfer-Graf UM, Schrey S, Kehl S, Lastinger J, Seeger S, Parchmann O, Iannaccone A, Rohne J, Gattung L, Morfeld CA, Abou-Dakn M, Schmidt M, Glöckner M, Jebens A, Sondern KM, Pecks U, Schmitz R, Möllers M. Correction: Multiple Gestation as a Risk Factor for SARS-CoV-2-Associated Adverse Maternal Outcome: Data From the COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS). Geburtshilfe Frauenheilkd 2023; 83:e42. [PMID: 38292374 PMCID: PMC10827381 DOI: 10.1055/a-2232-5598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
[This corrects the article DOI: 10.1055/a-2196-6224.].
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Affiliation(s)
- Marina Sourouni
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Ariane Germeyer
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | - Alexandra Balzer
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | | | - Annemarie Minte
- Department of Obstetrics and Gynecology, Cristophorus Hospital, Coesfeld, Germany
| | - Dörthe Brüggmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Celine Kohll
- Gynäkologie und Geburtshilfe, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Kristin Reinhardt
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Halle, Halle, Germany
| | - Michaela Möginger
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - Anja Leonhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Constanze Banz-Jansen
- Gynäkologie und Geburtshilfe, Evangelisches Klinikum Bethel gGmbH, Bielefeld, Germany
| | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | | | - Clara Backes
- Klinik für Gynäkologie und Geburtshilfe, Schön Hospital Munich Harlaching, München, Germany
| | - Dietrich Hager
- Klinik für Gynäkologie und Geburtshilfe, Thüringen-Kliniken Saalfeld-Rudolstadt, Thüringen, Germany
| | - Lisa Kaup
- Dr. Geisenhofer Clinic for Gynecology and Obstetrics, München, Germany
| | | | | | | | - Carsten Hagenbeck
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Hening Schäffler
- Klinik für Gynäkologie und Geburtshilfe, Ulm University Hospital, Ulm, Germany
| | - Jennifer Winkler
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes Stubert
- Dept. of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Katharina Rathberger
- Klinik für Frauenheilkunde und Geburtshilfe, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Laura Lüber
- Klinik für Gynäkologie und Geburtshilfe, Oberschwaben Hospital Group, Ravensburg, Germany
| | - Linda Hertlein
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU, München, Germany
| | - Antonia Machill
- Department of Obstetrics and Gynecology, Vinzenz Pallotti Hospital, Bensberg, Germany
| | - Manuela Richter
- Neonatologie, Kinderkrankenhaus auf der Bult, Hannover, Germany
| | - Martin Berghäuser
- Klinik für Kinderheilkunde, Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
| | - Michael Weigel
- Frauenklinik, Leopoldina-Krankenhaus der Stadt Schweinfurt GmbH, Schweinfurt, Germany
| | - Mirjam Morgen
- Klinik für Gynäkologie und Geburtshilfe, St. Vincenz-Krankenhaus, Datteln, Germany
| | - Nora Horn
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Peter Jakubowski
- Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, Germany
| | - Bastian Riebe
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Links der Weser gGmbH, Bremen, Germany
| | - Babett Ramsauer
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Robert Sczesny
- Klinik für Gynäkologie und Geburtshilfe, Marienhaus Hospital Saint Elisabeth Neuwied, Neuwied, Germany
| | | | - Susanne Schrey
- Abteilung für Geburtsmedizin, Uniklinik Leipzig, Leipzig, Germany
| | - Sven Kehl
- Gynecology & Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Julia Lastinger
- Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria
| | - Sven Seeger
- Klinik für Geburtshilfe, Krankenhaus St. Elisabeth und St. Barbara Halle, Halle, Germany
| | - Olaf Parchmann
- Klinik für Gynäkologie und Geburtshilfe, HELIOS Hospital Sangerhausen, Sangerhausen, Germany
| | - Antonella Iannaccone
- Klinik für Gynäkologie und Geburtshilfe, University Hospital Essen, Essen, Germany
| | - Jens Rohne
- Klinik für Gynäkologie und Geburtshilfe, Maria Heimsuchung Caritas Klinik Pankow, Berlin, Germany
| | - Luise Gattung
- Klinik für Gynäkologie und Geburtshilfe, Bad Salzungen Hospital, Bad Salzungen, Germany
| | | | - Michael Abou-Dakn
- Klinik für Gynäkologie, St. Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany
| | - Markus Schmidt
- Gynecology & Obstetrics, Sana Kliniken Duisburg GmbH, Duisburg, Germany
| | - Michaela Glöckner
- Abteilung für Gynäkologie und Geburtshilfe, Hospital Memmingen, Memmingen, Germany
| | - Anja Jebens
- Abteilung für Gynäkologie und Geburtshilfe, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | | | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Mareike Möllers
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
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10
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Schneider MO, Faschingbauer F, Kagan KO, Groß U, Enders M, Kehl S. Toxoplasma gondii Infection in Pregnancy - Recommendations of the Working Group on Obstetrics and Prenatal Medicine (AGG - Section on Maternal Disorders). Geburtshilfe Frauenheilkd 2023; 83:1431-1445. [PMID: 38046526 PMCID: PMC10689109 DOI: 10.1055/a-2111-7394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/18/2023] [Indexed: 12/05/2023] Open
Abstract
Aim The AGG (Working Group for Obstetrics and Prenatal Diagnostics, Section Maternal Diseases) has issued these recommendations to improve the detection and management of Toxoplasma gondii infection in pregnancy. Methods Members of the Task Force developed the recommendations and statements presented here using recently published literature. The recommendations were adopted after a consensus process by members of the working group. Recommendations This article focuses on the epidemiology and pathophysiology of Toxoplasma gondii infection in pregnancy and includes recommendations for maternal and fetal diagnosis, transmission prophylaxis, therapy, prevention, screening, and peripartum management.
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Affiliation(s)
- Michael Oliver Schneider
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Karl Oliver Kagan
- Department for Womenʼs Health, University Hospital of Tübingen, Tübingen, Germany
| | - Uwe Groß
- Institute of Medical Microbiology and Virology, University Medical Centre Göttingen, Göttingen, Germany
| | - Martin Enders
- Laboratory Prof. Gisela Enders and Colleagues, Stuttgart, Germany
| | - Sven Kehl
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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11
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Sourouni M, Germeyer A, Feißt M, Balzer A, Köster H, Minte A, Brüggmann D, Kohll C, Reinhardt K, Möginger M, Leonhardt A, Banz-Jansen C, Bohlmann M, Fröhlich C, Backes C, Hager D, Kaup L, Hollatz-Galuschki E, Engelbrecht C, Markfeld-Erol F, Hagenbeck C, Schäffler H, Winkler J, Stubert J, Rathberger K, Lüber L, Hertlein L, Machill A, Richter M, Berghäuser M, Weigel M, Morgen M, Horn N, Jakubowski P, Riebe B, Ramsauer B, Sczesny R, Schäfer-Graf UM, Schrey S, Kehl S, Lastinger J, Seeger S, Parchmann O, Iannaccone A, Rohne J, Gattung L, Morfeld CA, Abou-Dakn M, Schmidt M, Glöckner M, Jebens A, Sondern KM, Pecks U, Schmitz R, Möllers M. Multiple Gestation as a Risk Factor for SARS-CoV-2-Associated Adverse Maternal Outcome: Data From the COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS). Geburtshilfe Frauenheilkd 2023; 83:1508-1518. [PMID: 38046525 PMCID: PMC10689107 DOI: 10.1055/a-2196-6224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/22/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Studies have shown that pregnant women with COVID-19 have a higher risk of intensive care unit admission and invasive mechanical ventilation support than non-pregnant women. Pregnancy-associated physiological changes in respiratory function may contribute to the elevated risk. Alteration in lung volumes and capacities are attributed to the mechanical impediment caused by the growing fetus. Multiple pregnancies may therefore compromise functional lung capacity earlier than singleton pregnancies and contribute to severe respiratory symptoms of COVID-19. Materials and Methods A total of 5514 women with a symptomatic SARS-CoV-2 infection during pregnancy registered in the COVID-19 Related Obstetric and Neonatal Outcome Study were included. The COVID-19-related adverse maternal outcomes were compared in 165 multiple versus 5349 singleton pregnancies. Combined adverse maternal outcome was defined as presence of COVID-19-related hospitalization and/or pneumonia and/or oxygen administration and/or transfer to ICU and/or death. Multivariate logistic regression was used to estimate the odds ratios and 95% confidence intervals were calculated. Results The frequency of dyspnea, likelihood of developing dyspnea in a defined pregnancy week and duration of the symptomatic phase of the COVID-19 infection did not differ between the two groups. On average, COVID-19-related combined adverse outcome occurred earlier during pregnancy in women expecting more than one child than in singleton pregnancies. The overall incidence of singular and combined COVID-19-associated adverse maternal outcomes was not significantly different between groups. However, regression analysis revealed that multiple gestation, preconceptional BMI > 30 kg/m 2 and gestational age correlated significantly with an increased risk of combined adverse maternal outcome. Conversely, maternal age and medically assisted reproduction were not significant risk factors for combined adverse maternal outcome. Conclusion Our data show that multiple gestation alone is a risk factor for COVID-19-associated combined adverse maternal outcome. Moreover, severe courses of COVID-19 in women expecting more than one child are observed earlier in pregnancy than in singleton pregnancies.
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Affiliation(s)
- Marina Sourouni
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Ariane Germeyer
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | - Alexandra Balzer
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | | | - Annemarie Minte
- Department of Obstetrics and Gynecology, Cristophorus Hospital, Coesfeld, Germany
| | - Dörthe Brüggmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Celine Kohll
- Gynäkologie und Geburtshilfe, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Kristin Reinhardt
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Halle, Halle, Germany
| | - Michaela Möginger
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - Anja Leonhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Constanze Banz-Jansen
- Gynäkologie und Geburtshilfe, Evangelisches Klinikum Bethel gGmbH, Bielefeld, Germany
| | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | | | - Clara Backes
- Klinik für Gynäkologie und Geburtshilfe, Schön Hospital Munich Harlaching, München, Germany
| | - Dietrich Hager
- Klinik für Gynäkologie und Geburtshilfe, Thüringen-Kliniken Saalfeld-Rudolstadt, Thüringen, Germany
| | - Lisa Kaup
- Dr. Geisenhofer Clinic for Gynecology and Obstetrics, München, Germany
| | | | | | | | - Carsten Hagenbeck
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Hening Schäffler
- Klinik für Gynäkologie und Geburtshilfe, Ulm University Hospital, Ulm, Germany
| | - Jennifer Winkler
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes Stubert
- Dept. of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Katharina Rathberger
- Klinik für Frauenheilkunde und Geburtshilfe, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Laura Lüber
- Klinik für Gynäkologie und Geburtshilfe, Oberschwaben Hospital Group, Ravensburg, Germany
| | - Linda Hertlein
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU, München, Germany
| | - Antonia Machill
- Department of Obstetrics and Gynecology, Vinzenz Pallotti Hospital, Bensberg, Germany
| | - Manuela Richter
- Neonatologie, Kinderkrankenhaus auf der Bult, Hannover, Germany
| | - Martin Berghäuser
- Klinik für Kinderheilkunde, Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
| | - Michael Weigel
- Frauenklinik, Leopoldina-Krankenhaus der Stadt Schweinfurt GmbH, Schweinfurt, Germany
| | - Mirjam Morgen
- Klinik für Gynäkologie und Geburtshilfe, St. Vincenz-Krankenhaus, Datteln, Germany
| | - Nora Horn
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Peter Jakubowski
- Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, Germany
| | - Bastian Riebe
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Links der Weser gGmbH, Bremen, Germany
| | - Babett Ramsauer
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Robert Sczesny
- Klinik für Gynäkologie und Geburtshilfe, Marienhaus Hospital Saint Elisabeth Neuwied, Neuwied, Germany
| | | | - Susanne Schrey
- Abteilung für Geburtsmedizin, Uniklinik Leipzig, Leipzig, Germany
| | - Sven Kehl
- Gynecology & Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Julia Lastinger
- Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria
| | - Sven Seeger
- Klinik für Geburtshilfe, Krankenhaus St. Elisabeth und St. Barbara Halle, Halle, Germany
| | - Olaf Parchmann
- Klinik für Gynäkologie und Geburtshilfe, HELIOS Hospital Sangerhausen, Sangerhausen, Germany
| | - Antonella Iannaccone
- Klinik für Gynäkologie und Geburtshilfe, University Hospital Essen, Essen, Germany
| | - Jens Rohne
- Klinik für Gynäkologie und Geburtshilfe, Maria Heimsuchung Caritas Klinik Pankow, Berlin, Germany
| | - Luise Gattung
- Klinik für Gynäkologie und Geburtshilfe, Bad Salzungen Hospital, Bad Salzungen, Germany
| | | | - Michael Abou-Dakn
- Klinik für Gynäkologie, St. Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany
| | - Markus Schmidt
- Gynecology & Obstetrics, Sana Kliniken Duisburg GmbH, Duisburg, Germany
| | - Michaela Glöckner
- Abteilung für Gynäkologie und Geburtshilfe, Hospital Memmingen, Memmingen, Germany
| | - Anja Jebens
- Abteilung für Gynäkologie und Geburtshilfe, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | | | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Mareike Möllers
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
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12
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Stumpfe FM, Schneider MO, Antoniadis S, Mayr A, Fleckenstein T, Staerk C, Kehl S, Hermanek P, Böhm J, Scharl A, Beckmann MW, Hein A. Lack of evidence for effects of lockdowns on stillbirth rates during the SARS-CoV-2 pandemic in Bavaria: analysis of the Bavarian perinatal survey from 2010 to 2020. Arch Gynecol Obstet 2023; 308:1457-1462. [PMID: 36348075 PMCID: PMC9643984 DOI: 10.1007/s00404-022-06838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Internationally, potential effects of national SARS-CoV-2-related lockdowns on stillbirth rates have been reported, but data for Germany, including risk factors for fetal pregnancy outcome, are lacking. The aim of this study is to compare the stillbirth rates during the two first lockdown periods in 2020 with previous years from 2010 to 2019 in a large Bavarian cohort. METHODS This study is a secondary analysis of the Bavarian perinatal data from 2010 to 2020, including 349,245 births. Univariate and multivariable regression analyses were performed to investigate the effect of two Bavarian lockdowns on the stillbirth rate in 2020 compared to the corresponding periods from 2010 to 2019. RESULTS During the first lockdown, the stillbirth rate was significantly higher compared to the reference period (4.04 vs. 3.03 stillbirths per 1000 births; P = 0.03). After adjustment for seasonal and long-term trends, this effect can no longer be observed (P = 0.2). During the second lockdown, the stillbirth rate did not differ in univariate (3.46 vs. 2.93 stillbirths per 1000 births; P = 0.22) as well as in multivariable analyses (P = 0.68), compared to the years 2010 to 2019. CONCLUSION After adjustment for known long-term effects, in this study we did not find evidence that the two Bavarian lockdowns had an effect on the rate of stillbirths.
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Affiliation(s)
- Florian Matthias Stumpfe
- Department of Obstetrics and Gynecology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Universitätsstraße 21-23, 91054, Erlangen, Germany.
| | - Michael Oliver Schneider
- Department of Obstetrics and Gynecology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Universitätsstraße 21-23, 91054, Erlangen, Germany
| | - Sophia Antoniadis
- Department of Obstetrics and Gynecology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Universitätsstraße 21-23, 91054, Erlangen, Germany
| | - Andreas Mayr
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Tobias Fleckenstein
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Christian Staerk
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Sven Kehl
- Department of Obstetrics and Gynecology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Universitätsstraße 21-23, 91054, Erlangen, Germany
| | - Peter Hermanek
- Department of Methods and Perinatology, BAQ, Bavarian Institute for Quality Assurance, Munich, Germany
| | - Julian Böhm
- Department of Methods and Perinatology, BAQ, Bavarian Institute for Quality Assurance, Munich, Germany
| | | | - Matthias Wilhelm Beckmann
- Department of Obstetrics and Gynecology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Universitätsstraße 21-23, 91054, Erlangen, Germany
| | - Alexander Hein
- Department of Obstetrics and Gynecology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Universitätsstraße 21-23, 91054, Erlangen, Germany
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13
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Schiermeier S, von Kaisenberg CS, Kehl S, Reister F, Mosimann B, Reif P, Harlfinger W, König K, Schwarz C, Matern E, Kühnert M, Schmitz R, Hoopmann M, Ramsell A, Kalberer BS, Heule PG, Heinzl S, Kayer B, Gruber P, Steiner H, Schaeffer L. Fetal Assessment in Pregnancy (Indication and Methodology for Fetal Monitoring in a Low-risk Population). Guideline of the DGGG, DEGUM, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/089, February 2023). Geburtshilfe Frauenheilkd 2023; 83:996-1016. [PMID: 37588256 PMCID: PMC10427199 DOI: 10.1055/a-2096-1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose The aim of this guideline was to find evidence on whether carrying out Doppler examinations and CTGs in low-risk cohorts of pregnant women improves outcomes. Methods First, a systematic search for guidelines was carried out. Identified guidelines were evaluated using the DELPHI instrument of the AWMF. Three guidelines were found to be suitable to evaluate CTG. Two DEGUM best practice guidelines were judged suitable to describe the methods. All studies on this issue were additionally analyzed using 8 PICO questions. A structured consensus of the participating professional societies was achieved using a nominal group process and a structured consensus conference moderated by an independent moderator. Recommendations No antepartum Doppler sonography examinations should be carried out in low-risk cohorts in the context of antenatal care. No antepartum CTG should be carried out in low-risk cohorts. Note The guideline will be published simultaneously in the official journals of both professional societies (i.e., Geburtshilfe und Frauenheilkunde for the DGGG and Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM).
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Affiliation(s)
- Sven Schiermeier
- Lehrstuhl für Frauenheilkunde und Geburtshilfe der Universität Witten/Herdecke, Marien-Hospital Witten, Witten, Germany
| | | | - Sven Kehl
- Gynecology & Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Frank Reister
- Sektion Geburtshilfe, Univ.-Frauenklinik, Univ.-Klinikum Ulm, Ulm, Germany
| | - Beatrice Mosimann
- University Womenʼs Hospital, Department of Obstetrics, Inselspital, Bern, Switzerland
| | - Philipp Reif
- Obstetrics & Gynecology, Medical University of Graz, Graz, Austria
| | | | - Klaus König
- Berufsverband der Frauenärzte, Eschborn, Germany
| | - Christiane Schwarz
- Institute of Health Sciences, Department of Midwifery Science, Universität zu Lübeck, Lübeck, Germany
| | - Elke Matern
- Medical Department, Martin Luther University Halle Wittenberg, Halle, Germany
| | - Maritta Kühnert
- Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany
| | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Beate Kayer
- Österreichisches Hebammengremium, Wien, Austria
| | | | - Horst Steiner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Landeskrankenhaus Salzburg, Paracelsus, Salzburg, Austria
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14
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Stumpfe FM, Mayr A, Schneider MO, Kehl S, Stübs F, Antoniadis S, Titzmann A, Pontones CA, Bayer CM, Beckmann MW, Faschingbauer F. Cerebroplacental versus Umbilicocerebral Ratio-Analyzing the Predictive Value Regarding Adverse Perinatal Outcomes in Low- and High-Risk Fetuses at Term. Medicina (Kaunas) 2023; 59:1385. [PMID: 37629674 PMCID: PMC10456565 DOI: 10.3390/medicina59081385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The aim of this study was to investigate the prediction of adverse perinatal outcomes using the cerebroplacental (CPR) and umbilicocerebral (UCR) ratios in different cohorts of singleton pregnancies. Materials and Methods: In this retrospective cohort study, we established our own Multiple of Median (MoM) for CPR and UCR. The predictive value for both ratios was studied in the following outcome parameters: emergency cesarean delivery, operative intervention (OI), OI due to fetal distress, 5-min Apgar < 7, admission to neonatal intensive care unit, and composite adverse perinatal outcome. The performance of the ratios was assessed in the following cohorts: total cohort (delivery ≥ 37 + 0 weeks gestation, all birth weight centiles), low-risk cohort (delivery ≥ 37 + 0 weeks gestation, birth weight ≥ 10. centile), prolonged pregnancy cohort (delivery ≥ 41 + 0 weeks gestation, birth weight ≥ 10. centile) and small-for-gestational-age fetuses (delivery ≥ 37 + 0 weeks gestation, birth weight < 10. centile). The underlying reference values for MoM were estimated using quantile regression depending on gestational age. Prediction performance was evaluated using logistic regression models assessing the corresponding Brier score, combining discriminatory power and calibration. Results: Overall, 3326 cases were included. Across all cohorts, in the case of a significant association between a studied outcome parameter and CPR, there was an association with UCR, respectively. The Brier score showed only minimal differences for both ratios. Conclusions: Our study provides further evidence regarding predictive values of CPR and UCR. The results of our study suggest that reversal of CPR to UCR does not improve the prediction of adverse perinatal outcomes.
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Affiliation(s)
- Florian M. Stumpfe
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.M.S.)
| | - Andreas Mayr
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, 53127 Bonn, Germany
| | - Michael O. Schneider
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.M.S.)
| | - Sven Kehl
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.M.S.)
| | - Frederik Stübs
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.M.S.)
| | - Sophia Antoniadis
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.M.S.)
| | - Adriana Titzmann
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.M.S.)
| | - Constanza A. Pontones
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.M.S.)
| | | | - Matthias W. Beckmann
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.M.S.)
| | - Florian Faschingbauer
- Department of Obstetrics and Gynecology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (F.M.S.)
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15
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Pontones CA, Titzmann A, Huebner H, Danzberger N, Ruebner M, Häberle L, Eskofier BM, Nissen M, Kehl S, Faschingbauer F, Beckmann MW, Fasching PA, Schneider MO. Feasibility and Acceptance of Self-Guided Mobile Ultrasound among Pregnant Women in Routine Prenatal Care. J Clin Med 2023; 12:4224. [PMID: 37445258 DOI: 10.3390/jcm12134224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Mobile and remote ultrasound devices are becoming increasingly available. The benefits and possible risks of self-guided ultrasound examinations conducted by pregnant women at home have not yet been well explored. This study investigated aspects of feasibility and acceptance, as well as the success rates of such examinations. METHODS In this prospective, single-center, interventional study, forty-six women with singleton pregnancies between 17 + 0 and 29 + 6 weeks of gestation were included in two cohorts, using two different mobile ultrasound systems. The participants examined the fetal heartbeat, fetal profile and amniotic fluid. Aspects of feasibility and acceptance were evaluated using a questionnaire. Success rates in relation to image and video quality were evaluated by healthcare professionals. RESULTS Two thirds of the women were able to imagine performing the self-guided examination at home, but 87.0% would prefer live support by a professional. Concerns about their own safety and that of the child were expressed by 23.9% of the women. Success rates for locating the target structure were 52.2% for videos of the fetal heartbeat, 52.2% for videos of the amniotic fluid in all four quadrants and 17.9% for videos of the fetal profile. CONCLUSION These results show wide acceptance of self-examination using mobile systems for fetal ultrasonography during pregnancy. Image quality was adequate for assessing the amniotic fluid and fetal heartbeat in most participants. Further studies are needed to determine whether ultrasound self-examinations can be implemented in prenatal care and how this would affect the fetomaternal outcome.
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Affiliation(s)
- Constanza A Pontones
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Adriana Titzmann
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Hanna Huebner
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Nina Danzberger
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Matthias Ruebner
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Lothar Häberle
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Bjoern M Eskofier
- Machine Learning and Data Analytics Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany
| | - Michael Nissen
- Machine Learning and Data Analytics Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany
| | - Sven Kehl
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Florian Faschingbauer
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Peter A Fasching
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Michael O Schneider
- Department of Obstetrics and Gynaecology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
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Abstract
Liebe Leserinnen und Leser,spüren Sie auch diesen Wind? Es gab ihn schon mal. Das Lied „Wind of
Change" ist ein Song der deutschen Rockband Scorpions und handelt von der
politischen und gesellschaftlichen Veränderung, die Anfang der 1990er-Jahre
in Europa stattfand, insbesondere im Zusammenhang mit dem Fall der Berliner Mauer
und dem Ende des Kalten Krieges. Das Lied reflektiert die Hoffnungen und
Träume der Menschen in diesem historischen Moment des Wandels und feiert das
Ende einer Ära der Konfrontation und des Misstrauens zwischen Ost und West.
Es ist eine Hymne an die Freiheit und die Überwindung von Grenzen, die
sowohl politisch als auch persönlich sein können.
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Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen
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17
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Stelzl P, Kehl S, Oppelt P, Mayr A, Fleckenstein T, Maul H, Enengl S, Berger R, Rath W. Maintenance tocolysis, tocolysis in preterm premature rupture of membranes and in cervical cerclage - a Germany-wide survey on the current practice after dissemination of the German guideline. J Perinat Med 2023:jpm-2022-0572. [PMID: 36972689 DOI: 10.1515/jpm-2022-0572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/26/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To investigate the adherence of German perinatal specialist units and those of basic obstetric care to the national guideline we compared data from a nation-wide survey on the practice of maintenance tocolysis, tocolysis in preterm premature rupture of membranes and in the perioperative setting of cervical cerclage, and bedrest during and after tocolysis with recommendations from the current German Guideline 015/025 "Prevention and Treatment of Preterm Birth". METHODS 632 obstetric clinics in Germany were approached and received a link to an online questionnaire. Data were descriptively analyzed by performing measures of frequency. To compare two or more groups Fisher's exact test was used. RESULTS The response rate was 19%; 23 (19.2%) of respondents did not perform maintenance tocolysis, while 97 (80.8%) conducted maintenance tocolysis; 30 (25.0%) of obstetric units performed cervical cerclage without tocolysis and 90 (75.0%) combined cervical cerclage with tocolysis; 11 (9.2%) of respondents did not use tocolytics in patients with preterm premature rupture of membranes, while 109 (90.8%) conducted tocolysis in these patients; 69 (57.5%) of obstetric units did not recommend bed rest during tocolysis, whereas 51 (42.5%) favored bedrest. Perinatal care centers of basic obstetric care recommend bed arrest during tocolysis statistically significant more often to their patients than those of higher perinatal care levels (53.6 vs. 32.8%, p=0.0269). CONCLUSIONS The results of our survey are in accordance to others from different countries and reveal considerable discrepancies between evidence-based guideline recommendations and daily clinical practice.
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Affiliation(s)
- Patrick Stelzl
- Universitätsklinik für Gynäkologie, Geburtshilfe und gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
- Frauenklinik, Universitätsklinikum Erlangen, Universitätsstrasse 21 - 23, Erlangen, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Universitätsstrasse 21 - 23, Erlangen, Germany
| | - Peter Oppelt
- Universitätsklinik für Gynäkologie, Geburtshilfe und gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
| | - Andreas Mayr
- Institut für Medizinische Biometrie, Informatik und Epidemiologie, Medizinische Fakultät, Universität Bonn, Bonn, Germany
| | - Tobias Fleckenstein
- Institut für Medizinische Biometrie, Informatik und Epidemiologie, Medizinische Fakultät, Universität Bonn, Bonn, Germany
| | - Holger Maul
- Frauenkliniken der Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, c/o. Asklepios Klinik Barmbek, Hamburg, Germany
| | - Sabine Enengl
- Universitätsklinik für Gynäkologie, Geburtshilfe und gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
| | - Richard Berger
- Marienhaus Klinikum St. Elisabeth, Klinik für Gynäkologie und Geburtshilfe, Neuwied, Germany
| | - Werner Rath
- Medizinische Fakultät Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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18
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Hamza A, Schlembach D, Schild RL, Groten T, Wölfle J, Battefeld W, Kehl S, Schneider MO. Recommendations of the AGG (Working Group for Obstetrics, Department of Maternal Diseases) on How to Treat Thyroid Function Disorders in Pregnancy. Geburtshilfe Frauenheilkd 2023; 83:504-516. [PMID: 37152543 PMCID: PMC10159725 DOI: 10.1055/a-1967-1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/23/2022] [Indexed: 03/11/2023] Open
Abstract
Abstract
Objective These recommendations from the AGG (Committee for Obstetrics, Department of Maternal Diseases) on how to treat thyroid function disorder during pregnancy aim to improve the diagnosis and management of thyroid anomalies during pregnancy.
Methods Based on the current literature, the task force members have developed the following recommendations and statements. These recommendations were adopted after a consensus by the members of the working group.
Recommendations The following manuscript gives an insight into physiological and pathophysiological thyroid changes during pregnancy, recommendations for clinical and subclinical hypo- and hyperthyroidism, as well as fetal and neonatal diagnostic and management strategies.
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Affiliation(s)
- Amr Hamza
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universität des Saarlandes, Homburg a. d. Saar, Germany
- Klinik für Geburtshilfe und Pränatalmedizin, Kantonspital Baden, Baden, Switzerland
| | | | - Ralf Lothar Schild
- Klinik für Geburtshilfe und Perinatalmedizin, Diakovere Perinatalzentrum Hannover, Hannover, Germany
| | - Tanja Groten
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Joachim Wölfle
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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19
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Abou-Dakn M, Schäfers R, Peterwerth N, Asmushen K, Bässler-Weber S, Boes U, Bosch A, Ehm D, Fischer T, Greening M, Hartmann K, Heller G, Kapp C, von Kaisenberg C, Kayer B, Kranke P, Lawrenz B, Louwen F, Loytved C, Lütje W, Mattern E, Nielsen R, Reister F, Schlösser R, Schwarz C, Stephan V, Kalberer BS, Valet A, Wenk M, Kehl S. Vaginal Birth at Term - Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82:1143-1193. [PMID: 36339636 PMCID: PMC9633231 DOI: 10.1055/a-1904-6546] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.
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Affiliation(s)
- Michael Abou-Dakn
- Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus, Berlin-Tempelhof, Berlin, Germany,Correspondence Prof. Dr. med. Michael Abou-Dakn Klinik für Gynäkologie und GeburtshilfeSt. Joseph Krankenhaus
Berlin-TempelhofWüsthoffstraße 1512101
BerlinGermany
| | - Rainhild Schäfers
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany,Prof. Dr. Rainhild Schäfers Hochschule für GesundheitDepartment für Angewandte
GesundheitswissenschaftenGesundheitscampus 6 – 844801
BochumGermany
| | - Nina Peterwerth
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany
| | - Kirsten Asmushen
- Gesellschaft für Qualität in der außerklinischen Geburtshilfe e. V., Storkow, Germany
| | | | | | - Andrea Bosch
- Duale Hochschule Baden-Württemberg Angewandte Hebammenwissenschaft, Stuttgart, Germany
| | - David Ehm
- Frauenarztpraxis Bern, Bern, Switzerland
| | - Thorsten Fischer
- Dept. of Gynecology and Obstetrics Paracelcus Medical University, Salzburg, Austria
| | - Monika Greening
- Hochschule für Wirtschaft und Gesellschaft, Hebammenwissenschaften – Ludwigshafen, Ludwigshafen, Germany
| | | | - Günther Heller
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
| | - Claudia Kapp
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Constantin von Kaisenberg
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Beate Kayer
- Fachhochschule Burgenland, Studiengang Hebammen, Pinkafeld, Austria
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Frank Louwen
- Frauenklinik, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christine Loytved
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Wolf Lütje
- Institut für Hebammen, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Switzerland
| | - Elke Mattern
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Renate Nielsen
- Ev. Amalie Sieveking Krankenhaus – Immanuel Albertinen Diakonie Hamburg, Hamburg, Germany
| | - Frank Reister
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christiane Schwarz
- Institut für Gesundheitswissenschaften FB Hebammenwissenschaft, Lübeck, Germany
| | - Volker Stephan
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V., Köln, Germany
| | | | - Axel Valet
- Frauenklinik Dill Kliniken GmbH, Herborn, Germany
| | - Manuel Wenk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Kaiserwerther Diakonie, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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20
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Abou-Dakn M, Schäfers R, Peterwerth N, Asmushen K, Bässler-Weber S, Boes U, Bosch A, Ehm D, Fischer T, Greening M, Hartmann K, Heller G, Kapp C, von Kaisenberg C, Kayer B, Kranke P, Lawrenz B, Louwen F, Loytved C, Lütje W, Mattern E, Nielsen R, Reister F, Schlösser R, Schwarz C, Stephan V, Kalberer BS, Valet A, Wenk M, Kehl S. Vaginal Birth at Term - Part 2. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82:1194-1248. [PMID: 36339632 PMCID: PMC9633230 DOI: 10.1055/a-1904-6769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. The second part of this guideline presents recommendations and statements on care during the dilation and expulsion stages as well as during the placental/postnatal stage. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in individual cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions where necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline, and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.
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Affiliation(s)
- Michael Abou-Dakn
- Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus, Berlin-Tempelhof, Berlin, Germany,Korrespondenzadresse Prof. Dr. med. Michael Abou-Dakn Klinik für Gynäkologie und GeburtshilfeSt. Joseph Krankenhaus
Berlin-TempelhofWüsthoffstraße 1512101
BerlinGermany
| | - Rainhild Schäfers
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany,Prof. Dr. Rainhild Schäfers Hochschule für GesundheitDepartment für Angewandte
GesundheitswissenschaftenGesundheitscampus 6 – 844801
BochumGermany
| | - Nina Peterwerth
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany
| | - Kirsten Asmushen
- Gesellschaft für Qualität in der außerklinischen Geburtshilfe e. V., Storkow, Germany
| | | | | | - Andrea Bosch
- Duale Hochschule Baden-Württemberg Angewandte Hebammenwissenschaft, Stuttgart, Germany
| | - David Ehm
- Frauenarztpraxis Bern, Bern, Switzerland
| | - Thorsten Fischer
- Dept. of Gynecology and Obstetrics Paracelcus Medical University, Salzburg, Austria
| | - Monika Greening
- Hochschule für Wirtschaft und Gesellschaft, Hebammenwissenschaften – Ludwigshafen, Ludwigshafen, Germany
| | | | - Günther Heller
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
| | - Claudia Kapp
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Constantin von Kaisenberg
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Beate Kayer
- Fachhochschule Burgenland, Studiengang Hebammen, Pinkafeld, Austria
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Frank Louwen
- Frauenklinik, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christine Loytved
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Wolf Lütje
- Institut für Hebammen, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Switzerland
| | - Elke Mattern
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Renate Nielsen
- Ev. Amalie Sieveking Krankenhaus – Immanuel Albertinen Diakonie Hamburg, Hamburg, Germany
| | - Frank Reister
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christiane Schwarz
- Institut für Gesundheitswissenschaften FB Hebammenwissenschaft, Lübeck, Germany
| | - Volker Stephan
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V., Köln, Germany
| | | | - Axel Valet
- Frauenklinik Dill Kliniken GmbH, Herborn, Germany
| | - Manuel Wenk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Kaiserwerther Diakonie, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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21
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Pretscher J, Kehl S, Stelzl P, Stumpfe FM, Mayr A, Schmid M, Staerk C, Schild R, Beckmann MW, Faschingbauer F. Influence of Sonographic Fetal Weight Estimation Inaccuracies in Macrosomia on Perinatal Outcome. Ultraschall Med 2022; 43:e56-e64. [PMID: 32767300 DOI: 10.1055/a-1205-0191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate the influence of inaccurate sonographic fetal weight estimation in macrosomia on the mode of delivery and neonatal outcome (NO). METHODS In 14 633 pregnancies between 2002 and 2016, this retrospective study evaluated the association between sonographic fetal weight estimation, true birth weight (BW), mode of delivery (primary cesarean section [pCS], secondary cesarean section, vaginal delivery, and operative vaginal delivery rates) and NO parameters (5-min Apgar < 7, pH < 7.1, neonatal intensive care unit [NICU] admission, shoulder dystocia). Singleton pregnancies > 37 + 0 weeks with ultrasound-estimated fetal weight (EFW) within 7 days before delivery were included. The study population was divided into four groups: Group 1 (false-negative): EFW < 4000 g/BW ≥ 4000 g; Group 2 (true-positive): EFW ≥ 4000 g/BW ≥ 4000 g; Group 3 (false-positive): EFW ≥ 4000 g/BW < 4000 g; and Group 4 (true-negative): EFW < 4000 g/BW < 4000 g. RESULTS As expected, the highest secondary cesarean section (sCS) rate was found in Group 2 (true-positive) (30.62 %), compared with only 17.68 % in Group 4 (true-negative). The sCS rate in the false-positive Group 3 was significantly higher (28.48 %) in comparison with the false-negative Group 1 (21.22 %; OR 1.48; 95 % CI, 1.16 to 1.89; P = 0.002). In comparison with the true-negative Group 4, univariate analyses showed significantly higher rates for sCS in all other groups: odds ratio (OR) 2.06 for Group 2 (95 % CI, 1.74 to 2.42; P < 0.001), 1.85 for Group 3 (95 % CI, 1.54 to 2.22, P < 0.001), and 1.25 for Group 1 (95 % CI, 1.05 to 1.49; P < 0.01). No significant differences were found for NO between Groups 1 and 3 for the parameters 5-min Apgar < 7 (P = 0.75), pH < 7.1 (P = 0.28), or NICU admission (P = 0.54). However, there was a significantly higher chance for shoulder dystocia in Group 1 compared with Group 3 (OR 4.58; 95 % CI, 1.34 to 24.30; P = 0.008). CONCLUSION Sonographic EFW inaccuracies in fetal macrosomia appear to have a greater impact on the mode of delivery than birth weight itself. Underestimation of fetal weight may be associated with a higher probability of shoulder dystocia.
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Affiliation(s)
- Jutta Pretscher
- Obstetrics and Gynecology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sven Kehl
- Obstetrics and Gynecology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Patrick Stelzl
- Obstetrics and Gynecology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Andreas Mayr
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Germany
| | - Christian Staerk
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Germany
| | - Ralf Schild
- Obstetrics and Gynecology, DIAKOVERE gGmbH, Hannover, Germany
| | - Matthias W Beckmann
- Obstetrics and Gynecology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florian Faschingbauer
- Obstetrics and Gynecology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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22
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Stumpfe FM, Schneider MO, Hein A, Faschingbauer F, Kehl S, Hermanek P, Böhm J, Scharl A, Beckmann MW, Staerk C, Mayr A. Limited Effects of SARS-CoV-2 Pandemic-related Lockdowns and Reduced Population Mobility on Preterm Birth Rates: A Secondary Analysis of Bavarian Obstetric Quality Parameters
from 2010 to 2020. Geburtshilfe Frauenheilkd 2022; 82:842-851. [PMID: 35967741 PMCID: PMC9365461 DOI: 10.1055/a-1857-6414] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/19/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction
International studies on preterm birth rates during COVID-19 lockdowns report different results. This study examines preterm birth rates during lockdown periods and the
impact of the mobility changes of the population in Bavaria, Germany.
Material and Methods
This is a secondary analysis of centrally collected data on preterm births in Bavaria from 2010 to 2020. Preterm births (< 37 weeks) in singleton and twin
pregnancies during two lockdowns were compared with corresponding periods in 2010 – 2019. Fisherʼs exact test was used to compare raw prevalence between groups. Potential effects of two
fixed lockdown periods and of variable changes in population mobility on preterm birth rates in 2020 were examined using additive logistic regression models, adjusting for long-term and
seasonal trends.
Results
Unadjusted preterm birth rates in 2020 were significantly lower for singleton pregnancies during the two lockdown periods (Lockdown 1: 5.71% vs. 6.41%; OR 0.88; p < 0.001;
Lockdown 2: 5.71% vs. 6.60%; OR = 0.86; p < 0.001). However, these effects could not be confirmed after adjusting for long-term trends (Lockdown 1: adj. OR = 0.99; p = 0.73; Lockdown 2:
adj. OR = 0.96; p = 0.24). For twin pregnancies, differences during lockdown were less marked (Lockdown 1: 52.99% vs. 56.26%; OR = 0.88; p = 0.15; Lockdown 2: 58.06% vs. 58.91%; OR = 0.97;
p = 0.70). Reduced population mobility had no significant impact on preterm birth rates in singleton pregnancies (p = 0.14) but did have an impact on twin pregnancies (p = 0.02).
Conclusions
Reduced preterm birth rates during both lockdown periods in 2020 were observed for singleton and twin pregnancies. However, these effects are reduced when adjusting for
long-term and seasonal trends. Reduced population mobility was associated with lower preterm birth rates in twin pregnancies.
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Affiliation(s)
- Florian Matthias Stumpfe
- Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Department of Obstetrics and Gynecology, Erlangen, Germany
| | - Michael Oliver Schneider
- Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Department of Obstetrics and Gynecology, Erlangen, Germany
| | - Alexander Hein
- Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Department of Obstetrics and Gynecology, Erlangen, Germany
| | - Florian Faschingbauer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Department of Obstetrics and Gynecology, Erlangen, Germany
| | - Sven Kehl
- Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Department of Obstetrics and Gynecology, Erlangen, Germany
| | - Peter Hermanek
- Department of Methods and Perinatology, BAQ, Bavarian Institute for Quality Assurance, Munich, Germany
| | - Julian Böhm
- Department of Methods and Perinatology, BAQ, Bavarian Institute for Quality Assurance, Munich, Germany
| | - Anton Scharl
- Department of Methods and Perinatology, BAQ, Bavarian Institute for Quality Assurance, Munich, Germany
- Kliniken Nordoberpfalz Weiden AG, Department of Obstetrics and Gynecology, Weiden, Germany
| | - Matthias Wilhelm Beckmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital of Erlangen, Department of Obstetrics and Gynecology, Erlangen, Germany
| | - Christian Staerk
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Andreas Mayr
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
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Stumpfe FM, Faschingbauer F, Kehl S, Pretscher J, Emons J, Gass P, Mayr A, Schmid M, Beckmann MW, Stelzl P. Amniotic-Umbilical-to-Cerebral Ratio - A Novel Ratio Combining Doppler Parameters and Amniotic Fluid Volume to Predict Adverse Perinatal Outcome in SGA Fetuses At Term. Ultraschall Med 2022; 43:159-167. [PMID: 32722822 DOI: 10.1055/a-1205-0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Introduction of a novel ratio - the amniotic-umbilical-to-cerebral ratio (AUCR) - to predict adverse perinatal outcome in SGA fetuses at term and comparison of its predictive accuracy with established parameters. MATERIALS AND METHODS This retrospective cohort study included 165 singleton pregnancies with SGA fetuses (birth weight < 10th percentile) at term. Cases with planned vaginal delivery and documented pulsatility indices (PI) of the umbilical artery (UA), middle cerebral artery (MCA), and single deepest pocket (SDP) were included. CPR was calculated as the ratio between MCA PI and UA PI, UCR as the ratio between UA PI and MCA PI. AUCR was defined as follows: SDP/(UA PI/MCA PI). Adverse perinatal outcomes were defined as operative intervention (OI), OI due to fetal distress, admission to the neonatal intensive care unit (NICU), and composite adverse perinatal outcome (CAPO). Associations between Doppler parameters and these outcomes were estimated using regression analyses. RESULTS OI was statistically significantly associated with UCR, SDP, and AUCR, whereas no association was observed for UA PI, MCA PI, and CPR. Fetuses requiring OI due to fetal distress revealed a significantly higher UA PI and UCR as well as a lower MCA PI, CPR, and AUCR. With regard to NICU admission and CAPO, a significantly higher UA PI and lower CPR were found. Furthermore, a significant association was shown for SDP, UCR, and AUCR. AUCR achieved the best area under the curve for all outcome parameters. CONCLUSION AUCR leads to an improvement in the prediction of unfavorable outcome in SGA fetuses at term. Furthermore, results of our study show that UCR might be superior to CPR.
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Affiliation(s)
| | | | - Sven Kehl
- Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Jutta Pretscher
- Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Julius Emons
- Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Paul Gass
- Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Andreas Mayr
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Germany
| | | | - Patrick Stelzl
- Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
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24
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Hein A, Kehl S, Häberle L, Tiemann C, Peuker R, Mereutanu D, Stumpfe FM, Faschingbauer F, Meyer-Schlinkmann K, Koch MC, Kainer F, Dammer U, Philipp H, Kladt C, Schrauder MG, Weingärtler S, Hanf V, Hartmann A, Rübner M, Schneider H, Lelieveld J, Beckmann MW, Wurmthaler LA, Fasching PA, Schneider MO. Prevalence of SARS-CoV-2 in Pregnant Women Assessed by RT-PCR in Franconia, Germany: First Results of the SCENARIO Study (SARS-CoV-2 prEvalence in pregNAncy and at biRth In
FrancOnia). Geburtshilfe Frauenheilkd 2022; 82:226-234. [PMID: 35169390 PMCID: PMC8837405 DOI: 10.1055/a-1727-9672] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/22/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose
Detection of SARS-CoV-2-infected pregnant women admitted to maternity units during a pandemic is crucial. In addition to the fact that pregnancy is a risk factor for severe
COVID-19 and that medical surveillance has to be adjusted in infected women and their offspring, knowledge about infection status can provide the opportunity to protect other patients and
healthcare workers against virus transmission. The aim of this prospective observational study was to determine the prevalence of SARS-CoV-2 infection among pregnant women in the hospital
setting.
Material and Methods
All eligible pregnant women admitted to the nine participating hospitals in Franconia, Germany, from 2 June 2020 to 24 January 2021 were included.
COVID-19-related symptoms, secondary diseases and pregnancy abnormalities were documented. SARS-CoV-2 RNA was detected by RT-PCR from nasopharyngeal swabs. The prevalence of acute SARS-CoV-2
infection was estimated by correcting the positive rate using the Rogan–Gladen method. The risk of infection for healthcare workers during delivery was estimated using a risk calculator.
Results
Of 2414 recruited pregnant women, six were newly diagnosed RT-PCR positive for SARS-CoV-2, which yielded a prevalence of SARS-CoV-2 infection of 0.26% (95% CI, 0.10 – 0.57%).
Combining active room ventilation and wearing FFP2 masks showed an estimated reduction of risk of infection for healthcare workers in the delivery room to < 1%.
Conclusions
The prevalence of newly diagnosed SARS-CoV-2 infection during pregnancy in this study is low. Nevertheless, a systematic screening in maternity units during pandemic
situations is important to adjust hygienic and medical management. An adequate hygienic setting can minimise the calculated infection risk for medical healthcare workers during patientsʼ
labour.
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Affiliation(s)
- Alexander Hein
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Kehl
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Rebecca Peuker
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Denise Mereutanu
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Florian M. Stumpfe
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Martin C. Koch
- Department of Gynaecology and Obstetrics, ANregiomed Klinikum Ansbach, Ansbach, Germany
| | - Franz Kainer
- Department of Gynaecology and Obstetrics, Klinik Hallerwiese, Nürnberg, Germany
| | - Ulf Dammer
- Department of Gynaecology and Obstetrics, St. Theresien-Krankenhaus, Nürnberg, Germany
| | - Hanna Philipp
- Department of Gynaecology and Obstetrics, REGIOMED Klinikum Coburg, Coburg, Germany
| | - Carolin Kladt
- Department of Gynaecology and Obstetrics, Clinic Bayreuth, Bayreuth, Germany
| | - Michael G. Schrauder
- Department of Gynaecology and Obstetrics, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Stefan Weingärtler
- Department of Gynaecology and Obstetrics, Klinikum Forchheim-Fränkische Schweiz, Forchheim, Germany
| | - Volker Hanf
- Department of Gynaecology and Obstetrics, Klinikum Fürth, Fürth, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Rübner
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Holm Schneider
- Department of Pediatrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Matthias W. Beckmann
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lena A. Wurmthaler
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter A. Fasching
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael O. Schneider
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Morhart P, Mardin C, Rauh M, Jüngert J, Hammersen J, Kehl S, Schuh W, Maier-Wohlfart S, Hermes K, Neubert A, Schneider M, Hein A, Woelfle J, Schneider H. Maternal SARS-CoV-2 infection during pregnancy: possible impact on the infant. Eur J Pediatr 2022; 181:413-418. [PMID: 34355278 PMCID: PMC8341836 DOI: 10.1007/s00431-021-04221-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
The risk and potential consequences of mother-to-child transmission of severe acute respiratory syndrome-coronavirus type 2 (SARS-CoV-2) during pregnancy are still a matter of debate. We studied the impact of SARS-CoV-2 infection on 56 complete households, including 27 newborns whose mothers were pregnant when exposed to the virus. Two PCR-confirmed perinatal SARS-CoV-2 transmissions with mild symptoms in affected neonates were recorded. In addition, we observed a severe eye malformation (unilateral microphthalmia, optic nerve hypoplasia, and congenital retinopathy) associated with maternal SARS-CoV-2 infection in weeks 5 and 6 of embryonic development. This embryopathy could not be explained by other infectious agents, genetic factors, drug use, or maternal disease during pregnancy. Eight other women with a history of SARS-CoV-2 infection prior to gestational week 12, however, delivered healthy infants.Conclusion: The repeated occurrence of mother-to-child transmission in our cohort with risks that remain incompletely understood, such as long-term effects and the possibility of an embryopathy, should sensitize researchers and stimulate further studies as well as support COVID-19 vaccination recommendations for pregnant women. Trial registration number: NCT04741412. Date of registration: November 18, 2020 What is Known: •Materno-fetal transmission of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) during pregnancy has rarely been reported so far, but was demonstrated in isolated cases. What is New: •In a study of complete households with documented SARS-CoV-2 infection, including a cohort of pregnant women, we observed perinatal coronavirus transmission at a higher frequency than expected. •We also describe a newborn boy with an eye malformation reminiscent of rubella embryopathy but associated with early gestation SARS-CoV-2 infection of his mother. •A coronavirus-related embryopathy, reported here for the first time, is a finding that requires further investigation.
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Affiliation(s)
- Patrick Morhart
- grid.5330.50000 0001 2107 3311Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
| | - Christian Mardin
- grid.5330.50000 0001 2107 3311Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Rauh
- grid.5330.50000 0001 2107 3311Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
| | - Jörg Jüngert
- grid.5330.50000 0001 2107 3311Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
| | - Johanna Hammersen
- grid.5330.50000 0001 2107 3311Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
| | - Sven Kehl
- grid.5330.50000 0001 2107 3311Department of Obstetrics and Gynecology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Schuh
- grid.5330.50000 0001 2107 3311Division of Molecular Immunology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Sigrun Maier-Wohlfart
- grid.5330.50000 0001 2107 3311Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
| | - Katharina Hermes
- grid.5252.00000 0004 1936 973XHauner’sches Kinderspital, University of Munich, Munich, Germany
| | - Antje Neubert
- grid.5330.50000 0001 2107 3311Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
| | - Michael Schneider
- grid.5330.50000 0001 2107 3311Department of Obstetrics and Gynecology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Hein
- grid.5330.50000 0001 2107 3311Department of Obstetrics and Gynecology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Woelfle
- grid.5330.50000 0001 2107 3311Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestr. 15, 91054 Erlangen, Germany
| | - Holm Schneider
- Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestr. 15, 91054, Erlangen, Germany.
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26
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Schmidt M, Kühnert M, Kuschel B, Kehl S, Schäfer-Graf UM. Care of Women with Chronic Inflammatory Bowel Disease (Chronic IBD) During Pregnancy: Recommendations of the Obstetrics and Prenatal Medicine Working Group of the DGGG. Geburtshilfe Frauenheilkd 2021; 81:1348-1353. [PMID: 34899047 PMCID: PMC8654510 DOI: 10.1055/a-1429-2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022] Open
Abstract
The incidence of chronic inflammatory bowel disease (chronic IBD) in persons of reproductive age is high. Chronic IBD does not typically lead to impaired fertility. Nevertheless, the percentage of women suffering from chronic IBD who have children is lower than that of the general population, due to self-imposed childlessness. Providing women with open, unbiased information and, if necessary, helping them to overcome baseless fears should therefore be an essential part of preconception counseling. With the exception of methotrexate, most standard drugs can and should be continued during pregnancy. If the pregnancy occurs during an inactive phase of disease, the rate of complications in pregnancy should, in principle, not be higher than normal. Nevertheless, pregnant women with chronic IBD are classed as high-risk pregnancies. Organ screening in accordance with DEGUM II criteria should be carried out in every case, and women must be monitored for the potential development
of placental insufficiency. Any flare-ups which occur during pregnancy should be treated in full. Vaginal delivery can be considered if there is no perianal manifestation of disease; however, the individual risk must be carefully weighed up.
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Affiliation(s)
- Markus Schmidt
- Klinik für Frauenheilkunde und Geburtshilfe, Sanakliniken Duisburg, Duisburg, Germany
| | - Maritta Kühnert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Marburg, Marburg, Germany
| | - Bettina Kuschel
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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27
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Kehl S, Weiss C, Pretscher J, Baier F, Faschingbauer F, Beckmann MW, Stumpfe FM. The use of PAMG-1 testing in patients with preterm labor, intact membranes and a short sonographic cervix reduces the rate of unnecessary antenatal glucocorticoid administration. J Perinat Med 2021; 49:1135-1140. [PMID: 34271603 DOI: 10.1515/jpm-2021-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the frequency of antenatal corticosteroid (ACS) administration in cases with shortened cervical length by addition of placental alpha-microglobulin-1 (PAMG-1) testing to sonographic examination. METHODS Single centre retrospective cohort study. Rate of ACS administration was compared between cases with cervical length between 15 and 25 mm and cases with positive PAMG-1 testing and cervical length between 15 and 25 mm. We evaluated the following outcome parameters: Rate of ACS administration, gestational age at delivery, time to delivery, delivery within seven days, delivery <34 and <37 weeks' gestation, rate of admission to neonatal intensive care unit (NICU). RESULTS In total, 130 cases were included. "PAMG-1 group" consisted of 68 women, 62 cases built the "historical control group". ACS administration was performed less frequently in the "PAMG-1 cohort" (18 (26%) vs. 46 (74%); p<0.001). The rate of delivery within seven days did not differ (2 (3%) vs. 4 (6.5%); p=0.4239). The rates of delivery <34 weeks' gestation (7 (10%) vs. 9 (15%); p=0.4643) and <37 weeks' gestation (19 (28%) vs. 26 (42%); p=0.0939) did not differ. Time to delivery interval was longer in the PAMG-1 group (61.5 vs. 43 days, p=0.0117). NICU admission occurred more often in the "historical control group" (22 (38%) vs. 28 (60%); p=0.0272). CONCLUSIONS Addition of biomarker testing can help to avoid unnecessary ACS administrations in women with shortened cervical length.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Jutta Pretscher
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Friederike Baier
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian M Stumpfe
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
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28
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Rossi R, Bauer NH, Becke-Jakob K, Grab D, Herting E, Mitschdörfer B, Olbertz DM, Rösner B, Schlembach D, Tillig B, Trotter A, Kehl S. Empfehlungen für die strukturellen Voraussetzungen der
perinatologischen Versorgung in Deutschland (Entwicklungsstufe S2k,
AWMF-Leitlinien-Register Nr. 087–001, März 2021). Z Geburtshilfe Neonatol 2021; 225:306-319. [PMID: 34384132 DOI: 10.1055/a-1502-5869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rainer Rossi
- Klinik für Kinder- und Jugendmedizin, Vivantes Klinikum Neukölln, Berlin
| | - Nicola H Bauer
- Studienbereich Hebammenwissenschaft, Department für angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum
| | | | - Dieter Grab
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm
| | - Egbert Herting
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck
| | | | - Dirk M Olbertz
- Abt. Neonatologie und Neonatologische Intensivmedizin, Klinikum Südstadt Rostock
| | - Bianka Rösner
- Klinik für Neonatologie, Charité, Campus Virchow, Berlin
| | - Dietmar Schlembach
- Spezielle Geburtshilfe und Perinatalmedizin, Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin
| | - Bernd Tillig
- Klinik für Kinderchirurgie, Neugeborenenchirurgie und Kinderurologie, Vivantes Klinikum Neukölln, Berlin
| | - Andreas Trotter
- Klinik für Kinder und Jugendliche, Hegau-Bodensee-Klinikum Singen
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen
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29
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Louwen F, Wagner U, Abou-Dakn M, Dötsch J, Lawrenz B, Ehm D, Surbek D, Essig A, Greening M, Schäfers R, Mattern E, Waterstradt IC, Kästner R, Lütje W, Kranke P, Messroghli L, Wenk M, Kehl S, Schlößer R, Lüdemann K, Maier B, Misselwitz B, Heller G, Bosch A, Nielsen R, Rothe C, Sirsch E, Kalberer BS, Vogel T, von Kaisenberg C, Nothacker M, Hülsewiesche B, Allert R, Jennewein L. Caesarean Section. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/084, June 2020). Geburtshilfe Frauenheilkd 2021; 81:896-921. [PMID: 34393255 DOI: 10.1055/a-1529-6141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022] Open
Abstract
Purpose This is an official S3-guideline of the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (ÖGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline contains evidence-based information and recommendations on indications, complications, methods and care associated with delivery by caesarean section for all medical specialties involved as well as for pregnant women. Methods This guideline has adapted information and recommendations issued in the NICE Caesarean Birth guideline. This guideline also considers additional issues prioritised by the Cochrane Institute and the Institute for Research in Operative Medicine (IFOM). The evaluation of evidence was based on the system developed by the Scottish Intercollegiate Guidelines Network (SIGN). A multi-part nominal group process moderated by the AWMF was used to compile this S3-level guideline. Recommendations Recommendations on consultations, indications and the process of performing a caesarean section as well as the care provided to the mother and neonate were drawn up.
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Affiliation(s)
- Frank Louwen
- Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
| | - Uwe Wagner
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Gießen und Marburg, Philipps-Universität Marburg, Marburg, Germany
| | | | - Jörg Dötsch
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Köln, Köln, Germany
| | | | - David Ehm
- Praxis für Geburtshilfe und Gynäkologie, Bern, Switzerland
| | - Daniel Surbek
- Frauenklinik, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | - Andreas Essig
- Institut für Medizinische Mikrobiologie & Hygiene, Universitätsklinikum Ulm, Ulm, Germany
| | - Monika Greening
- Fachbereich Gesundheit und Pflege, Katholische Hochschule Mainz, Mainz, Germany
| | - Rainhild Schäfers
- Hebammenwissenschaft, Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum, Germany
| | - Elke Mattern
- Hebammenwissenschaft, Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum, Germany
| | - Ina C Waterstradt
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Ralph Kästner
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum München, Ludwig-Maximilians-Universität München, München, Germany
| | - Wolf Lütje
- Klinik für Gynäkologie und Geburtshilfe, Evangelisches Amalie Sieveking Krankenhaus, Hamburg, Germany
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Leila Messroghli
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
| | - Manuel Wenk
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie am Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Rolf Schlößer
- Schwerpunkt Neonatologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
| | | | - Barbara Maier
- Gynäkologisch-geburtshilfliche Abteilung, Klinik Ottakring, ehem. Wilhelminenspital, Wien, Austria
| | | | - Günther Heller
- aQua - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany
| | | | | | | | - Erika Sirsch
- Lehrstuhl für Akutpflege, Philosophisch-Theologische Hochschule Vallendar, Vallendar, Germany
| | | | - Thea Vogel
- Frauengesundheitszentrum e. V., Frankfurt a. M., Germany
| | - Constantin von Kaisenberg
- Pränatalmedizin und Geburtshilfe im Perinatalzentrum, Medizinische Hochschule Hannover, Hannover, Germany
| | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Berlin, Germany
| | - Barbara Hülsewiesche
- Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
| | - Roman Allert
- Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
| | - Lukas Jennewein
- Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
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Kehl S, Hösli I, Pecks U, Reif P, Schild RL, Schmidt M, Schmitz D, Schwarz C, Surbek D, Abou-Dakn M. Induction of Labour. Guideline of the DGGG, OEGGG and SGGG (S2k, AWMF Registry No. 015-088, December 2020). Geburtshilfe Frauenheilkd 2021; 81:870-895. [PMID: 34393254 DOI: 10.1055/a-1519-7713] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 01/17/2023] Open
Abstract
Aim The aim of this official guideline published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG) in cooperation with the Austrian Society of Gynaecology and Obstetrics (OEGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG) is to provide a consensus-based overview of the indications, methods and general management of induction of labour by evaluating the relevant literature. Methods This S2k guideline was developed using a structured consensus process which included representative members from various professions; the guideline was commissioned by the guidelines commission of the DGGG, OEGGG and SGGG. Recommendations The guideline provides recommendations on the indications, management, methods, monitoring and special situations occurring in the context of inducing labour.
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Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Irene Hösli
- Frauenklinik, Universitätsspital Basel, Basel, Switzerland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Philipp Reif
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum Graz, Graz, Austria
| | - Ralf L Schild
- Klinik für Geburtshilfe und Perinatalmedizin, Diakovere Krankenhaus gGmbH, Hannover, Germany
| | - Markus Schmidt
- Frauenheilkunde und Geburtshilfe, Sana Kliniken Duisburg, Duisburg, Germany
| | - Dagmar Schmitz
- Institut für Geschichte, Theorie und Ethik der Medizin, Uniklinik RWTH Aachen, Aachen, Germany
| | - Christiane Schwarz
- Fachbereich Hebammenwissenschaft, Institut für Gesundheitswissenschaften, Universität zu Lübeck, Lübeck, Germany
| | - Daniel Surbek
- Frauenklinik, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | - Michael Abou-Dakn
- Klinik für Gynäkologie, St. Joseph Krankenhaus, Berlin Tempelhof, Berlin, Germany
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31
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Berger R, Maul H, Kehl S, Schiermeier S, Schlembach D, Kainer F, Abou-Dakn M. Aus der AGG – Stellungnahme der AGG mitgetragen von DGGG und DGPGM zur S3-Leitlinie „Vaginale Geburt am Termin“. Geburtshilfe Frauenheilkd 2021. [DOI: 10.1055/a-1522-0697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Richard Berger
- Klinik für Frauenheilkunde und Geburtshilfe, Marienhaus Klinikum, Neuwied
| | - Holger Maul
- Geburtshilfe und Pränatalmedizin, Asklepios Klinik Barmbek, Hamburg
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - Sven Schiermeier
- Zentrum für Frauenheilkunde und Geburtshilfe der St. Elisabeth Gruppe, Witten
| | | | - Franz Kainer
- Abteilung für Geburtshilfe und Pränatalmedizin, Klinik Hallerwiese, Nürnberg
| | - Michael Abou-Dakn
- Klinik für Frauenheilkunde und Geburtshilfe, St. Joseph Krankenhaus, Berlin
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32
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Hagenbeck C, Hamza A, Kehl S, Maul H, Lammert F, Keitel V, Hütten MC, Pecks U. Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine - Section on Maternal Disorders. Geburtshilfe Frauenheilkd 2021; 81:922-939. [PMID: 34393256 PMCID: PMC8354365 DOI: 10.1055/a-1386-3912] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease specific to pregnancy. The cardinal symptom of pruritus and a concomitant elevated level of bile acids in the serum and/or alanine aminotransferase (ALT) are suggestive for the diagnosis. Overall, the maternal prognosis is good. The fetal outcome depends on the bile acid level. ICP is associated with increased risks for adverse perinatal outcomes, including preterm delivery, meconium-stained amniotic fluid, and stillbirth. Acute fetal asphyxia and not chronic uteroplacental dysfunction leads to stillbirth. Therefore, predictive fetal monitoring is not possible. While medication with ursodeoxycholic acid (UDCA) improves pruritus, it has not been shown to affect fetal outcome. The indication for induction of labour depends on bile acid levels and gestational age. There is a high risk of recurrence in subsequent pregnancies.
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Affiliation(s)
| | - Amr Hamza
- Universitätsklinikum des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Germany
- Kantonsspital Baden AG, Baden, Switzerland
| | - Sven Kehl
- Frauenklinik, Friedrich Alexander University Erlangen Nuremberg, Faculty of Medicine, Erlangen, Germany
| | - Holger Maul
- Section of Prenatal Disgnostics and Therapy, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Frank Lammert
- Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Verena Keitel
- Universitätsklinikum Düsseldorf, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Düsseldorf, Germany
| | - Matthias C. Hütten
- Clinique E2 Neonatology, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
| | - Ulrich Pecks
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
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33
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Kehl S, Weiss C, Rath W, Schneider M, Stumpfe F, Faschingbauer F, Beckmann MW, Stelzl P. Labour Induction with Misoprostol in German Obstetric Clinics: What Are the Facts on Such Use? Geburtshilfe Frauenheilkd 2021; 81:955-965. [PMID: 34393259 PMCID: PMC8354357 DOI: 10.1055/a-1538-2200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/25/2021] [Indexed: 11/09/2022] Open
Abstract
Subject While the synthetic prostaglandin E1 analogue misoprostol is the most effect labour induction agent, its use is off-label for the most part. For this reason, and in view of its potential adverse effects and varying approaches to its administration, the drug has recently once again become a focus of critical attention. The objective of this survey was thus to establish a record of labour induction with misoprostol in German clinics and determine the impact of the negative reporting on everyday obstetric practice. Material and Methods In this cross-sectional study, 635 obstetrics and gynaecology departments in Germany were requested by email to participate in our survey in February/March 2020. Online responses to 19 questions were requested regarding the clinic, use of misoprostol before and after the critical reporting, use of misoprostol (sourcing, method of administration, dosage, monitoring) and other labour induction methods. Results A total of 262 (41.3%) of the clinics solicited for the survey completed the questionnaire. There were no differences regarding the care level (Perinatal Centre Level I, Perinatal Centre Level II, Clinic with Perinatal Focus or Obstetric/Private Clinic; p = 0.2104) or birth counts (p = 0.1845). In most cases, misoprostol was prepared in the clinic's own pharmacy (54%) or imported from another country (46%) and administered orally in tablet form (95%). Misoprostol dosage levels varied (25 µg [48%], 50 µg [83%], 75 µg [6%], 100 µg [47%] and > 100 µg [5%]). Most of the clinics used premanufactured tablets/capsules (59%), although Cytotec tablets were also divided (35%) or dissolved in water (5%). Misoprostol administration intervals were mainly every 4 hours (64%) or every 6 hours (30%). CTG checks were run in most cases before and after administration of a dose of misoprostol (78% and 76%) and before and after administration of a dose of prostaglandin E2 (both 88%). Presence of contractions led to no misoprostol (59%) or no prostaglandin E2 (64%) being administered in most cases. The critical reporting resulted in discontinuation of use of misoprostol in 17% of the clinics - mainly smaller obstetric/private clinics with fewer than 1000 births. Labour cocktails were used mainly in obstetric and private clinics (61%). Conclusion Misoprostol is an established agent for labour induction in German clinics. The dosing schemes used vary. Improvements of currently common management practices are required, especially in the area of labour induction (CTG checks before and after administration of labour-inducing medication, no administration of prostaglandin if contractions are ongoing). The discussion of use of misoprostol in the media resulted in stoppage of its use mainly in smaller clinics.
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Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christel Weiss
- Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Werner Rath
- Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Florian Stumpfe
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | | | - Patrick Stelzl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
- Abteilung für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum Linz, Linz, Austria
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34
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Hagenbeck C, Pecks U, Lammert F, Hütten MC, Borgmeier F, Fehm T, Schleußner E, Maul H, Kehl S, Hamza A, Keitel V. [Intrahepatic cholestasis of pregnancy]. Gynakologe 2021; 54:341-356. [PMID: 33896963 PMCID: PMC8056200 DOI: 10.1007/s00129-021-04787-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 12/19/2022]
Abstract
Die Schwangerschaftscholestase („intrahepatic cholestasis of pregnancy“, ICP) ist die häufigste schwangerschaftsspezifische Lebererkrankung. Das Leitsymptom Juckreiz sowie eine begleitende Serumkonzentrationserhöhung von Gallensäuren und/oder der Alaninaminotransferase (ALT) sind wegweisend in der Diagnosestellung. Die mütterliche Prognose ist gut. Das fetale Outcome ist abhängig von der Gallensäurenkonzentration. Die ICP ist dabei sowohl mit Frühgeburt als auch mit intrauterinem Fruchttod (IUFT) assoziiert. Dieser ist Folge einer akuten fetalen Asphyxie, nicht einer chronischen uteroplazentaren Dysfunktion. Ein prädiktives Monitoring, z. B. durch Kardiotokographie (CTG) oder Ultraschall gibt es nicht. Eine medikamentöse Therapie mit Ursodeoxycholsäure (UDCA) bessert den Juckreiz, aber beeinflusst das fetale Outcome nicht nachweislich. Eine Entbindungsindikation ist in Abhängigkeit von Gallensäurenkonzentration und Gestationsalter gegeben. In Folgeschwangerschaften besteht ein hohes Wiederholungsrisiko.
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Affiliation(s)
- Carsten Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Deutschland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Frank Lammert
- Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Homburg, Deutschland
| | - Matthias C. Hütten
- Neonatologie, Maastricht Universitair Medisch Centrum+, Maastricht, Niederlande
| | - Felix Borgmeier
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Deutschland
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Deutschland
| | | | - Holger Maul
- Frauenklinik, Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Deutschland
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Amr Hamza
- Kantonsspital Baden, Baden, Schweiz
- Klinikum für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universität des Saarlandes, Homburg, Deutschland
| | - Verena Keitel
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universität Düsseldorf, Düsseldorf, Deutschland
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Kühnert M, Kehl S, Pecks U, Schäfer-Graf UM, Groten T, Schild RL, Schlembach D, Schmidt M, Hamza A. Recommendations of the AGG (Task Force for Obstetrics, Section Maternal Diseases) on the Management of Maternal Hepatitis B, C and D Infection in Pregnancy. Geburtshilfe Frauenheilkd 2021; 81:390-397. [PMID: 33867560 PMCID: PMC8046515 DOI: 10.1055/a-1330-7514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 10/27/2022] Open
Abstract
These statements and recommendations should provide appropriate information about maternal and fetal routes of infection, screening, detection of risk factors, diagnostic procedures, treatment, birth planning and peripartum and postpartum management of maternal hepatitis infection and offer pointers for prenatal counselling and routine clinical care on delivery wards.
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Affiliation(s)
| | - Sven Kehl
- Frauenklinik, Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Tanja Groten
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Jena, Jena, Germany
| | - Ralf Lothar Schild
- Klinik für Geburtshilfe und Perinatalmedizin, Diakovere Perinatalzentrum Hannover, Hannover, Germany
| | - Dietmar Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln-Berlin, Berlin, Germany
| | - Markus Schmidt
- Klinik für Frauenheilkunde und Geburtshilfe, Sana Kliniken Duisburg GmbH, Duisburg, Germany
| | - Amr Hamza
- Gynäkologie und Geburtshilfe, Universitätsklinikum des Saarlandes, Homburg, Germany
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Pretscher J, Weiss C, Dammer U, Stumpfe F, Faschingbauer F, Beckmann MW, Kehl S. Influence of Preeclampsia on Induction of Labor at Term: A Cohort Study. In Vivo 2021; 34:1195-1200. [PMID: 32354909 DOI: 10.21873/invivo.11892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Even though vaginal delivery is a feasible option in patients with preeclampsia, the cesarean section rate in those patients is high. The aim of this study was to evaluate the influence of preeclampsia on induction of labor at term. PATIENTS AND METHODS This historical cohort study analyzed inductions of labor in women at term having preeclampsia versus women who were induced due to other reasons. The primary outcome measure was the cesarean section rate. RESULTS The cesarean section rate was higher in the preeclampsia group for both nulliparous and multiparous women after induction of labor but failed to reach statistical significane. The induction-to-delivery interval was longer in nulliparous women and the rate of vaginal birth within 48 h was lower in the nulliparous patiens with preeclampsia. However, the impact of preeclampsia on the cesarean section rate was not significant in the multivariable analysis following adjustment for BMI and parity. CONCLUSION Preeclampsia at term did not influence the cesarean section rate in nulliparous and parous women when labor was induced.
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Affiliation(s)
- Jutta Pretscher
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany
| | - Ulf Dammer
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian Stumpfe
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Sven Kehl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
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Rath W, Stelzl P, Kehl S. Outpatient Induction of Labor - Are Balloon Catheters an Appropriate Method? Geburtshilfe Frauenheilkd 2021; 81:70-80. [PMID: 33487667 PMCID: PMC7815336 DOI: 10.1055/a-1308-2341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/06/2020] [Indexed: 12/22/2022] Open
Abstract
As the number of labor inductions in high-income countries has steadily risen, hospital costs and the additional burden on obstetric staff have also increased. Outpatient induction of labor is therefore becoming increasingly important. It has been estimated that 20 – 50% of all pregnant women requiring induction would be eligible for outpatient induction. The use of balloon catheters in patients with an unripe cervix has been shown to be an effective and safe method of cervical priming. Balloon catheters are as effective as the vaginal administration of prostaglandin E
2
or oral misoprostol. The advantage of using a balloon catheter is that it avoids uterine hyperstimulation and monitoring is less expensive. This makes balloon catheters a suitable option for outpatient cervical ripening. Admittedly, intravenous administration of oxytocin to induce or augment labor is required in approximately 75% of cases. Balloon catheters are not associated with a higher risk
of maternal and neonatal infection compared to vaginal PGE
2
. Low-risk pregnancies (e.g., post-term pregnancies, gestational diabetes) are suitable for outpatient cervical ripening with a balloon catheter. The data for high-risk pregnancies are still insufficient. The following conditions are recommended when considering an outpatient approach: strict selection of appropriate patients (singleton pregnancy, cephalic presentation, intact membranes), CTG monitoring for 20 – 40 minutes after balloon placement, the patient must be given detailed instructions about the indications for immediate readmission to hospital, and 24-hour phone access to the hospital must be ensured. According to reviewed studies, the balloon catheter remained in place between 12 hours (“overnight”) and 24 hours. The most common reason for readmission to hospital was expulsion of the balloon catheter. The advantages of outpatient versus inpatient induction of cervical ripening with a balloon
catheter were the significantly shorter hospital stay, the lower costs, and higher patient satisfaction, with both procedures having been shown to be equally effective. Complication rates (e.g., vaginal bleeding, severe pain, uterine hyperstimulation syndrome) during the cervical ripening phase are low (0.3 – 1.5%); severe adverse outcomes (e.g., placental abruption) have not been reported. Compared to inpatient induction of labor using vaginal PGE
2
, outpatient cervical ripening using a balloon catheter had a lower rate of deliveries/24 hours and a significantly higher need for oxytocin; however, hospital stay was significantly shorter, frequency of pain during the cervical ripening phase was significantly lower, and patientsʼ duration of sleep was longer. A randomized controlled study comparing outpatient cervical priming with a balloon catheter with outpatient or inpatient induction of labor with oral misoprostol would be of clinical interest.
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Affiliation(s)
- Werner Rath
- Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Patrick Stelzl
- Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Johannes Kepler Universität Linz, Linz, Austria
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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Kehl S. „Die Welt hat sich verändert
…“. Z Geburtshilfe Neonatol 2020; 224:325. [DOI: 10.1055/a-1288-3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Liebe Leserinnen und Leserwir können wahrlich nicht behaupten, dass das Jahr 2020 ein langweiliges
gewesen ist. Seit Anfang des Jahres hat die SARS-CoV-2-Pandemie die ganze Welt,
unseren Alltag und die Perinatalmedizin fest im Griff. „Die Welt hat sich
verändert. Und deshalb müssen auch wir uns
ändern“, sagte einst der ehemalige US-amerikanische
Präsident Barack Obama.
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Affiliation(s)
- Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen
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39
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Baier F, Weinhold L, Stumpfe FM, Kehl S, Pretscher J, Bayer CM, Topal N, Pontones C, Mayr A, Schild R, Schmid M, Beckmann MW, Faschingbauer F. Longitudinal Course of Short-Term Variation and Doppler Parameters in Early Onset Growth Restricted Fetuses. Ultraschall Med 2020; 41:e23-e32. [PMID: 31238380 DOI: 10.1055/a-0858-2290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate the longitudinal pattern of fetal heart rate short term variation (STV) and Doppler indices and their correlation to each other in severe growth restricted (IUGR) fetuses. MATERIALS AND METHODS In this retrospective study, pregnancies with a birth weight below the 10th percentile, born between 24 and 34 gestational weeks with serial Doppler measurements in combination with a computerized CTG (cCTG) with calculated STV were included. Longitudinal changes of both Doppler indices and STV values were evaluated with generalized additive models, adjusted for gestational age and the individual. For all measurements the frequency of abnormal values with regard to the time interval before delivery and Pearson correlations between Doppler indices and STV values were calculated. RESULTS 41 fetuses with a total of 1413 observations were included. Over the course of the whole study period, regression analyses showed no significant change of STV values (p = 0.38). Only on the day of delivery, a prominent decrease was observed (mean STV d28-22: 7.97 vs. mean STV on day 0: 6.8). Doppler indices of UA and MCA showed a continuous, significant deterioration starting about three weeks prior to delivery (p = 0.007; UA and p < 0.001, MCA). Correlation between any Doppler index and STV values was poor. CONCLUSION Fetal heart rate STV does not deteriorate continuously. Therefore, cCTG monitoring should be performed at least daily in these high-risk fetuses. Doppler indices of umbilical artery (UA) and middle cerebral artery (MCA), however, showed continuous deterioration starting about 3 weeks prior to delivery.
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Affiliation(s)
- Friederike Baier
- Obstetrics and Gynecology, University-Hospital of Erlangen, Germany
| | - Leonie Weinhold
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University-Hospital of Bonn, Germany
| | | | - Sven Kehl
- Obstetrics and Gynecology, University-Hospital of Erlangen, Germany
| | - Jutta Pretscher
- Obstetrics and Gynecology, University-Hospital of Erlangen, Germany
| | | | - Nalan Topal
- Obstetrics and Gynecology, University-Hospital of Erlangen, Germany
| | | | - Andreas Mayr
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ralf Schild
- Obstetrics and Gynecology, Diakovere Hospital, Hannover, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University-Hospital of Bonn, Germany
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40
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Bührer C, Felderhoff-Müser U, Gembruch U, Hecher K, Kainer F, Kehl S, Kidszun A, Kribs A, Krones T, Lipp V, Maier RF, Mitschdörfer B, Nicin T, Roll C, Schindler M. Frühgeborene an der Grenze der Lebensfähigkeit
(Entwicklungsstufe S2k, AWMF-Leitlinien-Register Nr. 024/019, Juni
2020). Z Geburtshilfe Neonatol 2020; 224:244-254. [PMID: 33075837 DOI: 10.1055/a-1230-0810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Redaktionskomitee
Federführende Fachgesellschaft
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Affiliation(s)
- Christoph Bührer
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin
| | | | - Ulrich Gembruch
- Zentrum für Geburtshilfe und Frauenheilkunde, Universitätsklinikum Bonn, Bonn
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätskrankenhaus Eppendorf, Hamburg
| | - Franz Kainer
- Abteilung für Geburtshilfe und Pränatalmedizin, Klinik Hallerwiese, Nürnberg
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - André Kidszun
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz
| | | | - Tanja Krones
- Klinische Ethik, Universitätsspital Zürich, Zürich
| | - Volker Lipp
- Lehrstuhl für Bürgerliches Recht, Zivilprozessrecht, Medizinrecht und Rechtsvergleichung, Juristische Fakultät / Institut für Notarrecht / Zentrum für Medizinrecht, Universität Göttingen, Göttingen
| | - Rolf F Maier
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Marburg, Marburg
| | | | - Tatjana Nicin
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Hanau, Hanau
| | - Claudia Roll
- Abteilung Neonatologie, Pädiatrische Intensivmedizin, Schlafmedizin, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Datteln
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41
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Pontones CA, Lubrich H, Schwenke E, Cupisti S, Dittrich R, Kehl S, Beckmann MW, Fahlbusch C, Oppelt PG. Präkonzeptionelle Beratung, Schwangerschaftsvorsorge und peripartales Management bei Patientinnen mit Ullrich-Turner-Syndrom und kardiovaskulärem Hochrisikoprofil. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- CA Pontones
- Universitätsfrauenklinik Erlangen, Kinder- und Jugendgynäkologie
| | - H Lubrich
- Universitätsfrauenklinik Erlangen, Kinder- und Jugendgynäkologie
| | - E Schwenke
- Universitätsfrauenklinik Erlangen, Geburtshilfe
| | - S Cupisti
- Universitätsfrauenklinik Erlangen, Endokrinologie
| | - R Dittrich
- Universitätsfrauenklinik Erlangen, Endokrinologie
| | - S Kehl
- Universitätsfrauenklinik Erlangen, Geburtshilfe
| | | | - C Fahlbusch
- Universitätsfrauenklinik Erlangen, Kinder- und Jugendgynäkologie
| | - PG Oppelt
- Universitätsfrauenklinik Erlangen, Kinder- und Jugendgynäkologie
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42
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Stumpfe F, Faschingbauer F, Kehl S, Pretscher J, Mayr A, Schmidt M, Beckmann M, Stelzl P. Amniotic-Umbilical-to-Cerebral Ratio – eine neue Ratio aus Dopplerparametern und der Fruchtwassermenge zur Vorhersage eines ungünstigen perinatalen Outcomes bei SGA-Feten am Geburtstermin. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | | | - S Kehl
- Universitätsklinikum Erlangen, Frauenklinik
| | | | - A Mayr
- Universität Bonn, Institut für Medizinische Biometrie, Informatik und Epidemiologie
| | - M Schmidt
- Universität Bonn, Institut für Medizinische Biometrie, Informatik und Epidemiologie
| | | | - P Stelzl
- Universitätsklinikum Erlangen, Frauenklinik
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43
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Stumpfe F, Kehl S, Pretscher J, Mayr A, Schmidt M, Schneider M, Beckmann M, Faschingbauer F. Correlation of short-term variation and Doppler parameters with adverse perinatal outcome in small-for-gestational age fetuses at term. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - S Kehl
- Universitätsklinikum Erlangen, Frauenklinik
| | | | - A Mayr
- Universität Bonn, Institut für Medizinische Biometrie, Informatik und Epidemiologie
| | - M Schmidt
- Universität Bonn, Institut für Medizinische Biometrie, Informatik und Epidemiologie
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Pretscher J, Kehl S, Stelzl P, Stumpfe FM, Mayr A, Schmid M, Staerk C, Schild RL, Beckmann MW, Faschingbauer F. Influence of sonographic fetal weight estimation in (suspected) fetal macrosomia on perinatal outcome. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Pretscher
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Frauenklinik
| | - S Kehl
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Frauenklinik
| | - P Stelzl
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Frauenklinik
| | - FM Stumpfe
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Frauenklinik
| | - A Mayr
- Universitätsklinikum Bonn, Institut für Medizinische Biometrie, Informatik und Epidemiologie
| | - M Schmid
- Universitätsklinikum Bonn, Institut für Medizinische Biometrie, Informatik und Epidemiologie
| | - C Staerk
- Universitätsklinikum Bonn, Institut für Medizinische Biometrie, Informatik und Epidemiologie
| | - RL Schild
- Perinatalzentrum Hannover, Diakovere Krankenhaus gGmbH
| | - MW Beckmann
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Frauenklinik
| | - F Faschingbauer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Frauenklinik
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45
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Scharl A, Abou-Dakn M, Kehl S. „Zur Geburt ein Magenmittel“ – ein Lehrstück. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/a-1124-8908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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46
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Stumpfe FM, Titzmann A, Schneider MO, Stelzl P, Kehl S, Fasching PA, Beckmann MW, Ensser A. SARS-CoV-2 Infection in Pregnancy - a Review of the Current Literature and Possible Impact on Maternal and Neonatal Outcome. Geburtshilfe Frauenheilkd 2020; 80:380-390. [PMID: 32322107 PMCID: PMC7174004 DOI: 10.1055/a-1134-5951] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
In December 2019, cases of pneumonia of unknown cause first started to appear in Wuhan in China; subsequently, a new coronavirus was soon identified as the cause of the illness, now known as Coronavirus Disease 2019 (COVID-19). Since then, infections have been confirmed worldwide in numerous countries, with the number of cases steadily rising. The aim of the present review is to provide an overview of the new severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) and, in particular, to deduce from it potential risks and complications for pregnant patients. For this purpose, the available literature on cases of infection in pregnancy during the SARS epidemic of 2002/2003, the MERS (Middle East respiratory syndrome) epidemic ongoing since 2012, as well as recent publications on cases infected with SARS-CoV-2 in pregnancy are reviewed and reported. Based on the literature available at the moment, it can be assumed that the clinical course of COVID-19 disease may be complicated by pregnancy which could be associated with a higher mortality rate. It may also be assumed at the moment that transmission from mother to child in utero is unlikely. Breastfeeding is possible once infection has been excluded or the disease declared cured.
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Affiliation(s)
| | | | | | - Patrick Stelzl
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Germany
| | - Sven Kehl
- Universitätsklinikum Erlangen, Frauenklinik, Erlangen, Germany
| | | | | | - Armin Ensser
- Universitätsklinikum Erlangen, Virologisches Institut, Erlangen, Germany
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47
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Puhl A, Weiss C, Schneid A, Zahn E, Kraft K, Pretscher J, Faschingbauer F, Beckmann MW, Kehl S. [Does Induction of Labor for Preterm Premature Rupture of Membranes at 34 Weeks of Gestation Increase the Risk for Cesarean Section?]. Z Geburtshilfe Neonatol 2020; 224:269-274. [PMID: 32120446 DOI: 10.1055/a-1110-1132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Induction of labor at 34 weeks of gestation is often linked to increased risk for cesarean section. Recently, the PPROMT trial demonstrated a higher cesarean section rate when labor was induced for preterm premature rupture of membranes (PPROM). The purpose of this study was therefore to evaluate the success rate of induction of labor for PPROM at 34 and 35 weeks of gestation in comparison with a higher gestational age. MATERIAL AND METHODS In this historic cohort study, cases with labor inductions for PPROM ≥ 34 weeks of gestation were included. Induction of labor at 34 and 35 weeks of gestation (group 1) were compared with those performed at 36 weeks (group 2) and 37 weeks (group 3). Induction of labor was started 12 to 24 hours after (preterm) premature rupture of membranes. Antibiotics were given routinely. The primary outcome was the rate of cesarean section. RESULTS There were significantly more cesarean sections in group 3 in comparison with group 2 (7 vs. 25%, p=0.0136). However, univariable and multiple logistic regression analysis of the primary outcome measure showed that there was no impact of the group affiliation on cesarean section rate. Significant parameters influencing the risk of cesarean section were body mass index and Bishop score. CONCLUSION Induction of labor for PPROM at 34 weeks of gestation is not associated with an increased rate of cesarean section.
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Affiliation(s)
- Alexander Puhl
- Frauenklinik, Klinikverbund Kempten-Oberallgäu gGmbH, Kempten
| | - Christel Weiss
- Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim
| | - Anna Schneid
- Frauenklinik, Klinikverbund Kempten-Oberallgäu gGmbH, Kempten
| | - Eva Zahn
- Frauenklinik, Klinikverbund Kempten-Oberallgäu gGmbH, Kempten
| | | | - Jutta Pretscher
- Gynäkologie und Geburtshilfe, Universitätsklinikum Erlangen Frauenklinik, Erlangen
| | | | | | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
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48
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Pretscher J, Kehl S, Stumpfe FM, Mayr A, Schmid M, Schild RL, Beckmann MW, Faschingbauer F. Ultrasound Fetal Weight Estimation in Diabetic Pregnancies. J Ultrasound Med 2020; 39:341-350. [PMID: 31436342 DOI: 10.1002/jum.15112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/14/2019] [Accepted: 06/29/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate different formulas for estimating fetal weight in diabetic pregnancies. METHODS This retrospective study evaluated the precision of ultrasound fetal weight estimation in 756 pregnancies complicated by gestational diabetes between 2002 and 2016. The estimated fetal weights (EFWs) were obtained within 7 days of delivery from 10 weight estimation formulas and were compared with pair-wise matched controls from 15,701 patients. The precision of the evaluated formulas for EFW was analyzed by median absolute percentage errors (MAPEs), mean percentage errors (MPEs), and proportions of estimates within 10% of actual birth weight. RESULTS Among the tested formulas, the lowest MAPE was detected with formula I of Hadlock et al (Am J Obstet Gynecol 1985; 151:333-337), and the formula of Schild et al (Ultrasound Obstet Gynecol 2004; 23:30-35) had the highest proportion of estimates within the 10% range. The EFW in diabetic patients showed a slight trend toward overestimation in comparison with the matched controls (MPE estimates showed a trend toward more positive values). In most of the EFW formulas that were evaluated, no significant differences were detected in MAPEs and estimates within the 10% range. The MPE estimates with most formulas in both groups were close to zero. Overall, the differences between most of the evaluated formulas were small. CONCLUSIONS Little evidence was found for differences in the accuracy of the EFW in diabetic pregnancies and controls. The Hadlock I formula showed the lowest MAPE, and the Schild formula had the highest proportion of estimates within the 10% range.
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Affiliation(s)
- Jutta Pretscher
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Sven Kehl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian M Stumpfe
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Andreas Mayr
- Department of Medical Biometry, Informatics, and Epidemiology, Bonn University Hospital, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics, and Epidemiology, Bonn University Hospital, Bonn, Germany
| | - Ralf L Schild
- Department of Obstetrics and Perinatal Medicine, Perinatalzentrum Hannover, Diakovere Krankenhaus gGmbH, Hannover, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
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49
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Koch MC, Lermann J, van de Roemer N, Renner SK, Burghaus S, Hackl J, Dittrich R, Kehl S, Oppelt PG, Hildebrandt T, Hack CC, Pöhls UG, Renner SP, Thiel FC. Clarifications concerning the commentary “Published analysis of contraceptive effectiveness of Daysy and DaysyView app is fatally flawed”. Reprod Health 2019; 16:83. [PMID: 31208442 PMCID: PMC6572732 DOI: 10.1186/s12978-019-0746-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Abstract
INTRODUCTION Maintenance tocolysis, mostly defined as the continuation of tocolytic treatment beyond 48 h, remains a matter of debate. There is no sufficient evidence from randomized controlled trials, that maintenance tocolysis is able to prolong pregnancy significantly and to reduce severe neonatal morbidity and mortality. Hence, it is not recommended in current guidelines. On the contrary, maintenance tocolysis is commonly used in clinical practice and subject of current clinical-scientific investigations. TOCOLYTICS FOR MAINTENANCE TREATMENT None of the conventional tocolytics (beta-sympathomimetics, calcium-channel blockers, magnesium, cyclooxygenase inhibitors, and oxytocin receptor antagonists) have proven to be appropriate for maintenance treatment. Progesterone and 17-α-hydroxyprogesterone caproate have shown promising results in low-quality randomized trials, but not in high-quality studies. DISCUSSION Basically, the value of studies regarding maintenance tocolysis is limited by a considerable heterogeneity, its mostly low quality, significant differences in methodology as well as the inadequate statistical power due to the small number of women studied. So far, maintenance tocolysis is a case-by-case decision outweighing the benefits and harms of tocolytic treatment.
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Affiliation(s)
- Patrick Stelzl
- Frauenklinik, Universitätsklinikum Erlangen, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Werner Rath
- Medizinische Fakultät Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
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