Search

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., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091) was published in December 2021. This guideline combines and summarizes earlier guidelines such as "Female stress urinary incontinence," "Female urge incontinence" and "Use of Ultrasonography in Urogynecological Diagnostics" for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion e. V., AGUB). Methods This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline "Urinary Incontinence in Adults" published by the European Association of Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated. Recommendations The short version of this guideline consists of recommendations and statements on the surgical treatment of female patients with stress urinary incontinence and urge incontinence. Specific solutions for the diagnostic workup and treatment of uncomplicated and complicated urinary incontinence are discussed. The diagnostics and surgical treatment of iatrogenic urogenital fistula are presented., Competing Interests: Conflict of Interest The conflicts of interest of the authors are listed in the long version of the guideline ( https://register.awmf.org/de/leitlinien/detail/015-091 )./ Die Interessenkonflikte der Autoren sind in der Langfassung der Leitlinie ( https://register.awmf.org/de/leitlinien/detail/015-091 ) aufgelistet., (Thieme. All rights reserved.)

Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091) was published in December 2021. This guideline combines and summarizes earlier guidelines such as "Female stress urinary incontinence," "Female urge incontinence" and "Use of Ultrasonography in Urogynecological Diagnostics" for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion e. V., AGUB). Methods This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline "Urinary Incontinence in Adults" published by the European Association of Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated. Recommendations The short version of this guideline consists of recommendations and statements on the epidemiology, etiology, classification, symptoms, diagnostics, and treatment of female patients with urinary incontinence. Specific solutions for the diagnostic workup and appropriate conservative and medical therapies for uncomplicated and complication urinary incontinence are discussed., Competing Interests: Conflict of Interest The conflicts of interest of all the authors are listed in the long version of the guideline ( https://register.awmf.org/de/leitlinien/detail/015-091 )./ Die Interessenkonflikte der Autoren sind in der Langfassung der Leitlinie ( https://register.awmf.org/de/leitlinien/detail/015-091 ) aufgelistet., (Thieme. All rights reserved.)

Introduction To date, the optimal axillary staging procedure for initially node-positive breast carcinoma patients after neoadjuvant chemotherapy (NACT) has been unclear. The aim of the AXSANA study is to prospectively compare different surgical staging techniques with respect to the oncological outcome and quality of life for the patients. Little is known about current clinical practice in Germany. Material and Methods In this paper we analyzed data from patients enrolled in the AXSANA study at German study sites from June 2020 to March 2022. Results During the period under investigation, 1135 patients were recruited at 143 study sites. More than three suspicious lymph nodes were initially found in 22% of patients. The target lymph node (TLN) was marked in 64% of cases. This was done with clips/coils in 83% of patients, with magnetic seeds or carbon suspension in 8% each, and with a radar marker in 1% of patients. After NACT, targeted axillary dissection (TAD) or axillary lymphadenectomy (ALND) were each planned in 48% of patients, and sentinel lymph node biopsy alone (SLNB) in 2%. Clinically, the nodal status after NACT was found to be unremarkable in 65% of cases. Histological lymph node status was correctly assessed by palpation in 65% of patients and by sonography in 69% of patients. Conclusion At the German AXSANA study sites, TAD and ALND are currently used as the most common surgical staging procedures after NACT in initially node-positive breast cancer patients. The TLN is marked with various markers prior to NACT. Given the inadequate accuracy of clinical assessment of axillary lymph node status after NACT, it should be questioned whether axillary dissection after NACT should be performed based on clinical assessment of nodal status alone., Competing Interests: Conflict of Interest/Interessenkonflikt T. D. W. has received fees for lectures and activities from Pfizer, Roche, and NeoDynamics. M. T. has acted in an advisory capacity for Amgen, AstraZeneca, Aurikamed, Becton & Dickinson, BiomʼUp, Celgene, ClearCut, Clovis, Daiichi Sankyo, Eisai, Exact Sciences, Gilead Science, Lilly, MSD, Norgine, Neodynamics, Novartis, Onkowissen, Pfizer, pfm Medical, Pierre Fabre, Roche, RTI Surgical, Seagen, and Sysmex. He received manuscript support from Amgen, Celgene, ClearCut, pfm medical, Roche, and Servier, travel expenses from Amgen, Art Tempi, AstraZeneca, Celgene, Cleracut, Clovis, Connect Medica, Daiichi Sankyo, Eisai, Exact Sciences, Hexal, I-Med-Institute, Lilly, MCI, Medtronic, MSD, Norgine, Novartis, Omniamed, Pfizer, pfm Medical, Roche, and RTI Surgical, conference costs from Amgen, AstraZeneca, Celgene, Daiichi Sanyko, Hexal, Novartis, Pfizer, and Roche, lecturing fees from Amgen, Art Tempi, AstraZeneca, Celgene, Clovis, Connect Medica, Eisai, Genomic Health, Gilead Science, Hexal, I-Med-Institute, Jörg Eickeler, Lilly, MCI, Medtronic, MSD, Novartis, Omniamed, Pfizer, pfm Medical, Roche, RTI Surgical, Seagen, Sysmex, and Vifor, and study support from Endomag and Exact Sciences. M. P. L. has acted in an advisory capacity for Lilly, AstraZeneca, MSD, Novartis, Pfizer, Eisai, Gilead, Exact Sciences, Daiichi Sankyo, Grünenthal, Pierre Fabre, PharmaMar, Samantree, Sysmex, and Roche. He has given lectures for Lilly, Roche, MSD, Novartis, Pfizer, Exact Sciences, Daiichi Sankyo, Gilead, Grünenthal, AstraZeneca, pfm, Samantree, and Eisai, received travel expenses from Roche and Pfizer, and is on the Editorial Board at medac. S. L. has received fees or research support from Abbvie, AstraZeneca, Celgene, Daiichi Sankyo, Gilead, Novartis, Pfizer, Pierre Fabre, Prime/Medscape, Roche, and Samsung. In addition, she has acted in an advisory capacity for Abbvie, Amgen, AstraZeneca, Bayer, BMS, Celgene, Daiichi Sankyo, Eirgenix, GlaxoSmithKline, Gilead, Lilly, Merck, Novaris, Pfizer, Pierre Fabre, Prime/Medscape, Puma, Roche, and Seagen, and is a member of GBG Forschungs GmbH. H.-C. K. has received fees and travel expenses support from Carl Zeiss meditec, Theraclion, Novartis, Amgen, AstraZeneca, Pfizer, Roche, Daiichi Sankyo, Tesaro, MSD, Onkowissen, Eli Lilly, SurgVision, Exact Sciences, and Genomic Health, and holds shares in Theraclion and Phaon Scientific. M. W. has received fees for lectures and consulting activities from Pfizer, Roche, Novartis, Lilly, GlaxoSmithKline, and AstraZeneca. S. P. has received fees for advisory activities from Becton & Dickinson, Grünenthal, Sysmex Deutschland, Sysmex Europe, Endomag, pfm medical AG, NeoNavia, NeoDynamics, and Triconmed, as well as support for training courses from Roche and for travel activities from Motiva. D. W. has received fees for lectures and activities from Roche and Pfizer. M. H. has received lecture fees from Roche and Novartis. M. U. has received fees for lectures and advisory activities from Abbvie, Amgen, AstraZeneca, BMS, Celgene, Daiji Sankyo, Eisai, Gilead, GlaxoSmithKline, Lilly, Molecular Health, MSD Merck, Mundipharma, Mylan, Myriad Genetics, Novartis, Pierre Fabre, Pfizer, Roche, Sanofi Aventis, and Saegen. M. B.-P. receives fees for lectures and advisory activities from Roche, Novartis, Pfizer, Eli Lilly, Eisai, GlaxoSmithKline, Seagen, Daiichi Sankyo, pfm medical AG, and AstraZeneca, and study support from Exact Sciences. The AXSANA study is financially supported by the AGO-B, the Claudia von Schilling Foundation for Breast Cancer Research, the Ehmann Foundation Savognin, AWOgyn, EndoMag, Merit Medical GmbH, and Mammotome. The sponsors of the study had no influence on the study protocol or conduct./ T. K. erhielt Honorare für Vorträge und beratende Tätigkeiten von Pfizer, Roche und NeoDynamics. M. T. war beratend tätig für Amgen, AstraZeneca, Aurikamed, Becton & Dickinson, BiomʼUp, Celgene, ClearCut, Clovis, Daiichi Sankyo, Eisai, Exact Sciences, Gilead Science, Lilly, MSD, Norgine, Neodynamics, Novartis, Onkowissen, Pfizer, pfm Medical, Pierre Fabre, Roche, RTI Surgical, Seagen und Sysmex. Er erhielt Manuskriptunterstützung von Amgen, Celgene, ClearCut, pfm medical, Roche, und Servier, Reisekosten von Amgen, Art Tempi, AstraZeneca, Celgene, Cleracut, Clovis, Connect Medica, Daiichi Sankyo, Eisai, Exact Sciences, Hexal, I-Med-Institute, Lilly, MCI, Medtronic, MSD, Norgine, Novartis, Omniamed, Pfizer, pfm Medical, Roche und RTI Surgical, Kongresskostenübernahmen von Amgen, AstraZeneca, Celgene, Daiichi Sanyko, Hexal, Novartis, Pfizer und Roche, Vortragshonorare von Amgen, Art Tempi, AstraZeneca, Celgene, Clovis, Connect Medica, Eisai, Genomic Health, Gilead Science, Hexal, I-Med-Institute, Jörg Eickeler, Lilly, MCI, Medtronic, MSD, Novartis, Omniamed, Pfizer, pfm Medical, Roche, RTI Surgical, Seagen, Sysmex und Vifor und Studienunterstützung von Endomag und Exact Sciences. M. P. L. war beratend für Lilly, AstraZeneca, MSD, Novartis, Pfizer, Eisai, Gilead, Exact Sciences, Daiichi Sankyo, Grünenthal, Pierre Fabre, PharmaMar, Samantree, Sysmex und Roche tätig. Er hielt Vorträge für Lilly, Roche, MSD, Novartis, Pfizer, Exact Sciences, Daiichi Sankyo, Gilead, Grünenthal, AstraZeneca, pfm, Samantree und Eisai, erhielt Reisekosten von Roche und Pfizer und ist im Editorial Board bei medac. S. L. erhielt Honorare bzw. Forschungsunterstützung von Abbvie, AstraZeneca, Celgene, Daiichi Sankyo, Gilead, Novartis, Pfizer, Pierre Fabre, Prime/Medscape, Roche und Samsung. Weiterhin ist sie beratend tätig für Abbvie, Amgen, AstraZeneca, Bayer, BMS, Celgene, Daiichi Sankyo, Eirgenix, GlaxoSmithKline, Gilead, Lilly, Merck, Novaris, Pfizer, Pierre Fabre, Prime/Medscape, Puma, Roche und Seagen und ist Mitglied der GBG Forschungs GmbH. H.-C. K. hat Honorare und Reisekostenunterstützung erhalten von Carl Zeiss meditec, Theraclion, Novartis, Amgen, AstraZeneca, Pfizer, Roche, Daiichi Sankyo, Tesaro, MSD, Onkowissen, Eli Lilly, SurgVision, Exact Sciences und Genomic Health und hält Anteile von Theraclion und Phaon Scientific. M. W. hat Honorare erhalten für Vorträge und beratende Tätigkeiten von Pfizer, Roche, Novartis, Lilly, GlaxoSmithKline und AstraZeneca. S. P. erhielt Honorare für beratende Tätigkeiten von Becton & Dickinson, Grünenthal, Sysmex Deutschland, Sysmex Europe, Endomag, pfm medical AG, NeoNavia, NeoDynamics und Triconmed sowie Unterstützungen für Fortbildungen von Roche und für Reisetätigkeiten von Motiva. D. W. hat Honorare für Vorträge und beratende Tätigkeiten von Roche und Pfizer erhalten. M. H. hat Vortragshonorare von Roche und Novartis erhalten. M. U. erhielt Honorare für Vorträge und beratende Tätigkeiten von Abbvie, Amgen, AstraZeneca, BMS, Celgene, Daiji Sankyo, Eisai, Gilead, GlaxoSmithKline, Lilly, Molecular Health, MSD Merck, Mundipharma, Mylan, Myriad Genetics, Novartis, Pierre Fabre, Pfizer, Roche, Sanofi Aventis und Saegen. M. B.-P. erhielt Honorare für Vorträge und beratende Tätigkeiten von Roche, Novartis, Pfizer, Eli Lilly, Eisai, GlaxoSmithKline, Seagen, Daiichi Sankyo, pfm medical AG und AstraZeneca, und Studienunterstützung von Exact Sciences. Die AXSANA-Studie wird finanziell von der AGO-B, der Claudia von Schilling Foundation for Breast Cancer Research, der Ehmann-Stiftung Savognin, der AWOgyn, EndoMag, der Merit Medical GmbH und Mammotome unterstützt. Die Sponsoren der Studie hatten weder auf das Protokoll noch auf die Studiendurchführung Einfluss., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)