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Question The purpose of this investigation is to find any differences between important maternal and infantile perinatal data from a clinic and a birth center group. Is the perinatal and/or maternal mortality in the birth center group higher? What influence do different socioeconomic factors have on the clinic group? Patients and methods We have carried out a retrospective comparison of the obstetric parameters from all birth center deliveries in the states Berlin and Bavaria for the years 1999 and 2000 (n = 3,060) and the perinatal data investigations of selected clinical groups of both states (n = 55,875). Results Objective parameters in both groups regarding week of potation at delivery, parity, age of pregnant women, infantile measures, primi- and multiparae and Apgar scales were comparable. There are significant differences in the delivery mode (spontaneous deliveries: birth centers > clinics; operative deliveries: birth centers clinics), in the episiotomy and perineal tear rate (birth centers clinics). The perinatal and maternal mortality in the groups were similar. Within the clinical group the socioeconomic status and a background of immigration had no significant influence on the perinatal data. Conclusion The retrospective data show that the more "invasive" clinical obstetrics leads to a similar postnatal condition of the neonates in comparison to the birth house group. Further comparative studies over several years are necessary to make statements about the occurrence of rare risks and maternal mortality in the free-standing birth center groups.

Question For a sound consultation of pregnant women e. g. regarding the choice of delivery place, a simple, reliable prepartal risk estimation system would be desirable. Methods After exclusion of all "hospital required" risk cases, out of 203,111 records from the Berlin Clinical Perinatal Data 1993 - 1999 176,734 births remained, for which all risks already discernible before delivery (catalogues of the German Maternity Guidelines) were retrospectively valued and weighted by means of a logistic regression analysis on their real importance for the prediction of a spontaneous birth. On the basis of logarithms of the odds ratio for the individual risk factors a point system was developed. Results There is a clearly higher risk for a surgical delivery in primiparae compared with multiparae. For multiparae 27, for primiparae 26 statistically significant (p 1 point (with a specificity of 0.5 and a sensitivity of 0.5), in the multiparae > 3 points (sensitivity 0.7, specificity 0.7). Conclusions As for primiparae the resulting prognosis of birth mode (spontaneous vs. surgical birth) using the described score is false at 46 %, in multiparae at 33 %, the prognosis power of the risk score can therefore only be classified as relatively poor. The risk assessment system is therefore not suitable e. g. as aid to decision-making for or against an extra-clinical delivery place where no obstetrical operations are possible.

Background Preterm infants should be delivered with as little trauma as possible. Fetal extraction during cesarean delivery can be facilitated by modification of the incision or by use of short-term tocolytic agents. A possible alternative to intravenous administration of beta-mimetics is i.v. application of nitroglycerin to induce rapid uterine relaxation. This has been recommended by various clinical teams, but with relatively little experience being available regarding preterm births. Patients and methods Retrospective analysis of the perinatal data for all single neonates weighing 500 to 1500 g delivered by cesarean section at the Berlin-Neukolln Hospital in the period from 6/1995 to 9/1999 following prophylactic intraoperative i.v. application to the mother of 0.2 mg nitroglycerin (n = 55). Control groups: 1. All infants weighing 500 to 1500 g delivered by cesarean section at the Berlin-Neukolln Hospital with no intraoperative application of nitroglycerin (n = 38); 2. All infants weighing 500 to 1500 g delivered by cesarean section included in Berlin perinatal statistics (BePE) 1993-1998 (n = 715). Results There were no differences between the groups in terms of Apgar scores or the incidence of arterial umbilical pH values 1000 ml. Within the nitroglycerin group, in a shorter interval between nitroglycerin application and cutting of umbilical cord ( 3 min: n = 13) 1-minute Apgar scores Conclusions 1. Intraoperative nitroglycerin application during cesarean section has no unfavorable effect on the condition of newborns 1000 ml was not increased. 3. Differences in the interval between nitroglycerin application and cutting of the umbilical cord have no clinically relevant effects on Apgar scores or arterial umbilical pH.

Ziel: Ziel war die Wertigkeit von Zervixlange (Cx) und fFN bei symptomatischen Patientinnen. Methodik: Im Rahmen einer Multicenter Doppelblind-Studie erfolgte der Einschluss von symptomatischen Patientinnen mit einer Einlingsschwangerschaft zwischen 23+0–33+6 SSW. Bei der Spekulumuntersuchung erfolgte die Abstrichentnahme auf fFN und die Auswertung durch das rapid fFN TLiq-System. Die Ergebnisse wurden verblindet und post partum ausgewertet. Die Cx wurde durch transvaginalen Ultraschall gemessen. Ergebnis: 136 Patientinnen wurden bisher ausgewertet.Das mittlere Alter der Patientinnen betrug 28 Jahre.Das Gestationsalter bei Aufnahme betrug 28+3 SSW und bei Entbindung 37+3 SSW.Die mittlere Cx ergab 24,8mm.Das mittlere Aufnahme-Entbindungsintervall (AD) lag bei 62.8 Tagen.Bei neg. fFN betrug das mittlere GA bei Entbindung 38.3 SSW (30–42 SSW) und das AD 68.6 Tage (3–127). Bei pos Ergebnis betrug das mittlere GA bei Entbindung 34+3 SSW (27–40) und das AD 33.9 Tage (0–113). Die Cx bei neg Ergebniss war durchschnittlich 26.3mm (1–49) lang, bei pos 16.7mm (3–44). Patientinnen, die 25mm,fFN neg) entweder pos fur fFN oder Cx ≤15mm. 111 Pat. (81.6%) zeigten einen neg Test, 25 (18,4%) einen pos. 17 Frauen (12.5%) wurden 5mm ≤ 25mm wurde innerhalb der nachsten 14Tage entbunden.

The purpose of this investigation is to find any differences between important maternal and infantile perinatal data from a clinic and a birth center group. Is the perinatal and/or maternal mortality in the birth center group higher? What influence do different socioeconomic factors have on the clinic group?We have carried out a retrospective comparison of the obstetric parameters from all birth center deliveries in the states Berlin and Bavaria for the years 1999 and 2000 (n = 3,060) and the perinatal data investigations of selected clinical groups of both states (n = 55,875).Objective parameters in both groups regarding week of potation at delivery, parity, age of pregnant women, infantile measures, primi- and multiparae and Apgar scales were comparable. There are significant differences in the delivery mode (spontaneous deliveries: birth centersclinics; operative deliveries: birth centersclinics), in blood loss over 1,000 ml (birth centersclinics), in the episiotomy and perineal tear rate (birth centersclinics), in the infantile transfer rate to a neonatology unit (birth centersclinics) and in the frequency of necessary neonatological measures in the neonate (birth centersclinics). The perinatal and maternal mortality in the groups were similar. Within the clinical group the socioeconomic status and a background of immigration had no significant influence on the perinatal data.The retrospective data show that the more "invasive" clinical obstetrics leads to a similar postnatal condition of the neonates in comparison to the birth house group. Further comparative studies over several years are necessary to make statements about the occurrence of rare risks and maternal mortality in the free-standing birth center groups.

Bewegungtherapie hat einen positiven Einfluss auf Verlauf und Prognose bei Diabetes mellitus. Fahrradergometrie kann erfolgreich aber leider nur mit niedriger Compliance zur Therapie von Gestationsdiabetes eingesetzt werden. Wir entwickelten ein Armsportprogramm, welches langfristig auserhalb der Klinik ohne zusatzliche Gerate durchfuhrbar ist. Studie: Fahrradbelastung und Armsportprogramm wurden bezuglich ihrer Effekte auf Mutter und Fet in 33 Schwangschaften verglichen. Armsportubungen: 18 verschiedene Armbewegungen im Sitzen und Liegen, 2 Belastungsintervalle von je 20min mit 5min Pause. Fahrradergometrie: Dosiert am Zielpulswert orientiert mit je 2 Belastungsphasen a 15min mit 5min Pause. Gemessene Parameter: Blutzucker, Laktat, Blutdruck, Puls, CTG und Zufriedenheit. Resultate: Keine Auffalligkeiten der fetale Herzfrequenz durch die sportlichen Belastungen. Keine Steigerung von Wehentatigkeit. Stearke Senkung der Blutzuckerwerte durch beide Sportformen. Niedrigere maximale Herzfrequenz beim Arm- als beim Radsport. Dies kann als wichtiger Sicherheitsfaktor fur eine langfristige eigenstandige Belastung in der hauslichen Umgebung gewertet werden. Schlussfolgerung: Armsport ist eine sinnvolle und sichere Alternative zur Fahrradergometrie bei der Therapie des Diabetes mellitus in der Schwangerschaft. Moglicherweise sind nicht zuletzt wegen des geringeren apparativen Aufwandes und der als gunstiger empfundenen Bewegungsablaufe Akzeptanz und Compliance des Armsportprogramms erhoht.

For a sound consultation of pregnant women e. g. regarding the choice of delivery place, a simple, reliable prepartal risk estimation system would be desirable.After exclusion of all "hospital required" risk cases, out of 203,111 records from the Berlin Clinical Perinatal Data 1993 - 1999 176,734 births remained, for which all risks already discernible before delivery (catalogues of the German Maternity Guidelines) were retrospectively valued and weighted by means of a logistic regression analysis on their real importance for the prediction of a spontaneous birth. On the basis of logarithms of the odds ratio for the individual risk factors a point system was developed.There is a clearly higher risk for a surgical delivery in primiparae compared with multiparae. For multiparae 27, for primiparae 26 statistically significant (p0.01) risk factors could be identified. After conversion of the odds ratio-values into the point system of the score, for the group of primiparae the cut off value was1 point (with a specificity of 0.5 and a sensitivity of 0.5), in the multiparae3 points (sensitivity 0.7, specificity 0.7).As for primiparae the resulting prognosis of birth mode (spontaneous vs. surgical birth) using the described score is false at 46 %, in multiparae at 33 %, the prognosis power of the risk score can therefore only be classified as relatively poor. The risk assessment system is therefore not suitable e. g. as aid to decision-making for or against an extra-clinical delivery place where no obstetrical operations are possible.

Preterm infants should be delivered with as little trauma as possible. Fetal extraction during cesarean delivery can be facilitated by modification of the incision or by use of short-term tocolytic agents. A possible alternative to intravenous administration of beta-mimetics is i.v. application of nitroglycerin to induce rapid uterine relaxation. This has been recommended by various clinical teams, but with relatively little experience being available regarding preterm births.Retrospective analysis of the perinatal data for all single neonates weighing 500 to 1500 g delivered by cesarean section at the Berlin-Neukölln Hospital in the period from 6/1995 to 9/1999 following prophylactic intraoperative i.v. application to the mother of 0.2 mg nitroglycerin (n = 55). Control groups: 1. All infants weighing 500 to 1500 g delivered by cesarean section at the Berlin-Neukölln Hospital with no intraoperative application of nitroglycerin (n = 38); 2. All infants weighing 500 to 1500 g delivered by cesarean section included in Berlin perinatal statistics (BePE) 1993-1998 (n = 715).There were no differences between the groups in terms of Apgar scores or the incidence of arterial umbilical pH valuesor = 7.10 or of maternal blood loss1000 ml. Within the nitroglycerin group, in a shorter interval between nitroglycerin application and cutting of umbilical cord (or = 3 min: n = 42;3 min: n = 13) 1-minute Apgar scores7 were observed more rarely, but no differences in arterial umbilical pH valuesor = 7.10.1. Intraoperative nitroglycerin application during cesarean section has no unfavorable effect on the condition of newborns32 SSW or between 500 and 1500 g. 2. The incidence of intraoperative maternal blood loss1000 ml was not increased. 3. Differences in the interval between nitroglycerin application and cutting of the umbilical cord have no clinically relevant effects on Apgar scores or arterial umbilical pH.