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For healthy women entering labor after an uneventful pregnancy, advantages of birth in midwife-led models of care have been demonstrated. We aimed to study the level of awareness regarding care in alongside midwifery units (AMU), factors involved in the decision for birth in obstetrician-led units (OLU), and wishes for care and concerns about birth in women registering for birth in OLU who would have been eligible for care in AMU. Healthy women with a term singleton cephalic fetus after an uneventful pregnancy course booking for birth in OLU were prospectively recruited. Data were collected by questionnaire. In total, 324 questionnaires were analyzed. One quarter (23.1%) of participants never had heard of care in AMU. Two thirds (64.2%) of women had made their choice regarding model of care before entering late pregnancy; only 16.4% indicated that health professionals had the biggest impact on their decision. One-to-one care and the availability of a pediatrician were most commonly quoted wishes (30.8 and 34.0%, respectively), and the occurrence of an adverse maternal or perinatal event the greatest concern (69.5%). Although the majority of respondents had some knowledge about care in AMU, expressed wishes for birth matching core features of AMU and concerns matching those of OLU, a decision for birth in OLU was taken. This finding may be a result of lack of knowledge about details of care in AMU; additionally, wishes and concerns may be put aside in favor of other criteria. [ABSTRACT FROM AUTHOR]

In Germany, cesarean section (CS) rates more than doubled within the past two decades. For analysis, auditing and inter-hospital comparison, the 10-Group Classification System (TGCS) is recommended. We used the TGCS to analyze CS rates in two German hospitals of different levels of care. From October 2017 to September 2018, data were prospectively collected. Unit A is a level three university hospital, unit B a level one district hospital. The German birth registry was used for comparison with national data. We performed two-sample Z tests and bootstrapping to compare aggregated (unit A + B) with national data and unit A with unit B. In both datasets (national data and aggregated data unit A + B), Robson group (RG) 5 was the largest contributor to the overall CS rate. Compared to national data, group sizes in RG 1 and 3 were significantly smaller in the units under investigation, RG 8 and 10 significantly larger. Total CS rates between the two units differed (40.7 vs. 28.4%, p<0.001). The CS rate in RG 5 and RG 10 was different (p<0.01 for both). The most relative frequent RG in both units consisted of group 5, followed by group 10 and 2a. The analysis allowed us to explain different CS rates with differences in the study population and with differences in the clinical practice. These results serve as a starting point for audits, inter-hospital comparisons and for interventions aiming to reduce CS rates. [ABSTRACT FROM AUTHOR]

Background: Alongside midwifery-led care (AMC) was introduced in Germany in 2003. The aim of our study was to collect data about the utilization of AMC within North Rhine-Westfalia (NRW), Germany's most populous state, and to collect information regarding the approach used for implementation of AMC and providers' experiences in day-to-day work. Methods: Quantitative data were collected by questionnaire, telephone interview and comparative analysis of documents created for use in AMC. Qualitative data were compiled by questionnaire and workshop. Results: Seven obstetric departments offer AMC in NRW. On average, 3.4% of women gave birth in these AMC units, corresponding to 0.3% of all births in NRW. For the establishment of AMC, institutional, organizational, professional and formal arrangements were undertaken. An eligibility and transfer checklist was agreed upon between midwives and obstetricians. Both professions were faced with skepticism. Daily work in AMC resulted in improved teamwork between the two professions and increased job satisfaction for midwives. Acquisition of manual skills and time constraints were the major challenges. Conclusion: The low utilization of AMC is not due to the concept of care itself or difficulties with its implementation, nor to a lack of eligible women. Reasons may be insufficient awareness about AMC or a lack of interest in this type of care. [ABSTRACT FROM AUTHOR]

Aims: To investigate fetomaternal hemorrhage (FMH) rate and quantity in the second trimester of pregnancies with fetal anomalies and to assess the impact of invasive prenatal and termination procedures. Methods: Blood samples from women before termination of pregnancy were collected and analyzed by dual-color flow cytometry. Various clinical parameters were studied for their association with FMH. Results: In total, 67 women were recruited; pre- and post-termination pairs were collected for 31 women. HbF cells were present in 91.0% of specimens, in 29.9% the transfused blood volume was ≥4.2 mL. FMH ≥30 mL was found in 3.0%, and chronic FMH, defined as FMH ≥40% of fetoplacental blood volume in 7.5%. At the limit of quantification (0.1%) none of the clinical parameters was associated with the presence of HbF cells, nor was there a difference in HbF cell concentrations between pre- and post-termination blood samples. Conclusions: Compared to normal term pregnancy, transfer of fetal red blood cells into the maternal circulation is increased in second-trimester pregnancies with fetal anomalies. FMH is not associated with invasive procedures or surgery performed in the context of termination. We hypothesize that the abnormal pregnancy itself, by means of an abnormal uteroplacental interface, is causing the increased transfer. [ABSTRACT FROM AUTHOR]

Aim: To analyze the spectrum of cardiovascular diseases occurring during pregnancy and delivery at a tertiary referral center. Methods: All patients presenting at our institution with pre-existing or first diagnosis of cardiac disease were recruited. Cardiac and obstetric complications and maternal and neonatal outcomes were recorded. Results: Fifty-two pregnancies in 49 women, including three pregnancy terminations were analyzed. Cardiac lesions were congenital in 26 (53.1%) and acquired in nine (18.4%); six patients (12.2%) had cardiomyopathies, eight (16.3%) ar-rhythmic conditions. A total of 42 women (85.7%) had a pre-existing cardiac condition and seven (14.3%) presented with first manifestation. Overall 22 cardiac complications occurred: five in pregnancy, eight around parturition, nine during follow-up. They included >1 New York Heart Association functional class deterioration (n=5), congestive heart failure/cardiomyopathy (n=5), valve replacement (n=4), sustained arrhythmia (n=3), cerebral insult, aortic dissection, transplantation (one case each), and death (n=2). Mean gestational age at delivery was 36+6. The cesarean section rate was 77.5%; 31.6% were performed for cardiac indications. Obstetric complications happened in 23 pregnancies (46.9%). There was no perinatal loss; cardiac defects were diagnosed in 9.3% (n=5) of offspring. Conclusion: Cardiovascular diseases occurring during pregnancy and parturition comprise a heterogeneous spectrum of conditions. Established scores aid in the identification of high-risk patients; however, in our series 14.3% women had been healthy previously. [ABSTRACT FROM AUTHOR]

Aims: Fetoscopic laser photocoagulation (FLP) has become standard therapy for severe twin-twin transfusion syndrome. Data on adverse maternal events are rare. We performed a literature review to obtain data on maternal complications of FLP. Methods: Extensive literature review, searching MEDLINE and other databases from 1990 to 2009, using MESH-terms and further keywords. Data extraction was performed using the following criteria: (i) maternal complications reported as primary or secondary outcome parameters; (ii) any comment on adverse maternal events. Results: Of 321 publications found 40 were included, comprising 1785 patients. The overall rate of adverse maternal events was 5.4%. In studies with systematic assessment (n=3, 379 patients) the complication rate was significantly higher (17.4% vs. 2.2%, P<0.0001). Adverse events were classified and the rate was 1.0% (1.8% vs. 0.8%, P=0.12) for severe complications; 2.9% (11.9% vs. 0.5%, P<0.0001) for intermediate/minor adverse events; and 1.5% (3.7% vs. 0.9%, P<0.0001) for complications with undetermined relevance. Conclusions: High-quality data on maternal complications of FLP are rare. With systematic assessment, the rate of adverse events is significantly higher. Underreporting has to be assumed. Further studies are required to confirm these data. [ABSTRACT FROM AUTHOR]

No abstract available [ABSTRACT FROM AUTHOR]