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Aim This is an update of the interdisciplinary S3-guideline on the Diagnosis, Therapy and Follow-up of Cervical Cancer (AWMF Registry No. 032/033OL), published in March 2021. The work on the updated guideline was funded by German Cancer Aid (Deutsche Krebshilfe) as part of the German Guideline Program in Oncology. The guideline was coordinated by the German Society of Gynecology and Obstetrics ( Deutsche Gesellschaft für Gynäkologie und Geburtshilfe , DGGG) and the Working Group on Gynecological Oncology ( Arbeitsgemeinschaft Gynäkologische Onkologie , AGO) of the German Cancer Society ( Deutsche Krebsgesellschaft , DKG). Method The process used to update the 2014 S3-guideline was based on an appraisal of the available evidence using the criteria of evidence-based medicine, adaptations of existing evidence-based national and international guidelines or - if evidence was lacking - on the consensus of the specialists involved in compiling the update. After an initial review of the current literature was carried out according to a prescribed algorithm, several areas were identified which, in contrast to the predecessor version from September 2014, required new recommendations or statements which would take account of more recently published literature and the recent appraisal of new evidence. Recommendations The short version of this guideline consists of recommendations and statements on palliative therapy and follow-up of patients with cervical cancer. The most important aspects included in this updated guideline are the new FIGO classification published in 2018, the radical open surgery approach used to treat cervical cancer up to FIGO stage IB1, and the use of the sentinel lymph node technique for tumors ≤ 2 cm. Other changes include the use of PET-CT, new options in radiotherapy (e.g., intensity-modulated radiotherapy, image-guided adaptive brachytherapy), and drug therapies to treat recurrence or metastasis., Competing Interests: Conflict of Interest/Interessenkonflikt The conflicts of interest of all the authors are listed in the long German-language version of the guideline report./Die Interessenkonflikte der Autoren sind im Leitlinienreport aufgelistet., (Thieme. All rights reserved.)

Purpose:  Artifacts may be part of any 3D sonographic examination during pregnancy and can disturb a routine diagnostic procedure, even simulate fetal malformation. The aim of this study was to classify the artifacts in different types according to their appearance., Materials and Methods:  A total of 2349 healthy fetuses examined during the last five years was included in this study. The observed artifacts have been grouped into 6 different types according to their appearance: 1. fetal movement artifacts, 2. shadow artifacts, 3. amputation artifacts caused by the volume box, 4. defects caused by the improper use of the electronic scalpel, 5. artifacts due to an unfavorable threshold adjustment and 6. artifacts due to superimposed objects., Results:  Significant artifacts were found in 119 ultrasound examinations: 39 artifacts were caused by fetal movement, 25 by acoustic shadowing, 19 artifacts occurred due to amputation of objects by the volume box and 15 by the improper use of the electronic scalpel. In 12 cases the threshold adjustment was unfavorable and in 9 cases the artifacts were caused by superimposed objects., Conclusion:  In 3D ultrasound some artifacts can be avoided by optimizing the size and position of the volume box or by using a different scanning angle. Other artifacts can be minimized using gain and threshold properly and by precise use of the electronic scalpel. In doubtful situations it is recommended to rescan the volume and to use all diagnostic 3D rendering possibilities. Proper recognition of the artifacts can avoid the risk of misdiagnosis., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

First-trimester screening between 11 + 0 and 13 + 6 weeks with qualified prenatal counseling, detailed ultrasound, biochemical markers and maternal factors has become the basis for decisions about further examinations. It detects numerous structural and genetic anomalies. The inclusion of uterine artery Doppler and PlGF screens for preeclampsia and fetal growth restriction. Low-dose aspirin significantly reduces the prevalence of severe preterm eclampsia. Cut-off values define groups of high, intermediate and low probability. Prenatal counseling uses detection and false-positive rates to work out the individual need profile and the corresponding decision: no further diagnosis/screening - cell-free DNA screening - diagnostic procedure and genetic analysis. In pre-test counseling it must be recognized that the prevalence of trisomy 21, 18 or 13 is low in younger women, as in submicroscopic anomalies in every maternal age. Even with high specificities, the positive predictive values of screening tests for rare anomalies are low. In the general population trisomies and sex chromosome aneuploidies account for approximately 70 % of anomalies recognizable by conventional genetic analysis. Screen positive results of cfDNA tests have to be proven by diagnostic procedure and genetic diagnosis. In cases of inconclusive results a higher rate of genetic anomalies is detected. Procedure-related fetal loss rates after chorionic biopsy and amniocentesis performed by experts are lower than 1 to 2 in 1000. Counseling should include the possible detection of submicroscopic anomalies by comparative genomic hybridization (array-CGH). At present, existing studies about screening for microdeletions and duplications do not provide reliable data to calculate sensitivities, false-positive rates and positive predictive values., Competing Interests: U Gembruch participated 2013 – 2015 in a clinical follow-up study on PraenaTest supported by LifeCodexx.KO Kagan runs a prospective study on cfDNA supported by Ariosa.T Schramm is member of Scientic Advisory Board at GE Healthcare Viewpoint., (© Georg Thieme Verlag KG Stuttgart · New York.)