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To evaluate the relationship between the fetal head-circumference-to-maternal-height (HC/MH) ratio measured shortly before delivery and the occurrence of Cesarean section (CS) for labor dystocia.This was a multicenter prospective cohort study involving four tertiary maternity hospitals. An unselected cohort of women with a singleton fetus in cephalic presentation, at a gestational age beyond 36 + 0 weeks and without any contraindication for vaginal delivery, was enrolled between September 2020 and November 2021. The MH and fetal HC were measured on admission of the patient to the labor ward. The primary outcome of the study was the performance of the HC/MH ratio in the prediction of CS for labor dystocia. Women who underwent CS for any indication other than failed labor progression, including fetal distress, were excluded from the final analysis.A total of 783 women were included in the study. Vaginal delivery occurred in 744 (95.0%) women and CS for labor dystocia in 39 (5.0%). CS for labor dystocia was associated with shorter MH (mean ± SD, 160.4 ± 6.6 vs 164.5 ± 6.3 cm; P 0.001), larger fetal HC (339.6 ± 9.5 vs 330.7 ± 13.0 mm; P 0.001) and a higher HC/MH ratio (2.12 ± 0.11 vs 2.01 ± 0.10; P 0.001) compared with vaginal delivery. Multivariate logistic regression analysis showed that the HC/MH ratio was associated independently with CS for labor dystocia (adjusted odds ratio, 2.65 (95% CI, 1.85-3.79); P 0.001). The HC/MH ratio had an area under the receiver-operating-characteristics curve of 0.77 and an optimal cut-off value for discriminating between vaginal delivery and CS for labor dystocia of 2.09, which was associated with a sensitivity of 0.62 (95% CI, 0.45-0.77), specificity of 0.79 (95% CI, 0.76-0.82), positive predictive value of 0.13 (95% CI, 0.09-0.19) and negative predictive value of 0.98 (95% CI, 0.96-0.99).In a large cohort of unselected pregnancies, the HC/MH ratio performed better than did fetal HC and MH alone in identifying those cases that will undergo CS for labor dystocia, albeit with moderate predictive value. The HC/MH ratio could assist in the evaluation of women at risk for CS for labor dystocia. © 2022 The Authors. Ultrasound in ObstetricsGynecology published by John WileySons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

To determine German obstetricians' self-perceived experience with vacuum and forceps deliveries.Using a web-based survey, German obstetricians were invited to participate in a survey. This survey was approved by the German society of obstetrics and gynecology.Surveys of 635 obstetricians were received. All obstetricians reported performing significantly less forceps than vacuum deliveries. Almost all obstetricians want to perform more delivery, which indicates the willingness to learn both. More obstetricians felt confident to perform vacuum than forceps. In a similar obstetrical indication, most of the obstetricians would prefer to perform a vacuum assisted delivery. The majority of the obstetricians wished to receive more training in vaginal operative deliveries.Most of the German obstetricians prefer to use vacuum-assisted vaginal deliveries and feel less confident to perform forceps deliveries. Standardized training to improve the quality of care is recommended.

Wenn die Milch der eigenen Mutter nicht oder nicht ausreichend zur Verfugung steht, wird bei der Ernahrung von Fruhgeborenen und kranken Neugeborenen die Gabe von qualitatskontrollierter Spenderinnenmilch empfohlen. In diesem Kontext erfullen Frauenmilchbanken eine wichtige Funktion, um sicherzustellen, dass Fruhgeborene und kranke Neugeborene mit der fur sie wertvollen Spenderinnenmilch versorgt werden konnen. Das Bewusstsein bezuglich der Vorteile der Ernahrung mit Muttermilch soll gestarkt und den Kliniken sollen die ersten Schritte bei der Errichtung und der Organisation von Frauenmilchbanken erleichtert werden. Daruber hinaus dient das Positionspapier als Anregung fur die Erstellung einer Leitlinie durch die nationalen Fachgesellschaften. Fachexperten aus Deutschland, Osterreich und der Schweiz (D-A-CH), die teilweise selbst Frauenmilchbanken betreuen, haben ihre Erfahrungen und ihr Wissen eingebracht und aktuelle Richtlinien aus verschiedenen europaischen Landern verglichen. Basierend auf den gangigen Vorgehensweisen in den bestehenden Frauenmilchbanken wurden Empfehlungen zur Forderung von Frauenmilchbanken im Expertenbeirat abgestimmt, die auf der aktuellen wissenschaftlichen Datenlage aufbauen und die Umsetzbarkeit in den Alltag berucksichtigen. Im D‑A-CH-Raum ist derzeit keine einheitliche Empfehlung, Leit- oder Richtlinie fur die Errichtung und Organisation von Frauenmilchbanken vorhanden. Der Expertenbeirat fordert, dass der Aufbau von weiteren Frauenmilchbanken forciert wird, einheitliche Empfehlungen zu Errichtung und Organisation etabliert werden, mehr Mutter als Spenderinnen gewonnen werden und das offentliche Gesundheitssystem der jeweiligen Lander dabei unterstutzend einwirkt.

Stillen gilt als die optimale Ernahrungsform fur gesunde reif geborene Sauglinge und ist mit einer Vielzahl an Vorteilen fur Gesundheit und Entwicklung verbunden. Jedoch fuhren Stillprobleme haufig zu einem fruhzeitigen Abbruch der Stillbeziehung. Um eine optimale Betreuung von stillenden Frauen zu gewahrleisten, sind einheitliche Handlungsempfehlungen fur die Therapie der stillassoziierten Brusterkrankungen notwendig. Auf Initiative der Nationalen Stillkommission wurde eine evidenz- und konsensbasierte Leitlinie zur Therapie wunder Brustwarzen, der verstarkten initialen Brustdrusenschwellung, der Mastitis puerperalis und des Milchstaus entwickelt. Die Leitlinienentwicklung folgte methodisch den Kriterien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Die Empfehlungen wurden basierend auf systematischen Recherchen und Bewertungen der Literatur und unter Berucksichtigung praktischer Erfahrungen in einer interdisziplinar zusammengesetzten Expertengruppe abgeleitet. Zusatzlich wurden Klinische Konsensuspunkte als Expertenmeinung zu Fragestellungen formuliert, zu denen keine wissenschaftlichen Untersuchungen moglich sind oder angestrebt werden. Im vorliegenden Artikel werden die Empfehlungen der S3-Leitlinie zusammenfassend prasentiert.

Breastfeeding is widely acknowledged to be the best and most complete form of nutrition for healthy infants born at term and is associated with numerous benefits in terms of infantsʼhealth, growth, immunity and development. However, breastfeeding problems often result in early weaning. Standardized treatment recommendations for breastfeeding-related diseases are necessary to optimize the care offered to breastfeeding women. Evidence and consensus based guidelines for the treatment of puerperal mastitis, sore nipples, engorgement and blocked ducts were developed on the initiative of the National Breastfeeding Committee. These guidelines were developed in accordance with the criteria set up by the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), the Association of Scientific Medical Societies in Germany. The recommendations were drawn up by an interdisciplinary group of experts and were based on a systematic search and evaluation of the literature but also took clinical experience into account. Additionally good clinical practice (GCP) in terms of expert opinion was formulated in cases where scientific investigations could not be performed or were not aimed for. This article presents a summary of the recommendations of the S3-guidelines

Die Frauenheilkunde und insbesondere die Geburtshilfe haben bereits fruhzeitig psychosomatische Aspekte in ihre theoretischen und praktischen Uberlegungen einbezogen. Seit den 1960er Jahren kam es unter dem zunehmenden Einfluss der ganzheitlichen Betrachtungsweise des Geburtsprozesses zu einer Umorientierung der klinischen Geburtshilfe. Interventionen, vom klinischen Alltag bestimmte Eingriffe wie auch die schmerzfreie Geburt werden zunehmend kritisch hinterfragt. Ein positives Geburtserlebnis ist von der Erfullung von Wunschen des Paares abhangig, z. B. Wahl des Geburtsortes, Geburtsposition und Einsatz von medizinisch notwendigen Masnahmen. Gesellschaftliche Vorstellungen spielen dabei eine grose Rolle. Die Moglichkeit einer intensiven Betreuung der Frau und des Paares in der Geburtssituation nimmt einen zunehmend starkeren Stellenwert ein. Kreissale und Wochenbettstationen werden „familiar“ gestaltet und Konzepte aus der ambulanten Geburtshilfe in den klinischen Alltag ubernommen.

Background: Recent studies from predominantly rural areas in Germany show that neonatal outcome of very low birth weight (VLBW) neonates is (on average) inferior with lower NICU (neonatal intensive care unit) volume. However, there are no data available which show that study results of one specific region can be transferred to other areas with possibly different medical infrastructure and needs. Aim: It was investigated whether a systematic difference of treatment quality between smaller (1000–2000 births/year; ≤20 neonatal beds) vs. larger neonatal centres in Berlin (>3000 births/year; >20 neonatal beds) exists. Furthermore, the results are compared to data from a rural region in order to discuss transferability between regions. Methods: Retrospectively, completely, and for the first time, the data of all centres which treat VLBW neonates (≤1500 g birth weight) in the city-state of Berlin, Germany, from the years 2003/2004 were reviewed. Results: Our study showed no difference in the treatment quality of smaller vs. larger neonatal units in Berlin. This result differs from those of a study in Baden-Wurttemberg, a predominately rural state, with different medical infrastructure than Berlin. Conclusion: The present study suggests that regional investigations on the infrastructure vs. treatment outcome are not transferable between areas. Patient volume/unit appears inadequate for predicting the future treatment quality of neonatal departments. Direct quality indicators are stable for the assessed departments and should be preferably used to organize medical infrastructure.

A decrease of breastfeeding culture could be observed since the 1950's. However in the 1980's the WHO and UNICEF began engaging in campaigns for breastfeeding since the benefits for mother and child are evident. In 1990 UNICEF set up the "10 steps to successful breastfeeding" that gave birth clinics around the world "guidelines" that would initiate an unproblematic breastfeeding relationship between mother and child. These guidelines can be understood as measures toward increasing staff motivation, training and instruction as well as actually helping parents and increasing their motivation. Further points cover the optimal beginning of breastfeeding and aspects of complementary feeding. Certification of departments by internationally renowned observers is a means of implementing and securing best quality breastfeeding encouragement in the birth clinics. The positive effects of this promotion on the ratio of mothers breastfeeding and thus in respect to childrens health could be proved by randomised studies. The experience gained in the Obstetrical Department of the Vivantes Humboldt Clinic is described.

Many epidemiological studies show clearly the restraining effect of breast-feeding on breast cancer. So it could be shown that breast-feeding for one year reduces the individual risk for premenopausal breast cancer by 45%. The risk of postmenopausal breast cancer in the developed countries could be decreased by 42% by increasing the breast-feeding time in life. Most authors assume that the protective value of breast-feeding is hormone-conditioned. Further theoretical implications result from the increasing knowledge of the immunologic characteristics of the mother's milk. Beside well-known positive effects of breast-feeding on children's health, breast-feeding should also be further promoted from the view of women's health.

We describe two term infants who developed severe jaundice with kernicterus due to hemolytic disease (anti-B and anti-c, respectively) after outpatient delivery. The total serum bilirubin levels were 38 and 39 mg/dL, respectively. The infants developed permanent deafness (bilateral hearing threshold above 80dB). The diagnosis was delayed because a finding of anti-c antibody was not recorded in the maternity pass and because a direct Coombs test was negative. Short hospital stays after delivery may increase the risk of missing severe hemolytic disease of the newborn, particularly if pediatric follow-up after discharge is not guaranteed.

To evaluate the potential contribution of maternal glucose and lipids to fetal metabolic variables and growth in pregnancies with normal glucose tolerance in comparison with pregnancies with well-controlled gestational diabetes previously reported by us.In 190 pregnancies with normal oral glucose tolerance tests (controls), insulin, glucose and lipid components were determined in maternal and arterial cord blood serum. Birthweight and neonatal fat mass were obtained after delivery. Values were adjusted for maternal pre-pregnancy BMI, Caesarean section and gestational age. Measurements were compared with those of gestational diabetes previously reported.Maternal serum glucose, triacylglycerol, free fatty acid and cholesterol levels did not differ between control pregnancies and those with gestational diabetes, whereas insulin, homeostasis model assessment and glycerol values were significantly lower in the former (2.6 vs. 5.6 μmol/l and 176 vs. 193 μmol/l, respectively). In contrast, cord blood glucose and free fatty acids were significantly lower in control pregnancies than in those with gestational diabetes (3.9 vs. 4.4 mmol/l and 80.7 vs. 137 μmol/l, respectively); the same was valid for insulin (0.03 vs. 0.05 nmol/l) and homeostasis model assessment (1.0 vs. 1.87). In control pregnancies, maternal serum glucose, free fatty acids and glycerol correlated with those in cord blood, but not with neonatal weight and fat mass, as seen for free fatty acids in those with gestational diabetes. The negative correlation between cord blood triacylglycerols and neonatal weight or fat mass previously reported in gestational diabetes could not be confirmed in control pregnancies, where all fetal lipids showed a positive correlation to neonatal anthropometrics.In normal pregnancies, in contrast to those with gestational diabetes, maternal lipids do not influence neonatal weight. Similar levels of maternal lipids in pregnancies with gestational diabetes and control pregnancies, but higher free fatty acids in the cord blood of those with gestational diabetes, indicate their enhanced placental transport and/or enhanced lipolysis as a result of decreased fetal insulin responsiveness.

Painful and/or damaged nipples associated with breastfeeding are common and represent a challenge for both the persons experiencing nipple pain and/or trauma and for those providing treatment. However, evidence-based data has been insufficient to demonstrably minimize these common reasons for failure to initiate or continue successful breastfeeding. The aim of this study was to evaluate the efficacy of specific-grade highly purified anhydrous (HPA) lanolin versus expressed breastmilk (EBM) for the treatment of painful and damaged nipples associated with breastfeeding in a prospective controlled clinical trial evaluating 84 lactating mothers. Nipple trauma and healing rates were rated by the Nipple Trauma Score. Nipple pain intensity was assessed on a visual analog scale. Outcome parameters were in favor of the HPA lanolin group, reaching statistical significance for healing rates, nipple trauma and nipple pain. In our study, we found HPA lanolin more effective than EBM, inducing faster healing of nipple trauma (absolute risk reduction of 0.43) and reducing nipple pain (absolute risk reduction of 0.61 on day 3). We concluded that HPA lanolin, combined with breastfeeding education, was more effective than EBM, combined with breastfeeding education, in reducing nipple pain and promoting healing of nipple trauma.