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Objective The LACC (Laparoscopic Approach to Cervical Cancer) study revealed advantages in terms of overall survival and relapse risk favouring abdominal radical hysterectomy over the laparoscopic procedure. The present paper will compare the two surgical techniques from the economic point of view based on a process cost calculation. Material/Methods A retrospective cost analysis of all radical hysterectomies from the year 2018 was done at the Hanover University Medical School based on the bottoms-up method and guided by the clinical treatment pathway. Result Of 51 primary cases treated, 19 patients underwent radical hysterectomies, of which 8 were performed using the abdominal technique and 11 as endoscopic surgeries. 89.4% of the cancers were FIGO IB1 carcinomas. The total cost of a laparoscopic radical hysterectomy with an average hospital stay of 4.6 days came to € 2512.34, compared to an abdominal radical hysterectomy at € 2586.78 with an average hospital stay of 7.6 days. The greatest cost factor in which the laparoscopic method exceeded abdominal radical hysterectomy was the surgical procedure itself (€ 1836.75 vs. € 1411.21). Personnel represented the largest cost item in the surgical theatre (59%), so that surgery time was a significant multiplying factor. Average surgical time required for abdominal radical hysterectomy was 154 minutes, whereby the laparoscopic procedure required an average of 220.1 minutes. Inpatient care in the abdominal radical procedure cases was more costly by € 499.98 due to the longer hospitalization and additional medication required. Profit levels, including the DRG revenues, were higher with the abdominal method than with the laparoscopic method by € 186.21 despite longer hospital stays. Conclusion The present paper shows slightly greater profitability for the abdominal radical hysterectomy. On the other hand, this method entails longer hospitalization and a higher level of personnel deployment. Adequate occupancy management could make up for the revenue shortfall observed with the laparoscopic method.

Subject While the synthetic prostaglandin E1 analogue misoprostol is the most effect labour induction agent, its use is off-label for the most part. For this reason, and in view of its potential adverse effects and varying approaches to its administration, the drug has recently once again become a focus of critical attention. The objective of this survey was thus to establish a record of labour induction with misoprostol in German clinics and determine the impact of the negative reporting on everyday obstetric practice. Material and Methods In this cross-sectional study, 635 obstetrics and gynaecology departments in Germany were requested by email to participate in our survey in February/March 2020. Online responses to 19 questions were requested regarding the clinic, use of misoprostol before and after the critical reporting, use of misoprostol (sourcing, method of administration, dosage, monitoring) and other labour induction methods. Results A total of 262 (41.3%) of the clinics solicited for the survey completed the questionnaire. There were no differences regarding the care level (Perinatal Centre Level I, Perinatal Centre Level II, Clinic with Perinatal Focus or Obstetric/Private Clinic; p = 0.2104) or birth counts (p = 0.1845). In most cases, misoprostol was prepared in the clinicʼs own pharmacy (54%) or imported from another country (46%) and administered orally in tablet form (95%). Misoprostol dosage levels varied (25 µg [48%], 50 µg [83%], 75 µg [6%], 100 µg [47%] and > 100 µg [5%]). Most of the clinics used premanufactured tablets/capsules (59%), although Cytotec tablets were also divided (35%) or dissolved in water (5%). Misoprostol administration intervals were mainly every 4 hours (64%) or every 6 hours (30%). CTG checks were run in most cases before and after administration of a dose of misoprostol (78% and 76%) and before and after administration of a dose of prostaglandin E2 (both 88%). Presence of contractions led to no misoprostol (59%) or no prostaglandin E2 (64%) being administered in most cases. The critical reporting resulted in discontinuation of use of misoprostol in 17% of the clinics – mainly smaller obstetric/private clinics with fewer than 1000 births. Labour cocktails were used mainly in obstetric and private clinics (61%). Conclusion Misoprostol is an established agent for labour induction in German clinics. The dosing schemes used vary. Improvements of currently common management practices are required, especially in the area of labour induction (CTG checks before and after administration of labour-inducing medication, no administration of prostaglandin if contractions are ongoing). The discussion of use of misoprostol in the media resulted in stoppage of its use mainly in smaller clinics.

Introduction The aim of this study was to record the perinatal data of refugee women at Charité Hospital, Berlin, and to evaluate possible differences in pre-, peri- and postnatal outcomes compared with indigenous women. Material and Methods All pregnant women who gave birth in the period from 1 January 2014 to 30 September 2017 and were registered at least once in the hospital as “refugee” were included in the analysis. The data recorded from the refugee women were compared with the perinatal data of the German Federal obstetric analysis for the year 2016, which was published by the IQTIG (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen [Institute for Quality Assurance and Transparency in Healthcare]). Results The analysis comprised 907 refugee women and 928 infants (21 twin pregnancies). Pregnant refugee women were significantly younger than the pregnant women from the Federal analysis (birth before the age of 30: 66 vs. 41%, p 2 miscarriages: 9.7 vs. 5.9%, p Conclusion Both refugee women and their infants showed significant differences. Despite the average younger age of the pregnant refugee women, the rates of premature birth and stillbirth and congenital malformations were significantly more frequent. More intensive antenatal screening with differentiated foetal organ diagnostics including psychosomatic care could contribute to early identification and prompt diagnosis. As regards the postpartum anaemia and puerperal endometritis, which occur more often in refugee women, midwife engagement and an improvement in the living situation in homes and accommodation facilities could be of great importance.

Video consultations could support patient care in hand surgery during social distancing in the COVID-19 era. According to the literature, images of hand and fingers can support telediagnosis in hand emergencies. We present this feasibility study on online video consultation in hand surgery.A structured examination was designed to query the medical history and examine motor skills, sensitivity, strength and function tests of the hand. Thirty examinations on both hands were carried out by online video consultation, then in direct contact and compared with each other.With 4560 evaluated range of movement of the hand and finger joints, there was a high correlation between the measurement methods of R = 0.995 (p 0.0001, confidence interval 0.9946 - 0.9954). In the video-based examination, 84.6% of the measured values showed a deviation of less than 5° compared to the direct examination, 92.8% less than 10° deviation. Good accordance was also found in the patient's medical history. An estimating examination of sensitivity, function and strength during video examination is feasible with simple auxiliary aids. Deficits are evident in the detection of scars, in function tests and the absence of haptic findings.Online video consultation allows hand examination with sufficient documentation of hand and finger movements (range of motion) and proper evaluation of symptoms. It cannot replace direct examination but complement patient care in hand surgery even beyond the current COVID-19 pandemic.Videosprechstunden können bei Social Distancing in der COVID-19-Pandemie die Patientenversorgung unterstützen. Während zur Einholung handchirurgischer Fach- und Zweitmeinungen über Bildbefunde eine gute Literaturlage vorliegt, fehlt diese für die Videosprechstunde. Dies soll mit der vorliegenden Machbarkeitsstudie zur handchirurgischen Befunderhebung per Video nachgeholt werden.Ein strukturierter Untersuchungsbogen wurde entworfen zur Abfrage der Anamnese und Untersuchung von Motorik, Sensibilität, Kraft sowie spezifischer Funktionstests an der Hand. 30 Untersuchungen an jeweils beiden Händen wurden per Videosprechstunde und nachfolgend in direktem Kontakt durchgeführt und miteinander verglichen.Bei 4560 Bewegungsumfängen an der Hand zeigte sich eine hohe Korrelation zwischen den Messmethoden von R = 0,995 (p 0,0001, Konfidenzintervall 0,9946 – 0,9954). Dabei zeigten bei der videobasierten Untersuchung 84,6% der Messwerte eine Abweichung von weniger als 5° im Vergleich mit der direkten Untersuchung, 92,8% weniger als 10° Abweichung. Eine gute Übereinstimmung zeigte sich auch bei der Anamnese. Die orientierende Untersuchung von Sensibilität, Funktion und Kraft ist mit einfachen Hilfsmitteln gut möglich in der Videosprechstunde. Defizite zeigen sich bei der Erkennung von Narben, bei differenzierten Funktionstests sowie durch das Fehlen haptischer Befunde.Die Untersuchung der Hand in der Videosprechstunde erlaubt eine sehr gute Untersuchung des Bewegungsumfanges an den Gelenken der Hand, die Aufnahme der Beschwerden und eine Eingrenzung der Befunde. Sie kann die traditionelle Fachsprechstunde mit direktem Kontakt nicht vollständig ersetzen, stellt jedoch eine sinnvolle Ergänzung dar und besitzt eine Berechtigung über die aktuelle COVID-19-Pandemie hinaus.

Due to the current COVID-19 pandemic, the German Health Ministry has issued restrictions applying to the field of orthopaedics and trauma surgery. Besides postponement of elective surgeries, outpatient consultations have been drastically reduced. Parallel to these developments, an increase in telemedical consultations has reflected efforts to provide sufficient patient care. This study aims to evaluate the feasibility of a clinical examination of the hip joint and pelvis by way of a telemedical consultation.Twenty-nine patients of a German university clinic were recruited and assessed in both telemedical and conventional examinations. Agreement between the two examinations was then assessed, and connections between the observed agreement and patient-specific factors such as age, BMI and ASA classification were investigated.The inspections agreed closely with a mean Cohen's kappa of 0.76 ± 0.37. Palpation showed adequate agreement with a mean Cohen's kappa of 0.38 ± 0.19. Function showed good agreement with a mean Cohen's kappa of 0.61 ± 0.26 and range of motion showed adequate agreement with a mean Cohen's kappa of 0.36 ± 0.19. A significant positive correlation was observed between the number of deviations in the different examinations and age (p = 0.05), and a significant positive correlation was shown between the number of non-feasible examinations and age (p 0.01), BMI (p 0.01) and ASA classification score (p 0.01).Inspection and function can be reliably evaluated, whereas the significance of palpation, provocation and measurement of range of motion is limited. The small sample size puts limitations on the significance of a statistically relevant correlation between patient-specific factors such as age, BMI and ASA classification score and valid and successful implementation of a telemedical examination. The authors recommend targeted patient selection. If, however, patients are being evaluated who are very old ( 75 years), obese (BMI 30) or with multiple comorbidities (ASA 3 and above), caution is advised. Large, prospective studies are needed in the future to fully validate telemedical consultations in the fields of orthopaedics and trauma surgery.A telemedical examination of the hip joint and pelvis can be performed with certain limitations. Patient-specific factors such as age, BMI, and extent of comorbidities appear to have a relevant impact on validity and execution of the examination. Patients with multiple comorbidities (ASA 3 and above), advanced age ( 75 years) or obesity (BMI 30) should, whenever possible, be examined in a conventional outpatient setting.Aufgrund der aktuellen COVID-19-Pandemie erfolgten Einschränkungen im Fach der Orthopädie und Unfallchirurgie durch das Gesundheitsamt. Neben der Verlegung von elektiven operativen Eingriffen erfolgte auch die drastische Reduktion der Sprechstunden. Hierdurch kam es zu einem deutlichen Anstieg von telemedizinisch durchgeführten Sprechstunden zur Gewährleistung der Patientenversorgung. Die Zielsetzung dieser Arbeit ist, die Umsetzbarkeit einer klinisch-orthopädischen Untersuchung der Hüfte und des Beckens durch telemedizinische Verfahren im Rahmen einer Videosprechstunde zu untersuchen.Im Rahmen der vorliegenden Auswertung wurden 29 stationäre Patienten eines deutschen Universitätsklinikums rekrutiert und im Rahmen einer Videosprechstunde und konventionell untersucht. Anschließend wurde die Übereinstimmung der erhobenen Befunde ausgewertet und Zusammenhänge mit patientenspezifischen Daten wie Alter, BMI und ASA-Klassifikation untersucht.Es zeigte sich eine gute Übereinstimmung der Inspektion mit einem durchschnittlichen Cohens Kappa von 0,76 ± 0,37, eine angemessene Übereinstimmung der Palpation mit einem durchschnittlichen Cohens Kappa von 0,38 ± 0,19, eine gute Übereinstimmung der Funktion mit einem durchschnittlichen Cohens Kappa von 0,61 ± 0,26 und eine angemessene Übereinstimmung der Bewegungsausmaße mit einem Cohens Kappa von 0,36 ± 0,19. Es zeigte sich ein signifikanter positiver Zusammenhang zwischen Anzahl der Abweichungen der verschiedenen Untersuchungen und Alter (p = 0,05) und ein positiver signifikanter Zusammenhang zwischen Anzahl der nicht durchführbaren Untersuchungen und Alter (p 0,01), BMI (p 0,01) und ASA-Klassifikationswert (p 0,01).Vor allem die Inspektion und Funktion sind gut untersuchbare Parameter während Palpation, Provokation und die Erfassung der Bewegungsausmaße eine limitierte Aussagekraft zeigen. Bei begrenzter Anzahl der Probanden ist die Aussagekraft eines statistisch relevanten Zusammenhangs zwischen patientenspezifischen Faktoren wie Alter, BMI und ASA-Klassifikationswert und der validen und erfolgreichen Durchführung einer telemedizinischen Untersuchung limitiert. Die Autoren sprechen sich für eine gezielte Patientenselektion aus. Sollten dennoch sehr alte ( 75 Jahren), adipöse (BMI 30) oder stark vorerkrankte Patienten (ab ASA 3) untersucht werden, ist Vorsicht geboten. Es bedarf in der Zukunft weiterer großangelegter, prospektiver Studien, um eine ausreichende Validierung einer telemedizinischen Untersuchung in der Orthopädie und Unfallchirurgie zu erreichen.Die telemedizinische Untersuchung von Hüftgelenk und Becken ist mit Einschränkungen möglich. Patientenspezifische Faktoren wie Alter, BMI und Grad der Vorerkrankungen scheinen einen relevanten Einfluss auf die Validität und die Durchführung zu haben. Patienten, die stark vorerkrankt (ab ASA 3) sind, ein hohes Lebensalter haben ( 75 Jahre) und/oder adipös sind (BMI 30), sollten, wenn möglich, in eine herkömmliche Sprechstunde einbestellt werden.

Far-reaching political steps to contain the COVID-19 pandemic have been undertaken in recent weeks. These also impact on surgical specialties not directly involved in the management of patients infected with the coronavirus. The Spine Section, the interdisciplinary professional political arm of the German Spine Society (DWG), the Professional Association for Orthopedic and Trauma Surgery (BVOU), and the Federal Association of German Neurosurgeons (BDNC) conducted a survey on the collateral effects of the pandemic on spine surgery in Germany.This cross-sectional study included outpatient, day-patient and inpatient facilities caring for patients with spinal disorders during the COVID-19 pandemic. The survey was designed to analyse the impact of the COVID-19 pandemic on the management of inpatients and outpatients with spinal disorders and to assess the economic ramifications in the various settings.All members of the Spine Section (n = 134) were invited to participate in the questionnaire consented by BVOU and BDNC. The questions were answered anonymously, and the personal data entered did not permit any de-anonymisation. All in all, 68% (n = 91) of the respondents completed the survey in full. Based on the type of employment (practice 30%, practice/staff: 45% and staff: 25%) and range of activities (conservative: 5%, conservative/operative: 75%, operative: 20%) the survey by the Spine Section can be regarded as representative. 95% of the practices/outpatient clinics reported a decline in their number of patients. In addition, the number of operations performed fell by 36% (SD 17%). The percentage of elective procedures declined from approximately 78% to 6%. As a result, more than half of the physicians anticipated moderate (20 - 40%) economic challenges and 25% major ( 50%) financial problems.In order to cushion collateral damage in the wake of future pandemic management, any implications in the interdisciplinary management of patients with spinal disorders should be based on these results.Weitreichende politische Maßnahmen zur Eingrenzung der COVID-19-Pandemie wurden während der letzten Wochen ergriffen. Diese betreffen auch chirurgische Fachrichtungen, die nicht direkt in die Behandlung von Coronavirus-Infektionen bei Patienten involviert sind. Das Referat Wirbelsäule, die fachübergreifende berufspolitische Einrichtung der Deutschen Wirbelsäulengesellschaft (DWG), des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie (BVOU) sowie des Bundesverbandes Deutscher Neurochirurgen (BDNC) führte eine Umfrage zum kollateralen Effekt der Pandemie auf die Wirbelsäulenchirurgie in Deutschland durch.In dieser Querschnittsstudie wurden ambulante, teilstationäre und stationäre Versorgungseinrichtungen von Patienten mit Wirbelsäulenerkrankungen während der COVID-19-Pandemie eingeschlossen. Das Ziel der Umfrage war die Analyse, welche Folgen die COVID-19-Pandemie auf die Betreuung von ambulanten und stationären Patienten mit Wirbelsäulenerkrankungen hat und wie die wirtschaftlichen Konsequenzen in den verschiedenen Bereichen eingeschätzt werden.Der vom BVOU und BDNC konsentierte Fragebogen wurde an alle Mitglieder des Referats Wirbelsäule versandt (n = 134). Die Beantwortung der Fragen erfolgte anonym und die personenbezogenen Daten erlaubten keine Deanonymisierung. Insgesamt 68% (n = 91) der Befragten führten die Befragung vollständig durch. Aufgrund der Beschäftigungsverhältnisse (Praxis: 30%, Praxis/Angestellte: 45% und Angestellte: 25%) und des Tätigkeitsspektrums (konservativ: 5%, konservativ/operativ: 75%, operativ: 20%) kann die Umfrage im Referat Wirbelsäule als repräsentativ angesehen werden. Bei 95% der Praxen/Ambulanzen wurde eine Reduktion des Patientenaufkommens beobachtet. Darüber hinaus erfolgte eine Reduktion der OP-Zahlen um 36% (SD 17%). Der Anteil der elektiven Eingriffe wurde von ca. 78 auf 6% reduziert. Daraus resultierend prognostizieren über die Hälfte der Ärzte/-innen mäßige (20 – 40%), 25% aber auch deutliche ( 50%) wirtschaftliche Schwierigkeiten.Zukünftige Implikationen im interdisziplinären Bereich der Versorgung von Patienten mit Wirbelsäulenerkrankungen sollen auf Grundlage der vorliegenden Ergebnisse abgeleitet werden, um die kollateralen Effekte einer Pandemiebewältigung zukünftig zu verbessern.

Objective The aim of this study was to determine the present oral health status of pregnant women depending on selected sociodemographic differences and deduce any resulting consequences for health prevention. Methods The participantsʼ data of relevance to the study such as age, school leaving qualification, migration background, smoking habits or last dentist visit were recorded using a questionnaire. The subsequent dental check-up concentrated on open carious lesions, any initiated root canal treatments and missing teeth. Finally, the Periodontal Screening Index was recorded to diagnose the presence of any gingivitis or periodontitis. The subsequent biometric evaluation comprised descriptive data analysis, χ2 test and logistical regression. Results The higher the school leaving qualification, the lower the probability that a pregnant woman smoked prior to pregnancy (OR 0.291; 95% CI 0.114 – 0.743) and that tartar was diagnosed (OR 0.424; 95% CI 0.185 – 0.973). Regular dentist visits (OR 4.026; 95% CI 1.613 – 10.049) increase with the attained school leaving qualification. There is a greater chance that women born in Germany taking part in the study were aware of dental risks in pregnancy (OR 2.652; 95% CI 1.285 – 5.472) and attended the dentist during pregnancy (OR 2.507; 95% CI 1.281 – 4.907). Conclusion The rate of awareness of the risks and consequences of pregnancy for oral health must be increased. The main aim for primary prophylaxis should be a reduction in the periodontal bacteria and caries of the mother and father.

Introduction Changes in risk factors and the introduction of mammography screening in 2005 have led to dramatic changes in the breast cancer-associated burden of disease in Germany. This study aimed to investigate long-term disease-related incidence and mortality trends in women from East and West Germany since the reunification of Germany. Methods Total and stage-specific incidence rates were evaluated based on data obtained from selected cancer registries. Sufficiently complete data going back to 1995 were available for 4 East German and 3 West German regions. The figures were weighted for population size, and rates were calculated for the whole of Germany based on the rates for East and West Germany. The study particularly focused on 3 different age groups: women eligible for mammography screening (50 – 69 years), younger women (30 – 49 years) and older women (70+ years). All rates were standardised for age. The mortality rates obtained from the official statistics on cause of death since 1990 were processed accordingly. Results Incidence rates in the observation period increased, as they were affected by the increasing number of cases with early-stage cancers being diagnosed in the screening age group. The total incidence for this group, which included the incidence of non-invasive breast cancers, increased by 14.5% between 2005 and 2016. Early-stage cancers (UICC stages 0 and I) increased by 48.1% while late-stage diagnoses (UICC stages III and IV) decreased by 31.6%. Qualitatively similar changes were noted for the other age groups, although they were less pronounced. The decrease in breast cancer mortality observed since the mid-1990s ended around 2008 for the group of younger women but continued in the screening age group. After 2008, an increase in mortality was observed in the group of older women. The differences in disease burden between East and West Germany (in favour of East Germany) decreased in younger women during the observation period but tended to increase in the group of older women. Conclusion The analysis suggests that the introduction of mammography screening contributed to a decrease in the incidence of advanced-stage breast cancers and in breast cancer-related mortality rates but also resulted in a substantial number of overdiagnoses. The relatively unfavourable incidence trend in the group of younger women, particularly in East Germany, should be interpreted in the context of lifestyle changes. The slight increase in mortality observed in the group of older women after 2008 requires further analysis.

Introduction The clinical presentation of endometriosis is extremely varied. Because endometriosis symptoms may overlap with symptoms caused by gastroenterological disorders, this can lead to misdiagnosis and a considerable delay in arriving at the correct diagnosis. The aim was to evaluate the type and duration of endometriosis-related symptoms and to identify predictors for patterns of involvement depending on symptoms. Material and Method The data of 266 consecutive patients who were operated on in the Endometriosis Center between 1/2016 and 12/2017 after receiving a histologically verified diagnosis of endometriosis were recorded. In addition to recording the clinical parameters, a questionnaire was distributed to the patients, who were asked about their medical history. Infertile patients were grouped together as Group 1 and compared to non-infertile patients (Group 2). Results The response rate for returned questionnaires was 79.47% (182/229). 41.8% of patients reported that they were infertile and 91.8% reported pelvic pain. In more than ⅓ of cases in both groups, more than 10 years passed between the initial symptoms and the final diagnosis (39.4 vs. 37.5%). On average, patients consulted 2.72 (± 1.58) resp. 3.08 (± 1.72) doctors before they presented to a hospital or were referred for laparoscopic diagnostic workup (p = 0.162). Cycle-related diarrhea (odds ratio 2.707; 95% CI: 1.063 – 6.895, p = 0.037) and dysmenorrhea (odds ratio 2.278; 95% CI: 1.193 – 4.348, p = 0.013) were associated with involvement of the pelvic peritoneum, cycle-related dyschezia was associated with rectal involvement by a factor of 4.6 in binary regression analysis (odds ratio 4.659; 95% CI: 1.132 – 19.186; p = 0.033). Conclusion Cycle-related diarrhea and dysmenorrhea increase the risk probability of peritoneal endometriosis. Dyschezia increases the risk probability of rectal endometriosis.

Background The randomized ESTEEM trial reported that preimplantation genetic aneuploidy testing of oocytes by polar body biopsy (PGT-A) with array comparative genomic hybridization (aCGH) in women aged 36 – 40 years undergoing assisted reproduction treatment reduces the number of embryo transfers and the risk of miscarriage while not impacting the live birth rate. Method A decision tree model based on data from the ESTEEM trial was created and analyzed, using three cost scenarios for assisted reproduction treatment in Germany (statutory health insurance [GKV] = the deductible is 50% of the standard medical costs; private medical insurance [PKV] = invoicing is based on the German medical fee schedule [GOÄ]; private medical insurance with a simple GOÄ factor [simple GOÄ factor] = invoicing is based on the standard medical fees multiplied by a linear GOÄ factor). The scenarios were compared for cost-effectiveness (cost per live birth), cost per prevented miscarriage and the threshold values for cost and effectiveness. Results PGT-A increased the costs per live birth in all scenarios (GKV: + 208%; PKV: + 49%; simple GOÄ factor: + 89%). A threshold analysis showed a substantial cost discrepancy between the actual cost of the intervention based on GOÄ (€ 5801) vs. the theoretically tolerable PGT-A cost (GKV: € 561, PKV: € 1037, single GOÄ-factor: € 743). The incremental cost per one prevented miscarriage was approximately € 70 000 – 75 000 for all cost scenarios. Conclusion The use of PGT-A with aCGH in assisted reproduction cannot be recommended from a cost-effectiveness perspective.

Endometriosis affects a significant number of young premenopausal women. Quite apart from the medical challenges, endometriosis is a relevant burden for healthcare and social security systems. Standardized quality indicators for the treatment of endometriosis have not previously been systematically verified. The three-stage study QS ENDO was initiated to record and improve the reality and quality of care. One of its aims is to create quality indicators for the diagnosis and treatment of endometriosis. For the first stage of QS ENDO Real, letters were sent to all 1014 gynecological departments in the German-speaking area of Europe (the DACH region) which included a questionnaire as a means of surveying the current state of care. A total of 296 (29.2%) of the centers which received the questionnaire participated in the survey. The subsequent evaluation of the completed questionnaires showed that the majority of patients with endometriosis (around 60%, based on estimates from the data) are not treated in hospitals which have been certified by the SEF. The guidelines recommend the use of specific classification systems (rASRM, ENZIAN) but, depending on the level of care offered by the hospital, only around 44.4 to 66.4% of departments used the rASRM score and only 27% of hospitals used the ENZIAN classification system to describe deep-infiltrating endometriosis. When taking patientsʼ medical history, some centers (6.6 – 17.9%) considered questions about leading symptoms such as dyschezia, dysuria and dyspareunia to be unimportant. QS ENDO Real has made it possible, for the first time, to get an overview of the reality of care provided to patients with endometriosis in the German-speaking areas of Europe. The findings indicate that several of the measures recommended in international guidelines as the gold standard of care are only used to treat some of the patients. In this respect, more efforts will be needed to provide more advanced training. The approach used for treatment must be guideline-based, also in not-certified centers, to improve the quality of care in the treatment of patients with endometriosis.

Introduction Assisted reproductive technologies are typically perceived by couples as being an emotional burden. The objective of the study “Positive Ausrichtung bei unerfülltem Kinderwunsch” [Positive adjustment in infertility] (PACI) is to examine the efficacy and acceptance of a smartphone-supported psychosocial intervention during infertility treatment. In this investigation, the early drop-out of study subjects from the study is of primary interest. The objective of the investigation was to find predictors for ending a psychological intervention prematurely. Materials and Methods There are data available from an eight-month randomised, controlled study in which 141 patients and their partners participated. Sociodemographic and fertility-related data were collected at the start of the study. The couples received the ScreenIVF questionnaire at two points in time. As part of a post-evaluation, a survey was conducted on the efficacy of the psychological online intervention. To analyse the data, a dyadic data structure was used in order to determine connections within the study subject couples between the selected stress indicators and the drop-out. In addition, a “risk score” as a possible predictor for the drop-out was tested. Results The descriptive observation of the sample indicates in this interim assessment that the study subjects recruited are less stressed patient couples. Actor–partner interdependence models indicate statistically significant connections between the stress indicators of anxiety, little social support and helplessness and an early drop-out. Conclusions The statistically significant effects found in this study with regard to the stress indicators in connection with drop-outs from psychosocial intervention studies indicate that it is advisable to continue to seek measures for people undergoing stressful medical treatments in order to motivate and support them and thus optimally utilise the opportunities of a medical treatment. The number of patients who endure their ART treatment may also increase as a result, which could lead in turn to increased patient satisfaction over the long term (and thus possibly to higher pregnancy rates).

Introduction Foetal macrosomia is associated with various obstetrical complications and is a common reason for inductions and primary or secondary Caesarean sections. The objective of this study is the generation of descriptive data on the mode of delivery and on maternal and foetal complications in the case of foetal macrosomia. The causes and consequences of foetal macrosomia as well as the rate of shoulder dystocia are examined in relation to the severity of the macrosomia. Patients The study investigated all singleton births ≥ 37 + 0 weeks of pregnancy with a birth weight ≥ 4000 g at the Charité University Medicine Berlin (Campus Mitte 2001 – 2017, Campus Virchow Klinikum 2014 – 2017). Results 2277 consecutive newborns (birth weight 4000 – 4499 g [88%], 4500 – 4999 g [11%], ≥ 5000 g [1%]) were included. Maternal obesity and gestational diabetes were more common in the case of newborns weighing ≥ 4500 g than newborns weighing 4000 – 4499 g (p = 0.001 and p Conclusion An increased birth weight is associated with an increased maternal risk and an increased rate of primary and secondary sections as well as shoulder dystocia; no differences in the perinatal outcome between newborns with a birth weight of 4000 – 4499 g and ≥ 4500 g were seen. In our collective, a comparably low incidence of shoulder dystocia was seen. In the literature, the frequency is indicated with a large range (1.9 – 10% at 4000 – 4499 g, 2.5 – 20% at 4500 – 5000 g and 10 – 20% at ≥ 5000 g). One possible cause for the low rate could be the equally low prevalence of gestational diabetes in our collective. A risk stratification of the pregnant women (e.g. avoidance of vacuum extraction, taking gestational diabetes into account during delivery planning) is crucial. If macrosomia is presumed, it is recommended that delivery take place at a perinatal centre in the presence of a specialist physician, due to the increased incidence of foetal and maternal complications.

Purpose How many women assume that they have fibroids but are found not to have fibroids on ultrasound examination? How severe are the physical symptoms reported by these women compared to the symptoms reported by women with actual uterine fibroids? Are the symptoms more severe if the patient believes that she has at least one relatively large (dominant) fibroid or more than 3 fibroids? Material and Methods A total of 1548 patients completed an anonymous questionnaire in which they were asked about the number of their fibroids, dysmenorrhea and premenstrual symptoms, dyspareunia and bleeding disorders (using a numerical analog scale between 0 – 10). The questionnaire was administered in a hospital-based fibroid clinic. The information provided by the patients was then compared with transvaginal or abdominal ultrasound findings. The symptoms reported by women with and without fibroid(s) were compared. Results 1045 out of 1548 patients fulfilled the studyʼs inclusion criteria. Contrary to the information they provided, no fibroid(s) were detected in 6% (62 of 1045 patients) of patients on ultrasound examination. Of these women, 87% had dysmenorrhea, 79% had premenstrual pain and 57% reported dyspareunia. The severity of the symptoms was found not to be associated with the assumed size or number of fibroid(s). There was no significant difference in the pain reported by women without and by women with fibroids. Reporting a feeling of strong pressure on the bladder (OR: 1.18) or abdomen (OR: 1.12) or constipation (OR: 1.16) increased the likelihood of detecting a fibroid on ultrasound investigation. Conclusions The presence of manifest symptoms (dysmenorrhea, dyspareunia, premenstrual pain, bleeding disorders) does not allow conclusions to be made about the number or size of fibroids or about which therapy is indicated. Even an erroneous assumption about the presence of fibroids may result in patients experiencing symptoms.

Introduction When planning the treatment of women with gestational diabetes, the current standard approach also takes fetal growth development into account. The treatment of pregnant women with type 1 diabetes mellitus (DM) used to be based exclusively on maternal blood glucose values. This study investigated the impact of including fetal growth parameters in the monitoring of pregnant women with type 1 diabetes mellitus. Patients/Method 199 pregnant women with type 1 DM were included in a cohort study. The patient population was divided into two study cohorts. In the mBG cohort (n = 94; investigation period: 1994 – 2005) treatment was monitored using only maternal blood glucose (mBG) values; the aim was to achieve standard target glucose values (mean BG Results 91.4% of all patients were normoglycemic at the time of delivery (HbA1c Conclusion Using maternal blood glucose values combined with fetal growth parameters to monitor DM treatment allows therapeutic interventions to be individualized and reduces the risk of maternal and infant morbidity. The metabolism of patients in the fUS cohort was significantly more stable and there were fewer variations in glucose values. It is possible that the detected benefits are due to this metabolic stabilization.

Introduction Venous thromboses and their consequences are among the main causes of death in patients with tumour diseases. The objective of this study is the analysis of risk factors and the evaluation of the applicability of two risk scores in a purely gynaecological oncology patient collective. The identification of patients at high risk for the occurrence of venous thromboses could enable the implementation of targeted medication-based thrombosis prophylaxis which has a significant benefit and, simultaneously, a low risk. Materials and Methods A retrospective case-control study on 152 patients who were undergoing oncological treatment in the Department of Gynaecology of the Mainz University Medical Centre between 2006 and 2013 investigated the data from 104 patients with breast, 26 with ovarian and 22 with cervical cancer. A control was assigned to 76 subjects in the case group who suffered a venous thrombosis during chemotherapy and this control coincided in the points of tumour location, age, lymph node involvement, metastasis and time of initial diagnosis. The group differences were analysed using the χ2 test, t test, Mann-Whitney-U test and a logistic regression analysis. Results There were clear group differences in the lack of inpatient thrombosis prophylaxis (p = 0.014), elevated leukocyte counts (p = 0.018) prior to the start of chemotherapy and port systems (p = 0.032). Surgical interventions were confirmed to be an independent risk factor (p ≤ 0.001). The Khorana and Protecht scores did not emerge from the analysis as independent predictors for a thrombosis. More patients died in the case group than in the control group (p = 0.028; OR: 8.1; CI: 1.254 – 52.162). Conclusion In this patient collective, surgeries represent an independent risk factor for venous thromboses. In addition, a correlation was seen between inpatient thrombosis prophylaxis, leukocytosis as well as port systems and an increased risk of thrombosis. Neither the Khorana nor the Protecht score were independent risk factors for venous thromboses. Significantly more thrombosis patients died during the observation period.

Introduction In recent decades, there has been a continuous rise in the average age at which women give birth. A maternal age of 35 years and above is considered an independent risk factor in pregnancy and birth, due to higher rates of intervention. This study investigates the influence of maternal age on birth procedure, gestational age, and rate of interventions during delivery. The influence of maternal parity is also analyzed. Material and Methods Data from the Austrian Register of Births was retrospectively collected and evaluated. The collected data was the data of all singleton live births in Austria between January 1, 2008 and December 31, 2016 (n = 686 272). Multiple births and stillbirths were excluded from the study. Maternal age and parity were analyzed in relation to predefined variables (birth procedure, gestational age, episiotomy in cases of vaginal delivery, epidural anesthesia in both vaginal and cesarean deliveries, and intrapartum micro-blood gas analysis). Statistical data was evaluated using (1) descriptive univariate analysis, (2) bivariate analysis, and (3) multinomial regression models. Results The cesarean section rate and the rate of surgically-assisted vaginal deliveries increased with advancing maternal age, especially in primiparous women, while the rate of spontaneous deliveries decreased with increasing maternal age. A parity of ≥ 2 had a protective effect on the cesarean section rate. The rate of premature births also increased with increasing maternal age, particularly among primiparous women. Discussion Although higher maternal age has a negative effect on various obstetric parameters, it was nevertheless not possible to identify a causal connection. Maternal age should not be assessed as an independent risk factor; other factors such as lifestyle or prior chronic disease and parity must be taken into consideration.

Endometriosis is one of the most common benign gynecological diseases. The extremely heterogeneous complex of symptoms complicates the diagnosis and treatment of this disease. In most patients, there is a latency period of several years between the first occurrence of symptoms and the definitive diagnosis. This paper aims (1) to evaluate standards for the diagnosis and treatment of patients with (symptoms suspicious for) endometriosis in terms of feasibility, and (2) to assess the potential use of data collected by a certified clinical and scientific endometriosis center to answer scientific questions. Standards for outpatient consultations were developed for a special endometriosis outpatient clinic. Between January 2014 and December 2017, a total of 1715 outpatients with a suspicion of endometriosis presented to this special endometriosis outpatient clinic; the diagnosis and treatment of patients was carried out in accordance with the developed standards. Data of this patient cohort obtained from patient records created during outpatient consultations and from a questionnaire recorded in an Oracle-based database was analyzed. The patient cohort was also compared with another patient cohort who had attended different outpatient clinics and had been diagnosed intraoperatively with endometriosis. 41.8% of patients examined during special outpatient consultations had surgery for suspicion or recurrence of endometriosis. Endometriosis was confirmed in 81.5% of cases. Pain symptoms were the main indication for surgery in 70.1% of cases compared to 45.1% of cases in the comparison group. The structured approach used in the special endometriosis outpatient clinic is a key aspect of the care provided by the certified clinical and scientific endometriosis center. It ensures that patients are diagnosed and treated in accordance with guideline recommendations, that diagnosis and treatment comply with certification requirements, and that the collected data can be used to answer scientific questions.

Introduction In connection with the reorganisation of cervical carcinoma screening, the importance of colposcopy as an integral part of the planned series of clarification testing will greatly increase. Quality standards for performing the colposcopic examination should therefore be defined in detail. A precondition for this is surveying the current standard in clinical practice. The objective of this study was to evaluate the current practice of colposcopy and conisation in Germany by means of a questionnaire aimed at gynaecologists who perform colposcopies in order to document the actual therapeutic standard of treatment of cervical dysplasia. Materials and Methods Gynaecologists were invited via e-mail or during events to participate in a web-based survey. The questionnaire contained 38 questions on management before, during and after the examination as well as questions on the technical implementation of colposcopy and conisation. Results From February 2018 to April 2018, 961 e-mails were sent. A response was received in 197 cases (response rate 20.5%). Responses were received for another 40 questionnaires during events (response rate approx. 80%). After taking the inclusion criteria into account, 160 questionnaires were evaluated. The majority of those surveyed take an average of 2 cervical biopsies (67.3%) and nearly all of those surveyed (94.5%) do not use any local anaesthetic. As a standard method for removing cervical precancerous cells, most of the physicians surveyed perform a loop excision with the electrosurgical loop (91.2%) under colposcopic visualisation (61.2%) under general anaesthesia (92.5%). Postoperative bleeding prophylaxis by means of tamponade is performed only in 27.6% of all cases. Conclusion A differential colposcopy with two colposcopically targeted biopsies and treatment with the electrosurgical loop are the methods most frequently used by clinicians who perform colposcopy in Germany. A uniform procedure should be defined in detail within the scope of directives or guidelines.

Background Reduced resources for financing healthcare services are available to the German health system. For this reason, demographic development represents one of the greatest challenges for the German health system. Reproductive medicine can offer potential solutions and counteract the ageing of the population through an increase in the birth rate. Most reproductive medical treatments take place in private centres. For the development of new, innovative therapeutic approaches, continuing education and scientific advancement, university centres are essential. Materials and Methods Using multistage contribution margin accounting, IVF and ICSI treatments at the University Fertility Centre Franken (UFF) were investigated in 2012. The cost situation from the perspective of the patient couple and the statutory payer were contrasted with the cost and revenue situation of the service provider as a university reproductive medicine centre. Results The costs for the patient couple for an IVF treatment cycle were 538.71 € and for an ICSI cycle, 700.07 €. For the payer, the costs, including the university flat rate (194.80 €) to be paid, amount to 733.51 € for an IVF cycle and 894.87 € for an ICSI cycle. The payments of the patient couple and the payer were added and this yielded total costs of 1272.22 € and 1594.94 €. The University Fertility Centre Franken, as a part of the Department of Gynaecology of the Erlangen University Hospital, incurred costs of 1364.47 € for an IVF treatment cycle and 1423.48 € for an ICSI treatment cycle. In addition, the OB/GYN clinic had to pay the university hospital a flat general expense rate of 14.9% of the income. There was thus a loss for the department of gynaecology of 281.81 € for an IVF cycle and 66.19 € for an ICSI cycle. Discussion From the perspective of a university reproductive medicine centre, IVF and ICSI treatments currently cannot be performed in a cost-covering manner. At the same time, a reproductive medicine treatment cycle represents a significant financial burden on the patient couple due to only partial cost coverage by most statutory health insurance funds. This therefore demonstrates a need for action in health policy to revise and, in the interest of the patient couples, reproductive medicine centres and, not least of all, in the interest of society, to improve existing cost absorption policies and thus also benefit from this as a society over the long term.

Unfavourable intrauterine environmental factors increase the risk of delivery complications as well as postpartum developmental and behavioural problems in children and adolescents with ongoing effects into older age. Biomarker studies show that maternal stress and the use of alcohol and tobacco during pregnancy are associated with a higher intrauterine testosterone exposure of the child. The antenatal testosterone load, in turn, is a risk factor for lasting adverse health effects which extend into adulthood. A 15-week, mindfulness-oriented, app-based programme for the reduction of stress as well as for the reduction of alcohol and tobacco use in pregnant women is established. In the monocentre, prospective, controlled, and investigator-blinded MINDFUL/PMI (Maternal Health and Infant Development in the Follow-up after Pregnancy and a Mindfulness Intervention) study, pregnant women carry out the programme. Its effect on antenatal testosterone exposure of the child is examined by assessing the index/ring finger length ratio and other biomarkers in the 1-year-old children. In addition, the programme's effects on self-regulation, the developmental status and the mental health of the children at the age of one year will be investigated. Additional aspects of the course of the pregnancy and delivery represent exploratory study objectives. This longitudinal study project is intended to improve the understanding of the impact of intrauterine environmental factors on early childhood development and health. Maternal stress as well as alcohol and tobacco use during pregnancy are modifiable factors and represent potential preventive targets.Ungünstige intrauterine Umweltfaktoren erhöhen das Risiko für Geburtskomplikationen sowie postpartale Entwicklungs- und Verhaltensauffälligkeiten bei den Kindern und Jugendlichen mit permanenten Auswirkungen bis ins höhere Alter. Biomarkerstudien zeigen, dass mütterlicher Stress und Konsum von Alkohol und Tabak während der Schwangerschaft mit höherer intrauteriner Testosteronexposition des Kindes assoziiert sind. Die pränatale Testosteronlast ist wiederum ein Risikofaktor für anhaltende und bis ins Erwachsenenalter reichende Gesundheitsbeeinträchtigungen. Es wird ein 15-wöchiges, achtsamkeitsorientiertes, App-basiertes Programm zur Reduktion von Stress sowie zur Verminderung von Alkohol- und Tabakkonsum bei schwangeren Frauen etabliert. In der monozentrischen, prospektiven, kontrollierten und untersucherverblindeten MINDFUL/PMI (Maternal Health and Infant Development in the Follow-up after Pregnancy and a Mindfulness Intervention)-Studie führen schwangere Frauen das Programm durch. Dabei wird der Effekt auf die pränatale Testosteronexposition des Kindes untersucht, die mit dem Zeige-/Ringfingerlängenverhältnis und weiteren Biomarkern bei den 1-jährigen Kindern erhoben wird. Außerdem soll beforscht werden, wie sich das Programm auf die Selbstregulation, den Entwicklungstand und die psychische Gesundheit der Kinder im Alter von einem Jahr auswirkt. Weitere Aspekte des Schwangerschafts- und Geburtsverlaufs stellen explorative Studienziele dar. Dieses longitudinale Studienprojekt soll das Verständnis der Bedeutung intrauteriner Umweltfaktoren für die frühe kindliche Entwicklung und Gesundheit verbessern. Mütterlicher Stress sowie Alkohol- und Tabakkonsum während der Schwangerschaft sind modifizierbare Faktoren und stellen potenzielle präventive Ansatzpunkte dar.

During the current COVID-19 pandemic video consultations are increasingly common in order to minimize the risk of infection for staff and patients. The aim of this study was to evaluate the feasibility of a spine examination via video.A total of 43 patients were recruited. Each participant underwent a video-based (VB) and a conventional face-to-face (FTF) spine examination. Pain intensity, active range of motion, inspection, a neurophysiologic basic exam and provocations tests were evaluated using video-based and face-to-face methods.The intra-rater reliability (IRR) was measured between both examinations. Good to very good IRR values were obtained in inspection (Kappa between 0,752 und 0,944), active range of motion and basic neurophysiological examination (Kappa between 0,659 und 0,969). Only moderate matches were found in specific provocation tests (Kappa between 0,407 und 0,938). A video-based spine examination is a reliable tool for measuring pain intensity, active range of motion and a basic neurophysiologic exam.A basic spine examination during a video consultation is possible. A good agreement of the test results between video-based and face-to-face examination could be found.Während der aktuellen COVID-19-Pandemie sind Videosprechstunden zur Kontaktvermeidung zunehmend verbreitet. Die vorliegende Studie soll die Machbarkeit einer Wirbelsäulenuntersuchung im Rahmen einer Videosprechstunde evaluieren.Es wurden 43 Patienten in unserer Klinikambulanz untersucht. Die Patienten wurden zunächst videogestützt und unmittelbar später mit direkten Arzt-Patienten-Kontakt untersucht. Zur Strukturierung der Untersuchungsergebnisse wurde bei allen Untersuchungen ein systematischer Frage- und Untersuchungsbogen verwendet. Gemessen wurde die Intrarater-Reliabilität (IRR) zwischen beiden Untersuchungsdurchgängen.Gute bis sehr gute IRR-Werte ergaben sich bei Inspektion (Kappa zwischen 0,752 und 0,944), Bewegungsausmaßen und neurophysiologischer Basisuntersuchung (Kappa zwischen 0,659 und 0,969). Nur moderate Übereinstimmungen konnten bei spezifischen Provokationstests (Kappa zwischen 0,407 und 0,938) gefunden werden.Eine Basisuntersuchung der Wirbelsäule ist im Rahmen einer Videosprechstunde möglich. Es konnte eine gute Übereinstimmung der Testergebnisse zwischen videogestützter und direkter Arztuntersuchung gefunden werden.

The COVID 19 pandemic is a major challenge to all social systems, particularly the healthcare system. Within an international study, German Trauma Centres DGU and Geriatric Trauma Centres DGU have been questioned about their situation.The questionnaire was translated from English into German and sent to all contacts. The evaluation was performed descriptively.71 of 692 centres participated in this study. Government instructions to avoid elective treatments have been adhered to by 68% of the hospitals, and the remaining performed only urgent elective treatments. There was also a decline in the number of traumatological patients. In more than 90% of the hospitals, only 0 - 4% of all patients treated for proximal femur fracture were tested positive for COVID-19. It appears that 84% of these hospitals have or will have financial deficits. Almost all hospitals were organised and ready to fight the pandemic with their personal and/or infrastructural resources they possess.Our questionnaire shows that the pandemic had an enormous effect on Trauma Centres DGU and Geriatric Trauma Centres DGU. The hospitals expect financial losses. Almost all the hospitals have provided personal and infrastructural resources to be used in the fight against the pandemic with a better outcome in Germany in comparison with international standards.Die COVID-19-Pandemie stellt neben den gesellschaftlichen auch eine große Herausforderung für das Gesundheitssystem dar. Im Rahmen einer internationalen Studie wurden die deutschen TraumaZentren DGU und AltersTraumaZentren DGU hierüber befragt.Der englische Fragebogen wurde ins Deutsche übersetzt, mit spezifischen Fragen ergänzt und durch die Akademie der Unfallchirurgie an alle Ansprechpartner der Zentren verschickt. Die Auswertung erfolgte rein deskriptiv.Es nahmen 71 von 692 Zentren an der Umfrage teil. Die Vorgabe zur Einstellung von elektiven Behandlungen wurde von 68% der teilnehmenden Kliniken umgesetzt, der Rest führte nur noch dringliche Behandlungen durch. Es zeigte sich auch ein Rückgang unfallchirurgischer Patienten. Tatsächliche COVID-19-Infektionen traten bei über 90% der Kliniken nur in 0 – 4% der behandelten Patienten mit hüftgelenksnaher Femurfraktur auf. Bei 84% der Kliniken ist ein wirtschaftlicher Schaden für die Klinik eingetreten oder wird erwartet. Von fast allen Kliniken wurden personelle oder infrastrukturelle Ressourcen zur Bekämpfung der Pandemie bereitgestellt.Unsere Umfrage zeigt, dass die Pandemie einen starken Einfluss auf die TraumaZentren DGU und AltersTraumaZentren DGU hat. Die Kliniken erwarten wirtschaftliche Einbußen. Fast alle Kliniken stellten aber personelle und infrastrukturelle Ressourcen zur Bekämpfung der Pandemie bereit und leisteten so einen Beitrag für den bisher guten Pandemieverlauf in Deutschland im internationalen Vergleich.

Background In Germany, the highly sensitive issue of late terminations of pregnancy and feticide is regulated in Sec. 218a para. 2 of the German Penal Code (medical indication). This study aimed to investigate the prenatal obstetric approach after feticide and the rate of maternal complications. Material and Methods All feticides of singleton pregnancies carried out at Leipzig University Hospital (n = 164) in the period between 01/2016 and 12/2019 were retrospectively analyzed. Selective feticides of multiple pregnancies were excluded from the study. Target indicators for the prenatal obstetric approach were sonographic accuracy of estimation, method used to induce feticide, time between feticide and delivery, and whether curettage was required. The rate of maternal complications was defined as blood loss of ≥ 500 ml. Results The number of feticides as a percentage of the total number of births during the investigation period was 1.6%. None of the terminations were performed primarily because of a serious risk to the motherʼs physical health; all of the indications to terminate the pregnancy were based on the psychosocial burden and the risk to the motherʼs mental health as outlined in Sec. 218a StGB (German Penal Code). The most common fetal diagnoses in the context of a maternal psychosocial emergency were central nervous system abnormalities (29.3%), numerical chromosomal aberrations (29.3%) and structural chromosomal aberrations/syndromes (21.3%). Sonographic measurements were used to estimate fetal weight and the weight of around half of the fetuses was underestimated (− 121.8 ± 155.8 g). The margin of estimation error increased with increasing gestational age (p Conclusion Late terminations of pregnancy carried out in accordance with Sec. 218a para. 2 StGB are a reality and must be understood and accepted as a possible consequence of modern prenatal medicine. The complication rate after feticide and the subsequent obstetric procedure was 10% for the above-defined maternal complication. Late terminations and their obstetric management should be carried out in specialized perinatal centers which offer interprofessional expertise.

Background Women have a markedly increased lifetime risk for cardiovascular morbidity and mortality following hypertensive disorders of pregnancy. Arterial stiffness is regarded as a target parameter for reducing cardiovascular risk and can be modified by lifestyle changes. Methods In a prospective, randomised, controlled interventional study, starting 6 weeks postpartum, the effect of nutritional intervention combined with an intensive 6-month cardiovascular exercise programme on arterial stiffness was investigated by means of pulse wave velocity (PWV) in 38 women with severe hypertensive disorder of pregnancy (preeclampsia with or without pre-existing hypertension and/or HELLP syndrome). A reference group was formed with postpartum women without pregnancy complications or known cardiovascular risk and the arterial stiffness was studied by means of PWV at the time of delivery. The PWV was measured in the intervention and control groups within a week after delivery and after 32 weeks (6 weeks + 6 months). A feasibility analysis was performed in addition. Results 29 of 38 women with severe hypertensive disorder of pregnancy and 38 postpartum women in the reference group were included in the analysis (intervention group n = 14; control group n = 15; reference group n = 38). Adherence to a) the nutritional counselling and b) the intensive cardiovascular exercise programme was 73% and 79% respectively. A clinically significant difference (d = 0.65) in pulse wave velocity between the intervention and control groups was found after 6 months (6.36 ± 0.76 vs. 7.33 ± 2.25 m/s; group × time: p = 0.632). The PWV of the intervention group corresponded to that of the reference group at the end of the study (6.36 ± 0.76 m/s vs. 6.5 ± 0.70; d = 0.19), while the results in the control group differed markedly from this (7.33 ± 2.25 m/s; d = 0.56). Conclusion The study documents the feasibility of lifestyle intervention with physical exercise after delivery (starting 6 weeks postpartum). The intervention showed a significant clinical effect by reducing arterial stiffness to the level of the reference group. Before this intervention can be included in the standard of care and prevention, follow-up studies must confirm these results and the medium-term effects on cardiovascular risk.

Introduction Optimal cytoreduction is the most important prognostic factor in advanced ovarian cancer. Although staging and assessment of operability are made by exploratory surgery, preoperative computed tomography (CT) of the abdomen is regarded as standard. The aim of this study was to examine various CT parameters with regard to prediction of optimal cytoreduction. Patients and Methods The retrospective study included 131 patients with ovarian cancer newly diagnosed between 2010 and 2014. Of these, n = 36 with FIGO stage I to IIB were excluded from the study. A preoperative abdominal CT was available for n = 75 of the 95 patients with FIGO stage IIC to IV. The CT scans underwent blinded review. The 11 evaluated CT parameters were examined by means of χ2 test and logistic regression analysis with regard to the endpoints of macroscopic residual tumour and residual tumour > 1 cm. Survival analyses used the Kaplan-Meier method and log rank test. Results Of 75 patients, 28 (37.3%) had complete tumour resection and 26 (34.7%) had residual tumour ≤ 1 cm. Residual tumours > 1 cm were found in 21 (28%) patients, five of which were not resectable. Overall survival with residual tumour > 1 cm differed significantly from the group with no macroscopic residual tumour (p = 0.003) and with residual tumour ≤ 1 cm (p = 0.04). The CT parameters tumour foci in the diaphragm, mesocolon, greater omentum and peritoneum as well as ascites correlated with macroscopic residual tumour. In the multivariate logistic regression analysis only the CT parameter intraparenchymal liver metastasis was statistically significant with regard to prediction of suboptimal tumour resection (> 1 cm) (OR 8.04; 95% CI 1.57 – 42.4; p = 0.0134). The sensitivity, specificity, PPV and NPV were 37.5, 89.7, 66.7 and 72.2%. Conclusion Although risk parameters for suboptimal tumour reduction can be identified by CT of the abdomen, surgical exploration with histological confirmation of the diagnosis is essential because of the poor diagnostic accuracy.

Background BRCA1/2 mutations are the leading cause of hereditary epithelial ovarian cancer (EOC). The German Consortium for Hereditary Breast and Ovarian Cancer has defined inclusion criteria, which are retrievable as a checklist and facilitate genetic counselling/testing for affected persons with a mutation probability of ≥ 10%. Our objective was to evaluate the prevalence of the BRCA1/2 mutation(s) based on the checklist score (CLS). Methods A retrospective data analysis was performed on EOC patients with a primary diagnosis treated between 1/2011 – 5/2019 at the Central Essen Clinics, where a BRCA1/2 genetic analysis result and a CLS was available. Out of 545 cases with a BRCA1/2 result (cohort A), 453 cases additionally had an extended gene panel result (cohort B). Results A BRCA1/2 mutation was identified in 23.3% (127/545) in cohort A, pathogenic mutations in non- BRCA1/2 genes were revealed in a further 6.2% in cohort B. In cohort A, 23.3% (127/545) of patients had a BRCA1 (n = 92) or BRCA2 (n = 35) mutation. Singular EOC (CLS 2) was present in 40.9%. The prevalence for a BRCA1/2 mutation in cohort A was 10.8%, 17.2%, 25.0%, 35.1%, 51.4% and 66.7% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. The mutation prevalence in cohort B was 15.9%, 16.4%, 28.2%, 40.4%, 44.8% and 62.5% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. Conclusions The BRCA1/2 mutation prevalence in EOC patients positively correlates with a rising checklist score. Already with singular EOC, the prevalence of a BRCA1/2 mutation exceeds the required 10% threshold. Our data support the recommendation of the S3 guidelines Ovarian Cancer of offering genetic testing to all patients with EOC. Optimisation of the checklist with clear identification of the testing indication in this population should therefore be aimed for.

Objectives The study aimed to answer a number of questions: Which medical, psychological and sociodemographic factors affect the recovery of women after gynecological surgery for benign indications? Does patientsʼ health-related quality of life improve after surgical intervention? How long are patients signed off work postoperatively? How do patients assess their own capacity to work? Method Study population: All women between the ages of 18 and 67 years who underwent gynecological surgery for benign indications at the Charité Campus Virchow Clinic over a 7-month period were consecutively enrolled in the study. Four standardized patient surveys (the first survey [T0] was carried out in hospital, T1 at 1 week, T2 at 6 weeks and T3 at 7 – 8 months after discharge by telephone interview) were carried out using evaluated questionnaires to record patientsʼ recovery (Recovery Index), quality of life (RAND-36), satisfaction, complications, sociodemographic information and time off work with a medical sick note. Relevant medical and demographic data were also collected. Statistical analysis was carried out using univariate statistical tests for descriptive analysis and complex multifactorial statistical procedures to record observations over time. Results A total of 182 patients were included in this study (participation rate: 70%). Relevant prior operations (p = 0.01), in-hospital (p = 0.004) and postoperative complications (p Conclusion Recovery after gynecological surgery is a multifactorial process. This survey of a patient population identified psychological and physical factors which influence recovery but did not find significant sociodemographic parameters affecting recovery. Irrespective of these findings, gynecological surgery for benign indications resulted in an improvement in health-related quality of life. Prospective studies need to investigate whether psychological interventions could reduce preoperative fear and thereby improve postoperative recovery.

Introduction The complication of tape erosion in the urethra following placement of a retropubic (TVT) or transobturator (TOT) tension-free suburethral vaginal sling or an accidental iatrogenic transurethral tape position can result in the formation of a urethrovaginal or vesicovaginal fistula. The objective of the investigation is the evaluation of the management of such rare complications. Patients and Methods Retrospective analysis of 14 patients who were treated for a urethral lesion or urethrovaginal fistula formation status post TVT/TOT placement between June 2011 and February 2018 in the Tübingen University Department of Gynaecology. Results As surgical therapy, 57.1% (n = 8) cases underwent vaginal fistula closure using a Martius flap of the labium majus and in 21.4% (n = 3) using a vaginal rotation skin flap. In 21.4% (n = 3), exclusively vaginal suture reconstruction of the urethra following excision of the tape running transurethrally or tape erosion was performed. 50% (n = 7) of the patients had lasting continence postoperatively without any further need for therapy. In 28.6% (n = 4), there was ongoing stress urinary incontinence, in 21.4% (n = 3) mixed urinary incontinence. Six of the 7 patients with persistent incontinence underwent new placement of a tension-free suburethral retropubic sling (TVT) an average of 8.8 months (5 – 13 months) postoperatively which was uncomplicated in all patients and achieved satisfactory continence. The 3 patients with mixed urinary incontinence and persistent urgency components additionally received anticholinergic medication. During the time period investigated, there were no long-term complications, in particular no recurrent fistulas. Conclusion The rare but relevant complications of a urethral erosion, transurethral tape position or urethrovaginal fistula formation status post TVT/TOT placement can be successfully managed via vaginal surgery. Persistent postoperative urinary incontinence with the need for a two-phase repeat TVT placement following sufficient wound healing must be preoperatively clarified.

Introduction Numerous couples discontinue fertility treatment before achieving the objective, the birth of a child. The aim of this retrospective data analysis is to identify the reasons for early discontinuation of therapy (drop-out). Materials and Methods Retrospective data analysis. With the aid of the German IVF Registry (D·I·R®), a total of 122 560 “last cycles” in Germany in the period 2012 – 2015 were identified and the courses were analysed. Results From the named cohort of “last cycles”, 37.3% of the female patients (45 699) gave birth to a child and ended the therapy. The remaining 76 861 discontinued the treatment before having a child. The fertility treatment was conducted due to a purely male indication in 46.27% of cases and in 17.96% the cause lay exclusively with the woman. 4.53% of the drop-outs suffered a miscarriage in the last cycle. 73.56% of the drop-out patients ended the therapy after the lack of a positive pregnancy test. After the third therapy cycle, 67% of the couples ended their treatment. Conclusion The results make it possible to provide couples with individual counselling. They offer an option for preparing for the emotional and physical hurdles.

Introduction Would adolescent girls in Germany choose a different method of contraception to the combined oral contraceptive if provided with the appropriate information? Is there a need for long-acting contraception among our adolescent girls? How satisfied are female patients with the information they receive at their respective gynaecology practices, and how much do the girls know about different methods of contraception? Materials and Methods In the study “Thinking About Needs in COntraception” (TANCO), not only female patients, but also their respective gynaecologists were surveyed online about current methods of contraception, their satisfaction with these methods, and also their level of knowledge concerning the individual methods of contraception, the situation related to advice about different contraceptive options and their general satisfaction with gynaecological care. This article presents the data from the subset of adolescent girls aged 14 to 19 years (n = 2699) out of the total of 18 521 women surveyed. Results The girls surveyed were familiar with at least the name of more than five different methods of contraception (average 5.3). The doctors assumed that the respondents would know only 4.2 different methods. When asked explicitly about how the individual methods of contraception work, clear deficits became evident. This applies not only to the entire population of respondents, but also the users of the respective contraceptive method. In addition, a strong interest in long-acting contraception emerged from the survey, particularly among young women. Discussion The data from the TANCO study reveal a clear discrepancy between the existing contraception almost exclusively in the form of the contraceptive pill and the contraceptive options considered by adolescent girls if they are thoroughly informed. The need for education into alternatives to the pill is high, as is the willingness to use such alternatives after receiving information – much higher than the figures suggested by the gynaecologists.

Introduction Cervical cancer is the fourth most frequent cancer in women worldwide. Addition of the VEGF antibody bevacizumab in combination with platinum-containing chemotherapy achieved an improvement in overall survival in advanced cervical cancer. To date there are no data on neoadjuvant use of bevacizumab. We therefore studied the benefit of neoadjuvant combined therapy with bevacizumab in a group of cervical cancer patients. Patients and Methods This retrospective cohort study analysed 14 patients with cervical cancer FIGO stages 1b1 to IV who received neoadjuvant platinum-containing chemotherapy in combination with bevacizumab. The comparative cohort consisted of 16 patients who were treated with neoadjuvant platinum-containing chemotherapy alone. The response rates were determined by means of preoperative clinical examination, diagnostic imaging (RECIST), changes in tumour markers (SCC) and by histopathology. Results A clinical response was found in 93.8% (n = 15) of patients after bevacizumab-free therapy and in 100% (n = 14) of the patients who were treated with bevacizumab in addition. Combined therapy with bevacizumab led to a higher rate of clinical complete remission (42.9 vs. 12.5%; p = 0.072) and significantly improved the reduction in tumour size (Δ longest diameter: 3.7 vs. 2.5 cm; p = 0.025). Downgrading was observed in 100% of all patients treated with bevacizumab compared with 75% in the control arm. The rate of pathological complete remission (pCR) was not altered significantly (28.6% [n = 4] vs. 37.5% [n = 6]; p = 0.460). Discussion Overall, combined therapy with bevacizumab led to a better clinical response. Operability was therefore improved more often. Because of the small patient cohort, larger prospective studies are necessary to validate the effect of neoadjuvant combined therapy with bevacizumab.

Introduction It is known that perinatal mortality is increased with births at night and at the weekend. The aim of the study was to investigate whether there is also an association between the time of delivery (weekday, night, weekend) and perinatal morbidity. Material and Methods All births at Hannover Medical College between 2000 and 2014 were included in a retrospective data analysis. Multiple births, primary sections, severe foetal malformations and intrauterine deaths were not included. A 5-minute Apgar score ≤ 5 and cord arterial pH Results 18 394 deliveries were included in the study. Pathological prepartum Doppler, medical induction of labour and delivery at night and/or at the weekend significantly increased the probability of an Apgar score ≤ 5 after 5 minutes. The probability that a child will have cord arterial pH 25 before pregnancy, primiparity, medical induction of labour, peripartum administration of oxytocic agents, when the delivery took place at night and weekend combined, but also when the delivery took place at night or at the weekend/on a public holiday. Multivariate regression analysis showed that a time of delivery at night and/or at the weekend or on a public holiday is not a prognostic factor for a 5-minute Apgar score ≤ 5 (p = 0.2377) but is a prognostic factor for cord arterial pH Conclusion The time of delivery at night or at the weekend/on a public holiday increases the risk for cord arterial pH

Introduction With the introduction of the first trastuzumab biosimilar in the summer of 2018, biosimilar antibodies for breast cancer have found their way into the area of gynaecological oncology. The switch of anti-human epidermal growth factor receptor 2 (HER2) therapy from the reference drug Herceptin® to a biosimilar has presented challenges to the clinics. In addition to structural and organisational measures, training of employees as well as patient briefing and acceptance were major challenges. The study presented here records – within the context of quality assurance – how the switch to a trastuzumab biosimilar was implemented at four Bavarian university clinics in the Purchasing Association of Bavarian University Pharmacies. Materials/Methods Questionnaires on treatment figures and the switching process were sent to breast centres and pharmacies of four Bavarian university clinics between July and December 2019. The neoadjuvant, adjuvant and metastasised anti-HER2 therapy with trastuzumab with or without pertuzumab was recorded, evaluated and summarised. Results In the anti-HER2-therapy, trastuzumab was used intravenously (i. v.) and subcutaneously. Between July and December 2018, all four clinics in the Purchasing Association switched the i. v. trastuzumab therapy from the reference drug (Herceptin) to a biosimilar (for 2018: Kanjinti®). Over 200 patients were treated with trastuzumab i. v. in each of the two half-years of 2018 (before and after the switch). The spectrum of side effects and pCR rates under therapy with the biosimilar were comparable to the experiences made with the reference drug. Three out of four clinics provided training to employees and informed patients by means of a defined information leaflet. Patient acceptance was high. Summary The anti-HER2 therapy could be switched successfully and safely to trastuzumab biosimilars at the Bavarian university hospitals. This may serve as guideline for the further implementation of biosimilars. The structures necessary for this initial switching process have been prepared with trastuzumab as an example.

Introduction Perinatal data of women with a Vietnamese migration background have not been systematically studied in Germany to date. Numerous details of important maternal and child outcomes were compared and analysed. The studyʼs primary parameters were the frequency of and indication for c-section. Methodology The perinatal data from a Berlin hospital were analysed retrospectively. The women (Vietnamese migration background vs. autochthonous) were grouped using name analysis. Datasets of 3002 women giving birth, including 999 women with a Vietnamese migration background, were included. The associations between primary or secondary cesarean delivery and different child outcomes depending on the migration background (exposure) were studied using logistical regression analysis. Results Women with a Vietnamese migration background have a lower c-section rate of 8.0% for primary and 12.6% for secondary c-section than women without a migration background (11.1% primary and 16.4% secondary c-section respectively). Regression analysis shows that the odds that women with a Vietnamese migration background will have a primary (OR 0.75; p = 0.0884) or secondary c-section (OR 0.82; p = 0.1137) are not significantly lower. A Vietnamese migration background was associated with higher odds for an episiotomy but not for a grade 3 – 4 perineal tear. A Vietnamese migration background does not have a significant influence on poor 5-min Apgar scores ≤ 7 and low umbilical cord arterial pH values ≤ 7.10. Newborns of mothers with a Vietnamese migration background have higher odds of a relatively higher birth weight (> 3110 g). Summary There was no evidence that women with a Vietnamese migration background are delivered more often by caesarean section. There were also no differences as regards important child outcome data from women in the comparator group. Overall, the results do not provide any evidence for poorer quality of care of women with a Vietnamese migration background in Berlin despite the cultural and communication barriers in the reality of care provision.

Introduction The mammography screening programme has been the subject of criticism for some time. Invitation to take part is currently based only on the risk factors of age and female sex, whereby women with an above-average risk are screened too seldom and women with a low risk are possibly screened too often. In future, an individualised risk assessment could make a risk-adapted procedure possible in breast cancer screening. In the RISIKOLOTSE.DE project, schemes are devised to calculate the individual breast cancer risk and evaluate the results. The aim is to assist doctors and screening participants in participatory decision-making. To gauge the baseline situation in the target groups, qualitative and quantitative surveys were conducted. Method At the start of the project, a guideline-based focus group discussion was held with 15 doctors and representatives of the public health service. The transcript of this discussion was evaluated by means of a qualitative content analysis. Results The participants assessed the concept of risk-adapted screening positively overall. At the same time, the majority of them were of the opinion that the results of individualised risk calculation can be understood and evaluated adequately only by doctors. The great communication requirement and lack of remuneration were given as practical obstacles to implementation. Discussion The suggestions and new ideas from the focus group ranged from administrative and regulatory changes to new forms of counselling and adaptable practice aids. An important indicator for the RISIKOLOTSE.DE conception and for planning future surveys was that risk calculation for mammography screening 2.0 was regarded as a purely medical function and that the concept of participatory decision-making played hardly any part in the discussion.

Objectives Recent breastfeeding studies from immigration countries have found that acculturation factors influence breastfeeding behaviour in women with a migration background. To date, there has been no systematic investigation for Germany. Therefore, we study whether and how the degree of acculturation within a population of migrant women influences the start, time and duration of breastfeeding. Patient Population and Methodology Pregnant women who were admitted to one of the three participating maternity clinics in Berlin for the birth of their child in the one-year study period were surveyed (including sociodemographic details, data on migration/acculturation). These women were interviewed again two or three days post partum (including start of breastfeeding, planned breastfeeding duration, reasons for not breastfeeding). In a subgroup, a telephone interview took place 6 months post partum about the actual breastfeeding duration, contraceptive behaviour post partum and availing of midwife services following delivery. Breastfeeding behaviour was analysed using multivariate regression models, among other things. Results The prepartum survey included 7100 women, 6884 women were contacted in the postnatal wards, and the subgroup six months after delivery comprised 605 women. No acculturation-related differences were found in the start of breastfeeding. In the adjusted model, a medium and higher degree of acculturation diminished the chance of planning a long breastfeeding period. More acculturated women show a greater risk of weaning within the first six months than less acculturated women. Conclusion The degree of acculturation has relevant significance for some aspects of breastfeeding behaviour in women with a migration background. This should be considered both in breastfeeding promotion programmes and in further national breastfeeding studies.

Laparoscopic pancreatoduodenectomy is a highly challenging procedure. The aim of this study was to analyse post-operative morbidity and mortality as well as long term overall survival in patients undergoing hybrid LPD, as compared to open pancreaticoduodenecomy (OPD) in a single surgeon series.Patients undergoing pancreatoduodenectomy (PD) in the period from 2000 to 2015 were identified from a prospectively maintained database. All LPD procedures were performed by one specialised pancreatic surgeon (TK). Patients were matched 1 : 1 for age, sex, BMI, ASA, histological diagnosis, pancreatic texture and portal venous resection (PVR). All LPD procedures were performed as hybrid LPD - combining laparoscopic resection and open reconstruction via mini laparotomy.A total of 549 patients were identified, including 489 patients in the OPD group and 60 patients in the LPD group. 60 patients were identified who underwent LPD between 2010 and 2015 versus 60 OPD patients operated in the same period. Median overall operation time was shorter in the LPD group than with OPD patients (LPD 352 vs. OPD 397 min; p = 0.002). Overall transfusion units were lower in the LPD group (LPD range 0 - 4 vs. OPD range 0 - 11; p = 0.032). Intensive care unit stay (LPD 1 vs. OPD 6 d; p = 0.008) and overall hospital stay (OHS: LPD 14 vs. OPD 18 d; p = 0.012) were shorter in the LPD groups than in the OPD group. As regards postoperative complications, LPD was associated with reduced rates of clinically relevant grade B/C postoperative pancreatic fistula (LPD 15 vs. OPD 36%; p = 0.036) and grade B/C delayed gastric emptying (LPD 8 vs. OPD 20%; p = 0.049). A total of 56 patients were diagnosed with malignant disease. The number of harvested lymph nodes and R0-resection rates were equal for LPD and OPD patients. LPD patients showed a trend to improved median overall survival (LPD mean 56 months vs. OPD mean 48 months; p = 0.056).Hybrid LPD is a safe procedure associated with a reduction in clinically relevant postoperative complications and allows faster recovery. Long term oncological outcome of hybrid LPD for malignant disease is equal to that with the standard open approach.Ziel dieser Studie war es, die postoperative Morbidität und Mortalität sowie Langzeit-Gesamtüberlebensraten bei Patienten nach laparoskopischer Pankreatoduodenektomie (LPD) in Hybridtechnik im Vergleich zur offenen Pankreatoduodenektomie (OPD) anhand der Serie eines LPD-spezialisierten Pankreaschirurgen zu analysieren.Daten von Patienten, die im Zeitraum 2000 – 2015 eine Pankreatoduodenektomie (PD) erhalten haben, wurden einer prospektiv geführten Datenbank entnommen. Alle LPD-Resektionen wurden von einem Chirurgen (TK) durchgeführt. Es erfolgte ein 1 : 1 Matching der Patienten anhand der Parameter Alter, Geschlecht, BMI, ASA, Histologie, Textur des Pankreasparenchyms und Durchführung einer Pfortaderresektion. Alle LPD-Resektionen wurden in Hybridtechnik mit laparoskopischer Resektion und anschließender Rekonstruktion mittels Minilaparotomie durchgeführt.Insgesamt konnten 549 Patienten anhand der Datenbank identifiziert werden, 489 Patienten in der OPD-Gruppe und 60 Patienten in der LPD-Gruppe. 60 LPD-Patienten aus dem Zeitraum 2010 – 2015 und 60 OPD-Patienten aus dem Zeitraum 2000 – 2015 wurden in die Studie eingeschlossen. Die mediane Operationszeit in der LPD-Gruppe war verkürzt im Vergleich zur OPD-Gruppe (LPD 352 vs. OPD 397 min; p = 0,002). Die Anzahl perioperativ benötigter Erythrozytenkonzentrate war geringer in der LPD-Gruppe (LPD 0 – 4 vs. OPD 0 – 11; p = 0,032). Die mediane Dauer der intensivmedizinischen Therapie (LPD 1 vs. OPD 6 d; p = 0,008) und die mediane Gesamtdauer des Krankenhausaufenthalts (LPD 14 vs. OPD 18 d; p = 0,012) waren kürzer in der LPD-Gruppe im Vergleich zur offenen Resektion. Die LPD war mit einer geringeren Rate klinisch relevanter Grad-B/C-Pankreasfisteln (LPD 15 vs. OPD 36%; p = 0,036) und verzögerter Magenentleerung Grad B/C assoziiert (LPD 8 vs. OPD 20%; p = 0,049). 56 der eingeschlossenen Patienten wiesen eine maligne Raumforderung auf. Die Anzahl resezierter Lymphknoten und die Rate an R0-Resektionen waren vergleichbar in der LPD- und der OPD-Gruppe. Bei LPD-Patienten zeigte sich der Trend einer verbesserten medianen Gesamtüberlebensrate (LPD 56 vs. OPD 48 Monate; p = 0,056).Die LPD in Hybridtechnik ist eine sichere Technik, die mit der Reduktion klinisch relevanter postoperativer Komplikationen assoziiert ist und eine schnelle postoperative Erholung erlaubt. Die onkologischen Langzeitergebnisse nach LPD in Hybridtechnik bei malignen Befunden sind gleichwertig zur offenen Technik.

Objective The aim of this study was to assess the influence of premature rupture of membranes (PROM) on the induction of labor. Material and Method This historical cohort study analyzed 1861 inductions of labor at term using misoprostol which occurred between 2010 and 2015. Exclusion criteria included intrauterine fetal death, previous cesarean section, and fetal structural or chromosomal anomalies. Induction of labor for PROM (PROM group) was compared to induction for other indications (no-PROM group); the primary outcome measure was the cesarean section rate. Results The cesarean section rate for the PROM group was significantly lower (21.9% vs. 26.3%, p = 0.029). The induction-to-delivery interval was shorter (mean: 972 [854 – 6734] min vs. 1741 [97 – 10 834] min, p Conclusion Premature rupture of membranes significantly affects various outcome measures when delivery is induced, particularly the induction-to-delivery interval.

Introduction Worldwide the prevalence of neuropsychiatric illness among women of reproductive age is higher than ever before. This study investigates the influences of maternal substance abuse/dependence and neuropsychiatric illness on pregnancy and neonatal outcomes. Patients and Methods Using a retrospective study design 185 pregnancies in women with neuropsychiatric illnesses or substance abuse were identified at a single centre over a period of 3.25 years and compared to 4907 pregnancies in healthy women without mental illness. Differences in pre-, peri- and postnatal pregnancy parameters were studied. Results Numbers of previous abortions on obstetric history were significantly higher in cases compared to controls, women with depression being especially affected. The number of antenatal visits was also higher among cases, especially in women with depression. The caesarean section rate was significantly higher in cases compared to controls. Children of women with neuropsychiatric illness were born at lower gestational ages than those of healthy control mothers, however there were no significant differences between case and control groups for birth weight, head circumference or Apgar scores. Some isolated differences were found for disease-specific case subgroups compared to controls. Conclusion The study shows a relationship between maternal neuropsychiatric illness and pregnancy outcomes independent of medication use. Rates of spontaneous abortion were higher. Children were born earlier, yet the neonatal outcomes birth weight, head circumference and Apgar score were not worse than children of mentally healthy women.

Introduction Patients who suffer from pelvic organ prolapse can experience severe limitations in their quality of life. To improve the quality of life of women affected and achieve a stable reconstruction, surgical therapy is often indispensable. In conventional prolapse surgery, the rate of recurrence is high. For this reason, alloplastic mesh has been implanted increasingly in recent years to reconstruct the anatomy of the pelvic floor organs. Even if the anatomical result can be significantly improved as a result, the mesh-induced complications have been the subject of controversial discussion. In this national, multicentre study, the quality of life, anatomical result as well as the rate of complications following the implantation of an alloplastic mesh for the correction of a cystocele were investigated. Method Fifty-four patients with symptomatic ≥ grade II were included in this prospective, national, multicentre study. The study participants were implanted with a titanised polypropylene mesh (TiLOOP® PRO A, pfm medical ag). The follow-up observation period was 12 months. Primary as well as repeat procedures were taken into account. The anatomic result of the pelvic floor reconstruction was quantified using the POP-Q system. Data on quality of life and sexuality were collected using validated questionnaires. All complications which occurred were documented and evaluated by an independent committee. Results On average, the patients were in line with the census. An improvement in quality of life was able to be determined during the study in all domains investigated (p Conclusion In the reconstruction of the anatomical position of the pelvic floor organs given the presence of a symptomatic cystocele, the implantation of a third-generation alloplastic mesh achieves very good results. Affected patients benefit from the anatomical stability as well as a significant improvement in quality of life, whereby the risks are justifiable.

Background Breast cancer is the most common cancer affecting women in Germany. Despite breast-conserving therapy (BCT) being carried out in almost 70% of cases, a high number of women still require complete mastectomy. Prophylactic mastectomy is also indicated for women with a BRCA 1/2 gene mutation. In addition to implant-based heterologous breast reconstruction, autologous breast reconstruction using a DIEP flap has been found to be beneficial, particularly for patients who had prior radiotherapy. This study aims to show that DIEP flap reconstruction surgery is the method of choice for autologous breast reconstruction with a low rate of complications. Patients and Methods Autologous breast reconstruction using a DIEP flap was performed in 1124 patients between July 2004 and December 2014. Retrospective study criteria included potential risk factors such as age, BMI, smoking, chemotherapy and/or radiotherapy, and comorbidities as well as outcome parameters such as postoperative complications. Outcomes were evaluated with a mean follow-up of 24 months. Results A total of 1124 patients underwent 1274 free DIEP flap breast reconstructions, of which 150 were bilateral reconstructions. The primary indication was previous mastectomy in 785 cases, followed by prior implant-based reconstruction in 265 cases. The total flap loss rate was 0.6%. Postoperative surgical revision for abdominal wall hernia was required in 0.2% of cases. The group with a higher BMI and the group of smokers had significantly higher complication rates. Elderly patients (> 65 years), patients who had undergone chemo-/radiotherapy and patients with diabetes did not have higher complication rates. Conclusion DIEP flap surgery is an excellent option for autologous breast reconstruction, with a low rate of donor site morbidity and low complication rates. DIEP flap surgery carried out in a specialised interdisciplinary breast centre in a standardised clinical setting after prior careful patient selection to take account of risk factors such as high BMI and smoking is a reliable method with a low complication rate and satisfactory long-term reconstruction results.

Introduction Hypothermia is defined as a decrease in body core temperature to below 36 °C. If intraoperative heat-preserving measures are omitted, a patientʼs temperature will fall by 1 – 2 °C. Even mild forms of intraoperative hypothermia can lead to a marked increase in morbidity and mortality. The temperature of the insufflation gas is usually disregarded in the treatment and prevention of hypothermia. This study was conducted to investigate the effect of body-temperature and humidified CO 2 on the intraoperative temperature profile and avoidance of hypothermia in laparoscopic surgery. Material and Methods In this retrospective, non-randomised case control study, 110 patients whose planned operation lasted at least 60 minutes were identified from 376 patients by means of an algorithm. Dry (20% humidity) CO 2 at room temperature was insufflated in 51 patients (control group). 59 patients were insufflated with humidified (98% humidity) CO 2 at body temperature (37 °C) (study group). These conditions were achieved with the HumiGard MR860 Surgical Humidification System (Fisher & Paykel Healthcare Limited, Auckland, New Zealand). The intraoperative temperature profile was evaluated by measurements every 10 minutes. Statistical analysis was performed with IBM ® SPSS ® Statistics 23.0.0. Results The intraoperative temperature in the control group fell steadily, while a continuous rise in temperature was observed in the study group. Warming was demonstrated in the study group with a start-end temperature difference of 0.09 °C, which differed significantly from the control group, in which it was − 0.09 °C (p = 0.011). The middle-end difference of 0.11 °C showed even higher significance in favour of the warmed gas (p = 0.003). The rate of hypothermia at the start of the operation fell from 50 to 36% in the study group and increased from 36 to 42% in the control group. Conclusion These results show that the use of body-temperature and humidified insufflation gas for laparoscopy can help to prevent intraoperative hypothermia.

Background During cancer therapy, many patients suffer from malnutrition or vitamin deficiency. Treatment for nutrition-related deficiencies should therefore include nutritional therapy and possibly oral or intravenous substitution of micronutrients. Little information exists on multinutrient infusion therapies. The aim of this study was to develop standardized infusion protocols for integrative medicine infusions with micronutrients (IMed infusions) and to report on side effects of the treatment and patientsʼ satisfaction with it. Methods For the IMed consultancy service, four special formulas for intravenous use were developed in cooperation with the pharmacy at Erlangen University Hospital. A retrospective cross-sectional study was conducted between October 2015 and January 2018 in which 45 patients with gynecological or breast cancer (BC) and IMed infusion therapy were included. Follow-up data were obtained from 20 patients using a standardized questionnaire on IMed infusions. Results A total of 280 IMed infusions were administered in the study period. The majority of the patients received an IMed regeneration infusion (78%). The majority of the patients had BC and were receiving chemotherapy. Most patients reported a high or very high level of satisfaction with the organization (60%), general treatment (65%) and counseling (85%). Subjective improvement in their disease-related and therapy-induced symptoms, such as fatigue, polyneuropathy and physical efficiency, was reported by 70% of the patients, while 75% reported a subjective increase in quality of life. Side effects were rare and minor. Conclusions Therapy with IMed infusions in women with BC or gynecological cancer requires the same standards set for drug therapy. Although vitamins represent dietary supplements, appropriate assessment of the patientʼs medical history is needed and patients must receive appropriate information. For this purpose, standardized processes, as in the context of an IMed consultancy service, are helpful.

Induction of labour for small-for-gestational-age (SGA) foetus or intrauterine growth restriction (IUGR) is common, but data are limited. The aim of this trial was therefore to compare labour induction for SGA/IUGR with cases with normal fetal growth beyond the 10This historical multicentre cohort study included singleton pregnancies at term. Labour induction for SGA/IUGR (IUGR group) was compared with cases of fetal growth beyond the 10The caesarean section rate was not different between the 2 groups (27.0 vs. 26.2%, p=0.9154). In the IUGR group, abnormal CTG was more common (30.8 vs. 21.9%, p=0.0214), and fetal blood analyses were conducted more often (2.5 vs. 0.5%, p=0.0261). There were more postpartum transfers to the NICU in the IUGR group (40.0 vs. 12.8%, p0.0001), too.Induction of labour for fetal growth restriction was not associated with an increased rate of caesarean section.ZIEL: Die Datenlage zu Geburtseinleitungen bei einem small-for-gestational-age Fetus (SGA-Fetus) oder einer intrauterinen Wachstumsrestriktion (IUGR) ist limitiert, sodass das Ziel dieser Untersuchung war, Geburtseinleitungen bei SGA-/IUGR-Feten mit Geburtseinleitungen bei Schwangerschaften mit einem fetalen Schätzgewicht oberhalb der 10. Perzentile zu vergleichen.In diese multizentrische Kohortenstudie wurden Einlingsschwangerschaften am Termin eingeschlossen. Geburtseinleitungen bei SGA-/IUGR-Feten (IUGR-Gruppe) wurden mit Geburtseinleitungen bei Feten mit einem fetalen Schätzgewicht oberhalb der 10. Perzentile (Kontrollgruppe) verglichen. Der primäre Zielparameter war die Kaiserschnitt-Rate.Es gab keinen Unterschied bezüglich der Kaiserschnitt-Rate zwischen den beiden Gruppen (27,0 vs. 26,2%, p=0,9154). In der IUGR-Gruppe lag jedoch häufiger ein pathologisches CTG (30,8 vs. 21,9%, p=0,0214) vor, und es wurden mehr Fetalblutanalysen (2,5 vs. 0,5%, p=0,0261) durchgeführt. Die Rate an kindlichen Verlegungen in die Kinderklinik war ebenfalls in der IUGR-Gruppe höher (40,0 vs. 12,8%, p0,0001).Geburtseinleitungen bei wachstumsrestringierten Feten sind nicht mit einer höheren Rate an Kaiserschnitten assoziiert.

Introduction The studyʼs objectives were to determine the success rate following radiofrequency endometrial ablation to treat abnormal menstrual bleeding and to assess risk factors for failure of the method. Materials and Methods 195 women who were treated with bipolar radiofrequency endometrial ablation between 01/2009 and 06/2016 were included in this prospective cohort study. Postoperative data from 187 women were collected at a median of 17.5 months (IQR 4.5–34.9; 1–82). Multivariate analyses of risk factors were performed. Success was defined as amenorrhoea or spotting. Results Patient characteristics were as follows: mean age 44 years (SD ± 5), median parity 2 (IQR 2–3), median hysterometer 8.7 cm (SD ± 1.1), and median BMI 23.5 kg/m2 (IQR 21–27). 30 patients (19.5%) had intramural masses that could be measured with ultrasound. Postoperative success rate was 86.1%. 10 patients (5%) had a hysterectomy postoperatively – 6 for heavy bleeding, 3 due to prolapse, and 1 due to dysmenorrhoea. Multivariate analyses showed the presence of intramural masses in women Conclusion Bipolar radio frequency endometrial ablation was highly successful in the absence of an intramural mass (88%). Even smaller intramural fibroids (DD: adenomyomas of a median of 15 mm) reduce the success rate (76%), which is why preoperative ultrasound is recommended. In the presence of intramural masses, the risk of a hysterectomy for women

Background Various methods of intrapartum analgesia are available these days. Pethidine, meptazinol and epidural analgesia are among the most commonly used techniques. A relatively new one is patient-controlled intravenous analgesia with remifentanil, although the experiences published so far in Germany are limited. Our goal was to study the influence of these analgesic techniques (opioids vs. patient-controlled intravenous analgesia with remifentanil vs. epidural analgesia) on the second stage of labour and on perinatal outcome. Material and Methods We conducted a retrospective study with 254 parturients. The women were divided into 4 groups based on the analgesic technique and matched for parity, maternal age and gestational age (opioids n = 64, patient-controlled intravenous analgesia with remifentanil n = 60, epidural analgesia n = 64, controls without the medicinal products mentioned n = 66). Maternal, fetal and neonatal data were analysed. Results The expulsive stage was prolonged among both primiparas and multiparas with patient-controlled intravenous analgesia with remifentanil (79 [74] vs. 44 [55] min, p = 0.016, and 28 [68] vs. 10 [11] min, p Conclusion Parturients with patient-controlled intravenous analgesia with remifentanil and epidural analgesia showed a prolonged expulsive stage compared with the opioid group and controls. The short-term neonatal outcome was not influenced by the three methods examined.

Introduction For decades, conventional galactography was the only imaging technique capable of showing the mammary ducts. Today, diagnosis is based on a multimodal concept which combines high-resolution ultrasound with magnetic resonance (MR) mammography and ductoscopy/galactoscopy and has a sensitivity and specificity of up to 95%. This study used tomosynthesis in galactography for the first time and compared the synthetic digital 2D full-field mammograms generated with this technique with the images created using the established method of ductal sonography. Both methods should be able to detect invasive breast cancers and their precursors such as ductal carcinoma in situ (DCIS) as well as being able to identify benign findings. Material and Methods Five patients with pathological nipple discharge were examined using ductal sonography, contrast-enhanced 3D galactography with tomosynthesis and the synthetic digital 2D full-field mammograms generated with the latter method. Evaluation of the images created with the different imaging modalities was done by three investigators with varying levels of experience with complementary breast diagnostics (1, 5 and 15 years), and their evaluations were compared with the histological findings. Results All 3 investigators independently evaluated the images created with ductal sonography, contrast-enhanced 3D galactography with tomosynthesis, and generated synthetic digital 2D full-field mammograms. Their evaluations were compared with the histopathological assessment of the surgical specimens resected from the 5 patients. There was 1 case of invasive breast cancer, 2 cases with ductal carcinoma in situ and 2 cases with benign findings. All 3 investigators made more mistakes when they used the standard imaging technique of ductal sonography to diagnose suspicious lesions than when they used contrast-enhanced galactography with tomosynthesis and the generated synthetic digital 2D full-field mammograms. Conclusion This is the first time breast tomosynthesis was used in galactography (galactomosynthesis) to create digital 3-dimensional images of suspicious findings. When used together with the generated synthetic digital 2D full-field mammograms, it could be a useful complementary procedure for the diagnosis of breast anomalies and could herald a renaissance of this method. Compared with high-resolution ductal ultrasound, the investigators achieved better results with contrast-enhanced galactography using tomosynthesis and the generated synthetic digital 2D full-field mammograms, as confirmed by histopathological findings.

Introduction Tubal pregnancy is the most clinically relevant form of ectopic pregnancy. Surgery consisting of laparoscopic salpingotomy is the therapeutic gold standard. This study looked at risk factors for non-tube-preserving surgery. The aim was to determine a cut-off value for beta-hCG levels, which could be used to predict the extent of tubal surgery. Materials and Method 97 patients with tubal pregnancy who underwent primary salpingotomy in the Department of Gynecology and Obstetrics of Jena University Hospital between 2010 and 2016 were retrospectively analyzed. A prior medical history of risk factors such as adnexitis, ectopic pregnancy, tubal surgery, treatment for infertility and intrauterine pessary was included in the analysis. The study population was divided into two subgroups: (1) a group which underwent laparoscopic linear salpingotomy, and (2) a group which had laparoscopic partial tubal resection or salpingectomy. Risk factors for salpingectomy were determined using binary logistic regression analysis. Statistical analysis was done using SPSS, version 24.0, to identify risk factors for non-tube-preserving surgery. Results 68 patients (70.1%) underwent laparoscopic salpingotomy and 29 patients (29.9%) had laparoscopic salpingectomy. The two groups differed with regard to age (p = 0.01) but not with regard to the parameters ‘gestational age’, ‘viability and rupture status of the ectopic pregnancy’ or ‘symptoms at presentation’. Patients who were known to have endometriosis prior to surgery or who were diagnosed with endometriosis intraoperatively were more likely to undergo salpingectomy (OR: 3.28; 95% CI: 0.9 – 10.8; p = 0.05). Calculated mean beta-hCG levels were higher in the salpingectomy group compared to the group who had tube-preserving salpingotomy (3277.8 IU/l vs. 9338.3 IU/l, p = 0.01). A cut-off beta-hCG value of 775 IU/l prior to surgery was predictive for salpingectomy with a true positive rate of 86.2% and increased the probability that salpingectomy would be necessary (OR: 5.23; 95% CI: 0.229 – 0.471; p = 0.005). Conclusion Endometriosis and a beta-hCG value of more than 775 IU/l significantly increased the risk for non-tube-preserving surgery in women with tubal pregnancy.

Introduction Fasting during Ramadan while pregnant has been shown to have long-term negative effects on the offspringʼs physical and cognitive health. Even though most Muslims do not believe pregnant women are obligated to fast during Ramadan, fasting rates of up to 87% have been reported for pregnant women. No data exists to date about Ramadan adherence and behavior in Germany. Methods The Mainz Study of Ramadan and Pregnancy surveyed pregnant Muslims and new Muslim mothers in Mainz between October 2016 and January 2017 and collected information on Ramadan adherence and behavior. We also collected data on personal characteristics and opinions, to identify determinants of fasting using statistical analysis. Results We found that 43% of pregnant Muslim women fasted at least one day during Ramadan 2016. Women who fasted were significantly younger and less educated. There was no significant difference in terms of country of origin between those women who fasted and those who did not. Only 49% of women who fasted and 38% of women who did not fast discussed their Ramadan behavior with their doctor. Less than 2% of women reported being proactively approached by their doctor. Conclusion To ensure that pregnant Muslim women living in Germany can make their fasting decision based on objective information, it is necessary to raise awareness about Ramadan fasting during pregnancy among medical professionals in Germany.