Abstract Women’s health care is committed to providing high-quality, patient-centred care within a multiprofessional team. While guideline-based psycho-oncological structures are well established and existent in oncology, comparable standardised psychosocial support services have so far been lacking in obstetrics and non-oncological gynaecology, even though complex situations involving distress and crisis regularly arise in these fields. Against this background, we investigated how a structured, psychosocial care service could be designed for these areas and integrated into routine care. In a retrospective data analysis, key process steps in the implementation of psychosocial support by the Psychosocial Service of the Department of Obstetrics and Gynaecology at University Hospital Erlangen were evaluated. The analysis was based on routine patient data and staffing data from the period 2008–2019. Based on relevant S2k guidelines, normative quality-assurance requirements and current specialist literature, the indications, range of services, and psychosocial care processes were systematically consolidated. Through an interprofessional coordination process, these elements were developed into a Standard Operating Procedure (SOP) for a university perinatal centre. The Psychosocial Service is structurally embedded in routine clinical practice. The care service provided under the Erlangen Model is based on a biopsychosocial, theoretically grounded, and quality-assured concept with defined staffing resources. The SOP specifies responsibilities, screening and determination of indications as well as a tiered range of services extending from initial contact and crisis intervention to ongoing support. The continuous increase in utilisation during the study period highlights the relevance and successful establishment of the model. A standardised psychosocial care service based on medical indication and delivered primarily by specially qualified midwives and nursing professionals, improves the quality of psychosocial care for patients in obstetrics and non-oncological gynaecology, thereby reducing the burden on the multiprofessional team. Implementing an SOP for the Psychosocial Service promotes the early identification of psychosocial distress, facilitates access to specialised support, and strengthens high-quality patient- and family-centred care.
Abstract To evaluate the association between tokophobia and labor course, mode of delivery, and obstetric outcomes among term pregnant women admitted for delivery. This cross-sectional study included 361 term pregnant women admitted to a tertiary referral center between January 2024 and January 2025. Fear of childbirth was assessed before active labor using the Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A). Clinical and obstetric data assessed using the Visual Analog Scale (VAS), were prospectively collected. Participants were categorized into low–moderate and severe–clinical tokophobia groups. Two multivariable logistic regression models were constructed: one to identify antecedent factors associated with severe–clinical tokophobia and another to evaluate whether severe–clinical tokophobia was independently associated with cesarean delivery after adjustment for potential confounders. Clinical tokophobia (W-DEQ-A ≥ 85) was identified in 35.7% of participants, whereas 61.8% were classified as having severe–clinical tokophobia. Women with severe–clinical tokophobia experienced a significantly longer second stage of labor and higher pain scores than those with low–moderate fear (both p < 0.001). After adjustment for maternal age, body mass index, parity, and regular antenatal follow-up, severe–clinical tokophobia remained independently associated with cesarean delivery (adjusted OR 4.92, 95% CI 2.77–8.73, p < 0.001). In addition, higher rates of fetal distress, obstetric complications, delayed breastfeeding initiation, and early mother–infant separation were observed in women with severe–clinical tokophobia (all p < 0.001). Tokophobia is common among women presenting for term delivery and is significantly associated with prolonged labor, increased cesarean delivery, adverse obstetric outcomes, delayed breastfeeding initiation, and early mother–infant separation. These findings support routine antenatal screening for fear of childbirth and suggest that timely psychosocial assessment and supportive interventions may improve both obstetric and early postpartum outcomes.
Objective The aim of the German-language S3 guideline on lichen sclerosus (LS) is to provide an evidence- and consensus-based foundation for the diagnosis and management of this disease. The present publication offers a concise summary of the relevant content, focusing on genital LS in girls and women. This first part addresses, among other aspects, the definition, symptomatology, and diagnosis of LS, as well as its management during pregnancy. The separately published second part focuses on the treatment of LS. Methods The German-language, evidence- and consensus-based S3 guideline on LS was developed under the leadership of the German Society of Gynecology and Obstetrics (DGGG) and the German Dermatological Society (DDG), based on the European "EuroGuiDerm Guideline on Lichen Sclerosus." The interdisciplinary guideline panel included 24 experts from 16 professional societies and actively involved patient representatives in the development process. Recommendations LS is a chronic inflammatory skin disease with predominant manifestation in the anogenital region. It may be associated with pruritus, pain, sexual dysfunction, urinary symptoms, and constipation, although it can occasionally remain asymptomatic. Awareness of the broad spectrum of symptoms, as well as reversible and irreversible clinical signs, is essential to enable early diagnosis and appropriate treatment. Early and adequate therapy can not only alleviate symptoms but also reduce the risk of permanent damage and the development of associated carcinomas. During pregnancy, treatment with topical glucocorticoids should be continued as needed to control disease activity and prevent complications.
Purpose:The introduction of an organized cervical cancer screening program in Germany in 2020 changed screening algorithms and referral patterns, increasing the number of patients referred to specialized centers. This study examines the concordance between ex-house Pap smear findings and in-house colposcopy-guided cytology and relates both to colposcopy-guided biopsy and histopathological outcomes within the new screening program. Methods:In this retrospective study, data from 3161 patients referred for colposcopy to a certified university dysplasia unit between January 2020 and May 2024 were analyzed. All patients underwent standardized assessment including Pap smear, HPV testing, colposcopy, and colposcopy-guided biopsy, with surgical treatment when indicated. Results:Concordance between ex-house and in-house cytology was moderate (Spearman's ρ = 0.453, p < 0.001; weighted Cohen's κ = 0.581). Compared with histology, ex-house cytology showed overdiagnosis in 252 cases (14.29%), underdiagnosis in 631 cases (35.79%), and concordant findings in 880 cases (49.91%). In contrast, in-house cytology demonstrated lower rates of overdiagnosis (183 cases, 9.48%) and underdiagnosis (495 cases, 25.65%), with agreement in 1252 cases (64.87%). HPV positivity increased with cytological severity, with HPV16 being the most prevalent genotype in high-grade lesions. Among low-grade cytological findings, CIN3+ yield differed markedly according to HPV status. Conclusion:In the setting of the cervical cancer screening program, in-house cytology performed in a specialized dysplasia unit demonstrated closer agreement with histology than ex-house cytology. HPV status emerged as a key modifier of risk within low-grade cytological categories, highlighting the importance of risk-adapted triage and reassessment colposcopy in contemporary screening practice.
Objective:To compare recurrence, survival, morbidity, and quality of life in early-stage vulvar cancer patients with tumour-free lymph nodes undergoing sentinel lymph node biopsy (SNB) versus inguinofemoral lymphadenectomy (IFL). Study Design:A total of 74 vulvar cancer patients (SNB: n = 58; IFL: n = 16) with a tumour size of < 4 cm and tumour-free lymph nodes were included. Endpoints were overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). DFS was further divided into local, inguinal, or distant recurrence. Additionally, morbidity and quality of life were analysed. Results:No significant differences in survival outcomes were observed after a median follow-up of 58.0 months for OS, 59.1 months for DSS, and 40.0 months for DFS. Inguinal recurrences occurred in two patients in the SNB group (3.77%) and in none of the patients in the IFL group (0%). However, DFS related to isolated inguinal recurrence did not differ significantly between the groups (96.2% vs. 100%, p = 0.374). Complications were less frequent following SNB, with a significant difference observed only for lymphocele formation (13.8% vs. 50%; p = 0.02). Quality of life scores did not differ significantly between the groups. Conclusion:This study confirms SNB as an oncologically safe procedure. Although inguinal recurrences were slightly more frequent after SNB, there was no significant difference in DSS, DFS, or OS. Lymphocele was significantly more common after IFL, without impacting self-reported quality of life.
Overuse in medicine refers to the provision of medical services that exceed what is necessary to meet patient needs and therefore result in more harm than benefit. Up to 30% of provided services can be classified as overuse. In several countries worldwide, including Canada, "Choosing Wisely" committees exist that issue recommendations to reduce overuse. In Germany, there are currently no recommendations for avoiding overuse in gynecology and obstetrics, which is why we adapted the recommendations of the Canadian "Choosing Wisely" initiative and discussed them in the context of the guidelines and directives applicable in Germany. Our article provides 13 concrete recommendations as well as practice-oriented suggestions for reducing overdiagnosis and overtreatment in gynaecology and obstetrics, thereby supporting the continuous and sustainable optimisation of patient care. Furthermore, reducing overuse in our field can help improve working conditions in healthcare professions and lower the ecological and economic costs of our healthcare system.
Introduction In Germany, a stillbirth is defined as a birth without signs of life from the 24th week of pregnancy onwards or with a birth weight of >= 500 g. Stillbirths must be recorded at the registry office by means of a death certificate. It is often difficult to classify the specific cause in such cases. Methods In this retrospective, register-based observational study, the new online database GeMoRe is compared with all stillbirths reported to the Central Archive for Post-mortem Certificates in Berlin in 2024. The cases were then classified using the WHO-ICD-PM system to assess the accuracy (quality) and completeness (quantity) of the cases. Results GeMoRe recorded 128 stillbirths and the Central Archive for Death Certificates recorded 123 stillbirths; however, only 47 cases were found in both datasets. 18.8% of stillbirths recorded in the GeMoRe online register were attributed to a non-specific cause according to ICD-PM, compared with 70.7% of cases recorded via death certificates. Discussion The current method of recording death certificates often provides too few details for an ICD-PM classification in accordance with WHO recommendations. Furthermore, the number of stillbirths recorded in death certificates in Berlin may be underreported. A digital, Germany-wide register is required to enable high-quality data collection and to strengthen preventive measures.
