Elective (pre-labour) cesarean sections are, by design, concentrated during staffed hours, limiting the interpretability of overall temporal patterns. We examined whether the proportion of documented discretion-susceptible indications for non-elective (intrapartum) cesarean sections shifts with time of day and weekday, using the Robson classification for stratification. We retrospectively analysed 5,850 cesarean sections at University Hospital Giessen and Marburg, 2015–2021, classified as elective (n=2,851) or non-elective (n=2,998) by documented decision timepoint. Among non-elective cases, we assessed threshold-susceptible ("soft") indications (protracted labour/arrest, non-reassuring fetal heart rate) by shift and weekend, adjusted for Robson group and gestational age. Guideline-defined absolute ("hard") indications served as a supportive comparison, with Holm correction for exploratory comparisons. Among non-elective cesarean sections, the proportion with documented discretion-susceptible indications was significantly higher during evening/night shifts (OR 2.63, 95
The assessment of fetal well-being remains challenging. Despite the development of several surveillance methods, preventing metabolic acidosis and adverse neonatal outcomes without increasing unnecessary obstetric intervention remains difficult. Lactate levels have been evaluated in maternal blood, umbilical cord blood, fetal scalp blood, and, with growing interest, amniotic fluid. Although lactate exchange between the maternal, uteroplacental, and fetal compartments is not fully understood, amniotic fluid lactate (AFL) has been investigated as a potential marker of uterine metabolic activity and labor progression. Higher AFL concentrations have been associated with labor dystocia and operative delivery in some studies. Accordingly, AFL assessment may provide complementary information on labor progression, but its potential role as an adjunct to fetal surveillance and routine clinical decision-making requires further investigation and validation. Interventions aimed at reducing elevated AFL concentrations during labor have also been proposed. However, evidence that AFL-guided treatment improves obstetric or neonatal outcomes remains limited. Further technological development and prospective clinical validation may clarify whether AFL assessment could support existing maternal and fetal surveillance strategies. This narrative review examines lactate physiology during pregnancy and labor and evaluates the potential role of lactate measurements as adjunctive biomarkers and as possible guides for future therapeutic strategies.
Since July 2022, non-invasive prenatal testing (NIPT) for trisomies 21, 18, and 13 has been available as a statutory health insurance (GKV) benefit in Germany. It is not a routine examination offered to all pregnant women; according to the Maternity Directives of the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA), it is reimbursed in justified individual situations after physician-led counselling. While uptake data have been reported from the healthcare provider perspective, patients’ knowledge, counselling experiences, motivations, and intended post-test decisions have not been systematically studied in a multicenter German cohort since NIPT became a GKV benefit. A multicenter, exploratory, anonymous questionnaire-based survey was conducted at seven prenatal diagnostic centres across Germany between June and November 2024. Pregnant women who had already undergone GKV-NIPT were invited to participate. The questionnaire addressed four domains: (1) counselling and informed consent, (2) factual knowledge about GKV-NIPT, (3) motivation for testing, and (4) reactions and intended post-test decisions. A composite knowledge score was calculated from six factual items (Q4, Q5, Q7–Q10); the intended use of confirmatory amniocentesis (Q17) was analysed exclusively as an outcome variable. Descriptive statistics and Spearman rank correlations were applied. Ethics approval was obtained from the University of Heidelberg Ethics Committee (S-259/2024). A total of 1252 questionnaires were distributed across the seven centres, of which 645 were returned (overall response rate 51.5
The clinical significance of arcuate uterine morphology, a mild fundal indentation regarded as normal in the ASRM 2021 classification, remains unclear. We examined whether arcuate uterine morphology diagnosed before conception by three-dimensional transvaginal ultrasonography (3D-TVUS) is associated with perinatal outcomes. This prospective cohort study included women who underwent infertility treatment (April 2022 to November 2025) and delivered at our hospital. Uterine morphology was classified on 3D-TVUS using an operational definition based on ASRM 2021 (indentation depth <10 mm and fundal angle ≥90° defined as arcuate uterine morphology). Perinatal outcomes were compared between groups; outcomes that differed significantly were entered together into a multivariable logistic regression model with arcuate uterine morphology as the dependent variable. Exploratory analyses by placental implantation site (fundal vs non-fundal) were performed. Of 228 women, 41 (18.0
Combined twin delivery, defined as vaginal delivery of the first twin followed by cesarean delivery of the second twin, is associated with adverse neonatal outcomes. We evaluated presentation-stratified clinical and intrapartum factors associated with combined delivery. This 13-year retrospective study included twin pregnancies with a vertex first twin in which the first twin was delivered vaginally. Pregnancies were stratified according to the presentation of the second twin before delivery of the first twin. Conventional multivariable logistic regression was used in the vertex–vertex group, whereas Firth penalized logistic regression was used in the vertex–nonvertex group because of the small number of outcome events and evidence of separation. Among 754 women, 565 had vertex–vertex and 189 had vertex–nonvertex pregnancies. Combined delivery occurred in 4.2
