OBJECTIVE:Pregnant patients with a previous spontaneous preterm birth are at high risk for recurrent (spontaneous) preterm birth. We investigated whether the number of previous spontaneous preterm births, gestational age of the previous birth and cervical length could stratify patients into different risk groups for recurrence to investigate whether there is a risk group that does not require additional interventions. DATA SOURCES:A systematic search of MEDLINE and EMBASE was conducted from 1995 until April 2025. STUDY ELIGIBILITY CRITERIA:Studies that were included were prospective studies with original individual patient data available that reported on asymptomatic pregnant individuals with ≥1 previous spontaneous preterm births at <37 weeks' gestation for whom cervical length had been measured between 18 and 24 weeks' gestation and who did not receive any preventative treatment for recurrent spontaneous preterm birth. METHODS:A pooled analysis of individual patient data was performed including assessment of the associations among cervical length, obstetrical history, and recurrent spontaneous preterm birth. RESULTS:We included data from 1316 patients (7 data sets). The preterm birth rates of the current pregnancy before 32, 34, and 37 weeks' gestation were 9.1%, 14%, and 31% respectively. Cervical length and gestational age of the earliest previous spontaneous preterm birth and gestational age of the most recent previous delivery contributed independently to the risk for recurrent preterm birth and can be used to stratify the recurrence risk. The incidence of total preterm birth among patients with a previous spontaneous preterm birth before 24 weeks' gestation and a current short cervical length of <15 mm was as high as 50% (95% confidence interval, 12-88) for delivery <32 weeks' gestation and 67% (95% confidence interval, 22-96) for delivery <37 weeks' gestational age. In the lowest risk group (earlier previous spontaneous preterm birth between 32+0 and 36+6 weeks' gestational age and cervical length of >30 mm in their current pregnancy), the rates for total preterm birth before 32, 34, and 37 weeks' gestational age were 3.9% (95% confidence interval, 1-8), 9.8% (95% confidence interval, 6-16), and 23% (95% confidence interval, 19-32), respectively. Low-risk references groups had spontaneous preterm birth rates of 1.5%, 1.3% to 2.6%, and 4.9% to 10.5% before 32, 34, and 37 weeks of gestation, respectively. CONCLUSION:Independent of cervical length or gestational age of the previous spontaneous preterm birth, all patients with a history of spontaneous preterm birth retain an increased risk for recurrence of preterm birth at any gestational age. Even patients with the lowest risk still have a higher risk than those without a previous spontaneous preterm birth. Therefore, counselling and surveillance for preventative treatments remain essential in managing these patients.

Background:Health professionals and their patients should understand the importance of evidence. In the case of gestational diabetes mellitus, which is often associated with an abnormally high body mass index, the immediate and long-term outcome of women and their offspring depends in part on advice and implementation of lifestyle changes before, during and after pregnancy.Methods:Up to September 2023, MEDLINE, CENTRAL, and WEB OF SCIENCE were used to identify systematic reviews and meta-analyses on the prevention of gestational diabetes. The ROBIS and AMSTAR criteria were analyzed for all systematic reviews.Results:A total of 36 systematic reviews were identified. Dietary interventions, physical activity or a combined approach all reduced adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and related morbidities. Within the randomized controlled trials included in the 36 systematic reviews, the type, intensity and frequency of interventions varied widely. The primary outcomes, reporting and methodological quality of the 36 systematic reviews and meta-analyses also varied.The meta-analysis with the highest ROBIS and AMSTAR-2 scores was selected to design an icon array based on a fact box simulating 100 patients.Conclusions:We propose a methodology for selecting the best evidence and transforming it into a format that illustrates the benefits and harms in a way that can be understood by lay patients, even if they cannot read. This model can be applied to counselling for expectant mothers in low and high-income countries, regardless of socioeconomic status, provided that women have access to appropriately trained healthcare providers.

The cesarean section rates for twin births vary widely across the world and across Europe. Mothers of twins, however, prefer a vaginal birth following a competent counselling in which they can have a say. The prerequisite is that multiple birth mothers are advised, monitored and delivered by experienced obstetric teams, which should be available and reachable 24 h a day. Regardless of the chorionicity, gestational age and fetal weight discrepancy, a vaginal birth is recommended if the presenting fetus is in a cephalic presentation, regardless of the position of the second twin. In the case of a high position of the nonpresenting fetus either in a cephalic, breech or transverse position, the birth management requires a special set of birth maneuvers and procedures. A timely epidural anesthesia may be helpful in performing these maneuvers. The birth of the second twin should take place quickly when possible by a well-drilled birth maneuver and in cases of a standing amniotic sac, as a short birth interval between the two fetuses (< 10 min) is associated with a better outcome. The vaginal birth in cases of triplets is also possible depending on the experience of the team but involves more logistical challenges. Through regular simulations and exercises, the awareness and acceptance of vaginal birth in multiple pregnancies can be increased within the obstetrical team.

Die Kaiserschnittraten bei Zwillingsgeburten variieren welt- und europaweit stark. Zwillingsmütter wünschen sich allerdings eine Vaginalgeburt nach kompetenter Beratung, in der sie über ihr Geburtserlebnis mitentscheiden dürfen. Voraussetzung ist, dass Mehrlingsmütter durch erfahrene geburtsmedizinische Teams beraten, überwacht und entbunden werden. Diese sollten 24 h erreichbar und abrufbar sein. Unabhängig von der Eihautkonstellation, Schwangerschaftsalter und kindlicher Gewichtsdiskrepanz wird bei einer Schädellage des führenden Kindes unabhängig von der Lage des zweiten Zwillings eine vaginale Geburt empfohlen. Bei einem hochstehenden zweiten Fetus in Schädel‑, Beckenend- oder Querlage erfordert die Geburtsleitung besondere Geburtsmanöver und -prozeduren, für dessen einfache Umsetzung eine frühzeitige Periduralanästhesie hilfreich sein kann. Die Geburt des zweiten Zwillings sollte nach Möglichkeit durch geübte Geburtsmanöver schnell und bei stehender Fruchtblase erfolgen, da ein kurzes Geburtsintervall zwischen beiden Feten (< 10 min) mit einem besseren Outcome assoziiert ist. Die vaginale Geburt bei Drillingsschwangerschaften ist ebenso bei Erfahrung des Teams möglich, birgt jedoch mehr logistische Probleme. Durch regelmäßige Simulationen und Übungen können Bewusstsein und Akzeptanz für die vaginale Geburt bei Mehrlingsschwangerschaft im geburtshilflichen Team gesteigert werden.

OBJECTIVE: Mental health affects maternal well-being and indirectly affects the development of fetal brain structures and motor and cognitive skills of the offspring up to adulthood. This study aimed to identify specific characteristics of music interventions that improve validated maternal outcomes. DATA SOURCES: Randomized controlled trials and systematic reviews investigating music interventions during pregnancy were identified from the start of data sources up to December 2023 using MEDLINE, the Cochrane Central Register of Controlled Trials, or Web of Science. STUDY ELIGIBILITY CRITERIA: Using Covidence, 2 reviewers screened for randomized controlled trials with >= 3 music interventions during pregnancy and applied either the Perceived Stress Scale score, State-Trait Anxiety Inventory score, Edinburgh Postnatal Depression Scale score, or blood pressure as outcomes. METHODS: The Cochrane risk-of-bias tool 2, the checklist to assess Trustworthiness in RAndomised Clinical Trials, and the reversed Cohen d were applied. This review was registered in the International Prospective Register of Systematic Reviews (registration number: RESULTS: From 251 detected records, 14 randomized controlled trials and 2375 pregnancies were included. Music interventions varied from 3 to 84 active or passive sessions with either patient-selected or preselected music and a duration of 10 to 60 minutes per session. Thereby, 2 of 4 studies observed a significant decrease in the Perceived Stress Scale, 8 of 9 studies observed a significant decrease in the State-Trait Anxiety Inventory, and 3 of 4 studies observed a significant decrease in the Edinburgh Postnatal Depression Scale. Blood pressure was significantly reduced in 3 of 4 randomized controlled trials. The Cochrane risk-of-bias tool 2 was "high" in 5 of 14 studies or "with concerns" in 9 of 14 studies. Stratifying the Cohen d in 14 intervention arms suggested a big effect in 234 of 469 mothers on blood pressure and in 244 of 489 mothers on maternal anxiety and a medium effect in 284 of 529 mothers on maternal anxiety. Small or very small effects on blood pressure, the Edinburgh Postnatal Depression Scale, and the Perceived Stress Scale were observed in 35 of 70, 136 of 277, and 374 of 784 mothers-to-be, respectively. CONCLUSION: Our study found a general positive effect of music interventions on maternal stress resilience. This was independent of the music but was influenced by the frequency and empathy of the performances. How far music interventions may improve postnatal development and skills of the offspring should be increasingly evaluated with follow-ups to interrupt

To date, there have only been provisional recommendations about the appropriate gestational weight gain in twin pregnancies. This study aimed to contribute evidence to this gap of knowledge. Using a cohort of 10 603 twin pregnancies delivered between 2000 and 2015 in the state of Hessen, Germany, the individual and combined impact of maternal body mass index and gestational weight gain on maternal and neonatal outcomes was analyzed using uni- and multivariable logistic regression models. The analysis used newly defined population-based quartiles of gestational weight gain in women carrying twin pregnancies (Q1: <419.4 g/week [low weight gain], Q2–Q3: 419.4–692.3 g/week [optimal weight gain], Q4: >692.3 g/week [high weight gain]) and the World Health Organization body mass index classification. Pre-pregnancy body mass index ≥25 kg/m 2 was associated with significantly increased rates of cesarean deliveries (aOR1.2, 95% CI: 1.01–1.41) and pregnancy-induced hypertensive disorders (aOR 1.53, 95% CI: 1.11–2.1) but not with any adverse neonatal outcome. Perinatal mortality (aOR 2.23, 95% CI: 1.38–3.6), preterm birth (aOR 1.88, 95% CI: 1.58–2.25), APGAR′5 < 7 (aOR 1.61, 95% CI: 1.19–2.17) and admissions to the neonatal intensive care unit (aOR 1.6, CI: 1.38–1.85) were increased among women with low gestational weight gain. Rates of cesarean deliveries were high in both women with low (aOR 1.25, 95% CI: 1.05–1.48) and high gestational weight gain (aOR 1.17, 95% CI: 1.01–1.35). A high gestational weight gain was also associated with higher rates of hypertensive disorders in pregnancy (aOR 2.32, 95% CI: 1.79–3.02) and postpartum hemorrhage (aOR 1.72, 95%CI: 1.12–2.63). The risk of preterm birth, low Apgar scores and NICU admissions showed a converse linear relation with pre-pregnancy body mass index in women with low gestational weight gain. In twin pregnancies, nonoptimal weekly maternal weight gain seems to be strongly associated with maternal and neonatal adverse outcomes. Since gestational weight gain is a modifiable risk factor, health care providers have the opportunity to counsel pregnant women with twins and target their care accordingly. Additional research to confirm the validity and generalizability of our findings in different populations is warranted.

IntroductionTo date, there have only been provisional recommendations about the appropriate gestational weight gain in twin pregnancies. This study aimed to contribute evidence to this gap of knowledge. Material and methodsUsing a cohort of 10 603 twin pregnancies delivered between 2000 and 2015 in the state of Hessen, Germany, the individual and combined impact of maternal body mass index and gestational weight gain on maternal and neonatal outcomes was analyzed using uni- and multivariable logistic regression models. The analysis used newly defined population-based quartiles of gestational weight gain in women carrying twin pregnancies (Q1: <419.4 g/week [low weight gain], Q2-Q3: 419.4-692.3 g/week [optimal weight gain], Q4: >692.3 g/week [high weight gain]) and the World Health Organization body mass index classification. ResultsPre-pregnancy body mass index >= 25 kg/m(2) was associated with significantly increased rates of cesarean deliveries (aOR1.2, 95% CI: 1.01-1.41) and pregnancy-induced hypertensive disorders (aOR 1.53, 95% CI: 1.11-2.1) but not with any adverse neonatal outcome.Perinatal mortality (aOR 2.23, 95% CI: 1.38-3.6), preterm birth (aOR 1.88, 95% CI: 1.58-2.25), APGAR ' 5 < 7 (aOR 1.61, 95% CI: 1.19-2.17) and admissions to the neonatal intensive care unit (aOR 1.6, CI: 1.38-1.85) were increased among women with low gestational weight gain. Rates of cesarean deliveries were high in both women with low (aOR 1.25, 95% CI: 1.05-1.48) and high gestational weight gain (aOR 1.17, 95% CI: 1.01-1.35). A high gestational weight gain was also associated with higher rates of hypertensive disorders in pregnancy (aOR 2.32, 95% CI: 1.79-3.02) and postpartum hemorrhage (aOR 1.72, 95%CI: 1.12-2.63). The risk of preterm birth, low Apgar scores and NICU admissions showed a converse linear relationship with pre-pregnancy body mass index in women with low gestational weight gain. ConclusionsIn twin pregnancies, nonoptimal weekly maternal weight gain seems to be strongly associated with maternal and neonatal adverse outcomes. Since gestational weight gain is a modifiable risk factor, health care providers have the opportunity to counsel pregnant women with twins and target their care accordingly. Additional research to confirm the validity and generalizability of our findings in different populations is warranted.

Schwangere mit vorbestehenden oder neu auftretenden urologischen Erkrankungen wie Plazenta accreta Spektrum mit Beteiligung des Urogenitaltrakts haben Anspruch auf eine Begleitung in multidisziplinären Teams. Schwere Formen von Präeklampsie verstärken eine Prädisposition zu chronischen Nierenerkrankungen. Der Beckenboden wird vor, aber vor allem unter der Geburt, stark beansprucht. Dies kann temporäre Beschwerden auslösen, bei irreversiblen Läsionen bleiben Folgen, die später als Senkungsbeschwerden, Urin- oder Stuhlinkontinenz die Lebensqualität der Frauen beeinträchtigen. Nach unsachgemäßen Operationen können Rezidive oder weitere Komplikationen entstehen. In Entwicklungsländern sind die Raten von Verletzungen des Geburtskanals mit anschließendem Descensus, Inkontinenz und urogenitalen Fisteln sowie der Mangel an kompetenten Fachärzten für eine Behandlung noch dramatischer. Generell sollte eine kompetente Prävention und Nachsorge durch Geburtsmediziner verbessert werden.

International guidelines recommend vaginal pessaries as a first-choice treatment of symptomatic pelvic organ prolapse (POP). Gynecologists rarely receive systematic training or just do not take the time to communicate with their patients. We hypothesized that we could identify key deficits and limitations of counseling before or during pessary therapy from questions directed to manufacturers with the aim to improve and promote health literacy of women with POP. We approached five manufacturers to provide anonymized inquiries related to pessary use. After exclusion of duplicates and questions about obstetric pessaries, 174 data sets from 145 patients remained. In 19/145 patients (13.1

IntroductionFollowing the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years.Methods and analysisWomen with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is <10th percentile or has decreased by 50 percentiles since 18–32 weeks will be included for observational data collection. Participants will be randomised if cerebral blood flow redistribution is identified, based on umbilical to middle cerebral artery pulsatility index ratio values. Computerised cardiotocography (cCTG) must show normal fetal heart rate short term variation (≥4.5 msec) and absence of decelerations at randomisation. Randomisation will be 1:1 to immediate delivery or delayed delivery (based on cCTG abnormalities or other worsening fetal condition). The primary outcome is poor condition at birth and/or fetal or neonatal death and/or major neonatal morbidity, the secondary non-inferiority outcome is 2-year infant general health and neurodevelopmental outcome based on the Parent Report of Children’s Abilities-Revised questionnaire.Ethics and disseminationThe Study Coordination Centre has obtained approval from London-Riverside Research Ethics Committee (REC) and Health Regulatory Authority (HRA). Publication will be in line with NIHR Open Access policy.Trial registration numberMain sponsor: Imperial College London, Reference: 19QC5491. Funders: NIHR HTA, Reference: 127 976. Study coordination centre: Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS with Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University. IRAS Project ID: 266 400. REC reference: 20/LO/0031. ISRCTN registry: 76 016 200.

QR-Codescannen&Beitragonline lesen Als charismatisches Vorbild, Vorreiter der fetomaternalen Medizin, Mentor und Freund hat Erich Saling Generationen von „Perinatologen“ im Inund Ausland geprägt [1]. Er hinterfragte Physiologie und Pathophysiologie von Schwangerschaft und Geburt, realisierte viele Ideen zum Wohl des Kindes und faszinierte sowohl sein Team als auch nationale und internationale innovationsfreudige Kolleg*innen. „Meilensteine“ der Perinatalmedizin wurden durch Saling und Arabin bereits 1988 zusammengefasst [2]: – Der Beginn der Perinatalmedizin beruhte auf einer systematischen Vorgehensweise – Die Perinatalmedizin bewirkte enorme Verbesserungen in Diagnostik und Therapie – In der Geschichte des Faches ist die Geschwindigkeit dieser Entwicklungen einzigartig

Objective This retrospective cohort study analyzes risk factors for abnormal pre-pregnancy body mass index and abnormal gestational weight gain in twin pregnancies. Methods Data from 10603/13682 twin pregnancies were analyzed using uni- and multivariable logistic regression models to determine risk factors for abnormal body mass index and weight gain in pregnancy. Results Multiparity was associated with pre-existing obesity in twin pregnancies (aOR: 3.78, 95% CI: 2.71-5.27). Working in academic or leadership positions (aOR: 0.57, 95% CI: 0.450.72) and advanced maternal age (aOR: 0.96, 95% CI: 0.950.98) were negatively associated with maternal obesity. Advanced maternal age was associated with a lower risk for maternal underweight (aOR: 0.95, 95% CI: 0.92-0.99). Unexpectedly, advanced maternal age (aOR: 0.98, 95% CI: 0.960.99) and multiparity (aOR: 0.6, 95% CI: 0.41-0.88) were also associated with lower risks for high gestational weight gain. Pre-existing maternal underweight (aOR: 1.55, 95% CI: 1.072.24), overweight (aOR: 1.61, 95% CI: 1.39-1.86), obesity (aOR: 3.09, 95% CI: 2.62-3.65) and multiparity (aOR: 1.64, 95% CI: 1.23-2.18) were all associated with low weight gain. Women working as employees (aOR: 0.85, 95% CI: 0.73-0.98) or in academic or leadership positions were less likely to have a low gestational weight gain (aOR: 0.77, 95% CI: 0.64-0.93). Conclusion Risk factors for abnormal body mass index and gestational weight gain specified for twin pregnancies are relevant to identify pregnancies with increased risks for poor maternal or neonatal outcome and to improve their counselling. Only then, targeted interventional studies in twin pregnancies which are desperately needed can be performed.

To compare the impact of lifestyle interventions for overweight and obese pregnant women a systematic review and meta-analysis was conducted using pre-registration and audit of the interventions as selection criteria. PubMed, Web of Science and CENTRAL were searched for randomized controlled trials examining diet, exercise, combined interventions or associated behavioral therapy. Trials were selected if they reported one of the primary outcomes (gestational diabetes, hypertensive disorders, perinatal mortality, admission to neonatal intensive care unit). Results were established from the total group and separately from pre-registered or clinically audited studies. Out of 1304 titles, 28 randomized controlled trials were included. Among the primary outcomes only hypertensive disorders were significantly reduced by exercise in the total group: odds ratio 0.52 (95% confidence interval 0.28 to 0.96, four trials, 1324 participants). When behavioral therapy supported combined interventions, maternal weight gain, (Standardized Mean Difference - 0.16 kilogram; 95% confidence interval - 0.28 to - 0.04, four trials, 2132 participants) and neonatal birthweight, (Standardized Mean Difference - 0.4 gram; 95% confidence interval - 0.62 to - 0.18, five trials, 1058 participants), were significantly reduced within the total group and both specified meta-analyses. Higher frequencies of physical activity improved the results. Risk of bias, assessed with the Cochrane Tool, was low to moderate. Elements of behavioral therapy might better prevent adverse effects of maternal obesity when combined with lifestyle interventions. Unfortunately, high heterogeneity due to different intervention and population characteristics was a limiting factor. Future studies should also focus on increased intensities of physical activity.

Experimental and clinical studies suggest that prenatal experiences may influence health trajectories up to adulthood and high age. According to the hypothesis of developmental origins of health and disease exposure of pregnant women to stress, nutritional challenges, infection, violence, or war may "program" risks for diseases in later life. Stress and anxieties can exist or be provoked in parents after fertility treatment, after information or diagnosis of fetal abnormalities and demand simultaneous caring concepts to support the parents. In vulnerable groups, it is therefore important to increase the stress resilience to avoid harmful consequences for the growing child. "Enriched environment" defines a key paradigm to decipher how interactions between genes and environment change the structure and function of the brain. The regulation of the fetal hippocampal neurogenesis and morphology during pregnancy is one example of this complex interaction. Animal experiments have demonstrated that an enriched environment can revert consequences of stress in the offspring during critical periods of brain plasticity. Epigenetic markers of stress or wellbeing during pregnancy might even be diagnosed by fragments of placental DNA in the maternal circulation that show characteristic methylation patterns. The development of fetal senses further illustrates how external stimulation may impact individual preferences. Here, we therefore not only discuss how maternal stress influences cognitive development and resilience, but also design possibilities of non-invasive interventions for both mothers and children summarized and evaluated in the light of their potential to improve the health of future generations.