ObjectiveUnlike other types of acute pain, labor pain is considered physiological. Due to the heterogeneous management during labor, there is a lack of intention to define quality of care of peripartal analgesia. This study presents the first results of the national register for this evaluation.MethodsThis prospective cross-sectional study, conducted in five different German level-three hospitals, included women after vaginal childbirth between January 2020 and January 2022. A validated questionnaire was completed 24 h postpartum, including information about labor pain, satisfaction, and expectations regarding analgesia. Data were centrally recorded with obstetric records using the database of the QUIPS (Quality Improvement in Postoperative Pain Management) Project.ResultsA total of 514 women were included. On an 11-point Numerical Rating Scale, pain intensity during labor was severe (8.68 +/- 1.8) while postpartal pain was 3.9 (+/- 2.1). The second stage of labor was considered the most painful period. Only 62.6% of the parturients obtained pharmacological support, with epidural being the most effective (reduction of 3.8 +/- 2.8 points). Only epidural (odds ratio [OR] 0.22) and inhalation of nitrous oxide (OR 0.33) were protective for severe pain. In benchmarking, a relation between satisfaction, pain intensity, and the use of epidural was found; 40.7% of the women wished they had received more analgesic support during labor.ConclusionThis study highlights deficiencies in analgesic management in high-level perinatal centers, with more than 40% of parturients considering actual practices as insufficient and wishing they had received more analgesic support, despite the availability of analgesic options. Using patient-reported outcomes can guarantee qualitative tailored analgesic care in women. This study exposes relevant analgesic shortcomings for parturients in perinatal centers, highlighting the need for tools to monitor and improve the quality of obstetric analgesic care.

Objective.Women developing preeclampsia or foetal growth restriction during pregnancy

Introduction Patients with congenital severe deficiency of the VWF degrading protease ADAMTS13 (cTTP) have a lifelong risk for arterial and venous thrombosis. In the neonatal period and in pregnancy this risk is dramatically increased by the increase of VWF in circulation. A poor outcome is reported for both, the mother and the fetus if left untreated. Even since the introduction of plasma therapy in cTTP patients the rate of complications as placenta infarction, growth restriction, still birth, and eclampsia-like symptoms of the mother remains high.