Purpose The aim of this guideline was to find evidence on whether carrying out Doppler examinations and CTGs in low-risk cohorts of pregnant women improves outcomes. Methods First, a systematic search for guidelines was carried out. Identified guidelines were evaluated using the DELPHI instrument of the AWMF. Three guidelines were found to be suitable to evaluate CTG. Two DEGUM best practice guidelines were judged suitable to describe the methods. All studies on this issue were additionally analyzed using 8 PICO questions. A structured consensus of the participating professional societies was achieved using a nominal group process and a structured consensus conference moderated by an independent moderator. Recommendations No antepartum Doppler sonography examinations should be carried out in low-risk cohorts in the context of antenatal care. No antepartum CTG should be carried out in low-risk cohorts. Note The guideline will be published simultaneously in the official journals of both professional societies (i.e., Geburtshilfe und Frauenheilkunde for the DGGG and Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM).

BACKGROUND:The aim of this study was to investigate whether time of birth, unit volume, and staff seniority impact the incidence of maternal complications in deliveries ≥34 + 0 gestational weeks.METHODS:We conducted a population-based cross-sectional study of 87 065 deliveries occurring between 2004 and 2015 in ten public hospitals in Styria, Austria. A composite adverse maternal outcome measure of uterine atony, postpartum hysterectomy, postpartum bleeding, impaired wound healing, postpartum infections requiring antibiotic treatment, sepsis, or maternal death was used to compare outcomes by time of birth, unit volume, and staff seniority. Based on delivery data, generalized estimating equations (GEEs) were used to calculate the risk of maternal adverse outcomes.RESULTS:Maternal adverse events occurred in 1.33% of deliveries. Incidence of maternal adverse events was highest for units with >1000 deliveries (adjusted OR 1.40; CI 95%: 1.16-1.69) and higher for perinatal centers (adjusted OR 1.35; CI 95%: 1.15-1.57) compared with reference units (500-1000 deliveries/year). Delivery during the daytime compared with the afternoon and nighttime did not affect the incidence of maternal complications (P = 0.765 and P = 0.136, respectively). Compared with resident-guided deliveries, the odds ratio for an adverse event was the same when a consultant attended the delivery (adjusted OR 1.13; CI 95%: 0.98-1.30) but lower in deliveries managed by midwives only (adjusted OR 0.21; CI 95%: 0.07-0.64).CONCLUSION:Procedures performed during the night shift were not associated with increased complication rates. Delivery volume and high-volume centers were associated with the highest risk of maternal complications, and units with 500-1000 deliveries per year were the lowest. With increasing odds of pregnancy risks, these results change, and delivering in a high-volume center becomes at least as safe as delivering in a smaller unit.

Einleitung Die Frühgeburtlichkeit ist derzeit eine der bedeutendsten Herausforderungen in der Geburtshilfe und Neonatologie. Als extreme Frühgeburtlichkeit (extremely preterm birth) wird ein Gestationsalter unter 28+0 Schwangerschaftswochen definiert. Der Entbindungsmodus, Kaiserschnitt vs. Spontangeburt, ist immer wieder Gegenstand von Diskussionen. Ziel dieser Studie war es, die Häufigkeit und die Indikationen der Änderung des angestrebten Geburtsmodus zu evaluieren.

Regeneration of the endometrial stromal compartment in premenopausal women is likely maintained by the perivascular endometrial mesenchymal stem/stromal cells (eMSC) expressing sushi domain containing 2 (SUSD2). The fate of SUSD2+ eMSC during pregnancy and their role in decidualization is not fully known. The aim of our study was to determine the effect of progesterone on the stemness of the SUSD2+ eMSC isolated from non-pregnant uterine samples. Secondary objectives were to characterize the functional capacity including differentiation and clonogenicity assays of SUSD2+ eMSC isolated from decidua at full term and compare it to the capacity of those isolated from non-pregnant uterine samples. Progesterone treatment induced changes in the decidual gene expression profile in non-pregnant SUSD2+ eMSC. Data analysis of a publicly available single cell RNA-seq data set revealed differential expression of several mesenchymal and epithelial signature genes between the SUSD2+ eMSC and the decidual stromal cells, suggesting mesenchymal-to-epithelial transition occurs during decidualization. Histological analysis revealed a significantly lower abundance of SUSD2+ eMSC in 1st trimester and full term samples compared to non-pregnant samples, p = 0.0296 and 0.005, respectively. The differentiation and the colony forming capacity did not differ significantly between the cells isolated from non-pregnant and pregnant uterine samples. Our results suggest that SUSD2+ eMSC undergo decidualization in vitro, while maintaining MSC plasma membrane phenotype. Human eMSC seem to play an important role in the course of endometrial decidualization and embryo implantation. Pregnancy reduced the abundance of SUSD2+ eMSC, however eMSC function remains intact.

Introduction Preterm birth is defined as a live birth before 37 weeks of gestation and is associated with increased neonatal morbidity and mortality. The aim of this study is to compare the efficacy of hexoprenaline and atosiban for short- and long-term tocolysis and their effects on neonatal and maternal outcomes. Methods This retrospective cohort study included women with threatened preterm labor between 24 + 0 and 34 + 0 weeks of gestation without premature rupture of membranes. The tocolytic efficacy of hexoprenaline and atosiban was compared in women receiving one of the two medications for short- and long-term tocolysis. Continuous variables were compared using t-test or Mann-Whitney U test, as appropriate. Comparison of categorical variables between the two groups was done with χ 2 test after Pearson's and Fisher's exact test. Results 761 women were enrolled in this study; 387 women received atosiban and 374 women received hexoprenaline as their primary tocolytic agent. Atosiban showed a higher efficacy as a primary tocolytic agent (p = 0.000) within 48 hours. As regards long-term tocolysis, there were no differences between the treatment groups (p = 0.466). Maternal side effects such as tachycardia (p = 0.018) or palpitations (p = 0.000) occurred more frequently after the administration of hexoprenaline, while there were no differences between the two drugs administered with regard to any other maternal or neonatal outcome parameter. Conclusion Our retrospective study shows a significantly higher efficacy of atosiban in the first 48 hours, especially when administered at an early gestational age. There were no significant differences in terms of neonatal outcome but significantly more maternal adverse effects during the administration of hexoprenaline.

Introduction Preterm birth is defined as a live birth before 37 weeks of gestation and is associated multiple gestation, severe peripartum bleeding, major fetal malforma-tion or intrauterine death before the start of tocolysis.

There are few data on complications with gender affirming surgery. The aim of this study was to assess peri- and postoperative complications of laparoscopic hysterectomy and mastectomy performed in a single sitting in transgender men. Assessment of intra- and postoperative complications in a series of 65 transgender men (mean age 27, range 18–47) undergoing concomitant mastectomy and laparoscopic hysterectomy with salpingo-oophorectomy. Mean operating time was 292 ± 47 min. Thirty-four (52%) patients experienced complications: 28 (41%) DINDO grade I, 0 DINDO grade 2, 6 (11%) DINDO grade III. The six grade 3 complications consisted of 5 hematomas requiring evacuation after mastectomy and 2 vaginal tears requiring transvaginal repair. Three patients were readmitted within 30 days, all for postoperative bleeding/hematoma. In transgender men, performing laparoscopic hysterectomy and mastectomy at a single sitting has a modest rate of perioperative complications, and may improve resource utilization.

Einleitung Frühgeburtlichkeit ist definiert als eine Geburt vor vollendeter 37. Schwangerschaftswoche und ist assoziiert mit einer erhöhten Morbidität und Mortalität der Kinder. Ziel dieser Studie ist der Vergleich der Effektivität von Hexoprenalin und Atosiban als Kurz- und Langzeittokolyse sowie die Auswirkung auf das kindliche und maternale Outcome.

Aim The aim of this official guideline published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG) in cooperation with the Austrian Society of Gynaecology and Obstetrics (OEGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG) is to provide a consensus-based overview of the indications, methods and general management of induction of labour by evaluating the relevant literature. Methods This S2k guideline was developed using a structured consensus process which included representative members from various professions; the guideline was commissioned by the guidelines commission of the DGGG, OEGGG and SGGG. Recommendations The guideline provides recommendations on the indications, management, methods, monitoring and special situations occurring in the context of inducing labour.

Fragestellung: Perioperatives Management ist im Wandel. Für die Kaiserschnittentbindung sind ERAS (Enhanced Recovery After Surgery)-Empfehlungen erarbeitet worden [1], [2], [3]. Wir überprüften, wieweit diese Empfehlungen 2019 in Graz angewandt werden.

Zielsetzung Die Robson 10-Gruppen Klassifikation wird zur Dokumentation, Überwachung und zum Vergleich von CS Raten verwendet. Unser Ziel war es die CS Raten an der UFK Graz in den Jahren 2008-2010 und 2017-2019 zu ermitteln und Trends in der Entwicklung im 10-Jahres-Intervall zu erfassen.

Zielsetzung Ein gutes postoperatives Schmerzmanagement ermöglicht eine frühe Mobilisierung, senkt das postpartal erhöhte Thromboserisiko, unterstützt die Genesung und Selbstbestimmung der Frau und damit die Versorgungsautonomie der „frisch-gebackenen“ Mutter gegenüber dem Neugeborenen und sich selbst. Unsere Hypothese war, dass eine orale Schmerztherapie einer intravenösen Therapie in diesem Sinne überlegen ist.

OBJECTIVE:The Robson ten group classification system is used as a global standard for assessing, monitoring and comparing caesarean delivery (CD) rates within and between maternity services. Our objective was to compare the changes of CD rates at our institution between the years 2008-2010 and 2017-2019 using the Robson ten group classification system.STUDY DESIGN:Data was collected retrospectively and all women were classified using the obstetric concepts and parameters described in the Robson ten group classification system.RESULTS:During 2008-2010 7,832 deliveries were performed, increasing to 9,490 in 2017-2019. The CD rate also increased from 29.1% to 32.2% (p<.05) during this 10 year period. In both observed periods group 5 (single cephalic multiparous women at term with a previous CD) was the largest contributor to the overall CD rate accounting for 20.2% of all CD during 2008-2010 and increasing to 26.9% in 2017-2019 (p<.001). The overall size of group 5 also increased from 8.3% to 11.6% (p<.001). Furthermore, an increase in CD rate in group 7 (multiparous women with a single breech pregnancy, including women with a uterine scar) from 92.9% to 98.2% (p = .752) could be observed. In group 8 (women with multiple pregnancies, including women with a uterine scar) a slight shift towards vaginal delivery (VD) can be reported with CD rates decreasing from 82% to 79.2% (p = .784). There was no observed difference with CD rates in group 1 although the group size decreased from 29.4% in 2008-2010 to 24.2% in 2017-2019 (p<.001). The CD rate in group 10 experienced a slight elevation, in 2008-2010 46.2% were delivered per CD and in 2017-2019 48.8% (p = .553). The overall size of group 10 decreased, contributing 8.9% in 2008-2010 and 8% in 2017-2019 (p<.05) to the overall birthrate.CONCLUSION:The biggest contributors to the CD rate in our hospital remain multiparous women at term with a previous CD. The CD rates, as well as the overall size of this group, keep rising, resulting in a need to establish more effective ways to motivate women with one previous CD towards vaginal birth after caesarean delivery (VBAC). Furthermore, the CD rate in preterm deliveries is increasing and approaching 50%. This illustrates the need to discuss whether CD is the appropriate mode of delivery in half of the preterm infants.

Einleitung: Ein RFVL Uterus gilt als Normvariante und wird in der Literatur in bis zu 15% in der Frühschwangerschaft beschrieben. Im Verlauf des ersten Trimenons richtet sich der Fundus uteri üblicherweise von der Sakralhöhle in die Abdominalhöhle auf. Diese Positionsänderung unterbleibt jedoch in 1/3000 Schwangerschaften und wird Uterus incarceratus (UI) genannt. Unspezifischen Symptome wie Harnentleerungsstörungen, vaginale Blutung oder Komplikationen wie Uterusruptur und Frühgeburt sind als Folge des UI beschrieben. Unerkannt kommt es bei einer Sectio zur Blasen-, Cervix- und Vaginalverletzung. Sonographisch zeigt sich die Cervix elongiert und hinter der Symphyse nur schwer einstellbar. Neben chirurgische Maßnahmen ist in der Frühschwangerschaft die manuelle Reposition in Narkose beschrieben, um den UI aufzurichten. In der Spätschwangerschaft kann zusätzlich kolonoskopischer Druck auf den UI appliziert werden, um die manuelle Reposition zu erleichtern [1]. Eine Aufrichtung in fortgeschrittener Schwangerschaft unter Lachgasapplikation wurde bis dato noch nie beschrieben.