Cardiovascular (CV) disease remains the leading cause of death in women, yet risk is often recognized late. Pregnancy is a physiologically demanding, routinely monitored period with repeated health care contact, standardized clinical assessments and blood-based testing, creating a strategic window to capture early signals of CV vulnerability long before conventional midlife risk assessment. Research has largely focused on hypertensive pregnancy complications, but most future CV events occur in women without such complications. Emerging evidence indicates that blood pressure trajectories, angiogenic and cardiac biomarkers, and routinely assessed metabolic parameters are associated with long-term maternal hypertension, subclinical CV phenotypes, and clinical CV events, even in the absence of overt hypertensive pregnancy complications. This review summarizes data on soluble fms-like tyrosine kinase-1, placental growth factor, natriuretic peptides, cardiac troponins, blood pressure, and the metabolic parameters weight and glycemic status, and discusses limitations of the current evidence base and key priorities for translating pregnancy-derived signals into clinically actionable CV risk assessment.

Objective: To evaluate the diagnostic utility of antepartum amnioinfusion in cases of severe oligo- and anhydramnios and to descriptively report perinatal outcomes. Methods: This retrospective single-center study analyzed all antepartum amnioinfusions performed between 2009 and 2024 in pregnancies between 16 + 0 and 34 + 0 weeks of gestation. The primary endpoint was diagnostic impact following amnioinfusion. Secondary endpoints were descriptive perinatal outcomes. No inferential statistical analyses were performed. Results: A total of 37 amnioinfusions were performed in 31 patients. Median gestational age at first amnioinfusion was 22 ± 4.3 weeks, with a mean infusion volume of 259 ± 59.4 mL. The most frequent etiologies were preterm prelabor rupture of membranes (PROM, 29%), fetal growth restriction (FGR, 25.8%), and urogenital malformations (22.6%). Amnioinfusion improved sonographic visualization and diagnostic assessment in the majority of cases. Pregnancy prolongation was observed in selected subgroups; however, causal inference regarding therapeutic efficacy cannot be drawn. Conclusions: Antepartum amnioinfusion represents a valuable adjunct for prenatal diagnostic evaluation in severe oligo- and anhydramnios. Observed perinatal outcomes should be interpreted descriptively. Further prospective, controlled studies are required to define the role of amnioinfusion beyond diagnostic feasibility.

Abstract Women with inherited thrombophilia represent more than 15% of the pregnant population. 20–50% of pregnancy-related venous thromboembolism (VTE) is associated with at least one inherited thrombophilia, which increases the risk of VTE up to 40-fold depending on the type of thrombophilia and the family history of VTE. Most societies consider homozygosity of factor V Leiden and the prothrombin gene mutation, compound heterozygosity of both, and severe deficiency of factor V Leiden and prothrombin gene mutation as “high risk” thrombophilia and heterozygous for factor V Leiden or the prothrombin gene mutation as “low risk” thrombophilia. Recommendations on pharmacological prophylaxis vary across international guidelines. According to expert consensus, pharmacological prophylaxis may be indicated if the risk threshold for VTE is > 3% balancing benefit against harm of heparin prophylaxis. In women with low-risk thrombophilia, guidelines recommend pharmacological prophylaxis ante- and postpartum only in cases with a positive family history of VTE or additional VTE risk factors. Most guidelines suggest heparin prophylaxis in women with homozygosity for factor V Leiden mutation or compound thrombophilia regardless of family history of VTE in the antenatal period and for 6 weeks after delivery. In women with protein S and protein C deficiencies, some guidelines advocate clinical surveillance rather than pharmacological prophylaxis antenatally, while postpartum pharmacological prophylaxis was recommended by all guidelines for women with a positive family history of VTE or with additional risk factors. Pharmacological prophylaxis in women with antithrombin deficiency remains a matter of debate and depends on the subtype and extent of antithrombin deficiency. There is yet no evidence from randomized, controlled trials that pharmacological prophylaxis significantly reduces the risk of VTE in women with inherited thrombophilia. Overestimation of the VTE risk and unnecessary use of heparin is an unsolved problem. Decision-making should also consider the increased risk of bleeding complications and wound hematoma associated with pharmacological thromboprophylaxis. Until there is more evidence for the benefit of pharmacological prophylaxis, the decision for or against prophylaxis remains a case-by-case decision taking into account the patient’s individual risk profile and woman’s preference.

Introduction:Infection with SARS-CoV-2 during pregnancy increases the risk for adverse events in mothers and newborns. Research is increasingly exploring potential consequences of intrauterine exposure to the developing nervous system. However, there is still a lack of high-quality studies on long-term outcomes. The CRONOS-Kids study aims to investigate the global development of children after exposure to SARS-CoV-2 in utero in comparison to an unexposed control group. This paper outlines the CRONOS-Kids study protocol. Methods:The study is designed as a prospective population-based cohort study and will recruit children aged 36-60 months at the time of assessment. The exposed cohort will be recruited from the German CRONOS registry and will include only children who have been exposed to the Alpha and Delta variants of SARS-CoV-2. The unexposed cohort will be recruited by local pediatricians and via social media. For clinical evaluations, the Movement Assessment Battery for Children, 2nd Edition will be used. Parental self-reports on development will use the Ages and Stages Questionnaire, 3rd Edition. Additional questionnaires cover information about maternal and child health, vaccinations, healthcare usage, media consumption, and maternal quality of life. Until April 2026, we aim to recruit 125 exposed and 125 unexposed children across five study sites. Discussion:The CRONOS-Kids study will explore the impact of intrauterine SARS-CoV-2 exposure to specific virus variants on long-term neurologic outcomes in children as well as broader consequences of the pandemic.

Purpose The purpose of this official guideline, updated and published by the German Society for Gynecology ( Deutsche Gesellschaft für Gynäkologie und Geburtshilfe , DGGG) and coordinated by the joint guidelines program of the DGGG, Austrian Society for Gynecology and Obstetrics ( Österreichische Gesellschaft für Gynäkologie und Geburtshilfe, OEGGG) and Swiss Society for Gynecology and Obstetrics ( Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe , SGGG) is to provide a consensus-based overview of the diagnosis and management of intrauterine growth restriction based on an evaluation of the relevant literature. Methods This S2k-guideline is the result of a structured consensus of representative members from various medical professions. It was compiled at the request of the guidelines commission of the DGGG. Recommendations The guideline provides recommendations on the diagnosis, management, counseling, prophylaxis, and screening of fetal growth restriction.

Das Ziel dieser offiziellen überarbeiteten Leitlinie, die von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) publiziert und im gemeinsamen Leitlinienprogramm der DGGG, Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG) und Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG) koordiniert wurde, ist es, durch die Evaluation der relevanten Literatur einen konsensbasierten Überblick über die Diagnostik und das Management der intrauterinen Wachstumsrestriktion zu geben. Diese S2k-Leitlinie wurde durch einen strukturierten Konsens von repräsentativen Mitgliedern verschiedener Professionen im Auftrag der Leitlinienkommission der DGGG entwickelt. Es werden Empfehlungen zur Diagnostik, Management, Beratung, Prophylaxe und Screening der fetalen Wachstumsrestriktion gegeben.

Pregnant patients require intensive medical treatment relatively rarely: in industrialized countries they account for only about 2% of ICU-patients. Compared to pregnancy, the need for intensive care occurs more often in the immediate postpartum setting, primarily due to peripartum complications such as severe haemorrhage, hypertensive crises, or sepsis. The treatment of such patients requires a multiprofessional and interdisciplinary approach involving obstetricians, neonatologists, intensive care physicians, nursing staff, and other specialists, as well as, if necessary, psychologists. Particular importance is attached to involving the (competent-to-consent) patient and her relatives in clinical decision-making processes. In the case of fetal viability, and if the mother's condition is stable, transfer to a hospital with connected obstetrics and neonatology should be considered. Maternal X-ray examinations are possible during pregnancy, taking into account the fetal radiation dose.

Aim The AGG (Working Group for Obstetrics and Prenatal Diag-nostics, Section Maternal Diseases) has issued these recom-mendations to improve the detection and management of genital herpes simplex virus (HSV) infections during preg-nancy and the peripartal period. Methods Members of the Task Force developed the recommenda-tions and statements presented here using recently pub-lished literature. The recommendations were adopted after a consensus process by members of the working group. Recommendations This article focuses on the epidemiology and pathophysiol-ogy of genital HSV infections during pregnancy and contains recommendations on maternal and fetal diagnosis, (sup-pressive) therapy, obstetric management, screening, and prevention.

Aim This S2k guideline of the German Society of Gynecology and Obstetrics (DGGG) contains consensus-based recommendations for the care and treatment of women with hypertension in pregnancy. It aims to serve as a guide for all professions involved in the care of pregnant women and to improve interprofessional and interdisciplinary cooperation. A new focus was placed on patients' long-term health beyond the postpartum period. Methods The existing S2k guideline was revised and the relevant literature reviewed. Where new questions arose, they were formulated and developed in PICO format. A targeted systematic literature search was carried out using PubMed. Other international guidelines were also consulted. After summarizing and presenting the available data, recommendations and statements were developed, discussed, and agreed on by the guideline group. Recommendations The recommendations cover prediction, prevention, diagnosis, and treatment from the moment hypertensive disease is detected in pregnancy as well as postpartum, in the puerperium, and during breastfeeding. A major change from the previous version of the guideline is the reduction in blood pressure levels that should be achieved during pregnancy. Suggestions are made on how to proceed with regards to the long-term health of mother and child, which the guideline group believes is currently regulated inadequately in the German healthcare system.

The aim of the present study was to quantify the rate of thromboembolic events (TE) in pregnant women with SARS-CoV-2 infection and to characterize risk factors to provide a basis for individualized recommendation on prophylactic measures. CRONOS is a multicenter, prospective observational study conducted in Germany and Austria during the COVID-19 pandemic. Pregnant women with confirmed SARS-CoV-2 infection were enrolled. Data on demographics, medical history, COVID-19-related aspects, and pregnancy and birth outcomes were collected. TE was particularly queried and used as the primary outcome. A combination of “TE,” “maternal or fetal death,” or “severe postpartum hemorrhage” was defined as a secondary endpoint. Risk analyses were performed using univariate and multivariable logistic regression models. Data from 8033 pregnant patients showed 40 TEs (0.5

Infants with perinatal asphyxia require immediate support in order to prevent further damage. If asphyxia progresses towards hypoxic ischemic encephalopathy, therapeutic hypothermia (TH) in a specialised NICU is indicated. In order to provide evidence-based recommendations for an appropriate perinatal care structure, data for Germany are needed. German NICUs which offer TH (cooling centres) provided data in order to analyse how many neonates were treated with TH and how many of them were transferred for TH. Furthermore, for transferred infants the level of care of birth hospital was analysed and the rate of neonates with TH per 1,000 deliveries was calculated for each hospital. Data for 1,431 neonates with TH was obtained from 20 cooling centres. The average annual rate of neonates receiving TH in each cooling centre varied between 3 and 12 neonates. In only 13% of the analysed hospital years was the annual rate of neonates receiving TH equal to or more than 12. For 19 out of the 20 cooling centres, detailed information on the place of birth was available. Out of these 1,390 neonates, 46% (n=637) were transferred for TH. 4.7% of the transferred neonates were born out-of-hospital, whereas 95.3% (n=607) were born in 111 different hospitals, with a total of 1,298,058 deliveries during the respective data reporting period. Altogether, 55.3%, 18.5%, and 26.2% were born in hospitals caring for high-, medium-, or low-risk pregnancies, respectively. For each hospital, the respective rate of neonates with TH per 1,000 deliveries was calculated and showed variations between different hospitals. However, the median rate was similar among hospitals caring for high-, medium-, or low-risk pregnancies. Our findings could be used for subsequent planning of perinatal care. Since the annual number of neonates treated with TH is rather low in the majority of participating cooling centres, more centralisation is needed. Furthermore, the relative rate of newborns requiring TH is similar in hospitals providing care for high-, medium-, or low-risk pregnancies. In order to provide immediate resuscitation to asphyxiated infants, paediatric expertise should be available in each hospital where infants are born.

Venous thromboembolism (VTE) is a severe complication associated with cesarean delivery (c.d.). The risk of VTE has been estimated to be 2–4-fold higher compared to vaginal delivery and appears independent of other risk factors. Pharmacologic thromboprophylaxis after c.d. represents a daily challenge for obstetricians and is a common practice in many countries such as in Germany. However, the evidence of thromboprophylaxis efficacy is based on only four randomized controlled trials and one prospective cohort study. Risk assessment models to predict VTE after c.d. have not adequately been validated. According to meta-analyses pharmacologic thromboprophylaxis was not associated with a significant reduction in the risk of VTE but is associated with an increased risk of bleeding and hematomas compared to placebo. Due to the lack of evidence current guidelines differ markedly regarding recommendations on post-cesarean pharmacologic thromboprophylaxis. Most guidelines recommend no pharmacologic thromboprophylaxis after elective c.d. in the absence of additional VTE risk factors. In case of additional risk factors associated with elective c.d. as well as in case of emergency c.d. pharmacologic prophylaxis is advised for 7–10 days after delivery, and for at least 6 weeks after c.d. in high-risk patients. In view of the great number of various risk factors, the challenge not recognizing all risk factors timely and the low incidence of serious complications associated with the use of low molecular weight heparin (LMWH), we consent with others to suggest universal LMWH prophylaxis following c.d. rather than a selective being aware that universal LMWH prophylaxis is associated with significantly higher costs.

Objective These recommendations by the AGG (Committee for Obstetrics, Department of Maternal Diseases) on how to treat iron-deficiency anemia during pregnancy aim to improve the diagnosis and management of iron-deficiency anemia in pregnancy. Methods The task force members developed the following recommendations and statements based on the current literature. Recommendations were adopted after the members of the working group achieved consensus. Recommendations This article gives an insight into the diagnosis and management of iron-deficiency anemia in pregnancy and provides recommendations on its treatment.

SARS-CoV-2 infection during pregnancy can adversely affect maternal and neonatal health, although risks vary depending on the variant of concern (VOC). Omicron, although highly infectious, causes fewer maternal and neonatal complications than earlier VOC, so vaccination may be considered unnecessary in planned pregnancy. Using data from the CRONOS registry, we compared pregnancy outcomes according to VOC and vaccination status. We found that vaccination during pregnancy reduced preterm birth rates compared with unvaccinated or vaccinated women with Omicron infection, without increasing severe neonatal outcomes. Given the risks associated with preterm birth, the study consistently supports vaccination recommendations for women planning pregnancy.