Gynakologisch-geburtshilfliche Rundschau最新文献

{"title":"[External cephalic version in cases of breech presentation: renaissance of a well-known procedure?].","authors":"M Schmidt,&nbsp;R Callies,&nbsp;U Kuhn,&nbsp;A Willruth,&nbsp;R Kimmig","doi":"10.1159/000184443","DOIUrl":"https://doi.org/10.1159/000184443","url":null,"abstract":"<p><strong>Objective: </strong>About 3-4% of all pregnant women will have a fetus presenting by the breech at term. External cephalic version offers the opportunity to reduce the rate of caesarean sections caused by breech presentation. We analysed retrospectively 51 cases of external cephalic version at our clinic.</p><p><strong>Methods: </strong>External cephalic version was performed 51 times between 37 and 41 weeks of pregnancy.</p><p><strong>Results: </strong>External cephalic version was successful in 32/51 cases (62,7%) with a consecutive rate of vaginal delivery of 71,9%. The best results were seen at 37 weeks of pregnancy with 81,25% of successful versions followed by 76,9% of vaginal deliveries. Complications were rare. There was just 1 case of emergency caesarean section due to persisting fetal bradycardia.</p><p><strong>Conclusion: </strong>External cephalic version is an effective and safe treatment to enable vaginal delivery of cephalic presentation. For this operation, 37 weeks of pregnancy can be considered the best time.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 1","pages":"29-34"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000184443","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27974839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Complications of hormonal contraception. 38th Congress of the \"Zurich Discussion Group\", April 2007].","authors":"M Birkhäuser,&nbsp;W Braendle,&nbsp;P J Keller,&nbsp;L Kiesel,&nbsp;H Kuhl,&nbsp;J Neulen","doi":"10.1159/000184445","DOIUrl":"https://doi.org/10.1159/000184445","url":null,"abstract":"durch das Gestagen gewährleistet, sodass sich bei ausreichender Dosierung auch durch eine Gestagenmonotherapie eine sichere Kontrazeption erzielen lässt. Eine adäquate Kombination mit EE ist vor allem für die Zykluskontrolle wesentlich. Werden Tabletten vergessen, steigt das Risiko für Zwischenblutungen und ungewollte Schwangerschaften; dies trifft besonders für die erste Einnahmewoche zu. Zwischenblutungen treten vor allem während der ersten 3 Einnahmezyklen auf und gehen bei Fortführung der Einnahme zurück. Deshalb ist ein Präparatewechsel oder Abbruch aufgrund von Zwischenblutungen in den ersten 3 Monaten nicht sinnvoll. 2. Durch ihren Einfluss auf die Follikelreifung reduzieren OH die endogene Östrogenproduktion. Normalerweise ist EE in einer Dosierung von 20–30 g ausreichend, um Östrogenmangelerscheinungen zu verhindern. Die Dosis des Gestagens richtet sich nach der jeweiligen Wirkungsstärke (Ovulationshemmdosis). Für die Zykluskontrolle spielt das Verhältnis zwischen EEund Gestagendosis eine Rolle. Bei vielen Frauen beginnt im hormonfreien Intervall von 7 Tagen die Follikelreifung. Daher können Einnahmefehler insbesondere in der ersten und dritten Woche zu einer Ovulation führen. Eine Verkürzung oder das Auslassen des pillenfreien Intervalls führt zu einer stärkeren ovariellen Suppression und damit zu einer höheren kontrazeptiven Sicherheit. OH und andere Medikamente können sich durch pharmakologische Interaktionen in ihrer Wirkung abschwächen oder verstärken (z.B. Enzyminduktion oder -hemmung in der Leber, Störung des enterohepatischen Kreislaufs). Derartige Effekte können auch nach Absetzen der Medikation bis zu einigen Wochen persistieren. Bei langfristiger Anwendung von Medikamenten, welche die kontrazeptive Sicherheit beeinträchtigen können (z.B. Antikonvulsiva), ist eine ununterbrochene Einnahme von monophasischen Kombinationspräparaten (ohne einnahmefreies Intervall; Langzyklus, kontinuierliche Langzeiteinnahme) zu empfehlen. Bei einer kurzfristigen medikamentösen Therapie (z.B. Antibiotika), welche die Wirksamkeit von OH abschwächen könnte, sind zusätzliche kontrazeptive Massnahmen anzuraten. 3. Ernsthafte Nebenwirkungen treten unter der Einnahme von OH sehr selten auf und sind meistens von der individuellen Disposition abhängig. Vor der Verordnung von OH sind neben der sorgfältigen Anamnese eine allgemeine und gynäkologische Studien der letzten Jahrzehnte haben gezeigt, dass eine adäquate Information über die korrekte Anwendung kontrazeptiver Massnahmen zum deutlichen Rückgang ungewollter Schwangerschaften und damit auch von Schwangerschaftsabbrüchen führt; Schwangerschaftsabbrüche können nicht als verantwortungsbewusste Familienplanung angesehen werden. Die hormonale Kontrazeption zählt zu den zuverlässigsten Methoden der reversiblen Empfängnisverhütung. Zusätzliche therapeutische und präventive Wirkungen sind ebenso wie unerwünschte Nebenwirkungen abhängig von der Östrogendosis, der Gestagenkomponente und der individuellen Dispos","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 1","pages":"39-44"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000184445","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27974841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Laparoscopic lymph node dissection: technique and results].","authors":"Markus C Fleisch,&nbsp;Daniel T Rein","doi":"10.1159/000213060","DOIUrl":"https://doi.org/10.1159/000213060","url":null,"abstract":"<p><p>For 20 years laparoscopic pelvic and para-aortal lymph node dissection has become increasingly popular as part of minimally invasive surgical treatment concepts for women suffering from gynaecological malignancies. Especially patients suffering from early-stage cervical or endometrial cancers can benefit from the general advantages of a minimally invasive procedure if a comparable degree of radical surgery is achieved. The feasibility and case-control studies published so far suggest comparable indicators of radicality, such as the number of dissected lymph nodes, but also demonstrate potential advantages like a lower intra-operative blood loss, shorter hospital stay and lower postoperative complication rate in comparison with the conventional approach. Regarding long-term survival, reliable data from prospective randomized studies are still lacking but can be expected to be available in the near future.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 3","pages":"117-25"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000213060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28241953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between carnitine, fatty acids and insulin resistance.","authors":"Alfred Lohninger,&nbsp;U Radler,&nbsp;S Jinniate,&nbsp;S Lohninger,&nbsp;H Karlic,&nbsp;S Lechner,&nbsp;D Mascher,&nbsp;A Tammaa,&nbsp;H Salzer","doi":"10.1159/000301075","DOIUrl":"https://doi.org/10.1159/000301075","url":null,"abstract":"<p><p>Increased plasma free fatty acid (FFA) levels are a feature of insulin resistance and type 2 diabetes. The aim of the present study was to assess the effect of L-carnitine supplementation on plasma lipids and the expression of enzymes in peripheral mononucleated cells (PMNC) involved in the regulation of fatty acid and glucose oxidation. L-Carnitine supplementation of 2 g/day resulted in a significant decrease in plasma FFA and in a less pronounced diminution of the plasma triacylglycerols. In addition, a concomitant increase in the relative mRNA abundances of carnitine acyltransferases (5- to 10-fold) and of the carnitine carrier OCTN2 (12-fold) in PMNC of pregnant women was found. The results of the present study provide evidence that L-carnitine supplementation in pregnancy (2 g/day) avoids a striking increase in plasma FFA, which are thought to be the main cause of insulin resistance and consequently gestational diabetes mellitus.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 4","pages":"230-5"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000301075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29042546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The dilemma of diabetes in pregnancy: worldwide differences in diagnosis and management].","authors":"W Zeck,&nbsp;D Schlembach,&nbsp;T Panzitt,&nbsp;U Lang,&nbsp;H D McIntyre","doi":"10.1159/000301086","DOIUrl":"https://doi.org/10.1159/000301086","url":null,"abstract":"<p><strong>Objective: </strong>Type 1 and type 2 diabetes in pregnancy as well as gestational diabetes mellitus (GDM) pose major risks to mother and fetus. We assessed to which extent two obstetric centers on two different continents coincide in their management of diabetes in pregnancy.</p><p><strong>Methods: </strong>Within the scope of research activities between the Obstetric Department of the Medical University of Graz, Austria, and the Centre of Obstetric Medicine at the Mater Misericordiae Mothers' Hospital in Brisbane, Australia, current practices among the two obstetric centers in Austria and Australia were assessed.</p><p><strong>Results: </strong>The management of type 1 and type 2 diabetes in pregnancy was almost identical, whereas major differences were found in the management of GDM.</p><p><strong>Conclusion: </strong>Standardization of screening methods in diabetes in pregnancy remains challenging. National and international consensus has yet to be achieved in order to put a hold to the 'diabetic epidemic' we are going to face in the future.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 4","pages":"267-70"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000301086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29042552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Significance of laparoscopy in gynaecological oncology: limitations for adnexal tumours].","authors":"Pauline Wimberger,&nbsp;Rainer Kimmig","doi":"10.1159/000213062","DOIUrl":"https://doi.org/10.1159/000213062","url":null,"abstract":"<p><p>In the last few decades, the impact and use of laparoscopy for benign adnexal tumours have markedly increased. However, the surgical resection of early-stage ovarian malignoma remains controversial. This review evaluates the importance of laparoscopy in surgery of adnexa and especially of malignant tumours. Certainly, morbidity after laparoscopy is lower, but there is a risk of possibly more restricted staging, rupture of the tumour and port metastases. Analysis showed that the standard treatment of ovarian malignant tumours is laparotomy via a vertical incision, because data on laparoscopy are scarce and prospective, randomized trials for early-stage ovarian cancer are still missing. Staging by laparoscopy is technically feasible, but so far there is no proof of safety.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 3","pages":"133-7"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000213062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28243515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Society news].","authors":"Franziska Maurer-Marti","doi":"10.1159/000197910","DOIUrl":"https://doi.org/10.1159/000197910","url":null,"abstract":"","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 2","pages":"104-6"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000197910","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28362486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Detection of microcalcifications by high-resolution B-mode sonography in patients with BI-RADS 4a lesions].","authors":"F Stöblen,&nbsp;S Landt,&nbsp;A Köninger,&nbsp;J Hecktor,&nbsp;R Kimmig,&nbsp;S Kümmel","doi":"10.1159/000301095","DOIUrl":"https://doi.org/10.1159/000301095","url":null,"abstract":"<p><strong>Objective: </strong>Evaluation of the diagnostic quality of high-resolution B-mode sonography for the detection of microcalcifications and calcification-associated focal findings in patients with BI-RADS lesions of subtype 4a.</p><p><strong>Patients and methods: </strong>40 patients underwent X-ray mammography and 13-MHz B-mode sonography. The following parameters were examined: with X-ray mammography: extent of microcalcification and visibility of associated focal areas; with ultrasound: sensitivity of microcalcification findings, quality of presentation, extent of microcalcification, visibility of associated focal areas and feasibility of ultrasound-assisted biopsy.</p><p><strong>Results: </strong>X-ray mammography showed a mean extent of microcalcification of 28 8 21 mm. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and accuracy of microcalcification-associated focal findings were 61.5, 57.9, 50, 45.8 and 47.5%. B-mode sonography achieved a sensitivity of 100%. Sonographically, the mean extent of microcalcification was 7 +/- 3 mm and thus significantly smaller (p < 0.01). Sensitivity, specificity, PPV, NPV and accuracy were 14.3, 84.2, 50, 47.1 and 47.5%. Ultrasound-assisted biopsy appeared feasible in 22 patients (55%).</p><p><strong>Conclusion: </strong>High-frequency B-mode sonography allows a highly sensitive confirmation of microcalcifications in the case of BI-RADS 4a lesions and seems to allow ultrasound-assisted biopsy in about half the patients.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 4","pages":"292-8"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000301095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29040273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Hyperreactive luteomas during pregnancy--symptoms and complications: a case report].","authors":"Ariane Germeyer,&nbsp;Friedrich Kommoss,&nbsp;Thomas Strowitzki,&nbsp;Michael von Wolff","doi":"10.1159/000301113","DOIUrl":"https://doi.org/10.1159/000301113","url":null,"abstract":"<p><p>A 27-year-old Caucasian (gravida 2 para 1) presented in week 16 of her twin pregnancy with worsening of hyperandrogenic symptoms. In week 17, she developed an acute abdomen due to a twisted, incarcerated right ovary, which was surgically removed. Histological analysis revealed a diffuse steroid cell hyperplasia. Postsurgery testosterone levels fell temporarily within normal limits, diminishing the hyperandrogenic symptoms. Over time androgen levels rose again slowly above normal values with clinical worsening of hirsutism. In the 32nd week of gestation, a cesarean section of two healthy female infants was necessary due to the development of preeclampsia. An ovarian biopsy revealed again the picture of hyperreactio luteinalis. Postpartum peripheral hormone levels fell within normal limits and the hyperandrogenic symptoms subsided.</p>","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 4","pages":"331-4"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000301113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29040687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Water birth: control of infection and contraindications. Expert correspondence no. 27 of 26 May 2009].","authors":"","doi":"10.1159/000301120","DOIUrl":"https://doi.org/10.1159/000301120","url":null,"abstract":"Stuhl kommen, weshalb die meisten Frauen vor der Geburt einen Einlauf wünschen. Die mütterlichen Keime, welche identifiziert werden konnten, betreffen das gesamte Spektrum aus Vagina, Darm und Haut wie Enterobacteriaceae, vor allem Escherichia coli , Staphylokokken und Streptokokken. Verschiedene Arbeiten konnten eine Verunreinigung des Badewassers mit koliformen Keimen und in geringerem Ausmass auch Staphylococcus aureus feststellen [14] . Im Leitungswasser (Bade-/Trinkwasser), für dessen Qualität die kantonalen Behörden bzw. die spitaleigenen Hygienekommissionen verantwortlich sind, sind folgende potenziell pathogene Keime relevant: Pseudomonas aeruginosa , andere Nonfermenter und Legionellen. Es existieren denn auch einzelne Fallberichte von Neugeboreneninfektionen mit P. aeruginosa und Legionellen, die im Zusammenhang mit einer Wassergeburt aufgetreten sind [15–19] . Obwohl das Wasser in einer Entbindungswanne erwartungsgemäss verunreinigt ist, zeigt die aktuelle Datenlage keine erhöhte Infektionsrate bei Mutter und Kind [1, 2, 10–14] . Auch zeigen Kinder, die von Gruppe-B-Streptokokken-positiven Müttern im Wasser geboren werden, keine erhöhte Besiedelungsrate mit Gruppe-B-Streptokokken. Die neonatale Infektionsrate und die Verlegungsrate auf eine neonatale Intensivstation sind nach einer Wassergeburt vergleichbar mit der einer konventionellen Spontangeburt [1, 12] .","PeriodicalId":12827,"journal":{"name":"Gynakologisch-geburtshilfliche Rundschau","volume":"49 4","pages":"341-3"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000301120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29040690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}