No abstract

based on the literature review and our own observation, we recommend minor surgical approaches in combination with chemotherapy as the treatment of choice for early stage I cervical rhabdomyosarcoma.

Uterine myomas are found in 0.3-2.6% of pregnant women. In one case out of ten they cause complications. Treatment is primarily conservative but in cases of failure, surgery cannot be avoided. We present a case of a pregnant woman with myomas. Because of failure of conservative management and severe abdominal pain, we performed a myomectomy at 18 weeks' gestation with preservation of the pregnancy. We describe a modified surgical technique whereby interrupted sutures are first placed around the myoma for haemostasis. We achieved good pregnancy outcome by caesarean section carried out near term. Incidence, presentation, and challenges associated with the management of myomas during pregnancy are briefly discussed.

Die öffentliche Diskussion über die Finanzierung des Gesundheitswesens in Deutschland besitzt für das Fach Gynäkologie und Geburtshilfe erhebliche Bedeutung. Der vorliegende 2. Teil der Publikation der Finanzierungskommission in der DGGG e. V. stellt weitere wesentliche aktuelle Finanzierungsaspekte bzw. Finanzierungsprobleme dar, welche unser Fachgebiet betreffen. Unter anderem werden die Eingaben in das DRG-System unseres Fachbereichs näher beleuchtet. Hier fällt weiterhin eine Über-und Unterrepräsentation mancher Versorgungsstufen als auch Bundeslän-der in der InEK-Kalkulation auf. Insbesondere bei den gynäkologischen Operationen zeigte sich ein Rückgang der stationären Fälle um 23 % -dieses aufgrund der zunehmenden Verschiebung in den ambulanten Bereich. Die ambulanten Operationen sind fachübergreifend von 2004-2008 um 31,5 % gestiegen. Zudem zeigte sich ein Rückgang der geburtshilflichen Fälle um 5,7 %, und der Fälle, welche direkt der eigentlichen Geburt zuzuordnen sind, um 7,3%. Insgesamt wurden 6,8 % aller stationären Fälle in den letzten Jahren eingebüßt. Der wirtschaftliche Druck auf die geburtshilflichgynäkologischen Fachabteilungen ist nach wie vor sehr hoch. Sinkende Auslastungen machen es immer schwerer, eine Abteilung kostendeckend zu führen. In Bezug auf die personellen Ressourcen sind insbesondere die gesetzlichen Anforderungen an die Perinatalzentren problematisch, z. B. Wegfall der Rufbereitschaft, Verfügbarkeit von Facharztkompetenz und dauerhafte Hintergrundpräsenz der Abteilungsleiter. Weitere Probleme im stationären Bereich zeigen sich im Bereich der Urogynäkologie (Mangel an Nachwuchs, Problem neuer Techniken mit schwacher Datenlage, fehlende Abbildung von Komplexeingriffen, mangelnde Erlöse bei geforderter ambulanter Durchführung) und der malignen sowie benignen operativen Eingriffe. Während hier StandardeinAbstract ! AutorenM.

Recurrent pregnancy loss has been associated with autoimmune responses to membrane phospholipids and alloimmune reactions against paternally derived molecules on the trophoblast. The problem is psychologically and economically stressful as it undermines the capacity of some couples to reproduce and participate effectively in the day-to-day economic activities. This article reviews the adoption of intravenous immunoglobulin as a form of therapy for the clinical management of recurrent pregnancy loss and of selected autoimmune disorders. Side effects, contraindications and safety of use are discussed.

Purpose: The purpose of this study was to investigate the impact of maternal, fetal and obstetric parameters in twin pregnancies due to chorionicity, perinatal morbidity and early neonatal mortality. Methods: Early neonatal outcome parameters were retrospectively analysed in 240 twin pregnancies (51 monochorionic [MC], 189 dichorionic [DC] twins) over a 7.5 years period. Beside chorionicity, we focused on risk factors affecting perinatal morbidity and early neonatal outcome in the overall study cohort and subgroups 1) late preterm and 2) pregnancies conceived by artificial fertilization (IVF/ICSI). Mixed effects logistic regression models were used for multivariate risk analyses. Results: MC vs DC pregnancies showed significantly lower birth weights (p < 0.01), decreased gestational ages (p < 0.01), increased rates of mechanical ventilation (p < 0.05) and higher early neonatal mortality rates (p < 0.05). Additional risk factors for perinatal morbidity and adverse early neonatal outcome were prematurity (<36 completed weeks of gestation), severe intertwin birth weight discordance > 25% and amniotic inflammation (amniotic infection syndrome [AIS]). A gestational age > 36 completed weeks was accompanied by a decrease of early neonatal complications (p < 0.05). Pregnancies conceived by IVF/ ICSI didn't differ from the overall study cohort regarding the investigated risk factors. Conclusions: Twin pregnancies complicated by prematurity, AIS and severe intertwin birth weight discordance are associated with higher perinatal morbidity and adverse early neonatal outcome. In addition, MC twins are jeopardized by an increased early neonatal mortality and therefore represent considerable challenges to both obstetricians and neonatologists. Based on our results, we recommend such twin pregnancies to be monitored and delivered at tertiary perinatal care centres to minimize perinatal morbidity and adverse early neonatal outcomes.

Gestational diabetes mellitus results in endothelial dysfunction which can be measured in a non-invasive, painless and easy manner by a transcranial Doppler test.

Recurrent pregnancy loss is a disease of grave psychological and economic concern. The etiology in the vast majority of the cases is unknown or at best poorly understood. Although Klebsiella pneumonia infections have been reported in humans and animals during pregnancy, there is hardly any information to indicate whether or not these infections may be responsible for early pregnancy loss. We present a review of literature and report for the first time in humans, Klebsiella pneumonia infection in placenta of a 38-year-old secondary recurrent aborter (parity 2 + 3).