Interinstitutional variations in mode of birth after a previous caesarean section : a cross-sectional study in six German hospitals

Aims: Regional and interinstitutional variations have been recognized in the increasing incidence of caesarean section. Modes of birth after previous caesarean section vary widely, ranging from elective repeat caesarean section (ERCS) and unplanned repeat caesarean section (URCS) after trial of labour to vaginal birth after caesarean section (VBAC). This study describes interinstitutional variations in mode of birth after previous caesarean section in relation to regional indicators in Germany. Material and methods: A cross-sectional study using the birth registers of six maternity units (n=12,060) in five different German states (n=370,209). Indicators were tested by χ2 and relative deviations from regional values were expressed as relative risks and 95% confidence intervals. Results: The percentages of women in the six units with previous caesarean section ranged from 11.9% to 15.9% (P=0.002). VBAC was planned for 36.0% to 49.8% (P=0.003) of these women, but actually completed in only 26.2% to 32.8% (P=0.66). Depending on the indicator, the units studied deviated from the regional data by up to 32% [relative risk 0.68 (0.47–0.97)] in respect of completed VBAC among all initiated VBAC. Conclusions: There is substantial interinstitutional variation in mode of birth following previous caesarean section. This variation is in addition to regional patterns

Longitudinal Clinical Features of Post-COVID-19 Patients—Symptoms, Fatigue and Physical Function at 3- and 6-Month Follow-Up

Post-COVID-19 syndrome (PCS) has been described as ‘the pandemic after the pandemic’ with more than 65 million people worldwide being affected. The enormous range of symptoms makes both diagnosis complex and treatment difficult. In a post-COVID rehabilitation outpatient clinic, 184 patients, mostly non-hospitalized, received a comprehensive, interdisciplinary diagnostic assessment with fixed follow-up appointments. At baseline, three in four patients reported more than 10 symptoms, the most frequent symptoms were fatigue (84.9%), decreased physical capacity (83.0%), tiredness (81.1%), poor concentration (73.6%), sleeping problems (66.7%) and shortness of breath (67.3%). Abnormalities were found in the mean values of scores for fatigue (FAS = 34.3), cognition (MoCA = 25.5), psychological alterations (anxiety, depression, post-traumatic stress disorder), limitation of lung function (CAT) and severity scores for PCS (PCFS, MCRS). Clinical abnormalities were found in elevated values of heart rate, breathing rate at rest, blood pressure and NT-proBNP levels. As the frequency of the described symptoms decreases only slowly but most often significantly over the course, it is important to monitor the patients over a longer period of time. Many of them suffer from an immense symptom burden, often without pre-existing clinical correlates. Our results show a clear association with objectifiable assessments and tests as well as pronounced symptoms

Results of the German part of OptiBIRTH (ISRCTN10612254) : a cluster randomised trial to increase vaginal birth after one previous caesarean section

Objective: The OptiBIRTH intervention was developed to enhance women-centred care for pregnant women who had had one previous caesarean section. Firstly, systematic reviews and focus group interviews with clinicians and women were carried out. Another systematic review focused on computer-based behavioural change interventions informed the design of an online component of the OptiBIRTH intervention, which was then tested in the trial to assess its impact on the VBAC rate in the German sites, as well as on interventions and events during labour. Methods: A cluster randomised trial (ISRCTN10612254) was carried out in 15 sites in three European countries (Ireland, Italy, Germany). The German part of the study was led by the Midwifery Research and Education Unit at Hannover Medical School (MiREdU). The participating sites were Buergerhospital Frankfurt, Diakovere Krankenhaus Henriettenstift Hannover, Klinikum Dritter Orden Muenchen, University hospital Wuppertal, and Hannover Medical School. The sites were randomly allocated into three intervention and two control sites. Recruitment of women took place between May 2014 and October 2015. Main international analysis was performed by Queen's University Belfast. Intranational comparisons in Germany were performed by MiREdU using descriptive statistics. Data of the baseline rate came from 2012 compared with data from 2015, which is an interim analysis pending the final comparison to 2016. Results: Overall, there was no statistically significant difference in the change in the proportion of women having a VBAC between 2012 and 2015 in the intervention sites compared to the controls. Although there were significant changes in Italy and Ireland, there were none in Germany. The 2015 VBAC rates in the German sites showed an increase compared to baseline (2012) in one intervention site (+1.0%) and in one control site (+3.2%) but decreases in the three other sites (-0.1, -6.2 and -10.1%). Regarding German OptiBIRTH participants, there was no significant difference in VBAC rates between intervention and control sites (39.1 vs. 40.3%, p = 0.75). There was no significant difference in the frequencies of labour induction (23.2 vs. 20.5%, p = 0.51), amniotomy (16.1 vs. 22.0%, p = 0.13), or oxytocin (47.5 vs. 47.0%, p = 0.93) between intervention and control sites. Epidural analgesia was significantly higher in control compared to intervention sites (45.8 vs. 28.5%, p < 0.001). Opioid application was significantly more common in intervention than in control sites (31.1 vs. 7.7%, p < 0.001). The median duration between onset of labour and birth was significantly shorter in intervention compared to control sites (7.63 vs. 9.95 hrs, p = 0.04). Conclusions: The OptiBIRTH intervention was safe but not effective at increasing VBAC rates in the whole study population or in the German part of the study. It might be more successful in countries with very low rates. Interinstitutional variations in obstetric practice are obvious in Germany

Prävention und Therapie der Frühgeburt

Mitarbeit und Mitautorin der S2k Leitlinie "Prävention und Therapie der Frühgeburt". Hier frei zugänglich: https://www.awmf.org/leitlinien/detail/ll/015-025.htm

Interinstitutional variations in mode of birth after a previous caesarean section: a cross-sectional study in six german hospitals

Aims: Regional and interinstitutional variations have been recognized in the increasing incidence of caesarean section. Modes of birth after previous caesarean section vary widely, ranging from elective repeat caesarean section (ERCS) and unplanned repeat caesarean section (URCS) after trial of labour to vaginal birth after caesarean section (VBAC). This study describes interinstitutional variations in mode of birth after previous caesarean section in relation to regional indicators in Germany. Material and methods: A cross-sectional study using the birth registers of six maternity units (n = 12,060) in five different German states (n = 370,209). Indicators were tested by chi(2) and relative deviations from regional values were expressed as relative risks and 95% confidence intervals. Results: The percentages of women in the six units with previous caesarean section ranged from 11.9% to 15.9% (P = 0.002). VBAC was planned for 36.0% to 49.8% (P = 0.003) of these women, but actually completed in only 26.2% to 32.8% (P = 0.66). Depending on the indicator, the units studied deviated from the regional data by up to 32% [relative risk 0.68 (0.47-0.97)] in respect of completed VBAC among all initiated VBAC. Conclusions: There is substantial interinstitutional variation in mode of birth following previous caesarean section. This variation is in addition to regional patterns

Interinstitutional variations in mode of birth after a previous caesarean section: a cross-sectional study in six german hospitals

Aims: Regional and interinstitutional variations have been recognized in the increasing incidence of caesarean section. Modes of birth after previous caesarean section vary widely, ranging from elective repeat caesarean section (ERCS) and unplanned repeat caesarean section (URCS) after trial of labour to vaginal birth after caesarean section (VBAC). This study describes interinstitutional variations in mode of birth after previous caesarean section in relation to regional indicators in Germany. Material and methods: A cross-sectional study using the birth registers of six maternity units (n = 12,060) in five different German states (n = 370,209). Indicators were tested by chi(2) and relative deviations from regional values were expressed as relative risks and 95% confidence intervals. Results: The percentages of women in the six units with previous caesarean section ranged from 11.9% to 15.9% (P = 0.002). VBAC was planned for 36.0% to 49.8% (P = 0.003) of these women, but actually completed in only 26.2% to 32.8% (P = 0.66). Depending on the indicator, the units studied deviated from the regional data by up to 32% [relative risk 0.68 (0.47-0.97)] in respect of completed VBAC among all initiated VBAC. Conclusions: There is substantial interinstitutional variation in mode of birth following previous caesarean section. This variation is in addition to regional patterns

Interinstitutional variations in mode of birth after a previous caesarean section: a cross-sectional study in six German hospitals

Abstract Aims: Regional and interinstitutional variations have been recognized in the increasing incidence of caesarean section. Modes of birth after previous caesarean section vary widely, ranging from elective repeat caesarean section (ERCS) and unplanned repeat caesarean section (URCS) after trial of labour to vaginal birth after caesarean section (VBAC). This study describes interinstitutional variations in mode of birth after previous caesarean section in relation to regional indicators in Germany. Material and methods: A cross-sectional study using the birth registers of six maternity units (n = 12,060) in five different German states (n = 370,209). Indicators were tested by χ 2 and relative deviations from regional values were expressed as relative risks and 95% confidence intervals. Results: The percentages of women in the six units with previous caesarean section ranged from 11.9% to 15.9% (P = 0.002). VBAC was planned for 36.0% to 49.8% (P = 0.003) of these women, but actually completed in only 26.2% to 32.8% (P = 0.66). Depending on the indicator, the units studied deviated from the regional data by up to 32% [relative risk 0.68 (0.47 -0.97)] in respect of completed VBAC among all initiated VBAC. Conclusions: There is substantial interinstitutional variation in mode of birth following previous caesarean section. This variation is in addition to regional patterns

General laws passed by the General Court of Massachusetts

This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups

[Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, February 2019) - Part 2 with Recommendations on the Tertiary Prevention of Preterm Birth and the Management of Preterm Premature Rupture of Membranes].

AIMS This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups. METHODS The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus). RECOMMENDATIONS Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes

Prävention und Therapie der Frühgeburt - Leitlinie der DGGG, OEGGG und SGGG (S2k-Niveau, AWMF-Registernummer 015/025, Februar 2019) : Teil 1 mit Empfehlungen zur Epidemiologie, Ätiologie, Prädiktion, primären und sekundären Prävention der Frühgeburt

Aims: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups. Methods: Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus). Recommendations: P art I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth