Need for less tight glucose control in early pregnancy after embryogenesis due to high risk of maternal hypoglycaemia in women with pre-existing diabetes can be compensated by good control in late pregnancy.

AIM: Poor glucose control is associated with adverse outcomes in pregnancies with pre-existing diabetes. However, strict glucose control increases the risk of severe hypoglycaemia, particularly in the first trimester. Therefore, we aimed to investigate whether less tight glucose control in the first trimester determines adverse outcomes or can be compensated for by good control in late pregnancy. METHODS: Retrospective data were collected from 517 singleton pregnancies complicated by pre-existing diabetes delivering between 2010 and 2017. Three hundred and thirty-six pregnancies fulfilled the inclusion criteria of having available HbA1c values either pre-conception or in the first trimester (65% type 1 diabetes, 35% type 2 diabetes). RESULTS: Higher HbA1c values in the first trimester were associated with increasing rates of large for gestational age (LGA) neonates, preterm delivery or neonatal intensive care unit admissions. Multiple regression analysis demonstrated third trimester HbA1c , type 1 diabetes, multiparity and excess weight gain, but not first trimester HbA1c , to be independently predictive for LGA. Pre-eclampsia and third trimester HbA1c increased the risk for preterm delivery. If HbA1c was ≤ 42 mmol/mol (6.0%) in the third trimester, rates of adverse outcomes were not significantly higher even if HbA1c targets of ≤ 48 mmol/mol (6.5%) had not been met in the first trimester. Good first trimester glucose control did not modify the rates of adverse outcomes if HbA1c was > 42 mmol/mol (6.0%) in the third trimester. CONCLUSIONS: Less tight glycaemic control, for example due to high frequency of severe hypoglycaemia in the first trimester, does not lead to increased adverse neonatal events if followed by tight control in the third trimester. Besides glycaemic control, excess weight gain is a modifiable predictor of adverse outcome.

Higher rates of large-for-gestational-age newborns mediated by excess maternal weight gain in pregnancies with Type 1 diabetes and use of continuous subcutaneous insulin infusion vs multiple dose insulin injection.

AIMS: To compare glycaemic control, maternal and neonatal outcomes in pregnancies with Type 1 diabetes, managed either by continuous subcutaneous insulin infusion, multiple daily insulin injection or switch from multiple daily insulin injection (MDI) to continuous subcutaneous insulin infusion (CSII) in early pregnancy. RESEARCH DESIGN AND METHODS: Data from 339 singleton pregnancies were retrospectively reviewed. HbA1c values were measured preconception and in each trimester. In a secondary analysis, use of CSII pre-pregnancy was compared with initiation of CSII during pregnancy. RESULTS: MDI was used in 140 pregnancies (41.3%) and CSII was used in 199 (58.7%), including 34 pregnancies (10.0%) during which the women switched to CSII. In pregnancies during which CSII was used duration of diabetes [median (interquartile range) 16.0 (8.0-23.0) years vs 11.0 (5.5-17.5) years; P<0.001] was longer, and the Institute of Medicine recommendations for appropriate weight gain were exceeded more often (64.8% vs. 50.8%; P=0.01). CSII use and pre-pregnancy BMI were independent predictors of excess weight gain. There was no difference in glucose control, but CSII was associated with higher birth weight [median (interquartile range) 3720 (3365-4100) g vs 3360 (3365-4100) g; P<0.001] and higher large-for-gestational-age (LGA) rate (44.7% vs. 33.6%; P=0.04) than MDI. HbA1c concentration in the third trimester and excess weight gain were predictive of LGA infants [odds ratio 2.33 (95% CI 1.54-3.51); P<0.001 and 1.89 (95% CI 1.02-3.51); P=0.04]. In pregnancies where CSII therapy was initiated in the first trimester and in those with pre-pregnancy use, similar glucose control and outcome was achieved. CONCLUSIONS: There was no advantage of CSII with respect to glycaemic control and neonatal outcomes. The rate of LGA neonates was higher in the CSII group, possibly mediated by excess maternal weight gain, which was more frequent than in women treated with MDI.

[Is there also a gynecologist for men? : A randomised controlled trial of ÄGGF information sessions in schools as a bridge to the urologist's consultations with boys]. / Gibt's auch 'nen Frauenarzt für Männer? : Eine randomisiert kontrollierte Studie der ÄGGF-Präventionsveranstaltungen in Schulen als Brücke zur Jungensprechstunde beim Urologen.

BACKGROUND: There are hardly any prevention programmes for health education and communication for boys in Germany. Boys seldom know when, how and to whom to turn to for questions or problems in the field of sexual and reproductive health. METHODS: From 2014-2016 the Medical Society for Health Promotion carried out a unique project for gender-sensitive medical health promotion for boys of all school types at 130 Bavarian schools. In 2015, 15 Bavarian schools took part in the evaluation (6th, 8th, 9th and 11th grade). At school level, similar schools have been randomised to trial and control groups. In the experimental group, three waves were conducted in panel design and two interviews were conducted in the control group using paper questionnaires. The number of cases in the panel is 599 (358 intervention group, 241 waiting control group). RESULTS: In all school types and grade levels, a highly significant increase in knowledge can be demonstrated. There is an average of 28% of the intervention group's overall knowledge improvement compared to the control group. More than 50% of the participants consider themselves to be very well informed before the intervention, although the objectively available knowledge does not justify this (e. g. average proportion of correctly answered questions on male anatomy and physiology 0.7 out of 6). The participants rate the medical information sessions and the fact that they are conducted by doctors with 1.7 or 1.6 (1: very good, to 5: poor). DISCUSSION: Boys urgently need proper knowledge transfer in the field of sexual health. They benefit regardless of the types of school from these health information sessions. The gender-sensitive and socially compensatory medical information sessions are highly accepted, effective and serve as a bridge to the general practitioners. A nationwide establishment of the intervention seems thus absolutely necessary.

[Anesthesia in obstetrics: Tried and trusted methods, current standards and new challenges]. / Anästhesie in der Geburtshilfe: Altbewährtes, gegenwärtige Standards und neue Herausforderungen.

Obstetric analgesia and anesthesia have some specific aspects, which in particular are directly related to pathophysiological alterations during pregnancy and also to the circumstance that two or even more individuals are always affected by complications or therapeutic measures. This review article deals with some evergreens and hot topics of obstetric anesthesia and essential new knowledge on these aspects is described. The article summarizes the talks given at the 16th symposium on obstetric anesthesia organized by the Scientific Committee for Regional Anaesthesia and Obstetric Anaesthesia within the German Society of Anaesthesiology. The topics are in particular, special features and pitfalls of informed consent in the delivery room, challenges in education and training in obstetric anesthesia, expedient inclusion of simulation-assisted training and further education on risk minimization, knowledge and recommendations on fasting for the delivery room and cesarean sections, monitoring in obstetric anesthesia by neuraxial and alternative procedures, the possibilities and limitations of using ultrasound for lumbal epidural catheter positioning in the delivery room, recommended approaches in preparing peridural catheters for cesarean section, basic principles of cardiotocography, postoperative analgesia after cesarean section, the practice of early bonding in the delivery room during cesarean section births and the management of postpartum hemorrhage.

[How can young academics be recruited? Acceptance and effects of urological practice-oriented training]. / Nachwuchs gewinnen - aber wie? : Akzeptanz und Effekte eines urologischen Praxistrainings.

BACKGROUND: There is an increasing lack of young doctors in German hospitals, including urology departments. The aim of this study was to evaluate the benefit of urology practice-oriented courses for German students in a skills laboratory with respect to acceptance, learning success and enthusiasm of the students for urology. METHODS: Transurethral catheterization, digital rectal examination and kidney/bladder sonography were trained in the urology course. Using a 12-point questionnaire, acceptance and quality of the training were evaluated. Learning success was checked using a urological OSCE-station (Objective Structured Clinical Examination). Additionally, participants were questioned on interest in urology and the consideration of future work in the field (medical elective or practical year). RESULTS: A total of 147 questionnaires from 190 participating students were suitable for analysis. Acceptance and quality of training were highly ranked accompanied by a very satisfying objective and subjective learning success. Interest for urology was stimulated in 98.4 % and future work in urology was imaginable for 60.4 % of the students. DISCUSSION: Practice-oriented urology student courses show high acceptance, high learning success and increase of attractiveness of urology. The training of urological skills represents a sufficient tool to entice students for urology and is helpful in enhancing the future of urology.

[Individual neonatal end-of-life care and family-centred bereavement support]. / Familienzentrierte Sterbe- und individuelle Trauerbegleitung an einem Perinatalzentrum.

Neonatal end-of-life care and family-centred bereavement support in perinatal medicine are a multiprofessional challenge directed to the dying newborn and the parents as well as to the care-givers. Clinical experience shows that many aspects of individual neonatal end-of-life care and family-centred bereavement support are not well known to the health-care providers. This is especially true for a standardised quality management and the components of bereavement support offered to parents. An interdisciplinary concept for an individual neonatal end-of-life care and famlily-centred bereavement support has been developed at the Center of Perinatal Medicine at the Charité, Berlin. The concept aims for two main aspects: (1) meeting the individual medical, psychological, emotional and spiritual needs of the dying newborn, the parents and family, and (2) facilitating standardised and process-orientated preparation, evaluation and reflexion of every case of end-of-life care. In this article some recommendations for implementing a basic care concept for families and their dying newborns are presented.

Sexual behaviour and Chlamydia trachomatis infections in German female urban adolescents, 2004.

This ad-hoc observational study, conducted in the metropolitan area of Berlin during 2004, revealed that the prevalence of Chlamydia trachomatis (CT) infections in female urban adolescents self-presenting at their gynaecologist without (n=397) or with (n=124) symptoms of CT infection was 5.5% (95% CI 3.7-8.2%) and 9.7% (95% CI 5.6-16.2%), respectively. The prevalence of CT infection was significantly dependent on the number of lifetime sexual partners. Condom use was inconsistent, and lack of knowledge about CT infections and associated health risks predominated in this cohort. The data indicated a need for health education concerning CT to be targeted at female adolescents.

[Chlamydia trachomatis infections in teenagers]. / Chlamydia-trachomatis-Infektionen bei Teenagern.

Adolescents enter puberty early and many have sexual intercourse at a young age. That sexual intercourse can have side effects with life-long consequences is still a taboo field. In Germany, we do not have figures about the prevalence of the most frequently occurring sexually transmitted diseases in young people. Therefore the Medical Association for the Promotion of Women's Health (AGGF) initiated a prevalence study on infection with Chlamydia trachomatis (CT) in girls younger than 18 years in Berlin (n=266). After informed consent, information was given in 92 school classes. Thereafter in 30 offices of gynecologists the girls were offered a PCR test for the detection of CT free of charge. The results--10% of the 17-year-old girls had an acute chlamydial infection after an average of 19 months of sexual activity--suggest that in Germany there is a hidden epidemic among adolescents. Adolescents are not adequately informed about the risks of CT infection; medical counseling is both desired and effective.

[Pregnancy in young girls]. / Schwangerschaft bei jungen Mädchen.

More and increasingly young adolescents are sexually active and pay less or no attention to contraception. The pregnancy rate among adolescents has been definitely increasing in recent years and especially among the youngest. This entails a large proportion of medicosomatic and also psychosocial risks such as premature labour and delivery as well as social disadvantages. Moreover, abortions have greatly increased. e.g. by 20% in 2001. Among the causes besides earlier maturity we may assume inadequate sex education falling short of cognitive capacity and emotional needs as well as difficult social problems with deficiencies in tenderness requirements and poor prospects of vocational training and professional career 8 examples, case reports). The overall situation pre-programmes medium-term and long-term consequences such as deficient school education and training, financial dependence and excessive financial and emotional strain on mother and child. A considerable gap in this regard can be filled by medical health promotion in step with physical and mental development, as well as by primary and secondary prevention in respect of information deficits, within the framework of a sound relationship of trust and reliability between the physician and the (female) patient.

[Testing a screening strategy for identifying psychosomatic patients in gynecologic practice]. / Testung einer Screening-Strategie zur Identifizierung psychosomatisch auffälliger Patientinnen einer gynäkologischen Praxis.

In a pilot-study 103 gynecological outpatients answered a gynecological questionnaire (FGB) including items of the (non-gynecological) complaints questionnaire (GBB) and a mood questionnaire (BSF). Cluster analyses of the FGB- and BSF-scores identify four groups. One group, consisting of 26 outpatients (= 25%), has as high GBB- and BSF-scores as a group of 256 psychosomatic in-patients answering these questionnaires at the beginning of their psychosomatic therapy. These 26 outpatients are labeled as high risk patients. Further results show high correlations between all FGB- and GBB-scores among the gynecological outpatients. A significant connection between the four group classification and ten biopsychosocial variables is found only for the variable professional state. The results are seen as a first confirmation of the tested screening-strategy. Moreover they give evidence that further investigations should pay more attention to the connection between job strain and gynecological complaints or disorders.

[Pictures by pregnant patients with premature labor. Initial experiences with art therapy]. / Bilder von Schwangeren mit vorzeitigen Wehen. Erste Erfahrungen eines maltherapeutischen Angebots.

Patients with preterm labor not only suffer from anxiety and uncertainty regarding the healthy development of their child but, especially as inpatients, in part severely from loss of autonomy and feelings of insufficiency. By the creative therapeutic means of art therapy it is aimed at influencing the disturbed emotional state and strengthening self-esteem. During the sessions patients experience challenge, success and relaxation with endurance some time after the sessions. Paintings produced by hospitalized patients in art therapeutic sessions are presented. Further psychophysiological investigations are in process for controlling the effects on preterm labor. Paintings of inpatients are discussed.