[S3 guidelines on "full-term vaginal birth" from an anesthesiological perspective : Worthwhile knowledge for anesthesiologists]. / S3-Leitlinie "Vaginale Geburt am Termin" aus anästhesiologischer Sicht : Wissenswertes für den Anästhesisten.

The publication of the new S3 guidelines on "full-term vaginal birth" and the guidelines on cesarean section, also published in 2020, provide further steps towards the promotion of evidence-based medicine in obstetrics, even if the exact configuration of neonatal monitoring during birth, in particular, is still the subject of current discussions. The multiprofessionality in the medical supervision of a birth is also fundamentally well-represented in the compilation of the S3 guidelines by the participating actors and specialist societies. Important from an anesthesiological perspective is the fact that neuraxial procedures still represent the gold standard in obstetric analgesia. With remifentanil PCA an alternative option is available that enables a reliable analgesia to be accomplished, e.g. when there are contraindications to performing neuraxial methods, if this is appropriate under the prevailing circumstances (1:1 support and appropriate monitoring). During an uncomplicated birth the strict fasting rules are relaxed. Overall, the guidelines underline the importance of self-determination and self-control for the expectant mother and give the highest priority to the safety and well-being of mother and child; however, this presupposes that the expectant mother is sufficiently informed about the value of neuraxial analgesia. For this it appears to be of importance to initiate information proposals, which go beyond the usual information sessions for parents that are often organized exclusively by midwives.

[Sonographic studies of patients with postmenopausal hemorrhage (endometrium/myometrium index)]. / Sonographische Untersuchung an Patientinnen mit postmenopausalen Blutungen (Endometrium/Myometrium-Index).

Ultrasonographic examination was performed in 120 patients with post-menopausal bleedings before a diagnostic curettage. In comparison with the final histological diagnoses the sonographic diagnoses were found to be correct in 97 patients (86.2% right-negative; 79.7% right-positive). The proportion of false-negative and false-positive results was found to be 12.1% and 16.9% respectively. Specificity and sensitivity values were 83.3% and 87.1%. The endometrium/myometrium-index enabled us to make a good judgment of the endometrium, since it considers both the endometrial and myometrial thicknesses simultaneously. This index was found to be below 0.5 (0.27) in those patients with normal sonographic findings and in patients with pathological sonographic findings it was found to be 1.3. Ultrasound is therefore a non-invasive diagnostic aid for the diagnoses of pathological changes of the endometrium.

[Cervical pregnancy--an unusual form of extrauterine pregnancy]. / Die zervikale Schwangerschaft--eine seltene Form der extrauterinen Gravidität.

We present a case report about a 27 years old patient with cervical pregnancy. The extrauterine implantation was recognized in the 14th week of gestation. Abdominal hysterectomy was performed because of a life threatening bleeding.

[Pregnancy-induced trophoblast diseases--results from the years 1976-1992]. / Gestationsbedingte Trophoblast-Erkrankungen--Ergebnisse der Jahre 1976-1992.

INTRODUCTION: Gestational trophoblastic diseases (GTD) represent a spectrum of different disorders, derived from the human placental trophoblast. GTDs are potentially fatal disorders and are of great importance for gynaecologists and pathologists. STUDY DESIGN: In recent years 148 GTDs were treated at department of Obstetrics and Gynaecology of Leipzig University. We reexamined these cases with respect to diagnostic findings, diagnostic mistakes, the necessity of consecutive chemotherapy and outcome. RESULTS: The 148 relevant cases included 103 complete hydatidiform moles, 13 invasive moles and 32 choriocarcinomas. 61.5% showed a spontaneous regression of HCG after molar evacuation. 57 cases developed persistent trophoblastic disease with consecutive mono-combined or polychemotherapy. An overall remission rate of 91.2% was achieved. The two patients, who died, showed a late stage of disease. 5.3% of the cases had a recurrence of disease. The most frequent side effect of chemotherapy was a moderate bone marrow depression in 58% of cases. 88.5% were diagnosed by suction curettage alone. Twelve patients had an operative intervention before chemotherapy, often due to diagnostic misinterpretation of the symptoms. Eight cases needed a secondary operation to attain complete remission. CONCLUSIONS: Initiating chemotherapy is very important for therapy success. In cases of complete hydatidiform mole, it is difficult to make a prognostic statement with reference to biological behaviour of the disease by morphological methods alone. The difficulties are discussed. These cases emphasise the need for appropriate clinical monitoring and close cooperation between the gynaecologist, the pathologist and the clinician.

[Ultrasound image of endometrial cancer]. / Das sonographische Bild des Endometriumkarzinoms.

In this prospective study 571 patients with postmenopausal bleeding/discharge (group I) and 300 patients without symptoms (group II) were ultrasonographically examined. The sonographic findings were compared with those of histology to evaluate the value of ultrasonography in endometrium diagnosis. The main parameters which we considered in the diagnosis of malignancy of the endometrium, were the thickness of the endometrium, the boundary of the endometrium, homogeneity and collection of fluid in the uterine cavity. However, the size of the uterus and the central endometrial echo were found not to be sensitive signs of malignancy. The sensitivity of sonography in group I was 86.3% higher than group II which is 75%. The rate of false-positive and false-negative in the total study population was 7.1%. We believe that ultrasonography is the easiest, most painless out-patient based and non-invasive diagnostic method in comparison to all other endometrium diagnostic measures, and is an advance towards better approach in the early diagnosis of endometrial carcinoma.

[Ultrasound assessment of the endometrium in early detection of endometrial cancer in high risk patients]. / Sonographische Endometriumbeurteilung zur Früherkennung des Endometriumkarzinoms bei Risikopatientinnen.

In 300 postmenopausal adipose and complaint-free patients but with one risk factor for the development of endometrial carcinoma one prospective study transabdominal and transvaginal ultrasonographic examinations by 3.75-MHZ abdominal and 5-MHZ vaginal sound was carried out. In all cases with endometrial thickness of 10 mm and also with endometrial thickness of 5-10 mm and irregular endometrial boundary fractional curettage was done. The rate of abnormal findings was 8% of which in 18 patients the findings were histologically confirmed (3 endometrial cancer, 5 hyperplasia, 8 polyp and 2 submucosal myomas). The sensitivity of ultrasonography was found to be 75%. Patients with normal findings were controlled in 6 months, none of these patients showed pathological symptoms.