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1.
Arch Gynecol Obstet ; 302(1): 1-4, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32409923

RESUMEN

BACKGROUND: Effective prevention of preterm birth as cause of serious risks for the infant as well as the mother pre- and postpartum is one of the still unsolved problems in modern medicine. METHOD: The government of the State of Thuringia in cooperation with the professional organization of obstetricians and gynecologists decided in 2016 to reestablish and promote a self-care screening program based on intravaginal (i.vag.) pH measurement to reduce the incidence of preterm birth by early diagnosis and therapy of genital infection. RESULTS: Starting at zero in 2016, > 80% of pregnant women in the state had their vaginal pH monitored at the end of 2018 (n = 17.180). This was associated with a reduced incidence of early preterm birth measured by gestational week ≤ 32 (1.46 vs. 1.26%). CONCLUSION: The fourth millennium goal missed worldwide in 2015 as well as the newly declared third objective of the UN could come closer using the simple and cheap i.vag. pH-self-screening regime in prevention of preterm birth, an approach partly turning the woman from being object of medical care to being the subject in self-control of her pregnancy. This is also a well perceived change in paradigm from the perspective of females as well as physicians.


Asunto(s)
Tamizaje Masivo/métodos , Nacimiento Prematuro/epidemiología , Vagina/química , Aborto Espontáneo/prevención & control , Administración Intravaginal , Femenino , Edad Gestacional , Humanos , Concentración de Iones de Hidrógeno , Incidencia , Recién Nacido , Embarazo , Nacimiento Prematuro/etiología , Nacimiento Prematuro/prevención & control , Vagina/metabolismo , Vagina/microbiología
2.
Z Geburtshilfe Neonatol ; 223(5): 304-316, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31623006

RESUMEN

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: Part 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.


Asunto(s)
Guías de Práctica Clínica como Asunto , Nacimiento Prematuro , Austria , Femenino , Humanos , Recién Nacido , Embarazo , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Nacimiento Prematuro/prevención & control , Prevención Primaria , Sistema de Registros , Prevención Secundaria , Sociedades Médicas
3.
Z Geburtshilfe Neonatol ; 223(6): 373-394, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31801169

RESUMEN

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.


Asunto(s)
Rotura Prematura de Membranas Fetales , Trabajo de Parto Prematuro/prevención & control , Guías de Práctica Clínica como Asunto , Nacimiento Prematuro , Sociedades Médicas , Prevención Terciaria , Incompetencia del Cuello del Útero , Austria , Femenino , Rotura Prematura de Membranas Fetales/prevención & control , Rotura Prematura de Membranas Fetales/terapia , Humanos , Recién Nacido , Obstetricia , Embarazo , Nacimiento Prematuro/prevención & control , Nacimiento Prematuro/terapia , Sistema de Registros
4.
Arch Gynecol Obstet ; 298(3): 461-463, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30066142

RESUMEN

Prevention of preterm birth as a cause of serious risks for the infant as well as the mother is one of the still unsolved problems in modern medicine. The list of factors for miscarriage, prematurity and stillbirth is lengthy. The Thuringia preventional campaign 2017 offers an effective simple screening approach based on intravaginal pH measurement.


Asunto(s)
Tamizaje Masivo/métodos , Nacimiento Prematuro/prevención & control , Aborto Espontáneo/prevención & control , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Embarazo , Nacimiento Prematuro/etiología , Mortinato
5.
Arch Gynecol Obstet ; 294(1): 1-3, 2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-27146862

RESUMEN

Effective prevention of preterm birth is one of the unsolved problems in modern medicine. In the Thuringia campaign 2000 based on a simple screening with intravaginal pH self-measurements, adequate medical diagnosis and immediate antimicrobial therapy of genital infection, the rate of newborns <1000 g was reduced to 0.38 %, the lowest incidence ever seen in any of the German states. Therefore, the regime should be implicated as a necessary step of optimizing and rationalizing the health care system. However, in the discussion we had to learn that the best way to inhibit progress is to cope with problems by preferring the most complicated policies under persistent renunciation of simple solutions. As long as we do not have other alternative safe, simple and cheap methods, do we really have to wait even more decades to come for a prospectively randomized double-blinded almost impracticable study to convince the latest skeptical scientist that we have plenty of evidence-based means to reduce the incidence of premature birth, now, by decreasing infectious morbidity in pregnancy and by the same action childbed fever as well? Insisting scholastically on nothing but the 100 % pure evidence sometimes can hamper innovations and potential benefit. Would a similar caution ever had allowed us for instance to introduce handwashing according to Semmelweis? Good news, the Government of the State of Thuringia has decided this year to reestablish a pH selfcare screening programme.


Asunto(s)
Medicina Basada en la Evidencia , Nacimiento Prematuro/prevención & control , Femenino , Humanos , Recién Nacido , Embarazo , Nacimiento Prematuro/etiología
6.
Geburtshilfe Frauenheilkd ; 83(11): 1331-1349, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37928409

RESUMEN

Aim This official guideline was coordinated and published by the DGGG, OEGGG and SGGG with the involvement of additional professional societies. The aim of the guideline is to evaluate the relevant literature and use it to provide a consensus-based overview of the diagnosis and management of bacterial vaginosis. Methods This S2k-guideline was developed by representative members from different medical professional societies on behalf of the guidelines commission of the above-listed societies using a structured consensus process. Recommendations This guideline provides recommendations on the diagnosis, management, counselling, prophylaxis, and other aspects related to bacterial vaginosis.

9.
Geburtshilfe Frauenheilkd ; 83(5): 547-568, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37152544

RESUMEN

Aim This revised guideline was coordinated by the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (OEGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). It aims to improve the prediction, prevention, and management of preterm birth, based on evidence from the current literature, the experience of members of the guidelines commission, and the viewpoint of self-help organizations. Methods The members of the contributing professional societies and organizations developed recommendations and statements based on international literature. The recommendations and statements were presented and adopted using a formal process (structured consensus conferences with neutral moderation, written Delphi vote). Recommendations Part 1 of this short version of the guideline presents statements and recommendations on the epidemiology, etiology, prediction, and primary and secondary prevention of preterm birth.

10.
Geburtshilfe Frauenheilkd ; 83(5): 569-601, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37169014

RESUMEN

Aim The revision of this guideline was coordinated by the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (OEGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of the guideline is to improve the prediction, prevention and management of preterm birth based on evidence from the current literature, the experience of members of the guidelines commission, and the viewpoint of self-help organizations. Methods The members of the contributing professional societies and organizations developed recommendations and statements based on international literature. The recommendations and statements were presented and adopted using a formal process (structured consensus conferences with neutral moderation, written Delphi vote). 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.

11.
GMS Infect Dis ; 8: Doc12, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32373437

RESUMEN

This is the eighth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. The chapter deals with the treatment of more severe infections of the kidney and the urogenital tract, including urosepsis. Recommendations for empiric and targeted antibacterial treatment are given.

12.
Geburtshilfe Frauenheilkd ; 79(8): 800-812, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31423016

RESUMEN

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 Part 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.

13.
Geburtshilfe Frauenheilkd ; 79(8): 813-833, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31423017

RESUMEN

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.

16.
Dtsch Arztebl Int ; 108(6): 81-6, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21373274

RESUMEN

BACKGROUND: From 2004 to 2006, in a model project carried out by four German health insurers, expectant mothers were offered self-testing of vaginal pH in order to prevent preterm delivery. They were given pH test gloves on request so that they could measure their vaginal pH twice a week from the 12(th) to the 32(nd) week of gestation. They were instructed to consult with a gynecologist after any positive result. All further diagnostic or therapeutic decisions were at the discretion of the treating gynecologist. We assessed the effectiveness of the screening intervention, using delivery before the 37th week of gestation as the primary endpoint. METHODS: In this prospective, controlled trial, we collected data on deliveries from 2004 to 2006 that were covered by the four participating insurers in five German federal states. We compared the outcomes of pregnancy in women who did and did not request test gloves (intervention group, [IG], and control group, [CG]). The data were derived from claims data of the participating insurers, as well as from a nationwide quality assurance auditing program for obstetrics and perinatal care. Propensity score matching and multivariate adjustment were used to control for the expected self-selection bias. RESULTS: The study sample comprised 149 082 deliveries. 13% of the expectant mothers requested test gloves, about half of them up to the 16(th) week of gestation. As expected, women with an elevated risk of preterm birth requested test gloves more often. Delivery before the 37(th) week of gestation was slightly more common in the intervention group than in the control group (IG 7.97%, CG 7.52%, relative risk 1.06, 95% confidence interval 1.00-1.12). This result was of borderline statistical significance in the propensity score matched analysis, but it was not statistically significant in the multivariate model. CONCLUSION: This trial did not demonstrate the efficacy of self-testing of vaginal pH for the prevention of preterm delivery (< 37 weeks of gestation).


Asunto(s)
Autoevaluación Diagnóstica , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/prevención & control , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/prevención & control , Adolescente , Adulto , Comorbilidad , Femenino , Alemania/epidemiología , Humanos , Concentración de Iones de Hidrógeno , Persona de Mediana Edad , Embarazo , Nacimiento Prematuro/diagnóstico , Nacimiento Prematuro/epidemiología , Prevalencia , Reproducibilidad de los Resultados , Medición de Riesgo , Factores de Riesgo , Sensibilidad y Especificidad , Vaginosis Bacteriana/epidemiología , Adulto Joven
17.
Dtsch Arztebl Int ; 108(24): 415-23, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21776311

RESUMEN

BACKGROUND: Urinary tract infections (UTIs) are among the most common types of bacterial infection in outpatient medicine. Rising rates of antibiotic resistance and a better understanding of the ecological adverse effects (collateral damage) of antibiotics warrant a reevaluation of the treatment recommendations for uncomplicated UTI. The new S3 guideline contains updated recommendations. METHODS: The new S3 guideline is based on a review of publications on uncomplicated UTI retrieved by a systematic search of the Medline and Cochrane Library databases. Guidelines from abroad were also considered in the review. RESULTS: Uncomplicated UTI is classified as either uncomplicated cystitis (UC) or uncomplicated pyelonephritis (UP). The choice of a suitable antibiotic is determined by the following main criteria: the patient's individual risk profile and prior antibiotic treatment, if any; the spectrum of pathogens and antibiotic susceptibility; the proven efficacy of the antibiotic; the ecological adverse effects (collateral damage) of antimicrobial therapy; the side effects for the patient under treatment. On the basis of these criteria, co-trimoxazole/trimethoprim and fluoroquinolones can no longer be recommended as first-line empirical treatment for UC. Rather, the new recommended treatment of first choice consists of fosfomycin-trometamol, nitrofurantoin, or pivmecillinam. High-dose fluoroquinolones are still recommended, however, as first-line oral treatment for UP. Asymptomatic bacteriuria should only be treated in exceptional situations such as pregnancy or before urological procedures that will probably injure the mucosa of the urinary tract. CONCLUSION: The new S3 guideline on uncomplicated UTI incorporates a forward-looking approach to the use of antibiotics in treating this common type of infection. It is intended to bring about a sustained improvement in the quality of care.


Asunto(s)
Antibacterianos/administración & dosificación , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/prevención & control , Urología/normas , Antibacterianos/efectos adversos , Relación Dosis-Respuesta a Droga , Humanos , Prevención Secundaria
18.
J Matern Fetal Neonatal Med ; 21(8): 513-6, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18609356

RESUMEN

OBJECTIVE: The connection between adhesions and post-operative symptoms is well established. Adhesions are found in nearly half of the women at the time of their repeat cesarean section. For the first time a prospective pilot study has been done in order to evaluate the clinical significance of post-cesarean adhesions. STUDY DESIGN: Fifty women who underwent cesarean section in their first pregnancy were interviewed prior to their repeat operation regarding their symptoms after the first surgery. The clinical history was correlated with the findings during the second intervention. RESULTS: No correlation was found between the clinical symptoms and the operative findings regarding abdominal pains, urinary symptoms, dyspareunia, or dysmenorrhea. Surprisingly, although non-significant, women with adhesions reported fewer postoperative gastrointestinal symptoms than the women with no adhesions. CONCLUSION: More studies will have to been done, but the analysis of this pilot study supports the hypothesis that adhesions following cesarean section are a unique entity.


Asunto(s)
Cesárea/efectos adversos , Enfermedades Peritoneales/etiología , Adherencias Tisulares/etiología , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Adulto , Estreñimiento/diagnóstico , Estreñimiento/etiología , Método Doble Ciego , Dismenorrea/diagnóstico , Dismenorrea/etiología , Dismenorrea/patología , Femenino , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/etiología , Humanos , Enfermedades Peritoneales/diagnóstico , Enfermedades Peritoneales/patología , Proyectos Piloto , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Embarazo , Proyectos de Investigación , Adherencias Tisulares/diagnóstico , Adherencias Tisulares/patología
19.
Infect Dis Obstet Gynecol ; 11(1): 65-70, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12839635

RESUMEN

Bacterial contamination of the operative site is a common occurrence in obstetrics and gynecology. The widespread use of antibiotic prophylaxis has reduced but not eliminated serious postoperative infections. For most operations, a single dose of a limited-spectrum drug has been as effective as a multidose regimen. In the differential diagnosis it is important to consider cellulitis, abscess, necrotizing fasciitis and septic pelvic thrombophlebitis. Abscess and necrotizing fasciitis are expected to require invasive therapy in addition to antibiotics, while cellulitis and septic pelvic thrombophlebitis should respond to medical management alone. Although a postoperative fever is a warning sign of possible infection, it may also be caused by the antibiotics that are given for treatment. The use of prolonged courses of antibiotics once the patient is clinically well is discouraged. While clinical guidelines are provided for use in the diagnosis and management of postoperative infections, these recommendations are intended for general direction and not as an exclusive management plan.


Asunto(s)
Antibacterianos/administración & dosificación , Profilaxis Antibiótica/normas , Guías de Práctica Clínica como Asunto , Prevención Primaria/normas , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/prevención & control , Femenino , Estudios de Seguimiento , Alemania , Adhesión a Directriz , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Procedimientos Quirúrgicos Obstétricos/efectos adversos , Procedimientos Quirúrgicos Obstétricos/métodos , Complicaciones Posoperatorias/tratamiento farmacológico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Resultado del Tratamiento
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