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1.
Z Geburtshilfe Neonatol ; 223(6): 373-394, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801169

RESUMO

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.


Assuntos
Ruptura Prematura de Membranas Fetais , Trabalho de Parto Prematuro/prevenção & controle , Guias de Prática Clínica como Assunto , Nascimento Prematuro , Sociedades Médicas , Prevenção Terciária , Incompetência do Colo do Útero , Áustria , Feminino , Ruptura Prematura de Membranas Fetais/prevenção & controle , Ruptura Prematura de Membranas Fetais/terapia , Humanos , Recém-Nascido , Obstetrícia , Gravidez , Nascimento Prematuro/prevenção & controle , Nascimento Prematuro/terapia , Sistema de Registros
2.
Z Geburtshilfe Neonatol ; 223(5): 304-316, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31623006

RESUMO

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.


Assuntos
Guias de Prática Clínica como Assunto , Nascimento Prematuro , Áustria , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Prevenção Primária , Sistema de Registros , Prevenção Secundária , Sociedades Médicas
3.
Geburtshilfe Frauenheilkd ; 79(8): 800-812, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31423016

RESUMO

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.

4.
Geburtshilfe Frauenheilkd ; 79(8): 813-833, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31423017

RESUMO

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.

5.
Arch Gynecol Obstet ; 298(3): 461-463, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30066142

RESUMO

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.


Assuntos
Programas de Rastreamento/métodos , Nascimento Prematuro/prevenção & controle , Aborto Espontâneo/prevenção & controle , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Nascimento Prematuro/etiologia , Natimorto
6.
Arch Gynecol Obstet ; 294(1): 1-3, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27146862

RESUMO

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.


Assuntos
Medicina Baseada em Evidências , Nascimento Prematuro/prevenção & controle , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/etiologia
8.
Dtsch Arztebl Int ; 108(24): 415-23, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21776311

RESUMO

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.


Assuntos
Antibacterianos/administração & dosagem , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/prevenção & controle , Urologia/normas , Antibacterianos/efeitos adversos , Relação Dose-Resposta a Droga , Humanos , Prevenção Secundária
10.
Dtsch Arztebl Int ; 108(6): 81-6, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21373274

RESUMO

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).


Assuntos
Autoavaliação Diagnóstica , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/prevenção & controle , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/prevenção & controle , Adolescente , Adulto , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Concentração de Íons de Hidrogênio , Pessoa de Meia-Idade , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/epidemiologia , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Vaginose Bacteriana/epidemiologia , Adulto Jovem
11.
J Matern Fetal Neonatal Med ; 21(8): 513-6, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18609356

RESUMO

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.


Assuntos
Cesárea/efeitos adversos , Doenças Peritoneais/etiologia , Aderências Teciduais/etiologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Constipação Intestinal/diagnóstico , Constipação Intestinal/etiologia , Método Duplo-Cego , Dismenorreia/diagnóstico , Dismenorreia/etiologia , Dismenorreia/patologia , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/etiologia , Humanos , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/patologia , Projetos Piloto , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Gravidez , Projetos de Pesquisa , Aderências Teciduais/diagnóstico , Aderências Teciduais/patologia
12.
Infect Dis Obstet Gynecol ; 11(1): 65-70, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12839635

RESUMO

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.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/normas , Guias de Prática Clínica como Assunto , Prevenção Primária/normas , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/prevenção & controle , Feminino , Seguimentos , Alemanha , Fidelidade a Diretrizes , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Procedimentos Cirúrgicos Obstétricos/efeitos adversos , Procedimentos Cirúrgicos Obstétricos/métodos , Complicações Pós-Operatórias/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Resultado do Tratamento
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