Dysplasmatisch-idiotische Kinder ovariell insuffizienter Mütter

Archives of Gynecology and Obstetrics -     

Entwicklungsstörungen bei Kindern tuberkulöser Mütter

Archives of Gynecology and Obstetrics -     

Versorgung frühgeborener Kinder

Background

Even in the post-surfactant era, the care of very preterm infants has evolved in recent years.

Question

The perinatal mortality in Germany is mainly triggered by the mortality rate of premature infants. How can a perinatal mortality that is only average compared to the international range be reduced?

Methods

A literature review and evaluation of the latest study results in terms of perinatal mortality and morbidity of very preterm infants were carried out.

Results

The risk of premature infants to die after birth is increased if born in a low volume perinatal center and mortality is 20–100?% higher as compared to being born in a high volume center. Late clamping of the umbilical cord also reduces mortality and the incidence of intracranial hemorrhage. In addition, an invasive and aggressive treatment of preterm infants in the first days of life and in the neonatal intensive care unit carries the risk of a poorer outcome. New studies show that stabilization of even the smallest premature infants on continuous positive airway pressure (CPAP) with and without surfactant administration is beneficial for long-term development. A controlled and dosed oxygen supply with a narrow target range for oxygen saturation between 90–95?% can also have a positive impact on the healthy survival of very immature preterm infants.

Conclusion

Nowadays infants born extremely preterm can have an excellent chance of overall survival and a prospect of healthy survival under optimized conditions and optimized care.     

Müllerian anomalies

Müllerian anomalies are a relatively uncommon occurrence with implications for adolescents and adults as they may result in specific gynecologic, fertility, and obstetrical issues. The exact incidence of Müllerian anomalies is difficult to ascertain. However, clinicians should be suspicious for Müllerian anomalies in cases of primary amenorrhea, pelvic pain, repetitive pregnancy loss, and certain adverse obstetrical outcomes. While for many women a good reproductive outcome can be achieved, counseling, and in particular psychologic counseling, may be needed for some women, especially those with lesions that preclude childbearing and affect normal sexual function.     

Müllerian anomalies

The reproductive organs in both males and females consist of gonads, internal ductal structures, and external genitalia. Normal sexual differentiation is dependent on the genetic sex determined by the presence or absence of the Y chromosome at fertilization. Testes develop under the influence of the Y chromosome and ovaries develop when no Y chromosome is present. In the absence of testes and their normal hormonal products, sexual differentiation proceeds along the female pathway, resulting in a normal female phenotype. Anatomic gynecologic anomalies occur when there is failure of normal embryologic ductal development. These anomalies include congenital absence of the vagina as well as defects in lateral and vertical fusion of the Müllerian ducts. Treatment of müllerian anomalies begins with the correct identification of the anomaly and an understanding of the embryologic origin. This includes evaluation for other associated anomalies such as renal or skeletal abnormalities. After correct identification, treatment options include nonsurgical as well as surgical intervention. This chapter serves to review the embryology and development of the reproductive system and to describe common genital tract anomalies. Details of surgical or nonsurgical correction of these anomalies are presented.     

Non-Obstructive Müllerian Anomalies

BackgroundThe nonobstructive group of anatomic variants involving the reproductive tract includes vaginal agenesis as well as the congenital anomalies of the vagina and uterus, occurring without pain during the pubertal years.ObjectiveThe objective is to discuss the non-obstructive morphologic variations in anatomy of the uterus and vagina.DesignSystematic review using the GRADE system.ResultsThese congenital anomalies are not associated with abnormalities of the external genitalia and therefore may be missed on routine physical examination. When these anomalies do cause symptoms they may be as minor as difficulty with menstrual hygiene or more significant such as primary amenorrhea, dyspareunia, recurrent pregnancy loss, and reproductive complications.ConclusionsWomen with non-obstructive reproductive tract anomalies present at various ages due to the asymptomatic nature or late symptom onset of certain conditions. An MRI is the gold standard in evaluation of such conditions to aid in confirming the müllerian variant. Each condition requires careful counseling because obstetric and gynecologic risks and consequences may differ. Treatment is individualized in cases of uterovaginal agenesis with both nonsurgical and surgical options available for neovagina creation. In cases of uterine or vaginal septae, the treatment timing may vary depending on patient history. Finally, in cases of non-obstructive communicating uterine horns, the risk of ectopic pregnancy is high in the remnant horn. Should a pregnancy occur in this small underdeveloped horn, therefore, excision is recommended.     

Geburtshilfliche Kriterien für Kinder an der Grenze der Lebensfähigkeit

Progress in technology has led to substantial improvement and new options for most medical disciplines. In perinatal medicine this process has substantially changed the situation of prenatal and neonatal care. Improvement of organization, such as centralization of care of high risk pregnancies as well as improvement of medical interventions, such as induction of fetal lung maturation by prenatal transplacental administration of steroids as well as postnatal administration of surfactant following premature delivery have led to a shift of the edge of potential survival of early preterm neonates to 23 gestational weeks. Decisive prerequisites for the improvement of neonatal care are risk-adapted obstetrical management with application of modern methods of pregnancy surveillance. Optimal time, mode and place of delivery are the basis of good clinical outcome. The core is a well trained team of highly experienced perinatologists and neonatologists as well as nurses, midwives, anesthesiologists in the place of final care and delivery, a level III perinatal center.