Publications by authors named "Matthias David"

120 Publications

Alte Hebammentaschen und -koffer als medizinhistorische Schatztruhen mit (Er-) Forschungsbedarf.

Z Geburtshilfe Neonatol 2021 Aug 12;225(4):377-378. Epub 2021 Aug 12.

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http://dx.doi.org/10.1055/a-1532-7773DOI Listing
August 2021

Psychosomatically Oriented Diagnostics and Therapy for Fertility Disorders. Guideline of the DGPFG (S2k-Level, AWMF Registry Number 016/003, December 2019).

Geburtshilfe Frauenheilkd 2021 Jul 13;81(7):749-768. Epub 2021 Jul 13.

Fertility Center Berlin, Berlin, Germany.

The purpose of this official guideline published and coordinated by the German Society for Psychosomatic Gynecology and Obstetrics [Deutsche Gesellschaft für Psychosomatische Frauenheilkunde und Geburtshilfe (DGPFG)] is to provide a consensus-based overview of psychosomatically oriented diagnostic procedures and treatments for fertility disorders by evaluating the relevant literature. This S2k guideline was developed using a structured consensus process which included representative members of various professions; the guideline was commissioned by the DGPFG and is based on the 2014 version of the guideline. The guideline provides recommendations on psychosomatically oriented diagnostic procedures and treatments for fertility disorders.
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http://dx.doi.org/10.1055/a-1341-9664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277440PMC
July 2021

Forceps mit integriertem Dynamometer von Samuel Kristeller (1820–1900).

Z Geburtshilfe Neonatol 2021 Jun 5;225(3):283-284. Epub 2021 Jul 5.

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http://dx.doi.org/10.1055/a-1480-6259DOI Listing
June 2021

[Perinatal Data of Women with and without Refugee Status in Berlin - Results of a Comparative Cross-Sectional Study].

Z Geburtshilfe Neonatol 2021 Apr 15. Epub 2021 Apr 15.

Klinik für Geburtsmedizin, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.

Introduction: In Germany,1.2 million asylum seekers have entered the country in 2015-2016. More than a third of these asylum seekers were women. To understand the situation of asylum seekers' pregnancies, we examined the primary health care of this particular group to understand what, if anything, needs to improve to make the German health system more accessible to pregnant asylum seekers.

Methodology: we examined 960 cases of pregnant women who delivered in 2 large maternity clinics in Berlin-Charité between January 2016-August 2017. In our comparative cross-sectional study, we compared 480 asylum-seeking women with 480 local German women. For both patient populations we acquired data on various parameters.

Results: We found only two significant differences: (1) The number of antenatal appointments attended by refugee women during their pregnancy was lower than that of the control group. The average number of antenatal appointments in the local control group was 10.6 (Max.: 27, SD 2.85, Min: 2); the refugee women attended on average 8.0 appointments (Max.: 20, SD 3.385, Min: 0) (p=0.000, adjusted relative risk 0.77 95% CI 0.74-0.81). (2) The mean Hb value in the local control group was 11.1 g/dl, while in the asylum-seeking women's group it was 10.6 g/dl (p= 0.00, adjusted difference 0.54 95% CI -0.77 to -0.34).

Conclusions: This study showed that the German health care system is capable of treating asylum-seeking women. Nevertheless, it is possible that our results do not necessarily reflect the ability of the health care system but stem from other selection parameters of the health condition of our subjects, such as the "healthy migrant effect."
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http://dx.doi.org/10.1055/a-1440-1762DOI Listing
April 2021

Placental weight in first generation migrant mothers in Germany. Do the length of stay, acculturation or migrant status play a role?

Placenta 2021 05 28;108:103-108. Epub 2021 Mar 28.

Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.

Introduction: Migration status affects perinatal outcomes. A small placenta is associated with placental dysfunction and poor outcomes. Placental weight and perinatal outcomes are influenced by migrant status, the length of stay and the level of acculturation in the host country. Our aim was to compare placental weight in first generation immigrants to native non-immigrants in a teaching hospital in Berlin. The influence of migrant status, the length of stay and the level of acculturation on placental weight was also ascertained.

Methods: At the Charité University Hospital in Berlin Germany between January 2011 and January 2012, 1373 non-migrant and 1243 first generation migrants were included. Data collection was by means of a standardized questionnaire. The level of acculturation was based on the Frankfurter Acculturation Questionnaire (Frankfurter Akkulturationsfragebogen-FRAKK). Demographic parameters such as age, maternal weight, country of origin, parity, anemia, diabetes, hypertension, smoking and neonatal outcomes including neonatal weight, placental weight were measured.

Results: We found no difference in mean placenta weight when comparing first generation women with a migration background to women of the native population (608 g vs 597 g, p-value 0.41). There was also no difference in placental weight when assessed by the length of stay and degree of acculturation in the host country.

Discussion: While first generation migrant women have increased perinatal complications, there is no influence of migrant status, length of stay and the degree of acculturation on placenta weight. Pregnancy outcomes maybe be more dependent on factors such as the access to adequate maternal care.
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http://dx.doi.org/10.1016/j.placenta.2021.03.016DOI Listing
May 2021

"Ever Forward": In Memory of the Foundation of Monatsschrift für Geburtshülfe und Gynaekologie (Monthly Review of Obstetrics and Gynecology) 125 Years Ago.

Gynecol Obstet Invest 2020 14;85(6):457-463. Epub 2021 Apr 14.

Klinik für Gynäkologie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.

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http://dx.doi.org/10.1159/000514124DOI Listing
April 2021

Gynaekeumenes: A Nonrepresentative Selection of Notable Articles Published in the Monatsschrift and Gynaecologia from 1896 to 1969.

Gynecol Obstet Invest 2020 14;85(6):501-508. Epub 2021 Apr 14.

Praxis für Frauengesundheit, Gynäkologie und Geburtshilfe, Berlin, Germany.

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http://dx.doi.org/10.1159/000514816DOI Listing
April 2021

[Use of emergency rooms by so-called multiple users: results of a prospective study with special consideration of the migration status].

Notf Rett Med 2021 Feb 24:1-7. Epub 2021 Feb 24.

Campus Virchow-Klinikum, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Deutschland.

Objectives: Can we identify predictive factors for the group of so-called multiple users (MU; 4 and more uses of an emergency department [ED] in the past 12 months)? Are people with a migration background more likely to be classified in the MU group?

Methodology: Included were consecutive patients who visited three EDs in Berlin from July 2017 to July 2018. Using a questionnaire, diseases, reasons for visiting the ED and socioeconomic factors were recorded. Comparisons between migrants (1st generation), their descendants (2nd generation) and nonmigrants were assessed using logistic regression.

Results: A total of 2339 patients were included in the evaluation (repeat rate 56%), of which 901 had a migration background. Young women (<30 years), chronically ill, pregnant women, patients with severe complaints and people with (self-assessed) moderate and poor health quality as well as those without medical referral had a greater chance of multiple use of ED.

Conclusion: MU burden the already increasing patient volume of ED. However, they represent a heterogeneous group of patients, among whom people with a migration background are not common. Further research is warranted to better understand the factors that lead to frequent use and to develop effective strategies to address the complex health needs of MUs.
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http://dx.doi.org/10.1007/s10049-021-00851-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904028PMC
February 2021

Evaluation of Biomarkers in Myoma Patients: A Prospective Study Investigating the Role of LDH, CA 125, and IGF-1 after Uterus-Preserving Surgical Therapy.

Gynecol Obstet Invest 2021 12;86(1-2):100-107. Epub 2021 Feb 12.

Department of Gynecology with Center for Oncological Surgery, Campus Virchow Charité University Hospital Berlin, Berlin, Germany,

Objective: Myomas are one of the most common tumors of the lower abdomen in women. At present, sonography and clinical examination are the prevalent diagnostic standards for these tumors, and no biomarkers have been established yet. The primary aim of this study was to determine if the surgical removal of myomas leads to a drop of lactate dehydrogenase (LDH), CA 125, and/or insulin-like growth factor (IGF-1) and therefore if these parameters are suitable as potential biomarkers for the presence or recurrence of a myoma.

Study Design: The blood levels of LDH, CA 125, and IGF-1 were determined in 83 patients (age 18-50) with a verified diagnosis of myomas and surgical therapy at 3 different timepoints: preoperative (T0), 2 days postoperative (T1), and 6 months postoperative (T2). Vaginal sonography was performed preoperatively and once again at 6 months postoperatively.

Results: The median (Q1-Q3) LDH values dropped significantly postoperatively: 239 (217-266) U/L at T0 versus 217 (190-255) U/L at T1, p < 0.001. The median (Q1-Q3) IGF-1 values also dropped: 140.4 (118.6-179.0) ng/mL versus 112.4 (99.5-143.0), p < 0.001. By contrast, the CA 125 values rose slightly but not significantly. At 6 months (n = 34), the LDH values were not significantly different from either the preoperative or the immediate postoperative values. This was observed both in patients with and without a recurrence of myoma. In contrast, the median (Q1-Q3) IGF-1 level at T2 was significantly elevated both in patients with sonographic evidence of new myomas (129.0 [116.0-163.1] ng/mL, p = 0.023) and in patients with sonographic proof of no new myomas (161.0 [130.2-198.5] ng/mL, p < 0.001).

Conclusion: Both LDH and IGF-1 dropped significantly in the immediate postoperative days in women with myomas after uterus-preserving surgeries were performed. The postoperative concentration of IGF-1 was correlated with the evidence of new myomas and can be potentially used for further monitoring. Future studies should be able to confirm these results. This study concludes that myomas do influence LDH and IGF-1 and could possibly be suitable as biomarkers.
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http://dx.doi.org/10.1159/000513045DOI Listing
June 2021

Adequate Utilization of Emergency Services in Germany: Is There a Differential by Migration Background?

Front Public Health 2020 8;8:613250. Epub 2021 Jan 8.

Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany.

The role of emergency services (ES) is to provide round-the-clock acute care. In recent years, inadequate use of ES has been internationally thematised because of overcrowding and the associated cost. Evidence shows that migrant populations tend to use more ES than non-migrant but it remains to show if there is a differential in inadequacy. Quantitative data from consecutive patients visiting three ES in Berlin (hospital-based outpatient clinics for internal medicine or gynecology) from July 2017 to July 2018 were obtained. Utilization was defined as adequate if the patient was admitted to hospital and/or if all of the three following criteria were fulfilled: reported to have been sent by medical staff; reported strong pain; and reported a high urgency (both ≥7, scale from 0 to 10). Differences between migrants (1st generation), their offspring (2nd generation), and non-migrants were evaluated using logistic regression. Of the 2,327 patients included, 901 had a migration background. Adjusting for gender, age, gynecological hospital-based outpatient clinic, and the number of chronic diseases, 1st generation migrant patients ( = 633) had significantly lower odds than non-migrants to have an adequate utilization of services [OR 0.78, 95% confidence interval (0.62, 0.99), -value 0.046]. For 2nd generation patients ( = 268), no statistically significant difference was found [OR 0.80, 95% confidence interval (0.56, 1.15), -value 0.231]. Only adjusting for gynecological hospital-based outpatient clinic did weaken the association between migration status on adequacy but interactions between type of hospital-based outpatient clinic and migration were not significant. First generation migrants show lower odds of adequate ES use compared to non-migrants. Only visiting a gynecological hospital-based outpatient clinic as opposed to internal medicine could partly explain the lower odds of adequate use among immigrants. This indicates a need for structural changes in the healthcare system: The threshold of access to general practices needs to be lowered, considering the needs of diverse subgroups of migrant patients.
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http://dx.doi.org/10.3389/fpubh.2020.613250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820806PMC
May 2021

Effects of epigallocatechin gallate-enriched green tea extract capsules in uterine myomas: results of an observational study.

Arch Gynecol Obstet 2021 05 2;303(5):1235-1243. Epub 2021 Jan 2.

Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Campus Virchow-Klinikum (Clinic for Gynecology with Centre for Oncological Surgery, Campus Virchow Klinikum), Charité-Universitätsmedizin Berlin (University Medicine Berlin), Augustenburger Platz 1, 13353, Berlin, Germany.

Purpose: The daily ingestion of green tea extract (GTE) capsules in women with oligo- or asymptomatic uterine myomas was monitored over 6 months with regard to their quality of life, myoma-associated complaints and side effects.

Methods: The participants were interviewed and examined at the beginning of the study (T1) and then again after 6 months (T3). Quality of life was assessed using a SF-12 questionnaire while their myoma-associated complaints were ascertained by using a self-developed myoma symptom questionnaire. Changes in the size of the myomas were evaluated by vaginal sonography. Side effects after 3 months (T2) and 6 months were documented by systematic interviews.

Results: Overall; 25 participants (median 45 years) have been enrolled. The analysis of the SF-12 questionnaire showed a significant improvement of the physical cumulative score of the SF-12 during the 6 month GTE capsule ingestion (T1: mean value (M) = 52.731; 95% confidence interval (KI): 49.791-55.671; T3: M = 55.862; KI%: 55.038-56.685; p = 0.019). However, the mental cumulative score of the SF-12 did not change significantly (p = 0.674). No significant correlation could be established between the capsule ingestion and changes in the symptom questionnaire, the laboratory parameters nor the myoma size. No relevant adverse side effects were reported.

Conclusion: Women who took GTE capsules showed a significant improvement in their physical cumulative score on the SF-12, but not in the global QoL score. Myoma size or other objective parameters did not change.
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http://dx.doi.org/10.1007/s00404-020-05907-6DOI Listing
May 2021

[Pregnant Women with Gestational Diabetes in Berlin - An Analysis of Perinatal Data Especially Regarding Immigration Background].

Z Geburtshilfe Neonatol 2021 Jun 2;225(3):244-250. Epub 2020 Nov 2.

Klinik für Gynäkologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin.

To date there has not been a systematic analysis of pregnant patients with an immigrant background and gestational diabetes in Germany, even though the number of these patients has been rising continuously since the 1980s.

Methods: The case number estimate for this prospective study targeted 160 patients with gestational diabetes with and without an immigrant background. A questionnaire on socio-economic status, immigrant background, acculturation, and food intake was developed. The birth parameters and pre- and postpartum parameters were regularly documented.

Results: In our study we included 198 patients with gestational diabetes, consisting of 110 patients with an immigrant background and 88 patients without an immigrant background. The number of labor inductions for the suspected diagnosis of fetal macrosomia was almost the same in both groups (immigrant background 3.6% vs. without immigrant background 4.6%, p=1.0; OR 1.73; 95% CI; 0.79-3.89, p=0.17). The study patients with an immigrant background were more likely to give birth spontaneously than via cesarean section or vaginal-operative birth. The perinatal outcome of children from our study patients with and without an immigrant background were similar.

Conclusion: We show that regardless of their immigrant background gestational diabetes patients have similar and homogeneous patient-centered care at our clinic.
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http://dx.doi.org/10.1055/a-1270-8258DOI Listing
June 2021

Factors Influencing Postoperative Recovery and Time Off Work of Patients with Benign Indications for Surgery - Results of a Prospective Study.

Geburtshilfe Frauenheilkd 2020 Jul 14;80(7):723-732. Epub 2020 Jul 14.

Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.

The study aimed to answer a number of questions: Which medical, psychological and sociodemographic factors affect the recovery of women after gynecological surgery for benign indications? Does patients' health-related quality of life improve after surgical intervention? How long are patients signed off work postoperatively? How do patients assess their own capacity to work? Study population: All women between the ages of 18 and 67 years who underwent gynecological surgery for benign indications at the Charité Campus Virchow Clinic over a 7-month period were consecutively enrolled in the study. Four standardized patient surveys (the first survey [T0] was carried out in hospital, T1 at 1 week, T2 at 6 weeks and T3 at 7 - 8 months after discharge by telephone interview) were carried out using evaluated questionnaires to record patients' recovery (Recovery Index), quality of life (RAND-36), satisfaction, complications, sociodemographic information and time off work with a medical sick note. Relevant medical and demographic data were also collected. Statistical analysis was carried out using univariate statistical tests for descriptive analysis and complex multifactorial statistical procedures to record observations over time. A total of 182 patients were included in this study (participation rate: 70%). Relevant prior operations (p = 0.01), in-hospital (p = 0.004) and postoperative complications (p < 0.001), preoperative psychological wellbeing (p = 0.01), physical functioning (p = 0.005) and postoperative anxiety (p = 0,006) had a significant impact on recovery (Recovery Index) and changed significantly over time (p < 0.001). The invasiveness of the surgery or sociodemographic parameters (including migration background) had no significant effect. Health-related quality of life (measured with the RAND-36 questionnaire) also improved postoperatively. More invasive surgical interventions were associated with longer sick leave times and, to a certain extent, with a poorer evaluation of patients' capacity to work. Recovery after gynecological surgery is a multifactorial process. This survey of a patient population identified psychological and physical factors which influence recovery but did not find significant sociodemographic parameters affecting recovery. Irrespective of these findings, gynecological surgery for benign indications resulted in an improvement in health-related quality of life. Prospective studies need to investigate whether psychological interventions could reduce preoperative fear and thereby improve postoperative recovery.
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http://dx.doi.org/10.1055/a-1157-8996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360394PMC
July 2020

Rare Ectopic Pregnancies - A Literature Review for the Period 2007 - 2019 on Locations Outside the Uterus and Fallopian Tubes.

Geburtshilfe Frauenheilkd 2020 Jul 14;80(7):686-701. Epub 2020 Jul 14.

Charité - Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow Klinikum, Berlin, Germany.

The majority of ectopic pregnancies (EP) are tubal pregnancies, but other implantation sites outside the uterus and tubes are also found. These rare EP locations present a particular diagnostic and therapeutic challenge. We present an overview of potential very rare locations of ectopic pregnancies, their symptoms, diagnosis and treatment, based on a systematic analysis of case reports. A literature review of the databases PubMed, Livivo and Google Scholar for the period 2007 to 2019 was carried out. A total of 113 publications were included in our review. These studies describe EP implantations in the posterior cul-de-sac, on the uterine serosa and uterine ligaments, in the vicinity of almost all intraperitoneal organs, on the abdominal wall as well as in retroperitoneal sites. The most common presenting symptom was abdominal pain occurring in different locations. The diagnostic procedures included various imaging procedures and/or explorative surgery at different advanced stages of pregnancy. The most common and preferred option was laparotomy for surgical treatment. The placenta was successfully resected in the majority of cases. A rare EP location should be considered when making a differential diagnosis in patients of child-bearing age with abdominal pain.
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http://dx.doi.org/10.1055/a-1181-8641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360401PMC
July 2020

[Effects of hyperemesis gravidarum on the course of pregnancy and birth, with special attention to the risk factor of migration background].

Z Geburtshilfe Neonatol 2021 Feb 6;225(1):39-46. Epub 2020 Jul 6.

Klinik für Gynäkologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin.

Main Questions: In this investigation of hospitalized cases of HG and subsequent births, we examine differences between patients who have and who have not experienced migration as well as the effect of HG on perinatal outcome.

Methods: Retrospective quantitative data of hospitalized patients suffering from HG (1997-2015) was analyzed. Also analyzed was a retrospective record of perinatal data on a subgroup of patients (2002-2016), and a control group (matched pairs) based on the register of births created.

Results: 1103 women with HG were hospitalized; in 434 cases birth outcome data could be evaluated as well. Migrants suffer from HG earlier in pregnancy; they are, however, less frequently exposed to psychosocial stress (according to anamnestic data). HG patients are younger and have more multiple pregnancies; the newborns are lighter (-70g) but have fewer congenital malformations (aOR 0.32, 95% CI 0.11-0.96) and are less frequently in need of treatment on the neonatology ward (aOR 0.59, 95% CI 0.36-0.97).

Conclusion: Pregnant migrants are a special risk group for HG, possibly because of migration-caused stress. With severe HG, there are no adverse outcomes on the rest of the pregnancy.
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http://dx.doi.org/10.1055/a-1144-3811DOI Listing
February 2021

"Fair to all interests and impartial towards all schools of thought": in honour of the 150th anniversary of the foundation of the "Archiv/Archives".

Arch Gynecol Obstet 2020 09;302(3):539-543

Practice for Women's Health, Gynecology and Obstetrics, Berlin, Germany.

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http://dx.doi.org/10.1007/s00404-020-05637-9DOI Listing
September 2020

Sexually assaulted women: Results of a retrospective analysis of 850 women in Germany.

Eur J Obstet Gynecol Reprod Biol 2020 Jul 1;250:117-123. Epub 2020 May 1.

Clinic for Gynaecology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Germany. Electronic address:

Objective: According to prevalence studies, at least 5-6 % of women in Europe experience rape in their lives. The initial treatment after a sexual assault can influence the individual healing process positively. In Germany, there are hardly any studies that investigate larger collection of cases of sexual assault treated in hospitals. However, knowledge about characteristics of cases of sexual assault is a prerequisite for the optimal processing of primary care.

Study Design: For this study, the retrospective collection of data on cases of suspected sexual assault of patients presented for treatment at the Charité was carried out. Standardized findings sheets as part of a rape kit used in all cases were evaluated. Overall, 850 cases from the period between 01.01.2011 and 30.06.2016 were analyzed. The statistical evaluation was descriptive.

Results: The median age of patient was 26 years (range 16-92). Penetration (vaginal/anal/oral) occurred in 75 % of cases. The suspect was unknown to 48,4 % of those affected, 26 % came from a circle of friends or acquaintances. 15,5 % were partners or expartners. 2/3 of the sexual assaults took place in private rooms, especially in the apartments of the victims. More than 2/3 of the women had drunk alcohol in temporal proximity to the crime. Extragenital injuries were present in 61,4 % of those affected and anogenital injuries in 25,4 %. Extragenital injuries were predominantly classified as mild (92,9 % in general physical examination and 62,4 % in eyes-nose-throat-examination). 42,1 % of the assaults took place on the weekend. 74,8 % of the patients presented themselves within 24 h of the suspected offence.

Conclusion: To our knowledge, this is the largest analysis of cases of sexually assaulted women treated at a hospital in Germany. The results point to important components of primary care, e.g. standardized injury recording and alcohol measurement, as these can serve as evidence in subsequent court proceedings. The structures of the first care of victims after sexual assault should consider that the majority of those affected present themselves at the weekend.
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http://dx.doi.org/10.1016/j.ejogrb.2020.04.059DOI Listing
July 2020

Are Social Status and Migration Background Associated with Utilization of Non-medical Antenatal Care? Analyses from Two German Studies.

Matern Child Health J 2020 Jul;24(7):943-952

Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.

Objective: Non-medical antenatal care (ANC) refers to a range of non-medical services available to women during pregnancy aiming at supporting women and prepare them for the birth and the postpartum period. In Germany, they include antenatal classes, breastfeeding classes and pregnancy-specific yoga or gymnastics courses. Studies suggest that various types of non-medical ANC carry benefits for both the women and their babies. Little is known about the uptake of non-medical ANC among different socioeconomic population subgroups, but one may expect lower utilization among socio-economically disadvantaged women. We analyzed factors contributing to the utilization of non-medical ANC in general and antenatal classes in particular.

Methods: Baseline data of the Bielefeld BaBi birth cohort (2013-2016) and the Berlin perinatal study (2011-2012) were analyzed. Comparing the two cohorts allowed to increase the socio-economic and migration background variance of the study population and to capture the effect of the local context on uptake of services. Multivariate logistic regression analyses were performed to study associations between the uptake of non-medical ANC and socio-economic and migration status.

Results: In Berlin and Bielefeld, being a first generation migrant and having lower levels of education were associated with lower non-medical ANC uptake. In Berlin, being a 2nd generation woman or having a low income was also associated with lower uptake.

Conclusions For Practice: Our study suggests that non-medical ANC remains in some part the prerogative of non-migrant, well-educated and economically privileged women. Since differences in non-medical ANC have the potential to create inequalities in terms of birth outcomes and maternal health during pregnancy and post-partum, more efforts are needed to promote the use of non-medical ANC by all population groups.
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http://dx.doi.org/10.1007/s10995-020-02937-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261266PMC
July 2020

Comparison of Clinical Symptoms of Assumed vs. Actual Uterine Fibroids - Symptoms Described by Patients and Ultrasound Findings.

Geburtshilfe Frauenheilkd 2020 Mar 30;80(3):316-323. Epub 2019 Oct 30.

Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Klinik für Gynäkologie, Berlin, Germany.

How many women assume that they have fibroids but are found not to have fibroids on ultrasound examination? How severe are the physical symptoms reported by these women compared to the symptoms reported by women with actual uterine fibroids? Are the symptoms more severe if the patient believes that she has at least one relatively large (dominant) fibroid or more than 3 fibroids? A total of 1548 patients completed an anonymous questionnaire in which they were asked about the number of their fibroids, dysmenorrhea and premenstrual symptoms, dyspareunia and bleeding disorders (using a numerical analog scale between 0 - 10). The questionnaire was administered in a hospital-based fibroid clinic. The information provided by the patients was then compared with transvaginal or abdominal ultrasound findings. The symptoms reported by women with and without fibroid(s) were compared. 1045 out of 1548 patients fulfilled the study's inclusion criteria. Contrary to the information they provided, no fibroid(s) were detected in 6% (62 of 1045 patients) of patients on ultrasound examination. Of these women, 87% had dysmenorrhea, 79% had premenstrual pain and 57% reported dyspareunia. The severity of the symptoms was found not to be associated with the assumed size or number of fibroid(s). There was no significant difference in the pain reported by women without and by women with fibroids. Reporting a feeling of strong pressure on the bladder (OR: 1.18) or abdomen (OR: 1.12) or constipation (OR: 1.16) increased the likelihood of detecting a fibroid on ultrasound investigation. The presence of manifest symptoms (dysmenorrhea, dyspareunia, premenstrual pain, bleeding disorders) does not allow conclusions to be made about the number or size of fibroids or about which therapy is indicated. Even an erroneous assumption about the presence of fibroids may result in patients experiencing symptoms.
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http://dx.doi.org/10.1055/a-0991-0105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7056396PMC
March 2020

The role of acculturation in migrants' use of gynecologic emergency departments.

Int J Gynaecol Obstet 2020 Apr 28;149(1):24-30. Epub 2020 Jan 28.

Department of Gynecology and Center for Oncological Surgery, Virchow Campus, Charité University Hospital, Berlin, Germany.

Objective: To examine whether acculturation of migrant patients is a predictor of non-urgent use of gynecologic emergency departments (GEDs).

Methods: A cross-sectional study based on standardized questionnaire interviews among migrant (n=477) and non-migrant (n=246) women attending a GED in Berlin, Germany, between 2017 and 2018. Non-urgent GED use was defined by health system (e.g., no hospital admission) or patient (e.g., low subjective urgency) criteria. Acculturation was assessed by the Frankfurt Acculturation Scale. Logistic regressions were calculated with non-migrants as the reference.

Results: Relative to migrants, low acculturation of migrants had no significant effect on overall non-urgent GED use. However, low acculturation was a significant predictor of non-urgent use if defined only by health system criteria (adjusted odds ratio [AOR], 1.58; 95% confidence interval [CI], 1.02-2.44; P=0.041). Inversely, low acculturation had a significant negative effect on non-urgent use if defined only by patient criteria (AOR, 0.58; 95% CI, 0.38-0.90; P=0.014).

Conclusion: Low-acculturated migrants were more prone to non-urgent GED use as defined by health system criteria, and might have a distorted perception of urgency. According to their perception, however, low-acculturated patients showed appropriate GED use for urgent complaints, indicating that they are insufficiently cared for by the healthcare system.
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http://dx.doi.org/10.1002/ijgo.13099DOI Listing
April 2020

The influence of migration on women's use of different aspects of maternity care in the German health care system: Secondary analysis of a comparative prospective study with the Migrant Friendly Maternity Care Questionnaire (MFMCQ).

Birth 2020 03 18;47(1):39-48. Epub 2019 Dec 18.

Clinic of Gynecology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.

Introduction: Approximately 21% of Germany's inhabitants or their parents have been born abroad. There is evidence that immigrant women are starting antenatal care later than nonimmigrants. In Berlin, equality in health care access had improved until 2011-2012, leaving only women with Low German language proficiency and an insecure residence status particularly at risk. With the recent influx of refugees, we analyzed whether access to antenatal and postpartum care differs depending on immigration, residence status, income, and education.

Methods: At our Berlin tertiary care center, a modified version of the Migrant Friendly Maternity Care Questionnaire was administered to women who delivered in the first half of 2017. Multivariate modeling compared nonimmigrant women, immigrants, and women who are direct descendants of immigrants.

Results: The study included 184 nonimmigrant women, 214 immigrant women, and 62 direct descendants of immigrants. Germany is relatively good in prenatal care for immigrant women, as most are getting adequate prenatal care. However, 21% of immigrants compared with 11% of nonimmigrant women started pregnancy care after the first trimester (P = .03). Low income was a more powerful predictor than immigration status for starting prenatal care after the first trimester. Immigrant women (23%) were less informed on postpartum care availability than nonimmigrants (3%) and used less postpartum midwifery care.

Conclusions: When designing health care interventions for immigrant women, not only migration-specific factors should be considered but also low income as a barrier to access to maternity care.
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http://dx.doi.org/10.1111/birt.12476DOI Listing
March 2020

Peritoneal and upper genital tract tuberculosis.

Med Glas (Zenica) 2020 Feb;17(1):86-91

Gynecological Tumour Centre and European Competence Centre for Ovarian Cancer, Charité Universitätsmedizin Berlin, Germany.

Aim To present diagnostic and therapeutic possibilities for genital and peritoneal tuberculosis, mimicking to other pathological conditions, mainly, ovarian cancer. Methods Transabdominal and transvaginal ultrasound, computerized tomography, Ca125 and HE 4, ROMA- index (Risk of Ovarian Maligancy Algorithm index) and diagnostic laparoscopy were performed in order to diagnose genital tuberculosis in a female patient. Results: A 23-year-old woman from Morocco presented with intermitting abdominal pain, unintentional weight loss and primary infertility. There was no positive family history for breast or ovarian cancer and no history of previous tuberculosis (TB). Elevated CA-125 level, HE 4 normal, ROMA-Index of 13.2 % suggested high risk for epithelial ovarian cancer (EOC). Ultrasound revealed free fluid, dilated fallopian tubes and a cystic mass near the right ovary. Suspecting fallopian tube or ovarian cancer, we performed exploratory laparoscopy, revealing adhesions, multiple miliary nodes and dilated fallopian tubes. Histological investigation revealed granulomatous abscessing salpingitis with suspicion of genital TB, so antituberculous therapy was administered with success. Conclusion Female genital tuberculosis is very rare but important in differential diagnosis and should be kept in mind regarding suspected fallopian tube or ovarian carcinoma to prevent women from extensive surgery. An algorithm for possible differentiation between peritoneal/female genital TB and EOC may be helpful in clinical setting.
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http://dx.doi.org/10.17392/1023-20DOI Listing
February 2020

[Is There a Negative Night or Weekend Effect on the Child's Postnatal State Among Migrant Women?]

Z Geburtshilfe Neonatol 2020 Jun 22;224(3):143-149. Epub 2019 Oct 22.

Klinik für Gynäkologie, Charité Campus Virchow-Klinikum, Berlin.

Research Question: Is neonatal morbidity of women with a migration background (= a proxy variable for an increased risk of cultural/linguistic communication problems) increased in the sense of a "weekend effect"?

Methods: Data was collected at 3 Berlin maternity hospitals directly in the delivery room based on standardized interviews (questions on sociodemographics, care aspects, migration) and supplemented by maternal and clinical perinatal data. Surrogate markers for the child's morbidity were the Apgar score and umbilical cord pH value or transfer to a children's hospital. Descriptive and logistic regression analyses were carried out.

Results: The data sets of 2,014 1st-generation migrants, 771 2nd-generation migrants, and 2,564 women without a migrant background were included, including 39.7% so-called day-births (Monday - Friday, 7 a.m.-6 p.m.). In 2 models, the influence of birth time and various other parameters was examined for the 2 proxy parameters of childhood morbidity. The chances of unfavorable Apgar or umbilical pH levels were increased in births in the evening, at night, on weekends and public holidays (OR 1.84, 95% CI 1.23-2.76, p=0.003), in operative vaginal births (OR 3.36, 95% CI 2.07-5.46, p<0.001) or a secondary cesarean section (OR 1.94; 95% CI 1.28-2.96, p=0.002). The migration status of the woman giving birth was irrelevant.

Summary: Despite possible intercultural and linguistic communication problems, women with a migration background are treated as well as pregnant women without a migration background irrespective of the time of day or day of the week.
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http://dx.doi.org/10.1055/a-1017-3916DOI Listing
June 2020

MR-Guided Focused Ultrasound in Fibroid Treatment - Results of the 4th Radiological-Gynecological Expert Meeting.

Geburtshilfe Frauenheilkd 2019 Jul 28;79(7):693-696. Epub 2019 May 28.

Department of Gynecology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.

Magnetic Resonance-guided focused ultrasound (MRgFUS; Syn.: HIFU = high intensity focused ultrasound) is a safe and effective thermoablative technique to treat fibroid-related symptoms. The evidence is limited due to a lack of randomized trials. The indication for treatment by MRgFUS are symptomatic uterine fibroids. This consensus paper covers criteria to measure success, contraindications, side effects and complications of MRgFUS treatment. The role of MRgFUS in the setting of family planning is part of this publication.
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http://dx.doi.org/10.1055/a-0893-4752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647353PMC
July 2019

Uterine Artery Embolization (UAE) for Fibroid Treatment - Results of the 7th Radiological Gynecological Expert Meeting.

Geburtshilfe Frauenheilkd 2019 Jul 28;79(7):688-692. Epub 2019 May 28.

Department of Gynecology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.

Uterine artery embolization (UAE) is a safe and effective organ sparing treatment for fibroid-related symptoms based on a broad range of published evidence including randomized-controlled trials. Indication for treatment by means of UAE are symptomatic uterine fibroids. UAE is an alternative to surgical and medical treatment for uterine fibroids as well as treatment by MRgFUS. This consensus paper covers the structural prerequisites, the criteria for technical and clinical success, contraindications, side effects and complications as well as the role of UAE treatment in women wishing to conceive and gives guidance on radiation safety measures and clinical follow-up.
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http://dx.doi.org/10.1055/a-0893-4807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647352PMC
July 2019

Anxiety of myoma patients: results of standardized interviews with the State Trait Anxiety Inventory and the Kessler 10 questionnaire.

J Psychosom Obstet Gynaecol 2020 06 10;41(2):122-130. Epub 2019 Jun 10.

Department of Gynecology, Virchow Campus; Charité - University Hospital Berlin, Humboldt University of Berlin, Berlin Institute of Health, Berlin, Germany.

The aim of this study was to explore a possible relation between myoma-related anxieties and general state or trait anxiety or psychological distress, to get a better understanding of the impact of anxiety on the patients. This prospective study was conducted at the myoma clinic of a large university hospital in a major European city from November 2016 to February 2017. Patients completed standardized questionnaires on myoma-related fears, the State Trait Anxiety Inventory (STAI), and the Kessler 10. Eighty-five out of 88 women agreed to participate. State-anxiety on the STAI had a mean of 49.4 (11 points above the norm ( < .001)), and trait-anxiety had a mean of 42.0 (5 points above the norm ( = .001)). Thirty-seven percent of the patients had distress values on the K10 above the norm (defined as <20). More myoma-related fears correlated with higher scores on the Kessler and STAI. The scores were not related to the level of information about myomas or duration of illness. Myoma-related fears correlated with higher mental distress and elevated state and trait anxiety levels. Thus, physicians can contribute to the overall well-being of patients when they relieve them of the myoma-related anxiety. Further research is needed to determine whether treatment has any impact on anxiety or mental distress.
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http://dx.doi.org/10.1080/0167482X.2019.1624951DOI Listing
June 2020

MR-Guided Focused Ultrasound in Fibroid Treatment - Results of the 4th Radiological-Gynecological Expert Meeting.

Rofo 2019 Jul 28;191(7):626-629. Epub 2019 May 28.

Department of Gynecology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.

Magnetic Resonance-guided focused ultrasound (MRgFUS; Syn.: HIFU = high intensity focused ultrasound) is a safe and effective thermoablative technique to treat fibroid-related symptoms. The evidence is limited due to a lack of randomized trials. The indication for treatment by MRgFUS are symptomatic uterine fibroids. This consensus paper covers criteria to measure success, contraindications, side effects and complications of MRgFUS treatment. The role of MRgFUS in the setting of family planning is part of this publication. KEY POINTS:: · MRgFUS therapy should be based on a clear understanding of the aim of treatment and the wish of the patient.. · Success of MRgFUS/HIFU treatment should be judged by the degree of improvement (alleviation) or disappearance of fibroid-related symptoms.. · The indication for treatment by means of MRgFUS/HIFU is based on a gynecological examination incl. ultrasound performed by a specialist. Necessary prerequisite for MRgFUS/HIFU treatment is a contrast-enhanced MRI of the pelvis.. · A number of more than 5 fibroids (leiomyomata) limits the success of MRgFUS/HIFU therapy; the indication to treat fibroids exceeding 10 cm in diameter should be reviewed critically.. · A recommendation for the treatment of fibroids by MRgFUS to patients who seek to conceive cannot be given based on the current state of knowledge.. CITATION FORMAT: · Kröncke T, David M. MR-Guided Focused Ultrasound in Fibroid Treatment - Results of the 4th Radiological-Gynecological Expert Meeting. Fortschr Röntgenstr 2019; 191: 626 - 629.
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http://dx.doi.org/10.1055/a-0884-3143DOI Listing
July 2019

Uterine Artery Embolization (UAE) for Fibroid Treatment - Results of the 7th Radiological Gynecological Expert Meeting.

Rofo 2019 Jul 28;191(7):630-634. Epub 2019 May 28.

Department of Gynecology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.

Uterine artery embolization (UAE) is a safe and effective organ sparing treatment for fibroid-related symptoms based on a broad range of published evidence including randomized-controlled trials. Indication for treatment by means of UAE are symptomatic uterine fibroids. UAE is an alternative to surgical and medical treatment for uterine fibroids as well treatment by MRgFUS. This consensus paper covers the structural prerequisites, the criteria for technical and clinical success, contraindications, side effects and complications as well as the role of UAE treatment in women wishing to conceive and gives guidance on radiation safety measures and clinical follow-up. KEY POINTS:: · The therapeutic aim of UAE for fibroids is the improvement (alleviation) or disappearance of fibroid-related symptoms. · The indication for UAE treatment is based on a gynecological examination incl. ultrasound performed by a specialist. · UAE is an alternative to surgical or medical therapy of fibroids as well as fibroid treatment by means of MRgFUS, independently of the size and number of fibroids (leiomyoma) or previous surgery. · The decision to offer UAE should be based on the wish of the patient and having regard to treatment alternatives, their success rates, limitations and side effects. · For women with uterine fibroids who wish to conceive the role of UAE as a treatment options is still not clarified based on the current state of knowledge. CITATION FORMAT: · Kröncke T, David M. Uterine Artery Embolization (UAE) for Fibroid Treatment: Results of the 7th Radiological Gynecological Expert Meeting. Fortschr Röntgenstr 2019; 191: 630 - 634.
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http://dx.doi.org/10.1055/a-0884-3168DOI Listing
July 2019

The impact of migration background on maternal near miss.

Arch Gynecol Obstet 2019 08 10;300(2):285-292. Epub 2019 May 10.

Department of Epidemiology and International Public Health; Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany.

Purpose: (1) To evaluate the association between immigration background and the occurrence of maternal near miss (MNM). (2) To identify medical co-factors, health-care utilization, and health-care disparities as explanations of a possibly higher risk of MNM among immigrants.

Methods: We compared perinatal outcomes between immigrant women (first- or second-generation) versus non-immigrant women, delivering at three maternity hospitals in Berlin, Germany, 2011-2012. Near-miss events were defined as: HELLP syndrome, eclampsia, the occurrence or threat of uterine rupture, postpartum hemorrhage (PPH) > 1000 ml, sepsis, peripartal hysterectomy, cardiovascular complications, lung embolism. Logistic regression analyses were performed to determine the associations of immigration status, acculturation, and language competency with near-miss events, and of near-miss events with the perinatal outcomes.

Results: The databank included 2647 first-generation immigrants, 889 second-generation immigrants, and 3231 women without an immigration background (total N = 6767). Near-miss events occurred in 141 women. The likelihood of near-miss events was lower among multiparous women (OR 0.6; 95% CI 0.42-0.87; p = 0.01). No other factors had a statistically significant influence. Near-miss events are associated with an elevated likelihood for an unfavorable perinatal condition: the ORs ranged from 2.15 for an arterial umbilical cord pH value < 7.1-2.47 for premature delivery.

Conclusions: Immigration status does not change the risk of near-miss events. Besides parity, no medical or socio-demographic factors were identified that were associated with an elevated likelihood for the occurrence of severe peripartal complications.
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http://dx.doi.org/10.1007/s00404-019-05179-9DOI Listing
August 2019
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