Ursula Peschers

The prognostic impact of a prolonged second stage of labor on maternal and fetal outcome

Objective.  While obstetrical management has changed significantly over years, the optimal duration of the second stage of labor still remains to be defined. The purpose of this study was to evaluate the effect of the duration of labor on fetal distress and maternal perinatal morbidity.

Bladder neck mobility in continent nulliparous women

Objective To evaluate the mobility of the vesical neck during coughing and valsalva in healthy nulliparous volunteers and to test the reliability of the technique applied.

Prevalence of sexual abuse among women seeking gynecologic care in Germany

OBJECTIVE: To estimate the prevalence of sexual abuse among patients seen for gynecologic care in Germany. METHODS: A short anonymous questionnaire was distributed to 1157 women attending a gynecologic outpatient clinic at a large urban teaching hospital. Data collected using the questionnaire included patient characteristics, sexual abuse history, and screening practices. Women who reported that they had been abused were asked if they had ever discussed the issue with their gynecologist. RESULTS: A total of 1075 questionnaires were returned, for a response rate of 92.9%. Almost half (n = 479 [44.6%]) of the women surveyed reported that they had been the subject of unwanted sexual attention. One fifth (n = 216 [20.1%]) had been forced to engage in sexual activities: 6.8% in childhood, 10.3% during adolescence, 6.4% as an adult, and 3.5% across more than one stage. Thirteen women (6%) reported having discussed the abuse with their gynecologist. Sixty‐six (30.5%) were too afraid to raise the issue, and 119 (55.1%) stated it was not relevant to their care. Only one woman (0.5%) reported that her gynecologist had asked about sexual abuse. CONCLUSION: Despite the high prevalence of sexual abuse among women seeking gynecologic care, routine screening does not appear to be part of standardized practice. (Obstet Gynecol 2003;101:103‐8.

Urinary and anal incontinence after vacuum delivery.

OBJECTIVES To evaluate urinary and fecal incontinence symptoms, and occult anal sphincter defects in women after vacuum and spontaneous vaginal delivery. STUDY DESIGN In a case-control study, 50 primiparous women delivered by vacuum extraction were compared to 50 women delivered spontaneously. Urinary and anal incontinence symptoms, pelvic floor muscle strength and sphincter defects on endoanal ultrasound were evaluated 6-24 weeks postpartum. RESULTS New anal incontinence symptoms after childbirth were found in 30% of the vacuum group compared to 34% of the controls, new urinary incontinence symptoms in 28 and 42%, respectively (not significant). After excluding Grade III perineal tear, sonographic sphincter defects were found in 11 (27.5%) after vacuum delivery compared to 4 (10%) after spontaneous delivery (P<0.05, chi(2)-test). CONCLUSION Anal and urinary incontinence symptoms are frequent after vaginal delivery. Vacuum delivery causes more sonographic sphincter defects but appears to cause no more harm to pelvic floor function than spontaneous vaginal delivery.

Differences between cough and Valsalva leak-point pressure in stress incontinent women.

The aim of the study was to evaluate the relationship between Valsalva leak‐point pressure (VLPP) and cough leak‐point pressure (CLPP). Sixty women with stress urinary incontinence were included. One woman was excluded from evaluation because of detrusor instability. At a bladder volume of 200–300 mL (mean, 284; standard deviation, 29) CLPP and VLPP were measured in the sitting position. Intra‐abdominal pressure was recorded with a rectal balloon catheter. A standardized pad test and multi‐channel urodynamics were performed. VLPP was significantly lower than CLPP (58.9 ± 27.6 versus 112.5 ± 46.9 cm H2O, P< 0.0001). Although CLPP was negative in two women only, VLPP was negative in 24 of 59 women (40.1 %). If intrinsic sphincter deficiency was defined as a leak‐point pressure of 65 cm H2O, 16.9% of women fulfilled this criterion using the CLPP compared to 35.6% if the VLPP is used. In conclusion, coughing and Valsalva seem to result in a different reaction of the pelvic floor. Neurourol. Urodynam. 19:677–681, 2000.

Long-term efficacy of pelvic floor re-education with EMG-controlled biofeedback

OBJECTIVE To evaluate the long-term efficacy of pelvic floor re-education (PFR) with EMG-controlled biofeedback in the treatment of female genuine stress or mixed incontinence. STUDY DESIGN Between 1995 and 1998, 36 women completed a pelvic floor muscle training with a biofeedback device for 3-6 months. A mean of 26 months later, a follow-up examination was performed. RESULTS The prevalence of lower urinary tract symptoms decreased significantly immediately after the training but increased again at the long-term follow-up. Levator ani muscle strength improved after the treatment and remained significantly better for long-term follow-up. Immediately after the program, 25 (70%) women reported cure or improvement of stress incontinence. At the long-term follow-up, 17 (47%) reported the same result. CONCLUSIONS About half of the patients after PFR with biofeedback are still improved or cured after 26 months. Women should be counseled about the long-term efficacy and about the necessity of maintaining training.

RADIOTHERAPY OF THE CHEST WALL FOLLOWING MASTECTOMY FOR EARLY-STAGE BREAST CANCER: IMPACT ON LOCAL RECURRENCE AND OVERALL SURVIVAL

INTRODUCTION Recent studies have renewed an old controversy about the efficacy of adjuvant radiotherapy following mastectomy for breast cancer. Radiotherapy is usually recommended for advanced disease, but whether or not to use it in pT1-T2 pN0 situations is still being debated. This study was designed to clarify whether or not routine radiotherapy of the chest wall following mastectomy reduces the risk of local recurrence and if it influences the overall survival rate. METHODS Retrospective analysis of patients treated with mastectomy for pT1-T2 pN0 tumors and no systemic treatment. Patients treated with radiotherapy of the chest wall following mastectomy (Group A) are compared with those treated with mastectomy alone (Group B). RESULTS A total of 918 patients underwent mastectomy. Patients who received adjuvant radiotherapy after mastectomy (n = 114) had a significantly lower risk for local recurrence. Ten years after the primary diagnosis, 98.1% of the patients with radiotherapy were disease free compared to 86.4% of the patients without radiotherapy. The average time interval from primary diagnosis until local recurrence was 8.9 years in Group A and 2.8 years in Group B. The Cox regression analysis including radiotherapy, tumor size and tumor grading found the highest risk for local recurrence for patients without radiotherapy (p < 0.0004). In terms of overall survival however, the Kaplan-Meier analysis showed no difference between the two groups (p = 0.8787) and the Cox regression analysis failed to show any impact on overall survival. CONCLUSION With observation spanning over 35 years, this study shows that adjuvant radiotherapy of the chest wall following mastectomy reduces the risk for local recurrence in node-negative patients with pT1-T2 tumors but has no impact on the overall survival rate.

Matched pair analysis of survival after chest-wall recurrence compared to mammary recurrence: a long-term follow up.

Background: Local recurrence remains a major concern after primary treatment of breast cancer and has a major impact on subsequent survival. While most studies report a poorer survival rate in patients with a local recurrence after mastectomy than after breast conservation, it remains controversial whether different risk profiles at the time of primary diagnosis may account for this difference. Method: Matched pair analysis of 134 patients with newly diagnosed locoregional recurrence of breast cancer without evidence of systemic disease. Matching criteria included the primary surgical treatment, tumor size, nodal status, and age. The significance of various prognostic parameters at the time of primary diagnosis and at the time of recurrence were evaluated, by univariate and multivariate analyses, with respect to survival after recurrence. The median follow-up was 8.4 years. Results: Risk factors at the time of presentation, such as tumor size and lymph node status, were comparable between both groups. Local recurrence occurred on an average 9 months earlier in patients after mastectomy (P=0.08). Univariate analysis showed that lymph node status (P=0.0001) and disease-free interval from primary treatment to local recurrence (P=0.0002) were the most significant single prognostic factors for subsequent survival after local recurrence. The primary surgical treatment modality was shown to be of marginal statistical influence (only P=0.05). Conclusion: Local recurrence after mastectomy seems to be associated with worse survival than after breast-conserving therapy. Early onset of chest-wall recurrence, moreover, represents the highest independent risk for cancer-associated death.

Pregnant Women after Physical and Sexual Abuse in Germany

Background/Aims: The aim of our study was to evaluate the prevalence of abuse among pregnant women in Germany attending our antenatal outpatient clinic and to observe whether a history of abuse had consequences for women’s feelings about their pregnancy. Methods: 455 women between the 35th and 42nd weeks of gestational age were included and were asked to fill out an anonymous questionnaire concerning their pregnancy, their actual psychological state, and their history of physical/sexual abuse. 600 questionnaires were distributed (return rate 75.8%), 70 women (10.4%) were excluded because of male companionship to ensure their safety in case that they were currently in an abusive relationship with the attending man. Results: 88 women (19.3%) reported a history of sexual and/or physical abuse. Pregnant women after physical and/or sexual abuse significantly more frequently associate negative feelings with their pregnancy than nonabused women. The Hospital Anxiety Depression Scale (HADS) and the SCL-K-9 demonstrated significantly more negative feelings of depression and anxiety, strain, loneliness and less expectation of happiness for their future in abused women. Conclusion: Physical and sexual abuse are relevant problems among women in obstetric care that may complicate their pregnancies and make them feel more depressive.

Therapie der Dranginkontinenz

ZusammenfassungDie konservative Therapie der nichtneurogenen überaktiven Blase umfasst die Änderung des Trink- und Miktionsverhaltens, die Physiotherapie, die lokale Östrogenisierung und die anticholinerge Medikation. Bei älteren und multimorbiden Patientinnen ist bei der Auswahl der Anticholinergika zu beachten, dass Anticholinergika zu einer kognitiven Beeinträchtigung führen können. Patientinnen mit Deszensus sollte eine Pessartherapie oder eine operative Behandlung angeboten werden. Die Injektion von Botulinumtoxin und die sakrale Neuromodulation erweitern das Behandlungsspektrum bei therapierefraktärer überaktiver Blase.AbstractThe conservative treatment of nonneurogenic overactive bladder symptoms includes the changing of drinking and micturition patterns, physiotherapy, local estrogens, and anticholinergic medication. Anticholinergics can impair cognitive function especially in elderly and multimorbid patients. Pessary treatment or surgical treatment should be offered to women with pelvic organ prolapse. The intravesical injection of botulinum toxin A and sacral neuromodulation expand the treatment options for patients who do not respond to conservative treatment.