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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., Competing Interests: Conflict of Interest/Interessenkonflikt The conflicts of interest of the authors are listed in the long version of the guideline./Die Interessenkonflikte der Autorinnen und Autoren sind in der Langfassung der Leitlinie aufgelistet., (Thieme. All rights reserved.)

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., Competing Interests: Conflict of Interest/Interessenkonflikt The statements of all of the authors about their conflicts of interest are available in the long version of the guideline./Die Interessenkonflikterklärungen aller Autoren finden Sie in der Langversion der Leitlinie., (Thieme. All rights reserved.)

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., Competing Interests: Conflict of Interest/Interessenkonflikt The statements of all of the authors about their conflicts of interest are available in the long version of the guideline./Die Interessenkonflikterklärungen aller Autoren finden Sie in der Langversion der Leitlinie., (Thieme. All rights reserved.)

Aim The aim of this official guideline, published and coordinated by the German (DGGG), Austrian (OEGGG) and Swiss (SGGG) Societies of Gynecology and Obstetrics in collaboration with the DMykG, DDG and AGII societies, was to provide consensus-based recommendations obtained by evaluating the relevant literature for the diagnosis, treatment and management of women with vulvovaginal candidosis. Methods This S2k guideline represents the structured consensus of a representative panel of experts with a range of different professional backgrounds commissioned by the Guideline Committee of the above-mentioned societies. Recommendations This guideline gives recommendations for the diagnosis, management, counseling, prophylaxis and screening of vulvovaginal candidosis., Competing Interests: Conflict of Interest/Interessenkonflikt The conflicts of interest of the authors are listed in the long version of the guideline./Die Interessenkonflikte der Autoren sind in der Langfassung der Leitlinie aufgelistet., (Thieme. All rights reserved.)

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.

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.

Problem: According to the guidelines, acute vulvovaginal candidosis (VVC) may be treated vaginally, through a combination of vaginal treatment and cream for the vulva or orally. However, there is a lack of investigations into whether combined treatment for the vagina and vulva achieves better results than vaginal treatment alone. Method: In 1999, 160 patients with vulvovaginal candidosis from ten German gynaecological practices were included in a study and treated on a randomised basis with three 200 mg clotrimazol vaginal suppositories = clotrimazol 2 % cream (verum n = 79) or + placebo (active-ingredient-free cream base n = 79). The examinations took place before treatment (T1), six to eight days following the end of treatment (T2) and approximately four weeks following the end of treatment (T3). In addition to demographic data, the clinical findings of each investigation were documented in a standardised way and a native preparation and a fungal culture were taken. The doctor and patient evaluated the healing process and tolerance. The main efficacy variables were the pre/post difference scores for extravaginal redness. Results: On T1, there was no difference between the two groups. By T2, there was a significant difference in the extent of extravaginal redness between the verum and the placebo groups (p = 0.0002), as well as in the subgroup of the per-protocol analysis (verum 64, placebo 70 patients, p = 0.0015). Genital itching or burning had entirely disappeared in 51 % and 56 % of patients respectively in the verum group and in only 30 % and 45 % of patients in the placebo group on T2 (p = 0.0181). There was no difference in intravaginal redness on T1 and T2 in either group. The overall assessment by the doctor went accordingly (p = 0.0004). On T1, the extravaginal fungal culture was positive in 75 women in the verum group and in 76 women in the placebo group. On T2, however, this was positive in 51.9 % (verum) and 73.1 % (placebo) of cases, and a positive culture was evinced in the vagina in 6 vs. 8 women (7.5 vs. 10.1 %, p = 0.3802). The local tolerance in both groups was 70 % very good, and 29 vs. 27 % good. After four weeks (T3), 16 out of 23 patients in the verum group and only 8 out of 21 in the placebo group had negative extravaginal fungal cultures. Discussion: There is a lack of studies into the issue of whether vaginal treatment or combined vulvovaginal treatment of acute VVC would be more advantageous. However, there are two studies that support the significant results of this paper that when it comes to acute VVC, the combination of three 200 mg clotrimazol vaginal suppositories with clotrimazol cream 2 % is better than with vaginal suppositories alone.

Secretory IgA of the cervico-vaginal secretions was determined for the first time using a modified ELISA method following the recommendations of Sohl Akerlund et al. (Scand. J. Immunol. 6 [1977] 1275). The results were compared with the total protein content of the cervico-vaginal secretions, which were within the normal limits reported in literature. Women in the middle of the menstrual cycle and those taking anti-ovulants, showed lower and those during pregnancy higher values. Secretory sIgA could not be detected in vaginal secretions of hysterectomised women.

The problem of side effects of radiotherapy in genital carcinomas on a concomitant vaginal yeast infection was investigated by subjecting candida albicans cells in vitro to the effects of gamma radiation. Agar plates with a defined number of candida albicans cells were irradiated with the conventional gynaecological sources of radium applicators and tele-cobalt. The experimental incubation of the agar plates showed that the number and growth of the yeast colonies were either completely inhibited or stunted by the effect of the radiation. There were also mutations in the cell morphology, animal pathogenecity and sensitivity to antimycotic drugs. The clinical implications of these results are discussed.

From 1917 to 1979, the maternal mortality in the Rheinische Landesfrauenklinik Wuppertal has been investigated on the basis of 136084 live births. From 1917 to 1921, it was 10.1% and decreased to 0.16% in the period from 1973 to 1979. The maternal mortality in association with caesarean section, which was 11.8% in the period from 1917 to 1921 with a frequency of caesarean sections of 2.5%, decreased to zero since 1973 with a frequency of 6.3%. A caesarean section preceded more than 50% of the deaths since 1962. Most of the decreased (24.4%) were in the group of 30-34 years of age and 48.3% aged more than 30 years. 51.5% were primiparas and 14.6% of the women were at least para 4's. From 1917 to 1936, infection was the main cause of maternal mortality with 39.6%; from 1957 to 1966, however, thrombo-embolism advanced to the leading cause with 27.3%. Since 1960, 4 of 35 deaths were anaesthetic deaths. During all the examined periods, non-specific reasons of maternal mortality were an important factor with more than 30%.

Torulopsis glabrata, a pathogenic yeast, causes a vulvovaginal mycosis in about 10% of all cases, whereas mostly candida albicans is identified. Yeasts of the genus Torulopsis seem to occur especially on healthy women, whereas in cases of the well-known risk factors the growth of Candida albicans is advanced. Torulopsidosis of the vagina commonly takes a mild course. The diagnosis is ensured only in cooperation with special laboratories. However, microscopic traps are absence of pseudomycelia and relatively small buds which contrast with the big buds of candida albicans. Although the clinical course is usually less heavy than in cases of candidosis, a six- to ten-day treatment with local imidazole or Polyene antimycotics is necessary to avoid recurrences. The fact that yeasts of the genus Torulopsis form no pseudomycelia is perhaps an explanation for the mostly mild course of illness on the one hand and for the weak response to cellwall-synthesis blocking antimycotics on the other hand.

After laparoscopic confirmation of adnexitis, a bacteriological examination was made of specimens taken from the small pelvis of 63 patients, with an average age of 26.4 years, at the Rheinischen Landesfrauenklinik (Gynecological Hospital) in Wuppertal. To this end, various aerobic and anaerobic optimal and selective culture media were used. The cultured germs were identified with API systems, other conventional methods, and by using gas chromatography. All bacilli were tested for their sensitivity to mezlocillin and metronidazole. In 40 cases (63.5%), it was possible to determine 1-10 bacilli from the inner genital tract. In most cases there was an aerobic/anaerobic mixed infection, with participation of streptococci, staphylococci, enteric bacteria, as well as peptococci, peptostreptococci and bacteroid types. Neisseria gonorrhoeae was only identified three times. In 23 cases (36.5%), it was not possible to determine bacilli in spite of definite inflammatory symptoms. Since, according to international literature, Chlamydia trachomatis was to be found on the inflamed tubes of roughly one third of cases of adnexitis, the presence of this bacillus is suspected even in the many bacteriologically negative cases in the author's own study. Only in one case of a monoinfection by Staphylococcus aureus did the combination of mezlocillin and metronidazole prove to be unsuitable. In 25% of the cases where the presence of bacilli was proved, metronidazole was even necessary, since bacilli of the Bacteroides fragilis and Bacteroides bivius and disiens groups were involved, all of which are capable of inactivating penicillins and cephalosporins by formation of a beta-lactamase.(ABSTRACT TRUNCATED AT 250 WORDS)

The case of a 22-year-old primigravida in the 33rd week of pregnancy is presented, showing an uncommon form of EPH-gestosis which so far has been described very rarely in German literature. It is a case of pre-eclampsia with haemolytic anaemia, thrombocytopenia, increased liver values and beginning kidney failure. The key to the survival of mother and child lies in rapid delivery and an adequate substitution of erythrocytes and blood plasma. Symptomatics, differential diagnosis and therapy are discussed. Reference literature is given.

A new method of transvaginal pudental block is described with a carbon dioxide jet-injector. During the second stage of labor and good anaelgesia of the perineum was obtained in 119 of 125 cases. No side-effects or complications were noted although the amount of local anaesthetic used was only 3 ml. for each side.

Before the beginning of radium therapy a vaginal yeast contamination of 9,7% was found of 113 patients with different genital carcinomas. However, the incidence of vaginal yeast contamination increased suddenly to 30,9% under the contac irradiation therapy with radium. The radiation effect of radium is not sufficient for a "selfsterilisation" of the radium-carrier in the case of yeast contamination. Therefore, a chemic desinfection of the radium-carriers is principly necessary. The significance of radium therapy with respect to vaginal yeast contamination is discussed and the recommendation is made that routine mycological supervision be carried out on all patients with gynaecological carcinomas and appropriate antimycotic therapy initiated where necessary.