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Die Einfuhrung der non-invasiven genetischen pranatalen Testung in die pranatale Diagnostik fuhrt zu einer verbesserten Diagnostik der meisten autosomalen Aneuploidien und zu einer verminderten Anwendung invasiver Methoden. Andererseits ergeben sich durch die mogliche Anwendung als Screening Methode vielfaltige ethische Fragen, die von der fachlichen und der gesellschaftlichen Offentlichkeit bearbeitet und beantwortet werden mussen.

Tranexamic acid is effective in reducing blood loss during various types of surgery and after trauma. No compelling evidence has yet been presented for post-partum haemorrhage. A systematic literature search of relevant databases was performed to identify trials that assessed blood loss and transfusion incidence after tranexamic acid administration for post-partum haemorrhage. The random effects model was used for meta-analysis. Risk ratios (RRs) and weighted mean differences (WMDs) were calculated with 95% confidence intervals (CIs). Seven trials with a low risk of bias comparing tranexamic acid vs. placebo with a total of 1760 parturients were included in our systematic review and meta-analysis. Blood loss was significantly lower after tranexamic acid use (WMD -140.29 ml, 95% CI -189.64 to -90.93 ml; P

Nationale und internationale epidemiologische Studien zeigen, dass v. a. im Winter grose Teile der Bevolkerung einen Vitamin D Mangel aufweisen und die nutritive Vitamin D Aufnahme generell zu gering ist. Dies gilt auch fur Schwangere. Im Januar 2012 hat die Deutsche Gesellschaft fur Ernahrung die Zufuhrempfehlungen bei Vitamin D um das Vierfache erhoht. Eine ausreichende Vitamin D Versorgung soll nicht nur auf zahlreiche chronische Krankheiten protektiv wirken, sondern z. B. auch Fruhgeburten verringern. Der Beitrag untersucht die Evidenz zu Zusammenhangen zwischen einem Vitamin D Mangel und Komplikationen in der Schwangerschaft bzw. bei der Geburt. Bei der derzeitigen epidemiologischen Datenlage kann von einem gesicherten Risiko eines Vitamin D Mangels fur Komplika­tionen in der Schwangerschaft und bei der Geburt nicht gesprochen werden. Umso schwieriger sind rationale Antworten auf die Frage zu finden, ob und in welcher Dosis supplementiert werden und ob eine Vitamin D Serumdiagnostik erfolgen soll. Eine Beobachtungsstudie an 2 oder 3 groseren Geburtskliniken konnte die zentrale Frage recht zeitnah klaren.

Iron deficiency with and without anaemia is a common cause of morbidity, particularly in women. Iron deficiency is generally the result of an imbalance between iron loss and iron absorption. In women with symptoms suspicious for iron deficiency, it is important to confirm or exclude the suspicion using proper tests. The use of serum ferritin levels is considered the gold standard for diagnosis. Although the ideal ferritin levels are not unknown the current consent is that levels 40 ng/ml indicate iron deficiency, which needs to be treated in symptomatic patients. However, symptoms can already occur at ferritin levels of 100 ng/ml and treatment must be adapted to the individual patient. Iron supplementation is only indicated in symptomatic patients diagnosed with iron deficiency whose quality of life is affected. It is important to treat iron deficiency together with its causes or risk factors. For example, blood loss from hypermenorrhea should be reduced. Women also need to receive information about the benefits of an iron-rich diet. If oral treatment with iron supplements is ineffective, parenteral iron administration is recommended.Eisenmangel mit und ohne Anämie sind häufige Ursachen für Morbidität und Organdysfunktionen, vor allem bei Frauen. Gründe hierfür ist im Allgemeinen ein Missverhältnis zwischen Eisenverlusten und Eisenaufnahme. Bei Beschwerden, die auf einen Eisenmangel hinweisen, muss dieser mit den korrekten Methoden diagnostiziert oder ausgeschlossen werden. Als Goldstandard hierfür gilt der Serumferritinwert. Der ideale Zielwert für Ferritin ist nicht bekannt, nach dem derzeitigen Wissenstand sind Werte 40 ng/ml hinweisend für einen Eisenmangel und sollten bei entsprechenden Symptomen behandelt werden. Beschwerden können allerdings bei Ferritinwerten bis zu 100 ng/ml gefunden werden und auch individuell behandelt werden. Eine Therapie mit Eisen sollte nur bei nachgewiesenem Eisenmangel und Symptomen bzw. Leidensdruck oder verminderter Lebensqualität begonnen werden. Dabei soll der Eisenmangel per se und die Ursachen bzw. Risikofaktoren behandelt werden. Gegebenenfalls müssen uterine Blutverluste vermindert werden. Schließlich sollte die Frau über Möglichkeiten und Grenzen der „eisenreichen“ Ernährung instruiert werden. Bei ungenügender Wirksamkeit von oralen Eisenpräparaten ist die parenterale Eisengabe eine Erfolg versprechende, wichtige Alternative der ersten Wahl.

Die Haufigkeit von Lebensstil-Faktoren wie Bildungsstand, Berufstatigkeit, Rauchen, Alkoholgenus sollen in den verschiedenen Gewichtsgruppen (normal-, unter-, ubergewichtig, adipos) in der Schwangerschaft erkannt werden. 12 000 Datensatze aus 36 000 Fragebogen des BabyCare-Programmes von 2000–2010 uber Body-Mass-Index (BMI) und andere Lebensstil-Faktoren werden ausgewertet. Ubergewichtige und Adipose haben eine geringere Schulbildung und sind haufiger als Arbeiterinnen beschaftigt. 18% der Schwangeren geben an, bei Beginn der Schwangerschaft geraucht zu haben, 12,3% bejahen einen Alkoholkonsum in der Schwangerschaft, 1,4% geben einen Alkoholkonsum von mehr als 60 g/Woche und 0,5% von mehr als 120 g/Woche an. Die Fruhgeburtsrate in der Gesamtgruppe betrug 5,6%, die adiposen Schwangeren zeigten eine Fruhgeburtsrate 4 000 g 16,1% gegenuber 9% bei normalgewichtigen Gebarenden. Die Risiken der Ubergewichtigkeit und der Adipositat sowie anderer abstellbarer Lebensstil-Faktoren sollen in der prakonzeptionellen Beratung angesprochen und auf Anderung gedrungen werden.

In June 1909, The Empress Auguste Victoria House in Berlin was opened. This first institute for preventive paediatrics had the objective to overcome infant mortality in Germany. This objective was attained. Since then, an unprecedented decrease of mortality in all age groups occurred as well as a doubling of life expectancy. With this "retreat of death", our concepts of health changed fundamentally, and a new spectrum of diseases emerged. This article discusses some mile stones of this change, and explains why we find more illness despite the great improvement in the field of health. The "new diseases" amenable to early prevention are presented in a table. To make disease prevention successful requires the participation of the individual. Therefore, it is important to know the demand to make a good programme effective in the population. Empirical results of a nationwide representative study on the demand by expecting and young parents for preventive consultation are presented. Anticipatory guidance of young parents is a modern approach to health promotion and disease prevention. A controlled trial shows that this approach improved knowledge, behaviour, health risk indicators, health, and development during the first two years after delivery. Future studies should focus on long term effects of early health promotion.

AIMS: The aim of this study was to collect information on and to evaluate the impact of the timing of first suckling and breast-feeding initiation in Berlin and to assess the practicability and acceptance of using a short questionnaire to collect breast-feeding data in hospitals and birth centres. METHODS: A three-month observational study was conducted in 19 maternity units and 4 birth centres, using a short questionnaire to collect quantitative data on the timing of first suckling and breast-feeding from mother-child pairs on the day of discharge. RESULTS: The data indicate a breast-feeding rate of 96.1% at discharge. Infants born in birth centres were more frequently put to their mother's breast within the first hour after birth (p

BACKGROUND: It was the objective of this study to compare the efficacy and safety of oral misoprostol with those of vaginal dinoprostone for the induction of labour at term. PATIENTS AND METHODS: Between 2003 and 2006 224 pregnant women were included in our prospective randomised clinical trial. All of them were admitted for induction of labor at term. Half of the patients received oral misoprostol, initially at a test dose of 25 μg, followed by 50 μg and 100 μg every 4 hours. The control group received 3 mg vaginal dinoprostone every 6 hours. Primary endpoints were time interval until delivery and mode of delivery as well as maternal and neonatal outcome, secondary endpoints were side effects and costs. RESULTS: In the dinoprostone group, the median time interval until delivery was 17.6 hours compared to 24.1 hours in the misoprostol group. Without the test dose, the difference was no longer significant. After dinoprostone induction, more patients had a vaginal delivery within 24 hours (n = 60, 53.6 %, vs. n = 46, 41.1 %). The frequencies of spontaneous deliveries and emergency Caesarean sections did not differ between the groups. The rate of vacuum extractions was higher in the misoprostol group (23 vs. 11, i. e. 20.5 vs. 9.8 %, p < 0.05). With regard to side effects there was no significant difference. No case of hyperstimulation was documented. CONCLUSION: Oral misoprostol is effective and safe for induction of labour at term. In addition, it is much cheaper and independent of storage conditions. At the doses and with the administration intervals used in this study, dinoprostone was slightly more effective than misoprostol.

TOPIC: We studied those characteristics of mothers that are related to occupational activity two years after the birth of the first child. Differences in the health-related quality of life between working mothers and mothers who are not working were also analysed, taking other parameters into account, in particular household income. METHODOLOGY: 311 mothers with a first child were given a questionnaire on the quality of life based on WHOQOL-BREF, on depression (also surveyed one year before for 139 mothers), on their work situation, socio-demography and other possible confounders. The probability of vocational activity was analysed using logistic regression and the influence of multiple roles on the quality of life was analysed using multiple linear regression. RESULTS: About 60% of mothers were not working two years after the birth of their first child, 25% were working part-time and 11% full time, with 4% in training or education. Working mothers were more likely to have a higher level of education (60% vs. 31%) and less likely to have a household income below the poverty line (13% vs. 47%). The results of the logistic regression showed that the odds ratio for being employed was six times higher for mothers with higher education than mothers with a lower level of education [OR 5.99; 95% confidence interval (CI) 2.58-13.91], whereas the odds ratio for mothers with additional children against those with only one child was 0.14; (95% CI 0.05-0.40), and for mothers with German nationality against those of other ethnicities the odds ratio was 2.37 (95% CI 1.12-5.04). Working mothers give more positive ratings than non-working mothers for their physical and mental quality of life (both p

Voraussetzung einer effizienten Regionalisierung der Risikogeburtshilfe sind unter anderem das Zusammenwirken der ambulant und stationar arbeitenden Frauenarzte, die in den Mutterschaftsrichtlinien vorgesehene Beratung der Schwangeren uber die Wahl der Geburtsklinik und die Akzeptanz der Beratung des Frauenarztes durch die Schwangere mit oder ohne Risikofaktor. An einer Zufallsstichprobe von Mitgliedern einer Krankenkasse wurden die Beratung der Schwangeren sowie die Wahl der Geburtsklinik untersucht. Es zeigte sich, dass 20% der Schwangeren mit Risiken uber das Risiko nicht informiert wurden und 82% der Schwangeren mit Risiko keine Empfehlung fur eine bestimmte Geburtsklinik erhielten. Bei etwa zwei Drittel aller Schwangeren wurde die Wahl der Geburtsklinik nicht angesprochen, daher war der Einfluss des Frauenarztes auf die Wahl der Klinik auch gering.

In this report: Preterm birth will be characterized as a so far widely neglected public health problem in Germany. Actual evidence with respect to epidemiological and intervention knowledge will be summarized. Objectives, methods and routines of the BabyCare program will be presented. Associations between main risk factors and preterm birth will be calculated. Considerable deficiencies in nutritional habits and in micro nutritional intake will be summarized. And conclusions will be derived for future additional focussed actions in the prevention of preterm birth and other important complications in pregnancy within the program and for additional interventions in health policy which are imperative. It will be shown that the rate of preterm birth can be reduced and there is a high probability for further reduction by additional and targeted interventions in smoking, stress and especially nutrition.

Um die auch in Deutschland steigende Fruhgeburtenrate einzudammen, sind praventive Masnahmen erforderlich, namlich im Sinne einer Primarpravention die Beseitigung von Risikofaktoren, als Sekundarpravention die Fruhdiagnose und Fruhtherapie und als Tertiarpravention die Verringerung der Folgen einer Fruhgeburt. Bei der Bekampfung sozialer Risikofaktoren sind auch politische und soziale Aktivitaten gefordert. Bei den personlichen Risikofaktoren wird der Arzt im Gesprach, unterstutzt durch sozialwissenschaftliche Kompetenz, vieles erreichen konnen. Die Treffsicherheit von Screeningfaktoren und Pradiktoren einer drohenden Fruhgeburt ist noch verbesserungsbedurftig. Hierzu gehoren sonographische, biochemische Marker und bakteriologische Tests, z. B. fur die Vaginose. Eine geeignete Therapie kann zumindest die Schwangerschaftsdauer im Sinne einer Sekundarpravention verlangern. Eine tertiare Pravention nach erfolgter Fruhgeburt ist notwendig und kostenintensiv.

Tranexamic acid is effective in reducing blood loss during various types of surgery and after trauma. No compelling evidence has yet been presented for post-partum haemorrhage. A systematic literature search of relevant databases was performed to identify trials that assessed blood loss and transfusion incidence after tranexamic acid administration for post-partum haemorrhage. The random effects model was used for meta-analysis. Risk ratios (RRs) and weighted mean differences (WMDs) were calculated with 95% confidence intervals (CIs). Seven trials with a low risk of bias comparing tranexamic acid vs. placebo with a total of 1760 parturients were included in our systematic review and meta-analysis. Blood loss was significantly lower after tranexamic acid use (WMD -140.29 ml, 95% CI -189.64 to -90.93 ml; P0.00001). Tranexamic acid reduced the risk for blood transfusions (RR 0.34, 95% CI 0.20-0.60, P=0.0001). The incidence of transfusions in the placebo group varied between 1.4% and 33%. When omitting the two trials with the highest incidence of transfusions, the RR was no longer significant. Additional uterotonics were necessary in the placebo groups; gastrointestinal adverse events were more common after tranexamic acid use. Only four cases of thrombosis were found, two each in the tranexamic acid and control groups. Tranexamic acid effectively reduced post-partum blood loss; the effect on the incidence of blood transfusions requires further studies. Only few trials observed adverse events including thromboembolic complications and seizures.

Die Bestimmung von Akute-Phase-Proteinen und Zytokinen im Nabelschnurblut stellt eine wertvolle Erganzung der Diagnostik des Neugeborenen dar. Die Analyse des Nabelschnurbluts ist einfach durchzufuhren, die Ergebnisse sind schnell erhaltlich. Problematisch ist, dass die Evaluierung der Bestimmung dieser Parameter im Nabelschnurblut noch nicht fur alle Parameter befriedigend durchgefuhrt ist. Angesichts der schweren Erkrankungen, die lebenslang aus einer Infektion vor und wahrend der Neonatalphase resultieren konnen, muss allerdings die Bestimmung von Infektparametern im Nabelschnurblut weiter verfolgt werden und wird voraussichtlich in wenigen Jahren bei bestimmten Geburtsverlaufen selbstverstandlich werden.

Shoulder dystocia with subsequent brachial plexus lesions in neonates is a common reason for obstetric liability litigation. Trauma during delivery is often assumed to be directly responsible for the lesion. We recently gave an expert opinion in a case involving Erb's palsy after an unremarkable delivery with no evidence of shoulder dystocia. We review the recent North American literature on plexus lesions in neonates without shoulder dystocia. The analysis of neonates with Erb's paralysis after delivery without shoulder dystocia, particularly after atraumatic cesarean delivery, have led to a new concept of prenatal (in utero) development of plexus lesions. These cases are inconsistent with the traditional concept of plexus lesions due to trauma sustained at delivery. In this group the traditional risk factors for shoulder dystocia play only a minor role. Overall, at least 50% of neonatal brachial plexus lesions result from unavoidable antepartum or intrapartum events and occur without shoulder dystocia. Antenatal brachial plexus lesions may result from stretching forces or pressure exerted on the plexus in utero by uterine anomalies (e.g., leiomyomas, intrauterine septa, bicornuate uterus) or other factors. Abnormal forces of labor may also play a role. The concept of Erb's paralysis unrelated to trauma at delivery and shoulder dystocia has medicolegal implications.

In the future the goal should be increased cooperation between the different disciplines of obstetrical work (maternity ward, lying-in ward, parents' school). At the same time, personnel continuity in patient care should be ensured. Since the solution is difficult, inclusion of freelance midwives in the clinic like the Charite-Virchow model could be helpful. More important for the acceptance of clinical obstetrics than the means “alternative” delivery is how interested the members of the obstetrics team are in the patient and her care and well-being.

Die Fruhgeburt ist eine wesentliche Ursache kindlicher Mortalitat und Morbiditat. Wir bemuhen uns, die Rate der Fruhgeburten durch geeignete soziale und medizinische Masnahmen zu senken, wobei besondere Hoffnung auf die Pravention gesetzt werden mus. Um praventiv tatig werden zu konnen, ist die Identifikation der fruhgeburtsgefahrdeten Frauen mit Hilfe von anamnestischen, klinisch befundbaren, ultrasonographischen, laborchemischen und mikrobiologischen Fruhgeburtsmarkern notwendig.

Evaluation of Fetal Pulse Oximetry: Case Cnntrol Study for Assessing Undesirable Complications: Objectives: Fetal pulse oximetry (PO) requires basically continuous contact of a transcervically positioned oxisensor with fetal skin. To improve signal quality adjustments of the oxisensor may be necessary. Against this background it was our intention to find out if this intrauterine device causes an increase in fetal or maternal infectious morbidity. Study Design: We enrolled into this prospective trial 63 deliveries monitored by a blinded fetal pulse oximeter (N 400, Nellcor Inc. Pleasanton, CA) and a fetal oxisensor (FS 10; λ = 660 + 890 nm). The control group of similar gestational age was formed by 63 chronologically following deliveries under responsibility of the same physician to reduce personal bias of obstetrical management. Results: While the obstetrical risk factors (non-reassuring FHR i. e.) were significantly higher in the group with PO, gestational age, number of operative deliveries, pH of umbilical cord and Apgar score ratings did not show any significant difference. The number of post partum anaemias and local or systemic infections were identical (3 in each group). Seven neonates of the PO group had to be transferred to NICU versus 12 in the control group. The duration of antibiotic treatment, mechanical ventilation or phototherapy did not differ significantly; neither did the number of neonatal infections. Conclusion: In the group of fetuses monitored by fetal pulse oximetry there was no increase in fetal or maternal infectious morbidity. There was no evidence of adverse side effects which might limit the advantage of continuous oxygen saturation monitoring.

Phospholipid classes in human amniotic fluid, whose quantitative determination plays an important role in obstetrics for diagnosing lung maturity in the fetus, are separated through normal phase chromatography by HPLC. In this study an already known chromatographic system is described with which not only the phospholipids, but also phosphatidylcholine partly after being combined with both its fatty acid residues, is separated. This separation implies the fatty acid residues which are of greatest interest to the obstetrician. A mass or evaporative light-scattering detector was used for the detection.

Current approaches to the detection of patients at risk for preterm delivery (PTD) have focused on the diagnosis of preterm labor. However, these approaches are complicated by treatment biases and our inability to convincingly differentiate preterm labor from Braxton-Hicks contractions. Moreover, preterm labor with intact membranes accounts for only one-half of all spontaneous PTDs since uterine contractions follow preterm premature rupture of the membranes (PROM) in an additional 50% of cases. Clinical dogma holds that the prevention of PTD requires the early detection of at risk patients. However, clinical indicators of PTD risk including cervical change, uterine contractions, vaginal bleeding, maternal demographic featuers and obstetrical history have poor sensitivity and/or specificity. Fortunately, an improved understanding of the association between preterm parturition and cervical, chorionic and decidual extracellular matrix degradation has led to a number of promising new biochemical indices of the proteolytic processes leading to PTD. These include measurement of serum collagenase activity and assessment of cervico-vaginal granulocyte elastase and oncofetal fibronectin levels. It remains to be seen, however, whether an improved detection of patients at risk will lead to a reduction in the occurrence of PTD.

To assess neonatal outcome and delivery mode in dichorionic twin delivery at term with a cephalic-presenting first twin.A retrospective cohort study of 308 twin deliveries after 37 completed weeks of gestation with a cephalic-presenting first twin undertaken in one perinatal center with active management of second twin delivery. The neonatal outcome was measured by the Apgar score, the umbilical artery pH and the transfer into the neonatal unit.In the whole group, 57% were vaginally delivered and 43% needed a Cesarean delivery. The planned vaginal delivery group contained 71% while the planned elective Cesarean delivery group contained 29%. In the planned vaginal delivery group 80% were delivered vaginally, in 15% an emergency Cesarean was necessary, 5% had a vaginal delivery of the first twin followed by Cesarean delivery of the second twin. The neonatal outcome of the second twin shows a higher risk. There are significant differences in the rates of the second twin having lower rates of the umbilical artery pH7.20 in the group of planned vaginal delivery. The higher risks are compensated in the group of planned elective Cesarean delivery.Planned vaginal delivery of dichorionic twins at term and active second-stage management is associated with lower rate of normal neonatal outcome. These risks should be considered in prenatal informed consent discussions with the pregnant woman.

Quality of life and achievements are impaired by unrecognised iron deficiency. The iron requirement of women during their child-bearing age is high and increases in pregnancy. The aim of this study was to determine the prevalence and risk factors for iron deficiency in young mothers under contemporary German life conditions. Between September 1997 and August 1998 the iron status of 507 mothers of one-year old children was assessed. The data was derived from venous blood and questionnaires. Besides conventional methods, the concentration of soluble transferrin receptor was used as leading indicator of iron status. 9.5% had cellular iron deficiency and 2.2% of all mothers had iron deficiency anemia. In addition to absence of school education non-German nationality, a high number of children and vegetarian food are risk factors for iron deficiency. In contrast, high alcohol intake and cigarette smoking are associated with a better iron status. Children of mothers with insufficient iron supply are also at higher risk of iron deficiency.

In June 1909, The Empress Auguste Victoria House in Berlin was opened. This first institute for preventive paediatrics had the objective to overcome infant mortality in Germany. This objective was attained. Since then, an unprecedented decrease of mortality in all age groups occurred as well as a doubling of life expectancy. With this "retreat of death", our concepts of health changed fundamentally, and a new spectrum of diseases emerged. This article discusses some mile stones of this change, and explains why we find more illness despite the great improvement in the field of health. The "new diseases" amenable to early prevention are presented in a table. To make disease prevention successful requires the participation of the individual. Therefore, it is important to know the demand to make a good programme effective in the population. Empirical results of a nationwide representative study on the demand by expecting and young parents for preventive consultation are presented. Anticipatory guidance of young parents is a modern approach to health promotion and disease prevention. A controlled trial shows that this approach improved knowledge, behaviour, health risk indicators, health, and development during the first two years after delivery. Future studies should focus on long term effects of early health promotion.

The aim of this study was to collect information on and to evaluate the impact of the timing of first suckling and breast-feeding initiation in Berlin and to assess the practicability and acceptance of using a short questionnaire to collect breast-feeding data in hospitals and birth centres.A three-month observational study was conducted in 19 maternity units and 4 birth centres, using a short questionnaire to collect quantitative data on the timing of first suckling and breast-feeding from mother-child pairs on the day of discharge.The data indicate a breast-feeding rate of 96.1% at discharge. Infants born in birth centres were more frequently put to their mother's breast within the first hour after birth (p0.05), and were more frequently mainly (p0.05) or exclusively (p0.01) breast-fed at discharge than infants born in hospitals. Hospitals' breast-feeding policies (i.e., following the 'ten steps to successful breast-feeding') were not associated with a higher prevalence of early first suckling and any breast-feeding at discharge, but rather with exclusivity of breastfeeding (p0.001).Breast-feeding initiation rates are satisfactorily high in Berlin. Rates of early first suckling and (exclusive) initial breast-feeding are highest in birth centres. No consistent association was found between hospitals' breast-feeding policy and initial breast-feeding variables. The questionnaire was well accepted and is deemed suitable for monitoring purposes.

It was the objective of this study to compare the efficacy and safety of oral misoprostol with those of vaginal dinoprostone for the induction of labour at term.Between 2003 and 2006 224 pregnant women were included in our prospective randomised clinical trial. All of them were admitted for induction of labor at term. Half of the patients received oral misoprostol, initially at a test dose of 25 microg, followed by 50 microg and 100 microg every 4 hours. The control group received 3 mg vaginal dinoprostone every 6 hours. Primary endpoints were time interval until delivery and mode of delivery as well as maternal and neonatal outcome, secondary endpoints were side effects and costs.In the dinoprostone group, the median time interval until delivery was 17.6 hours compared to 24.1 hours in the misoprostol group. Without the test dose, the difference was no longer significant. After dinoprostone induction, more patients had a vaginal delivery within 24 hours (n=60, 53.6%, vs. n=46, 41.1%). The frequencies of spontaneous deliveries and emergency Caesarean sections did not differ between the groups. The rate of vacuum extractions was higher in the misoprostol group (23 vs. 11, i. e. 20.5 vs. 9.8%, p0.05). With regard to side effects there was no significant difference. No case of hyperstimulation was documented.Oral misoprostol is effective and safe for induction of labour at term. In addition, it is much cheaper and independent of storage conditions. At the doses and with the administration intervals used in this study, dinoprostone was slightly more effective than misoprostol.

Knowledge of the risks of smoking during pregnancy induces only part of the pregnant women to give up smoking. How many pregnant women in Germany smoke from the beginning to delivery, and what characterises these smokers, is the topic of this article.Results from the German Mikrozensus, several national surveys, perinatal statistics and Euro-scip III are presented, compared, and assessed. Findings of our own studies conducted between 1999 and 2002 at the obstetric department and gynacological practices in Berlin allow an insight into the magnitude of "underreporting".In the ages 15-45 years 36-45 % of German women smoke, prevalence rates that probably are valid even for the beginning of pregnancy. While smoking prevalence in men has decreased during the last 20 years, there is an increasing trend in women. The prevalence is higher in pregnant women of low social status, living with smoking partners and those of German nationality. At most, half of the women give up smoking during pregnancy. Assuming an "underreporting" in pregnant women of at least one third, the prevalence of smoking up to delivery is 24 %. Although 76 % of the practicing gynacologists in Berlin feel responsible for smoking counselling, only 12 % are convinced that it is successful.A quarter of the pregnant women in Germany smoke through to delivery, which means that 150 000 newborns per year have been exposed to passive smoking in utero, and its long-term health effects, which is a national disaster.

Health and diseases are generally perceived to be caused genetically. It is meanwhile accepted, however, that alterations in the intrauterine and early postnatal nutritional, metabolic, and hormonal environment may also predispose to disorders and diseases throughout later life. Studies in the offspring of diabetic mothers (ODM) have decisively contributed to this perception and our understanding of causal mechanisms. It has long been known that hormones are environment-dependent organizers of the developing neuroendocrine-immune network, which regulates all fundamental processes of life. When present in non-physiological concentrations during critical periods of development, induced by altered intrauterine and/or neonatal environment, hormones can therefore also act as endogenous functional teratogens. Fetal and neonatal hyperinsulinism is the pathognomic feature in ODM. Epidemiological, clinical, as well as experimental data obtained by our group indicate that insulin itself, when occurring in elevated concentrations during perinatal life, may program the development of obesity and diabetes. Similar situations may occur due to maternal overweight accompanied by increased fetal food supply, and neonatal overfeeding. From a clinical point of view, general screening and therapy of all types of diabetes during pregnancy as well as avoidance of early postnatal overfeeding are therefore recommended. These measures might serve as causal approaches to a genuine primary prevention.