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Postpartum hemorrhage (PPH) is one of the main causes of maternal deaths even in industrialized countries. It represents an emergency situation which necessitates a rapid decision and in particular an exact diagnosis and root cause analysis in order to initiate the correct therapeutic measures in an interdisciplinary cooperation. In addition to established guidelines, the benefits of standardized therapy algorithms have been demonstrated. A therapy algorithm for the obstetric emergency of postpartum hemorrhage in the German language is not yet available. The establishment of an international (Germany, Austria and Switzerland D-A-CH) "treatment algorithm for postpartum hemorrhage" was an interdisciplinary project based on the guidelines of the corresponding specialist societies (anesthesia and intensive care medicine and obstetrics) in the three countries as well as comparable international algorithms for therapy of PPH.The obstetrics and anesthesiology personnel must possess sufficient expertise for emergency situations despite lower case numbers. The rarity of occurrence for individual patients and the life-threatening situation necessitate a structured approach according to predetermined treatment algorithms. This can then be carried out according to the established algorithm. Furthermore, this algorithm presents the opportunity to train for emergency situations in an interdisciplinary team.

Zusammenfassung Fragestellung: Ziel dieser Studie war es, Risikofaktoren für Dammverletzungen während einer spontanen vaginalen Geburt bei erstgebärenden Frauen zu definieren. Material und Methodik: Es wurden insgesamt 725 erstgebärende Frauen mit einer spontanen, vaginalen Geburt an der Universitätsfrauenklinik Wien in die Studie eingeschlossen. Die Risikofaktoren für Dammverletzungen wurden mit einer univariaten und multivariaten Analyse evaluiert. Die Datenanalyse erfolgte mit folgenden Variablen: mütterliches Alter, Dauer der Austreibungsphase, Verwendung von Oxytocin, Durchführung einer Episiotomie, Periduralanästhesie, vorzeitiger Blasensprung, Geburtsposition, kindliches Geburtsgewicht sowie Häufigkeit und Schweregrad von Dammverletzungen. Ergebnisse: 74% aller erstgebärenden Frauen hatten keine Dammverletzungen. Es zeigte sich eine Dammverletzungsrate von 26%, wobei in 16% der Fälle ein erstgradiger und in 9% der Fälle ein zweitgradiger Dammriss festgestellt wurde. Bei einem geringen Patientenanteil (0,6 %) wurde ein drittgradiger Dammriss festgestellt. Eine univariate Analyse identifizierte das Fehlen einer Episiotomie (p = 0,0001) und die Rückenlage (p = 0,033) als Risikofaktoren. Das mütterliche Alter, die Periduralanästhesie, die Gabe von Oxytocin, ein vorzeitiger Blasensprung und Dauer der Austreibungsphase zeigten keinen signifikanten Zusammenhang mit dem Auftreten von Dammverletzungen (p > 0,05). Im multiplen logistischen Regressionsmodell blieb das Fehlen einer Abstract Purpose: We sought to identify risk factors for spontaneous perineal tears of all degrees during vaginal delivery in nulliparous women.Material and Methods: We studied 725 consecutive term, singleton, spontaneous vaginal deliveries in nulliparous women at the University Hospital of Vienna. Risk factors for perineal tears were evaluated using univariate and multivariate logistic regression analysis. Medical and obstetric records were reviewed for the following characteristics: maternal age, duration of the second stage of labor, donation of oxytocin, use of episiotomy, use of epidural analgesia, premature rupture of the membranes (PROM), delivery position, fetal birth weight and occurrence and severity of perineal tears. Results: 74% of nulliparous parturients had no detectable tears. An overall rate of perineal trauma of 26% was found, resulting in 16% first degree tears and 9% second degree tears, whereas third degree perineal tears only occurred in a small percentage (0.6%). A univariate analysis revealed that absence of episiotomy (p = 0.0001) and supine position (p = 0.033) increased the risk of perineal tears during first spontaneous vaginal delivery. Age, the use of epidural analgesia, the donation of oxytocin, PROM and the duration of the second stage of labor showed no statistically significant influence on the occurrence of perineal lacerations (p > 0.05). Furthermore, a multiple logistic regression model revealed that absence of episiotomy (p = 0.0001) remained inde-Originalarbeit 68 Institutsangaben

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A specially developed linear everting catheter (LEC) in combination with a microendoscope, enables for the first time the visualisation of the complete tubal mucosa from a vaginal approach. Preliminary results in using this technique are described. Physiological and pathological results of tubal mucosa can be presented, which will influence the diagnostic and therapeutic part of subsequent sterility treatment.