[Requirements and current state of birth documentation in Germany]. / Moderne Anforderungen und derzeitiger Standard in der Geburtsdokumentation in Deutschland.

INTRODUCTION: The partogram is a central record in everyday practice for midwifes and obstetricians. For legal enquiries it is one of the most important documents, however, so far there is no standardised partogram in use in Germany. This study explores the current requirements and develops a standardised partogram. MATERIAL AND METHODS: In Germany 95 hospitals with a focus on tertiary referral centres were randomly selected to be questioned. Obstetricians and midwifes were asked to answer a questionnaire, which was based on a current literature search and expert interviews. RESULTS: 49 obstetricians (51.6%) and 24 midwives (25.3%) returned the questionnaires. 80% of those regularly cooperate with the other specialty with a partogram. 75% are using a standardised partogram, 8% an empty page and 6% computerised obstetric records. Most responders are using parameters which are defined in the current guidelines of the German Society of Obstetrics and Gynaecology. Variations were especially pronounced in the scoring system of the cardiotocogram and on legal issues. Room for improvement of the current documentation was documented in half of the cases. DISCUSSION: There is a need for optimising the current birth documentation. With the results of the questionnaire a standardised model for a partogram was developed.

Laparoscopic pectopexy: a randomised comparative clinical trial of standard laparoscopic sacral colpo-cervicopexy to the new laparoscopic pectopexy. Short-term postoperative results.

PURPOSE: Sacral colpopexy is a well established method of vaginal prolapse correction. Although it is capable of restoring the physiologic axis of the vagina, this method also bears some serious operative risks [1]. The aim of the study was to compare the laparoscopic sacral colpopexy with a laparoscopic bilateral fixation of the vagina/cervix to the iliopectineal ligaments via a PVDF-mesh (pectopexy). METHODS: This part of a single-center randomized prospective clinical trial (Canadian Task Force Classification) compared the short-term operative outcome of laparoscopic sacropexy and pectopexy. We evaluated the operating time, blood loss, hospital stay duration, occurrence of major complications, episodes of constipation, urinary retention, de novo urinary incontinence, urinary tract infections, body mass index and postoperative Creactive protein values. The 1-year follow up examination will be carried out to evaluate the occurrence of relapse as well as late complications. Local symptoms and sexual activity will be evaluated using a German version of the ICIQ Vaginal Symptoms Questionnaire. RESULTS: We carried out 43 pectopexies and 40 sacropexies in conjunction with other laparoscopic and/or vaginal procedures, as indicated. No major complications occurred in both groups during the hospital stay. There were no significant differences in the body mass index, average age, hospital stay duration and occurrence of constipation. The average operating time (43.1 vs. 52.1 min) and blood loss (4.6 vs. 15.3 ml) were significantly lower in the pectopexy group (p < 0.001). CONCLUSION: Although laparoscopic pectopexy cannot yet be generally recommended as an alternative to sacropexy until the follow-up data is obtained, the new method can be considered in patients where the presacral preparation bears a higher risk of injury.