[Caesarean sections under regional anesthesia: pros and cons of supplementary oxygen]. / Sectio caesarea in Regionalanästhesie : Pro und Kontra der supplementären Sauerstoffgabe.

The routine administration of supplemental oxygen to women undergoing elective caesarean section under regional anesthesia in order to optimize oxygen supply to the fetus is common anesthetic practice in many German hospitals. However, this practice has been controversially discussed in the non-German literature for many years. This review presents and discusses the pros and cons of routinely providing supplemental oxygen to a parturient during caesarean section on the basis of the literature published over the last 30 years. Proponents of routine oxygen administration point to potential and unforeseeable risks of caesarean sections and consider the prophylactic administration of oxygen based on physiological considerations to be advantageous in terms of patient safety. Interestingly, data regarding the effects of an increased maternal FIO2 on improvement of fetal oxygenation are inconsistent, therefore, no unambiguous recommendation concerning which FIO2 to choose can be given. Opponents of routine oxygen supplementation allude above all to an increase in free radical activity in both mother and fetus; however, data in this respect are not consistent either. As supplemental oxygen to patients undergoing elective caesarean section without any risk factors under regional anesthesia is associated with potential risks while no advantage has so far been demonstrated, routine administration of oxygen has to be challenged and is no longer considered to be indicated by many. On the contrary, in cases of emergency with a concomitant risk of hypoxia for mother and fetus, administration of oxygen is indispensable in the light of present data.

[Quality of data transfer in perinatal data -- experience of a centre]. / Ubertragungsqualität von Perinataldaten -- Erfahrungen an einem Zentrum.

BACKGROUND: A sufficient quality of data transfer from written patient records to electronic data processing is a precondition for a reasonable usage of perinatal data. However the quality of data transfer of the almost 200 characteristics routinely recorded at each delivery is largely unknown. MATERIALS AND METHODS: The quality of data transfer of 33 characteristics in 350 randomly selected singleton deliveries of the women's clinic of the University of Marburg from 2002 and 2003 has been checked by comparing electronically recorded data with the original written documents. RESULTS: The quality of data transfer of the tested characteristics turned out to be heterogeneous. Characteristics necessary to calculate quality indicators show a very high data quality when excluding the characteristic attendance of a paediatrician. The quality of data transfer of characteristics denoting time as well as blood gas analysis are heterogeneous. Characteristics with a low quality of data transfer are associated with ambiguous instructions, the fact that the coding obstetrician is not dealing in the first instance with the item being encoded and the characteristics are of no immediate relevance for delivery, as well as difficult application of the software. CONCLUSION: The quality of data transfer of the characteristics collected in perinatal surveys needs to be validated. The type and amount of data being collected should be reassessed considering improvements of data quality.

[Dynamics of thrombin-antithrombin-III complex (TAT-III) and prothrombin fragments F1 + 2 during labour with and without aprotinin administration]. / Die Dynamik des Thrombin-Antithrombin-III-Komplexes und der Prothrombinfragmente F1 + 2 sub partu mit und ohne Aprotiningabe.

OBJECTIVE: The aim of this study was to determine if aprotinin could affect postpartal fibrinolysis when given at the latest 15 min before delivery and if there is a difference between normal delivery and caesarean section. Furthermore we wanted to examine if the thrombin-antithrombin-III-complex (TAT-III) and prothrombin fragments F1 + 2 changed in the peripartal period and if prethrombotic stages could be recognized. PATIENTS AND METHODS: 84 patients (15 - 44 years of age) have been examined (41 normal deliveries, 43 cesarean sections). After giving informed consent and randomization, 30 of these patients were administered 1 Mio KIE aprotinin (Trasylol(R)) at the latest 15 min before delivery (15 normal deliveries, 15 cesarean sections). The results of TAT-III, prothrombin fragments F1 + 2, factor VIII and partial thromboplastin-time (PTT) were collected shortly before and after delivery and 30 and 120 min after detachment of the placenta. RESULTS: Normal deliveries without aprotinin showed a significant increase of TAT-III and an evident increase of prothrombin fragments F1 + 2. After administration of aprotinin this increase was significantly lower. The increase of TAT-III and prothrombin fragments F1 + 2 in patients with caesarean sections was evidently lower than in normal deliveries and was not influenced significantly by aprotinin. Factor VIII and partial thromboplastin time (PTT) showed no relevant changes in all study groups. DISCUSSION AND CONCLUSION: The consumption of coagulation and fibrinolysis factors induced by delivery of the child and detachment of the placenta can be reduced after administration of aprotinin given at the latest 10 - 18 min before partus. This could be used in therapy and prophylactic treatment in high-risk patients (e. g., pre-eclampsia, HELLP syndrome, etc.).

[Personal Digital Assistants assisting in clinical and administrative tasks]. / Unterstützung klinisch-administrativer Aufgaben durch Personal Digital Assistants (PDAs)--Möglichkeiten und Grenzen.

Personal digital assistants (PDAs) are increasingly used by many professional and private users. They replace and combine common calendars, directories, to-do-lists and much more. Supplemented by useful additional software they can assist the clinician in his daily routine work. This concerns typical medical information as well as administrative work but gets more importance with regard to the planned introduction of diagnosis related groups in Germany however. Exact coding of medical performance is essential for this future invoice system. How PDAs can be used convenient in this respect will be shown with examples from our department.

[Principles and advanced techniques for better internetpresentations in obstetrics and gynecology]. / Prinzipien und aktuelle Techniken der Internetpräsentation in der Frauenheilkunde.

Internet presentations are common tools for better medical communication and better scientific work. Meanwhile a great number of gynecological and obstetrical institutions present data via the world wide web within a wide range of quality and performance. Specific HTML editors offer quick and easy presentations, but only advanced internet techniques enable interesting multimedia presentations. N-tier applications are the future standard and we must integrate them in general informatical systems. New Concepts, actual tools and general problems will be discussed and new principles similar to actual E commerce techniques are able to solve our special medical demands.

[Computer-assisted cardiotocogram analysis--from descriptive to perinatal expert system]. / Die computergestützte Kardiotokographieanalyse--Von der Deskription zum perinatologischen Expertensystem.

The interpretation of cardiotocograms is essentially for perinatal management, it remains labour intensive and depends on training and experience. With the development of modern analysing systems with conventional classification techniques, it seems possible to introduce expert systems and neuronal networks for a better interpretation and classification of cardiotocograms. Techniques of artificial intelligence are powerful tools and should be integrated in future systems. Because CTG-analysis--as a single procedure--is only of limited value for sufficient fetal prognosis, we conclude that computer aided CTG-analysis in combination with additional fetal parameters, for example partial oxygen pressure, will allow the development of future sufficient perinatal expert systems. Nothing should hinder future integration of computerized cardiotocogram analysing systems into everyday clinical routine and to connect it to obstetrical databases.

[Integration of quality assurance procedures into medical documentation systems--from quality indicator to improved medical quality]. / Die Integration qualitätssichernder Prozeduren in medizinische Dokumentationssysteme--vom Qualitätsindikator zur verbesserten medizinischen Qualität.

Medical and commercial data are essential for sufficient clinical management. While regional quality studies--for example the German Perinatal Data Study--are mighty tools to compare the quality of departments in total--the integration of evaluated individual quality indicators in data processing systems can highly improve clinical results and clinical management. The evaluation of quality indicators improves the benefit of quality management. Parameters monitoring the contentment of patients are extremely valuable information. Quality management and information management are closely linked.

[Medical controlling--principles, conditions and current tools]. / Medical controlling--Prinzipien, Vorgaben und aktuelle Tools.

In 2003 diagnosis related groups (DRG's) will be established in Germany as a new system for describing costs of inpatient treatment. Principles of medical controlling are explained, the development from the system formerly used in Germany towards DRG's is described and computer-based assistance already available is pointed out and evaluated critically.

[Current internet technology for gynecology--from hypertext transfer protocol to embedded web server]. / Aktuelle Internettechnologien für die Frauenheilkunde--Vom Hypertext Transfer Protokol zum eingebetteten Web-Server.

The scientific and commercial use of the internet has caused a revolution in information technologies and has influenced medical communication and documentation. Web browsers are the becoming universal starting point for all kinds of client-server applications. Many commercial and medical systems--such as information reservation systems--are being shifted towards web-based systems. This paper describes new techniques. Security problems are the main topics for further developments in medical computing.

[Optimizing performance documentation in gynecology--assistance from the internet]. / Optimierung der Leistungsdokumentation in der Frauenheilkunde--Hilfestellungen aus dem Internet.

The documentation of operations in the field of gynecology and obstetrics is regulated by social laws in Germany. Only by optimal encoding of diagnoses and procedures an efficient cashing with the health insurance's can be achieved. This requires profound knowledge of the invoice modalities and usually support by computer systems. The Internet offers in this respect some assistance, which in the following is pointed out and evaluated critically.

[Hospital information systems or data processing in gynecology? Strategic reflections towards a comprehensive information concept]. / Krankenhausinformationssysteme oder Abteilungslösungen für die Frauenheilkunde? Strategische Uberlegungen zu einem umfassenden Informationskonzept.

Hospital information systems are essential tools for efficient hospital management and improvement of medical procedures. Structural differences between the management of hospital information systems and the management of other huge, distributed and heterologous information systems cannot be found. However, there are differences concerning special tasks in patient care and medical research with high demands in data protection and modularity. The management of information processing has to be performed systematically.

[Congress organization and the internet--new structures in scientific communication for gynecology?]. / Kongressorganisation und Internet--Neue Strukturen der wissenschaftlichen Kommunikation für die Frauenheilkunde?

For decades scientific sessions and conferences were a proven way to spread and exchange scientific results worldwide--not only in the field of medicine. With growing availability and accessibility of information on the internet and WWW conferences are now not only listed and announced on a multitude of websites, but also are prepared ahead from simple registration to online discussions. By means of selected examples information is provided on how keeping oneself informed about former or planned conferences by using the internet.