In addition to seven main topics, the SGGG Congress in Lugano offered numerous other program items. Between the smaller halls where the free communications and poster sessions were held, there was a lot of traffic and lively discussions. Here is a small selection of interesting presentations.
Gestational diabetes mellitus (GDM) is an important issue with up to 14% prevalence and should be assessed early in pregnancy. Women at increased risk are evaluated in the first trimester with a fasting venous glucose test, an occasional glucose test, or an HbA1c measurement. Amylidi et al. questioned whether, in a high-risk population, the value of the HbA1c value has any significance for the prediction of GDM.
218 pregnant women (10-14 weeks gestation) with at least one risk factor according to SGGG/SGED (BMI >30, positive first-degree family history for diabetes, positive personal history for GDM, PCO syndrome, ethnicity) were included in the study. In them, HbA1c measurement was performed in the first trimester. In all cases, the 24-28th week was then used. week, an oral glucose tolerance test with 75 g glucose was performed.
The prevalence of GDM was 32/218 (14.7%). Women who later developed GDM had significantly higher HbA1c levels compared with women without GDM.
CONCLUSION: The prevalence of GDM in an at-risk population appears to be lower than expected. The results also show that measurement of HbA1c in the first trimester is useful not only to exclude a pre-existing metabolic disorder, but also to risk stratify women who later develop GDM. A prospective study with a normal and at-risk population is planned to investigate the reliability of HbA1c measurement in screening for GDM [1].
SGA babies under stress
Intrauterine deficiency (“Small for Gestational Age”, SGA) is a significant risk factor for the development of cardiovascular and metabolic disease in adulthood (fetal programming). A disturbed regulation of the stress axis seems to play a decisive role here. Neonatal SGA infants show significant suppression of stress reactivity as early as the neonatal period. The further dynamics of this disorder were examined at four to six months.
Material and Methods: 19 term-born SGA infants (GG <10th percentile) and 17 control infants of normal weight at birth were studied by stress stimulus during routine immunization at four and six months of age, respectively. Cortisol values were measured under resting conditions and 25 or 45 min. measured in saliva after the stress stimulus. Individual cortisol responses were analyzed as the difference in individual time points (delta) by Mann-Whitney test.
Results: Gestational age at birth was comparable between SGA and control groups (271 vs. 264 days, n.s.). The median birth weight of the SGA group was 2200 g (6th percentile), of the control group 3270 g (48th percentile) (p<0.05). SGA children continued to be significantly lighter than the control group at the study time point (6300 g vs. 7160 g, p<0.05). Resting values for cortisol between SGA and controls were comparable (1.06 [0,41–10,65] ng/ml vs. 1.25 [0,32–1,09] ng/ml (median [range] n.s.). While no relevant cortisol response to the stress stimulus followed in control children (1.03 [0,29–2,26] ng/ml (delta -0.27 [-1.83-1.71] n.s.), children in the SGA group showed a significant increase in cortisol (2.31 [0,47–6,09] ng/ml (delta 0.73 [-5.23-5.61] ng/ml, p<0.05). This increase was more pronounced after 45 min compared to the control group. normalized.
Conclusion: Intrauterine deficiency leads to a significant and permanent disturbance of the infantile stress axis, which seems to change from suppression at birth to overreaction during the first year of life. This increased sensitivity to stress stimuli, if persistent, could be partly responsible for the intrauterine imprinting of disease later in life [2].
Teamwork in the building department
Following an accumulation of complaints about inappropriate communication in the delivery room at Winterthur Cantonal Hospital, the hospital management initiated improvement measures. A communication scientist was hired for this purpose, as Elke Barbara Prentl, MD, of the Women’s Clinic reported.
The communication competence of all employees in the building department was put to the test, and questionnaires were used to interview midwives and physicians separately. Complaints came mainly from midwives. Conflicts in the area of conflict between the midwife’s competence to manage birth and the physician’s competence to make decisions were in the foreground. In four interdisciplinary workshops, the following measures were decided: Conducting joint birth planning meetings, debriefing after each birth, detailed discussion of complicated or problematic cases.
Communication between physicians and midwives is now effective and trouble-free. The measures introduced have improved communication within the team. The sustainability of the measures must be monitored. The physicians see less benefit for themselves in the result than the midwives [3].
Not interested in rebuilding?
What do breast cancer patients know about secondary breast reconstruction after mastectomy and what kind of care do they expect? What would they like to have explained? These questions were addressed by a multicenter Swiss study group. Since only a minority of approximately 25% of breast cancer patients undergo secondary breast reconstruction, the reasons for this were of interest. On the one hand, this could be due to the fact that patients are insufficiently informed about the possibilities of a build-up, and on the other hand, that a large number of patients come to terms with the changed body image relatively quickly.
Material and methods: 101 patients who had undergone mastectomy for invasive breast carcinoma (stage I-III) between 1998 and 2009 completed a 16-item questionnaire regarding their attitudes toward breast reconstruction and their experiences and expectations regarding physician education. <The women were 70 years old at the time of the interview (median: 56 years, range: 37-70 years). By then, 26 patients had undergone breast reconstruction.
Results: Nearly all respondents (97%) were informed about breast reconstruction options. However, 39.5% of respondents indicated that such education was not of concern to them, either before mastectomy or later in the course of tumor follow-up, as they had never been interested in reconstruction; older patients were more likely to show disinterest. As time progressed, patients perceived the body image injury as less severe. This was similarly true for women after breast reconstruction as well as for women who did not have reconstruction. Of 63 women who did not want reconstruction in the future, 28 (44.4%) were fully satisfied with the postmastectomy condition as it was; 30 women (47.6%) gave reasons for not performing reconstruction to date that could possibly be corrected or invalidated by detailed consultation with a plastic surgeon.
The relatively low take-up of reconstruction opportunities does not appear to be due to a lack of information. The majority of patients quickly overcome the initial negative feelings after breast removal and then have only a limited interest in reconstruction. However, ambivalent patients should be given the opportunity to clarify questions about breast reconstruction in a detailed discussion [4].
Clitoral Neuroma
Women who were subjected to genital circumcision as girls suffer not only the psychological trauma but also the local consequences of this procedure. They cannot experience satisfying sexuality, suffer from the appearance of their genitals and pain. So far, three cases of amputation neuroma at the clitoris with very severe pain have been described; one case from Geneva was presented by the research group of Abdulcadir et al. before. Reconstruction of the mutilated external genitalia and also the clitoris is possible and, as the case study revealed, can also end pain symptoms. A 38-year-old woman presented with FGM/C type IIc (“Female genital mutilation/cutting I-III”) as initial findings and suffered from severe, chronic vulvar pain and dyspareunia. A multidisciplinary team cared for her preoperatively and postoperatively, and the surgery took place after three months of preparation. During the reconstructive procedure, the clitoral stump was freed from the fibrous scar plate, which turned out to be an amputation neuroma, and used as a neoglans. The patient was satisfied with the result, the pain stopped after one month. Subsequently, the woman reported satisfying sexuality with orgasms [5].
Pain without end
The topic “Chronic lower abdominal pain between soma and psyche” was the 7th main topic and formed the conclusion of the SGGG congress.
The psychosomatics specialist Dr. med. Wolf Lütje from Hamburg has become accustomed to certain formulations when dealing with women with “pain without end” in order to make his empathy credible to those affected. The result of a laparoscopy, for example, should never be conveyed with the words “There’s nothing there.” Better to say, “I didn’t see anything pathological,” he said. As a general rule, too many surgeries promote triggering toward chronic pain. “Your pain is finding enough, you can’t just be imagining it. The cause cannot be determined,” Dr. Lütje formulates cautiously. It is important to ask about the patient’s subjective theory, he said, “Where do you think your pain is coming from?”
The somato-psychic approach assumes that pain hypersensitivity, anxiety, or boundary violations may underlie chronic lower abdominal pain. The important thing here, she says, is to give the suffering a name (“You have a pain disorder”) and to open a window for new meaning together with the patient. Motto: A kitten can see itself in the mirror as a lion.
Another tip from Dr. Lütje was to make greater use of human resources. A practice assistant or aide can listen empathically and often already do a very good job of finding out what is behind a chronic pain disorder [6].
Source: annual congress gynécologie suisse, SGGG, 27-29 June 2013, Lugano.
Literature:
- FMV/50: HbA1c as a predictor of GD; Free communications.
- FMV/51: Permanent disruption of the stress axis in SGA neonates 4 to 6 months of age.
- FMV/55: Teamwork in the building department.
- Poster 100: Secondary reconstruction of the breast from the patient’s perspective.
- Poster 176 : Clitoral reconstruction after FGM/C: why can it decrease vulvar pain? About a case.
- S3- Guideline “Non-specific, functional and somatoform body complaints” (051/001) at www.awmf.de.
Family Practice 2013, Vol. 8, issue 9
