Kosian P, Strizek B, Kehl S, Abou-Dakn M, Jost E, Merz W M
Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.
Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich, Munich, Germany.
Arch Gynecol Obstet. 2025 Apr 7. doi: 10.1007/s00404-025-08016-4.
Pregnancies in women with chronic medical conditions are characterized by a higher maternal and perinatal complication rate during pregnancy, childbirth, and the postpartum period. The German Maternity Guideline does not provide specific recommendations for the care of these women. The aim of this study was to evaluate the care of pregnant women with pre-existing medical conditions in German perinatal centers (Level 1 and 2) and perinatal care level 3 hospitals.
Based on guidelines and literature, seven topics were identified: preconception counseling, timing of consultation, care for pregnant women with rare diseases, participation in continuing education, multidisciplinary case conferences, resources for patient counseling, and transfer of the patient to another center. Representatives of all perinatal centers were contacted by email and invited to participate. The anonymous online survey was conducted using the SoSci Survey platform.
Of 310 centers, 103 (33.2%) representatives responded. 62.2% (n = 64) reported managing 11-30 pregnant women with pre-existing conditions per month. 22.1% (n = 23) of all centers regularly care for pregnant women with rare diseases, and 46.6% offer preconception counseling. University hospitals offer these services more frequently. Regular case conferences are held in 34.0% of centers, and 80.6% of medical staff regularly participate in continuing education on the topic.
According to the results of our survey, 76.7% (n = 79) of perinatal centers regularly care for patients with pre-existing conditions, while only 22.1% care for patients with rare diseases. The findings highlight the need to implement standardized recommendations and targeted resource allocation to ensure optimal care for this patient group.
患有慢性疾病的女性怀孕的特点是在孕期、分娩期及产后出现更高的孕产妇和围产期并发症发生率。德国孕产妇指南并未针对这类女性的护理提供具体建议。本研究的目的是评估德国围产期中心（一级和二级）及三级围产期护理医院中患有基础疾病的孕妇的护理情况。
基于指南和文献，确定了七个主题：孕前咨询、咨询时机、罕见病孕妇的护理、参与继续教育、多学科病例讨论会、患者咨询资源以及患者转至另一中心。通过电子邮件联系了所有围产期中心的代表并邀请他们参与。使用SoSci Survey平台进行了匿名在线调查。
在310个中心中，103名（33.2%）代表做出了回应。62.2%（n = 64）报告每月管理11 - 30名患有基础疾病的孕妇。所有中心的22.1%（n = 23）定期护理患有罕见病的孕妇，46.6%提供孕前咨询。大学医院更频繁地提供这些服务。34.0%的中心定期召开病例讨论会，80.6%的医务人员定期参与关于该主题的继续教育。
根据我们的调查结果，76.7%（n = 79）的围产期中心定期护理患有基础疾病的患者，而只有22.1%护理患有罕见病的患者。研究结果凸显了实施标准化建议和有针对性的资源分配以确保为这一患者群体提供最佳护理的必要性。
