Birgitt Schönfisch

Background/Objectives: Castor oil has long been used as a traditional method for inducing labor, but evidence regarding its safety and effectiveness remains limited. This study aimed to assess the efficacy and safety of castor oil for labor induction in a large cohort within a high-risk university hospital setting. Methods: A retrospective analysis was conducted on women who underwent labor induction between January 2017 and June 2018 at the Department for Women’s Health, University Hospital Tübingen. Outcomes of women induced primarily with castor oil-based induction cocktail and their offspring were compared with those induced using standard methods (prostaglandins, oxytocin, ripening balloon). Primary outcomes included induction-to-delivery time, need for additional induction methods, mode of delivery, and maternal/fetal complications. Results: A total of 1015 women were included; 824 (82.1%) received castor oil, and 191 (18.8%) underwent standard induction. The mean induction-to-delivery interval was 26.9 h in the castor oil group versus 19.0 h in the standard group. Additional induction was required in 50.5% of the castor oil group compared to 37.2% of the standard group. No significant differences were observed between groups regarding delivery mode or maternal/fetal complications. Conclusions: Castor oil appears to be a safe but slightly less effective option for inducing labor close to the calculated due date, even in a high-risk population. Large-scale prospective randomized trials are warranted to further evaluate its role in clinical practice.

Background: Endometriosis is known to be a common chronic disease that often affects the quality of life of patients. Especially for deep endometriosis (DE), the most challenging form of the disease, surgery remains an important component of treatment. However, long-term outcomes after surgery are poorly studied. Therefore, we aimed to evaluate the postoperative clinical course of women with DE who underwent surgery, particularly with regard to pain relief, fertility, and re-operations. Methods: Thus, women who underwent surgical treatment for DE between 2005 and 2015 were included in this retrospective questionnaire-based analysis. Results: A total of 87.0% of the patients who underwent surgery for pain reported a postoperative relief of their complaints. Moreover, 44.6% even stated that they were free of pain at the time of the questionnaire. Patients who underwent surgery for infertility and tried to become pregnant postoperatively gave birth to a child in 45.9% of cases. Approximately one-third of the patients had to undergo another surgery because of endometriosis-related symptoms. The main reasons for re-operation were pain and infertility. The median time to re-operation was 2.1 years. Conclusions: In this extraordinarily long follow-up with a remarkable response rate, we show that surgical treatment of DE leads to pain relief and improved fertility in most cases. However, the risk of recurrence and the need for re-operation remains remarkable.

The Mayer–Rokitansky–Küster–Hauser syndrome is characterized by aplasia of the uterus and upper two-thirds of the vagina. While it can appear as an isolated genital malformation, it is often associated with extragenital abnormalities, with little still known about the pathogenetic background. To provide an overview of associated malformations and syndromes as well as to examine possible ties between the rudimentary tissue and patient characteristics, we analyzed a cohort of 469 patients with MRKHS as well as 298 uterine rudiments removed during surgery. A total of 165 of our patients (35.2%) had associated malformations (MRKHS type II). Renal defects were the most common associated malformation followed by skeletal abnormalities. Several patients had atypical associated malformations or combined syndromes. Uterine rudiments were rarer in patients with associated malformations than in patients without them. Rudiment size ranged from 0.3 cm³ to 184.3 cm³ with a mean value of 7.9 cm³. Importantly, MRKHS subtype or concomitant malformations were associated with a different frequency of uterine tissue as well as a different rudiment size and incidence of endometrial tissue, thereby indicating a clear heterogeneity of the phenotype. Further research into the associated molecular pathways and potential differences between MRKHS subtypes is needed.