Huseyin Kiyak, Nazli Korkmaz, Sema Suzen Caypinar, Zuat Acar, Alev Atis Aydin, Batuhan Ustun, Zubeyde Aytufan, Ali Gedikbasi
Background: The purpose of the study, to determine whether exposure to nifedipine before delivery is associated with an increased risk of postpartum blood loss in patients with preterm labor. Methods: This was a retrospective study screening a total of 486 patients who were admitted due to preterm labor from 2012 to 2019. Patients who were given nifedipine for tocolysis before delivery were considered as the study group (n: 240), and the patients who gave birth without getting tocolysis were considered as the control group (n: 246). The dose of nifedipine used during the last 24 hours, 72 hours and 1 week before delivery, the total dose of nifedipine given and the duration from the last dose to the delivery were recorded separately. Hemoglobin and hematocrit and platelet values measured before and 6 hours after delivery were recorded and postpartum bleeding amount was calculated. Results: No significant difference is observed in terms of mean difference between pre/postpartum hemoglobin and hematocrit levels between control group and nifedipine group (p > 0.05). But when subgroups that are created according to the time of use of nifedipine before delivery, a positive correlation was observed between difference in hemoglobin and hematocrit levels between prepartum and postpartum and nifedipine dosage for the last 24 hours (r = 0.176, p = 0.006), (r = 0.139, p = 0.030), but not for 72 hours or one week. Conclusions: The use of nifedipine in patients with preterm labor for tocolysis may be associated with increase in postpartum blood loss in the last 24 hours before delivery.
背景:本研究的目的是确定产前接触硝苯地平是否与早产患者产后失血风险增加有关。方法:对2012 - 2019年因早产入院的486例患者进行回顾性研究。将分娩前给予硝苯地平消产的患者作为研究组(n: 240)，未给予消产的患者作为对照组(n: 246)。分别记录分娩前24小时、72小时和1周硝苯地平的用药剂量、硝苯地平总剂量和最后一次给药至分娩的持续时间。记录分娩前及产后6小时血红蛋白、红细胞压积、血小板值，计算产后出血量。结果:对照组和硝苯地平组产前/产后血红蛋白和红细胞压积水平的平均差异无统计学意义(p >0.05)。但根据分娩前硝苯地平使用时间建立亚组时，观察到产前和产后血红蛋白和红细胞压积水平的差异与最后24小时硝苯地平剂量呈正相关(r = 0.176, p = 0.006)， (r = 0.139, p = 0.030)，但72小时或1周不呈正相关。结论:早产患者使用硝苯地平溶胎可能与分娩前最后24小时的产后出血量增加有关。
{"title":"The Relationship between Nifedipine and Postpartum Blood Loss in Patients with Preterm Labor","authors":"Huseyin Kiyak, Nazli Korkmaz, Sema Suzen Caypinar, Zuat Acar, Alev Atis Aydin, Batuhan Ustun, Zubeyde Aytufan, Ali Gedikbasi","doi":"10.31083/j.ceog5011225","DOIUrl":"https://doi.org/10.31083/j.ceog5011225","url":null,"abstract":"Background: The purpose of the study, to determine whether exposure to nifedipine before delivery is associated with an increased risk of postpartum blood loss in patients with preterm labor. Methods: This was a retrospective study screening a total of 486 patients who were admitted due to preterm labor from 2012 to 2019. Patients who were given nifedipine for tocolysis before delivery were considered as the study group (n: 240), and the patients who gave birth without getting tocolysis were considered as the control group (n: 246). The dose of nifedipine used during the last 24 hours, 72 hours and 1 week before delivery, the total dose of nifedipine given and the duration from the last dose to the delivery were recorded separately. Hemoglobin and hematocrit and platelet values measured before and 6 hours after delivery were recorded and postpartum bleeding amount was calculated. Results: No significant difference is observed in terms of mean difference between pre/postpartum hemoglobin and hematocrit levels between control group and nifedipine group (p > 0.05). But when subgroups that are created according to the time of use of nifedipine before delivery, a positive correlation was observed between difference in hemoglobin and hematocrit levels between prepartum and postpartum and nifedipine dosage for the last 24 hours (r = 0.176, p = 0.006), (r = 0.139, p = 0.030), but not for 72 hours or one week. Conclusions: The use of nifedipine in patients with preterm labor for tocolysis may be associated with increase in postpartum blood loss in the last 24 hours before delivery.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135167492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: About a quarter of a million women die from pregnancy-related conditions every year. This study aimed to contribute to the literature by assessing causes and demographic data of maternal deaths in our region. Methods: Our study is retrospective and descriptive. The study sample comprised 36 mothers who died in Kayseri between 2015 and 2019. The assessment was performed on the Provincial Directorate of Health data-“Maternal Death Record Forms”. Patients’ demographic and clinical characteristics and the factors associated with mortality were analyzed. Results: A total of 33 maternal deaths that occurred between 2015 and 2019 were assessed in our study. The mean age of mothers included in the study was 33.3 ± 6.3. Median gestational week was 24.5 (min: 3–max: 39) weeks of pregnancy. The majority of preventable deaths were from indirect causes. Cesarean history was higher in previous pregnancies in preventable maternal deaths (p = 0.006). First-phase and third-phase delay models were higher in preventable maternal deaths (p = 0.008, p = 0.007). Conclusions: The rates of preventable maternal mortality are considerably high. The first-phase delay model has an important place in preventable maternal deaths.
背景:每年约有25万妇女死于与妊娠有关的疾病。本研究旨在通过评估本地区孕产妇死亡的原因和人口数据，为文献做出贡献。方法:采用回顾性和描述性研究。该研究样本包括2015年至2019年期间在开塞利去世的36名母亲。评估是根据省卫生局的数据——"产妇死亡记录表"进行的。分析患者的人口学、临床特征及与死亡相关的因素。结果:我们的研究共评估了2015年至2019年期间发生的33例孕产妇死亡。研究中母亲的平均年龄为33.3±6.3岁。中位妊娠周为24.5周(最小:3 -最大:39)。大多数可预防的死亡是由间接原因造成的。以前妊娠的剖宫产史在可预防的孕产妇死亡中较高(p = 0.006)。第一阶段和第三阶段延迟模型在可预防的孕产妇死亡中较高(p = 0.008, p = 0.007)。结论:可预防的产妇死亡率相当高。第一阶段延迟模式在可预防的孕产妇死亡中占有重要地位。
{"title":"Maternal Deaths in Kayseri: Causes and Risk Factors","authors":"Mebrure Beyza Gökçek, Hümeyra Aslaner, Seçkin Özsaydı","doi":"10.31083/j.ceog5011226","DOIUrl":"https://doi.org/10.31083/j.ceog5011226","url":null,"abstract":"Background: About a quarter of a million women die from pregnancy-related conditions every year. This study aimed to contribute to the literature by assessing causes and demographic data of maternal deaths in our region. Methods: Our study is retrospective and descriptive. The study sample comprised 36 mothers who died in Kayseri between 2015 and 2019. The assessment was performed on the Provincial Directorate of Health data-“Maternal Death Record Forms”. Patients’ demographic and clinical characteristics and the factors associated with mortality were analyzed. Results: A total of 33 maternal deaths that occurred between 2015 and 2019 were assessed in our study. The mean age of mothers included in the study was 33.3 ± 6.3. Median gestational week was 24.5 (min: 3–max: 39) weeks of pregnancy. The majority of preventable deaths were from indirect causes. Cesarean history was higher in previous pregnancies in preventable maternal deaths (p = 0.006). First-phase and third-phase delay models were higher in preventable maternal deaths (p = 0.008, p = 0.007). Conclusions: The rates of preventable maternal mortality are considerably high. The first-phase delay model has an important place in preventable maternal deaths.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135167488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Huimin Tang, Qiucheng Jia, Zhiyong Dong, Yao Chen, Wulin Shan, Yihan Wu, Miao Miao, Tingwei Xing, Weiwei Wei, Bin Tang, Hong Zheng, Ruxia Shi, Bairong Xia, Jiming Chen
Objective: The purpose of this review is to summarize drug selection for peri-menopausal symptoms caused by gonadotropin releasing-hormone agonist (GnRH-a) in the treatment of endometriosis. Mechanism: GnRH-a treatment often leads to low estrogen levels, resulting in peri-menopausal symptoms and osteoporosis. Add-back therapy relieves clinical symptoms by supplementing low-dose estrogen. The idea of “combined regulation” is to improve symptoms by adding plant preparations or proprietary Chinese medicines. Studies have shown that they may play a role by regulating serotonin activity. Findings in Brief: For patients treated with GnRH-a for less than 3 months, the combined-regulation regimen can be considered, whereas for patients who have had more than 3 courses of GnRH-a, add-back therapy with sex hormones must be used because the patients will have begun to have obvious bone-mass loss and even bone pain; this bone-mass loss is often irreversible. Conclusions: In the early treatment of endometriosis with GnRH-a, non-hormone combined-regulation therapy is a relatively safe and feasible choice, but hormone add-back therapy should be selected for patients who have had more than 3 courses of GnRH-a.
{"title":"Add-Back and Combined Regulation in GnRH-a Treatment of Endometriosis","authors":"Huimin Tang, Qiucheng Jia, Zhiyong Dong, Yao Chen, Wulin Shan, Yihan Wu, Miao Miao, Tingwei Xing, Weiwei Wei, Bin Tang, Hong Zheng, Ruxia Shi, Bairong Xia, Jiming Chen","doi":"10.31083/j.ceog5010224","DOIUrl":"https://doi.org/10.31083/j.ceog5010224","url":null,"abstract":"Objective: The purpose of this review is to summarize drug selection for peri-menopausal symptoms caused by gonadotropin releasing-hormone agonist (GnRH-a) in the treatment of endometriosis. Mechanism: GnRH-a treatment often leads to low estrogen levels, resulting in peri-menopausal symptoms and osteoporosis. Add-back therapy relieves clinical symptoms by supplementing low-dose estrogen. The idea of “combined regulation” is to improve symptoms by adding plant preparations or proprietary Chinese medicines. Studies have shown that they may play a role by regulating serotonin activity. Findings in Brief: For patients treated with GnRH-a for less than 3 months, the combined-regulation regimen can be considered, whereas for patients who have had more than 3 courses of GnRH-a, add-back therapy with sex hormones must be used because the patients will have begun to have obvious bone-mass loss and even bone pain; this bone-mass loss is often irreversible. Conclusions: In the early treatment of endometriosis with GnRH-a, non-hormone combined-regulation therapy is a relatively safe and feasible choice, but hormone add-back therapy should be selected for patients who have had more than 3 courses of GnRH-a.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135413781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mladen Andjić, Zaki Sleiman, Radmila Sparić, Đina Tomašević, Andrea Morciano, Andrea Tinelli
Objective: The transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a kind of natural orifice transluminal endoscopic surgery in which the abdominal cavity is reached by using the natural orifices, such as the stomach, rectum, esophagus, and bladder. In comparison to traditional laparoscopic and robotic surgery, there are potential advantages of the vNOTES. This narrative review shows the use of vNOTES in contemporary gynecologic endoscopic surgery. Mechanism: MEDLINE, Scopus, and PubMed searches on these themes were conducted from 1990 to 2023 using a mix of keywords. Papers and articles were identified and included in this narrative review after the authors’ revision and evaluation. Findings in Brief: The vNOTES procedures allow a short surgery time, as well as estimated blood loss and postoperative pain. These procedures are safe and feasible in contemporary endoscopic gynecology surgery. Conclusions: The vNOTES procedures are beneficial for the patients, and to be added to other minimally invasive procedures, such as conventional laparoscopy and robotic surgery. However, further studies about the long-term outcomes of vNOTES procedures are still needed.
{"title":"The Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Procedures in Contemporary Gynecology: An Appraisal of the Published Evidence and a Review","authors":"Mladen Andjić, Zaki Sleiman, Radmila Sparić, Đina Tomašević, Andrea Morciano, Andrea Tinelli","doi":"10.31083/j.ceog5010223","DOIUrl":"https://doi.org/10.31083/j.ceog5010223","url":null,"abstract":"Objective: The transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a kind of natural orifice transluminal endoscopic surgery in which the abdominal cavity is reached by using the natural orifices, such as the stomach, rectum, esophagus, and bladder. In comparison to traditional laparoscopic and robotic surgery, there are potential advantages of the vNOTES. This narrative review shows the use of vNOTES in contemporary gynecologic endoscopic surgery. Mechanism: MEDLINE, Scopus, and PubMed searches on these themes were conducted from 1990 to 2023 using a mix of keywords. Papers and articles were identified and included in this narrative review after the authors’ revision and evaluation. Findings in Brief: The vNOTES procedures allow a short surgery time, as well as estimated blood loss and postoperative pain. These procedures are safe and feasible in contemporary endoscopic gynecology surgery. Conclusions: The vNOTES procedures are beneficial for the patients, and to be added to other minimally invasive procedures, such as conventional laparoscopy and robotic surgery. However, further studies about the long-term outcomes of vNOTES procedures are still needed.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135413782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nedaa Mohammed Bahkali, Ghaida Abdullah Eissa, Abdulaziz Mohammed Bashar Shaheen, Abdullah Mohammed Sanedi, Duaa Mohammed Bahkali
Background: The most prevalent type of inherited intellectual disability worldwide is Down syndrome. Prenatal testing can determine the possibility of a pregnant woman giving birth to an infant with Down’s. Many invasive interventions help with early diagnosis of Down’s. Although high-risk pregnancies should be offered invasive prenatal diagnosis, the International Society for Prenatal Diagnosis encourages non-invasive prenatal screening testing (NIPT) as a primary screening test for all pregnant women, regardless of risk. The present study aimed to determine the knowledge and attitude regarding NIPT among Saudi Arabian women. Methods: This cross-sectional study involving 1028 participants living in Saudi Arabia was conducted from February to March 2023, using a re-designed questionnaire shared among women with pregnancy history. The questionnaire assessed their knowledge, attitudes, and beliefs regarding NIPT. Results: Only 14.8% of our respondents had undergone NIPT; the most common indication was a recommendation from their healthcare provider (41.7%). About 3.4% of the respondents had given birth to a child with Down syndrome, and 22% had relatives with chromosomal abnormalities or genetic diseases. Surprisingly, only 22.3% of the respondents had previously heard about NIPT. The mean knowledge score about NIPT was 2.82 ± 1.89. The mean knowledge score was found to be significantly higher among females who had undergone NIPT, were aged <30, and had high school education. Conclusions: Most Saudi Arabian women have poor knowledge about NIPT and a positive attitude toward it. Thus, the suggestion is to raise awareness about NIPT use, indications, prices, and possible complications.
{"title":"Knowledge and Attitude Regarding Non-Invasive Prenatal Testing (NIPT) among Women: A Cross-Sectional Study in Saudi Arabia","authors":"Nedaa Mohammed Bahkali, Ghaida Abdullah Eissa, Abdulaziz Mohammed Bashar Shaheen, Abdullah Mohammed Sanedi, Duaa Mohammed Bahkali","doi":"10.31083/j.ceog5010220","DOIUrl":"https://doi.org/10.31083/j.ceog5010220","url":null,"abstract":"Background: The most prevalent type of inherited intellectual disability worldwide is Down syndrome. Prenatal testing can determine the possibility of a pregnant woman giving birth to an infant with Down’s. Many invasive interventions help with early diagnosis of Down’s. Although high-risk pregnancies should be offered invasive prenatal diagnosis, the International Society for Prenatal Diagnosis encourages non-invasive prenatal screening testing (NIPT) as a primary screening test for all pregnant women, regardless of risk. The present study aimed to determine the knowledge and attitude regarding NIPT among Saudi Arabian women. Methods: This cross-sectional study involving 1028 participants living in Saudi Arabia was conducted from February to March 2023, using a re-designed questionnaire shared among women with pregnancy history. The questionnaire assessed their knowledge, attitudes, and beliefs regarding NIPT. Results: Only 14.8% of our respondents had undergone NIPT; the most common indication was a recommendation from their healthcare provider (41.7%). About 3.4% of the respondents had given birth to a child with Down syndrome, and 22% had relatives with chromosomal abnormalities or genetic diseases. Surprisingly, only 22.3% of the respondents had previously heard about NIPT. The mean knowledge score about NIPT was 2.82 ± 1.89. The mean knowledge score was found to be significantly higher among females who had undergone NIPT, were aged <30, and had high school education. Conclusions: Most Saudi Arabian women have poor knowledge about NIPT and a positive attitude toward it. Thus, the suggestion is to raise awareness about NIPT use, indications, prices, and possible complications.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135616874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Group B streptococcus (GBS) is commonly recognized as an opportunistic pathogen, which can cause infections in pregnant women and their newborns. The aim of this study was to explore the invasiveness of GBS by comparing various indices of pregnant mothers and newborns. Methods: This retrospective study involved 6892 consecutive GBS screened pregnant women, and 48 GBS-positive newborns. The data of pregnant women and newborns was compared by Chi-square test and Kruskal-Wallis test. A p-value ≤ 0.05 was considered statistically significant. Results: After excluding the other risk factors which can cause adverse pregnancy outcomes, there were no differences between pregnant women in GBS-positive and GBS-negative groups, except the age group. In the GBS-negative and positive groups the incidence of prematurity, premature rupture of membranes (PROM), and chorioamnionitis were 1.06% and 0.74%, 7.72% and 8.14%, 0.63% and 0.74%, respectively. The corresponding p-values were 0.619, 0.263, and 0.626. The GBS-positive rate was 6.83% (201/2943) in the 19–30 years (y) group, 6.89% in the (262/3802) in the 31–40 y group, and 1.36% (2/147) in the 41–52 y group (p = 0.031). The indices in the different newborn groups exhibited significant differences. Analysis of the data revealed significant differences in delivery mode, gestational age, neonatal birth weight, and Apgar scores among the GBS-colonization, GBS-infection, and death groups (p = 0.010, 0.004, 0.022, and 0.000 < 0.05, respectively). Conclusions: After excluding related factors, the evidence showing that GBS-colonization independently induced adverse pregnancy outcomes in pregnant women was insufficient. GBS was more likely to attack premature newborns with low weight and poor health status.
{"title":"A Retrospective Study Comparing of Group B Streptococcus Invasiveness in Pregnant Women and Infants","authors":"Hui Yang, Shengmei Zhang","doi":"10.31083/j.ceog5010221","DOIUrl":"https://doi.org/10.31083/j.ceog5010221","url":null,"abstract":"Background: Group B streptococcus (GBS) is commonly recognized as an opportunistic pathogen, which can cause infections in pregnant women and their newborns. The aim of this study was to explore the invasiveness of GBS by comparing various indices of pregnant mothers and newborns. Methods: This retrospective study involved 6892 consecutive GBS screened pregnant women, and 48 GBS-positive newborns. The data of pregnant women and newborns was compared by Chi-square test and Kruskal-Wallis test. A p-value ≤ 0.05 was considered statistically significant. Results: After excluding the other risk factors which can cause adverse pregnancy outcomes, there were no differences between pregnant women in GBS-positive and GBS-negative groups, except the age group. In the GBS-negative and positive groups the incidence of prematurity, premature rupture of membranes (PROM), and chorioamnionitis were 1.06% and 0.74%, 7.72% and 8.14%, 0.63% and 0.74%, respectively. The corresponding p-values were 0.619, 0.263, and 0.626. The GBS-positive rate was 6.83% (201/2943) in the 19–30 years (y) group, 6.89% in the (262/3802) in the 31–40 y group, and 1.36% (2/147) in the 41–52 y group (p = 0.031). The indices in the different newborn groups exhibited significant differences. Analysis of the data revealed significant differences in delivery mode, gestational age, neonatal birth weight, and Apgar scores among the GBS-colonization, GBS-infection, and death groups (p = 0.010, 0.004, 0.022, and 0.000 < 0.05, respectively). Conclusions: After excluding related factors, the evidence showing that GBS-colonization independently induced adverse pregnancy outcomes in pregnant women was insufficient. GBS was more likely to attack premature newborns with low weight and poor health status.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135616249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yanna Ye, Zhiqiang Li, Biliang Chen, Shan Kang, Bin Ling, Li Wang, Jilong Yao, Jinghe Lan, Ping Liu, Chunlin Chen
Background: To compare the oncological outcomes of Chinese patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC cervical cancer (CC) receiving radical chemoradiotherapy (R-CT), abdominal radical hysterectomy (ARH), or neoadjuvant chemotherapy and radical surgery (NACT). Methods: Overall, 4086 patients in 47 hospitals from 2004 to 2018 were divided into groups according to stage (4029 with stage IIIC1 and 57 with stage IIIC2). Kaplan-Meier and Cox regression analyses were applied to compare the 5-year overall survival (OS) and disease-free survival (DFS) of the three initial treatments before and after propensity score matching (PSM). Results: The 5-year DFS was worse in patients with stage IIIC2 than in those with stage IIIC1 (post-PSM: 68.3% vs. 39.9%, p < 0.001). For stage IIIC1, the ARH group had better 5-year OS (post-PSM: 71.0% vs. 80.0%, p < 0.001) and DFS (post-PSM: 67.2% vs. 71.0%, p < 0.001) than the R-CT group, while the NACT group had worse 5-year DFS (post-PSM: 67.7% vs. 55.3%, p = 0.002). The 5-year OS (post-PSM: 80.9% vs. 70.5%, p < 0.001) and DFS (post-PSM: 70.7% vs. 54.1%, p < 0.001) were better in the ARH than in the NACT group. For stage IIIC2, the 5-year DFS was better in the ARH than in the NACT group (45.4% vs. 30.1%, p = 0.025). Conclusions: The oncological prognosis of patients with stage IIIC1 CC was generally better than that of patients with stage IIIC2, thereby supporting the rationale behind the classification of stage IIIC. In less developed areas, the ARH is a promising alternative treatment option for patients with stage IIIC; nonetheless, the use of NACT is not advisable. Clinical Trial Registration: The study was registered at http://apps.who.int/trialsearch/, registration number CHiCTR1800017778.
背景:比较国际妇产科学联合会(FIGO) 2018年IIIC期宫颈癌(CC)患者接受根治性放化疗(R-CT)、腹部根治性子宫切除术(ARH)或新辅助化疗加根治性手术(NACT)的肿瘤预后。方法:2004 - 2018年47家医院4086例患者按分期分为组(IIIC1期4029例，IIIC2期57例)。采用Kaplan-Meier和Cox回归分析比较三种初始治疗前后的5年总生存期(OS)和无病生存期(DFS)。结果:IIIC2期患者的5年DFS较IIIC1期患者差(psm后:68.3% vs. 39.9%， p <0.001)。对于IIIC1期，ARH组有更好的5年OS (psm后:71.0% vs 80.0%， p <0.001)和DFS (psm后:67.2% vs. 71.0%， p <0.001)，而NACT组的5年DFS较R-CT组差(psm后:67.7%比55.3%，p = 0.002)。5年OS (psm后):80.9% vs. 70.5%， p <0.001)和DFS (psm后:70.7% vs. 54.1%， p <0.001)， ARH组优于NACT组。对于IIIC2期，ARH组的5年DFS优于NACT组(45.4% vs. 30.1%， p = 0.025)。结论:IIIC1期CC患者的肿瘤预后普遍好于IIIC2期，支持IIIC分期的理论基础。在欠发达地区，ARH是IIIC患者的一种有希望的替代治疗方案;然而，使用NACT是不可取的。临床试验注册:本研究注册于http://apps.who.int/trialsearch/，注册号CHiCTR1800017778。
{"title":"Abdominal Radical Hysterectomy as an Alternative Treatment Option for Patients with Cervical Cancer without Access to Radiotherapy Facilities","authors":"Yanna Ye, Zhiqiang Li, Biliang Chen, Shan Kang, Bin Ling, Li Wang, Jilong Yao, Jinghe Lan, Ping Liu, Chunlin Chen","doi":"10.31083/j.ceog5010219","DOIUrl":"https://doi.org/10.31083/j.ceog5010219","url":null,"abstract":"Background: To compare the oncological outcomes of Chinese patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IIIC cervical cancer (CC) receiving radical chemoradiotherapy (R-CT), abdominal radical hysterectomy (ARH), or neoadjuvant chemotherapy and radical surgery (NACT). Methods: Overall, 4086 patients in 47 hospitals from 2004 to 2018 were divided into groups according to stage (4029 with stage IIIC1 and 57 with stage IIIC2). Kaplan-Meier and Cox regression analyses were applied to compare the 5-year overall survival (OS) and disease-free survival (DFS) of the three initial treatments before and after propensity score matching (PSM). Results: The 5-year DFS was worse in patients with stage IIIC2 than in those with stage IIIC1 (post-PSM: 68.3% vs. 39.9%, p < 0.001). For stage IIIC1, the ARH group had better 5-year OS (post-PSM: 71.0% vs. 80.0%, p < 0.001) and DFS (post-PSM: 67.2% vs. 71.0%, p < 0.001) than the R-CT group, while the NACT group had worse 5-year DFS (post-PSM: 67.7% vs. 55.3%, p = 0.002). The 5-year OS (post-PSM: 80.9% vs. 70.5%, p < 0.001) and DFS (post-PSM: 70.7% vs. 54.1%, p < 0.001) were better in the ARH than in the NACT group. For stage IIIC2, the 5-year DFS was better in the ARH than in the NACT group (45.4% vs. 30.1%, p = 0.025). Conclusions: The oncological prognosis of patients with stage IIIC1 CC was generally better than that of patients with stage IIIC2, thereby supporting the rationale behind the classification of stage IIIC. In less developed areas, the ARH is a promising alternative treatment option for patients with stage IIIC; nonetheless, the use of NACT is not advisable. Clinical Trial Registration: The study was registered at http://apps.who.int/trialsearch/, registration number CHiCTR1800017778.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135616250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irene Passerini, Francesco Marasciulo, Federico Prefumo, Anna Fichera, Nicola Fratelli, Filippo Alberto Ferrari, Federico Ferrari, Franco Odicino
Background: Cesarean scar pregnancy (CSP) is a pregnancy in the scar area or “niche” from a prior hysterotomy, usually from a cesarean section. Currently, there is no consensus on the best management of CSP. A recent proposed treatment consists in placing a cervical ripening double-balloon catheter in the uterus under ultrasound guidance. Methods: In this systematic review on cervical ripening double-balloon catheter (CRDBC) treatment for CSP, we performed a literature search in electronic databases (Scopus, PubMed, MEDLINE, and Cochrane Library), from their inception until April 2023. The review was written following PRISMA guidelines for systematic reviews. Results: We identified 30 studies, and we finally analyzed 5 studies that met the inclusion criteria (one case report, two retrospective case series studies, a retrospective cohort study, and a retrospective multicentric case series). The total of pregnancies treated with CRDBC is 71, of which 8 (11%) were cervical pregnancies. The gestational age at treatment ranges from 5 + 0 to 10 + 1 gestational weeks, with variable human chorionic gonadotropin (hCG) levels (433–64.700 IU/mL). Most of the patients (73%) received adjuvant systemic methotrexate (MTX) and the catheter dwell time ranges from 1 to 5 days. Treatment was successful in all the patients. Maternal complications, defined as the need for transfusion, vaginal bleeding resulting in readmission, or requiring further treatment occurred in a small number of patients (4.2%). Conclusions: CRDBC was successful in the treatment of early CSPs. The effectiveness and safety of this minimally invasive method is testified to a small rate of maternal complications. Further prospective studies are warranted to explore this treatment modality. The study was registered on INPLASY (https://inplasy.com/), registration number: INPLASY202390070 (doi: 10.37766/inplasy2023.9.0070).
{"title":"Treatment of Early Cesarean Scar Pregnancy with Double Balloon Catheter: A Systematic Review of the Literature","authors":"Irene Passerini, Francesco Marasciulo, Federico Prefumo, Anna Fichera, Nicola Fratelli, Filippo Alberto Ferrari, Federico Ferrari, Franco Odicino","doi":"10.31083/j.ceog5010222","DOIUrl":"https://doi.org/10.31083/j.ceog5010222","url":null,"abstract":"Background: Cesarean scar pregnancy (CSP) is a pregnancy in the scar area or “niche” from a prior hysterotomy, usually from a cesarean section. Currently, there is no consensus on the best management of CSP. A recent proposed treatment consists in placing a cervical ripening double-balloon catheter in the uterus under ultrasound guidance. Methods: In this systematic review on cervical ripening double-balloon catheter (CRDBC) treatment for CSP, we performed a literature search in electronic databases (Scopus, PubMed, MEDLINE, and Cochrane Library), from their inception until April 2023. The review was written following PRISMA guidelines for systematic reviews. Results: We identified 30 studies, and we finally analyzed 5 studies that met the inclusion criteria (one case report, two retrospective case series studies, a retrospective cohort study, and a retrospective multicentric case series). The total of pregnancies treated with CRDBC is 71, of which 8 (11%) were cervical pregnancies. The gestational age at treatment ranges from 5 + 0 to 10 + 1 gestational weeks, with variable human chorionic gonadotropin (hCG) levels (433–64.700 IU/mL). Most of the patients (73%) received adjuvant systemic methotrexate (MTX) and the catheter dwell time ranges from 1 to 5 days. Treatment was successful in all the patients. Maternal complications, defined as the need for transfusion, vaginal bleeding resulting in readmission, or requiring further treatment occurred in a small number of patients (4.2%). Conclusions: CRDBC was successful in the treatment of early CSPs. The effectiveness and safety of this minimally invasive method is testified to a small rate of maternal complications. Further prospective studies are warranted to explore this treatment modality. The study was registered on INPLASY (https://inplasy.com/), registration number: INPLASY202390070 (doi: 10.37766/inplasy2023.9.0070).","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135616876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Da Eun Jeong, Jung Yun Lee, Eun Ji Oh, Kyong-No Lee, Hyunsu Kim, Hyeon Ji Kim, Jee Yoon Park, Young Hwa Jung, Kyung Joon Oh, Chang Won Choi
Background: Late preterm birth is associated with increased risks of adverse neonatal outcomes, including respiratory distress syndrome (RDS) and hypoglycemia. The use of antenatal corticosteroids (ACS) has been shown to reduce these risks in early preterm infants. However, the efficacy of rescue ACS in late preterm infants remains uncertain. This study aimed to assess the effectiveness of rescue ACS in reducing the incidence of RDS and hypoglycemia in late preterm infants. Methods: A retrospective cohort study was conducted on women who delivered singleton late preterm infants (34 + 0 to 36 + 6 weeks of gestation) at a tertiary hospital. The inclusion criteria were completion of the initial cycle of ACS in the early preterm period (before 34 + 0 weeks of gestation). Data on maternal baseline characteristics, ACS administration, and neonatal outcomes were collected from medical records. Statistical analyses, including logistic regression and multivariate modeling, were performed to assess the association between rescue ACS and neonatal outcomes. Results: A total of 155 singleton late preterm infants were included in the study. Among them, 27.8% (43/155) received rescue ACS after 34 weeks of gestation, while 72.2% (112/155) did not. Neonates who did not receive rescue ACS had a significantly higher incidence of RDS compared to those who did (10.7% vs. 0%, p = 0.038). However, the results were not statistically significant in the multivariate analysis (odds ratio (OR), 0.07; 95% confidence interval (CI), 0.00–1.48; p = 0.087). Additionally, there were no significant differences in the frequencies of hypoglycemia (glucose level ≤40 mg/dL) (8.0% vs. 9.3%, p = 0.755) and hypoglycemia (glucose level ≤60 mg/dL) (52.7% vs. 37.2%, p = 0.106) between the two groups. Conclusions: Rescue ACS administration in late preterm infants was not associated with a reduced risk of RDS. Additionally, there was no significant difference in the incidence of hypoglycemia. Further studies with larger sample sizes are needed to confirm these results and assess potential long-term implications.
{"title":"Rescue Antenatal Corticosteroids in Late Preterm Birth after Completion of the Initial Cycle of Antenatal Corticosteroids during the Early Preterm Period","authors":"Da Eun Jeong, Jung Yun Lee, Eun Ji Oh, Kyong-No Lee, Hyunsu Kim, Hyeon Ji Kim, Jee Yoon Park, Young Hwa Jung, Kyung Joon Oh, Chang Won Choi","doi":"10.31083/j.ceog5010218","DOIUrl":"https://doi.org/10.31083/j.ceog5010218","url":null,"abstract":"Background: Late preterm birth is associated with increased risks of adverse neonatal outcomes, including respiratory distress syndrome (RDS) and hypoglycemia. The use of antenatal corticosteroids (ACS) has been shown to reduce these risks in early preterm infants. However, the efficacy of rescue ACS in late preterm infants remains uncertain. This study aimed to assess the effectiveness of rescue ACS in reducing the incidence of RDS and hypoglycemia in late preterm infants. Methods: A retrospective cohort study was conducted on women who delivered singleton late preterm infants (34 + 0 to 36 + 6 weeks of gestation) at a tertiary hospital. The inclusion criteria were completion of the initial cycle of ACS in the early preterm period (before 34 + 0 weeks of gestation). Data on maternal baseline characteristics, ACS administration, and neonatal outcomes were collected from medical records. Statistical analyses, including logistic regression and multivariate modeling, were performed to assess the association between rescue ACS and neonatal outcomes. Results: A total of 155 singleton late preterm infants were included in the study. Among them, 27.8% (43/155) received rescue ACS after 34 weeks of gestation, while 72.2% (112/155) did not. Neonates who did not receive rescue ACS had a significantly higher incidence of RDS compared to those who did (10.7% vs. 0%, p = 0.038). However, the results were not statistically significant in the multivariate analysis (odds ratio (OR), 0.07; 95% confidence interval (CI), 0.00–1.48; p = 0.087). Additionally, there were no significant differences in the frequencies of hypoglycemia (glucose level ≤40 mg/dL) (8.0% vs. 9.3%, p = 0.755) and hypoglycemia (glucose level ≤60 mg/dL) (52.7% vs. 37.2%, p = 0.106) between the two groups. Conclusions: Rescue ACS administration in late preterm infants was not associated with a reduced risk of RDS. Additionally, there was no significant difference in the incidence of hypoglycemia. Further studies with larger sample sizes are needed to confirm these results and assess potential long-term implications.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ying Ji, Shanshan Liu, Genju Wang, Xin Chen, Yujuan Li, Xiaogai Zhi, Hongxiu Jiang, Juan Tang, Yi Ding, Shuli Zhao, Hongmei Zhou, Aiwei Xiong
Background: Exosomes, harboring donor-cell-derived biomarkers, are implicated in transferring oncologic protein and genetic materials. CD200, an immune checkpoint, has been engineered to affect immunosuppression in ovarian cancer. However, the potential of CD200 to serve as a predictor of ovarian cancers remains unexplored. Methods: We performed dynamic measurements of exosome-mediated or serum CD200 levels at primary diagnosis, post-operation, and three cycles after chemotherapy. The receiver operating characteristic curve and cumulative survival rate were paralleled to decode the predictive and prognostic profiles. Results: Independent enrichment and identification of exosomes revealed a significant concentration of CD200, predominantly located within these exosomes. The CD200 level was elevated in non-responders compared to responders at the serial points and significantly decreased after treatment. At the 335.50 pg/mL cut-off, CD200 at primary diagnosis enabled accurate discrimination between responders and non-responders with an area under the curve (AUC) of 0.94 (95% confidence interval (CI) = 0.902–0.979, p = 0.01). With the cut-off dropping from 311.00 pg/mL to 265.00 pg/mL, the AUC decreased from 0.918 (95% CI = 0.873–0.963, p = 0.02) to 0.908 (95% CI = 0.862–0.955, p = 0.02), respectively. Elevated levels of CD200 levels at both primary diagnosis and three cycles after chemotherapy were identified as independent predictors for poor progression-free survival (PFS) (hazard ratio (HR) = 2.8, 95% CI = 2.08–3.49, p = 0.01; HR = 6.7, 95% CI = 4.01–8.02, p = 0.01, respectively) and overall survival (OS) (HR = 3.5, 95% CI = 2.14–4.99, p = 0.04; HR = 5.6, 95% CI = 3.01–7.34, p = 0.01, respectively). Based on CD200 dynamics, patients were stratified into high- and low-AUC groups. High CD200-AUC was independently associated with unfavourable PFS and OS (HR = 4.6, 95% CI = 3.6–15.7, p = 0.01; HR = 3.2, 95% CI = 1.5–6.3, p = 0.01, respectively). Conclusions: This study proposes high exosome-mediated CD200 as a liquid-based biomarker indicative of chemotolerance and dismal survival in ovarian neoplasms.
背景:外泌体含有供体细胞来源的生物标志物，与肿瘤蛋白和遗传物质的转移有关。CD200是一种免疫检查点，已被设计用于影响卵巢癌的免疫抑制。然而，CD200作为卵巢癌预测因子的潜力仍未被探索。方法:我们在初诊、手术后和化疗后三个周期对外泌体介导或血清CD200水平进行了动态测量。对照受试者工作特征曲线和累积生存率，解码预测和预后概况。结果:外泌体的独立富集和鉴定显示CD200的显著浓度，主要位于这些外泌体内。与应答者相比，无应答者的CD200水平在序列点上升高，治疗后显著降低。在335.50 pg/mL的临界值下，初诊时的CD200能够准确区分应答者和无应答者，曲线下面积(AUC)为0.94(95%置信区间(CI) = 0.902-0.979, p = 0.01)。截止值从311.00 pg/mL降至265.00 pg/mL, AUC分别从0.918 (95% CI = 0.873-0.963, p = 0.02)降至0.908 (95% CI = 0.862-0.955, p = 0.02)。原发性诊断和化疗后3个周期CD200水平升高被确定为无进展生存期(PFS)差的独立预测因子(风险比(HR) = 2.8, 95% CI = 2.08-3.49, p = 0.01;HR = 6.7, 95% CI = 4.01-8.02, p = 0.01)和总生存期(OS) (HR = 3.5, 95% CI = 2.14-4.99, p = 0.04;HR = 5.6, 95% CI = 3.01-7.34, p = 0.01)。根据CD200动态，将患者分为高auc组和低auc组。高CD200-AUC与不良PFS和OS独立相关(HR = 4.6, 95% CI = 3.6-15.7, p = 0.01;HR = 3.2, 95% CI = 1.5 ~ 6.3, p = 0.01)。结论:本研究提出高外泌体介导的CD200可作为卵巢肿瘤化疗耐受性和低生存率的液体生物标志物。
{"title":"Dynamic Monitoring of CD200 Mediated by Ascites-Derived Exosomes as a Predictor of Survival and Response to Front-Line Chemotherapeutics in Advanced High-Grade Serous Ovarian Cancer","authors":"Ying Ji, Shanshan Liu, Genju Wang, Xin Chen, Yujuan Li, Xiaogai Zhi, Hongxiu Jiang, Juan Tang, Yi Ding, Shuli Zhao, Hongmei Zhou, Aiwei Xiong","doi":"10.31083/j.ceog5010217","DOIUrl":"https://doi.org/10.31083/j.ceog5010217","url":null,"abstract":"Background: Exosomes, harboring donor-cell-derived biomarkers, are implicated in transferring oncologic protein and genetic materials. CD200, an immune checkpoint, has been engineered to affect immunosuppression in ovarian cancer. However, the potential of CD200 to serve as a predictor of ovarian cancers remains unexplored. Methods: We performed dynamic measurements of exosome-mediated or serum CD200 levels at primary diagnosis, post-operation, and three cycles after chemotherapy. The receiver operating characteristic curve and cumulative survival rate were paralleled to decode the predictive and prognostic profiles. Results: Independent enrichment and identification of exosomes revealed a significant concentration of CD200, predominantly located within these exosomes. The CD200 level was elevated in non-responders compared to responders at the serial points and significantly decreased after treatment. At the 335.50 pg/mL cut-off, CD200 at primary diagnosis enabled accurate discrimination between responders and non-responders with an area under the curve (AUC) of 0.94 (95% confidence interval (CI) = 0.902–0.979, p = 0.01). With the cut-off dropping from 311.00 pg/mL to 265.00 pg/mL, the AUC decreased from 0.918 (95% CI = 0.873–0.963, p = 0.02) to 0.908 (95% CI = 0.862–0.955, p = 0.02), respectively. Elevated levels of CD200 levels at both primary diagnosis and three cycles after chemotherapy were identified as independent predictors for poor progression-free survival (PFS) (hazard ratio (HR) = 2.8, 95% CI = 2.08–3.49, p = 0.01; HR = 6.7, 95% CI = 4.01–8.02, p = 0.01, respectively) and overall survival (OS) (HR = 3.5, 95% CI = 2.14–4.99, p = 0.04; HR = 5.6, 95% CI = 3.01–7.34, p = 0.01, respectively). Based on CD200 dynamics, patients were stratified into high- and low-AUC groups. High CD200-AUC was independently associated with unfavourable PFS and OS (HR = 4.6, 95% CI = 3.6–15.7, p = 0.01; HR = 3.2, 95% CI = 1.5–6.3, p = 0.01, respectively). Conclusions: This study proposes high exosome-mediated CD200 as a liquid-based biomarker indicative of chemotolerance and dismal survival in ovarian neoplasms.","PeriodicalId":10312,"journal":{"name":"Clinical and experimental obstetrics & gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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