European journal of obstetrics, gynecology, and reproductive biology最新文献

{"title":"A multi-cycle approach via DuoStim is beneficial to treat couples indicated to PGT-M plus PGT-A. A propensity score matching-based case series","authors":"Alberto Vaiarelli ,&nbsp;Danilo Cimadomo ,&nbsp;Claudia Blancafort ,&nbsp;Elisabetta Trabucco ,&nbsp;Erminia Alviggi ,&nbsp;Roberta Vallefuoco ,&nbsp;Claudia Livi ,&nbsp;Francesca Benini ,&nbsp;Stefano Canosa ,&nbsp;Joaquín Llácer ,&nbsp;Alessandro Ruffa ,&nbsp;Andrea Borini ,&nbsp;Antonio Capalbo ,&nbsp;Laura Rienzi ,&nbsp;Gianluca Gennarelli ,&nbsp;Filippo Maria Ubaldi","doi":"10.1016/j.ejogrb.2024.11.003","DOIUrl":"10.1016/j.ejogrb.2024.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>To compare DuoStim versus a conventional approach in patients indicated to Preimplantation-Genetic-Testing for both monogenic conditions and aneuploidies (PGT-M + PGT-A).</div></div><div><h3>Study design</h3><div>Retrospective case-control study. In 5 years, 132 couples indicated to PGT-M + PGT-A who obtained ≤5 blastocysts after a first retrieval were suggested to undergo a second stimulation in the same ovarian cycle. Of them, 55 accepted, while 77 preferred the standard approach. Propensity-Score-Matching method was adopted to produce two matched groups of 41 patients per arm. The primary outcome was the cumulative-live-birth-rate (cLBR) per couple within 1 year from the first oocyte retrieval.</div></div><div><h3>Results</h3><div>In the DuoStim arm, 100 % of the patients underwent two ovarian stimulations. In the conventional approach group, 85 % discontinued the treatment after a failed first cycle (N = 28/33, 95 %CI:69.1–93.4 %). After DuoStim, 16 couples had ≥ 1 healthy LB (1-year cLBR: 39 %, 95 %CI:25.7–54.3 %),<!--> <!-->19 % of them delivered 2 healthy babies after singleton pregnancies (N = 3/16, 95 %CI:6.6–43 %) and 68 % have surplus transferable blastocysts (N = 11/16, 95 %CI:44.4–85.8 %). In the control, 9 couples obtained a healthy LB (1-year cLBR: 22 %, 95 %CI:12.0–36.7 %), and only 1 have<!--> <!-->surplus transferable blastocysts. Overall, couples opting for DuoStim obtained 3.9 ± 2.5 blastocysts of which 1.2 ± 1.3 transferable, while couples opting for the conventional approach obtained 2.3 ± 2.1 blastocysts of which 0.8 ± 1.0 transferable.</div></div><div><h3>Conclusions</h3><div>DuoStim may minimize treatment discontinuation and increase the probability to obtain transferable blastocysts in the studied population. Nevertheless, larger prospective studies are required. Also, the suitability of a threshold set at 5 blastocysts should be further validated.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 272-278"},"PeriodicalIF":2.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593562","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}

{"title":"Comparative efficacy and safety between intravenous labetalol and intravenous hydralazine for hypertensive disorders in pregnancy: A systematic review and meta-analysis of 19 randomized controlled trials","authors":"Ocílio Ribeiro Gonçalves ,&nbsp;Lucas Cael Azevedo Ramos Bendaham ,&nbsp;Gabriel Henrique Simoni ,&nbsp;Giovana Schlichta Adriano Kojima ,&nbsp;Hilária Saugo Faria ,&nbsp;Victoria Städler de Abreu ,&nbsp;Arlindo Bispo da Silva Júnior ,&nbsp;Victor Gonçalves Soares ,&nbsp;Bianca Leal Ribeiro ,&nbsp;Benjamim Barbosa de Azevedo ,&nbsp;Keliany Carla Duarte de Araújo Melo ,&nbsp;Cynthia Dantas de Macedo Lins","doi":"10.1016/j.ejogrb.2024.11.002","DOIUrl":"10.1016/j.ejogrb.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypertensive disorders during pregnancy elevate the likelihood of unfavorable outcomes for both mother and fetus. In cases of acute hypertension, several pharmacological interventions are available to lower blood pressure, such as hydralazine, a direct arteriolar vasodilator, and labetalol, a combined alpha and beta-blocker.</div></div><div><h3>Objectives</h3><div>This systematic review and <em>meta</em>-analysis of randomized controlled trials (RCTs) aims to compare the efficacy and safety of intravenous labetalol and intravenous hydralazine for acute hypertensive disorders during pregnancy.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase and Cochrane for studies comparing labetalol versus hydralazine in pregnant patients. The primary outcomes were median arterial blood pressure (MABP), diastolic blood pressure (DBP) and systolic blood pressure (SBP). We performed statistical analyses using R 4.1.1. Heterogeneity was examined with the Cochran Q test and I² statistics. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI), were computed with a random-effects model.</div></div><div><h3>Results</h3><div>Nineteen RCTs were included in this <em>meta</em>-analysis, comprising 2,261 patients. Among them, 1,131 (50 %) received treatment with labetalol. There was no statistically significant difference between groups in terms of SBP (MD −1.74; 95 % CI −6.72 to 3.23; p = 0.49; I² = 93 %), MABP (MD −0.72; 95 % CI −2.34 to 0.90; p = 0.39; I² = 0 %), DBP (MD 0.25; 95 % CI −4.72 to 5.21; p = 0.92; I² = 96 %), tachycardia (RR 0.42; 95 % CI 0.15 to 1.18; p = 0.099; I² = 41 %), and placenta abruption (RR 0.42; 95 % CI 0.15 to 1.16; p = 0.093; I² = 0 %). However, labetalol significantly reduced maternal hypotension (RR 0.26; 95 % CI 0.21 to 0.33; p &lt; 0.001; I² = 41 %) compared with hydralazine.</div></div><div><h3>Conclusion</h3><div>This systematic review and <em>meta</em>-analysis of RCTs found that labetalol and hydralazine were efficient for hypertension disorders in pregnancy. However, labetalol reduced the incidence of maternal hypotension.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 337-344"},"PeriodicalIF":2.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617441","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}

{"title":"Variation between countries for routine transvaginal cervical length measurement and interventions to prevent preterm birth","authors":"E.V.J. van Limburg Stirum ,&nbsp;N. Pilarski ,&nbsp;M.A. de Boer ,&nbsp;E. Pajkrt ,&nbsp;M.A. Oudijk ,&nbsp;J. van ’t Hooft","doi":"10.1016/j.ejogrb.2024.11.005","DOIUrl":"10.1016/j.ejogrb.2024.11.005","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the variation between countries for routine transvaginal ultrasound assessment of the cervical length and interventions offered to prevent preterm birth (PTB).</div></div><div><h3>Study Design</h3><div>An anonymous digital questionnaire was sent out between August and October 2023 to delegates of the European Spontaneous Preterm Birth Congress. Outcomes assessed included method, indications (i.e. singleton pregnancy in women with or without a history of PTB, or a multiple pregnancy), timing and frequency of routine cervical length measurement, interventions offered to pregnant women with a short cervix or a history of PTB, and advice on physical- and sexual activity.</div></div><div><h3>Results</h3><div>In total, 247 visitors of the European Spontaneous Preterm Birth Congress were approached for this study and 103 (42 %) participants completed the questionnaire representing 15 countries. Most participants worked in a Public/University hospital (n = 54, 53 %) and worked as a specialist (registrar or consultant; n = 84, 82 %). In most countries, the cervix was measured via a straight-line method without the cervical isthmus, but variety existed also within countries. Routine cervical length measurement in women with no prior PTB or a multiple pregnancy is rarely performed in the first trimester. For women with a history of PTB, 39 (38 %) respondents from six countries reported to start serial cervical measurement in the first trimester and 99 (96 %) from 14 countries in the second trimester. Follow-up for women at risk for PTB mainly occurs fortnightly (n = 40, 39 %) or monthly (n = 14, 14 %). However, follow-up is often individualized according to patient’s history and/or cervical length. In women with a history of PTB or a short cervix progesterone is administered vaginally (n = 99, 96 %), however dosage vary between 100 mg and 400 mg daily. The timing and gestational age at which a (primary/secondary/tertiary) vaginal cerclage is offered widely differ between countries (e.g. up to 24–28 weeks of gestation for a secondary cerclage). Advice on restrictions regarding sexual activity in pregnancy is frequently prescribed for women with a short cervix (n = 38, 37 %).</div></div><div><h3>Conclusion</h3><div>Substantial variation exist between and within countries regarding the indications and timing of cervical length measurement and interventions offered. There is a need for a more universal approach to manage patients at risk for PTB based on the existing evidence.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 266-271"},"PeriodicalIF":2.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of previous history of Pre-Eclampsia on subclinical carotid atherosclerosis up to 20 years Postpartum: A systematic review and Meta-Analysis","authors":"Andrea Sonaglioni ,&nbsp;Antonino Bruno ,&nbsp;Irene Pusca ,&nbsp;Gian Luigi Nicolosi ,&nbsp;Stefano Bianchi ,&nbsp;Michele Lombardo","doi":"10.1016/j.ejogrb.2024.11.001","DOIUrl":"10.1016/j.ejogrb.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>During the last two decades, a few studies have evaluated the common carotid artery (CCA) intima-media thickness (IMT) in women with previous history of pre-eclampsia (pPE) in comparison to women with uncomplicated pregnancies, providing not univocal results. This systematic review and <em>meta</em>-analysis has been designed to summarize the main findings of these studies and to examine the overall influence of pPE on CCA-IMT.</div></div><div><h3>Methods</h3><div>All studies assessing CCA-IMT in pPE women in comparison to women who had uncomplicated pregnancies, selected from PubMed and EMBASE databases, were included. Studies evaluating women with previous history of early-onset (EO) or late-onset (LO) PE vs healthy controls were separately analyzed. Continuous data (CCA-IMT) were pooled as a standardized mean difference (SMD) comparing pPE group with healthy controls. The subtotal and overall SMDs of CCA-IMT were calculated using the random-effect model.</div></div><div><h3>Results</h3><div>The full-texts of 12 studies with 583 pPE women and 610 healthy controls were analyzed. The average time after delivery was 8.5 yrs (range 1.1–20 yrs). The average CCA-IMT was significantly increased in pPE women than healthy controls in five studies (41.7 % of total), whereas it was similar between the two study groups or surprisingly reduced in pPE women vs controls in more than half of studies (58.3 % of total). The effect of pPE on CCA-IMT was very small for the studies including women with previous LO-PE (subtotal SMD 0.067, 95 %CI −0.339,0.472, P = 0.75) and small for those analyzing women with previous EO-PE (subtotal SMD 0.250, 95 %CI-0.231,0.732, P = 0.31). Overall, the effect of pPE on CCA-IMT was small and not statistically significant (SMD 0.143, 95 %CI −0.167,0.453, P = 0.37). Substantial heterogeneity was detected for the included studies, with an overall I² statistic value of 81 % (P &lt; 0.001). Egger’s test for a regression intercept yielded a P-value of 0.58, indicating no publication bias. On <em>meta</em>-regression analysis, none of the moderators and/or potential confounders was significantly associated with effect modification (all P &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>Women with previous history of PE have an increased burden of cardiovascular risk factors, but do not appear to be affected by significant subclinical carotid atherosclerosis, up to 20 years postpartum.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 250-258"},"PeriodicalIF":2.1,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590307","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}

{"title":"A quality assessment and systematic review of clinical practice guidelines on hormone replacement therapy for menopause using the AGREE II instrument","authors":"Maria-Patricia Roman ,&nbsp;Răzvan Ciortea ,&nbsp;Stergios K. Doumouchtsis ,&nbsp;Roxana Din ,&nbsp;Andrei Mihai Măluţan ,&nbsp;Carmen Elena Bucuri ,&nbsp;Elena-Alexandra Căşeriu ,&nbsp;Cristina Mihaela Ormindean ,&nbsp;Ionel Daniel Nati ,&nbsp;Viorela-Elena Suciu ,&nbsp;Dan Mihu","doi":"10.1016/j.ejogrb.2024.10.046","DOIUrl":"10.1016/j.ejogrb.2024.10.046","url":null,"abstract":"<div><div>Clinical Practice Guidelines (CPGs) have an indispensable role in guiding the selection of treatments for menopause. Variations in guidelines can impact treatments and health outcomes. The aim of this study was to assess CPGs on hormone replacement therapy (HRT) for menopause, systematically reviewing their quality and compiling recommendations for HRT usage.</div><div>Embase, Scopus, MedLine, Geneva Foundation for Medical Education and Research databases were searched to identify relevant publications. CPGs published in English language, focusing specifically on HRT for menopause were included in the analysis. Four reviewers assessed the quality of the included CPGs using the Appraisal of Guidelines for Research &amp; Evaluation II (AGREE II) instrument and compiled congruent as well as contradictory recommendations.</div><div>Nine guidelines met the inclusion criteria. The National Institute for Health and Care Excellence (NICE), the Endocrine Society and The Association of the Scientific Medical Societies guidelines were deemed to have the highest quality and are recommended without modifications. Out of 300+ extracted recommendations, merely 17 showed consistency, overlapping in at least two CPGs. The recommendations were categorized into three domains: treatment considerations, impact of HRT on non-reproductive organ systems, and the associations of HRT with cancer. The included CPGs exhibited the highest scores in the “Clarity of presentation” and “Scope and purpose” AGREE II domains.</div><div>This study found variation in recommendations and quality of CPG on HRT for menopause. Notably, only a small fraction of recommendations showed consistency across guidelines, highlighting the variability in HRT management. Efforts to improve the quality of CPGs in this area are essential to optimize patient care and outcomes in menopausal women receiving HRT.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 294-301"},"PeriodicalIF":2.1,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603221","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}

{"title":"CardioMEMS as an aid to the management of a pregnant patient with peripartum Cardiomyopathy: A case report","authors":"Ruchira Sharma ,&nbsp;Morgan C. Dunn ,&nbsp;Hima Tam Tam ,&nbsp;Samit K. Shah","doi":"10.1016/j.ejogrb.2024.10.049","DOIUrl":"10.1016/j.ejogrb.2024.10.049","url":null,"abstract":"<div><div>Pregnancy with history of peripartum cardiomyopathy, residual left ventricular dysfunction is associated with high maternal and neonatal morbidity and mortality. Remote monitoring of pulmonary artery pressure and vital signs have been utilized in clinical settings to manage select patients with heart failure. However, data of using these systems to aid clinical management in pregnancy remains unexplored. To our knowledge, this case report is the first to describe successful management of a 31-year-old pregnant patient with history of peripartum cardiomyopathy, severe left ventricular dysfunction and pulmonary embolism using the CardioMEMS device throughout pregnancy. CardioMEMS system provided continuous remote hemodynamic monitoring during pregnancy, aiding in the management of this high-risk patient. The device’s ability to provide real-time data allowed for correlation between symptoms and hemodynamics, allowing for prompt adjustments in treatment, ensuring stability throughout the pregnancy. This patient was able to avoid hospital admissions and successfully deliver a healthy baby via vaginal delivery. This report highlights the potential benefits of utilizing CardioMEMS in clinical management of such patients.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 279-281"},"PeriodicalIF":2.1,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caesarean section scar: Histological analysis on hysterectomy specimen. A pilot study","authors":"Constance Maudot ,&nbsp;Elodie Debras ,&nbsp;Astrid Laurent-Bellue ,&nbsp;Margot Dupeux ,&nbsp;Suzanne Chartier ,&nbsp;Sophie Prevost ,&nbsp;Victor Beaucoté ,&nbsp;Pascale Chavatte-Palmer ,&nbsp;Perrine Goussault Capmas","doi":"10.1016/j.ejogrb.2024.10.048","DOIUrl":"10.1016/j.ejogrb.2024.10.048","url":null,"abstract":"<div><h3>Introduction</h3><div>In recent years, caesarean section (CS) rate has risen worldwide. Complications associated with CS scars have risen too, such as scar dehiscences and uterine ruptures. Uterine healing is a complex phenomenon still poorly understood. The aim of this study is to carry out a comparative histological analysis of healthy and scarred uterus.</div></div><div><h3>Material and methods</h3><div>Women who underwent hysterectomy for benign pathology were included prospectively and divided into two groups: previous CS (group 1) versus control (group 2). Hysterectomy specimen were analyzed histologically and immunohistochemically.</div></div><div><h3>Results</h3><div>Sixty women were included: 30 women per group. In group 1, only 19 women could be analyzed. Median total thickness at the thinnest site of the scar is significantly thinner (4.34 mm; IQR [2.76–9.45]) than that of adjacent healthy isthmus (12.70 mm; IQR [10.45–14.95]) (p &lt; 0.001). It is also thinner than in group 2 (13.45 mm; IQR [11.03–16.90]) (p &lt; 0.001). Median myometrial thickness within the scar in group 1 was also thinner (1.14 mm; IQR [0.30–2.69]) than that of the adjacent healthy isthmus (8.90 mm; IQR [8.18–10.08]) (p &lt; 0.001) and that in group 2 (10.00 mm; IQR [8.38–13.35]) (p &lt; 0.001). There was a significant increase in fibrosis in the scar (55.01 %; IQR [35.71–63.46]) compared with adjacent tissue (17.41 %; IQR [15.08–24.78]) (p &lt; 0.001) and with healthy uterus (33.91 %; IQR [18.93–46.53]) (p = 0.006).</div></div><div><h3>Conclusion</h3><div>In uterus with previous CS scar, total thickness of the wall and thickness of the myometrium are reduced and proportion of fibrosis is significantly increased. This study shows that the thickness of the wall remains reduced in scarred uterus, even very long after CS. Further studies are currently in progress to understand its pathophysiology within the uterus using animal models.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 236-243"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of different doses of mifepristone in the treatment of uterine fibroids: A meta-analysis","authors":"Xiaoxiao Yin,&nbsp;Liuqing He,&nbsp;Haofei Xu,&nbsp;Shunping Lou,&nbsp;Ying Tan,&nbsp;Yunqing Wang,&nbsp;Xinyu Luo,&nbsp;Yefang Huang","doi":"10.1016/j.ejogrb.2024.10.059","DOIUrl":"10.1016/j.ejogrb.2024.10.059","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically assess the safety and effectiveness of mifepristone at doses of 2.5 mg, 5 mg, 10 mg, 25 mg, and 50 mg in the treatment of uterine fibroids.</div></div><div><h3>Methods</h3><div>The protocol is registered with INPLASY (registration number is INPLASY202460075). Computer retrieval PubMed, the Cochrane Library, Embase database related (mifepristone group) compared to placebo and mifepristone or conventional treatment (control group) in the treatment of uterine fibroids randomized controlled trial (RCT), retrieve the time limit for a Library to in October 2023, Refer to the Cochrane faced the quality evaluation of the literature of included in the 6.0 and uses the RevMan 5.4.1 software Meta-analysis and sensitivity analysis.</div></div><div><h3>Results</h3><div>There were 18 studies with a total of 2066 patients as participants. A <em>meta</em>-analysis found that the patients in the mifepristone group had lower uterine volume or uterine fibroid volume than the control group, with a statistically significant difference. Mifepristone treatment for 3 months uterine volume smaller is better than 6 months the difference is statistically significant. Compared with the control group, mifepristone can improve pelvic pain, pelvic pressure, bladder pressure, urinary symptoms, lower back pain, dyspareunia, rectal pain, menorrhagia, hypermenorrhea, and other clinical symptoms. The Mifepristone group had hot flashes, endometrium thickness increases, the incidence of hepatic transaminases associated is significantly higher than the control group, the patients in the 10 mg/d mifepristone group had endometrial thickness that was greater than those in the 5 mg/d mifepristone group.</div></div><div><h3>Conclusions</h3><div>Mifepristone reduces fibroid volume and improves clinical symptoms, and 5 mg/day of mifepristone for three months may be the optimal clinical regimen.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 302-309"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603265","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}

{"title":"Smoking during pregnancy in an Irish obstetric Population: Prevalence, maternal and ethnic factors","authors":"Julia C. Morrison,&nbsp;Mark A. Dempsey,&nbsp;Clare Greaney,&nbsp;John J. Morrison","doi":"10.1016/j.ejogrb.2024.10.057","DOIUrl":"10.1016/j.ejogrb.2024.10.057","url":null,"abstract":"<div><h3>Objectives</h3><div>Maternal cigarette smoking during pregnancy is associated with adverse health outcomes for the mother and her fetus in utero. A high prevalence of smoking during pregnancy is reported within an Irish obstetric population. However, there are no recent Irish data regarding change in smoking rates over time, or factors associated with declining smoking prevalence. Therefore, the objectives of this study were: 1. To investigate smoking patterns in pregnancy among an Irish obstetric population, 2. To identify trends over time, and 3. To evaluate associated demographic factors.</div></div><div><h3>Study Design</h3><div>The data for this study were obtained from EuroKing, a computerised obstetric database, to which data had been entered prospectively during the 8-year period between January 2015 and December 2022 at Galway University Hospital, Ireland. A total of 22,673 deliveries were recorded during this time period. Complete information regarding the mother’s smoking history was available for 19,247 women at the time of antenatal booking, and again at delivery. Statistical analyses was performed using GraphPad Prism (version 10.1.2). Chi-square test for proportions and trend were used to assess differences between groups.</div></div><div><h3>Results</h3><div>Rates of smoking during pregnancy declined over the duration of the study. The percentage of mothers who smoked during pregnancy declined from 8.3 % in 2015 to 6.0 % in 2022 (P = 0.007). The greatest reduction in smoking was observed among those aged 21 to 30 years, from 15.3 % in 2015 to 10.1 % in 2022 (P &lt; 0.001). There was no significant decline in smoking within the other age groups. There was an overall reduction in the rate of smoking from the time of antenatal booking to delivery of 31.9 %. Increasing maternal age was associated with lower rates of smoking (P &lt; 0.001). Increasing parity was associated with higher rates of smoking (P &lt; 0.001). Smoking rates were highest in the White Irish Traveller ethnic group, at 40.3 % across the 8-year study period. Breastfeeding rates were lower in smokers versus non-smokers (P &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>This study indicates that the rate of maternal smoking during pregnancy in Ireland is approximately 6%, which is less than previously reported. A significant proportion of women who smoked at the time of antenatal booking have ceased smoking by the time of delivery. Overall there was a decline in maternal smoking over the duration of the study. However, high rates of smoking were associated with certain sociodemographic characteristics, including younger maternal age, increasing parity and White Irish Traveller background.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 317-321"},"PeriodicalIF":2.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617548","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}

{"title":"The effectiveness of low-dose aspirin for the prevention of hypertensive disorders of pregnancy in a sub-Saharan Africa Country: A randomized clinical trial","authors":"P.Z. Mkhize ,&nbsp;V. Dorsamy ,&nbsp;O.P. Khaliq ,&nbsp;C. Bagwandeen ,&nbsp;J. Moodley","doi":"10.1016/j.ejogrb.2024.10.052","DOIUrl":"10.1016/j.ejogrb.2024.10.052","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether a daily dose of low-dose aspirin (LDA) can prevent hypertensive disorders of pregnancy (HDP), including preeclampsia, among pregnant women in a South African cohort, and to assess its impact on related maternal and fetal outcomes, such as preterm birth and neonatal complications.</div></div><div><h3>Study design</h3><div>This single-center, open-label, parallel-group randomized controlled trial (RCT) was conducted at a regional hospital in Durban, KwaZulu-Natal, South Africa, from May 2021 to March 2024. A total of 423 pregnant women, aged 18 years or older with singleton pregnancies between 12 and 20 weeks of gestation, were randomized to receive either 162 mg of LDA daily or standard care. The primary outcome was the incidence of HDP, while secondary outcomes included early-onset preeclampsia (EOPE), preterm birth, low birth weight (LBW), and neonatal death. Data analysis used relative risk (RR) and 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Of the 423 women, 209 were in the LDA group and 214 in the control group. The incidence of HDP was significantly lower in the LDA group (6.2 % vs. 25.2 %; RR = 0.25, 95 % CI [0.14–0.44], p &lt; 0.001), corresponding to a 75 % reduction in HDP risk, with an absolute risk reduction (ARR) of 19 % and a number needed to treat (NNT) of 5.3. EOPE was reduced (2.4 % vs. 14.0 %; RR = 0.17, 95 % CI [0.07–0.41], p &lt; 0.001), as was preterm birth (6.7 % vs. 26.2 %; RR = 0.26, 95 % CI [0.15–0.45], p &lt; 0.001). There were no significant differences for LBW or neonatal death. Sensitivity analysis confirmed the importance of initiating LDA before 16 weeks, showing continued reductions in HDP incidence with early initiation.</div></div><div><h3>Conclusion</h3><div>LDA significantly reduces the risk of HDP, EOPE, and preterm birth, particularly when initiated before 16 weeks of gestation. These findings support the use of LDA for preventing hypertensive disorders of pregnancy in low-resource settings and underscore the value of early intervention for improved maternal and fetal outcomes.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 259-265"},"PeriodicalIF":2.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593496","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}