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

All global organisations involved in setting standards of care for sexual and reproductive rights for women have strongly emphasised that care during pregnancy, labour and post-partum should not only focus on preventing maternal deaths and complications but should provide a women centred care to meet their individual needs and human rights principles. Maternity care should respect autonomy, privacy, dignity, confidentiality and involve women in decision making at each stage during pregnancy. It is deeply concerning that most women surveyed in the UNFPA EECARO supported research¹, covering the countries of Eastern Europe and Central Asia has reported at least one episode of obstetric mistreatment. Such experiences can have a long term impact on maternal health and wellbeing. European Board and College of Obstetrics and Gynaecology (EBCOG) asserts that an inter-disciplinary multi-faceted strategic approach is needed to address challenges for the provision of respectful care.

Objective: To compare laparoscopic lateral suspension (LLS) and transvaginal natural orifice transluminal endoscopic surgery lateral suspension (vNOTES-LS) in the surgical treatment of pelvic organ prolapse (POP), focusing on anatomical outcomes and complication rates.

Study design: Single-center retrospective cohort study.

Method: A total of 111 women with stage ≥ 2 apical POP who underwent LLS (n = 63) or vNOTES-LS (n = 48) between August 2020 and March 2024. Subgroup analyses were performed based on uterine preservation status.

Results: The overall surgical success rate was 82.5% in the LLS group and 95.8% in the vNOTES-LS group. vNOTES-LS was associated with significantly greater improvement in POP-Q points (Aa, Ap, Ba,Bp, C; p < 0.05 for all). Reoperation rates were significantly lower in the vNOTES uterine-preserving subgroup compared to the corresponding LLS subgroup (4.2% vs. 17.5%, p = 0.035). Estimated blood loss was higher in the vNOTES group (p = 0.0001). Intraoperative and postoperative complication rates were comparable between the groups (p > 0.05 for all). All late mesh removals due to pelvic pain occurred in the LLS group.

Conclusion: Both LLS and vNOTES-LS are effective and safe techniques for POP repair. vNOTES-LS appears to provide superior anatomical outcomes and lower reoperation rates, particularly uterine-preserving cases, supporting its broader adoption in minimally invasive pelvic reconstructive surgery.

Objective: There is currently no consensus on the risk factors for recurrent ovarian endometrioma after surgery. This study aimed to identify independent risk factors and develop a clinical nomogram to predict postoperative recurrence.

Methods: A retrospective study was conducted on 589 patients who underwent ovarian endometrioma excision at a tertiary institute between March 2013 and December 2018. Clinical variables were compared between patients with and without recurrence using logistic multiple regression analysis to identify independent predictors. A nomogram was subsequently constructed and validated.

Results: Of the 589 patients, 82 (13.92%) experienced recurrence. Multivariate analysis identified five independent risk factors: younger age at surgery, longer duration of menstruation, higher dysmenorrhea severity (VRS-5 scores), larger endometrioma diameter, and fewer postoperative deliveries (p < 0.05). Based on these factors, a nomogram was developed, yielding an area under the curve (AUC) of 0.703 in the development cohort and 0.719 in the validation cohort. Calibration curves and decision curve analysis (DCA) demonstrated the model's good fit and clinical net benefit.

Conclusion: Younger age, menstruation duration, dysmenorrhea severity, cyst diameter, and postoperative deliveries are key determinants of recurrence. The novel nomogram serves as a practical tool for clinicians to estimate risk and personalize postoperative management.

Introduction: Atypical endometriosis (AE) is a histologically distinct entity considered a potential precursor to Endometriosis-Associated Ovarian Cancer (EAOC). Preoperative diagnosis is challenging as imaging often fails to distinguish AE from benign ovarian endometrioma (OMA). This study evaluated the diagnostic performance of inflammatory biomarkers, specifically Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR), in predicting AE.

Methods: We conducted a retrospective analysis of 105 patients surgically treated between 2015 and 2024. The cohort included women with histologically confirmed AE (n = 15), benign OMA (n = 45), and EAOC (n = 45). Preoperative blood samples were analyzed to calculate NLR and PLR. Statistical analysis included group comparisons, logistic regression to identify predictors of atypia, and Receiver Operating Characteristics (ROC) curve analysis to determine optimal cut-offs.

Results: Patients with EAOC exhibited significantly higher NLR (p = 0.002) and PLR (p = 0.001) compared to benign OMA. While mean biomarkers levels did not differ significantly between AE and benign OMA in univariate analysis, logistic regression identified cyst size (p = 0.017) and NLR (p = 0.025) as significant independent predictors of progression from typical to atypical OMA. The optimal NLR threshold for detecting AE was 2.294 (AUC 0.77), yielding a sensitivity of 70.0% and specificity of 75.6%. PLR distinguished malignancy but was not a significant predictor for AE.

Conclusion: NLR is a promising, non-invasive biomarker for the early detection of atypical endometriosis. An NLR value > 2.294, particularly in larger cysts, may assist in preoperative risk stratification, identifying patients who require specialized surgical management to rule out malignant transformation.

Background: Intrauterine growth restriction (IUGR) is a major cause of perinatal morbidity and mortality. Although placental insufficiency is considered the principal mechanism, maternal physiological factors influencing fetal growth remain incompletely understood. Maternal digestive physiology has received little attention in this context. Fecal elastase-1 (FE-1) is a non-invasive biomarker reflecting pancreatic enzyme secretion.

Objective: To explore whether maternal FE-1 concentrations differ between pregnancies complicated by IUGR and those with normal fetal growth.

Methods: In this prospective case-control study, 50 pregnancies with IUGR were compared with 50 gestational age-matched controls. FE-1 concentrations were measured using ELISA. Group comparisons, correlation analyses, multivariable logistic regression, and receiver operating characteristic (ROC) analysis were performed.

Results: Median FE-1 levels were lower in the IUGR group than in controls (315 µg/g [IQR 180-546] vs. 461 µg/g [IQR 240-720]; p = 0.030). FE-1 concentrations below 200 µg/g were more frequent among IUGR pregnancies (30.0% vs. 12.0%, p = 0.027). In multivariable analysis, higher FE-1 levels were independently associated with lower odds of IUGR (OR 0.79 per 100 µg/g increase; 95% CI 0.64-0.97; p = 0.027). FE-1 concentrations were not significantly correlated with fetal biometric parameters. ROC analysis showed modest discriminative ability (AUC 0.625, 95% CI 0.516-0.734).

Conclusions: Pregnancies complicated by IUGR were associated with relatively lower maternal FE-1 concentrations compared with gestational age-matched controls. These findings should be interpreted as exploratory and hypothesis-generating rather than evidence of a causal relationship. Further studies incorporating nutritional biomarkers and detailed assessments of maternal digestive function are needed to clarify the underlying mechanisms.

Objectives: Genital prolapse is a significant health issue among women aged 20-54 years worldwide. Quantifying its burden in this age group can guide healthcare resource allocation and public health strategies.

Methods: Using Global Burden of Disease (GBD) data, we assessed trends in age-standardized prevalence (ASPR), incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) of genital prolapse from 1990 to 2021. Estimated annual percentage changes evaluated temporal patterns, and Pearson correlation coefficients examined associations between socio-demographic index (SDI) and ASRs across GBD regions. The Age-Period-Cohort model predicted future trends, while cross-country inequality, decomposition, and frontier analyses explored disparities, drivers, and potential reductions.

Results: Globally, ASPR, ASIR, ASMR, and DALY rates declined over the study period. In 2021, Tropical Latin America had the highest ASPR, ASIR, and DALY rates, while the Northern Mariana Islands showed the fastest growth. ASRs were negatively correlated with SDI. Burden increased with age but was lower in more recent birth cohorts. Inequality in prevalence, incidence, and DALYs narrowed across SDI levels, whereas mortality inequality rose. Population growth, followed by aging, was the main driver of burden in global and low-SDI regions. High-SDI countries had greater potential for further reduction.

Conclusions: The burden of genital prolapse among women aged 20-54 years decreased globally, though marked geographic and socioeconomic disparities persist. Population growth remains the leading driver, underscoring the need for targeted prevention and resource allocation.

Objectives: Hyperemesis gravidarum (HG) is characterized by severe nausea and vomiting in pregnancy and often requires hospitalization. Risk factors for severe HG remain poorly investigated. We aimed to identify risk factors for more severe HG, defined by prolonged and recurrent hospitalizations.

Methods: This cross-sectional study included 102 women hospitalized for HG. Data from medical records and questionnaires covered history of motion sickness, nausea related to migraine, and family history of nausea and vomiting in pregnancy (NVP). Women were categorized using three criteria: (1) hospitalization length (≤3 days vs. > 3 days), (2) readmissions (none vs. ≥ 1), and (3) combined HG severity: milder vs. more severe HG (≤3 days and no readmissions vs. > 3 days and ≥ 1 readmission). Logistic regression was adjusted for age, body mass index, parity, and marital status.

Results: Women with more severe HG (longer hospitalizations and readmissions) were hospitalized earlier in pregnancy than those with milder HG (8.0 vs. 10.0 gestational weeks, p = 0.002). After adjustment, readmissions were more common among women with a history of motion sickness (71%) than among those without (49%, p = 0.029). Nausea related to migraine and a family history of NVP showed no association with readmissions. None of the nausea-related factors were associated with longer hospital stays or combined HG severity.

Conclusion: Earlier hospitalization may indicate a more severe HG phenotype, emphasizing the importance of timely recognition and sufficient medical care. Although personal history of nausea and family history of NVP are known HG risk factors in general, they did not strongly predict more severe HG.

Introduction: Preventing unwanted pregnancies is essential for women of childbearing age. The increasing demand for non-hormonal, non-invasive contraceptive methods and the desire for greater body awareness have increased the use of fertility monitoring applications. The aim of this study was to evaluate the effectiveness of mobile applications as a contraceptive method.

Methods: The systematic review was carried out in accordance with the PRISMA statement and registered in PROSPERO. An electronic search was performed in the PubMed/MEDLINE and LILACS databases, up to December 2024, using the following search strategy: ["mobile application" OR "mobile app" OR "app" AND "contraception"].

Results: A total of 122 records were identified; after duplicate removal and screening of titles and abstracts, nine studies were assessed in full text, and six met the inclusion criteria. The quality of the studies was considered low, as all of them were classified as poor quality due to failures to control bias and a high rate of loss to follow-up. Two mobile applications were analyzed for efficacy, effectiveness and cumulative probability of pregnancy: Natural Cycles and Dynamic Optimal Timing (Dot). The studies showed Pearl Indexes with estimates for typical use between 5.8 and 6.8 and for perfect use between 0.5 and 2, similar to some already established hormonal contraceptive methods. The cumulative probability of pregnancy in the included studies varied between 5.8% and 8.3%.

Conclusion: Even with the increasing use of mobile applications as a contraceptive tool, the lack of well-designed studies and representative samples limits the evaluation of their effectiveness. Further studies, including randomized clinical trials and comparative studies with traditional methods, are needed to validate the real effectiveness of these devices as a contraceptive method.

Objective: Evaluate the appropriateness of primary care referrals for urinary incontinence and pelvic organ prolapse against national guideline standards, and to identify patient characteristics associated with inappropriate referral using univariable analyses.

Study design: Retrospective service evaluation of all primary care referrals to a urogynaecology service at a UK district general hospital over a twelve-month period. Referrals were categorised as urinary incontinence or pelvic organ prolapse and assessed against predefined criteria derived from NICE NG123.

Results: A total of 869 referrals were analysed, comprising 518 urinary incontinence and 351 prolapse referrals. Just over half of urinary incontinence referrals (54.1%) met guideline criteria for appropriate referral, compared with only 8.0% of prolapse referrals. In the incontinence group, increasing age was significantly associated with inappropriate referral on univariable analysis (p = 0.039). In the prolapse cohort, increasing age (p < 0.001) was also significantly associated with inappropriate referral on univariable analysis. For BMI ≥30 kg/m², the unadjusted odds ratio suggested a possible but non-significant trend towards higher odds of inappropriate referral in prolapse group. (OR 2.54, 95% CI 0.86-7.51).

Conclusions: Adherence to national guidance for pelvic floor disorder management in primary care was suboptimal, particularly for pelvic organ prolapse. Older women showed higher unadjusted odds of referral without full conservative management on univariable analyses. These findings support targeted education, clearer referral pathways, and improved access to community pelvic health services to optimise referral quality.