During fetal life the right valve of the sinus venosus directs oxygenated blood from the inferior vena cava to the left atrium through the foramen ovale, until the regression of the right valve which usually occurs within the 15th week of pregnancy. Incomplete regression of the right venous valve in varying degrees can lead to different types of remnants such as the Eustachian valve, the Chiari Network and Cor Triatriatum Dexter. Prenatal diagnosis of remnants of right venous valve has only rarely been reported in the literature. We present a case of prenatal diagnosis of Chiari Network associated with severe tricuspid regurgitation, further complicated by tachyarrhythmia and signs of fetal heart failure with the appearance of abundant pleural and ascitic effusion. A cesarean section was performed at 32 weeks. After 48 h of life, because of persistence of atrial flutter, an electrical cardioversion was performed. The physical examination 7 months after being discharged showed a normal growth, good condition and persistence of mild tricuspid regurgitation. We also reviewed the available evidence on persistent right venous valve diagnosed in utero or early postnatal life. In conclusion we believe that prenatal recognition is helpful in planning fetal surveillance identifying those newborns at risk of dyspnea, cyanosis or neonatal heart failure.
{"title":"Remnants of right venous valve in utero and early postnatal life. Case report and literature review","authors":"Luigi Ferraro , Evelina Bertelli , Claudio Bonanno , Antonella Cromi , Fabio Ghezzi","doi":"10.1016/j.ejogrb.2024.10.020","DOIUrl":"10.1016/j.ejogrb.2024.10.020","url":null,"abstract":"<div><div>During fetal life the right valve of the sinus venosus directs oxygenated blood from the inferior vena cava to the left atrium through the foramen ovale, until the regression of the right valve which usually occurs within the 15th week of pregnancy. Incomplete regression of the right venous valve in varying degrees can lead to different types of remnants such as the Eustachian valve, the Chiari Network and Cor Triatriatum Dexter. Prenatal diagnosis of remnants of right venous valve has only rarely been reported in the literature. We present a case of prenatal diagnosis of Chiari Network associated with severe tricuspid regurgitation, further complicated by tachyarrhythmia and signs of fetal heart failure with the appearance of abundant pleural and ascitic effusion. A cesarean section was performed at 32 weeks. After 48 h of life, because of persistence of atrial flutter, an electrical cardioversion was performed. The physical examination 7 months after being discharged showed a normal growth, good condition and persistence of mild tricuspid regurgitation. We also reviewed the available evidence on persistent right venous valve diagnosed in utero or early postnatal life. In conclusion we believe that prenatal recognition is helpful in planning fetal surveillance identifying those newborns at risk of dyspnea, cyanosis or neonatal heart failure.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 186-205"},"PeriodicalIF":2.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564125","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}
To compare the outcomes of laparoscopic myomectomy (LM) and open myomectomy (OM) by reviewing the frequency, type and severity of complications reported by the Clavien–Dindo classification. In addition, this study evaluated differences in blood loss, length of operative time and hospital stay between these two surgical approaches.
Methods
A systematic search of electronic databases was conducted from their inception to January 2024 to identify studies comparing LM and OM with detailed surgical complications reported. The random effect model was applied, and the odds ratio was used for the main outcomes, with effect sizes presented alongside 95 % confidence intervals (CI). A p-value < 0.05 was considered to indicate significance.
Results
Of 296 studies identified, nine studies (total 224 patients) were included. LM was found to be associated with significantly lower rates of overall postoperative complications compared with OM. With no statistical heterogeneity between the studies (I2 = 0 %), the overall effect size was 0.67 (95 % CI 0.45–0.99), indicating a significant association between postoperative complications and open surgery (p = 0.04). Regarding Clavien–Dindo complications >grade 3, the overall effect size was 1.55 (95 % CI 0.47–5.08), indicating a non-significant association between grade 3 complications and surgical approach (p = 0.47). Despite superimposable operative time (effect size 1.40, 95 % CI 0.70–2.79; p = 0.342), LM showed significantly lower mean blood loss compared with OM, with an overall effect size of 0.34 (95 % CI 0.12–1.00; p = 0.049). The duration of hospital stay was significantly shorter in the LM group (2.0 vs 3.1 days), with an overall effect size of 0.09 (95 % CI 0.05–0.18), strongly associating the laparoscopic approach with reduced hospitalization stay (p < 0.001).
Conclusion
LM offers favourable outcomes compared with OM for the treatment of uterine myomas. Despite a slightly longer operative time, LM was found to be associated with lower rates of postoperative complications and reduced hospital stay. These findings support the preference for LM for the treatment of uterine myomas, highlighting its potential to improve patient outcomes and recovery.
{"title":"Unveiling the advantages of laparoscopic myomectomy: A comprehensive systematic review and meta-analysis of outcomes and complications compared with traditional open surgery","authors":"Vito Andrea Capozzi , Michela Gaiano , Elisa Scarpelli , Giuseppe Barresi , Licia Roberto , Giosuè Giordano Incognito , Marco Palumbo , Paola Romeo , Vittorio Palmara , Stefano Cianci","doi":"10.1016/j.ejogrb.2024.10.038","DOIUrl":"10.1016/j.ejogrb.2024.10.038","url":null,"abstract":"<div><h3>Aims</h3><div>To compare the outcomes of laparoscopic myomectomy (LM) and open myomectomy (OM) by reviewing the frequency, type and severity of complications reported by the Clavien–Dindo classification. In addition, this study evaluated differences in blood loss, length of operative time and hospital stay between these two surgical approaches.</div></div><div><h3>Methods</h3><div>A systematic search of electronic databases was conducted from their inception to January 2024 to identify studies comparing LM and OM with detailed surgical complications reported. The random effect model was applied, and the odds ratio was used for the main outcomes, with effect sizes presented alongside 95 % confidence intervals (CI). A <em>p</em>-value < 0.05 was considered to indicate significance.</div></div><div><h3>Results</h3><div>Of 296 studies identified, nine studies (total 224 patients) were included. LM was found to be associated with significantly lower rates of overall postoperative complications compared with OM. With no statistical heterogeneity between the studies (<em>I</em><sup>2</sup> = 0 %), the overall effect size was 0.67 (95 % CI 0.45–0.99), indicating a significant association between postoperative complications and open surgery (<em>p</em> = 0.04). Regarding Clavien–Dindo complications >grade 3, the overall effect size was 1.55 (95 % CI 0.47–5.08), indicating a non-significant association between grade 3 complications and surgical approach (<em>p</em> = 0.47). Despite superimposable operative time (effect size 1.40, 95 % CI 0.70–2.79; <em>p</em> = 0.342), LM showed significantly lower mean blood loss compared with OM, with an overall effect size of 0.34 (95 % CI 0.12–1.00; <em>p</em> = 0.049). The duration of hospital stay was significantly shorter in the LM group (2.0 vs 3.1 days), with an overall effect size of 0.09 (95 % CI 0.05–0.18), strongly associating the laparoscopic approach with reduced hospitalization stay (<em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>LM offers favourable outcomes compared with OM for the treatment of uterine myomas. Despite a slightly longer operative time, LM was found to be associated with lower rates of postoperative complications and reduced hospital stay. These findings support the preference for LM for the treatment of uterine myomas, highlighting its potential to improve patient outcomes and recovery.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 322-330"},"PeriodicalIF":2.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615390","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}
Pub Date : 2024-10-28DOI: 10.1016/j.ejogrb.2024.10.045
Kit-Sum Mak , Yi-Ting Huang , Cindy Hsuan Weng , Kai-Yun Wu , Wei-Li Lin , Chin-Jung Wang
Objective
To identify related factors that affect the ovarian reserve after laparoscopic ovarian cystectomy in patients with endometriomas.
Study design
It was a retrospective cohort study performed in a tertiary-care university hospital. A total of 409 patients with endometriomas underwent laparoscopic ovarian cystectomy between June 2014 and November 2021.
Results
The demographic and operative data, including age, parity, body mass index, tumor size, operating time, and estimated blood loss were recorded. Serum anti-Mullerian hormone (AMH) levels were recorded preoperatively, as well as 10 days (immediately) and 6 months after the procedure respectively. The decrease of serum AMH level at 6 months after the surgery were 0.7 ± 1.6 ng/mL (22.5 ± 57.1 %) in the unilateral group and 1.5 ± 2.1 ng/mL (48.3 ± 65.6 %) in the bilateral group. The reduction in the serum AMH level at 10 days and 6 months after the operation were significant compared to the baseline level. The bilateral group has a significantly lower serum AMH level than that of the unilateral group in terms of 10 days and 6 months after operation (p < 0.001). Baseline serum AMH level < 2 ng/mL have shown less reduction in both 10 days group and 6 months group with odds ratio (OR) 0.36 (p = 0.01) and OR 0.264 (p < 0.001) respectively. Neither patient’s age nor tumor size contributed to the decline of ovarian reserve.
Conclusions
Bilaterality and pre-operative serum AMH level are the two key factors that affect ovarian reserve after laparoscopic cystectomy.
{"title":"Factors affected the ovarian reserve after laparoscopic cystectomy for ovarian endometriomas","authors":"Kit-Sum Mak , Yi-Ting Huang , Cindy Hsuan Weng , Kai-Yun Wu , Wei-Li Lin , Chin-Jung Wang","doi":"10.1016/j.ejogrb.2024.10.045","DOIUrl":"10.1016/j.ejogrb.2024.10.045","url":null,"abstract":"<div><h3>Objective</h3><div>To identify related factors that affect the ovarian reserve after laparoscopic ovarian cystectomy in patients with endometriomas.</div></div><div><h3>Study design</h3><div>It was a retrospective cohort study performed in a tertiary-care university hospital. A total of 409 patients with endometriomas underwent laparoscopic ovarian cystectomy between June 2014 and November 2021.</div></div><div><h3>Results</h3><div>The demographic and operative data, including age, parity, body mass index, tumor size, operating time, and estimated blood loss were recorded. Serum anti-Mullerian hormone (AMH) levels were recorded preoperatively, as well as 10 days (immediately) and 6 months after the procedure respectively. The decrease of serum AMH level at 6 months after the surgery were 0.7 ± 1.6 ng/mL (22.5 ± 57.1 %) in the unilateral group and 1.5 ± 2.1 ng/mL (48.3 ± 65.6 %) in the bilateral group. The reduction in the serum AMH level at 10 days and 6 months after the operation were significant compared to the baseline level. The bilateral group has a significantly lower serum AMH level than that of the unilateral group in terms of 10 days and 6 months after operation (p < 0.001). Baseline serum AMH level < 2 ng/mL have shown less reduction in both 10 days group and 6 months group with odds ratio (OR) 0.36 (p = 0.01) and OR 0.264 (p < 0.001) respectively. Neither patient’s age nor tumor size contributed to the decline of ovarian reserve.</div></div><div><h3>Conclusions</h3><div>Bilaterality and pre-operative serum AMH level are the two key factors that affect ovarian reserve after laparoscopic cystectomy.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 244-249"},"PeriodicalIF":2.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590299","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}
Pub Date : 2024-10-28DOI: 10.1016/j.ejogrb.2024.10.043
Sofia Tsiapakidou , Hajra Khattak , Sambit Mukhopadhyay , Tahir Mahmood , Charles Savona-Ventura , Ioannis Messinis , Jure Klanjscek , Johannes Bitzer
Substantial discrepancies were observed in the healthcare services available for sexually transmitted diseases (STDs) among different countries. An assessment of the present situation in 26 European countries was performed through a questionnaire-based survey developed jointly by the European Board and College of Obstetrics and Gynaecology, and the European Society of Contraception. Considerable potential opportunities exist in European training and education programmes to bring about improvements. Nonetheless, the most significant disparity stems from the absence of formal education and training opportunities for healthcare professionals, that appears to have an impact and may be a significant factor contributing to the disparities observed in STD care delivery. The health impact of sexually transmitted infections (STIs) is frequently underestimated, but if left untreated, these common infections can lead to complications that have a disproportionate long-term impact on the health of women and children. The variation in the availability of educational initiatives and training opportunities on STDs across Europe underscores the necessity for a standardised, evidence-based care model to address disparities and enhance sexual healthcare outcomes. The implementation of such a model of training and care needs to become part of national health policies supported by the necessary governmental financial support.
{"title":"Safer Sex. Access, availability, and quality of sexually transmitted infections healthcare across Europe: Call for Action by the European Board and College of Obstetrics & Gynaecology (EBCOG) and European Society of Contraception (ESCRH)","authors":"Sofia Tsiapakidou , Hajra Khattak , Sambit Mukhopadhyay , Tahir Mahmood , Charles Savona-Ventura , Ioannis Messinis , Jure Klanjscek , Johannes Bitzer","doi":"10.1016/j.ejogrb.2024.10.043","DOIUrl":"10.1016/j.ejogrb.2024.10.043","url":null,"abstract":"<div><div>Substantial discrepancies were observed in the healthcare services available for sexually transmitted diseases (STDs) among different countries. An assessment of the present situation in 26 European countries was performed through a questionnaire-based survey developed jointly by the European Board and College of Obstetrics and Gynaecology, and the European Society of Contraception. Considerable potential opportunities exist in European training and education programmes to bring about improvements. Nonetheless, the most significant disparity stems from the absence of formal education and training opportunities for healthcare professionals, that appears to have an impact and may be a significant factor contributing to the disparities observed in STD care delivery. The health impact of sexually transmitted infections (STIs) is frequently underestimated, but if left untreated, these common infections can lead to complications that have a disproportionate long-term impact on the health of women and children. The variation in the availability of educational initiatives and training opportunities on STDs across Europe underscores the necessity for a standardised, evidence-based care model to address disparities and enhance sexual healthcare outcomes. The implementation of such a model of training and care needs to become part of national health policies supported by the necessary governmental financial support.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 349-354"},"PeriodicalIF":2.1,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617466","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}
This study aimed to explore the use of an anesthetic lidocaine thermogel in outpatient operative hysteroscopies. Specifically, it assessed the safety, tolerability, and ease of use of the gel, as well as its potential for pain reduction during the procedure.
Study design
This was a multicenter observational study conducted in 9 gynecological units between March 2023 and January 2024. The study included adult women scheduled for outpatient operative hysteroscopies, excluding those with hypersensitivity to the product or recent participation in other clinical studies. The target sample size was 60 to account for potential dropouts. Data collection was electronic, and SPSS was used for analysis. The study assessed visibility conditions, procedure duration, pain scores at different stages of the procedure, and adverse event frequency. Statistical analyses utilized descriptive statistics, Student’s t-tests, Wilcoxon and Friedman tests, and Chi-Square or Fisher tests as appropriate. Binary logistic regression was applied to identify factors influencing gel volume.
Results
All 60 participants met the inclusion criteria. The mean age was 45.5 (SD 8.8) years, with a mean BMI of 27.0 (SD 5.6) kg/m2. Medical histories were reported in 46.7% of participants, and 50% had undergone previous gynecological surgeries. Prior to the procedure, 51.8% of participants took analgesics. The average procedure duration was 13.9 (SD 15.1) minutes. Pain scores were collected at different stages of the procedure, with median VAS scores ranging from 0 to 5 out of 10. In 50% of cases, the quality of vision during the procedure was rated 9 or higher on a 10-point scale. The full recommended dose of thermogel was administered in 91.7% of cases. The mean gel volume used was 7.0 (SD 1.9) milliliters. Regression analysis showed that younger age and a history of abortions or childbirth were significantly associated with higher gel volume use.
Conclusions
The anesthetic thermogel demonstrated effectiveness in managing pain during outpatient operative hysteroscopies, with median pain scores ranging from 0 to 5 out of 10 across different stages of the procedure. The gel showed a favorable safety profile, with only 15% of participants reporting adverse effects, all of which were minor and resolved satisfactorily. The high rate of complete gel application (91.7% of cases) and positive physician feedback suggest good tolerability and ease of use. Further research is recommended to evaluate the gel’s efficacy in other gynecological procedures and to optimize application protocols based on patient-specific factors such as age and reproductive history.
{"title":"A multi-center study on the use of lidocaine thermogel for pain control in outpatient operative hysteroscopy","authors":"Laura Nieto-Pascual , Maite López-Yarto , Mauricio Agüero Mariño , Sonia Martínez García , Gregorio López González , Jessica Navarrete Domínguez , Carlota García-Salmones González , Pilar Lafuente González , Margalida Esperança Sastre Cuadri , Jorge Peñaloza Bustamante , Alejandro Doménech , Elisabet Augé , Mercedes Andeyro García","doi":"10.1016/j.ejogrb.2024.10.041","DOIUrl":"10.1016/j.ejogrb.2024.10.041","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to explore the use of an anesthetic lidocaine thermogel in outpatient operative hysteroscopies. Specifically, it assessed the safety, tolerability, and ease of use of the gel, as well as its potential for pain reduction during the procedure.</div></div><div><h3>Study design</h3><div>This was a multicenter observational study conducted in 9 gynecological units between March 2023 and January 2024. The study included adult women scheduled for outpatient operative hysteroscopies, excluding those with hypersensitivity to the product or recent participation in other clinical studies. The target sample size was 60 to account for potential dropouts. Data collection was electronic, and SPSS was used for analysis. The study assessed visibility conditions, procedure duration, pain scores at different stages of the procedure, and adverse event frequency. Statistical analyses utilized descriptive statistics, Student’s t-tests, Wilcoxon and Friedman tests, and Chi-Square or Fisher tests as appropriate. Binary logistic regression was applied to identify factors influencing gel volume.</div></div><div><h3>Results</h3><div>All 60 participants met the inclusion criteria. The mean age was 45.5 (SD 8.8) years, with a mean BMI of 27.0 (SD 5.6) kg/m<sup>2</sup>. Medical histories were reported in 46.7% of participants, and 50% had undergone previous gynecological surgeries. Prior to the procedure, 51.8% of participants took analgesics. The average procedure duration was 13.9 (SD 15.1) minutes. Pain scores were collected at different stages of the procedure, with median VAS scores ranging from 0 to 5 out of 10. In 50% of cases, the quality of vision during the procedure was rated 9 or higher on a 10-point scale. The full recommended dose of thermogel was administered in 91.7% of cases. The mean gel volume used was 7.0 (SD 1.9) milliliters. Regression analysis showed that younger age and a history of abortions or childbirth were significantly associated with higher gel volume use.</div></div><div><h3>Conclusions</h3><div>The anesthetic thermogel demonstrated effectiveness in managing pain during outpatient operative hysteroscopies, with median pain scores ranging from 0 to 5 out of 10 across different stages of the procedure. The gel showed a favorable safety profile, with only 15% of participants reporting adverse effects, all of which were minor and resolved satisfactorily. The high rate of complete gel application (91.7% of cases) and positive physician feedback suggest good tolerability and ease of use. Further research is recommended to evaluate the gel’s efficacy in other gynecological procedures and to optimize application protocols based on patient-specific factors such as age and reproductive history.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 230-235"},"PeriodicalIF":2.1,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142586323","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}
Pub Date : 2024-10-26DOI: 10.1016/j.ejogrb.2024.10.042
Ann-Sophie Page , Eline Borowski , Emma Bauters , Susanne Housmans , Frank Van der Aa , Jan Deprest
Objectives
To compare the efficacy of Er:YAG laser for mild to moderate pelvic organ prolapse (POP) to that of pelvic floor exercises (PFE).
Design
Single center randomised controlled trial.
Setting
Tertiary center, Belgium.
Participants
Forty-six women with mild to moderate prolapse were enrolled (23 in each group). There were no missing data for the primary outcome; three patients were lost to follow-up at 24-months.
Interventions
Comparison of vaginal laser treatment (3–6 applications) to PFE (9–18 sessions).
Main outcome measures
Subjective change in prolapse symptoms at four months from baseline measured by the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) (primary), adverse events, other subjective outcomes and independent anatomical assessment up to 24 months.
Results
The mean difference in POPDI-6 scores at 4 months was 1.09 (95 %CI = −6.02;8.12), showing non-inferiority of laser to PFE (p = 0.004). Within groups, the difference in mean POPDI-6 four months following the start of therapy tended to be lower for laser-treatment (65.2 % (15/23) of laser-participants were ‘better’ or ‘much better’) than for PFE (60.9 % (14/23) in the PFE group), yet without difference between groups (OR = 1.21; 95 %CI = 0.39–3.23). There were no obvious between group differences in any other subjective nor objective outcomes. At 24 months, 50 % (11/22) of laser-patients and 43 % (9/21) of PFE-patients requested additional, yet alternative treatment. There were no serious adverse events at any time-point.
Conclusions
Vaginal laser application and PFE improve symptoms of mild and moderate prolapse to a similar extent. Both treatments had a measurable yet not durable effect. There were no adverse events in either arm.
Trial registration
ClinicalTrials.gov(NCT04523298).
Funding
The laser device was provided by Fotona, Slovenia for the duration of this trial.
{"title":"Vaginal erbium laser versus pelvic floor exercises for the treatment of pelvic organ prolapse: A randomised controlled trial","authors":"Ann-Sophie Page , Eline Borowski , Emma Bauters , Susanne Housmans , Frank Van der Aa , Jan Deprest","doi":"10.1016/j.ejogrb.2024.10.042","DOIUrl":"10.1016/j.ejogrb.2024.10.042","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare the efficacy of Er:YAG laser for mild to moderate pelvic organ prolapse (POP) to that of pelvic floor exercises (PFE).</div></div><div><h3>Design</h3><div>Single center randomised controlled trial.</div></div><div><h3>Setting</h3><div>Tertiary center, Belgium.</div></div><div><h3>Participants</h3><div>Forty-six women with mild to moderate prolapse were enrolled (23 in each group). There were no missing data for the primary outcome; three patients were lost to follow-up at 24-months.</div></div><div><h3>Interventions</h3><div>Comparison of vaginal laser treatment (3–6 applications) to PFE (9–18 sessions).</div></div><div><h3>Main outcome measures</h3><div>Subjective change in prolapse symptoms at four months from baseline measured by the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) (primary), adverse events, other subjective outcomes and independent anatomical assessment up to 24 months.</div></div><div><h3>Results</h3><div>The mean difference in POPDI-6 scores at 4 months was 1.09 (95 %CI = −6.02;8.12), showing non-inferiority of laser to PFE (p = 0.004). Within groups, the difference in mean POPDI-6 four months following the start of therapy tended to be lower for laser-treatment (65.2 % (15/23) of laser-participants were ‘better’ or ‘much better’) than for PFE (60.9 % (14/23) in the PFE group), yet without difference between groups (OR = 1.21; 95 %CI = 0.39–3.23). There were no obvious between group differences in any other subjective nor objective outcomes. At 24 months, 50 % (11/22) of laser-patients and 43 % (9/21) of PFE-patients requested additional, yet alternative treatment. There were no serious adverse events at any time-point.</div></div><div><h3>Conclusions</h3><div>Vaginal laser application and PFE improve symptoms of mild and moderate prolapse to a similar extent. Both treatments had a measurable yet not durable effect. There were no adverse events in either arm.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>(NCT04523298).</div></div><div><h3>Funding</h3><div>The laser device was provided by Fotona, Slovenia for the duration of this trial.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 165-170"},"PeriodicalIF":2.1,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564144","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}
Pub Date : 2024-10-26DOI: 10.1016/j.ejogrb.2024.10.006
Hadas Zafrir-Danieli , Ohad Houri , Reut Rotem , Dror Weinberg-Almog , Or Bercovich , Eran Hadar , Alexandra Berezowsky
Objective
This study aimed to assess the accuracy of measuring fasting plasma glucose (FPG) within 24–48 h postpartum in women with gestational diabetes mellitus (GDM) as a predictor for abnormal 6–12-week postpartum oral glucose tolerance test (OGTT).
Study design
A retrospective cohort study (2012–2021) included women with GDM and singleton pregnancies who had FPG levels recorded 24–28 h postpartum and underwent a 6–12-week OGTT. The study compared the predictive accuracy of these FPG readings with the OGTT results.
Results
Among 3128 GDM patients, 1163 (37.2 %) had a postpartum OGTT, with 935 (80.2 %) showing normal FPG (<100 mg/dL). In low-risk GDM cases (managed by lifestyle modifications), 86.15 % had normal postpartum FPG. Normal 24–48 h FPG readings, especially in low-risk GDM cases, had a high negative predictive value (NPV of 99.3 %) for type-2 diabetes at the 6–12-week OGTT, but a lower NPV (85.8 %) for predicting future glucose intolerance.
Discussion
Immediate postpartum FPG testing effectively excludes low-risk GDM women with regards to future type-2 diabetes and reasonably excluded future glucose intolerance in this group. Due to low compliance with standard OGTT, postpartum FPG could be a more practical predictive tool for diabetes in low-risk GDM cases.
{"title":"Gestational diabetes mellitus – Can we do better with postpartum diabetes screening?","authors":"Hadas Zafrir-Danieli , Ohad Houri , Reut Rotem , Dror Weinberg-Almog , Or Bercovich , Eran Hadar , Alexandra Berezowsky","doi":"10.1016/j.ejogrb.2024.10.006","DOIUrl":"10.1016/j.ejogrb.2024.10.006","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to assess the accuracy of measuring fasting plasma glucose (FPG) within 24–48 h postpartum in women with gestational diabetes mellitus (GDM) as a predictor for abnormal 6–12-week postpartum oral glucose tolerance test (OGTT).</div></div><div><h3>Study design</h3><div>A retrospective cohort study (2012–2021) included women with GDM and singleton pregnancies who had FPG levels recorded 24–28 h postpartum and underwent a 6–12-week OGTT. The study compared the predictive accuracy of these FPG readings with the OGTT results.</div></div><div><h3>Results</h3><div>Among 3128 GDM patients, 1163 (37.2 %) had a postpartum OGTT, with 935 (80.2 %) showing normal FPG (<100 mg/dL). In low-risk GDM cases (managed by lifestyle modifications), 86.15 % had normal postpartum FPG. Normal 24–48 h FPG readings, especially in low-risk GDM cases, had a high negative predictive value (NPV of 99.3 %) for type-2 diabetes at the 6–12-week OGTT, but a lower NPV (85.8 %) for predicting future glucose intolerance.</div></div><div><h3>Discussion</h3><div>Immediate postpartum FPG testing effectively excludes low-risk GDM women with regards to future type-2 diabetes and reasonably excluded future glucose intolerance in this group. Due to low compliance with standard OGTT, postpartum FPG could be a more practical predictive tool for diabetes in low-risk GDM cases.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 153-158"},"PeriodicalIF":2.1,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552822","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}
Pub Date : 2024-10-24DOI: 10.1016/j.ejogrb.2024.10.032
Lior Lowenstein , Omer Mor , Emad Matanes , Naftali Justman , Andrea Stuart , Jan Baekelandt
Objective
Vaginal hysterectomy combined with uterosacral suspension (USLS) is a technique for treating pelvic organ prolapse. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has been described as an alternative minimal invasive approachfor treating various gynecological and non-gynecological pathologies. The aim was to compare the surgical time between conventional vaginal hysterectomy combined with USLS and vNOTES hysterectomy combined with USLS.
Study design
Multi-center randomized controlled trial performed 2019–2021 at Rambam Health Care Campus (Israel) and Imelda Hospital (Belgium). Thirty women underwent vNOTES procedures and 30 women underwent conventional vaginal procedures. The primary outcome was total surgical time. Secondary outcomes included hysterectomy time, USLS time, intraoperative bleeding, length of hospitalization, pain during the first 24 h postoperative, the need of analgesia, intraoperative and postoperative adverse events, and patient-reported outcomes questionnaires. Parametric statistical methods were used to analyze the data.
Results
Compared to conventional vaginal procedures, vNOTES procedures were shorter in total surgical time (77 vs. 93 min, p = 0.004), hysterectomy time (26 vs 33 min, p < 0.001), and USLS time (20 vs 26 min. p = 0.02). Blood loss was higher in conventional vaginal compared to vNOTES surgery, as reflected by the mean blood loss estimate (143 vs 60 ml. p < 0.001) and the delta-hemoglobin (pre-operation minus the post-operation hemoglobin level (1.8 vs 1.2 ml/dL, p = 0.01). There was no difference between the groups regarding analgesics used, postoperative pain, surgical objective outcomes, and scores on patient-reported outcomes questionnaires. Adverse events were significantly more frequent in the conventional vaginal group than in the vNOTES group (p < 0.001 for intraoperative events and p = 0.05 for events that occurred in the follow-up time interval).
Conclusion
vNOTES hysterectomy with USLS has lower surgical times than conventional vaginal hysterectomy with USLS, lower blood loss and less adverse events. Other surgical objective and subjective outcomes were similar between the approaches.
目的：阴道子宫切除术联合子宫骶骨悬吊术（USLS）是一种治疗盆腔器官脱垂的技术。阴道自然孔腔镜内窥镜手术（vNOTES）已被描述为治疗各种妇科和非妇科疾病的另一种微创方法。研究旨在比较传统阴道子宫切除术联合USLS与vNOTES子宫切除术联合USLS的手术时间：多中心随机对照试验于2019-2021年在以色列兰巴姆医疗保健园区和比利时伊梅尔达医院进行。30名女性接受了vNOTES手术，30名女性接受了传统阴道手术。主要结果是手术总时间。次要结果包括子宫切除时间、USLS时间、术中出血量、住院时间、术后24小时内的疼痛、镇痛需求、术中和术后不良事件以及患者报告结果问卷。数据采用参数统计方法进行分析：与传统的阴道手术相比，vNOTES手术的总手术时间（77分钟 vs. 93分钟，P = 0.004）、子宫切除时间（26分钟 vs. 33分钟，P 结论：vNOTES子宫切除术与传统的阴道子宫切除术相比，手术时间更短、失血更少、不良事件更少。两种方法的其他手术客观和主观结果相似。
{"title":"Conventional vaginal approach vs. transvaginal natural orifice transluminal endoscopic surgery for treating apical prolapse, a randomized controlled study","authors":"Lior Lowenstein , Omer Mor , Emad Matanes , Naftali Justman , Andrea Stuart , Jan Baekelandt","doi":"10.1016/j.ejogrb.2024.10.032","DOIUrl":"10.1016/j.ejogrb.2024.10.032","url":null,"abstract":"<div><h3>Objective</h3><div>Vaginal hysterectomy combined with uterosacral suspension (USLS) is a technique for treating pelvic organ prolapse. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has been described as an alternative minimal invasive approachfor treating various gynecological and non-gynecological pathologies. The aim was to compare the surgical time between conventional vaginal hysterectomy combined with USLS and vNOTES hysterectomy combined with USLS.</div></div><div><h3>Study design</h3><div>Multi-center randomized controlled trial performed 2019–2021 at Rambam Health Care Campus (Israel) and Imelda Hospital (Belgium). Thirty women underwent vNOTES procedures and 30 women underwent conventional vaginal procedures. The primary outcome was total surgical time. Secondary outcomes included hysterectomy time, USLS time, intraoperative bleeding, length of hospitalization, pain during the first 24 h postoperative, the need of analgesia, intraoperative and postoperative adverse events, and patient-reported outcomes questionnaires. Parametric statistical methods were used to analyze the data.</div></div><div><h3>Results</h3><div>Compared to conventional vaginal procedures, vNOTES procedures were shorter in total surgical time (77 vs. 93 min, p = 0.004), hysterectomy time (26 vs 33 min, p < 0.001), and USLS time (20 vs 26 min. p = 0.02). Blood loss was higher in conventional vaginal compared to vNOTES surgery, as reflected by the mean blood loss estimate (143 vs 60 ml. p < 0.001) and the delta-hemoglobin (pre-operation minus the post-operation hemoglobin level (1.8 vs 1.2 ml/dL, p = 0.01). There was no difference between the groups regarding analgesics used, postoperative pain, surgical objective outcomes, and scores on patient-reported outcomes questionnaires. Adverse events were significantly more frequent in the conventional vaginal group than in the vNOTES group (p < 0.001 for intraoperative events and p = 0.05 for events that occurred in the follow-up time interval).</div></div><div><h3>Conclusion</h3><div>vNOTES hysterectomy with USLS has lower surgical times than conventional vaginal hysterectomy with USLS, lower blood loss and less adverse events. Other surgical objective and subjective outcomes were similar between the approaches.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 180-185"},"PeriodicalIF":2.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564142","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}
Pub Date : 2024-10-24DOI: 10.1016/j.ejogrb.2024.10.033
İlke Özer Aslan , Çağrı Doğan
Objective
To produce a bibliographic source by compiling the most-cited articles about stress urinary incontinence to guide researchers for novel research topic ideas in urogynecology.
Study design
We analyzed 200 most-cited articles (T200) between 1995–2022 by reviewing the Institution for Scientific Information (ISI) − Web of Science (WOS) and PubMed databases about the stress urinary incontinence. The time span-effect of publications was normalized by calculating average citations per item (ACI) index for each article. The publications were sub-classified by the publication year, journals, countries, surgical methods, and departments.
Results
The median for total citation numbers and the ACI indices of T200 were 35 and 5 respectively. The top-cited articles were mostly published in USA with 91 articles (46.5 %) followed by Italy (22, 11 %), and United Kingdom (21, 10.5 %). Among T200, 149 were original research, 44 reviews, 4 meta-analyses, and 3 editorial articles. Further, 59 were about surgical procedures (of which 28 were about TOT-TVT comparison). M. Serati and L. Bruker were the most contributing authors to T200 with 19 articles. On the top of T200, the article of Pierre A. Clavien et al. (2009) sits with 6201 citations, published in the journal of “Annals of Surgery”.
Conclusions
We suggest that the most-cited articles commonly conducted in the high-income countries, mostly published between 2014–2018. Best of our knowledge, this is the first study analyzing the most-cited 200 publications in urogynecology field under two different perspectives of two different disciplines, namely urology and obstetrics and gynecology.
{"title":"Top cited articles about the stress urinary incontinence: A bibliometric analysis","authors":"İlke Özer Aslan , Çağrı Doğan","doi":"10.1016/j.ejogrb.2024.10.033","DOIUrl":"10.1016/j.ejogrb.2024.10.033","url":null,"abstract":"<div><h3>Objective</h3><div>To produce a bibliographic source by compiling the most-cited articles about stress urinary incontinence to guide researchers for novel research topic ideas in urogynecology.</div></div><div><h3>Study design</h3><div>We analyzed 200 most-cited articles (T200) between 1995–2022 by reviewing the Institution for Scientific Information (ISI) − Web of Science (WOS) and PubMed databases about the stress urinary incontinence. The time span-effect of publications was normalized by calculating average citations per item (ACI) index for each article. The publications were sub-classified by the publication year, journals, countries, surgical methods, and departments.</div></div><div><h3>Results</h3><div>The median for total citation numbers and the ACI indices of T200 were 35 and 5 respectively. The top-cited articles were mostly published in USA with 91 articles (46.5 %) followed by Italy (22, 11 %), and United Kingdom (21, 10.5 %). Among T200, 149 were original research, 44 reviews, 4 <em>meta</em>-analyses, and 3 editorial articles. Further, 59 were about surgical procedures (of which 28 were about TOT-TVT comparison). M. Serati and L. Bruker were the most contributing authors to T200 with 19 articles. On the top of T200, the article of Pierre A. Clavien <em>et al</em>. (2009) sits with 6201 citations, published in the journal of “Annals of Surgery”.</div></div><div><h3>Conclusions</h3><div>We suggest that the most-cited articles commonly conducted in the high-income countries, mostly published between 2014–2018. Best of our knowledge, this is the first study analyzing the most-cited 200 publications in urogynecology field under two different perspectives of two different disciplines, namely urology and obstetrics and gynecology.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 206-211"},"PeriodicalIF":2.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567860","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}
Pub Date : 2024-10-24DOI: 10.1016/j.ejogrb.2024.10.034
Sandra Coll, Marta Vila, Julia Caminal, Anna Pagès, Marta Sanjosé, Francesc Tresserra, Ignacio Rodríguez, Rebeca Fernández, Pere N. Barri-Soldevila
Objective
To provide a description of laparoscopic approach to correct pelvic organ prolapses and evaluate the risk factors associated with the prolapse recurrence.
Study design
We retrospectively analyzed 418 patients with symptomatic pelvic organ prolapse who underwent a laparoscopic reparation at our university center from 2010 to 2020. Prolapses were assessed by Baden-Walker system (stage I–IV). The association between the potential prognostic factors and the recurrence was analyzed using Cox regression.
Results
We included 418 patients. Most patients (97.6%) had at least one vaginal delivery and 92 (22%) had a previous prolapse surgery. In 29.74% of cases levator ani muscle avulsion was observed. We performed a cervicosacropexy in 336 (80.38%) cases, a sacrohysteropexy in 13 (3.11%), and a sacrocolpopexy in 69 (16.5%). Also, concomitantly, 66 (15.79%) patients with stress and occult urinary incontinence underwent TOT surgery. Surgical complications were low (9.51%) and the majority were minor. Median follow-up was 37 months (IQR 10.5, 61.4 months), and the global recurrence rate was 9.57%. Only 4.06% of cases required reintervention. In Cox regression analysis only levator ani muscle avulsion remained as a recurrence-associated factor.
Conclusion
Our series is one of the largest and with the longest follow-up. Recurrence rate was low, and comparable to other large series. The only independent factor related to recurrence was the levator ani muscle avulsion.
{"title":"Long-term follow-up after laparoscopic reparation of pelvic organ prolapses in a large teaching gynecological center","authors":"Sandra Coll, Marta Vila, Julia Caminal, Anna Pagès, Marta Sanjosé, Francesc Tresserra, Ignacio Rodríguez, Rebeca Fernández, Pere N. Barri-Soldevila","doi":"10.1016/j.ejogrb.2024.10.034","DOIUrl":"10.1016/j.ejogrb.2024.10.034","url":null,"abstract":"<div><h3>Objective</h3><div>To provide a description of laparoscopic approach to correct pelvic organ prolapses and evaluate the risk factors associated with the prolapse recurrence.</div></div><div><h3>Study design</h3><div>We retrospectively analyzed 418 patients with symptomatic pelvic organ prolapse who underwent a laparoscopic reparation at our university center from 2010 to 2020. Prolapses were assessed by Baden-Walker system (stage I–IV). The association between the potential prognostic factors and the recurrence was analyzed using Cox regression.</div></div><div><h3>Results</h3><div>We included 418 patients. Most patients (97.6%) had at least one vaginal delivery and 92 (22%) had a previous prolapse surgery. In 29.74% of cases levator ani muscle avulsion was observed. We performed a cervicosacropexy in 336 (80.38%) cases, a sacrohysteropexy in 13 (3.11%), and a sacrocolpopexy in 69 (16.5%). Also, concomitantly, 66 (15.79%) patients with stress and occult urinary incontinence underwent TOT surgery. Surgical complications were low (9.51%) and the majority were minor. Median follow-up was 37 months (IQR 10.5, 61.4 months), and the global recurrence rate was 9.57%. Only 4.06% of cases required reintervention. In Cox regression analysis only levator ani muscle avulsion remained as a recurrence-associated factor.</div></div><div><h3>Conclusion</h3><div>Our series is one of the largest and with the longest follow-up. Recurrence rate was low, and comparable to other large series. The only independent factor related to recurrence was the levator ani muscle avulsion.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 146-152"},"PeriodicalIF":2.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544523","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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