Pub Date : 2024-10-19DOI: 10.1016/j.ejogrb.2024.10.005
Joseph F Barraza, Karmina M Ruiz, Mehrzad Zarghouni
We describe a patient who presented with a symptomatic abdominal wall endometrioma. Therapy for such cases currently relies heavily on a surgical approach through laparoscopic means. This case demonstrates how the use of vascular embolization can provide long-lasting symptomatic relief. Patients who may be better candidates for this procedure compared to laparoscopy may benefit from embolization as a first-line therapy for abdominal wall endometrioma.
{"title":"Vascular embolization as a therapeutic approach for abdominal wall endometrioma: Case report.","authors":"Joseph F Barraza, Karmina M Ruiz, Mehrzad Zarghouni","doi":"10.1016/j.ejogrb.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2024.10.005","url":null,"abstract":"<p><p>We describe a patient who presented with a symptomatic abdominal wall endometrioma. Therapy for such cases currently relies heavily on a surgical approach through laparoscopic means. This case demonstrates how the use of vascular embolization can provide long-lasting symptomatic relief. Patients who may be better candidates for this procedure compared to laparoscopy may benefit from embolization as a first-line therapy for abdominal wall endometrioma.</p>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497490","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 : 2024-10-19DOI: 10.1016/j.ejogrb.2024.10.024
Sroda Agudogo, Rachel Moody, Anna Whelan, Stephen Wagner, Vincenzo Berghella, Suneet P Chauhan, Sebastian Ramos, Megha Gupta
{"title":"Characteristics of obstetrical randomized controlled trials with large versus modest or no treatment effects.","authors":"Sroda Agudogo, Rachel Moody, Anna Whelan, Stephen Wagner, Vincenzo Berghella, Suneet P Chauhan, Sebastian Ramos, Megha Gupta","doi":"10.1016/j.ejogrb.2024.10.024","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2024.10.024","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497487","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 video-article describes a laparoscopic cervico-isthmic cerclage technique for managing cervical insufficiency in both pregnant and non-pregnant patients, utilizing a port-site closure device for precise suture placement. Two cases—one non-pregnant and one at 12 weeks gestation—underwent the procedure, with details on trocar placement, dissection, and suture passage documented. Both surgeries were completed successfully, with minimal blood loss and no complications. The use of the port-site closure device allowed for precise suture placement near the uterine vessels, contributing to favorable postoperative outcomes. This laparoscopic approach offers a minimally invasive alternative to the open technique in specialized centers.
{"title":"Laparoscopic cervico-isthmic cerclage: A “Needle-free” approach for managing cervical insufficiency in pregnant and non-pregnant patients","authors":"Ignacio Miranda-Mendoza , Rocío Durán-Cuiza , Paz Navarrete-Rey , Alvaro Carrasco , Bernardita Walker , Alvaro Insunza , Manuel Parra , Mauricio Esteban Correa","doi":"10.1016/j.ejogrb.2024.10.025","DOIUrl":"10.1016/j.ejogrb.2024.10.025","url":null,"abstract":"<div><div>This video-article describes a laparoscopic cervico-isthmic cerclage technique for managing cervical insufficiency in both pregnant and non-pregnant patients, utilizing a port-site closure device for precise suture placement. Two cases—one non-pregnant and one at 12 weeks gestation—underwent the procedure, with details on trocar placement, dissection, and suture passage documented. Both surgeries were completed successfully, with minimal blood loss and no complications. The use of the port-site closure device allowed for precise suture placement near the uterine vessels, contributing to favorable postoperative outcomes. This laparoscopic approach offers a minimally invasive alternative to the open technique in specialized centers.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 116-122"},"PeriodicalIF":2.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497494","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 : 2024-10-18DOI: 10.1016/j.ejogrb.2024.10.026
Alec Sun , Madison Lyon , Carrie Bennett , Sri Sivalingam , Anna Zampini , Smita De
Objective
To compare neonatal outcomes following URS, stent, or PCN in pregnant women presenting with suspected renal colic.
Methods
Women undergoing a procedure for suspected renal colic during pregnancy at a large multi-center institution between 2008 and 2022 were retrospectively reviewed and categorized by initial intervention. Neonatal outcomes were recorded and linked to maternal and obstetric data. Groups were compared by a Kruskal-Wallis, ANOVA, or Fisher’s Exact test, followed by pairwise post-hoc testing as appropriate (α = 0.05). Multivariate analyses were also conducted.
Results
95 patients were analyzed, of whom 32 were managed with PCN, 47 with stent, and 16 with URS. Maternal baseline characteristics were similar between groups, except for lower gravidity and parity in the stent group. Rates of premature delivery did not differ, but gestational age at delivery was lower in the PCN group versus the stent and URS groups (p = 0.006 and p = 0.025, respectively). Neonatal Intensive Care Unit (NICU) admission rates were higher in the PCN group versus the stent and URS groups (p = 0.006 and 0.036, respectively). Respiratory distress syndrome significantly differed between groups (p = 0.041). Neonatal birth weight, Apgar scores, and other complications did not significantly differ.
Conclusion
This study demonstrated higher rates of NICU admissions and lower gestational age at delivery for neonates born to mothers managed with PCN compared to stent and URS. Larger multi-institutional studies are warranted to further explore these associations.
{"title":"Neonatal outcomes after intervention for suspected renal colic in pregnancy","authors":"Alec Sun , Madison Lyon , Carrie Bennett , Sri Sivalingam , Anna Zampini , Smita De","doi":"10.1016/j.ejogrb.2024.10.026","DOIUrl":"10.1016/j.ejogrb.2024.10.026","url":null,"abstract":"<div><h3>Objective</h3><div>To compare neonatal outcomes following URS, stent, or PCN in pregnant women presenting with suspected renal colic.</div></div><div><h3>Methods</h3><div>Women undergoing a procedure for suspected renal colic during pregnancy at a large multi-center institution between 2008 and 2022 were retrospectively reviewed and categorized by initial intervention. Neonatal outcomes were recorded and linked to maternal and obstetric data. Groups were compared by a Kruskal-Wallis, ANOVA, or Fisher’s Exact test, followed by pairwise post-hoc testing as appropriate (α = 0.05). Multivariate analyses were also conducted.</div></div><div><h3>Results</h3><div>95 patients were analyzed, of whom 32 were managed with PCN, 47 with stent, and 16 with URS. Maternal baseline characteristics were similar between groups, except for lower gravidity and parity in the stent group. Rates of premature delivery did not differ, but gestational age at delivery was lower in the PCN group versus the stent and URS groups (p = 0.006 and p = 0.025, respectively). Neonatal Intensive Care Unit (NICU) admission rates were higher in the PCN group versus the stent and URS groups (p = 0.006 and 0.036, respectively). Respiratory distress syndrome significantly differed between groups (p = 0.041). Neonatal birth weight, Apgar scores, and other complications did not significantly differ.</div></div><div><h3>Conclusion</h3><div>This study demonstrated higher rates of NICU admissions and lower gestational age at delivery for neonates born to mothers managed with PCN compared to stent and URS. Larger multi-institutional studies are warranted to further explore these associations.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 106-110"},"PeriodicalIF":2.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497495","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 : 2024-10-17DOI: 10.1016/S0301-2115(24)00569-4
{"title":"Inside Back Cover - Editors with images","authors":"","doi":"10.1016/S0301-2115(24)00569-4","DOIUrl":"10.1016/S0301-2115(24)00569-4","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"302 ","pages":"Page IBC"},"PeriodicalIF":2.1,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446427","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 : 2024-10-16DOI: 10.1016/j.ejogrb.2024.10.012
Shahzaib Ahmed , Eeman Ahmad , Eeshal Fatima , Umar Akram , Obaid Ur Rehman , Arya Harikrishna , Shaiza Sharif , Noreen Akmal , Abdulqadir J. Nashwan
Objective
We conducted a systematic review and meta-analysis to evaluate the fetomaternal outcomes after the administration of norepinephrine or phenylephrine for the treatment of post spinal hypotension in preeclamptic women undergoing a cesarean section.
Data sources
We searched on PubMed, Embase, Scopus, Cochrane CENTRAL, and clinicaltrials.gov from inception till June 2024.
Study selection
Randomized controlled trials of preeclamptic women receiving norepinephrine or phenylephrine for post spinal hypotension were included.
Data extraction and synthesis
Two reviewers extracted data onto an Excel spreadsheet. R version 4.4 was used for statistical analysis. Risk ratios (RR) and their 95% confidence intervals (CIs) were calculated and pooled using the random effects model. Cochrane’s risk of bias (RoB 2) tool was used for quality assessment. This review has been registered with PROSPERO (CRD42024532740).
Results
A total of 4 trials, comprising 413 participants, were included in this review. 206 patients received norepinephrine, while 207 received phenylephrine. The incidence of maternal bradycardia was significantly lower in the norepinephrine group compared with the phenylephrine group (RR = 0.25, 95 % CI = 0.16 to 0.39, p < 0.01). There were no statistical differences in other maternal outcomes or in the umbilical artery and umbilical vein blood gas analysis values. We also analyzed adverse events such as nausea (RR = 1.00, 95 % CI: 0.62 to 1.60, p = 1.00) and vomiting (RR = 0.99, 95 % CI: 0.89 to 1.11, p = 0.61), but they did not show a significant association with any group. All the trials had a moderate or low risk of bias.
Conclusion
Bolus doses of NE and PE for the treatment of post-spinal hypotension in preeclamptic women undergoing cesarean sections were found to exhibit comparable neonatal outcomes. However, NE provided superior maternal safety due to a lower incidence of bradycardia compared to PE.
目的我们进行了一项系统性综述和荟萃分析，以评估对接受剖宫产术的先兆子痫产妇施用去甲肾上腺素或苯肾上腺素治疗脊柱术后低血压后的母胎结局：我们在PubMed、Embase、Scopus、Cochrane CENTRAL和clinicaltrials.gov上进行了检索，检索时间从开始到2024年6月：研究选择：纳入了对接受去甲肾上腺素或苯肾上腺素治疗脊柱术后低血压的先兆子痫妇女的随机对照试验：两名审稿人将数据提取到 Excel 电子表格中。使用 R 4.4 版本进行统计分析。使用随机效应模型计算风险比（RR）及其 95% 置信区间（CI）并进行汇总。质量评估采用 Cochrane 的偏倚风险（RoB 2）工具。本综述已在 PROSPERO 注册（CRD42024532740）：本综述共纳入了 4 项试验，共有 413 名参与者。206名患者接受了去甲肾上腺素治疗，207名患者接受了苯肾上腺素治疗。与苯肾上腺素组相比，去甲肾上腺素组产妇心动过缓的发生率明显降低（RR = 0.25，95 % CI = 0.16 至 0.39，p 结论：去甲肾上腺素组产妇心动过缓的发生率明显低于苯肾上腺素组（RR = 0.25，95 % CI = 0.16 至 0.39，p 结论）：对接受剖宫产手术的先兆子痫患者治疗椎管内术后低血压时，发现注射剂量的去甲肾上腺素和去甲肾上腺素对新生儿的影响相当。然而，与 PE 相比，NE 的心动过缓发生率更低，因此对产妇的安全性更高。
{"title":"Efficacy and safety of norepinephrine versus phenylephrine for post-spinal hypotension in preeclamptic patients: A systematic review and meta-analysis","authors":"Shahzaib Ahmed , Eeman Ahmad , Eeshal Fatima , Umar Akram , Obaid Ur Rehman , Arya Harikrishna , Shaiza Sharif , Noreen Akmal , Abdulqadir J. Nashwan","doi":"10.1016/j.ejogrb.2024.10.012","DOIUrl":"10.1016/j.ejogrb.2024.10.012","url":null,"abstract":"<div><h3>Objective</h3><div>We conducted a systematic review and <em>meta</em>-analysis to evaluate the fetomaternal outcomes after the administration of norepinephrine or phenylephrine for the treatment of post spinal hypotension in preeclamptic women undergoing a cesarean section.</div></div><div><h3>Data sources</h3><div>We searched on PubMed, Embase, Scopus, Cochrane CENTRAL, and <span><span>clinicaltrials.gov</span><svg><path></path></svg></span> from inception till June 2024.</div></div><div><h3>Study selection</h3><div>Randomized controlled trials of preeclamptic women receiving norepinephrine or phenylephrine for post spinal hypotension were included.</div></div><div><h3>Data extraction and synthesis</h3><div>Two reviewers extracted data onto an Excel spreadsheet. R version 4.4 was used for statistical analysis. Risk ratios (RR) and their 95% confidence intervals (CIs) were calculated and pooled using the random effects model. Cochrane’s risk of bias (RoB 2) tool was used for quality assessment. This review has been registered with PROSPERO (CRD42024532740).</div></div><div><h3>Results</h3><div>A total of 4 trials, comprising 413 participants, were included in this review. 206 patients received norepinephrine, while 207 received phenylephrine. The incidence of maternal bradycardia was significantly lower in the norepinephrine group compared with the phenylephrine group (RR = 0.25, 95 % CI = 0.16 to 0.39, p < 0.01). There were no statistical differences in other maternal outcomes or in the umbilical artery and umbilical vein blood gas analysis values. We also analyzed adverse events such as nausea (RR = 1.00, 95 % CI: 0.62 to 1.60, p = 1.00) and vomiting (RR = 0.99, 95 % CI: 0.89 to 1.11, p = 0.61), but they did not show a significant association with any group. All the trials had a moderate or low risk of bias.</div></div><div><h3>Conclusion</h3><div>Bolus doses of NE and PE for the treatment of post-spinal hypotension in preeclamptic women undergoing cesarean sections were found to exhibit comparable neonatal outcomes. However, NE provided superior maternal safety due to a lower incidence of bradycardia compared to PE.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 91-98"},"PeriodicalIF":2.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497492","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 : 2024-10-16DOI: 10.1016/j.ejogrb.2024.10.023
Rebeca Benito-Villena , Naomi Cano-Ibáñez , Rosario M. Román-Gálvez , Sandra Martín-Peláez , Khalid S. Khan , Juan Miguel Martínez-Galiano , Juan Mozas-Moreno , Carmen Amezcua-Prieto
Objective
To study the relationship between gestational weight gain (GWG) and Daily Life Impact of Pregnancy Symptoms (DLIPS) scores.
Methods
A multivariable analysis of a clinical trial (the Walking Preg_Project (WPP), ClinicalTrials.gov NCT03735381) was conducted. The cohort data concerning GWG across gestational trimesters (T1, T2 and T3) was categorized into adequate, excessive, and reduced based on published criteria. DLIPS was measured using the pregnancy symptoms inventory (PSI) a validated tool, across the gestational trimesters. Univariable and multivariable analyses were employed to assess the association between the GWG categories and DLIPS scores in each trimester of pregnancy estimating the β-coefficients and 95% confidence intervals (CI).
Results
There were 221 participants in the cohort. DLIPS mean score in the overall sample and within adequate, excessive, and reduced GWG categories significantly increased across pregnancy (p < 0.005). DLIPS mean score was higher in the excessive GWG category compared to adequate and reduced GWG, in T1 and T2 (p = 0.035; p = 0.031, respectively). An excessive GWG at T1 [β-coefficient (95 % CI) = 3.88, (0.84, 6.93)] and T2 [β-coefficient (95 % CI) = 4.47 (1.24; 7.70)] was associated with higher DLIPS score compared to an adequate GWG.
Conclusion
The impact of pregnancy symptoms on daily life increased throughout pregnancy, overall. Excessive GWG was associated with daily life impact of pregnancy symptoms, particularly in the first and second trimester.
{"title":"Gestational weight gain and daily life impact of pregnancy symptoms in healthy women: A multivariable analysis","authors":"Rebeca Benito-Villena , Naomi Cano-Ibáñez , Rosario M. Román-Gálvez , Sandra Martín-Peláez , Khalid S. Khan , Juan Miguel Martínez-Galiano , Juan Mozas-Moreno , Carmen Amezcua-Prieto","doi":"10.1016/j.ejogrb.2024.10.023","DOIUrl":"10.1016/j.ejogrb.2024.10.023","url":null,"abstract":"<div><h3>Objective</h3><div>To study the relationship between gestational weight gain (GWG) and Daily Life Impact of Pregnancy Symptoms (DLIPS) scores.</div></div><div><h3>Methods</h3><div>A multivariable analysis of a clinical trial (the Walking Preg_Project (WPP), <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT03735381) was conducted. The cohort data concerning GWG across gestational trimesters (T1, T2 and T3) was categorized into adequate, excessive, and reduced based on published criteria. DLIPS was measured using the pregnancy symptoms inventory (PSI) a validated tool, across the gestational trimesters. Univariable and multivariable analyses were employed to assess the association between the GWG categories and DLIPS scores in each trimester of pregnancy estimating the β-coefficients and 95% confidence intervals (CI).</div></div><div><h3>Results</h3><div>There were 221 participants in the cohort<strong>.</strong> DLIPS mean score in the overall sample and within adequate, excessive, and reduced GWG categories significantly increased across pregnancy (p < 0.005). DLIPS mean score was higher in the excessive GWG category compared to adequate and reduced GWG, in T1 and T2 (p = 0.035; p = 0.031, respectively). An excessive GWG at T1 [β-coefficient (95 % CI) = 3.88, (0.84, 6.93)] and T2 [β-coefficient (95 % CI) = 4.47 (1.24; 7.70)] was associated with higher DLIPS score compared to an adequate GWG.</div></div><div><h3>Conclusion</h3><div>The impact of pregnancy symptoms on daily life increased throughout pregnancy, overall. Excessive GWG was associated with daily life impact of pregnancy symptoms, particularly in the first and second trimester.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 85-90"},"PeriodicalIF":2.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461107","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 : 2024-10-15DOI: 10.1016/j.ejogrb.2024.10.022
Hayal Uzelli Şimşek , Ozan Can Tatar , Turgay Şimşek
Introduction
Vulvar Necrotizing Fasciitis (VNF) is a critical, severe soft tissue infection characterized by aggressive progression and significant morbidity and mortality. Rapid diagnosis and immediate, comprehensive treatment, including antibiotic therapy, meticulous surgical debridement, and multidisciplinary care, are crucial for improving outcomes. This study aimed to investigate mortality-related factors in VNF and evaluate treatment modalities, focusing on Vacuum-Assisted Closure (VAC) therapy versus traditional debridement.
Methods
This retrospective study analyzed data from 22 VNF patients. Criteria included adults diagnosed with vulvar necrotizing infections, excluding those transferred or not completing treatment at the center. The study examined mortality-related factors and the efficacy of VAC therapy compared to debridement, considering treatment costs and outcomes.
Results
Analysis divided patients into survivors (13) and non-survivors (9). Higher heart rate, elevated WBC and CRP levels, and higher Clavien-Dindo scores were associated with increased mortality. VAC therapy, compared to traditional debridement, resulted in significantly lower CRP levels and reduced treatment costs. However, other parameters such as the length of hospital stay and debridement frequency showed no significant differences.
Conclusion
The study highlights that older age, systemic inflammation, and severe postoperative complications are key factors associated with higher mortality in VNF. VAC therapy emerges as a promising modality, effectively reducing systemic inflammation and healthcare costs. Nonetheless, the retrospective nature and the small sample size of the study limit the generalizability of the findings. Future research, particularly larger, multicentric studies, is essential to further explore and validate the effectiveness of VAC therapy in VNF management.
{"title":"Vulvar necrotizing wounds: Unveiling mortality-associated parameters and assessing the efficacy of VAC therapy","authors":"Hayal Uzelli Şimşek , Ozan Can Tatar , Turgay Şimşek","doi":"10.1016/j.ejogrb.2024.10.022","DOIUrl":"10.1016/j.ejogrb.2024.10.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Vulvar Necrotizing Fasciitis (VNF) is a critical, severe soft tissue infection characterized by aggressive progression and significant morbidity and mortality. Rapid diagnosis and immediate, comprehensive treatment, including antibiotic therapy, meticulous surgical debridement, and multidisciplinary care, are crucial for improving outcomes. This study aimed to investigate mortality-related factors in VNF and evaluate treatment modalities, focusing on Vacuum-Assisted Closure (VAC) therapy versus traditional debridement.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed data from 22 VNF patients. Criteria included adults diagnosed with vulvar necrotizing infections, excluding those transferred or not completing treatment at the center. The study examined mortality-related factors and the efficacy of VAC therapy compared to debridement, considering treatment costs and outcomes.</div></div><div><h3>Results</h3><div>Analysis divided patients into survivors (13) and non-survivors (9). Higher heart rate, elevated WBC and CRP levels, and higher Clavien-Dindo scores were associated with increased mortality. VAC therapy, compared to traditional debridement, resulted in significantly lower CRP levels and reduced treatment costs. However, other parameters such as the length of hospital stay and debridement frequency showed no significant differences.</div></div><div><h3>Conclusion</h3><div>The study highlights that older age, systemic inflammation, and severe postoperative complications are key factors associated with higher mortality in VNF. VAC therapy emerges as a promising modality, effectively reducing systemic inflammation and healthcare costs. Nonetheless, the retrospective nature and the small sample size of the study limit the generalizability of the findings. Future research, particularly larger, multicentric studies, is essential to further explore and validate the effectiveness of VAC therapy in VNF management.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 48-52"},"PeriodicalIF":2.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441214","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 : 2024-10-12DOI: 10.1016/j.ejogrb.2024.10.017
Vivian Wai Yan Ng, Mimi Tin Yan Seto, Ka Wang Cheung
Objective
To assess the obstetric and neonatal outcomes of Jehovah’s Witness (JW) mothers and the willingness to accept blood products after multidisciplinary management.
Study Design
A retrospective case-control study was conducted at Queen Mary Hospital from 2005 to 2020. Delivery records of pregnant women who identified themselves as JW were reviewed. The immediate next age-matched non-JW patient in the booking register was assigned as control.
Results
A total of 96 subjects were identified within the study period (48 JW and 48 non-JW age-matched patients). The haemoglobin levels of JW and non-JW were similar at booking, 28 weeks of gestation, pre-delivery and postnatal day 2. JW mothers were more likely to receive iron supplements in the antenatal period than the control group (27.1 % vs. 6.3 %, p = 0.01) despite the similar rate of antenatal anemia in both groups (4.2 % vs. 4.2 %, p = 1.00). There were no differences in mode of delivery, total blood loss at delivery, rate of primary postpartum haemorrhage, gestational age at delivery, birth weight, and Apgar score at 1 and 5 min between JW and non-JW. There were no maternal deaths, hysterectomy or admissions to the adult intensive care unit in either group. Six JW women accepted packed cell transfusion at the initial consultation and did not receive multidisciplinary care. The remaining 42 JW women had consultant obstetric and anesthesiologist review before delivery. After multidisciplinary consultation, two (4.8 %, 2/42) accepted blood transmission and 11 (26.2 %, 11/42) accepted some components of blood. The remaining 29 (69 %, 29/42) women refused all blood products.
Conclusion
JW patients who received multidisciplinary care achieved comparable pregnancy and neonatal outcomes to the normal population. Antenatal iron supplement was more common among pregnant JW despite the similar rate of antenatal anemia compared with the non-JW women. 12.5% of JW women agreed packed cell transfusion at the initial consultation and a further 27.1% of JW women agreed to some forms of blood products after multidisciplinary counseling.
{"title":"Multidisciplinary care to optimise pregnancy outcomes among Jehovah’s Witness: Case series over fifteen years in a tertiary teaching hospital","authors":"Vivian Wai Yan Ng, Mimi Tin Yan Seto, Ka Wang Cheung","doi":"10.1016/j.ejogrb.2024.10.017","DOIUrl":"10.1016/j.ejogrb.2024.10.017","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the obstetric and neonatal outcomes of Jehovah’s Witness (JW) mothers and the willingness to accept blood products after multidisciplinary management.</div></div><div><h3>Study Design</h3><div>A retrospective case-control study was conducted at Queen Mary Hospital from 2005 to 2020. Delivery records of pregnant women who identified themselves as JW were reviewed. The immediate next age-matched non-JW patient in the booking register was assigned as control.</div></div><div><h3>Results</h3><div>A total of 96 subjects were identified within the study period (48 JW and 48 non-JW age-matched patients). The haemoglobin levels of JW and non-JW were similar at booking, 28 weeks of gestation, pre-delivery and postnatal day 2. JW mothers were more likely to receive iron supplements in the antenatal period than the control group (27.1 % vs. 6.3 %, p = 0.01) despite the similar rate of antenatal anemia in both groups (4.2 % vs. 4.2 %, p = 1.00). There were no differences in mode of delivery, total blood loss at delivery, rate of primary postpartum haemorrhage, gestational age at delivery, birth weight, and Apgar score at 1 and 5 min between JW and non-JW. There were no maternal deaths, hysterectomy or admissions to the adult intensive care unit in either group. Six JW women accepted packed cell transfusion at the initial consultation and did not receive multidisciplinary care. The remaining 42 JW women had consultant obstetric and anesthesiologist review before delivery. After multidisciplinary consultation, two (4.8 %, 2/42) accepted blood transmission and 11 (26.2 %, 11/42) accepted some components of blood. The remaining 29 (69 %, 29/42) women refused all blood products.</div></div><div><h3>Conclusion</h3><div>JW patients who received multidisciplinary care achieved comparable pregnancy and neonatal outcomes to the normal population. Antenatal iron supplement was more common among pregnant JW despite the similar rate of antenatal anemia compared with the non-JW women. 12.5% of JW women agreed packed cell transfusion at the initial consultation and a further 27.1% of JW women agreed to some forms of blood products after multidisciplinary counseling.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 53-56"},"PeriodicalIF":2.1,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445530","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 : 2024-10-12DOI: 10.1016/j.ejogrb.2024.10.019
Maëlys Nkobetchou , Aude Girault , François Goffinet , Camille Le Ray
Objectives
Emergency cervical cerclage is a high-risk surgical procedure associated with maternal and fetal risks, including preterm birth. Authors have developed scores to try to predict the probability of success following emergency cerclage, but these tools have yet to be externally validated.
Our main objective was to assess the preterm birth rate before 32 weeks following emergency cerclage. Secondary objectives included assessing perinatal outcomes and the predictive validity of two published scores in our setting. We hypothesized that predictive scores, such as Fuchs and Kokia scores, may not perform optimally in our population due to variability in clinical and biological characteristics that influence eligibility for cerclage across different settings.
Study design
We conducted a retrospective, monocentric study in a tertiary maternity hospital. All patients who underwent emergency cerclage between January 1st, 2010, and December 31st, 2021, were included. The main outcome was preterm birth rate before 32 weeks. Secondary outcomes were need for maternal hospitalization after initial hospitalization for cerclage, preterm premature rupture of membrane, and perinatal death. The rate of preterm birth before 32 weeks and adverse perinatal outcomes were estimated. To assess the predictive validity of Fuchs’ score in our population, we performed a multivariable logistic regression model including the score’s variables and constructed receiver operating characteristic (ROC) curve. To assess the validity of Kokia’s score in our population, we studied the correlation between the initial score and gestational age at delivery using Pearson’s correlation coefficient.
Results
Our population was composed of 64 women who underwent an emergency cerclage. The median gestational age at delivery was 30.6 weeks (IQR (24.2; 37.6)). The preterm birth rate before 32 weeks was 54.7 %. The rate of perinatal death was 30.7 %. There were no statistical differences between the patients delivered before and after 32 weeks. The multivariable logistic regression model showed that none of the variables of Fuchs’s score were significantly associated with preterm birth risk in our population. The AUC of the ROC curve using Fuchs’ score was 0.63. There was a minor yet significant correlation between Kokia’s score and gestational age at delivery (r = 0.26 – p = 0.04).
Conclusions
Our study underscores the persistent risks associated with cervical insufficiency, including very preterm birth. It highlights the variability in performance of predictive scores across different populations, underscoring the need for external validation in diverse clinical settings.
{"title":"Emergency cerclage: Neonatal outcomes and evaluation of prognostic scores − A decade of experience at a tertiary center","authors":"Maëlys Nkobetchou , Aude Girault , François Goffinet , Camille Le Ray","doi":"10.1016/j.ejogrb.2024.10.019","DOIUrl":"10.1016/j.ejogrb.2024.10.019","url":null,"abstract":"<div><h3>Objectives</h3><div>Emergency cervical cerclage is a high-risk surgical procedure associated with maternal and fetal risks, including preterm birth. Authors have developed scores to try to predict the probability of success following emergency cerclage, but these tools have yet to be externally validated.</div><div>Our main objective was to assess the preterm birth rate before 32 weeks following emergency cerclage. Secondary objectives included assessing perinatal outcomes and the predictive validity of two published scores in our setting. We hypothesized that predictive scores, such as Fuchs and Kokia scores, may not perform optimally in our population due to variability in clinical and biological characteristics that influence eligibility for cerclage across different settings.</div></div><div><h3>Study design</h3><div>We conducted a retrospective, monocentric study in a tertiary maternity hospital. All patients who underwent emergency cerclage between January 1st, 2010, and December 31st, 2021, were included. The main outcome was preterm birth rate before 32 weeks. Secondary outcomes were need for maternal hospitalization after initial hospitalization for cerclage, preterm premature rupture of membrane, and perinatal death. The rate of preterm birth before 32 weeks and adverse perinatal outcomes were estimated. To assess the predictive validity of Fuchs’ score in our population, we performed a multivariable logistic regression model including the score’s variables and constructed receiver operating characteristic (ROC) curve. To assess the validity of Kokia’s score in our population, we studied the correlation between the initial score and gestational age at delivery using Pearson’s correlation coefficient.</div></div><div><h3>Results</h3><div>Our population was composed of 64 women who underwent an emergency cerclage. The median gestational age at delivery was 30.6 weeks (IQR (24.2; 37.6)). The preterm birth rate before 32 weeks was 54.7 %. The rate of perinatal death was 30.7 %. There were no statistical differences between the patients delivered before and after 32 weeks. The multivariable logistic regression model showed that none of the variables of Fuchs’s score were significantly associated with preterm birth risk in our population. The AUC of the ROC curve using Fuchs’ score was 0.63. There was a minor yet significant correlation between Kokia’s score and gestational age at delivery (r = 0.26 – p = 0.04).</div></div><div><h3>Conclusions</h3><div>Our study underscores the persistent risks associated with cervical insufficiency, including very preterm birth. It highlights the variability in performance of predictive scores across different populations, underscoring the need for external validation in diverse clinical settings.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 63-69"},"PeriodicalIF":2.1,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445532","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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