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High-grade uterine cancer with ambiguous features – a clinicopathological study 具有模糊特征的高级别子宫癌的临床病理研究
IF 1.9 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-09 DOI: 10.1016/j.ejogrb.2026.114952
Roy Kessous , Ofer Wiesel , Jacob Dreiher , Mihai Meirovitz , Sharon Davidesko , Yarden Kezerle , Benzion Samueli , Ruthy Shaco-Levy

Objective

Endometrial endometrioid carcinoma FIGO grade 3 (EC3) and endometrial serous carcinoma (SEC), sometimes present diagnostic challenges due to overlapping and ambiguous features. The prognostic significance of assigning histological subtype remains debatable due to conflicting clinical outcome data. This study examined definite and ambiguous EC3 and SEC cases to compare clinicopathologic characteristics and prognosis.

Methods

This is a retrospective study of 129 patients diagnosed with EC3 and SEC at a single tertiary center between 2006–2022. Pathological slides were revised and classified as definite or ambiguous for EC3 and SEC. Survival, progression-free survival, and associations between tumor histologic type and clinicopathologic characteristics were analyzed.

Results

Definite SEC displayed higher mortality compared to definite EC3 (68.2 % vs. 41.4 %, p = 0.023) as well as a non-significant trend towards lower 5-year survival (p = 0.096). Ambiguous SEC also showed higher mortality compared to ambiguous EC3 (68.8 % vs. 37.5 %, p = 0.020) and a non-significant trend towards lower 5-year survival (p = 0.098). Several parameters suggest that ambiguous cases are intermediate between the definite EC3 (lower) and definite SEC (higher) groups. Rates of lymph node metastases (EC3 6.9 %; ambiguous 16.4 % and SEC 29.5 %; p = 0.013), broad ligament involvement (EC3 0 %; ambiguous 1.8 % and SEC 11.4 %; p = 0.016), and omental involvement (EC3 3.4 %; ambiguous 10.9 % and SEC 29.5 %; p = 0.002). A similar trend was observed for ovarian involvement, but it did not reach statistical significance (EC3 6.9 %; ambiguous 12.7 % and SEC 22.7 %; p = 0.055).

Conclusion

Ambiguous cases may represent an intermediate group that displays clinicopathologic features which are more aggressive than in EC3, yet more favorable than in SEC. These results hold implications for managing patients with high-grade endometrial carcinomas, as identifying an intermediate group may inform treatment strategies and prognostic evaluations.
目的:FIGO 3级子宫内膜样癌(EC3)和子宫内膜浆液性癌(SEC)由于特征重叠和模糊,有时存在诊断挑战。由于临床结果数据相互矛盾,分配组织学亚型的预后意义仍然存在争议。本研究对明确和不明确的EC3和SEC病例进行比较,以比较其临床病理特征和预后。方法回顾性研究2006-2022年间在单一三级中心诊断为EC3和SEC的129例患者。对病理切片进行修改,并对EC3和SEC进行明确或模糊分类。对生存期、无进展生存期以及肿瘤组织学类型和临床病理特征之间的关系进行分析。结果明确的SEC死亡率高于明确的EC3 (68.2% vs. 41.4%, p = 0.023),但5年生存率较低(p = 0.096)。与不明确的EC3相比,不明确的SEC也显示出更高的死亡率(68.8%对37.5%,p = 0.020),并且5年生存率较低(p = 0.098)。几个参数表明,模棱两可的情况是介于确定的EC3(较低)和确定的SEC(较高)组之间。淋巴结转移率(EC3为6.9%,歧义为16.4%,SEC为29.5%,p = 0.013),宽韧带受累率(EC3为0%,歧义为1.8%,SEC为11.4%,p = 0.016),网膜受累率(EC3为3.4%,歧义为10.9%,SEC为29.5%,p = 0.002)。卵巢受累也有类似的趋势,但没有达到统计学意义(EC3为6.9%,不明确为12.7%,SEC为22.7%,p = 0.055)。结论:模棱两可的病例可能代表一个中间组,其临床病理特征比EC3更具侵袭性,但比SEC更有利。这些结果对管理高级别子宫内膜癌患者具有重要意义,因为确定中间组可以为治疗策略和预后评估提供信息。
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引用次数: 0
Stem cell therapy in thin endometrium and Asherman’s syndrome: a systematic review and meta-analysis 干细胞治疗薄子宫内膜和阿什曼综合征:系统回顾和荟萃分析
IF 1.9 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-09 DOI: 10.1016/j.ejogrb.2026.114949
Leila Adamyan , Laura Pivazyan , Maria Yurkanova , Veronika Tarlakyan , Elizaveta Platonova , Agnessa Osipova , Karina Mailova , Assia Stepanian

Objective

To evaluate the efficacy and safety of mesenchymal stem cell (MSC)-based therapies in improving endometrial thickness and reproductive outcomes in women with refractory thin endometrium or Asherman’s syndrome.

Methods

Following PRISMA 2020 guidelines, a systematic search of PubMed, Cochrane Library, Embase, Scopus, ClinicalTrials.gov, and Google Scholar through June 2025 was performed. Eighteen clinical studies involving 323 patients were included. MSCs derived from umbilical cord, bone marrow, adipose tissue, endometrium, or menstrual blood were administered via intrauterine infusion, transmyometrial injection, or scaffold-assisted delivery. The primary outcome was change in endometrial thickness; secondary outcomes included clinical pregnancy rate, live birth rate, and miscarriage rate.

Results

Meta-analysis demonstrated a significant increase in endometrial thickness following MSC therapy compared to baseline or control (mean difference = 2.35 mm; 95 % CI, 1.97–2.74; p < 0.00001). Subgroup analysis showed the largest gains in endometrial- and adipose-derived MSC groups. Randomized controlled trials confirmed higher clinical pregnancy (OR = 2.72; p = 0.002) and live birth rates (OR = 2.27; p = 0.01), with a reduced miscarriage rate (OR = 0.24; p = 0.004). No serious adverse events were reported.

Conclusion

While MSC therapy appears to be safe, its efficacy must be confirmed by large-scale randomized trials before it can be presented to the public or recommended as an effective approach for endometrial regeneration.
目的评价间充质干细胞(MSC)治疗改善难治性子宫内膜薄或Asherman综合征女性子宫内膜厚度和生殖结局的有效性和安全性。方法遵循PRISMA 2020指南,系统检索PubMed、Cochrane Library、Embase、Scopus、ClinicalTrials.gov和谷歌Scholar,检索时间截止到2025年6月。纳入18项临床研究,涉及323例患者。从脐带、骨髓、脂肪组织、子宫内膜或经血中提取的间充质干细胞通过宫内输注、经子宫肌注射或支架辅助输送给予。主要结局是子宫内膜厚度的改变;次要结局包括临床妊娠率、活产率和流产率。荟萃分析显示,与基线或对照组相比,MSC治疗后子宫内膜厚度显著增加(平均差异= 2.35 mm; 95% CI, 1.97-2.74; p < 0.00001)。亚组分析显示,子宫内膜和脂肪来源的间充质干细胞组获益最大。随机对照试验证实临床妊娠率(OR = 2.72; p = 0.002)和活产率(OR = 2.27; p = 0.01)较高,流产率(OR = 0.24; p = 0.004)较低。无严重不良事件报告。虽然MSC治疗似乎是安全的,但其有效性必须通过大规模随机试验来证实,然后才能向公众展示或推荐作为子宫内膜再生的有效方法。
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引用次数: 0
The utility of interleukin-6 compared to conventional sepsis biomarkers in pregnancy – A real-world cohort study 白细胞介素-6与妊娠期传统脓毒症生物标志物的比较——一项真实世界队列研究
IF 1.9 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-09 DOI: 10.1016/j.ejogrb.2026.114936
Seán Olann Whelan , Gráinne Kelleher , Sharon Campbell , Maeve Eogan , Frank Moriarty , Mohamed Elsammak , Richard John Drew

Objective

To assess the diagnostic performance of interleukin-6 (IL-6) versus in-use inflammatory markers (C-reactive protein [CRP], procalcitonin [PCT], neutrophil–lymphocyte ratio [NLR]) in maternal sepsis.

Methods

This was a retrospective cohort study in a single Dublin maternity hospital. All maternity patients (conception to 6-weeks post-partum) in whom IL-6 was measured to investigate suspected sepsis in an 11-month period were included. Cases were categorized twice into physiological (normal, systemic inflammatory response syndrome, sepsis, septic shock) and etiological (bacterial, viral or no infection) categories. Biomarker performance was assessed by area under the receiver operating characteristic curves (AUC) and measures of diagnostic accuracy at optimal cut-offs. Serial sampling evaluated biomarker kinetics.

Results

Seventy-two patients were included, 31.9 % had sepsis/septic shock, and 70.9 % had bacterial infection. Significant differences between categories were seen for both physiological and etiological axes for IL-6, for physiological categories alone for NLR, and for neither for PCT and CRP. IL-6 had an AUC of 0.78 for the primary physiological endpoint, significantly higher than CRP and PCT (p = 0.02), but not NLR (AUC 0.72, p = 0.47). The IL-6 AUC for the primary etiological endpoint was 0.94, higher than all other biomarkers (p < 0.001). IL-6 was highly sensitive (91.4 %) but poorly specific (55.1 %) for the physiological endpoint, while both were high in the diagnosis of bacterial infection (88.2 % and 90.5 %). On serial sampling, IL-6 fell rapidly between first and second sampling, while others initially rose further.

Conclusion

IL-6 exhibited significantly higher sensitivity compared to conventional sepsis biomarkers in detecting both bacterial infection and maternal sepsis.
目的探讨白细胞介素-6 (IL-6)与常用炎症标志物(c反应蛋白(CRP)、降钙素原(PCT)、中性粒细胞-淋巴细胞比值(NLR))在产妇脓毒症中的诊断价值。方法:在都柏林一家妇产医院进行回顾性队列研究。所有孕妇(怀孕至产后6周)在11个月期间测量IL-6以调查疑似脓毒症。病例分为生理(正常、全身炎症反应综合征、败血症、感染性休克)和病因(细菌、病毒或未感染)两类。通过受试者工作特征曲线(AUC)下的面积和最佳截止点的诊断准确性来评估生物标志物的性能。连续取样评估生物标志物动力学。结果72例患者中,脓毒症/感染性休克占31.9%,细菌感染占70.9%。不同类别之间IL-6的生理和病因轴均有显著差异,NLR仅为生理类别,PCT和CRP均无显著差异。IL-6的主要生理终点AUC为0.78,显著高于CRP和PCT (p = 0.02),但不高于NLR (AUC 0.72, p = 0.47)。主要病因终点的IL-6 AUC为0.94,高于所有其他生物标志物(p < 0.001)。IL-6对生理终点具有高敏感性(91.4%),但特异性较差(55.1%),而对细菌感染的诊断均较高(88.2%和90.5%)。在连续采样中,IL-6在第一次和第二次采样之间迅速下降,而其他采样一开始进一步上升。结论il -6对细菌感染和母体脓毒症的检测敏感性均高于常规脓毒症标志物。
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引用次数: 0
Joint hypermobility syndrome for the urogynaecologist – A narrative review 泌尿妇科医生的关节过度活动综合征-叙述性回顾
IF 1.9 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-07 DOI: 10.1016/j.ejogrb.2026.114943
Islam Abaza, Miriam Tadros, Bernadette Lemmon, Alka Bhide, Ruwan Fernando, Vik Khullar

Purpose of this review

Joint Hypermobility Syndrome (JHS), also referred to as hypermobile Ehlers–Danlos Syndrome (hEDS), is increasingly recognised as a significant contributor to gynaecological, pelvic floor and lower urinary tract symptoms. This review aims to highlight the current evidence on the relationship between JHS and key urogynaecological conditions, with particular attention to recent developments in epidemiology, clinical presentation, and management.

Recent findings

Emerging research demonstrates a strong association between JHS and pelvic organ prolapse (POP), with meta-analytic data showing more than a twofold increased risk. Large cohort studies highlight substantial symptom burden, including high rates of stress and urgency incontinence, bladder pain, pelvic floor dysfunction and sexual difficulties. Recent work also reveals distinct challenges in perioperative care, such as dysautonomia-related anaesthetic risks, tissue fragility, impaired wound healing and higher rates of surgical complications in some series. Studies document higher prevalence of urinary incontinence, bladder diverticula, recurrent urinary infections and voiding dysfunction linked to increased bladder capacity and elevated residual volumes.

Summary

Women with JHS experience a wide and often severe spectrum of urogynaecological symptoms that significantly affect quality of life. Although management generally mirrors standard care pathways, the unique connective-tissue and systemic features of JHS necessitate tailored assessment and multidisciplinary involvement. Further high-quality research is required to develop specific management algorithms and clarify the role of conservative versus surgical treatments in this complex clinical population.
关节过度活动综合征(JHS),也被称为过度活动ehers - danlos综合征(hEDS),越来越被认为是妇科、盆底和下尿路症状的重要因素。本综述旨在强调JHS与主要泌尿妇科疾病之间关系的现有证据,特别关注流行病学、临床表现和管理方面的最新进展。最近的研究表明JHS和盆腔器官脱垂(POP)之间有很强的联系,荟萃分析数据显示风险增加了两倍以上。大型队列研究强调了大量的症状负担,包括高发生率的压力和急迫性尿失禁、膀胱疼痛、盆底功能障碍和性困难。最近的研究也揭示了围手术期护理面临的独特挑战,如自主神经异常相关的麻醉风险、组织脆弱性、伤口愈合受损以及某些系列手术并发症的高发生率。研究表明,尿失禁、膀胱憩室、复发性尿路感染和排尿功能障碍的高发与膀胱容量增加和残余容量升高有关。患有JHS的妇女会经历广泛且通常是严重的泌尿妇科症状,这些症状会显著影响生活质量。虽然管理通常反映了标准的护理途径,但JHS独特的结缔组织和系统特征需要量身定制的评估和多学科参与。需要进一步的高质量研究来制定具体的管理算法,并明确在这一复杂的临床人群中保守治疗与手术治疗的作用。
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引用次数: 0
Impact of placenta accreta spectrum on sexual and psychological health: a comparative analysis using FSFI and SF-36 胎盘增生谱对性健康和心理健康的影响:FSFI和SF-36的比较分析
IF 1.9 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-06 DOI: 10.1016/j.ejogrb.2026.114942
Dini Hidayat , Sri Dewi Rahmawati Syarief , Vyanda Sri Weningtyas , Faradiba Janiyustika

Background

Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric condition characterized by abnormal placental adherence to the myometrium. While hysterectomy remains the standard definitive management, conservative strategies such as wedge resection or delayed hysterectomy have been increasingly adopted to preserve fertility. The comparative impact of these approaches on women’s quality of life (QoL), particularly social and sexual functioning, has not been well investigated.

Method

A cross-sectional study included 185 women who underwent caesarean section (CS) for histopathologically confirmed PAS at Dr. Hasan Sadikin General Hospital, Bandung, West Java, from 2022 to 2024. A total of 161 met the inclusion criteria and were analyzed, while 24 were excluded. Sexual function and QoL were assessed using the Female Sexual Function Index (FSFI) and the 36-Item Short Form Health Survey (SF-36), respectively. Non-parametric analysis using the Mann–Whitney U test was applied for scale scores and categorical comparisons were analyzed using Chi-square or Fisher’s exact test, with p < 0.05 considered significant.

Result

Median FSFI scores for desire (3.0 [2.5–3.5] vs. 3.0 [2.0–4.0], p = 0.015), arousal (2.5 [2.0–3.5] vs. 3.0 [2.0–4.0], p = 0.048), and pain (2.4 [2.0–2.7] vs. 3.0 [2.0–4.0], p = 0.021) differed significantly between the hysterectomy and conservative groups, although median values for desire were similar. Other FSFI domains and total scores were not significantly different (p > 0.05). In the SF-36, a statistically significant difference was observed only in the social functioning domain, despite comparable median scores between groups.

Conclusion

Conservative management in PAS was associated with better preservation of specific aspects of sexual function, particularly pain and arousal.
背景:胎盘增生谱(PAS)是一种潜在危及生命的产科疾病,其特征是胎盘异常粘附于子宫肌层。虽然子宫切除术仍然是标准的最终治疗方法,但越来越多地采用楔形切除或延迟子宫切除术等保守策略来保持生育能力。这些方法对妇女生活质量(QoL)的相对影响,特别是社会和性功能,尚未得到很好的调查。方法横断面研究纳入了2022年至2024年在西爪哇万隆Dr. Hasan Sadikin总医院因组织病理学证实的PAS接受剖腹产(CS)的185名妇女。符合纳入标准的161例进行分析,排除24例。分别采用女性性功能指数(FSFI)和36项简短健康调查(SF-36)对性功能和生活质量进行评估。量表得分采用Mann-Whitney U检验进行非参数分析,分类比较采用卡方检验或Fisher精确检验,p <; 0.05为显著性。结果子宫切除术组与保守组的FSFI评分中位数分别为欲望(3.0 [2.5 - 3.5]vs. 3.0 [2.0-4.0], p = 0.015)、兴奋(2.5 [2.0-3.5]vs. 3.0 [2.0-4.0], p = 0.048)、疼痛(2.4 [2.0-2.7]vs. 3.0 [2.0-4.0], p = 0.021),但欲望中位数相似。其他FSFI域及总分差异无统计学意义(p > 0.05)。在SF-36中,尽管两组之间的中位数得分相当,但仅在社会功能领域观察到统计学上的显著差异。结论:PAS患者的保守治疗可以更好地保存性功能的某些方面,特别是疼痛和兴奋。
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引用次数: 0
Epidural analgesia in small for gestational age and growth restricted fetuses: Impact on emergency delivery for presumed fetal distress 小胎龄和生长受限胎儿的硬膜外镇痛:对推定胎儿窘迫的紧急分娩的影响。
IF 1.9 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-05 DOI: 10.1016/j.ejogrb.2026.114940
Anna Fichera , Chiara Pedretti , Nicola Fratelli , Adriana Valcamonico , Daniela Recupero , Andrea Coelli , Angelica Fiorini , Antonino D’Ippolito , Franco E. Odicino

Introduction

Epidural analgesia (EDA) is widely used for pain relief during labor. Concerns have been raised about its potential association with an increased risk of emergency delivery for presumed fetal compromise, particularly in fetuses with low birth weight. This study aimed to evaluate whether EDA increases the risk of emergency delivery for suspected fetal distress in small-for-gestational-age and fetal growth restricted fetuses.

Methods

Retrospective cohort study conducted on singleton pregnancies with prenatal diagnosis of small-for-gestational-age or fetal growth restricted fetuses, delivering at ≥ 36 + 0 weeks at a tertiary care center between January 2020 and January 2024. The primary exposure was EDA; the primary outcome was emergency cesarean section or vacuum-assisted delivery due to presumed fetal distress, based on cardiotocographic findings. The secondary outcome was the incidence of a composite neonatal outcome defined as the occurrence of at least one of umbilical artery pH < 7.00, base excess < –12 mEq/L, 5-minute Apgar score < 7, or NICU admission. The two groups (EDA vs. non-EDA) were compared using the chi-square test for categorical variables and the Mann–Whitney U test for continuous variables. Multivariate logistic regression was used to control for confounders.

Results

Among 310 eligible deliveries, 135 (43.5 %) received EDA. Emergency delivery for suspected fetal distress occurred in 16.5 % of cases. There were no significant differences in emergency delivery rates between the EDA and non-EDA groups (15.56 % vs 17.14 %; p = 0.759), nor within the small-for-gestational-age (13.4 % vs 13.9 %; p = 0.896) and the growth restricted fetuses (21.5 % vs 22.4 %; p = 0.874) subgroups. No significant difference in the composite adverse neonatal outcome was observed between the EDA and non-EDA groups (8.15 % vs 7.43 %; p = 0.814). Multivariate analysis confirmed no association between EDA and emergency delivery (p = 0.600), whereas nulliparity (p = 0.024) and U/C ratio > 0.8 (p = 0.004) emerged as independent risk factors. Composite neonatal outcomes were similar between groups.

Conclusions

In this cohort of well-characterized small-for-gestational-age and fetal growth restricted fetuses, EDA was not associated with an increased risk of emergency delivery for suspected fetal distress. Individualized patient assessment and tailored management of labor analgesia remain crucial to ensure maternal and fetal safety.
简介:硬膜外镇痛(EDA)被广泛应用于分娩过程中的疼痛缓解。已提出的关切是,它可能与假定胎儿受损的紧急分娩风险增加有关,特别是在出生体重低的胎儿中。本研究旨在评估EDA是否会增加小胎龄和胎儿生长受限胎儿疑似胎儿窘迫的紧急分娩风险。方法:对2020年1月至2024年1月在三级保健中心分娩≥36 + 0周且产前诊断为胎龄小或胎儿生长受限的单胎妊娠进行回顾性队列研究。主要暴露为EDA;主要结局是急诊剖宫产或真空辅助分娩,由于假定胎儿窘迫,根据心脏造影结果。次要结局是新生儿复合结局的发生率,定义为至少有一种脐动脉pH < 7.00,基础过量结果:在310例符合条件的分娩中,135例(43.5%)接受了EDA。16.5%的病例因怀疑胎儿窘迫而紧急分娩。EDA组和非EDA组的紧急分娩率无显著差异(15.56% vs 17.14%, p = 0.759),小胎龄组(13.4% vs 13.9%, p = 0.896)和生长受限胎儿组(21.5% vs 22.4%, p = 0.874)内也无显著差异。EDA组和非EDA组的新生儿综合不良结局无显著差异(8.15% vs 7.43%; p = 0.814)。多因素分析证实EDA和紧急分娩之间没有关联(p = 0.600),而未分娩(p = 0.024)和U/C比>.8 (p = 0.004)成为独立的危险因素。两组新生儿的综合结局相似。结论:在这个具有明显特征的胎龄小和胎儿生长受限胎儿队列中,EDA与疑似胎儿窘迫的紧急分娩风险增加无关。个体化患者评估和量身定制的管理分娩镇痛仍然是至关重要的,以确保产妇和胎儿的安全。
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引用次数: 0
Role of mediolateral or lateral episiotomy in preventing obstetric anal sphincter injury (OASI) in nulliparous women undergoing vacuum-assisted delivery: A systematic review and meta-analysis 中外侧或外阴切开术在预防无产妇女接受真空辅助分娩时产科肛门括约肌损伤(OASI)中的作用:一项系统回顾和荟萃分析
IF 1.9 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-05 DOI: 10.1016/j.ejogrb.2026.114939
Giovanni Morganelli , Gabriella Maria Celora , Maria Chiara Bassi , Andrea Dall’Asta , Maurizio Di Serio , Vito Andrea Capozzi , Tullio Ghi , Stefania Fieni

Background

The potential preventive effect of mediolateral and lateral episiotomy on the risk of anal sphincter injury related to vacuum delivery in nullipara has been reported by different well-designed studies in the last years.

Objectives

The aim of this systematic review and meta-analysis is to summarize the available evidence on the protective effect of mediolateral or lateral episiotomy towards the occurrence of obstetric anal sphincter injury (OASI) in nulliparous women who were submitted to vacuum-assisted delivery.
Search strategy: PubMed, Embase, CINAHL, Cochrane Library and Scopus databases were retrospectively searched without any temporal restriction up to March 1st 2025.
Selection criteria: Randomized controlled trials, retrospective, prospective case-control or cohort studies investigating the incidence of perineal tears involving anal sphincter muscles and/or rectal mucosa after vacuum-assisted birth with and without mediolateral/lateral episiotomy in nulliparous women were included.
Data collection and analysis: Risk of bias assessment was conducted for each included study by applying ROB2 score for RCTs and ROBINS-I score for non-randomized studies. Data were extracted and analyzed with Review Manager 5.4.1, results were reported by means of pooled Odd-ratios (ORs) and presented as Forest plots.
Main results: 31 studies (3 RCTs and 28 non-randomized studies) were included. Cumulative sample size consisted in 608,359 nulliparous women who were submitted to vacuum-assisted delivery. Mediolateral/lateral episiotomy was found to halve the incidence of OASI (OR 0.56 [95 % CI 0.42–0.73]) with high between-study heterogeneity reported (I2 = 99 %). At sensitivity analysis, a significant reduction in OASI incidence in case of mediolateral/lateral episiotomy was confirmed (OR 0.58 [95 %CI 0.44–0.78]); this analysis was conducted on low/moderate risk of bias studies (1RCT e 5 non-randomized studies, 15,799 patients) and associated with low heterogeneity (I2 = 42 %).

Conclusions

This updated meta-analysis on the role of mediolateral/lateral episiotomy in nulliparous women submitted to vacuum assisted delivery confirms its protective role from OASI.
背景:在过去的几年里,不同的精心设计的研究已经报道了外阴中外侧切开术对肛门括约肌损伤风险的潜在预防作用。目的:本系统回顾和荟萃分析的目的是总结关于真空辅助分娩的未产妇女中外阴切开或外阴切开对产科肛门括约肌损伤(OASI)发生的保护作用的现有证据。检索策略:回顾性检索PubMed, Embase, CINAHL, Cochrane Library和Scopus数据库,无任何时间限制,截止到2025年3月1日。选择标准:包括随机对照试验、回顾性、前瞻性病例对照或队列研究,这些研究调查了无产妇女在有或没有外阴中外侧切开术的真空辅助分娩后涉及肛门括约肌和/或直肠粘膜的会阴撕裂的发生率。资料收集与分析:随机对照试验采用ROB2评分,非随机试验采用ROBINS-I评分,对每项纳入的研究进行偏倚风险评估。采用Review Manager 5.4.1软件对数据进行提取和分析,结果以混合奇比(or)报告,并以Forest样地表示。主要结果:纳入31项研究(3项rct和28项非随机研究)。累积样本量包括608359名接受真空辅助分娩的无产妇女。发现外阴内外侧切开术使OASI的发生率减少一半(OR 0.56 [95% CI 0.42-0.73]),研究间异质性较高(I2 = 99%)。在敏感性分析中,证实外阴中外侧切开术的OASI发生率显著降低(OR 0.58 [95% CI 0.44-0.78]);本分析是在低/中等偏倚风险研究(1RCT和5个非随机研究,15799例患者)中进行的,并且与低异质性相关(I2 = 42%)。结论:这一最新的荟萃分析证实了真空辅助分娩的无产妇女中外阴中外侧切开术的保护作用。
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引用次数: 0
Microbiota and infertility: a translational review of mechanisms and clinical applications in assisted reproduction 微生物群与不孕症:辅助生殖机制和临床应用的翻译综述
IF 1.9 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-05 DOI: 10.1016/j.ejogrb.2026.114941
Bixiu Du , Yaru Yang , Lang He , Ying Tang
Infertility constitutes a major global health concern, affecting approximately 17.5% of couples of reproductive age. Although advances in assisted reproductive technologies (ART) have expanded treatment options, success rates remain highly variable due to host-specific and biological determinants. This review synthesizes current evidence on the reproductive impact of the human microbiota and its translational relevance to ART outcomes. Vaginal microbial communities dominated by Lactobacillus, particularly L. crispatus, are associated with improved conception and implantation, whereas genital or intestinal dysbiosis correlates with infertility and suboptimal treatment responses. The microbiota modulates reproductive competence through intertwined immune, endocrine–metabolic, and mucosal barrier pathways that regulate inflammation, hormonal balance, and epithelial integrity. Emerging findings indicate that gut microbial alterations linked to polycystic ovary syndrome (PCOS) and endometriosis are accompanied by insulin resistance and chronic inflammation, impairing ovulation, endometrial receptivity, and embryo viability. Interventions such as probiotics and synbiotics yield heterogeneous efficacy; individualized antimicrobial strategies, metabolic modulation, and lifestyle optimization may offer complementary benefit, while microbiota reconstruction remains experimental. Methodological limitations, including contamination in low biomass samples, variations in sequencing workflows, and population heterogeneity, still hinder data comparability and mechanistic interpretation. Future research should prioritize adequately powered randomized controlled trials using standardized microbiome metrics and live birth as a primary endpoint. Integrating microbiome profiling into ART workflows may refine patient stratification and inform precision adjuvant therapies. However, clinical implementation requires stronger causal evidence, validated biomarkers, and harmonized methodological frameworks to translate microbiome discoveries into reproducible reproductive gains.
不孕不育是一个主要的全球健康问题,影响到约17.5%的育龄夫妇。尽管辅助生殖技术(ART)的进步扩大了治疗选择,但由于宿主特异性和生物学决定因素,成功率仍然高度可变。这篇综述综合了目前关于人类微生物群对生殖影响的证据及其与抗逆转录病毒治疗结果的转化相关性。以乳酸菌为主的阴道微生物群落,尤其是脆皮乳杆菌,与受孕和着床的改善有关,而生殖器或肠道生态失调与不孕和治疗反应不佳有关。微生物群通过相互交织的免疫、内分泌代谢和粘膜屏障途径调节生殖能力,这些途径调节炎症、激素平衡和上皮完整性。新的研究结果表明,与多囊卵巢综合征(PCOS)和子宫内膜异位症相关的肠道微生物改变伴随着胰岛素抵抗和慢性炎症,影响排卵、子宫内膜容受性和胚胎活力。干预措施,如益生菌和合成菌产生不同的疗效;个性化的抗菌策略、代谢调节和生活方式优化可能提供互补的益处,而微生物群重建仍处于实验阶段。方法上的限制,包括低生物量样本的污染、测序工作流程的变化和种群异质性,仍然阻碍了数据的可比性和机制解释。未来的研究应优先考虑使用标准化微生物组指标和活产作为主要终点的充分有力的随机对照试验。将微生物组分析整合到ART工作流程中可以改进患者分层,并为精确的辅助治疗提供信息。然而,临床实施需要更有力的因果证据、经过验证的生物标志物和统一的方法框架,才能将微生物组的发现转化为可重复的生殖收益。
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引用次数: 0
Should we modify eligibility criteria for fetal surgery for open spinal dysraphism? 我们是否应该修改开放性脊柱畸形胎儿手术的资格标准?
IF 1.9 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-04 DOI: 10.1016/j.ejogrb.2025.114912
Jean-Marie Jouannic , Anaïs Dugas , Paul Maurice , Ferdinand Dhombres , Catherine Garel , Éléonore Blondiaux , Timothée de Saint Denis , Lucie Guilbaud
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引用次数: 0
Lactobacillus, vitamin C, cranberry and hibiscus versus placebo for prolonging the latency period of premature rupture of membranes: a double-blind randomized clinical trial 乳杆菌、维生素C、蔓越莓和木槿与安慰剂对延长胎膜早破潜伏期的疗效:一项双盲随机临床试验
IF 1.9 4区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2026-01-03 DOI: 10.1016/j.ejogrb.2026.114938
Iris Janeth Portillo Gonzales , Ramon Armando Lobo Oliva , Betsaida María Colindres Cruz , Lessy Yolanda Díaz Galeas , Ricardo Arturo Gutierrez-Ramirez

Objective

To evaluate the effect of a supplement blend (lactobacillus, vitamin C, cranberry and hibiscus) on the latency period after preterm premature rupture of membranes (PPROM).

Study design

A single-center, randomized (1:1), double-blind, placebo-controlled trial enrolled 84 patients with PPROM (24–34 weeks). Participants were assigned to daily oral supplements or an identical placebo. The primary outcome was the latency period from membrane rupture to delivery. Analysis was by intention-to-treat.

Result

The mean latency period was significantly longer in the intervention group compared to the placebo group (11.7 ± 7.2 days vs. 7.6 ± 4.8 days; mean difference 4.1 days, 95 % CI 1.4–6.8; p = 0.003). The standardized mean difference (Cohen’s d) was 0.67 (95 % CI 0.23–1.10), indicating a moderate-to-large effect size. Exploratory analysis suggested a more pronounced effect when treatment was initiated before 32 weeks and continued for over six days.

Conclusion

Supplementation with lactobacillus, vitamin C, cranberry and hibiscus significantly prolonged the latency period in PPROM, which may represent a low-cost adjunct to conservative management.
目的:评价乳杆菌、维生素C、蔓越莓和木槿混合补充剂对早产儿胎膜早破潜伏期的影响。研究设计:单中心、随机(1:1)、双盲、安慰剂对照试验,纳入84例PPROM患者(24-34周)。参与者被分配每日口服补充剂或相同的安慰剂。主要观察指标是从胎膜破裂到分娩的潜伏期。通过意向治疗进行分析。结果:干预组的平均潜伏期明显长于安慰剂组(11.7±7.2天比7.6±4.8天;平均差4.1天,95% CI 1.4-6.8; p = 0.003)。标准化平均差(Cohen’s d)为0.67 (95% CI 0.23-1.10),表明存在中等到较大的效应量。探索性分析表明,当治疗在32周前开始并持续6天以上时,效果更明显。结论:补充乳酸菌、维生素C、蔓越莓和木槿可显著延长PPROM的潜伏期,这可能是一种低成本的保守治疗方法。
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引用次数: 0
期刊
European journal of obstetrics, gynecology, and reproductive biology
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