Pub Date : 2024-09-27DOI: 10.1016/j.ejogrb.2024.09.039
Li-mei Wu , Ling Zhang , Meng-xia Ji, Lin Zhang, Zhen Jin, Shi-shi Li, Wei-hai Xu, Xiao-hua Fu, Yi-dan Wu
Objective
With remarkable deficiency in both oocyte stock and competence, the prognosis of IVF-ET in diminished ovarian reserve (DOR) is obstinately poor, underscoring warranted optimization to current procedures. We compared the efficacy of dual-trigger (hCG plus GnRH-a) and hCG alone on the outcomes for DOR patients.
Study design
A total of 381 couples and 857 controlled ovarian stimulation (COS) cycles, and 222 couples and 366 frozen embryo transfer (FET) ones were included. The intermediate outcomes during oocyte retrieval and in vitro culture were compared based on COS dataset, while outcomes after embryo transfer analyzed based on FET dataset. The marginal effect of all study factors and covariates were evaluated with a cluster-weighted GEE model.
Results and conclusion
Neither the intermediate nor implantation outcomes were improved by dual-trigger. The OR values were 1.08 (95 % CI: 0.41–2.78) for retrieval cancellation, 1.33 (95 % CI: 0.89–2.00) for oocyte harvest, 1.04(95 %CI: 0.94–1.15) for viable embryo and 1.03(95 %CI: 0.88–1.19) for top-quality embryo. Similarly, the ORs were 0.90 (95 %CI: 0.62–1.30) for implantation and 0.97 (95 %CI: 0.56–1.69) for clinical pregnancy. This equivalence remained unchanged after adjusting for the covariates such as age, BMI, controlled ovarian stimulation protocols, etc. Thus, dual-trigger cannot provide significant advantage over hCG in related to immediate or clinical outcomes of IVF-ET treatments in DOR patients.
目的：卵巢储备功能减退（DOR）患者的卵母细胞存量和能力均明显不足，IVF-ET的预后极差，因此需要对现有程序进行优化。我们比较了双触发（hCG 加 GnRH-a）和单用 hCG 对 DOR 患者疗效的影响：研究设计：共纳入了 381 对夫妇和 857 个控制性卵巢刺激（COS）周期，以及 222 对夫妇和 366 个冷冻胚胎移植（FET）周期。根据 COS 数据集比较了取卵和体外培养期间的中期结果，而根据 FET 数据集分析了胚胎移植后的结果。采用聚类加权 GEE 模型评估了所有研究因素和协变量的边际效应：结果和结论：双触发器均未改善中期和植入结果。取卵取消的 OR 值为 1.08（95 % CI：0.41-2.78），卵母细胞收获的 OR 值为 1.33（95 % CI：0.89-2.00），存活胚胎的 OR 值为 1.04（95 % CI：0.94-1.15），优质胚胎的 OR 值为 1.03（95 % CI：0.88-1.19）。同样，植入的 OR 值为 0.90（95 %CI：0.62-1.30），临床妊娠的 OR 值为 0.97（95 %CI：0.56-1.69）。在对年龄、体重指数、控制性卵巢刺激方案等协变量进行调整后，这种等效性保持不变。因此，在 DOR 患者的 IVF-ET 治疗的即时或临床结果方面，双触发器与 hCG 相比并无明显优势。
{"title":"Dual trigger or hCG alone: A retrospective analysis on patients with diminished ovarian reserve under in vitro fertilization and embryo transfer (IVF-ET) treatment","authors":"Li-mei Wu , Ling Zhang , Meng-xia Ji, Lin Zhang, Zhen Jin, Shi-shi Li, Wei-hai Xu, Xiao-hua Fu, Yi-dan Wu","doi":"10.1016/j.ejogrb.2024.09.039","DOIUrl":"10.1016/j.ejogrb.2024.09.039","url":null,"abstract":"<div><h3>Objective</h3><div>With remarkable deficiency in both oocyte stock and competence, the prognosis of IVF-ET in diminished ovarian reserve (DOR) is obstinately poor, underscoring warranted optimization to current procedures. We compared the efficacy of dual-trigger (hCG plus GnRH-a) and hCG alone on the outcomes for DOR patients.</div></div><div><h3>Study design</h3><div>A total of 381 couples and 857 controlled ovarian stimulation (COS) cycles, and 222 couples and 366 frozen embryo transfer (FET) ones were included. The intermediate outcomes during oocyte retrieval and in vitro culture were compared based on COS dataset, while outcomes after embryo transfer analyzed based on FET dataset. The marginal effect of all study factors and covariates were evaluated with a cluster-weighted GEE model.</div></div><div><h3>Results and conclusion</h3><div>Neither the intermediate nor implantation outcomes were improved by dual-trigger. The OR values were 1.08 (95 % CI: 0.41–2.78) for retrieval cancellation, 1.33 (95 % CI: 0.89–2.00) for oocyte harvest, 1.04(95 %CI: 0.94–1.15) for viable embryo and 1.03(95 %CI: 0.88–1.19) for top-quality embryo. Similarly, the ORs were 0.90 (95 %CI: 0.62–1.30) for implantation and 0.97 (95 %CI: 0.56–1.69) for clinical pregnancy. This equivalence remained unchanged after adjusting for the covariates such as age, BMI, controlled ovarian stimulation protocols, etc. Thus, dual-trigger cannot provide significant advantage over hCG in related to immediate or clinical outcomes of IVF-ET treatments in DOR patients.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"302 ","pages":"Pages 339-345"},"PeriodicalIF":2.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380302","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}
Several topical and oral drugs are available for maintenance therapy of recurrent vulvovaginal candidiasis (RVVC)(≥ 3 episodes of symptomatic Candida infection per year). The study aimed to assess the risk of early (24 weeks) and late (48–52 weeks) clinical and mycological recurrences associated with oral/topical pharmacological maintenance therapy of RVVC.
Methods
Search strategy: PubMed, EMBASE, Cochrane Library, OVID and clinical trials registers,from inception until January 2024. Selection criteria: Blinded and unblinded randomized studies of pharmacological prevention of RVVC recurrences during active treatment and after discontinuation of therapy. Data collection and Analysis: Risk of bias, indirectness, imprecision, heterogeneity and incoherence of the network were evaluated by a semi-automated software.Bayesian network meta-analysis was used to evaluate effects of interventions on outcomes,league table and ranking of effects.
Results
The network included 17 studies with 2304 women for early and 2179 for late recurrences. During active treatment weekly oral oteseconazole (OR = 0.05,95 %CI = 0.02–0.12, moderate confidence),weekly oral fluconazole/itraconazole (OR = 0.12,95 %CI = 0.052–0.35,moderate confidence) and weekly topical clotrimazole (OR = 0.087,95 %CI = 0.018–0.48,moderate confidence) were associated with a significant reduction in RVVC recurrence risk compared to placebo/untreated subjects.Weekly use of fluconazole/itraconazole (OR = 0.44,95 %CI = 0.24–0.80,moderate confidence) and monthly topical treatment (OR = 0.34,95 %CI = 0.18–0.66,moderate confidence) maintained efficacy after discontinuation of therapy (48–52 weeks). Weekly oteseconazole was significantly more effective in reducing the occurrence of late clinical (OR = 0.065,95 %CI = 0.036–0.11,moderate confidence) and mycological (OR = 0.073,95 %CI = 0.044–0.12,moderate confidence) RVVC recurrences than all other types of treatment tested.
Conclusions
Weekly maintenance therapy with oral fluconazole/itraconazole,oteseconazole, or topical clotrimazole was equally effective in preventing early RVVC recurrence.After therapy discontinuation, oteseconazole outperformed all other oral or topical regimens, lowering RVVC clinical and mycological recurrence rates by more than 90%.
{"title":"Maintenance pharmacological therapy of recurrent vulvovaginal candidiasis. A Bayesian network meta-analysis of randomized studies","authors":"Barbara Gardella , Chiara Cassani , Mattia Dominoni , Marianna Francesca Pasquali , Arsenio Spinillo","doi":"10.1016/j.ejogrb.2024.09.040","DOIUrl":"10.1016/j.ejogrb.2024.09.040","url":null,"abstract":"<div><h3>Objective</h3><div>Several topical and oral drugs are available for maintenance therapy of recurrent vulvovaginal candidiasis (RVVC)(≥ 3 episodes of symptomatic Candida infection per year). The study aimed to assess the risk of early (24 weeks) and late (48–52 weeks) clinical and mycological recurrences associated with oral/topical pharmacological maintenance therapy of RVVC.</div></div><div><h3>Methods</h3><div>Search strategy<strong>:</strong> PubMed, EMBASE, Cochrane Library, OVID and clinical trials registers,from inception until January 2024. Selection criteria<strong>:</strong> Blinded and unblinded randomized studies of pharmacological prevention of RVVC recurrences during active treatment and after discontinuation of therapy. Data collection and Analysis<strong>:</strong> Risk of bias, indirectness, imprecision, heterogeneity and incoherence of the network were evaluated by a semi-automated software.Bayesian network <em>meta</em>-analysis was used to evaluate effects of interventions on outcomes,league table and ranking of effects.</div></div><div><h3>Results</h3><div>The network included 17 studies with 2304 women for early and 2179 for late recurrences. During active treatment weekly oral oteseconazole (OR = 0.05,95 %CI = 0.02–0.12, moderate confidence),weekly oral fluconazole/itraconazole (OR = 0.12,95 %CI = 0.052–0.35,moderate confidence) and weekly topical clotrimazole (OR = 0.087,95 %CI = 0.018–0.48,moderate confidence) were associated with a significant reduction in RVVC recurrence risk compared to placebo/untreated subjects.Weekly use of fluconazole/itraconazole (OR = 0.44,95 %CI = 0.24–0.80,moderate confidence) and monthly topical treatment (OR = 0.34,95 %CI = 0.18–0.66,moderate confidence) maintained efficacy after discontinuation of therapy (48–52 weeks). Weekly oteseconazole was significantly more effective in reducing the occurrence of late clinical (OR = 0.065,95 %CI = 0.036–0.11,moderate confidence) and mycological (OR = 0.073,95 %CI = 0.044–0.12,moderate confidence) RVVC recurrences than all other types of treatment tested.</div></div><div><h3>Conclusions</h3><div>Weekly maintenance therapy with oral fluconazole/itraconazole,oteseconazole, or topical clotrimazole was equally effective in preventing early RVVC recurrence.After therapy discontinuation, oteseconazole outperformed all other oral or topical regimens, lowering RVVC clinical and mycological recurrence rates by more than 90%.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"302 ","pages":"Pages 310-316"},"PeriodicalIF":2.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371283","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 : 2024-09-27DOI: 10.1016/j.ejogrb.2024.09.028
Moein Masjedi , Yalda Izadi , Talieh Montahaei , Rahim Mohammadi , Mohammad Ali Helforoush , Katayoun Rohani Rad
Infertility is one of the significant global issues that affects approximately 15–17 % of couples worldwide, with around 50 % of cases being attributed to female infertility factors. The exploration of herbal extracts and their effects on female infertility has been limited, particularly regarding the underlying mechanisms beyond hormonal and oxidative stress influences. In this study, the herbal medicines with potential effects such as antioxidative properties, enhancement of insulin sensitivity, and modulation of the hypothalamic–pituitary–gonadal axis have been reviewed. Several herbal extracts were found to exhibit significant antioxidant properties and demonstrate phytoestrogenic effects on reproductive factors and hormonal levels. Antioxidants are essential in mitigating oxidative stress by neutralizing free radicals, which in turn helps to lower insulin resistance, total cholesterol, fat accumulation, and the proliferation of cancerous cells. Furthermore, this review highlights that certain parts of specific plants are rich in polyphenolic compounds, including isoflavones and flavonoids, along with other advantageous substances that support women’s reproductive health. These compounds not only modulate female endocrine systems but also alleviate menopausal symptoms and effectively address a range of reproductive disorders, such as polycystic ovary syndrome (PCOS), premature ovarian failure (POF), endometriosis, hyperprolactinemia, and hypothalamic dysfunction. Turning to the other side, the plants and herbal extracts with suppressive effects on female fertility have been reviewed. These findings indicated that herbal extracts could be exploited to develop natural products as supplements for supporting the female reproductive system.
{"title":"An illustrated review on herbal medicine used for the treatment of female infertility","authors":"Moein Masjedi , Yalda Izadi , Talieh Montahaei , Rahim Mohammadi , Mohammad Ali Helforoush , Katayoun Rohani Rad","doi":"10.1016/j.ejogrb.2024.09.028","DOIUrl":"10.1016/j.ejogrb.2024.09.028","url":null,"abstract":"<div><div>Infertility is one of the significant global issues that affects approximately 15–17 % of couples worldwide, with around 50 % of cases being attributed to female infertility factors. The exploration of herbal extracts and their effects on female infertility has been limited, particularly regarding the underlying mechanisms beyond hormonal and oxidative stress influences. In this study, the herbal medicines with potential effects such as antioxidative properties, enhancement of insulin sensitivity, and modulation of the hypothalamic–pituitary–gonadal axis have been reviewed. Several herbal extracts were found to exhibit significant antioxidant properties and demonstrate phytoestrogenic effects on reproductive factors and hormonal levels. Antioxidants are essential in mitigating oxidative stress by neutralizing free radicals, which in turn helps to lower insulin resistance, total cholesterol, fat accumulation, and the proliferation of cancerous cells. Furthermore, this review highlights that certain parts of specific plants are rich in polyphenolic compounds, including isoflavones and flavonoids, along with other advantageous substances that support women’s reproductive health. These compounds not only modulate female endocrine systems but also alleviate menopausal symptoms and effectively address a range of reproductive disorders, such as polycystic ovary syndrome (PCOS), premature ovarian failure (POF), endometriosis, hyperprolactinemia, and hypothalamic dysfunction. Turning to the other side, the plants and herbal extracts with suppressive effects on female fertility have been reviewed. These findings indicated that herbal extracts could be exploited to develop natural products as supplements for supporting the female reproductive system.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"302 ","pages":"Pages 273-282"},"PeriodicalIF":2.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344112","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 : 2024-09-26DOI: 10.1016/j.ejogrb.2024.09.030
Shina Jang, Sung-Ook Hwang
Objectives
To assess the prevalence and risk factors for atypical hyperplasia (AH) or endometrial cancer (EC) in premenopausal women aged ≤ 45 years with abnormal uterine bleeding (AUB).
Methods
This was a retrospective study of premenopausal patients aged 18 to 45 years who underwent hysteroscopy, dilation and curettage, or pipelle sampling at Inha University Hospital, South Korea, from 2014 to 2023. We used multivariable logistic regression analysis to identify risk factors and calculate the predicted probabilities of AH or EC with various combinations of these factors.
Results
Of 821 patients included in the study, 6.0 % were diagnosed with AH or EC. The significant risk factors identified were nulliparity (odds ratio (OR): 4.75, 95 % confidence interval (CI): 2.11–10.70), PCOS (OR: 2.72, 95 % CI: 1.34–5.52), and multiple polyps (OR: 2.33, 95 % CI: 1.23–4.41). The predicted probabilities of developing AH or EC increased with the number of risk factors present, ranging from 1 % to 33.6 %.
Conclusions
The predicted probabilities within combinations of risk factors may be considered helpful in making better clinical decisions regarding endometrial sampling for patients ≤ 45 years with AUB.
{"title":"Risk factors for atypical hyperplasia or endometrial cancer in premenopausal women aged ≤ 45 years with abnormal uterine bleeding","authors":"Shina Jang, Sung-Ook Hwang","doi":"10.1016/j.ejogrb.2024.09.030","DOIUrl":"10.1016/j.ejogrb.2024.09.030","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the prevalence and risk factors for atypical hyperplasia (AH) or endometrial cancer (EC) in premenopausal women aged ≤ 45 years with abnormal uterine bleeding (AUB).</div></div><div><h3>Methods</h3><div>This was a retrospective study of premenopausal patients aged 18 to 45 years who underwent hysteroscopy, dilation and curettage, or pipelle sampling at Inha University Hospital, South Korea, from 2014 to 2023. We used multivariable logistic regression analysis to identify risk factors and calculate the predicted probabilities of AH or EC with various combinations of these factors.</div></div><div><h3>Results</h3><div>Of 821 patients included in the study, 6.0 % were diagnosed with AH or EC. The significant risk factors identified were nulliparity (odds ratio (OR): 4.75, 95 % confidence interval (CI): 2.11–10.70), PCOS (OR: 2.72, 95 % CI: 1.34–5.52), and multiple polyps (OR: 2.33, 95 % CI: 1.23–4.41). The predicted probabilities of developing AH or EC increased with the number of risk factors present, ranging from 1 % to 33.6 %.</div></div><div><h3>Conclusions</h3><div>The predicted probabilities within combinations of risk factors may be considered helpful in making better clinical decisions regarding endometrial sampling for patients ≤ 45 years with AUB.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"302 ","pages":"Pages 288-293"},"PeriodicalIF":2.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344113","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 : 2024-09-26DOI: 10.1016/j.ejogrb.2024.09.038
Harika Yumru Celiksoy , Sultan Can
Objective
This study aimed to evaluate the quality of surgical content in laparoscopic radical hysterectomy (LRH) videos on YouTube.
Study Design
On February 20, 2024, a search was conducted on YouTube using the keyword “laparoscopic radical hysterectomy,” filtering videos with durations over 20 min and sorting by relevance. Two experienced gynecologists assessed the first 250 videos retrieved to determine if they illustrated anatomical landmarks and surgical procedures in a standardized step-by-step manner.
Results
Forty videos met the inclusion criteria for analysis. Sixty percent (24 out of 40) of these videos presented the complete list of predetermined surgical steps. According to the LAP-VEGaS assessment tool, only 32.5 % (13 out of 40) of the videos achieved a total score of 11 or higher, and 12.5 % (5 out of 40) scored 12 or higher. Videos with a LAP-VEGaS score of 11 or above had a statistically higher number of views per day (4.64 [IQR: 10.47]) compared to those with a lower score (1.48 [IQR: 3.40], p = 0.019). Additionally, videos featuring a didactic voice were significantly more popular, with higher views per day compared to those with music or no audio (8.66 [IQR: 32.75] vs. 1.69 [IQR: 3.12], p = 0.001).
Conclusion
The majority of LRH videos on YouTube lacked comprehensive surgical content and received low LAP-VEGaS scores. Videos with a didactic voice and higher LAP-VEGaS scores tended to attract more viewers.
{"title":"The evaluation of surgical content in laparoscopic radical hysterectomy videos on YouTube","authors":"Harika Yumru Celiksoy , Sultan Can","doi":"10.1016/j.ejogrb.2024.09.038","DOIUrl":"10.1016/j.ejogrb.2024.09.038","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the quality of surgical content in laparoscopic radical hysterectomy (LRH) videos on YouTube.</div></div><div><h3>Study Design</h3><div>On February 20, 2024, a search was conducted on YouTube using the keyword “laparoscopic radical hysterectomy,” filtering videos with durations over 20 min and sorting by relevance. Two experienced gynecologists assessed the first 250 videos retrieved to determine if they illustrated anatomical landmarks and surgical procedures in a standardized step-by-step manner.</div></div><div><h3>Results</h3><div>Forty videos met the inclusion criteria for analysis. Sixty percent (24 out of 40) of these videos presented the complete list of predetermined surgical steps. According to the LAP-VEGaS assessment tool, only 32.5 % (13 out of 40) of the videos achieved a total score of 11 or higher, and 12.5 % (5 out of 40) scored 12 or higher. Videos with a LAP-VEGaS score of 11 or above had a statistically higher number of views per day (4.64 [IQR: 10.47]) compared to those with a lower score (1.48 [IQR: 3.40], p = 0.019). Additionally, videos featuring a didactic voice were significantly more popular, with higher views per day compared to those with music or no audio (8.66 [IQR: 32.75] vs. 1.69 [IQR: 3.12], p = 0.001).</div></div><div><h3>Conclusion</h3><div>The majority of LRH videos on YouTube lacked comprehensive surgical content and received low LAP-VEGaS scores. Videos with a didactic voice and higher LAP-VEGaS scores tended to attract more viewers.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"302 ","pages":"Pages 301-305"},"PeriodicalIF":2.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364837","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 : 2024-09-25DOI: 10.1016/j.ejogrb.2024.09.037
Dávid Rátonyi , Erzsébet Koroknai , Krisztina Pákozdy , Attila G. Sipos , Peter Takacs , Zoárd Tibor Krasznai , Bence Kozma
Objective
Our study aimed to improve the understanding of the biomechanical changes occurring in the pelvic floor due to pelvic floor muscle training (PFMT), which is responsible for improving stress urinary incontinence (SUI) symptoms.
Study design
In this prospective cohort study, we examined the impact of a six-week PFMT program in women with stress or stress-predominant urinary incontinence on the biomechanical parameters of the pelvic floor. Fifty-two biomechanical parameters were measured by Vaginal Tactile Imager (VTI) at baseline and at a six-week follow-up. In addition, we have assessed the Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Patient’s Global Impression of Severity (PGI-S) scores at enrolment and at six-week follow-up. We have divided our cohort into two groups, Improved Group (IG) and Not-improved Group (NIG), based on the change in UDI-6 score after six weeks and compared the biomechanical changes within and between the two groups.
Results
The overall cohort included twenty women with stress or stress-predominant SUI based on MESA questionnaire [MESA SUI index (mean ± SD) 63.3 % ± 24.0 %, MESA UUI index (mean ± SD) 13.3 % ± 15.3 %, p < 0.01]. Nine of the 52 VTI parameters have changed significantly after six weeks of PFMT in the entire cohort. Eleven women (IG) achieved the minimum 11-point change in the UDI-6 scaled score. In IG, we found that three VTI parameters differed significantly: Parameter 1: the maximum value of force measured during the VTI probe insertion [(N, mean ± SD) 0.55 ± 0.18 vs. 0.78 ± 0.31, p < 0.049], parameter 18: the maximum gradient at the upper third of the vagina (posterior) [(kPa/mm, mean ± SD) 0.16 ± 0.05 vs. 0.36 ± 0.28, p < 0.048], and parameter 47: integral force change in the anterior compartment at reflex pelvic muscle contraction (cough) [(N, mean ± SD) 1.61 ± 0.85 vs. 1.97 ± 0.71, p < 0.045].
Conclusion
Our study revealed a significant association between the improvement of strength in targeted muscle groups and a reduction in urinary incontinence symptoms. Identifying specific muscles changing PFMT provides valuable insights for specific interventions. Our findings may help to create personalized and targeted interventions to improve the quality of life of women affected by SUI.
研究目的我们的研究旨在进一步了解盆底肌肉训练（PFMT）对改善压力性尿失禁（SUI）症状所产生的盆底生物力学变化：在这项前瞻性队列研究中，我们考察了为期六周的压力性或压力主导性尿失禁女性盆底肌肉训练计划对盆底生物力学参数的影响。通过阴道触觉成像仪（VTI）对基线和六周随访的 52 个生物力学参数进行了测量。此外，我们还评估了注册时和六周随访时的尿失禁压力量表（UDI-6）、尿失禁影响问卷（IIQ-7）和患者对严重程度的总体印象（PGI-S）评分。根据六周后 UDI-6 评分的变化，我们将队列分为两组，即改善组（IG）和未改善组（NIG），并比较了两组内部和两组之间的生物力学变化：根据 MESA 问卷调查，共有 20 名女性患有压力型或压力主导型 SUI [MESA SUI 指数（平均值±标准差）63.3%±24.0%，MESA UUI 指数（平均值±标准差）13.3%±15.3%，P 结论：我们的研究发现，UDI-6 与压力型 SUI 之间存在显著关联：我们的研究表明，目标肌群力量的改善与尿失禁症状的减轻之间存在明显关联。确定改变 PFMT 的特定肌肉为特定干预措施提供了宝贵的见解。我们的研究结果可能有助于制定个性化和有针对性的干预措施，以改善受 SUI 影响的女性的生活质量。
{"title":"The impact of short-term pelvic floor muscle training on the biomechanical parameters of the pelvic floor among patients with stress urinary incontinence: A pilot study","authors":"Dávid Rátonyi , Erzsébet Koroknai , Krisztina Pákozdy , Attila G. Sipos , Peter Takacs , Zoárd Tibor Krasznai , Bence Kozma","doi":"10.1016/j.ejogrb.2024.09.037","DOIUrl":"10.1016/j.ejogrb.2024.09.037","url":null,"abstract":"<div><h3>Objective</h3><div>Our study aimed to improve the understanding of the biomechanical changes occurring in the pelvic floor due to pelvic floor muscle training (PFMT), which is responsible for improving stress urinary incontinence (SUI) symptoms.</div></div><div><h3>Study design</h3><div>In this prospective cohort study, we examined the impact of a six-week PFMT program in women with stress or stress-predominant urinary incontinence on the biomechanical parameters of the pelvic floor. Fifty-two biomechanical parameters were measured by Vaginal Tactile Imager (VTI) at baseline and at a six-week follow-up. In addition, we have assessed the Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Patient’s Global Impression of Severity (PGI-S) scores at enrolment and at six-week follow-up. We have divided our cohort into two groups, Improved Group (IG) and Not-improved Group (NIG), based on the change in UDI-6 score after six weeks and compared the biomechanical changes within and between the two groups.</div></div><div><h3>Results</h3><div>The overall cohort included twenty women with stress or stress-predominant SUI based on MESA questionnaire [MESA SUI index (mean ± SD) 63.3 % ± 24.0 %, MESA UUI index (mean ± SD) 13.3 % ± 15.3 %, p < 0.01]. Nine of the 52 VTI parameters have changed significantly after six weeks of PFMT in the entire cohort. Eleven women (IG) achieved the minimum 11-point change in the UDI-6 scaled score. In IG, we found that three VTI parameters differed significantly: Parameter 1: the maximum value of force measured during the VTI probe insertion [(N, mean ± SD) 0.55 ± 0.18 vs. 0.78 ± 0.31, p < 0.049], parameter 18: the maximum gradient at the upper third of the vagina (posterior) [(kPa/mm, mean ± SD) 0.16 ± 0.05 vs. 0.36 ± 0.28, p < 0.048], and parameter 47: integral force change in the anterior compartment at reflex pelvic muscle contraction (cough) [(N, mean ± SD) 1.61 ± 0.85 vs. 1.97 ± 0.71, p < 0.045].</div></div><div><h3>Conclusion</h3><div>Our study revealed a significant association between the improvement of strength in targeted muscle groups and a reduction in urinary incontinence symptoms. Identifying specific muscles changing PFMT provides valuable insights for specific interventions. Our findings may help to create personalized and targeted interventions to improve the quality of life of women affected by SUI.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"302 ","pages":"Pages 283-287"},"PeriodicalIF":2.1,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344114","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 : 2024-09-24DOI: 10.1016/j.ejogrb.2024.09.033
Lea Kirstine Hansen , Andrew H. Shennan , Emma Louise Eisland-Schmidt Christiansen , Graham Tydeman , Laura Stirrat , Rikke Bek Helmig , Niels Uldbjerg , Julie Glavind
Introduction
In women with cervical incompetence, transvaginal cerclage may help prevent preterm birth. However, training for this procedure poses challenges due to the low number of cases and difficulties in visualizing the operative field. Furthermore, the objective criteria for a successful cerclage procedure are not well-described. Quality assessment relies heavily on self-assessment rather than objective criteria and feedback. To address this issue, training on a simulator may offer a solution. We aimed to objectively assess surgical performance and compare it to the self-assessed performance in transvaginal cerclage procedures.
Materials and methods
During the Nordic Federation of Obstetrics and Gynecology (NFOG) congress in 2023, surgeons proficient in transvaginal cerclage procedures performed a transvaginal cerclage on a simulator. To compare the observed and self-assessed outcomes we obtained measurements on the cerclage height and number of bites from the detachable cervix, and from computed tomography scans we analyzed suture bite depth, reduction of cervix surface area, and whether cerclages had perforated the cervical canal. The same outcomes were self-assessed by each participant after the cerclage procedure. We visualized the continuous paired data in a Bland-Altman plot and compared these data with a paired t-test. Paired binary data was analyzed using McNemars test.
Results
29 participants from eight different nationalities performed one transvaginal cerclage each. The mean height of the cerclage was 26.8 mm (SD 9 mm) and mean depth was 6.5 mm (SD 1.9 mm) across a mean of 4.1 (SD 0.8) bites. The mean reduction of the cervix surface area was 7.6 % (SD 5.9 %). Two sutures perforated the cervical canal. The participants significantly underestimated the height of their cerclage with a mean difference of 6.0 mm (95 % CI 2.1–9.9), (p 0.002), between the observed and the self-assessed height, but otherwise revealed good self-assessment of their performed procedure.
Conclusions
Overall, the experienced cerclage surgeons showed a genuine insight into their surgical performance of a transvaginal cerclage. These results could warrant development of a procedural guidelines with objective measures, now reassured that surgeons are capable of self-assessing their procedures.
导言：对于宫颈机能不全的妇女，经阴道宫颈环扎术有助于预防早产。然而，由于病例数量少，手术视野难以观察，因此这种手术的培训工作面临挑战。此外，成功实施宫颈环扎术的客观标准也没有得到很好的描述。质量评估在很大程度上依赖于自我评估，而不是客观标准和反馈。为了解决这个问题，模拟器培训可能是一个解决方案。材料和方法在2023年北欧妇产科联盟（NFOG）大会期间，精通经阴道环扎术的外科医生在模拟器上进行了经阴道环扎术。为了比较观察结果和自我评估结果，我们测量了宫颈环扎高度和可分离宫颈的咬合次数，并通过计算机断层扫描分析了缝线咬合深度、宫颈表面积的减少以及宫颈环扎是否穿孔。每位受试者在宫颈环扎术后都对同样的结果进行了自我评估。我们在布兰-阿尔特曼图（Bland-Altman plot）中将连续配对数据可视化，并用配对 t 检验对这些数据进行比较。结果29名来自8个不同国家的参与者每人进行了一次经阴道环扎术。阴道环扎术的平均高度为 26.8 毫米（标准差为 9 毫米），平均深度为 6.5 毫米（标准差为 1.9 毫米），平均缝合 4.1 针（标准差为 0.8 针）。宫颈表面积的平均缩减率为 7.6%（SD 5.9%）。有两处缝线穿透了宫颈管。参与者明显低估了宫颈环扎的高度，观察到的高度与自我评估的高度平均相差 6.0 mm (95 % CI 2.1-9.9) (p 0.002)，但除此之外，他们对所实施手术的自我评估良好。这些结果为制定具有客观衡量标准的手术指南提供了依据，现在可以放心了，外科医生有能力对自己的手术进行自我评估。
{"title":"Transvaginal cervical cerclage – How well do surgeons assess their own procedures?","authors":"Lea Kirstine Hansen , Andrew H. Shennan , Emma Louise Eisland-Schmidt Christiansen , Graham Tydeman , Laura Stirrat , Rikke Bek Helmig , Niels Uldbjerg , Julie Glavind","doi":"10.1016/j.ejogrb.2024.09.033","DOIUrl":"10.1016/j.ejogrb.2024.09.033","url":null,"abstract":"<div><h3>Introduction</h3><div>In women with cervical incompetence, transvaginal cerclage may help prevent preterm birth. However, training for this procedure poses challenges due to the low number of cases and difficulties in visualizing the operative field. Furthermore, the objective criteria for a successful cerclage procedure are not well-described. Quality assessment relies heavily on self-assessment rather than objective criteria and feedback. To address this issue, training on a simulator may offer a solution. We aimed to objectively assess surgical performance and compare it to the self-assessed performance in transvaginal cerclage procedures.</div></div><div><h3>Materials and methods</h3><div>During the Nordic Federation of Obstetrics and Gynecology (NFOG) congress in 2023, surgeons proficient in transvaginal cerclage procedures performed a transvaginal cerclage on a simulator. To compare the observed and self-assessed outcomes we obtained measurements on the cerclage height and number of bites from the detachable cervix, and from computed tomography scans we analyzed suture bite depth, reduction of cervix surface area, and whether cerclages had perforated the cervical canal. The same outcomes were self-assessed by each participant after the cerclage procedure. We visualized the continuous paired data in a Bland-Altman plot and compared these data with a paired <em>t</em>-test. Paired binary data was analyzed using McNemars test.</div></div><div><h3>Results</h3><div>29 participants from eight different nationalities performed one transvaginal cerclage each. The mean height of the cerclage was 26.8 mm (SD 9 mm) and mean depth was 6.5 mm (SD 1.9 mm) across a mean of 4.1 (SD 0.8) bites. The mean reduction of the cervix surface area was 7.6 % (SD 5.9 %). Two sutures perforated the cervical canal. The participants significantly underestimated the height of their cerclage with a mean difference of 6.0 mm (95 % CI 2.1–9.9), (p 0.002), between the observed and the self-assessed height, but otherwise revealed good self-assessment of their performed procedure.</div></div><div><h3>Conclusions</h3><div>Overall, the experienced cerclage surgeons showed a genuine insight into their surgical performance of a transvaginal cerclage. These results could warrant development of a procedural guidelines with objective measures, now reassured that surgeons are capable of self-assessing their procedures.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"302 ","pages":"Pages 268-272"},"PeriodicalIF":2.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326848","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 : 2024-09-24DOI: 10.1016/j.ejogrb.2024.09.035
Ying Zhu , Renjie Zhu , Li Sun , Lijuan Xiao , Liyuan Jiang
{"title":"Relationships of diastasis recti abdominis with stress urinary incontinence and pelvic floor muscle dysfunction in postpartum women: A letter to the editor","authors":"Ying Zhu , Renjie Zhu , Li Sun , Lijuan Xiao , Liyuan Jiang","doi":"10.1016/j.ejogrb.2024.09.035","DOIUrl":"10.1016/j.ejogrb.2024.09.035","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"302 ","pages":"Pages 384-385"},"PeriodicalIF":2.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344111","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 : 2024-09-24DOI: 10.1016/j.ejogrb.2024.09.036
Ayad Palani , Hawal Lateef Fateh , Dyari H. Ahmed , Sulagna Dutta , Pallav Sengupta
Background
While numerous studies have examined the impact of individual or combined nutrients on semen quality, research on the correlation between overall dietary patterns and semen quality remains limited. This cross-sectional study investigates the relationship between adherence to the alternative Mediterranean diet (aMED) and semen quality.
Methods
A total of 274 men, presenting with both normal and abnormal semen parameters, participated in this study. Dietary data were collected using a 147-item semi-quantitative food frequency questionnaire (FFQ). Participants were divided into three groups based on their adherence to the Mediterranean diet (T1, T2, and T3). Statistical analyses, including ANOVA for numerical data and Chi-square tests for categorical data, were conducted. Multivariable logistic regression models were employed to estimate the association between aMED scores and abnormal semen parameters.
Results
Participants in the highest adherence group (T3) were younger and had lower BMI compared to those in the other tertiles. Significant differences in sperm parameters were observed across the tertiles. T3 recorded the highest levels of sperm concentration, total sperm count, motility, progressive motility, and normal morphology (57.53 ± 36.16, 213.8 ± 158.9, 73.4 ± 25.9, 61.2 ± 24.6, and 6.42 ± 1.51, respectively), whereas T1 had the lowest values (11.92 ± 22.29, 43.3 ± 73.8, 36.7 ± 33.8, 4.6 ± 5.7, respectively). No significant differences were found in semen volume and viscosity. The regression analysis revealed a significant positive correlation between aMED scores and sperm concentration (B = 1.32, P = 0.001), total sperm count (B = 1.12, P = 0.001), and total motility (B = 0.71, P = 0.001).
Conclusion
Adherence to a high-quality Mediterranean diet is positively associated with improved semen quality and increased male fertility potential. Promoting healthy dietary patterns may be an effective strategy to enhance sperm motility and overall male reproductive health.
{"title":"Correlation of mediterranean diet pattern and lifestyle factors with semen quality of men attending fertility clinics: A cross-sectional study","authors":"Ayad Palani , Hawal Lateef Fateh , Dyari H. Ahmed , Sulagna Dutta , Pallav Sengupta","doi":"10.1016/j.ejogrb.2024.09.036","DOIUrl":"10.1016/j.ejogrb.2024.09.036","url":null,"abstract":"<div><h3>Background</h3><div>While numerous studies have examined the impact of individual or combined nutrients on semen quality, research on the correlation between overall dietary patterns and semen quality remains limited. This cross-sectional study investigates the relationship between adherence to the alternative Mediterranean diet (aMED) and semen quality.</div></div><div><h3>Methods</h3><div>A total of 274 men, presenting with both normal and abnormal semen parameters, participated in this study. Dietary data were collected using a 147-item semi-quantitative food frequency questionnaire (FFQ). Participants were divided into three groups based on their adherence to the Mediterranean diet (T1, T2, and T3). Statistical analyses, including ANOVA for numerical data and Chi-square tests for categorical data, were conducted. Multivariable logistic regression models were employed to estimate the association between aMED scores and abnormal semen parameters.</div></div><div><h3>Results</h3><div>Participants in the highest adherence group (T3) were younger and had lower BMI compared to those in the other tertiles. Significant differences in sperm parameters were observed across the tertiles. T3 recorded the highest levels of sperm concentration, total sperm count, motility, progressive motility, and normal morphology (57.53 ± 36.16, 213.8 ± 158.9, 73.4 ± 25.9, 61.2 ± 24.6, and 6.42 ± 1.51, respectively), whereas T1 had the lowest values (11.92 ± 22.29, 43.3 ± 73.8, 36.7 ± 33.8, 4.6 ± 5.7, respectively). No significant differences were found in semen volume and viscosity. The regression analysis revealed a significant positive correlation between aMED scores and sperm concentration (B = 1.32, P = 0.001), total sperm count (B = 1.12, P = 0.001), and total motility (B = 0.71, P = 0.001).</div></div><div><h3>Conclusion</h3><div>Adherence to a high-quality Mediterranean diet is positively associated with improved semen quality and increased male fertility potential. Promoting healthy dietary patterns may be an effective strategy to enhance sperm motility and overall male reproductive health.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"302 ","pages":"Pages 262-267"},"PeriodicalIF":2.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326709","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}
We aimed to establish normal reference ranges for insula, sylvian fissure (SF), parieto-occipital fissure (POF), and calcarine fissure (CF) measured by prenatal ultrasonography (USG) between 20–24 weeks of gestation in healthy fetuses.
Method
A total of 186 fetuses in the second trimester were evaluated by transabdominal USG. All measurements were obtained by a single clinician. The study was divided into four subgroups (Group A: 20–20 weeks six days, Group B: 21–21 weeks six days, Group C: 22–22 weeks six days, Group D: 23–23 weeks six days).
Results
Eight fetuses (4.23 %) between 20 and 21 weeks of gestation could not be included in the study because the sulcus borders could not be clearly evaluated. Measurements were obtained in all fetuses over 21 weeks of gestation. Reference ranges were obtained for insula, SF, POF, and CF in all fetuses and subgroups. At 20 and 23 weeks and six days gestation, mean insula depth was 14.96 ± 1.62 mm (min 11.0 mm − max 18.9 mm), mean SF depth was 6.96 ± 1.35 mm (min 3.6 mm − max 10.0 mm), mean POF depth was 2.05 ± 0.66 mm (min 1.1 mm − max 5.6 mm) and mean CF depth was 2.42 ± 0.68 mm (min 1.5 mm − 6.1 mm). There was a correlation between the cerebellum and cisterna magna and all fissure depths.
Conclusion
Our nomograms of healthy fetuses may be helpful in the early detection of cortical maturation abnormalities.
{"title":"Evaluation of cerebral fissure depths measured by prenatal ultrasonography in healthy fetuses at 20–24 weeks gestational age","authors":"Nuran Mammadova , Nizamettin Bozbay , Gokcen Orgul","doi":"10.1016/j.ejogrb.2024.09.032","DOIUrl":"10.1016/j.ejogrb.2024.09.032","url":null,"abstract":"<div><h3>Aim</h3><div>We aimed to establish normal reference ranges for insula, sylvian fissure (SF), parieto-occipital fissure (POF), and calcarine fissure (CF) measured by prenatal ultrasonography (USG) between 20–24 weeks of gestation in healthy fetuses.</div></div><div><h3>Method</h3><div>A total of 186 fetuses in the second trimester were evaluated by transabdominal USG. All measurements were obtained by a single clinician. The study was divided into four subgroups (Group A: 20–20 weeks six days, Group B: 21–21 weeks six days, Group C: 22–22 weeks six days, Group D: 23–23 weeks six days).</div></div><div><h3>Results</h3><div>Eight fetuses (4.23 %) between 20 and 21 weeks of gestation could not be included in the study because the sulcus borders could not be clearly evaluated. Measurements were obtained in all fetuses over 21 weeks of gestation. Reference ranges were obtained for insula, SF, POF, and CF in all fetuses and subgroups. At 20 and 23 weeks and six days gestation, mean insula depth was 14.96 ± 1.62 mm (min 11.0 mm − max 18.9 mm), mean SF depth was 6.96 ± 1.35 mm (min 3.6 mm − max 10.0 mm), mean POF depth was 2.05 ± 0.66 mm (min 1.1 mm − max 5.6 mm) and mean CF depth was 2.42 ± 0.68 mm (min 1.5 mm − 6.1 mm). There was a correlation between the cerebellum and cisterna magna and all fissure depths.</div></div><div><h3>Conclusion</h3><div>Our nomograms of healthy fetuses may be helpful in the early detection of cortical maturation abnormalities.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"302 ","pages":"Pages 254-261"},"PeriodicalIF":2.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323268","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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