Gynecologic and Obstetric Investigation最新文献

Introduction Primary ovarian insufficiency (POI) that caused infertility could decrease the quality of life in women. Therefore, an effective treatment is needed. Adipose-derived stem cells (ADSCs) have been reported to have therapeutic benefits in POI. This review aims to evaluate the therapeutic effect of ADSCs in POI. Methods Literatures were searched according to PRISMA 2020 guidelines in the following databases: PubMed, ProQuest, Wiley, Emerald, and JSTOR (until July 10th, 2024). The study inclusion criteria are original articles, in vivo study with adipose-derived stem cells therapy towards POI with ovarian function as the outcome. SYRCLE's risk of bias tool was used to evaluate the quality of the studies. Results We retrieved 9 from 292 articles published in English between 2013 and 2024. Animals used in this study were mice (n=5) and rats (n=4). ADSCs were administered either systematically or directly by injection into the ovaries. Decreased apoptosis, increased follicle survival, and hormone levels were observed. These showed that ADSCs implantation could improve ovarian function in rats and mice. Overall, ADSCs in POI showed satisfactory results. Conclusion ADSCs showed benefits in increasing ovarian function in POI. Further studies, especially human studies are needed to evaluate the efficacy and side effects of the ADSCs treatment before reaching general conclusions.

Objectives: This study aimed to explore potential differences in efficacy between vaginal progesterone (VPG) and VPG+oral progesterone (OPG) for luteal-phase support in hormone replacement therapy-frozen embryo transfer (HRT-FET) cycles.

Design: A single-centre, open-label, randomized controlled, phase IV pilot study.

Participants/materials, setting, methods: Infertile women aged 20-38 years undergoing HRT-FET cycles were included. Participants were randomized to VPG (n=86) or VPG+OPG (n=86). The primary efficacy endpoint was ongoing pregnancy at 10-12 weeks. Secondary efficacy endpoints included β-human chorionic gonadotropin (β-hCG) positivity, implantation rate, and clinical-pregnancy rate. Safety analyses included adverse events (AE) and vital signs.

Results: A higher ongoing pregnancy rate was observed with VPG+OPG (29.1%) versus VPG (18.8%); treatment difference 8.4% (90% confidence interval [CI] -2.2%, 19.0%). Numerical differences also favoured VPG+OPG over VPG for β-hCG positivity (0.9% [90% CI -10.8%, 12.7%]), implantation (10.4% [90% CI 0.5%, 21.3%]), and clinical pregnancy (10.1% [90% CI -0.8%, 21.1%]). Incidences of treatment-emergent AEs were comparable.

Limitations: The single-centre study was limited by a relatively small sample size which could have impacted the reported outcomes. Another limitation was the open-label design, which might have increased the risk of bias for subjective endpoints, such as AE reporting.

Conclusions: A higher ongoing pregnancy rate was observed with VPG+OPG vs VPG; however, a statistical conclusion cannot be reached considering the small sample size. These data suggest that a minimum daily progesterone dose, such as VPG 90 mg+OPG 20 mg reported here, or VPG 180 mg reported in other studies, may be required for successful outcomes following HRT-FET cycles.

Introduction: Proper management of large endometriomas in patients scheduled for IVF continues to be a matter of debate. While small endometriomas are no longer an absolute indication for surgery, the large ones present unique challenges, potentially impacting ovarian response and follicle accessibility. This study aims to evaluate current practices among gynecologists in managing large endometriomas before IVF.

Methodology: An online survey with 18 questions was distributed to gynecologists through various professional societies. The survey addressed their clinical experience, type of practice, threshold size for surgery, surgical techniques used, hormonal treatment protocols, and the timing of ovarian stimulation post-surgery. Data were collected anonymously and analyzed using SPSS 29.0.2.0.

Results: Of the 111 respondents, 73% practiced in academic settings, and 61% had over 15 years of experience. Laparoscopic cystectomy was the most common procedure (48.2%). The median threshold size for surgery was 50 mm (IQR 40-60). Despite the same median threshold, surgeons performing laparoscopic surgery as their main clinical activity had a significantly different distribution of thresholds (IQR 40-60 vs. 47-89, p = 0.006), with a tendency to recommend surgery for smaller endometriomas. Techniques like CO2 laser ablation and plasma energy were less commonly used. Notably, 40.5% of participants indicated they would change their practice if a CO2 laser or plasma energy device were available in their surgical armamentarium. Most participants (67.9%) adjusted their strategy based on pre-operative AMH levels. The average timing for IVF stimulation post-surgery was 6 weeks(IQR 4-8) with no difference across different experiences.

Conclusion: Managing large endometriomas before IVF involves balancing surgical benefits with risks to ovarian reserve. The survey highlights significant variability in practices, with a median surgical threshold size of 50 mm. Laparoscopic cystectomy, while common, is associated with ovarian tissue loss, whereas emerging techniques like CO2 laser ablation show promise in preserving ovarian reserve. The need for up-to-date evidence-based guidelines is essential to standardize practices and optimize outcomes for IVF patients.

Objectives: The aim of our study was to analyze the percentage of acute urinary retention after midurethral sling (MUS) surgery for stress urinary incontinence (SUI). The results of our study directed us to conduct a systemic review (SR) because of the need to consolidate existing knowledge on the incidence and management of postoperative urinary retention.

Design: The first part of the article presents the SR, which was conducted after the retrospective analyses of our data. Participants/Materials: This article presents a retrospective study conducted on a sample of 55 patients who underwent three different types of MUS surgery: TVT-Abbrevo, TVT-O, and single-incision Ophira Mini Sling.

Setting: The study analyzes outcomes at a median 8-year follow-up, focusing on the significance of acute urinary retention after MUS surgery.

Methods: SR was conducted using Medline, Cochrane, and Clinical Trials databases, following PRISMA guidelines. The retrospective study involved 55 patients who underwent three types of MUS surgery (TVT-Abbrevo, TVT-O, and Ophira) at our clinic, with a median follow-up of 8 years. Postoperative outcomes, including acute urinary retention and residual urine, were assessed using ultrasound, and success was evaluated through the Patient Global Impression of Improvement (PGI-I) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF).

Results: The SR has shown that the reported percentage of patients with acute postoperative urinary retention after MUS procedures varies between 1.5% and 6.6%. In our retrospective analyses, five patients had acute urinary retention after the procedure (9.1%) and required the use of a Foley catheter for several days. All three surgical procedures resulted in similar levels of patient satisfaction at follow-up, as indicated by the PGI-I scores and patients' ICIQ-SF scores. The type of procedure and the patients' ICIQ-SF or PGI-I scores do not significantly correlate with the post-void residual volume.

Limitations: One of the major limitations in our analyses is the lack of any possibility to compare all TVT approaches, including retropubic. A larger sample size would be necessary to draw more definitive conclusions from these observations.

Conclusions: Our SR provides a comprehensive synthesis of previous research on urinary retention after MUS surgery. We noted that many studies fail to consider the possibility of preexisting urinary retention. Clinically significant long-term urinary retention in our cohort of patients was below 100 ml, was not specifically correlated with any type of procedure, and was not statistically correlated with acute urinary retention after operation.

Objective: BRCA 1 and 2 mutation carriers are invited to follow intensive clinical and instrumental surveillance programs or are offered prophylactic ovarian surgery. These recommendations impact many aspects of their lives. The primary objective of this study was to assess the overall quality of life (HRQoL) before and after prophylactic bilateral salpingo-oophorectomy (BSO). Secondary objectives were investigating sexual health (SH) and fatigue severity state (FSS).

Design: This was a single-center, retrospective observational, study.

Setting: Women who underwent surgical treatment of bilateral salpingo-oophorectomy between 2018 and 2024 at "DAI Materno Infantile" of Azienda Ospedaliera Universitaria "Federico II" of Naples were included.

Methods: These patients were tracked down to undergo specific questionnaires, such as "Global Health Status and Quality of Life Scale (QOL) (EORTC QLQ-C30)", "EORTC Sexual Health Questionnaire (QLQ-SH22), and "Fatigue Severity Scale (FSS)", to evaluate their psychological, sexual and general physical condition impact before the surgery, 3 and 6 months later.

Results: The overall mean QoL score was 88.3±29.8 (mean + standard deviation), and this score worsened when the surgery was performed at 3 months (p <.0001) with a score of 51.7±30.7 with a mean difference (MD) of 36.6 points; instead, when we evaluated at 6 months, the overall mean QoL score was 73.1±24.3 with an MD of 21.4 points. FSS reported a score of 2.7±1.15 vs 4.2±1.59 (p<.0001) vs 3.5±1.43 (p<.0001), respectively, before and 3-6 months after surgery. EORTC QLQ-SH22 before and after treatment showed statistically significant changes in sexual satisfaction (p<.0001).

Conclusion: BSO may impact the quality of life regardless of the hormonal status of patients related to age or menopause, both about the functional evaluation and the psychological and emotional assessment report. The physical change related to the surgical procedure is associated with a mental shift that affects both the physical and sexual energy of our patients in the first 3 months postoperatively, with a slight improvement of these data at 6 months.

Background Embryo implantation and early survival in a synchronized, receptive endometrium are critical for establishing a successful pregnancy, but uterine pathologies can present challenges to reproductive success by significantly impacting this complex process. Objectives The purpose of this review is to analyze the impact of uterine pathologies on embryo implantation, early embryo survival, and finally on the development of infertility, with references to reproductive outcomes and the main evidence related to therapeutic strategies. Methods The relevant publications were identified after queries of the following sources: PubMed, Google Scholar, Web of Science, and publishers' databases, complemented by a cross-check of the reference lists. We used a combination of the search terms "uterine pathology", "infertility", "embryo implantation" and "embryo survival" with terms relevant to the topic of each paragraph, such as "endometrial polyps", "leiomyoma", "uterine malformations", "adenomyosis", "intrauterine adhesions". Outcome All articles describing the influence of each uterine pathology on embryo implantation/early survival were included, with a focus on the role of endometrial polyps, leiomyomas, uterine malformations, adenomyosis, and intrauterine adhesions. Conclusions and Outlook The exact influence of uterine diseases on the uterine-embryo crosstalk is unknown. Nevertheless, numerous molecular mechanisms have been proposed to explain some of the underlying processes. Tailored treatments for each specific disease may improve the endometrial milieu, and thus reproductive outcomes. Future studies should aim to further understand the underlying molecular phenomena driving the development of these pathologies, how they may disrupt early embryo life stages, and the exact benefit of medical and surgical treatments on embryo survival.

Background: Endometriosis-related infertility and its treatment with assisted reproductive technologies (ART) have been broadly researched. Yet, underlying mechanisms of infertility, particularly in the absence of tubal dysfunction, remain unclear. While the impact of inflammatory milieu on the ovary and/or endometrium has been indicated as a contributing factor, recent evidence from euploid transfers and donor cycles questions the extent of these effects. Moreover, the frequent coexistence of other confounders, such as adenomyosis, further complicates the clinical picture, making it difficult to isolate the specific impact of endometriosis on ART outcomes.

Objectives: The aim of the study was to evaluate the influence of endometriosis on various aspects of ART, including oocyte competence, ART success, and whether surgical or medical treatments improve these.

Methods: We primarily focused on recent high-quality sources, including systematic reviews, large-scale observational studies, and meta-analyses, to provide a robust and reliable synthesis of the available evidence.

Outcome: While oocyte yield can decrease in the presence of an endometrioma or history of endometrioma excision, oocyte quality, early embryo development indicators, aneuploidy rates, and clinical outcomes of endometriosis patients do not differ from other infertility diagnoses in ART setting. Surgical treatments and hormonal suppression before ART do not seem to improve outcomes. Ovarian stimulation for ART does not exacerbate endometriosis symptoms.

Conclusions and outlook: Endometriosis, despite its high prevalence among infertile patients, does not inherently impair ART success, except in cases where ovarian reserve is compromised due to ovarian disease or its surgical treatment. The causal link between endometriosis and infertility remains an enigma, and future studies should continue to explore this association with other confounding factors.

Introduction Bacterial vaginosis (BV) is a risk factor for preterm delivery. Yet, previous studies have found BV treatment ineffective in preventing preterm delivery in unselected population. This study aims to evaluate the effectiveness of BV screening and treatment in reducing the rate of preterm deliveries before 37 weeks in high-risk women. Material and methods Embase, PubMed, Ovid-Medline, and Web of Science were searched. Randomized controlled trials that evaluated antibiotic treatment for BV versus no treatment/placebo were included. The primary outcome was the rate of preterm delivery and/or late miscarriages in pregnant women with a history of preterm delivery. The pooled relative risks (with 95% CI) were estimated. The Cochrane's Q test of heterogeneity and I² were used to assess heterogeneity. In total, 4701 papers were retrieved of which seven met inclusion criteria and were analyzed. Results Among the participating women, 738 were at high risk for preterm delivery and included in the analysis. Among them, 397 and 341 women received active or placebo treatment, respectively. The included studies had a low risk of bias. In six out of seven studies, the risk factor for preterm delivery was a previous preterm delivery. One study (N=16) was excluded from the analysis since no group had preterm deliveries. Treatment for BV in high-risk women reduced the rate of preterm deliveries (pooled RR with 95% CI 0.65 [0.44-0.98[. The protective effect of BV treatment was statistically significant in women treated with clindamycin, and when treatment was started after 20 gestational weeks. Conclusion Screening for and treatment of BV may be effective in preventing preterm delivery in high risk pregnant women. Randomized clinical trials are needed to confirm the findings of this study. Trial registration: This study was registered on PROSPERO (CRD42020162621).

Background Over the past decade, transvaginal ultrasound (TVUS) has revolutionized the diagnosis of deep endometriosis. We can now accurately describe and evaluate lesions in multiple compartments of the pelvis, increasing diagnostic capacity without the need for initial laparoscopy. Recent consensus and publications support the new and growing evidence for this technique. Research into deep endometriosis has increased substantially and new diagnostic evidence is now available. Objectives The aim of this article is to review the state of the art in ultrasound diagnosis of deep endometriosis. Methods We performed a detailed search of the PubMed database to identify eligible primary studies. We included English-language publications with the following terms: "endometriosis" AND "deep" AND "ultrasound" AND "transvaginal". Studies focusing on ultrasound in deep endometriosis were included, we selected them based on title reading, then narrowed the selection by reading the abstract. -We excluded publications that didn't use TVUS as one of the main techniques to evaluate deep endometriosis. Results 243 studies were identified and selected as described above, resulting in a total of 73 studies included in this review. Conclusions and outlook Our understanding of deep endometriosis has evolved over the past decade. Efforts have been made to reduce the diagnostic delay in this common disease, particularly with the increased use of imaging, especially transvaginal ultrasound, as a first-line diagnostic modality because of its availability, good test performance, cost-effectiveness, and low environmental impact compared to other imaging modalities. This statement is supported by recent publications and guidelines from some medical societies. Advances in technology, equipment and research have allowed us to identify additional compartments involved, including the parametrium. The progress made in recent years offers hope for earlier detection and improved management of patients with suspected endometriosis who suffer not only from pelvic pain but also from infertility.

Objectives: To evaluate the impact of a comprehensive intervention using nursing-sensitive quality indicators on pregnant women with hepatitis B and their newborns.

Design: A randomized controlled monocentric trial conducted from January 2020 to May 2022. Participants/Materials: 80 pregnant women diagnosed with hepatitis B were randomly assigned to either a control group (n=40) or an experimental group (n=40). The experimental group received care-sensitive quality indicators during treatment.

Setting: Department of Traditional Chinese Medicine, Nantong Third People's Hospital, affiliated with Nantong Hospital 3 of Nantong University, Jiangsu, China.

Methods: Participants in the experimental group received daily Tenofovir from late pregnancy to early postpartum, and newborns received hepatitis B vaccine and immunoglobulin within 24 hours of birth. Healthcare personnel underwent six months of training on care-sensitive quality indicators. The effectiveness of the intervention was assessed using various indicators such as health education coverage, antiviral medication compliance, follow-up rates, and psychological health.

Results: The results showed that after comprehensive intervention, the coverage rate of health education increased from 82.50% before intervention to 92.50% (P=0.033), and adherence to antiviral medication improved from 82.50% to 97.50% (P=0.000). The follow-up rate for hepatitis B mothers also significantly increased from 80.00% to 95.00% (P=0.001). In addition, the incidence of negative emotions such as anxiety and depression among pregnant women significantly decreased from 57.50% to 30.00% (P=0.000). These findings demonstrate the effectiveness of comprehensive interventions in improving health education coverage and participation, enhancing adherence to antiviral medication, and effectively reducing the psychological burden of pregnant women. Moreover, after the intervention, the awareness of mother-to-child transmission prevention for hepatitis B significantly increased from 82.36 points before intervention to 94.32 points after intervention (P=0.000). At the same time, adherence to neonatal immunization increased from 80.00% to 95.00%, and satisfaction with nursing services improved from 90.66 points to 98.64 points (P=0.000). These results indicate that comprehensive interventions significantly enhance knowledge related to mother-to-child transmission prevention, increase immunization adherence, and improve satisfaction with nursing services.