Gynecologic and Obstetric Investigation最新文献

Objectives: To evaluate whether ultrasound-based #Enzian classification predicts pain profiles and response to hormonal therapy in patients with endometriosis. Endometriosis is a chronic inflammatory disease affecting 10% of reproductive-age women, often causing debilitating pelvic pain. Although #Enzian is validated for surgical planning, its predictive role in medical therapy remains unexplored.

Design: Retrospective cohort study including 89 premenopausal patients referred between 2018-2023. Hormonal therapies included progestin-only pills (Dienogest - POP-D or other progestins - POP-O), combined estrogen-progestin pills (Dienogest - EP-D or other EP-O), or norethisterone acetate (NETA). Pain assessed via 0-10 VAS at baseline, ≥3 months, and ≥6 months.

Participants/materials, setting, methods: Patients had ultrasound-confirmed endometriosis and were hormone therapy-naïve for ≥6 months. Baseline evaluation included demographic data, reproductive history, prior surgeries, and six pain domains. #Enzian classification mapped lesion location and size (A: rectovaginal/vagina; B: uterosacral/parametria; C: rectum; FA: adenomyosis; FB: bladder; FU: ureter; FI: intestine above rectum; FO: extra-pelvic; O: ovary; P: peritoneum; T: fallopian tubes/adhesions). Linear regression and linear mixed-effects models assessed associations between #Enzian compartments and pain trajectories.

Results: Dysmenorrhea occurred in 86.5%, dyspareunia in 56.2%. Ovarian endometriomas (O) were present in 76.4%, DIE (A, B, C) in 51.7%, adenomyosis (FA) in 66.3%. POP-D was most effective in reducing ovulatory pain in ovarian (O), uterosacral/parametria (B), rectal (C), and tubal/adhesion (T) involvement, while EP-D was superior for dyspareunia in T. Chronic pelvic pain remained refractory. Higher total #Enzian scores correlated with reduced therapy efficacy.

Limitations: Retrospective design, single-center, small sample, use of aggregated pain scores, and incomplete follow-up may limit generalizability.

Conclusions: Ultrasound-based #Enzian classification correlates with lesion distribution and predicts hormonal therapy efficacy. POP-D therapy is superior at lower #Enzian scores; chronic pelvic pain remains challenging. Findings support individualized medical management and warrant prospective validation including multidimensional pain and quality-of-life assessments.

Objective: To establish reference values for bile acids and bilirubin levels in amniotic fluid and to assess their correlation to amniotic fluid digestive enzymes in normal pregnancies as a foundation for future diagnostic studies.

Methods: This prospective cross-sectional study included pregnant women with a singleton pregnancy at 17-23 weeks' gestational age who underwent amniocentesis. Levels of bile acids, total bilirubin, direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, and γ-glutamyltransferase were assessed. Gestational age reference ranges were established for bile acids and bilirubin levels.

Results: A total of 133 women were recruited. The most common indication for amniocentesis was advanced maternal age. The 5th, 50th, and 95th percentile of bile acids for the entire cohort was 1.3, 7.2, and 30.8 µM, respectively. There was no significant change in bile acid levels throughout gestational weeks. Mean, standard deviation, and median values for all hepatobiliary enzymes were calculated. On regression analysis a significant positive correlation between bile acids and GGT was found.

Conclusion: Reference values for amniotic fluid bile acids and bilirubin at 17-23 weeks in normal pregnancies were established. The significant correlation between bile acids and GGT, combined with the direct biological relevance of bile acids in biliary pathology, suggests potential utility as complementary or alternative biomarkers in pregnancies complicated with non-visualization of the fetal gallbladder.

Background: Dysmenorrhea is a debilitating symptom in patients with endometriosis, contributing significantly to disease burden. While the relationship between body mass index (BMI) and dysmenorrhea in these patients is unclear, emerging evidence suggests BMI may be correlated with pain in the presence of endometriosis.

Objective: This systematic review and meta-analysis aimed to evaluate the association between BMI and dysmenorrhea in women with endometriosis.

Search strategy: We systematically searched PubMed, Scopus, Web of Science, and Google Scholar from inception to November 15, 2024.

Selection criteria: Eligible studies for this review included original observational articles reporting outcomes related to the prevalence of dysmenorrhea in relation to body weight in patients with confirmed endometriosis.

Data collection and analysis: Data for a two-way contingency table were extracted from the articles, and odds ratios (ORs) for the association between BMI categories and dysmenorrhea were calculated. These individual ORs were pooled using a random-effects model.

Main results: Six studies involving 2,274 women with endometriosis were included. The meta-analysis revealed that underweight individuals with endometriosis had significantly higher odds of experiencing dysmenorrhea compared to non-underweight patients (OR = 1.38, 95% CI = 1.05 to 1.80, I² = 0.00%) or to those with normal weight (OR = 1.39, 95% CI = 1.05 to 1.83, I² = 0.00%). No significant association was found between dysmenorrhea and overweight or obese individuals. Sensitivity analyses showed variability in the findings based on the exclusion of certain studies. No publication bias was detected in the analysis.

Conclusions: There was an association between underweight status and dysmenorrhea in endometriosis. We speculate that managing weight and nutrition may be useful in mitigating dysmenorrhea symptoms. However, due to the study limitations, prospective trials are needed to test the ability of diet to alleviate pain.

Objectives: Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder affecting up to 10% of women of reproductive age, commonly associated with visceral obesity, insulin resistance, and chronic low-grade inflammation. Sodium butyrate, a microbial-derived short-chain fatty acid, has been proposed as a therapeutic agent due to its anti-inflammatory and metabolic regulatory properties. However, its efficacy under hyperandrogenic and proinflammatory conditions remains uncertain.

Design: Experimental study using female BALB/c mice. Forty animals were allocated into five groups: control (CT), high-fat diet (HFD), dehydroepiandrosterone (DHEA), butyrate without PCOS (BUT), and butyrate with PCOS (DHEA+BUT).

Participants/materials, setting, methods: Animals received a high-fat diet (except CT), and hyperandrogenism was induced by DHEA. Sodium butyrate was administered via oral gavage during the last 40 days of the protocol. Body weight, glucose tolerance, adipose tissue mass and morphology, serum adipokines, inflammatory gene expression, and gut microbiota profiles were assessed.

Results: Butyrate-treated groups, particularly DHEA+BUT, exhibited greater body weight gain and significant expansion of subcutaneous, visceral, and brown adipose depots (p < 0.01). Adipose morphometry showed reduced adipocyte number with preserved diameter, indicative of hypertrophy, accompanied by elevated IL-6 and TNF-α expression in visceral fat (p < 0.01). Leptin levels tended to increase, while adiponectin was significantly reduced in the DHEA+BUT group. Glucose tolerance was impaired in all high-fat diet groups, with the BUT group showing the highest glycemic peaks. Although butyrate increased gut microbial diversity, it failed to prevent metabolic or inflammatory dysfunction.

Limitations: The modest number of animals per group reduced statistical power, reflecting constraints in breeding and availability of age-matched BALB/c mice. Their relatively small adipose depots limited tissue yield for molecular and histological assays. Daily oral gavage, required for precise dosing, was technically challenging and led to the loss of one DHEA+BUT animal. Microbiota sequencing was performed in only one animal per group due to high costs, limiting the strength of conclusions regarding microbial changes. Finally, lean mass composition was not directly assessed, although depot weights strongly support adipose expansion.

Conclusions: In this model of pre-established obesity and hyperandrogenism, butyrate supplementation was not metabolically protective. Instead, it was associated with worsened adipose inflammation, altered adipokine profiles, and impaired glucose regulation. These findings highlight the context-dependent nature of butyrate's effects and caution against its generalization as a universally beneficial metabolic modulator.

Introduction Investigation of the number of oocytes recovered from different ovarian stimulation (OS) protocols is essential, as oocyte number is positively associated with the number of good-quality embryos obtained; however, there are few data comparing the number of oocytes retrieved following OS with recombinant or urinary gonadotropins. Methods A systematic review and meta-analysis of published evidence was performed to compare the number of oocytes retrieved with recombinant human follicle stimulating hormone:recombinant human luteinizing hormone (r-hFSH:r-hLH) in a 2:1 ratio versus highly purified human menopausal gonadotropin (HP-hMG) alone from Day 1 of OS. The literature search was conducted according to PRISMA guidelines (https://www.prisma-statement.org/) using Medline, EMBASE, Biosis, Scisearch, and TOXCENTER on STN. Studies were included if they reported on r-hFSH:r-hLH in a 2:1 ratio versus HP-hMG alone, both administered from Day 1 of OS, and the results for the number of oocytes retrieved were presented for both interventions. Data were extracted from the full articles independently by two reviewers (JES and BH). Results were analyzed using a random-effects meta-analysis model. Any potential risk of bias was assessed using the ROBINS-I tool. Secondary outcomes were the number of mature (MII) oocytes, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate. Results Six studies were included in the meta-analysis (5287 cycles): four non-interventional studies, one non-interventional cross-over study and one randomized controlled trial. The number of oocytes per cycle was significantly higher in women treated with r-hFSH:r-hLH 2:1 compared with those treated with HP-hMG alone (mean difference 1.43, 95% CI 0.18-2.69; P = 0.025). Clinical pregnancy rate per started cycle was significantly higher with r-hFSH:r-hLH 2:1 compared with HP-hMG (rate ratio 1.18, 95% CI 1.06 to 1.33; P = 0.004; five studies). There were insufficient data to draw any firm conclusions on the other secondary outcomes. Conclusions The higher number of oocytes retrieved with r-hFSH:r-hLH is a pertinent finding, owing to the well-established positive association between oocyte number and reproductive outcomes. Although we report a higher clinical pregnancy rate for r-hFSH:r-hLH, limited data prevented us from drawing firm conclusions regarding live birth outcomes.

Objective: To investigate the association between maternal vitamin D status and fetal cortical maturation using detailed neurosonographic assessment at 28-30 weeks of gestation.

Methods: This prospective observational study included 422 singleton pregnancies evaluated between 28 and 30 gestational weeks. Maternal serum 25-hydroxyvitamin D [25(OH)D] was measured by chemiluminescence immunoassay and categorized as deficient (< 20 ng/mL), insufficient (20-30 ng/mL), or sufficient (> 30 ng/mL). Fetal neurosonography was performed with a GE Voluson E8 system to quantify sulcal depths (insula, Sylvian, parieto-occipital, calcarine, and cingulate fissures), corpus callosum thickness, cavum septum pellucidum length, operculization, and cortical maturation grades. Inter-observer reliability, correlation, regression, and ROC analyses were conducted.

Results: Of 422 women, 280 (66.4 %) were vitamin D deficient, 110 (26.1 %) insufficient, and 32 (7.6 %) sufficient. Deficient participants showed significantly lower mean insula, parieto-occipital, and calcarine fissure depths and thinner corpus callosum (p < 0.05). Operculization and cortical maturation grades were also reduced (p = 0.02 and p = 0.01, respectively). Maternal 25(OH)D levels positively correlated with calcarine fissure depth (r = 0.42, p < 0.001) and cortical maturation grade (r = 0.45, p < 0.001). After adjustment for gestational age, vitamin D deficiency independently predicted low cortical maturation (≤ grade 3) (adjusted OR 2.56, 95 % CI 1.34-4.89, p = 0.004). ROC analysis demonstrated good discriminatory ability (AUC = 0.74, p < 0.001), with an optimal vitamin D threshold of ≈ 21 ng/mL yielding 78 % sensitivity and 65 % specificity.

Conclusion: Maternal vitamin D deficiency during the late second to early third trimester is associated with delayed fetal cortical sulcation and reduced operculization grades. Quantitative neurosonography can noninvasively identify early neurodevelopmental vulnerability related to suboptimal maternal vitamin D status, supporting the role of adequate vitamin D as a modifiable determinant of fetal brain development. Given the high prevalence of hypovitaminosis D observed in this cohort, assessment of maternal 25(OH)D levels may be justified in high-risk or high-prevalence populations. Based on commonly applied clinical thresholds, supplementation of approximately 600 IU/day for vitamin D-sufficient women, 1,000 IU/day for those with insufficiency, and 1,500-2,000 IU/day for deficient women may be considered.

Introduction: To evaluate the effect of obesity on vaginal myomectomy (VM) results.

Methods: Patients who underwent VM for uterine leiomyomas were enrolled in the study. Demographic characteristics of patients, leiomyoma-related properties, and operative and postoperative parameters were retrieved from medical records. The study population was divided into two groups according to BMI: patients with BMI <30 kg/m² and patients with BMI ≥30 kg/m². The two groups were compared in terms of preoperative patient characteristics, operative parameters, and postoperative outcomes.

Results: A total of 156 patients matched the study inclusion criteria, with 108 patients having BMI <30 kg/m² and 48 patients having BMI ≥30 kg/m². The mean BMI was 23.9 kg/m² for Group 1 and 34.5 kg/m² for Group 2 (p = 0.001). The mean operation time was 65.2 minutes in patients with BMI <30 kg/m² and 79.9 minutes in patients with BMI ≥30 kg/m², and operation time was significantly shorter in favor of patients with BMI <30 kg/m² (p = 0.001). In addition, the mean hospitalization time was 24.0 hours for Group 1 and 36.0 hours for Group 2, and statistical analysis revealed that hospitalization time was significantly longer in patients with BMI ≥30 kg/m² (p = 0.001).

Conclusion: The present study showed that VM is a reliable and efficacious surgical technique in the management of uterine leiomyomas. However, our findings revealed for the first time that obesity resulted in significantly longer operation time and significantly longer hospitalization time in patients who underwent VM.

Objectives: The aim of this study was to evaluate the clinical outcomes of salvage surgery for localized recurrent ovarian clear cell carcinoma (OCCC), a chemoresistant subtype with poor prognosis.

Design: We retrospectively analyzed 75 patients who underwent primary surgery for OCCC between January 1996 and December 2022.

Participants and methods: Twenty-two patients experienced recurrence after complete resection, of whom 10 met the institutional criteria for localized, resectable recurrence and underwent 17 salvage procedures. The clinical characteristics, surgical outcomes, and survival data were also reviewed. Progression-free survival (PFS) and post-recurrence survival (PRS) were analyzed using the Kaplan-Meier method.

Results: Complete resection was achieved in all procedures. The median PFS after the first salvage surgery was 30 months and the median PRS was not reached. Four patients underwent a second and third salvage surgery, with several achieving long-term disease control or remaining disease-free. At the last follow-up, 7 of the 10 patients were alive without evidence of disease, including multiple survivors beyond five years. In contrast, the chemotherapy-only cohort (n = 12) showed a median PFS of 5 months and PRS of 10 months. No perioperative mortality occurred, and all complications were Clavien-Dindo grade II or lower.

Conclusion: Salvage surgery for localized recurrent OCCC can achieve durable disease control and long-term survival in carefully selected patients, particularly when complete resection is possible. Even in chemoresistant diseases, repeated cytoreductive surgery may offer meaningful benefits, supporting its role as a viable treatment option within a multidisciplinary framework.

Objectives: Human papillomavirus (HPV) infection establishes persistent infection in cervical epithelial cells, leading to Deoxyribonucleic Acid (DNA) damage, inflammation, and oxidative stress. This process predisposes to the development of precancerous lesions. Melatonin is believed to play a role in this pathogenesis, as it can inhibit viral persistence by reducing oxidative damage and modulating the immune response. This study aimed to investigate the effect of melatonin levels in cervicovaginal fluid on HPV infection leading to High-grade Squamous Intraepithelial Lesion (HSIL).

Design: A total of 89 women aged 22-55 years were enrolled and divided into three groups: HPV-positive with HSIL (n=30), HPV-positive without HSIL (n=30), and HPV-negative controls (n=29)-prospective experimental melatonin marker study. Participants/Materials: Three groups were formed. The two HPV-positive groups were divided into those that developed HSIL and those that did not. The control group was then considered HPV and HSIL negative.

Setting: The study was conducted at the Department of Obstetrics and Gynecology, Selçuk University Faculty of Medicine,2025.

Methods: Melatonin levels were measured in all three groups. A total of 89 people were evaluated in the study, with 30 patients in each of the two HPV-positive groups and 29 patients in the control group.

Results: No sociodemographic difference was found between the groups (p>.05). Melatonin levels were lower in the group developing HSIL than in the group not developing HSIL and the control group (p<.05).

Limitations: However, this study is limited by a single-time measurement, a relatively small sample size, and a single-center design, which may restrict the generalizability of the findings.

Conclusion: Low cervico-vaginal melatonin levels were significantly associated with HSIL progression, suggesting its potential role as a biomarker.