Gynecologic and Obstetric Investigation最新文献

Objective: To evaluate the clinical outcomes of salvage surgery for localized recurrent ovarian clear cell carcinoma (OCCC), a chemoresistant subtype with poor prognosis.

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

Objectives: Women with pre-pregnancy polycystic ovary syndrome (PCOS) may face higher risks during pregnancy, yet evidence on its link to severe maternal morbidity (SMM) is limited. This population-based study addresses these gaps.

Design: Population-based cohort study using linked administrative health data from Ontario, Canada. All hospital livebirths and stillbirths 2006-2021, in women aged 15-50 years were included.

Participants/materials, setting, methods: PCOS was identified using a validated algorithm combining diagnostic codes for PCOS or hirsutism with irregular menses. Among 1,596,228 pregnancies, 110,910 (6.9%) had prior PCOS, diagnosed a median 11 years before delivery.

Results: Women with PCOS were older and more often obese. SMM occurred in 2.6 vs. 2.2 per 100 births among women with and without PCOS, respectively (adjusted relative risk 1.10, 95% CI 1.06-1.15).

Limitations: Limitations include potential residual confounding and misclassification inherent in administrative data.

Conclusions: Polycystic Ovary Syndrome confers a modest but significant increase in severe maternal morbidity, underscoring the need for targeted risk assessment and preventive strategies. Awareness of this association may inform clinical risk assessment and management strategies to mitigate serious maternal complications.

The article "A Prospective Comparative Study on IVF Outcomes with Either Purified FSH or Human Menopausal Gonadotrophin in Downregulated Normogonadotrophic Women" [Gynecol Obstet Invest. 2002;53:220-223; https://doi.org/10.1159/000064568] by Aboul Foutouh Ismail, Al-Inany Hesham, Zaki Salah, M. Khaled, Nahas Fouad, Nasr Ashraf, Shawky Hatem and Badrawi Hamdi has been retracted by the Publisher and the Editor. Following publication, concerns were raised regarding a significant difference between intervention groups in the average number of embryos transferred. When asked to comment, the corresponding author stated that they believed the value of transferred embryos in the Menogon group in the article is likely to be incorrect and that the data underlying the study are no longer available due to the time elapsed since the study was conducted. As the concerns raised cannot be addressed or resolved, and due to the relevance of this difference for the conclusions of the study, the reliability of the findings presented in the article cannot be guaranteed and the article is being retracted. Hesham Al-Inany disagrees with the retraction. The remaining authors could not be reached for comment regarding this retraction.

The article "Evaluation of Serum Nidogen-2 as a Screening and Diagnostic Tool for Ovarian Cancer" [Gynecol Obstet Invest. 2018;83:461-465; https://doi.org/10.1159/000481798] by Haitham A. Torky, Ahmed Sherif, Ashraf Abo-Louz, Mohamed Ali, Ali Ahmed, and Ahmad Ali has been retracted by the Publisher and the Editors.Following publication, concerns were raised about a higher-than-expected frequency of even numbers for the dichotomous variables reported in the article. When asked to comment on this and provide the original data, the corresponding author stated that the data is not available. As the concerns raised cannot be addressed or resolved, the reliability of the findings presented in the article can not be guaranteed and the article is being retracted.The authors did not respond to correspondence about this retraction within the timeframe specified.

Objectives: The aim of this study was to investigate the ovarian response in different phases of the menstrual cycle in breast cancer women candidates for fertility preservation.

Design: A retrospective study was carried out, including women with breast cancer undergoing oocyte cryopreservation at the Fertility Preservation Unit of the University of Naples Federico II between 2017 and 2023.

Participants/materials, setting, methods: Women who started ovarian stimulation (OS) during the follicular phase (FP) were compared with those who started during the luteal phase (LP). The two study groups were further stratified according to the phase of the menstrual cycle at OS initiation: early (day 1-5, EFP) or late follicular phase (day 6-14, LFP), early (day 15-21, ELP) or late luteal phase (day 22-32, LLP). The primary outcome was oocyte recovery.

Results: A total of 113 women who underwent fertility preservation for breast cancer were included. No differences in oocytes retrieved and ovarian sensitivity were observed when comparing follicular and luteal phases. No differences were observed regarding oocytes retrieved and ovarian sensitivity among the four groups divided according to the menstrual cycle phase. OS was significantly shorter in the early follicular phase (9 days; 8-10) than in the other menstrual phases (LFP: 10 days, 9-11, p < 0.04; ELP: 11, 9-11, p < 0.004; and LLP: 11 days, 10-12, p < 0.001).

Limitations: Our study's limitations are its small sample size and retrospective design.

Conclusions: The phases of the menstrual cycle at which OS was started did not affect oocyte yield and ovarian sensitivity in women with breast cancer undergoing a random-start protocol with letrozole.

Background: Vitamin D deficiency during pregnancy has been linked to adverse maternal-fetal outcomes. However, it remains unclear whether standard supplementation mitigates risks equally in patients with differing baseline 25-hydroxyvitamin D [25(OH)D₃] levels.

Objectives: The objective of this study was to determine whether differences exist in obstetric outcomes and pregnancy-related disorders among patients with different levels of 25(OH)D₃ in the first trimester who receive standard supplementation.

Design: This retrospective comparative cohort study involves pregnant women aged 16-50 years who received prenatal care at a semiprivate hospital in Northeastern México between January 2022 and December 2024.

Participants/materials, setting, methods: Participants were grouped based on first-trimester serum 25(OH)D₃ levels (≥30 ng/mL vs. <30 ng/mL), all receiving standard 25(OH)D₃ supplementation (4,000 IU/day). For comparisons between groups, we performed independent samples t-tests or Mann-Whitney U tests for quantitative variables and chi-square tests for qualitative variables. A multivariate logistic regression analysis was conducted to identify predictors of adverse obstetric outcomes.

Results: A total of 303 women (mean [standard deviation] age 29.3 [5.4] years) were analyzed, divided almost equally between first-trimester 25(OH)D₃ deficient group (n = 151) and the sufficient group (n = 152), with similar baseline characteristics. Although insufficient 25(OH)D₃ women reached sufficiency during the second and third trimesters, sufficient women maintained significantly higher serum 25(OH)D₃ levels throughout pregnancy (p < 0.001) and had lower rates of preeclampsia (1.3% vs. 10.6%, p < 0.001), gestational diabetes (8.6% vs. 24.5%, p < 0.001), preterm labor (0% vs. 5.3%, p = 0.003), urinary tract infections (4.6% vs. 14.6%, p = 0.003), and bacterial vaginosis (3.9% vs. 13.2%, p = 0.004). Logistic regression confirmed first-trimester 25(OH)D₃ sufficiency as independently protective against adverse outcomes (OR = 0.21, 95% CI: 0.10-0.43, p < 0.001).

Conclusions: First-trimester 25(OH)D₃ sufficiency was associated with reduced risk of obstetric complications, compared with women with insufficiency, even when the last achieved sufficiency in the second and third trimester. These findings highlight the importance of early screening and support the need for personalized supplementation strategies before conception to optimize maternal-fetal outcomes.

Background: The nature and functions of the innermost layer of the myometrium, which is located immediately below the endometrium, coined the "junctional zone" (JZ), continue to be the subject of debate. The role and significance of the JZ have attracted little attention beyond its relation to the diagnosis of adenomyosis.

Objectives: This review was conducted to update our current understanding of the role of the JZ as a specific uterine region.

Methods: This is a comprehensive review of literature that was published in PubMed and MEDLINE platforms till April 2025 and that addresses the uterine JZ, excluding articles concerned with uterine adenomyosis.

Outcome: It is not possible to reconcile JZ appearance on imaging with embryological or functional correlates. There are clear histological and immunohistological differences between the inner and outer myometrium, but the change is gradual with no demarcation of the transition. Whether the JZ has a different origin remains controversial because of the lack of supportive embryological evidence. There is evidence that JZ appearance on MRI is hormonally dependent, but it is not always recognizable and is often indistinct before puberty and after menopause. JZ seems to increase in thickness in the secretory and menstrual phases.

Conclusion: While increased thickness is often considered a sign of adenomyosis, considerable uncertainty remains. We have not been able to identify studies that related features of the JZ per se to clinical outcomes. This supports the need for caution when interpreting the relevance of the JZ.

Background: In the field of polycystic ovary syndrome (PCOS), metformin and myo-inositol are frequently employed to treat the endocrine-metabolic aspects of the condition. Accordingly, myo-inositol is sometimes considered as a nutraceutical alternative for metformin. Both compounds have undergone repurposing efforts to identify new applications; however, the mechanisms of both these compounds differ considerably, as does their potential in conditions outside of PCOS.

Objectives: This paper discusses contrasts both molecules in terms of mechanism, possible adverse effects, and novel indications, with an aim of detangling the unique properties of each molecule.

Methods: A narrative review was conducted independently by the authors using the search platforms PubMed, Google Scholar, and Web of Science between August and November 2024.

Conclusions and outlook: Myo-inositol has a more acceptable safety profile than metformin, which is known to be associated with gastrointestinal adverse effects and, in rare cases, lactic acidosis. Myo-inositol is a naturally present molecule in physiological conditions, which underlines its importance in a variety of biological functions, as opposed to the strict pharmacological action of metformin. Both myo-inositol and metformin have been investigated in several pathological fields, particularly in gynecology where they may improve pregnancy outcomes and fertility care. The safety profile of these molecules seems quite different since data, even if incomplete, sustain high tolerance of myo-inositol, while the safety of metformin use during pregnancy is still controversial. However, further study is required to fully understand the potential of each of these molecules, specifically within the fields of mental health and oncology.

Objective: The aims of this study were to investigate influence of placental position and type on occurrence of placenta accreta spectrum (PAS) and to analyze their correlation with adverse perinatal outcomes.

Methods: This retrospective study included 270 pregnant women who delivered at the Affiliated Hospital of Guangdong Medical University and Huizhou Central People's Hospital between January 2021 and December 2023. Placental position, type, and related imaging features were assessed using magnetic resonance imaging (MRI) and compared with PAS and perinatal outcomes. Logistic regression was used to analyze the associations between placental position, type, and PAS, as well as adverse outcomes.

Results: There were significant differences between the PAS group and the non-PAS group in terms of pregnancy history, cesarean section history, delivery history, history of placenta previa, antepartum hemorrhage, and intraoperative blood loss. Lateral wall/fundus placenta location (OR = 4.984, 95% CI: 1.376-18.050, p = 0.014) and complete placenta previa (OR = 3.160, 95% CI: 1.321-7.558, p = 0.010) were significantly associated with the occurrence of PAS.

Conclusion: Placental location and the type of placenta previa were significantly associated with the occurrence of PAS and adverse perinatal outcomes. In future clinical management, particular attention should be paid to placental location and type, especially in cases of lateral wall/fundus placenta and severe placenta previa. Individualized monitoring and intervention strategies should be implemented to improve both PAS-related and overall perinatal outcomes.