Gynecologic and Obstetric Investigation最新文献

Objectives: Women with prepregnancy 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: This was a 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: PCOS confers a modest but significant increase in SMM, 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.

Objectives: To explore the relationship between brain structural connectivity and polycystic ovary syndrome (PCOS).

Design: Two-sample Mendelian randomization (2SMR) was conducted by querying a relevant European population genome-wide association studies (GWAS) database about the anatomical connections of the brain and polycystic ovarian syndrome from the Ieu Open GWAS Project database. Two hundred six brain structural connectivity-related single-nucleotide polymorphisms (SNPs) were evaluated as instrumental variables (IVs).

Methods: To investigate the potential causal effect between brain structure and PCOS, we applied several statistical models, including inverse variance weighting (IVW), weighted median (WME), MR-Egger regression, simple mode, and weighted mode approaches.

Results: IVW analysis indicated significant associations between certain white matter tracts and PCOS risk, including the connection between the right default mode network and the amygdala (OR = 1.559; 95% CI = 1.028-2.36; p = 0.037), as well as the pathway linking the right somatomotor and limbic networks (OR = 1.800; 95% CI = 1.077-3.009; p = 0.025). Additionally, negative correlations with PCOS risk were observed in white matter tracts involving limbic-control and limbic-thalamic connections across both hemispheres, as well as in the left somatomotor-control circuit. Horizontal pleiotropy was not detected by heterogeneity tests or sensitivity analyses that used the leave-one-out approach.

Limitations: More research involving bigger and more heterogeneous cohorts is necessary to evaluate the functional consequences of anatomical brain changes in PCOS.

Conclusion: The structural integrity of white matter tracts linking the right default mode network to the amygdala and connecting the right somatomotor and limbic networks appears to be causally associated with the development of PCOS.

Background: Stress urinary incontinence (SUI) commonly affects women's quality of life. The widespread recommendation of using non-absorbable meshes has delayed a more definitive surgical solution. Newer, less invasive biomaterial treatments show promise.

Objective: Our aim was to describe and evaluate a new urethral suspension technique called "shore-up," performed with APTOS® resorbable tensor threads on an outpatient procedure.

Design: A pilot study was conducted.

Participants: 32 SUI women, unresponsive to conservative treatment, participated in the study.

Settings: The study was conducted at the HM IMI Clinic, Toledo, Spain.

Method: Patients completed validated incontinence questionnaires (Sandvik and ISCQ SF) before and at 1, 2, 6, and 12 months post-procedure. A blinded analysis of results was conducted.

Results: Women with SUI of different degrees: mild (3/32), moderate (19/32), severe (8/32), and very severe (2/32) showed a significant improvement (p < 0.05) in scores on both tests. After 12 months, a success rate of 72% (23/32) without SUI was observed, 16% with mild (5/32) and 12% with moderate SUI (4/32). None of them required hospitalization or post-surgical assistance, and the most frequent complications were extrusion of the final thread end through the vagina in 33% (9/32), transient dyspareunia in 6% (4/31), and early suture dehiscence in 6% (2/32).

Conclusion: The shore-up technique is a promising, minimally invasive option for managing SUI, offering high efficacy, safety, and patient satisfaction.

Limitations: This is a small study, and further research is recommended to confirm these findings (ethic code 23.02.2155-GHM).

Objectives: This study aimed to combine dynamic magnetic resonance imaging (MRI) with three-dimensional (3D) reconstruction and form a plane based on osseous structures to evaluate the degree of pelvic organ prolapse (POP). The correlation of this novel evaluation approach with the POP-Q system was assessed.

Methods: A retrospective analysis was conducted on 71 POP patients with POP-Q stage ≥II. The dynamic MRI images of those patients were reconstructed in three dimensions. A plane was created by using the midpoint of the line between the inferior margins of the two pubic bones and the starting points of the superior margins of the bilateral sacrotuberous ligaments (the pubic inferior midpoint - sacrotuberous ligament starting point superior edge plane). Distances from the lowest point of the anterior vaginal wall, cervix, and rectal ampulla to this evaluation plane were measured, modeled, and categorized. The consistency and correlation of the categorized results with POP-Q scores were verified by performing a kappa analysis and Spearman's rank correlation analysis, respectively.

Results: The highest consistency with POP-Q scores was found in the prolapse of the central pelvic cavity (kappa = 0.713, p < 0.05), followed by the anterior POP (kappa = 0.427, p < 0.05), and posterior POP (kappa = 0.261, p < 0.05), with all showing statistically significant differences. The strongest positive correlation was observed between central POP and POP-Q scores (r = 0.864, p < 0.01), followed by posterior POP and POP-Q scores (r = 0.710, p < 0.01), with both exhibiting a strong positive correlation. Anterior POP and POP-Q scores showed a moderate positive correlation (r = 0.586, p < 0.01).

Conclusions: The results of the proposed evaluation method were highly consistent in the anterior and central pelvic cavities and strongly correlated in the central and posterior pelvic cavities. In particular, the assessment of the posterior cavity showed a strong positive correlation with that of the POP-Q system. The evaluation plane demonstrated high consistency and correlation with the POP-Q system.

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.

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.

Introduction: Oxytocin has long been used for the induction of labor, but it can be associated with fetal and maternal complications that could potentially be reduced by discontinuing the treatment during labor. We performed this meta-analysis to determine whether discontinuation of oxytocin, once the active phase of induced labor is achieved, affects the second stage of labor and the rate of various maternal and fetal outcomes.

Methods: We searched for randomized controlled trials (RCTs) comparing discontinuing oxytocin after the active stage of labor is established versus continuing to give oxytocin throughout the labor process using databases like PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from the inception till February 1, 2025. Results were pooled using RevMan 5.4, and the effect metric was the risk ratio (RR). Our systematic review and meta-analysis was registered with PROSPERO (CRD42024534076).

Results: Pooled analysis of fifteen RCTs included in our review showed that discontinuation of oxytocin, once the active stage of labor is established, did not reduce the primary outcome of incidence of cesarean delivery (RR = 0.91; 95% CI, 0.77-1.07; p = 0.21). The incidence of uterine tachysystole, postpartum hemorrhage, and non-reassuring fetal heart rate was significantly lower in the oxytocin discontinuation group compared to oxytocin continuation. The rates of uterine rupture, vaginal instrument use, epidural use, and neonatal intensive care unit admission did not differ among both groups. The duration of the active stage of labor was significantly prolonged in the oxytocin-discontinued group; however, the duration of the second stage of labor and total delivery time remained comparable between the two groups.

Conclusions: Discontinuation of oxytocin during the active phase of labor did not reduce the incidence of cesarean section or neonatal morbidity. We therefore recommend an individualized approach regarding oxytocin discontinuation while factoring in patient-specific factors. New large-scale RCTs focusing on identifying subgroups that might benefit from one approach over the other are required to provide more reliable results.

Objectives: Endometriosis is a chronic gynecological condition characterized by abnormal angiogenesis and cell adhesion processes driven by VEGF-VEGFR-2 signaling. cabergoline, a dopamine agonist, has been shown to inhibit angiogenesis in endometriosis. This study investigates the therapeutic potential of cabergoline in modulating these pathways to mitigate endometriotic lesion progression and improve oocyte quality.

Design: A randomized, placebo-controlled study was conducted, involving two groups of participants: one receiving cabergoline treatment and the other receiving a placebo.

Methods: Eutopic endometrial tissue from women diagnosed with endometriosis was analyzed. VEGFR-2, FAK, PXN, ITGB3, and ITGAV expression levels were measured using qPCR. DNA methylation at the VEGFR-2 promoter was assessed using high-resolution melting analysis to examine epigenetic modifications. Western blot analysis was performed to evaluate the phosphorylation status of tyrosine residue 951 on the VEGFR-2 receptor, which is implicated in cell migration and survival. Oocyte quality was also assessed in both groups.

Results: Cabergoline treatment reduced the expression levels of VEGFR-2, FAK, PXN, ITGB3, and ITGAV, with ITGAV showing a statistically significant decrease (p = 0.0174). Hypomethylation of the VEGFR-2 promoter was observed in the treatment group (p = 0.3566). However, phosphorylation of tyrosine residue 951 on VEGFR-2 significantly increased in the cabergoline-treated group (p = 0.004). Notably, oocyte quality significantly improved in the cabergoline group (p = 0.0318). A strong correlation was found between reduced VEGFR-2 expression (p = 0.0184), decreased promoter methylation (p = 0.0159), and downregulation of PTK2 expression (p = 0.0057), all of which are associated with improved oocyte quality.

Limitations: The sample size was limited, and additional long-term studies are needed to confirm the therapeutic potential of cabergoline in endometriosis treatment.

Conclusions: Cabergoline may enhance oocyte quality by modulating key regulators of the angiogenic pathway. These findings suggest its potential role in the management of endometriosis-related infertility, warranting further clinical investigation.

Objectives: The objective of this study was to explore the lymph node metastasis (LNM) and related risk factors of low-grade endometrioid endometrial carcinomas (EECs) and analyse the efficacy of related risk factors in predicting LNM.

Design: Data from 424 patients with low-grade EEC treated between January 2019 and June 2024 were retrospectively analysed, according to the International Federation of Gynecology and Obstetrics (FIGO) 2009.

Methods: Univariate and multivariate logistic regression analyses were used to examine the factors associated with LNM. Receiver operating characteristic (ROC) curves were plotted to assess the predictive efficacy of independent risk factors for LNM.

Results: The rate of LNM was 7.8% (33/424). Histological grade, tumour size, depth of myometrial invasion, cervical stromal invasion, lymphovascular space invasion (LVSI), microcystic, elongated, fragmented (MELF) pattern, carbohydrate antigen 125 (CA125), carbohydrate antigen 199, and human epididymis protein 4 were associated with LNM. However, only LVSI, MELF pattern, depth of myometrial invasion, and CA125 were identified as independent risk factors. The area under the ROC curve for CA125 and depth of myometrial invasion was 0.796 and 0.734, respectively. The optimal cut-off value for CA125 was 31.36 U/mL, with a maximum Youden index of 53.9%. Combining CA125 with depth of myometrial invasion improved diagnostic accuracy compared to either parameter alone.

Limitations: This is a single-center retrospective study.

Conclusions: LNM is more likely with independent risk factors. Combining CA125 and depth of myometrial invasion enhances diagnostic accuracy for LNM. This study provides valuable insights for predicting LNM risk in low-grade EEC patients and guiding stratified management.