Gynecologic and Obstetric Investigation最新文献

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.

Introduction: Triggering final oocyte maturation is a critical step in in vitro fertilization-embryo transfer (IVF-ET), especially for optimizing outcomes in patients with poor ovarian response or low oocyte maturation. The double trigger protocol, combining a GnRH agonist with human chorionic gonadotropin (hCG), has been proposed to enhance oocyte quality and improve reproductive outcomes compared to hCG alone. Our review aimed to evaluate the efficacy of the double trigger compared to hCG-only trigger on reproductive outcomes in patients undergoing IVF-ET.

Methods: A systematic review and meta-analysis were conducted using PubMed, Scopus, and Google Scholar up to June 15, 2025. Studies comparing double trigger to hCG-only trigger were included. Outcomes such as the number of oocytes retrieved, MII oocytes, 2PN embryos, and day-3 top-quality embryos (TQEs) were analyzed using mean difference (MD), while clinical pregnancy rate was evaluated using odds ratio (OR). Risk of bias was assessed using RoB-2 and ROBINS-I tools. Meta-analysis was performed with a random-effects model in RevMan, and certainty of evidence was evaluated using GRADE. The review was registered with PROSPERO (CRD420251071480).

Results: Six studies involving a total of 352 patients were included. In poor ovarian responders, the double trigger protocol significantly increased the number of oocytes retrieved (MD 0.49; p = 0.02) and MII oocytes (MD 0.62; p = 0.005). Among normo-responders with low oocyte maturation, the double trigger significantly improved MII oocytes (MD 5.08; p = 0.03), 2PN embryos (MD 4.70; p < 0.0001), TQEs (MD 1.46; p = 0.01), and clinical pregnancy rate (OR 5.75; p = 0.009).

Conclusion: The double trigger protocol may improve certain reproductive outcomes compared to hCG-only triggering, particularly among poor ovarian responders and normo-responders with low oocyte maturation. These findings suggest that double trigger could be considered a potential personalized strategy in selected IVF populations, although further high-quality studies are needed to confirm its effectiveness.

Introduction: Lymphocele is one of the complications after lymphadenectomy for female pelvic malignancies. In recent years, some studies indicated that the use of biomedical materials during surgery for gynecological malignancies may help to reduce the occurrence of lymphatic cysts, but results were inconsistent. The aim of the study was to evaluate the correlation between the use of biomedical materials intraoperatively and formation of lymphocele after lymph node dissection in patients with gynecological malignancies.

Methods: We conducted a systematic search of 4 electronic databases (PubMed, Web of science, EMBASE, Cochrane Library) for articles published before April 14, 2025. We included randomized controlled clinical trials (RCTs) on the results of lymphatic cysts after the application of biomedical materials for gynecological malignant patients undergoing lymph node dissection. Statistical analyses were conducted using the RevMan 5.3 software.

Results: Ten randomized controlled studies were finally included in the present study. A total of 879 patients (from 10 studies) with gynecological cancer who underwent pelvic lymph node dissection and/or para-aortic lymph node dissection were included in the meta-analysis. Pelvic lymphoceles were diagnosed in 249 (28.3%) patients. The symptomatic lymphocele incidence proportion was 6.4% (47/731). The lymphocele incidence of biomedical material group was significant lower compared with control group (432 vs. 447 cases, OR 0.68, 95% CI: 0.50-0.93, p = 0.02, data derived from 10 studies), while symptomatic lymphocele incidence was not significantly different between the two groups (358 vs. 373 cases, OR 0.66, 95% CI: 0.39-1.10, p = 0.11, data derived from 9 studies). In the subgroup analysis, the incidence difference of lymphoceles between the biomedical material group and control group showed significant association with extension of nodes dissection (p = 0.02) and diagnosis time after surgery (p = 0.02).

Conclusions: The present meta-analysis supports that the use of biomedical materials is effective in reducing the incidence of lymphocele after lymphadenectomy due to gynecologic cancer, and subgroup analysis found the reduction was more significant in the group without para-aortic lymph node dissection, and in the short term after surgery. Further well-designed clinical studies are required to confirm our conclusions.

Objectives: This prospective cohort study aimed to identify key factors influencing the success rate of external cephalic version (ECV) and to evaluate its impact on the mode of delivery and maternal-neonatal outcomes.

Design: A prospective cohort study was conducted. Participants/Materials: The study enrolled 62 pregnant women with singleton breech presentations at or beyond 37 weeks of gestation who consented to undergo ECV. A convenience sample of 12 women with cephalic presentations was also enrolled as a control group for outcome comparison.

Setting: The study was conducted at the Department of Obstetrics and Child Health Hospital, Jinniu District Maternal and Child Health Hospital, Chengdu, China.

Methods: Participants were divided into ECV success (n = 51) and failure (n = 11) groups based on procedural outcome. Baseline characteristics were compared, and predictors of ECV success were analyzed using univariable logistic regression. Maternal and neonatal outcomes were compared between the success group and the control group.

Results: Five independent predictors of ECV success were identified: lower maternal body mass index (BMI) at delivery (odds ratio [OR] = 0.816, 95% confidence interval [CI]: 0.662-0.991; p = 0.042), prior spontaneous vaginal delivery (OR = 8.250, 95% CI: 1.879-58.080; p = 0.012), non-posterior placental location (OR = 0.171, 95% CI: 0.034-0.678; p = 0.017), higher amniotic fluid index (OR = 1.442, 95% CI: 1.053-2.185; p = 0.048), and fewer ECV attempts (OR = 0.174, 95% CI: 0.059-0.375; p = 0.001). The ECV success group had a significantly higher vaginal delivery rate (81% vs. 0%; p = 0.012) and a lower cesarean delivery rate (19% vs. 100%) compared to the failure group. Neonates in the success group exhibited higher birth weights (3,266.4 ± 352.54 g vs. 3,063.2 ± 202.93 g; p = 0.017). Outcomes in the success group were comparable to the cephalic-presentation control group, except for a higher rate of labor induction (33.3% vs. 0%, p = 0.050).

Limitations: The main limitations of this study include its modest sample size, single-center design, and the lack of long-term follow-up data on maternal and neonatal outcomes post-ECV.

Conclusions: ECV is an effective intervention for reducing cesarean delivery rates in breech presentations. Success is associated with lower maternal BMI, a history of vaginal delivery, favorable placental location, adequate amniotic fluid, and fewer procedural attempts. These findings support the integration of patient-specific factors into clinical protocols to optimize ECV success and improve perinatal outcomes.

Introduction: Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive technique that accesses the abdominal cavity through natural orifices, eliminating the need for abdominal incisions. While this approach holds significant promise, particularly with its adaptation as vaginal NOTES (vNOTES), long-term safety data remain limited, especially beyond benign indications and hysterectomy. This review aims to evaluate the feasibility and outcomes of vNOTES in gynaecological oncology procedures that do not involve concurrent hysterectomy.

Methods: This systematic review, registered with PROSPERO (CRD42022380581) and conducted per PRISMA guidelines, searched MEDLINE, Embase, CINAHL, SCOPUS, and CENTRAL up to March 31, 2023. Using MeSH, Emtree, and keywords including "vaginal natural orifice transluminal endoscopic surgery," "vNOTES," and "gynaecological surgery," studies were selected if they included women undergoing vNOTES for oncological indications without hysterectomy.

Results: Of 5,367 records screened, 58 underwent full-text review; four articles (n = 6) were included for oncological procedures without hysterectomy. These involved staging of peritoneal (n = 3), endometrial (n = 2), and cervical cancers (n = 1). Mean age was 54.3 years, BMI 30 kg/m2, and operative time 93.5 min. Mean estimated blood loss was 17.2 mL. No conversions occurred. One patient developed a postoperative fever (12.5%), managed conservatively.

Conclusion: This review highlights the limited but promising evidence for vNOTES in gynaecological oncology beyond hysterectomy. It offers a potential minimally invasive alternative for complex pelvic procedures requiring retroperitoneal access, including obturator pathology, sentinel lymph node dissection, and mesh excision. Careful patient selection and use within a research setting, mirroring protocols for transanal total mesorectal excision, are recommended. Prospective case registration via the International NOTES Society is advised to support safe implementation.