International Journal of Gynecology & Obstetrics最新文献

Objective: To investigate the association between household air pollution (HAP) exposure and adverse maternal and perinatal outcomes among mothers in Ghana using evidence from the 2022 Demographic and Health Survey.

Methods: A retrospective secondary analysis was conducted using data from the 2022 Ghana Demographic and Health Survey (GDHS). The study included women aged 15-49 years with a recent pregnancy outcome. HAP exposure was proxied using unclean cooking fuel. Outcomes assessed were maternal anemia (hemoglobin <11.0 g/dL), low birth weight (LBW) (<2500 g), preterm birth (<37 weeks), and stillbirth. Multivariable logistic regression models were fitted to estimate associations between HAP exposure and outcomes. Statistical significance was set at P < 0.05.

Results: Unclean cooking fuel use was highly prevalent (88.2%), especially in rural households (95.7%) and among the poorest households (99.8%). After adjustment, unclean fuel use was associated with higher odds of LBW (adjusted odds ratio [aOR] 1.47; 95% CI 1.10-1.96; P < 0.008). Anemia, cesarean section and prolonged length of hospital stay after delivery were associated with HAP.

Conclusion: HAP remains a significant risk factor for adverse maternal and perinatal outcomes in Ghana, underscoring the need to accelerate adoption of clean cooking technologies.

Objective: To identify risk factors associated with postpartum readmission following vacuum-assisted vaginal delivery.

Methods: A retrospective cohort study at a single university-affiliated tertiary medical center from 2012 to 2023, including all singleton pregnancies delivered at ≥37 weeks' gestation. Women who underwent a vacuum-assisted vaginal delivery (VAD) trial were identified. Multiple gestations, nonviable fetuses, and failed VAD requiring emergency cesarean delivery (CD) were excluded. Participants were categorized as readmitted or not readmitted within 6 weeks postpartum for obstetrical or gynecologic indications. Univariate analysis followed by multivariate logistic regression determined risk factors for readmission.

Results: Among 111 878 vaginal deliveries, 8730 (7.8%) involved VAD, with a readmission rate of 1.2% (105 women). Infectious causes accounted for 67.6% of readmissions. The most common infectious diagnosis was endometritis (27.6%), followed by urinary tract infection (14.3%), mastitis (12.4%), fever of unknown origin (8.6%), and infected laceration or episiotomy site (4.8%). Multivariate analysis revealed that pre-eclampsia (odds ratio [OR] = 5.0, 95% confidence interval [CI]: 2.2-11.0, P < 0.001), postpartum fever (OR = 3.4, 95% CI: 1.0-11.0, P = 0.036), previous CD (OR = 2.0, 95% CI: 1.0-4.0, P = 0.046), and persistent occiput posterior fetal position (OR = 1.9, 95% CI: 1.2-3.3, P = 0.013) were significant risk factors for readmission. Notably, the primary indications for VAD, such as prolonged second stage of labor and non-reassuring fetal heart rate monitoring, were not independently associated with an increased risk of postpartum readmission.

Conclusion: Several risk factors are associated with increased risk of postpartum readmission following VAD. Enhanced postpartum surveillance in these high-risk groups may help reduce readmissions and improve maternal outcomes.

Objective: The aim of the present study was to investigate the relationship between dysmenorrhea and rational drug use (RDU), health literacy (HL), and emotional symptoms among university students.

Method: In this cross-sectional study, the population consisted of 8524 female students studying at a university. The sample size was calculated using the known population sampling formula, and the study was completed with 646 students. Data were collected using the Descriptive Information Form, numerical rating scale (NRS), RDU scale, adolescent e-Health Literacy Scale (eHEALS), and the Depression, Anxiety and Stress Scale-21 (DASS-21). Data collection took place between April and June 2023.

Results: The mean age of the participants was 21.5 ± 3.1 years. A low positive correlation was found between eHEALS and RDU scores, a low negative correlation between the depression subscale and eHEALS, and a low positive correlation between the anxiety subscale and NRS scores. The structural equation model for the scales was found to be statistically significant (P <0.05). The fit indices obtained (χ² = 16.7, df = 6) indicate an acceptable model fit (χ²/df = 2.8).

Conclusion: Results regarding changes in HL, rational drug use behaviors, and bidirectionally influential emotional states-factors that may be associated with the management of dysmenorrhea-related pain-offer valuable contributions to the literature when supported by theoretical modeling and empirical data.

Objective: This study compares medium-term outcomes of retropubic tension-free vaginal tape (TVT) and transobturator tape (TOT) for stress urinary incontinence (SUI), focusing on patient satisfaction and overactive bladder (OAB) symptoms.

Methods: This prospective, single-surgeon cohort study included women with SUI who underwent TVT or TOT at a single center (July 2021-October 2022). Follow-up was conducted at 26-41 months through chart review and patient interviews. Satisfaction was rated on a 0-100% global scale (≥75% = satisfied). Outcomes and complications followed International Continence Society criteria. Continuous variables were compared with the Mann-Whitney U-test and categorical variables with Fisher's exact test. Sensitivity analysis addressed the effects of loss to follow-up. Statistical significance was set at P < 0.05.

Results: Fifty-three women (25 TVT, 28 TOT) completed follow-up. Satisfaction (≥75%) was reported by 88.0% of TVT and 89.3% of TOT patients (P ≈ 1.00). Sensitivity analyses assuming all lost patients were satisfied or unsatisfied did not alter statistical significance (P ≈ 1.00 and P = 0.54, respectively). Among women with pre-existing overactive bladder, improvement in symptoms occurred in 78.3% (18/23) of TVT and 61.1% (11/18) of TOT patients (P = 0.47). One bladder perforation occurred in the TVT group; other complications were infrequent and similar between groups.

Conclusions: Both TVT and TOT provided high satisfaction and improvement in OAB symptoms at 26-41 months, with low complication rates. These findings suggest that both procedures remain safe and effective in the medium term, reinforcing their established role in the surgical management of SUI.

Objective: To evaluate trends in hysterectomy case volume for placenta accreta spectrum (PAS) disorder over time and compare maternal outcomes between high- and low-volume centers. Specifically, we examined whether surgical volume influences severe maternal morbidity (SMM) and other key perioperative outcomes.

Methods: We conducted a population-based retrospective cohort study of patients aged 18-50 years who underwent hysterectomy for PAS in Ontario, Canada, from January 1, 2003, to January 1, 2022. Cases were identified using provincial administrative health databases. High-volume centers were defined as institutions performing ≥9 PAS hysterectomies annually, based on probability modeling and receiver operating characteristic analysis. The primary outcome was a validated composite measure of SMM, including massive transfusion, intensive care unit (ICU) admission, surgical complications, readmission, and length of hospital stay.

Results: Among 778 patients, 151 were treated at high-volume centers. These patients experienced significantly lower rates of SMM compared to those treated at low-volume centers (45.0% vs. 71.7%; adjusted relative risk [aRR] 0.59, 95% confidence interval [CI]: 0.49-0.72). Risks of massive transfusion (aRR 0.57, 95% CI: 0.47-0.70) and ICU admission (aRR 0.30, 95% CI: 0.15-0.58) were also markedly reduced. Length of hospital stay was shorter at high-volume centers (1.88 vs. 3.90 days; P < 0.0001). Each additional PAS hysterectomy performed in the prior year at a given institution was associated with a 3% reduction in SMM risk (aRR 0.97, 95% CI: 0.96-0.98).

Conclusion: High-volume centers demonstrate significantly better maternal outcomes for PAS hysterectomy. These findings support centralizing PAS care to improve patient safety and surgical outcomes.

Background: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital anomaly of the Müllerian ducts and represents the second most common cause of primary amenorrhea, accounting for 10%-15% of cases. Despite its significance, limited data exist regarding its clinical profile and associated anomalies in the Indian population.

Objective: This study aims to determine the prevalence of MRKH syndrome among women presenting with primary amenorrhea at a tertiary care center in South India and to describe their clinical profiles and associated anomalies using the Vagina Cervix Uterus Adnexa-associated Malformation (VCUAM) classification system.

Methods: A retrospective study was conducted over 15 years (January 2008 to December 2022) including women diagnosed with MRKH syndrome based on inclusion criteria: primary amenorrhea, normal secondary sexual characteristics, 46-XX karyotype, and normal serum follicle-stimulating hormone levels. Data were extracted from medical records and analyzed using SPSS v25.0.

Results: Out of 340 women with primary amenorrhea, 181 (60%) were diagnosed with MRKH syndrome. The mean age at presentation was 21 years. The predominant complaint was non-attainment of menarche (66.8%), with 16.5% reporting cyclical abdominal pain. Type 1 MRKH was most common (78.9%), followed by Müllerian duct aplasia-renal agenesis-cervicothoracic somite dysplasia (MURCS) association (16.5%). Renal anomalies (15.5%) were the most frequent extragenital malformations. All women had vaginal and cervical agenesis (V5bC2b). Uterine anomalies included bilateral aplasia (89.1%), unilateral aplasia (0.6%), and hypoplasia (10.5%).

Conclusion: MRKH syndrome is a significant cause of primary amenorrhea, with notable extragenital anomalies, especially renal. Systematic evaluation using the VCUAM classification enables comprehensive assessment, aiding in individualized and multidisciplinary care strategies.

Objective: To evaluate the perceived educational value of a multimodal surgical training model designed to improve obstetricians' skills in managing placenta accreta spectrum (PAS).

Methods: A prospective, descriptive observational study was conducted to evaluate a multimodal educational model during three standardized workshops held in Bolivia and Peru between January and August 2023. The educational strategy combined flipped-classroom preparation, simulation-based training, interactive theoretical discussions, live ultrasound and surgical sessions, and follow-up mentorship. A total of 290 participants were enrolled, and 175 practicing obstetricians who completed all three surveys (precourse, immediate postcourse, and 6-month follow-up) were included in the analysis. Surveys assessed participants' prior exposure to PAS, perceived usefulness of each educational component, and implementation of learned techniques.

Results: Before the workshops, most participants had prior exposure to PAS but limited experience with uterine-sparing procedures. Following the workshop, participants rated the overall clarity and usefulness of simulation and theoretical sessions around an 8 out of 10 and the value of integrating live surgery as a 9 out of 10. At 6-month follow-up, between 16% and 52% reported having performed at least one technique taught during the workshop. All participants would recommend the course to colleagues. Nearly 30% maintained contact with instructors for diagnostic or surgical support.

Conclusion: A multimodal educational model combining theory, simulation, and hands-on experience is well received by obstetricians and gynecologists and facilitates the integration of new surgical skills into clinical practice, supporting individualized management of PAS.

Objective: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality globally. Most PPH deaths are preventable through evidence-based interventions. This study assessed the availability, direct costs, and economic implications of World Health Organization-recommended PPH interventions in public hospitals in Zambia.

Methods: A cross-sectional survey was conducted in 31 purposively selected public hospitals across seven provinces. Data (June 2019 to May 2020) on PPH prevalence, resource availability, and direct costs of PPH interventions were collected via a structured questionnaire administered to hospital administrators. An ingredients-based costing model compared an ideal pathway (severe PPH managed at a fully equipped primary-level health facility) to a referral pathway (patients unresponsive to early-stage interventions transferred to a tertiary hospital). Data were analyzed using Python.

Results: Among 74 238 deliveries, 1957 (2.6%) were PPH cases, resulting in 94 (4.8%) fatalities. Most cases (86.9%) received medical management, primarily by nurse-midwives. Tranexamic acid (TXA) was available in only 58.1% of the hospitals (subsidized cost: US$1.91/dose). Managing a severe PPH case in the ideal pathway cost US$133.46-US$276.22, compared to US$153.34-US$332.53 via the referral pathway , representing an 18.6% increase. Scaled nationally (approximately 672 000 births), this inefficiency translates to an avoidable annual burden of US$133121.

Conclusion: While oxytocin is universally available, access to critical treatments such as TXA and advanced interventions remains limited. The low cost of preventive interventions contrasts with the high cost of managing severe PPH, which is exacerbated by system fragmentation. Strengthening primary-level facilities with essential commodities, surgical capacity, and training is critical to containing costs and reducing maternal mortality due to PPH.