International Journal of Gynecology & Obstetrics最新文献

Objective: The Objective of the Study Was to Explore the Associations between 20 Polymorphic Loci Related to Angiogenesis, Endothelial Dysfunction, Coagulation, Fibrinolysis, Lipid Metabolism, and Immune Response. These Loci Included Genes Such as PGF (rs12411), FLT1 (rs4769612), KDR (rs2071559), ACE (rs4340), FV (rs6025), FII (rs1799963), FVII (rs6046), SERPINE1 (rs1799889), ITGA2 (rs1126643), THBD (rs1042580), FTO (rs1421085), LPL (rs285), TLR4 (rs4986790), PLEKHA1 (rs2281673), PLEKHG1 (rs9478812), and Genome-Wide Association Studies (GWAS)-Associated Genes with Pre-Eclampsia (PE; MECOM, rs419076) in the Kazakh Population. The Study Aimed to Identify their Potential Role in the Development of PE and Related Complications.

Methods: A case-control genetic study was conducted with 103 Kazakh female patients with acute cerebral circulatory failure in severe PE (40 [38.8%] of whom had a fatal outcome) and 104 Kazakh female patients with severe PE from the comparison group. Genotyping of polymorphism × loci was performed by real-time polymerase chain reaction. Associations of genotypes of single nucleotide polymorphisms (SNPs) with the development of acute cerebral circulatory failure (ACF) were studied using logistic regression analysis (PLINK 1.9 beta software), both unadjusted and adjusted for potential confounders. Multiple comparisons were accounted for using the Bonferroni correction.

Results: Significant associations (P < 0.05) between genotypes (heterozygote and/or unfavorable homozygote) of five polymorphisms of coagulation genes and the odds of ACF in severe PE were found-FV: GA (odds ratio [OR] 8.10, 95% confidence interval [CI] 3.01-21.98); FII: GA (OR 3.50, 95% CI 1.80-6.78); angiogenesis and endothelial dysfunction, PGF: TT (OR 8.40, 95% CI 2.83-25.20); immune response, TLR4: AG (OR 6.70, 95% CI 1.47-30.86); and PLEKHA1: TA (OR 3.90, 95% CI 1.64-9.00).

Conclusion: The identified genetic associations can aid in predicting the development and severity of the clinical course of ACF in severe PE, forming high-risk groups, preventing its development, and personalizing therapy for the prevention of diseases in pregnant women and the fetus.

Background: Preoperative prophylactic balloon occlusion (PPBO) of internal iliac arteries (IIAs) in placenta previa and placenta accreta spectrum (PAS) has been widely used as a preventive adjuvant technique to reduce blood loss and to preserve fertility. Nevertheless, the efficacy of PPBO is based primarily on retrospective studies.

Objective: To examine the effectiveness of PPBO of the IIAs in placenta previa and PAS in reducing perioperative bleeding.

Search strategy: MEDLINE, EMBASE, Web-of-Science, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched from their inception to July 2023.

Selection criteria: Randomized controlled trial (RCT) in which the use of PPBO on the IIAs was compared to non-use.

Data collection and analysis: The primary outcome was number of packed red blood cell (RBC) units transfused. We executed meta-analysis using a random-effects model. Quality of the studies was assessed using the Cochrane Risk-of-Bias tool. The GRADE criteria were used to assess evidence certainty.

Main results: Of 164 reports identified, three RCTs representing 167 women (83 and 84 in the intervention and control groups, respectively) were eligible. Mean number of RBC units transfused was 4.52 ± 1.70 and 3.70 ± 1.88 in the intervention and control groups, respectively (weighted mean difference, 1.04; 95% CI: 0.52-1.55; P = 0.001; I², 0%; low certainty evidence). Transfusion of other blood products was comparable. Incidence of postoperative fever was higher (P =  0.024) and hospitalization duration was longer (P = 0.001) in the intervention group compared to the control group.

Conclusions: Use of PPBO of the IIAs in placenta previa and PAS was associated with increase in number of RBC units transfused.

Objectives: To estimate the prevalence of cognitive dysfunction and associated behavioral changes and their prevalence among postpartum women, and also the prevalence of lactational failure and its determinants among postpartum women.

Methods: A cross-sectional study was conducted involving 200 postpartum women (65% rural, 35% urban). Data were collected through structured interviews and assessments using the Indian version of the Montreal Cognitive Assessment and Depression, Anxiety, and Stress Scale-21. Statistical analyses included chi-square tests and regression models.

Results: Cognitive dysfunction was observed in 25% of participants (21.5% mild, 3.5% moderate). Stress, anxiety, and depression were prevalent in 80.5%, 27%, and 30% of women, respectively. Lactational failure was reported by 21%, strongly correlated with cognitive dysfunction (P = 0.01) and mental health issues (stress, anxiety, and depression; P < 0.001). Key determinants of lactational failure included poor mother-partner relationships, lack of social support, low education levels, delayed breastfeeding initiation, childcare stress, comorbidities, mode of delivery, and low birth weight. Cognitive dysfunction was significantly associated with male offspring, insufficient milk production, lack of social support, and poor education levels (P < 0.001).

Conclusion: The study highlights a strong association between maternal mental health, cognitive dysfunction, and lactational failure. Addressing psychosocial and demographic determinants through targeted interventions is critical for improving maternal and child health outcomes in postpartum populations.

Objective: To evaluate the association between ambient temperature and ovarian hyperstimulation syndrome (OHSS).

Methods: This retrospective cohort study included 28 397 women aged 40 years and younger who underwent oocyte retrieval at a tertiary hospital between January 2018 and December 2023. Women were grouped according to their average ambient temperatures 7 days after oocyte retrieval. The main outcome was severe to critical OHSS, and the secondary outcome was live birth rate.

Results: Of the 28 397 patients, 23 916 women (84.24%) experienced no OHSS or mild OHSS, 4250 women (17.77%) experienced moderate OHSS, and 231 women (0.97%) experienced severe to critical OHSS. Their average ambient temperatures were 15.27 ± 9.19°C, 15.83 ± 9.22°C, and 17.39 ± 8.88°C, respectively. The incidence rates of severe to critical OHSS were 0.61%, 0.72%, and 1.02% at ambient temperatures <10°C, between 10°C and 20°C, and >20°C, respectively. Using a two-piecewise linear regression model, the ambient temperature inflection point was calculated to be 22.1°C. The risk of severe to critical OHSS increased with ambient temperature until the turning point of 22.1°C (odds ratio, 1.11 [95% confidence interval, 1.00-1.22]; P = 0.043). The increase in average ambient temperature was significantly associated with the incidence of severe to critical OHSS (adjusted odds ratio, 1.025 [95% confidence interval, 1.01-1.04]; P = 0.001). There was no significant association between ambient temperature and live birth rate.

Conclusions: Elevated ambient temperature after oocyte retrieval was associated with an increased risk of severe to critical OHSS. Physicians should be aware of OHSS in women who undergo oocyte retrieval on hot days.

The interplay between the gut microbiome and reproductive health has gained increasing attention in recent years. Emerging research suggests that imbalances in the gut microbiome may impact reproductive function through various mechanisms. This review explores the link between gut and vaginal microbiomes and reproductive dysfunctions in women, focusing on conditions such as polycystic ovary syndrome (PCOS), endometriosis, pre-eclampsia, gestational diabetes mellitus (GDM), preterm premature rupture of membranes (PROM), preterm birth, and sexually transmitted infections (STIs). The review highlights the significant associations between microbial dysbiosis and these reproductive conditions, emphasizing the role of gut and vaginal microbiota in their pathogenesis. Understanding these links opens potential avenues for novel diagnostic and therapeutic strategies targeting the microbiome to improve reproductive and long-term health outcomes in women.

Objective: To evaluate the burden of vitamin D deficiency in female patients attending a fertility clinic in a tertiary referral center, assess temporal trends-including the potential impact of COVID-19 lockdowns-and explore socioeconomic disparities in vitamin D levels.

Methods: This retrospective cohort study analyzed vitamin D measurements from 765 female patients (mean age 35.7 ± 5.8 years) attending a fertility clinic between March 2010 and May 2022. Vitamin D status was categorized as deficient (<30 nmol/L), insufficient (30-50 nmol/L), or normal (>50 nmol/L). Comparative analyses examined pre- and post-COVID periods and healthcare funding status.

Results: Overall, 39.9% (n = 305) of patients exhibited suboptimal vitamin D levels, with 8.8% (n = 67) deficient and 31.1% (n = 238) insufficient. Mean serum 25(OH)D was 62.8 ± 27.4 nmol/L. No statistically significant difference was observed between pre-COVID (44.2% suboptimal) and post-COVID (38.1% suboptimal) periods (OR 0.78, 95% CI: 0.57-1.06, P = 0.110). However, marked seasonal variation was identified, with winter values significantly lower than summer values (45.3 ± 24.6 vs. 72.1 ± 28.3 nmol/L, P < 0.001). Furthermore, state-funded patients had a significantly higher rate of suboptimal vitamin D status (50.2%, n = 107) compared to self-funded patients (35.9%, n = 198, P < 0.001).

Conclusion: Our findings demonstrate a high prevalence of suboptimal vitamin D levels in a subfertility population, with significant seasonal fluctuations and notable socioeconomic disparities. Despite initial concerns, COVID-19 lockdown measures did not appear to adversely affect overall vitamin D status. These results support the incorporation of routine vitamin D screening in infertility evaluations and the implementation of targeted supplementation, particularly in economically vulnerable groups and during winter months.