International Journal of Gynecology & Obstetrics最新文献

Despite global progress and a marked reduction in maternal mortality ratio worldwide, the burden of maternal death and morbidity remains a huge challenge, especially among low- and middle-income settings. Maternal mortality is determined by multiple components. As a result, sustainable strategies require not only the implementation of effective health policies but also social development. In this narrative review, we discuss strategies to improve the maternal mortality ratio based on recent advances in public health. Primary care plays a key role in identifying background conditions, risk factors and early signs of some major causes of maternal mortality and morbidity. Antenatal care also addresses other conditions that influence outcomes: unwanted pregnancies, nutrition, sexually transmitted illnesses, family planning, immunization, and child health. Therefore, awareness about major causes of maternal mortality, direct and indirect targeted interventions to adequately identify risk factors, implement prophylactic interventions when available and guarantee early diagnosis, can certainly impact outcomes.

There are many barriers contributing to poor health outcomes for women in low- and middle-income countries (LMICs), one of which is the lack of necessary medical devices. Presently, the development of various kinds of devices intended to improve women's health outcomes specifically in LMICs remains underrepresented in the literature; therefore, we performed a narrative review to understand this current state of literature. A literature search was conducted in Scopus and Overton between December 2023 to February 2024, and PubMed in October 2024 to broadly explore peer-reviewed publications focusing on understanding the development of devices used specifically in obstetrics and gynecology (OBGYN) care in LMICs. The initial search identified 132 published manuscripts: 114 non-duplicates from 1993 to 2024. After a two-research team member independent review, 22 manuscripts from 2011 to 2023 were included, and 18 devices identified. Nine devices focus on postpartum hemorrhage, four on general obstetrics, one on fetal monitoring, one on vaginal deliveries, one on gynecology hemorrhage, one on gynecology screening, and one on OBGYN anesthesia. This review provides recommendations for areas of improvement of key gaps affecting the development and implementation of OBGYN devices for use in LMICs. Recommendations are provided for various stages of the development to early commercialization phases. We believe future incorporation of these recommendations can aid in equitable and implementable medical device design for OBGYN care in LMICs.

Objective: Our primary objective was to evaluate the interpregnancy interval (IPI) of women who have experienced obstetric anal sphincter injuries during delivery. Additionally, we compared adverse perinatal outcomes in subsequent deliveries following obstetric anal sphincter injuries (OASIS) in women with longer and shorter IPIs.

Methods: This retrospective cohort study included women who had a subsequent pregnancy following OASIS and women without a history of such injuries, who delivered in a tertiary medical center between 2015 and 2019. Data were retrieved from patient computerized medical records. Kaplan-Meier curves and Cox regression analysis were used to evaluate the IPI defined as the time from delivery to the last menstruation prior to the subsequent delivery. Data analysis for our secondary objective was performed using mean and standard deviation for quantitative variables.

Results: During the study period, 233 women experienced OASIS (0.27%), of whom 142 met the study criteria. There was no significant difference in the mean IPI between women in the two groups. However, women were significantly more likely to have a repeat perineal tear (49 [34.5%], P < 0.001), an episiotomy (16 [11.3%], P < 0.001), and an elective or an emergency cesarean section (60 [42.3%], P < 0.001) in their subsequent delivery. There was no difference in pregnancy outcomes among women who had a long compared with a short IPI.

Conclusions: Women do not delay or avoid childbirth after experiencing OASIS. However, women are more likely to experience perineal tears, episiotomies, or a cesarean delivery in the subsequent pregnancy.

Objective: Induction of labor (IOL) is a controversial topic in contemporary obstetric practice, with some suggesting that the increase in elective induction (eIOL) as a potential contributor to increasing cesarean delivery (CD) rates. The objectives of this single-center study were to examine the rates of IOL, trends in indications for IOL, and the contribution of IOL to the overall CD rate at one of Europe's largest obstetric hospitals.

Methods: This retrospective observational cohort study evaluated the outcomes of patients who were delivered following IOL from 2018 to 2022 inclusive at the largest obstetric hospital in Ireland.

Results: A total of 36 938 women (16 155 nulliparous and 20 783 multiparous) were delivered during the 5-year study period, of whom 8072 nulliparous and 6343 multiparous women underwent IOL. There was a significant increase in rates of induction, increasing from 42% to 57% (P <0.001) in nulliparous women, and from 27% to 33% (P < 0.001) in multiparous women. The highest contributions to the hospital CD rate were from those being induced for 'fetal' (5%), spontaneous rupture of membranes ('SROM') (4%), and 'maternal' (4%) reasons, with the lowest CD rates in the eIOL category (<1%) in both groups.

Conclusion: Our data confirm that the rate of IOL is increasing. The contribution of maternal and fetal reasons for IOL to the overall CD rate may reflect increasing numbers of higher-risk pregnancies. Despite current controversy regarding the role of eIOL, our data do not confirm a significant contribution to either the overall IOL or CD rates in this center.

Background: This study aimed to assess the value of a HPV E6/E7 mRNA assay (Aptima® HPV [AHPV]) for primary cervical cancer screening combined with menopausal status.

Methods: A total of 16 917 women underwent AHPV testing and had complete histopathological results at the Affiliated Hospital of Jining Medical University China between January 1, 2017 and March 31, 2022. We evaluated the performance of different screening strategies and combined strategies, as well as evaluations of different menopausal states.

Results: When identifying LSIL+ (includes low- and high-grade squamous intraepithelial lesions and invasive cervical cancer [ICC]), the sensitivity (91.2%) and negative predictive value (NPV; 96.6%) were significantly higher for AHPV than for liquid-based cytology assay (LBC; 33.2% and 84.7% for sensitivity and NPV, respectively). Furthermore, the co-testing strategy (cytology combined with AHPV), when compared with AHPV, achieved a slightly higher sensitivity (93.6% vs. 91.2%, respectively, P < 0.001), a similar specificity (61.3% vs. 62.7%, respectively, P = 0.014), a similar positive predictive value (PPV; 37.5% vs. 37.8%, respectively, P = 0.709) and a similar NPV (97.5% vs. 96.6%, respectively, P = 0.001). Moreover, AHPV (when compared with menopausal women) achieved a higher sensitivity (93.5% vs. 77.7%, respectively, P < 0.001), a higher NPV (97.3% vs. 93.9%, respectively, P < 0.001), a similar PPV (37.8% vs. 37.0%, respectively, P = 0.618) and a slightly lower specificity (60.7% vs. 72.1%, respectively, P < 0.001) in premenopausal women. These results were similar when identifying HSIL+ (includes high-grade squamous intraepithelial lesion and ICC).

Conclusion: The present study suggests that initial screening with HPV E6/E7 mRNA testing rather than combined screening is a suitable candidate for cervical cancer screening in China (especially for premenopausal women) based on economic reasons.

Objective: Antiphospholipid antibodies (aPL) are recognized to have a pivotal role in recurrent pregnancy loss (RPL) and cardiovascular disease. Therefore, we assessed the vascular function of women with RPL and examined the association with each type of aPL.

Methods: In this retrospective study, 569 women with RPL and 55 healthy women who had never experienced pregnancy loss were recruited. We performed blood tests for aPL and acceleration plethysmography (APG) to evaluate peripheral vascular function.

Results: The differential pulse wave index (DPI), indicating vascular elasticity, was significantly lower in women with RPL (115.6 ± 4.1) compared to the control group (117.0 ± 2.3). DPI in RPL women with anti-β₂ glycoprotein I (aβ₂GPI) IgG was significantly lower than those without. Remained blood volume (RBV), indicating post-vasoconstriction blood content, was significantly higher in RPL women with aβ₂GI IgG than in those without. Regression analysis showed aβ₂GPI IgG and body mass index (BMI) linked negatively with DPI.

Conclusion: Women with RPL have subclinical vascular dysfunction even at reproductive age. It is possible that aβ₂GPI IgG is associated with vascular dysfunction in RPL women.

To investigate the risk factors influencing very early preterm and early preterm births in twin pregnancies after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This retrospective study analyzed 2042 twin pregnancies that underwent embryo transfer via IVF/ICSI at the Reproductive Center of Sir Run Run Shaw Hospital between January 2019 and December 2022. Spontaneous very early, early preterm, and provider-initiated preterm births were examined separately. Based on gestational age, participants were categorized into three groups: very early preterm birth (<28 weeks), early preterm birth (≥28 to <34 weeks), and ongoing pregnancy (≥34 weeks). Univariate analysis was conducted to assess general conditions, among the three groups. Multiple logistic regression analysis was performed to identify independent risk factors for very early and early spontaneous preterm birth in twin pregnancies. A total of 2042 twin pregnancies were included in the study, with birth rates of 4.36% (89 of 2042) <28 weeks, 12.14% (248 of 2042) ≥28 to <34 weeks, and 83.50% (1705 of 2042) ≥34 weeks. The primary cause of provider-initiated preterm birth <28 weeks was placental factors, while hypertensive disorders of pregnancy (31.11%) were the predominant cause for preterm births ≥28 to <34 weeks. Multiple logistic regression analysis identified the independent risk factors for births <28 weeks (P < 0.05) as cervical cerclage, history of late miscarriage or premature birth, uterine adhesions, primary infertility of polycystic ovary syndrome (PCOS), monochorionic pregnancies, history of cervical surgery, uterine malformations, body mass index ≥25 kg/m², and uterine longitudinal axis lengths <3.6 cm. Cervical cerclage, main factors of infertility (PCOS), adenomyosis, and uterine longitudinal axis lengths <3.6 cm were identified as independent risk factors for ≥28 to 34 weeks (P < 0.05). It is crucial to consider risk factors during IVF/ICSI treatment because of the high incidence of very early and early preterm twin pregnancies, which can be identified early and properly managed.