International Journal of Gynecology & Obstetrics最新文献

Objective: This study examined the efficacy of a quality improvement initiative aimed at decreasing both operative vaginal deliveries and rectal lacerations, while also exploring the mechanisms contributing to rectal injuries and evaluating the effects of the standardized management of rectal lacerations during vaginal deliveries.

Method: We conducted a prospective cohort study of isolated rectal injuries during vaginal deliveries at a specialty hospital in northern China between 2023 and 2025. Patients were included if they fulfilled all three criteria: (i) isolated rectal injury during childbirth; (ii) gestational age 28 weeks or greater; and (iii) vaginal delivery. Prospectively collected data included demographic characteristics, labor and delivery details, and perioperative outcomes.

Results: Among 24 510 vaginal deliveries, 16 isolated rectal lacerations were identified, giving an incidence of 0.065% (1/1532). Fourteen cases (87.5%) occurred in nulliparous women. Five patients (31.3%) underwent forceps delivery, and six (37.5%) had mediolateral episiotomy. Most injuries (68.8%) occurred during the day shift. During the same period, the overall rates of operative vaginal delivery and mediolateral episiotomy were 8.8% and 11%, respectively. Following a revision of obstetric policies aimed at reducing operative vaginal deliveries, the incidence of isolated rectal laceration decreased significantly (0.077% vs. 0.039%, P < 0.01). All repairs were performed by the obstetric team without the involvement of other specialties. One patient developed an anovaginal fistula near the hymen.

Conclusion: Isolated rectal laceration is a rare but potentially serious complication of vaginal delivery. Reducing operative vaginal deliveries might help lower its incidence, and careful rectal examination after vaginal birth is recommended to improve detection. Primary repair by an obstetric team is feasible and associated with generally good outcomes.

Objective: Little is known about the birthing patterns of patients having experienced a prior cesarean section (CS) in low- and middle-income countries (LMICs). We sought to estimate the prevalence of and characterize trends relating to vaginal birth after cesarean section (VBAC) and repeat CS in LMICs.

Methods: We analyzed 107 nationally representative surveys across 59 LMICs. For countries with population CS rates above 8%, we analyzed repeat CS trends across two or three consecutive surveys and estimated the association between repeat CS and facility level and facility type.

Results: The prevalence of VBAC ranged from 0.5% in Turkey (95% CI: 0.1, 3.5) to 67.6% in Niger (95% CI: 53.4, 79.2). We observed an inverse association between the population CS rate and VBAC prevalence. Of the 33 countries with CS rates below 10%, 26 countries had VBAC prevalence estimates ranging from 20% to 50% with the prevalence of six countries exceeding 50%. Of the 26 countries with CS rates at or above 10%, 19 had VBAC prevalence estimates below 20%. We observed strong associations between repeat CS and births in private facilities or hospitals, and we found that repeat CS also increases over time across multiple countries. However, many of these associations were not statistically significant across multiple countries.

Conclusion: VBAC prevalence is greatest in countries with the lowest population CS rates, indicating that unplanned, unmonitored, and unsafe VBACs are occurring, necessitating shifts in birth planning and preparedness strategy. Repeat cesareans predominate where population CS rates are already high.

Objective: Novel human papillomavirus (HPV) tests must undergo thorough validation before implementation in the cervical cancer screening population. The MyGene HPV sexually transmitted infection (STI) assay (MHSA), an emerging test based on emerging next-generation sequencing, presents as a promising tool for enhancing detection capabilities in screening settings. This study aims to conduct a comparative analysis of the clinical performance of two assays (Cobas 4800 vs. MHSA) in detecting 14 high-risk (GR)-HPV genotypes for the identification of high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) in longitudinal cervical cancer screening among Chinese women.

Methods: A total of 2985 consecutive specimens from a cervical screening program in Erdos City were examined using both MHSA and Cobas 4800 assays. Follow-up study was also conducted for 3 years.

Results: The overall percent agreement (OPA), percentage of negative agreement (PNA), and Kappa statistics for 14 HR-HPV positivity, type-specific HPV16, HPV18, and 12 other HR-HPV demonstrated strong concordance between the two assays. The clinical performance of MHSA was comparable to the Cobas 4800 assay at both baseline and over the 3-year cumulative follow-up. Moreover, MHSA effectively reduced unnecessary colposcopy referrals and showed better triage efficiency both at baseline and at the 3-year follow-up. When combined with HPV typing and cytology results, MHSA outperforms the Cobas 4800 in terms of clinical performance and triage efficiency.

Conclusion: Our study indicated that MHSA could be considered a valuable option for cervical cancer screening in China.

Objective: The accurate diagnosis of multicompartment pelvic organ prolapse (POP) is fundamental to surgical success. This study aims to compare the diagnostic performance of transperineal ultrasound against clinical examination (pelvic organ prolapse quantification, POP-Q) for the detection of compartmental defects in patients with multicompartment POP, using assessment under spinal anesthesia as the reference standard.

Method: A prospective randomized diagnostic accuracy study was designed, including 129 patients scheduled for multicompartment POP surgery. Patients were randomly assigned to undergo either a preoperative POP-Q two-dimensional transperineal ultrasound assessment. The reference standard for all patients was the intraoperative POP-Q assessment, conducted under spinal anesthesia immediately before surgery. Sensitivity, specificity, and likelihood ratios (LR) were calculated for each method and compartment.

Results: Both techniques demonstrated high sensitivity for the diagnosis of cystocele (100% vs 98.3%). However, their performance varied across the other compartments. Ultrasound showed superior specificity for uterine prolapse (73.4% vs 45.4%) and rectocele (86.3% vs 66.0%) and was particularly robust in confirming enterocele (LR+ of 10.5). In turn, clinical examination had a higher sensitivity for detecting rectocele (61.5% vs 21.4%) and was highly reliable for ruling out cystocele and uterine prolapse (LR- of 0).

Conclusion: Clinical examination and ultrasound are complementary in the diagnosis of prolapse. Their combined use is key to accurate surgical planning.

Pregnancy provides a unique opportunity to identify women at increased risk of future chronic disease, as adverse pregnancy outcomes (APOs) such as hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm birth, placental complications, and fetal growth restriction are associated with later cardiometabolic morbidity. However, postpartum care remains fragmented and limited, representing a missed opportunity for preventive intervention. Currently in pilot phase, NuViva is a novel, multidisciplinary, community-based postpartum program, providing nutrition, physical exercise, and pelvic floor assessment education at 4 time points over a 12-month period post delivery. A smartphone application, based on recommendations of the FIGO pregnancy passport, supports biometric record keeping, self-monitoring, education, and adherence. Assessments include blood pressure and biometrics; laboratory investigations where indicated; pelvic floor assessment; functional fitness tests; and validated psychosocial, lifestyle, and nutrition questionnaires. The primary outcome is cardiovascular health score at 1 year postpartum. Secondary outcomes include anthropometric measures, mental health indicators, reproductive health factors, breastfeeding, physical fitness, and program feasibility metrics such as retention, satisfaction, and resource utilization.

Objective: To evaluate the learning curve of uterine artery blockage via the anterior cul-de-sac and demonstrate the favorable outcomes of its application into complex minimally invasive myomectomy (MIM).

Methods: A retrospective case series conducted at a teaching hospital and tertiary referral center, including 86 consecutive patients who underwent MIM by a single surgeon between September 2022 and August 2025. Uterine artery blockage via the anterior cul-de-sac was attempted in 61 cases, while 25 cases of MIM were performed without attempt.

Results: Of the 61 attempted cases, bilateral blockage was successful in 49 cases, unilateral in seven, and none in four. Consistent bilateral success was achieved after 34 cases. Most patients had more than five fibroids (39/61), with a median largest fibroid size of 8.1 cm (interquartile range [IQR]: 6.2-12.0 cm), and specimen weight of 430 g (IQR: 205.5-772.5 g). The median estimated uterine size was 16.0 weeks (IQR: 15-20 weeks). The median operative time was 246 min (IQR: 209-281 min), and the median estimated blood loss (EBL) was 250 mL (IQR: 100-350 mL). Preoperative hemoglobin averaged 11.8 ± 1.8 mg/dL, with a mean drop of 2.1 ± 1.4 mg/dL. Surgical approaches included laparoscopy (17), laparoscopic-assisted myomectomy (LAM) (26), and mini-laparotomy (18). One intraoperative vascular complication and one intraoperative transfusion occurred. The median hospital stay was 1 day (IQR: 1.0-2.0). There was eight postoperative transfusions, and two Clavien-Dindo class I complications with no readmissions.

Conclusion: Approximately 34 cases are required for a surgeon to achieve proficiency, and incorporation of this technique facilitates the safe and feasible performance of complex MIM.

Objective: To compare the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) and dienogest (DNG) on systemic inflammatory markers and anemia parameters in patients with adenomyosis after 6 months of treatment.

Methods: This retrospective longitudinal observational cohort study included 162 women diagnosed with adenomyosis at İzmir Buca Seyfi Demirsoy Training and Research Hospital between 2020 and 2025. A total of 89 patients received LNG-IUS (Mirena), and 73 were treated with DNG 2 mg/day. Hemoglobin (Hb), neutrophil, lymphocyte, and platelet counts were obtained before treatment (baseline) and at 6 months to calculate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Statistical analyses were performed using SPSS 27.0, with P < 0.05 considered significant.

Results: Baseline demographic and obstetric characteristics were similar between the groups (P > 0.05). At 6 months, hemoglobin levels increased significantly more in the LNG-IUS group compared with the DNG group (2.29 ± 3.61 vs. 0.84 ± 4.82; P = 0.035). No significant differences were observed between groups in neutrophil, lymphocyte, platelet counts, or inflammatory indices (NLR, PLR, SII) before and after treatment (P > 0.05).

Conclusion: Both LNG-IUS and DNG are safe and effective medical options for adenomyosis management. LNG-IUS provided superior improvement in hemoglobin levels and bleeding control, while neither treatment significantly altered systemic inflammatory indices. These findings suggest that inflammation in adenomyosis is largely confined to the local uterine environment and that hematologic markers such as NLR, PLR, and SII may have limited sensitivity in reflecting short-term therapeutic response.