International Journal of Gynecology & Obstetrics最新文献

Objective: Intrauterine balloon tamponade is an appropriate first-line "surgical" intervention where uterine atony is the principal cause of hemorrhage. The optimal duration of insertion is unclear. Patients are often treated as "at risk" of bleeding while an intrauterine balloon is in situ. The present study aimed to ascertain if duration of intrauterine balloon use is associated with volume of blood loss at time of removal.

Methods: An 11-year data collection of all intrauterine balloons inserted at a tertiary hospital was conducted.

Results: Intrauterine balloons were inserted for 279 patients over 137 months (2.0 month). Their mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was 27.4 (±6.5, 16.3-57.8). The median parity was (2, 0-7), with an average estimated blood loss (EBL) of 2137 mL (±938 mL, 500-5620). The mean length of time intrauterine balloons were in situ was 16.3 h (±7.5, 0-51). The mean additional blood loss at removal was 92 mL ± 152.9. There was a positive correlation between EBL at delivery and the length of time the intrauterine balloon was left in situ (r = 2.67, P < 0.01). No difference was seen in additional blood loss at removal of those balloons left in situ for more than 12 h (98 mL ± 160) compared with less than 12 h (80 mL ± 136, P = 0.59). Continuous oxytocin infusions were used in all but 16 cases during balloon insertion. A total of 55 patients were fed with an intrauterine balloon in situ (19.6%, n = 280).

Conclusion: Intrauterine balloons are left in for longer than necessary, and earlier removal is not associated with a greater blood loss. We suggest that earlier removal is reasonable and should the balloon prove successful at insertion, patients should not be treated as at ongoing risk of bleeding. Further randomized studies should be conducted to elicit optimal time of removal to improve patient experience and flow through the labor ward.

Objectives: To compare the incidence of postpartum depression, mother-infant bonding, and anxiety among women with diabetes mellitus.

Methods: This prospective cohort study included women who had singleton pregnancies and delivered a live neonate (either vaginal delivery or cesarean delivery) in a tertiary care center in South India. Group A consisted of women with gestational diabetes mellitus who received medical management. Group B included age-, gestational age-, and parity-matched women with no medical comorbidities. Both groups were administered locally validated versions of three questionnaires (Patient Health Questionnaire [PHQ-9], the Generalized Anxiety Disorder Questionnaire [GAD-7], and Postpartum Bonding Questionnaire [PBQ]) at two points (1-3 days postnatal/postoperative (T1) and 6 weeks postpartum). The variables were assessed using χ² or Fisher exact tests. Binomial logistic regression was used to identify risk factors for depression in the diabetic group.

Results: A total of 520 women (260 in each arm) were recruited and analyzed; their demographic variables were comparable. Diabetic women had a significantly higher incidence of depression (assessed using PHQ-9 score) in the immediate postpartum period (11.9% versus 5.8%; odds ratio [OR] 2.21, P = 0.013) and 6 weeks postpartum (4.6% versus 1.2%; P = 0.018). However, the levels of maternal anxiety (17 [6.5%] versus 14 [5.4%]; P = 0.578) and mother-child bonding (0 [0%] versus 0 [0%]; P = 1) at time point 1 were comparable. No significant differences were observed in maternal anxiety and bonding at time point 2. Multiple logistic regression revealed neonatal intensive care unit admission (adjusted OR 11.83, 95% confidence interval 3.7-37.78; P = 0.000) as significant predictors for early postpartum depression.

Conclusion: Postpartum depression was significantly higher in women having antenatal diabetes. However, maternal anxiety and mother-child bonding were comparable.

Objective: This study aimed to investigate the efficacy of thermal ablation (TA) for treating cervical intraepithelial neoplasia grade 1 (CIN 1) among women with positive high-risk human papillomavirus (hr-HPV).

Methods: This prospective study was conducted at Tu Du Hospital, Vietnam between August 2023 and February 2025. The study enrolled all the women aged greater than 30 years with CIN 1 and positive hr-HPV test treated with TA. The primary outcome included evaluation of healed lesion on cytology, colposcopy combined with visual inspection of the cervix with acetic acid (VIA) and Lugol's iodine testing as well as HPV clearance rate. The secondary outcome included patient's satisfaction and undesirable effects during the treatment and follow-up visits.

Results: Among 66 women eligible for inclusion in the study, the clearance rate of all hr-HPV genotypes at 3 and 6 months was 62.1% and 84.6%, respectively. The clearance rates of HPV 16 and HPV 18 after undergoing TA treatment was highly achieved at 88.8% and 85.7%, respectively. Overall, the clearance rate of HPV 16, 12 other hr-HPV genotypes, overall hr-HPV genotypes and normal colposcopic findings were significantly improved following treatment compared to before treatment (P < 0.05). After 6 months, the overall cure rate of thermal ablation was observed at 60.6% (40/66 cases). The most common side effects included vaginal heat (43.1%), abdominal pain (34.8%), and vaginal pain (27.9%). On monitoring, patient's satisfaction was highly achieved at 93.9% on day 0 post-treatment and for 95.5% at 3-month control visit. No adverse effects as well as requirement of repeated ablation were reported.

Conclusions: Thermal ablation is an effective, safe, and well-tolerated treatment for women with CIN 1 and positive hr-HPV genotypes. This reliable modality shows a promising option for cervical cancer prevention in low-resource settings. Further studies are required to strengthen these findings in different populations.

Objective: We aimed to evaluate the differences in short-term outcomes of twins admitted to the neonatal intensive care unit (NICU) based on chorionicity.

Study design: A retrospective study of mothers and their twins admitted between January 1, 2015, and 31 December, 2023, was performed. Length of stay (LOS) and noninvasive ventilation (NIV) were compared between 143 monochorionic diamniotic (MoDi) and 149 dichorionic diamniotic twins (DiDi). Linear regression was then conducted to explore identified potential relationships from these analyses.

Results: Univariate analysis revealed longer LOS and duration of NIV in MoDi compared to DiDi twins (P = 0.008 and 0.010, respectively). Linear regression analysis confirmed that these results were due to chorionicity and not gestational age and birth weight. This was again true in propensity matched grouping.

Conclusion: MoDi twins have longer LOS and duration for NIV compared to DiDi twins.

Objective: Numerous studies have assessed the relationship between estrogen and cancer, and an association between uterine fibroids and an increased risk of endometrial cancer and thyroid cancer has been found. However, previous studies are limited by small sample sizes and lack of information on patient characteristics. This population-based retrospective cohort study aimed to confirm the association between uterine fibroids and cancer risk.

Methods: This population-based retrospective cohort study used insurance information recorded in the Korea's Health Insurance Review and Assessment Service from January 1, 2009, to December 31, 2020. Patients with a diagnosis of uterine fibroids and uterine fibroid removal surgery code were included in the uterine fibroid group. Women who visited a clinic for a health checkup were included in the non-uterine fibroid group.

Results: In total, 714 171 individuals were studied, 492 610 in the non-uterine fibroids group and 221 561 in the uterine fibroids group. The all-site cancer hazard ratio (HR) of the uterine fibroid group was higher than that of the non-uterine fibroid group (all sites: HR, 1.399, confidence interval [CI]: 1.346-1.454), with HR for breast 1.263 (CI: 1.177-1.354), uterus 2.459 (CI: 2.009-3.010), ovary 1.349 (CI: 1.097-1.659), kidney 1.432 (CI: 1.014-2.022), thyroid 1.693 (CI: 1.591-1.800), and retroperitoneum and peritoneum 3.059 (CI: 1.263-7.414).

Conclusion: Surgically treated uterine fibroids are associated with increased cancer risk. They are associated with an increased risk of breast, uterine, ovarian, kidney, thyroid, peritoneal, and retroperitoneal cancers.

Objective: This study investigates the prenatal characteristics and postnatal outcomes of fetal abdominal cysts and evaluates the diagnostic performance of prenatal ultrasonography (US).

Methods: All cases of fetal abdominal cystic lesions followed up in our center between 2020 and 2024 were retrospectively analyzed. Cysts of urinary system origin and major complex multiple organ anomaly cases were excluded. Cysts were divided into subgroups according to prenatal diagnosis. Sensitivity, specificity, positive predictive value, false positive rate, and accuracy of prenatal US were calculated for each subgroup.

Results: A total of 86 cases were included in the study. The majority of cases diagnosed by prenatal ultrasonography were of ovarian origin (39.5%), followed by duplication cysts (16.2%) and choledochal cysts (11.6%). Five cases resulted in termination of pregnancy, and two cases resulted in intrauterine fetal death. After delivery, 25.3% of cases required surgical intervention. When comparing prenatal and postnatal diagnoses, the overall sensitivity, specificity, and accuracy of prenatal ultrasonography were 98.61%, 98.44%, and 98.44%, respectively.

Conclusion: Prenatal diagnosis of fetal abdominal cysts is important for appropriate management and counseling. The etiology of cysts can be accurately diagnosed by prenatal ultrasonography in approximately 85% of cases.

Objective: Our study aimed to evaluate the combined risk of macrosomia and nulliparity. We investigated whether macrosomia is independently associated with an increased rate of intrapartum cesarean delivery (CD) and adverse maternal and neonatal outcomes among nulliparous women delivering at term.

Methods: We conducted a retrospective cohort study including nulliparous women with singleton, term (37-42 weeks) deliveries between 2005 and 2024 at two university-affiliated medical centers in Jerusalem, Israel. Women who delivered macrosomic neonates (birth weight ≥4000 g) were compared with those delivering neonates weighing 3000-3500 g. Exclusions included multifetal gestations, preterm deliveries, elective cesareans, fetal anomalies, and antepartum demise. The primary outcome was intrapartum cesarean delivery. Secondary outcomes included a range of maternal and neonatal complications. Multivariable logistic regression was used to adjust for potential confounders including maternal obesity, pre-gestational diabetes, labor induction, and gestational age at delivery.

Results: Among 86 801 eligible nulliparous women, 2762 (3.2%) delivered macrosomic neonates and 40 963 (47.2%) served as the control group. The rate of intrapartum CD was significantly higher among macrosomic deliveries compared to controls (18.6% vs. 7.8%, P < 0.01), though this association was not statistically significant after adjustment (adjusted odds ratio [aOR] 1.81, 95% confidence interval [CI]: 0.91-3.58). Macrosomia was independently associated with increased odds of shoulder dystocia (aOR 33.42, 95% CI: 11.32-98.68), postpartum hemorrhage (aOR 2.13, 95% CI: 1.79-2.54), blood transfusion (aOR 2.45, 95% CI: 1.51-3.98), chorioamnionitis (aOR 2.03, 95% CI: 1.57-2.61), neonatal intensive care unit admission (aOR 1.62, 95% CI: 1.15-2.29), neonatal hypoglycemia (aOR 2.23, 95% CI: 1.32-3.77), and Erb's palsy or clavicular fracture (aOR 9.43, 95% CI: 4.01-22.21). Stratification by birth weight categories revealed a dose-response relationship, with the highest complication rates among neonates >4500 g.

Conclusion: In nulliparous women delivering at term, macrosomia is independently associated with a higher risk of multiple adverse maternal and neonatal outcomes. These findings underscore the compounded risk faced by nulliparous women with macrosomic fetuses and highlight the need for enhanced prenatal surveillance and individualized delivery planning in this population.

Objective: To examine the correlation between levels of anti-Müllerian hormone (AMH)-which serves as an indicator of ovarian reserve-and inflammation markers in women with endometriomas.

Methods: This retrospective investigation involved 91 women with surgically verified endometriomas. Data on demographics, endometriosis features, and serum inflammatory markers were gathered.

Results: Age exhibited a negative correlation with AMH levels (r = -0.474, P < 0.001). The monocyte-to-lymphocyte ratio, Systemic Immune-Inflammation Index, and platelet-to-lymphocyte ratio exhibited negative correlations with AMH (r = -0.225, P = 0.032; r = -0.223, P = 0.033; and r = -0.270, P = 0.010, respectively). Age and the platelet-to-lymphocyte ratio were found to be independent predictors of AMH levels.

Conclusions: Systemic inflammation appears to be an independent predictor and causative factor of diminished ovarian reserve in endometriosis. These findings highlight the necessity for additional studies regarding the influence of inflammation on ovarian reserve and the possible therapeutic ramifications of regulating inflammation in managing endometriosis.