International Journal of Gynecology & Obstetrics最新文献

Objective: To present our surgical outcomes by comparing the transumbilical and transvaginal methods for the removal of specimens in laparoscopic surgery of fibroids and adnexal masses during our 12 years of experience.

Methods: A retrospective cohort study was conducted at our referral center between January 2012 and April 2024. We evaluated surgical outcomes, patients' clinical-demographic characteristics, cosmetic-pain scores and dyspareunia by comparing the two methods that we use routinely.

Results: We retrospectively reviewed 285 patients. Visual analog scale (VAS) scores at 24 h were lower in the transvaginal group than in the transumbilical group (0.4 ± 0.6 vs. 0.8 ± 0.8, P < 0.001). The 3-month postoperative cosmetic score (CS) was higher in the transvaginal group than in the transumbilical group (4.5 ± 0.5 vs. 4.1 ± 0.6, P < 0.001). Furthermore, myomectomy and transumbilical were independent risk factors for lower VAS scores 24 h post surgery (myomectomy: odds ratio [OR] 3.42, P = 0.001, transvaginal route: OR 0.41, P = 0.005). Finally, the transumbilical extraction route and extension of the umbilical incision were independent risk factors for lower CS (P = 0.035 and P = 0.028).

Conclusion: Removal of the specimen via the transvaginal route in laparoscopic adnexal mass and fibroid surgeries may lead to less pain in the early postoperative period and better cosmetic results without increasing the duration of the operation, the rate of intraoperative complications, and the rate of dyspareunia.

Objective: To investigate the perioperative and pregnancy outcomes among different surgical approaches and methods for treating heterotopic pregnancy (HP) and to identify the risk factors for the loss of intrauterine pregnancy (IUP).

Methods: We retrospectively reviewed 59 cases of interstitial and angular HP treated surgically between 2014 and 2024 in two women's health centers in southwest China. Surgical methods included multi-port laparoscopy (MPL), transumbilical laparoendoscopic single-site surgery (TU-LESS), and conventional laparotomy (CL), along with cornual wedge resection and linear incision. Clinical outcomes were compared among IUP loss and successful IUP delivery; MPL, TU-LESS, and CL; and cornual wedge resection and linear incision groups. Binary logistic regression analysis was used to assess factors for predicting IUP loss.

Results: There were 47 cases of live births of IUP. The operation duration was longer in the IUP-lost group (94.58 ± 32.51 min) versus the IUP-delivered group (67.29 ± 25.37 min, P = 0.001), and the incidence of hemorrhagic shock was significantly higher in the IUP-lost group (25% vs 2.1%, P = 0.024). There was one case of incomplete uterine rupture in the cornual wedge resection group. A history of biochemical pregnancy or missed abortion (Exp B = 32.610, P = 0.042), and fresh embryo transfer (Exp B = 0.126, P = 0.022) predicts IUP loss.

Conclusion: CL, MPL, and TU-LESS, as well as cornual wedge resection and linear incision for treating HP, all showed comparable perioperative and IUP outcomes. Linear incision has relatively better surgical outcomes than cornual wedge resection. Factors such like fresh embryo transfer and a previous history of biochemical pregnancy or missed miscarriage predict IUP loss.

Pre-eclampsia, placental abruption, and fetal growth restriction (FGR) are collectively referred to as placental ischemic disease (PID). Heat shock proteins (HSPs), originally considered as a response to the heat shock, have a central role in regulating the cellular functions by quality controlling the newly synthesized proteins. The aim of the present review is to investigate the expression of the HSPs in PID and their potential role as biomarkers, based on the available data in the literature. A considerable amount of research has been conducted in order to determine the significance of HSPs in placental pathology and insufficiency, using both immunochemistry and circulating mRNA approaches. HSPs seem to be promising biomarkers that could be used for screening and monitoring the cellular stress of the placenta and its dysfunction. Yet, in order to be able to reach more solid evidence and draw a safer conclusion regarding their utility in clinical practice there is still a long way to go and further well-designed greater scale studies are required.

This article presents the case of a 22-year-old woman at 29 weeks of pregnancy, who exhibited recent onset neurologic symptoms including paresthesia of the right side of the face, involuntary myoclonic movements in the ipsilateral hand, 1 week of weakness in the right side of the body, and imaging features that were highly suggestive of a brain tumor diagnosis. A challenging decision making process was conducted by a team of multidisciplinary experts, leading to a consensus on adopting a conservative approach involving the use of steroids and antiepileptic medications, to which the patient responded favorably. When the patient reached 34 weeks of pregnancy, a cesarean section was performed, without complications, with the delivery of a healthy premature newborn. Upon delivery, surgical resection of the brain lesion was performed. Histopathologic analysis of the biopsy did not show signs consistent with neoplasia. Instead, it highlighted areas of necrosis along with the presence of granulomas and giant cells. Notably, despite extensive testing and staining for tuberculous bacilli across multiple samples yielding negative results, definitive confirmation was only secured via a gene X-pert test on the biopsied tissue. This diagnostic process emphasizes the importance of considering infectious diseases in atypical cases, highlighting the complexity of neurologic symptom assessment during pregnancy and the need to explore epidemiologic, systemic, and personal history factors.

Medical racism perpetuates health inequities contributing to why Black people in the United States (US) experience worse health outcomes when compared to non-Hispanic White populations. In terms of endometriosis, research on endometriosis-associated stigma has included mainly non-Hispanic White populations, with far less research on non-Hispanic Black populations. This leaves a gap in our knowledge on how stigma informs the intersection of racism and endometriosis. Thus, this study assessed the stigma experiences of Black women with endometriosis residing in the Washington, DC, area. An anonymous cross-sectional survey obtained key demographics, healthcare experiences, stigma, and depression. Mean stigma scores were similar (scale of 1 (least) to 5(most): enacted = 2.0 (SD ± 0.9), anticipated = 2.3 (SD ± 1.0), and internalized = 2.5 (SD ± 0.7) (n = 28). Those reporting healthcare providers made assumptions based on racial stereotypes had higher anticipated stigma, compared to those who did not (2.6 vs. 1.7). It was also observed that there was higher anticipated stigma for those changed providers due to racial discrimination, compared to those who did not (2.9 vs. 1.7). It can be theorized that the real-world outcomes from these stigma experiences may include delayed treatment and interruption in care continuity leading to worse health outcomes. This highlights why culturally responsive care practices are needed to address medical racism and stigma.

Objective: In this study, we examined quantitative blood loss (QBL) values and postpartum hemorrhage (PPH) diagnoses in relation to clinical, demographic, and hospitalization related variables.

Methods: A retrospective chart review was conducted of deliveries at a regional hospital over a nine-month period, querying patient demographics, PPH diagnosis, blood loss, and hospital stay variables.

Results: PPH was substantially underdiagnosed by current USA guidelines (78%). Deliveries with >1000 mL of blood loss were not diagnosed with PPH (78%), including 84% of cesarean deliveries. Deliveries with >500 mL blood loss were not diagnosed with PPH (92%), including 89% of vaginal deliveries. There was no difference between estimated blood loss (EBL) and QBL levels for all deliveries (P = 0.9981); however, when separated by type of delivery, EBL was underestimated for vaginal deliveries (P = 0.02) and overestimated for cesarean deliveries (P = 0.02). PPH values were both associated with longer hospital stays (P < 0.001), and higher cost of care (P < 0.0001). Compared to Caucasian women, African American and Hispanic/Latina women had higher rates of PPH (P < 0.001 and P < 0.05, respectively).

Conclusion: Quantitative measurement of blood loss identified many cases of undiagnosed PPH. Additionally, African American and Hispanic/Latina women were more likely to be diagnosed with PPH.

Objective: Relapsed/refractory gestational trophoblastic neoplasia (RR-GTN) presents a significant therapeutic challenge, with limited options available for patients who fail first-line treatments. In the present study we describe a few unique cases of RR-GTN and various options available for such situations.

Methods: We identified three cases of RR-GTN between January 2021 and December 2022 who failed two or more lines of standard treatment. Clinical characteristics, therapeutic regimens, toxicities, and outcomes were collected from the case records.

Results: We present this case series of three patients with RR-GTN treated with distinct therapeutic approaches: (1) Surgery for localized disease, (2) immunotherapy with pembrolizumab, and (3) tandem autologous stem cell transplantations. We also provide a detailed review of the available literature and guidance on managing RR-GTN.

Conclusion: Intensified chemotherapy regimens, immune checkpoint inhibitors, and autologous stem cell transplantation offer promising avenues for improving outcomes in these high-risk patients. Clinical trials are warranted to establish the optimal sequencing of these therapies in clinical practice, but it may not be possible due to the paucity of such clinical situations.

All female oncology patients undergoing controlled ovarian stimulation for fertility cryopreservation should be offered an antagonist protocol. Therapy can begin at the time of the first visit, providing consent is obtained. There is no need to delay until the next period. Stimulated patients should be monitored with ultrasound and estradiol levels as per normal clinic practice. For women with a diagnosis of breast cancer, and with the agreement of the treating oncologist, the stimulation protocol should include an aromatase inhibitor such as letrozole to reduce the circulating estradiol levels. All patients should have a gonadotropin-releasing hormone trigger to eliminate the risk of ovarian hyperstimulation syndrome and facilitate timely return for cancer therapy.

Objective: To analyze independent risk factors for endometrial cancer (EC), a common female cancer globally, and construct individualized prediction models for EC recurrence.

Methods: The EC patients from the medical record system were divided into low-grade (n = 392) and high-grade (n = 183) groups. Immunohistochemical expression of estrogen receptor, progestin receptor, Ki67, and L1 cell adhesion molecule (L1CAM) was detected. Univariate Cox regression, LASSO regression, and stepwise Cox regression were applied for identifying independent risk factors for EC recurrence. The predictive value of the model was verified by using receiver operating characteristics curves, bootstrap method, calibration curves, and decision curve analysis curves.

Results: Multivariate Cox analysis revealed that FIGO (the International Federation of Gynecology & Obstetrics) Stage, progestin receptor, lymphovascular space invasion (LVSI), and tumor size were independent risk factors for low-grade EC recurrence-free survival (RFS), and FIGO Stage, L1CAM, LVSI, and pelvic lymph node status were independent risk factors for high-grade EC. The areas under the curves at 1-, 3-, and 5-year RFS in low-grade and high-grade groups were 0.881/0.825, 0.888/0.853, and 0.807/0.832, respectively. Calibration curves were close to the diagonal, and the decision curve analysis curves were located mostly above the All and None lines in both groups.

Conclusion: The prediction model demonstrates accurate discriminative ability and strong calibration capability. It has high clinical application value and provides decision making information regarding RFS for both low-grade and high-grade EC patients. This may assist in formulating personalized treatment plans, monitoring follow-up strategies, and implementing lifestyle intervention measures.