International Journal of Gynecology & Obstetrics最新文献

Objective: Supported by remote signal processing techniques and wireless communication technology, remote electronic fetal monitoring (REFM) has emerged as a promising alternative to traditional electronic fetal monitoring (TEFM) in clinical practice. The aim of this study was to evaluate the comparability, accessibility, and clinical utility of REFM in contrast to TEFM.

Methods: This was a multicenter prospective cohort study. A cohort of 2900 pregnant women were enrolled from three medical centers between June 1, 2021 and June 31, 2022. Among them, 800 utilized REFM, with 760 of them completing the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) assessments using the devices for 1 month. The control group comprised 2100 pregnant women who did not use REFM. Additionally, 80 pregnant women concurrently employed both REFM and TEFM, and their respective curve coincidence rates were determined through curve fitting. Primary outcomes encompassed pregnancy outcomes in both groups, average curve coincidence rates between REFM and TEFM, as well as SDS and SAS scores.

Results: Among the 760 pregnant women who completed SAS and SDS assessments, their average SAS scores before and after 1 month of REFM usage were 43.09 ± 8.04 and 41.58 ± 6.59, respectively. Concurrently, the average SDS scores before and after 1 month of REFM usage were 45.45 ± 9.60 and 44.80 ± 9.17, respectively. A statistically significant decrease was observed in SAS scores (P = 0.005), whereas no significant difference was noted in SDS scores (P = 0.340). Furthermore, a statistically significant difference in the rate of adverse pregnancy outcomes (neonatal asphyxia) emerged between the two groups, those who employed REFM and those who did not (P = 0.021). In the subset of 80 pregnant women employing both REFM and TEFM, all 80 results showed precise congruence between the two methods. The average coincidence rate was determined to be 79.45% ± 12.64%.

Conclusion: REFM contributes to improved pregnancy outcomes and exhibits a high level of concordance with TEFM, thereby accurately reflecting the quality of fetal heart monitoring. Additionally, REFM effectively mitigates pregnant women's anxiety. Thus, REFM demonstrates comparability, accessibility, and clinical utility.

Background: Literature is lacking strong evidence about comparisons of efficacy and quality of life-related outcomes between laparoscopic total and/or supracervical hysterectomy (LTH/LSCH) with laparoscopic sacrocolpopexy (LSC) and minimally invasive sacrohysteropexy (LSH).

Objective: To summarize and compare available data on this topic providing a useful clinical tool in the treatment decision process.

Search strategy: We performed a systematic research of PubMed (MEDLINE), Web of Science, and Gooogle Scholar.

Selection criteria: We included studies that compared at least one efficacy outcome (objective or subjective outcome) between LTH/LSCH with LSC and LSH. Data on surgery-related morbidities were also extracted where available.

Data collection and analysis: A random-effect meta-analysis was conducted reporting pooled mean differences and odds ratios (OR) between groups using Review Manager V.7.9.0.

Main results: We included a total of nine observational studies. LTH/LSCH with LSH was associated with a significantly higher objective success (apical compartment OR 7.95; 95% confidence interval [CI] 2.23-28.33; I² = 0%; P = 0.001; anterior compartment OR 2.23; 95% CI 1.26-4.30; I² = 12%; P = 0.007) and subjective success (OR 3.19; 95% CI 1.42-7.17; I² = 39%; P = 0.005). No differences were found regarding intraoperative and postoperative complications, sexual dysfunction, and stress urinary incontinence rate after surgery. Hysteropexy showed shorter operative time and shorter hospital length with a pool mean difference of 27.37 min (95% CI 18.04-32.71; I² = 0%; P < 0.001) and 0.7 days (95% CI 0.24-1.17; I² = 75%; P = 0.003), respectively. Concurrent hysterectomy was not associated with a higher rate of mesh-related complications (P = 0.53). No major differences were found regarding recurrence and reoperation rate (P = 0.10 and P = 0.93, respectively).

Conclusions: LTH/LSCH with LSC has better objective and subjective outcomes in pelvic organ prolapse surgery than LSH alone, especially for apical and anterior compartments, and is not associated with higher postoperative sexual dysfunction and mesh-related complications. Adequate preoperative counseling is highly recommended in patients who desire uterine preservation.

Prospero registration number: CRD42024537270.

Objective: To evaluate clinical factors prior to methotrexate (MTX) treatment for tubal ectopic pregnancy and to apply the data to a prediction model for treatment success.

Methods: A retrospective cohort study was conducted during 2014-2022. Of the 808 patients with a tubal ectopic pregnancy, 372 with a β-hCG level less than 5000 IU/L were treated with a single dose of MTX and were included in this study. Pretreatment factors, including patient characteristics, initial β-hCG level, and sonographic parameters, were compared between those who achieved complete resolution and those who needed additional MTX or surgical intervention. A logistic regression model and multivariable analysis were used to predict success. A graphic nomogram was generated to represent the model.

Results: Complete resolution of the ectopic pregnancy was achieved in 290 (77.9%) patients after a single dose of MTX. A second dose or surgical intervention was required for 82 (22.0%): 49 (13.2%) received a second dose of MTX and 33 (8.9%) underwent laparoscopic salpingectomy. In the MTX Success group compared to the MTX Failure group, the median β-hCG levels were lower (746 vs 1347 IU/L, P < 0.001) and the presence of a yolk sac and a fetal pole were less frequent. The predictive model, based on significant variables, includes initial β-hCG concentration and the visibility of a yolk sac or fetal pole. Analysis with cross-validation techniques revealed that the model was both accurate and discriminative.

Conclusion: A predictive nomogram was developed to predict the success of single-dose MTX treatment for tubal ectopic pregnancy.

Objective: To evaluate the relationship between premenstrual disorders (PMD) and age, we analyzed the prevalence and severity of psycho-emotional and physical symptoms in a representative sample of Brazilian women.

Methods: This observational and retrospective study analyzed data from Brazilian women aged 20-49 years from five regions of the country who reported premenstrual symptoms. Participants completed a premenstrual symptom screening questionnaire and self-reported the presence and severity of their symptoms. Among 23 104 women reporting does premenstrual symptoms, 38.91% (n = 8990) experienced PMD caused functional impairment. Finally, 5121 participants agreed to complete the adapted version of the screening questionnaire.

Results: The age group distribution was 20-29 (46.7%), 30-39 (38.3%), and 40-49 years (15%). The most prevalent and severe physical symptom was acne/oily skin in participants aged 20-29 years and headache in women aged 30-49 years. Regarding psycho-emotional symptoms, the most prevalent was anxiety/tension in women aged 20-29 years and 40-49 years and irritability/anger in those aged 30-39 years. Irritability/anger was the most severe symptom in all groups.

Conclusion: PMD significantly impacts the quality of life of Brazilian women with varying intensity. Physical symptoms associated with PMD vary with age, while psycho-emotional symptoms, particularly irritability/anger and anxiety, were intense in Brazilian women of reproductive age. These findings inform early diagnosis and individualized treatment approaches for PMD, addressing the needs of women.

The editors of the International Journal of Gynecology and Obstetrics (IJGO) are pleased to announce a prize award for the best clinical research paper from a low- or middle-income country published in the IJGO during 2024.

All clinical research articles from low- and middle-income countries published in 2024 will be considered for this prize. Selection will be made by the editors and the decision will be announced in IJGO in 2025. The winning corresponding author will receive an £800 stipend, a certificate of recognition, and complimentary access to the online version of IJGO for a period of 1 year from the date the prize is awarded. Notification will be made to the corresponding author, who will be responsible for determining distribution of the winnings.

This award has been established for the purpose of encouraging investigators, especially young scientists, from low- and middle-income countries to submit their very best clinical research articles for publication in IJGO.

IJGO is the official publication of the International Federation of Gynecology and Obstetrics (FIGO), the primary international organization for the specialty of obstetrics and gynecology. FIGO is dedicated to enhancing the health care of women worldwide, and the prize award is intended to encourage authors to work toward the FIGO mission, which is, in part, to serve an international audience by publishing original scientific articles and communications originating in low-income countries, emphasizing important obstetric and gynecologic problems, issues, and perspectives, such as maternal mortality and family planning.

Objectives: Our study aimed to evaluate the effect of superior hypogastric nerve plexus (SHNP) block in postoperative pain management in the first 24 h after minimally invasive gynecological (MIG) surgeries.

Methods: We conducted a double-blinded, randomized controlled trial in the Department of Obstetrics and Gynecology at a tertiary care centre from May 1, 2023 to September 30, 2023 in women undergoing major MIG surgeries. At the completion of the surgery, women were randomized to the intervention group who received SHNP block with ropivacaine 10 mL (0.75%) before port removal, whereas no intervention was taken in the control group. The extubation time was noted, and the pain score was assessed after 1, 2, 6, 12, and 24 h of extubation in the postoperative period using the visual analog scale (VAS). Statistical analysis was done, with a significance level of 0.05, to test the differences between the two groups.

Results: A total of 64 patients were randomly allocated to intervention and control groups. The median pain score was lower at 1 and 2 h post-extubation and comparable between the two groups at 6, 12, and 24 h. The surrogate markers that is need for additional analgesia and duration of stay did not differ significantly in the two groups, with P-values of 0.08 and 0.943, respectively.

Conclusion: Although the SHNP group experienced considerably lower immediate postoperative pain levels in the initial hours following extubation, the impact of this benefit remains uncertain in the longer postoperative period. The effectiveness of this modality for pain control needs further study, particularly at later postoperative hours.

Contraception, and the opportunity and ability to decide the timing, number, and spacing of one's pregnancies, is not just critical for maternal and infant health, but necessary for the attainment of basic reproductive rights. Short inter-pregnancy intervals have significant consequences for both maternal and newborn mortality, including preterm birth and maternal anemia, and they are a key cause of preventable deaths worldwide. Addressing the unmet need for contraception could have widespread implications for health equity and access. Integrating comprehensive contraceptive services into various health settings including antenatal care, postpartum care, and child immunization visits is vital. Contraceptive counseling should be holistic, and should involve shared decision-making and patient autonomy. Contraceptive counseling is particularly important in the post-pregnancy period, where loss to follow-up may be high, and for adolescents and other vulnerable populations who are often overlooked in these discussions. Addressing the unmet need for contraception requires collaboration and teamwork among healthcare professionals, particularly midwives and physicians, who have the opportunity to amplify one another's efforts, share best practices, advocate for broader contraceptive services, and strengthen training among midwifery and medical trainees. Members of FIGO and ICM have worked together to produce this joint statement, identifying priorities within contraceptive provision and underlining key collaborative strategies to address the unmet need for contraception.