International Journal of Gynecology & Obstetrics最新文献

Historically, blind intrauterine procedures such as dilation and curettage (D&C) and blind endometrial biopsies have been the primary approach for diagnosing and managing intrauterine pathologies. However, these techniques lack direct visualization, leading to diagnostic limitations, incomplete treatment, and increased complication rates. Despite substantial advances in hysteroscopic technology, including high-definition imaging and minimally invasive instruments, blind procedures remain widely used. This paper examines the limitations of blind intrauterine procedures, underscoring the advantages of hysteroscopy, which provides real-time visualization and allows for more accurate, targeted interventions. With the adoption of the "See and Treat" philosophy, hysteroscopy enables nearly 90% of procedures to be performed in an office setting, enhancing both patient convenience and outcomes. FIGO and GCH advocate for the gradual replacement of blind procedures with hysteroscopic approaches whenever feasible, noting that hysteroscopy improves diagnostic accuracy, reduces risks, and minimizes the need for repeat interventions. Recommendations include expanding access to hysteroscopy through targeted training, especially in low- and middle-income countries, where financial and logistical barriers limit access to advanced gynecological care. Furthermore, this paper emphasizes the importance of patient-centered care, encouraging transparent counseling to support informed decision-making.

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.

Obstetric fistula is a debilitating childbirth injury causing immense suffering for women and girls with the condition. The majority of fistulas can be successfully treated with a surgical repair, performed by a competent surgeon who has undergone specialist training and who works with a holistic fistula care team. As well as surgical repair, a critical component of fistula treatment is meticulous postoperative assessment to accurately determine surgical outcomes so that further treatment and support can be provided as required, and the risk substantially reduced of any patient being discharged with associated ongoing problems, such as urinary retention or residual/ongoing incontinence. Based on the opinions of experts in the field, these good practice recommendations provide a practical and standardized protocol for the correct assessment of surgical outcomes following vesicovaginal fistula surgery and appropriate subsequent management.

Objective: Lack of accessibility to oral glucose tolerance tests (OGTTs) in South Africa means many pregnant women go without testing for gestational diabetes mellitus (GDM). This study evaluated point-of-care (POC) glucometers against the laboratory-based glucose method in pregnant women.

Methods: This was a cross-sectional study on pregnant women attending the prenatal clinic in Johannesburg who were recommended for the OGTT. OGTTs were conducted as per International Association of Diabetes and Pregnancy Study Groups (IADPSG) guidelines. Women who consented to the study donated both venous and capillary blood for laboratory-based and POC glucose measurements using seven POC glucometers: I-STAT, Xpress, LDX, VivaChek-Ino, Accu-Chek Active, StatStrip, and Codefree. By assessing sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) and comparing Bland-Altman plots, the diagnostic accuracy of each glucose meter was compared with the reference method, the laboratory-based glucose method.

Results: Data were analyzed for 1076 pregnant women. Based on OGTT testing, 83 women had GDM (7.7%). Overall, the POC glucometers performed poorly, with sensitivity ranging from 17.6% to 87.18% and specificity ranging between 62.7% and 99.8%. The AUC ranged from 0.59 to 0.79. All POC glucometers showed moderate to poor reliability. Laboratory-based fasting plasma glucose (FPG) surpassed the POC glucometers in sensitivity, specificity, and AUC, with values of 94.0%, 100%, and 0.98, respectively.

Conclusion: We demonstrated that laboratory-based FPG has the potential to be used as a diagnostic test for GDM and that the POC glucometers cannot replace OGTT laboratory-based measurements.

Objective: To determine the value of the Aggregate index of systemic inflammation (AISI) in predicting admission to neonatal intensive care unit (NICU) and chorioamnionitis.

Methods: The present retrospective cohort study with pregnant women who were diagnosed with preterm premature rupture of membranes (PPROM) in the Department of Perinatology, Ministry of Health Ankara City Hospital between January 1, 2021, and June 1, 2023 (n = 357). The patients were categorized into subgroups: (1) cases with (n = 27) or without (n = 330) chorioamnionitis, (2) admission (n = 182) or no admission (n = 175) to NICU; (3) gestational age at birth <28 weeks or 28 weeks or longer; and (4) gestational age at birth <34 weeks or 34 weeks or longer. AISI values were compared between the subgroups, and cut-off values for AISI were determined to predict adverse outcomes.

Results: AISI values were significantly higher in the admission to NICU group compared with the no admission to NICU group (707.0 vs 551.2) (P < 0.05). AISI values were also significantly higher in the chorioamnionitis group compared with those without chorioamnionitis (850.3 vs 609.4) (P < 0.05). AISI levels were significantly higher in cases delivered before 28 weeks of gestation compared with the cases delivered at 28 weeks of gestation or later (945.6 vs 604.9) (P < 0.05), and were also significantly higher in cases delivered before 34 weeks of gestation compared with the cases delivered at 34 weeks of gestation or later (715.5 vs 550.1) (P < 0.05). Optimal cut-off values of AISI were found to be 626.19 (74.1% sensitivity, 52.8% specificity), 506.09 (68.9% sensitivity and, 47.7% specificity), and 555.1 (69.8% sensitivity, 48.1% specificity) in predicting NICU admission, chorioamnionitis, and delivery before 28 weeks, respectively.

Conclusion: The novel inflammatory marker AISI may be used in the prediction of chorioamnionitis and NICU admission in PPROM cases.

Synopsis: Aggregate index of systemic inflammation may be used as a novel marker in predicting high-risk for chorioamnionitis and neonatal intensive care unit admission in women with preterm premature rupture of membranes.

Importance: FGM/C is common, effecting over 200 million women worldwide and has substantial associated morbidity. We seek improving the reversal procedure using ultrasound imaging.

Objective: The use of peri- and intraoperative ultrasound imaging for reconstructive surgery following FGM/C for staging and surgical planning, with focus on the clitoral structures and blood flow.

Study design: This is a case series of patients with FGM/C who were evaluated and underwent reconstructive surgical management at a single institution between 2018 and 2022. Ultrasound examination with Doppler imaging was performed. The electronic medical record was queried for data regarding patient characteristics, examination and ultrasound findings, and surgical and postoperative course.

Results: Seven patients are described in this case series who sustained the FGM/C with classifications ranging from Ia to IIIb. The primary complaints were dyspareunia or apareunia. Six of seven (86%) reported anorgasmia. Four of seven (57%) had prior vaginal deliveries, and one of seven (14%) was delivered only by cesarean sections, two of seven (29%) have not been able to have intercourse. Ultrasound examination was utilized to facilitate recognition of the anatomic structures during the reconstruction, and Doppler was used to evaluate the clitoral blood flow. Doppler was useful to delineate clitoral tissues from a closely involved periclitoral inclusion cyst, aiding in surgical excision while minimizing clitoral vascular or nerve injury. Postoperative anatomical restoration, sexual function, and alleviation of dyspareunia were excellent. None of the patients reported decreased sexual pleasure postoperatively.

Conclusions: Ultrasound imaging with Doppler can be utilized to facilitate personalized approaches to optimize both anatomical and functional results in cases of genital reconstruction.