International Journal of Gynecology & Obstetrics最新文献

Objective: Labor induction is offered to reduce the risk of stillbirth at late term (41⁺⁰ to 41⁺⁶) but earlier induction in normotensive singleton pregnancies is supported by weak evidence. The aim of the present study was to investigate the optimal timing for induction in normotensive women.

Methods: This was a retrospective cohort study including 70 293 singleton term births in Iceland during 1997-2018. Women with serious pre-gestational comorbidity, hypertension, stillbirth or previous cesarean birth were excluded. The risk of adverse maternal and neonatal outcomes for induction at each week from gestational age 37-41 weeks was compared with expectant management, defined as deliveries at a later gestational age. Risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated using log-binomial regression adjusting for sociodemographics, parity, and pregnancy complications.

Results: The risk of cesarean was lower with induction at ≥40⁺⁰ than expectant management, especially at late term (RR 0.73, 95% CI: 0.63-0.83). Respiratory distress was diagnosed in 4.4% of infants after induction from 37⁺⁰ to 37⁺⁶ but 1.3% in the expectant management group (RR 3.08, 95% CI: 1.97-4.81). Induction between 37⁺⁰ and 38⁺⁶ compared with expectant management was associated with a reduced risk of shoulder dystocia, but this was non-significant in births of infants with normal birthweight.

Conclusion: Labor induction from 40⁺⁰ compared with expectant management was associated with reduced risk of cesarean birth in Icelandic women without an increase in risk of adverse maternal or neonatal outcomes. No additional benefit appeared to be from inducing at earlier gestations in low-risk pregnancies.

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: Polycystic ovary syndrome (PCOS) affects many women and is linked to nutrient intake, but the causal role of nutrients is unclear. Our study used Mendelian randomization (MR) to explore this relationship.

Methods: We employed two-sample MR to investigate the causal effects of four macronutrients (carbohydrates, fats, sugars, proteins) and 12 micronutrients (vitamin A [retinol], folate, vitamin B6, vitamin B12, vitamin C [ascorbic acid], vitamin D, vitamin E [alpha-tocopherol], magnesium, calcium, iron, selenium, and zinc) on the risk of PCOS based on their circulating levels. We conducted analyses using the inverse variance-weighted method (IVW), MR-Egger regression, weighted median method, and simple model approach, with IVW as the primary method. To correct for multiple testing, the false discovery rate (FDR) method was applied. The reliability and potential bias of the results were assessed by sensitivity analysis and F-statistics.

Results: From a genetic standpoint, higher circulating vitamin A (retinol) levels were found to be a protective factor for PCOS and closely associated with the risk of PCOS, consistent with recent research findings. The inverse variance-weighted (IVW) estimation indicated a protective effect of vitamin A (retinol) on PCOS (IVWOR = 0.97, 95% CI: 0.95-0.99, P = 0.002, FDR_P = 0.03). However, no causal relationship was found between other nutrients and PCOS. In addition, MR-PRESSO and MR-Egger regression showed that our results were not affected by horizontal pleiotropy (P > 0.05). Finally, leave-one-out sensitivity analysis confirmed the robustness of MR Results.

Conclusion: Our findings suggest that circulating vitamin A (retinol) levels influence the risk of PCOS, but further research is needed.

The decision to add hysterectomy to planned adnexectomy is often nuanced and likely increases the complexity of the planned procedure; however, these risks are not well characterized in practice. We conducted a comprehensive search in the PubMed database for English-language articles from 1997 to 2022, identifying studies reporting complication rates for open and minimally invasive surgery (MIS) hysterectomy and adnexal surgeries. We calculated medians and first and third quartiles for each complication and used a Mann-Whitney U test to calculate differences between complications for minimally invasive hysterectomy and adnexal case data. We identified 135 appropriate studies for inclusion. There were higher prevalences of blood loss requiring transfusion (1.70% versus 0.13%, P = 0.01) and urinary tract injury (0.80% versus 0.20%, P = 0.001) in MIS hysterectomy cases compared with MIS adnexal surgery, respectively. MIS hysterectomy cases were similar to MIS adnexal surgery cases in the risk of surgical site infection (1.20% versus 1.49%, P = 0.74), bowel injury (0.50% versus 0.35%, P = 0.45), vascular injury (0.20% versus 0.9%, P = 0.82), and conversion to laparotomy (1.95% versus 3.84%, P = 0.49). There were not enough data on open adnexal surgery complications to make a meaningful comparison between complications of open hysterectomy and adnexal-only cases. Patients should be counseled that the addition of hysterectomy to planned MIS adnexal surgery likely increases the risk of blood loss requiring transfusion and urinary tract injury. The increased comorbidity associated with adding hysterectomy to planned open adnexal removal is less clear.

Objective: The primary objective was to evaluate the prevalence of undiagnosed iron deficiency in patients with endometriosis.

Methods: We performed a multi-center, cross-sectional study at two tertiary care hospitals. We included 251 non-pregnant women (18-50 years old) presenting with a clinical or surgical diagnosis of symptomatic endometriosis. Patients who consented to the study underwent screening bloodwork (including complete blood count, ferritin, and transferrin saturation) and completed the study survey assessing demographics, medical and surgical history, and validated questionnaires to assess iron deficiency and endometriosis symptoms.

Results: The prevalence of iron deficiency in our endometriosis cohort was 53.4% (134/251), and the prevalence of iron deficiency anemia was 13.5% (34/251). Patients with iron deficiency were more likely to have heavy menstrual bleeding (HMB) compared with patients without iron deficiency (66/133, 49.6% vs. 40/115, 34.8%, p = 0.022). Nonetheless, 58% (142/251) of our study population did not endorse HMB. Despite absence of HMB, 47% (67/142) of these patients were iron-deficient. Transferrin saturation was diagnostic for iron deficiency in 63 of 176 patients (35.7%) who had a normal ferritin (≥30 ng/mL). Patients with iron deficiency had a significantly lower adjusted median Functional Assessment of Chronic Illness Therapy Fatigue Subscale score compared with those without iron deficiency (26.3. vs. 29.8, p = 0.025).

Conclusion: This study highlights the high prevalence of iron deficiency, which remains undiagnosed in over half of patients with endometriosis presenting to a gynecologist. Future research should focus on assessing the effectiveness of iron therapy in improving symptoms and overall well-being in this population.

Objective: To evaluate the value of serial post-cerclage cervical length measurements in predicting preterm birth.

Methods: This was a retrospective study of women with a singleton pregnancy who underwent prophylactic transvaginal cerclage from 2017 to 2023. Prophylactic cerclage was performed in women with an obstetric history of cervical insufficiency. After cerclage, all participants underwent routine transvaginal cervical measurement every 2-4 weeks until 32-34 weeks of gestation. Trajectory patterns of changes in cervical length were identified through latent class trajectory modeling. The association of patterns with spontaneous preterm birth and pregnancy interval was analyzed by multivariable logistic regression analysis and Cox proportional hazards regression models. The specific characteristics of changes in cervical length associated with preterm birth were identified.

Results: We involved 225 women and acquired a total of 1248 measurements of cervical length. Two distinct trajectories of cervical length change along gestation were identified: Class 1 (persistent shortening of cervix, n = 52 [23.11%]) and class 2 (stable cervix, n = 173 [76.89%]). Women in class 1 were highly associated with spontaneous preterm birth, with a hazard ratio (95% confidence interval [CI]) of 2.00 (1.36, 2.96). The average shortening rate ≥0.24 cm per week and cervical length ≤1.1 cm was significantly associated with spontaneous preterm birth at different gestational age.

Conclusion: Serial sonographic cervical length measurements after prophylactic cerclage are valuable in predicting preterm birth.

Objective: The pregnancy, delivery, and neonatal outcomes of pregnancies complicated by gout have yet to be evaluated in a population-based study. We sought to evaluate the obstetric and neonatal outcomes in pregnant patients with gout using a national population database.

Methods: This is a retrospective population-based cohort study utilizing the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). All women who delivered or had a maternal death in the USA (2004-2014) were included in the study. Pregnancy, delivery, and neonatal outcomes were compared between women with an ICD-9 diagnosis of gout to those without.

Results: Overall, 9 096 788 women met the inclusion criteria. Of these, 168 women (1.8/100000) had gout. Patients with gout, compared to those without, were more likely to be older and obese and to have chronic hypertension, pregestational diabetes mellitus, and thyroid disease. Pregnant women with gout were more likely to develop gestational diabetes mellitus (aOR 1.78 [95% CI 1.17-2.72], P = 0.008), to require operative vaginal delivery (aOR 3.26 [95% CI 2.03-5.22], P = 0.0001), and to experience venous thromboembolism (aOR 8.47 [95% CI 2.06-34.82], P = 0.003) compared to pregnant patients without gout. Patients with gout were more likely to deliver a neonate with congenital anomalies compared to those without gout (aOR 3.38 [95% CI 1.24-9.20], P = 0.02).

Conclusion: Gout in pregnancy, or pregnancies complicated by a history of gout, are associated with increased risk of gestational diabetes mellitus, pulmonary embolism, and neonatal anomalies.