International Journal of Gynecology & Obstetrics最新文献

Objective: To determine the accuracy of formulas for estimation of fetal weight in twin pregnancy.

Methods: Inclusion criteria from the ESPRiT twin cohort were twin pregnancies that resulted in live-born twins without congenital anomalies or twin-twin transfusion syndrome, ultrasound examination within 3 days of delivery, birth weight (BW) > 500 g and gestational age > 24 weeks. A total of 63 formulas using various combinations of abdominal circumference (AC), femur length (FL), biparietal diameter (BPD) and head circumference (HC) for the estimation of fetal weight (EFW), were compared to BW for accuracy in 226 twin pregnancies/452 fetuses.

Results: Using median percentage error (MPE), the most accurate formulas were the Hadlock formulas (1984, 1985 with MPE < 1%) incorporating AC, HC, and FL. The INTERGROWTH-21st formula, which incorporates AC and HC, marginally underestimated BW (MPE -3.7%). The Hadlock formulas were more likely to overestimate BW than underestimate it. Using small-for-gestational (SGA, EFW < 5th centile), the sensitivity for detection of low BW (BW < 5th centile) was 92%, 81% and 89% for the Hadlock 1984, Hadlock 1985 and INTERGROWTH-21st formulas, respectively. SGA prevalence was noted to be higher for the INTERGROWTH-21st formula for fetal factors.

Conclusion: Among 63 proposed formulas for EFW, the Hadlock formulas incorporating HC, AC and FL were the most accurate in twins. However, the INTERGROWTH-21st standard, which incorporates AC and HC, did not show lower detection rates for LBW. The frequency and intensity of twin ultrasound surveillance is such that restriction of ultrasound examination to two parameters in ultrasound could be recommended without diminution of accuracy.

Gorham-Stout disease (GSD) is a rare disorder characterized by spontaneous and progressive bone resorption. Its clinical presentation varies from unremarkable to life-threatening, making diagnosis and treatment challenging. Despite extensive research, no definitive correlations have been established between GSD and age, gender, race, or environmental and infectious risk factors. A 32-year-old woman with GSD presented during her second pregnancy, experiencing gingival mass recurrence after 20 years. Biopsy revealed pyogenic granuloma, leading to 20 cycles of radiotherapy with no disease progression. She underwent an elective cesarean section at 37 weeks for low-lying placenta, recovering well postpartum. The limited documentation of GSD in pregnant women complicates diagnosis and management. Outcomes vary widely, from life-threatening complications like chylothorax to unremarkable cases. Comprehensive understanding is crucial for providing appropriate prenatal, antenatal, and postnatal care for affected women in the future.

Purpose: The aim of the current study was to assess the analgesic efficacy of erector spinae plane block with liposomal bupivacaine in women undergoing cesarean delivery.

Methods: We prospectively enrolled patients undergoing elective cesarean delivery under spinal or combined spinal epidural anesthesia. At the end of surgery, a bilateral ESPB was performed. All patients received a standardized intraoperative and postoperative multimodal analgesic regimen. Prospectively enrolled patients were matched with historical controls who received the same multimodal analgesic regimen but no truncal blocks. The primary outcome was postoperative oxycodone consumption 0-48 h. Secondary outcomes included opioid consumption through 24 h, time to first opioid rescue, area under the curve of visual analog scale pain intensity scores through 48 h, need for treatment of postoperative nausea and vomiting and pruritus, and proportion of opioid-free patients.

Results: Thirty prospectively enrolled patients were matched with 120 historical controls. There were no significant differences between the groups in 48-h oxycodone consumption (median, 12.5 [interquartile range (IQR), 5.0-40.0] vs. 25.0 [IQR, 3.8-50.0 mg], P = 0.38). There were also no significant differences between the groups in any of the secondary outcomes, but the area under the curve for pain scores 0-48 h was significantly lower in the ESPB group compared with the historical controls (median, 115 [IQR, 26-151] vs. 140 [IQR, 86-180], P = 0.007).

Conclusion: ESPB with liposomal bupivacaine did not reduce postoperative opioid consumption but was associated with reduced pain scores compared with historical controls not receiving a truncal block. Future studies with a larger sample size are needed to further assess whether ESPB provides clinically significant benefit in this patient population.

Trial registration: The study was registered on clinicaltrials.gov on 12/09/2022 (NCT05664958, principal investigator Ashraf S. Habib https://clinicaltrials.gov/study/NCT05664958).

Objective: To investigate the impact of body mass index (BMI), body composition (BC), and the expression of genes linked to obesity or lipid metabolism on the prognosis of endometrial cancer.

Methods: We conducted a comprehensive review of patients with confirmed endometrial cancer treated at the Pontificia Universidad Católica de Chile (PUC) and analyzed publicly available data from the endometrial cancer TCGA-UCEC cohort. BC was assessed using computed tomography (CT) scans, and gene expression analysis was performed using RNA-seq data. We evaluated the associations between BMI, BC, gene expression, and patient outcomes, including overall survival (OS) and progression-free survival (PFS).

Results: Our study included 127 patients (67 from PUC and 60 from TCGA-UCEC). BMI was not significantly associated with OS or PFS. However, BC metrics such as visceral adiposity and muscle mass were critical determinants of prognosis. We identified a 30-gene risk score significantly associated with poorer PFS and OS, independent of other factors. Analysis of the tumor microenvironment (TME) revealed significant differences in immune cell composition and functional states between high- and low-risk groups.

Conclusion: BMI alone is not a significant prognostic factor in endometrial cancer. Comprehensive assessments of BC, gene expression profiles, and the TME provide more accurate prognostic information and highlight potential therapeutic targets. These findings advocate for a shift towards personalized medicine, incorporating detailed phenotyping and molecular profiling to improve patient outcomes.

Objective: To identify potential biomarkers in patients with polycystic ovary syndrome (PCOS) and atherosclerosis, and to explore the common pathologic mechanisms between these two diseases in response to the increased risk of cardiovascular diseases in patients with PCOS.

Methods: PCOS and atherosclerosis data sets were downloaded from the GEO database, and their differentially expressed genes were identified. Weighted gene co-expression network analysis was used to obtain intersection genes, and then protein-protein interaction and functional enrichment analysis were performed. Machine learning algorithms were used to select the key genes, which were then validated through external data sets. We constructed a nomogram to predict the risk of atherosclerosis in women with PCOS. Finally, the CIBERSORT algorithm was used to analyze the infiltration of immune cells in the atherosclerosis group.

Results: We identified six hub genes (CD163, LAPTM5, TNFSF13B, MS4A4A, FGR, and IRF1) that exhibited excellent diagnostic value in validation data sets. Gene ontology terms and KEGG signaling pathway analysis revealed that key genes were associated with immune responses and inflammatory reactions. Abnormal immune cell infiltration was also found in the atherosclerosis group and was correlated with the six hub genes.

Conclusion: Common therapeutic targets of PCOS and atherosclerosis were preliminarily identified through bioinformatics analysis and machine learning techniques. These findings provide new treatment ideas for reducing the risk that PCOS will develop into atherosclerosis.

Ewing sarcoma is an aggressive, rare bone and soft tissue malignancy, often affecting the long bones and pelvis. A woman was diagnosed with Ewing sarcoma of the left pelvis at 18 years of age. She underwent left paravesical lesion resection with ipsilateral ureteral reimplantation and received combined multi-agent chemotherapy and high-dose pelvic radiotherapy. A gonadotropin-releasing hormone analog was administered to preserve ovarian function. The patient received oral contraceptives as hormone replacement therapy due to secondary amenorrhea. She spontaneously conceived after the withdrawal of oral contraceptives at 24 years. The pregnancy was complicated by early third-trimester impaired fetal growth and preterm premature rupture of membranes at 32 weeks of pregnancy. Spontaneous preterm labor started and the patient delivered vaginally at 34 weeks, without any complications. Including our report, only 10 cases of pregnancy after pelvic Ewing sarcoma are reported in the literature. Pregnancy and delivery can be achieved after combined pelvic treatment for Ewing sarcoma, taking into account possible obstetric risks and complications. Complex bone surgery is associated with cesarean delivery, but previous high-dose pelvic irradiation does not seem to affect mode of delivery. Our report provides further information on perinatal management, given the cases previously described.