International Journal of Gynecology & Obstetrics最新文献

Objective: To identify the long-term child outcomes after prenatal aspirin exposure.

Methods: This study is a follow-up of a randomized controlled trial (RCT) evaluating low-dose aspirin in the prevention of recurrent spontaneous preterm labor (the APRIL study) comparing aspirin 80 mg daily (n = 194) to placebo (n = 193) in singletons. Children were assessed at 4 years corrected age using the Ages and Stages Questionnaire (third edition, ASQ-3) and the Strengths and Difficulties Questionnaire (SDQ) for (neuro)development and behavioral outcomes, respectively. Data on mortality, general health, growth and a composite of abnormal child outcome or mortality were also collected. Analyses were performed reporting odds ratio (OR) and 95% confidence intervals (CIs).

Results: Eight children were deceased until 4 years follow-up (all perinatal deaths; n = 6 in aspirin and n = 2 in the placebo group). We included 231/379 (60.9%) children: 111/231 in the aspirin and 120/231 in the placebo groups. Total ASQ-3 score was higher in the aspirin group (mean 259.3 vs. 248.3, mean difference 10.96, 95% CI: 0.17-21.76). The rate of children with an ASQ-3 score of ≥1SD below the normative data did not differ between groups (35.2% vs. 47.4%; OR 0.60, 95% CI: 0.33-1.09), nor did a score on the SDQ ≥80th centile (18.3% vs. 14.7%; OR 1.30, 95% CI: 0.64-2.66). General health, growth and the composite outcome of abnormal child development or mortality did not significantly differ between groups.

Conclusion: We found no harmful effects of daily prenatal exposure to aspirin 80 mg. Our findings contribute to the existing data confirming the safety of low-dose aspirin use in pregnancy.

Background: More than 740 000 people identified as female at intake were incarcerated globally as of 2022, reflecting a 60% global increase since the year 2000, with a concomitant increase in gynecologic conditions experienced behind bars.

Objectives: The purpose of this scoping review was to examine the breadth of benign and malignant gynecologic conditions experienced during incarceration, including the prevalence, special management considerations, access to services, and the patient experience.

Method: The search strategy included a combination of keywords and subject headings for incarceration and benign or malignant gynecologic conditions with no language or date limits. Studies were eligible for the review if they: (i) discussed a benign or malignant gynecologic condition; (ii) included a population of people experiencing incarceration; and (iii) answered one or more of the four key questions identified prior to the search. One researcher independently screened each reference title and abstract for eligibility, and two reviewers independently screened each full text reference. One researcher extracted data from each study using a data extraction template, with verification and consensus by the primary and senior investigators.

Results: After screening, 135 studies corresponding to 137 reports from 38 countries were included in the review. Included studies focused on cervical dysplasia and human papilloma virus (56), normal menstruation (38), vaginitis (36), routine gynecologic care (23), abnormal bleeding (17), pelvic pain (13), menopause (8), urinary incontinence (7), and gynecologic malignancy (5) during incarceration.

Conclusion: The included studies demonstrate that across the globe, gynecologic conditions in carceral settings are common and can be exacerbated by the physical and emotional stress of incarceration, trauma histories, lack of access to care, and conditions of confinement in these settings. Gaps in the published literature exist on health education and interventions to address gynecologic health disparities and the gynecologic health needs of aging and older adults. There is a pressing need for parallel efforts at global de-carceration and policy interventions to provide for basic gynecologic needs, decrease intersectional stigma, and improve the conditions of confinement.

Objective: This study aimed to evaluate the effects of video-assisted midwifery care provided to primiparous pregnant women during non-stress test (NST) administration on their anxiety levels and prenatal attachment.

Methodology: This randomized controlled trial was conducted between April and October 2024, with 74 primiparous women undergoing a non-stress test (NST). Participants were randomly allocated to intervention (n = 37) or control (n = 37) groups using block randomization. The intervention group received video-assisted training plus routine care, while the control group received standard care. Blinding was not feasible. Data were analyzed with repeated-measures analysis of variance and analysis of covariance.

Results: Mean scores for both state and trait anxiety were lower in the intervention group compared with the control group, although the difference was not statistically significant. However, a significant difference was observed in the change in total mean scores on the Prenatal Attachment Inventory between the intervention and control groups. Compared to pre-test scores, a significant and sustained increase in prenatal attachment scores was observed among pregnant women in the intervention group who received video-assisted midwifery care before the NST application. In contrast, the control group showed a significant but decreasing change in their prenatal attachment scores compared to the pretest.

Conclusion: Short-term training, midwifery care, and fetal heart sound monitoring provided before NST did not significantly affect state or trait anxiety levels but were found to influence prenatal attachment positively. Further comprehensive studies are recommended in this regard.

Background: Pyomyoma is a rare but potentially life-threatening phenomenon with a high mortality rate reaching up to 20%-30%. It can present in women during the antenatal or postpartum period as well as after uterine artery embolization or even spontaneously. Common presenting symptoms include abdomino-pelvic pain and fever in the presence of uterine leiomyoma.

Objectives: To assess the different presentations of pyomyoma in a non-pregnant population, and review the treatment modalities.

Search strategy: This systematic review was conducted following the PRISMA guidelines. We performed a comprehensive search of PubMed, Scopus, Google Scholar and Embase during the years 1945-2024.

Selection criteria: Included case reports assessed the types of intervention (hysterectomy, myomectomy, or other forms of treatments) to treat pyomyoma. All case studies confirming diagnosis of pyomyoma on either operative and/or histologic findings were eligible.

Data collection and analysis: A total of 121 studies were initially screened and after a full text evaluation, 52 articles were included in this systematic review.

Main results: Pyrexia and abdominal pain were the commonest presenting symptoms found in 72% and 57% of patients, respectively. The most common causative organism was E-coli (23%). A total of 61% of patients underwent hysterectomy, and 27% patients had a myomectomy performed. A total of 12% of patients were treated with conservative management.

Conclusions: Given the considerable mortality risk of approximately 20%-30%, the benefits of surgical treatment tend to outweigh the potential risks. Where future fertility is a concern, it may be possible to eliminate the source of infection by performing myomectomy instead of hysterectomy in conjunction with antimicrobials.

Objective: The study identified the knowledge, attitude, practice, self-efficacy and barriers to exclusive breastfeeding practices.

Methods: A prospective cohort study was conducted among 505 Omani breastfeeding women. An online questionnaire was used to collect data from 2020 to 2022.

Results: A large portion of women reported having good knowledge and very good attitude toward breastfeeding; however, 33.5% reported less self-efficacy. A total of 79.2% of women-initiated breastfeeding within 1 h after delivery. While 77.3% practiced combination of both breastfeeding and formula feeding, only 22.7% reported exclusive breastfeeding practices. In addition, 81% of the women reported high level of barriers to exclusive breastfeeding. Most of the women believed that formula feeding is equivalent to breastfeeding. Further, embarrassment about feeding in public and lactation problems were reported as barriers to exclusive breastfeeding. Additionally, policies and practices by some health services and health care providers, lack of knowledge regarding essential diet for breastfeeding and lack of support from employer for allowing special time/facilities for breastfeeding were the predictors related to the barriers to exclusive breastfeeding practices. The other predictors include younger women, particularly <20 years; less educated women; unsure if the baby is getting enough milk and a belief that formula is easy to use and easily available.

Conclusion: Exclusive breastfeeding is associated with innumerable benefits to both the mother and the child. The policy makers and healthcare providers must emphasize on the exclusive breastfeeding practices and create stringent policies allowing special time/facilities for breastfeeding. Strategies must be created to combat the barriers to exclusive breastfeeding practices.

Objective: Length of stay (LoS) is a significant performance indicator in healthcare systems. Prolonged LoS in the obstetrics and gynecology emergency rooms (OB-GYN ERs) contributes to ER congestion and resource inefficiencies. The aim of this epidemiological study was to identify factors associated with prolonged LoS among patients attending a university hospital OB-GYN ER in Saudi Arabia.

Methods: A retrospective analysis was conducted on 7987 OB-GYN ER visits from January to December 2022. Variables analyzed included patient age, triage level, visit timing and season, discharge status, and chief complaint. Predictors of prolonged LoS were assessed using a multivariable linear regression analysis.

Results: Prolonged LoS was observed in 19.62% of visits. Higher-acuity triage levels were associated with shorter LoS. Patients who were admitted or referred had shorter LoS than those discharged routinely, while absconded patients and those not located had significantly longer stays. Visits for non-obstetric complaints such as cardiovascular or neurologic issues were associated with longer LoS than obstetric-related complaints. Seasonal and temporal factors were also significant, with shorter durations noted in summer and nighttime visits.

Conclusion: Multiple factors contribute to variation in LoS in OB-GYN ER settings, including triage severity, time of visit, and type of complaint. Strengthening the integration of women's health subspecialties within family medicine at the primary healthcare level can play a pivotal role in managing non-urgent cases more efficiently. These improvements align with the goals of Saudi Vision 2030 by enhancing healthcare delivery, optimizing resource utilization, and expanding access to specialized women's health services outside hospital-based OB-GYN ER settings.

Objective: This study retrospectively reviewed genitourinary fistula (GUF) cases repaired at a leading tertiary care center in northern India, analyzing surgical outcomes.

Methods: The study was conducted in the Department of Urology at King George's Medical University, Lucknow, from 2000 to 2024. This study obtained ethical approval from the institutional committee. Data were collected from hospital records, telephonic communication, and digital media. Obstetric and gynecologic histories, examination findings, cystoscopy, vaginoscopy results (including site, size, number of fistulae, and vaginal status), and imaging findings were documented. Operative details of open transabdominal (TA), transvaginal (TV), and laparoscopic repairs, along with surgical success rate and follow-up, were analyzed.

Results: A total of 638 GUF cases were repaired over a 25-year period. Vesicovaginal fistula (VVF) was the most common (572 cases, 89.65%), followed by ureterovaginal fistula (44 cases, 46 units, 6.89%), and urethrovaginal fistula (UVF) (12 cases, 1.88%). Hysterectomy was the leading cause (431 cases), followed by obstetric causes (175 cases), traumatic (12), radiation (5), and other causes (15). Surgical techniques included open TA (309 cases), TV (213), and laparoscopic repairs (116). The surgical success rate (cure of urinary incontinence with complete restoration of bladder and vaginal functions at 3 months) following first repairs was 93.95% (TA), 94.24% (TV), and 96.55% (laparoscopic). The surgical success rate following the second repair at 3 months was 82.05% (TA) and 82.75% (TV). No repeat laparoscopic repairs were performed. The overall success rates (combined first and second repair) were 95.78% (TA) and 95.77% (TV). The overall mean follow-up was 48 months (ranging from 3 to 120 months).

Conclusion: Over 25 years, our single-center experience reveals a shift from obstetric to gynecologic causes of genitourinary fistulas, with hysterectomy emerging as the leading etiology. Surgical repairs via TA, TV, and laparoscopic approaches showed high success rates. A clear trend toward minimally invasive techniques was observed, reflecting advancements in surgical practice.

Objective: We sought to evaluate the impact of a prospective change in practice to dual pharmacologic prophylaxis with oxytocin and misoprostol for patients at moderate or high risk for postpartum hemorrhage (PPH) based on validated hemorrhage risk assessments on PPH rates, quantitative blood loss (QBL) amounts, and morbidities.

Methods: A quality improvement effort was undertaken with the addition of sublingual misoprostol prophylaxis immediately after birth for patients with moderate or high risk for hemorrhage during pre-birth PPH risk assessment, 200 μg for moderate and 400 μg for high risk. "Oxytocin only" prophylaxis was administered June 2021 to April 2022 and "dual agent" prophylaxis was given April 2022 to April 2023.

Inclusion criteria: deliveries ≥20 weeks' gestation with moderate or high-risk pre-birth PPH risk assessment.

Exclusion criteria: missing QBL, gestational age <20 weeks or low PPH risk. Primary outcomes were QBL at delivery and total postpartum blood loss (PPBL). Secondary outcomes were PPH rate (≥ 1000 mL) and a composite of maternal morbidity. Data were captured electronically retrospectively for both time periods, with morbidities confirmed by chart review.

Results: A total of 2104 (47.9%) patients were treated with oxytocin only prophylaxis and 2293 (52.1%) patients were in the intervention period with dual agent prophylaxis. The cesarean delivery rate for the oxytocin only group was 37.3%, and 39.2% for the dual agent prophylaxis group. Postpartum hemorrhage rate was similar between the two groups, but composite morbidity was significantly lower for the dual agent prophylaxis group (0.4% vs. 1.4% for single agent prophylaxis; P < 0.001). In a subgroup analysis of cesarean delivery, PPH rate and composite morbidity were significantly lower for the dual agent prophylaxis group after adjusting for potential confounders (PPH rate: odds ratio [OR]: 0.76, 95% confidence interval [CI]: 0.60-0.95, P = 0.02; composite morbidity: OR: 0.31, 95% CI: 0.12-0.69, P = 0.004).

Conclusion: Dual agent prophylaxis with oxytocin and misoprostol immediately after delivery was associated with a significant reduction in total blood loss, PPH rates, and composite morbidity compared to oxytocin only prophylaxis in patients undergoing cesarean birth. Prospective studies are warranted to assess replicability and safety.

Objective: This study aims to analyze prenatal diagnostic indications, methods, and prognosis of fetuses with mosaicism, providing a reference for related prenatal diagnosis and genetic counseling.

Method: Cases of fetuses prenatally diagnosed with mosaicism via amniocentesis at our center over a 3-year period were retrospectively reviewed. The review covered maternal age, prenatal ultrasound phenotypes, results of whole-genome non-invasive prenatal testing (wgNIPT), and outcomes of prenatal diagnosis, including karyotype analysis, chromosomal microarray (CMA), and fluorescence in situ hybridization (FISH). Pregnancy outcomes and postnatal phenotypes were also examined.

Results: Among the 37 cases reviewed, 43% (16/37) involved women of advanced maternal age (≥35 years), while 22% (8/37) exhibited ultrasound abnormalities. Of the subset of 31 cases that underwent wgNIPT prior to amniocentesis, 94% (29/31) had results concordant with prenatal diagnostic findings. A total of 35 cases were analyzed using multiple techniques, with 17 showing consistent findings, 10 discrepancies in mosaic or non-mosaic status, and 8 conflicting results across methods. Thirteen cases resulted in live births with no apparent abnormalities detected in follow-ups at ages 3-5.

Conclusion: wgNIPT is a valuable tool for prenatal mosaicism screening, although its detection of complex cases remains limited. Prenatal diagnosis of mosaicism requires the mutual verification of multiple genetic techniques. Postnatally, mosaicism might lack apparent phenotypes; prolonged monitoring is needed to detect delayed effects.