International Journal of Gynecology & Obstetrics最新文献

Objective: To investigate maternal serum and placental osteopontin levels in pregnancies complicated with fetal growth restriction (FGR) and to evaluate their association with composite adverse neonatal outcomes (CANO).

Methods: A prospective case-control study was conducted at Etlik City Hospital between March and September 2024, including 40 women with pregnancies affected by FGR (34-39 weeks) and 40 gestational age-matched healthy control women. FGR was diagnosed using Delphi criteria. Maternal venous blood and placental samples were collected at delivery. Serum and placental osteopontin levels were measured using enzyme-linked immunosorbent assay. Placental osteopontin concentrations were normalized to total protein by the Bradford method (ng/mg protein). Statistical analyses included Mann-Whitney U, χ², and Fisher exact tests, and receiver operating characteristic (ROC) analysis.

Results: A total of 80 participants were analyzed. Gravidity and parity were lower in the FGR group, whereas maternal age and body mass index were comparable. As expected, adverse perinatal outcomes were more frequent in the FGR group. Both maternal serum and placental osteopontin levels were significantly decreased in FGR cases compared with controls (P = 0.002 and P < 0.001, respectively). ROC analysis demonstrated the best predictive performance for placental osteopontin normalized to total protein, with a cut-off of 61.2 ng/mg (area under the curve [AUC] 0.791, sensitivity 77.5%, specificity 70.0%). Lower osteopontin levels were also predictive of CANO (AUC up to 0.760, P < 0.001).

Conclusions: In pregnancies complicated by FGR, osteopontin levels were significantly reduced in both maternal serum and placental tissue. This decrease may reflect impaired spiral artery remodeling and placental angiogenesis, contributing to the molecular mechanisms of placental insufficiency and adverse neonatal outcomes.

Objective: To assess the prevalence and associations between period poverty and depressive symptoms among college students with food and/or housing insecurity in the University of Hawai'i system. Period poverty is an important public health concern within the USA and has been linked with poor mental health among university students in prior research.

Methods: An anonymous, online survey was conducted in February-March, 2023, with college students in Hawai'i (N = 462) through an academic-community partnership. Unadjusted and adjusted logistic regressions assessed relationships between period poverty and depressive symptoms, stratified by food insecurity and housing.

Results: Nearly 43% (n = 199) of students (N =462) reported past-year period poverty and 28% reported moderate/severe depressive symptoms. Among women with food insecurity and/or housing insecurity, those experiencing period poverty were nearly two times more likely to report depressive symptoms (adjusted odds ratio [aOR] 1.86, 95% confidence interval [CI] 1.03-3.40; aOR 1.98, 95% CI 1.10-3.40, respectively) compared with those without period poverty.

Conclusion: Period poverty may be an added mental health burden for those experiencing other forms of basic needs insecurity. Understanding the impact of period poverty on students' well-being is critical to implementing effective policies and interventions to foster student success.

Objective: Sentinel lymph node biopsy (SLNB) is considered an essential step in the surgical management of endometrial and cervical cancers as it has led to a reduction in the need for full pelvic lymphadenectomy. This proof-of-concept study aimed to evaluate the feasibility and diagnostic performance of intraoperative sonographic assessment of sentinel lymph nodes (SLNs) during laparoscopic and robotic surgeries for endometrial and cervical cancers.

Methods: This was a prospective, single-center, non-interventional diagnostic feasibility study conducted between October 2023 and July 2024 at the University Women's Hospital, Tübingen, Germany, and registered at the German Clinical Trials Register (DRKS00032919). A total of 20 patients underwent intraoperative sonographic SLN evaluation using a sterile drop-in ultrasound probe prior to resection. The assessment was based on the Vulvar International Tumor Analysis (VITA) criteria that includes parameters, such as lymph node shape, cortical thickening, vascularization, and echogenicity. Findings were correlated with histopathologic results to determine diagnostic accuracy. To assess the diagnostic accuracy of the sonographic criteria, a receiver operating characteristic (ROC) analysis was conducted, focusing on sensitivity and specificity with respect to lesion dignity classification (benign vs malignant).

Results: Among the 25 initially prepped patients, 20 successfully underwent intraoperative sonographic SLN evaluation, while five were excluded due to logistical issues or consent withdrawal. A total of 49 SLNs were analyzed, and the analysis included histopathologic confirmation. The sonographic assessment demonstrated perfect sensitivity and specificity of 1.0 as reflected by the area under the ROC curve (AUC = 1.0). No adverse events were reported.

Conclusion: The study confirms that intraoperative sonographic evaluation of SLNs in minimally invasive gynecologic oncology surgeries is feasible, safe, and highly accurate. This technique may serve as a valuable adjunct to current SLNB protocols and lead to a potential reduction in the need for extensive lymphadenectomy while concurrently maintaining diagnostic reliability. Further research using larger cohorts is warranted to validate these findings and assess broader clinical applicability.

Objective: To compare the ease of learning the Vacca 5-step vacuum technique versus the OdonAssist device for assisted vaginal birth (AVB) among healthcare professionals without previous experience in AVBs.

Methods: A prospective, randomized crossover, simulation-based study was conducted with 12 final-year medical students. Each participant underwent training in both techniques. The primary outcome was the number of attempts required to achieve three consecutive error-free AVBs on a simulation model. Secondary outcomes included procedure duration, perceived difficulty, and error rates.

Results: A total of 24 training sessions were studied, including 123 simulated AVBs (74 vacuum, 49 OdonAssist). Participants required fewer attempts to master the OdonAssist technique compared with the Vacca 5-step vacuum technique (4, interquartile range (IQR) 3-5, attempts versus 6, IQR 4-8, attempts; P = 0.012). Training sessions and AVBs with OdonAssist were also perceived as easier.

Conclusion: Both techniques can be effectively taught using simulation-based methods. However, the OdonAssist device was easier to learn and required fewer repetitions, making it a promising tool for introducing AVB into settings where AVB is underused.

Objective: Combined oral contraceptives (COCs) for dysmenorrhea management have been covered by the Japanese universal health insurance system since 2008. Several public awareness events regarding COC prescriptions for dysmenorrhea were implemented between 2013 and 2015, including media reports on COC-related fatalities in 2013, drug safety alerts in 2014, and new clinical guidelines in 2015. This study aimed to examine the trends in patient characteristics, coagulation testing, and thromboembolism incidence before and after these events.

Methods: We used the JMDC claims database to identify patients with dysmenorrhea prescribed COCs between 2009 and 2021. We evaluated the annual trends in guideline-listed thromboembolism risk factors (age ≥ 40 years, obesity, and smoking), frequency of patients undergoing coagulation testing among patients prescribed COCs, and thromboembolism incidence.

Results: Of 860 840 patients with dysmenorrhea, 173 502 received COCs. The proportion of patients prescribed COCs decreased temporarily from 12.2% to 11.2% in 2014. The proportion of new COC prescriptions increased for women aged <40 years and decreased for those aged ≥40 years. The proportions of patients with obesity and smokers remained stable from 2016. The frequency of coagulation testing increased annually, rising sharply from 15% to 22% in 2014. The incidence of thromboembolism with treatment decreased from 11.8 to 9.9 per 10 000 person-years from 2016 to 2021.

Conclusion: Although no direct causal relationship is clear, public health awareness events might have influenced clinical practices, including the preferential selection of lower-risk patients and promotion of coagulation screening, possibly resulting in a decline in the incidence of thromboembolism.