International Journal of Gynecology & Obstetrics最新文献

Objective: To evaluate the usefulness of first-trimester crown-rump length (CRL) and nuchal translucency (NT) thickness discordance in predicting adverse outcomes in monochorionic diamniotic (MCDA) twin pregnancies.

Methods: This retrospective cohort study enrolled MCDA twin pregnancies in which CRL and NT were measured at 11-13⁺⁶ weeks of pregnancy and collected for pregnancy outcomes between January 2022 and June 2023 at Tu Du Hospital in Vietnam. The intertwin discrepancy of CRL and NT was calculated as a percentage of the larger fetuses and smaller fetuses. Regression analysis was used to determine the significance of the association between the intertwin discordance in NT and CRL and the development of twin-to-twin transfusion syndrome (TTTS), fetal growth restriction (FGR), intrauterine fetal demise (IUFD), and those with normal outcomes. Receiver operating characteristic curves were constructed to evaluate the performance of inter-twin discrepancy in the prediction of FGR, TTTS, and IUFD.

Results: A total of 294 MCDA twin pregnancies were studied. Among them, 149 cases (50.7%) had at least one adverse outcome. The complications included TTTS in 82 cases (55.0%), FGR in 89 cases (59.7%), one IUFD in 95 cases (63.8%), and two IUFDs in 19 cases (12.8%). CRL discordance greater than 10.0% and NT discordance greater than 20.0% were not related to TTTS and IUFD, only to FGR. A CRL discordance greater than 20.0% decreased the survival rate of fetuses. CRL discordance greater than 10.0% had specificity in diagnosing TTTS, IUFD, and FGR of more than 80%, whereas, NT discordance greater than 20.0% had specificity in detecting these complications of more than 50.0%. A predictive model including CRL and NT discordance showed a poor value with area under the curve of:0.69 (95% confidence interval 0.69-0.75).

Conclusion: In MCDA twin pregnancies, discordant CRL greater than 10.0% was related to FGR. Meanwhile, an intertwin discordance of NT thickness greater than 20.0% was not related to TTTS, FGR, and IUFD. However, adequate surveillance is still required.

Retraction: H. O. Hamed, M. A. Alsheeha, A. M. Abu-Elhasan, A. E. Abd Elmoniem, and M. M. Kamal, "Pregnancy Outcomes of Expectant Management of Stable Mild to Moderate Chronic Hypertension as Compared With Planned Delivery," International Journal of Gynecology & Obstetrics 127, no. 1 (2014): 15-20, https://doi.org/10.1016/j.ijgo.2014.04.010. The above article, published online on 03 June 2014 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Michael Geary; and John Wiley & Sons Ltd. UK. Concerns were raised by a third party regarding the authenticity of the data and results presented in this study. In light of these concerns, the authors were asked to provide the raw data. The authors cooperated fully and provided the individual patient data. However, anomalies were identified regarding the accuracy of the data and their compatibility with normal biological variation. As a result, the data and conclusions are considered unreliable, therefore the article must be retracted.

Objective: To evaluate the trends, safety, and feasibility of a trial of labor after cesarean (TOLAC) among kidney and liver transplant recipients.

Methods: This was a retrospective cohort study using the Transplant Pregnancy Registry International. It included recipients of a kidney or liver transplant with a live-birth pregnancy ≥20 weeks following a prior cesarean, with births between 1967 and 2019 from 289 hospitals, primarily in North America. The primary outcomes of severe maternal morbidity (SMM) and neonatal composite morbidity were compared between those with repeat cesarean deliveries (RCDs), vaginal births after cesarean (VBACs), and failed TOLAC. Multivariable regression was conducted to calculate odds ratios and 95% confidence intervals.

Results: The 243 deliveries included in this study were composed of 80.7% RCDs, 10.3% VBACs, and 9.1% with failed TOLAC, with similar demographics between groups. There was no significant difference in incidence of SMM (RCD, 1.0%; VBAC, 4.0%; failed TOLAC, 0%; P = 0.48) or neonatal composite morbidity (RCD, 15.2%; VBAC, 11.5%; failed TOLAC, 4.5%; P = 0.45) between groups. No cases of uterine rupture or neonatal death occurred. Trends in TOLAC demonstrate that the TOLAC rate has declined from 35% in 1989-1994 to 13% in 2014-2019.

Conclusions: In this cohort of transplant recipients, TOLAC resulted in successful vaginal delivery over half the time, and did not increase the risk of maternal or neonatal morbidity compared with RCD. We encourage offering transplant recipients a trial of labor after appropriate counseling to decrease the overall rate of cesarean delivery and morbidity in this high-risk population.

Objective: To explore the relevant factors associated with successful labor in twin pregnancies and investigate maternal and fetal outcomes in the group with failed labor.

Methods: A retrospective analysis was conducted on twin pregnancies that underwent labor in our hospital from July 2016 to June 2023. A total of 519 cases were divided into two groups: the successful labor group (450 cases with vaginal delivery of both fetuses) and the failed labor group (69 cases with cesarean delivery of one or two fetuses). The relevant factors of the labor, as well as the maternal and fetal outcomes, were analyzed between these two groups.

Results: Multivariate analysis indicated that advanced maternal age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.05-1.22), high pre-delivery body mass index (OR 1.11, 95% CI 1.04-1.19), and vertex/transverse twins (OR 3.75, 95% CI 1.35-10.40) were risk factors for the failure of vaginal labor. Multiparity (OR 0.15, 95% CI 0.08-0.29), premature birth (OR 0.43, 95% CI 0.24-0.78), and neuraxial analgesia (OR 0.37, 95% CI 0.20-0.72) were protective factors for the failure of delivery. There were no statistically significant differences (P > 0.05) in decreased hemoglobin and neonatal outcomes between the two groups. The postpartum hospitalization time in the successful labor group was shorter than that in the failed labor group (P < 0.05).

Conclusions: Labor in twin pregnancies is generally safe. Factors such as multiparity, previous premature birth, and neuraxial analgesia can significantly enhance the likelihood of a successful vaginal delivery.

Retraction: M. Kandeel, Z. Sanad, H. Ellakwa, A. El Halaby, M. Rezk, and I. Saif, "Management of Postpartum Hemorrhage With Intrauterine Balloon Tamponade Using a Condom Catheter in an Egyptian Setting," International Journal of Gynecology & Obstetrics 135, no. 3 (2016): 272-275, https://doi.org/10.1016/j.ijgo.2016.06.018. The above article, published online on 21 August 2016 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Michael Geary; and John Wiley & Sons Ltd. UK. Concerns were raised by a third party that a study nearly identical to the one published in this article had been published previously in a different journal.¹ When requested for clarification, the authors agreed that this was a duplicate publication. Author guidelines for the journal state that the authors must provide details if the paper had been submitted to another journal, which was not done at the time of its submission. Further, duplicate publication without proper attribution or justification is not permitted by COPE and Wiley. As a result of this being a duplicated article, a retraction is warranted. Reference Saif-elnasr AA, Kandeel MS, Emara MA, Rezk MA, Sanad ZF. Intrauterine balloon catheter in the management of postpartum hemorrhage. Menoufia Med J. 2015;28(4). https://doi.org/10.4103/1110-2098.173607.

Objective: Pudendal nerve block in modern obstetric practice is essential to providing comprehensive care. However, as clinical exposure declines, training opportunities also diminish. We aimed to develop and study an effective and reproducible simulation-based educational intervention for teaching pudendal nerve block.

Methods: The pudendal nerve block simulation-based educational intervention consists of a preintervention evaluation, didactic lecture, simulation-based practice session using a task trainer, and post-intervention evaluation. The intervention was developed and refined based on pilot testing and input from experts. Multiple standardized simulation sessions were implemented at four major academic institutions. We utilized paired t-tests to compare pre- and post-simulation surveys and performance assessments, and unpaired t-tests to compare the procedural checklist data.

Results: A total of 56 subjects (OBGYN residents, fellows, and attendings; family medicine residents, and attendings; and certified nurse midwives) participated in the simulation-based educational intervention. Competence, comfort, and confidence with identifying appropriate candidates, discussing benefits and risks, offering and performing, and identifying and managing complications of the procedure were higher at baseline for practicing clinicians and increased significantly after participating in the intervention for both residents and practicing clinicians (P value for all <0.001). Procedural competence as assessed by the checklist was not significantly different between residents and practicing clinicians (P value 0.96).

Conclusion: A pudendal nerve block simulation-based educational intervention allows residents and practicing clinicians to develop knowledge, comfort, and confidence in identifying patient candidates, discussing risks and benefits, offering and performing the procedure, and identifying and managing resultant complications.

Objective: To evaluate the prognostic impact of primary surgery on patients with HPV-independent, advanced or metastatic endocervical adenocarcinoma (EAC) who typically exhibit poor survival outcomes and resistance to conventional therapies such as chemoradiotherapy.

Methods: A bi-institutional retrospective study was conducted at Samsung Medical Center and Taiwan National University Hospital. Between 2001 and 2023, 92 patients with HPV-independent advanced or metastatic EAC were included. Patients were divided into two groups: 54 (58.7%) underwent primary surgery and 38 (41.3%) received non-surgical treatments, including definitive radiotherapy or palliative chemotherapy. Kaplan-Meier analysis was used to compare progression-free survival (PFS) and overall survival (OS) between groups. Multivariate analysis was performed to identify independent prognostic factors.

Results: The surgery group demonstrated significantly improved outcomes, with a median PFS of 19.2 months, compared with 10.0 months in the non-surgery group (P < 0.001). Median OS was not reached in the surgery group, whereas it was 24.1 months in the non-surgery group (P = 0.002). Multivariate analysis showed that non-surgical treatment was an independent predictor of poor PFS (hazard ratio [HR] 2.25; 95% confidence interval [CI] 1.18-4.29; P = 0.013) and OS (HR 3.25; 95% CI 1.37-7.73; P = 0.008). Additionally, the recurrence rate was significantly lower in the surgery group (55.6%) than in the non-surgery group (84.2%; P = 0.006).

Conclusion: Primary surgery significantly improves survival outcomes in patients with HPV-independent advanced or metastatic EAC. These findings suggest that surgery should be considered as part of a multimodal treatment strategy for this aggressive subtype, highlighting the need for individualized therapeutic approaches beyond standard chemoradiotherapy protocols.

Objective: The purpose of this study is to raise awareness of small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO) prevalence among patients with endometriosis to improve global recommendations in the standard of care for endometriosis.

Methods: This case-control study included a cohort of 1027 women who underwent the lactulose breath test (LBT) during their healthcare check-up to diagnose SIBO and/or IMO from November 2021 to June 2023. One hundred and forty-eight endometriosis patients were selected based on magnetic resonance imaging or a histological assessment. Each were matched with an equal number of women without endometriosis based on the exact age.

Results: SIBO/IMO prevalence was significantly higher among women with endometriosis, with up to 136 out of 148 who tested positive, 91.9% (95% confidence interval [CI] 86.3-95.7%) against 123 in the control group, 83.1% [76.1-88.8%], P = 0.0223. Women with endometriosis showed a significantly higher incidence of altered transit than those without (85.8 vs. 71%, P = 0.0019) and an increased prevalence of constipation (67.8 vs. 44.7%, P = 0.0017) and dizziness (44.8 vs. 28.7%, P = 0.0245). Overall, methane overgrowth accounted for up to 63.2% in women with endometriosis who tested positive for methane overgrowth. SIBO H2 was associated with a higher risk of developing diarrhea (P = 0.0027), whereas those positive for IMO were at a higher risk of developing acid reflux (P = 0.0132).

Conclusion: Abnormal digestive overgrowth should be assessed in all endometriosis cases, as this approach could offer a new therapeutic strategy.

Pyoderma gangrenosum is a rare inflammatory skin disease characterized by skin inflammation and painful ulcerative lesions. What's more the Letion related to vulvae was relatively rare. The patient's vulvar painful ulceration was initially misdiagnosed as a Bartholin's gland abscess in another hospital, so antibiotic therapy was prescribed. Then she was referred to our gynecology ward due to unsatisfactory outcome. Finally, the diagnosis was corrected as pyoderma gangrenosum by dermatopathological examination and the patient's lesion healed completely after one-month administration of sulfasalazine. The awareness of vulvar gangrenous pyoderma should be raised expecially when a vulva ulcerative letion presents.

Objective: To evaluate the relationship of leiomyoma characteristics with perinatal outcomes.

Methods: A retrospective cohort study was conducted. Women whose pregnancy was complicated with leiomyoma were recruited, and pregnant women without leiomyomas were enrolled as a control group. Demographic data, leiomyoma ultrasound characteristics, and pregnancy outcomes were collected. Subsequently, antepartum, intrapartum, postpartum, and neonatal complications were analyzed.

Results: The overall rate of leiomyomas in pregnancy was 5.46% (4393/80510). Out of the 932 pregnancies studied, 632 were affected by leiomyoma. Women with leiomyomas exhibited significantly higher age, pre-pregnancy BMI, gravidity, and in vitro fertilization-embryo transfer rate. The occurrence of antepartum, intrapartum, and postpartum complications was influenced by different features of leiomyomas. Among leiomyoma with diameter of 9 cm or greater, cervical or submucous types were detrimental. In the multivariate linear regression analyses, a leiomyoma with diameter of at least 9 cm during pregnancy was independently associated with preterm birth, cesarean section, preterm premature rupture of membranes, and postpartum hemorrhage.

Conclusion: The presence of leiomyoma of 9 cm or more increases the risk of antepartum, intrapartum, and postpartum complications; therefore, pre-conception myomectomy can be considered. For leiomyoma 7-9 cm, extensive discussions between patients and clinicians should be conducted. In women with leiomyomas smaller than 7 cm, the risk of obstetric complications is similar to that in women without leiomyomas, except for those with cervical or submucous leiomyomas.