International Journal of Gynecology & Obstetrics最新文献

Objective: Selective reporting of research results based on statistical significance compromises research validity, potentially misleading clinical decision-making and future research. In obstetrics, the extent of this issue remains unclear. This study aimed to characterize the frequency, patterns, and temporal trends in the reporting of P-values, effect sizes, and statistically significant results in abstracts of obstetric studies from 2013 to 2023.

Methods: We retrieved abstracts in the field of obstetrics between January 1, 2013, and December 31, 2023, from Medline, Embase and Cochrane CENTRAL. Automated text-mining was performed to detect and extract reporting of statistical inference, including P-values, effect sizes, Bayesian-related statistics, confidence intervals, and textual descriptions. The extracted statistical inferences were analyzed to assess trends over time and overall distribution, as well as specific patterns across different study designs.

Results: A total of 23 167 eligible obstetric studies were identified from 46 788 abstracts. The proportion of abstracts reporting only P-values remained relatively stable over time, from 28.5% (95% confidence interval [CI]: 26.5%-30.5%) in 2013 to 27.6% (95% CI: 25.7%-29.5%) in 2023. There was a consistent rise in the proportion of abstracts reporting effect sizes, whether alone or alongside P-values, increasing from 22.1% (95% CI: 20.3%-24.0%) in 2013 to 39.5% (95% CI: 37.4%-41.7%) in 2023. Abstracts that reported neither P-values nor effect sizes decreased from 49.4% (95% CI: 47.2%-51.6%) in 2013 to 32.9% (95% CI: 30.8%-34.9%) in 2023. Most reported P-values clustered around common cut-offs, with 30.7% at 0.001 and 31.5% at 0.05. Among abstracts that reported statistical significance, 89.0% (95% CI: 87.4%-90.5%) reported a statistically significant difference, and the trend has remained stable over the past decade. Randomized controlled trials reported a lower proportion of statistically significant statements (82.4%, 95% CI: 75.9%-88.8%) than other study types.

Conclusion: Although the reporting of effect sizes has gradually increased over time, the use of standalone P-values remains common. The consistently high proportion of abstracts presenting at least one statistically significant result might reflect entrenched reporting practices in the field.

Objectives: Assess high-risk human papillomavirus (HPV) prevalence and high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia (HSIL/CIN) grade 2+ detection by cervical biopsy and endocervical curettage (ECC) in women younger than 30 years.

Methods: We retrospectively analyzed medical records from January 2016 to June 2024 at a tertiary hospital. All women aged 21 years and older who underwent HPV and Papanicolaou testing, plus those younger than 30 years referred for colposcopy, were included. Data on age, HPV status, cytology, colposcopy-directed biopsy, and ECC findings were extracted. The primary outcome was HSIL/CIN 2+ incidence on pathology.

Results: Among 57 381 women, high-risk HPV prevalence was 14.3% overall: 36.8% in those aged 21-24 years, 24.0% in those aged 25-29 years, and 12.7% in those 30 years and older. Of 735 women younger than 30 years, 291 were managed by follow-up decision and 444 underwent biopsy/ECC; follow-up decision was more common in women aged 21-24 years versus those 25-29 years (49% vs. 35.8%). Among the 444 women who underwent biopsy, HSIL/CIN 2+ and HSIL/CIN 3+ occurred in 37.8% and 14.6%, respectively, with similar HSIL/CIN 3+ rates in those aged 21-24 years versus those 25-29 years (16.8% vs. 13.9%). In 173 women with benign cytology, 30.1% had HSIL/CIN 2+ on pathology. The number needed to screen for HSIL was approximately 2-3 after co-testing versus approximately 40 with Papanicolaou testing alone. In addition, Papanicolaou test alone demonstrated poor agreement with biopsy/ECC results (low Cohen κ), confirming its inadequate performance. Two cases of cervical cancers were diagnosed at ages 22 and 29 years.

Conclusions: Similar high-grade lesion rates in women aged 21-24 years and those 25-29 years support initiating cervical cancer screening at age 21 years. Given the substantial HSIL detection despite benign cytology, co-testing with Papanicolaou and HPV testing is recommended in this age group.

Objective: To determine physicians' attitudes towards surgical treatment for stress urinary incontinence (SUI) and its consequences for women of childbearing age.

Methods: Electronic survey approved by the International Urogynecological Association (IUGA) and American Urogynecologic Society (AUGS), distributed to their members.

Results: A total of 191 physicians completed the survey. The majority of respondents (115, 60.2%) stated that they would perform or recommend surgical treatment for SUI for patients who have not yet completed their family planning, although most (136, 71.2%) would advise them to postpone surgery until completion of their family planning. Male physicians tended to recommend surgery more readily than their female counterparts, while female physicians were more likely to advise postponing surgery until completion of childbearing (58 respondents [76.3%] vs. 56 [53.3%] P = 0.002; 87 [79.8%] vs. 47 [62.7%], P = 0.01, respectively). Physicians with subspecialty training were more likely to endorse surgical treatment as compared to physicians without such training (94 respondents [68.6%] vs. 21 [44.7%], P = 0.003). Physicians from North America were more likely to recommend surgical treatment for SUI as compared to their colleagues from other countries (82 respondents [71.3%] vs. 33 [47.8%], P < 0.001). If surgery would be considered, 98 respondents (51.3%) would use bulking agents as their procedure of choice followed by retropubic mid-urethral sling (MUS) (78 respondents [40.8%]). Following continence surgery, 64 respondents (37.4%) would recommend postponing subsequent pregnancy for 6-12 months and 50 respondents (26.2%) would recommend a permanent contraception procedure. Following anti-incontinence surgery, 91 respondents (47.6%) would recommend an elective cesarean section; however, in cases of persistent SUI, 144 respondents (75.4%) would recommend a trial of labor (TOL). Experienced (>5 years) physicians were less likely to recommend a TOL following continence surgical intervention as compared to less experienced (<5 years) physicians (67 respondents [45.9%] vs. 33 [73.3%], P < 0.001).

Conclusion: The current study results indicate that most physicians would recommend postponing surgical intervention until completion of family planning. In cases where surgery was recommended, bulking agents were the procedure of choice. Our survey demonstrated significant variability in physicians' attitudes towards the mode of delivery in women following anti-incontinence surgeries, affected by their gender, experience, geographical area of practice and patient continence status.

Objectives: Potential to conceive after successful cancer therapy remains a major concern for young female survivors, as cancer and its associated treatments can negatively affect both maternal and fetal outcomes in future pregnancies. This study aims to determine the association between the female survivors of childhood, adolescent, and young adult cancer and the adverse obstetric and feto-maternal outcomes.

Method: Literature search was done on PubMed, EMBASE, Scopus, and Web of Science to identify relevant studies. Literature published up to December 3, 2024, was included. Cancer survivors, with any type of cancer diagnosed during childhood, adolescence, or young adulthood (up to 39 years of age), were included. Studies reporting the comparative feto-maternal outcomes in pregnant women with and without any cancer history were included. Relevant studies were identified and screened, and duplicates were removed using NESTED Knowledge. Risk of bias was assessed using Newcastle-Ottawa Scale. The calculation of pooled estimates for outcomes using maximum likelihood estimators was carried out using a random effects model. R Studio was used to perform statistical analyses in accordance with accepted coding practices. Certainty in evidence was assessed by GRADE profile.

Results: Overall, 40 studies were eligible for inclusion, among which 37 were included in the meta-analysis. The pooled relative risk (RR) of the 15 studies reporting preterm births was 1.30 (95% confidence interval [CI]: 1.15, 1.47), significantly higher among the cancer survivors. Twelve studies had a pooled RR of 1.32 (95% CI: 1.09, 1.60) for gestational diabetes mellitus among the individuals with cancer history. Pooled RR was 1.13 (95% CI: 1.01, 1.27) for congenital anomalies, indicating a significantly higher risk among cancer survivors. Certainty of evidence was rated very low for all outcomes.

Conclusion: Female cancer survivors have an increased risk of preterm birth, gestational diabetes mellitus, congenital anomalies, and caesarean delivery.

Background: Fetal macrosomia is linked with increased risks of adverse maternal and neonatal outcomes, such as shoulder dystocia, cesarean delivery, and birth trauma. The optimal management strategy for non-diabetic pregnancies with suspected macrosomia remains uncertain, with conflicting evidence from previous trials.

Objective: To evaluate the effects of labor induction on maternal and neonatal outcomes in this population.

Search strategy: We searched electronic databases up to June 2025 to identify randomized clinical trials comparing induction of labor with expectant management for suspected fetal macrosomia in non-diabetic pregnant women.

Selection criteria: We included the studies that met the PICOs criteria. Women with pre-gestational or treated gestational diabetes mellitus were excluded.

Data collection and analysis: Continuous outcomes were summarized as mean differences (MD) and dichotomous outcomes as risk ratios (RR), both with 95% confidence intervals (CI), using a random-effects model. Analyses were performed using R version 4.3. The primary outcomes were shoulder dystocia and cesarean delivery.

Main results: Four studies with 4024 women were included. Induction of labor significantly reduced the risk of shoulder dystocia, cesarean delivery, and fetal fracture with a pooled RR of 0.68 (95% CI 0.49-0.95), 0.87 (95% CI 0.79-0.95), and 0.28 (95% CI 0.09-0.95), respectively, compared with expectant management. However, induction of labor was associated with increased risk of hyperbilirubinemia and phototherapy with a pooled RR of 3.03 (95% CI 1.60-5.74) and 1.63 (95% CI 1.17-2.26), respectively. No significant differences were observed in brachial plexus injuries, intracranial hemorrhages, perinatal deaths, operative vaginal delivery, or perineal tear, between the two groups.

Conclusion: Induction of labor at full term (between 38⁺⁰ and 38⁺⁴ weeks of pregnancy) significantly reduced the risks of shoulder dystocia, fetal fractures, and cesarean delivery rates, with an increase in spontaneous vaginal delivery. These findings support reconsideration of current management guidelines and highlight the potential benefits of timely labor induction.

Objective: Short cervix (SC) and vulvovaginal infections, such as bacterial vaginosis (BV) and vulvovaginal candidosis (VVC), are known risk factors for preterm birth (PTB). The objective of this study was to investigate whether the combined presence of SC and vulvovaginal infections further elevates the risk of PTB.

Methods: We retrospectively analyzed data from women treated at our institution for SC between June 2021 and March 2024, defined as having a cervical length ≤25 mm prior to 34⁺⁰ gestational weeks. At the time of SC diagnosis, infection screening was performed using Gram-stained smears, and cases of infection were adequately treated. The risk of PTB was analyzed using a Cox regression model.

Results: Among 220 eligible women with SC, 157 (71.4%) had no infection, 26 (11.8%) had BV, 33 (15%) had VVC, and four (1.8%) had both BV and VVC. All participants received standard-of-care antibiotic or antifungal treatment. The median gestational age at SC diagnosis was 26⁺² gestational weeks at an average cervical length of 20 mm. Preterm delivery occurred in 94 women (42.7%). Cox regression analysis revealed no significant effect of BV (P = 0.48) and/or VVC (P = 0.30) on gestational age at delivery in women with SC.

Conclusion: Adequately treated vulvovaginal infections do not appear to exacerbate the risk of PTB in women with SC, highlighting the importance of routine infection screening and timely treatment to ensure effective mitigation of the potential impact of coexisting infections. Prospective studies are required to confirm our findings and explore the underlying mechanisms.

Objective: Early detection of ovarian cancer at stage I is important to improve patients' prognosis. The goal of this study was to examine if transvaginal ultrasound (TVU) performed at the same time as cervical cancer screening can facilitate early detection of ovarian cancer.

Methods: From 2014 to 2022, 483 269 women underwent TVU examinations during cervical cancer screening. The criteria for abnormal findings on TVU were ovarian enlargement ≥3 cm in long diameter (≥2 cm in postmenopausal women).

Results: Of the 483 269 women who underwent TVU, 3294 (0.68%) were selected for detailed examination. Of these women, 550 underwent surgery and 80 cases of ovarian cancer were found (positive predictive value: 2.43%). Pathologic review in 76 of these cases showed 70 cases of epithelial ovarian cancer (type I: 54 [77.1%], Type II: 16 [22.9%]) and six cases of non-epithelial malignant tumors. Clinical staging analysis showed that 81.6% (62 cases) were at stage I. Significantly more type I than type II tumors were detected at stage I (87.3% (n = 46) vs. 56.3%, P = 0.0068 (n = 9)). Notably, 95.7% (22/23) of clear cell carcinoma cases were detected at stage I.

Discussion: The high rate of early detection of type I ovarian cancer might be due to its slow progression. In Asia, where type I is common, the benefits of screening for ovarian cancer are particularly great. However, screening with TVU has generally been considered to have little benefit. The results of this study suggest a need for reassessment of this view.

Objective: This study aimed to compare the effectiveness of oxytocin and carbetocin in preventing postpartum hemorrhage, based on hemoglobin changes between the preoperative and 6-h postoperative periods, operating time, and postoperative shock indices.

Methods: This retrospective cohort study was conducted on singleton pregnancies diagnosed with polyhydramnios that underwent cesarean delivery and had no fetal-placental-genetic or hematological diseases. In the study, oxytocin (n = 78, 52%) and carbetocin (n = 73, 48%) were used for intraoperative postpartum hemorrhage prophylaxis. The primary outcome of the study was a hemoglobin drop between the preoperative period and the sixth hour postoperatively, which served as an objective marker of postpartum blood loss. Secondary outcomes included operation duration, the number of laparotomy sponges and gauze swabs used, shock indices, and the need for additional uterotonics. Additional variables, including gestational diabetes mellitus, fetal macrosomia, gestational age, birth weight, and the deepest vertical pocket of amniotic fluid, were also recorded as demographic and clinical characteristics.

Results: The primary outcome showed no significant differences in hemoglobin drop between the preoperative period and the sixth postoperative hour. Among the secondary outcomes, although gestational diabetes mellitus (24% vs. 9.2%, P = 0.018) and macrosomia (13.7% vs. 2.6%, P = 0.011) were more common in the carbetocin group, there was no statistically significant difference between the groups in terms of operation duration, laparotomy sponge usage, shock indices, or the need for blood transfusion. Although not statistically significant, the need for additional uterotonics was almost twice as high in the oxytocin group (23.3% vs. 41%, P = 0.070).

Conclusion: This research indicated that carbetocin was as effective as oxytocin in reducing postpartum hemorrhage, particularly during a cesarean delivery for those who had been diagnosed with polyhydramnios. Moreover, cases managed with carbetocin require fewer additional uterotonic drugs.

Delays in the diagnosis of endometriosis in sub Saharan Africa persist, driven partly by limited access to advanced imaging techniques. Capacity building initiatives focused on ultrasound offer a practical and scalable solution to address this diagnostic gap.

Background: In low-resource settings like Mali, limited literacy and poor healthcare access hinder awareness of maternal, newborn, and child health (MNCH). Mobile voice messaging offers a promising solution to reach underserved populations. This study aimed to implement an MNCH awareness campaign using the Viamo "37 3-2-1" platform and assess user engagement and message comprehension on a key maternal health topic.

Methods: From August 1, 2022, to August 31, 2024, we conducted a descriptive observational study, in which 30 voice messages related to MNCH were disseminated through the Viamo "37 3-2-1" platform. Topics included antenatal care (ANC), pregnancy danger signs, obstetric emergencies, obstetric fistula, and family planning. Messages were provided in local languages and followed by short quizzes to assess comprehension. Descriptive statistics were used to analyze user engagement and quiz performance.

Results: A total of 628 409 unique listeners accessed the platform, generating 9 065 349 message listens. The most engaged demographic group was individuals under 25 years of age, representing 37% of all listeners. Listeners were geographically diverse, with the highest engagement in Sikasso (18%), Ségou (13%), and Kayes (11%). Frequently accessed topics included blood donation, ANC, risks associated with home births, and emergency obstetric care. Comprehension quizzes indicated strong knowledge uptake, with over 90% of respondents answering correctly.

Conclusion: The Viamo "37 3-2-1" voice platform was effective in disseminating MNCH information and improving comprehension, particularly among youth and male audiences. Although behavior change was not measured, high engagement, and quiz performance suggest strong potential for increasing MNCH awareness in resource-limited settings.