International Journal of Gynecology & Obstetrics最新文献

Objective: Our study aimed to investigate the association between maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and impaired pelvic floor muscle (PFM) morphology and function during the early postpartum period.

Methods: This retrospective cohort study was conducted at Shanghai First Maternity and Infant Hospital from December 2020 to December 2022. A total of 1118 primiparous women with singleton pregnancies who underwent vaginal deliveries and participated in postpartum PFM assessments were included. Maternal pre-pregnancy BMI and GWG were considered as exposures. PFM morphology and function impairment were the primary outcomes. PFM morphology impairment, defined as levator ani muscle avulsion, was assessed using transperineal ultrasound. PFM function impairment, manifested as diminished PFM fiber strength, was assessed through vaginal manometry. Multivariable logistic regression analysis was employed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Restricted cubic spline models were used to validate and visualize the relationship.

Results: Women with lower pre-pregnancy BMI were at an increased risk of levator ani muscle avulsion (aOR = 1.73, 95% CI: 1.10-2.70, P = 0.017), particularly when combined with excessive GWG during pregnancy (aOR = 3.20, 95% CI: 1.15-8.97, P = 0.027). Lower pre-pregnancy BMI was also identified as an independent predictor of PFM weakness (aOR = 1.53, 95% CI: 1.08-2.16, P = 0.017 for type I fiber injuries). Notably, regardless of the avulsion status, both underweight and overweight/obese women faced an elevated risk of reduced PFM strength (aOR = 1.74, 95% CI: 1.17-2.59, P = 0.006 for underweight women with type I fiber injuries; aOR = 1.67, 95% CI: 1.06-2.64, P = 0.027; and aOR = 1.73, 95% CI: 1.09-2.76, P = 0.021 for overweight/obese women with type I and type II fibers injuries, respectively).

Conclusions: Both lower and higher pre-pregnancy BMI, as well as excessive GWG, were strongly associated with PFM impairments. These findings highlighted the critical importance of comprehensive weight management throughout pregnancy to effectively promote women's pelvic health.

Objective: International migration from source countries has meant that clinicians in high income countries, that is, receiving countries, are increasingly caring for affected women affected by female genital mutilation/cutting (FGM/C). The aim of the present study was to assess the prevalence of FGM/C among women at childbirth, and its association with pregnancy outcomes.

Methods: This was an observational study using data from a cross-sectional population-based study from the French National Perinatal Survey of 2021 (ENP) conducted in all maternity units in mainland France and including all women delivering a live birth during 1 week in March 2021 (N = 10 928). We estimated the FGM/C prevalence using (i) the diagnosed cases and (ii) the indirect prevalence estimated by UNICEF in each source country. We compared population characteristics and perinatal outcomes between women diagnosed with FGM/C and two groups: (i) women originating in source countries and diagnosed as without FGM/C and (ii) all women without diagnosis of FGM/C whatever the country of birth.

Results: Diagnosed prevalence of FGM/C was 0.9% (95% CI: 0.78-1.14] and the indirect computed estimation prevalence was estimated at 1.53% (95% CI: 1.31-1.77) in 113 and 183 women, respectively. Labor and delivery outcomes were globally similar in women with FGM/C and the other two groups. Only episiotomy was more frequently performed in women with FGM/C than in the other two groups.

Conclusion: In receiving countries, obstetric outcomes of women with FGM/C can be similar to those of other women, which does not preclude need of further research and training to provide the most appropriate care, including enhanced attention to diagnosis.

For surgeons and clinicians, nonobstetric surgery during pregnancy has certain difficulties and considerations. In order to aid in decision-making in these situations, this manuscript offers a thorough review of the guidelines currently in place from renowned obstetric and surgical societies, such as the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians & Gynecologists, and others. Using AGREE II-S methodology, a comprehensive analysis of guidelines reveals differences in recommendations for anesthetics, surgical procedures, imaging modalities, and thromboembolic prophylaxis. Furthermore, a thorough discussion of strategic surgical planning is provided, covering aspects such as patient positioning, trocar placement, pneumoperitoneum generation, and thromboembolic risk management. The publication highlights that in order to maximize the results for both the mother and the fetus after nonobstetric surgery performed during pregnancy, a multidisciplinary approach and evidence-based decision-making are essential.

Objective: To assess variations in the presentation and clinical implications of pre-eclampsia between Iranian and Afghan mothers at a maternity center in Tehran.

Methods: We conducted a cross-sectional study of Iranian and Afghan mothers diagnosed with pre-eclampsia. Data were collected from March 2021 to February 2023 at a maternity center in Tehran, Iran. Demographic information, clinical characteristics, and laboratory findings were extracted from medical records. Statistical analyses were employed to compare differences between Iranian and Afghan mothers, including Mann-Whitney U, Pearson χ² tests, and logistic regression models.

Results: We included 822 pregnant women with pre-eclampsia, predominantly Iranian (75.5%) and Afghan (24.5%). Regarding the multivariate logistic regression model, Iranian mothers were older, with a higher proportion over 35 years. Although Afghan mothers showed higher gravidity counts and greater gestational ages at delivery, they had lower rates of hypothyroidism. Iranian women were more often categorized as obese than Afghan women, and the difference was statistically significant. Serum levels of alkaline phosphatase were significantly greater in Afghan women.

Conclusion: Pre-eclampsia poses significant maternal health risks, especially among Afghan refugees in Iran. Variances in age, gravidity, and hypothyroidism prevalence highlight the need for tailored healthcare strategies. Addressing cultural barriers and implementing targeted interventions can improve maternal and fetal outcomes in these populations.

Objective: In Haiti, cervical cancer continues to cause high levels of mortality and morbidity due to lack of resources and political unrest. Haitian women employed in factories are especially vulnerable because they are unable to take time away from work to access health resources. We aimed to describe a low-cost intervention which successfully addressed this need.

Methods: We present a retrospective review of data gathered through a public-private partnership, in which women working in garment factories near Port-au-Prince, Haiti, were offered health education, clinical breast exam, and free human papillomavirus (HPV) self-swab testing at their place of employment. Women testing positive for HPV were subsequently tested using visual inspection with acetic acid (VIA) to inform treatment referrals, and treated with mobile thermocoagulation in factory infirmaries. Factory-employed healthcare workers were trained on cancer screening, including VIA and clinical breast exam.

Results: A total of 6843 out of 6983 (98%) female factory employees attended free reproductive health education sessions, and 4005 out of 4153 eligible women (97%) were screened using HPV self-swab testing; 5176 women received a clinical breast exam. Of the women screened for HPV, 1001 (25%) tested positive and 905 (90%) of HPV-positive women received VIA testing and thermocoagulation. The intervention had a total cost of US$76 000, over half of which was spent on an HPV testing machine.

Conclusions: Innovative approaches to the prevention of cervical cancer are especially necessary in very low-resource, politically unstable environments like Haiti. Self-swab and screen-and-treat programs in the workplace were acceptable to employees and factory owners. This low-cost model was reached vulnerable women through a public-private partnership, and tracked them through screening and treatment. It could be implemented elsewhere or extended to include other health services.

Gynecologic cancer requires personalized care to improve outcomes. Large language models (LLMs) hold the potential to provide intelligent question-answering with reliable information about medical queries in clear and plain English, which can be understood by both healthcare providers and patients. We aimed to evaluate two freely available LLMs (ChatGPT and Google's Bard) in answering questions regarding the management of gynecologic cancer. The LLMs' performances were evaluated by developing a set questions that addressed common gynecologic oncologic findings from a patient's perspective and more complex questions to elicit recommendations from a clinician's perspective. Each question was presented to the LLM interface, and the responses generated by the artificial intelligence (AI) model were recorded. The responses were assessed based on the adherence to the National Comprehensive Cancer Network and European Society of Gynecological Oncology guidelines. This evaluation aimed to determine the accuracy and appropriateness of the information provided by LLMs. We showed that the models provided largely appropriate responses to questions regarding common cervical cancer screening tests and BRCA-related questions. Less useful answers were received to complex and controversial gynecologic oncology cases, as assessed by reviewing the common guidelines. ChatGPT and Bard lacked knowledge of regional guideline variations, However, it provided practical and multifaceted advice to patients and caregivers regarding the next steps of management and follow up. We conclude that LLMs may have a role as an adjunct informational tool to improve outcomes.

Objective: To determine the number of sessions required using procedural simulation to acquire the skill of vaginal examination, which is an essential part of obstetrics, but a difficult learned skill.

Methods: Using a high-fidelity simulator, we conducted a prospective, single-center, single-blind study, at the Angers School of Midwifery. A class of students completed a theory course, and took part in three simulation sessions. During the simulation sessions, each student was asked to describe five different cervixes, under five criteria: position, length, consistency, dilation, and head station. Each participant received individual feedback as part of a debrief session, after completing their description. A pass rate of 80% was set for the entire class.

Results: Twenty-six students participated. The class achieved a mean score of 70.77 ± 10.23% in the first session, 81.85 ± 9.91% in the second session, and 81.23 ± 8.63% in the third session. There was a significant improvement only between the first and second sessions (P < 0.001). Of the 26 participants, 6 (23%) scored over 80% in the first session, 17 participants (65%) scored above 80% in the first two sessions, and 21 participants (80%) scored above 80% over the three sessions.

Conclusion: Learning vaginal examination by procedural simulation with the aid of a high-fidelity simulator, and receiving individual feedback and debrief, resulted in an 80% pass rate in two practical sessions, working to describe 10 cervixes.

Objective: The aim of this study was to evaluate the clinical characteristics and outcomes of pregnant women with COVID-19 and to compare with pregnant women without COVID-19. In addition, in the subgroup of patients who were symptomatic at the time of diagnosis, the persistence of symptoms was assessed.

Methods: This was a retrospective cohort study. All pregnant women aged ≥18 years, admitted to the maternity ward from March 2020 to September 2023 were included in the study. All patients admitted were routinely screened for SARS-CoV-2. Clinical characteristics and outcomes were registered.

Results: During the study period, 880 patients met the inclusion and were included in the analysis: 385 were COVID-19 positive and 495 were COVID-19 negative. In a multivariate analysis of the outcomes associated with COVID-19 among pregnant women, hospitalization and the Apgar score at 5 min were independently associated with COVID-19. Cesarean delivery, preterm birth, Apgar scores at 1 and 5 min <7, and maternal death were more frequent in pregnant women with COVID-19 admitted to ICU than in those not admitted to ICU. Approximately 30% of patients had persistence of symptoms, for at least 6 months in almost 60%.

Conclusion: The findings of the present study suggest that COVID-19 was associated with increased morbidity and mortality among pregnant women. In addition, pregnant women with SARS-CoV-2 infection were at significantly higher risk of adverse perinatal outcomes, especially preterm birth.