International Journal of Gynecology & Obstetrics最新文献

Objective: Does an association exist between diminished ovarian reserve (DOR) and embryonic aneuploidy risk in young women of reproductive age?

Methods: This retrospective cohort study included 854 participants treated in the Department of Reproductive Medicine, Women's Hospital of Nanjing Medicine University, Nanjing Maternity and Child Health Care Hospital, from May 2016 to September 2023 for a total of 894 cycles. The relationship between ovarian reserve and embryonic euploidy was evaluated using statistical methods such as generalized estimating equation (GEE) and propensity score matching (PSM).

Results: Despite the higher number of biopsied blastocysts in women with normal ovarian reserve, no significant difference in embryonic aneuploidy rates was observed between DOR women and the control group. In addition, there were no significant disparities observed in the rates of metaphase II (MII) oocytes, normal fertilization, transferable embryos, blastocyst formation, and high-scoring blastocysts between the DOR and control groups after PSM.

Conclusion: This study showed that DOR had no significant effect on the incidence of aneuploidy in embryos. Young women informed about DOR should be relatively confident about the quality of their eggs and the euploidy status of their embryos before conventional assisted reproduction, thereby mitigating concern regarding adverse maternal outcomes due to aneuploidy.

Objective: We first estimated the prevalence of primary and secondary infertility in Tanzania and then examined its association with recent experiences of intimate partner violence (IPV).

Methods: We used cross-sectional data from the Tanzania Demographic and Health Survey 2022 and included 6894 women aged 20-49 years to estimate the prevalence of primary and secondary infertility. In a subset of 2802 partnered women who were surveyed about physical, emotional, and sexual IPV, we also examined the association of any form of IPV in the 12 months prior to the survey with both primary and secondary infertility using multivariable logistic regression.

Results: The prevalence of primary infertility was 1.8% (95% confidence interval [CI]: 1.0, 3.1) and secondary infertility was 15.4% (95% CI: 2.1, 61.0). Primary infertility was higher in urban areas (1.9%) compared to rural areas (1.7%) (P < 0.001). Over one-third (37.9%) of the women who were surveyed concerning IPV reported experiencing at least one form of IPV in the 12 months prior to the survey. Almost one-fifth (18.3%) of women with secondary infertility had experienced at least one form of violence in the past 12 months prior to the survey, compared to 1.5% with primary infertility (P = 0.656). Women with secondary infertility were 1.58 times more likely to have experienced any form of IPV (aOR = 1.58, 95% CI: 1.08, 2.33).

Conclusions: In Tanzania, the high prevalences of both infertility and IPV and the link between the two warrants the need for strengthening infertility care and treatment and support for women experiencing IPV.

Objective: To assess the safety of fertility-sparing treatments for early-stage ovarian cancer in women younger than 40 years old.

Methods: We performed a retrospective multicenter study including women aged 18-40 years diagnosed with early-stage (FIGO I-II) ovarian cancer in 55 Spanish hospitals, from January 2010 to December 2019. Benign and borderline tumors were excluded, as well as advanced stages (FIGO III-IV). All perioperative characteristics and follow-up data were collected and analyzed. Standard staging surgery (SSS) was compared with fertility-sparing surgery (FSS) in terms of oncological outcomes.

Results: In all, 366 women were included; 327 (89.3%) were stage I. Among all patients, 216 (59%) underwent SSS and 150 (41%) FSS. Up to 208 (56.8%) patients did not have children, but only 12 (3.2%) had oocyte preservation before treatment. Patients in the FSS group compared with the SSS group showed a non-significant difference in recurrences (8% vs. 9.3%, respectively; P < 0.711) and deaths (1.3% vs. 4.8%, respectively; P = 0.211) during the follow-up. No significant differences were found between epithelial and non-epithelial ovarian cancer both in recurrences (7.1% vs. 8.8%, respectively; P = 0.771) and in deaths (1.4% vs. 1.3%, respectively; P = 1) among patients who underwent FSS.

Conclusion: FSS seems a safe option for treatment of early-stage ovarian cancer in patients who want to preserve fertility, either for epithelial and non-epithelial histology.

The authors propose a new classification of intrauterine adhesions (IUAs) to facilitate understanding for both the gynecologist and the patient, documenting the location and characteristics of the adhesions in a single image. This tool significantly improves surgical planning and patient outcomes in the treatment of intrauterine adhesions. In addition, having a simple and consistent method of describing IUAs will facilitate longitudinal studies tracking the outcomes of various surgical techniques, adhesion barriers and the impact of hormonal treatment. The proposed new classification system may represent a significant advancement in the field of gynecology. Its adoption may facilitate and simplify the representation of intrauterine adhesion sites, allowing for better communication between doctors and more effective management of intrauterine adhesions.

Retraction: A. Hamdy, O. Azmy, R. Lotfy, A. A. Attia, M. M. Elsherbini, A. Al Sawaf, M. M. Soliman, M. F. Sharaf, A. Kamel, M. N. A. El-Raouf, S. Salem, M. A. Rasheed, H. Torky, and E. R. Issak, "Multicenter Randomized Controlled Trial Assessing the Impact of a Cervical Traction Maneuver (Amr's Maneuver) on the Incidence of Postpartum Hemorrhage," International Journal of Gynecology & Obstetrics 144, no. 1 (2019): 56-61. https://doi.org/10.1002/ijgo.12687. A third party raised concerns regarding miscalculated data and discrepancies between the reported sample size and the sample size included in the clinical trial registry. The authors responded to an inquiry by the journal and publisher, and have stated that the prospectively-registered sample size for the trial had changed from 4866 to 804 following the trial start, due to an interim analysis by the IRB and DSMB. Neither this change nor the reason for it were reported in the article. Therefore, the authors' stated original sample size and calculations do not correspond to the number presented in the published article. In addition, an independent review of the available dataset found that the results of all three categorical variables in Table 1 are not reproducible and the authors' argument of averaging the two-sided and one-sided Fisher's exact p values is not methodologically sound. The retraction has been agreed to because neither the data nor the results presented in the article can be considered reliable. Author M. M. Soliman disagrees with the retraction. All other authors did not respond to our notice regarding the retraction.

Background: ChatGPT, a sophisticated language model developed by OpenAI, has the potential to offer professional and patient-friendly support. We aimed to assess the accuracy and reproducibility of ChatGPT-4 in answering questions related to knowledge, management, and support within the field of reproductive medicine.

Methods: ChatGPT-4 was used to respond to queries sourced from a domestic attending physician examination database, as well as to address both local and international treatment guidelines within the field of reproductive medicine. Each response generated by ChatGPT-4 was independently evaluated by a trio of experts specializing in reproductive medicine. The experts used four qualitative measures-relevance, accuracy, completeness, and understandability-to assess each response.

Results: We found that ChatGPT-4 demonstrated extensive knowledge in reproductive medicine, with median scores for relevance, accuracy, completeness, and comprehensibility of objective questions being 4, 3.5, 3, and 3, respectively. However, the composite accuracy rate for multiple-choice questions was 63.38%. Significant discrepancies were observed among the three experts' scores across all four measures. Expert 1 generally provided higher and more consistent scores, while Expert 3 awarded lower scores for accuracy. ChatGPT-4's responses to both domestic and international guidelines showed varying levels of understanding, with a lack of knowledge on regional guideline variations. However, it offered practical and multifaceted advice regarding next steps and adjusting to new guidelines.

Conclusions: We analyzed the strengths and limitations of ChatGPT-4's responses on the management of reproductive medicine and relevant support. ChatGPT-4 might serve as a supplementary informational tool for patients and physicians to improve outcomes in the field of reproductive medicine.

Spontaneous hemoperitoneum in pregnancy (SHIP) is defined as sudden, nontraumatic intraperitoneal bleeding that occurs during pregnancy or up to 42 days postpartum. The incidence ranges between 4 and 4.9 per 100 000 births. Although seen rarely, it is associated with perinatal morbidity and mortality due to maternal hemodynamic instability. Endometriosis was shown to be present in 71% of SHIP cases. A 30-year-old primigravid woman with a spontaneous conception, at 29 weeks of gestation, presented to our obstetrics and gynecology emergency department with complaints of abdominal and back pain. In terms of her medical history, a laparoscopic cystectomy was performed in August 2022 due to a 90 mm × 50 mm endometrioma in the right ovary. However, deep endometriosis and adenomyosis were not observed. After decelerations appeared on the non-stress test, the repeat hemoglobin values dropped to 7.2 g/dL, with blood pressure at 70/50 mm Hg and a pulse rate of 95/min. The decision was made for laparotomy and emergency delivery of the baby. It is crucial to consider SHIP, especially in pregnant patients with a history of endometriosis surgery. Managing such high-risk cases in specialized centers and easily identifying predisposing factors for SHIP can lead to improved outcomes, despite its rarity and poor prognosis.

Objective: Cervical cancer and its precursor are labeled as HIV indicator conditions, justifying the recommendation of HIV testing for all patients. This study aimed to assess the acceptance and patients' and gynecologists' perceptions on HIV testing in patients with cervical dysplasia at the colposcopy outpatient clinic in hospitals in the Netherlands.

Methods: A cross-sectional study was conducted between May 2021 and February 2023 to implement point-of-care HIV testing in five hospitals in the Rotterdam region, the Netherlands. We included patients aged 18 years and older, without documented HIV, presenting with cervical dysplasia. The primary outcome was the HIV test acceptance rate. Secondary outcomes were the HIV positivity rate and the association between dysplasia severity and test acceptance. We also assessed patients' and gynecologists' perspectives on this testing strategy with a questionnaire.

Results: Of 563 patients, 523 accepted HIV testing, resulting in a test acceptance rate of 92.9% (95% confidence interval, 90.45%-94.88%). Testing rates were consistent among participating hospitals (91.6%-100.0%) None of the patients tested positive for HIV. Severity of dysplasia was not associated with test acceptance (P = 0.768). Most patients (n = 500, 96.0%) reported good or higher experience with this testing strategy. The main barriers for gynecologists to offer HIV testing were lack of time (n = 22, 33.9%) and fear to offend a patient (n = 7, 12.5%). Less than half (n = 19, 39.3%) of gynecologists believed an HIV test should be offered to all patients with cervical dysplasia.

Conclusion: Point-of-care HIV testing at colposcopy outpatient clinics was well accepted by patients. The data indicate that the primary barrier lies with the physicians to offer such testing.

X. Wang, C. Zhang, Xia Li, H. Qi, Q. Liu, and J. Lei, "Safety and Efficacy of Titrated Oral Misoprostol Solution Versus Vaginal Dinoprostone for Induction of Labor: A Single-Center Randomized Control Trial," International Journal of Gynecology & Obstetrics 154, no. 3 (2021): 436-443. https://doi.org/10.1002/ijgo.13546. The above article, published online on 17 December 2020, in Wiley Online Library (wileyonlinelibrary.com), and has been retracted by agreement between the journal Editor-in-Chief, Professor Michael Geary; the International Federation of Gynecology and Obstetrics; and John Wiley and Sons Ltd. A third party raised concerns regarding errors in the reported data and statistics of the article. An external statistician reviewed the data and was not able to reproduce the listed results for the Bishop score, the post-term pregnancy variable, the gestational hypertension variable, the not using insulin variable, the vaginal delivery variable, and the failed induction variable. In addition, the journal detected numerical errors in Table 4, with contradictions between frequencies and reported percentages. The authors did not respond to multiple requests for an explanation and the original data. The editors have determined that the large number of errors identified and lack of original data provided fundamentally compromise the results presented, which necessitates retraction. The authors did not respond to our notice regarding the retraction.