International Journal of Gynecology & Obstetrics最新文献

Background: Every day, over 5000 stillbirths and more than 6000 newborn deaths are estimated to occur worldwide, the majority in sub-Saharan Africa and South Asia. Estimates, however, rely on data that might underestimate these deaths. Further, outside major categories such as preterm birth, infection, and complications at delivery, little is known about the causes of death for newborns and even less for stillbirths.

Objectives: This systematic review and meta-analysis aimed to synthesize evidence on the incidence, causes, and risk factors for perinatal mortality in East Africa to inform public health policy.

Method: We searched major databases: Medline, Web of Science, EMBASE, Global Health, SCOPUS, Cochrane Library, CINAHL, HINARI, African Index Medicus, African Journals Online (AJOL), DHS website, and the World Health Organization African Regional Office (AFRO) Library. The search was conducted without imposing any language restrictions. Studies published 2010-2022 reporting perinatal mortality (incidence/causes/risk factors) in East African countries were included. We included all observational studies (cross-sectional, case-control, prospective cohort, and retrospective studies) and community-based trials. We performed meta-analyses with random effects to estimate pooled perinatal mortality rates for the population and health facility settings. We investigated and reduced heterogeneity where appropriate. We summarized causes of death descriptively and synthesized risk factors narratively.

Results: We included 99 out of 22 889 studies. The pooled population-based perinatal mortality rate was 33.1/1000 births (95% confidence interval [CI]: 29.3-37.1, I² = 96.9%), and for health facility settings 67.1/1000 (95% CI: 47.5, 89.7, I² = 98.9%). The major reported causes of perinatal deaths were infections and intrapartum-related events. However, our understanding of the specific causes of death was limited by the lack of detailed information necessary for diagnosing specific causes. Risk factors for perinatal mortality were demographic (low socioeconomic status), related to care (lack of antenatal care, obstetric complications), and maternal comorbidities. Protective factors included women's empowerment and supporting access to care through maternity waiting homes.

Conclusion: Perinatal mortality remains high in East Africa. Many deaths were preventable through addressing modifiable risk factors and strengthening health systems to provide quality antenatal and intrapartum care. Consistent use of standardized cause-of-death classification and improved data quality are needed to enhance the understanding of specific causes of death and target interventions.

Objective: The perception of insufficient milk is a common problem among mothers that is associated with the breastfeeding process and psychological well-being. This study examined the relationship between mothers' personality traits, perceived levels of social support, and perceptions of insufficient milk.

Methods: The study's sample comprised 323 breastfeeding primiparous mothers with singleton pregnancies and term deliveries, using a descriptive and cross-sectional research methodology. The Big Five Inventory (BFI), Multidimensional Scale of Perceived Social Support (MSPSS), and Perception of Insufficient Milk Supply (PIMS) were used to gather the data. Path analysis was used to examine which personality traits of the mothers were effective in influencing social support. Additionally, it examined the relationship between social support and inadequate milk perception.

Results: When the relationship between total scale scores was analyzed, it was found that as extraversion (β = 0.491, P = 0.005), agreeableness (β = 0.323, P = 0.045) and openness to experience (β = 0.318, P = 0.038) increased, so too did perceived social support scores, while the perception of milk deficiency decreased (β = 0.099, P = 0.004).

Conclusion: Two important factors associated with postnatal breastfeeding were mothers' personality traits and their perception of social support. The results suggest that strengthening social support through targeted programs and support networks might help promote mother-infant interactions and breastfeeding across the prenatal and postnatal periods.

Objective: This study evaluates the prevalence, gender differences, and impact of work-related musculoskeletal injuries (WRIs) among minimally invasive surgeons and assesses their ergonomic practices and awareness.

Methods: A cross-sectional study was conducted among surgeons performing minimally invasive surgery (MIS) across subspecialties, including gynecology, urology, orthopedics, general surgery, pediatrics, plastic surgery, and otolaryngology. Participants completed an anonymous electronic questionnaire addressing demographics, lifestyle, health status, WRIs, ergonomic practices, and preventive measures. Descriptive and comparative analyses were performed, and multivariable regression identified independent factors associated with WRIs.

Results: Sixty-nine MIS surgeons responded (48% female, 52% male; mean age 45 years). Half (49.3%) reported at least one WRI, most commonly affecting the neck, back, and wrists. Female surgeons were significantly more likely to experience WRIs compared with male surgeons (69.7% vs. 30.6%, p = 0.001), particularly back, neck, and wrist pain. Preventive measures were inconsistently implemented; male surgeons more often changed surgical approaches, while female surgeons more frequently limited surgical schedules. Robotic surgery alleviated some ergonomic risks but was associated with higher neck pain prevalence compared with non-robotic approaches (43.5% vs. 21.7%, P = 0.06). Multivariable regression confirmed female gender as the only independent predictor of WRI (P = 0.007).

Conclusion: Minimally invasive surgeons report a high prevalence of work-related injuries, with significant gender disparities in both injury rates and the adoption of preventive strategies. These findings highlight the need for targeted ergonomic education, gender-sensitive interventions, and systemic improvements to promote surgeon well-being and ensure professional sustainability.

Objective: The aim of the present study was to analyze breastfeeding rates and duration in relation to preterm birth, fetal growth restriction, and demographics over five decades.

Methods: This retrospective cohort study included 1559 individuals (aged 4-52 years) and their parents from the University Medical Center Mainz, Germany. Participants were categorized by gestational age (extremely preterm ≤28 weeks, very preterm 29-32 weeks, moderately preterm 33-36 weeks, term ≥37 weeks), and birth weight percentile (small for gestational age [SGA] <10th, appropriate for gestational age [AGA] 10th-90th, large for gestational age [LGA] >90th). Data were collected via interviews, questionnaires, and medical records.

Results: Data from 940 mothers were analyzed. Breastfeeding rates and duration significantly increased over 50 years. However, low gestational age, particularly ≤28 weeks and 29-32 weeks and being born SGA were significantly associated with reduced breastfeeding incidence. Delayed breastfeeding initiation was more frequent in preterm and SGA-born infants. Additionally, there was a significant positive association between year of birth and breastfeeding rates and duration. Higher maternal educational level correlated positively with breastfeeding initiation and duration.

Conclusion: Breastfeeding rates and duration significantly increased over the past 50 years. However, both preterm birth and fetal growth restriction were associated with lower breastfeeding incidence and delayed initiation. Notably, being born SGA was independently linked to reduced breastfeeding, even after accounting for gestational age. While the association between prematurity and breastfeeding challenges is well established, our findings suggest that being born SGA may represent a similarly important but less widely recognized risk factor. This underlines the need for increased awareness and tailored breastfeeding support for this specific group.

Objective: To investigate the diagnostic utility of three non-invasive hepatic fibrosis indices-aminotransferase-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4), and FIB-5-in pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP), and exploratory analysis of neonatal outcomes.

Methods: This retrospective case-control study included 217 pregnant women who delivered at Göztepe Prof. Dr. Süleyman Yalçın City Hospital, a tertiary care center affiliated with Istanbul Medeniyet University, between September 2018 and February 2024. The study population was divided into two groups: 105 women diagnosed with ICP and 112 pregnant women without ICP who served as controls. The diagnosis of ICP was based on clinical pruritus, elevated serum bile acid levels (>10 μmol/L), and abnormal liver function tests. Women with pre-eclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, coagulopathy, hepatitis, multiple pregnancies, or other hepatic conditions were excluded. Laboratory parameters including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), albumin, and platelet counts were used to calculate APRI, FIB-4, and FIB-5 scores. Statistical analyses included Mann-Whitney U-tests for group comparisons and receiver operating characteristics (ROC) curve analyses to determine the diagnostic performance of each score.

Results: APRI and FIB-5 scores were significantly higher in the ICP group compared with controls, whereas FIB-4 showed a smaller between-group difference (P < 0.001 for APRI and FIB-5; P = 0.022 for FIB-4). ROC analysis demonstrated good diagnostic performance for APRI (area nder the curve [AUC] = 0.902; cut-off = 0.39; sensitivity = 82%; specificity = 89%) and moderate performance for FIB-5 (AUC = 0.718; cut-off = -1.84; sensitivity = 67%; specificity = 70%). FIB-4 showed lower diagnostic value (AUC = 0.590). Elevated scores were also associated with adverse neonatal outcomes, increased rates of preterm birth, and greater need for neonatal intensive care.

Conclusion: APRI, FIB-4, and FIB-5 are elevated in pregnancies affected by ICP and may serve as supportive, non-invasive markers reflecting hepatocellular stress and hepatic involvement. Among these indices, APRI showed the best diagnostic performance, FIB-5 demonstrated moderate discriminative ability, and FIB-4 had limited diagnostic utility. These indices may provide clinicians with additional information when evaluating hepatic dysfunction and may be associated with neonatal outcomes, although they are not validated prognostic tools. Prospective studies are warranted to further validate their clinical utility.

A T-shaped uterus is a uterine malformation, which can be either congenital or acquired, potentially impairing fertility and increasing the risk of miscarriage. Diagnosis primarily relies on three-dimensional ultrasound and hysteroscopy. Hysteroscopic metroplasty is the standard surgical intervention aimed at restoring normal uterine anatomy and potentially improving reproductive outcomes. This narrative review, conducted in accordance with SANRA (Scale for the Assessment of Narrative Review Articles) guidelines, is based on a comprehensive database search and critically evaluates observational and interventional studies on the definition, diagnosis, and management of T-shaped uterus in the context of in vitro fertilization. Recent studies indicate that correction of this anomaly might not only improve spontaneous conception rates but also enhance the outcomes of IVF. However, the precise role of metroplasty in patients undergoing IVF outcomes remains controversial. Some evidence indicates that surgical correction might improve embryo implantation and endometrial perfusion. Despite these promising observations, randomized controlled trials are necessary to define optimal patient selection criteria and to confirm the true benefit of metroplasty in the context of IVF. Future research should also address the potential risks associated with the procedure. A standardized diagnostic and therapeutic approach might contribute to improved reproductive outcomes in affected patients.

Spontaneous uterine rupture in an unscarred uterus is a rare but life-threatening obstetric emergency, and endometriosis has increasingly been recognized as a potential risk factor. We report a 33-year-old primigravid woman with primary infertility who conceived via in vitro fertilization and embryo transfer, with no prior uterine surgery. At 22⁺² weeks of gestation, she presented with sudden-onset, severe, tearing lower abdominal pain shortly after defecation. Bedside ultrasound revealed free intraperitoneal fluid, and she was diagnosed with hemorrhagic shock, prompting urgent transfer to our center. Emergency laparotomy identified approximately 1200 mL of hemoperitoneum and a 2-cm focal rupture in the right lateral uterine wall near the cornua, which exhibited active bleeding beneath an intact serosal layer. Extensive deep infiltrating endometriosis was identified intraoperatively, involving the uterine serosa, bilateral adnexa, and the pouch of Douglas, accompanied by dense pelvic adhesions. An emergency cesarean delivery was performed, resulting in the birth of a live male infant weighing 430 g. Apgar scores were 4, 6, and 8 at 1, 5, and 10 min, respectively. The patient recovered uneventfully and was discharged on postoperative Day 6. The neonate was admitted to the neonatal intensive care unit immediately after birth and discharged after a hospital stay of over 4 months, with a weight of 3700 g at discharge. This case underscores that endometriosis is an important but exceedingly rare risk factor for spontaneous midtrimester uterine rupture in primigravid women with an unscarred uterus. For women with endometriosis, particularly those conceiving through assisted reproductive technology, enhanced preconception counseling and individualized antenatal monitoring are warranted. Clinicians should include uterine rupture in the differential diagnosis of acute abdominal pain during pregnancy to ensure timely evaluation and intervention.

Objective: This study investigates the prenatal characteristics and postnatal outcomes of fetal abdominal cysts and evaluates the diagnostic performance of prenatal ultrasonography (US).

Methods: All cases of fetal abdominal cystic lesions followed up in our center between 2020 and 2024 were retrospectively analyzed. Cysts of urinary system origin and major complex multiple organ anomaly cases were excluded. Cysts were divided into subgroups according to prenatal diagnosis. Sensitivity, specificity, positive predictive value, false positive rate, and accuracy of prenatal US were calculated for each subgroup.

Results: A total of 86 cases were included in the study. The majority of cases diagnosed by prenatal ultrasonography were of ovarian origin (39.5%), followed by duplication cysts (16.2%) and choledochal cysts (11.6%). Five cases resulted in termination of pregnancy, and two cases resulted in intrauterine fetal death. After delivery, 25.3% of cases required surgical intervention. When comparing prenatal and postnatal diagnoses, the overall sensitivity, specificity, and accuracy of prenatal ultrasonography were 98.61%, 98.44%, and 98.44%, respectively.

Conclusion: Prenatal diagnosis of fetal abdominal cysts is important for appropriate management and counseling. The etiology of cysts can be accurately diagnosed by prenatal ultrasonography in approximately 85% of cases.