International Journal of Gynecology & Obstetrics最新文献

Human papillomavirus (HPV) is a sexually transmitted virus, whose persistent infection is the main reason for invasive cervical cancer (ICC), which is the fourth most common type of cancer in women, with more than 500 000 new cases every year. After infection, various alterations occur in the host, facilitating the virus's evasion of immune system clearance and promoting its proliferation. Oral probiotic consumption can influence the whole body's immunity, inflammatory reflection, neural, endocrine humoral, metabolic pathways and other organs by adjusting the components of gut microbiota (GM). Some evidence shows there is a tight connection between GM and vaginal microbiota (VM), which is referred to as the gut-vaginal axis. This review investigates the potential role of probiotics in clearing HPV via the gut-vagina axis, emphasizing the effectiveness of Lactobacillus in preventing vaginal diseases and suggesting its potential for HPV clearance. Understanding the role of probiotics in the gut-vagina axis could pave the way for new strategies to reduce and eliminate HPV and related diseases.

Objective: To analyze the factors influencing the increase in the cesarean delivery (CD) rate in South Korea and test the hypothesis on advanced maternal age driving the trend.

Method: The present study is a population-based retrospective observational study utilizing administrative data from the Korean National Health Insurance Service. We analyzed a total 3 416 517 births from 2013 to 2022 covered by the national health insurance. The CD rate and contribution of demographic variables to changes in CD rates were calculated using Das Gupta's decomposition method.

Results: The CD rate increased from 37.8% in 2013 to 61.6% in 2022. The decomposition analysis revealed that changes in maternal age structure contributed only 8.7% to the increase in the CD rate. When parity was added to maternal age, the explained proportion increased to 17.8%. When other factors were added to the model, such as multiple births, residential area, and income level, it did not contribute significantly to the increase in the CD rates, accounting for 19.0%, 18.6%, and 18.0%, respectively.

Conclusions: According to our analysis, less than one-fifth of the increase in CD rate was explained by the change in maternal age. The rising CD rate in Korea should not be considered an unavoidable consequence of demographic change. Much more diverse factors, including increased risk of medical lawsuits, changes in childbirth culture, and other health system determinants, may be driving the trend.

Objective: To investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy.

Methods: In a prospective cohort study of 9420 pregnant women from 13 hospitals across India, we measured hemoglobin concentrations at recruitment (≥28 weeks of gestation) and blood loss after childbirth during follow-up and collected clinical information about PPH. Clinical obstetric and childbirth information at both visits were extracted from medical records. Anemia severity in the third trimester was categorized using hemoglobin concentrations (no/mild anemia: hemoglobin ≥10 g/dL; moderate: hemoglobin 7 to 9.9 g/dL; severe: hemoglobin <7 g/dL), while PPH was defined based on blood loss volume (vaginal births: ≥500 mL or cesarean sections: ≥1000 mL) and clinical diagnosis. Indications for labor induction/augmentation were classified as clinically indicated and elective as per guidelines. We performed multivariable modified Poisson regression analyses to investigate the associations of anemia severity and indications for labor induction/augmentation, including their interaction, with PPH, adjusted for potential confounders.

Results: PPH was associated with anemia but not with indications for labor induction/augmentation. However, there was a significant interaction between the two factors in relation to PPH (P = 0.003). Among pregnant women with severe anemia, a higher risk of PPH was associated with elective (adjusted risk ratio, 3.44 [95% confidence interval, 1.29-9.18]) but not with clinically indicated (adjusted risk ratio, 1.22 [95% confidence interval, 0.42-3.55]) labor induction/augmentation. No associations were observed among pregnant women with no/mild and moderate anemia.

Conclusion: The risk of PPH is higher in women who have moderate-severe anemia in late pregnancy. Induction/augmentation of labor is generally safe for women with anemia, but it can increase the risk of PPH in women with severe anemia if performed electively.

Objective: The aim of this study was to determine whether circulating tumor human papillomavirus (HPV) DNA is a potential specific biomarker for cervical cancer (CC).

Methods: This retrospective matched study included 87 patients with cervical intraepithelial neoplasia (CIN), 29 CC patients (FIGO IA1-IVA) and 29 HPV-negative controls at Yuhuangding Hospital of Qingdao University (from July 2022 to September 2023). The digital droplet PCR (ddPCR) was used to detect and quantify ctHPV DNA in the plasma of patients with HPV16, 18, 33, 52, or 58-associated CC.

Results: The ctHPV DNA was exclusively detectable in HPV-positive samples, with no detection in patients across various CIN stages (n = 87) or HPV-negative controls (n = 29). Additionally, ctHPV DNA was identified in nine out of 10 late-stage patients (90%) and six out of 19 early-stage patients (31.6%).

Conclusion: The ctHPV DNA serves as a specific biomarker for the diagnosis CC. Additionally, this discovery addresses the knowledge gap in ctHPV DNA research in the early stages of CC and promotes clinical diagnosis and treatment strategies.

Objective: To investigate the association between soluble adhesion molecules (sE-cadherin, sE-selectin, sICAM-1, sVCAM-1) in serum and peritoneal fluid and pelvic pain in infertile women with endometriosis.

Methods: This observational study included 86 infertile women undergoing diagnostic laparoscopy, 43 of whom were diagnosed with endometriosis. Pain intensity was evaluated using the visual analog scale (VAS). Levels of soluble adhesion molecules in serum and peritoneal fluid were quantified using ELISA. Statistical analysis included the Mann-Whitney U test for group comparisons, Spearman's rank correlation for associations with VAS scores, and receiver operating characteristic (ROC) curve analysis for diagnostic performance.

Results: Serum sE-selectin levels were significantly higher in women with pelvic pain (P = 0.022) and correlated with VAS scores (r = 0.271, P = 0.012). Peritoneal sE-selectin and sICAM-1 levels were elevated in women with pelvic pain (P = 0.044 and P = 0.029, respectively) and showed positive correlations with VAS scores (r = 0.246, P = 0.022 and r = 0.310, P = 0.004, respectively). Comparing endometriosis and control groups, peritoneal sE-selectin and sICAM-1 levels were significantly higher in endometriosis cases with pelvic pain (P = 0.003 and P < 0.001, respectively). ROC analysis revealed the potential diagnostic value of serum sE-selectin (AUC = 0.698, P = 0.002), serum sICAM-1 (AUC = 0.721, P < 0.001), and serum sVCAM-1 (AUC = 0.750, P < 0.001) in distinguishing endometriosis from non-endometriosis cases.

Conclusion: Elevated levels of sE-selectin and sICAM-1 in serum and peritoneal fluid are associated with pelvic pain in women with endometriosis, suggesting their role in pain pathogenesis and potential as biomarkers for pain severity and disease diagnosis. Further research is warranted to explore the underlying mechanisms and validate these findings in larger cohorts.

M. S. E. Elsedeek, "Impact of Preoperative Rectal Misoprostol on Blood Loss During and After Elective Cesarean Delivery," International Journal of Gynecology & Obstetric 118, no. 2 (2012): 149-152, https://doi.org/10.1016/j.ijgo.2012.03.038. The above article, published online on 13 June 2012 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Michael Geary; the International Federation of Gynecology and Obstetrics; and John Wiley & Sons Ltd. The retraction has been agreed following an investigation based on concerns raised by a third party. The editors found that the majority of the statistical results presented in Table 1 and 2 could not be reproduced from the summary data reported in the paper. These inaccuracies could not be attributed to rounding. The author was invited to comment on the concerns and provide supporting data but did not respond. The editors consider the results and conclusion reported in this article unreliable.

M. S. E. Elsedeek, "Comparison Between the Traditional Non-guided and a Novel Ultrasound-guided Technique for Office Fitting of Intrauterine Contraceptive Devices," International Journal of Gynecology & Obstetric 133, no. 3 (2016): 338-341, https://doi.org/10.1016/j.ijgo.2015.11.013. The above article, published online on 23 February 2016 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Michael Geary; the International Federation of Gynecology and Obstetrics; and John Wiley & Sons Ltd. The retraction has been agreed following an investigation based on concerns raised by a third party. Although the paper does not specify which statistical methods were used, the editors found that numerous results could not be reproduced from the summary data using t-tests or chi-squared tests. The author was invited to comment on the concerns and provide supporting data but did not respond. The editors consider the results and conclusion reported in this article unreliable.

M. S. E. Elsedeek, "Five-year Follow-up of Two Types of Contraceptive Device Fitted During Elective Cesarean Delivery," International Journal of Gynecology & Obstetric 130, no. 2 (2015): 179-182, https://doi.org/10.1016/j.ijgo.2015.02.031. The above article, published online on 29 April 2015 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Michael Geary; the International Federation of Gynecology and Obstetrics; and John Wiley & Sons Ltd. The retraction has been agreed following an investigation based on concerns raised by a third party. The editors found that numerous results are inconsistent with the summary data reported in the paper. The author was invited to comment on the concerns and provide supporting data but did not respond. The editors consider the results and conclusion reported in this article unreliable.

Objective: The study presents the risk of the maternal-fetal morbidity and mortality among one of the largest cohort of sickle cell disease (SCD) pregnancies in India and reports the epidemiology of the maternal morbidity.

Methods: This was a retrospective cohort study conducted at Kasturba Maternity Hospital, SEWA Rural, in the tribal area of Gujarat, India. All pregnant women admitted to the Hospital between 2016 and 2021 were screened for SCD, and their maternal-fetal morbidities were recorded throughout the pregnancy. We quantified risk of maternal-fetal morbidity and mortality among SCD, trait and normal pregnancies after adjusting for potential confounders using Poisson and logistic regression.

Results: A total of 24 256 delivered during the study period, with 354 (1.5%) and 4216 (17.4%) suffering from SCD and trait, respectively. After adjusting for potential confounders, the women with SCD pregnancy had higher risk of maternal death (adjusted-odds-ratio [AOR] 13.7, 95% CI: 4.5-42.7), anemia (AOR 6.8, 95% CI: 4.5-10.2), severe anemia (AOR 4.3, 95% CI: 3.3-5.6), preterm delivery (AOR 4.5, 95% CI: 3.6-5.7), cesarean section (AOR 5.5, 95% CI: 4.7-7.0), stillbirth (AOR 3.4, 95% CI: 2.3-5.3), and low birth weight (AOR 3.1, 95% CI: 2.4-39) compared to normal pregnancies. Maternal morbidities occurred throughout the pregnancy; however, the risk was highest during the last month of pregnancy. Pregnant women who had severe manifestation of SCD before the pregnancy were at higher risk of developing maternal morbidities.

Conclusion: We concluded that SCD might be an independent risk-factor for developing maternal-fetal morbidities. The SCD pregnancies with prior severe manifestations must be carefully managed during the last month of pregnancy when the risk is highest.

To evaluate whether the presence of proteinuria, although no longer mandatory in the revised diagnostic criteria, results in worse maternal and fetal outcomes in preeclampsia (PE). A retrospective cohort study was conducted, analyzing data from pregnant patients diagnosed with PE between January 2015 and December 2019 at a tertiary care center in Brazil. Ethical approval was obtained, and the patient records were reviewed to assess maternal and perinatal outcomes based on the revised diagnostic criteria by the College of Obstetricians and Gynecologists, focusing on the presence or absence of proteinuria. The study included 816 pregnant patients with PE, of whom 685 (83.9%) were diagnosed based on proteinuria. The revised criteria, which include indicators of organ damage, identified an additional 131 cases (16.4%). Analysis showed no significant differences in maternal outcomes between proteinuria and non-proteinuria groups, including intensive care unit (ICU) admission, acute pulmonary edema (APE), HELLP syndrome, eclampsia, or C-section rates. However, babies born to mothers with proteinuria PE experienced worse outcomes, including fetal growth restriction, low birth weight, ICU admission, and higher rates of preterm birth. Relative risk analysis demonstrated a high risk of babies being born with low birth weight, ICU admission, and being born preterm and very preterm in cases where proteinuria was present in mothers with PE. The presence of proteinuria is associated with significantly worse outcomes in babies born to mothers with preeclampsia, while no significant differences were observed in maternal outcomes.