International Journal of Gynecology & Obstetrics最新文献

Objective: To explore the contribution of selected methodological factors to the heterogeneity in published umbilical artery pulsatility index (UA-PI) reference charts.

Methods: Cross-sectional study of uncomplicated singleton pregnancies that underwent assessment of UA Doppler at a single center. We explored the effects of the cohort characteristics (parity and estimated fetal weight [EFW] centile cut-off) and the statistical modeling approach used to construct the UA-PI centile reference charts.

Results: 25 069 UA-PI measurements from 12 394 patients were analyzed. UA-PI centile values decreased as the minimal EFW centile inclusion cut-off of the study cohort increased. Interpretation of UA-PI using charts constructed from fetuses with EFW > 25th or 50th centiles resulted in a higher proportion of examinations with UA-PI > 95th centile compared with the chart based on fetuses with EFW⟩10th centile (11.5% and 13.2% versus 10.6% of the subgroup of small-for-gestational-age fetuses, respectively, P < 0.001). In contrast, parity and the statistical method used to construct the chart had minimal impact on the UA-PI centile reference charts. Considerable heterogeneity was identified among published UA-PI reference charts.

Conclusion: Variation in the distribution of EFW centiles across the populations used to construct the UA-PI reference chart may contribute to the heterogeneity observed in published charts.

Objective: To expound the efficacy of Huayu Xiaozheng Decoction (HYXZD) combined with triptorelin and mifepristone in the treatment of uterine fibroids, with a particular focus on its effect on uterine artery hemodynamics.

Methods: A total of 102 women with uterine fibroids were enrolled and randomly allocated into a control group and an observation group. The control group received triptorelin plus mifepristone, while the observation group was additionally treated with HYXZD. Both groups were treated for 3 months. Clinical efficacy was compared, and the following parameters were measured before and after treatment: menstrual flow, fibroid volume, sex hormone levels (LH, E₂, FSH), uterine artery hemodynamics (PI, RI, S/D), hemorheologic parameters (BVH/BVL, PAGT), serum tumor markers (CA125, CEA), adverse reactions, and 1-year recurrence rate.

Results: The total effective rate was higher in the observation group relative to the control group (P < 0.05). Before treatment, no notable differences existed between groups in menstrual flow, fibroid volume, LH, E₂, FSH, PI, RI, S/D, BVH, BVL, PAGT, CA125, or CEA (P > 0.05). Following treatment, both groups showed reductions in menstrual flow, fibroid volume, LH, E₂, FSH, BVH, BVL, PAGT, CA125, and CEA, with greater reductions in the observation group (P < 0.05); PI, RI, and S/D increased in both groups, with better improvements in the observation group (P < 0.05). The adverse reaction rate was lower in the observation group versus the control group (P = 0.013). At the 1-year follow up, recurrence occurred in 11.76% (6/51) of patients in the control group and 7.84% (4/51) of patients in the observation group (P = 0.505).

Conclusion: HYXZD combined with triptorelin and mifepristone improves clinical outcomes in uterine fibroid treatment by reducing fibroid size, optimizing hormone levels and hemodynamics, lowering tumor markers, and maintaining safety.

Introduction: Several European studies have shown health-related social inequalities in pelvic gynecological cancers, with a social gradient in incidence and mortality, partly explained by more advanced stages at diagnosis in low socioeconomic populations. Disparities in treatment and quality of care in these patients could be another cause of inequality in care.

Objectives: This study evaluates the impact of socioeconomic factors on quality of care for pelvic gynecological cancers (adnexal, uterine corpus, and cervix).

Methods: This retrospective multicentric cohort study included women diagnosed with pelvic gynecological invasive cancer, between January 1 and December 31, 2022, in six university hospitals in North Paris. Two socioeconomic indicators, the FDep index and the Evaluation of Deprivation and Inequalities in Health Examination Centers (EPICES) score, were collected. The quality of care was assessed using a binary quality indicator based on selected European Society of Gynecological Oncology (ESGO) quality indicators for each cancer. We compared the "Non-adherence to Quality Indicator" (NAQI) group, where one or more of the ESGO quality indicators were not met, to the "Adherence to Quality Indicator" (AQI) group using univariate analysis. An analysis of the time to first treatment, according to FDep and EPICES groups, using a Kaplan-Meier, estimation was completed.

Results: A total of 189 patients were included: 50 with ovarian cancer, 76 with endometrial cancer, and 63 with cervical cancer. Ninety-nine patients (52.4%) belonged to the NAQI group and 90 patients (46.7%) to the AQI group. Patients were significantly in poorer general condition and presented more advanced Federation International of Gynecology Obstetrics (FIGO) stages in the NAQI than in the AQI group (ASA score 3-4: 20/84 [23.8%] vs. 5/76 (6.6%), P < 0.01 and FIGO III-IV stage: 55/99 [55.6%] vs. 35/90 [38.9%], P = 0.03). There was no significant difference for socioeconomic indicators between the NAQI and the AQI groups (FDep quintiles 3-4-5 = 41/99 (41.4%) vs. FDep quintiles 1-2 = 39/90 (43.3%), P = 0.91; EPICES score ≤ 30 = 31/63 (49.2%) vs. EPICES score > 30 = 21/51 (41.2%), P = 0.50). According to FDep and EPICES groups, we found no difference in the time to first treatment.

Conclusion: We found no socioeconomic impact on hospital quality of care in pelvic gynecological cancers.

Objective: To evaluate the financial applicability of the DNA-HPV test for cervical cancer screening in a developing country like Brazil.

Methods: This was a retrospective, observational study based on documentary data, conducted to assess the cost-effectiveness of cervical cancer screening strategies in Brazil. The study used national cervical cancer screening data collected between January 1 and December 31, 2020 for women between 25 and 64 years old, performing a cost-effectiveness assessment of two different screening tests. No sensitivity analysis was conducted due to the descriptive nature of this preliminary cost assessment.

Results: Based on the cervical smear, the Brazilian protocol has an estimated cost of US$117.5 million. In contrast, when using the HPV DNA test, the estimated cost is US$1.39 billion.

Conclusion: The current use of the cervical smear is the least expensive and the only one that aligns with Brazil's financial resources allocated to health.

Objective: This study aimed to investigate maternal and neonatal outcomes of pregnancies complicated by pre-eclampsia (PE) in Indonesia and analyze regional variations in risk factors and clinical outcomes across the country.

Methods: A multicenter retrospective cohort study was conducted in 30 hospitals located across five major islands in Indonesia (Java, Sumatra, Kalimantan, Sulawesi, and Bali-West Nusa Tenggara) between January 2022 and December 2023. Data were collected from medical records, including demographic characteristics, risk factors, and clinical outcomes.

Results: A total of 6763 pregnancies complicated by PE were analyzed. The maternal mortality rate was 1.6%, while the stillbirth and neonatal mortality rates were 5.7% and 6.1%, respectively. Severe PE was observed in 69% of cases, and preterm PE occurred in 35.5%. High rates of cesarean deliveries (72.4%) were recorded. Key risk factors included obesity (50.4%), primiparity (27.5%), and chronic hypertension (20.5%). Regional disparities were noted, with Sulawesi reporting the highest maternal (4.7%) and neonatal (7.7%) mortality rates. Complications such as hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome (8.9%), eclampsia (7.4%), and others requiring intensive care unit (ICU) admission (12.6%) were significant contributors to adverse pregnancy outcomes.

Conclusion: PE continues to pose substantial risks for maternal and perinatal health in Indonesia, despite reductions in mortality rates. Variations in regional outcomes underscore disparities in healthcare accessibility and infrastructure. These findings emphasize the need for strengthened national strategies, including early screening, improved clinical management, and targeted interventions to reduce morbidity and mortality associated with PE.