International Journal of Gynecology & Obstetrics最新文献

Background: Management of recurrent endometrial carcinoma (EC) represents a challenge. Although a complete resection of visible disease at secondary surgery (R0) is recommended, the impact of R0 on survival outcomes is unclear and pooled data are lacking.

Objective: To quantitatively assess the impact of R0 on survival outcomes in women with EC recurrence.

Search strategy: A systematic review and meta-analysis was performed searching eight electronic databases from their inception up to January 2024.

Selection criteria: All peer-reviewed studies that assessed quantitatively the impact of R0 on survival outcomes in women at first EC recurrence were included.

Data collection and analysis: Hazard ratio (HR) with 95% confidence interval (CI) for death of any cause and secondary recurrent or progressive disease in women with EC recurrence who underwent R0 compared to non-optimal secondary surgical cytoreduction (R1) were pooled and assessed at both univariable and multivariable analyses.

Main results: Three studies with 442 patients were included. At univariate analysis, in women with EC recurrence and R0 compared to women with EC recurrence and R1, pooled HR was 0.451 (95% CI: 0.319-0.638) for death from any cause, and 0.517 (95% CI: 0.298-0.895; p = 0.019) for recurrent or progressive disease. At multivariate analysis, in women with EC recurrence and R0 compared to women with EC recurrence and R1, pooled HR was 0.447 (95% CI: 0.255-0.783; p = 0.005) for death from any cause, and 0.585 (95% CI: 0.359-0.952; p = 0.031) for recurrent or progressive disease.

Conclusion: In women with EC recurrence, R0 is an independent prognostic factor, decreasing the risk of death from any cause by approximatively 55%, and of recurrent or progressive disease by approximatively 40%, compared to R1.

Objective: Migration of pregnant women can be challenging. Access to adequate and respectful care may not be possible. We aimed to assess the maternity care that immigrant women receive and their satisfaction with the care they experience.

Methods: This multicenter prospective study was conducted in a tertiary public hospital and a private hospital in Istanbul between April 2023 and July 2023. A face-to-face questionnaire was completed in the postpartum department by obstetricians and translators.

Results: In total, 267 patients participated in this study. A majority of these patients delivered at the public hospital (75%). Approximately 21% of all deliveries in both hospitals were with foreign mothers. A majority of the patients (82%) in the public hospital said they easily reached midwives, nurses, and an obstetrician, while this number rose to 100% in the private hospital. Patients in the private hospital had a higher average number of obstetrician visits compared to those in the public hospital, which was statistically significant (P < 0.05). Patients in the public hospital were significantly less informed about various maternity topics than those in the private hospital group (P < 0.001 for all topics). Most patients said their ideas and thoughts were taken seriously by the health care providers (80% and 97% in the public and private hospitals, respectively). Almost all patients recommended giving birth in the same hospital (94% vs. 96%, public and private hospitals, respectively), while around 99% recommended giving birth in Turkey.

Conclusion: Immigrant women are overall satisfied with the care they receive in both public and private hospitals. They have easier access to obstetricians in private hospitals, as well as being more informed on maternal health issues. Clinical efforts should focus on patient education in antenatal care.

Fertility preservation services must offer information to patients, prior to their visit, so that they have time to read and digest the information, and also have the opportunity to write down any questions they wish to ask at the oncofertility consultation appointment. Appointments must be offered immediately, based on a specifically designed referral form. Each fertility service providing oncology cryopreservation should have a robust map of the patient's journey to include referral, counseling session, medical consultation, informed consent, treatment plan, and follow-up. Consent for fertility preservation should only be obtained after thorough assessment and discussion with the patient. It must contain basic aspects such as duration of storage, right to dispose or choose alternatives, wishes about stored material if death occurs, and need for patient contact on an annual basis. Appropriate legal advice should be sought in the process of establishing oncology cryopreservation services, most importantly related to patient consent. Ethical and legal aspects of fertility cryopreservation must be considered in the provision of care for cancer patients. Cancer patients attending for cryopreservation have significant concerns in relation to the success of the process, time frame to return for cancer treatment, and safety. Two major nonmedical aspects, coping ability and mortality, are best addressed by counselors and highlight the need to offer this type of psychological support to all cancer patients attending for fertility preservation. The role of genetic counseling is to discuss any potential risks of transmission of the disease to the resulting offspring and offer genetic testing when appropriate. A service based on availability of comprehensive information coupled with in-house implications counseling will have a positive impact and improve the overall care of patients attending for fertility cryopreservation and this should be standard care.

Objective: Previous studies found younger age was associated with an increased risk of hysterectomy after hysteroscopic surgeries (HS) due to abnormal uterine bleeding (AUB). The present study aimed to evaluate the effect of age on the incidence of hysterectomy after HS for treating AUB in Taiwan.

Methods: This was a nationwide population-based retrospective cohort study which utilized the Taiwan National Health Insurance Database. The present study involved 4150 participants who underwent HS due to AUB. The study focused on females aged ≥40 years diagnosed with AUB who underwent HS between 2000 and 2020. Hysterectomy outcomes were analyzed using the Cox proportional hazards model, and age was categorized into three groups (40-44, 45-49, and 50-55 years). Statistical significance was set at P < 0.05.

Results: This study involved 4150 participants with an average age of 46.1 years, categorized into the following age groups: 40-44 years (39.6%), 45-49 years (38.8%), and 50-55 years (21.6%). Approximately 8.1% of participants required hysterectomy treatment; the highest incidence was observed in the 40-44-year age group (8.6%). The median time from HS to hysterectomy varied across age groups, ranging from 0.25-2.78 years. The presence of uterine myoma (adjusted hazard ration [aHR]: 2.11; 95% CI: 1.70-2.64; P < 0.0001) and adenomyosis (aHR: 10.24; 95% CI: 8.17-12.85; P < 0.0001) significantly increased the risk of hysterectomy. Kaplan-Meier survival curves demonstrated a comparable likelihood of hysterectomy across age groups within 5 years post-HS, with most occurrences occurring in the initial 5 years.

Conclusion: Our study found no age effect on subsequent hysterectomy after HS. This study contributes to a significant understanding of HS outcomes, aiding information for patients seeking AUB surgical options.

Objective: To examine rates of postpartum hemorrhagic (PPH) morbidity among patients who did and did not have immediate skin-to-skin contact (SSC).

Methods: This study was a retrospective cohort of all non-anomalous, term singleton vaginal births at a Level IV center over 2 years. Exclusion criteria included COVID-19. Immediate SSC was defined as at least 60 min of direct contact initiated between parturient and neonate within 10 min of birth. The primary outcome was a composite of maternal morbidity related to PPH compared among those with and without immediate SSC. We used multivariable Poisson regression adjusted for possible confounders with robust error variance to determine the strength of the association.

Results: Of 8623 deliveries during the study period, 3520 (40.8%) deliveries were included; of which 2428 (55.5%) had immediate SSC and 1028 (31.0%) did not. Immediate SSC reduced the overall rate of composite morbidity (adjusted relative risk 0.78, 95% confidence interval 0.65-0.92), and rate of blood loss 1000 mL or greater, use of additional uterotonics, and use of mechanical tamponade. Blood loss and third stage of labor duration were significantly less for immediate SSC. Transfusion rate and hematocrit change after delivery, did not differ.

Conclusion: Immediate SSC among term vaginal deliveries was associated with a significant reduction in PPH. Emphasis on early contact for maternal benefit may increase uptake of SSC and provide an accessible intervention for PPH in high- and low-resource settings.

Retroperitoneal ectopic pregnancy is an uncommon condition in clinical practice, often associated with misdiagnosis and unconventional treatment. Delayed interventions can lead to poor prognosis and sometimes catastrophic situations. Due to the limited number of reported cases in the literature, an established treatment protocol has yet to be introduced. This case series presents three instances at a tertiary women's hospital in Vietnam. In cases 1 and 2, a single approach-either surgery or a chemo-regimen-was applied. However, the third patient was treated with a combination of both therapies. This series highlights an evolution in management, progressing from incomplete removal of the gestation to a comprehensive combination of surgery and chemotherapy. Additionally, high serum beta-human chorionic gonadotropin (β-hCG) levels and suspicious ultrasound and magnetic resonance imaging (MRI) findings are crucial for establishing the diagnosis.

Objectives: To develop and validate a nomogram to predict severe postpartum hemorrhage following cesarean delivery.

Methods: This is a two-center retrospective cohort study. Cesarean delivery patients from the First Affiliate Hospital of Jinan University were divided into a development cohort (n = 11 137) and an internal validation cohort (n = 4739). Cesarean delivery patients from the Dongguan Maternal and Child Health Care Hospital (n = 13 775) were enrolled in the external validation cohort. The nomogram was based on independent risk factors for severe postpartum hemorrhage obtained by multivariate logistic regression. We evaluated the discrimination and calibration of the nomogram in the development and validation cohorts.

Results: The nomogram used data including previous cesarean delivery, pre-pregnancy weight, preterm birth, placenta previa, placenta accreta spectrum disorders, placental abruption, and mode of anesthesia. The area under the curves of the nomogram in the internal and external validation cohorts were 0.922 (95% confidence interval [CI] 0.897-0.947) and 0.813 (95% CI 0.785-0.841), respectively. Consistency between the predicted and actual probabilities was observed in both validation cohorts.

Conclusions: The nomogram displayed good calibration and discrimination and can be used for screening in clinical practice to enable clinicians to intervene appropriately.

Pre-eclampsia remains a significant health challenge in sub-Saharan Africa, contributing substantially to maternal and neonatal mortality rates. This paper explores the potential of low-dose calcium supplementation as an alternative strategy to the conventional high-dose regimen in preventing pre-eclampsia. A consistent association between low serum calcium levels and an increased risk of pre-eclampsia is established based on studies spanning Ghana, Nigeria, and Ethiopia. The challenges associated with implementing high-dose calcium supplementation, including cost, logistics, limited information, and adherence issues, underscore the need for a paradigm shift. The evidence presented advocates for integrating low-dose calcium supplementation into sub-Saharan African prenatal care programs. The paper emphasizes the role of healthcare providers in educating women about the benefits and safety of low-dose calcium supplements. Future research and implementation initiatives are urged to refine and tailor these approaches to the region's diverse needs, advancing the collective goal of enhancing maternal and newborn health. This exploration of creative and context-specific solutions underscores the potential of low-dose calcium to significantly contribute to reducing the prevalence of hypertensive disorders in pregnancy, particularly pre-eclampsia, ultimately contributing to healthier and thriving communities in sub-Saharan Africa.