International Journal of Gynecology & Obstetrics最新文献

Background: The ratio of harvested lymph nodes to the number of metastatic nodes is known as the lymph node ratio (LNR) and its prognostic significance was investigated in many types of cancer.

Objectives: However, until now, the therapeutic role of lymphadenectomy in the management of endometrial cancer (EC) has remained controversial.

Search strategy: The search strategy involved the Medline, Scopus, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases.

Selection criteria: We included prospective and retrospective observational studies.

Data collection and analysis: The current systematic review includes seven studies with a total of 6050 patients. From Cox regression analyses, pooled hazard ratios (HRs) were obtained to reduce the confounding effect of other factors that affect the survival outcomes.

Main results: The meta-analysis revealed a significant difference in progression-free survival in patients with LNR below the cut-off point in comparison to individuals with LNR above the cut-off point (HR 2.06, 95% CI 1.57-2.71, data from 6 studies). Similarly, a significantly smaller overall survival was observed among patients with LNR above the cut-off value (HR 1.99, 95% CI 1.53-2.60; data from five studies).

Conclusions: The results of this systematic review provide strong evidence that LNR could be a prognostic factor for EC patients regarding the need for adjuvant therapy and survival rate. Further studies should focus on the specific cut-off levels of LNR and the role of the molecular markers in assessing the prognosis of EC patients.

Objective: The current study aimed to describe risk factors for adverse perinatal outcomes (APOs) among pregnant women nonvaccinated for COVID-19 who had respiratory symptoms.

Methods: A nested case-control study was performed within the REBRACO (in Portuguese, the Brazilian Network of COVID-19 During Pregnancy) initiative. Women were recruited during pregnancy in 15 maternity hospitals in Brazil from February 1, 2020, to February 28, 2021, while seeking medical care for respiratory symptoms, and were followed up until childbirth regardless of confirmation of COVID-19. For this analysis, women were divided into two groups: (1) those with APOs, defined as the occurrence of fetal or neonatal death, preterm delivery, 5-min Apgar score <7, neonatal respiratory distress, neonatal mechanical ventilation, admission to the neonatal intensive care unit, small-for-gestational-age newborn, or any neonatal morbidity; and (2) those without APOs.

Results: The total number of women included in this analysis was 481, with 210 having APOs (43.7%). The characteristics independently associated with APOs were a composite outcome of severe acute respiratory syndrome, maternal admission at the intensive care unit, or maternal death (relative risk [RR], 3.30 [95% confidence interval (CI), 1.38-7.89]), living in the North and Northeastern regions of Brazil (RR, 3.09 [95% CI, 1.13-8.41]), and pre-eclampsia (RR, 2.77 [95% CI, 1.19-6.43]).

Conclusion: Severe maternal illness was strongly associated with APO regardless of COVID-19 confirmation. It is essential to provide sufficient and timely health care for women who have respiratory symptoms compatible with COVID-19.

Background: Vulvovaginal atrophy (VVA) and sexual inactivity (SI) are prevalent among postmenopausal women (PMW). While hormonal therapies show significant improvement, non-hormonal therapies are considered the first-line for breast cancer women. However, vaginal hormonal therapies are unavailable in all countries, particularly developing countries such as the middle east, and there are no studies that have tested these therapies in women either with a history of breast cancer or those taking endocrine therapies for their cancer.

Objective: We conducted this meta-analysis to evaluate the effectiveness of vitamin D (VD), whether alone or in combination with other therapies, in managing VVA and SI in PMW.

Search strategy: A systematic literature search was undertaken on four electronic databases (Web of Science, PubMed, Cochrane, and Scopus) from inception until June 2023.

Selection criteria: The randomized controlled trials (RCTs) that used the vaginal maturation index (VMI) and vaginal pH to measure VVA and vaginal dryness and the female sexual function index (FSFI) to measure SI were included in the meta-analysis.

Main results: Eight RCTs (608 PMW) were included, and 222 were assigned to the VD arm. For the oral VD subgroup, there was no statistically significant improvement in the mean difference (MD) of VMI (MD -7.62, 95% confidence interval [CI]: -23.84, 8.59). However, VMI's topical VD subgroup was statistically significant (25.16; 95% CI: 18.74, 31.59). For topical form, the total FSFI score (0.24; 95% CI: -1.72, 2.20) and all FSFI domains did not demonstrate statistically significant improvement except arousal (0.56; 95% CI: 0.12, 1.00). Vaginal pH's oral VD subgroup showed statistically significant improvement (-0.27, 95% CI: -0.50, -0.05) compared to the topical VD. Topical VD subgroup (24.45; 95% CI: 7.14, 41.77) showed a statistically significant increase of vaginal superficial cells, in contrast to the oral VD subgroup (3.25; 95% CI: -5.44, 11.96).

Conclusion: Topical VD showed significant improvements in VMI and the arousal subscale of FSFI, whereas oral VD had no substantial improvement except in vaginal pH. VD alone is not a sufficient alternative to other available treatments, and further RCTs are needed to evaluate its effectiveness without any combination with other drugs.

Introduction: This study evaluates the feasibility, safety, and outcomes of gasless vNOTES (vaginal Natural Orifice Transluminal Endoscopic Surgery) for benign adnexal surgeries.

Materials and methods: This was an observational, retrospective study performed in two centers with over 3 years of experience in vNOTES: the University Hospital Center of Nice (France) and Kantys Private Hospital Center (Nice, France). Gasless vNOTES adnexal surgery was performed without the use of pneumoperitoneum or abdominal parietal material. Procedures followed a standardized technique using a posterior colpotomy, the placement of a mesh to push the bowels, and a transvaginal access platform.

Results: Fifty patients underwent gasless vNOTES adnexal surgery between December 18, 2023, and April 17, 2024. The median age of patients was 40.4 ± 9.7 years, with a median body mass index (BMI) of 22.4 (range 17.6-42.0). Thirteen patients (26.0%) had a history of abdominal or pelvic surgery. The most common procedure was bilateral salpingectomy (60.0%). The median and mean durations for all procedures were 21 min (range 15-60) and 27.4 min (SD ± 10.8), respectively. No postoperative bleeding complications were noted, but one patient developed an abscess requiring surgical intervention. Pain scores were low, with only one patient reporting pain (10/100 on the visual analog scale) 6 h post-surgery. Ninety percent of patients were managed in an ambulatory setting, with a median time to first stand-up of 4 h and 7 min.

Conclusion: Gasless vNOTES adnexal surgery is a feasible and safe technique for surgeons experienced in vNOTES. It offers the potential for reduced postoperative pain and analgesic requirements without increasing operating time or complication rates, making it a viable alternative to conventional pneumoperitoneum-assisted vNOTES. Further prospective studies are needed to confirm these findings and evaluate long-term outcomes.