International Journal of Gynecology & Obstetrics最新文献

Background: Obstetric violence (OBV), defined as mistreatment or abuse during childbirth, is a pervasive global issue, albeit with regional differences, affecting women's physical and emotional well-being.

Objectives: The purpose of this systematic review and meta-analysis is to assess the prevalence of OBV to identify risk factors associated with OBV and to make suggestions for improving maternal healthcare practices and policies.

Search strategy: In a systematic review and meta-analysis, we searched four electronic databases for studies published over 10 years up to 31 January 2024: Medline (PubMed), Scopus, Embase, and Web of Science (WOS). The search was conducted among English language papers using a carefully curated set of keywords.

Selection criteria: We conducted a comprehensive review, including all observational reporting data on the prevalence of and risk factors associated with OBV, irrespective of geographical location. The studies included in the review were required to be published in peer-reviewed. journals and available in the English language.

Data collection and analysis: The data of the studies were summarized in an Excel file (version 19) and analyzed using R (version 4.2.3). A meta-analysis was performed to evaluate the pooled prevalence of and identify risk factors associated with OBV.

Main results: The global prevalence of OBV estimated based on 25 studies, calculated with a random-effects model, was 59% (95% confidence interval [CI] 0.48-0.70; I² = 99.5%). The most prevalent subdomain of OBV was non-consented care (37%; 95% CI 0.23-0.50; I² = 99.7%). The following factors were found to be significantly associated with OBV: the presence of a midwife as skilled personnel beside the woman during childbirth (odds ratio [OR] [95% CI] = 0.4 [0.2-0.9]), which might reduce the likelihood of OBV; middle and high levels of income (OR [95% CI] = 0.5 [0.2-0.7]), which might also reduce the likelihood of OBV; and vaginal delivery (OR [95% CI] = 2.08 [1.1-3.08]), which is liable to increase the likelihood of OBV.

Conclusion: This systematic review and meta-analysis highlights the considerable prevalence and multifaceted nature of OBV, underscoring the urgent need for interventions at multiple levels to address this pervasive issue and ensure respectful, safe, and dignified maternal healthcare for all women.

Objective: A gluten-free diet (GFD) is becoming increasingly popular, especially among young females, and including those without diagnosed celiac disease (CD). Whether a GFD is appropriate during pregnancy remains unclear. Our primary aim was to evaluate the association of a GFD and neonatal birthweight and incidence of large for gestational age (LGA) and small for gestational age (SGA). Secondarily, we sought associations with other obstetric outcomes.

Methods: The data was collected retrospectively from the Tampere University Hospital database. The study period was from January 2015 to April 2021. The diet information was obtained from self-reported questionnaires. All women following a GFD were included. A total of 79 had CD and 291 followed a GFD without CD diagnosis. The latter are referred to here as people without CD avoiding gluten (PWAG). A total of 456 omnivores were randomly chosen to constitute a control group. Outcomes were analyzed by comparing gluten-free groups to a control group.

Results: The median birth weight was higher in the GFD group compared to the controls (3533 vs. 3440 g, P < 0.003), but the incidences of SGA or LGA did not differ between the study groups. The incidence of pregnancy complications was comparable between the groups. Induction of labor was more frequent (aOR 1.52; 95% CI: 1.12-2.08), and the duration of labor was longer (aOR1.56; 95% CI: 1.18-2.06) in the GFD group, especially among PWAG. However, no difference in the cesarean section rate were found between the groups.

Conclusion: In the present retrospective cohort study, a GFD did not appear to be associated with adverse pregnancy or neonatal outcomes.

The incidence of cesarean section is dramatically increasing worldwide, whereas the training opportunities for obstetrician/gynecologists to manage complex cesarean section appear to be decreasing. This may be attributed to changing working hours directives and the increasing use of laparoscopy for gynecological surgical procedures, including in gynecological oncology. Various situations can create surgical difficulties during a cesarean section; however, two of the most frequent are complications from previous cesarean (myometrial defects, with or without placental intrusion and peritoneal adhesions) and the high risk of postpartum hemorrhage (uterine overdistension, abnormal placentation, uterine fibroids). Careful surgical dissection, with safe mobilization of the bladder and exposure of the anterior and lateral surfaces of the uterus, are pivotal steps for resolving the technical difficulties inherent in performing a complex cesarean section. We propose a standardized surgical protocol for women at risk of complex cesarean, including the antenatal identification of increased surgical risk, paramedian access to the pelvis, bladder dissection and mobilization, and the selection of a bleeding control strategy, considering uterine anatomy and the arterial pedicles involved in blood loss, which should be tailored to the individual case. We propose preoperative surgical planning to include consideration of the most common situations encountered during a complex cesarean, which facilitates anticipating an appropriate response for common possible scenarios, and can be adapted for low-, middle-, and high-resource settings. This protocol also highlights the importance of self-evaluation, continuous learning, and improvement activities within surgical teams.

Objective: This paper evaluates the accuracy of C-reactive protein (CRP), leukocyte count, and neutrophil-to-lymphocyte ratio (NLR) for diagnosing tubo-ovarian abscess (TOA) and assessing the cost-effectiveness of different treatment regimens for pelvic inflammatory disease (PID), with and without TOA.

Method: A retrospective cohort study was conducted between January 1, 2003, and December 30, 2021, including women aged 13-80 years diagnosed with PID. The analysis focused on the incremental cost-effectiveness ratio of different treatment regimens.

Results: C-reactive protein, leukocyte count, and NLR were found to be statistically significant markers for diagnosing TOA. Out of 907 PID cases, 705 achieved clinical cure with initial treatment. The most cost-effective treatment for mild PID without TOA was ceftriaxone combined with azithromycin, which was considered less costly and more effective in the cost-effectiveness analysis. For severe PID with TOA, ampicillin combined with gentamicin and clindamycin was more cost-effective compared to ampicillin with sulbactam plus doxycycline, given a willingness-to-pay threshold of US$213.57 for a 4.2% increase in cure rate.

Conclusion: The study's findings support the use of CRP, leukocyte count, and NLR as diagnostic tools for TOA. Ceftriaxone combined with azithromycin is recommended as the first-line treatment for mild PID at our institution due to its cost-effectiveness. For TOA, ampicillin combined with gentamicin and clindamycin is a cost-effective option if the healthcare system's willingness to pay exceeds US$213.57 for a 4.2% increase in cure rate, contributing valuable insights for PID treatment strategies from a hospital's perspective. The average time of hospital admission for TOA was 3 days. After discharge, patients received oral doxycycline until completing 14 days of treatment.

Objective: To evaluate the worldwide use of FIGO's two systems for the classification of causes and contributors to nongestational abnormal uterine bleeding in the reproductive years by obstetrics and gynecology professionals worldwide, to identify knowledge gaps, and explore barriers to implementation.

Methods: An electronic survey was developed by members of FIGO's Menstrual Disorders and Related Health Impacts (MDRHI) Committee to assess knowledge of abnormal uterine bleeding (AUB) and the two FIGO AUB systems among obstetricians and gynecologists. The survey was conducted online from February 28 to June 30, 2023, and comprised demographic questions, educational content inquiries, and a knowledge assessment. Available in English, Spanish, French, and Mandarin, the survey was disseminated through representatives of the World Association of Trainees in Obstetrics and Gynecology (WATOG), as well as through digital platforms and trainee-focused Facebook groups.

Results: Out of 1317 initial participants from 65 countries, 1114 completed the survey. The highest representation was from China (42.6%), where both trainees and clinicians participated. Participation varied across FIGO regions, with Asia-Oceania contributing the most (n = 602) and North America the least (n = 62). Most participants were in hospital-based residency programs (73.9%), graduating around 2012 with 3 years of postgraduate medical education. Nearly 70% reported being familiar with FIGO systems, while over 93% were familiar with PALM-COEIN. About one-third reported frequent use of FIGO systems by faculty, except among French-speaking respondents. Higher composite FIGO systems knowledge scores correlated with familiarity with FIGO AUB systems and PALM COEIN. Language did not significantly affect scores.

Conclusion: FIGO's systems for nongestational AUB are widely used but gaps persist. Targeted strategies focusing on faculty development and research are needed to improve awareness and proficiency. This study highlights the necessity for interventions in medical education to enhance trainees' understanding and utilization of standardized nomenclature.

Objective: This study compares ambulatory glycemic profile and glycemic variability between pregnant women diagnosed with type 2 diabetes mellitus (T2DM) receiving pharmacotherapy and healthy pregnant women without diabetes and assesses their correlation with fetal outcome.

Method: This was a case-control study involving 60 pregnant women (40 with T2DM and 20 healthy controls) in the third trimester of pregnancy. A flash glucose monitor device was applied over the upper arm to obtain the ambulatory glucose profile. Various glycemic parameters were analyzed and correlated with fetal outcomes among the two groups.

Results: A total of 720 days of glucose data, comprising 69 120 data points, were analyzed. This included 46 080 glucose values from the T2DM group and 23 040 from the healthy control group. Mean glucose levels in the T2DM group were 23.75% higher compared to the controls. All measures of glycemic variability were significantly elevated in the T2DM group, including mean amplitude of glycemic excursions (MAGE) (52.85 mg/dL vs. 35.72 mg/dL, P = 0.036) and standard deviation (22.84 mg/dL vs. 14.00 mg/dL, P = 0.029). A MAGE >55 mg/dL was associated with adverse fetal outcomes, such as large-for-gestational-age (LGA) infants, neonatal hypoglycemia, and stillbirth. In the T2DM group, poor outcomes were also linked to a higher time above range (TAR) (13.39% vs. 2.5%, P = 0.0001). The LGA subgroup exhibited an elevated TAR (15.2%) compared to those with normal outcomes.

Conclusion: Pregnant women with T2DM exhibit higher glycemic variability compared to healthy pregnant women. A MAGE >55 mg/dL was associated with adverse fetal outcomes, and elevated TAR significantly influenced these outcomes.