International Journal of Gynecology & Obstetrics最新文献

Background: The human papillomavirus (HPV) integration test is a novel cervical cancer screening technique. This study aimed to explore the effect of HPV integration level on the risk of grade 3 cervical intraepithelial neoplasia (CIN) or more severe CIN (3+) in HPV integration-positive women, as well as the interaction between HPV type and HPV integration level on CIN3+.

Method: The HPV integration test was conducted using high-throughput viral integration detection. The number of HPV integration reads (NHIR) is used to represent the level of HPV integration. Multivariable logistic regression models were used to examine the independent and interaction of the NHIR and the HPV type on CIN3+.

Results: A total of 1053 HPV integration-positive women enrolled in this study. The percentage of CIN3+ in participants was 32.7%. The risk of CIN3+ increased by 0.9% (odds ratio [OR]: 1.009, 95% confidence interval [CI]: 1.006-1.012) per 10 increases in the NHIR. The risk of CIN3+ in the HPV16/18 group was higher than in the other 12 high-risk HPV group (OR: 2.875, 95% CI: 2.034-4.064). However, with the elevated NHIR, the risk gap between the two groups gradually narrowed until it disappeared. There is multiplicative (P = 0.031) and additive interaction between the NHIR and the HPV type on CIN3+.

Conclusion: There was an interaction between HPV type and NHIR on CIN3+. HPV integration can further assess a patient's risk based on HPV genotyping detection, which is conducive to reducing missed diagnoses. The NHIR might be a potential biomarker for early warning and precise identification of high-risk CIN lesions.

Objective: To determine delivery outcomes in women diagnosed with prelabor rupture of membranes (PROM) who required re-amniotomy.

Methods: This retrospective cohort study included 24 966 women with PROM at a single university-affiliated tertiary medical center (2011-2023). Labor outcome was compared between women requiring re-amniotomy during delivery and those who did not. The primary outcome was the rate of cesarean delivery (CD). Secondary outcomes were maternal obstetric complications, including assisted operative vaginal delivery, intrapartum fever, postpartum hemorrhage, need for blood products transfusion and need for re-admission within 30 days postpartum.

Results: Re-amniotomy was required in 5.5% (n = 1364) of cases and was associated with higher CD rates (10.2% versus 5.6%, P < 0.001). In the adjusted analysis controlling for significant confounders identified in univariate analysis, re-amniotomy remained independently associated with increased risk for CD (adjusted odds ratio 1.452, 95% confidence interval 1.010-2.080, P = 0.043). For secondary maternal obstetric outcomes (assisted vaginal delivery, intrapartum fever, and postpartum hemorrhage), no independent associations with re-amniotomy were found after multivariate adjustment. Women requiring re-amniotomy had significantly longer intervals from PROM to delivery (26:49 ± 19:52 vs. 18:36 ± 14:34 h:min, P < 0.001) and lower rates of achieving active labor within 24 h (62.3% vs. 74.2%, P < 0.001).

Conclusions: The need for re-amniotomy during delivery in women with PROM is associated with an increased risk for CD and prolonged labor.

Objective: To assess whether machine learning (ML) offers improved birth weight prediction accuracy, since despite numerous models, the Hadlock formula remains the clinical standard.

Methods: A multicenter retrospective study analyzed data from 9674 singleton pregnancies with estimated fetal weight (EFW) within 7 days of delivery. ML models-Linear Regression, Decision Tree, Random Forest, LightGBM, XGBoost, and Neural Networks-were trained using ultrasound and maternal features. Performance was measured by mean absolute percentage error (MAPE), root mean squared error (RMSE), mean absolute error (MAE), accuracy, precision, recall, and F1-score for percentile categories.

Results: LightGBM and XGBoost outperformed Hadlock in overall weight estimation (MAPE ~0.065; RMSE ~252; MAE ~190). For birth weight percentiles (<3rd, <10th, >90th, >97th), ML showed marginal or comparable improvement. LightGBM had higher accuracy and F1 for extreme percentiles, whereas Hadlock showed slightly better recall in some cases.

Conclusion: ML models, especially LightGBM and XGBoost, enhanced overall weight prediction but offered limited gains in identifying percentile-based risk. The Hadlock formula remains a strong tool for categorizing at-risk fetuses.

Objective: This study assessed the incidence of and risk factors associated with expulsion of copper intrauterine devices inserted in the immediate postpartum period at a public hospital in Brazil.

Methods: This retrospective cohort study included women who had a copper intrauterine device (IUD) inserted immediately after delivery at a teaching hospital and returned for follow-up within 12 months. The primary outcome was IUD expulsion (partial or complete) overall and by mode of delivery. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for expulsion. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results: Among the 543 participants, the overall expulsion rate was 14.7%, with significantly higher rates for placement after vaginal delivery (22.8%) compared to cesarean section (5.2%). In bivariate analysis, maternal age, parity, gestational age, mode of delivery, and insertion by first-year residents were associated with device expulsion. In multivariate analysis, maternal age <20 years (aOR 5.03, 95% CI: 1.30-19.42), age 20-34 years (aOR 4.68, 95% CI: 1.40-15.63), and vaginal delivery (aOR 5.78, 95% CI: 2.17-15.42) remained independently associated with IUD expulsion.

Conclusion: At a Brazilian teaching hospital, nearly 15% of the women who had a copper IUD inserted by residents in the immediate postpartum period expelled the device. Maternal age under 35 years and vaginal delivery were significant risk factors for expulsion. These findings highlight the importance of individualized counseling and close follow-up for higher-risk groups, as well as continuous training of providers.

Objective: To compare the efficacy and safety of fractional microablative radiofrequency (RF) and topical estriol in the treatment of genitourinary syndrome of menopause (GSM).

Methods: This pilot randomized controlled trial included 30 healthy postmenopausal women with GSM. Participants were randomly assigned to receive either fractional microablative RF plus placebo cream (RF group) or topical estriol plus sham RF (estriol group). Both treatments were administered over 3 months. Primary outcomes included vaginal health (Vaginal Health Index Score-VHIS), sexual function (Female Sexual Function Index-FSFI), and urinary symptoms (International Consultation on Incontinence Questionnaire-Short Form-ICIQ-SF). Safety was assessed through reports of adverse effects.

Results: Both RF and estriol significantly improved VHIS, FSFI, and ICIQ-SF scores (p < 0.05). Estriol provided greater improvement in sexual desire, while RF demonstrated superior results in satisfaction, dyspareunia reduction, and epithelial elasticity. No severe adverse effects occurred; mild discomfort was reported in the RF group.

Conclusion: Fractional microablative RF and topical estriol are both effective and safe for relieving GSM symptoms. RF offers a promising non-hormonal alternative, especially for women who cannot or choose not to use estrogen therapy.

Transverse vaginal septa are rare, with incidence estimated to be between 1 in 30 000 to 1 in 84 000 people. Despite much literature in the gynecologic setting, there is little guidance about how to manage them when diagnosed in labor. A 23-year-old G1P000 patient presented to Labor and Delivery at 40 weeks 0 days with contractions and vaginal bleeding. A sterile bimanual exam found a blind vaginal ending, with no identifiable cervix. A point of care transvaginal ultrasound showed a transverse septum that measured 0.39 cm in thickness, with a normal cervix behind the septum. The patient was offered an exam under anesthesia with possible septum resection or primary cesarean delivery. She elected for an exam under anesthesia, which revealed a small area of dimpling on the septum. This was bluntly dissected along the scar of the previous resection, without hemorrhage or other complications. Subsequently, the cervix was identified, and the exam was 5 cm dilated, 80% effaced. The patient progressed to an uncomplicated vaginal delivery with no hemorrhage noted in the antepartum or postpartum period. Though there is no consensus or official recommendation for how to manage transverse vaginal septa during labor, there is a concern that a transverse vaginal septum during labor can lead to bleeding or obstructed labor, which can potentially result in uterine rupture. Our patient was diagnosed via transvaginal ultrasound, allowing for blunt dissection and ultimately an uncomplicated vaginal delivery; and this option should be considered for such patients identified in the intrapartum period.

Objective: To determine the association between epidural analgesia and perineal injury, including obstetric anal sphincter injury (OASI), in primiparous women.

Methods: We conducted a retrospective cohort study of primiparous women with singleton, term, vertex, and vaginal deliveries between 2012 and 2024 at a tertiary medical center. Primary outcomes were (1) any perineal injury, and (2) OASI. Propensity score matching (1:1) was used to adjust for maternal and obstetric confounders. Perineal outcomes were compared in matched and unmatched cohorts using standardized mean difference (SMD). An SMD <0.1 was considered negligible, 0.1-0.2 small, and >0.2 clinically significant. Multivariable logistic regression was used to evaluate associations between epidural use and outcomes.

Results: Overall, 45 132 women were included, of whom 36 799 (81.5%) received epidural analgesia. After matching (n = 5974 per group), baseline characteristics were balanced apart from fetal head station at full dilation, which was higher in the no-epidural group (0.90 ± 0.9 vs. 0.66 ± 0.8; SMD = 0.239). Perineal injury occurred more often with epidural with a marginal difference (82.2% vs. 78.2%, SMD = 0.10). In a multivariable logistic regression analysis, epidural was associated with more perineal injury only in the absence of episiotomy (adjusted odds ratio [aOR] 1.321; 95% confidence interval [CI]: 1.225-1.425; P < 0.001), but not when episiotomy was performed. Conversely, epidural use was associated with lower OASI risk regardless of whether episiotomy was performed (aOR 0.492; 95% CI: 0.285-0.849; P = 0.011) or not (aOR 0.592; 95% CI: 0.424-0.825; P = 0.002).

Conclusion: In primiparous term vaginal deliveries, epidural analgesia modestly increased low-grade perineal tears but reduced OASI risk, supporting its safety regarding severe perineal trauma.

Objective: To compare the sensitivity and specificity of topical fluorescein sodium (FNa) to acetic acid (AA) for the detection of high-grade cervical lesions in colposcopy.

Materials and methods: This prospective, cross-sectional study was conducted between January and November 2017 at Christus Muguerza Hospital Conchita in Monterrey, Mexico. 78 women between 18 and 65 years age with a documented abnormal cervical smear test were included. Colposcopy by independent application of 5% AA and 0.06% topical FNa was performed and biopsy obtained for each woman.

Results: 68 (87%) women tested positive with FNa, while 10 (13%) tested negative. Biopsy demonstrated high grade cervical lesions in 31 of the FNa positive but none of the FNa negative women. FNa staining demonstrated 100% sensitivity, 21% specificity, 46% positive predictive value (PPV), and 100% negative predictive value (NPV) to detect high-grade lesions. In comparison, acetic acid staining demonstrated 100% sensitivity, 9% specificity, 42% PPV, and 100% NPV.

Conclusion: FNa had a 133% higher diagnostic specificity than AA (21% vs. 9%) for high-grade lesions at a comparable cost and convenience. Visual inspection with FNa has the potential to replace visual inspection with AA in low-resource settings, thus enabling true "diagnose and treat".