International Journal of Gynecology & Obstetrics最新文献

Intrauterine adhesions (IUA) are a condition characterized by the formation of scar tissue within the uterine cavity, resulting from endometrial injury. They severely affect female fertility. Despite continuous optimization of diagnostic and therapeutic strategies, the recurrence rate remains high, indicating an incomplete understanding of the pathogenesis. This paper systematically reviews the cellular and molecular mechanisms involved in the formation of IUA as revealed by current research. It particularly emphasizes the critical roles of fibrosis-related signaling pathways, immune-inflammatory responses, angiogenesis, non-coding RNAs, epithelial-mesenchymal transition, genetic susceptibility, and mitochondrial function. Based on these molecular mechanisms, this article delves into groundbreaking approaches for both the prophylaxis and management of IUA. These strategies include modulating fibrosis signaling pathways, stem cell and exosome therapy, suppressing inflammatory responses, estrogen therapy, enhancing endometrial blood supply and angiogenesis, and platelet-rich plasma therapy. Additionally, this paper highlights the limitations of current research and discusses future research directions. It underscores the importance of integrating multi-omics research methods and developing precision medicine strategies. Thorough elucidation of the mechanism of IUA is crucial for its prevention and treatment and has important clinical significance.

Objective: In the dose-escalation part of Study 101, which included multiple tumor types, objective responses were observed in 10 of 22 patients across multiple dose levels of farletuzumab ecteribulin (FZEC). We explored the safety/antitumor activity of FZEC in patients with platinum-resistant ovarian cancer (PROC) from the Study 101 expansion part.

Methods: Eligible patients were aged ≥20 years and received FZEC 0.9 or 1.2 mg/kg intravenously Q3W. Safety, objective response rate (ORR), duration of response (DOR), progression-free survival (PFS), and overall survival (OS) were evaluated. Tumor assessments were performed by investigators per Response Evaluation Criteria in Solid Tumors version 1.1, and folate receptor-alpha (FRα) status of tumor samples was assessed by central immunohistochemistry.

Results: A total of 45 patients from Japan were treated. Among these patients, 24 were treated with FZEC 0.9 mg/kg and 21 with 1.2 mg/kg; 70.8% and 85.7% had FRα expression in ≥75% of neoplastic cells, respectively. Grade (Gr) ≥3 treatment-emergent adverse events were observed in nine patients (37.5%) in the 0.9 mg/kg group and in six (28.6%) in the 1.2 mg/kg group. Interstitial lung disease (ILD)/pneumonitis occurred in 37.5% (Gr ≥3: 0%) of the 0.9 mg/kg group and 66.7% (Gr ≥3: 4.8%) of the 1.2 mg/kg group. In the 0.9 and 1.2 mg/kg groups, ORR was 25.0 and 52.4%, median (m)DOR was 10.6 and 7.6 months, mPFS was 6.7 and 8.2 months, and mOS was 10.5 and 20.5 months, respectively.

Conclusion: FZEC showed promising antitumor activity, and the observed adverse events were generally manageable, with the exception of ILD, in patients with PROC.

Clinicaltrials:

Gov registration: NCT03386942. URL: https://clinicaltrials.gov/study/NCT03386942.

RETRACTION: T. Shokeir, and S. Mousa, “ A Randomized, Placebo-Controlled, Double-Blind Study of Hysteroscopic-Guided Pertubal Diluted Bupivacaine Infusion For Endometriosis-Associated Chronic Pelvic Pain,” International Journal of Gynecology & Obstetrics 130, no. 3 (2015): 219-222, 10.1016/j.ijgo.2015.03.043.

The above article, published online on 03 June 2015 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Michael Geary; and John Wiley & Sons Ltd. UK. Concerns were raised by a third party regarding the reproducibility of the results reported in Tables 2 and 3, including the p-values stated Table 3. The authors were asked to provide their raw data. However, they did not provide the requested data. Because of the incompatibility of the statistical results presented in the publication and without an adequate explanation by the authors, the editorial team and publisher consider the data and conclusions as unreliable, therefore the article must be retracted.

Objective: To quantify how five altitude-adjustment algorithms affect anemia prevalence at 3560 m and to evaluate diagnostic agreement.

Methods: We conducted a retrospective, registry-based cross-sectional study of 10 660 pregnant women receiving antenatal care in Shannan, China (3560 m) from January 2022 to December 2024. Each woman contributed one hemoglobin (Hb) measurement, which was assigned to a trimester by gestational week at sampling. Observed Hb values were adjusted using five algorithms (WHO 2024, WHO 2011, Centers for Disease Control and Prevention [CDC], Dirren, Dallman). Anemia thresholds were <110 g/L for early and late and <105 g/L for mid-pregnancy under WHO-2024; for the other algorithms, <110 g/L across trimesters. Outcomes included overall and trimester-specific prevalence and diagnostic agreement quantified by Cohen's κ.

Results: Mean observed Hb decreased from 141.1 g/L in early pregnancy to 117.7 g/L in late pregnancy. Unadjusted anemia prevalence was 20.7%. After altitude adjustment, prevalence estimates were 69.3% (WHO 2024), 78.2% (WHO 2011/CDC), 52.9% (Dallman), and 82.9% (Dirren). Across algorithms, prevalence increased with advancing gestation. Agreement was perfect for WHO 2011 versus CDC (κ = 1.000), moderate for WHO 2024 versus CDC (κ = 0.773), and fair for Dirren versus Dallman (κ = 0.376).

Conclusion: Altitude adjustment increased estimated anemia prevalence by up to four-fold at 3560 m in China. Algorithms derived from non-high-altitude populations may misclassify anemia in these settings. Population-tailored standards that incorporate altitude and trimester are warranted to improve screening accuracy and guide interventions.

Objective: This study determines whether a machine-learning model integrating sonographic biometry with maternal clinical parameters improves prediction of large-for-gestational-age (LGA) compared with Hadlock's EFW formula.

Methods: We conducted a retrospective cohort study including all singleton live births at ≥32 gestational weeks at a tertiary medical center. Predictors comprised biparietal diameter, abdominal circumference, femur length, maternal demographics and anthropometrics, obstetric history, chronic and gestational morbidity, and glucose values from screening and diagnosis. A CatBoost gradient-boosting model estimated the probability of LGA (birthweight ≥90th percentile). Performance was compared with Hadlock's EFW using area under the curve (AUC) and detection at a fixed 10% false-positive rate. A prespecified subgroup analysis evaluated pregnancies with pregestational or gestational diabetes. Performance was assessed with fivefold cross-validation; calibration and utility were examined by decision curve analysis.

Results: Among 31 531 parturients, 18.17% delivered an LGA neonate. The model achieved an AUC of 0.946 (95% confidence interval [CI], 0.938-0.955), significantly outperforming Hadlock's EFW (AUC 0.867; 95% CI, 0.854-0.881; P = 0.01) and yielding a higher detection rate at a 10% false-positive rate (79% vs. 63%). The most influential contributors were abdominal circumference, gestational age at delivery, fetal sex, and maternal age. In 3871 diabetic pregnancies, among whom 24% delivered LGA, performance remained high (AUC 0.890; 95% CI, 0.847-0.918) and exceeded Hadlock's formula (AUC 0.820; 95% CI, 0.772-0.863; P = 0.02).

Conclusion: A predictive algorithm, incorporating sonographic and non-sonographic features, as developed here, achieved superior accuracy compared to the traditional EFW formula in predicting LGA neonates, in both general and diabetic pregnant populations.

Objective: To determine the rate of pharmacological treatment failure in early pregnancy loss, assess post-treatment residua thickness as a predictor of retained products of conception (RPOC), identify a clinically relevant cutoff, and evaluate additional clinical and sonographic predictors.

Methods: This retrospective cohort study was conducted at a tertiary medical center and included patients treated with mifepristone-misoprostol for first-trimester pregnancy loss between January 2019 and January 2022. Treatment success was assessed via transvaginal ultrasound, with residua thickness measured 14 days post-treatment. The primary outcome was failure, defined as histologically confirmed RPOC following hysteroscopy. Secondary analyses evaluated clinical and sonographic predictors, focusing on post-treatment residual thickness. Statistical analysis included receiver operating characteristic (ROC) curve assessment and multivariable logistic regression.

Results: Of the 717 patients included, 537 (74.9%) achieved successful medical management without further intervention, while 180 (25.1%) required intervention. Treatment failure was associated with greater post-treatment residua thickness (mean 19.1 ± 9.1 mm vs. 10.4 ± 6.7 mm, P < 0.001). Residua thickness was an independent predictor of failure (adjusted odds ratio [aOR] 1.17, 95% confidence interval [CI]: 1.13-1.21, P < 0.001). ROC analysis identified an optimal cutoff of 14.9 mm, yielding 70% sensitivity and 81% specificity (area under the curve [AUC]: 0.835, 95% CI: 0.80-0.87) for predicting the need for surgical intervention.

Conclusion: Post-treatment residual thickness is a significant predictor of pharmacological treatment failure in early pregnancy loss, with a clinically relevant cutoff of approximately 15 mm. Histologic validation provides a promising framework for refining management protocols, emphasizing the need for further studies to establish robust predictive criteria.

Objective: This study assesses the association between complete blood count (CBC) parameters, including the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) and predicts the need for postpartum packed red blood cell transfusion (pRBCT).

Methods: This retrospective cohort study was conducted at a tertiary, university-affiliated medical center with approximately 12 500 annual deliveries (2012-2023). Women requiring postpartum pRBCT were identified based on criteria including severe hemorrhage, symptomatic anemia with hemoglobin (Hb) levels of 7-8 g/dL, or severe anemia (Hb <7 g/dL). Maternal demographics, admission complete blood count (CBC), and delivery outcomes were analyzed. Multivariable logistic regression identified independent predictors of pRBCT, and a risk score was developed and evaluated using receiver operating characteristic (ROC) analysis.

Results: Admission CBC data were available for 37 631 vaginal deliveries, of which 957 (2.5%) required pRBCT. Risk factors for pRBCT included nulliparity, previous cesarean, assisted reproductive technology conception and intrapartum fever. Protective factors included spontaneous labor onset, body mass index >30, and admission hematocrit >40%. Key CBC independent predictors included Hb <11 g/dL (adjusted odds ratio [aOR] 5.70, 95% confidence interval [CI] 4.79-6.79), and NLR >5 (aOR 1.28, 95% CI 1.02-1.60). The scoring model, with a clinical cutoff of 5, predicted pRBCT with an area under the curve of 0.77 (95% CI 0.75-0.79, P < 0.001).

Conclusion: Admission CBC parameters, particularly NLR and Hb, alongside maternal factors, might help predict pRBCT in vaginal deliveries.

Objective: To evaluate the practicability of self-collected tampons with the MPap assay for endometrial cancer (EC) detection, by comparing with the results of cervical swabs.

Methods: A total of 85 women at Tri-Service General Hospital (TSGH) were included to directly compare the performance of physician-collected swabs and self-collected tampons. An additional cohort of 39 self-collected tampons from patients at Shuang Ho Hospital (SHH) was included for further validation. The effects of age, body mass index (BMI), and BHLHE22 and CDO1 methylation levels on MPap test performance were analyzed across samples from patients with and without EC. The performance of the MPap test is presented as percentage of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC). The Pearson's correlation test was used to examine the association between swab and tampon in the MPap test.

Results: The area under the curve (AUC) of MPap to detect EC in 85 swabs and tampons both were 0.94 (0.88-1.00). The sensitivity, specificity, PPV, NPV, and ACC of the two collection methods did not show significant differences. The testing results using a tampon were highly correlated with the results using a physician-collected swab (R² = 0.6810, P < 0.001). Furthermore, the AUC of MPap to detect EC in 39 tampons was 0.97 (0.93-1.02). The sensitivity, specificity, PPV, NPV, and ACC were 90.48%, 94.44%, 95.00%, 89.47%, and 92.31%, respectively.

Conclusion: Our data inferred the potential of the MPap test in early detection of EC using vaginal secretion collected by an intravaginal self-collected tampon.