International Journal of Gynecology & Obstetrics最新文献

Objective: Guatemala has one of the highest rates of maternal mortality in Central America. A total of 60% of births in Guatemala are attended by traditional Mayan birth attendants, or comadronas. Their prevalence in these communities makes them a valuable resource to bridge home births with safe prenatal care. The objective of this study was to evaluate a low-cost prenatal care training program for Guatemalan comadronas with the goal of improving maternal health outcomes in the region.

Methods: In this retrospective longitudinal cohort study, we examined the knowledge retention of comadronas enrolled in a 12-month prenatal care training program known as the School of PowHER (SOP). Recruited from the Lake Atitlán region of Guatemala by Saving Mothers, 501(c)(3) and the Guatemalan Ministry of Health, comadronas participated in a four-month didactic curriculum followed by a nine-month clinical curriculum. Pre- and post-tests were administered to assess learning outcomes over the study's duration (2014-2022), and test results were evaluated to assess the effectiveness of the SOP.

Results: A total of 123 women were recruited and enrolled in all eight graduating classes of the SOP from 2014, 2016-2019, and 2021-2022. An average, statistically significant improvement in didactic and clinical pre- and post-test scores was found across all years analyzed.

Conclusion: The SOP is a low-cost, culturally appropriate, community-based model that empowers comadronas through knowledge and skill acquisition to improve local maternal health outcomes. This program proves effective at not only teaching comadronas prenatal health information and clinical skills, but also at promoting long-term retention of these skills.

Objectives: To assess hotspot micro-vessel flow velocity waveforms in human papillomavirus (HPV) cervical infections using transvaginal power Doppler ultrasound (TV-PDU) and explore associations with high-grade squamous intraepithelial lesions (HSIL, cervical intraepithelial neoplasia [CIN] II and III).

Methods: In all, 62 patients with confirmed HPV-HSIL (14 CIN II, 48 CIN III) and 65 age- and parity-matched women with neither HPV infection nor CIN were compared. Seven parameters by TV-PDU were used to assess vascular classification and micro-vessel flow velocity, including vascular grading (class I, II, III), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end-diastolic velocity (ED), time average maximum velocity (TAMV), and the vascular index (VI = PS/ED).

Results: HSIL was primarily associated with vascular class I (75.8%), followed by class II (14.5%) and class III (9.7%). PI, RI, and VI in HSIL were significantly lower than the control group (P < 0.0001). Mean PI, RI, and VI values decreased progressively from the normal cervix to CIN II-III. At a PI cutoff of 1.03, sensitivity was 88.7%, specificity was 83.8%, and area under the curve (AUC) was 95.0. At an RI cutoff of 0.68, sensitivity was 96.8%, specificity 61.5%, and AUC 84.0. At a VI cutoff of 2.84, sensitivity was 85.5%, specificity 78.5%, and AUC 85.0.

Conclusion: Based on different patterns of hotspot vascular classification and micro-vessel flow velocity waveforms, particularly PI between HSIL and the normal cervix, TV-PDU may offer a potential role for aiding the planning for patients with suspicious HSIL. Further studies are needed to validate the findings.

The demand for female genital cosmetic surgery (FGCS) has significantly increased in recent years for two reasons: the advancement of surgical operations and the increased attention to women's esthetic and sexual well-being. Three authors independently analyzed different databases up to April 1, 2024. They selected the relevant data according to inclusion and exclusion criteria. Two team members retrieved and evaluated the full text of the articles for eligibility, extracted the data independently, and included populations, intervention type, and outcomes using a pre-piloted standard method. Any disagreement over the eligibility of some articles was resolved through discussion with an external collaborator. Considering the growing interest in FGCS procedures, the present review aims to analyze the most up-to-date surgical techniques, to provide adequate evidence-based surgical training, in order to avoid complications. Labiaplasty aims to reduce excess labial tissue. To perform this procedure, it is possible to implement several techniques, that have recently been updated to ensure the lowest rate of complications and the best esthetic result. Vaginoplasty involves strengthening the vaginal wall and repairing vaginal lesions or asymmetries. Perineoplasty, the technique of choice in all scenarios in which perineal trauma occurs, is achieved by strengthening the perineal body and restoring the rectovaginal fascia. Other procedures described are labia majora augmentation, mons pubis surgery, clitoral hood reduction, lipofilling, and hymen reconstruction. Our review emphasizes that robust, evidence-based training is required before performing such procedures, to avoid ineffective and potentially harmful surgical practices.

There is limited research concerning the transgender population's health issues, such as gender dysphoria, and disparities within the healthcare system, especially in the Latino or Hispanic population. This study aimed to report the case of a Puerto Rican transgender man who achieved pregnancy without reproductive assistance after cessation of testosterone therapy for 3 months and who in the postpartum period experienced significant gender dysphoria. A narrative literature review was carried out to identify the role of gender dysphoria in pregnancy, lactation, health-related spaces, and mental health. Gender dysphoria is an important component of reproductive care in this population and can be accompanied by mental health issues that can directly impact the preconception, conception, and postpartum periods. The identification of gender dysphoria and how to properly manage it during pregnancy in transgender individuals can aid in the process of providing affirming and inclusive reproductive health care to this population.

Negative pressure wound therapy (NPWT) is a very effective method in the treatment of dehiscent, infected, and non-healing wounds. Difficult wound healing occurs especially in late pregnancy due to the rapid enlargement of the uterus and the constantly increasing tension of the entire abdominal wall. In cases of dehiscence of the surgical wound during pregnancy, proper subsequent treatment is needed, where it is necessary to consider the safety of the mother as well as the fetus. We report the case of a 30-week pregnant patient who was surgically treated for acute appendicitis in pregnancy with an open appendectomy approach. Postoperative complications resulted in wound dehiscence with complete defect in fascia, which was treated with negative V.A.C. ATS® Therapy System. The therapy was started in the 30th week of pregnancy and continued until delivery with regular check-ups and regular redressing of the vacuum-assisted closure (VAC) system. At 38 weeks of pregnancy, the patient delivered vaginally with continued VAC therapy in situ. The final suture took place 3 days after vaginal delivery. Non-healing wounds with abdominal wall defects should be treated using a multidisciplinary approach, and NPWT can be used. This therapy can also be used during pregnancy. Vaginal delivery is preferred because it reduces the risk of further formation or deepening of the abdominal wall defect after a sufficient time interval from the start of the treatment. This complex case with a literature review of surgical complications in pregnancy treated with NPWT therapy highlights the advantage of a multidisciplinary approach.

Objective: The rising rates of cesarean delivery (CD), which are a leading cause of intra-abdominal adhesions, represent a major concern for maternal health. We aimed to describe early maternal complications following CD in women with severe intra-abdominal adhesions.

Methods: A prospective observational study was conducted at a university-affiliated tertiary medical center (January 2021 and March 2023) in Israel. Women who underwent CD were assessed for intra-abdominal adhesions by questionnaires completed by the surgeons. Adhesions were evaluated at four anatomical sites: abdomen-to-uterus, uterus-to-bladder, skin-to-fascia, and other intra-abdominal sites. Each site was scored on a scale of 0-2, with a total score ranging from 0 to 8. Severe adhesions were defined as a total score ≥5. The primary outcome measures were a composite complication which included at least one or more of postoperative need for blood or iron products, fever, prolonged hospitalization, re-hospitalization, and emergency room visits.

Results: Overall, 2797 women were included in the study, of whom 295 (10.6%) exhibited severe adhesions. Women with severe adhesions had a higher composite risk for maternal complications following CD (RR = 1.28, 95% confidence interval [CI]: 1.12-1.45, P < 0.001), specifically, postoperative need for blood or iron products (RR = 1.71, 95% CI: 1.15-2.55, P = 0.007) and prolonged hospitalization (RR = 1.49, 95% CI: 1.10-2.03, P = 0.009). There were no significant group differences in the rates of postoperative fever, re-hospitalization or emergency room visits. In multivariate analysis, severe adhesions had an independent impact on maternal complications (CI: 1.06-1.95, P value 0.017).

Conclusion: Severe intra-abdominal adhesions diagnosed in CD had an impact on early maternal complications.

Pulmonary sequestration is a rare pulmonary malformation, typically characterized by asymptomatic presentation or recurrent pulmonary infections, with chest pain and hemothorax being exceedingly rare occurrences. The rupture and hemorrhage of maternal pulmonary sequestration during pregnancy pose a life-threatening condition that is challenging to diagnose. We present a case of a 37-year-old pregnant woman in her third trimester who presented with acute progressive hemothorax, a complication arising from maternal pulmonary sequestration. The patient experienced chest pain, which was followed by a decrease in blood pressure, albeit without a concomitant drop in blood oxygen saturation. Within a critical 24-h window, an emergency cesarean section was performed, promptly followed by a right inferior lobectomy. Intraoperative diagnosis confirmed pulmonary sequestration. Fortunately, both the patient and the newborn had a favorable prognosis post-surgery. The diagnosis of pulmonary sequestration in pregnancy is challenging and can present with non-specific symptoms. Clinicians should maintain a high index of suspicion for pulmonary sequestration, especially in cases of unexplained chest pain or hemothorax during pregnancy. Timely surgical intervention can be life-saving and is crucial for maternal and fetal well-being.

Background: Prematurity complications are a leading cause of mortality and morbidity in offspring, including adverse neurodevelopmental outcomes. The association between preterm birth (PTB) and autism spectrum disorder (ASD) remains debated.

Objective: To investigate the association between PTB and ASD diagnosis during childhood.

Methods: This cohort study analyzed data from community clinics and a tertiary hospital, encompassing deliveries from 2005 to 2017. ASD incidence was compared across gestational age categories: extremely preterm (<28 weeks), very preterm (28-32 weeks), moderate to late preterm (32-37 weeks), and term (≥37 weeks). Additional comparisons were made between all preterm (<37 weeks) and term deliveries (≥37 weeks). Cumulative ASD incidence was assessed using Kaplan-Meier survival curves and a Cox proportional hazards model adjusted for potential confounders.

Results: Among 114 975 pregnancies, 0.3% delivered at <28 weeks, 0.6% at 28-32 weeks, and 6% at 32-37 weeks, with 6.9% preterm deliveries overall. Univariable analysis revealed a significant association between PTB and ASD (1.6% for <28 weeks vs 0.3% for 28-32 weeks vs 0.8% for 32-37 weeks vs 0.7% for term, P = 0.036). Crude ASD incidence was 0.8% (odds ratio [OR] 1.21, 95% confidence interval [CI] 0.93-1.56, P = 0.15). However, adjusted results showed no significant association: adjusted hazard ratio = 0.74 (95% CI 0.24-2.34, P = 0.61) for <28 weeks, 0.99 (95% CI 0.24-3.99, P = 0.98) for 28-32 weeks, and 1.07 (95% CI 0.81-1.43, P = 0.63) for 32-37 weeks. Kaplan-Meier analysis showed similar cumulative ASD incidence across groups (P = 0.855).

Conclusion: This retrospective cohort study found no significant association between PTB and childhood ASD diagnosis.