International Journal of Gynecology & Obstetrics最新文献

Objective: To investigate whether intraoperative confirmation of the disappearance of uterine cavity blood flow using color Doppler during manual vacuum aspiration (MVA) for missed miscarriage reduces the occurrence of retained products of conception (RPOC).

Methods: We conducted a retrospective cohort study of 202 patients who underwent MVA for missed miscarriage before 12 weeks of gestation at the University of Yamanashi between April 2019 and July 2025. Patients were divided into a flow-confirmation group, in which intraoperative transvaginal ultrasound with color Doppler was used to confirm the disappearance of blood flow, and a non-confirmation group. The primary outcome was the occurrence of RPOC diagnosed by postoperative ultrasound. Patient characteristics and surgical variables were compared between groups.

Results: RPOC occurred in 25 of 202 cases (12%). None of the 25 patients in the flow-confirmation group developed RPOC, whereas 14% of the 177 patients in the non-confirmation group did (P = 0.04). The surgeon's years of experience (2.6 ± 1.6 vs 4.9 ± 4.7 years, P = 0.004) and postoperative follow-up duration (1.9 ± 1.0 vs 3.3 ± 4.3 weeks, P = 0.02) were significantly shorter in the flow-confirmation group, but no other significant differences were found in baseline characteristics or surgical variables.

Conclusion: Intraoperative confirmation of the disappearance of uterine cavity blood flow using color Doppler during MVA is a simple, safe, and effective technique to prevent RPOC. This approach may reduce the need for repeat surgery and postoperative hemorrhage and could be incorporated into standard MVA protocols.

Objective: Uterine perforation (UP) is a rare complication, most commonly occurring during dilatation and evacuation, intrauterine device (IUD) insertion, or hysteroscopy. While a history of UP may increase the risk of complications in future pregnancies, data on this association remains limited. The aim of the present study was to evaluate obstetric and neonatal outcomes in subsequent pregnancies following documented UP.

Methods: A retrospective cohort study of all patients with prior UP delivered between June 2011 to May 2022 was conducted at a single tertiary medical center. The patients were compared to a control group without a history of UP using propensity score matching (1:8 ratio). Primary outcomes were: (1) maternal composite adverse outcome including uterine rupture, placental abruption, postpartum hemorrhage (PPH), blood products transfusion, and hysterectomy and (2) neonatal composite adverse outcome including low Apgar score, low cord pH, need for mechanical ventilation, and neonatal intensive care unit (NICU) hospitalization. Secondary outcomes included specific maternal and neonatal adverse events.

Results: The study group included 28 patients compared to 224 patients. There were no significant differences between the two groups in the composite maternal and neonatal outcomes. Two secondary outcomes-PPH and placenta accreta spectrum (PAS)-were significantly more common in the study group. One patient from the study group had a uterine rupture, and one patient underwent cesarean hysterectomy following a placenta percreta. These outcomes did not reach statistical significance.

Conclusion: A history of UP was not associated with composite maternal and neonatal complications. Higher rates of PPH and PAS were recorded in patients with prior UP.

Objective: Adenomyosis is a debilitating gynecologic condition. The present study aimed to compare the effects of laparoscopic total hysterectomy (LTH) and high-intensity focused ultrasound (HIFU) on pain relief, menstrual blood loss, and sexual function over a 12-month follow-up period in patients with adenomyosis.

Methods: A retrospective cohort study was conducted at our institution, including patients with adenomyosis who underwent LTH or HIFU. Propensity score matching (PSM) was performed to control for baseline differences in age, pictorial blood loss assessment chart (PBAC) score, numerical rating scale (NRS) for pain, and female sexual function index (FSFI) score, with a caliper value of 0.05.

Results: A total of 149 patients were included after PSM (LTH: n = 74, HIFU: n = 75). Both groups demonstrated significant reductions in pain scores over time, but the LTH group exhibited more rapid and sustained pain relief, with NRS scores at 6 months (LTH: 1.92 ± 1.06, HIFU: 3.58 ± 1.32, P < 0.001) and 12 months (LTH: 1.78 ± 1.03, HIFU: 2.94 ± 1.27, P < 0.001).

Conclusion: LTH and HIFU relieve adenomyosis differently, highlighting the need for personalized treatment based on symptom relief, function, and fertility.

Preterm birth occurs in approximately 10% of all pregnancies, and is not only the leading cause of neonatal mortality but also a major contributor to short- and long-term morbidities due to immaturity. Preterm birth has also been linked to an increased risk of maternal cardiovascular and cerebrovascular diseases, making it a critical concern in both perinatal medicine and women's lifelong health. Effective treatment requires interventions during threatened preterm labor, and several tocolytic agents have been developed and used in clinical practice. However, no pharmacological agent has been shown to prolong gestation and improve neonatal outcomes. Nifedipine, a calcium channel blocker, is widely used as a first-line tocolytic agent because of its oral administration route and relatively favorable safety profile compared with other drugs. Evidence from randomized controlled trials, meta-analyses, and Cochrane reviews suggests that nifedipine can delay delivery for a short period; however, robust evidence demonstrating sustained prolongation of pregnancy or improved neonatal survival is still lacking. Moreover, data on maternal hemodynamic changes and fetal effects are limited, highlighting the need for optimal dosing strategies and monitoring protocols. In this study, we discuss the clinical significance and limitations of nifedipine in the management of threatened preterm labor and outlined future directions. Future studies should involve large and homogeneous populations, continuous assessment of maternal hemodynamics, and application of novel biomarkers to support individualized therapy. Accumulation of such evidence is expected to optimize the management of threatened preterm labor and ultimately improve outcomes for mothers and infants.

Uterine leiomyomas are benign gynecologic tumors that occur in approximately 80% of women of reproductive age. Although often asymptomatic, these tumors may, in some cases, require gynecologic intervention. Conventional imaging tools, such as ultrasonography (US) and magnetic resonance imaging (MRI), are most commonly used to guide treatment selection. However, none of these methods provides definitive criteria for qualifying patients for medical, non-invasive, or surgical therapy. Therefore, there is a pressing need to develop innovative tools that improve the evaluation of uterine masses and allow for safer and more effective patient stratification for appropriate treatment options. In this context, the relatively recent development of techniques for assessing tissue stiffness offers promising possibilities. The aim of this review was to analyze available research on the use of ultrasound elastography and magnetic resonance elastography in the evaluation of uterine leiomyomas. It highlights the feasibility of these techniques in assessing the viscoelastic properties of leiomyomas and explores their potential application in differential diagnosis and treatment planning.

Pre-eclampsia (PE) and fetal growth restriction (FGR) are among the leading causes of maternal and perinatal morbidity and mortality worldwide. Both conditions are more frequent and severe at high altitudes due to physiological changes in oxygen availability and vascular adaptation. This narrative review explores the complex relationship between high-altitude pregnancy, the development of PE and FGR, and the underlying adaptive mechanisms that may influence maternal and fetal outcomes. We provide an updated synthesis of the current evidence regarding placental dysfunction, angiogenic imbalance, and oxidative stress in pregnancies at high altitude, highlighting the role of hypoxia-inducible factors, altered expression of sFlt-1 and PlGF, and their impact on trophoblast invasion and uteroplacental blood flow. The review also highlights genetic and physiological adaptations observed in permanent high-altitude populations that appear to mitigate these risks, including enhanced oxygen delivery, increased uterine artery diameter, and reduced placental vascular resistance. This review emphasizes the importance of considering geographic and environmental factors in pregnancy outcomes and calls for further research to better understand the mechanisms driving adverse outcomes at high altitude.