International Journal of Gynecology & Obstetrics最新文献

A T-shaped uterus is a uterine malformation, which can be either congenital or acquired, potentially impairing fertility and increasing the risk of miscarriage. Diagnosis primarily relies on three-dimensional ultrasound and hysteroscopy. Hysteroscopic metroplasty is the standard surgical intervention aimed at restoring normal uterine anatomy and potentially improving reproductive outcomes. This narrative review, conducted in accordance with SANRA (Scale for the Assessment of Narrative Review Articles) guidelines, is based on a comprehensive database search and critically evaluates observational and interventional studies on the definition, diagnosis, and management of T-shaped uterus in the context of in vitro fertilization. Recent studies indicate that correction of this anomaly might not only improve spontaneous conception rates but also enhance the outcomes of IVF. However, the precise role of metroplasty in patients undergoing IVF outcomes remains controversial. Some evidence indicates that surgical correction might improve embryo implantation and endometrial perfusion. Despite these promising observations, randomized controlled trials are necessary to define optimal patient selection criteria and to confirm the true benefit of metroplasty in the context of IVF. Future research should also address the potential risks associated with the procedure. A standardized diagnostic and therapeutic approach might contribute to improved reproductive outcomes in affected patients.

Spontaneous uterine rupture in an unscarred uterus is a rare but life-threatening obstetric emergency, and endometriosis has increasingly been recognized as a potential risk factor. We report a 33-year-old primigravid woman with primary infertility who conceived via in vitro fertilization and embryo transfer, with no prior uterine surgery. At 22⁺² weeks of gestation, she presented with sudden-onset, severe, tearing lower abdominal pain shortly after defecation. Bedside ultrasound revealed free intraperitoneal fluid, and she was diagnosed with hemorrhagic shock, prompting urgent transfer to our center. Emergency laparotomy identified approximately 1200 mL of hemoperitoneum and a 2-cm focal rupture in the right lateral uterine wall near the cornua, which exhibited active bleeding beneath an intact serosal layer. Extensive deep infiltrating endometriosis was identified intraoperatively, involving the uterine serosa, bilateral adnexa, and the pouch of Douglas, accompanied by dense pelvic adhesions. An emergency cesarean delivery was performed, resulting in the birth of a live male infant weighing 430 g. Apgar scores were 4, 6, and 8 at 1, 5, and 10 min, respectively. The patient recovered uneventfully and was discharged on postoperative Day 6. The neonate was admitted to the neonatal intensive care unit immediately after birth and discharged after a hospital stay of over 4 months, with a weight of 3700 g at discharge. This case underscores that endometriosis is an important but exceedingly rare risk factor for spontaneous midtrimester uterine rupture in primigravid women with an unscarred uterus. For women with endometriosis, particularly those conceiving through assisted reproductive technology, enhanced preconception counseling and individualized antenatal monitoring are warranted. Clinicians should include uterine rupture in the differential diagnosis of acute abdominal pain during pregnancy to ensure timely evaluation and intervention.

Objective: This study investigates the prenatal characteristics and postnatal outcomes of fetal abdominal cysts and evaluates the diagnostic performance of prenatal ultrasonography (US).

Methods: All cases of fetal abdominal cystic lesions followed up in our center between 2020 and 2024 were retrospectively analyzed. Cysts of urinary system origin and major complex multiple organ anomaly cases were excluded. Cysts were divided into subgroups according to prenatal diagnosis. Sensitivity, specificity, positive predictive value, false positive rate, and accuracy of prenatal US were calculated for each subgroup.

Results: A total of 86 cases were included in the study. The majority of cases diagnosed by prenatal ultrasonography were of ovarian origin (39.5%), followed by duplication cysts (16.2%) and choledochal cysts (11.6%). Five cases resulted in termination of pregnancy, and two cases resulted in intrauterine fetal death. After delivery, 25.3% of cases required surgical intervention. When comparing prenatal and postnatal diagnoses, the overall sensitivity, specificity, and accuracy of prenatal ultrasonography were 98.61%, 98.44%, and 98.44%, respectively.

Conclusion: Prenatal diagnosis of fetal abdominal cysts is important for appropriate management and counseling. The etiology of cysts can be accurately diagnosed by prenatal ultrasonography in approximately 85% of cases.

Objective: There is a lack of longitudinal evidence on depression among menopausal women. The present study aims to examine the developmental trajectories of depression and their impact on life satisfaction among Chinese menopausal women.

Methods: Using data from the China Health and Retirement Longitudinal Study, trajectories of depressive symptoms among 465 women were analyzed. Latent class growth modeling identified heterogeneous depressive trajectories. Analysis of variance was used to assess differences in life satisfaction across trajectories, and multinomial logistic regression was used to examine the effects of key demographic factors.

Results: Five distinct trajectory groups emerged: low-increasing (8.5%), high-decreasing (9.9%), high-increasing (9.1%), moderate (27.8%), and low (44.8%). Life satisfaction declined among all trajectory groups during the menopausal transition, with the smallest decrease observed in the low trajectory group and the largest in the high-increasing trajectory group. Compared with the low trajectory group, women with rural residency, chronic illness, lower education levels, lack of pension coverage, and lower household income were more likely to be classified into other high-risk depressive trajectory groups.

Conclusion: Findings reveal heterogeneous depressive trajectory groups among menopausal women in China. Socioeconomically disadvantaged rural women face elevated risks of depressive symptom deterioration. These results highlight the need for improved mental health support and equitable resource allocation to address psychological well-being among vulnerable menopausal populations.

Objective: To describe the Appropriate Use of Cesarean Section Through Quality Decision-Making (QUALI-DEC) intervention-a multifaceted strategy to optimize the use of cesarean section in low- and middle-income countries-using the Template for Intervention Description and Replication (TIDieR) checklist to enable replication and scale-up.

Methods: The QUALI-DEC intervention was implemented between July 2022 and April 2024 in 32 hospitals among Argentina, Burkina Faso, Thailand, and Viet Nam. Following the 12-item TIDieR checklist, we report in detail the four components of the intervention: (i) opinion leaders to promote evidence-based practices, (ii) audit and feedback using the Robson Ten Group Classification System, (iii) a Decision Analysis Tool to support informed decision-making by women, and (iv) companionship during labor and childbirth. Implementation processes, training, resources, and contextual adaptations were systematically documented.

Results: Opinion leaders were pivotal in training staff, leading audits, and sustaining implementation. Healthcare workers from participating facilities were trained in using clinical algorithms, the Ten Group Classification System, audit report forms, the Decision Analysis Tool, and the World Health Organization model of companionship. The intervention was coupled with online technology to facilitate training, data collection, and feedback loops. Overall, the QUALI-DEC intervention was feasible across diverse contexts, with variations reflecting local culture, infrastructure, and policy.

Conclusion: Appropriate cesarean section use is shaped by women, providers, and organizational factors, making behavioral change complex. The QUALI-DEC intervention provided a pragmatic, team-based strategy to empower women and engage healthcare providers in evidence-based and patient-centered decision-making. Using the TIDieR checklist ensured a detailed description, supporting replication, implementation, and monitoring in other maternity units in low- and middle-income countries.

Trial registration: ISRCTN67214403.

Objective: Cervical cancer remains a major public health concern globally. It is the fourth leading cause of cancer deaths among women worldwide. In 2020, the global incidence of cervical cancer was estimated to be 604 000 with a standardized mortality rate of 341 000. In Tanzania, cervical cancer is the most common female cancer and a leading cause of cancer-related deaths. The majority of data demonstrating the survival rate of cervical cancer originates from high- and middle-income countries with contributions from low-income countries such as Tanzania being relatively scarce. Determining the factors associated with survival is critical in an attempt to inform strategies to improve outcome of women with cervical cancer. The aim of the present study was to determine the 3-year overall survival rate and associated factors among women with invasive cervical cancer attended at Ocean Road Cancer Institute (ORCI) from 2018 to 2020.

Methods: A retrospective cohort study was conducted at ORCI by using their cancer registry database. The study included 256 women diagnosed with cervical cancer from 2018 to 2020. Survival analysis was estimated by using Kaplan-Meir analysis, Cox regression hazard proportion and log-rank test and a P value of less than 0.05 was considered statistically significant. Stata version 17 was used for analysis.

Results: Among 256 women with cervical cancer, the survival rate across one-, two- and 3-years, respectively were 83.6%, 77.0%, and 72.7%. Survival rate was significantly associated with both FIGO stage during diagnosis and hemoglobin level. Those who received concurrent chemoradiotherapy had a higher survival rate compared to those who received radiotherapy or chemotherapy only, and it was statistically significant with P < 0.001.

Conclusion: The study found an overall survival rate of 72.7% over 3 years. Factors associated with survival rate were early FIGO stage at diagnosis, normal hemoglobin level at diagnosis, and the use of concurrent chemoradiotherapy. Proper staging, good patient preparation and good choice of treatment improves survival. With availability of advance treatment options in the country the survival rate of women is promising.

Introduction: Pre-eclampsia (PE) involves systemic endothelial dysfunction and microvascular injury, yet routine obstetric care lacks noninvasive readouts of maternal microvascular health. We evaluated whether hypertensive retinopathy (HR) detected during pregnancy is associated with maternal disease severity and adverse neonatal outcomes.

Methods: We performed a retrospective cohort study of singleton pregnancies with PE and at least one ophthalmic assessment during pregnancy. Retinal findings were graded as none, mild, moderate, or severe. Primary outcomes were maternal composite adverse outcome (severe features, HELLP syndrome, eclampsia, admission to intensive care unit) and neonatal composite adverse outcome (indicated delivery <34 weeks, small for gestational below the third percentile, admission to neonatal intensive care unit). Multivariable models adjusted for maternal confounders were performed.

Results: Of 584 patients with PE with analyzable data, 182 (31.2%) had any HR (mild 20.4%, moderate 9.8%, severe 1.0%). HR was independently associated with maternal composite adverse outcome (adjusted odds ratio [aOR], 2.21 [95% CI, 1.45-3.36]) and neonatal composite adverse outcome (aOR, 2.40 [95% confidence interval (CI), 1.60-3.60]). HR was linked to earlier delivery (adjusted mean difference, -1.17 weeks) and lower birthweight z score (adjusted β, -0.34). Each one-grade increase in HR was associated with higher odds of both primary outcomes (maternal composite outcome aOR, 1.45 [95% CI, 1.10-1.90]; neonatal composite outcome aOR, 1.53 [95% CI, 1.17-1.99]).

Conclusions: In women with PE, HR is common and independently associated with maternal and neonatal adverse outcomes.

Objective: Artificial intelligence (AI) applications have garnered increasing interest in obstetrics and gynecology. This study aims to analyze the evolving research themes, temporal trends, and conceptual frameworks of AI applications in this field through a comprehensive bibliometric analysis.

Methods: A total of 815 original research articles published between 1980 and 2025 were retrieved from the Web of Science Core Collection using keywords such as "artificial intelligence," "machine learning," and "deep learning" within obstetrics and gynecology. Trend keyword analysis and factor analysis were conducted using the Bibliometrix package in R Studio to identify thematic clusters and research trajectories.

Results: The USA (n = 194), China (n = 168), and Japan (n = 44) were the most prolific countries, with Harvard University as the leading institution (n = 68). Key research focuses included in vitro fertilization, breast cancer, pregnancy complications (e.g., preeclampsia, gestational diabetes mellitus), assisted reproductive technology, cervical cancer, embryo selection, and patient education. Since 2020, research emphasis has shifted toward fertility, oncological gynecology, pregnancy complications, and patient education, with notable growth in topics such as preeclampsia and breast cancer during 2023-2024. Factor analysis revealed six thematic clusters encompassing clinical decision support systems, reproductive technologies, oncological modeling, and perinatal risk analysis.

Conclusion: AI is increasingly affecting obstetrics and gynecology beyond diagnostics and treatment, extending to risk prediction, patient education, and personalized medicine. Despite its transformative potential, challenges such as algorithmic bias, data security, and ethical considerations warrant vigilant attention.

Objective: To develop and internally validate a mechanistic, three-domain framework for early classification and prediction of pre-eclampsia (PE) using first-trimester angiogenic, uteroplacental, and maternal vascular biomarkers.

Methods: In a prospective cohort of 1925 singleton pregnancies screened at 11 to 13.6 weeks, placental growth factor (PGF), uterine artery pulsatility index (UtA-PI), and mean arterial pressure (MAP) were log-transformed and standardized to gestational age-adjusted multiples of the median. Prespecified percentile thresholds (PGF <10th; UtA-PI >95th; MAP >95th) defined domain abnormalities and mechanistic phenotypes. Associations with PE, fetal growth restriction (FGR), and the composite of PE or FGR were assessed using logistic regression. Discrimination (area under the [receiver operating characteristic] curve [AUC]), calibration, and clinical utility were evaluated; bootstrap internal validation was used for optimism correction; and decision-curve analysis quantified net clinical benefit.

Results: PE occurred in 104 of 1925 pregnancies (5.4%). Phenotypes were distributed as normo (81.7%), molecular (7.6%), hemodynamic (3.2%), tensional (5.1%), dual (≥2 domains; 2.1%), and triple (3/3; 0.3%). The risk of PE increased stepwise from 3.9% (normo) to 80.0% (triple) (P for trend <0.001). The three-domain model improved discrimination to an AUC of 0.81 (95% confidence interval [CI], 0.77-0.86) versus the clinical model (AUC, 0.68; P < 0.001), achieved good discrimination for isolated FGR (AUC, 0.75 [95% CI, 0.70-0.81]), and provided higher net clinical benefit among 5% to 30% thresholds. In early-onset PE (n = 14), discrimination was high (AUC, 0.99 [95% CI, 0.98-1.00]); estimates should be interpreted cautiously given the small number of events.

Conclusion: A first-trimester, mechanistic three-domain framework captures the pathophysiologic continuum of placental insufficiency and supports accurate, clinically meaningful early risk stratification for PE. Findings were internally validated; external validation-particularly for early-onset PE-is warranted.