International Journal of Gynecology & Obstetrics最新文献

Background: Hypertensive disorders are a leading cause of mortality and morbidity during pregnancy. For people with hypertensive disorders of pregnancy (HDP), self-management is a necessity. There is limited evidence on the influencing factors of self-management in women with HDP.

Objectives: To synthesize qualitative evidence on the influencing factors among women with HDP and explore how self-management can be optimized in this population based on the capability, opportunity, motivation and behavior (COM-B) model.

Search strategy: A systematic search of eight electronic databases was conducted until December 31, 2024.

Selection criteria: Qualitative and mixed-methods studies on the influencing factors of self-management in women with HDP.

Data collection and analysis: The methodological quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies and the Mixed Methods Appraisal Tool (MMAT) checklist for mixed-methods studies. Two independent reviewers screened, appraised, and extracted the data. Data analysis was carried out using the meta-aggregation method and mapped onto the COM-B model.

Main results: A total of 17 studies were included in the systematic review. Three themes with 10 subthemes were identified: capability of women with HDP (lack of disease-related knowledge, limited medication health literacy, deficits in blood pressure self-monitoring competence); opportunities in the self-management process (support from family and peers, guidance from healthcare professionals, external objective constraints, insufficient availability of professional support resources); motivation in the self-management process (responsibility for fetal health, gaining a sense of mastery, perceived benefits in disease management).

Conclusions: This qualitative systematic review identified a wide range of interacting factors that influence self-management in women with HDP and provided evidence for the design of the relevant interventions. Further research is recommended to carry out interventions from the aspects of information support, social support, digital technology support and positive psychological support to meet the information needs of pregnant women, enhance their confidence and ability in coping with the disease.

Objective: The aim of this study was to compare surgical outcomes of two laparoscopic techniques for bowel endometriosis and determine the optimal laparoscopic segmental resection technique with mesentery preservation.

Materials and methods: This was a single-center, retrospective, two-arm cohort study. A total of 135 patients underwent colorectal segmental resection for endometriosis from January 2014 to January 2022 in the Gynecology Department at the Jinhua Maternity and Child Health Care Hospital. The enrollment inclusion criteria were as follows: nodule ≥3 cm in size, ≥50% circumference/stenosis, and >5 cm from anal verge. Outcomes of laparoscopic segmental resection (LscSgR) of endometriosis were compared to laparoscopic segmental resection of endometriosis with mesentery preservation (LscPR). All eligible patients were informed that different intestinal surgical procedures would be performed as deemed necessary by a gynecologic surgeon.

Results: A total of 135 patients with bowel endometriosis were enrolled and surgically treated: 72 underwent LscSgR (Group A) and 63 LscPR (Group B). After a median follow-up of 4.8 years, 131 patients completed the questionnaire. Complications included pelvic encapsulated hydrops (2.90%), rectovaginal fistula (2.90%), and anastomotic stenosis (2.90%). The recurrence rates of deep endometriosis were 2.90% in Group A and 1.62% in Group B. LscPR demonstrated significantly better outcomes than LscSgR in terms of both low anterior resection syndrome incidence and bowel endometriosis symptom scores.

Conclusion: LscPR is an effective surgical treatment for bowel endometriosis. The initial findings from the current study suggest the potential for significant symptom improvement with a lower incidence of complications in patients undergoing LscPR for bowel endometriosis, but further validation in larger studies is warranted. The findings of the current study open new perspectives in relation to treatment of bowel endometriosis.

Objective: To investigate maternal serum and placental osteopontin levels in pregnancies complicated with fetal growth restriction (FGR) and to evaluate their association with composite adverse neonatal outcomes (CANO).

Methods: A prospective case-control study was conducted at Etlik City Hospital between March and September 2024, including 40 women with pregnancies affected by FGR (34-39 weeks) and 40 gestational age-matched healthy control women. FGR was diagnosed using Delphi criteria. Maternal venous blood and placental samples were collected at delivery. Serum and placental osteopontin levels were measured using enzyme-linked immunosorbent assay. Placental osteopontin concentrations were normalized to total protein by the Bradford method (ng/mg protein). Statistical analyses included Mann-Whitney U, χ², and Fisher exact tests, and receiver operating characteristic (ROC) analysis.

Results: A total of 80 participants were analyzed. Gravidity and parity were lower in the FGR group, whereas maternal age and body mass index were comparable. As expected, adverse perinatal outcomes were more frequent in the FGR group. Both maternal serum and placental osteopontin levels were significantly decreased in FGR cases compared with controls (P = 0.002 and P < 0.001, respectively). ROC analysis demonstrated the best predictive performance for placental osteopontin normalized to total protein, with a cut-off of 61.2 ng/mg (area under the curve [AUC] 0.791, sensitivity 77.5%, specificity 70.0%). Lower osteopontin levels were also predictive of CANO (AUC up to 0.760, P < 0.001).

Conclusions: In pregnancies complicated by FGR, osteopontin levels were significantly reduced in both maternal serum and placental tissue. This decrease may reflect impaired spiral artery remodeling and placental angiogenesis, contributing to the molecular mechanisms of placental insufficiency and adverse neonatal outcomes.

Retraction: M.M. El-Sherbini, A.M. Maged, O.M. Helal, M.O. Awad, S.A. El-Attar, J.A. Sadek, R. ElKomy, M.A. Dawoud "A Comparative Study Between Preoperative Rectal Misoprostol And Intraoperative Intrauterine Administration in The Reduction of Blood Loss During And After Cesarean Delivery: A Randomized Controlled Trial," International Journal of Gynecology & Obstetrics 153, no. 1 (2021): 113-118, https://doi.org/10.1002/ijgo.13426. The above article, published online on 16 October 2020 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 recruitment timeline, randomization integrity, and inconsistencies within the presented statistical analysis. Considering these concerns, the authors were asked to provide the raw data. Upon reviewing the study data the authors provided, however, a number of errors in the reported data and results were found. The concerns regarding randomization integrity and recruitment timeline were not alleviated by this review. Further investigation determined that the description of the administration of rectal misoprostol differs from that of the trial registry, which upon review described two different studies. The editorial team and investigators share significant doubt, as does the third party, regarding the conclusions drawn by the authors. In view of this, the article must be retracted.

Background: Respiratory syncytial virus (RSV) is a leading cause of hospitalization and mortality in early infancy. Maternal immunization offers a preventive strategy, but uncertainties regarding safety and economic value have limited its implementation.

Objectives: To synthesize phase 3 randomized trial evidence on the efficacy and safety of maternal RSV vaccination and to estimate its potential population and economic impact. By integrating a scenario-based modeling framework derived from pooled meta-analytic estimates, this review provides high-certainty, policy-relevant evidence to guide maternal immunization strategies in diverse settings.

Search strategy: PubMed, MEDLINE, Scopus, and Google Scholar were searched up to April 2025 using predefined terms for RSV vaccination, pregnancy, and randomized controlled trials (RCTs).

Selection criteria: Phase 3 RCTs comparing maternal RSV vaccination with placebo and reporting neonatal or maternal outcomes were included. Non-randomized studies, monoclonal antibody trials, or reports lacking extractable data were excluded.

Data collection and analysis: Two reviewers independently screened studies, extracted data, and assessed risk of bias (RoB-2). Pooled risk ratios (RR) and absolute risk differences were calculated with random-effects models. Certainty of evidence was graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A scenario-based cost-effectiveness model was applied to the Mexican birth cohort.

Main results: Four phase 3 RCTs (17 391 women) were included. Maternal RSV vaccination halved the risk of infant RSV infection (risk ratio [RR] 0.47, 95% confidence interval [CI]: 0.29-0.76; number needed to vaccinate [NNV] 85) and reduced severe disease by 64% (RR 0.36, 95% CI: 0.21-0.60; NNV 127). No increased risks were observed for preterm birth, pre-eclampsia, or stillbirth. Certainty was moderate (any RSV) to high (severe RSV). In Mexico, universal vaccination at list price (US$295 per dose) would prevent approximately 20 769 infections and 228 neonatal deaths annually, though with high costs per case averted. At public-sector pricing (US$50 per dose), cost-effectiveness improved substantially.

Conclusions: Maternal RSV vaccination is effective, safe, and potentially cost-justifiable in high-burden settings, supporting its integration into national immunization programs. PROSPERO registration: CRD420251014636 (March 2025).

Objective: To examine the relationship between prenatal vitamin D serum levels and postpartum bleeding.

Methods: We conducted a retrospective electronic health record cohort study of pregnant Alaska Native and American Indian (ANAI) people in southwestern Alaska who had at least one prenatal vitamin D level measurement recorded and had a vaginal birth between January 2017 and December 2019. Prenatal vitamin D level was the independent variable; postpartum abnormal bleeding and hemorrhage occurrence after a vaginal birth were the primary outcomes.

Results: A total of 1343 index pregnancies were included in this study, of which 1258 (94%) had a vaginal birth with 370 (29%) experiencing blood loss ≥500 mL and 127 (10%) ≥1000 mL. Risk factors included prior postpartum hemorrhage, suspected macrosomia, twin gestation, magnesium sulfate use in the setting of pre-eclampsia, induction time >36 h, oxytocin use >12 h and third stage of labor >20 min. Deficient vitamin D levels (under 12 ng/mL) were found in 10.5%, 4.8%, and 5.3% of records in the first, second and third trimesters, respectively. Logistic regression indicated an association between vitamin D level under 12 ng/mL in the first trimester and postpartum bleeding ≥500 mL (n = 540, P = 0.0097, odds ratio [OR] = 2.2). No association was found between abnormal bleeding and being vitamin D deficient in the second and third trimesters.

Conclusion: There is a need for further research of vitamin D screening and supplementation before and during pregnancy as a possible risk reduction tool for abnormal postpartum bleeding.

Background: Breast cancer survivors (BCS) often experience more severe symptoms of genitourinary syndrome of menopause (GSM). As estrogen-based hormonal therapy is generally avoided in BCS, physical energy methods may offer promising non-hormonal alternatives. However, the efficacy and safety of these treatments remain controversial.

Objectives: To evaluate the efficacy and safety of physical energy methods (laser and radiofrequency) for treating GSM in BCS.

Search strategy: The databases PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, SciELO, LILACS, and Clinical Trial databases were searched from their inception to July 2024, with no language restrictions.

Selection criteria: We included randomized controlled trials (RCTs) that assessed the efficacy and safety of any physical energy methods for treating GSM in BCS.

Data collection and analysis: Two authors independently selected studies based on titles, abstracts, and full texts to meet the inclusion criteria. Due to heterogeneity in methodologies and outcomes, a meta-analysis was not possible, so a narrative synthesis was conducted. Data were extracted, and the risk of bias was assessed using the Cochrane risk-of-bias tool (RoB 2). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the strength of the evidence.

Main results: Three RCTs involving 185 participants, and three different physical methods (microablative fractional CO₂ laser, erbium photothermal yttrium-aluminum-garnet laser, and radiofrequency) met the inclusion criteria for this systematic review. Laser and radiofrequency treatments improved GSM symptoms in BCS, with improvements in dyspareunia, the Vaginal Health Index, and quality of life in the short term, with minimal adverse events. Overall, only one study had a low risk of reporting bias, whereas two studies raised concerns due to critical weaknesses. Confidence in the evidence is low and critical across all studies.

Conclusions: Physical energy methods show short-term safety in treating GSM in BCS. However, limited blinded clinical trials result in uncertain efficacy.

Introduction: To evaluate the accuracy and completeness of responses across common obstetrical and gynecologic topics generated by the large language models (LLMs) ChatGPT and Google Gemini, which have become increasingly popular for patients seeking medical information before physician consultations.

Methods: Ten topics were identified, five obstetrical (prenatal labs, extended carrier screen, treatments for nausea and vomiting in pregnancy, gestational diabetes, and trial of labor after cesarean section) and five gynecologic (polycystic ovary syndrome, pelvic inflammatory disease, cervical smears, mammograms, and birth control). For each condition, ChatGPT generated five of the most frequently asked patient questions, which were then presented separately to ChatGPT and Google Gemini. Board-certified Obstetrics and Gynecology physicians evaluated the responses using Likert scales for accuracy (1-6) and completeness (1-3).

Results: Acceptable response criteria were defined as an accuracy score of 5 or greater ("nearly all correct") and a completeness score of 2 or greater ("adequately complete"). Most responses from both models met these thresholds. Wilcoxon signed-rank tests demonstrated statistically significant differences in accuracy and completeness between models (P < 0.05). Inter-rater agreement was measured using intraclass correlation coefficients. For obstetrical topics, ChatGPT scored -0.047 (completeness) and 0.112 (accuracy), whereas Google Gemini scored 0.367 and 0.205, respectively. For gynecologic topics, ChatGPT scored 0.328 and 0.20, compared with Google Gemini at 0.151 and -0.08.

Conclusion: Both LLMs provided largely accurate and complete responses to patient questions. ChatGPT demonstrated stronger outcomes overall, suggesting potential utility in patient education; however, patients should confirm online information with physicians given the limitations of LLMs.