International Journal of Gynecology & Obstetrics最新文献

Objective: This study examined the impact of the number of Day 2 four-cell (D2-4C) embryos on double embryo transfer and blastocyst culture therapy in the first in vitro fertilization (IVF) cycle.

Methods: A retrospective review was performed on 1039 blastocyst culture cycles to compare outcomes between available and unavailable blastocyst cycles, emphasizing the relationship between the number of D2-4C embryos and blastocyst availability. Furthermore, the correlation between four-cell embryo counts and live births was analyzed in 986 transfer cycles.

Results: The analysis revealed that the number of D2-4C embryos independently influenced the availability of blastocysts (odds ratio [OR] 1.693, 95% confidence interval [CI] 1.306-2.195, P < 0.001). Receiver operating characteristic (ROC) analysis indicated that D2-4C embryos displayed the highest predictive value for available blastocysts, with an area under the curve (AUC) of 0.861 (95% CI 0.826-0.896). The cut-off point was determined to be 4.5, particularly for individuals younger than 25 years, where the AUC reached 0.927. This suggests that the number of D2-4C embryos has significant predictive value for available blastocysts. The live birth rate (LBR) of fresh embryo transfers significantly increased with the number of D2-4C embryos (P = 0.004). LBRs for zero, one, and two four-cell embryos in double cleavage embryo transfer were 20.24%, 34.97%, and 38.08%, respectively (P = 0.005). In the twin group, the percentages for zero, one, and two four-cell embryos were 1.21%, 9.75%, and 89.02%, respectively (P < 0.001). Single blastocyst transfer achieved an LBR comparable to that of two four-cell embryos (34.8% vs 39.0%, P = 0.415), while the twin rate significantly decreased with single blastocyst transfer (25.17% vs 1.40%, P < 0.001).

Conclusion: The number of D2-4C embryos exhibits significant predictive value for available blastocysts, particularly among young women. Furthermore, most twins resulted from the transfer of double cleavage embryos derived from two four-cell embryos. Consequently, when the D2-4C count exceeds four in a cycle, blastocyst culture therapy is preferred over double cleavage-stage embryo transfer.

Background: Training health workers might facilitate respectful maternity care (RMC); however, the content and design of RMC training remain unclear.

Objective: To explore the content and design of RMC training packages for health workers in sub-Saharan Africa.

Search strategy: MEDLINE, EMBASE, CINAHL Complete, Web of Science Core Collections, SCOPUS, and grey literature sources (including websites of RMC-focused key organizations and Ministries of Health) were searched for journal papers, reports, and training guides from January 2006 up to August 2022.

Selection criteria: There were no restrictions on study designs, language, or health-worker cadre. Two reviewers independently screened results.

Data collection and analysis: Key data, including training content and methods used, were extracted and summarized.

Main results: Thirty-two citations from 26 studies/programs were identified (24 journal papers, 5 manuals/guides, 2 reports and 1 PhD thesis), with 27 citations from 22 studies informing the review findings. About half of all conducted studies were from East Africa. The most common topics in RMC trainings were communication, privacy and confidentiality, and human resources. Most trainings were multicomponent and appear to be largely in-service training. Health workers providing direct care to women, compared with non-clinical staff such as receptionists and cleaners, were the only recipients of training in most studies (81.8%). Two broad categories of training methods/tools were identified: workshop-based and action-based. Over 90% of the studies assessed impact of the training, with a majority focused on impacts on maternal health and care; however, half of the latter studies did not appear to have feedback mechanisms in place for implementing change.

Conclusions: The content and design of RMC training in sub-Saharan Africa are multifaceted, suggesting the complexity of implementing/promoting RMC. Some progress has been made; however, missed opportunities in training remain with respect to study populations, training topics, cadres, and feedback mechanisms.

Arcuate uterus does not impact the success of infertility treatments, but there is no consensus on whether it influences perinatal outcomes. The objective of the present study was to investigate whether minor congenital uterine anomalies such as an arcuate uterus contribute to perinatal complications. This was a retrospective cohort study at a single institution. The study included 1097 deliveries after 22 weeks of gestation. Transvaginal ultrasound, with three-dimensional functionality, assessed uterine morphology based on American Society for Reproductive Medicine criteria. We compared maternal backgrounds and perinatal complications between arcuate uterus and normal uterus groups. Statistical analyses, including multivariate analysis, aimed to identify independent risk factors. A total of 69 patients (7.5%) with diagnosed arcuate uterus were included. Maternal background factors showed no significant differences between groups. In perinatal complications, an arcuate uterus was associated with a significantly higher incidence of preterm delivery (13% versus 4.7%, P = 0.01), preterm premature rupture of membranes (7.2% versus 1.6%, P = 0.01), fetal growth restriction (FGR; 16% versus 6.7%, P = 0.01), and abnormal placental cord insertion (33% versus 7.6%, P < 0.01). After multivariate analysis, arcuate uterus emerged as an independent risk factor for preterm delivery (adjusted odds ratio [aOR], 4.0 [95% confidence interval (CI), 1.6-9.9], P < 0.01), FGR (aOR, 2.6 [95% CI, 1.2-5.6], P = 0.02), and abnormal placental cord insertion (aOR, 6.0 [95% CI, 3.4-10.6], P < 0.01). Arcuate uterus stands as an independent risk factor for preterm delivery, FGR, and abnormal placental cord insertion. The findings emphasize the importance of recognizing even minor uterine morphological abnormalities in assessing and managing perinatal complications.

To determine the prevalence of postpartum depression (PPD) and postpartum stress (PPS) and identify associated risk factors among mothers of preterm and low birth weight (LBW) infants. We conducted a secondary analysis of data collected from 255 mothers with preterm and LBW infants admitted to the neonatal intensive care unit (NICU) at Korle-Bu Teaching Hospital, Accra, Ghana. A standardized interviewer-administered questionnaire collected data on maternal, pregnancy, birth, and infant characteristics. The questionnaire also included the Patient Health Questionnaire-9 (PHQ-9) and the Perceived Stress Scale-4 (PSS-4) to assess PPD and PPS, respectively. Simple and multivariable linear regression analyses were performed to identify factors associated with PPD and PPS. The prevalence of moderate to moderately severe PPD was 3.9%, and that of PPS was 43.5%. The multivariable linear regression analysis showed that an increased number of prenatal care visits (β-estimate = 0.26; 95% confidence interval [CI] 0.08-0.43; P < 0.01) was positively associated with higher scores on the PHQ-9, whereas gestational age at birth (β = -0.21; 95% CI -0.40 to -0.03; P = 0.02) was inversely associated with PHQ-9 scores. Moreover, a longer gestational period at the first prenatal care visit (β = 0.25; 95% CI 0.05-0.45; P = 0.01) and following the Islamic religion were associated with elevated scores on the PSS-4 (β = 0.95; 95% CI 0.11-1.80; P = 0.011). Our findings underscore the presence of moderate PPD levels and high PPS levels among mothers. Active screening, diagnosis, and treatment for mothers at risk of mental health disorders during the peripartum period could enhance coping mechanisms for mothers navigating the challenging NICU environment and transitioning to the home environment.

Objective: This study evaluates the endometrial receptivity of obstetric anticardiolipin syndrome (OAPS) patients using various ultrasound indicators and the efficacy of low-dose aspirin (LDA) treatment.

Methods: This retrospective study recruited patients from Shanghai Ren Ji Hospital, China from January 2022 to December 2023. Doppler parameters of the endometrium and uterine artery blood flow were recorded to assess the endometrial receptivity of OAPS patients compared with normal pregnant women and an other immune diseases group. The receiver operating characteristic curve was used to predict the risk of OAPS patients. Doppler parameters of OAPS patients were conducted repeatedly after a 2-month period of treatment with LDA.

Results: Compared with normal pregnant women, the OAPS group showed remarkably increased endometrial perfusion resistance (PI, RI, S/D) and uterine artery perfusion resistance (RI and S/D) (P < 0.001) and had good predictive values (area under the curve = 0.806, 0.976, 0.942, 0.902, and 0.901, respectively). The endometrial thickness of the OAPS group was much thinner than that of the normal group (P < 0.001). Uterine blood flow impedance PI showed no difference in both groups (P = 0.68). In comparison to other autoimmune diseases, the OAPS group also showed an increasing trend in the resistance of endometrium and uterine artery blood flow. After LDA treatment, there was an obvious improvement in the endometrial blood flow perfusion in the OAPS group (P < 0.01).

Conclusion: Compared with the normal group and other autoimmune diseases, the resistance of endometrial and uterine artery blood flow in the OAPS group was increased significantly. The Doppler index showed the predictive value of OAPS, and it was confirmed that LDA could enhance blood perfusion among OAPS women.

Objective: To evaluate the levels of serum rare earth elements (REEs): lutetium [Lu], praseodymium [Pr], samarium [Sm], dysprosium [Dy], and cerium [Ce] in pregnant women with recurrent pregnancy loss (RPL) and evaluate their relationship with total antioxidant capacity (TAC) and 8-hydroxy-2'-deoxyguanosine (8-OHdG), a marker of DNA damage.

Methods: A case-controlled study was conducted on a cohort of 60 female participants, with first-trimester healthy pregnant women as the control group and pregnant women with a history of consecutive abortions as the recurrent pregnancy loss (RPL) group. Following blood collection, serum concentrations of Lu, Pr, Sm, Dy, and Ce were measured using an inductively coupled plasma mass spectrophotometer (ICP-MS). Oxidative stress and DNA damage were evaluated through TAC and DNA damage marker (8-OHdG).

Results: Serum levels of Lu, Pr, Sm, Dy, and Ce were higher in women with RPL compared with control (P < 0.001). Intriguingly, a strong significant negative correlation was observed between TAC and REEs (P < 0.05). Lu, Dy, and Ce demonstrated a significant positive correlation with increased DNA damage in the RPL group (P < 0.05). Contrary, there was no evidence of a correlation between 8-OHdG and Pr and Sm.

Conclusion: The study highlights a potential association between Lu, Sm, Dy, and Ce and an increased risk of RPL, highlighting REE-induced toxicity as a major risk factor for RPL. The outcome of the study is to advance our understanding of the interplay between rare earth elements and RPL, with potential implications for reproductive medicine, environmental health, and the development of preventive strategies for individuals at risk of RPL.

Objective: The study aimed to calculate the subsequent birth rate for different delivery modes, comparing them with spontaneous vaginal deliveries, using a comprehensive nationwide high-quality registry.

Methods: Data from the National Medical Birth Register (MBR) were used to evaluate the birth rate after different delivery modes. All first deliveries for a mother during the years 2004 to 2016 were included. For these women, all second pregnancies from the MBR during the years 2004 to 2018 were retrieved and combined with the data of the first deliveries. A Cox regression model was used to evaluate the risk for the second pregnancy after giving birth the first time. The results were interpreted with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).

Results: A total of 375 619 women with a first and second pregnancy leading to birth were included in this study. Of these, a total of 50 579 women underwent assisted vaginal delivery, 50 429 had an unplanned cesarean section (CS), 22 021 had elective CS, and 252 593 had spontaneous vaginal delivery as a mode of delivery in their first pregnancy. Women with assisted vaginal delivery (aHR, 1.23 [CI, 1.21-1.24]) and unplanned CS (aHR, 1.03 [CI, 1.02-1.05]) had higher birth rates after the first birth, and women with elective CS as a mode of delivery had lower birth rates (aHR, 0.86 [CI, 0.84-0.88]) when compared with women who had spontaneous vaginal delivery.

Conclusion: The findings of this study indicate that the CS operation itself is not the only cause of the observed lower birth rate; rather, there are underlying factors that have a greater impact on birth rates.

Objective: To evaluate the role of clinical exchange programs in postgraduate obgyn training using the International Federation of Gynecology and Obstetrics (FIGO)-World Association of Trainees in Obstetrics and Gynecology (WATOG) One World Exchange (OWE), a clinical exchange program held in France in October 2023, as a case-study.

Methods: This was a cross-sectional study. A 31-item structured questionnaire designed with Google Forms was electronically distributed to the 51 obgyn postgraduate trainees (OWE fellows) who participated in the OWE, to collect information about the exchange. Collected data was analyzed using IBM Statistical Product and Service Solutions (SPSS) Statistics for Windows.

Results: The survey response rate was 68.6%. The mean age of the respondents was 33.0 ± 4.0 years. Majority of the them were females (26, 74.3%), married (19, 54.3%), at least in their third year of training (30, 85.7%) and from Africa (11, 31.4%). During the period of the exchange program, fellows observed various obstetric and gynecologic procedures, including open and minimal access procedures, with more than one-fifth (8, 22.9%) of them reporting that they were allowed to assist in some of these procedures. The fellows noted salient differences in practice between their exchange hospitals and their home countries. An overwhelming majority (30, 85.7%) of the fellows believed the OWE was beneficial and would positively impact their clinical practices back in their home countries.

Conclusion: Clinical exchange programs like the OWE provide valuable benefits in improving the clinical knowledge and skills of postgraduate obgyn trainees.

Background: Peripartum hysterectomy (PH), the surgical removal of the uterus during or shortly after childbirth, is a critical procedure in maternal health care. Definitions of PH vary globally, leading to challenges in understanding its occurrence. Our study aimed to provide comprehensive insights into PH in a South African context, investigating indications, demographic characteristics, clinical and histopathological diagnoses, complications, and outcomes.

Methods: A retrospective record review study design was used, focusing on PH cases at a tertiary facility in Johannesburg, South Africa (SA), between January 2018 and December 2020. Medical records were systematically examined to identify trends, indications, and outcomes associated with PH. Data collection encompassed demographic characteristics, obstetric history, clinical indications, clinical and histopathological diagnoses, and complications. Data analysis used descriptive statistics, interrater reliability tests, and comparative findings with previous SA studies.

Results: The study included 56 pregnant women with a median age of 32 years (interquartile range: 25-35) who underwent PH between January 2018 and December 2020 at Charlotte Maxeke Johannesburg Academic Hospital in South Africa. We found that pregnancy-related sepsis (PRS) emerged as the most common indication of PH, as reported among 18 (32.1%) of the women, with an 88.8% histopathological confirmation rate. Abnormal placentation (14/56, 25%) and PPH (8/56, 14%) were other common indications. Clinical and histopathological diagnoses exhibited a strong level of agreement (70.9%), emphasizing the importance of accurate diagnostics.

Conclusion: Our study found a shift in the primary historical indications, such as uterine atony and uterine rupture in South Africa, with PRS emerging as the primary indication in recent years(2009-2020). Clinical assessment complemented by histopathological findings remains critical for improved obstetric complication management.

Objective: This study sought to compare the risks and outcomes associated with category I cesarean section procedures performed in the delivery room versus those performed in the operating room.

Patients and methods: The analysis included 126 singleton pregnant women who underwent inpatient delivery at the Second People's Hospital of Nanning between January 2021 and May 2024. Following propensity score matching, 21 cases were in the delivery room group, and 105 cases were in the operating room group. Parameters under investigation encompassed decision-to-delivery interval, incision-to-delivery interval, surgical duration, intraoperative blood loss, postoperative antibiotic duration, postoperative hospital stay length, postoperative fever incidence, adverse neonatal outcomes, and blood routine parameters.

Results: The decision-to-delivery interval was significantly shorter in the delivery room group than in the operating room group. Conversely, the delivery room group exhibited longer surgical durations, higher blood loss, prolonged postoperative antibiotic usage, extended hospital stays, and elevated white blood cell counts with statistical significance (p < 0.05). Nevertheless, no notable variations were observed between the groups in maternal and neonatal outcome indicators, such as adverse neonatal outcomes and postoperative fever rates.

Conclusions: The outcomes suggest that the delivery room group showed increased risks compared with the operating room group, potentially indicating heightened vulnerabilities to bleeding and infection. Hence, it is advisable for patients to undergo surgery in the operating room unless the delivery room is equipped with sterile surgical facilities or in cases of urgent necessity.