International Journal of Gynecology & Obstetrics最新文献

In this study, we report a 42-year-old woman who was preoperatively diagnosed with uterine prolapse degree III. After full communication and signing the informed consent, the patient received transumbilical single-port laparoscopic sacrohysteropexy with the assistance of a robot under general anesthesia on January 11, 2024. Our hospital successfully performed the single-port robot-assisted transumbilical laparoscopic sacrohysteropexy in China, which confirms the safety and effectiveness of Jingfeng single port surgical robot system SP1000 in clinical application.

Objective: To evaluate the ability of the fullPIERS model to predict adverse maternal outcomes in patients diagnosed as early-onset pre-eclampsia at Charlotte Maxeke Johannesburg Academic Hospital, South Africa.

Methods: Retrospective record review and analysis of 134 patients admitted with early-onset pre-eclampsia. Demographic data, symptoms, and investigation results relevant to the fullPIERS calculator present on admission were collected. Adverse maternal outcomes occurring before the end of 7 days from admission were recorded. Descriptive analysis was conducted, χ² and Wilcoxon rank-sum tests were used to evaluate the association between fullPIERS parameters, score, and adverse outcomes. Performance of fullPIERS score was evaluated by positive and negative predictive values, sensitivity, specificity, and receiver operating curve analysis.

Results: The median age was 34 years (interquartile range [IQR] 28-37 years). A total of 131 deliveries were recorded at a median gestation of 31 weeks (IQR 29-33 weeks). Most deliveries (71; 54.2%) were due to fetal indications and 102 (77.9%) were by cesarean section. A total of 20 (15.1%) patients had adverse maternal outcomes. Three (2.6%) neonates were delivered with Apgar score less than 7 at 5 minutes and were all admitted to the neonatal intensive care unit. FullPIERS formula predicted adverse maternal outcomes with positive and negative predictive values of 100% and 94.9%, respectively, and sensitivity and specificity of 70% and 100%, respectively. The area under the receiver operating characteristic curve was 0.88 (95% confidence interval 0.75-0.95), which shows good discrimination.

Conclusion: FullPIERS model is a useful adjunct in identifying patients at high risk of adverse outcomes from early-onset pre-eclampsia; this allows timely and appropriate management.

Background: In 2013, The Cancer Genome Atlas Research Network suggested that endometrial carcinoma patients may be reclassified into four molecular prognostic groups.

Objective: To compare survival of endometrial carcinoma patients with different mutational profiles.

Search strategy: Studies reporting survival of endometrial carcinoma patients were identified through systematic searches of four databases.

Selection criteria: We included relevant studies based on the literature type, data integrity and the methodological quality.

Data collection and analysis: The pooled survival data were compared among patients with different mutational profiles. Heterogeneity in the pooled data was assessed using the I² statistic.

Main results: Data were meta-analyzed from nine studies involving 4755 patients, who were classified into the following mutational profiles: p53abn, 745 patients (15.6%); MMRd, 1454 patients (30.6%); POLEmut, 351 patients (7.4%); and p53wt, 2205 patients (46.4%). Compared to the p53wt group, the p53abn group showed significantly worse overall survival (OS) (HR 2.31, 95% CI: 1.67-3.19), progression-free survival (PFS) (HR 2.86, 95% CI: 1.45-5.64) and disease-specific survival (HR 2.60, 95% CI: 1.41-4.79); and the MMRd group showed significantly worse OS (HR 1.30, 95% CI: 1.11-1.53) and PFS (HR 1.27, 95% CI: 1.01-1.59). The POLEmut group, in contrast, showed similar survival as the p53wt group.

Conclusions: The four mutational profiles for patients with endometrial carcinoma in the Cancer Genome Atlas for Endometrial Cancer are associated with worse to better survival in the trend: p53abn < MMRd < POLEmut ≈ p53wt. Mutational profiling may be useful for stratifying endometrial carcinoma patients by survival risk, which in turn may improve their management.

This article examines existing literature on oncofertility in Africa and explores the barriers to oncofertility care. Patient-level barriers include lack of awareness about fertility preservation options, financial constraints, and the heavy emotional burden of cancer diagnosis and treatment. Healthcare-provider barriers encompass lack of awareness, prioritization of prompt cancer treatment, and implicit biases. Health-system barriers include limited facilities that can provide assisted reproductive technologies, limited insurance coverage for oncofertility services, weak referral systems, and the absence of national guidelines on oncofertility care. Socio-cultural barriers include religious objections, misinformation contributing to mistrust of fertility preservation options, and ethical dilemmas related to discussing future fertility with cancer patients whose primary focus is survival or with pediatric patients. This article also explores ways of improving oncofertility care in the region. These include educational initiatives for healthcare providers, capacity building, incorporation of oncofertility services into national cancer control programs, development of a centralized referral system, telemedicine, and increasing awareness to cancer patients.

Placenta accreta spectrum (PAS) poses a significant risk for maternal morbidity and mortality. There is a global rise in incidence of PAS in tandem with an increase in rates of cesarian section. Previous cesarian section and presence of placenta previa are two independent risk factors for development of PAS. Other risk factors are dilatation and curettage, endometrial ablation, and hysteroscopy. Ultrasound and magnetic resonance imaging are useful in prenatal diagnosis, antenatal follow-up, and pre-operative planning. Patient care is individualized to optimize outcomes with appropriate preoperative counseling. However, a significant number of cases remain undiagnosed and are incidentally discovered during cesarian section or management for retained placenta. Patients may suffer significant morbidity such as postpartum hemorrhage, massive blood transfusion, injury to pelvic viscera, hysterectomy, acute kidney infection, and even death. Cesarean hysterectomy is the mainstay of treatment. In selected cases, conservative management may be offered. This includes leaving the placenta in situ with interval resolution, manual removal, application of compression sutures and balloon tamponade, myometrial resection with repair, and the triple P procedure. In this series, we present seven patients with PAS managed at a tertiary teaching and referral hospital in Kenya. We highlight and discuss their antenatal presentation, intraoperative findings, management and the postoperative course. Early diagnosis, involvement of multidisciplinary team, and good preoperative planning are key to achieving a good outcome. Patients with PAS should be managed in facilities with sufficient resources, skilled personnel to manage complications arising from treatment such as need for massive transfusion, and intensive care.

Objective: To compare low-cost "Suction Tube Uterine Tamponade" (STUT) treatment for refractory postpartum hemorrhage (PPH) with uterine balloon tamponade (UBT) using a randomized feasibility study.

Methods: After verbal assent, we allocated participants with refractory PPH by randomly ordered envelopes to STUT or routine UBT at 10 hospitals in South Africa and one tertiary referral center in Colombia between January 10, 2020, and May 3, 2024. In the STUT group, we inserted a 24 FG Levin stomach tube into the uterine cavity and applied suction. The control group received standard UBT, mainly the Elavi free-flow balloon or the Bakri fixed volume balloon. There were fundamental differences between the South African and the Colombian sites, so the pre-specified analysis combined data from the two countries by meta-analysis.

Results: We enrolled 59 participants. The rate of the primary outcome (blood loss >1000 mL or laparotomy or death) was 8/27 (30%) in the STUT group versus 14/27 (52%) in the UBT group (risk ratio [RR] 0.56, 95% confidence interval [CI] 0.30-1.05, P = 0.07). Per protocol analysis was 7/26 (27%) versus 15/28 (54%) (RR 0.49, 95% CI 0.25-0.96, P = 0.04). Reporting severe pain during the procedures was less frequent in the STUT group (RR 0.46, 95% CI 0.25-0.86, P = 0.01). Most secondary outcomes favored the STUT group, with low certainty.

Conclusions: STUT was experienced as less painful than UBT. Results were consistent with reported observational findings and one other randomized trial evidence of greater effectiveness for suction than balloon tamponade.

Objective: This study explores a hybrid approach to maternal-fetal care for gestational diabetes (GD), integrating virtual visits seamlessly with in-clinic assessments. We assessed the feasibility, time efficiency, patient satisfaction, and clinical outcomes to facilitate wider adoption of maternal-fetal telemedicine.

Methods: We conducted a 4-week prospective study involving 20 women with GD at ≥32 weeks of pregnancy, alternating between remote and in-clinic weekly visits. Remote assessments began with women self-measuring vital signs and using a digital urine dipstick. The remote encounter started with a midwife performing anamnesis and remotely connecting women to the fetal nonstress test. A physician concluded the meeting with remote sonographic assessment of amniotic fluid maximal vertical pocket that together with the nonstress test provided the modified biophysical assessment as well as a video encounter and ongoing glycemic control assessment. We assessed the feasibility of remote visits, compared visit durations, evaluated women's satisfaction using the Telehealth Usability Questionnaire, examined glucose documentation adherence during hybrid care compared with the following period until birth, and assessed GD-related clinical outcomes.

Results: Remote visits had a success rate of 97.4% (38 of 39), with significantly shorter durations compared with in-clinic visits (median 59.0 min vs. 159.0 min, P < 0.001). Women expressed high satisfaction (6.6 of 7), and adherence with recording fasting glucose values during the study period was significantly higher than the following period until birth (92.2% vs. 61.8%, P = 0.001). Notably, none required induction of labor for glycemic control imbalance, and there were no cases of macrosomia, shoulder dystocia, or neonatal hypoglycemia.

Conclusion: The hybrid approach to maternal-fetal care for GD demonstrated feasibility, safety, time efficiency, improved patient satisfaction, and enhanced glycemic control adherence.

Objective: Polycystic ovary syndrome (PCOS) is a diverse condition with an unknown cause. The precise mechanism underlying ovulatory abnormalities in PCOS remains unclear. It is widely believed that malfunction of granulosa cells is the primary factor contributing to aberrant follicular formation in PCOS.

Methods: A DHEA-induced PCOS rat model was established, and ovarian granulosa cells were extracted and identified. Anti-Müllerian hormone (AMH) and SMAD family member 4 (SMAD4) expression was detected in the serum, ovarian tissue and ovarian granulosa cells of each group, and proliferating cell nuclear antigen (PCNA), BCL2-associated 2 (BAX), cleaved caspase-3 and BCL-2 protein expression was detected by Western blot in ovarian granulosa cells. Recombinant anti-Müllerian hormone (rAMH) was administered at different concentrations to act on normal rat ovarian granulosa cells, cell proliferation was detected by cell counting kit-8 (CCK-8), apoptosis was detected by flow cytometry, and SMAD4, caspase-3, BCL-2 and cyclin A proteins were detected by Western blot. SMAD4-siRNA was transfected into rat ovarian granulosa cells of the PCOS group, and PCNA and BAX were detected by Western blot.

Results: Compared with those in the control group, the expression of AMH and SMAD4 was increased in the ovarian tissues and granulosa cells of rats in the PCOS group, the expression of PCNA and BCL-2 proteins was decreased in the ovarian granulosa cells of the PCOS group, the expression of BAX proteins was increased, and the expression of cleaved caspase-3 was increased. Western blot results indicated that rAMH upregulated SMAD4 and caspase-3 protein expression in granulosa cells and downregulated cyclin A and BCL-2 protein expression. CCK-8 and flow cytometry results indicated that AMH decreased granulosa cells proliferation and increased apoptosis. SiRNA knockdown of SMAD4 gene increased PCNA and BCL-2 protein expression in the granulosa cells of PCOS rats and decreased BAX and cleaved caspase-3 protein expression.

Conclusion: AMH may be involved in regulating impaired ovarian granulosa cells development in PCOS rats via SMAD4.

Objective: The objective of this paper is to study the association between obesity and tumor recurrence in patients with vulvar cancer.

Methods: This is a retrospective study including vulvar cancer patients from 2003 to 2022. Our primary outcome was progression-free survival (PFS) stratified by status of obesity, defined as body mass index (BMI) >30.0 kg/m².

Results: Overall, 48 patients were included in the study, with 32 (66.7%) diagnosed at early stages (I-II). The median BMI was 28.0 kg/m² [interquartile range 24.9-32.3 kg/m²]. There were 13 obese patients (27%), and the median follow-up time was 55 months [interquartile range 14-102]. Most patients (80%) were HPV-independent of human papilloma virus. Surgical intervention was the primary treatment modality for 88% (n = 42) of the cohort, and 26 patients (54%) received adjuvant chemoradiation. Disease recurrence was identified in 28 patients (58%). The median PFS was 68 months, and the median overall survival was 109 months. There was no difference in the median PFS between obese patients and non-obese patients (P = 0.370). In a Cox regression analysis, after adjusting for patient age, margin-free distance, and stage of disease, BMI was not associated with PFS hazard ratio 1.06 (0.99-1.12).

Conclusion: Obesity is not associated with PFS in patients with vulvar cancer, and BMI might not be considered a risk factor for recurrence.