International Journal of Gynecology & Obstetrics最新文献

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.

Objectives: This study compares maternal and neonatal outcomes between preterm vacuum and forceps-assisted vaginal births and evaluates preterm outcomes between those <34 + 0 weeks gestation to those ≥34 + 0.

Methods: This study is a single-center retrospective cohort study of all singleton assisted vaginal births during 2014-2021. Delivery data and data on neonatal and pregnant patient outcomes were extracted from electronic medical records. Categorical variables were described by frequencies and percentages, and adjusted odds ratios (aORs) were calculated using logistic regression.

Results: There were 5095 assisted vaginal births during this period, of which 246 were preterm (171 vacuum and 75 forceps assisted). Neonatal head ultrasounds were less common after preterm vacuum- than after preterm forceps-assisted births (6.4 vs. 13.3%). Of those under 34 weeks (18 vacuum and 18 forceps assisted), there were identical rates of head ultrasound in each group (n = 7, 38.9%). Rates of Grade 1 intraventricular hemorrhage were the same between the vacuum- and forceps-assisted groups under 34 weeks (n = 5, 27.7%). No major intra- or extra-cranial bleeds were found among infants who underwent a vacuum- or forceps-assisted birth before 34 weeks. Maternal outcomes showed significantly lower odds of obstetric anal sphincter injury (aOR 0.26) and episiotomy (aOR 0.16) with preterm vacuum compared to preterm forceps-assisted births.

Conclusion: This study adds to a small but growing body of literature that supports maternal and neonatal safety of vacuum-assisted birth under 34 weeks' gestation, in comparison with the use of forceps, when assisted vaginal birth is required. Larger prospective registry-based studies are suggested to determine the robustness of this conclusion.

Objectives: This study assessed Turkish women's attitudes toward intimate partner violence (IPV) and their levels of social support and depression.

Methods: This descriptive cross-sectional study collected data online between April 2022 and December 2023. The sample consisted of 405 women. The data were collected using a personal information form, the Intimate Partner Violence Attitude Scale-Revised (IPVAS-R), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Beck Depression Inventory (BDI).

Results: The participants' mean total IPVAS-R, MSPSS, and BDI scores were 35.41 ± 8.86 (18-59), 68.44 ± 14.34 (20-84), and 11.56 ± 9.63 (0-63), respectively. Approximately 22% of participants reported being exposed to emotional violence, 20% to economic violence, and 9.6% to physical violence. Participants' total IPVAS-R and MSPSS scores were negatively correlated (P < 0.01). Participants' total IPVAS-R and BDI scores were positively correlated (P < 0.01).

Conclusion: This study found that women's attitudes toward IPV acceptance correlated negatively with their levels of social support and positively with their levels of depression.

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.