International Journal of Gynecology & Obstetrics最新文献

Objective: Despite numerous studies on the optimal timing for planning a safe pregnancy, the impact of the interval between pregnancies on birth outcomes remains debatable. The aim of this study was to determine the association between early interpregnancy intervals (IPIs) ranging from 0 to 35 months and maternal and neonatal outcomes.

Methods: We conducted a retrospective cohort study involving 6764 multiparous women who gave birth between January and December 2022 at two secondary-level maternity hospitals under the Ministry of Health of the Kyrgyz Republic. We investigated IPIs (0-5, 6-11, 12-17, 18-23 [control group], and 24-35 months) in relation to maternal, perinatal, and neonatal outcomes.

Results: Maternal morbidity affected 14.9% of all women. The highest risk of maternal morbidity was observed at IPIs of 6-11 months (adjusted odds ratio [aOR] 2.634; 95% confidence interval [CI] 1.887-3.002) and 24-35 months (aOR 2.562; 95% CI 2.129-3.459). Mothers with short IPIs had higher odds of severe anemia (0-5 months: aOR 5.615, 95% CI 1.386-22.752; 6-11 months: aOR 2.812, 95% CI 1.007-5.891). Short IPIs were associated with higher odds of preterm birth (PTB), particularly extremely PTB (0-5 months: aOR 4.968, 95% CI 2.075-15.892; 6-11 months: aOR 4.024, 95% CI 2.361-8.452). In contrast, for an IPI of 24-35 months, the risk of extreme PTB was not statistically significant (aOR 1.110; 95% CI 0.714-2.463).

Conclusion: Short IPIs are significantly associated with increased risks of adverse maternal and neonatal outcomes. These findings emphasize the importance of optimal birth spacing and the need for enhanced postpartum family planning services to mitigate risks such as severe anemia and PTB.

Objective: To analyze prenatal indicators of management, process, and obstetrical outcomes, before and after training healthcare providers on the WHO recommendations for best evidence-based practices.

Methods: A quasi-experimental before-and-after operational study was conducted from January to July 2022. The study occurred in seven healthcare units and one municipal hospital on the coast of Brazil. Medical charts of all pregnant women receiving prenatal care in the sample units during this period were reviewed. Hospital data collection was conducted, with medical chart review of all postpartum women who had given birth in January and June and came from the same sample units. All healthcare professionals of the sample units participated in training focused on the best prenatal practices. For data analysis, the χ²-test, Fisher exact test and Student t-test were used, with a significance level of P values less than 0.05.

Results: In all, 568 medical charts were studied, 278 in the "before" and 290 in the "after" training period. After training, a significant improvement occurred with records of increased screening for: anemia (from 74% to 92%), HIV (from 95% to 98%), diabetes (from 75% to 93%), asymptomatic bacteriuria (from 74% to 88%), and ultrasound scan before 24 weeks of pregnancy (from 74% to 85%), although the management record of pregnant women with anemia was worse (from 85% to 45%).

Conclusion: Training was efficient in terms of process indicators. After staff training, there was a significant increase in documented screening for main maternal clinical conditions, including anemia, diabetes, and asymptomatic bacteriuria, although clinical management did not consistently improve.

Objective: The differential impact of pre-pregnancy body mass index (BMI) on large for gestational age (LGA) risk by gestational diabetes mellitus (GDM) status remains unquantified. We aimed to assess whether GDM modifies the association between pre-pregnancy BMI and LGA to inform precision prevention strategies.

Methods: In this prospective cohort study, 34 031 pregnant women enrolled at Hunan Provincial Maternal and Child Health Care Hospital (2013-2019) were stratified by GDM status. Multivariable logistic regression and restricted cubic spline (RCS) models adjusted for sociodemographic, behavioral, and clinical covariates evaluated the association between pre-pregnancy BMI and LGA.

Results: LGA incidence was significantly higher in GDM than non-GDM pregnancies (14.8% vs. 11.9%, P < 0.001). Adjusted models demonstrated a steeper BMI-LGA dose-response gradient in GDM: each 1-unit BMI increase conferred 20% higher odds (adjusted odds ratio [aOR]: 1.20, [95% confidence interval [CI]: 1.17, 1.23]) versus 11% in non-GDM pregnancies (aOR: 1.11, [1.09, 1.12]). Obesity amplified LGA risk more substantially in GDM (aOR: 6.66, [4.27, 10.39]) than non-GDM pregnancies (aOR: 2.78, [2.00, 3.87]). RCS models revealed nonlinear BMI-LGA trajectories in both cohorts (reference level: 21.05 for GDM and 26.18 for non-GDM). Associations remained consistent across demographic subgroups. Notably, significant interaction effects occurred exclusively in non-GDM pregnancies, with multigravida (aOR: 1.13) exhibiting a stronger BMI-LGA association than primigravida (aOR: 1.08).

Conclusion: GDM status significantly modifies the relationship between pre-pregnancy BMI and LGA risk, identifying a threshold that substantially increases risk in women with GDM and revealing subgroup-specific vulnerabilities. These findings suggest that incorporating pre-pregnancy BMI and estimated risk of developing GDM into early risk stratification can help identify high-risk pregnancies, thereby guiding targeted antenatal monitoring and individualized interventions of varying stringency to prevent LGA.

Objectives: Pelvic organ prolapses (POP), a common condition among elderly women, frequently coexists with urinary incontinence (UI). Although concomitant anti-incontinence procedures during POP surgery might reduce postoperative SUI, they also increase the risk of urinary retention, voiding dysfunction and long-term mesh complications. This study aims to evaluate the urinary outcomes in women with advanced POP who underwent colpocleisis alone, without anti-incontinence surgery.

Methods: This retrospective cohort study included all the consecutive patients who underwent colpocleisis between 2016 and 2023. Patients with concomitant anti-incontinence surgery or inability to follow up were excluded. Preoperative evaluation included demographics, medical history, pelvic ultrasound, POP quantification (POP-Q) staging, and ICIQ-UI-SF questionnaires. Total or partial colpocleisis was performed, and patients were reassessed using POP-Q and ICIQ-UI-SF, postoperatively.

Results: A total of 90 patients were included in the analysis. The mean age was 69.2 ± 7.4 years and body mass index (BMI) 24.6 ± 3.5 kg/m². Parity ranged from 1 to 13. Advanced POP predominated (Stage III: 44.4%, Stage IV: 54.4%). Major complications occurred in four patients. Generally, preoperative and postoperative distribution of urinary incontinence varied significantly (P-value = 0.012). Postoperatively, 83.7% of preoperative SUI cases resolved, and de novo SUI developed in two patients (4.4%). Patients with persistent or de novo urge urinary incontinence after surgery reported improvement in postoperative symptoms with lifestyle modifications, bladder training, or medication.

Conclusion: Colpocleisis is a safe and effective surgical option for POP that is also able to significantly improve urinary incontinence when performed without a concomitant anti-incontinence procedure. The low incidence of new-onset urinary incontinence after surgery supports a staged rather than concomitant approach for prolapse and anti-incontinence procedures. Counseling patients regarding the potential persistence or development of urinary symptoms is essential. Based on these findings, preoperative urodynamic testing might not be necessary for many elderly patients. Further comparative studies are required to confirm these findings and refine the patient selection criteria.

Objective: To investigate the impact of both pre- and post-ovulation post-wash total progressive motile sperm count (TPMSC) on pregnancy outcomes in intrauterine insemination (IUI) using husband's sperm (AIH).

Methods: This retrospective cohort study analyzed data from infertile couples who underwent IUI treatment at the Reproductive Medicine Center of Xinxiang Central Hospital from January 2020 to June 2024. A total of 462 IUI cycles were included, all of which had consistent pre- and post-ovulation post-wash TPMSC values. Cycles were divided into four groups based on TPMSC: Group A (<10 × 10⁶), Group B (10-20 × 10⁶), Group C (20-30 × 10⁶), and Group D (≥ 30 × 10⁶). Comparisons were made regarding baseline data and pregnancy outcomes among the groups. Multivariate logistic regression was employed to assess the impact of both pre- and post-ovulation post-wash TPMSC on clinical pregnancy rates.

Results: The clinical pregnancy rates differed significantly among TPMSC groups (P = 0.024), with the highest rate in the 10-20 × 10⁶ group (26.13%). Multivariate logistic regression identified this range as an independent predictor of clinical pregnancy (odds ratio [OR] = 1.922, 95% confidence interval [CI]: 1.026-3.600, P = 0.041).

Conclusion: Post-wash TPMSC influences clinical pregnancy rates in IUI. When both pre- and post-ovulation post-wash TPMSC are within the range of 10-20 × 10⁶, this may optimize clinical pregnancy outcomes.

Background: Violence against women remains a serious public health problem and a violation of human rights that affects women's health. Healthcare providers play a fundamental role in preventing and responding to violence against women and girls.

Objectives: This study analyzes strategies for preventing gender-based violence in healthcare services, focusing on identifying best practices for implementing evidence-based interventions in these settings.

Search strategy: The review was conducted following the Joanna Briggs Institute's method for umbrella reviews and the Evidence Synthesis for Health Policy. A comprehensive search strategy was applied across eight databases.

Selection criteria: Secondary studies of interventions that address gender-based violence in healthcare settings for women and adolescents of reproductive age were included in this review. Two reviewers independently screened the studies and assessed their quality.

Data collection and analysis: Narrative synthesis was performed to summarize the evidence.

Main results: A total of 24 systematic reviews conducted in healthcare settings were analyzed, most of them from high-income countries with diverse tools and methods. Screening strategies are implemented, particularly among at-risk populations in healthcare settings most frequented by women, such as sexual and reproductive services. Initiatives that include educational elements, counseling, and advocacy interventions show promising results.

Conclusion: Collaborative strategies in healthcare settings that guarantee the follow-up of the survivors, the mitigation of gender-based violence consequences, and its intergenerational transmission are necessary. Culturally sensitive strategies based on women-centered, diversity, and equity approaches must guide the implementation of the interventions.

Objective: This study evaluates forceful Foley balloon tugging for 30 s 3-hourly to retrieve a comfortably retained balloon compared to usual care (without tugging) during the 12 h of planned passive placement. The primary outcomes were the induction (Foley insertion) to delivery duration and patients' satisfaction.

Method: Participants were recruited into a randomized controlled trial in a university hospital in Malaysia from March 2023 to December 2023. Nulliparas admitted for induction of labor by Foley balloon were enrolled. After Foley insertion, participants were randomized to 3-hourly tugging or usual care. Following balloon retrieval (whether tugged out, spontaneously expelled, or at scheduled removal), suitability for amniotomy was assessed by vaginal examination. Follow-on labor induction management was guided by the cervical finding.

Results: A total of 264 patients were randomized, with 132 in each study arm. The primary outcomes of induction to birth duration median [interquartile range] was 33.2 [25.3-43.4] versus 37.2 [27.9-45.8] hours (P = 0.058) and participant satisfaction score (0-10 numerical rating scale [NRS]) with the labor induction process was 9 [7-10] versus 9 [7-10] P = 0.437 for tugging versus usual care, respectively. Secondary outcomes with P < 0.05 were Foley removal as planned at 12 h, Foley displacement after tugging, compliance to protocol, and umbilical artery blood pH. However, pH ≤7.10 was 2/126 (1.6%) versus 3/129 (2.3%) relative risk 0.67 95% CI 0.11-3.95 P > 0.99 for tugging vs. usual care.

Conclusion: At nulliparous Foley induction of labor with a planned 12-h ballon placement, tugging the Foley 3-hourly compared to usual care did not expedite birth or increase patient satisfaction.

Objective: This study evaluates the sexual function of Brazilian women of reproductive age and postmenopausal women during the COVID-19 pandemic.

Methods: A cross-sectional observational study was conducted virtually between 2020 and 2021, involving 200 sexually active women, divided into two groups: 100 women of reproductive age (WRA) and 100 postmenopausal women (PMW, amenorrhea for at least 12 consecutive months). Sexual function was assessed using the Female Sexual Function Index (FSFI). Comparisons between groups were performed using the Mann-Whitney test, with a significance level of 5%.

Results: No significant differences were observed between the groups in the total FSFI score (WRA: 17.29 ± 6.22; PMW: 17.38 ± 9.89). However, the WRA group had significantly higher scores in the desire domain (P < 0.001), while the PMW group showed higher scores in the sexual arousal (P = 0.015) and satisfaction (P < 0.001) domains. No significant differences were found in the other domains.

Conclusion: During the pandemic, both Brazilian women of reproductive age and postmenopausal women experienced impaired sexual function, as evidenced by reduced FSFI scores.

Objective: The aim of this study was to evaluate the cerebroplacental ratio (CPR) and the cerebroplacental-uterine ratio (CPUR) in pregnancies complicated by gestational diabetes mellitus (GDM) and to determine the role of these indices in predicting adverse perinatal outcomes.

Methods: This prospective, single-center observational study was conducted at a tertiary care institution between August 2024 and January 2025. A total of 117 pregnant women were enrolled, including 64 with GDM (group 1) and 53 without GDM (group 2). The GDM group was further subdivided according to treatment modality (diet-controlled vs. insulin-treated). Doppler parameters, as well as maternal and fetal outcomes, were compared between the groups.

Results: In the GDM group, body mass index (BMI) (P < 0.001), cesarean delivery rate (P = 0.037), and neonatal intensive care unit (NICU) admissions (P = 0.010) were significantly higher, whereas gfestational age at delivery (P = 0.016), first and fifth minute Apgar scores, and umbilical cord PH were significantly lower (P < 0.05). The umbilical artery pulsatility index (UA-PI) was significantly elevated in the GDM group, while CPR (P < 0.001) and CPUR (P < 0.001) were significantly lower. Both CPR and CPUR were significant predictors of adverse fetal outcomes. In the study group, the receiver operating characteristic analysis for CPR predicting NICU admission yielded an optimal cut-off value of 1.45 (area under the curve [AUC] = 0.725; P = 0.001), with 69.2% sensitivity and 69.2% specificity. For CPUR, the optimal cut-off was 1.37 (AUC = 0.761; P = 0.001), with 73.1% sensitivity and 72.5% specificity.

Conclusion: In patients with GDM, both CPR and CPUR were significantly lower compared to healthy pregnancies, and CPUR was shown to be a clinically useful predictor of adverse fetal outcomes.