International Journal of Gynecology & Obstetrics最新文献

Objective: To evaluate the effects of hysterectomy for benign uterine tumors on subsequent ovarian reserve, sexual function, and lower urinary tract symptoms (LUTS).

Methods: The present study was a prospective longitudinal analysis that recruited patients aged 35-45 years who underwent simple hysterectomy without oophorectomy for symptomatic benign uterine tumors. Anti-Müllerian hormone (AMH) and serum sex hormone profiles, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and total testosterone, were measured at four timepoints: before hysterectomy, and 3, 6, and 12 months postoperatively. Participants completed the following questionnaires at these timepoints: Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence and Sexual Function Questionnaire (PISQ-12) short form.

Results: A total of 36 patients completed the study. Serum AMH levels significantly declined post-hysterectomy compared with preoperative levels. Both UDI-6 and IIQ-7 scores significantly decreased post-hysterectomy compared with preoperative scores. No differences were observed in serum FSH, LH, estradiol, progesterone, and testosterone levels before and after hysterectomy. No significant differences were found in the short form of PISQ-12 before and after hysterectomy.

Conclusion: The present study demonstrated that simple hysterectomy with ovarian preservation had detrimental effects on ovarian reserves, whereas LUTS showed improvement. Furthermore, sexual dysfunction was not likely to occur within the first postoperative year.

Objective: To determine the prevalence of low-dose aspirin (LDA), missed opportunities in pre-eclampsia prevention and its impact on maternofetal outcomes among patients with pre-eclampsia.

Methods: A cross-sectional study of pre-eclampsia patients at the University of Benin Teaching Hospital, Benin City, Nigeria, prospectively recruited from February 1, 2023 to January 31, 2024. Data were collected using interviewer-administered questionnaires and medical records. Data were analyzed using SPSS 25.0. Chi-squared analysis and logistics regression were used and p-values <0.05 were considered significant.

Results: The mean age group of the 140 patients was 31.28 ± 6.29 years, of whom 17.9% used LDA and 52% were compliant. Missed opportunity for LDA use was 79.3% and was higher in high-parity women, those with a low level of education, unemployed women, unbooked patients, and in low levels of antenatal care (p < 0.049, p < 0.008, p < 0.001, and p < 0.001, respectively) and these were statistically significant. About 94.5% and 74.3% who had vaginal delivery and cesarean section, respectively, experienced missed opportunities for LDA use, results that were statistically significant (p < 0.022). The association between missed opportunities and materno-fetal complications (p > 0.604 and p > 0.318) were not significant. However, respondents who had missed opportunity LDA had higher odds of fetal complications (odds ratio 13.68, 95% confidence interval 2.50-74.91).

Conclusion: This study reveals underutilization and missed opportunities for LDA for pre-eclampsia prevention leading to adverse materno-fetal outcomes. There is a need to promote LDA use for the prevention of pre-eclampsia among clinicians, especially at peripheral healthcare institutions.

Objective: Despite numerous studies on the causes of recurrent pregnancy loss (RPL), nearly half of cases remain unidentified, which determines the research relevance. This study aims to investigate microchromosomal variations in the fetal genome associated with the development of idiopathic RPL.

Methods: The research was supported by the Centre for Molecular Medicine and the Research Institute of Obstetrics, Gynecology and Perinatology and conducted over a period of 2 years. The study employed the Prepito automatic analyzer from PerkinElmer and the ChemagicPrepito nucleic acid extraction system, to isolate 100 DNA samples from conception products of women with idiopathic RPL, and, subsequently, to analyze for the presence of full-genome chromosomal abnormalities by array comparative genomic hybridisation (aCGH) using CGX-HD microarrays (8x60K), Format 1: CGX (80x60K), a ScanRI microarray scanner (PerkinElmer, Finland), and Genoglyphix, Cytogenomix software.

Results: The study determined that 83% of the materials studied had a normal molecular karyotype, while unbalanced chromosomal abnormalities were detected in 17% of cases, of which 35.3% of abortions had aneuploidies and 64.7% had various structural abnormalities. Among the aneuploidies, 66.7% were trisomies and 33.3% were monosomies. In the group of structural disorders, 81.8% were microdeletions, while microduplications accounted for 18.2%. The data obtained on the frequency and structure of chromosomal abnormalities detected in abortions in the sample surveyed showed that idiopathic RPL is not caused by chromosomal abnormalities of embryos and, unlike all other forms of RPL, has a different cause not related to chromosomal abnormalities.

Conclusion: This study conducted molecular cytogenetic analysis of the fetal genome related to RPL. Its findings can help optimize the process of counseling patients with idiopathic RPL.

Objective: Hysteroscopic myomectomy is widely regarded as safe and feasible, although achieving single-session results for larger myomas often requires alternative methods. This study introduces a novel approach: ultrasound-guided myoma extirpation using ring forceps combined with hysteroscopy.

Methods: This retrospective, single-center study includes patients who underwent ultrasound-guided myoma extirpation between 2016 and 2024. Data were collected retrospectively, and myomas were classified according to the International Federation of Gynecology and Obstetrics leiomyoma subclassification system. Under ultrasound guidance, the myoma was extirpated using ring forceps. The pre-, peri-, and postoperative outcomes were recorded and analyzed.

Results: A total of 25 patients were included, with a mean age of 44.76 ± 8.09 years. Most patients (92%) were premenopausal, and the primary symptoms were irregular bleeding (76%) and menorrhagia (68%). The median myoma size was 3 cm (interquartile range [IQR]: 2-4 cm). The median operation time was 30 min (IQR: 20-42 min). There was no statistically significant correlation between the duration of the operation and the diameter of the myoma uteri. Most myomas were located in the fundus, left side, or anterior wall (20% each), with 60% classified as type 0. Postoperative assessments revealed no residual myomas in 84% of cases. Uterine perforation and cervical laceration occurred as complications in two cases, while four cases required an additional session. Two patients with infertility achieved full-term pregnancies post-surgery.

Conclusion: This new, minimally invasive technique might be a feasible option for large myomas, particularly in low-resource settings. It minimizes the need for multiple sessions, providing reassuring results for patients with suitable indications.

Background: The intrapartum period is critical for reducing maternal and perinatal morbidity and mortality. The WHO's Safe Childbirth Checklist (SCC) was designed as a reminder of the most critical, evidence-based practices (EBPs) to improve quality care and reduce preventable complications and deaths.

Objective: To assess the impact of SCC on birth attendant behavior and maternal and newborn health outcomes.

Search strategy: A systematic review and meta-analysis was performed searching across five databases from 2009 to 2023.

Selection criteria: We included randomized controlled trials, quasi-experimental studies, and pre/post studies.

Data analysis: A meta-analysis yielded a pooled estimate of relative risk (RR) for adherence to and effectiveness of the SCC.

Main results: Of 1070 articles identified, 16 were included. Use of the SCC increased adherence to EBPs by 65% (RR 1.65; 95% confidence interval [CI] 1.34-2.02). The behaviors that improved the most were danger sign counseling (RR 12.37; 95% CI 1.95-78.52; P = 0.008) and pre-eclampsia management (RR 3.43; 95% CI 1.33-8.88; P = 0.011). There was moderate evidence for stillbirth reduction (RR 0.89; 95% CI 0.80-0.99; P = 0.034).

Conclusion: There is moderate evidence demonstrating the effectiveness of the SCC in reducing stillbirths and improving adherence to EBPs.

Objective: To develop and validate an individualized nomogram for predicting adnexal torsion in women with abdominal pain and an adnexal mass based on preoperative non-contrast computed tomography (CT) findings.

Methods: This retrospective study included 200 women with surgically resected ovarian lesions who underwent preoperative non-contrast CT for abdominal pain from January 2017 to September 2023 in seven hospitals. The 200 patients were randomly divided into a development group (140 cases) and a validation group (60 cases). The independent risk factors for adnexal torsion from non-contrast CT signs were screened using univariate and multivariate logistic regression analyses. The corresponding nomogram prediction model was drawn according to the regression coefficients. The areas under the receiver operating characteristic curves (AUC) and the calibration plots were used to estimate the discrimination and calibration of the prediction model, respectively.

Results: The most common lesion causing adnexal torsion was ovarian cyst (30.1%), followed by mature cystic teratoma (25.7%), whereas malignant tumors and tubo-ovarian abscesses were more common in non-torsioned patients. Multivariable regression analysis showed that navel sign (odds ratio [OR] 14.78; P = 0.005), whirl sign (OR 38.05; P = 0.002), and peri-adnexal fat haziness (OR 0.20; P = 0.012) were independent significant parameters predicting adnexal torsion. The AUC of the development group and validation group were 0.903 and 0.861, respectively, and the calibration curve suggested good agreement between the predictive probability and the actual probability.

Conclusion: Navel sign, whirl sign, and peri-adnexal fat haziness, and an integrated nomogram derived from these non-contrast CT findings, can be useful for predicting adnexal torsion, especially when ultrasound and contrast-enhanced CT cannot be used.

All patients where the cancer treatment has gonadotoxic potential should be referred for oncofertility advice. The effect of chemotherapy and radiotherapy on the human ovary can vary from no impact to full-blown premature ovarian failure due to hormonal and follicular depletion. Total contraindications to fertility cryopreservation include acute malignancy that requires immediate lifesaving therapy. In prepubertal girls, the only option for urgent fertility preservation is ovarian tissue cryopreservation. Prepubertal testicular tissue cryopreservation is experimental.

Objective: Guatemala has one of the highest rates of maternal mortality in Central America. A total of 60% of births in Guatemala are attended by traditional Mayan birth attendants, or comadronas. Their prevalence in these communities makes them a valuable resource to bridge home births with safe prenatal care. The objective of this study was to evaluate a low-cost prenatal care training program for Guatemalan comadronas with the goal of improving maternal health outcomes in the region.

Methods: In this retrospective longitudinal cohort study, we examined the knowledge retention of comadronas enrolled in a 12-month prenatal care training program known as the School of PowHER (SOP). Recruited from the Lake Atitlán region of Guatemala by Saving Mothers, 501(c)(3) and the Guatemalan Ministry of Health, comadronas participated in a four-month didactic curriculum followed by a nine-month clinical curriculum. Pre- and post-tests were administered to assess learning outcomes over the study's duration (2014-2022), and test results were evaluated to assess the effectiveness of the SOP.

Results: A total of 123 women were recruited and enrolled in all eight graduating classes of the SOP from 2014, 2016-2019, and 2021-2022. An average, statistically significant improvement in didactic and clinical pre- and post-test scores was found across all years analyzed.

Conclusion: The SOP is a low-cost, culturally appropriate, community-based model that empowers comadronas through knowledge and skill acquisition to improve local maternal health outcomes. This program proves effective at not only teaching comadronas prenatal health information and clinical skills, but also at promoting long-term retention of these skills.

Objectives: To assess hotspot micro-vessel flow velocity waveforms in human papillomavirus (HPV) cervical infections using transvaginal power Doppler ultrasound (TV-PDU) and explore associations with high-grade squamous intraepithelial lesions (HSIL, cervical intraepithelial neoplasia [CIN] II and III).

Methods: In all, 62 patients with confirmed HPV-HSIL (14 CIN II, 48 CIN III) and 65 age- and parity-matched women with neither HPV infection nor CIN were compared. Seven parameters by TV-PDU were used to assess vascular classification and micro-vessel flow velocity, including vascular grading (class I, II, III), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end-diastolic velocity (ED), time average maximum velocity (TAMV), and the vascular index (VI = PS/ED).

Results: HSIL was primarily associated with vascular class I (75.8%), followed by class II (14.5%) and class III (9.7%). PI, RI, and VI in HSIL were significantly lower than the control group (P < 0.0001). Mean PI, RI, and VI values decreased progressively from the normal cervix to CIN II-III. At a PI cutoff of 1.03, sensitivity was 88.7%, specificity was 83.8%, and area under the curve (AUC) was 95.0. At an RI cutoff of 0.68, sensitivity was 96.8%, specificity 61.5%, and AUC 84.0. At a VI cutoff of 2.84, sensitivity was 85.5%, specificity 78.5%, and AUC 85.0.

Conclusion: Based on different patterns of hotspot vascular classification and micro-vessel flow velocity waveforms, particularly PI between HSIL and the normal cervix, TV-PDU may offer a potential role for aiding the planning for patients with suspicious HSIL. Further studies are needed to validate the findings.