International Journal of Women's Health最新文献

Objective: To explore the optimal cutoff value of fetal nuchal translucency (NT) in the Shihezi region and analyze the predictive value of NT and high-risk factors for pregnancy outcomes.

Methods: This retrospective study included pregnant women who underwent NT screening at the First Affiliated Hospital of Shihezi University between January 2021 and December 2023. Prenatal examination results and pregnancy outcomes were collected and analyzed. The optimal cutoff value of NT for predicting pregnancy outcomes was calculated.

Results: Using NT=2.5mm as the cutoff value, three groups were defined (<2.5mm, 2.5-3.5mm, ≥3.5mm). For NT≥2.0mm, the AUC for predicting outcomes was 0.652 (P<0.001). NT thickening was significantly associated with ≥2 abnormalities in soft ultrasound indicators, structural abnormalities (P<0.001), chromosomal abnormalities (P=0.008), and adverse outcomes (P<0.001). Compared with the NT<2.5 mm group, the risk of adverse outcomes increased with NT thickness (OR=2.009, 95% CI: 1.472-2.743, for 2.5-3.5mm; OR=13.090, 95% CI: 6.571-26.074, for ≥3.5mm). The top three adverse pregnancy outcomes were: 210 cases of macrosomia (7%), 158 cases of preterm birth (5.3%), and 109 cases of structural abnormalities (3.6%). As NT thickened, structural abnormalities, chromosomal abnormalities, and miscarriage were correlated with NT (P<0.05). HDP was associated with fetal growth retardation and preterm birth (P<0.001). Maternal age ≥35 was linked to structural abnormalities (P=0.017) and gestational diabetes mellitus (GDM) (P<0.001).

Conclusion: NT=2.5mm is the cutoff value of NT thickening in Shihezi area; structural and chromosomal abnormalities and miscarriage are related to the degree of NT thickening; NT, age and HDP are independent risk factors affecting pregnancy outcome, and age is associated with GDM. NT cannot serve as an independent risk factor for adverse pregnancy outcomes and should be evaluated in conjunction with prenatal screening ultrasound and maternal high-risk factors.

Purpose: This study aimed to categorize abdominal wall endometriosis (AWE) according to lesion depth, analyze its clinical features, treatment, outcomes, and prognosis, and share clinical treatment experience.

Patients and methods: A retrospective analysis was performed on 187 AWE patients who underwent surgery at the First Affiliated Hospital, Zhejiang University School of Medicine between January 2013 and April 2024. Patients were classified into three types: type I (skin and subcutaneous fat layer), type II (fascia or muscle layer), and type III (peritoneal layer). Clinical features, perioperative outcomes, and recurrence rates were analyzed.

Results: Among the 187 AWE patients, 28 (14.97%) were classified as type I, 104 (55.61%) as type II, and 55 (29.42%) as type III. The main complaint was an abdominal wall mass or/and pain (98.39%, 184/187). Both preoperative imaging and intraoperative exploration revealed a significant trend of increasing lesion diameter across types I, II, and III (P < 0.01). As the depth of endometriosis invasion increased, the proportion of lesions with a maximum diameter of ≥ 3 cm increased (P < 0.01). Additionally, there was a significant increase in the frequency of intraoperative mesh placement and drainage placement, as well as longer operative time (P < 0.01). Lesions were mainly located at corner sites of cesarean section incisions: 85.0% occurred in transverse incisions and 87.76% in longitudinal incisions. The three-year cumulative recurrence rate was 6.2%, with no identified risk factors for recurrence.

Conclusion: The presence of an abdominal mass or pain in or around a surgical scar should raise suspicion of AWE. Type III AWE is associated with the most severe clinical manifestations, larger lesion diameter, longer operative time, and a higher incidence of intraoperative mesh and drainage placement. Complete surgical excision is the treatment of choice, and the overall recurrence rate is low.

Background: Hypertensive disorders complicating pregnancy (HDCP) are a major cause of maternal and fetal morbidity. This study aims to examine the relationship between red blood cell folate (RBCF) and homocysteine (Hcy) levels and HDCP severity, as well as to assess their predictive value for pregnancy outcomes.

Methods: This retrospective study included 326 HDCP patients and 153 controls. The diagnostic criteria for HDCP were based on the American College of Obstetricians and Gynecologists. RBCF and Hcy levels were measured at diagnosis using automated immunoassays. ROC curve analysis was performed to assess the predictive value of RBCF and Hcy for poor pregnancy outcomes.

Results: A total of 326 women with HDCP and 153 normotensive controls were included. Blood pressure was significantly higher in the HDCP group (both p < 0.001). HDCP patients exhibited markedly lower RBC folate (286.08 ± 59.04 vs 334.83 ± 51.95 ng/mL, p < 0.001) and higher Hcy levels (8.41 ± 1.39 vs 7.58 ± 1.40 μmol/L, p < 0.001) than controls. Across HDCP severity, RBCF declined progressively from gestational hypertension to mild and severe preeclampsia, while Hcy increased correspondingly. Among HDCP patients, adverse pregnancy outcomes occurred in 44.5%, including prematurity (34.4%), low birth weight (19.3%), and fetal distress (12.9%). Compared with women with good outcomes, those with poor outcomes had significantly lower RBCF (255.61 ± 51.56 vs 310.45 ± 53.13 ng/mL, p < 0.001) and higher Hcy (9.04 ± 1.36 vs 7.90 ± 1.25 μmol/L, p < 0.001). ROC analysis showed that combined RBCF-Hcy testing provided the highest predictive performance for adverse outcomes (AUC = 0.85, 95% CI 0.81-0.89; sensitivity 85.52%; specificity 75.14%), outperforming either biomarker alone.

Conclusion: RBCF and Hcy are crucial biomarkers for assessing the severity of HDCP and predicting adverse pregnancy outcomes.

Background: Müllerian anomalies complicated by extrapelvic endometriosis are uncommon, and herniation of Müllerian remnants into the inguinal canal is exceptionally rare. These complex presentations pose significant diagnostic challenges arising from intricate embryological maldevelopment, necessitating multidisciplinary collaboration to optimize both patient safety and fertility preservation.

Case report: We report a case in which a non-communicating rudimentary uterine horn and endometriotic tissue presented as an incarcerated inguinal hernia in a woman with a solitary pelvic kidney. Multimodal imaging (3D ultrasound, CT with 3D reconstruction, and MRI) enabled preoperative mapping and guided a one-stage laparoscopic approach. Postoperative GnRH-agonist therapy was initiated for adjuvant suppression, and longer-term follow-up is ongoing.

Conclusion: This case underscores the importance of considering Müllerian anomalies and endometriosis in the differential diagnosis of inguinal masses in women with genitourinary malformations. Multidisciplinary integration of gynecological, urological, radiological, and surgical expertise is essential for accurate diagnosis and safe, fertility-sparing management.

The homeostasis of the uterine environment is crucial for reproductive health. Recent studies have revealed the complex interplay between the endometrial microbiome, immune system, and the endometrium. Under normal physiological conditions, the microbiome, primarily composed of Lactobacillus species, promotes a healthy reproductive environment by maintaining local immune homeostasis, inhibiting the growth of pathogenic microorganisms, and regulating the integrity of the endometrial barrier. However, dysbiosis can abnormally activate local immune responses, disrupting the immune tolerance mechanisms of the endometrium and thereby compromising pregnancy maintenance and overall reproductive health. This study uniquely highlights the role of the endometrial microbiome in modulating immune responses specifically within the uterine environment, a critical factor for reproductive success. Our findings also suggest novel therapeutic strategies targeting microbiome modulation and immune regulation, offering promising avenues for improving reproductive health outcomes. This review aims to explore the regulatory mechanisms of the microbiome-immune axis in both physiological and pathological conditions, with a particular focus on how these interactions specifically influence the uterine environment, while also considering the broader implications of microbiome-immune interactions throughout the entire body. We will analyze its potential role in reproductive health issues and discuss new therapeutic strategies based on microbiome and immune modulation.

Background: During pregnancy, there is a physiologic increase in heart rate and blood flow rate along with an increase in plasma volume. Although these changes are physiological, pregnant women with congenital cyanotic heart disease are known to have an increased risk of maternal heart failure, premature birth, intrauterine growth retardation, increased number of cesarean sections, and even maternal death. According to the World Health Organization, cardiovascular diseases (CVD) are the most common cause of indirect maternal deaths. The aim of this study was to assess how well obstetricians and cardiologists manage the care of a pregnant woman with cardiovascular disease.

Methods: This survey-based study included 45 obstetricians and 30 cardiologists. There is no ready-made scale or survey on the relevant subject. Therefore, the survey questions were created by us as a result of the literature review. In the survey, questions were asked to examine clinical decision-making tendencies and attitudes of obstetrics and cardiology doctors about recommending induced abortion in the first trimester in pregnant women with various heart diseases and about vaginal labor or cesarean section and infective endocarditis prophylaxis in term pregnancy.

Results: Survey responses from obstetricians and cardiologists revealed significant differences in management approaches. Regarding first-trimester elective termination, cardiologists overwhelmingly recommended it for most conditions (eg, 100% for pulmonary arterial hypertension, 96.7% for EF < 30%/Class III-IV heart failure), whereas obstetricians showed greater hesitation or preference for cardiology consultation (eg, 48.9% had "no opinion" for Marfan syndrome with aortic dilatation). For mode of delivery at term, cardiologists predominantly recommended cesarean section, often with infective endocarditis prophylaxis, for specific high-risk conditions (eg, 100% for prosthetic valve, 96.7% for severe PAH). In stark contrast, the majority of obstetricians (ranging from 53.3% to 80.0% across various CVDs) opted to defer the decision by seeking a cardiology consultation. Statistical analysis confirmed significant differences (p<0.05) between the two specialist groups in most management decisions.

Discussion: CVDs are the most common cause of non-direct maternal deaths. Patients should be closely monitored during pregnancy, labor and puerperium. Pregnant women with CVD should be evaluated by a multidisciplinary committee of competent physicians.

Background: Female reproductive system diseases, including malignant tumors such as breast, ovarian, and uterine cancers, and non-neoplastic disorders such as uterine fibroids, endometriosis, polycystic ovary syndrome (PCOS), infertility, and premenstrual syndrome (PMS), represent major health challenges in Asia. While malignant diseases receive considerable attention due to high mortality, the long-term burden of non-malignant conditions affecting fertility, psychological well-being, and quality of life remains underestimated.

Methods: Data from the Global Burden of Disease (GBD) 2021 were used to quantify the burden of female reproductive system diseases in 47 Asian countries and territories from 1990 to 2021. Incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were analyzed, together with age-standardized rates. Temporal trends were assessed using estimated annual percentage change (EAPC), and disease burden patterns were examined across Socio-demographic Index (SDI) levels. Associations between major modifiable risk factors and disease burden were described.

Results: In 2021, female reproductive system diseases accounted for over 33 million DALYs and approximately 600,000 deaths in Asia. Breast and cervical cancers were the leading contributors to mortality and DALYs, whereas PMS and infertility accounted for a substantial burden among younger women. From 1990 to 2021, absolute case numbers and deaths increased with population growth and aging, while most age-standardized rates declined, particularly for cervical cancer. In contrast, PCOS and infertility showed the fastest increases. High body mass index and elevated fasting glucose were strongly associated with breast and uterine cancer burden, while smoking was closely associated with cervical cancer burden.

Conclusion: Female reproductive system diseases impose a substantial and heterogeneous burden across Asia. Although malignant cancers remain the main contributors to mortality and DALYs, non-malignant disorders increasingly affect reproductive health, particularly among younger women. Prevention strategies tailored to SDI levels and major risk factors are needed to reduce the overall disease burden across the region.

Background: Gestational diabetes mellitus (GDM) elevates preterm birth risk, highlighting the need for improved prediction methods to enhance outcomes. Current models show limited accuracy by ignoring some inflammatory biomarkers (eg, PLR, LMR, SII). Machine learning (ML) can better analyze complex patterns but remains underused for GDM preterm birth prediction.

Objective: This study develops an interpretable ML model combining systemic inflammatory indices and traditional clinical markers to predict preterm birth in GDM. Enabling early risk stratification at diagnosis, it facilitates timely interventions for this high-risk population.

Methods: This retrospective study analyzed 389 GDM patients, stratified into training (n=272) and temporal external validation (n=117) cohorts, and further classified by birth outcome (term/preterm). Using the training cohort, we developed and internally validated multiple ML models incorporating: (1) systemic inflammation indices, (2) traditional clinical indicators, and (3) their combination. The optimal model underwent temporal external validation and subsequent Shapley Additive Explanations (SHAP) analysis for feature interpretation. To assess the robustness of our findings, sensitivity analyses were conducted.

Results: Our cohort of 389 GDM patients included 53 preterm births (13.6%). Analysis revealed seven significant predictors combining systemic inflammatory markers and traditional clinical parameters. The extreme gradient boosting (XGBoost) model outperformed comparative algorithms (AUC-ROC: 0.932 vs Logit: 0.871, SVM: 0.847, RF: 0.917; AUC-PRC: 0.754 vs Logit: 0.686, SVM: 0.582, RF: 0.670). SHAP analysis identified five key determinants (two clinical and three inflammatory markers) as most influential for preterm birth prediction. Sensitivity analyses were conducted to assess the robustness of the results.

Conclusion: The XGBoost model outperforms in predicting GDM-related preterm birth by integrating traditional clinical and systemic inflammatory markers, enabling precise risk assessment to guide clinical management.

Background: Gestational diabetes mellitus (GDM) increases the risk of complications such as gestational hypertension, genital tract infections, preterm birth, and adverse perinatal outcomes including fetal distress and macrosomia. Identifying serum biomarkers in early pregnancy may aid in prevention and improve maternal and fetal outcomes.

Aim: To evaluate the predictive value of placental growth factor (PIGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1) for GDM in early pregnancy.

Methods: A retrospective case-control study was conducted including 140 pregnant women screened for GDM in early pregnancy. Seventy women diagnosed with GDM formed the observation group, and 70 women with normal glucose levels served as controls. Inclusion criteria were singleton pregnancies with complete laboratory data and delivery follow-up at the same hospital. Primary outcomes were serum PIGF and sFlt-1 levels, and their predictive value for GDM was assessed.

Results: Pre-pregnancy BMI, fasting plasma glucose, HbA1c, HOMA-IR, and sFlt-1 levels were significantly higher in the observation group, while PIGF levels were lower. Pre-pregnancy BMI, PIGF, and sFlt-1 were independent predictors of GDM (P < 0.05). The incidence of gestational hypertension, preterm birth, genital tract infection, and macrosomia was higher in the observation group (P < 0.05). PIGF was negatively correlated with HOMA-IR, whereas sFlt-1 showed a positive correlation (P < 0.05). The area under the curve (AUC) for predicting GDM was 0.875 (95% CI: 0.818-0.932) for PIGF and 0.824 (95% CI: 0.752-0.897) for sFlt-1.

Conclusion: Lower PIGF and higher sFlt-1 levels in early pregnancy may be associated with GDM development and adverse outcomes. These biomarkers demonstrate potential predictive value, but large-scale prospective studies are required to confirm clinical utility.

Purpose: Women's sexual health is affected by physical, psychological, and emotional aspects. In Ayurvedic medicine, Shatavari (Asparagus racemosus) is traditionally classified as a Rasayana known to promote reproductive health and overall well-being in women. The present study aims to evaluate the safety and efficacy of a standardized Shatavari root extract (SHT) in improving women's sexual health.

Patients and methods: A prospective, randomized, double-blinded, placebo-controlled, three-armed study was conducted over 8 weeks with 135 women participants. Participants were randomly assigned to receive either SHT, Shatavari with Ashwagandha root extracts (SHT-ARE), or a placebo (PL). The primary outcome was assessed using the Female Sexual Function Index (FSFI). Secondary outcomes were measured by Satisfying Sexual Events (SSEs), Female Sexual Distress Scale (FSDS), Profile of Mood States (POMS), Oxford Happiness Questionnaire (OHQ), and Pittsburgh Sleep Quality Index (PSQI), which were used for efficacy analysis. The safety parameters were monitored by treatment-emergent adverse events and changes in liver, thyroid, and renal function markers.

Results: At post-intervention (8 weeks), the SHT-ARE group demonstrated improvements in FSFI Arousal (P = 0.041), Lubrication (P = 0.027), Orgasm (P = 0.031), and Total FSFI (P = 0.005) scores compared to the PL group, whereas the SHT group showed improvements in only Total FSFI (P = 0.025) and Satisfaction (P < 0.0001). The number of sexual intercourses between SHT-ARE and PL was increased significantly (P = 0.001), while FSDS scores showed a significant difference in both SHT-ARE (P < 0.0001) and SHT (P = 0.008) when compared to the PL group. Improved OHQ scores in the SHT-ARE group (P < 0.0001) signify greater happiness. Reduced POMS values (SHT-ARE) specified reductions in Tension, Anger, Depression, Fatigue, Esteem-related affect, Confusion, and Total score (P < 0.0001) compared to PL. The SHT-ARE group at week 8 represented no significant differences in PSQI scores, except for Sleep efficiency (P = 0.045) compared to PL. All reported events were mild and resolved with no intervention.

Conclusion: Shatavari root extract is considered a safe, effective, and well-tolerated treatment for improving women's sexual health and well-being. In addition, it shows an additive effect in combination with Ashwagandha.