International Journal of Women's Health最新文献

Purpose: Preoperative diagnosis of uterine leiomyosarcoma (ULMS) can be difficult due to its ability to mimic benign leiomyomas (LM). The current study aimed to investigate the influence of preoperative clinical characteristics and hematologic parameters on preoperative diagnosis and to design a scoring system.

Patients and methods: We conducted a retrospective analysis of 288 patients with uterine tumors treated at the First Affiliated Hospital of Wenzhou Medical University between January 2006 and April 2022, including 64 with ULMS and 224 with LM. Preoperative clinical and laboratory variables were compared between groups. Logistic regression analysis was employed to identify predictors of ULMS, with receiver operating characteristic (ROC) curves used to evaluate diagnostic performance.

Results: Multivariate analysis identified four independent risk factors for ULMS: older age (>48 years), larger tumor size (>9.7 cm), elevated systemic immune-inflammation index (SII > 500), and higher controlling nutritional status score (CONUT ≥ 3) (all P<0.001). A preoperative scoring system was developed by assigning one point for each risk factor, yielding a total possible score of 0-4 points. A score ≥ 2 points demonstrated significant utility in differentiating ULMS from LM (AUC = 0.823, sensitivity 64.1%, specificity 85.3%).

Conclusion: This single-center retrospective study demonstrates that the integration of age, tumor size, SII, and CONUT score shows promising utility for preoperative differentiation between ULMS and LM. The constructed scoring system may provide valuable auxiliary support for identifying occult ULMS preoperatively. However, given the study's limitations, including its retrospective design and sample size, external validation through large-scale, multicenter prospective studies is necessary before clinical implementation.

Background: Pelvic organ prolapse (POP) is a global problem that severely affects a woman's quality of life. This study aimed to investigate the association between weight change during pregnancy and post-pregnancy POP.

Methods: This study retrospectively enrolled 640 participants from Tianjin Central Hospital of Gynecology Obstetrics (institution 1, n = 363 cases) in northern China and First People's Hospital of Wanzhou District, Chongqing (institution 2, n = 277 cases) in southwestern China. The participants were grouped into POP-Q I-II (n = 288), POP-Q III-IV (n = 132), and non-POP groups (control group, n = 220). Pre-pregnancy body mass index (BMI), weight gain during pregnancy, and weight retention at 6 months postpartum were compared among the three groups after eliminating confounding factors.

Results: No statistically significant differences were detected in the pre-pregnancy BMI in the POP-Q I-IV, POP-Q I-II, and POP-Q III-IV groups compared to the control group (P > 0.05). Significant statistical differences (P < 0.05) were observed in weight gain during pregnancy (≥14 kg) in the POP-Q I-IV, POP-Q I-II, and POP-Q III-IV groups compared with the control group. Significant statistical differences (P < 0.05) were observed in weight retention (≥5 kg) at 6 months postpartum among the POP-Q I-IV, POP-Q I-II, and POP-Q III-IV groups compared to the control group.

Conclusion: Weight change during the perinatal period is the risk factor of postpartum POP. Specifically, a pre-pregnancy BMI < 23 kg/m² did not increase the risk of POP, whereas gestational weight gain ≥14 kg and weight retention ≥5 kg at 6 months postpartum significantly increased the risk of postpartum POP. Weight management programs during and after pregnancy may help reduce the risk of POP.

Objective: About 26% of all pregnancies result in miscarriage, with up to 10% occurring in clinically diagnosed pregnancies. Additionally, recurrent pregnancy loss affects approximately 5% of couples of childbearing age. Although there are several known causes of pregnancy loss in the first half, including parental chromosomal abnormalities, uterine malformations the possible role of placental growth factor (PLGF) remains unclear. The aim of this study was to evaluate the possible predictive role of serum and urinary PLGF for miscarriages in the first trimester of pregnancy.

Materials and methods: Case-control studies were conducted. The study included 347 pregnant women, the group of miscarriages comprised 156 and the control group 191. The study did not include patients with serious health problems or high risk of miscarriage. Miscarriages were identified: confirmed clinical and ultrasound signs of embryo/fetal expulsion, anembryonic pregnancy and missed abortion. Concentrations of serum and urinary PLGF were detected by ELISA.

Results: Serum PLGF concentrations in miscarriage were 19.8 (12.7-31.9) pg/mL, which was significantly lower than serum PLGF concentrations in uncomplicated pregnancy of 45.5 (25.4-60.0) pg/mL p <0.0001. ROC analysis revealed the diagnostic significance of serum PLGF: AUC 0.765 (CI 0.717-0.809) (p <0.0001), Se 84.6% (CI 77.7-90.0) Sp 68.7% (61.7-75.1), with cut-off ≤35.6 pg/mL, diagnostic odds ratio (DOR) 12. Odds ratio for miscarriages for serum PLGF concentration <35.6 pg/mL was 10.9 (6.5-18.4). Evaluation of urinary PLGF did not reveal diagnostic and prognostic efficacy of miscarriages.

Conclusion: The serum PLGF might be considered as a prediction marker of the miscarriages with a suggested cut off concentration of 35.6 pg/mL. A further investigation should be carried out on the larger cohorts from various geographical areas.

Background: Biological aging is a systemic driver of chronic disease, yet its relationship with female urinary incontinence (UI) remains unexamined. We leveraged three conceptually distinct metrics-PhenoAge (PA), Klemera-Doubal Method (KDM), and Homeostatic Dysregulation (HD)-to quantify biological age and assessed their associations with stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) in a nationally representative cohort.

Methods: This cross-sectional study included 8,561 women ≥20 years from NHANES 2005-2010 and 2015-2018. After outlier exclusion and covariate selection via LASSO regression, multivariable logistic regression and restricted cubic splines (RCS) were used to estimate ORs and dose-response shapes. Subgroup analyses, mediation analyses, and sensitivity analyses were performed.

Results: PA and KDM were positively associated with UI. The third quartile of PA and KDM conferred the highest risk for SUI (PA: Q3 OR = 1.58, 95% CI 1.33-1.88; KDM: Q3 OR = 1.39, 95% CI 1.20-1.62). Higher quartiles were also linked to greater UI severity. Fully adjusted RCS models revealed inverted J-shaped relationships for SUI (PA inflection: 43.6; KDM: 34.7) and inverted U-shaped relationships for UUI and MUI with KDM (UUI inflections: 40.7 and MUI inflections: 40.5). Associations were robust across most subgroups but attenuated with increasing reproductive risk factors. No significant mediation by sex steroids or α-Klotho was observed.

Conclusion: Biological aging is significantly positively associated with UI, and its relationship with SUI follows an inverted J-shaped curve. Interventions that slow biological aging may offer a novel strategy for UI prevention; however, longitudinal studies are required to establish causality.

Background: Non-medically indicated caesarean section (CS) is a growing contributor to rising CS rates globally and in Thailand, influenced by maternal preference, socio-cultural factors and clinical decision-making. Understanding women's perspectives is essential to guide counselling strategies and inform policy targeted at reducing unnecessary CS.

Objective: To explore pregnant women's attitudes, perceptions and determinants of preference for non-medically indicated CS and identify factors associated with CS preference.

Methods: This prospective, descriptive, three-phase mixed-methods study was conducted from May 1 to July 30, 2024. The study was conducted at an antenatal clinic. The study comprised three phases: in-depth interviews with 40 pregnant women, questionnaire development and validation, and a survey of 400 participants. Descriptive statistics summarised had demographic data, while univariable chi-squared tests and multivariable logistic regression analysed factors associated with non-medically indicated CSs. Odds ratios and 95% confidence intervals (CIs) were reported, with statistical significance set at P < 0.05. The main outcomes and measures were the attitudes, perceptions, policy, implementation science, counselling frameworks, and clinician-patient power dynamics of pregnant women towards non-medically indicated caesarean sections.

Results: Among the 400 women surveyed, 75% preferred vaginal delivery as a more natural and less risky option. However, 60% 60% reported they would still agree to a CS if recommended by a doctor, indicating high reliance on physician guidance even in situations without clear medical indication. Key factors affecting delivery preferences included prior caesarean delivery (adjusted odds ratio 2.5, 95% CI 1.5‒4.0) and maternal age over 35 years (adjusted odds ratio 1.8, 95% CI 1.1‒2.9). Comprehensive counselling was deemed essential by 80% of participants, who reported greater confidence in choosing vaginal delivery after thorough discussions of risks and benefits. Auspicious timing influenced 39.5%, while 37.3% were swayed by pain perception. Higher education levels, assisted conception methods and concerns about safety, such as blood loss, also shaped CS preferences.

Conclusion: Pregnant women in Thailand generally prefer vaginal birth but are highly influenced by physician recommendations. Strengthening counselling, addressing misconceptions and incorporating shared decision-making into routine antenatal care may reduce non-indicated CS demand. Findings support future development of counselling frameworks and policy interventions to promote safe, evidence-based delivery choices.

Thai clinical trials registry reference: TCTR 20230913007: Date of registration 13 September 2023.

Objective: The aim of this study was to explore potential novel genes associated with Müllerian duct anomalies (MDAs) through next-generation sequencing techniques.

Materials and methods: Whole-exome sequencing (WES) was conducted for 5 unrelated patients of Chinese Han ethnicity diagnosed with congenital absence of the uterus and vagina (CAUV), alongside 10 unaffected women. Genomic data were sourced from a public database. Diagnosis and classification of the anomalies were based on findings from ultrasound imaging, hysterosalpingography, and hysteroscopy. A previously unreported candidate gene, CASKIN2, was identified. Subsequently, 120 unrelated patients with MDAs, who sought infertility treatment at the Center for Reproductive Medicine, The First Affiliated Hospital of Anhui Medical University between January 2008 and December 2011, were included for targeted analysis of candidate genes and variants detected through WES.

Results: Two novel heterozygous missense variants in the CASKIN2 gene (NM_020753: c.969C>A, p.H323Q; c.1228G>A, p.V410M) were identified in two unrelated patients with CAUV through WES. Further direct sequencing of all coding exons of CASKIN2 in the cohort of 120 patients with MDA revealed three additional missense variants (c.1128G>A, p.V410M; c.2816C>T, p.T939M; c.3377G>A, p.R1126H). No pathogenic variants were detected among individuals in the control group.

Conclusion: The CASKIN2 gene, which is evolutionarily conserved across multiple species and known to interact with CASK, may represent a novel candidate gene associated with MDAs in people of Chinese Han ethnicity. The CASKIN2-CASK signaling axis appears to play an evolutionarily conserved and indispensable role during human Müllerian-duct development.

[This retracts the article DOI: 10.2147/IJWH.S542758.].

Objective: To investigate the effects of Diane-35 combined with metformin on hormone levels and pregnancy outcomes in patients with polycystic ovary syndrome (PCOS).

Methods: A retrospective analysis was conducted on patients diagnosed with PCOS who received treatment at our hospital between January 2023 and October 2024. Patients were divided into control and study groups based on their treatment regimens. The control group received conventional metformin therapy, while the study group received Diane-35 in addition to metformin. The inclusion criteria are based on the 2003 Rotterdam Conference criteria (oligoovulation/anovulation, hyperandrogenism, polycystic ovary morphology); Exclusion criteria include liver and kidney dysfunction, pituitary adrenal/thyroid disease, non PCOS infertility factors, fallopian tube obstruction, immune/hematological abnormalities, and severe complications. Finally, 170 PCOS patients were included (85 in each group after propensity score matching, Using propensity score matching (PSM) for 1:1 non replacement matching, based on age BMI, Construct a logistic regression model to calculate propensity score for 9 baseline characteristics, including basal hormone levels, with a caliper value of 0.02. After matching, the standardized deviations of each variable were all <10% and there was no significant difference in t-test). Hormone levels were compared between the two groups, and pregnancy outcomes were analyzed for patients with successful pregnancies.

Results: After treatment, the study group demonstrated significant reductions in ovarian volume and antral follicle count, alongside increased endometrial thickness (P < 0.05). Body mass index (BMI), luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T) levels, and insulin resistance index (HOMA-IR) were lower in the study group compared to the control group (P < 0.05), while estradiol (E2) levels were significantly elevated (P < 0.05). The study group achieved a higher pregnancy success rate (89.41% vs 34.12%) and live birth rate (98.68% vs 79.31%) compared to the control group (P < 0.05), with a markedly lower abortion rate (5.88% vs 25.88%) (P < 0.05).

Conclusion: This study confirms the significant efficacy of Diane-35 combined with metformin in improving hormone levels and pregnancy outcomes in PCOS patients, but it should be noted that retrospective design may have selection bias, short-term observation (12 months) limits long-term safety evaluation, and insufficient sample size limits subgroup analysis (such as differences in efficacy among different BMI stratification). Future multicenter prospective studies are needed for validation.

In Somalia, the cultural requirement for male family authorization before surgical procedures even in emergencies remains a silent but deadly barrier to timely care. This practice, particularly in obstetric emergencies such as caesarean section, delays life-saving interventions, heightening risks for mothers and newborns. Evidence from Somaliland shows that nearly half of prolonged caesarean section delays are due to family decision-making for consent, with a measurable increase in severe maternal outcomes. This article is presented as a policy commentary aimed at highlighting the impact of current consent practices on women's health and proposing feasible reforms. Respectfully, this commentary urges lawmakers, healthcare leaders, and community elders to consider a compassionate reform that enshrines a woman's right to make informed decisions about her own health. By aligning policy with both ethical medical practice and Islamic principles of preserving life, Somalia can move toward a safer, more equitable maternal health system. This commentary recommends five key actions: legally affirming women's right to self-consent, enabling emergency presumed consent when delays endanger life, introducing advance antenatal consent to prevent avoidable delays in emergencies, engaging communities to build understanding and acceptance, and strengthening provider training to support respectful and timely decision-making.

Purpose: Breast-conserving surgery (BCS) followed by adjuvant radiotherapy is the standard treatment for early breast cancer in Indonesia. Our aim was to compare the outcomes of BCS with oncoplastic surgery (OPS), a less common method of breast cancer treatment in the country.

Patients and methods: This retrospective cohort study was conducted at Hasan Sadikin General Hospital, Bandung, West Java, Indonesia. Patients with biopsy-proven Stage I to II breast cancer who underwent either OPS or BCS between 1 July 2020 to 30 June 2023, were identified. Data were collected by reviewing patient files and electronic records.

Results: A total of 82 patients were included in the study, with 43 (52.4%) undergoing BCS and 39 (47.6%) undergoing OPS. Age in OPS group 39.25 ± 4.9 was not significant difference compare with BCS group 39.86 ± 5.11. The mean tumor volume was higher in the OPS group (34.72 cm³) compared to the BCS group (22.35 cm³), and postoperative complications were also higher in the OPS group (7.6% vs 0%). Despite the use of frozen section analysis in the operating theatre, the frequency of positive margins was greater in the BCS group (9.3% vs 2.5%). There were no significant differences in the histologic type of tumor and immunohistochemistry between the two groups.

Conclusion: OPS is a valid alternative approach to breast cancer treatment that can be offered to women with early stage breast cancer at complex locations owing to the reduced occurrence of positive margins and thus lowered re-excision rates.