Journal of gynecology obstetrics and human reproduction最新文献

Background: Prolonged pregnancy is associated with an increased risk of maternal, fetal and neonatal complications. Careful monitoring and systematic induction at 42 weeks of gestation are recommended in France.

Objectives: Our primary objective was to identify determinants for spontaneous labor during expectant management for prolonged pregnancy. Our secondary objective was to assess the efficacy of membrane sweeping in bringing on labor.

Study design: This observational, retrospective, monocentric study included all patients with a singleton pregnancy who had reached the term of 41 weeks of gestation to within one day. They underwent an expectant period up to 41 weeks and 6 days with fetal heart monitoring and ultrasound every two days. The cohort was divided into two groups according to the presence or absence of membrane sweeping. In the group that did not undergo membrane sweeping (Natural History cohort), we compared patients who entered spontaneous labor with those who required induction of labour.

Results: A total of 366 patients were included. For the 293 patients without membrane sweeping, spontaneous labor occurred in 51.1% of cases. A higher Bishop score (p = 0.02) and a lower BMI (p = 0.08) were associated with spontaneous labor. Parity had no influence (p = 0.74). Effectiveness of membrane sweeping to promote spontaneous labor was highlighted after adjustment on parity, BMI and Bishop score (71.6% vs 51.5%, p=0.021, SMD=0.422).

Conclusion: In prolonged pregnancy, the probability of going into spontaneous labor was only 50.9%. Low BMI and high Bishop score were associated with spontaneous onset of labor in case of expectant management. Membrane sweeping was associated with spontaneous labor in our post-term population after adjustment on parity, BMI and Bishop score.

Background: Semaglutide, a glucagon-like peptide-1 receptor agonist, is increasingly used for the treatment of diabetes and weight loss, including in women of reproductive age. However, its impact on pregnancy outcomes remains largely unknown, with limited data available. The manufacturer advises against using semaglutide within two months prior to planned pregnancy, but some patients may unknowingly use it during early pregnancy.

Case presentation: We report the case of a 37-year-old woman with a pre-pregnancy Body Mass Index (BMI) of 27.73 kg/m². She received semaglutide 0.5 mg once weekly, initiated before conception and continued until approximately 7 weeks of gestation, and discontinued treatment immediately upon recognition of pregnancy. All prenatal screenings, including nuchal translucency and four-dimensional color Doppler ultrasound, were normal. She delivered a healthy male infant at nearly 40 weeks of gestation. The infant showed no adverse outcomes during follow-up assessments at 1 and 3 months of age.

Conclusions: This case suggests that semaglutide exposure during early pregnancy may not necessarily lead to adverse outcomes in obese women. However, larger studies are needed to confirm these findings and to better understand the impact of semaglutide on pregnancy outcomes. This case report contributes to the limited literature on this topic and may inform future clinical decision-making.

Cesarean scar pregnancy (CSP) is a variant of uterine ectopic pregnancy defined by full or partial implantation of the gestational sac in the scar of a previous cesarean section. The most usual recommendation is termination of pregnancy in the first trimester. In this article, we present a case of live birth after detecting CSP in early pregnancy and robotic scar reinforcement surgery, effectively relocating the pregnancy into the cavum. At 25+3 gestational weeks, an emergency caesarean section was performed. A girl weighing 800 g was delivered with APGAR 7/7/9. The percrete area of the placenta was excised and the uterus could be preserved. Prolongation of CSP and consecutive live birth is feasible and can be achieved. Using robotic surgical approach for both the scar reinforcement surgery as well as the surveillance of the pregnancy including caesarean section with management of placenta percreta require high expertise and specialized centres.

Introduction: This study sought to assess the impact of transcutaneous electrical nerve stimulation (TENS) prescribed by gynecologists in routine practice on pain, pelvic sensitization, quality of life, and catastrophization scores in patients with endometriosis and chronic pelvic pain.

Methods: Thirty patients at the University Hospital of Rennes, France, diagnosed with endometriosis and experiencing chronic pelvic pain, received TENS between September 2022 and February 2023. Pain, pelvic sensitization, quality of life, catastrophization, and Brief Pain Inventory (BPI) were assessed using standardized and validated questionnaires before and after 1, 3, and 6 months of TENS device use.

Results: After 1 month of device use, minimal changes occurred as improvement in the perception of treatment effectiveness by patients, sleep quality, and well-being (BPI). However, after 3 months, a significant improvement was observed in all these measures, which persisted at 6 months. Specifically, pain intensity (numerical rating scale) significantly decreased (p=0.029), pelvic sensitization decreased (p=0.039), quality of life assessed by the EHP-5 score improved (p=0.003), and catastrophization scores significantly decreased (p=0.003). Patients also reported a notable improvement in their perception of treatment effectiveness, particularly in terms of its impact on work and interactions with others (BPI).

Conclusions: TENS prescribed by gynecologists in routine practice may be effective in reducing pain, pelvic sensitization, and improving quality of life and catastrophization scores in patients with endometriosis and chronic pelvic pain. These findings are very useful in daily practice, especially for patients waiting for pain management physicians.

Radiation necrosis is a rare but serious complication of pelvic chemoradiotherapy that may closely mimic tumor recurrence on both imaging and clinical examination. We describe the case of a 43-year-old woman with FIGO stage II vaginal squamous cell carcinoma and synchronous CIN3 who developed profuse vaginal discharge and necrotic cervical lesions five months after completing chemoradiation and brachytherapy. MRI revealed a necrotic cervical mass with suspicious features, while biopsies initially yielded inconclusive results. A multidisciplinary approach was adopted: the patient received empirical antibiotics, underwent necrotic tissue debridement, and repeat biopsies. Final histology showed no viable malignancy, confirming radiation necrosis. The patient was managed conservatively with symptomatic improvement. This case highlights the diagnostic challenge of distinguishing necrosis from recurrence, where early imaging, cytology, and even initial biopsies may be misleading. Thorough evaluation and repeated sampling are essential to avoid overtreatment. We provide a literature-informed comparison of distinguishing features to guide clinical decision-making.

Background: Reproductive health is essential to women's well-being. Rising infertility rates are influenced by environmental and lifestyle factors. Aging significantly reduces ovarian reserve and oocyte quality, especially after age 35. Anti-Müllerian hormone (AMH) is a reliable marker for assessing ovarian reserve. Air pollution, particularly exposure to particulate matter (PM) and nitrogen oxides (NOx), may be negatively associated with ovarian reserve and reproductive health.

Objectives: To evaluate current evidence on the effects of air pollution on AMH levels.

Methods: We systematically searched PubMed, Embase, and Web of Science for studies published from January 2000 until December 29, 2024, using specific keywords. Two reviewers independently screened studies based on predefined inclusion criteria, focusing on original articles examining the relationship between air pollutants and AMH levels. Data were extracted using Google Sheets. Study quality was assessed using the AXIS tool for cross-sectional studies and the Newcastle-Ottawa Scale for cohort studies.

Results: Twelve studies were included. Nine reported a significant association between air pollution and reduced AMH levels. The methodological quality of studies ranged from fair to good, supporting the robustness of findings.

Conclusion: Air pollution may significantly reduce ovarian reserve. Reducing exposure to PM2.5 and NOx is crucial for fertility preservation, especially in polluted urban areas.

Introduction: Vaginal natural orifice transluminal surgery (vNOTES) is a promising tool in gynecology and is being increasingly adopted in minimally invasive surgery. The aim of this study is to assess the feasibility and outcomes of vNOTES for morbidly obese patients for gynecological surgeries.

Material and methods: Morbidly obese patients (BMI≥40kg/m²) who underwent vNOTES for gynecological conditions from March 2021 to June 2025 were identified. Data on patient demographics, operative factors, complications and postoperative outcomes were collected and analyzed. A literature review on gynecology vNOTES in morbidly obese patients was also performed.

Results: 32 patients were identified. The median BMI was 42.1kg/m² (range 40.0 - 72kg/m²). Their age ranged from 23 to 77 years old. 50% of them had a previous abdominal or pelvic surgery. 50% were nulliparous. The most common procedure performed was total hysterectomy bilateral salpingoophorectomy (81.3%). One patient underwent pelvic lymph node dissection. The median operative time was 150mins (range 75 - 475mins). The median blood loss was 200mL (range 0 - 1700mL). The median length of stay was 2 days (range 1 - 38 days) and postoperative pain scores were low. One patient developed a postoperative pelvic collection that was treated conservatively. In the literature review comparing 3 other studies, the perioperative and postoperative complication rates and median operation time were generally comparable, although this interpretation is limited by the small sample sizes.

Conclusion: vNOTES is a feasible approach in morbidly obese patients for various gynaecological surgeries, demonstrating favourable outcomes.

Context: Foetal Alcohol Syndrome (FAS) is the most severe form of Foetal Alcohol Spectrum Disorders (FASD), caused by prenatal alcohol exposure, a major preventable cause of congenital disability. FASD lack specific prenatal ultrasound signs, making early diagnosis difficult.

Objective: To describe prenatal ultrasound findings in pregnancies with reported alcohol use and compare maternal and neonatal characteristics according to the presence of anomalies.

Methods: We conducted a retrospective multicentre study in three hospitals from September 2013 to April 2025. All women reporting alcohol use during pregnancy were included. Exposure was classified by quantity (moderate: ≤3 drinks/day or <40 cl/day; excessive: >3 drinks/day or >40 cl/day) and frequency (occasional, often, chronic), based on maternal self-report. Ultrasound scans from all trimesters were reviewed for growth and morphological anomalies. Comparative analyses were performed between women with and without anomalies.

Results: Among 94 pregnancies, 30 (32%) showed ultrasound anomalies. Women with anomalies were older (33.9 vs. 31.7 years, p <0.01), with no differences in BMI, parity, or co-exposures. Occasional alcohol use appeared not associated with anomalies, whereas increasing maternal age (aOR = 1.22; 95% CI [1.09-1.40]) was an independent risk factor. Most anomalies were detected in the second trimester, mainly foetal growth restriction (FGR) and microcephaly. Neonatal abnormalities occurred in 70% of the anomaly group versus 10.9% without anomalies (p < 0.01). Seven neonates (11%) had undiagnosed FGR or microcephaly at birth.

Conclusion: Ultrasound anomalies were found in one-third of alcohol-exposed pregnancies, underscoring the risks of chronic alcohol use.