Journal of gynecology obstetrics and human reproduction最新文献_第2页

Nomograms for Predicting Risk and Prognosis of Liver Metastases in Ovarian Cancer Patients.

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction

Pub Date : 2025-01-30 DOI: 10.1016/j.jogoh.2025.102918

Feng Jiang, Chunfang Yao

Aims: Liver metastases (LiM) commonly manifest in ovarian cancer (OC) patients. We intended to establish nomograms for predicting the risk and prognostic factors in OCLiM patients.

Methods: Data from the SEER database (Nov 2022, Sub 1992-2020) were analyzed, excluding patients with missing data on liver metastases, survival months, race, AJCC T stage, marital status, rural/urban status, and metastases to bone, brain, or lung. Logistic and Cox regression analyses identified risk and prognostic factors for liver metastases. Predictive nomograms were developed from the multivariable regression results. The nomograms were evaluated using Harrell's C-index, ROC curve, calibration curve, DCA, NRI, and IDI. Moreover, the efficacy of the treatment in the new risk stratification subgroups was demonstrated by Kaplan-Meier (KM) curves.

Results: Among 17,056 OC patients, 5.67% (n = 967) had liver metastases. Nomograms were constructed based on identified risk and prognostic factors, with dynamic web-based nomograms developed for clinical use. The nomogram demonstrated C-index values of 81.9% (training) and 82.9% (validation) for predicting liver metastases. For OS and CSS, the C-index values were 73.3% and 73.7% (training), and 73.3% and 72.8% (validation), respectively. The ROC curves for OS at 1-, 3-, 5-year showed AUC values of 84.1%, 79.8%, 75.9% (training) and 82.9%, 78.5%, 82.2% (validation), respectively. For CSS, AUC values at 1-, 3-, and 5-year were 84.5%, 80.2%, 76.1% (training) and 82.6%, 78.0, 82.0% (validation), respectively. The calibration and DCA curves confirmed favorable performance. NRI and IDI analyses showed superiority over the Grade and AJCC stage systems. Surgery improved prognosis in the low-risk group, while chemotherapy was more effective in both low- and medium-risk groups.

Conclusions: we developed nomograms and risk stratification systems to assist clinicians in the individualized prediction, risk stratification, and prognostic assessment of OCLiM patients.

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引用次数: 0

Modelling the cost effectiveness and budget impact of uterine botulinum toxin injections versus conventional treatment in severe dysmenorrhoea: A French Perspective.

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction

Pub Date : 2025-01-29 DOI: 10.1016/j.jogoh.2025.102912

Jean Martial Kouame, Jason Robert Guertin, Éric Bautrant, Christine Levêque, Carole Siani

Objective: To assess the cost-effectiveness sand the budgetary impact of the combination of botulinum toxin (BT) + conventional treatment (CT) (hormonal treatments + analgesics) compared with CT alone in patients suffering from severe dysmenorrhoea, using a Markov model.

Methods: A Markov model was developed to estimate, from the perspective of French Health Insurance (HI), the cost effectiveness and the budgetary impact of BT+CT compared with CT alone. The main health states in the model were based on Visual Analogue Scale (VAS) scores and expert opinion. All model parameters were derived from a cohort of patients treated for 12 months at the Centre de Recherche de la Santé et de la Femme (CRSF) for severe dysmenorrhoea in 2021. A Cost-Utility Analysis (CUA) was carried out to assess the quality of life of patients, crucial in this context, in which the direct healthcare costs were considered in and Budget Impact Analysis (BIA). The main decision-making criteria were the Incremental Cost-Utility Ratio (ICUR) for the CUA and the net impact for the BIA. Deterministic and probabilistic univariate sensitivity analyses were performed to assess the robustness of our results.

Results: Over the 1-year time horizon (main analysis), the costs and quality-adjusted life year (QALY) of BT+CT versus CT alone were equal to €1895.65 vs €3055.20 and 2.03 QALYs vs 1.23 QALYs, respectively. Consequently, the ICUR equalled -€1651.5/QALY, which shows that, although the initial costs of BT are higher than those of CT, the reduced follow-up costs associated with the long-term efficacy of BT make it the most effective and economically dominant option at 1, 5 and 10 years. Sensitivity analyses show that 100% of Monte Carlo iterations are below the willingness-to-pay threshold of €30,000¹/QALY, making BT+CT an efficient strategy that could be adopted and reimbursed.

Conclusion: In the absence of a reference treatment for the management of severe dysmenorrhoea, BT+CT offering an improvement in quality of life, as well as a reduction in follow-up costs. It is therefore the most cost-effective strategy over 10 years.

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引用次数: 0

Success of outpatient hysterectomy: V-Notes versus Vaginal hysterectomy

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction

Pub Date : 2025-01-25 DOI: 10.1016/j.jogoh.2025.102916

Clara Dujardin , Michel Cosson , Helene Behal , David Vandendriessche , Margaux Merlier , Geraldine Giraudet

STUDY OBJECTIVE

Vaginal hysterectomy (VH) is the approach of choice for benign uterine conditions and is suitable for outpatient care. Many studies suggest that the vaginal natural orifice transluminal endoscopic surgery (V-Notes) technique is reliable and safe for outpatient surgery, but the literature includes only pilot studies with small cohorts. The aim is to assess the V-Notes technique compared to VH in outpatient settings with a larger cohort.

METHOD

This is a retrospective cohort study including patients who underwent V-Notes or VH, scheduled as outpatient procedures, at Lille University Hospital between 2016 and 2022.

Baseline characteristics and surgical outcomes were compared. The primary outcome was the success of outpatient surgery. Secondary outcomes were intraoperative and postoperative complication rates and factors limiting outpatient feasibility.

MEASUREMENTS AND MAIN RESULTS

373 patients were included, 204 underwent V-Notes and 169 VH. In the V-Notes group there were more nulliparous women (27.9% vs 14.8 %, p < 0.002), more larger uteri (>280 g) (30.8% vs 12.9 %, p < 0.001) and more salpingectomy performed (98% vs 79.9 %, p < 0.001), compared with the VH group. The outpatient success rate did not differ significantly between the two groups (83.3% vs 79.9 %, p = 0.39, adjusted p = 0.50), even after adjusting for nulliparity, salpingectomy, and uterine weight greater than 280 g (adjusted OR 1.24), with no differences in complications or factors limiting outpatient feasibility.

CONCLUSION

V-Notes hysterectomy is a safe outpatient procedure, showing no differences for outpatient care success compared to VH, even for patients with larger uteri or nulliparity, while allowing for more salpingectomies. Additionally, the V-Notes approach appears promising for hysterectomies in nulliparous women or those with large uteri.

研究目的：阴道子宫切除术（VH）是良性子宫疾病的首选方法，适合门诊治疗。许多研究表明，阴道自然腔道内窥镜手术（V-Notes）技术在门诊手术中是可靠和安全的，但文献中仅包括小样本的试点研究。本研究的目的是在门诊环境中通过更大规模的队列来评估 V-Notes 技术与 VH 的比较：这是一项回顾性队列研究，包括2016年至2022年期间在里尔大学医院接受V-Notes或VH手术的门诊患者。比较了基线特征和手术结果。主要结果是门诊手术的成功率。次要结果为术中和术后并发症发生率以及限制门诊手术可行性的因素：共纳入 373 名患者，其中 204 人接受了 V-Notes 手术，169 人接受了 VH 手术。与 VH 组相比，V-Notes 组中无阴道的女性更多（27.9% 对 14.8%，P < 0.002），子宫更大（>280g）的女性更多（30.8% 对 12.9%，P < 0.001），进行输卵管切除术的女性更多（98% 对 79.9%，P < 0.001）。两组的门诊成功率没有显著差异（83.3% vs 79.9%，p = 0.39，调整后p = 0.50），即使在调整了无子宫、输卵管切除术和子宫重量大于280克（调整后OR 1.24）后也是如此，并发症或限制门诊可行性的因素也没有差异：结论：V-Notes子宫切除术是一种安全的门诊手术，与VH相比，门诊护理的成功率没有差异，即使是子宫较大或无子宫的患者也是如此，同时允许进行更多的输卵管切除术。此外，V-Notes 方法似乎有望用于无子宫或子宫较大的妇女的子宫切除术。

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引用次数: 0

Vaginal versus laparoscopic suture for vaginal cuff closure in total robot-assisted laparoscopic hysterectomy: A multicentric comparative study

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction

Pub Date : 2025-01-25 DOI: 10.1016/j.jogoh.2025.102911

Henri Wohrer , Sixtine Bernard , Victor Gaultier , Clementine Gonthier , Geoffroy Canlorbe , Juan Pablo Estevez , Martin Koskas

Background

Vaginal cuff closure is an important step in hysterectomy. To date, the literature and data on this procedure are inconsistent, and the optimal approach (i.e., vaginal or laparoscopic) for closing the vagina at the end of laparoscopic robot-assisted hysterectomy remains unclear. Vaginal cuff complications are rare, but their prevention is an important issue.

Objective

The objective of the present study was to compare early postoperative complications in patients who underwent robot-assisted hysterectomy between the robot-assisted closure group and the transvaginal closure group.

Methods

In this observational, retrospective, multicentre study, patients who underwent total robot-assisted hysterectomy between January 2016 and March 2021 were included. Two groups (robot-assisted and transvaginal closure groups) were compared in terms of the rate of rehospitalization within the first 30 postoperative days, for all causes and for vaginal scar-related complications.

Results

Among the 328 patients included, 185 and 143 underwent robot-assisted and transvaginal closure, respectively. Patients in the transvaginal closure group had a significantly greater risk of rehospitalization for all causes (9.8 % vs. 3.2 %; p = 0.02) and for vaginal cuff complications (8.4 % vs. 2.6 %, p = 0.04). According to the univariate analysis, obesity, HIV infection, blood loss > 500 mL and transvaginal closure were associated with a higher incidence of rehospitalization within 30 days. Multivariate analysis revealed that transvaginal closure (p = 0.01) and obesity (p = 0.03) were significantly associated with a greater risk of rehospitalization.

Conclusion

Compared with transvaginal closure, robot-assisted vaginal closure in robot-assisted total hysterectomy is associated with a reduction in all-cause rehospitalization as well as a reduction in rehospitalization due to vaginal cuff complications. Rates of rehospitalization for vaginal abscess or bleeding could be reduced by avoiding transvaginal closure.

背景：阴道袖带闭合是子宫切除术的重要步骤。迄今为止，有关该手术的文献和数据并不一致，腹腔镜机器人辅助子宫切除术结束时关闭阴道的最佳方法（即阴道或腹腔镜）仍不明确。阴道袖带并发症很少见，但预防并发症是一个重要问题：本研究旨在比较机器人辅助阴道闭合组和经阴道闭合组接受机器人辅助子宫切除术患者的术后早期并发症：在这项观察性、回顾性、多中心研究中，纳入了2016年1月至2021年3月期间接受全机器人辅助子宫切除术的患者。比较了两组（机器人辅助组和经阴道闭合组）术后前30天内因各种原因和阴道疤痕相关并发症再次住院的比例：在328名患者中，分别有185人和143人接受了机器人辅助和经阴道闭合术。经阴道闭合组患者因各种原因（9.8% 对 3.2%；P = 0.02）和阴道袖带并发症（8.4% 对 2.6%；P = 0.04）再次住院的风险明显更高。根据单变量分析，肥胖、HIV 感染、失血量大于 500 毫升和经阴道闭合与 30 天内再次住院的发生率较高有关。多变量分析显示，经阴道闭合（p = 0.01）和肥胖（p = 0.03）与再次住院的风险显著相关：结论：与经阴道闭合术相比，机器人辅助全子宫切除术中的机器人辅助阴道闭合术可降低全因再住院率，并降低因阴道袖带并发症导致的再住院率。避免经阴道闭合术可降低阴道脓肿或出血的再住院率。

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引用次数: 0

Advocating a specific risk calculation of trisomy 18 in case of low maternal serum markers during screening for fetal Down syndrome

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction

Pub Date : 2025-01-20 DOI: 10.1016/j.jogoh.2025.102915

Emeline Gernez , Corinne Sault , Nicolas Chatron , Marion Beaumont , Estelle Roland , Gilles Renom

Background

In France, legislation concerning pregnancy monitoring only considers screening for Down syndrome (T21), while the contingent introduction of the circulating cell free DNA test (DPNI) also allows screening for trisomies 13 and 18 with similar performances.

Methods

We retrospectively studied more than 800,000 patients among whom 7971 presented serum markers suggestive of T18 (but without increased risk of T21), of which 438 benefited from NIPT and of a complete pregnancy follow-up.

Results

We show that the use of a specific risk calculation for T18 would have improve the relevance of the prescription.

Conclusion

The generalization of this calculation would allow an optimization of the management of patients presenting a suggestive biochemical profile without significantly increasing the number of NIPT prescribed.

引用次数: 0

Predictors for negative large loop excision of the transformation zone (LLETZ) in a primary HPV screened population 原发性HPV筛查人群中阴性大环切除转化区（LLETZ）的预测因素。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction

Pub Date : 2025-01-17 DOI: 10.1016/j.jogoh.2025.102913

Victoria L Parker , Emma Long , Kay Ellis , Madeleine C Macdonald , Julia E Palmer

Objective

To assess rates of histologically negative large loop excisions of the transformation zone (LLETZ) and potential predictive factors within a single UK Colposcopy Unit.

Design

Retrospective cohort study.

Setting

Jessop Wing Colposcopy Unit, Sheffield, U.K.

Population

Patients coded upon the Colposcopy database as having undergone a LLETZ procedure.

Methods

Univariate (Chi squared, t-test) and multivariate logistic regression analysis.

Main outcome measures

Histological negative LLETZ sample.

Results

2,969 patients underwent a LLETZ procedure; 291 (10 %) procedures resulted in a negative LLETZ. Older age group (p < 0.0001), referral with negative cytology high risk human papillomavirus (hrHPV) detected (p < 0.0001), unsatisfactory colposcopy (p < 0.0001), repeat LLETZ (p < 0.0001), and biopsy and treat procedures (p = 0.0005) were found significant predictors of negative LLETZ. Patients with negative LLETZ were significantly less likely to have had a 'select & treat' procedure (p < 0.0001).

Conclusion

Due to the increased sensitivity of HPV testing in combination with cytology for the detection of high-grade disease, it is more likely a negative LLETZ will occur following positive biopsy. This may be due to the detection of small volume high-grade disease removed by the punch biopsy alone, spontaneous regression of disease, or resolution due to localised immune responses and healing. As increasing age and unsatisfactory colposcopy are significant risk factors for obtaining a negative LLETZ, the authors recommend further studies are conducted in this more challenging referral population.

目的：评估组织学阴性大环切除转化区（LLETZ）的比率和潜在的预测因素在一个英国阴道镜单位。设计：回顾性队列研究设置：英国谢菲尔德Jessop Wing阴道镜检查中心人群：在阴道镜检查数据库中编码为接受过LLETZ手术的患者。方法：单因素（卡方、t检验）和多因素logistic回归分析。主要观察指标：组织学阴性LLETZ样本。结果：2969例患者接受了LLETZ手术；291例（10%）手术导致LLETZ阴性。结论：由于HPV检测结合细胞学检测高级别疾病的敏感性增加，活检阳性后更有可能出现LLETZ阴性。这可能是由于仅通过穿刺活检检测到小体积高级别疾病，疾病自发消退或局部免疫反应和愈合而消退。由于年龄的增长和不满意的阴道镜检查是获得阴性LLETZ的重要危险因素，作者建议在这个更具挑战性的转诊人群中进行进一步的研究。

{"title":"Predictors for negative large loop excision of the transformation zone (LLETZ) in a primary HPV screened population","authors":"Victoria L Parker , Emma Long , Kay Ellis , Madeleine C Macdonald , Julia E Palmer","doi":"10.1016/j.jogoh.2025.102913","DOIUrl":"10.1016/j.jogoh.2025.102913","url":null,"abstract":"<div><h3>Objective</h3><div>To assess rates of histologically negative large loop excisions of the transformation zone (LLETZ) and potential predictive factors within a single UK Colposcopy Unit.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Jessop Wing Colposcopy Unit, Sheffield, U.K.</div></div><div><h3>Population</h3><div>Patients coded upon the Colposcopy database as having undergone a LLETZ procedure.</div></div><div><h3>Methods</h3><div>Univariate (Chi squared, <em>t</em>-test) and multivariate logistic regression analysis.</div></div><div><h3>Main outcome measures</h3><div>Histological negative LLETZ sample.</div></div><div><h3>Results</h3><div>2,969 patients underwent a LLETZ procedure; 291 (10 %) procedures resulted in a negative LLETZ. Older age group (<em>p</em> < 0.0001), referral with negative cytology high risk human papillomavirus (hrHPV) detected (<em>p</em> < 0.0001), unsatisfactory colposcopy (<em>p</em> < 0.0001), repeat LLETZ (<em>p</em> < 0.0001), and biopsy and treat procedures (<em>p</em> = 0.0005) were found significant predictors of negative LLETZ. Patients with negative LLETZ were significantly less likely to have had a 'select & treat' procedure (<em>p</em> < 0.0001).</div></div><div><h3>Conclusion</h3><div>Due to the increased sensitivity of HPV testing in combination with cytology for the detection of high-grade disease, it is more likely a negative LLETZ will occur following positive biopsy. This may be due to the detection of small volume high-grade disease removed by the punch biopsy alone, spontaneous regression of disease, or resolution due to localised immune responses and healing. As increasing age and unsatisfactory colposcopy are significant risk factors for obtaining a negative LLETZ, the authors recommend further studies are conducted in this more challenging referral population.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102913"},"PeriodicalIF":1.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

2D-transperineal ultrasound in delivery room: Contribution in assessing labor progress, predicting outcome of labor and recognizing obstetric anal sphincter injuries (OASIS). A systematic review 产房的2d经会阴超声：评估产程、预测产程结局和识别产科肛门括约肌损伤（OASIS）的贡献。系统回顾。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction

Pub Date : 2025-01-13 DOI: 10.1016/j.jogoh.2025.102910

Siegfried Nebel , Delphine Vardon , Michel Dreyfus , Anne-Cécile Pizzoferrato

Aims

Ultrasound is used in the delivery room to assess fetal head position, engagement during labor, and anal sphincter injuries in the immediate postpartum period. The transperineal approach allows for direct visualization of the structures of interest without altering anatomical landmarks. Various ultrasound measurements during labor have been described in the literature, and their use varies widely across maternity units. Our objective was to conduct a systematic review of the literature on relevant ultrasound parameters for the management of labor and delivery.

Material and methods

We reviewed articles indexed in MEDLINE from 1990 to 2022, selecting those that evaluated transperineal ultrasound during labor for term singleton fetuses in cephalic presentation.

Results

We identified 124 articles out of 394 references, including 4 randomized controlled trials, 108 prospective studies, 6 cross-sectional studies, and 6 retrospective studies. The Angle of Progression (AOP) is better documented and appears more reliable than the Head-Perineum Distance (HPD) for diagnosing engagement, monitoring labor, and predicting its outcome. The HPD is easier to perform but shows inconsistencies in the literature. The Head Progression Distance (HPrD) shows good performance but requires further studies before routine use, as does Head-Symphysis Distance (HSD). Recent studies show a growing interest in ultrasound biofeedback of fetal head progression to improve pushing efforts as well as screening for Obstetrical Anal Sphincter Injuries (OASIS).

Conclusions

Transperineal ultrasound is a minimally invasive technique that can be used routinely in the delivery room. It can aid in monitoring labor, predicting the mode of delivery, and may serve as valuable biofeedback to optimize pushing during expulsion.

目的：利用超声在产房评估胎儿的头部位置、分娩过程中的接合情况以及产后早期肛门括约肌损伤情况。经会阴入路可以在不改变解剖标志的情况下直接观察感兴趣的结构。各种超声测量在劳动期间已经在文献中描述，他们的使用在产科单位差别很大。我们的目的是进行一个系统的文献综述有关超声参数的管理劳动和分娩。材料和方法：我们回顾了MEDLINE从1990年到2022年收录的文章，选择了那些评估分娩时经会阴超声对足月单胎胎儿头位表现的文章。结果：我们从394篇文献中筛选出124篇，包括4项随机对照试验、108项前瞻性研究、6项横断面研究和6项回顾性研究。在诊断妊娠、监测产程和预测产程方面，进展角（AOP）比头会阴距离（HPD）更可靠。火奴鲁鲁警署更容易执行，但在文献中显示出不一致。头部进展距离（HPrD）显示出良好的性能，但在常规使用前需要进一步研究，头部联合距离（HSD）也是如此。最近的研究表明，胎儿头部进展的超声生物反馈越来越有兴趣，以改善推动努力以及产科肛门括约肌损伤（OASIS）的筛查。结论：经会阴超声是一种微创技术，可在产房常规使用。它可以帮助监测分娩，预测分娩方式，并可能作为有价值的生物反馈来优化排出过程中的推动。

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引用次数: 0

Exploring the influence of perineal biometrics and stiffness measured by elastography during pregnancy on perineal tears : A pilot study 探索妊娠期间会阴生物特征和弹性测量刚度对会阴撕裂的影响：一项初步研究。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction

Pub Date : 2025-01-11 DOI: 10.1016/j.jogoh.2025.102904

Marine Lallemant , Tiguida Kadiaké , Arnaud Lejeune , Michel Cosson , Jérôme Chambert , Emmanuelle Jacquet , Nicolas Mottet

Objectives

This study aimed to describe the biometrics and elasticity of the perineal body and the anal sphincter in the ninth month of pregnancy and explore their association with the risk of perineal tears during childbirth.

Methods

In this prospective observational study, pregnant women at 36–40 weeks of gestation were included. Using transperineal 2D-mode ultrasound and shear wave elastography (SWE), we measured the biometrics and stiffness of the perineal body (PB), external anal sphincter (EAS), internal anal sphincter (IAS), and anal mucosa (AM) at rest and during Valsalva maneuvers.

Results

Of the 16 women, five (31.2 %) were nulliparous and 10 (62.5 %) underwent a perineal tear. All were first degree perineal tears. Women with perineal tear had statistically a higher perineal body area at rest (0.9 ± 0.1 cm² versus 0.7 ± 0.1 cm², p = 0.03), a thicker EAS at 9 o'clock at rest (0.6 ± 0.2 cm vs 0.4 ± 0.1 cm, p = 0.03), a smaller anteroposterior diameter (1.7 ± 0.2 cm vs 2 ± 0.2 cm, p = 0.047), a smaller lateral diameter (1.4 ± 0.2 cm vs 1.6 ± 0.1 cm, p = 0.05) and a thinner IAS in average at rest (0.2 ± 0.0 cm vs 0.3 ± 0.0 cm, p = 0.007) and at 12 o'clock at rest (0.2 ± 0.1 cm vs 0.3 ± 0.0 cm, p = 0.002). The PB, EAS, IAS and AM elastic modulus in the ninth month of pregnancy tended to be higher in women with a perineal tear.

Conclusion

Assessing perineal and anal sphincter biometrics and stiffness via ultrasound and SWE is feasible and may indicate a risk of perineal tears.

Trial registration

The study was registered on (NCT05556304).

目的：本研究旨在描述妊娠第9个月会阴体和肛门括约肌的生物特征和弹性，并探讨它们与分娩时会阴撕裂风险的关系。方法：在这项前瞻性观察研究中，纳入了妊娠36-40周的孕妇。利用经会阴2d模式超声和剪切波弹性成像（SWE），我们测量了静息和Valsalva动作时会阴体（PB）、外肛门括约肌（EAS）、内肛门括约肌（IAS）和肛门粘膜（AM）的生物特征和刚度。结果：16例患者中，5例（31.2%）未生育，10例（62.5%）发生会阴撕裂。均为会阴一级撕裂。女性会阴撕裂了统计学上更高的会阴体区域静止(0.9±0.1厘米²和0.7±0.1厘米²,p = 0.03),一个厚9点钟EAS静止(0.6±0.2厘米和0.4±0.1厘米,p = 0.03),一个较小的前后的直径(1.7±0.2厘米和2±0.2厘米,p = 0.047),一个较小的横向直径(1.4±0.2厘米和1.6±0.1厘米,p = 0.05)和一个薄IAS平均静止(0.2±0.0厘米和0.3±0.0厘米,p = 0.007)和12点钟休息(0.2±0.1厘米和0.3±0.0厘米,p = 0.002)。会阴撕裂患者妊娠第9个月PB、EAS、IAS和AM弹性模量较高。结论：通过超声和SWE评估会阴和肛门括约肌生物特征和僵硬度是可行的，并可能提示会阴撕裂的风险。试验注册：研究注册号为（NCT05556304）。

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引用次数: 0

Prognosis for fetuses with isolated severe growth retardation from 23 gestational weeks with an initial assessment unfavorable to an active management 23孕周孤立性严重生长迟缓胎儿的预后初步评估不利于积极治疗。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction

Pub Date : 2025-01-08 DOI: 10.1016/j.jogoh.2025.102905

Thibault Wartelle , Camille Le Ray , Emmanuelle Cohen , Héloise Torchin , François Goffinet

Objective

To study perinatal outcomes for newborns with early, isolated, severe FGR, for whom initial active management was considered unreasonable or impossible at an obstetric-pediatric assessment and to identify the determinants associated with a course that made active management reasonable.

Material and methods

This retrospective observational single-center study occurred in a level-3 university hospital maternity unit. It included all pregnancies with a singleton fetus presenting isolated FGR <3rd percentile at 23 weeks or more of gestation with an obstetric-pediatric assessment (OPA) initially unfavorable to active management. The main outcome measure was perinatal mortality. Characteristics of the women and pregnancies were compared between the groups “OPA became favorable” versus “OPA remained unfavorable”.

Results

Among the 80 cases included, 48 (60%) of the children died, 38 (47.5%) before birth, 2 (2.5%) in the delivery room, and 8 (10%) in the NICU. Overall, the OPA for 32 (40%) became favorable. There were 44 (91.7%) perinatal deaths when the OPA remained unfavorable versus 4 (12.5%) when it became favorable (P<0.001). The median gestational age at the first OPA (25 weeks) did not differ between the groups. The patients in the OPA became favorable group had initially abnormal uterine Doppler findings less often (56.2% vs 85.4%, P=0.001), absent diastole or reverse flow umbilical artery less often (9.4% vs 33.3%, P=0.0016), less preeclampsia (6.2% vs 31.2%, P=0.009) and a higher estimated fetal weight (520 [491-546] g vs 487 [449-523] g, P=0.005).

Conclusion

In fetuses with early severe FGR, the risk of perinatal death was very high when the initial OPA was unfavorable. Initial OPA without preeclampsia and umbilical reverse diastolic flow were associated with higher probability that the OPA became favorable.

目的：研究早期、孤立、严重FGR新生儿的围产儿结局，这些新生儿在妇产科评估中被认为不合理或不可能进行最初的积极治疗，并确定与使积极治疗合理的疗程相关的决定因素。材料和方法：本回顾性观察性单中心研究发生在一家三级大学医院产科。结果：在纳入的80例病例中，48例（60%）死亡，38例（47.5%）在出生前死亡，2例（2.5%）在产房死亡，8例（10%）在新生儿重症监护病房死亡。总的来说，32人（40%）的OPA是有利的。当OPA处于不利状态时，围产期死亡44例（91.7%），而当OPA处于有利状态时，围产期死亡4例（12.5%）。结论：早期重度FGR胎儿，当初始OPA处于不利状态时，围产期死亡风险非常高。没有先兆子痫和脐舒张反向血流的初始OPA与OPA变得有利的可能性较高相关。

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引用次数: 0

Artificial intelligence in in-vitro fertilization (IVF): A new era of precision and personalization in fertility treatments 人工智能在体外受精（IVF）：精准和个性化生育治疗的新时代。

IF 1.7 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of gynecology obstetrics and human reproduction

Pub Date : 2024-12-27 DOI: 10.1016/j.jogoh.2024.102903

David B. Olawade , Jennifer Teke , Khadijat K. Adeleye , Kusal Weerasinghe , Momudat Maidoki , Aanuoluwapo Clement David-Olawade

In-vitro fertilization (IVF) has been a transformative advancement in assisted reproductive technology. However, success rates remain suboptimal, with only about one-third of cycles resulting in pregnancy and fewer leading to live births. This narrative review explores the potential of artificial intelligence (AI), machine learning (ML), and deep learning (DL) to enhance various stages of the IVF process. Personalization of ovarian stimulation protocols, gamete selection, and embryo annotation and selection are critical areas where AI may benefit significantly. AI-driven tools can analyze vast datasets to predict optimal stimulation protocols, potentially improving oocyte quality and fertilization rates. In sperm and oocyte quality assessment, AI can offer precise, objective analyses, reducing subjectivity and standardizing evaluations. In embryo selection, AI can analyze time-lapse imaging and morphological data to support the prediction of embryo viability, potentially aiding implantation outcomes. However, the role of AI in improving clinical outcomes remains to be confirmed by large-scale, well-designed clinical trials. Additionally, AI has the potential to enhance quality control and workflow optimization within IVF laboratories by continuously monitoring key performance indicators (KPIs) and facilitating efficient resource utilization. Ethical considerations, including data privacy, algorithmic bias, and fairness, are paramount for the responsible implementation of AI in IVF. Future research should prioritize validating AI tools in diverse clinical settings, ensuring their applicability and reliability. Collaboration among AI experts, clinicians, and embryologists is essential to drive innovation and improve outcomes in assisted reproduction. AI's integration into IVF holds promise for advancing patient care, but its clinical potential requires careful evaluation and ongoing refinement.

体外受精（IVF）是辅助生殖技术的革命性进步。然而，成功率仍然不理想，只有大约三分之一的周期导致怀孕，更少的周期导致活产。本文探讨了人工智能（AI）、机器学习（ML）和深度学习（DL）在提高试管婴儿过程各个阶段的潜力。个性化卵巢刺激方案、配子选择、胚胎注释和选择是人工智能可能显著受益的关键领域。人工智能驱动的工具可以分析大量数据集来预测最佳刺激方案，从而有可能提高卵母细胞质量和受精率。在精子和卵母细胞质量评估中，人工智能可以提供精确、客观的分析，减少主观性，规范评估。在胚胎选择中，人工智能可以分析延时成像和形态学数据，以支持胚胎活力的预测，可能有助于植入结果。然而，人工智能在改善临床结果方面的作用仍有待大规模、精心设计的临床试验的证实。此外，人工智能有可能通过持续监测关键绩效指标（kpi）和促进有效的资源利用来加强试管婴儿实验室的质量控制和工作流程优化。伦理考虑，包括数据隐私、算法偏见和公平性，对于在试管婴儿中负责任地实施人工智能至关重要。未来的研究应优先在不同的临床环境中验证人工智能工具，确保其适用性和可靠性。人工智能专家、临床医生和胚胎学家之间的合作对于推动创新和改善辅助生殖的结果至关重要。人工智能与体外受精的结合有望改善患者护理，但其临床潜力需要仔细评估和不断完善。

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