Journal of gynecology obstetrics and human reproduction最新文献

{"title":"Barriers to prescription of hormonal contraception and hormone replacement therapy in gynecological cancer survivors: Results of a survey and literature review","authors":"Mariana Teves ,&nbsp;Fátima Palma ,&nbsp;Ana Fatela ,&nbsp;Lúcia Correia","doi":"10.1016/j.jogoh.2024.102902","DOIUrl":"10.1016/j.jogoh.2024.102902","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of gynecological cancers in premenopausal women is increasing, highlighting issues related to Hormonal Contraception (HC) and Hormone Replacement Therapy (HRT). However, the presence of hormonal receptors in many gynecological cancers complicates HC and HRT prescriptions.</div></div><div><h3>Objective</h3><div>To identify barriers experienced by gynecologists in prescribing HC and HRT to gynecological cancer survivors, with a secondary objective of conducting a literature review on the safety of these prescriptions.</div></div><div><h3>Methods</h3><div>A nationwide survey was conducted among Portuguese gynecologists, including questions about their prescribing practices for HC and HRT in gynecological cancer survivors. For the narrative review, the authors searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and SCOPUS from January 2019 to April 2024. The included studies encompassed gynecological cancer survivors using HC or HRT, detailing tumor histologic type and clinical outcomes.</div></div><div><h3>Results</h3><div>185 gynecologists participated in the questionnaire: 151 general gynecologists (81.6 %) and 34 oncology gynecologists (18.4 %). Of these, 49.7 % and 55.1 % had prescribed HC and HRT, respectively. Cervical cancer had the highest prescription rate, followed by vulvar and vaginal cancer, with fewer prescriptions for ovarian/fallopian tube, endometrial, and uterine corpus (non-endometrial) cancers. Older age and specialization in gynecologic oncology significantly predicted HC and HRT prescriptions (<em>p</em> &lt; 0.05). Uncertainty was the main reason for not prescribing HC/HRT. A narrative review confirmed the safety of prescribing for specific tumor subtypes.</div></div><div><h3>Conclusion</h3><div>The survey findings highlight an occasionally unfounded apprehension regarding the use of HC and HRT among gynecological cancer survivors. This underscores the crucial need for enhanced education on these matters.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102902"},"PeriodicalIF":1.7,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895148","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}

{"title":"Robot-assisted myomectomy versus open surgery: Cost-effectiveness analysis","authors":"Alexandre Boyer De Latour ,&nbsp;Alexandra Vappereau ,&nbsp;Alicia Le Bras ,&nbsp;Amélia Favier ,&nbsp;Martin Koskas ,&nbsp;Bruno Borghese ,&nbsp;Catherine Uzan ,&nbsp;Isabelle Durand-Zaleski ,&nbsp;Geoffroy Canlorbe","doi":"10.1016/j.jogoh.2024.102887","DOIUrl":"10.1016/j.jogoh.2024.102887","url":null,"abstract":"<div><h3>Introduction</h3><div>Fibroids are the most common benign uterine tumors. There are different possibilities for surgical approaches, and evaluating the cost of these operations is fundamental in modern surgery. The aim of our study is to evaluate the cost-effectiveness of robotic-assisted myomectomy (RAM) compared to open myomectomy (OM) in France.</div></div><div><h3>Materials and methods</h3><div>This is an original, retrospective cost analysis and cost-effectiveness comparison between RAM and OM. Women aged &gt;18 years who had undergone myomectomy for large (&gt;8 cm) or multiple (3–5) fibroids via RAM or OM were included from three French hospitals. Confounding factors were controlled using inverse probability of treatment weighting. Costs and major operative complications were assessed one month post-surgery for both groups. The cost per major operative complication (defined as intraoperative and/or postoperative transfusions and/or intraoperative blood loss ≥500 mL) averted was calculated. The incremental cost-effectiveness ratio was determined by dividing the difference in costs by the difference in complications. Uncertainty was explored through probabilistic and deterministic sensitivity analyses. Other complications were also compared between the two groups.</div></div><div><h3>Results</h3><div>33 womens were operate by RAM and 66 by OM. A statistically non-significant reduction in intraoperative and/or postoperative transfusions and/or intraoperative blood loss ≥ 500 mL will be in favor of RAM 36.19 % RAM vs. 38.48 % OM; <em>p</em> = 0.85), with a difference of 2.29 % [95 % CI:27.06 % to 16.58 %]. RAM was more expensive than OM, with an additional cost of €3,555 (<em>P</em> &lt; 0.01). The incremental cost-effectiveness ratio at one month was €155,241 per patient without complications. The intervention was 120 min shorter for OM (157) than RAM (277) (<em>p</em> &lt; 0,01). Readmissions were lower on RAM (0 %) vs. OM (1,21 %) (<em>p</em> &lt; 0,01) and the mean on length of stay was lower on RAM (2,90 days) vs. OM (4,34 days) (<em>p</em> &lt; 0,01).</div></div><div><h3>Conclusions</h3><div>RAM reduced the length of hospitalization without increasing the risk of intraoperative complications compared to OM, making it a viable alternative. However, the economic evaluation within our hospitals did not favor RAM. Prospective studies with optimized RAM procedures are needed to confirm these results.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102887"},"PeriodicalIF":1.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term patient-reported outcome for surgical management of pelvic organ prolapse: A retrospective cohort study","authors":"Alexander Nima Sharami ,&nbsp;Mari Heide Feiring ,&nbsp;Ellen Nydal Eide ,&nbsp;Heidi Thornhill ,&nbsp;Jone Trovik","doi":"10.1016/j.jogoh.2024.102895","DOIUrl":"10.1016/j.jogoh.2024.102895","url":null,"abstract":"<div><h3>Objectives</h3><div>Pelvic organ prolapse (POP) has traditionally been treated by vaginal native tissue repair. This study aimed to review two cohorts of women surgically treated for POP regarding surgical characteristics, and compare long-term outcomes based on subjective satisfaction and surgeon experience.</div></div><div><h3>Study design</h3><div>Retrospective cohort study of 490 women undergoing a primary native-tissue POP procedure during 2002–2004 (cohort 1, <em>n</em> = 201), or during 2012–2014 (cohort 2, <em>n</em> = 289). Patient-reported questionnaire data were collected in 2008 (cohort 1) and 2018 (cohort 2, and repeat survey cohort 1 (<em>n</em> = 97)). Clinical data were collected from patient files. Outcomes were assessed by Kaplan-Meier/log-rank test, binary logistic regression and Cox multivariate analysis.</div></div><div><h3>Results</h3><div>Women in cohort 2 were operated at a younger age (median 64 versus 66 years, <em>p</em> &lt; 0.001) with grade 2 as dominant prolapse (156/289, 54 %), versus grade 3 dominant prolapse (130/201, 65 %, <em>p</em> &lt; 0.001) in cohort 1. In cohort 2 a higher proportion (172/289 (60 %) versus 39/201 (19 %), <em>p</em> &lt; 0.001) were operated with a procedure including all three compartments (anterior, apical and posterior). For 24 % (117/490) of all patients a peri‑/postoperative procedure-related complication was noted. After a median observation time of 163 months (cohort 1, 95 % confidence interval 160–169) and 63 months (cohort 2, 95 % confidence interval 62–64), a total of 43 patients (9 %) had been subjected to further prolapse surgery, median 41 months (95 % confidence interval 23–72) after the primary surgery. In all, 89 % of women (176/196 cohort 1, and 253/285 cohort 2, <em>p</em> = 0.722) were very/somewhat satisfied 4–6 years postoperatively, although 18 % (38/193 in cohort 1 and 50/282 in cohort 2) still reported prolapse symptoms. After 14–16 years 88 % (84/97) remained satisfied, but 31 % (30/97) reported prolapse symptoms. Neither satisfaction, peri‑/post-operative complications, nor reoperation-rate differed regarding lead surgeon experience-level (gynecologist in-training versus specialist).</div></div><div><h3>Conclusions</h3><div>Women operated by primarily native-tissue POP surgery report high levels of satisfaction, even 15 years after surgery, despite 31 % reporting prolapse related symptoms. Outcomes were similar regardless of lead surgeon being in-training or certified gynecologist.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102895"},"PeriodicalIF":1.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of French practices in the management and the follow-up of obstetric anal sphincter injuries (OASIS)","authors":"Romane Bassi ,&nbsp;Rajeev Ramanah ,&nbsp;Nicolas Mottet ,&nbsp;Marine Lallemant","doi":"10.1016/j.jogoh.2024.102894","DOIUrl":"10.1016/j.jogoh.2024.102894","url":null,"abstract":"<div><h3>Objective</h3><div>The aim was to assess the current management and follow-up of obstetric anal sphincter injuries in maternity wards in France at two levels: the patient's and the care unit level.</div></div><div><h3>Study design</h3><div>We carried out an evaluation of professional practices in all French maternity hospitals by sending a questionnaire that covered five areas: (i) general information about the hospital, (ii) immediate management of OASIS and postpartum care, (iii) patient follow up, (iv) management of a subsequent pregnancy, and (v) training of health professionals.</div></div><div><h3>Results</h3><div>During this period, 102 answers (22.4 %) were obtained. Forty-five maternity hospitals (44.1 %) did not have a dedicated protocol for the management and the follow-up of OASIS. In four maternities (4 %), the resident or midwife repaired the anal sphincter alone. Ninety-eight percent of the obstetricians repaired the external anal sphincter using either the end-to-end or overlap techniques. Only two maternities (2 %) used postpartum symptom or quality of life questionnaires after OASIS. In the post-partum, in ten (9.8 %) maternities, patients attended a consultation with an urogynecologist. In this study, 57.8 % patients did not have an anal sphincter ultrasonography prescription in their follow-up even though they had symptoms.</div></div><div><h3>Conclusion</h3><div>We observed a great heterogeneity in the management of patients with OASIS in French maternity hospitals. National guidelines and regular training of health professionals are required to improve this management.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102894"},"PeriodicalIF":1.7,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aneuploidy rates and clinical pregnancy outcomes after preimplantation genetic testing for aneuploidy using the progestin-primed ovarian stimulation protocol or the gonadotropin-releasing hormone antagonist protocol","authors":"Xiufen Wang ,&nbsp;Bin Chen ,&nbsp;Lu Fang ,&nbsp;Jieyu Wang ,&nbsp;Aike Xu ,&nbsp;Wen Xu ,&nbsp;Xiaomei Tong","doi":"10.1016/j.jogoh.2024.102883","DOIUrl":"10.1016/j.jogoh.2024.102883","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the chromosome abnormality rates and clinical pregnancy outcomes after preimplantation genetic testing for aneuploidy (PGT-A) using either the progestin-primed ovarian stimulation (PPOS) protocol or the gonadotropin-releasing hormone (GnRH) antagonist protocol.</div></div><div><h3>Methods</h3><div>The study included 431 PGT-A cycles in which controlled ovarian stimulation was performed using the PPOS protocol (<em>n</em> = 320 cycles) or GnRH antagonist protocol (<em>n</em> = 111 cycles) between January 2018 and December 2021. Frozen embryo transfer was subsequently performed in 307 cycles with transferable blastocysts. The number of retrieved oocytes, embryo development, next-generation sequencing results, and clinical pregnancy outcomes were compared between the two protocols. The primary outcome measure was the aneuploidy rate. Secondary outcome measures were clinical pregnancy per first frozen-thawed embryo transfer cycle and cumulative live birth rates per PGT-A cycle.</div></div><div><h3>Results</h3><div>There were no statistically significant between-group differences in the number of retrieved oocytes, available blastocysts, and high-quality blastocyst rate. The aneuploidy rates were similar between the two groups. There was no significant difference in clinical pregnancy outcomes, including the clinical pregnancy, implantation, miscarriage, live birth, or cumulative live birth rates, after frozen-thawed embryo transfer cycles (<em>P</em>&gt;0.05).</div></div><div><h3>Conclusions</h3><div>The study found no significant differences in the aneuploidy rate, clinical pregnancy rate and cumulative live birth rate after PGT-A cycles between those using the PPOS protocol and those using the GnRH antagonist protocol.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 2","pages":"Article 102883"},"PeriodicalIF":1.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caracteristics of women presenting with chronic histiocytic intervillositis during pregnancy: A case-control study","authors":"Amandine Mawa ,&nbsp;Gabriel Bizet ,&nbsp;Morgane Stichelbout ,&nbsp;Louise Devisme ,&nbsp;Myrtille Pauchet ,&nbsp;Solène Gobert ,&nbsp;Anastasia Chudzinski ,&nbsp;Véronique Houfflin-Debarge ,&nbsp;Damien Subtil","doi":"10.1016/j.jogoh.2024.102882","DOIUrl":"10.1016/j.jogoh.2024.102882","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic Histiocytic Intervillositis (CHI) appears to be among the most severe placental diseases. Its rarity has limited our knowledge of the women in whom it occurs.</div></div><div><h3>Objective</h3><div>To search for maternal characteristics linked to the existence of CHI, by first studying the current pregnancy included in the study, then their previous pregnancies.</div></div><div><h3>Material and methods</h3><div>We conducted a monocentric case-control study between 2000 and 2020. CHI cases were diagnosed by microscopic examination of the placenta. \"Low-risk” controls gave birth just before each case, whatever the outcome. “High-risk” controls benefited from placental microscopy immediately after the case examinations.</div></div><div><h3>Results</h3><div>151 women were included in each group. CHI cases had twice as many previous pregnancies as both controls, but no more living children at home. Regarding obstetric history, fetal losses were significantly higher in CHI cases: compared to “low-risk” controls, there were more early miscarriages (20.0%, OR 2.6 [1.5;4.8]), late miscarriages (4.8%, OR 8.8 [1.1;187]) and in utero deaths (5.4%, OR 5.6 [1.7;19.8]). The risk of fetal loss does not appear to be increased in first pregnancies of CHI cases. However, differences appeared between cases and both “low-risk” and “high-risk” controls with a history of two previous miscarriages (21.7% vs 11.2%, p=0.009 or vs 9.6%, p=0.005) and the outcome of the second pregnancy (number of living children 59.7% vs 78.0%, p=0.033 or vs 63.0%, p=0.71), respectively.</div></div><div><h3>Conclusion</h3><div>Women with CHI have a more frequent history of pregnancy failure than other women. This excess fetal loss seems to occur only after the second pregnancy or after two previous miscarriages.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 2","pages":"Article 102882"},"PeriodicalIF":1.7,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647833","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}

{"title":"Anti N-methyl-D-aspartate receptor encephalitis during pregnancy: A case report","authors":"Leïa Kennel ,&nbsp;Dominique Luton ,&nbsp;Florence Gressier ,&nbsp;Chloé Daffos ,&nbsp;Emmanuelle Corruble ,&nbsp;Laure Julé ,&nbsp;Jean-Baptiste Brunet de Courssou ,&nbsp;Claire Szmulewicz","doi":"10.1016/j.jogoh.2024.102876","DOIUrl":"10.1016/j.jogoh.2024.102876","url":null,"abstract":"<div><div>Anti-N-methyl-<span>D</span>-aspartate receptor (NMDA-R) encephalitis is an immune-mediated encephalitis that primarily affects young women. Due to the psychiatric and neurological symptoms, the diagnosis can be challenging, especially during pregnancy. During pregnancy, treatments must take into account the fetal and neonatal risk and the risk of premature delivery. We report a case of anti-NMDA encephalitis in a 31-years-old, 30 weeks pregnant women characterized by predominantly psychiatric symptoms, associated with ovarian teratoma. First-line treatments have led to an improvement in symptoms, allowing the pregnancy to be carried to term and a vaginal delivery.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 2","pages":"Article 102876"},"PeriodicalIF":1.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621857","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}

{"title":"Interobserver agreement in CTG classification and clinical decision during labour: a comparison between STAN2007 and STAN2022 classifications","authors":"Delphine Duchanois ,&nbsp;Lola Loussert ,&nbsp;Anais Provendier ,&nbsp;Carole Brouet ,&nbsp;Maeva Chavin ,&nbsp;Louise Paret ,&nbsp;Paul Guerby ,&nbsp;Virginie Ehlinger ,&nbsp;Christophe Vayssière","doi":"10.1016/j.jogoh.2024.102874","DOIUrl":"10.1016/j.jogoh.2024.102874","url":null,"abstract":"<div><div>ST analysis during labour requires the classification of CTG traces in order to help clinical decisions. The usual STAN classification is based on the FIGO 1987 classification, modified in 2007. New STAN guidelines adapted to physiology-based interpretation have been proposed in 2022. This study compares the interobserver agreement of CTG classification and clinical decisions making, and the ease of use following the 2022 and 2007 STAN guidelines.</div></div><div><h3>Material and Methods</h3><div>Thirty CTG traces from STAN monitors were selected from a local French database and analysed (CTG classification, clinical decision making) by six observers with different levels of experience in two sessions three months apart. Observers followed the STAN2007 and the STAN2022 guidelines in the first and in the second sessions respectively. Weighted kappa (primary outcome), proportion of complete agreement within the 6 observers, and percent agreement (secondary outcomes) were estimated. At the end of the second session observers rated their satisfaction, ease of use and which guidelines they preferred.</div></div><div><h3>Results</h3><div>The interobserver agreement for CTG classification were comparable when following STAN2007 and STAN2022 guidelines (weighted kappa 0.57 versus 0.58, <em>P</em> = 0.91, moderate agreement), but a higher proportion of complete agreement within the 6 observers and a higher percent agreement were obtained when following STAN2022 compared to STAN2007 guidelines (complete agreement 50 % versus 20 % respectively, <em>P</em> = 0.01; percentage of agreement 72 % vs 55 %, <em>P</em> = 0.006). Interobserver agreement for clinical decisions did not differ when following STAN2007 or STAN2022 guidelines. Satisfaction scores were higher with STAN2022 guidelines, but not significantly (<em>P</em> = 0.052). All 6 observers stated that they preferred to use the STAN2022 guidelines.</div></div><div><h3>Conclusion</h3><div>Interobserver agreement is comparable between STAN2022 and STAN2007 for CTG classification in labour and clinical decision making. However, complete agreement and percent agreement are in favour of STAN 2022 for CTG classification.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102874"},"PeriodicalIF":1.7,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Induction of labor in late-term pregnancy: amniotomy plus early oxytocin perfusion versus amniotomy plus oxytocin perfusion delayed by 24 h","authors":"Maina Jan ,&nbsp;Sonia Guérin ,&nbsp;Marie-Alice Yanni ,&nbsp;Antoine Robin ,&nbsp;Linda Lassel ,&nbsp;Sonia Bhandari Randhawa ,&nbsp;Rémi Béranger ,&nbsp;Maela Le Lous","doi":"10.1016/j.jogoh.2024.102875","DOIUrl":"10.1016/j.jogoh.2024.102875","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the maternal and fetal benefits of delaying oxytocin perfusion by 24 h following labor induction by amniotomy after 41 weeks of gestation (WG).</div></div><div><h3>Methods</h3><div>We performed a retrospective review including all women with a vertex presentation fetus who had an indication for labor induction by amniotomy with or without oxytocin after 41 WG between 2015 and 2022. Patients who underwent an IOL by amniotomy followed by oxytocin perfusion within 0 to 4 hours (early oxytocin group: EO group) were compared with patients who underwent an IOL by amniotomy alone or followed by an oxytocin perfusion after an expectant period for up to 24 hours in the absence of a spontaneous onset of labor (delayed oxytocin group: DO group). The primary outcome was the rate of vaginal delivery (natural or operative). The secondary outcomes were maternal and neonatal complications.</div></div><div><h3>Results</h3><div>We included 363 patients: 103 patients in the EO group and 260 in the DO group. Only 47 of the women in the DO group (18 %) required oxytocin. The proportion of vaginal deliveries was significantly higher in the DO group (248 patients, 95.4 %) than in the EO group (85 patients, 82.55 %) (<em>p</em>&lt;0.01). Maternal morbidity did not differ significantly between groups. Fewer babies displayed severe newborn acidemia or required transfer to the neonatal intensive care unit in the DO group (<em>p</em>&lt;0.05).</div></div><div><h3>Conclusion</h3><div>Delaying oxytocin administration by 24 hours after amniotomy was associated with a significantly higher rate of vaginal delivery. These results required confirmation in prospective randomized studies.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102875"},"PeriodicalIF":1.7,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583389","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}

{"title":"Evaluating the proteinuria/creatininuria ratio as a rapid prognostic tool for complications of preeclampsia: A comparison with 24-hour proteinuria","authors":"Victoire de Logivière ,&nbsp;Vassilis Tsatsaris ,&nbsp;Jacques Lepercq ,&nbsp;François Goffinet ,&nbsp;Aude Girault","doi":"10.1016/j.jogoh.2024.102873","DOIUrl":"10.1016/j.jogoh.2024.102873","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate the agreement between the proteinuria/creatinuria (P/C) ratio and the traditional 24-hour proteinuria measurement for proteinuria levels above 3 g/24h in pregnant patients with preeclampsia. Additionally, we assessed whether high levels of each measurement are predictive of adverse maternal and neonatal outcomes.</div></div><div><h3>Material and methods</h3><div>We conducted a monocentric retrospective study of pregnant patients hospitalized for preeclampsia between January 1, 2019, and November 11, 2020. The primary outcome was a composite measure of adverse maternal outcomes associated with preeclampsia, and the secondary outcome focused on adverse neonatal outcomes. Agreement between high levels of 24-hour proteinuria and the P/C ratio was evaluated using Cohen's Kappa. Maternal and neonatal outcomes were compared across three groups: those with neither, one, or both high proteinuria levels (24-hour proteinuria ≥ 3 g/24h and/or P/C ratio ≥ 300 mg/mmol). Logistic regression, adjusted for confounders, analyzed associations between measures and outcomes, with ROC curves and AUC calculated for predictive models.</div></div><div><h3>Results</h3><div>We found a strong correlation between 24-hour proteinuria and P/C ratio, with 95.1% agreement at the threshold of 3 g/24h and 300 mg/mmol, respectively (Kappa = 0.87, p &lt; 0.01). Both measurements were associated with an increased risk of adverse maternal (aOR 6.78 [2.47–18.63]) and neonatal (aOR 7.00 [1.56–31.31]) outcomes.</div></div><div><h3>Discussion</h3><div>This study demonstrated a strong agreement between the P/C ratio ≥ 300 mg/mmol and 24-hour proteinuria ≥ 3 g/24h, both associated with an increased risk of adverse perinatal outcomes, with the P/C ratio offering a quicker, simpler alternative for managing preeclampsia.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 2","pages":"Article 102873"},"PeriodicalIF":1.7,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545758","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}