Pub Date : 2024-10-24DOI: 10.1016/j.jogoh.2024.102872
Anne–Lise Bulot , Ludivine Dion , Krystel Nyangoh Timoh , Pierre François Dupré , Henri Azaïs , Cyril Touboul , Yohann Dabi , Olivier Graesslin , Emilie Raimond , Hélène Costaz , Yohan Kerbage , Cyrille Huchon , Camille Mimoun , Martin Koskas , Cherif Akladios , Lise Lecointre , Geoffroy Canlorbe , Pauline Chauvet , Lobna Ouldamer , Xavier Carcopino , Vincent Lavoué
Introduction
The aims of this study were to describe survival outcomes in patients with ovarian cancer aged ≥80 years and to explore predictors of poor prognosis.
Methods
We collected clinical, demographic, histologic, surgical and follow-up data for patients with ovarian cancer aged ≥80 years from a multicenter French cohort (FRANCOGYN) who underwent surgery from 1999 to 2019. Primary endpoints were overall survival (OS) and disease-free survival (DFS). We performed a descriptive analysis of demographic and clinical data and a survival time analysis and comparison using the Kaplan Meier method and log-rank test.
Results
Of 1671 patients treated for ovarian cancer during the study period, 83 were aged ≥80 years (median age at diagnosis, 83 years; range, 80–99). Median OS was 39.6 months (range, 23.64–60.24). Factors significantly associated with OS in the univariate analysis were adjusted Charlson comorbidity index (ACCI) (HR 2.32; 95 % CI, 1.00–5.42 for ACCI >4), FIGO stage (HR 4.07 for FIGO stage >IIA; 95 % CI, 1.43–11.54), debulking surgery (HR 0.40; 95 % CI, 0.20–0.78), residual disease after surgery (HR 3.00; 95 % CI, 1.31–6.87), and postoperative complications (HR 2.24; 95 % CI, 1.04–4.81). Significant independent predictors of worse OS in the multivariate analysis were ACCI >4 (HR 4.96; 95 % CI, 1.57–15.75), perioperative complications (HR 5.01; 95 % CI, 1.32–18.95), and residual tumor after surgical debulking (HR 3.78; 95 % CI, 1.23–11.61).
Conclusion
Age by itself should not refrain surgeons and oncologist from proposing surgical debulking and chemotherapy, as recommended by international guidelines for patients with ovarian cancer aged ≥80 years
{"title":"Ovarian carcinoma in patients aged ≥80 years: A retrospective multicenter study of management and survival in the FRANCOGYN population","authors":"Anne–Lise Bulot , Ludivine Dion , Krystel Nyangoh Timoh , Pierre François Dupré , Henri Azaïs , Cyril Touboul , Yohann Dabi , Olivier Graesslin , Emilie Raimond , Hélène Costaz , Yohan Kerbage , Cyrille Huchon , Camille Mimoun , Martin Koskas , Cherif Akladios , Lise Lecointre , Geoffroy Canlorbe , Pauline Chauvet , Lobna Ouldamer , Xavier Carcopino , Vincent Lavoué","doi":"10.1016/j.jogoh.2024.102872","DOIUrl":"10.1016/j.jogoh.2024.102872","url":null,"abstract":"<div><h3>Introduction</h3><div>The aims of this study were to describe survival outcomes in patients with ovarian cancer aged ≥80 years and to explore predictors of poor prognosis.</div></div><div><h3>Methods</h3><div>We collected clinical, demographic, histologic, surgical and follow-up data for patients with ovarian cancer aged ≥80 years from a multicenter French cohort (FRANCOGYN) who underwent surgery from 1999 to 2019. Primary endpoints were overall survival (OS) and disease-free survival (DFS). We performed a descriptive analysis of demographic and clinical data and a survival time analysis and comparison using the Kaplan Meier method and log-rank test.</div></div><div><h3>Results</h3><div>Of 1671 patients treated for ovarian cancer during the study period, 83 were aged ≥80 years (median age at diagnosis, 83 years; range, 80–99). Median OS was 39.6 months (range, 23.64–60.24). Factors significantly associated with OS in the univariate analysis were adjusted Charlson comorbidity index (ACCI) (HR 2.32; 95 % CI, 1.00–5.42 for ACCI >4), FIGO stage (HR 4.07 for FIGO stage >IIA; 95 % CI, 1.43–11.54), debulking surgery (HR 0.40; 95 % CI, 0.20–0.78), residual disease after surgery (HR 3.00; 95 % CI, 1.31–6.87), and postoperative complications (HR 2.24; 95 % CI, 1.04–4.81). Significant independent predictors of worse OS in the multivariate analysis were ACCI >4 (HR 4.96; 95 % CI, 1.57–15.75), perioperative complications (HR 5.01; 95 % CI, 1.32–18.95), and residual tumor after surgical debulking (HR 3.78; 95 % CI, 1.23–11.61).</div></div><div><h3>Conclusion</h3><div>Age by itself should not refrain surgeons and oncologist from proposing surgical debulking and chemotherapy, as recommended by international guidelines for patients with ovarian cancer aged ≥80 years</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102872"},"PeriodicalIF":1.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501882","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}
Pub Date : 2024-10-21DOI: 10.1016/j.jogoh.2024.102870
Clémentine Bernard , Aubert Agostini , Florence Bretelle , Julie Blanc , Antoine Netter
Objective
To determine the factors associated with an increased risk of cesarean scar defect formation.
Methods
A systematic literature search was performed up to July 2022 in PubMed databases following the PRISMA recommendations. All available English-language clinical studies presenting one or more factors that may affect the risk of cesarean scar defect were included.
Results
39 studies meeting the selection criteria were identified. An association was found between the number of previous cesarean sections and a significant increase in the risk of cesarean scar defect formation. Regarding patient age, gestational age at cesarean section, birth weight and emergency context did not appear to influence the risk of cesarean scar defect. However, cesarean sections performed during labor advanced stages of labor, may increase the risk. The data remain too limited to conclude on the impact of BMI, flexion uterine, and pregnancy pathologies (gestational diabetes, preeclampsia, premature rupture of membranes), the use of oxytocic, or infectious and hemorrhagic complications. Regarding the surgical technique, the literature suggested that a lower hysterotomy is associated with an increased risk of scar defect. However, the single- or double-layer suture technique did not provide a change in risk, and the data were too limited to conclude on the impact of the type of thread or suture used.
Conclusion
The present systematic review of the literature suggests that several factors may increase the risk of developing a cesarean scar defect, such as the number of previous cesarean sections, a cesarean section performed during advanced labor, and a lower hysterotomy. However, the current state of the literature does not allow definitive conclusions to be drawn on most other factors.
{"title":"Risk factors and influence of surgical technique on the risk of caesarean scar defect formation: A systematic review of the literature","authors":"Clémentine Bernard , Aubert Agostini , Florence Bretelle , Julie Blanc , Antoine Netter","doi":"10.1016/j.jogoh.2024.102870","DOIUrl":"10.1016/j.jogoh.2024.102870","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the factors associated with an increased risk of cesarean scar defect formation.</div></div><div><h3>Methods</h3><div>A systematic literature search was performed up to July 2022 in PubMed databases following the PRISMA recommendations. All available English-language clinical studies presenting one or more factors that may affect the risk of cesarean scar defect were included.</div></div><div><h3>Results</h3><div>39 studies meeting the selection criteria were identified. An association was found between the number of previous cesarean sections and a significant increase in the risk of cesarean scar defect formation. Regarding patient age, gestational age at cesarean section, birth weight and emergency context did not appear to influence the risk of cesarean scar defect. However, cesarean sections performed during labor advanced stages of labor, may increase the risk. The data remain too limited to conclude on the impact of BMI, flexion uterine, and pregnancy pathologies (gestational diabetes, preeclampsia, premature rupture of membranes), the use of oxytocic, or infectious and hemorrhagic complications. Regarding the surgical technique, the literature suggested that a lower hysterotomy is associated with an increased risk of scar defect. However, the single- or double-layer suture technique did not provide a change in risk, and the data were too limited to conclude on the impact of the type of thread or suture used.</div></div><div><h3>Conclusion</h3><div>The present systematic review of the literature suggests that several factors may increase the risk of developing a cesarean scar defect, such as the number of previous cesarean sections, a cesarean section performed during advanced labor, and a lower hysterotomy. However, the current state of the literature does not allow definitive conclusions to be drawn on most other factors.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102870"},"PeriodicalIF":1.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501883","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}
For the past three decades, researchers have proposed an association between bacterial vaginosis (BV) and preterm birth. This association has been questioned since treating BV with antibiotics during pregnancy hasn't led to a decreased risk of preterm birth.
Objective
To re-assess the connection between BV and preterm birth by reviewing existing literature.
Search strategy
A systematic search was conducted on PubMed and Web of Science using the keywords "bacterial vaginosis" and "preterm birth" up to November 2020. The protocol followed PRISMA guidelines and was registered with PROSPERO (CRD42022337806).
Selection criteria
Studies were included if they: 1) explored the link BV and preterm birth, 2) used diagnostic criteria based on Nugent, Amsel or Spiegel methods, 3) defined preterm birth at <37, 35, or 32 weeks, and 4) involved patients without impending preterm labor symptoms when sampled.
Data collection and analysis
Data were extracted and analyzed by region, BV diagnosis method, study period, and quality score.
Mains results
A total of 28 studies were included in the analysis (comprising 50,466 patients). There was a significant link between BV and preterm birth, with an overall OR of 1.60 [95% CI, 1.36–1.89]. Heterogeneity was high (I²=67%). The elevated risk remained consistent across geographic areas, diagnostic procedures, study periods, and study quality scale (Newcastle-Ottawa score).
Conclusion
Our meta-analysis confirms the association between bacterial vaginosis and preterm birth. However, the connection appears to be weaker than previously documented. This observation may offer insight into the ineffectiveness of BV treatments in reducing preterm birth risk.
{"title":"Reassessing the association between bacterial vaginosis and preterm birth: A systematic review and meta-analysis","authors":"Sawsan Hadhoum , Damien Subtil , Julien Labreuche , Emmanuelle Couvreur , Gilles Brabant , Rodrigue Dessein , Rémi Le Guern","doi":"10.1016/j.jogoh.2024.102871","DOIUrl":"10.1016/j.jogoh.2024.102871","url":null,"abstract":"<div><h3>Background</h3><div>For the past three decades, researchers have proposed an association between bacterial vaginosis (BV) and preterm birth. This association has been questioned since treating BV with antibiotics during pregnancy hasn't led to a decreased risk of preterm birth.</div></div><div><h3>Objective</h3><div>To re-assess the connection between BV and preterm birth by reviewing existing literature.</div></div><div><h3>Search strategy</h3><div>A systematic search was conducted on PubMed and Web of Science using the keywords \"bacterial vaginosis\" and \"preterm birth\" up to November 2020. The protocol followed PRISMA guidelines and was registered with PROSPERO (CRD42022337806).</div></div><div><h3>Selection criteria</h3><div>Studies were included if they: 1) explored the link BV and preterm birth, 2) used diagnostic criteria based on Nugent, Amsel or Spiegel methods, 3) defined preterm birth at <37, 35, or 32 weeks, and 4) involved patients without impending preterm labor symptoms when sampled.</div></div><div><h3>Data collection and analysis</h3><div>Data were extracted and analyzed by region, BV diagnosis method, study period, and quality score.</div></div><div><h3>Mains results</h3><div>A total of 28 studies were included in the analysis (comprising 50,466 patients). There was a significant link between BV and preterm birth, with an overall OR of 1.60 [95% CI, 1.36–1.89]. Heterogeneity was high (I²=67%). The elevated risk remained consistent across geographic areas, diagnostic procedures, study periods, and study quality scale (Newcastle-Ottawa score).</div></div><div><h3>Conclusion</h3><div>Our meta-analysis confirms the association between bacterial vaginosis and preterm birth. However, the connection appears to be weaker than previously documented. This observation may offer insight into the ineffectiveness of BV treatments in reducing preterm birth risk.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102871"},"PeriodicalIF":1.7,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501884","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}
Pub Date : 2024-10-18DOI: 10.1016/j.jogoh.2024.102864
Xujing Deng , Dengke Qin , Qiuhong Ding, Liying Peng, Guohua Li, Shihua Bao
Objectives
Recurrent pregnancy loss (RPL) seriously affects women's reproductive and mental health, and the incidence has increased in recent years. Insulin resistance (IR) acts as a significant contributing factor to RPL. Studies suggest that vitamin B12, folate intake, and homocysteine are correlated with IR, but the exact nature remains controversial and requires further investigation. In this study, we aimed to assess the levels and correlations between vitamin B12-folate-homocysteine and insulin resistance in RPL patients.
Study design
73 control subjects and 256 RPL patients (144 RPL patients without IR and 112 RPL patients with IR) were included in this observational retrospective cross-sectional study. The differences in vitamin B12, folate, and homocysteine levels between RPL patients with and without IR were analyzed using a Student's t-test. Pearson correlations were utilized to examine the correlation between vitamin B12-folate-homocysteine and glucose and lipid metabolism parameters. Multivariable linear regressions were used to assess the independent correlation of each factor with HOMA-IR.
Results
Compared to the control subjects, RPL patients exhibited lower vitamin B12 (p < 0.001) and folate (p < 0.001), and higher homocysteine (p = 0.001). RPL patients with IR described decreases in vitamin B12 (p = 0.003) and folate (p = 0.028), and increases in homocysteine (p = 0.033) as RPL patients without IR. Vitamin B12 in RPL patients was significantly negatively correlated with homocysteine (r = −0.348, p < 0.001), HOMA-IR (r = −0.214, p < 0.001), BMI (r = −0.160, p = 0.017), TG (r = −0.148, p = 0.039) and CHO (r = −0.149, p = 0.038) and positively correlated with folate (r = 0.217, p < 0.001). In multivariable linear regressions, after adjusting for age, strong correlations were observed between vitamin B12 (β = −0.197, p = 0.010), BMI (β = 0.466, p < 0.001), and HOMA-IR in RPL patients.
Conclusion
Vitamin B12 is significantly correlated with IR in RPL patients. Circulating vitamin B12-folate-homocysteine metabolism could be a window of the pathological process of IR, obesity, and lipid metabolism disorders in RPL patients.
{"title":"Vitamin B12 is correlated with insulin resistance and metabolism disorder markers in women with recurrent pregnancy loss","authors":"Xujing Deng , Dengke Qin , Qiuhong Ding, Liying Peng, Guohua Li, Shihua Bao","doi":"10.1016/j.jogoh.2024.102864","DOIUrl":"10.1016/j.jogoh.2024.102864","url":null,"abstract":"<div><h3>Objectives</h3><div>Recurrent pregnancy loss (RPL) seriously affects women's reproductive and mental health, and the incidence has increased in recent years. Insulin resistance (IR) acts as a significant contributing factor to RPL. Studies suggest that vitamin B12, folate intake, and homocysteine are correlated with IR, but the exact nature remains controversial and requires further investigation. In this study, we aimed to assess the levels and correlations between vitamin B12-folate-homocysteine and insulin resistance in RPL patients.</div></div><div><h3>Study design</h3><div>73 control subjects and 256 RPL patients (144 RPL patients without IR and 112 RPL patients with IR) were included in this observational retrospective cross-sectional study. The differences in vitamin B12, folate, and homocysteine levels between RPL patients with and without IR were analyzed using a Student's <em>t</em>-test. Pearson correlations were utilized to examine the correlation between vitamin B12-folate-homocysteine and glucose and lipid metabolism parameters. Multivariable linear regressions were used to assess the independent correlation of each factor with HOMA-IR.</div></div><div><h3>Results</h3><div>Compared to the control subjects, RPL patients exhibited lower vitamin B12 (<em>p</em> < 0.001) and folate (<em>p</em> < 0.001), and higher homocysteine (<em>p</em> = 0.001). RPL patients with IR described decreases in vitamin B12 (<em>p</em> = 0.003) and folate (<em>p</em> = 0.028), and increases in homocysteine (<em>p</em> = 0.033) as RPL patients without IR. Vitamin B12 in RPL patients was significantly negatively correlated with homocysteine (<em>r</em> = −0.348, <em>p</em> < 0.001), HOMA-IR (<em>r</em> = −0.214, <em>p</em> < 0.001), BMI (<em>r</em> = −0.160, <em>p</em> = 0.017), TG (<em>r</em> = −0.148, <em>p</em> = 0.039) and CHO (<em>r</em> = −0.149, <em>p</em> = 0.038) and positively correlated with folate (<em>r</em> = 0.217, <em>p</em> < 0.001). In multivariable linear regressions, after adjusting for age, strong correlations were observed between vitamin B12 (<em>β</em> = −0.197, <em>p</em> = 0.010), BMI (<em>β</em> = 0.466, <em>p</em> < 0.001), and HOMA-IR in RPL patients.</div></div><div><h3>Conclusion</h3><div>Vitamin B12 is significantly correlated with IR in RPL patients. Circulating vitamin B12-folate-homocysteine metabolism could be a window of the pathological process of IR, obesity, and lipid metabolism disorders in RPL patients.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102864"},"PeriodicalIF":1.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467354","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}
To study the impact of a CT serology on intrauterine insemination (IUI) cumulative live-birth rate (cLBR) in women with documented bilateral tubal patency.
Design
Cohort study
Subjects
Infertile women with documented bilateral tubal patency and medical indication of IUI matched on the following criteria: woman's age, number of cycles completed and number of motile sperm inseminated (NMSI).
Exposure
This retrospective, observational and monocentric cohort study compared women with positive CT serology matched 1:1 to control women with negative CT serology.
Main outcome measures
Cumulative LBR, rates of clinical pregnancy, spontaneous abortion, biochemical pregnancy.
Results
A total of 71 women in the CT positive group were matched to 71 women in the negative CT group, leading to compare 136 cycles per group. No statistically significant difference was observed between groups regarding the demographic and medical characteristics of couples. Cumulative LBR per woman was similar in both groups with 32.4% (n = 23) in the negative serology group Vs 25.4% (n = 18) in the positive CT group (NS). The rates of clinical pregnancy, spontaneous abortion, biochemical pregnancy were comparable between the two groups.
Conclusion
In a population of infertile women with patent tubes, our study suggests that the serological status for CT has no impact on the IIU cLBR.
{"title":"No impact of a positive Chlamydia trachomatis serology on live-birth rate after intra-uterine insemination","authors":"Virginie Trabaud , Laura Miquel , Cindy Faust , Julie Berbis , Odile Paulmyer-Lacroix , Blandine Courbiere","doi":"10.1016/j.jogoh.2024.102863","DOIUrl":"10.1016/j.jogoh.2024.102863","url":null,"abstract":"<div><h3>Objective</h3><div>To study the impact of a CT serology on intrauterine insemination (IUI) cumulative live-birth rate (cLBR) in women with documented bilateral tubal patency.</div></div><div><h3>Design</h3><div>Cohort study</div></div><div><h3>Subjects</h3><div>Infertile women with documented bilateral tubal patency and medical indication of IUI matched on the following criteria: woman's age, number of cycles completed and number of motile sperm inseminated (NMSI).</div></div><div><h3>Exposure</h3><div>This retrospective, observational and monocentric cohort study compared women with positive CT serology matched 1:1 to control women with negative CT serology.</div></div><div><h3>Main outcome measures</h3><div>Cumulative LBR, rates of clinical pregnancy, spontaneous abortion, biochemical pregnancy.</div></div><div><h3>Results</h3><div>A total of 71 women in the CT positive group were matched to 71 women in the negative CT group, leading to compare 136 cycles per group. No statistically significant difference was observed between groups regarding the demographic and medical characteristics of couples. Cumulative LBR per woman was similar in both groups with 32.4% (n = 23) in the negative serology group <em>Vs</em> 25.4% (n = 18) in the positive CT group (NS). The rates of clinical pregnancy, spontaneous abortion, biochemical pregnancy were comparable between the two groups.</div></div><div><h3>Conclusion</h3><div>In a population of infertile women with patent tubes, our study suggests that the serological status for CT has no impact on the IIU cLBR.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102863"},"PeriodicalIF":1.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467353","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}
Current recommendations preconize prophylactic mastectomy for women over 30 with increased risk of breast cancer. Several surgical techniques are available to perform bilateral mastectomy with or without breast reconstruction. Our primary objective was to evaluate the feasibility of the Endoscopic Nipple Sparing Mastectomy (E-NSM) technique, without robotic assistance, using a single axillary incision and with immediate reconstruction using a prepectoral prosthesis in prophylactic indications. The secondary objectives were to evaluate the risks of postoperative complications and the esthetic results.
Material and methods
This is a preliminary report of a prospective single-center interventional clinical study with a final enrolment target of 20 patients. The primary endpoint was the rate of complete surgical procedures per E-NSM. The secondary endpoints were the rate of conversions to conventional surgery, infections, hematomas, skin injury, pain and esthetic results (Breast-Q questionnaire, additional cosmetic procedures).
Results
From April 2019 to June 2022, 10 patients were included for 19 procedures (9 bilateral mastectomies, 1 unilateral). All surgical procedures were complete; no conversion to conventional surgery was required. The rate of complications per procedure requiring revision surgery was 16% (1 skin necrosis, 1 postoperative hematoma and 1 surgical site infection). No prosthesis was removed. The seroma rate was 5%. All patients would recommend this technique and were very satisfied or satisfied with the esthetic result. A second cosmetic procedure (lipofilling) was necessary in 50% of patients.
Discussion
These preliminary data attest to the feasibility and safety of the E-NSM approach, and should be confirmed on a larger cohort and longer-term follow-up.
{"title":"Endoscopic Prophylactic Nipple-Sparing Mastectomy: first French survey of 10 patients","authors":"Gauthier Rathat , Maude Chaumette , Victoria Fontaine , Lucie Rebel , Joana Pissarra , Claire Duflos , Martha Duraes","doi":"10.1016/j.jogoh.2024.102862","DOIUrl":"10.1016/j.jogoh.2024.102862","url":null,"abstract":"<div><h3>Introduction</h3><div>Current recommendations preconize prophylactic mastectomy for women over 30 with increased risk of breast cancer. Several surgical techniques are available to perform bilateral mastectomy with or without breast reconstruction. Our primary objective was to evaluate the feasibility of the Endoscopic Nipple Sparing Mastectomy (E-NSM) technique, without robotic assistance, using a single axillary incision and with immediate reconstruction using a prepectoral prosthesis in prophylactic indications. The secondary objectives were to evaluate the risks of postoperative complications and the esthetic results.</div></div><div><h3>Material and methods</h3><div>This is a preliminary report of a prospective single-center interventional clinical study with a final enrolment target of 20 patients. The primary endpoint was the rate of complete surgical procedures per E-NSM. The secondary endpoints were the rate of conversions to conventional surgery, infections, hematomas, skin injury, pain and esthetic results (Breast-Q questionnaire, additional cosmetic procedures).</div></div><div><h3>Results</h3><div>From April 2019 to June 2022, 10 patients were included for 19 procedures (9 bilateral mastectomies, 1 unilateral). All surgical procedures were complete; no conversion to conventional surgery was required. The rate of complications per procedure requiring revision surgery was 16% (1 skin necrosis, 1 postoperative hematoma and 1 surgical site infection). No prosthesis was removed. The seroma rate was 5%. All patients would recommend this technique and were very satisfied or satisfied with the esthetic result. A second cosmetic procedure (lipofilling) was necessary in 50% of patients.</div></div><div><h3>Discussion</h3><div>These preliminary data attest to the feasibility and safety of the E-NSM approach, and should be confirmed on a larger cohort and longer-term follow-up.</div></div><div><h3>ClinicalTrials.gov identifier</h3><div>NCT03838549</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102862"},"PeriodicalIF":1.7,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406485","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}
Pub Date : 2024-10-06DOI: 10.1016/j.jogoh.2024.102861
Lola Loussert , Thomas Schmitz , Diane Korb , François Goffinet , Camille Le Ray , JUMODA study group and the GROG
Introduction
Both twin pregnancies and previous cesarean delivery are situations with increased risk of failed vaginal delivery. Cesarean delivery after a trial of labor is associated with an increased risk of postpartum hemorrhage Therefore, in twin pregnancies with a previous cesarean delivery, planned vaginal delivery could lead to an increased risk of postpartum hemorrhage due to an important rate of cesarean delivery after a trial of labor. Our objective was to evaluate the association between the planned mode of delivery and postpartum hemorrhage in women with twin pregnancies and a previous cesarean delivery.
Methods
We conducted a secondary analysis of the JUMODA French population-based prospective cohort study of twin pregnancies (n = 8823). We included women with one previous cesarean and without contraindication to vaginal birth. The primary outcome was postpartum hemorrhage.
Results
Among the 735 women included, 187 women (25.4%) had planned vaginal delivery and 548 (74.6%) had planned cesarean delivery. Among women with planned vaginal delivery, 125 (66.8%) had a successful vaginal delivery. The incidence of PPH was 8.2% in the planned cesarean group and 9.1% in the planned vaginal delivery group(p = 0.709). After adjustment for confounders, the planned mode of delivery was not associated with the risk of postpartum hemorrhage (adjusted relative risk 0.94, 95% CI 0.56–1.60). There were only 2 uterine ruptures, both in the planned cesarean delivery group.
Conclusion
In women with a twin pregnancy and a previous cesarean delivery, there is no overall association between the planned mode of delivery and the risk of postpartum hemorrhage.
{"title":"Risk of postpartum hemorrhage according to the planned mode of delivery among twin pregnancies with previous cesarean delivery","authors":"Lola Loussert , Thomas Schmitz , Diane Korb , François Goffinet , Camille Le Ray , JUMODA study group and the GROG","doi":"10.1016/j.jogoh.2024.102861","DOIUrl":"10.1016/j.jogoh.2024.102861","url":null,"abstract":"<div><h3>Introduction</h3><div>Both twin pregnancies and previous cesarean delivery are situations with increased risk of failed vaginal delivery. Cesarean delivery after a trial of labor is associated with an increased risk of postpartum hemorrhage Therefore, in twin pregnancies with a previous cesarean delivery, planned vaginal delivery could lead to an increased risk of postpartum hemorrhage due to an important rate of cesarean delivery after a trial of labor. Our objective was to evaluate the association between the planned mode of delivery and postpartum hemorrhage in women with twin pregnancies and a previous cesarean delivery.</div></div><div><h3>Methods</h3><div>We conducted a secondary analysis of the JUMODA French population-based prospective cohort study of twin pregnancies (<em>n</em> = 8823). We included women with one previous cesarean and without contraindication to vaginal birth. The primary outcome was postpartum hemorrhage.</div></div><div><h3>Results</h3><div>Among the 735 women included, 187 women (25.4%) had planned vaginal delivery and 548 (74.6%) had planned cesarean delivery. Among women with planned vaginal delivery, 125 (66.8%) had a successful vaginal delivery. The incidence of PPH was 8.2% in the planned cesarean group and 9.1% in the planned vaginal delivery group(<em>p</em> = 0.709). After adjustment for confounders, the planned mode of delivery was not associated with the risk of postpartum hemorrhage (adjusted relative risk 0.94, 95% CI 0.56–1.60). There were only 2 uterine ruptures, both in the planned cesarean delivery group.</div></div><div><h3>Conclusion</h3><div>In women with a twin pregnancy and a previous cesarean delivery, there is no overall association between the planned mode of delivery and the risk of postpartum hemorrhage.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102861"},"PeriodicalIF":1.7,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391035","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}
Pub Date : 2024-10-03DOI: 10.1016/j.jogoh.2024.102860
Gabriel Levin , Emad Matanes , Amber Yasmeen , Raanan Meyer , Melica Nourmoussavi Brodeur , Shannon Salvador , Susie Lau , H. Uri Saragovi , Walter Gotlieb
Objective
Gangliosides GD2 and GD3 have been proposed to be of significance in diagnosis of ovarian masses. We aim to study serum GD2 and GD3 gangliosides as predictors of oncological outcomes among high grade serous (HGS) ovarian cancer (OC).
Materials and methods
A retrospective study including biobanked serum samples of HGS OC treated between 2005 and 2016. Serum GD2 and GD3 concentrations were quantified using indirect ELISA and analyzed with respect to survival.
Results
Sixty patients were included. Patients with GD3>12.8 ng/mL had shorter PFS when compared to patients with lower level; median 31 vs. 67 months, p = 0.005. Patients with GD2> 7.1 ng/mL had shorter median PFS than those with lower level of (23 vs. 52 months, p = 0.024.) Patients with GD3>14.5 ng/mL had shorter OS vs. patients with lower level (median 31 vs. 70 months, p = 0.002). In a Cox regression, following adjustment for age, CA-125, disease stage and age, serum elevated GD3 was independently associated with short PFS (adjusted hazard ratio 2.0, 95 % CI 1.1–3.8, p=.024). In a separate Cox regression, elevated GD2 was independently associated with PFS (adjusted hazard ratio3.0 (1.2–7.7). p=.019. High serum GD3 and GD2 were independently associated with short OS as well.
Conclusions
High levels of serum GD2 and GD3 in HGS OC were associated with shorter PFS and OS. GD3 is superior to GD2 as a biomarker for prognosis.
{"title":"GD2 and GD3 gangliosides as prognostic biomarkers in high grade serous ovarian cancer","authors":"Gabriel Levin , Emad Matanes , Amber Yasmeen , Raanan Meyer , Melica Nourmoussavi Brodeur , Shannon Salvador , Susie Lau , H. Uri Saragovi , Walter Gotlieb","doi":"10.1016/j.jogoh.2024.102860","DOIUrl":"10.1016/j.jogoh.2024.102860","url":null,"abstract":"<div><h3>Objective</h3><div>Gangliosides GD2 and GD3 have been proposed to be of significance in diagnosis of ovarian masses. We aim to study serum GD2 and GD3 gangliosides as predictors of oncological outcomes among high grade serous (HGS) ovarian cancer (OC).</div></div><div><h3>Materials and methods</h3><div>A retrospective study including biobanked serum samples of HGS OC treated between 2005 and 2016. Serum GD2 and GD3 concentrations were quantified using indirect ELISA and analyzed with respect to survival.</div></div><div><h3>Results</h3><div>Sixty patients were included. Patients with GD3>12.8 ng/mL had shorter PFS when compared to patients with lower level; median 31 vs. 67 months, <em>p</em> = 0.005. Patients with GD2> 7.1 ng/mL had shorter median PFS than those with lower level of (23 vs. 52 months, <em>p</em> = 0.024.) Patients with GD3>14.5 ng/mL had shorter OS vs. patients with lower level (median 31 vs. 70 months, <em>p</em> = 0.002). In a Cox regression, following adjustment for age, CA-125, disease stage and age, serum elevated GD3 was independently associated with short PFS (adjusted hazard ratio 2.0, 95 % CI 1.1–3.8, <em>p</em>=.024). In a separate Cox regression, elevated GD2 was independently associated with PFS (adjusted hazard ratio3.0 (1.2–7.7). <em>p</em>=.019. High serum GD3 and GD2 were independently associated with short OS as well.</div></div><div><h3>Conclusions</h3><div>High levels of serum GD2 and GD3 in HGS OC were associated with shorter PFS and OS. GD3 is superior to GD2 as a biomarker for prognosis.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102860"},"PeriodicalIF":1.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375544","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}
Global burden of cardiovascular disease is growing worldwide among women, particularly in younger women. Corresponding increases in the number and severity of cardiovascular risk factors (CVRF) associated with a greater impact in women could explain this increase in incidence. The prevalence of CVRF remains poorly known within young women, especially their cumulative prevalence. This study aimed to determine the prevalence of traditional and emerging CVRF, including female-specific CVRF, in young French women of childbearing age (16–45 years). The GYNRISK® survey aimed to analyse the magnitude and cumulation of CVRF. Two thousand women, representative of the general population, completed a self-administered, computer-assisted web interviewing survey.
Results highlighted the high prevalence of traditional CVRF (73.8 % with at least one CVRF). Modifiable CVRF were also particularly high, especially overweight/obesity (31.3 %), tobacco/cannabis consumption (24.0 %), sedentary lifestyle (55.4 %), low fruit and vegetable intake (83.6 %), and poor health literacy (87.2 %). Additionally, a high prevalence of accumulated CVRF was reported, with 37.8 % of young French women having ≥2 traditional CVRF, 69.6 % having ≥1 traditional and ≥1 emergent CVRF, and 73.3 % having ≥1 traditional in addition to ≥1 lifestyle associated CVRF. Among women receiving combined hormonal contraception (CHC), 34.0 % had a contraindication for CHC due of the presence of CVRF (single or cumulative) according to recommendations. GYNRISK® survey highlighted the need for more data in this understudied population of young women. Increasing knowledge, screening, prevention, and information, with targeting on modifiable CVRF must be a priority to reduce women cardiovascular burden.
{"title":"Prevalence of cumulative cardiovascular risk factors among women of childbearing age in France: Results of the GYNRISK® survey","authors":"Stéphane Manzo-Silberman , Nathalie Chabbert-Buffet , Edouard Roux , Muriel Parisi , Pedro-Antonio Regidor , Claire Mounier-Vehier","doi":"10.1016/j.jogoh.2024.102859","DOIUrl":"10.1016/j.jogoh.2024.102859","url":null,"abstract":"<div><div>Global burden of cardiovascular disease is growing worldwide among women, particularly in younger women. Corresponding increases in the number and severity of cardiovascular risk factors (CVRF) associated with a greater impact in women could explain this increase in incidence. The prevalence of CVRF remains poorly known within young women, especially their cumulative prevalence. This study aimed to determine the prevalence of traditional and emerging CVRF, including female-specific CVRF, in young French women of childbearing age (16–45 years). The GYNRISK® survey aimed to analyse the magnitude and cumulation of CVRF. Two thousand women, representative of the general population, completed a self-administered, computer-assisted web interviewing survey.</div><div>Results highlighted the high prevalence of traditional CVRF (73.8 % with at least one CVRF). Modifiable CVRF were also particularly high, especially overweight/obesity (31.3 %), tobacco/cannabis consumption (24.0 %), sedentary lifestyle (55.4 %), low fruit and vegetable intake (83.6 %), and poor health literacy (87.2 %). Additionally, a high prevalence of accumulated CVRF was reported, with 37.8 % of young French women having ≥2 traditional CVRF, 69.6 % having ≥1 traditional and ≥1 emergent CVRF, and 73.3 % having ≥1 traditional in addition to ≥1 lifestyle associated CVRF. Among women receiving combined hormonal contraception (CHC), 34.0 % had a contraindication for CHC due of the presence of CVRF (single or cumulative) according to recommendations. GYNRISK® survey highlighted the need for more data in this understudied population of young women. Increasing knowledge, screening, prevention, and information, with targeting on modifiable CVRF must be a priority to reduce women cardiovascular burden.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102859"},"PeriodicalIF":1.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377949","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}
Pub Date : 2024-09-24DOI: 10.1016/j.jogoh.2024.102858
Ayisha A. Ashmore , Aemn Ismail , Matthew Wood , Angus C. Jennings , Hilary McDermott , Esther L. Moss
Objectives
Robotic gynaecological surgery (RS) is reported to be associated with feelings of apprehension and anxiety pre-operatively in a proportion of patients. This study aimed to investigate patients’ understanding and perceptions towards RS, and whether the format of RS information resources could improve acceptability of RS.
Design
A two-phase, sequential, mixed methods study involving semi-structured interviews of patients who had previously undergone gynaecological RS and a block-randomised crossover study of women from the general public. Qualitative data from interviews were analysed using thematic analysis, quantitative data from questionnaires were summarised and analysed using Mann-Whitney U and Fisher's exact tests.
Results
Interview participants reported very little background knowledge of RS prior to their surgery. Many participants stated that written information leaflets did not adequately describe the robotic set-up and procedure, leading to anxiety and information seeking from alternative sources. The use of videos or models to visually demonstrate how the surgery would be performed and the interaction between the surgeon and the robot were proposed to address patients’ needs. Questionnaire data from 30 women demonstrated an increase in acceptability of RS following provision of information, with 73.3 % of the participants reporting that the video alone was an adequate source of information, compared to only 46.7 % for the printed leaflet.
Conclusion
This study gives new insights into the impact of information provision for patients undergoing RS. Availability of information resources in different modality formats, in particular an information video, may help address patients’ information needs, reduce anxiety and hence increase acceptability of RS.
{"title":"Seeing is believing: Patients’ attitudes and information preferences towards robotic gynaecological surgery","authors":"Ayisha A. Ashmore , Aemn Ismail , Matthew Wood , Angus C. Jennings , Hilary McDermott , Esther L. Moss","doi":"10.1016/j.jogoh.2024.102858","DOIUrl":"10.1016/j.jogoh.2024.102858","url":null,"abstract":"<div><h3>Objectives</h3><div>Robotic gynaecological surgery (RS) is reported to be associated with feelings of apprehension and anxiety pre-operatively in a proportion of patients. This study aimed to investigate patients’ understanding and perceptions towards RS, and whether the format of RS information resources could improve acceptability of RS.</div></div><div><h3>Design</h3><div>A two-phase, sequential, mixed methods study involving semi-structured interviews of patients who had previously undergone gynaecological RS and a block-randomised crossover study of women from the general public. Qualitative data from interviews were analysed using thematic analysis, quantitative data from questionnaires were summarised and analysed using Mann-Whitney U and Fisher's exact tests.</div></div><div><h3>Results</h3><div>Interview participants reported very little background knowledge of RS prior to their surgery. Many participants stated that written information leaflets did not adequately describe the robotic set-up and procedure, leading to anxiety and information seeking from alternative sources. The use of videos or models to visually demonstrate how the surgery would be performed and the interaction between the surgeon and the robot were proposed to address patients’ needs. Questionnaire data from 30 women demonstrated an increase in acceptability of RS following provision of information, with 73.3 % of the participants reporting that the video alone was an adequate source of information, compared to only 46.7 % for the printed leaflet.</div></div><div><h3>Conclusion</h3><div>This study gives new insights into the impact of information provision for patients undergoing RS. Availability of information resources in different modality formats, in particular an information video, may help address patients’ information needs, reduce anxiety and hence increase acceptability of RS.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 1","pages":"Article 102858"},"PeriodicalIF":1.7,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348090","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}
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