Journal of gynecology obstetrics and human reproduction最新文献

Cervical ectopic pregnancy is one of the rarest types of pregnancy, representing less than 1 % of ectopic pregnancies. We report the case of minimally invasive management of a voluminous cervical ectopic pregnancy at 9 weeks gestation using uterine artery embolization and in situ methotrexate. During follow-up, we encountered no hemorrhagic complications, while β-hCG values returned to normal by Day 104 and the uterine cavity fully recovered within 6 months. Additionally, we present a review of the literature on this topic.

Research Question

What is the impact of ethanol sclerotherapy of endometriomas prior to IVF/ICSI on pregnancy rates?

Design

We reviewed women with endometrioma(s) larger than 25 mm having IVF/ICSI cycles. All patients with a history of ovarian cystectomy were excluded. Two groups were compared: patients who had transvaginal ethanol sclerotherapy of their endometrioma(s) before ovarian stimulation and patients whose endometrioma(s) were left in situ (untreated) at the time of IVF/ICSI (control group). Analyses were adjusted for confounding factors by inverse probability of treatment weighting. The primary endpoint was progressive pregnancy rates per IVF/ICSI cycle including fresh and frozen embryo transfers. Secondary endpoints were live birth rates, the number of mature oocytes retrieved, pregnancy loss. Endometriomas recurrence rates after sclerotherapy and procedural complications were also analyzed.

Results

A total of 96 cycles (67 patients) were included: 46 cycles (34 patients) in the ethanol sclerotherapy group and 50 cycles (33 patients) in the control group. After propensity score weighting, the pregnancy and live-birth rates were significantly higher in the ethanol sclerotherapy group compared to the control group (weighted OR, 2.9 ; 95 CI, 1.4 – 6.6 and weighted OR 2.4 ; 95 CI, 1.1 – 5.4 respectively), with a lower rate of pregnancy loss (weighted OR 0.3 ; 95 CI, 0.1 – 0.9). Ovarian response was similar in the two groups. The recurrence rate of endometrioma at 6 months after sclerotherapy was 20 %.

Conclusion

Sclerotherapy of endometrioma before ovarian stimulation may increase pregnancy rate, with a low rate of recurrence and a minimal risk of complication.

Objectives

In this study, the association of non-institutional births with neonatal and infant mortality in Japan was investigated as well as sociodemographic characteristics of non-institutional births.

Methods

The Vital Statistics data in Japan (the birth data from 2012 to 2021 and mortality data from 2012 to 2022) were used. Births were classified into three types based on the place of birth and birth attendant: institutional births, non-institutional births with a physician or a midwife, and non-institutional births without a physician or a midwife. Modified Poisson regression was used in order to investigate the association between the type of birth and neonatal and infant mortality and the association between sociodemographic characteristics and the type of birth.

Results

A total of 9,422,942 births were used in the analysis. The results of regression analysis investigating an association between the type of birth and neonatal and infant mortality showed that non-institutional births were positively associated with neonatal and infant mortality regardless of the attendance of a physician or a midwife. Furthermore, the results of regression analysis investigating predictors of non-institutional births showed that factors such as non-urban regions, older maternal age groups, and unmarried status of mothers were positively associated with the two types of non-institutional births, and non-Japanese mother was positively associated with non-institutional births without a physician or a midwife.

Conclusions

Non-institutional births were a predictor of neonatal and infant mortality regardless of the attendance of a physician or midwife, and some sociodemographic characteristics have been proven to be predictors of non-institutional births.

The incidental finding of endometrial thickness (ET) >4 mm in the absence of postmenopausal bleeding (PMB) is a common cause of referring women to secondary care. However, there is lack of consensus amongst gynecologists as regards the management. It is estimated that up to 15 % of endometrial cancers occur in women without PMB. The aim this study was to determine the optimal ET threshold, on trans-vaginal ultrasound scan, that discriminates normal endometrium from endometrial hyperplasia and cancer in this cohort. On using a thorough search strategy, a total 16 studies including 4088 women were deemed eligible. However, the data were not amenable to meta-analysis. There were wide variations in the thresholds reported with potential bias given the retrospective nature of the majority of the studies. Despite contacting authors, we could not obtain the primary data to generate a Receiver Operating Characteristic (ROC) Curve. No linear or curvilinear association was found between ET thresholds and the percentage of women diagnosed with endometrial hyperplasia and cancer using either Pearson's correlation, linear or curvilinear regression, or a simple visual scan/scatter diagram. The result of this study reveals the lack of evidence to inform clinical practice in this area, and there is a need for a well-designed multi-center prospective study.

Background

Elagolix, an approved non-peptide GnRH antagonist, shows promise in relieving endometriosis-related pain, but its short- and mid-term efficacy and potential side effects are still under investigation.

Objective

The aim is to provide data for therapeutic applications by methodically evaluating elagolix's safety and effectiveness in treating endometriosis-related pain.

Methods

Databases such as PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, and others were thoroughly searched. The search time was from the establishment date to September 2023. The study included randomized controlled trials (RCTs) that compared the efficacy of elagolix versus placebo in treating endometriosis-associated pain. After data extraction and literature scanning, quality assessment was carried out using Quality evaluation was carried out using the bias risk assessment tool suggested by the Cochrane Reviewers' Handbook 5.1.0 after literature screening and data extraction. Stata 15.0 was used to do the meta-analysis.

Results

In total, five RCTs involving 2056 patients were included in the analysis. The meta-analysis demonstrated a significant superiority of elagolix over placebo in the management of endometriosis-related pain, specifically in endometriosis pain [WMD=-0.77, 95% CI (-1.00, -0.53), P<0.001], as well as in non-menstrual pelvic pain, daily assessment of dysmenorrhea (DYS), and dyspareunia (DYSP), all of which are associated with endometriosis. Regarding safety, no discernible variation was observed in the incidence of serious adverse responses between the elagolix and placebo groups [RR=0.90, 95% CI (0.58, 1.40), P=0.643]. Conversely, the elagolix group exhibited a significantly higher incidence rate of general adverse responses [RR = 1.34, 95% CI (1.18, 1.52), P<0.001] compared to the control group.

Conclusions

The efficacy of elagolix in reducing pain in premenopausal women with endometriosis has been demonstrated over the short- to mid-term. However, careful monitoring for potential adverse effects is essential throughout the treatment duration.

Background

Previous studies have highlighted patients with chronic conditions seek for medical knowledge and therapeutics on their own. So far, no data exist on the health literacy of patients with gynecological conditions and especially those suffering from endometriosis, whose symptoms’ have a major impact on their daily lives.

Method

The objective was to evaluate the health literacy of patients consulting in a referral expert center for the management of endometriosis and gynecological cancers. The secondary objective was to compare the health literacy of patients with endometriosis to patients without. We conducted an observational, prospective, monocentric study in the gynecological department of Tenon Hospital (Paris, France) between July 6, 2022 to January 3, 2023. All patients fulfilled the validated French version of HLS-EU-Q16 questionnaire.

Results

One hundred and ten patients were included. The two following questions were identified as the most difficult among patients with endometriosis: “Find information about treatments for their disease” and “know when it would be helpful to have another doctor's opinion”. Compared to patients consulting for other conditions, it was more difficult for patients with endometriosis to respectively “find information about treatments for diseases” and “use information given by the doctor to take decisions about the illness” (p = 0.003). Compared to patients consulting for cancer, it was more difficult for patient with endometriosis to “find information about treatments for diseases” (p = 0.02).

Conclusion

Progresses in the capacity of the health care to better inform the patients would be highly beneficial, especially for those suffering from endometriosis.

Objective

Infertility is a significant public health concern affecting 10–15 % of couples. Young women undergoing gonadotoxic treatment are at higher risk of ovarian dysfunction and infertility. To mitigate this risk, ovarian tissue freezing and transplantation have been developed as a novel strategy. However, challenges such as follicular loss and dysfunction during the freezing process, and ovarian damage during transplantation, persist. This study aimed to investigate the potential of using appropriate antifreeze, antioxidant, wound healing, and biological hydrogels to reduce these injuries. Specifically, the effect of fibrin scaffold with endothelial cells and melatonin on apoptotic gene expression and antioxidants in cryopreserved ovaries after transplantation was examined.

Methods

A total of 36 adult female wistar rats) 6–8-week-old and weighing from 200 to 220 g) were divided equally into six groups (n = 6): 1) control group (C), 2) transplanted ovarian tissue after vitrification and thawing process (Group 1), 3) transplanted vitrified/thawed ovarian tissue while encapsulated in Fib/Alg hydrogel (Group 2), 4) transplanted vitrified/thawed ovarian tissue while encapsulated in Fib/Alg hydrogel in addition with melatonin (Group 3), 5) transplanted vitrified/thawed ovarian tissue while encapsulated in Fib/Alg hydrogel in addition with endothelial cells (Group 4) and 6) transplanted vitrified/thawed ovarian tissue while encapsulated in Fib/Alg hydrogel in addition with melatonin endothelial cells (Group 5). The ovaries were auto-transplanted in the rats' lumbar region. After 14 days, the ovaries were removed. Antioxidant levels (SOD, GPx, MDA, and TAC) were evaluated using ELISA, and apoptotic gene expressions (Bax/Bcl2 and caspase 3) were analyzed by real-time RT-PCR to determine apoptosis.

Results

In the transplanted frozen ovary group, Bax/Bcl2 and caspase 3 gene expression increased significantly (P < 0.05), while antioxidant levels (SOD, GPx, MDA, and TAC) decreased. The encapsulated frozen ovary group showed decreased gene expression and increased antioxidant levels. The ovary group encapsulated with fibrin scaffold, endothelial cells, and melatonin had the most significant decrease in gene expression and increase in antioxidant levels (P < 0.05).

Conclusion

Coordinated action of Fibrin-based scaffold with endothelial cells and melatonin could decrease apoptosis gene expression and increase antioxidant levels in cryopreserved ovaries after transplantation, providing valuable insights into preserving fertility in young women undergoing gonadotoxic treatment.

Background

Adenocarcinoma in situ (AIS) of the cervix can progress to invasive adenocarcinoma. While hysterectomy is standard, conservative management may be considered for women desiring future pregnancies. This study aimed to determine the prevalence of residual disease in hysterectomy specimens following excisional therapy with clear margins for AIS.

Methods

A retrospective FRANCOGYN cohort study was conducted on patients who underwent a hysterectomy after conization with clear margins for AIS between 2008 and 2021. The primary goal was to assess the prevalence of residual disease in the hysterectomy specimens. Secondary objectives included identifying preoperative predictors of residual disease and comparing recurrence rates between patients with and without residual disease.

Results

Of 53 hysterectomies performed after conization with negative margins for AIS, 20.8% (11/53) showed residual disease in the final histology. None of the patients had invasive cancer. In the residual disease group, 18% (2/11) had persistent CIN 3, and 82% (9/11) had persistent AIS. These patients tended to have higher BMI (27.5 kg/m² vs. 23.6 kg/m², p=0.04) and shorter endocervical margins (2mm vs. 5mm, p=0.01). No recurrences were observed during follow-up.

Conclusion

Despite clear margins on the initial conization for AIS, 20% of patients had residual disease in their hysterectomy samples, though no invasive cancer was found. A hysterectomy should be considered after completing childbearing, even if initial margins are clear.

Endometriosis is a condition that can cause significant pain and discomfort for women, and the clinical and surgical treatments available have variable efficacy and can have adverse effects. These drawbacks often lead to poor adherence and therapeutic failure. Consequently, there has been increasing interest in the use of nutritional supplements as an adjuvant therapy for endometriosis. To facilitate clinical decision-making in managing women with endometriosis, a narrative review of clinical studies was conducted to investigate the effects of oral nutritional supplements on endometriosis-related pain. A literature search of the English-language PubMed/MEDLINE database was performed using appropriate keywords to identify clinical studies involving oral nutritional supplements and reporting on endometriosis-related pain. This narrative review included 20 studies published between 2013 and 2023, comprising 12 randomized controlled trials, six non-comparative trials, and two observational studies. The studies investigated the effects of various nutritional supplements on endometriosis-related pain, including vitamins, fatty acids, probiotics, medicinal plants, and bioactive compounds. A significant decrease in endometriosis-related pain was found in three out of five studies on vitamins, four out of six studies on fatty acids, one study on probiotics, two studies on medicinal plants, and five out of six studies on bioactive compounds. These nutritional supplements exhibited diverse biological activities, such as anti-inflammatory, antioxidant, antiproliferative, and antiangiogenic effects, all of which are relevant for managing endometriosis. These findings suggest that oral nutritional supplements could be included as part of a multidisciplinary treatment for endometriosis to decrease pain and enhance overall medical treatment.

Introduction

Over the last several decades, cesarean delivery has been recommended as the safest mode of delivery for breech presentations. The purpose of this study was to evaluate the outcomes of planned vaginal births with planned cesarean births in breech presenting fetuses.

Methods

This retrospective population-based cohort study utilized data from the United States’ Period Linked Birth-Infant Death Public Use Files from 2008 to 2017. All term singleton breech deliveries of a live baby without congenital anomalies were identified (n = 546,842) and divided into two cohorts: women who had a planned vaginal birth (n = 116,828), and women who had a planned cesarean section (n = 430,014). Multivariate logistic regression models, adjusted for maternal baseline characteristics, examined the associations between the planned delivery method and neonatal outcomes.

Results

It was observed that 26.14 % of the planned vaginal birth cohort had a vaginal delivery. In adjusted analyses, undergoing a planned vaginal birth for breech delivery was associated with an increased risk of adverse neonatal outcomes including infant death, OR 1.32, 95 % CI 1.16–1.52, admission to NICU,1.23, 1.19–1.27, ventilation support at 〈 6 h of life, 1.47, 1.42–1.52, ventilation support at 〉 6 h of life, 1.19, 1.08–1.31, and Apgar score of ≤3 at 5 min, 2.27, 2.06–2.50.

Conclusion

In women carrying fetuses in breech presentation, having a planned vaginal birth had a low success rate and was associated with increased risk of neonatal morbidity and mortality. Women should be carefully counselled on the risks associated with breech vaginal delivery as well as the low success rate of vaginal delivery.