Journal of Obstetrics and Gynaecology Research最新文献

Japanese patients with polycystic ovary syndrome (PCOS) exhibit distinct body type characteristics, such that the rate of overweight/obese women is remarkably low. In addition, hyperandrogenism is relatively rare among Japanese PCOS patients. Therefore, these factors are considered in PCOS diagnostic criteria used in Japan. Diagnostic criteria for PCOS were recently revised by the Japan Society of Obstetrics and Gynecology based on a nationwide survey of PCOS and released on December 5, 2023 (JSOG2024). JSOG2024 criteria diagnosed PCOS according to the following three items: (1) irregular menstrual cycle/chronic anovulation, (2) polycystic ovarian morphology or elevated serum anti-Müllerian hormone (AMH) level, and (3) hyperandrogenism or high luteinizing hormone. The presence of all three items is required to diagnose PCOS, after excluding other diseases with symptoms similar to PCOS. We also established AMH cut-off values by age and a system for evaluating ovarian findings useful for both the JSOG2024 and Rotterdam criteria. We anticipate that the JSOG2024 criteria with cut-off values will enhance the treatment of Japanese patients with PCOS and those of other ethnicities with low obesity and hirsutism.

Aim: To evaluate the causes and clinical characteristics of primary amenorrhea and ovarian or gonadal disorders in women.

Methods: The medical records of all women evaluated for primary amenorrhea between January 2002 and December 2023 were retrospectively reviewed. Women with missing data were excluded from the study. Disorders of the ovary or gonads (hypergonadotropic hypogonadism) were defined as increased serum follicle-stimulating hormone (FSH) levels (>40 mIU/mL).

Results: Over a 21-year period, after excluding 1 woman with incomplete data, the study included 87 women who met the inclusion criteria. The median age at presentation was 18 years (interquartile range [IQR], 17-20). The median estradiol level was 5 pg/mL (IQR 5-10.4), and the median FSH level was 80 mIU/mL (IQR 63.1-94.9). The most common cause of primary amenorrhea was Turner syndrome (TS), followed by 46,XX and 46,XY gonadal dysgenesis. The median height was 147 cm (IQR, 140-158.7), and 50 women (57.5%) had karyotypic abnormalities, with TS being the most common abnormality.

Conclusion: TS was identified as the most common cause of primary amenorrhea with ovarian or gonadal disorders.

Aim: In developed nations, women have increasingly deferred childbearing, leading to a rise in demand for infertility treatments and the widespread use of assisted reproductive technologies. However, despite advancements in in vitro fertilization (IVF), live birth rates among women over 40 remain suboptimal. Mitochondrial dysfunction is widely recognized as a key factor in the processes driving the age-related deterioration in both the quantity and quality of oocytes. We aim to summarize current insights into ovarian aging, with a particular focus on pathways that impair mitochondrial function, and explore directions for future research.

Methods: Electronic databases were searched for articles published up to June 30, 2024.

Results: Ongoing ovulation, luteolysis, and menstruation trigger exogenous reactive oxygen species (ROS)-mediated oxidative stress that damages mitochondrial DNA. This, in turn, reduces nuclear gene expression, compromises mitochondrial oxidative phosphorylation, and diminishes adenosine 5' triphosphate production. Persistent endogenous ROS further exacerbate mitochondrial DNA damage and aneuploidy, ultimately causing irreversible chromosomal abnormalities, leading to oocyte aging.

Conclusions: We have delineated the pathway from oxidative stress to ovarian aging. Early detection and management of ovarian aging present challenges and opportunities to enhance IVF treatment strategies.

Aim: Primary splenic pregnancy is a rare form of extratubal ectopic pregnancy, frequently associated with life-threatening abdominal bleeding, with only 51 cases reported in the worldwide literature. The aim of this work, through the proposal of its own index case, is to identify the fundamental steps of the diagnostic process, crucial to reduce the mortality rate, while evaluating the available therapeutic options, through a review of the literature, particularly the more conservative ones, to avoid splenectomy.

Methods: We present the case of a 22-year-old woman, showing her diagnostic-therapeutic pathway. We searched Pubmed and other sources for all publications in English and all available non-English literature, including historical publications, on this rare topic, to identify the best treatment for these patients. We classified each article by clinical onset, diagnostic and therapeutic strategy, and histological findings, if available.

Results: We reviewed all the 43 cases available in the English-language literature (plus another paper in German), finding that 72.7% of patients presented in an emergency setting. Seventy-five percent of patients required splenectomy, 6.8% received pharmacological-only therapy, 11.3% received arterial embolization before definitive treatment. The other ones received non-radical surgical treatment.

Conclusions: Primary splenic pregnancy presents challenging diagnostic and therapeutic features. Treatment options (pharmacological, interventional, and/or surgical) should be tailored based on the clinical presentation and hemodynamic status of the patient. Our work would like to stimulate the validation of evidence-based therapeutic strategies validated by clinical experience.

Aim: This prospective, randomized, observational study aimed to compare the efficacy of intrauterine lidocaine, oral dexketoprofen, cervical lidocaine spray, and paracervical block with prilocaine for pain management during outpatient endometrial biopsy (EMB).

Methods: One hundred ninety-seven women aged 18-75 undergoing EMB were randomly assigned to one of four groups: intrauterine lidocaine (n = 49), oral dexketoprofen (n = 48), cervical lidocaine spray (n = 50), or paracervical block with prilocaine (n = 50). Pain intensity was assessed using a visual analog scale (VAS) immediately post-procedure and at 30 min, with additional analgesia needs recorded at 60 min. Statistical analyses included Kruskal-Wallis, chi-square tests, and post hoc analysis.

Results: The intrauterine lidocaine group had the lowest pain scores, while oral dexketoprofen had the highest (p < 0.001). Intrauterine lidocaine and paracervical block scores were significantly lower than those in the lidocaine spray and dexketoprofen groups (p < 0.001). Additional analgesia was needed in 30% of the lidocaine spray group, with none required in other groups. Severe pain (VAS ≥5.8) was more frequent in the dexketoprofen group compared to others (p < 0.001).

Conclusion: Intrauterine lidocaine and paracervical block are more effective than lidocaine spray and oral dexketoprofen in reducing procedural pain during EMB, highlighting the importance of appropriate analgesic selection to enhance patient comfort in office-based gynecological procedures.

Aim: To assess the feasibility, safety, and outcomes of modified laparoscopic transabdominal cerclage in patients with refractory cervical insufficiency.

Methods: This single-arm clinical trial examined women with refractory cervical insufficiency who underwent modified laparoscopic transabdominal cerclage at a specialized center in Japan between December 2017 and May 2022. Various parameters related to patient demographics, surgical techniques, outcomes, and complications were evaluated.

Results: The study enrolled 30 women with a median age of 36 years. The modified laparoscopic transabdominal cerclage was technically successful in all cases. The delivery rate and fetal survival rate at 28 days in the third trimester were both 93%. Surgical complication involving small bowel injury occurred in one case and was promptly repaired. No fetal complications or pregnancy losses occurred within 28 days of the procedure. Perinatal outcomes included a cesarean section rate of 93%, a neonatal intensive care unit admission rate of 30%, and an overall fetal survival rate of 93%. Additionally, no absence or reversal of end-diastolic flow in the uterine artery was identified at the time of cerclage in any of the cases.

Conclusions: This study demonstrated the feasibility and safety of modified laparoscopic transabdominal cerclage for refractory cervical insufficiency. The procedure achieved a high delivery rate in the third trimester and a good overall fetal survival rate. The study findings highlight the importance of anatomical precision during thread placement in modified laparoscopic transabdominal cerclage. This technique is promising for treating refractory cervical insufficiency and potentially preventing second-trimester losses and extreme preterm births.

Background: Recurrent miscarriage (RM) is influenced by immune factors, particularly regulatory T cells, which can impact immune function and miscarriage risk. Vitamin D (VD) is known to regulate the immune system, potentially improving pregnancy outcomes in RM patients. This study aims to assess the effect of VD adjuvant therapy on regulatory T cells and pregnancy outcomes in RM patients.

Methods: Clinical data from 104 individuals with RM admitted to our hospital between March 2022 and February 2023 were allocated at random to either the VD group (VDG) or the control group (CG), with 52 patients in each group. Both groups received standard treatment; the CG was treated with aspirin, while the VDG received additional VD therapy. Outcomes measured included regulatory T cell proportion, metabolic factors, immune inflammatory markers, and pregnancy outcomes.

Results: After treatment, the proportion of regulatory T cells in VDG was considerably higher (p < 0.05). Additionally, triglyceride levels, leptin, fasting blood glucose, and fasting insulin were lower in the VDG, whereas adiponectin levels were higher (p < 0.05). Levels of progesterone, luteinizing hormone, and 25-hydroxy VD were also higher in the VDG (p < 0.05). Furthermore, interleukin-17, gamma interferon, tumor necrosis factor-α, and C-reactive protein were lower in the VDG (p < 0.05). The pregnancy success rate in the VDG was higher, and the preterm birth rate was lower (p < 0.05).

Conclusion: Adjuvant treatment with VD can increase the proportion of regulatory T cells in peripheral blood of individuals with recurrent abortion, regulate metabolic disorder, alleviate immune inflammation, and improve pregnancy outcome.

Aim: To investigate the effects of surgical menopause on bone mineral density and bone quality because bilateral salpingo-oophorectomy for the treatment of gynecological malignancies is common even in premenopausal patients. This study is prospective one of bone mineral density and quality measurements after surgery for perimenopausal gynecologic malignancies.

Methods: In 50 women who underwent surgical menopause for a diagnosis of gynecological malignancies, bone mineral density (BMD), blood levels of tartrate-resistant acid phosphatase 5b (TRACP-5b) and bone-specific alkaline phosphatase (BAP) as bone metabolism markers, and urinary pentosidine level as bone quality marker were measured before surgery and at multiple points up to 24 months after surgery.

Results: In a group of 22 patients who did not undergo hormone replacement therapy (HRT) (HRT- group), BMD of the lumbar spine and total hip continued to decrease significantly from 6 months postoperatively. Percentages of changes in BMD progressively increased over time after surgery. TRACP-5b and urinary pentosidine levels significantly increased 6 months postoperatively compared with preoperative levels. Comparisons between 10 patients who underwent HRT (HRT+ group) and the HRT- group revealed significant reductions in the percentage of change in lumbar spine BMD only and TRACP-5b and urinary pentosidine levels 12 months postoperatively in the former group.

Conclusions: In this pilot study, we showed that BMD and bone-related markers are altered in patients with surgical menopause. It also suggested that HRT may reduce these influences on bone metabolism.

Aim: Pregnant women are at increased risk for severe illness associated with coronavirus disease 2019 (COVID-19) compared to nonpregnant women. The aim of this multicenter prospective study was to assess the current COVID-19 vaccination status of pregnant women in the southern Osaka district and to compare their antibody titers with those of nonpregnant women.

Methods: Serum antibody titers of anti-NCP antibodies (antibodies against the SARS-CoV-2 nucleocapsid) and anti-RBD antibodies (the receptor binding domain of the S1 subunit of the spike protein) were evaluated in 753 pregnant women at 34-35 weeks of gestation from October 2021 to March 2022. Anti-RBD antibody titre was also investigated in 1003 health care workers at Kindai University hospital 3 and 6 months after a second dose of the vaccine from March 2021 to April 2021. 519 (68.9%) pregnant women were vaccinated during pregnancy, of whom 497 (95.8%) received two doses.

Results: The COVID-19 infection rate calculated from the number of pregnant women with a positive anti-NCP antibody titre or with confirmed diagnosis was 5.1% (12/234) in the unvaccinated and 3.5% (18/519) in the vaccinated. The estimated half-life calculated from anti-RBD antibody titers and the number of days between vaccination and antibody testing was 39.9 days. The antibody titre and half-life in pregnant women were significantly lower and shorter than in nonpregnant women aged 20-39 years (109.4 days).

Conclusion: Our study showed that pregnant women may have lower vaccine-acquired COVID-19 immunity than nonpregnant women.