Journal of Obstetrics and Gynaecology Research最新文献

Aim: To assess fertility knowledge among Japanese medical students using the Japanese version of the Cardiff Fertility Knowledge Scale and to identify associated factors.

Methods: We conducted a cross-sectional survey of first- through sixth-year students at Kawasaki Medical School. Fertility knowledge was assessed using the 13-item Cardiff Fertility Knowledge Scale-Japanese version (CFKS-J), scored as the percentage of correct responses. Scores across academic years were compared using one-way analysis of variance. Factors associated with the continuous knowledge score and with high fertility knowledge (≥ 80%) were examined using multivariable linear and logistic regression models, adjusting for academic year and key covariates.

Results: A total of 613 students were included. The mean fertility knowledge score was 72.7%. Scores increased from the first to third year and then plateaued (from 55.0% in first-year to 83.5% in sixth-year students; p < 0.001). Item-level analysis showed particularly low correct responses for the obesity-related item and lower accuracy for items on mumps in males, amenorrhea and the possibility of conception, and sexually transmitted infections. In multivariable models, higher academic year was independently associated with higher knowledge, whereas not remembering whether sex education had been sufficient and not remembering having thought about age at childbearing were associated with lower scores. High fertility knowledge was less likely among students who had never learned about fertility or preconception care.

Conclusions: Fertility knowledge among Japanese medical students improved in earlier years but plateaued thereafter. Recall- and awareness-related factors and item-specific gaps highlight targets for curriculum-based fertility and preconception education.

Aim: The antenatal corticosteroid (ACS) administration rate in Japan is low. To achieve both high coverage and low overtreatment of ACS, understanding of facility-level factors is important. This study aimed to identify facility-level factors associated with ACS coverage and overtreatment and simulate the potential consequences of increased ACS use.

Methods: This observational study used data from the 2020 to 2022 Perinatal Registry Database maintained by the Japan Society of Obstetrics and Gynecology. Primary outcomes were: (1) ACS administration rate among preterm births before 34 weeks (ACS/34w rate) and (2) proportion of term births among ACS recipients (term/ACS proportion). Multivariable regression analyses examined associations with facility-level factors including perinatal care level, location, delivery volume, and prevalence of maternal conditions. A simulation estimated the impact of increasing ACS/34w rate to 80% in facilities with lower baseline rates.

Results: In the facility-level analysis of 244 facilities (376 717 records), the mean ACS/34w rate was 63.4%, and term/ACS proportion was 12.0%. The proportion of threatened preterm labor (coefficient: 4.4 [95% confidence interval: 2.1-6.7]), deliveries < 34 weeks (3.0 [0.1-5.8]), and cesarean section rate (-2.4 [-4.5 to -0.2]) were significantly associated with ACS/34w rate. ACS/34w rate (2.0 [0.8-3.3]), annual delivery volume (2.1 [0.6-3.5]), and cesarean section rate (1.5 [0.2-2.7]) were positively associated with term/ACS proportion, while perinatal care level was inversely associated (-3.5 [-6.3 to -0.6]). Simulation estimated 2311 additional ACS recipients and 465 term births per year.

Conclusions: Facility-level factors influence ACS coverage and overtreatment. These findings may inform strategies for optimizing ACS use.

Background: Fetal nutrient supply depends on maternal status. Pregnant women tend to pay close attention to their health and diet, and micronutrient supplementation is widely practiced. Overweight and obese pregnant women exhibit altered metabolism, inflammation, and placental function. These may limit the efficacy of nutritional supplementation in this population. Robust evidence on supplement efficacy and safety in this high-risk group is lacking. To evaluate the effects of antenatal nutritional supplementation on perinatal outcomes in women with pre-pregnancy overweight or obesity, we conducted a systematic review and meta-analysis.

Methods: We searched PubMed, Embase, and the Cochrane Library to 16 July 2025 for randomized controlled trials (RCTs) comparing any nutritional supplement versus placebo in pregnant women with body mass index (BMI) ≥ 25 kg/m². Nineteen RCTs (3482 participants) were included; risk ratios (RR) with 95% confidence intervals (CI) were pooled using fixed- or random-effects models.

Results: Supplements did not alter birth weight (SMD 0.04; 95% CI -0.04 to 0.11) or overall cesarean section risk. Probiotic supplementation increased preterm birth risk by 86% (RR 1.86; 95% CI 1.09-3.18). Inositol reduced preterm birth (RR 0.28; 95% CI 0.13-0.64) and preeclampsia (RR 0.40; 95% CI 0.19-0.83). Unsaturated fatty acids lowered macrosomia incidence (RR 0.53; 95% CI 0.29-0.95).

Conclusion: Routine unsaturated fatty acids and inositol supplementation should be considered for overweight or obese pregnant women to reduce macrosomia, preterm birth, preeclampsia, and gestational hypertension. Chronic or prophylactic probiotic supplementation is not recommended.

Reirradiation for cervical cancer recurrence in previously irradiated fields is challenging due to dose limitations. To our knowledge, this is the first case report describing successful reirradiation using a bioabsorbable spacer for vaginal cuff recurrence after initial concurrent chemoradiotherapy (CCRT) and hysterectomy. A 70-year-old woman with cervical cancer Stage IIIC2r initially received CCRT and chemotherapy. Three years later, uterine recurrence led to hysterectomy. Eighteen months post-surgery, vaginal cuff recurrence was diagnosed by imaging and tumor biopsy. A bioabsorbable spacer was surgically placed around the vaginal cuff tumor via an open abdominal approach. Reirradiation (55 Gy in 22 fractions) was started 23 days postoperatively. Use of the spacer provided adequate dose reduction to the small bowel, sigmoid colon, and rectum, with the rectal D1cc reduced to 37.9 Gy. Mild paralytic ileus occurred, but resolved conservatively, and there were no severe complications. The patient remains disease-free at 6 months post-treatment. In this case, bioabsorbable spacer placement allowed safe reirradiation for cervical cancer vaginal cuff recurrence. This technique may represent a promising approach for selected patients with in-field recurrent cervical cancer, although further accumulation of cases and longer follow-up are required.

Aim: The present study aimed to evaluate the therapeutic potential of the Unani formulation Ark-e-Kasni in alleviating the symptoms of polycystic ovary syndrome (PCOS).

Methods: In the present study, letrozole and a high-fat diet (HFD) were used to induce PCOS-like symptoms in rats. After induction, different groups were treated with varying doses of Ark-e-Kasni (5, 10, and 20 mL/kg), metformin, and finasteride. At the end of treatment, blood and ovaries were collected for biochemical and histological analysis.

Results: A significant weight gain and prolonged diestrous phase were observed in PCOS rats, accompanied by a considerable elevation in LH (42.52 ± 0.90 mIU/mL) and testosterone (8370 ± 122.18 pg/mL), and a low level of FSH (11.86 ± 0.43 mIU/mL). Moreover, an increase in insulin (14.31 ± 0.35 mIU/mL), TNF-α (358.81 ± 9.81 pg/mL), IL-1β (143.74 ± 3.39 pg/mL), and IL-6 (154.04 ± 2.04 pg/mL), and a reduction in SOD, CAT, and GSH were noticed. While the Ark-e-Kasni restored the levels of LH (30.97 ± 1.04 mIU/mL), testosterone (5651.83 ± 182.69 pg/mL), FSH (15.66 ± 0.56 mIU/mL), insulin (5.48 ± 0.23 mIU/mL), TNF-α (212.16 ± 8.66 pg/mL), IL-1β (78.79 ± 1.46 pg/mL), and IL-6 (74.53 ± 1.60 pg/mL), and lipid markers. Histological and microscopic analysis showed reduced cystic follicles and enhanced corpus luteum formation, improving ovarian morphology.

Conclusion: The findings suggest that Ark-e-Kasni ameliorates PCOS through diverse molecular mechanisms. Ark-e-Kasni may modulate steroidogenic enzyme activity to reduce hyperandrogenism, enhance insulin sensitivity through the PI3K/Akt pathway, and inhibit the downstream inflammatory pathway of NF-κB.

Aim: To compare outcomes, efficacy, and safety of vNOTES versus conventional laparoscopy and laparoendoscopic single-site surgery salpingectomy for ectopic pregnancy.

Methods: Electronic databases including PubMed, Medline, Cochrane Library, and Embase were systematically searched. Articles were evaluated according to specified inclusion criteria. Data were extracted and reviewed, with reported duration of procedure and length of patient stay as primary outcomes. Due to heterogeneity of data, analysis was further stratified depending on whether the control groups underwent conventional laparoscopy or laparoendoscopic single-site surgery. Secondary outcomes include success rates, estimated blood loss, Visual Analogue Scores (VAS) for postoperative pain and complications. A formal risk of bias assessment accompanied the included studies.

Results: Twenty-one studies were included within the review with a cumulative total of 405 cases of vNOTES salpingectomy. Studies included randomized control trials (n = 2), cohort control studies (n = 6), case series (n = 12), and case report (n = 1). Meta-analyses of duration of procedure and length of stay were performed across seven papers (stratified according to control groups). This revealed a significant reduction in length of stay but similar duration of surgery under fixed and random effects models (p < 0.05) for vNOTES versus conventional laparoscopic salpingectomy. Patients undergoing vNOTES salpingectomy versus laparoendoscopic single-site surgery had similar duration of surgery and length of stay. Women who had vNOTES demonstrated lower VAS pain scores and reduced analgesia requirements. Up to 4% of cases may need conversion to laparoscopy (these were cases associated with pelvic adhesions or torrential hemorrhage), and documented complications included hemorrhage, post-operative pyrexia, and need for blood transfusion.

Conclusions: vNOTES salpingectomy for ectopic pregnancy appears to be a safe and feasible procedure, with high levels of patient satisfaction and low pain scores. The heterogeneity of data of the control groups is acknowledged and patients undergoing vNOTES versus conventional laparoscopic salpingectomy had reductions in length of stay but similar duration of surgery, while vNOTES salpingectomy versus laparoendoscopic single-site surgery incurred similar duration of surgery and length of stay. Procedural standardization and larger randomized clinical trials to assess long-term outcomes are crucial if vNOTES salpingectomy should become widely used for surgical treatment of ectopic pregnancy.

Aim: To establish pregnancy-specific reference intervals for key biochemical parameters and to assess their associations with adverse pregnancy outcomes in a large Japanese cohort.

Methods: This retrospective cohort study analyzed outpatient biochemical test data from 33 085 women with singleton pregnancies who delivered at a perinatal center in Japan between 2013 and 2023. Plasma glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), uric acid (UA), total cholesterol (TC), and triglycerides (TG) were measured during early (< 20 weeks), mid (20-29 weeks), and late (≥ 30 weeks) gestation. Reference intervals were established nonparametrically, and multivariable logistic regression was performed to assess associations with gestational diabetes mellitus (GDM), and hypertensive disorders of pregnancy (HDP).

Results: Glucose, AST, and ALT showed minimal changes across gestation, whereas TG, TC, and UA increased progressively. Across BMI categories, glucose, TG, and UA rose with higher BMI, whereas AST and TC tended to be higher in lower-BMI groups after mid-pregnancy. Higher TG levels at 20-29 weeks were independently associated with HDP, while higher AST and lower TC at 20-29 weeks also showed modest associations. In contrast, glucose and ALT showed no significant relationships with HDP. Elevated glucose levels in both early and mid-pregnancy were the strongest correlates of GDM, followed by ALT, whereas AST demonstrated inverse associations.

Conclusions: This study established gestational age-specific reference intervals for major biochemical parameters in Japanese pregnant women. TG, AST, and TC were associated with HDP, whereas glucose and ALT were associated with GDM, providing clinically relevant insights into metabolic adaptation and pregnancy risk assessment.

Aim: The Prolapse Quality-of-Life Questionnaire (P-QOL) is a validated tool for assessing symptom severity and treatment outcomes in patients with pelvic organ prolapse (POP). This study investigates whether the total score of selected P-QOL component questions may serve as a surrogate marker for the Overactive Bladder Symptom Score (OABSS) and the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) in patients with POP undergoing transvaginal mesh surgery (TVM).

Methods: The study enrolled 148 patients who underwent TVM at our institution between September 2014 and March 2024. Correlations between the total score of selected P-QOL component questions and the OABSS or ICIQ-SF score were assessed using Spearman's rank correlation coefficient. The Kruskal-Wallis test compared P-QOL scores between OABSS ≥ 3 and ≤ 2 groups, and ICIQ-SF ≥ 6 and ≤ 5 groups at pre-operation and at 3, 6, and 12 months postoperatively.

Results: Significant correlations were observed between the total score of selected P-QOL component questions and the OABSS or ICIQ-SF score both preoperatively and postoperatively. Box plot analyses showed significant differences in P-QOL scores between the OABSS ≥ 3 and ≤ 2 groups and the ICIQ-SF ≥ 6 and ≤ 5 groups at all time points. Additionally, post-void residual urine volume, P-QOL scores, and OABSS and ICIQ-SF scores significantly decreased at 3, 6, and 12 months postoperatively compared with preoperative values.

Conclusions: The P-QOL provides reliable information regarding urinary storage conditions both preoperatively and postoperatively, making it a potential utility in reflecting urinary storage symptoms instead of the OABSS and ICIQ-SF for evaluating urinary storage symptoms in patients with POP.

We present a rare case of severe lymphatic leakage resembling hypovolemic shock following retroperitoneal lymphadenectomy for endometrial cancer. A 62-year-old female developed massive lymphorrhea and chylous ascites following total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy. Immediately postoperatively, massive lymphatic leakage caused hypotension and oliguria necessitating vasopressor support. Conservative management, including fasting and octreotide, was unsuccessful. Lymphangiography with Lipiodol and subsequent embolization using N-butyl cyanoacrylate were performed but did not achieve hemodynamic stabilization. Re-laparotomy was undertaken, and indocyanine green injection into the bilateral inguinal lymph nodes, along with oral milk ingestion, enabled precise intraoperative identification of leakage sites. These were successfully ligated with adjunctive fibrin glue and oxidized cellulose. Hemodynamics rapidly improved following repair. Although most lymphatic leakages resolve conservatively, severe cases can cause life-threatening circulatory failure. This case highlights the importance of a multidisciplinary approach, including interventional radiology and surgical repair, to achieve successful outcomes.