Journal of Obstetrics and Gynaecology Research最新文献

Aims: The United States is the only developed nation without a mandated paid parental leave. As of 2022, the Accreditation Council for General Medical Education has mandated a minimum 6-week parental leave during medical training in US training programs. Our objective was to evaluate current parental leave policies and attitudes toward leave across OBGYN subspecialties, identify barriers to fellows taking leave, and evaluate the level of support for lactation.

Methods: We distributed an anonymous electronic questionnaire to fellows and program directors (PDs) across OBGYN fellowships in five subspecialties (complex family planning, female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, and reproductive endocrinology and infertility) in the United States at the end of the 2023-2024 academic year.

Results: A total of 148 fellows and 76 PDs participated in the survey. Typical program parental leave reported by all participants was 6 weeks. Most (69.9%) fellows felt this typical leave to be too short, compared to half (45.7%) of PDs (p = 0.001). Only 4 (3.0%) fellows believed there are no barriers to trainees taking leave in fellowship, compared to 14 (20.0%) PDs (p < 0.001). Most commonly cited barriers to taking leave were culture in medicine, limited number of co-fellows, and need to extend training. Across the entire cohort, 74.3% fellows reported that being in training influenced their decision of when to have children, compared to 42.5% PDs (p < 0.0001). Fewer fellows compared to PDs were satisfied with their program's parental leave policy (46.6% vs. 68.5%, p = 0.03), and 51.2% fellows were neutral toward or dissatisfied with institutional support for lactation.

Conclusions: OBGYN fellows face barriers to being able to take leave in fellowship, are dissatisfied with parental leave length, and do not have enough lactation support.

Super super obesity increases perinatal risk, and monochorionic diamniotic twin gestation is uncommon. Although Wernicke's encephalopathy is linked to hyperemesis gravidarum in underweight women, severe obesity does not preclude micronutrient depletion. A woman with body mass index 65 kg/m² carrying monochorionic diamniotic twins developed Wernicke's encephalopathy at 25 weeks after prolonged poor diet with restrictions and persistent nausea and vomiting. Severe obesity may create a false impression of nutritional adequacy. Furthermore, twin pregnancy increases metabolic demand and complicates interpretation of weight changes. Serum thiamine was low-normal; magnetic resonance imaging showed a splenial corpus callosum lesion. Empiric high-dose intravenous thiamine rapidly improved symptoms. A central venous port was required for difficult access but complicated by a catheter-related bloodstream infection. Preterm membrane rupture at 31 weeks necessitated cesarean delivery for a nonvertex second twin; mother and twins survived. Reduced intake, frequent vomiting, and weight loss should trigger prompt thiamine treatment even with near-normal levels.

Aim: To compare the diagnostic accuracy of seven anthropometric indices for predicting metabolic syndrome (MetS) in Thai women with polycystic ovary syndrome (PCOS).

Methods: Electronic medical records of 1492 women aged 15-45 years who attended Siriraj Hospital during 2015-2024 were retrospectively analyzed. MetS was diagnosed using the International Diabetes Federation 2006 criteria. The indices assessed were a body shape index (ABSI), abdominal volume index (AVI), body adiposity index (BAI), body mass index (BMI), body roundness index (BRI), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Discrimination was evaluated by receiver operating characteristic (ROC) analysis with area under the curve (AUC) and 95% CI. Optimal cut-offs were identified using the Youden index.

Results: Metabolic syndrome prevalence was 20.8%. AVI, BMI, BRI, and WHtR showed comparable discrimination (AUC 0.84-0.85) and outperformed BAI (AUC 0.79), WHR (AUC 0.78), and ABSI (AUC 0.52). A composite of AVI, BRI, and WHtR did not improve discrimination. A BMI threshold of 25.78 kg/m² provided the best overall accuracy (69.6%). A WHtR threshold of 0.53 offered similar clinical utility.

Conclusions: BMI and waist-centered indices demonstrate comparable performance for predicting MetS in Thai women with PCOS. BMI provides the highest overall accuracy and, together with WHtR, can serve as practical first-line triage tools.

Aim: To compare the anatomical and functional outcomes of mesh-based and mesh-free laparoscopic uterus-preserving pectopexy in patients with apical pelvic organ prolapse: METHODS: This retrospective cohort study included 81 patients who underwent either mesh-based (n = 41) or mesh-free (n = 40) laparoscopic pectopexy between 2021 and 2024. Patients were evaluated for operative time, estimated blood loss, hospital stay, anatomical success based on the POP-Q system, sexual function using the PISQ-12 questionnaire, and postoperative complications. Follow-up assessments were conducted at 6 weeks and 1 year for anatomical outcomes (POP-Q) and at 3 months and 1 year for sexual function (PISQ-12).

Results: Both techniques significantly improved POP-Q parameters and PISQ-12 scores. The mesh group demonstrated superior apical and posterior support (C, Ap, and Bp points), while the mesh-free group showed longer total vaginal length. Operative time was significantly longer in the mesh-free group. Sexual function improved in both groups, with a greater early improvement in the mesh group, though differences leveled at 1 year. Complication and recurrence rates were low and comparable between groups.

Conclusions: Mesh-based and mesh-free pectopexy both offer effective anatomical correction and functional recovery in apical prolapse surgery. Mesh-based techniques provide stronger apical support, while mesh-free approaches may be preferable for patients avoiding synthetic implants. Individualized surgical planning remains essential.

Urethral prolapse (UP) is an uncommon condition that typically affects prepubertal girls and postmenopausal women, with adolescent cases rarely reported. We describe an 18-year-old girl with autism spectrum disorder and chronic diarrhea who presented with genital bleeding and a circumferential mass arising from the external urethral meatus. Marked leukocytosis (22 030/μL), neutrophilia, and elevated C-reactive protein levels indicated a systemic inflammatory response, although urine culture yielded only normal flora. Cystoscopy confirmed UP without intravesical lesions. The patient was treated with bladder drainage and intravenous piperacillin-tazobactam, leading to normalization of inflammatory markers; however, the prolapse persisted and required surgical excision. Postoperatively, she experienced complete symptom resolution, including disappearance of prolonged toilet use. This case illustrates the importance of considering UP in adolescents presenting with vulvar masses and highlights how hygiene-related factors and voiding patterns may contribute to complications such as suspected secondary infection or severe local inflammation. Surgical excision was safe and effective.