Journal of Obstetrics and Gynaecology Research最新文献

Radiotherapy and surgery are the two pivotal curative treatments for cervical cancer. Although cervical cancer is relatively sensitive to chemotherapy, chemotherapy is not included in the curative treatment of cervical cancer and has a role in limited medical conditions. Chemotherapy used to treat cervical cancer can be divided into four categories: (1) preceding chemotherapy (neoadjuvant chemotherapy) to augment the effects of radical therapy (surgery or radiation therapy), (2) chemotherapy administered concurrently with radiation therapy, and (3) adjuvant chemotherapy administered after radical therapy. In addition, (4) chemotherapy is used to prolong survival and alleviate symptoms in patients who cannot be radically cured. Recently, molecular targeted agents, angiogenesis inhibitors, and immune checkpoint inhibitors have been incorporated into existing chemotherapy regimens. This review summarizes these trends along with the history of chemotherapy for cervical cancer.

Minimally invasive surgery (MIS), including laparoscopic and robot-assisted procedures, has rapidly advanced in the treatment of gynecologic malignancies worldwide. However, its adoption and insurance coverage in AOFOG countries remain limited, particularly for advanced uterine and ovarian cancers. This limitation poses a challenge to the widespread use of MIS, highlighting the need for a more comprehensive evaluation of its role and the skills required by gynecologic oncologists to ensure safe and effective treatment. Furthermore, the Laparoscopic Approach to Cervical Cancer trial significantly impacted perceptions of MIS, revealing higher recurrence rates and inferior overall survival for minimally invasive radical hysterectomy (MIS-RH) compared to abdominal radical hysterectomy. Subsequent studies confirmed these findings, raising questions about the suitability of MIS-RH, particularly in centers with limited experience. Key issues affecting MIS outcomes include surgical expertise and tumor spillage prevention. As the landscape of cervical cancer treatment evolves, the integration of radiotherapy, chemotherapy, and immune therapies has challenged the traditional reliance on surgical monotherapy. There also exists ongoing debate over the optimal use of MIS in primary treatment and salvage surgery for cervical cancer to refine MIS techniques and explore their role in preserving fertility and managing residual disease post-chemoradiotherapy. For ensuring MIS as a viable treatment option, it is continuously necessary accumulating real-world data and reassessing surgical strategies to balance efficacy, safety, and patient preferences.

Objectives: We aimed to assess the effects of rooming-in kangaroo mother care (KMC) on the breastfeeding and behavioral status of full-term newborns.

Materials and methods: Full-term newborns born from June to December 2021 were divided into Group A (n = 50) and Group B (n = 50) using a random number table. The rooming-in routine nursing intervention and KMC were given to Group A (n = 50) and Group B, respectively. The outcomes were compared.

Results: The scores of breastfeeding knowledge, breastfeeding skills, and sense of responsibility for breastfeeding of Group B were higher than those of Group A (p < 0.05). The breastfeeding rate and lactation yield within 3 days of Group B were higher than those of Group A (p < 0.05). Compared with Group A, Group B had higher effective sucking times of newborns and lower behavioral status scores 1, 2, and 3 days after birth, and shorter duration of crying after invasive operation (p < 0.05). The newborns in Group B had better sleep quality, longer sleep time, and lower procedural pain score than those of Group A (p < 0.05).

Conclusion: Rooming-in KMC improves the maternal breastfeeding self-efficacy, breastfeeding rate, and lactation yield, ameliorates the behavioral status and sleep quality of newborns, shortens the crying time and relieves the procedural pain.

Ovarian carcinosarcoma in hereditary breast and ovarian cancer syndrome is rare. A 43-year-old woman with a family history of prostate and uterine or ovarian cancer had an 8-cm mass in the right ovary. Although computed tomography suggested peritoneal dissemination to the Douglas pouch, she wanted to preserve her fertility; therefore, she underwent a right salpingo-oophorectomy. Histopathological diagnosis was carcinosarcoma consisting of high-grade serous carcinoma and sarcomatous components, including cartilage. Three weeks later, she underwent radical surgery. The disease was classified as advanced stage IIIB (FIGO 2014). A germline BRCA2 pathogenic variant was identified. After postoperative adjuvant chemotherapy, maintenance therapy with a poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitor was continued for 25 months without recurrence. A detailed examination of a mass in her left breast at her first visit revealed a ductal carcinoma in situ. PARP inhibitors may be effective as maintenance therapy for advanced ovarian carcinosarcoma with germline BRCA mutations.

Aim: To investigate the efficacy and safety of long-term adjusted low-dose gonadotropin-releasing hormone agonist therapy (GnRH agonist drawback therapy) with nafarelin acetate in patients with uterine fibroids and/or adenomyosis with menstrual symptoms.

Methods: This single-center, retrospective, observational study initially included 118 patients with uterine fibroids and/or adenomyosis with menstrual symptoms who had received GnRH agonist (nafarelin acetate) drawback therapy for at least 7 months between 2010 and 2020. Blood hemoglobin level, maximum fibroid diameter, area of the corpus uteri, blood estradiol level, daily dosage of nafarelin acetate, and bone density in the lumbar spine and femoral neck were assessed before and after the treatment initiation.

Results: The median treatment period was 28 months. Menstruation had ceased in all patients. The median hemoglobin level significantly increased from 8.6 to 13.2 g/dL before treatment and at 12 months after the treatment initiation in patients with fibroids and from 8.8 to 13.3 g/dL in patients with adenomyosis, respectively. Although the treatment did not exert a significant shrinking effect on the fibroids and adenomyosis, an increase in their size was not observed in any patient. The initial dose of nafarelin acetate was 400 μg/day and was lowered to 130 μg/day at 12 months. Only 29 patients (25%) had an estradiol level <30 pg/mL. The average rate of bone density change over 6 months was -1.23% in the lumbar spine and -1.12% in the femoral neck in patients with fibroids and -1.06% in the lumbar spine and -0.14% in the femoral neck in patients with adenomyosis, which were lower than the previously reported rates.

Conclusions: GnRH agonist drawback therapy was found to be useful for the long-term conservative treatment of uterine fibroids and adenomyosis. The treatment was safely and inexpensively performed with few adverse events.