Journal of Obstetrics and Gynaecology Research最新文献

Aim: This study examined the relationship between postpartum hair loss and psychological symptoms.

Methods: This questionnaire-based, cross-sectional study included postpartum women who had delivered at two facilities and completed the questionnaire 10-18 months after delivery. Study protocols were sent by mail in two parts. Baseline characteristics and information regarding the pregnancy, delivery, childcare, and postpartum hair loss were obtained via a questionnaire. Psychological symptoms were assessed via the Whooley Questions, Generalized Anxiety Disorder 2-item, and Edinburgh Postnatal Depression Scale. Participants were divided into two groups based on psychological symptoms. Multivariate analyses were performed.

Results: In total, 331 responses were analyzed. Women with very much hair loss felt significantly more anxious than those with no postpartum hair loss, as reported on the Generalized Anxiety Disorder 2-item anxiety subscale (odds ratio: 4.47). Multiple logistic regression analysis revealed that primiparity, greater amount of postpartum hair loss, and higher Athens Insomnia Scale scores were predictors of Generalized Anxiety Disorder 2-item anxiety. Adjusted odds ratio of having anxiety among those with very much postpartum hair loss was 4.58 (95% confidence interval, 1.18-17.74) compared to those with no postpartum hair loss.

Conclusions: A greater amount of postpartum hair loss was independently associated with postpartum anxiety on the Generalized Anxiety Disorder 2-item.

Aim: Fontan surgery is a palliative procedure commonly performed for functional single-ventricle heart diseases. Fontan circulation is characterized by elevated central venous pressure and low cardiac output. It causes placental hypoxia, which could lead to poor obstetric outcomes. During post-Fontan pregnancies, ultrasonography may detect abnormal appearance of the placenta. We have focused on higher incidences of unexpected onset of labor when this ultrasonographic finding is present. In this study, we aimed to investigate whether this finding could be an indicator of premature delivery before pre-scheduled dates in post-Fontan pregnancies.

Methods: During post-Fontan pregnancies, the placenta exhibits a mosaic pattern with areas of low and high echogenicity and unusually thick on ultrasonography. We refer to these changes as "ultrasonographic placental edematous changes." We retrospectively analyzed clinical charts and ultrasonograms for post-Fontan pregnancies between 2015 and 2022.

Results: Fifteen patients were included in this study. Ultrasonographic placental edematous changes in the placenta during pregnancy were detected in eight cases (53%). Six (75%) of these patients experienced unexpected premature labor. Two patients underwent vaginal delivery because of sudden onset of labor. Four patients underwent emergency cesarean sections. Two patients underwent planned preterm cesarean sections. In the seven pregnancies without placental edematous changes, all deliveries occurred on the pre-scheduled dates determined based on the maternal heart condition.

Conclusions: Pregnancies with ultrasonographic placental edematous changes have a higher risk of unexpected preterm delivery than those without these changes. Ultrasonographic placental edematous changes may serve as predictive markers for unplanned preterm births in post-Fontan pregnancies.

Aim: We investigated the association between the length of anogenital distance (AGD) and intra-vaginal pH, an indicator of vaginal eubiosis or dysbiosis, in women with endometriosis.

Methods: A prospective cohort study was performed including patients with (n = 67) and without (n = 40) endometriosis undergoing surgery between July 2021 and June 2022. AGD was measured from the posterior fourchette to the center of the anus using digital caliper and vaginal pH was measured by inserting pH paper strip mostly into the posterior fornix.

Results: There was no significant difference in the median AGD among control women (n = 40) (21.5 mm), women with revised-American Society of Reproductive Medicine stage I-II endometriosis (n = 27) (22.0 mm) and stage III-IV endometriosis (n = 40) (20.0 mm). In contrast, a significant difference of vaginal pH was observed among groups (p = 0.012) and between groups: control versus stage I-II, p = 0.004; stage I-II, versus stage III-IV, p = 0.037. After adjusting different confounding variables, the univariate analysis showed that women with endometriosis are less likely to have an alkaline vaginal pH (≥4.5) (OR [95% CI] = 0.40 [0.17, 0.93], p = 0.034). Multivariate analysis revealed that AGD or any of the other variables did not serve as an independent risk factor to predict the presence of endometriosis.

Conclusions: This study with Japanese women suggests a lack of association between length of AGD, either shorter or longer, and the status of vaginal pH or the presence of endometriosis in pelvis.

Objectives: To evaluate the effect of idiopathic thrombocytopenic purpura (ITP) on pregnancies and the role of the delta hemoglobin indices in the evaluation of treatment effectiveness.

Methods: This case-control study was conducted with 23 ITP and 115 low-risk pregnancies. Obstetric outcomes (fetal growth retardation (FGR), preterm delivery) and neonatal outcomes (weights, APGAR scores, NICU admissions, thrombocytopenia) were recorded. ITP group was subgrouped based on the platelet ratio at the admission for delivery and evaluated the impact of platelet ratios on blood loss amounts at delivery by using delta hemoglobin indices.

Results: Eleven patients received treatment during pregnancy. The gestational age at birth and fetal APGAR scores were lower, and the preterm delivery and FGR rates were higher in the ITP group. Four newborns (17.4%) had thrombocytopenia. There were two postpartum hemorrhages. Newborn platelet counts did not correlate with maternal platelet counts. The study showed no difference in delta hemoglobin counts between the ITP and control groups.

Conclusions: ITP is associated with an increased risk of maternal and fetal complications. The presented study showed by using the delta hemoglobin indices that, hemorrhagic complications could be prevented with appropriate management. Neonatal thrombocytopenia should be considered for all ITP patients.

Aim: Preeclampsia (PE) is a critical and severe disease in obstetrics, which seriously affects maternal and neonatal life safety and long-term prognosis. However, the etiology and pathogenesis of PE are complex, and no unified conclusion has been reached. The types and number of exosomes and their transport substances in PE patients changed. The study of exosomes in PE patients helps clarify the etiology, diagnosis, effective treatment, accurate monitoring, and prognosis.

Method: The published articles were reviewed.

Results: Exosomes may affect endothelial and vascular production and function, participate in maternal-fetal immune regulation, and transport substances such as miRNAs, lncRNAs, and proteins involved in the development of PE. Detection of the contents of exosomes can help in the early diagnosis of PE, and can help to improve PE by inhibiting the action of exosomes or preventing their binding to target organs.

Conclusion: Exosomes may be involved in the development of PE, and exosomes can be used as markers for predicting the onset of PE and tracking the disease process and determining the prognosis, and exosomes have great potential in the treatment of PE.

Background: Tisotumab vedotin (TV) holds promise for treating recurrence or metastatic cervical cancer (r/mCC), with recent FDA approval for second-line use in recurrent or metastatic cases. Our research aims to evaluate TV's efficacy and safety in these patients, focusing on overall survival (OS) and progression-free survival (PFS) outcomes.

Methods: We searched five electronic databases in February 2024, retrieved articles, screened them based on inclusion and exclusion criteria, and assessed their quality. A meta-analysis of the extracted data was performed and applied a random-effects model for our analysis.

Results: The search identified 86 articles, with six meeting the inclusion criteria. Meta-analysis revealed 80.8% and 48.0% OS at 6 and 12 months, and a 29.9% PFS at 6 months. Combined treatment with carboplatin or pembrolizumab showed 33.0% PFS at 1 year and 15.1% at 2 years. The objective response rate (ORR) was 21.0%, reaching 43.3% with combined treatment. Confirmed disease control rate (CDCR) was 70.0% overall and in combination. The median duration of response (DOR) was 6.1 months, increasing to 9.5 months in combined treatment, with a consistent time to response (TTR) of 1.4 months. Adverse events included ocular issues (conjunctivitis 30.3%, dry eye 18.7%) and common side effects (nausea 38.4%, epistaxis 35.7%).

Conclusion: This systematic review and meta-analysis highlights the potential of TV as a treatment option for r/mCC patients. However, healthcare providers must communicate safety profiles and recommend prophylactic measures for optimal patient outcomes. Further studies, particularly assessing combination treatments, are needed to clarify TV's role in treatment algorithms and improve clinical outcomes.

Aim: To evaluate Hyuganatsu oranges (Citrus tamurana Hort. Ex Tanaka) derived arabinogalactan for bone turnover, we performed a randomized placebo-controlled trial.

Methods: Sixty-three postmenopausal women were age-stratified and randomly assigned to receive arabinogalactan-rich hyuganatsu juice (study group) or a placebo drink (control group) for 90 days. We measured blood tartrate-resistant acid phosphatase 5b (TRACP5b), type I procollagen N-terminal propeptide (P1NP), and other bone turnover biomarker levels at baseline, days 45 and 90 (T90) of the intervention, and day 30 of recovery. Cumulative effects were compared between groups using repeated-measures linear mixed model analysis. The primary endpoint was the difference between the pre- and post-intervention TRACP5b and P1NP levels.

Results: Using repeated measures linear mixed model analysis, the study group had significantly lower TRACP5b and P1NP levels at day 90 than the control group (mean [95% confidence interval]; TRACP5b: 310.0 [269.2-350.9] vs. 386.4 [341.2-431.6] mU/dL; P1NP: 53.7 [48.6-58.7] vs. 70.3 [64.1-76.4] ng/mL), whereas other biomarker levels showed no change.

Conclusion: Arabinogalactan-rich Hyuganatsu juice suppressed bone mineral turnover and potentially improved ovarian hormone deficiency-induced osteoporosis in postmenopausal women.

Objective: To examine the association between adverse childhood experiences (ACEs) and pregnancy morbidities, including preterm birth (PTB), gestational diabetes (GDM), preeclampsia, and small-for-gestational-age (SGA) among the general population in Japan.

Methods: The data were from the JACSIS study, an online-based nationwide survey conducted from July to August 2021 in Japan (N = 5444). ACEs included physical, sexual, and psychological abuse, neglect, childhood poverty, bully victimization, domestic violence, parental death, and parental divorce. Pregnancy morbidities, including PTB, GDM, preeclampsia, and SGA were identified through questionnaires. A multivariable logistic regression model was applied.

Results: Of 5444 women, 2778 (51.0%) had no ACEs, and 374 (6.9%) had four or more ACEs. A dose-response association was found between total ACE score and PTB and preeclampsia (p-value: 0.016 and 0.001). Women with four or more ACE scores showed higher risks of preeclampsia (adjusted odds ratio [aOR] [95% confidence interval, CI]: 3.06 [1.57-5.94], p-value: 0.001). Besides, those with two or three ACEs had higher risks of PTB (aOR [95%CI]: 1.42 [1.01-2.02], p-value: 0.046, and aOR [95%CI]: 1.61 [1.04-2.50], p-value: 0.041), and women with one ACE showed a higher risk of GDM (aOR [95%CI]: 1.34 [1.02-1.77], p-value: 0.035). SGA was not associated with ACEs.

Conclusion: ACEs were associated with an increased risk of PTB, preeclampsia, and GDM, but not SGA among the general population in Japan.