Journal of Obstetrics and Gynaecology Research最新文献

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.

Aim

The study aimed to describe the incidence of pregnancy-associated colorectal cancer (PACRC) in New South Wales (NSW), Australia, and to examine the perinatal outcomes of women with PACRC and their babies.

Methods

A population-based cohort study was conducted using linked data from NSW. The study group comprised all women diagnosed with colorectal cancer during pregnancy (gestational CRC) or postpartum (postpartum CRC). Women who gave birth without cancer during pregnancy or postpartum formed the comparison group (no-cancer group).

Results

A total of 123 women were diagnosed with PACRC (22 gestational, 101 postpartum), and 1 786 078 women were in the no-cancer group. The incidence of PACRC was 6.9/100 000 women giving birth. From 1994 to 2013, the incidence significantly increased even when adjusting for maternal age (adjusted increase of 5.8% per year). Women with gestational CRC had significantly higher odds of severe maternal complications (AOR 29.27, 95% CI: 11.18–76.63) and were more likely to give birth by labor induction or no-labor caesarean section (AOR 4.39, 95% CI: 1.50–12.84) than women in the no-cancer group. Although babies born to women with gestational CRC did not experience congenital anomalies, they had higher odds of planned preterm birth (AOR 9.91, 95% CI: 1.99–49.21) and severe neonatal adverse outcomes (AOR 8.65, CI: 3.65–20.5) than babies of women without cancer.

Conclusions

The study found a significant increase in PACRC incidence in NSW over the study period, independent of maternal age. Increased interventions during gestational CRC births reflect management challenges with higher maternal and neonatal morbidities.

Aim

Research on the effects of methylphenidate on female fertility is limited. This study evaluated the effects of methylphenidate on reproductive function, oxidants, antioxidants, proinflammatory cytokines, prolactin, and cortisol in female rats.

Methods

Forty-eight albino Wistar female rats were divided into four groups consisting of 12 rats, which were given pure water orally once daily for 7 days (HG-1), 10 mg/kg methylphenidate orally once daily for 7 days (MP-1), pure water orally once daily for 30 days (HG-2), and 10 mg/kg methylphenidate orally once daily for 30 days (MP-2). At the end of the treatment periods, tail vein blood was collected from six rats per group for prolactin and cortisol determination. Subsequently, euthanasia was performed and the ovaries were removed. Ovaries were analyzed for malondialdehyde (MDA), total glutathione (tGSH), superoxide dismutase (SOD), catalase (CAT), interleukin-1 beta (IL-1β), and tumor necrosis factor-alpha (TNF-α), and immunohistochemically. For breeding, the remaining six rats were mated with male rats for 1 month. Rats that failed to give birth were classed as infertile.

Results

A comparison of MP-1 and MP-2 groups to healthy controls revealed an elevation in MDA and corticosterone levels, and a decline in tGSH, SOD, and CAT levels (p < 0.001). Methylphenidate did not affect prolactin, IL-1β, and TNF-α levels (p > 0.05). MP-1 and MP-2 exhibited immunopositivity for 8-hydroxy-2'-deoxyguanosine (8-OHDG). MP-2 rats developed 66.7% infertility while MP-1, HG-1, and HG-2 rats did not.

Conclusion

In ovaries, methylphenidate caused oxidative stress, but did not induce inflammation. Long-term use of methylphenidate caused increased cortisol levels and infertility.

Objective

This study aimed to examine the diseases requiring surgery during pregnancy, the changes in surgical methods over time, and the characteristics of surgeries performed in different trimesters.

Methods and Materials

A retrospective study conducted at Bundang CHA Hospital between 2006 and 2023 analyzed surgeries performed during pregnancy and compared laparoscopic and open approaches across the three trimesters of pregnancy. Additionally, general (appendicitis, cholecystitis) and gynecologic (heterotopic pregnancy, adnexal torsion) cases were compared.

Results

Among 36 181 delivery patients, 101 (0.28%) underwent surgery. The most common conditions were appendicitis (44.6%), cholecystitis (1.9%), heterotopic pregnancy (23.8%), adnexal torsion (27.7%), and cancer (1.9%). The laparoscopic group had a shorter operative time (41.5 ± 19.3 vs. 57.9 ± 33.9 min, p = 0.009) and hospital stay (4.9 ± 2.7 vs. 9.0 ± 9.8 days, p = 0.016) than open surgery group. Heterotopic pregnancy (47.1%) and adnexal torsion (39.2%) were common in the first trimester, whereas appendicitis peaked in the second (80%) and third trimesters (66.7%).

The increasing use of assisted reproductive technology (ART) has led to a rise in gynecological patients requiring surgery in the first trimester, resulting in more laparoscopic surgeries during this period. Interestingly, an increase in laparoscopic surgery was also observed in general surgery during the second and third trimesters. Perioperative tocolysis was more frequent (51.1% vs. 3.8%, p < 0.001) and of longer duration (4.6 ± 8.8 vs. 0.1 ± 0.6 days, p = 0.001) after general surgical procedures.

Conclusion

Laparoscopic surgery during pregnancy offers several advantages such as shorter operative time and hospital stay. Since 2011, laparoscopic surgery for the entire gestational period has been on the rise.