Journal of Obstetrics and Gynaecology最新文献

Background: To investigate the association between maternal Group B Streptococcus (GBS) colonisation in late pregnancy and pregnancy outcomes, with a focus on GBS colonisation risk factors and the role of colonisation density in influencing maternal and neonatal health.

Methods: This retrospective study analysed clinical data from 20,040 pregnant women at 35-37 weeks of gestation between January 2020 and January 2023. GBS colonisation was assessed using rectovaginal swabs, followed by culture, PCR quantification, and antibiotic susceptibility testing. Demographic and clinical characteristics, maternal outcomes, and neonatal outcomes were compared between GBS-positive and GBS-negative groups. Further stratified analysis was conducted on the impact of high GBS colonisation on maternal and neonatal outcomes. Logistic regression was used to identify independent risk factors for GBS colonisation.

Results: GBS colonisation was detected in 505 of 20,040 women (2.52%). Among the 236 isolates tested, all were sensitive to penicillin. Significant risk factors for GBS colonisation included maternal age ≥35 years, gestational diabetes mellitus, and coexisting vaginitis (p < 0.05). The incidence of puerperal infection, PROM, postpartum haemorrhage, premature birth, and neonatal pneumonia were significantly higher in the GBS-positive group than in the GBS-negative group (p < 0.05). Stratification by colonisation density revealed that women with high GBS colonisation had elevated rates of puerperal infection (23.01% vs. 14.29%), PROM (34.51% vs. 19.13%), and postpartum haemorrhage (18.58% vs. 8.93%) compared to those with lower GBS colonisation (p < 0.05). Neonatal outcomes also varied by colonisation density: neonatal infection (14.16% vs. 6.89%) and premature birth (16.81% vs. 9.69%) were significantly more common in the high-colonisation group.

Conclusions: Maternal GBS colonisation, especially with high density, increases adverse outcomes. Risk factors include age ≥35, vaginitis, and diabetes. Routine screening and targeted prophylaxis are essential.

Background: Triage of human papillomavirus (HPV)-positive women with atypical squamous cells of undetermined significance (ASC-US) remains a longstanding clinical challenge in cervical cancer screening, as conventional strategies often lead to excessive colposcopy referrals. We conducted a diagnostic cohort study of 195 HPV-positive women who underwent ASC-US cytology.

Methods: Multigene DNA methylation analysis was performed on residual cervical exfoliated cells, using histology from colposcopy-directed biopsy and/or endocervical sampling as the reference standard to minimise colposcopy referrals.

Results: Our results showed that methylation levels of PAX1, EPB41L3, and FAM19A4 increased progressively from ≤ CIN1 to CIN2, CIN3, and cervical cancer, with significant decreases in ΔCt values from ≤ CIN1 to CIN3 for all three genes (p < 0.05). For detection of CIN2+, the assay achieved a sensitivity of 85.19%, specificity of 96.43%, positive predictive value (PPV) of 79.31%, negative predictive value (NPV) of 97.59%, and an area under the receiver operating characteristic curve (AUC) of 0.91, thereby avoiding colposcopy referrals in 96.43% (162/168). For CIN3+, the assay demonstrated sensitivity, specificity, PPV, NPV, and AUC values of 94.44%, 93.22%, 58.62%, 99.4%, and 0.94, respectively. Stratified analyses showed high and comparable sensitivity (81.82% vs. 87.50%), specificity (96.92% vs. 96.12%), and AUC (0.89 vs. 0.92) in women with HPV16/18 compared with those with non-16/18 high-risk HPV. Optimal diagnostic accuracy was observed in women aged ≥30 years, with sensitivities ranging from 85.70% to 100%, specificities from 94.44% to 100%, and AUC values ranging from 0.93 to 0.97. In contrast, the performance was suboptimal in women aged <30 years (sensitivity, 33.33%; AUC, 0.64).

Conclusions: The host multigene DNA methylation assay demonstrates high specificity and good sensitivity for triaging HPV-positive ASC-US women, with the potential to reduce colposcopy referrals while maintaining robust detection of high-grade lesions, particularly in those aged ≥30 years.

Background: According to the World Health Organisation, antenatal care should ensure continuity, respect and evidence-based education. Fear of childbirth (FOC), affecting 20-40% of women globally, contributes to prolonged labour, higher caesarean rates and negative birth experiences. In Türkiye, where midwifery-led support remains limited, this study examined how pregnant women's health literacy influences empowerment and FOC within antenatal care and evaluated the effectiveness of the midwifery-led continuity-of-care (MLCC) model.

Methods: A quasi-experimental study with a comparative group design was conducted online between April 2024 and April 2025 using digital maternal communities and antenatal platforms in Türkiye. The intervention consisted of four structured online sessions based on the MLCC model, focusing on pregnancy adaptation, labour preparation, birth preferences and postpartum care. A total of 81 pregnant women participated, with 40 in the intervention group receiving MLCC-based antenatal education and 41 in the control group receiving standard care. Participants self-selected into groups, and data were collected online using validated scales: MHELIP, PRES and W-DEQ (Version A). All analyses were performed using SPSS 25.0 software. Independent samples t-tests and Pearson's correlations were used for analysis, and multiple regression was performed to identify predictors of empowerment and FOC. All statistical values were verified and reported as mean ± SD with exact p values.

Results: Pregnant women in the intervention group had significantly higher health literacy and empowerment scores and significantly lower FOC scores than those in the control group (p <.05). Health literacy was positively correlated with empowerment (r = .748) and negatively correlated with FOC (r = -.710).

Conclusions: The intervention reduced fear and increased empowerment, likely through improved knowledge, self-efficacy and perceived control during pregnancy. The MLCC model enhanced health literacy and empowerment while reducing FOC. Structured education models integrated into antenatal care can support women's autonomy and psychological preparedness for birth.

Background: Postoperative voiding dysfunction is common after nerve-sparing radical hysterectomy (NSRH); therefore, we examined whether adjunct transcutaneous electrical nerve stimulation (TENS) could improve bladder management, pelvic floor muscle strength, and quality of life (QoL) in this population.

Methods: A total of 78 NSRH patients from May 2023 to May 2024 were divided into conventional catheter management (control group, n = 39) and conventional management + TENS (intervention group, n = 39). Outcomes including urinary retention incidence, postvoid residual urine volume (PVR), catheter indwelling duration, intervention compliance, pelvic floor muscle strength grading, voiding function parameters, QoL scores, and safety were assessed.

Results: The intervention group demonstrated significantly lower urinary retention incidence, reduced PVR, and shorter catheter duration versus controls (all P < 0.05). Both groups maintained > 90% intervention compliance (P > 0.05). Post-intervention voiding parameters (FD, BC, MCC) improved more significantly in the intervention group (all P < 0.05), with superior pelvic floor muscle strength grading (P < 0.001). QoL assessment revealed lower functional domain scores and higher symptom/global health scores in the intervention group (all P < 0.001). Safety analysis showed only mild dermal reactions in the intervention group, without significant between-group difference in complication rates (P > 0.05).

Conclusions: TENS would significantly improves bladder function, pelvic floor muscle strength, and QoL in post-NSRH patients with a favourable safety profile, demonstrating substantial clinical value.

Background: Diastasis recti abdominis (DRA) is characterised by a separation of the rectus abdominis muscles, which is common in the postpartum period. This randomised controlled trial investigated the effects of a physiotherapy protocol combining abdominal exercises and physical agents-namely electromagnetic shock waves, transfer of energy capacitive and resistive (TECAR) therapy, and neuromuscular electrical stimulation-on reducing the inter-rectus distance in women with DRA six months after childbirth.

Methods: Sixty women diagnosed with DRA were randomised into three groups: kinesiotherapy (Group A); electromagnetic shock waves, TECAR therapy, and neuromuscular electrostimulation (Group B); and a combination of both (Group C). The inter-rectus distance (IRD) of participants was assessed before and after treatment, with re-evaluation conducted sixty days after the initial assessment, using ultrasound and abdominal perimeter measurements.

Results: group C showed a 0.80 cm reduction in supraumbilical IRD when compared with Group B. In the infraumbilical region, Group C had a 0.74 cm reduction compared to Group A and 0.85 cm compared to Group B. Regarding abdominal perimeter, Groups B and C showed greater reductions in the infraumbilical circumference than Group A, with mean differences of approximately 10 cm. No significant differences were observed in the supraumbilical and umbilical regions.

Conclusions: the combination of kinesiotherapy and physical agents is more effective in reducing inter-rectus distance and abdominal circumference than either approach alone in postpartum women with diastasis recti abdominis.

Background: This study aimed to estimate the global trend of age-standardised incidence rates (ASIR) and age-standardised disability-adjusted life years (AS-DALYs) of pelvic organ prolapse from 1990 to 2021, and analyse the separate effects of age, period and birth cohort.

Methods: Data of pelvic organ prolapse's ASIR and AS-DALYs were obtained from the Global Burden of Disease (GBD) 2021. The regions were classified by the socio-demographic index (SDI). An age-period-cohort (APC) model was employed to analyse the effect of every age, period and birth cohort on pelvic organ prolapse's ASIR.

Results: In 2021, the global ASIR and AS-DALY were 317.51 (95% UI, 267.67-378.25) and 8.68 (95% UI, 4.26-16.38) per 100,000 population, respectively. The rates decreased globally and in five SDI regions from 1990 to 2021. APC analysis demonstrated that ASIR significantly increased with advancing age, exhibiting a bi-peak curve, with one peak appearing around 50 years and the other around 70 years.

Conclusion: Over the past 32 years, the global ASIR and AS-DALY of pelvic organ prolapse have continued to decrease significantly, while in low SDI regions, the rates remain high. These findings highlight the need for targeted pelvic organ prolapse prevention programs and proper investment in pelvic floor care in low SDI regions.

Background: Pelvic floor dysfunction (PFD) commonly affects postpartum women, yet surgical interventions carry invasiveness and recurrence risks. This retrospective study aims to investigate the effects of pelvic floor electrical muscle stimulation (EMS) combined with proprioceptive training (PT) on pelvic floor function and structural integrity in women with PFD.

Methods: A total of 320 women with PFD treated at Ningde Municipal Hospital from October 2022 to December 2024 were stratified into control group, EMS group, PT group and combined group, with 80 patients in each group. All patients received routine pelvic floor functional training; the EMS group additionally received pelvic floor EMS, the PT group received PT and the combined group received pelvic floor EMS following PT. Pelvic floor resting/tonic contraction electromyography (EMG) value, muscle fibre strength, pelvic floor distress inventory-short form 20 (PFDI-20) scores, and pelvic floor ultrasound parameters were assessed before and after treatment.

Results: Post-treatment, all groups showed significant improvements in resting/tonic contraction EMG value, muscle fibre strength, PFDI-20 scores and pelvic floor ultrasound parameters (levator ani muscle (LAM) thickness, bladder neck descent, etc.) compared to baseline (p < 0.001). The combined group achieved superior outcomes across all measures (p < 0.0001), with higher EMG value, greater structural restoration (e.g. increased LAM thickness, reduced hiatus area). No baseline differences were observed among groups (p > 0.05), confirming treatment-specific efficacy of the combined approach.

Conclusions: Pelvic floor EMS combined with PT effectively promotes recovery of pelvic floor function and structural integrity in women with PFD. This combined therapy warrants clinical application and dissemination.

Background: The gamma-glutamyl transferase (GGT) to high-density lipoprotein (HDL) ratio (GGT/HDL) has recently emerged as a potential biomarker for metabolic and liver diseases. This study aimed to investigate the association between GGT/HDL ratio and endometriosis using a population-based dataset from the National Health and Nutrition Examination Survey (NHANES).

Methods: Data from NHANES 1999 to 2006 were used to assess the relationship between the GGT/HDL ratio and endometriosis. The diagnosis of endometriosis was based on self-reported data from the Reproductive Health Questionnaire. The GGT/HDL ratio was calculated and Ln-transformed for analysis. Multivariable logistic regression and sensitivity analysis were used to estimate the odds ratio (OR) for endometriosis in relation to the GGT/HDL ratio.

Results: A total of 3815 individuals were included, with 307 diagnosed with endometriosis. The Ln-transformed GGT/HDL ratio was positively associated with the endometriosis. Each unit increase in the Ln-GGT/HDL ratio was associated with a 22% higher likelihood of endometriosis (OR = 1.220, 95% CI: 1.003-1.483, p = 0.046). Sensitivity analyses including the use of original GGT/HDL value, the further adjustments of covariates, the exclusion of those with CVD and liver diseases confirmed the robustness of this association.

Conclusions: This study found a significant positive association between the GGT/HDL ratio and endometriosis. Higher GGT/HDL levels may serve as a potential biomarker for identifying women at risk of endometriosis.