Journal of Obstetrics and Gynaecology最新文献

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a novel minimal invasive technique which employs the vaginal orifice for surgical access, after which endoscopic instruments are introduced, thus obviating the need for any external skin incisions. This approach has gained traction as it is associated with reduced morbidity, improved cosmesis, lower pain scores and decreased length of hospital stay, with no increase in adverse events, when compared with conventional laparoscopic surgery. Initially limited to hysterectomy and adnexectomy, its role has now expanded to include indications such as urogynaecology, oncology and fertility. Clinicians wishing to implement vNOTES need to undergo appropriate training and appreciate judicious governance. Further randomised controlled trials will allow us to better understand if this newer technique will offer well-evidenced preferable outcomes and become the preferred surgical approach.

Background: This study aimed to investigate the role of B7H4 and Fas in pre-eclampsia (PE) occurrence and development and reveal its potential mechanisms.

Methods: Thirty healthy individuals and 60 patients with PE were enrolled in the study. In addition, the clinical characteristics of all participants were collected, including age, gestational weeks at delivery, gestational time, number of births, systolic blood pressure, diastolic blood pressure and foetal weight. The chi-square test was used to evaluate differences in clinical characteristics between the high- and low-expression groups. The expression levels of B7H4 and Fas were analysed using western blotting and real-time quantitative polymerase chain reaction (RT-qPCR). The upstream regulators of B7H4 in trophoblasts were predicted and estimated using a luciferase reporter assay. The proliferation and motility of trophoblasts were assessed using CCK8 and transwell assays, respectively.

Results: B7H4 and Fas were upregulated in PE (p < 0.05) and showed diagnostic potential with insufficient sensitivity and specificity [B7H4: area under curve (AUC) = 0.790, sensitivity = 65%, specificity = 83.33%; Fas: AUC = 0.717, sensitivity = 68.34%, specificity = 73.33%]. B7H4 and Fas were closely associated with increased blood pressure in patients with PE (p < 0.05), and the combination of B7H4 and Fas increased the diagnostic efficacy (AUC = 0.864), sensitivity (73.33%) and specificity (86.67%). In trophoblast cells, miR-4319 negatively regulated B7H4 and Fas expression as well as cell proliferation, migration and invasion (p < 0.05). Overexpression of B7H4 alleviated the inhibitory effects of miR-4319, which were reversed by Fas knockdown (p < 0.05).

Conclusions: miR-4319 mediates the progression of trophoblast progression by negatively regulating the expression of B7H4 and Fas. Therefore, B7H4 and Fas may serve as potential biomarkers for the prediction and treatment of PE.

Background: This study aimed to assess the prevalence of female sexual dysfunction (FSD) and its association with clinical characteristics in female patients with Sjögren's syndrome (SS).

Methods: In this cross-sectional study, 158 female patients with SS admitted to the Department of Rheumatology and Immunology of three Grade-III Class-A hospitals in Beijing between January 2021 and December 2023 were included. The general clinical data, sexual function feelings, medication use, psychological status, and socioeconomic factors of the patients were collected with a standardised questionnaire and assessed.

Results: Of the 158 patients, 124 (78.5%) were diagnosed with FSD based on Female Sexual Function Index scores <26.5. The mean age and course of disease were significantly higher in the FSD group than in the non-FSD group (p < 0.05), with a higher proportion of patients aged ≥40 years in the former (71.8%) than the latter (11.8%). After adjusting for potential confounding factors, including medication use, psychological status and socioeconomic factors, the association between SS and FSD remained significant (p < 0.05). In the FSD group, decreased libido (79.0%), difficulty in sexual arousal (71.8%), difficulty in vaginal lubrication (66.1%), orgasmic disorder (77.4%), decreased sexual satisfaction (81.5%) and dyspareunia (75.0%) were commonly reported.

Conclusions: The findings of this study suggest that early identification and intervention of FSD for female patients with SS is essential to improve their quality of life.

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide, and effective training in PPH rescue techniques is crucial. This study aims to evaluate the effectiveness of combining case-based learning (CBL) and problem-based learning (PBL) with simulation teaching methods in improving midwifery trainees' technical proficiency in managing PPH.

Methods: This quasi-experimental study involved 76 trainees who received PPH training at Peking University Third Hospital from March to July 2023. They were divided into two groups: the control group (n = 50) followed traditional simulation training methods, and the research group (n = 26) used a combination of CBL-PBL and scenario simulation. After the training, all participants completed a theoretical examination and questionnaire to assess their satisfaction with the program and self-assessment of clinical management skills in PPH. Statistical analysis was performed using unpaired t-tests and chi-square tests to compare the groups.

Results: The combination of CBL-PBL and scenario simulation was highly satisfactory compared to traditional simulation training, significantly enhancing self-assessed skills in clinical thinking (100% vs. 61.8%, p = .03), operant skills related to PPH (100% vs. 57.4%, p < .01), relevant knowledge pertaining to PPH (100% vs. 58.7%, p < .01), and management abilities (97.1% vs. 39%, p < .01) among midwifery trainees in the research group, who also scored significantly higher on post-training assessments of PPH knowledge than control groups(91.7 ± 6.0 vs 76.0 ± 7.1, p < .01). A majority of trainees expressed a preference for regular simulation exercises (98.7%) and detailed discussions on PPH cases (93.4%) in future training sessions.

Conclusion: Combining CBL-PBL with simulation practice is a more effective teaching method for PPH management training in maternity staffs with a certain level of clinical experience, compared to traditional methods. Future studies should explore the implementation of regular PPH rescue skill training in real clinical settings to support these findings.

Background: Luteal phase support (LPS) with progesterone is a generally accepted practice after controlled ovarian stimulation, although the best protocols for LPS have been debated. We aimed to compare the efficacy of vaginal micronised progesterone tablets and 8% vaginal progesterone gel for LPS using real-world data.

Methods: This retrospective study included 459 in vitro fertilisation/intracytoplasmic sperm injection cycles performed at a university hospital from 2005 to 2019. All cycles were followed by fresh day 3 embryo transfer (ET). Either progesterone tablets or gel was used for LPS. To control the conditional probability of progesterone tablets or gel use, doubly robust inverse probability weighting composed of inverse-probability-of-treatment weighting (IPTW) and regression adjustment (RA). IPTW was performed based on the covariate balancing propensity score (CBPS).

Results: Progesterone tablets were administered in 65 cycles, and progesterone gel was administered in 394 cycles. Women who used progesterone tablets were more likely to be older (36 vs. 34 years), have primary infertility (78.5% vs. 61.4%), use gonadotropin-releasing hormone antagonist (60.0% vs. 43.2%), and have fewer retrieved oocytes (seven vs. nine) and transferred embryos (two vs. three) than participants who used progesterone gel. After IPTW-CBPS and RA analysis for the above covariates, the adjusted odds for clinical pregnancy in women who used progesterone tablets were 1.10 times compared with women who used progesterone gel; however, the 95% confidence interval did not reach statistical significance (0.96-1.26).

Conclusions: Clinical pregnancy was comparable between vaginal micronised progesterone tablets and vaginal progesterone gel for LPS in fresh day 3 ET cycles.

Background: Research on fertility preservation among women diagnosed with lymphoma is very limited. We aimed to assess the receipt of fertility preservation information and use of fertility preservation among women diagnosed with lymphoma.

Methods: This was a retrospective, single-centre study. Patients with Hodgkin and non-Hodgkin lymphoma were screened from the electronic medical records of individuals who attended the Haematology Department at the study site between 2000 and 2018 and were followed-up for obstetric outcomes and onset of menopause until December 2023.

Results: Forty-three patients had available electronic health records. Overall, 13 (36.1%) of the 36 patients ≤45 years old received fertility preservation counselling; it was more frequent among nulliparous women (11/23, 47.8%), women aged ≤35 years (11/26, 42.3%), and those diagnosed in the latest study period from 2015 to 2018 (9/16, 56.3%). Of the 13 patients who were informed about fertility preservation, 2 patients refused this intervention, and fertility preservation was contraindicated for 3 patients, leading to a total of eight women who underwent fertility preservation strategies: six underwent ovarian cortex cryopreservation, and two underwent oocyte vitrification. Among the participants aged ≤45 years, 10 (27.8%) had at least one live birth after diagnosis. Fifteen (34.9%) of the 43 participants exhibited amenorrhoea after the initiation of chemotherapy, including 4 women ≤35 years of age. The median (range) age at menopause in this series was 45 (27-50) years.

Conclusion: Even though the situation appears to have improved in recent years, we are far from reaching the target of all women with lymphoma who are of reproductive age receiving fertility preservation counselling before initiating chemotherapy.

Background: Ectopic pregnancies represent a potentially life-threatening medical emergency, with 95% being tubal. This meta-analysis aimed to identify early predictors for single-dose methotrexate (MTX) treatment failure in tubal pregnancies.

Methods: A literature search was conducted across several databases from their inception to December 2023, with references in the selected studies manually reviewed. 14 studies involving 2,804 patients were included in this meta-analysis.

Results: The results revealed that higher serum beta-human chorionic gonadotropin (β-hCG) levels on Day 1 (SMD = 1.25, 95% CI 0.73-1.77), foetal cardiac activity presence (OR = 12.64, 95% CI 3.15-50.75), adnexal mass presence (OR = 4.66, 95% CI 2.02-10.74), yolk sac presence (OR = 5.35, 95% CI 2.33-12.27), thicker endometrium (MD = 1.74, 95% CI 0.30-3.19), more number of previous ectopic pregnancies (MD = 0.21, 95% CI 0.13-0.30), history of pelvic inflammatory disease (PID) (OR = 3.97, 95% CI 2.02-7.79), higher progesterone levels on Day 1 (SMD = 0.22, 95% CI 0.07-0.36), a higher 48-hour pre-treatment increment in serum β-hCG percentage (MD = 11.46, 95% CI 2.95-19.98), and a higher percentage of serum β-hCG change from Day 4 to Day 0/1 (SMD = 2.58, 95% CI 1.02-4.14) were early predictive factors for treatment failure of tubal pregnancy with the MTX single-dose regimen.

Conclusions: This review clarifies early predictive factors for treatment failure with the MTX single-dose regimen in tubal pregnancies. High-risk tubal pregnancies likely to fail MTX monotherapy could be identified earlier, allowing for personalised intervention measures to be implemented at an early stage to prevent harm and improve treatment outcomes.

Background: The gonadotropin-releasing hormone antagonist (GnRH-ant) protocol is associated with few oocytes retrieved, few mature oocytes and poor endometrial receptivity. Omission of GnRH-ants on trigger day seems unlikely to induce preovulation and may improve outcomes in the GnRH-ant protocol. This study aimed to systematically evaluate the effects of GnRH-ant cessation on trigger day on in vitro fertilisation outcomes following the GnRH-ant protocol.

Methods: We searched PubMed, Ovid/MEDLINE, Wanfang, VIP, CNKI and ClinicalTrials.gov databases. The last search was conducted on 10 December 2023 in English or Chinese, without time limitations on the collection of studies from the databases. The references in these articles were manually searched. Randomised controlled trials (RCTs) and cohort studies aimed at assessing the effects of GnRH-ant cessation on trigger day using the GnRH-ant protocol were included. The eligible studies included at least one of the main outcomes: number of oocytes retrieved, proportion of mature oocytes, implantation rate or clinical pregnancy rate.

Results: Three studies with 1449 cycles were included. Cessation of GnRH-ant on trigger day improved the proportion of mature oocytes (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.09-1.45, I² = 0%) but did not affect the number of oocytes retrieved (mean difference [MD] = 0.50, 95% CI = -0.07 to 1.07, I² = 47%), implantation rate (OR = 0.95, 95% CI = 0.69-1.30, I² = 0%), clinical pregnancy rate (OR = 1.06, 95% CI = 0.71-1.58, I² = 0%), endometrial thickness (MD = -0.09, 95% CI = -0.27 to 0.10, I² = 0%) or cycle cancellation rate (OR = 0.64, 95% CI = 0.15-2.74, I² = 0%).

Conclusions: Cessation of GnRH-ant on trigger day of the GnRH-ant protocol is suggested because it could improve the proportion of mature oocytes. However, further RCTs are required.