Journal of Obstetrics and Gynaecology最新文献

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: Standardised early mobilisation within Enhanced Recovery After Surgery (ERAS) for endometrial cancer is lacking. This study developed and evaluated a protocol.

Methods: This retrospective study analysed outcomes of a clinical quality improvement initiative conducted at a tertiary care centre (February 2021-May 2022). Phase 1: Protocol developed via evidence/expert consensus. Phase 2: Retrospective analysis of 90 patients who received care in two units during the study period. Patients admitted to unit A (n = 45) received a structured early mobilisation protocol implemented as part of routine clinical practice improvement, whilst patients admitted to unit B (n = 45) received standard care. Ward assignment was determined by bed availability at admission without researcher involvement in allocation. Primary outcomes: Pulmonary function, physical capacity (ambulation time/day 5 walking distance) and gastrointestinal recovery. Secondary: Complications, LOS, emotional status (Brief Profile of Mood States, BPOMS). Statistical analyses included effect sizes and 95% confidence intervals.

Results: The intervention group was associated with significantly better first ambulation (6.8 ± 2.1 h vs. 18.5 ± 4.3 h, mean difference: 11.7 h, 95% CI: 10.3-13.1, p < 0.001), day 5 walking distance (385 ± 68 m vs. 142 ± 45 m, mean difference: 243 m, 95% CI: 220-266, p < 0.001), time to first flatus (28.5 ± 6.2 h vs. 48.3 ± 8.5 h, mean difference: 19.8 h, 95% CI: 16.9-22.7, p < 0.001), fewer pulmonary complications (8.9% vs. 24.4%, OR: 0.30, 95% CI: 0.09-0.96, p = 0.047), shorter LOS (4.2 ± 1.1 d vs. 6.8 ± 1.5 d, mean difference: 2.6 d, 95% CI: 2.0-3.2, p < 0.001) and improved BPOMS anxiety/depression scores.

Conclusions: This retrospective analysis suggests that the structured early mobilisation protocol, implemented as a clinical quality improvement initiative, was associated with improved recovery, reduced complications/LOS and better emotional wellbeing in endometrial cancer patients within ERAS.

Background: Ethnic minority patients experience a higher uterine fibroid disease burden and reduced access to minimally invasive myomectomy. Restrictive selection criteria may disproportionately exclude these patients from laparoscopic surgery.

Methods: This was a prospective service-evaluation database analysed retrospectively, including all conventional (non-robotic) laparoscopic myomectomies performed between January 2004 and December 2024 at a single UK university hospital. Primary outcomes were estimated blood loss (EBL), length of hospital stay (LOS) and operating time. Secondary outcomes were blood transfusion rate, conversion to laparotomy and analysis of fibroid burden by ethnicity. Outcomes were compared between patients with large fibroids (>10 cm), high-order fibroids (>10 fibroids removed), both and neither. We performed inferential descriptive statistics using SPSS v27 (SPSS Inc., Chicago, IL).

Results: Among 550 patients, 164 had large fibroids, 30 high-order fibroids, 18 both and 338 neither. Ethnic minority patients represented 77%, 93%, 89% and 72% of these groups, respectively. Mean EBL was higher in large fibroid (345 mL) and combined groups (483 mL) compared with neither (211 mL), without associated increases in transfusion, conversion to laparotomy, or LOS. Black African and Black Caribbean patients had greater fibroid burden and higher blood loss than Caucasian patients, reflecting disease severity rather than ethnicity as an independent determinant of outcome.

Conclusions: In a specialist setting, laparoscopic myomectomy is feasible and safe for patients with large and/or multiple fibroids, including those from ethnic minority backgrounds with higher disease burden. Expansion of access within appropriately resourced centres may help reduce inequities in fibroid care.

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: Gushen Antai recipe (GSAT), known herbal medicine, has long been used in China to treat early pregnancy loss. Several randomised controlled trials have demonstrated its efficacy in improving clinical pregnancy rates. This study aimed to elucidate the mechanism of GSAT in patients undergoing in vitro fertilisation-embryo transfer (IVF-ET).

Methods: Patients undergoing IVF-ET were recruited on day 14 after embryo transfer. Participants either received GSAT alongside hormonal medication for 2 weeks (intervention group) or received hormonal treatment (control group). Plasma metabolites and inflammatory factors was analysed by gas chromatography-mass spectrometry and enzyme-linked immunosorbent assay, respectively. Faecal microbiota was assessed by 16S rRNA sequencing.

Results: GSAT was found to contain 56.44% flavonoids, primarily come from Scutellariae Radix, including baicalin, baicalein, wogonoside, wogonin, oroxylin A and Chrysin 6-C-glucoside 8-C-arabinoside. At the end of the fourth week after embryo transfer, plasma levels of interleukin (IL)-2 and tumour necrosis factor-α were significantly lower in the intervention group than in the control group, whereas the anti-inflammatory cytokine IL-10 were markedly higher (687.3 vs. 448.5 pg/mL, p < 0.01). Moreover, the plasma IL-10 levels and proportion of four kinds of fatty acids (lauric acid, myristic acid, palmitic acid, linoleic acid) in plasma correlated with each other. These fatty acids were not directly detected in GSAT and may originate from biosynthesis by gut microbiota.

Conclusions: The alteration of plasma cytokine levels (IL-10, TNF-α and IL-2) associated with GSAT intervention was linked to specific fatty acids produced by characteristic intestinal microbiota. These results provide insights into the mechanism underlying the role of the GSAT in improving clinical pregnancy rates.

Background: Pelvic inflammatory disease (PID) is a common gynaecologic condition linked to infertility, ectopic pregnancy, and reproductive tract cancers. While active smoking has been associated with PID, the impact of environmental tobacco smoke (ETS) on non-smoking women remains unclear. Most studies rely on self-reported exposure, which may be inaccurate. Cotinine, a stable nicotine metabolite, serves as an objective biomarker of tobacco exposure. This study investigated the association between serum cotinine levels and PID risk in non-smoking women using data from the National Health and Nutrition Examination Survey (NHANES).

Methods: This cross-sectional study included 3,718 non-smoking women aged ≥18 years from NHANES 2013-2020. ETS exposure was assessed using serum cotinine measured by isotope dilution high-performance liquid chromatography with tandem mass spectrometry. Cotinine levels were categorised as unexposed, low, or high exposure. PID was identified based on self-reported treatment for pelvic infections. Weighted logistic regression was used to examine associations between cotinine and PID, adjusting for confounders identified by a directed acyclic graph. Restricted cubic spline and subgroup analyses were also conducted.

Results: Among participants, 3.1% reported a history of PID. Those with PID had higher serum cotinine levels. In fully adjusted models, each one-unit increase in log₂-transformed cotinine was associated with a 10% increase in PID risk (OR = 1.10; 95% CI: 1.02-1.19). High ETS exposure (≥3 ng/mL) was linked to a significantly higher risk of PID compared to unexposed individuals (OR = 2.53; 95% CI: 1.05-6.08). A linear dose-response relationship was observed. Subgroup analyses showed consistent results across all strata.

Conclusion: Serum cotinine-defined ETS exposure was significantly associated with increased PID risk in non-smoking women. Reducing ETS exposure may help prevent reproductive tract infections.

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.

Background: This study investigates how clinical factors and hormonal levels affect oocyte retrieval in modified natural cycles, aiming to improve understanding and enhance treatment protocols.

Methods: A retrospective analysis of data from 306 women undergoing in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) at a fertility clinic (2018-2023) was conducted. Clinical factors and hormonal levels were analysed. Follicular development was monitored via ultrasound.

Results: Baseline comparisons between the oocyte retrieval and non-retrieval groups showed no significant differences in age, body mass index, infertility types, duration, associated conditions (e.g. tubal issues, ovulation disorders and endometriosis) or assisted reproductive methods (p > 0.05). After human chorionic gonadotropin (HCG) injection, both groups showed significant increases in progesterone, oestradiol and luteinising hormone levels (p < 0.0001). Before HCG injection, the retrieval group had significantly higher levels of progesterone, oestradiol and LH (p < 0.05), with oestradiol remaining higher afterward (p < 0.01). There were significant differences between the two groups on anti-Müllerian hormone levels (p ˂ 0.05). No significant differences were found in follicle-stimulating hormone, total testosterone, thyroid hormone levels and antral follicle count (p > 0.05).

Conclusions: In conclusion, the findings suggest that clinical factors do not impact oocyte retrieval in modified natural cycle assisted reproductive techniques. However, high hormone levels on the day of HCG injection in the study subjects may indicate a greater possibility of successful oocyte retrieval.