Journal of Obstetrics and Gynaecology最新文献

Background: We investigated the relationship between immune cells and endometrial cancer by conducting a two-sample bidirectional Mendelian randomisation (MR) analysis.

Methods: MR uses genetic variation as an instrumental variable to study the causal effects of exposure on observed data outcomes. We conducted a dual-sample MR analysis to investigate the causal relationship between 731 immune cell phenotypes and endometrial cancer (EC). The weighted-median method and inverse variance weighted method MR were mainly used, and the p-value was corrected with the Benjamini-Hochberg procedure.

Results: The forward MR analysis revealed a causal relationship between EC and eight immune-cell phenotypes. The reverse MR analysis identified two immune-cell phenotypes with a potential causal effect on EC, with additional subtype-specific associations observed for endometrioid and non-endometrioid histology.

Conclusion: Our study demonstrated a causal relationship between immune cells and EC, thereby providing guidance for the development of future immunoregulatory therapeutic strategies.

Background: To investigate the occurrence of the persistent left superior vena cava (PLSVC) anomaly and evaluate its postpartum outcomes.

Methods: This retrospective analysis included 425 pregnant women carrying singleton foetuses diagnosed with PLSVC. Comprehensive data on maternal characteristics and postpartum outcomes were collected.

Results: Among the cohort, 307 foetuses (72.2%) were diagnosed with isolated PLSVC, while 118 (27.8%) presented with PLSVC in conjunction with other structural and/or chromosomal abnormalities. The cardiovascular system exhibited the highest incidence of malformations, followed by single umbilical artery (SUA), and abnormalities of the digestive and urinary systems. Foetuses with PLSVC and additional abnormalities had poorer outcomes. The most common cardiovascular abnormality was right heart enlargement, followed by ventricular septal defect (VSD) and either coarctation of the aorta (COA) or interrupted aortic arch (IAA).

Conclusions: Upon diagnosing PLSVC in a foetus, a thorough structural examination is essential. Particular attention should be paid to evaluating the cardiovascular system and identifying the presence of SUA. If associated malformations are detected, continuous monitoring of the right heart, ventricles, and aortic arch is advised to screen for complications such as right heart enlargement, VSD, COA, or IAA.

Background: The objective of this study was to explore the factors that influence overall survival in obese patients with endometrial cancer (EC).

Methods: The retrospective study included patients with EC who were treated between 2000 and April 2013. Subjects were divided into the following groups based on body mass index (BMI): non-obese (<24.0 kg/m²), overweight (24.0-28.0 kg/m²) and obese (>28.0 kg/m²). Survival data were estimated using Kaplan-Meier's curves and compared using log-rank statistics.

Results: A total of 280 cases were enrolled, including 22.5% in non-obese group, 42.9% in overweight group and 34.6% in obese group. Among different BMI groups, obese EC patients with diabetes have a lower survival rate (p = .041), and obese EC patients with menopause have a lower survival rate (p = .021). The survival rate of overweight EC patients was significantly reduced if vascular thrombus and lymph node metastasis were found during operation (p < .001).

Conclusions: Our data suggest that the association of obese EC patients with menstrual status, diabetes and intraoperative vasculature embolus and lymph node metastasis significantly affects postoperative survival. In all subjects, the relevant factors were independent prognostic factors in patients with obese.

Background: Maternal obesity is a growing global health concern, yet its impact on maternal haemodynamic throughout pregnancy remains underexplored. We investigated haemodynamic adaptations across gestation in women with high body mass index (BMI) (≥35 kg/m²) and results were compared to low-risk controls (BMI 18.5-24.9 kg/m²).

Methods: This prospective observational study used non-invasive cardiac output monitoring (NICOM; Baxter Healthcare, Deerfield, IL) to assess maternal haemodynamic parameters, including cardiac output (CO), stroke volume (SV), total peripheral resistance (TPR), systolic blood pressure (sBP) and mean arterial pressure (MAP) in pregnant women with high BMI. Assessments were carried out across five gestational windows (11-19 + 6, 20-27 + 6, 28-33 + 6, 34-37 + 6 and ≥38 weeks). Results were compared to low-risk healthy controls (BMI 18.5-24.9 kg/m²).

Results: A total of 329 women were recruited, including 125 with high BMI and 189 controls. Across all gestational windows, women with high BMI consistently demonstrated significantly higher CO and SV. Compared to controls, median CO was high among women with high BMI, at 11-19 + 6 weeks [8.8 L/min (IQR 7.2-9.9) versus 6.7 L/min (5.8-7.6); p < .001]; median SV was 104.2 mL (93.7-124.9) versus 81.9 mL (74.3-94.0) (p < .001). This trend persisted at later gestations. In contrast, median TPR was significantly lower in the high BMI group; at 28-33 + 6 weeks, 847 dyn·s·cm^-5 (unit of measurement of TPR: dynes·seconds per centimetre to the fifth power) (783-937) versus 1083 (924-1161) in the controls (p < .001). Despite reduced TPR, sBP and MAP were higher in women with high BMI throughout pregnancy. Heart rate (HR) and diastolic blood pressure (dBP) did not differ significantly between groups at any gestational window.

Conclusions: Pregnant women with high BMI have a distinctive haemodynamic profile characterised by high CO with a compensatory reduction in TPR. Further research is required to assess the risk of placental mediated diseases in that group.

Background: Preterm birth is the leading cause of neonatal mortality and long-term health complications. Cervical cerclage (CC) represents a critical intervention for extending pregnancy duration and enhancing neonatal survival in patients diagnosed with cervical insufficiency. The aim of this study was to identify risk factors for preterm birth through a meta-analysis comparing outcomes between preterm and full-term deliveries following non-emergency CC.

Methods: PubMed, EMBASE, Cochrane Library, Web of Science (WOS), and Scopus were searched to identify studies fulfilling predefined inclusion and exclusion criteria on 31 March 2025. The primary outcome measure was the preterm birth rate, which was calculated as the proportion of preterm birth cases in the total sample size. The impact of various risk factors on preterm birth was further analysed.

Results: A total of 45 studies were included, and the meta-analysis revealed that the aggregate preterm birth rate at 37 weeks was approximately 48.09% following CC. Compared with twin pregnancies, singleton pregnancies were associated with a lower risk of preterm birth (odds ratio [OR]: 0.71; 95% CI: 0.55-0.91; p = 0.008). Among surgery-related factors, CC indicated by physical examination poses a greater risk. Short cervical length prior to CC and elevated inflammatory markers, such as C-reactive protein (CRP), were significantly associated with preterm birth (OR: 0.79; 95% CI: 0.66-0.95; p = 0.011).

Conclusions: This study identified critical risk factors for preterm birth following CC, including physical examination indications, a cervical length ≤ 1.5 cm, cervical dilatation, and CRP abnormalities. These findings are instrumental in identifying high-risk individuals and guiding effective medical resource allocation. However, due to study limitations, large-scale studies with multiple PTB cut-off timepoints and comprehensive analyses of risk factors are necessary to refine preventive and therapeutic approaches for preterm birth.

Background: Endometrial polyps (EPs) are a localised hyperproliferative disorder of the endometrium, and its pathogenesis remains unclear. Progesterone resistance may influence the recurrence rate of progesterone-treated EPs. Expression of the Hippo-YAP1 signalling pathway has been studied in various diseases. However, few studies have explored their expression in EPs and association with progesterone resistance. Prolactin (PRL), a molecular marker of endometrial mesenchymal cell metaplasia, indirectly reflects progesterone action in vivo. This study aimed to explore the role of Hippo-YAP1 signalling pathway in EPs.

Methods: Endometrial tissue specimens obtained by surgical resection from 35 patients with a normal endometrium and 35 with EPs were collected between July 2023 and July 2024. Immunohistochemically, the expressions of mammalian STE20-like kinase 1 (MST1), Yes-associated protein 1 (YAP1), progesterone receptor (PR) and PRL in the normal endometrium and EPs tissues were detected.

Results: Compared to normal endometrial tissues, the expression of MST1 was relatively low in EPs (p < .05), while the total and nuclear expression of YAP1 was relatively high in EPs (p < .0001). The expression of PR in EPs tissues was significantly lower than that in normal endometrial tissues (p < .05), and the expression level of PRL was lower than that of normal endometrium in EPs tissues (p < .001).

Conclusions: EPs have progesterone resistance, and the Hippo-YAP1 signalling pathway may be involved in the development and progression of EPs by acting on the progesterone resistance mechanism.

Background: The systemic immune-inflammation index (SII) has been a marker and prognostic indicator of several diseases. However, its utility in pregnancy is unknown. Herein, we reviewed the evidence on the ability of SII to predict gestational diabetes mellitus (GDM) and preeclampsia (PE).

Methods: A systematic search of PubMed, Embase, Scopus and Web of Science was conducted for studies comparing SII between GDM/PE and non-GDM/non-PE groups. Studies reporting diagnostic accuracy data were also included. The last date of the search was 5 November 2024. Risk of bias was assessed using Newcastle Ottawa Scale. Random-effect meta-analysis was conducted comparing values of SII between GDM/PE and non-GDM/non-PE groups.

Results: Nine studies were eligible. Four studies reported data on GDM and five on PE. Most studies measured SII in the first trimester. The pooled analysis showed no statistically significant difference in the SII values between PE and non-PE groups (MD: 13.07, 95% confidence interval (CI): -117.21, 143.35, I² = 78%). Meta-analysis of four studies comparing data of GDM and non-GDM groups showed that SII was significantly higher in GDM females (MD: 210.32, 95% CI: 57.3, 363.34, I² = 94%). The sensitivity of SII to predict PE varied from 40 to 77.5% while specificity varied from 53.8 to 67.5%. For studies on GDM, the sensitivity and specificity values varied from 66 to 80.2% and 34.4 to 65%, respectively.

Conclusions: SII values are significantly higher in GDM compared to non-GDM females. However, SII values did not correlate with PE. SII may have potential in predicting GDM which needs to be explored by further studies.