Journal of Obstetrics and Gynaecology最新文献

Male foetuses have historically been perceived as more active than females, and foetal movement has been observed to be greater in male foetuses in late pregnancy. Nonstress tests (NSTs), a common form of antepartum assessment, rely on movement in their interpretation. To see if this difference could influence their interpretation, NSTs of patients undergoing clinically indicated testing at 36 weeks' gestation were evaluated. In this cross-sectional observational study, tests were compared between male and female foetuses for maternal indicators of foetal movement and heart rate characteristics including baseline, variability, and number of accelerations. Among 287 foetuses analysed, recordings of foetal movement and heart rate characteristics were similar between the two groups. The results suggest no difference in movement or NST parameters between males and females, and foetal sex should not affect NST interpretation.

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: Hearing disabilities are a significant risk factor for adverse pregnancy outcomes. This study aimed to analyse the impact of hearing impairment on maternal and neonatal outcomes, and to evaluate the adequacy of prenatal care among women diagnosed with hearing disabilities.

Methods: A literature search of the PubMed, Medline, Cochrane Library, Embase, and Scopus databases for relevant studies published in English was performed. Two researchers independently performed screening and quality assessments. Adverse maternal outcomes (gestational diabetes, preeclampsia, and caesarean delivery), adverse neonatal outcomes (preterm birth and low birth weight), and utilisation of prenatal care resources were primary outcomes of this review. A comparative effects meta-analysis and a narrative synthesis were performed.

Results: Ten retrospective cohort studies comprising 97,251,223 participants, of whom 63,387 had a hearing disability, were included in this review. Meta-analysis revealed a significantly higher risk for gestational diabetes, preeclampsia, eclampsia, caesarean delivery, placental abruption, preterm birth, low birth weight, and adequate-plus utilisation of prenatal care resources. The results were similar in the sensitivity analyses based on different statistical models. There were no statistical differences in pooled estimates of the incidence of chorioamnionitis, although a significantly higher risk was observed when the model was modified.

Conclusion: Compared to women without disabilities, those with hearing disabilities exhibited a higher risk for adverse maternal and neonatal outcomes and excessive use of prenatal care services.

Background: Inadequate milk production during the immediate postpartum period is a common problem. Shatavari (Asparagus racemosus), a revered herb in Ayurveda, is traditionally used as a galactagogue. The objective of this study is to assess the safety and effectiveness of Shatavari root extract (SHT) on lactation in post-partum women.

Methods: This prospective, randomised, double-blind, placebo-controlled study enrolled post-partum women (≥37 weeks' gestation, aged 20-40 years) with uncomplicated vaginal or caesarean deliveries who intended to breastfeed. Participants received either Shatavari root extract (SHT; 300 mg) or placebo (PL) capsules twice daily for 72 h postpartum. The primary outcomes included time to evident breast fullness after the last feeding and the total milk volume expressed at 72 h. The secondary outcomes were maternal and investigator-rated satisfaction (e.g. noticeable breast fullness, maternal/infant wellbeing), assessed by a five-point Likert scale. Safety was assessed through adverse event reports.

Results: From the 120 enrolled participants, seven participants (3 SHT, 4 PL) did not complete the study, yielding a per-protocol dataset of 113 women (57 SHT and 56 PL). The baseline characteristics were comparable across groups. The time to evident breast fullness after the last feeding was significantly shorter in the SHT group (p = 0.002), and milk volume at 72 h was significantly higher (p < 0.001). Maternal satisfaction with lactation was higher in the SHT group (52.63% vs. 25.00%, p = 0.008). SHT participants also reported greater satisfaction with infant well-being. Investigators rated maternal and infant well-being higher for SHT than placebo (80.70% vs. 64.29%). No adverse events occurred, and treatment compliance was high.

Conclusion: Shatavari root extract improved the milk volume and maternal satisfaction about lactation, indicating its potential as a safe, effective galactagogue.

Background: Adenomyosis is a common gynaecological condition where ectopic endometrial glands and stroma grow within the myometrium. This condition has a high clinical burden impacting those afflicted with debilitating symptoms including heavy painful periods. Simvastatin is an oral hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, typically used to treat hyperlipidaemia. Simvastatin has recently shown promise for treating gynaecological conditions such as endometriosis and uterine fibroids with nanoliposomal formulations demonstrating improved efficacy. In this pilot study, we tested simvastatin-loaded liposomal nanoparticles on xenografted adenomyosis tissues in a patient-derived mouse model.

Methods: We surgically inserted oestrogen/progesterone pellets into mice, followed by adenomyosis tissue xenografts 15 days later. Mice were then randomised into three groups: control, simvastatin, and simvastatin-loaded liposomal nanoparticles (simvastatin-NP). We quantified the changes in adenomyosis xenograft size weekly using a calliper as well as ultrasound imaging 28 days after treatment, prior to sacrifice. We also measured the proliferation of biomarker Ki67 in the xenografted tissues using immunohistochemistry after animal sacrifice.

Results: Treatment with simvastatin-NP significantly reduced volume and weight of adenomyosis xenografts while attenuating Ki67 expression when compared to the control and simvastatin groups. Conclusions: This pilot study demonstrates promising improved efficacy of simvastatin delivered via liposomal nanoparticles. However, larger studies are needed to fully explore the potential of simvastatin-NP in adenomyosis.

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: This study compared maternal and foetal outcomes of managing placenta accreta spectrum (PAS) disease with and without prophylactic internal iliac balloon occlusion (IIABO) at a tertiary hospital between 2002 and 2021.

Methods: This retrospective cohort study included patients with confirmed PAS disorder, comparing maternal and foetal outcomes between those who underwent IIABO before caesarean delivery and those who did not, both receiving standardised multidisciplinary care. Primary outcomes included perioperative haemoglobin drop. Secondary outcomes included estimated blood loss, transfusion rate, operative duration, ICU stay, hysterectomy rates, and newborns' Apgar scores.

Results: Thirty-one antenatally diagnosed PAS patients were analysed (IIABO n = 21, non-IIABO n = 10). Over 90% had prior caesarean deliveries. IIABO is associated with lower intraoperative haemoglobin drop (p < .001) and higher postoperative haemoglobin (p = 0.047). The linear regression model demonstrated that IIABO and classical caesarean significantly reduced intraoperative blood loss (p = 0.019). No differences were seen in operative time, ICU stay, hysterectomy rates, or newborn Apgar scores. No IIABO-related complications were reported.

Conclusion: Prophylactic IIABO during caesarean delivery for PAS is associated with less haemoglobin drop and higher postoperative haemoglobin. IIABO under local anaesthesia was feasible, possibly reducing risks tied to extended general anaesthesia. Larger studies are recommended to support the role of IIABO in PAS disorders.

Background: Recent research has shown that long noncoding RNA (lncRNA) performs a critical regulatory function across multiple malignancies. The involvement of RNA in the progression of multiple human cancer types has been elucidated; however, there is limited understanding regarding the importance of the lncRNA CCDC144NL-AS1 in cervical carcinoma (CC).

Methods: CCDC144NL-AS1 expression was measured in 86 CC samples by RT-PCR. CC cell lines were engineered with CCDC144NL-AS1 overexpression using plasmid vectors, allowing for the exploration of its impact on the migration of tumour cells. Additionally, we studied how CCDC144NL-AS1 impacts epithelial-mesenchymal transition signalling, focusing on its expression levels and functional roles.

Results: CCDC144NL-AS1 expression showed a notable increase in gynaecological tumour specimens and cell lines in contrast to normal control (all p < 0.05). This expression exhibited relationships with the clinical stage (p = 0.003), histologic grade (p = 0.020), and lymph node metastasis (p = 0.013). Additionally, survival rates were found to be lower in CC patients with increased CCDC144NL-AS1 expression, as confirmed by multivariate analysis, compared to individuals with reduced expression levels (Hazard ratio = 1.960; p = 0.020). CCDC144NL-AS1 also facilitated increased cell viability and migration while triggering the EMT pathway. Xenograft models demonstrated that lower CCDC144NL-AS1 levels resulted in smaller tumours and longer survival (median survival: 43.5 vs. 35.5 days, p < 0.05).

Conclusion: CCDC144NL-AS1 significantly influences cell migration, making it a promising target for CC treatment and a valuable prognostic indicator.

Background: Robotic single-port transvaginal natural orifice transluminal endoscopic surgery (RSP-vNOTES) is an emerging minimally invasive approach that combines the advantages of robotic surgery with scarless transvaginal access. Its application in gynecologic oncology remains limited, particularly for omentectomy during ovarian cancer staging.

Methods: We present the case of a 45-year-old woman with an ovarian granulosa cell tumor (GCT) who underwent supplemental staging surgery following unilateral oophorectomy. Using a single-port robotic system via the transvaginal route, hysterectomy, right salpingo-oophorectomy, and omentectomy were performed. Key technical steps included enhanced visualization with gauze placement and use of an additional robotic arm for omental traction.

Results: The procedure lasted 2 hours and 10 minutes with an estimated blood loss of 50 mL. No intraoperative or postoperative complications occurred. The patient did not require postoperative analgesics and was discharged on postoperative day 3. Final pathology confirmed absence of omental metastasis.

Conclusion: This case demonstrates the feasibility and safety of RSP-vNOTES for omentectomy in gynecologic oncology. The technique offers potential benefits including reduced abdominal trauma, faster recovery, and superior visualization for complex dissections. While further studies are necessary to validate long-term oncologic outcomes, RSP-vNOTES may represent a promising minimally invasive option for selected patients requiring ovarian cancer staging surgery.