Journal of Obstetrics and Gynaecology最新文献

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.

Background: Urinary incontinence (UI) may be associated with cardiovascular disease. Life's Essential 8 (LE8), a recently updated measure of cardiovascular health (CVH), has been investigated for its association with all-cause and cardiovascular mortality among US female adults with UI.

Methods: This population-based retrospective cohort study utilised data from 6314 US female adults aged ≥20 years with UI (weighted population: 4.14 million) derived from the National Health and Nutrition Examination Survey (NHANES) 2005-2018, along with their linked mortality data up to December 2019. The LE8 metric, ranging from 0 to 100, was categorised into low, moderate, and high levels. UI status was determined by self-report. Multivariable Cox proportional hazards regression models were employed to assess the associations between LE8 and both all-cause and cardiovascular disease (CVD) mortality. A stratified analysis and sensitivity analysis were also conducted.

Results: During a median follow-up period of 92 months (with a maximum of 180 months) among US adult females with UI, 684 all-cause deaths were recorded, including 169 deaths attributable to cardiovascular disease. A 10-point increase in the LE8 score was associated with a 14% reduction in the risk of all-cause mortality (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.79-0.93) and a 17% reduction in the risk of CVD mortality (HR, 0.83; 95% CI, 0.71-0.97). Physical activity has the most significant effect. In the stratified subgroups and sensitivity analyses, the results remained robust.

Conclusions: An elevated LE8 score was independently correlated with reduced risks of all-cause and cardiovascular mortality among US female adults with UI. Future prospective studies are required to further strengthen our findings.

Background: Endometriosis is a chronic inflammatory disease with a prevalence of approximately 10% in women of childbearing age. Metabolic pathways have been demonstrated by previous studies to be potential avenues for the development of new therapeutic strategies and may be used for early diagnosis of the disease. This study aimed to investigate the potential causal relationships between 1400 metabolites and various endometriosis subtypes using Mendelian randomisation (MR) analysis.

Methods: Data from a genome-wide association study were analysed. MR analysis was performed using the inverse-variance weighted, MR-Egger, and weighted-median methods, accompanied by heterogeneity testing, sensitivity analysis, and pleiotropy analysis. Metabolic-pathway enrichment analysis was conducted on the preliminarily screened differential metabolites, and colocalisation analysis was subsequently performed for exposure-outcome pairs that remained causally associated after multiple-testing correction.

Results: After multiple-testing correction, only the glycerol-to-palmitoylcarnitine (C16) ratio reduced the risk of stage 1-2 endometriosis (P_FDR = 0.045; odds ratio [OR], 0.737; 95% confidence interval [CI], 0.638-0.852) and pelvic peritoneal endometriosis (P_FDR = 0.039; OR, 0.721; 95% CI, 0.619-0.841). Colocalisation analysis revealed that they did not share causal variant loci at the genetic level. No reverse causal associations were found in the reverse Mendelian analysis. Metabolic pathway enrichment analysis identified major metabolic pathways, including caffeine metabolism, glutathione metabolism, arginine biosynthesis, sphingolipid metabolism, pantothenate and CoA biosynthesis, plasmalogen synthesis, and biosynthesis of unsaturated fatty acids.

Conclusions: Our study suggests potential causal relationships between metabolites and various endometriosis subtypes from an MR perspective. However, the limited number of associations that survived multiple-testing correction indicates that these findings are preliminary and require validation in larger cohorts. This exploratory analysis may contribute to advancing future research on metabolomics-based diagnosis, treatment, and prevention of endometriosis.

Background: Obstetric violence (OV) is a gender-based human rights violation during pregnancy, labour, and postpartum. Despite increasing recognition, the global prevalence and risk factors associated with OV remain poorly understood. We aim to estimate the prevalence of OV worldwide, examine regional disparities, and identify the associated risk factors through an umbrella review.

Methods: After prospective registration (PROSPERO CRD42025631985), a comprehensive search was conducted in PubMed, Scopus, Web of Science, and Scielo for reviews published between January 2015 and March 2025. Two reviewers independently selected studies, extracted data, and assessed methodological quality using the AMSTAR 2 tool. Overlap of studies among the included reviews was quantified using the corrected covered area (CCA). The risk factor data were summarised as odds ratio (OR) with 95% confidence interval (CI).

Results: Fourteen reviews, with a total of 1,116,159 participants, were included; of which 10 (71.4%) were of critically low or low quality and only one review was high quality. The CCA was very low at 1.136%. OV prevalence varied from 23.2% to 59%, depending on region and definitional criteria. Forms of OV included physical (3.1-78.4%), verbal or psychological (2.6-66%), and social (1.9-94%) mistreatment. Statistically significant risk factors included low socioeconomic status (maximum OR = 3.68; 95% CI = 1.4-9.7), obstetric complications (maximum OR = 6.41; 95% CI: 1.36-30.14), limited education (OR = 5.92; 95% CI 1.38-23.81), public healthcare births (maximum OR = 4.34; IC 95%: 1.58-11.97), instrumental delivery (OR = 2.35; 95% CI: 1.72-3.22), and inadequate provider training (OR = 1.47; 95% CI: 1.05-2.04).

Conclusions: OV is a prevalent global issue. Vulnerable populations, i.e. those with lower socioeconomic status and limited education, were more often affected. The low methodological quality of the existing literature is a key weakness. There is a need for standardised definitions and improved research validity for the development of evidence-based interventions.

Background: Urinary retention following total hysterectomy is a prevalent postoperative complication that significantly impacts patient recovery and quality of life. Current prevention methods have limitations, prompting exploration of more effective strategies. Sacral nerve magnetic stimulation (SMS), an innovative, non-invasive approach, has shown potential in managing urinary disorders.

Methods: In this single-centre, prospective, randomised controlled trial, 100 patients undergoing surgery for gynaecological malignancies were randomly assigned to receive either standard care (control group) or SMS treatment plus standard care (intervention group). The primary outcome was the incidence of post-operative urinary retention (POUR) (the number of patients with residual urine volume over 100 mL or inability to void divided by the total number of patients in each group, expressed as a percentage), with secondary outcomes including time to spontaneous voiding, re-catheterisation rate and pelvic floor muscle strength.

Results: The intervention group had a significantly lower POUR incidence (14% vs. 36%, p = .002), shorter time to spontaneous voiding (1.5 days vs. 2.5 days, p < .001) and lower re-catheterisation rate (12% vs. 30%, p = .012) compared to the control group. Pelvic floor muscle strength also improved in the intervention group (p = .03). No serious adverse events related to SMS were reported.

Conclusions: SMS can significantly reduce the incidence of POUR and shortened the time to spontaneous voiding, while also decreasing the re-catheterisation rate compared to the control group.