Journal of Obstetrics and Gynaecology最新文献

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: 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.

Background: To investigate the expression of serum Growth differentiation factor 15 (GDF-15) and examine its correlation with systolic and diastolic blood pressure in third-trimester pregnant women with hypertensive disorders of pregnancy (HDP).

Methods: This cross-sectional study included 60 patients with HDP in the third trimester (HDP group) and 50 healthy pregnant women (control group). Clinical characteristics were collected and serum GDF15 levels were measured.

Results: Serum GDF-15 levels were significantly elevated in the HDP group compared to controls. Moreover, Serum GDF-15 levels were positively correlated with both systolic blood pressure and diastolic blood pressure in the HDP group.

Conclusions: Serum GDF‑15 levels may be associated with the severity of HDP.

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: 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: The aims of this study are to investigate the causal relationships between sleep traits and the risk of gestational diabetes mellitus (GDM), preterm birth, and foetal growth restriction (FGR).

Methods: This two-sample Mendelian Randomisation (MR) study was conducted from May to June 2024 to investigate the associations between seven sleep traits and GDM, preterm birth, and FGR. The study utilised data from large-scale genome-wide association study datasets, and specifically focused on individuals of European descent. The main analysis employed inverse-variance-weighted MR, with sensitivity analyses conducted to mitigate potential pleiotropy-induced biases. Additionally, multivariable MR analysis was conducted to adjust for potential confounding factors.

Results: Genetically predicted excessive daytime sleepiness (OR 13.67; 95% CI, 1.03-180.59; p = 0.047) and sleep apnoea (OR 1.29; 95% CI, 1.00-1.65; p = 0.049) were found to be associated with a higher risk of GDM. No sleep trait was associated with either preterm birth or FGR. These results were robust across various sensitivity analyses. In the multivariable MR analysis, adjusting for body mass index (BMI) and smoking, the genetically instrumented excessive daytime sleepiness (OR 14.58; 95% CI 1.67-127.36; p = 0.015) and sleep apnoea (OR 1.30; 95% CI 1.02-1.64; p = 0.030) were consistently associated with an increased GDM risk.

Conclusions: This study suggests a causal relationship between both excessive daytime sleepiness and sleep apnoea to the development of GDM. Excessive daytime sleepiness and sleep apnoea demonstrate promise as potentially preventable risk factors for GDM.

Background: Intrauterine adhesion (IUA) often recurs after surgery, and hysteroscopic follow-up is essential for early detection. However, the ideal timing for follow-up is uncertain. This study examines how different follow-up timings affect IUA recurrence after surgery.

Methods: All patients (142) who received hysteroscopic surgery in our hospital between 1 January 2021 and 31 November 2024 were retrospectively recruited using the convenience sampling method. The patients were retrospectively divided into two groups based on the timing of postoperative hysteroscopic follow-up. Group A (n = 71) underwent a routine follow-up at 3 months postoperatively, whereas Group B (n = 71) had an early follow-up at 14 days, with additional follow-ups after each menstrual cycle for 3 months. The primary outcomes measured were uterine cavity morphology and menstrual improvement 3 months post-surgery. The recovery of uterine cavity morphology and menstrual improvement after 3 months of follow-up were compared between the two groups.

Results: There was a significant positive correlation between the recovery of uterine cavity morphology and the number of postoperative hysteroscopies in Group B (r = 0.335, P < 0.001). After 3 months following the operation, the improvement of menstruation (Z = -3.423, P = 0.001) and the recovery of uterine morphology (Z = -3.741, P = 0.001) in Group B were better than those in Group A, and the difference was statistically significant.

Conclusion: Early and regular hysteroscopy in patients with IUA undergoing hysteroscopic adhesion separation is effective in restoring uterine cavity morphology, preventing re-adhesion and improving menstruation.

Background: An estimated 230 million girls and women are living with female genital mutilation (FGM) which causes ongoing physical and psychological harm. This review aims to explore what is known about FGM and incontinence, including the underexamined implications for women's health, and identify gaps in the literature.

Methods: A comprehensive database search was conducted using MEDLINE, CINAHL Plus, APA Psych Info, AMED, Child Development and Adolescent Studies, and PubMed. To gather all relevant complications of FGM, no restrictions were imposed on date or study type. Themes were identified by organising the 20 eligible articles by symptom type.

Results: The findings indicate that urological symptoms such as dribbling incontinence, slow micturition, urgency, stress incontinence and overactive bladder are prevalent among women who have undergone FGM. Additional complications include fistulas, pelvic organ prolapse, somatic symptoms, and urinary tract infections. The impact of FGM and incontinence on quality of life and daily activities remains under-explored, with the lived experiences of affected women largely unreported.

Conclusions: FGM has multiple urogynaecological consequences, with more severe forms causing increased symptoms and associated complications. This review highlights the need for further research into the biopsychosocial impacts of FGM and incontinence to provide evidence-based support for affected women.