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: 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: This study aimed to investigate the role of B7H4 and Fas in pre-eclampsia (PE) occurrence and development and reveal its potential mechanisms.

Methods: Thirty healthy individuals and 60 patients with PE were enrolled in the study. In addition, the clinical characteristics of all participants were collected, including age, gestational weeks at delivery, gestational time, number of births, systolic blood pressure, diastolic blood pressure and foetal weight. The chi-square test was used to evaluate differences in clinical characteristics between the high- and low-expression groups. The expression levels of B7H4 and Fas were analysed using western blotting and real-time quantitative polymerase chain reaction (RT-qPCR). The upstream regulators of B7H4 in trophoblasts were predicted and estimated using a luciferase reporter assay. The proliferation and motility of trophoblasts were assessed using CCK8 and transwell assays, respectively.

Results: B7H4 and Fas were upregulated in PE (p < 0.05) and showed diagnostic potential with insufficient sensitivity and specificity [B7H4: area under curve (AUC) = 0.790, sensitivity = 65%, specificity = 83.33%; Fas: AUC = 0.717, sensitivity = 68.34%, specificity = 73.33%]. B7H4 and Fas were closely associated with increased blood pressure in patients with PE (p < 0.05), and the combination of B7H4 and Fas increased the diagnostic efficacy (AUC = 0.864), sensitivity (73.33%) and specificity (86.67%). In trophoblast cells, miR-4319 negatively regulated B7H4 and Fas expression as well as cell proliferation, migration and invasion (p < 0.05). Overexpression of B7H4 alleviated the inhibitory effects of miR-4319, which were reversed by Fas knockdown (p < 0.05).

Conclusions: miR-4319 mediates the progression of trophoblast progression by negatively regulating the expression of B7H4 and Fas. Therefore, B7H4 and Fas may serve as potential biomarkers for the prediction and treatment of PE.

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: 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: 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: 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.