Journal of Obstetrics and Gynaecology最新文献

Background: Adolescents with developmental disability (DD) may experience similar menstrual disorders as their peers, as well as unique challenges associated with their underlying conditions. They have access to the same hormonal medications as the general population, but little is known about the effects of menstrual management in adolescents with DD. The aim of this study was to assess the efficacy, satisfaction with, side effects and complications of hormonal medications that are used for menstrual management in adolescents and young adults with DD.

Methods: A systematic review was performed in Medline, Embase, Cochrane library and PsycNet, using keywords related to menstrual management, hormonal medications, adolescents and disability. Meta-analyses of proportions were conducted for outcomes that could be combined across studies.

Results: Of the 2088 articles identified, 20 studies were included. The total number of participants was 3317 and varied significantly across studies (from 14 to 1560 individuals). Menstrual management was associated with a reduction in bleeding and high rates of amenorrhoea. We found that 45.4% (95% CI, 32.1-59%) of levonorgestrel-intrauterine device users experienced amenorrhoea. Satisfaction was high with all methods and correlated with the reduction in bleeding. Breakthrough bleeding was the most common side effect and the primary reason for ceasing or switching medication. No case of venous thromboembolism was reported.

Conclusions: Menstrual management was associated with improvement in menstrual symptoms and high levels of satisfaction in adolescents with DD. Side effects and complication rates were low in this population. This should support the use of menstrual management in adolescents with DD, who deserve similar access to menstrual health care as their peers.

Background: To evaluate the effect of opioid-free anaesthesia on postoperative pain and prognosis in gynaecological laparoscopic surgery.

Methods: A systematic search of four English and four Chinese databases was conducted up to 31 January 2024. Ten randomised controlled trials involving 861 patients were included.

Results: Opioid-free anaesthesia substantially reduced the incidence of postoperative nausea and vomiting (odds ratio = 0.25), lowered pain scores measured by numeric rating scale (mean difference = -1.43) and Visual Analog Scale (mean differenc = -1.50), improved Quality of Recovery-40 scores (mean differenc = 15.39) and shortened the hospital stay (length of hospital stay) (mean differenc = -1.72). Sensitivity analysis confirmed the robustness of most outcomes.

Conclusion: Opioid-free anaesthesia improves postoperative pain control and recovery in patients who undergo gynaecological laparoscopic surgery. It effectively reduces postoperative nausea and vomiting and enhances recovery quality, suggesting that opioid-free anaesthesia may be a promising alternative to opioid-based anaesthesia.

Background: Menopause is linked to declining ovarian function and adverse health outcomes such as cardiovascular disease and osteoporosis. Early menopause exacerbates these risks, underscoring the need to identify modifiable risk factors. Prior studies associate parabens with altered ovarian reserve markers and ovarian ageing in animal models, yet their relationship with natural menopause onset remains unexplored.

Methods: This cross-sectional study included 2668 female participants aged 18 years and older from the NHANES 2005-2016, excluding those with missing paraben measurements, hysterectomy/ovariectomy or critical variable data. Exposure was assessed via creatinine-corrected urinary concentrations of four parabens [butyl paraben (BuP), ethyl paraben (EtP), methyl paraben (MeP), propyl paraben (PrP)], each categorised by tertiles. The primary outcome was natural menopause onset, defined by self-report (no menstrual periods for ≥12 months due to menopause) per NHANES protocol. Weighted Cox regression models were used to examine associations between each paraben and natural menopause onset. Subgroup analyses were conducted by smoking status, alcohol use and oral contraceptive use.

Results: Natural menopause occurred in 1043 women in the total population. Compared with women with the lowest tertile of EtP, women in the second tertile of EtP (HR = 1.26, 95% CI: 1.01-1.57) and the highest tertile of EtP (HR = 1.28, 95% CI: 1.01-1.64) was associated with an increased risk of earlier onset of natural menopause. However, all BuP, MeP and PrP levels were not statistically associated with the onset of natural menopause. The results of subgroup analysis indicated that EtP, MeP and PrP were all associated with the earlier onset of natural menopause in women who did not used oral contraceptives.

Conclusion: Our findings suggested an association between higher EtP levels and an earlier onset of natural menopause in general U.S. women. The findings of our study necessitate further prospective epidemiologic research to validate.

Background: Antenatal perineal massage (APM) is an established technique for preventing severe perineal trauma, but it is uncommonly practised in Hong Kong. This study aimed to investigate pregnant women's knowledge, attitudes and interest in APM, and to identify factors that influence their interest in the technique.

Methods: A prospective cross-sectional study was conducted over 7 months at Princess Margaret Hospital. Pregnant women aged 18 years or above and under 37 weeks of gestation were invited to participate via a bilingual questionnaire distributed during antenatal clinic visits. Descriptive and regression analyses were used.

Results: Out of 385 respondents, only 31.4% were aware of APM with social media (61.2%) as their main source of knowledge. Only 44.8% of the questions were answered correctly, with a median knowledge score of 3.0 out of 7. A majority were unaware of the long-term impacts of severe perineal injury (57.7%) and potential benefits of perineal massage (54.5%), highlighting a deficiency of knowledge. Interest in APM was high (66.2%). Non-Chinese, higher education, planned vaginal delivery and knowledge of the technique's benefit are positive predictors of expressed interest. However, concerns about discomfort (38.5%) and embarrassment (38.5%) were notable barriers to participation. Among those who practised APM, the median Likert score was 4 out of 5, indicating a generally positive perception of its benefits.

Conclusions: This study reveals important areas where knowledge regarding obstetric anal sphincter injuries (OASIS) and APM is lacking among some pregnant women in Hong Kong. There is a need to enhance education and resources regarding these topics in antenatal classes.

Background: Antenatal screening for Trisomy 21 (T21) in the UK is performed primarily in the first trimester. Nuchal Translucency (NT), gestational age, Free β-HCG and PAPP-A are used in combination, creating the 'combined' test. Multivariate Gaussian distribution models then determine the chance of T21 expressed as an odds ratio. This study investigates the use of machine-learning algorithms in the prediction of T21 in first-trimester singleton pregnancies and compares their performance to existing screening models.

Methods: A total of 86,354 anonymised, first trimester, singleton pregnancy screening cases, including 211 with T21, were used to train and test machine-learning models using adaptive boosting technology. Test case results were compared with pregnancy outcome data to assess performance.

Results: A machine-learning model was able to outperform current multivariate distribution models (McNemar's p = .006, AUC 0.978 vs 0.974). False positive rates were reduced from 3.82% to 2.28% (95% CI: 3.56-4.08 and 2.08-2.48 respectively) and overall screen positive rates were reduced from 4.00% to 2.48% (95% CI: 3.74-4.28 and 2.27-2.70 respectively).

Conclusions: Machine-learning algorithms offer demonstrable improvements to first-trimester singleton T21 screening without major changes to the UK programme. Larger datasets and improved outcome data would likely offer further increases in performance.

Background: The rising caesarean section rates are a global concern, highlighted by the World Health Organisation due to the adverse impacts associated with the overuse of this intervention. This study assessed the use of Robson Classification (RC) in a Brazilian university hospital from 2016 to 2020.

Methods: A retrospective observational study was conducted from 2016 to 2020, including 9723 deliveries in a tertiary maternity hospital located in southeastern Brazil. Demographic, obstetric, and delivery data were considered to ascertain the RC. Caesarean section rates were calculated for each group and their absolute and relative contributions to the overall rate. Additionally, indications for induction and caesarean section were described.

Results: The overall caesarean section rate was 38.9%, with a predominance of Group 5 (women with a previous caesarean section), which accounted for 37.1% of all caesarean sections. Group 1 (nulliparous women with spontaneous labour) had a caesarean section rate of 17%, while Group 10 (preterm pregnancies) showed a rate of 50.7%. The main indications for caesarean sections were foetal distress (24.5%), repeat caesarean section (16.8%), and dystocia (10.9%). Labour inductions occurred in 22% of cases, primarily due to post-term pregnancy (35.7%) and premature rupture of membranes (23.4%).

Conclusions: The RC was an effective tool for monitoring and comparing obstetric practices, identifying the groups with the highest contributions to caesarean section rates. Specific strategies, such as protocols to encourage vaginal birth after caesarean (VBAC) and improvements in induction management, could help reduce unnecessary interventions. This study underscores the importance of implementing evidence-based guidelines to improve obstetric and neonatal outcomes.

Background: This study aimed to analyse the clinical characteristics of mifepristone-associated congenital and foetal cardiac adverse events using data from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS).

Methods: A retrospective pharmacovigilance analysis was conducted using FAERS data from Q1 2016 to Q4 2022. Disproportionality analysis was performed using the Bayesian Information Component (IC) to detect potential associations between mifepristone and congenital or foetal cardiac adverse events.

Results: A total of 1,130 reports involving mifepristone were identified, of which 18 (1.59%) were related to congenital or foetal cardiac events. Most reports originated from the United States. The most frequently reported events were foetal arrhythmia and foetal heart rate disorder. Notably, foetal arrhythmia showed the strongest signal (IC = 3.13, CI₀₂₅ = 1.37). No disproportional signals were detected for structural cardiac malformations. A partial assessment of the Bradford Hill criteria suggested a possible association with functional cardiac anomalies.

Conclusion: This study did not identify an association between mifepristone exposure and structural congenital heart defects. However, a positive signal for transient foetal heart rhythm abnormalities was observed. Clinicians should remain vigilant for foetal heart rate irregularities following maternal mifepristone use and consider enhanced cardiac monitoring during labour and delivery to enable early detection and management.

Background: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy is gaining increasing popularity among gynaecological surgeons worldwide due to its minimally invasive nature and associated benefits. However, despite its growing adoption, it remains a relatively novel surgical technique that continues to be evaluated and refined in clinical practice. The primary objective of this study is to share and analyse our initial experiences with the implementation of vNOTES hysterectomy across six specialised gynaecological centres in Turkey.

Methods: This retrospective analysis included all women who underwent vNOTES hysterectomy, with or without salpingo-oophorectomy, for benign or malignant conditions. All procedures adhered to the standardised protocol described by Baekelandt et al. Data on baseline patient characteristics, intraoperative details, and postoperative outcomes were collected and analysed.

Results: A total of 685 patients underwent vNOTES procedures. Among them, 64 women (9.3%) had a history of one caesarean delivery, 38 (5.5%) had two prior caesareans, and 11 (1.6%) had three or more. Myoma, with or without accompanying metrorrhagia, was the most common surgical indication (53.0%). The mean operative time was 72.4 ± 40.2 min, and the average haemoglobin decrease was 1.3 ± 1.0 g/dL. The mean uterine weight was 204 ± 145 g. Intraoperative complications occurred in 1.7% of cases (n = 12), while postoperative complications were observed in 1.4% (n = 10). Conversion to conventional laparoscopy occurred in six cases (0.9%), primarily due to an obliterated pouch of Douglas or intraoperative complications. The average hospital stay was 2.3 ± 1.4 days.

Conclusions: These findings support vNOTES as a safe and effective surgical approach, offering a viable alternative to traditional laparoscopic or vaginal techniques in select patient populations.