Journal of Obstetrics and Gynaecology最新文献

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.

Background: Endometrial carcinoma is a clinically complex gynaecologic malignancy exhibiting significant molecular heterogeneity. This heterogeneity manifests as marked variability in clinical outcomes and heterogeneous therapeutic responses to emerging treatment modalities, particularly to immune checkpoint inhibitors. Metabolic reprogramming has been implicated in tumour progression and immune evasion in endometrial carcinoma. However, the prognostic implications of metabolism-related genes and their interaction with the tumour immune microenvironment remain insufficiently characterised.

Methods: RNA-seq and clinical data of endometrial carcinoma were downloaded from The Cancer Genome Atlas (TCGA) database, along with a metabolism-related gene set (MRGs) curated from the Msigdb database. Differential expression analysis was conducted to identify differentially expressed metabolism-related genes (DE-MRGs), which were subsequently analysed to evaluate their expression patterns and prognostic significance in uterine corpus endometrial carcinoma. Functional enrichment was performed via GO and KEGG analysis. The CIBEROSRT computational algorithm was employed to quantify immune infiltration characteristics and their correlation with MRGs. Furthermore, an external GEO dataset (GSE17025) was employed to validate hub gene expression.

Results: A total of 49 differentially expressed MRGs were identified in endometrial carcinoma. Functional analyses showed enrichment in retinol and tyrosine metabolism pathways. Two hub genes, LIPG and DDC, were significantly associated with overall survival (p = 0.01 and p = 0.0015, respectively). Multivariate analysis confirmed DDC as an independent prognostic factor (p < 0.001). Immune profiling revealed higher infiltration of regulatory T cells (p = 0.005) and M0 macrophages (p = 2.6 × 10^-16) in tumours. LIPG and DDC exhibited significant correlations with various immune cell populations.

Conclusion: Our study analysed the expression and prognostic relevance of MRGs of endometrial carcinoma. We validated the prognostic value of MRGs and their potential to offer novel insights into prognostication and personalised treatment strategies for endometrial carcinoma.

Background: Ectopic pregnancies represent a potentially life-threatening medical emergency, with 95% being tubal. This meta-analysis aimed to identify early predictors for single-dose methotrexate (MTX) treatment failure in tubal pregnancies.

Methods: A literature search was conducted across several databases from their inception to December 2023, with references in the selected studies manually reviewed. 14 studies involving 2,804 patients were included in this meta-analysis.

Results: The results revealed that higher serum beta-human chorionic gonadotropin (β-hCG) levels on Day 1 (SMD = 1.25, 95% CI 0.73-1.77), foetal cardiac activity presence (OR = 12.64, 95% CI 3.15-50.75), adnexal mass presence (OR = 4.66, 95% CI 2.02-10.74), yolk sac presence (OR = 5.35, 95% CI 2.33-12.27), thicker endometrium (MD = 1.74, 95% CI 0.30-3.19), more number of previous ectopic pregnancies (MD = 0.21, 95% CI 0.13-0.30), history of pelvic inflammatory disease (PID) (OR = 3.97, 95% CI 2.02-7.79), higher progesterone levels on Day 1 (SMD = 0.22, 95% CI 0.07-0.36), a higher 48-hour pre-treatment increment in serum β-hCG percentage (MD = 11.46, 95% CI 2.95-19.98), and a higher percentage of serum β-hCG change from Day 4 to Day 0/1 (SMD = 2.58, 95% CI 1.02-4.14) were early predictive factors for treatment failure of tubal pregnancy with the MTX single-dose regimen.

Conclusions: This review clarifies early predictive factors for treatment failure with the MTX single-dose regimen in tubal pregnancies. High-risk tubal pregnancies likely to fail MTX monotherapy could be identified earlier, allowing for personalised intervention measures to be implemented at an early stage to prevent harm and improve treatment outcomes.

Background: Pregnancy and childbirth are vulnerable periods for women's mental health, with common occurrences of postnatal depression (PPD), postpartum post-traumatic stress symptoms (PP-PTSS) and postnatal severe fear of childbirth (PP-FOC). While previous trauma is linked to higher rates of postpartum psychological difficulties, the mechanisms and variations by parity and sociodemographic factors remain poorly understood. The aim of this study was to compare the prevalence of PPD symptoms, postnatal post-traumatic stress disorder (PP-PTSD), PP-PTSS and PP-FOC between women with a history of trauma and those without. Additionally, the study aimed to analyse the prevalence of previous trauma and postnatal mental health problems in subgroups of primi- and multiparous women, and to investigate how trauma influenced mental health in relation to sociodemographic characteristics.

Methods: This was a cross-sectional study including 619 women who had given birth at five maternity clinics in Sweden. Data for the survey were collected online using validated instruments to measure PPD, PP-PTSD, PP-PTSS and PP-FOC. Data were analysed using Chi-squared tests, independent t-tests and uni- and multivariable regression.

Results: Women with a trauma history (n = 298) showed significantly higher rates of PPD (26% vs. 13%) and PTSD (5% vs. 2%) than those without a trauma history (n = 321). Previous trauma, age and parity significantly influenced postnatal outcomes, with trauma having the most substantial impact.

Conclusions: A history of trauma is correlated to higher risk of postpartum mental health problems, while previous births may offer some protection, especially against PP-PTSS and PP-FOC. Early identification and targeted support for women with trauma histories are recommended.

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.