Journal of Obstetrics and Gynaecology最新文献

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.

Background: The gonadotropin-releasing hormone antagonist (GnRH-ant) protocol is associated with few oocytes retrieved, few mature oocytes and poor endometrial receptivity. Omission of GnRH-ants on trigger day seems unlikely to induce preovulation and may improve outcomes in the GnRH-ant protocol. This study aimed to systematically evaluate the effects of GnRH-ant cessation on trigger day on in vitro fertilisation outcomes following the GnRH-ant protocol.

Methods: We searched PubMed, Ovid/MEDLINE, Wanfang, VIP, CNKI and ClinicalTrials.gov databases. The last search was conducted on 10 December 2023 in English or Chinese, without time limitations on the collection of studies from the databases. The references in these articles were manually searched. Randomised controlled trials (RCTs) and cohort studies aimed at assessing the effects of GnRH-ant cessation on trigger day using the GnRH-ant protocol were included. The eligible studies included at least one of the main outcomes: number of oocytes retrieved, proportion of mature oocytes, implantation rate or clinical pregnancy rate.

Results: Three studies with 1449 cycles were included. Cessation of GnRH-ant on trigger day improved the proportion of mature oocytes (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.09-1.45, I² = 0%) but did not affect the number of oocytes retrieved (mean difference [MD] = 0.50, 95% CI = -0.07 to 1.07, I² = 47%), implantation rate (OR = 0.95, 95% CI = 0.69-1.30, I² = 0%), clinical pregnancy rate (OR = 1.06, 95% CI = 0.71-1.58, I² = 0%), endometrial thickness (MD = -0.09, 95% CI = -0.27 to 0.10, I² = 0%) or cycle cancellation rate (OR = 0.64, 95% CI = 0.15-2.74, I² = 0%).

Conclusions: Cessation of GnRH-ant on trigger day of the GnRH-ant protocol is suggested because it could improve the proportion of mature oocytes. However, further RCTs are required.

Background: This study aim to compare the proportion of pessary users reporting satisfaction with ultra-low dose oestriol and Lactobacillus vaginal tablets and vaginal moisturiser.

Methods: A randomised-controlled trial enrolled patients who were able to take care, insert, and remove a pessary themselves and did not use any local oestrogen or vaginal moisturiser for 3 months at a tertiary centre. Participants were randomised to receive either vaginal moisturisers or ultra-low-dose oestriol and Lactobacillus vaginal tablets for 2 months. A single-blinded evaluator assessed outcomes. The oestriol group received one vaginal tablet daily for 6 days followed by two tablets weekly for 8 weeks. The moisturiser group received one application every 3 days for 8 weeks. The primary outcome was the proportion of patients reporting high satisfaction, defined as 'very much improved' or 'much improved', using the Thai version of the Patient Global Impression of Improvement (PGI-I) scale. Secondary outcomes were subjective and objective outcomes of vaginal health. Sixty patients were randomised, of whom one did not complete treatment.

Results: The majority of enrolled participants were postmenopausal women with a mean age of 65.54 years, mean BMI of 25.13 kg/m², and advanced-stage POP. The average duration of pessary use was 12-15 months. Patient satisfaction was not significantly different between the oestriol and moisturiser groups at 4 or 8 weeks (93.10% vs. 96.67%, P = 0.61 and 89.66% vs. 93.33%, P = 0.67, respectively). There were no serious adverse events.

Conclusions: Vaginal moisturisers and ultra-low-dose oestriol and Lactobacillus acidophilus vaginal tablets provided high satisfaction in pessary users. Both preparations were comparable in both subjective and objective outcomes.

Background: Vaginal preparation before transvaginal gynecological surgeries improves the success rate. However, there is no consensus on which agent is superior for transvaginal repair of vesicovaginal fistula (VVF). We aimed to compare irritation symptoms and antimicrobial function between sterile normal saline (SS) and 1% povidone-iodine (PI) for vaginal preparation in surgical repair of VVF.

Methods: This randomised, controlled trial was conducted on patients with VVF underwent transvaginal repair. Preoperative vaginal irrigation was randomly performed with either SS or 1% PI. The patients' self-reported symptoms questionnaires, including numerical rating scale (NRS) of pain, Indevus urgency severity scale (IUSS), and vaginal symptoms, tissue edoema degree and pathogenic microbiology were recorded.

Results: The study included 30 patients in the SS group and 31 patients in the PI group. After twice irrigations before surgery, compared with the PI group, the SS group had a similar count of bacterial species but a higher bacterial load (p = .079 and p = .033). The NRS of pain and IUSS in the SS group were lower than those in the PI group (p < .001). The SS group had less severe vaginal symptoms (p < .001) and tissue edoema (p < .001) than the PI group. The successful repair rates were 86.7% in the SS group and 83.9% in the PI group (p = .758). Patients with more severe urinary and vaginal symptoms had lower successful repair rates (92.3% vs. 72.7%, p = .047).

Conclusions: SS is an effective vaginal preparation liquid for transvaginal repair of VVF with less irritation symptoms and acceptable antimicrobial function.

Background: This study aimed to examine the alterations in apoptosis and autophagy in placental tissues from normal pregnancies compared to those affected by preeclampsia (PE) and HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. We analysed the expression of autophagy-associated proteins, Beclin-1 and BCL-2, in human placental tissues and assessed their variations in placentas from pregnancies complicated by PE and HELLP syndrome by immunohistochemical (IHC) and in silico analyses.

Methods: An experimental case-control study was performed, involving 40 pregnant women complicated with preeclampsia, 25 pregnant women with HELLP syndrome, and 40 healthy pregnant women. The placental sections were stained with BCL-2 and Beclin-1 immunostains and subjected to IHC examination. The results of the IHC staining were assessed using semi-quantitative analysis. In silico analyses were performed using STRING and Cytoscape software to construct protein interaction networks for BCL-2 and Beclin-1 in PE and HELLP syndrome, followed by Gene Ontology analysis of common interactors to identify significant biological pathways.

Results: Both BCL-2 expression was significantly decreased (p < 0.001 and p < 0.0001, respectively) and Beclin-1 staining was significantly increased (p < 0.0001 and p < 0.0001, respectively) in the PE group and HELLP group compared to the control group. The changes in BCL-2 and Beclin-1 expression between PE and the HELLP group were also statistically significant. BCL2 expression was notably lower (p < 0.0001), and Beclin-1 staining was significantly higher (p < 0.05) in the HELLP group compared to the PE group. In PE, BCL-2 interactors were enriched in apoptosis, cytokine production, and cell proliferation pathways, while Beclin-1 interactors were linked to autophagy and phosphatidylinositol-mediated signalling. In HELLP, BCL-2 interactors were involved in inflammatory response regulation, whereas Beclin-1 interactors were associated with vascular endothelial growth factor (VEGF) signalling and immune regulation.

Conclusions: The differential expression patterns of BCL-2 and Beclin-1 between the PE and HELLP groups suggest that these proteins play distinct roles in the pathophysiology of these conditions.

Background: A growing body of evidence indicates that the systemic immune-inflammation index (SII) is associated with the prognosis of cervical cancer (CC). However, its prognostic value remains controversial. This study aimed to comprehensively evaluate the performance of SII in predicting the prognosis of CC.

Methods: Studies on the prognostic potential of SII in CC were acquired from PubMed, Embase, Web of Science, and the Cochrane Library from database inception to July 4, 2024. Outcome measures included progression-free survival (PFS), overall survival (OS), relapse-free survival (RFS), and complete response (CR), which were expressed as hazard ratio (HR) and 95% confidence interval (CI). Sensitivity and subgroup analyses were carried out to evaluate the stability of results and identify potential sources of heterogeneity.

Results: Ten cohort studies involving 2007 patients were included in the meta-analysis. High SII levels were significantly associated with reduced OS (HR = 2.45; 95% CI: 1.56-3.86, p = 0.001), PFS (HR = 2.93; 95% CI: 1.88-4.58, p < 0.00001), and CR (HR = 0.23, 95% CI: 0.11-0.50; p = 0.0002) in patients with CC. Subgroup analyses suggested that SII was more effective in predicting outcomes in Asian patients with CC.

Conclusions: High SII levels are significantly associated with reduced OS, PFS, and CR in CC. Therefore, SII is a promising biomarker for predicting outcomes and informing treatment decisions for immunotherapy in CC.