Journal of Obstetrics and Gynaecology最新文献

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: 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.

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.