Journal of Obstetrics and Gynaecology最新文献

Background: The challenging incidence of preterm birth, the underlying causes of preterm birth remain unclear. This study determined the relationship between disturbed gastrointestinal symptoms, inflammatory markers, blood lipid levels, and preterm birth.

Method: One hundred and twenty pregnant women with preterm labour were compared to 120 pregnant women with full-term deliveries. All subjects underwent lactose breath and serologic testing. The correlation between small intestinal bacterial overgrowth (SIBO)-positivity, gastrointestinal symptoms, inflammatory factors, and blood lipid metabolism and preterm birth was analysed using the Spearman method.

Results: SIBO, hydrogen, and methane levels were significantly higher in the preterm birth (PTB) group than the full-term birth (FTB) group at different time points (P < 0.05); Levels of high-sensitivity C-reactive protein (hs-CRP) (3.95[2.70-5.77] vs. 2.47[1.45-3.83]), Interleukin (IL)-10 (3.05[2.27-4.33] vs. 2.09[1.04-3.47]), IL-6 (5.23[3.95-8.50] vs. 2.98[2.22-4.44]), tumour necrosis factor -alpha (TNF-α) (3.23[1.55-4.90] vs. 1.76[0.98-3.10]), total cholesterol (TC) (5.52[4.97-5.95] vs. 5.24[4.73-5.85]), and triglycerides (TG) (2.58[2.04-3.53] vs. 2.24[1.59-3.05]) were significantly higher in the PTB group than the FTB group (P < 0.05). Abdominal distension (2.67[1.67-3.00] vs. 2.33[1.67-2.67]) and constipation (2.00[1.33-2.00] vs. 1.67[1.33-2.00]) scores were also markedly higher in the PTB group than the FTB group (P < 0.05). Preterm birth was positively correlated with SIBO, TC, and TG levels. Additionally, SIBO was positively correlated with hs-CRP, IL-10, IL-6, and TNF-α levels, abdominal distension, and constipation (P < 0.05). Logistic regression analysis found the close association between positive SIBO, biochemistry indicators and preterm birth.

Conclusion: Gastrointestinal disturbances, hyperlipidaemia and SIBO-positivity are more likely to occur among pregnant women with preterm labour. Further research with a large sample size in multi-centers is needed to validate the results.

Background: Chronic pelvic pain is a substantial clinical challenge that profoundly impacts quality of life for many women. The Neuro Emotional Technique (NET) is a novel mind-body intervention designed to attenuate emotional arousal of distressing thoughts and pain. This study evaluated functional connectivity changes in key areas of the brain in patients with chronic pelvic pain receiving the NET intervention. The goal was to assess whether the NET intervention was associated with functional connectivity (FC) changes in the brain related to reductions in emotional distress and pain, particularly in the limbic areas, sensory/pain regions, and cerebellum.

Methods: This is a prospectively designed study that included twenty-six patients with a diagnosis of chronic pelvic pain who were randomised to either the NET intervention or a waitlist control. To evaluate the primary outcome of neurophysiological effects, all participants received resting state functional blood oxygen level dependent (BOLD) magnetic resonance imaging (rs-fMRI) before and after the NET intervention or waitlist control period. Pain, mood, anxiety, and quality of life also were assessed.

Results: Compared to the control group, the NET group demonstrated significant improvements in pain interference and pain intensity, and in emotional measures such anxiety and depression. Functional connectivity in the NET group compared to controls, was significantly decreased in the amygdala, cerebellum, and postcentral gyrus. There were also significant correlations between FC changes and changes in clinical measures.

Conclusions: This study is an initial step towards describing a neurological signature of reducing emotional distress in women with chronic pelvic pain. Specifically, FC changes between the cerebellum and the amygdala and sensory areas appears to be associated with a reduction in pain and the effects of that pain. Future, larger clinical trials are warranted to further evaluate these mechanisms and NET as a potential therapeutic intervention in patients with chronic pelvic pain.

Background: Rac3 is associated with the malignancy of various tumours, including endometrial cancer (EC). Silencing Rac3 has been shown to effectively enhance the sensitivity of EC cells to chemotherapeutic drugs. Nonetheless, the underlying mechanism is still unclear.

Methods: Firstly, the association between Rac3 and EC was verified through the TCGA database. Subsequently, Ishikawa cell lines with Rac3 knockdown were constructed. The effects of Rac3 knockdown on the growth, migration and invasion of Ishikawa cells were assessed through clone formation experiments, CCK-8 experiments, flow cytometry, and Transwell experiments. Finally, qRT-PCR and WB experiments were conducted to initially explore the potential mechanism of action of Rac3 in the development of EC.

Results: Compared with normal tissues, the expression of Rac3 in EC tissues was significantly elevated, and this expression further increased with the aggravation of tumour. In Ishikawa cells with Rac3 knockdown, cell viability was significantly reduced, the apoptosis rate increased, and the invasion and migration abilities of the cells were inhibited. Correlation analysis of EC samples revealed a positive correlation between Rac3 and AKT2, AKT3 and mTOR. Additionally, WB and qRT-PCR also suggested that the mechanism of action of Rac3 in the development of EC may be related to the upregulation of AKT2, AKT3 and mTOR.

Conclusions: Knockdown of Rac3 may inhibit the occurrence and development of EC, which is related to its inhibition of AKT2, AKT3 and mTOR. This discovery provides a theoretical basis for clinical screening of biomarkers for EC and the development of potential therapeutic targets.

Background: Women infertility is associated with cardiovascular diseases. Life's Essential 8 (LE8), a recently updated measure of cardiovascular health (CVH), has been investigated for its association with women infertility.

Methods: The study adopted a cross-sectional design with national scope, incorporating 2534 women aged 20-49 years, selected from the National Health and Nutrition Examination Survey dataset from 2013 to 2018. The LE8 metric, which varies from 0 to 100, was evaluated based on the criteria set by the American Heart Association and then classified into three levels of CVH: low level (0-49), moderate level (50-79) and high level (80-100). Infertility status was determined based on self-report. To evaluate these correlations, we employed models with multivariable logistic variables and a restricted cubic spline. For subgroup assessment in relation to the LE8 score, a stratified multivariate logistic regression model was utilised.

Results: Among 2534 participants (mean weighted age 34.96 years), 314 experienced infertility (weighted percentage 13.20%). Higher LE8 scores (mean 73.87) were associated with lower odds of infertility (odds ratio (OR) 0.77 per 10-point increase; 95% confidence interval (CI) 0.68-0.86), even after adjusting for confounders. Similar trends were observed for associations between health behaviour scores, health factor scores and infertility rates, with diet, sleep health, body mass index (BMI), blood glucose and blood pressure showing more pronounced influences. LE8 scores exhibited an inverse dose-response relationship with female infertility, with a significant interaction with age (p for interaction <0.001). Among women under 35 years, the association between LE8 scores and infertility was stronger (OR 0.65 per 10-point increase; 95% CI 0.56-0.74).

Conclusions: Our study demonstrates that increased LE8 scores are associated with reduced infertility risk, providing an effective strategy for female infertility prevention.

Background: Care experiences of women with obesity are often shaped by weight stigma, negatively affecting health outcomes. Research on this issue within Brazilian healthcare remains limited. This study explored how overweight and obese pregnant and postpartum women perceive the care provided by healthcare teams during prenatal, childbirth, and postpartum periods, with emphasis on experiences of prejudice or discrimination (fatphobia).

Methods: A qualitative, descriptive, exploratory, and inductive field study was conducted using netnography. Data was collected from the Facebook community 'Gestantes de Alto Risco - Obesas, Hipertensas e etc.' (High-Risk Pregnant Women - Obese, Hypertensive, etc.) through daily virtual immersion and an online survey between August 2021 and December 2023. Participants included pregnant or postpartum women with a body mass index (BMI) >25 kg/m². Thematic analysis was performed using the Discourse of the Collective Subject (DCS) technique.

Results: A total of 149 women completed the survey. Overall, 52.6% reported negative care experiences. Qualitative findings revealed recurrent themes of weight stigma, humiliation, shame, lack of empathy, dismissive attitudes, and structural barriers such as inadequate equipment. Many felt blamed for complications, often encountering judgmental or moralising language. In contrast, 47.4% described positive experiences when interactions involved respect, empathy, and individualised communication, though occasional weight-related criticism persisted.

Conclusion: The study demonstrates a high prevalence of fatphobia among overweight and obese pregnant and postpartum women in Brazil. Findings highlight the need for more respectful, individualised, and humanised obstetric care. Enhancing professional training and institutional practices is essential to reduce stigma and improve health outcomes for this population.

Background: In this prospective follow-up longitudinal study, we investigated the long-term impact of laparoscopic sacrocolpopexy (SCP) on voiding dysfunction present prior to surgery in women with symptomatic pelvic organ prolapse (POP).

Methods: Women from a previously published study who underwent SCP for symptomatic POP with objective and/or subjective voiding dysfunction between 01/2019 and 08/2021 were contacted and invited to attend an additional long-term follow-up visit for a clinical re-evaluation identical to the preoperative and postoperative visit (6-12 weeks). The postoperative outcome was assessed using uroflowmetry, the POP-Q quantification system and the validated German version of the Australian Pelvic Floor Questionnaire.

Results: Forty-nine of the 84 women seen at the mid-term follow-up returned for a long-term visit, with a mean follow-up period of 20.3 ± 6.5 months. A significant (p < 0.001) objective improvement in POP correction was seen (for Ba, C and Bp) at the long-term visit. A significant (p < 0.001) overall decrease in median postvoid residual volume was achieved (preoperative: 90 ml, mid-term: 10 ml, long-term: 15 ml). Furthermore, the maximal flow rate significantly (p = 0.003) increased and there was a decrease in voiding time (p = 0.048), with no significant difference found between mid- and long-term assessments. Similarly, subjective parameters improved significantly, concerning prolonged urine stream, sensation of incomplete bladder emptying and straining to void (all p values < 0.001). In the same way, a significant improvement was observed in subjective reports regarding overactive bladder symptoms and POP complaints (all p values < 0.001), with no change between mid- and long-term analysis, while no change was noted in dyspareunia over time.

Conclusions: Laparoscopic SCP performed for symptomatic POP provides durable anatomical correction and is associated with significant mid- and long-term improvements in both objective voiding function and patient-reported symptoms.

Background: Gastroesophageal reflux disease (GERD) is common during pregnancy. In India, its management varies and is often based on Western guidelines, which may not reflect local dietary patterns, drug availability, or diagnostic constraints. To address this gap, an expert panel of Indian gastroenterologists and gynaecologists aimed to develop consensus recommendations tailored for Indian practice.

Methods: Modified Delphi consensus method was followed. Steering committee with three gastroenterologists was formed. This committee reviewed available literature and identified 65 relevant articles, based on which 9 pilot consensus statements were formed. An expert panel comprising 9 gastroenterologists and 6 gynaecologists located pan-India was formed. Pre-reads were circulated a month in advance, and 15 experts discussed evidence and pilot statements during the consensus meeting. Based on the discussion, modified statements were shared with the experts through a Google form for voting using a 5-point Likert scale. Consensus was defined as ≥80% agreement. Results were analysed by the steering committee, followed by a virtual meeting to finalise statements. The manuscript was drafted and circulated for final approval.

Results: Six consensus statements were finalised, with 100% agreement. (1a) Symptoms of gastroesophageal reflux are common during pregnancy. (1b) Gastroesophageal reflux is associated with poor health-related quality of life in pregnancy. (2) Diagnosis of gastroesophageal reflux during pregnancy should be based on symptoms. (3) Endoscopy must be postponed to the post-partum period, except in the presence of alarm symptoms. (4) Lifestyle changes are recommended as the first step in management. (5) Alginates/antacids should be preferred as the first-line pharmacological treatment after lifestyle changes. (6) Histamine-2 receptor antagonists or proton pump inhibitors are effective and may be used if symptoms are not controlled by alginates/antacids alone.

Conclusion: These consensus statements provide practical guidance for diagnosing and managing GERD in pregnancy, emphasising symptom-based diagnosis, lifestyle interventions, and judicious pharmacological therapy.

The COVID-19 pandemic was declared in March 2020 and London maternity units were among the first in the United Kingdom to report maternal infection and vertical transmission. To manage resources, over half of all Obstetrics and Gynaecology trainees were redeployed to support front-line specialities such as Core Medicine and Accident and Emergency. The vignettes in this article illustrate how three trainees maximised their limited training opportunities in the face of exceptional disruption, lack of surgical training opportunities and workload pressures.

Background: This study aimed to investigate the potential role of ferroptosis/hypoxia-related genes in cervical cancer to improve early management and treatment of cervical cancer.

Methods: All data were downloaded from public databases. Ferroptosis/hypoxia-related genes associated with cervical cancer prognosis were selected to construct a risk score model. The relationship between risk score and clinical features, immune microenvironment and prognosis were analysed.

Results: Risk score model was constructed based on eight signature genes. Drug prediction analysis showed that bevacizumab and cisplatin were related to vascular endothelial growth factor A. Risk score, as an independent prognostic factor of cervical cancer, had a good survival prediction effect. The two groups differed significantly in degree of immune cell infiltration, gene expression, tumour mutation burden and somatic variation.

Conclusions: We developed a novel prognostic gene signature combining ferroptosis/hypoxia-related genes, which provides new ideas for individual treatment of cervical cancer.