Journal of Obstetrics and Gynaecology最新文献

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.

Foetal growth restriction (FGR) is associated with neonatal morbidity, suboptimal neurodevelopmental outcomes and chronic diseases. Successful pregnancies of women with recurrent mid-trimester pregnancy losses may still be at risk of FGR and small for gestational age (SGA) outcomes. This study aimed to investigate whether patients with recurrent mid-trimester pregnancy losses who undergo transabdominal cerclage (TAC) are at an increased risk of FGR. Due to a paucity of information in this regard, and to inform accurate counselling, we performed a secondary analysis of a unique set of patients with a TAC procedure. Foetal growth restriction (<3rd centile) was present in 8% of cases, with more female than male babies falling in this category (9.2 vs. 7.4%). When combined, FGR plus SGA were present in 19.4% of cases. This rate is not higher than the expected population rate of around 20% in low- and middle-income countries.

Background: Gestational diabetes mellitus (GDM) can negatively impact newborn cardiac health, particularly causing myocardial hypertrophy. This study examined the relationship between umbilical cord blood levels of angiopoietin-like protein 7 (ANGPTL7) in term neonates born to mothers with GDM and myocardial development, assessing its potential as an early predictive marker.

Methods: The study involved 46 newborns exposed to GDM and 46 healthy controls. Measure the interventricular septum (IVS) thickness through cardiac ultrasound and evaluate the level of ANGPTL7 in umbilical cord blood using the ELISA method.

Results: The incidence of myocardial hypertrophy in the GDM group was 19.6%, significantly higher than 0% in the control group, and increased to 27.3% in neonates of mothers with GDM and poor glycaemic control. ANGPTL7 levels in the GDM group were significantly elevated compared to the control group (1.87 vs. 1.11 ng/mL). Furthermore, these levels were positively correlated with IVS thickness. In the poorly-controlled GDM subgroup (GDM-A), neonates had significantly higher ANGPTL7 levels and IVS/LVPW ratio (1.19 vs. 1.03), indicating more severe myocardial abnormalities.

Conclusion: ANGPTL7 may contribute to myocardial hypertrophy in GDM neonates by promoting insulin resistance. Monitoring ANGPTL7 levels in umbilical cord blood could help identify high-risk neonates and guide optimal glycaemic management during pregnancy. Although the sample size was small, the study offers new evidence of ANGPTL7's clinical utility. Future research should expand the sample size and investigate the molecular mechanisms of ANGPTL7 to develop personalised interventions.

Trial registration: This study was not registered prospectively.

Background: Hysterectomy is a significant component of gender-affirming treatment for transgender individuals. The choice of surgical technique and associated complications have been studied, but very few studies have used a standardised classification system to grade surgical complications. This study aimed to describe our hospital's experience on gender-affirming hysterectomies with regards to patient demographics, surgical techniques, and postoperative complications using a validated classification system.

Methods: The study is a prospective follow-up case-series study of 72 consecutive patients undergoing gender-affirming hysterectomy at Karolinska University Hospital between 2016 and 2023. Patient demographics (age and mean body mass index), tobacco and alcohol habits, medical history and comorbidities, route of hysterectomy, complications and 30-days postoperative outcomes were reported. Surgical complications were graded according to the Clavien-Dindo classification system.

Results: The study population, with an average age of 27.6 years, presented diverse medical conditions, with psychiatric diagnoses being the most prevalent. The most common procedure was total laparoscopic hysterectomy, with low intraoperative blood loss. Surgical complications were rare, and primarily required minimal interventions. The 30-day Clavien-Dindo postoperative complication rate of grade II or higher was 19%, although only 4% experienced complications necessitating re-surgery (grade III or higher). Postoperative follow-up emerged as a critical aspect, with 22% of patients seeking non-elective medical attention within the first month, often due to vaginal bleeding or abdominal pain.

Conclusions: Our findings support the safety and feasibility of gender-affirming hysterectomies, particularly when performed laparoscopically, with very few severe complications observed using a validated scoring system. Extensive follow-up care, as well as addressing common postoperative concerns, is essential. Despite a relatively small sample size and lack of a control group, this study provides valuable insights into transgender healthcare from a previously unstudied region. Future research should preferably include larger cohorts, multicentre and registry-based studies.

Background: This study aimed to investigate the potential causal association between chronic hepatitis B (CHB) infection and the risk of pre-eclampsia/eclampsia using a Mendelian randomisation (MR) design.

Methods: We conducted a two-sample MR analysis using genome-wide association study (GWAS) summary statistics from three large-scale datasets. For CHB infection, we used data from 351,885 individuals UK Biobank. For pre‑eclampsia/eclampsia, we analysed two FinnGen datasets with sample sizes of 118,291 and 126,760 individuals, respectively. Genetic variants strongly associated with CHB infection (p < 5 × 10^-8) were selected as instrumental variables. The inverse-variance weighted (IVW) method was employed as the primary analysis. Sensitivity analyses included MR-Egger regression, weighted median, weighted mode and MR-PRESSO. Cochran's Q test and MR-Egger intercept tests were performed to assess heterogeneity and horizontal pleiotropy, respectively.

Results: MR analysis revealed significant positive genetic associations between CHB infection and increased risk of pre-eclampsia (OR = 1.154, 95%CI = 1.014-1.313, p = .029) and eclampsia (OR = 1.561, 95%CI = 1.030-2.366, p = .035). Findings were robust across sensitivity analyses for both outcomes.

Conclusions: Our study provides genetic evidence that CHB infection increases the risk of both pre-eclampsia and eclampsia. These findings suggest that considering CHB status as a risk factor and implementing targeted HBV screening programmes may be beneficial for pregnant women.

Bisphenol A and di-(2-ethylhexyl) phthalate are among the most widespread endocrine-disrupting chemicals (EDCs), widely present in consumer products and the environment. Preclinical studies have shown that these compounds and their metabolites may interfere with key reproductive processes, including folliculogenesis and steroidogenesis. However, translating these findings into clinical relevance remains challenging. Human studies have yielded conflicting results, with some suggesting associations between EDC levels and reduced ovarian reserve or poorer in vitro fertilisation outcomes, while others report no significant correlations. Differences in study design, population characteristics and exposure assessment contribute to this heterogeneity. Despite the current limitations, the topic warrants attention within reproductive medicine, particularly from a preventive perspective. While evidence remains inconclusive, raising awareness and considering lifestyle factors potentially linked to environmental exposures may be a reasonable step in clinical practice. Further studies are needed to clarify their clinical impact and to guide evidence-based reproductive care.

Background: Although most cases of endometrial cancer (EC) are diagnosed at an early stage with favourable outcomes, the prognosis for advanced or recurrent disease remains poor, highlighting the need for novel therapeutic targets. This study aimed to examine the correlation between Cyclin B1 (CCNB1) and Cyclin B2 (CCNB2) expression and disease severity in EC through bioinformatics analysis.

Methods: Common differentially expressed genes were identified in two EC cohorts from the Gene Expression Omnibus. A protein-protein interaction (PPI) network was constructed to identify hub genes. Aberrant expression of the hub genes was validated in external datasets. Their prognostic values were evaluated in a cohort from The Cancer Genome Atlas (TCGA). Knockdown of the hub genes was conducted to explore their functions in the malignant behaviour of EC cells in vitro.

Results: CCNB1 and CCNB2 were identified as the top 2 hub genes in the PPI network. High CCNB1/CCNB2 expression was significantly associated with shorter survival in EC patients. Overexpression of CCNB1/CCNB2 in endometrial tumour tissue was validated in public datasets. In TCGA cohort, high expression of CCNB1/CCNB2 correlated with greater disease severity and predicted poor prognosis. In addition, high expression of CCNB1/CCNB2 was strongly associated with immune cell infiltration, as well as increased expression of immune checkpoint genes and mismatch repair genes. Furthermore, knockdown of CCNB1/CCNB2 significantly suppressed the proliferation, migration, and invasion of HEC-1 and Ishikawa cells in vitro.

Conclusions: CCNB1 and CCNB2 may serve as potential prognostic markers and therapeutic targets for the management of EC.

Background: The use of cervical length (CL) to predict spontaneous preterm birth (sPTB) is limited in performance due to the low prevalence of a short cervix in the Thai population. Therefore, this study aims to evaluate the diagnostic performance of the uterocervical angle (UCA) in comparison with CL, and the integration of these parameters alongside cervical wedging to predict sPTB.

Methods: This prospective cohort study was designed to assess the diagnostic performance of UCA, CL, and cervical wedging for sPTB in singleton pregnancies, between gestational ages of 16 and 24 weeks, using transvaginal ultrasonography. The primary outcome was the diagnostic performance of the UCA, along with the integration of UCA with other parameters in women who delivered before 37 and 34 weeks.

Results: A total of 261 participants were included in the analysis. The optimal cut-off value for predicting sPTB before 37 weeks was 85 degrees for UCA, with a sensitivity of 44.8%, specificity of 46.6%, and a diagnostic odds ratio (DOR) of 0.71. For predicting sPTB before 34 weeks, the optimal cut-off for UCA was found to be 95 degrees, with a sensitivity of 71.4%, specificity of 59.8%, and a DOR of 3.73. The integration of UCA with CL or cervical wedging did not yield superior results compared to CL alone. The area under the receiver operating characteristic curve showed that UCA over 85 degrees was not as effective as CL under 33 mm for predicting sPTB before 37 weeks (0.54 vs. 0.51, respectively). However, CL under 30 mm was better than UCA over 95 degrees at predicting sPTB before 34 weeks (0.71 vs. 0.66, respectively).

Conclusion: A wider UCA is associated with an increased risk of sPTB. However, while UCA alone does not have as high diagnostic performance as CL or cervical wedging alone in predicting sPTB.