Journal of Obstetrics and Gynaecology最新文献

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.

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: 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.

Background: This study aimed to explore and evaluate the effectiveness of WeChat app-based health management in patients with gestational diabetes mellitus (GDM).

Methods: This study retrospectively analysed a cohort of 100 patients with GDM. Since the application we used went live in April 2023, we enrolled patients from April 2022 to June 2022 into the control group (n = 50) and patients from April 2023 to June 2023 into the observation group (n = 50) for contemporaneous comparisons. The control group received routine health management procedures, whereas the observation group received app-based health management. Fasting plasma glucose, 2-hour postprandial blood glucose, and haemoglobin A1c levels were compared between the two groups before and four and eight weeks after app management; the incidence of adverse pregnancy outcomes and weight gain before and after pregnancy was also compared between the two groups.

Results: Fasting plasma glucose and 2-hour postprandial blood glucose levels were lower in the observation group than in the control group four and eight weeks after intervention (p < 0.05). In addition, the incidence of adverse pregnancy outcomes and weight gain was lower in the observation group than in the control group (p < 0.05).

Conclusions: Implementing WeChat app-based health management can effectively improve blood glucose levels, reduce adverse pregnancy events in patients with GDM, and decrease weight gain during pregnancy.

Background: This study aimed to ascertain prognostic indicators impacting progression-free survival (PFS) and overall survival (OS) in patients diagnosed with vulvar cancer. The secondary aim was to determine a quantifiable measure of PFS and OS for these patients.

Methods: A comprehensive retrospective review was conducted of the medical records of vulvar cancer patients treated at Siriraj Hospital from 2006 to 2020. Patient characteristics, surgical outcomes, pathological features and immunohistochemical results for p16, p53 and PD-L1 were analysed for their potential as prognostic indicators for survival outcomes.

Results: In the sample of 104 vulvar cancer patients, four factors were significantly associated with a worsening PFS. They were coexisting vulvar lesions such as lichen sclerosus and extramammary Paget's disease (p = .008); lymphovascular space invasion (LVSI; p = .011); pelvic or paraaortic lymph node metastases (p = .042); and positive p53 status (p = .046). Additionally, a tumour size exceeding 4 cm in diameter was significantly linked with decreased OS (p = .001). The median PFS and OS were calculated as 26.3 and 44.7 months, respectively. Significantly improved PFS and OS were noted in patients with a positive p16 or a negative p53 immunohistochemical profile. The calculated hazard ratios for these two subsets were 3.032 (95% CI = 1.419-6.480; p = .004) and 2.421 (95% CI = 1.120-5.232; p = .025), respectively.

Conclusions: Factors leading to unfavourable PFS are coexisting vulvar lesions, positive LVSI status, pelvic or paraaortic lymph node metastases, and positive p53 status. Regarding OS, a tumour diameter exceeding 4 cm significantly correlates with poorer outcomes.

Background: Insufficient nutrition during pregnancy can lead to negative health outcomes for both mother and foetus. Maternal undernourishment (MUN) can be due to many factors like hyperemesis gravidarum or poor access to nutrition. Just as MUN can affect the mother and foetus, it can adversely affect the vital placental interface between the two. We suspect an observed increase in fetuin-B and oxidative stress in MUN placentas could be major players responsible for the placental insufficiency often seen with MUN.

Methods: To establish a model of MUN during pregnancy, a reduced protein chow was fed to pregnant dams at a caloric deficit. We examined the MUN placentas and the downstream effects of fetuin-B and oxidative stress at the whole organ and trophoblast levels. We examined fetuin-B's role in trophoblast pathology by measuring apoptosis, proliferation, TLR4 activation, expression of NF-ΚB p65, oxidative stress, and mitochondrial superoxide production. The effects of MUN and fetuin-B on mitochondrial superoxide production, antioxidant levels, metabolism, and electron transport chain complex activity were compared directly. Pharmaceutical interventions were utilised to narrow down specific pathways involved.

Results: Studies indicated that MUN and oxidative stress upregulated fetuin-B in the placenta. This relationship displayed a positive feedback loop as fetuin-B, in turn, promoted oxidative stress through activation of TLR4. Consequently, MUN, fetuin-B, and oxidative stress promoted apoptosis and reduced proliferative expansion of trophoblast, thereby reducing their quantity. MUN and fetuin-B reduced mitochondrial metabolism and function, promoting mitochondrial dysregulation and superoxide generation in MUN trophoblasts.

Conclusions: Our study sheds light on the mechanisms responsible for MUN-induced placental insufficiency while identifying therapeutic agents as possible add-on interventions.

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.