Minerva obstetrics and gynecology最新文献

Background: To describe a novel laparoscopic technique, prophylactic ureteral suturing (PUS), developed to reinforce structurally weakened ureteral segments following extensive ureterolysis for deep endometriosis, to avoid segmental resection or reimplantation.

Methods: In selected patients with deep ureteral endometriosis, circumferential periureteral fibrosis was dissected after cystoscopic insertion of a double-J ureteral stent. Laparoscopic ureterolysis restored ureteral mobility and revealed a mucosa-only segment, considered at high risk of postoperative stricture or rupture, resulting from complete loss of the muscularis layer. The muscularis layers proximal and distal to the mucosal tract were then gently mobilized and reapproximated using interrupted absorbable 3-0 polyglactin sutures, avoiding mucosal penetration. This suture-based reconstruction restored circumferential wall support while maintaining luminal patency.

Results: An observational study was conducted on a cohort of 6 patients using the novel technique. No intraoperative or postoperative complications were observed. Renal function was preserved in all cases. Among three patients with preoperative hydronephrosis and elevated creatinine, imaging confirmed resolution of obstruction and normalization of renal parameters at follow-up.

Conclusions: Prophylactic ureteral suturing may represent a safe and effective conservative alternative to reconstructive procedures in cases of ureteral muscularis loss during ureterolysis. The approach is technically straightforward, preserves ureteral continuity and the native antireflux mechanism, and can be integrated into standard laparoscopic treatment of urinary tract endometriosis. Further studies are warranted to confirm its long-term safety and broader applicability.

Introduction: Persistent inequities in unintended pregnancy among adolescents across the globe combined with their increased use of technology warrants an increased understanding of technology-based pregnancy prevention interventions designed specifically for this population. The objective of this systematic review was to identify "standalone" (i.e., able to be implemented without facilitation by people) technology-based interventions designed to support pregnancy prevention among adolescents and young adults.

Evidence acquisition: We included peer-reviewed articles available on the PubMed database that were published between 2010-2025 if they evaluated a standalone technology-based adolescent pregnancy prevention intervention. Articles went through a title and abstract review and subsequently a full-text review. Intervention characteristics and reported impacts were extracted and summarized from included articles.

Evidence synthesis: From 247 articles identified, 16 articles representing 13 interventions were included. Among the interventions, three were text message-based, four were web-based, and six were smartphone applications. Most of the interventions were developed in the USA for female adolescents and young adults. Five interventions used randomized control trials and demonstrated improvements in behaviors that can reduce the risk of unintended pregnancies.

Conclusions: Several technology-based interventions have been shown to improve adolescent pregnancy prevention behaviors; however, more attention to intervention implementation efforts, mechanisms of action that lead to behavior change, and the impact youth engagement has on the development and implementation has on outcomes is needed. In addition, greater investments and attention to pregnancy prevention efforts that target youth from different cultural backgrounds, countries and contexts are also needed to reach those who have less access to information and care. Future research and practice should also address how engaging males, gender-expansive and sexual minorities in pregnancy prevention efforts can contribute to improved outcomes. There is also a need to standardize behavioral measures to facilitate meta-analysis.

Background: Chronic hypertensive disorders in pregnancy are associated with adverse maternal and perinatal outcomes. Hemodynamic-guided management has been proposed to optimize antihypertensive therapy. This study evaluates outcomes before and after the introduction of the USCOM^® device-a non-invasive hemodynamic monitor-into clinical practice for tailoring antihypertensive treatment.

Methods: A retrospective, monocentric descriptive study was conducted at the AOU Policlinic of Modena. USCOM^® was implemented in March 2022. The control group included 22 pregnant individuals with chronic hypertensive disorder (HD) from 2021, while the USCOM group included 46 individuals from 2023 who received USCOM^® hemodynamic monitoring to tailor antihypertensive therapy. Patients with missing delivery data or gestational hypertension were excluded. Maternal and neonatal outcomes were collected retrospectively from electronic medical records and analyzed using SPSS v.28. Continuous variables were presented as means with standard deviations, and categorical variables as counts and percentages.

Results: No significant differences in maternal characteristics were observed between groups. The USCOM group showed a significantly lower incidence of low-birthweight (<2500 g) newborns (6.5% vs. 36.4%; P=0.004) and longer gestational age (38.9 vs. 37.4 weeks; P=0.049). Although not statistically significant, trends indicated fewer extremely preterm births (<34 weeks; P=0.096) and lower Neonatal Intensive Care Unit (NICU) admissions (P=0.096). Multivariate analysis confirmed USCOM^® evaluation as the only significant factor reducing the risk of low birth weight (adjusted odds ratio [aOR] 0.118, P=0.004), adjusted for parity, ethnicity, and prepregnancy Body Mass Index (BMI).

Conclusions: While larger studies are needed to confirm these findings, the implementation of USCOM^® in routine clinical practice may contribute to improved neonatal outcomes in pregnancies complicated by chronic hypertensive disorders.

Introduction: Advanced endometriosis (Stage III/IV) represents a particularly severe variant of endometriosis with more pronounced symptomatology and challenging surgical treatment. This review shall examine the role of robotic surgery, the latest breakthrough in surgical technology, in addressing this challenging condition.

Evidence acquisition: A systematic search of the literature in peer-reviewed databases was performed, focusing mainly on surgical outcomes. Meta-analysis was performed on comparative studies. Studies included in the meta-analysis were also subjected to risk of bias assessment and sensitivity analysis.

Evidence synthesis: From the initial study pool, ultimately 36 studies were included, which indicated that robotic surgery was safe and feasible, with satisfactory surgical outcomes. Long-term quality of life and fertility outcomes were also positive, particularly for endometriosis-related pain, gastrointestinal symptoms and infertility, with 25-100% pregnancy rate after surgery. Comparative data versus laparoscopy, indicated no statistically significant differences between the two approaches with regard to blood loss, hospitalization or complications (including transfusion, conversion to open surgery, re-hospitalization and re-operation), although operative time was significantly longer for robotic surgery (WMD: 38.32, 95%CI: 24.14, 52.49, P<0.001). However, Robotic surgery was superior in addressing endometriosis-related pain and was less harmful on ovarian reserve according to two studies.

Conclusions: Robotic surgery for advanced endometriosis is a safe and viable approach. While current data reveal no differences in surgical outcomes compared to laparoscopy, the lack of randomized studies precludes definitive conclusions. Future research should focus on patient randomization and on identifying subgroups that would most benefit from the application of this novel technology.

Introduction: Labor progression is traditionally considered linear; however, recent evidence highlights natural variations, including pauses or plateaus in contraction intensity or cervical dilation. Recognizing these variations is crucial, as a lack of clear distinction between physiological and pathological plateaus often leads to unnecessary interventions with potential short- and long-term consequences. This scoping review aims to map and summarize the characteristics, differences and management strategies of physiological and pathological labor plateaus in low-risk women.

Evidence acquisition: This scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and its extension for scoping reviews (PRISMA-ScR). Eligibility criteria included studies on physiological term pregnancies detailing labor plateau characteristics or management strategies. We searched five databases (MEDLINE, CINAHL, Embase, Scopus, CENTRAL), relevant gray literature, and reference lists of included studies, without restrictions on time, geography, or setting. Two reviewers independently screened abstracts and full-text articles for inclusion. Data were synthesized narratively and summarized in tables.

Evidence synthesis: We included 35 studies. Definitions of labor plateaus varied widely. Factors contributing to labor plateaus were categorized into modifiable and non-modifiable factors. Management strategies ranged from non-invasive approaches such as emotional support and hydration to invasive interventions like amniotomy and oxytocin administration.

Conclusions: Current literature does not clearly distinguish between physiological and pathological labor plateaus. Standardized definitions and management protocols are needed to improve clinical outcomes. Recognizing the potential for physiological progression during plateaus may help balance timely interventions with the benefits of supporting natural labor processes.

Nerve-sparing gynecologic surgery has evolved as a critical advancement in the management of deeply infiltrating endometriosis, aiming to reduce postoperative dysfunction while preserving surgical efficacy. Historically, procedures such as radical hysterectomy and excision of deeply infiltrating endometriosis carried high risks of urinary, bowel, and sexual dysfunction due to inadvertent injury to pelvic autonomic nerves. Recent developments in pelvic neuroanatomy, enhanced laparoscopic visualization, and operative technique have enabled surgeons to identify and preserve key neural structures during dissection. This review traces the evolution of nerve-sparing surgery, from early radical oncologic techniques to contemporary minimally invasive approaches guided by functional anatomy. We highlight contributions from key innovators and describe standardized terminology for pelvic nerves, fasciae, and retroperitoneal spaces, which aim to improve surgical reproducibility. Surgical techniques including the laparoscopic neuronavigation technique, the Negrar Method, and hypogastric nerve-based dissection are presented in detail, emphasizing both neuroanatomical precision and practical application. The use of anatomical landmarks in settings without advanced equipment is also discussed. Special attention is given to bowel surgery in endometriosis, balancing radicality with preservation of pelvic nerve function. Collectively, these strategies underscore a shift toward personalized, anatomy-guided surgery that prioritizes both disease control and long-term quality of life. As interest in nerve-sparing approaches continues to grow, education, multidisciplinary collaboration, and ongoing refinement of surgical methods will be essential to broadening access and improving patient outcomes for patients with deeply infiltrating endometriosis.

Introduction: Identifying eligible studies is a foundational component of systematic reviews, requiring careful interpretation of complex inclusion and exclusion criteria. Given the rapid integration of large language models (LLMs) into evidence synthesis, their reliability in autonomously performing this task necessitates timely evaluation. This study intends to assess whether general-purpose LLMs can accurately perform the study identification phase of a published systematic review in obstetrics using only predefined eligibility criteria.

Evidence acquisition: Six publicly accessible LLMs were given a standardized prompt, without iterative refinement or human oversight, to identify eligible studies from a 2023 JAMA Network Open meta-analysis. Each model's output was compared with the 14 studies included in the reference review. Primary outcomes were precision, recall, F1 score, and hallucination severity.

Evidence synthesis: Claude 3.7 achieved the highest accuracy, correctly identifying 5 of 14 reference studies (precision 71.4%, recall 35.7%, F1 score of 0.48). In comparison, all other models exhibited substantially lower performance with minimal variation in F1 scores (ranging between 0.08-0.12), indicating a poor balance of precision and recall. Precision was generally inversely related to the number of false positives, and LLMs that returned more total studies tended to produce more hallucinations.

Conclusions: Current general-purpose LLMs are unreliable for autonomous study identification in clinically relevant systematic reviews and human oversight remains essential. The low F1 scores highlight major limitations in current LLMs' ability to accurately and comprehensively identify relevant studies. These findings underscore the need for fine-tuning and hybrid AI-human workflows before safe integration into evidence synthesis in obstetrics and gynecology.

Background: We evaluated the common histopathological characteristics of preeclampsia (PE) and fetal growth restriction (FGR), and demonstrated the major differences of the three groups of 1/ PE with FGR, 2/ PE without FGR and 3/ FGR without PE.

Methods: Placental slides were studied retrospectively. Predominantly FGR- and PE-associated lesions were identified. Gestational age at the time of delivery (GATD) and diagnosis-to-delivery time (DTDT) were also examined.

Results: Decidual arteriopathies, maternal hypertension and obesity were more common in PE, and villous capillarization was significantly lower in FGR. We found that only villous infarction and chorangiosis had a connection with GATD. Villous infarction and chorangiosis were associated with DTDT >80 days, while placental changes leading to decreased villous capillarization was associated with DTDT <30 days.

Conclusions: Despite several common histopathological characteristics, placental histopathological profile of PE with FGR, PE without FGR and FGR without PE have remarkable differences, indicating histological background of their distinguished prognosis. Inadequate vascular development and decidual vasculopathies are characteristic in PE, while the undercapillarization of placental villous tree and villitis of unknown etiology leading to placental damage are characteristic of FGR. The dynamic equilibrium of different entities determines global placental function, and manifestation of FGR and/or PE.

Background: Cytomegalovirus (CMV) is the leading cause of congenital infection in pregnancy and non-genetic infant hearing loss. Evidence showed that antenatal education about hygiene practices might decrease infection acquisition. We aimed to assess pregnant women's awareness of CMV infection and knowledge of preventive behaviors and to identify associated factors.

Methods: A prospective cross-sectional survey study was conducted at a single academic maternity center between May and November 2023. Data were gathered via a self-administered paper questionnaire from pregnant women aged 18 or older.

Results: Out of 384 participants, 65.4% were aware that CMV infection could pose risks during pregnancy. CMV awareness was significantly linked to university education (OR 7.18, 95% CI 2.79-18.44), preconceptional provision of information (OR 1.98, 95% CI 1.17-3.36), folic acid intake (OR 2.75; 95% CI 1.53-4.95, P=0.0007), and pregnancy vaccination uptake (OR 1.64; 95% CI 1.06-2.52, P=0.0249). Women starting folic acid when already pregnant and smoking during pregnancy, were 55% and 72% less aware of CMV, respectively (OR 0.45, 95% CI 0.23-0.86; OR 0.28, 95% CI 0.14-0.59). Only 28.1% of women had adequate CMV preventive behaviors knowledge, rising to just 33.1% among those aware of CMV and its risks in pregnancy. Mass-media use positively influenced awareness of CMV (OR 2.57, 95% CI 1.44-4.60).

Conclusions: Although we identified a moderately high rate of CMV infection awareness, appropriate knowledge of its specific preventive measures was low. Mass-media use to inform before conception and the adoption of effective communication methods early in pregnancy might represent feasible ameliorating interventions.

Endometriosis is a frequent chronic estrogen-dependent condition that can significantly impair fertility and reduce the quality of life in affected individuals. Women with endometriosis face a 30-50% risk of infertility. Multifactorial factors such as peritoneal inflammation, altered ovarian reserve, impaired tubal function and modified endometrial receptivity have been proposed to contribute to infertility. Endometriosis has been highlighted as a condition that may require a fertility preservation to safeguard reproductive potential. This review aims to provide a comprehensive update on fertility preservation for women with endometriosis. A comprehensive literature search was conducted using PubMed, focusing on peer-reviewed studies. Key words included "endometriosis," "fertility preservation," "oocytes," and "cryopreservation." Studies in English and French that delve into FP techniques, success factors, and risks were included. Several fertility preservation techniques are available, but oocyte cryopreservation following ovarian stimulation is the most common and effective option for women affected by endometriosis. Success rates depend on factors such as age and prior surgical history. Surgery for ovarian endometriomas may reduce ovarian reserve, underscoring the importance of considering fertility preservation before surgery. All of ovarian stimulation protocols can be used and may not increase the risk of disease progression or recurrence however the use of an antagonist protocol with GnRH agonist triggering could be particularly beneficial in this context, as it may help reduce pain and minimize the risk of ovarian hyperstimulation syndrome. The number of cryopreserved oocytes is directly correlated with pregnancy success. Multiple stimulation cycles can be performed to obtain a sufficient number of oocytes, increasing the chances of achieving a successful live birth in case of reuse. FP should be routinely discussed with women with endometriosis, particularly those who may undergo surgery, however, its implementation is not systematic and should be considered on a case-by-case basis. Further research is essential to tailor FP strategies for women with endometriosis optimizing both clinical outcomes and cost-effectiveness.