Minerva obstetrics and gynecology最新文献

Background: The most common cause of hyperandrogenism in women is polycystic ovary syndrome (PCOS), the prevalence of which among women of reproductive age ranges from 8.0 to 21%. The clinical manifestations of PCOS are diverse, and the degree of metabolic and hormonal disorders depends on the PCOS phenotype. The non-classic congenital adrenal hyperplasia (NCCAH) ranks second in the structure of diseases associated with hyperandrogenism. PCOS and NCCAH have a similar clinical picture and laboratory parameters, which requires differential diagnosis.

Methods: Urinary steroid profiles were studied by gas chromatography-mass spectrometry.

Results: We revealed differences in glucocorticoid and androgen metabolism in women with different PCOS phenotypes, which is reflected in the clinical manifestation of the disease. It was evaluated the activity of enzymes involved in the metabolism of steroid hormones. In patients with NCCAH, it was found that polycystic ovarian changes are secondary and develop due to the presence of prolonged adrenal hyperandrogenism.

Conclusions: The results obtained are important for understanding the mechanisms of disorders in various variants of hyperandrogenism and determining further tactics for managing patients.

Background: Previous studies suggest surgical quality outcomes are similar between rural and urban hospitals, but data about gynecology in rural hospitals is sparse.

Methods: This was a retrospective cohort study utilizing the National Inpatient Sample database from the Agency of Healthcare Research and Quality. Patients who underwent benign hysterectomy for non-prolapse indications between 2012-2016 were identified using ICD-9 and 10 codes. Patients were stratified into rural or urban non-teaching groups; urban teaching hospitals were the referent group. The primary outcome was the rate of patient safety indicator (PSI) events. PSI events were identified using ICD-9 and 10 codes. Statistical analysis was performed using analysis of variance and uni- and multivariate Poisson regressions.

Results: 154,810 patients met all inclusion criteria. The cumulative rate of PSI events was 11.9% at rural hospitals, 13.9% at urban non-teaching hospitals and 16.9% at urban teaching hospitals, P<0.001. The most common PSI events were postoperative metabolic derangement, hemorrhage, and accidental puncture. The rate of transfusion was highest in urban teaching hospitals (6.7%) and similar for rural (5.1%) and urban non-teaching hospitals (5.5%), P<0.001. The rate of genitourinary tract injury was between 1.4-1.6%, and similar across sites, P=0.89. After adjusting for confounders, the risk of PSI events was similar across locations. The risk of transfusion was lower at rural hospitals (aRR=0.84, 95% CI: 0.74-0.94).

Conclusions: Hysterectomy performed at rural hospitals, typically thought of as having low surgical volume compared to urban hospitals, is associated with similar risk of PSI events and lower risk of transfusion.

Background: The aim of this study was to determine factors involved in urinary incontinence (UI), and psychological resilience in postmenopausal women.

Methods: In this cross-sectional study, 137 postmenopausal women (aged 50-75 years) filled out the 4-item International Consultation on Incontinence Questionnaire short form (ICIQ-SF), the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), the 10-item Connor-Davidson Resilience Scale (CD-RISC), and a questionnaire containing personal data. We designed a directed acyclic graph (DAG) to identify covariates related to urinary incontinence and resilience in postmenopausal women.

Results: The mean age of all surveyed women was 58.7±5.1 years, the majority were Caucasian (92.7%). There was an inverse correlation between item-1 ICIQ-SF scores and CD-RISC Scores. Women with severe UI had a higher median total ICIQ-SF score and lower total CD-RISC Scores as compared to those with nil or mild (P<0.05 for both). Odds ratios of sociodemographic and clinical characteristics indicate that phytoestrogen use (OR: 10.80; 95% CI 2.42-48.13) and economic problems (OR: 2.46; 95% CI 1.22-4.93) were associated with UI. However, a multivariable logistic model only identified urinary incontinence significantly associated with phytoestrogen use and age (P<0.05). The effect of other variables was attenuated in the model when controlling for population confounders, and significance was not achieved.

Conclusions: Urinary incontinence was significantly associated with economic problems, phytoestrogen use, and depressive symptoms compared to women without urinary complaints. The multivariable logistic model confirmed age and phytoestrogen use as causal factors for urinary incontinence.

Introduction: Dysgerminoma is a histologic subtype of malignant ovarian germ cell tumor (MOGCT). Most publications describing dysgerminoma are of small cohorts. Large cohorts usually describe MOGCT as a group, and therefore, drawing specific conclusions regarding dysgerminomas is challenging. In this study, we sought to highlight and review the most recently published data on dysgerminoma.

Evidence acquisition: We performed an electronic search in PubMed, using a range of medical subject heading terms (MeSH), including English language articles only, published earliest in 2010. Papers including "germ cell tumors," and "dysgerminoma" were included. We excluded reviews, meta-analyses, and case reports. We followed the PRISMA guidelines to prepare this review. All included articles were reviewed by two reviewers (LF, GL).

Evidence synthesis: We found that dysgerminomas mostly present in an early stage of the disease and therefore harbor a favorable prognosis. Most dysgerminomas occur in women of reproductive age, in which fertility-sparing treatment is safe. While complete staging surgery for all patients is debatable, adjuvant chemotherapy seems to be beneficial. Long-term follow-up by a gynecologic oncologist is necessary as recurrence may occur.

Conclusions: Since most studies are small and retrospective, the development of multicenter prospective studies protocols is of utmost importance to study future lines of therapy.

Background: Induction of labor in women with unfavorable cervix can be started with cervical ripening by dinoprostone vaginal insert. In cases of unsuccessful response, management is unclear: a possible option is a repeated induction with prostaglandins. The aim of this study was to assess the results of a second induction by either dinoprostone or misoprostol, comparing those treatments.

Methods: A retrospective analysis was carried out on a cohort of 109 women with unsuccesful response to a first attempt of induction with dinoprostone vaginal insert, who required a second stimulation by either dinoprostone vaginal gel (56 patients) or oral misoprostol (53 patients). The outcomes assessed where the rates of active labor and vaginal delivery, and secondarily maternal and perinatal adverse events.

Results: Overall 70.6% of patients reached active labor and 62.4% had a vaginal delivery; the efficacy of the double induction was similar for dinoprostone vaginal gel and oral misoprostol, with active labor in 69.6% and 71.7% (P=0.83), and vaginal delivery in 62.5% and 62.3% of patients (P=0.99) respectively. The incidence of adverse events was low, with no perinatal complications and similar rates of maternal complications, notably major post-partum hemorrhage in 1.8% and 3.8% of patients (P=0.61) for dinoprostone and misoprostol respectively.

Conclusions: Dinoprostone vaginal gel and oral misoprostol as a second cycle of induction appear to be both effective in achieving active labor and vaginal delivery after failure of dinoprostone vaginal insert, without a significant rate of adverse events.

Background: The aim of this study was to determine the effect of caffeine on fetal heart rate (FHR) as determined by computerized cardiotocography (cCTG) parameters.

Methods: Term pregnancies that performed a fetal antepartum cCTG were included. Two physicians recorded coffee habits before the cCTG, and pregnant women were divided into two groups: the coffee group and the control group. Furthermore, cCTG' parameters were compared between the two groups.

Results: One hundred thirty-four pregnant women were enrolled. Based on maternal coffee habits, 82 pregnant women were allocated to the coffee group, while 52 were in the control group. The two groups shared similar demographic and obstetric characteristics. The mean daily coffee intake was 1.4±0.6 cups. Coffee group fetuses evidenced a lower FHR baseline, 135±9.9 bpm, versus the control group, 138±8.0 bpm, (P value = 0.03). Other cCTG parameters did not show statistical differences. Multivariate analysis demonstrated no confounding factors. A subanalysis that evaluated the daily amount of coffee consumed or the half-life of caffeine found no difference in cCTG measures.

Conclusions: Maternal caffeine consumption did not influence fetal cardiac reactivity after absorption.

Background: The objectives of this study are to evaluate the cycle outcomes from IVF treatment preceded by oral contraceptive pills (OCP) priming compared to estradiol pretreatment and to determine if there is a role for OCP priming for those undergoing frozen embryo transfers.

Methods: The study took place at a university-affiliated fertility center in Canada. The study included in-vitro fertilization (IVF) antagonist cycles from Jan 2016 to Jun 2019. Those with protocol deviation or treatment cancellation were excluded.

Results: There were 2237 cycles by 1958 patients; 27% of cycles utilized OCP priming. The average age in the OCP group was 34 years old compared to 36.5 in the estradiol group (P<0.01). AMH was reported in 43% of patients and was 3.7ng/mL in the OCP group versus 2.2 ng/mL in the estradiol group (P<0.01). The number of oocytes (15.2 vs. 12.5) and number of blastocysts (4.6 vs. 3.3) were higher in the OCP group (P all <0.01). After adjusting for age and AMH with linear regression for the 978 cycles with recorded AMH (24% with OCP prime), a significantly higher number of oocytes (13.8 vs. 11.9, P=0.002) was still noted in the OCP group. There were 866 euploid embryo transfer cycles (28% with OCP prime). There were no significant differences in implantation (77% vs. 76%) or ongoing pregnancy rates (56% vs. 54%) between those who had a frozen embryo transfer after OCP primed compared to estradiol primed stimulation cycles (P all >0.6).

Conclusions: There were no differences in pregnancy outcomes from euploid frozen blastocyst transfers after OCP primed antagonist cycles compared to estradiol pretreatment. In fact, the use of OCP pretreatment was associated with increased oocyte yield, keeping in mind demographic differences with the OCP pretreatment group being younger with higher anti-Müllerian hormone and a higher prevalence of PCOS. Thus, OCP priming should still be considered in specific populations, such as those with oligo-ovulation or adequate ovarian reserve.

Female genital mutilation/cutting (FGM/C or FGM) are injuries to the female genital organs for non-medical reasons. Every year, over 4 million girls are at risk of FGM. Complications of this practice are very common and some of them are still under investigation. The purpose of this short narrative review is to highlight and summarize the main ones. Psychologic and psychiatric sequelae, chronic vulvar pain, urogenital symptoms, pelvic organs prolapse, sexual disfunction, cervical dysplasia and infections resulted as chronic sequalae of FGM. Severe pain, excessive bleeding, and tissues swelling are acute consequences of FGM. Rates of caesarean section, time of second stage of delivery, post-partum blood loss (but not major hemorrhage), peri-clitoral and perineal injuries and episiotomy rates are higher in pregnant women with FGM, when compared with those non victims of mutilation. The female genital mutilation practice is often cause of severe urogynecologic, psychologic and obstetrics sequelae. Although several studies have been carried out on FMG complications and treatments, long term sequelae are still very common and deserve major attention and further research.