Minerva obstetrics and gynecology最新文献

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.

Introduction: Female fertility is influenced by a complex interplay of lifestyle factors. They may include weight, diet, supplementation, physical activity, sleep and substance use. Understanding these factors, in combination with a thorough understanding of strategies to support effective behavior change is essential to develop effective lifestyle interventions for women who wish to enhance their fertility. This review aimed to summarize the evidence on female fertility and lifestyle, and to discuss intervention considerations which may affect implementation of the evidence.

Evidence acquisition: Electronic databases (PubMed, Google Scholar) were searched to identify relevant peer-reviewed studies and evidence-based guidelines.

Evidence synthesis: The following lifestyle factors are associated with improved female fertility: maintaining a healthy weight, following a healthy dietary pattern (e.g. Mediterranean diet) with appropriate supplementation, participating in regular physical activity, attaining 7-8.5 hours of high-quality nocturnal sleep and avoiding or limiting substance use (caffeine, alcohol and smoking). Considering the factors affecting lifestyle management in both consumers (e.g. emotional eating and financial barriers) and health professionals (e.g. time constraints and concerns about patient expectations of care) is essential to optimize success of lifestyle interventions to improve fertility.

Conclusions: Lifestyle management has an important role in improving reproductive health and overall health for women who wish to conceive. A patient-centered approach which incorporates behavioral science, individual preferences, and healthcare delivery considerations is essential. There is a need for further research to inform optimal intervention components and behavior change strategies for this population.

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.

Introduction: Artificial intelligence (AI) is revolutionizing healthcare by enhancing diagnostics, optimizing treatment plans, and improving patient outcomes through data analysis and predictive modeling. Within the field of reproductive endocrinology and infertility, machine learning algorithms trained on large datasets can analyze images, laboratory results, and genetic information to optimize in vitro fertilization outcomes.

Evidence acquisition: A comprehensive search of the electronic databases PubMeD and MEDLINE was conducted, and search results were narrowed to publications after the year 2020 yielding 54 publications included in this review; select seminal publications from before the year 2020 were also included.

Evidence synthesis: This review summarizes the most recent evidence demonstrating the design, implementation, and validation of AI in assisted reproductive technologies. The summarized findings are categorized by application of AI to the embryology laboratory and to clinical workflows as well as highlighting ethical concerns regarding the use of such tools.

Conclusions: AI-powered tools have been deployed in fertility clinics and embryology laboratories to enhance gamete selection and as drivers of quality improvement. Despite the promise of AI, challenges such as data bias, ethical concerns, and regulatory hurdles persist. As AI continues to evolve, its integration into reproductive medicine holds the potential to improve success rates and expand the accessibility of infertility treatments.

Background: Given associations between abnormal maternal serum analytes and small for gestational age, 3^rd trimester fetal growth ultrasounds are commonly obtained despite lack of evidence. We evaluated associations between isolated abnormal analytes, 3^rd trimester fetal growth restriction, and neonatal complications.

Methods: This retrospective, single institution cohort study included women with analytes from 2010-2019. Multiple gestation, delivery <28 weeks gestation, and those with another indication for a 3^rd trimester US were excluded. Fetal growth restriction prevalence at the first 3^rd trimester US with abnormal analytes was calculated, as well as its association with small for gestational age. Associations between abnormal analytes and neonatal outcomes (small for gestational age, intensive care, umbilical artery pH <7.0, 5-minute APGAR <7, preterm delivery, neonatal death) were also evaluated.

Results: Among 11,092 pregnancies, 1136 had isolated abnormal analytes, of which 613 had 3^rd trimester ultrasounds. Of these, 10 (1.6%) had growth restriction at the first 3^rd trimester ultrasound, and 99 (16.1%) were small for gestation. Abnormal analytes were associated with increased small for gestational age, intensive care admit, and preterm delivery. Only 9.1% of small for gestational age neonates had growth restriction at the first 3^rd trimester ultrasound.

Conclusions: Third trimester fetal growth restriction is uncommon with isolated abnormal analytes, and early 3^rd trimester ultrasound for this indication may commonly miss small for gestational age. These findings contribute to 1) evidence-based fetal surveillance in this setting, and 2) knowledge regarding potential implications on growth restriction detection by replacing serum analyte screening with cell free fetal DNA.

Introduction: Assisted reproductive technologies (ART) aim to address the underlying causes of infertility, resulting in a healthy live birth. One aspect that appears receiving less attention yet is equally crucial as any other steps in the ART process, is embryo transfer (ET). Even with optimal embryos, a successful live birth cannot be achieved without a precise and atraumatic transfer to the correct location within the uterine cavity. Compared to other advancements in laboratory and clinic, relatively few innovations have occurred in ET.

Evidence acquisition: This literature review aimed to summarize the latest evidence in four main sections: requirements and preparations for ET, the ET procedure, complications, training and competence.

Evidence synthesis: The review emphasizes the need for appropriate equipment, including soft-tip catheters and high-resolution ultrasound machines, to minimize trauma and enhance ET precision. Additionally, rigorous quality control in the laboratory is essential for achieving optimal clinical outcomes. Despite the technical simplicity of ET, complications such as cervical trauma, retained embryos, and rare expulsion from the cervix highlight the need for further research and improvement in this critical step of the process. Finally, the necessity for well-trained practitioners and embryologists, with competence regularly evaluated through performance indicators, is crucial.

Conclusions: Further research is needed to standardize ET techniques and improve ART outcomes, suggesting that each step of ET may significantly influence the procedure's success. Attention to detail and adherence to key factors are critical to optimizing the transfer of an embryo to the uterus, leading to higher pregnancy rates and better patient outcomes.

Background: The association of cervical ripening balloons (CRB) and misoprostol for induction of labor (IoL) is frequently used, although there is poor evidence about the optimal timing and protocol for their combination. The aim of this study was to compare a concurrent and a sequential scheme for administration of oral misoprostol in association with CRB, in terms of mode and timing of delivery and rate of adverse events.

Methods: This was an observational study comparing two consecutive cohorts of women with unfavorable cervix undergoing IoL by means of double-balloon CRB combined with oral misoprostol, with either a sequential scheme (retrospective cohort, N.=36) or a concurrent administration (prospective cohort, N.=30). The primary outcome was the rate of vaginal delivery (VD); secondary outcomes included the interval of time to labor and delivery and the incidence of maternal or perinatal complications.

Results: The concurrent administration of misoprostol combined with CRB resulted in a similar rate of VD compared to the sequential scheme (63.9% vs. 76.7%, P=0.29). Both time to active labor (32.7±10.9 vs. 21.8±9.6 hours, P=0.001) and to vaginal delivery (34.0±12.6 vs. 25.3±10.2 hours, P=0.016) were shorter for concurrent misoprostol administration, resulting in a higher rate of VD within 24 hours (13.9% vs. 43.3%, P=0.01). The rate of maternal and perinatal adverse outcomes did not differ significantly between the two groups.

Conclusions: Concurrent use of CRB and oral misoprostol might be preferable due to similar results in terms of mode of delivery, achieved in a shorter time with no increase in complications; further studies on larger populations will be needed to verify potential differences in CS rates and rare adverse events.