Minerva obstetrics and gynecology最新文献

Background: The Italian Medically Assisted Reproduction (MAR) Register (ItMARR) was established by the Decree of the Minister of Health issued on October 7^th, 2005. ItMARR has a crucial role in clearly and publicly disseminating epidemiological information on the MAR activities and outcomes.

Methods: ItMARR data is collected in aggregate form and is mandatory as set out in Law 40/2004. The aim of this article is to make a snapshot of the authorized centers that perform IUI and ART in Italy. Data used in this article refer to MAR treatments started between January 1^st and December 31^st, 2020.

Results: MAR techniques were performed by 332 centers. In total, 67,927 ART cycles and 12,171 IUI cycles were performed in 2020. Gametes donation cycles represent 12.9% of ART activity and 4.0% of IUI. ART cycles performed per million women of childbearing age was 6525. In 2020, 2.5% of births in the general population in Italy were a result of application of ART techniques. MAR activity in 2020, has been heavily reduced by the limitations to reproductive treatment due to SARS-CoV-2 pandemic. Pregnancy rates per transfers were 26.7% with fresh techniques, 32.6% with FER, 25.7% with FO, 38.0% with OD and 39.1% with SD. There were fewer multiple deliveries than the previous year.

Conclusions: The ItMARR, has become a great asset in the reproductive health scenario promoting a better MAR information dissemination. ItMARR is working on the implementation towards a "cycle-by-cycle" data collection system. This will bring the Italian monitoring system in line with others European countries.

Introduction: The current guidelines regarding chronic hypertension during pregnancy recommend induction of labor at term. The only previous meta-analysis on this topic found two randomized controlled trials but failed to pool together their results. We aimed to find the best literature-based evidence regarding delivery timing in chronic hypertension during pregnancy.

Evidence acquisition: We searched the following electronic databases: MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, and the Cochrane Central Register of Controlled Trials, Google Scholar. We selected randomized controlled trials comparing expectant management versus immediate delivery. The search was performed by two authors and the conflicts resolved in meetings. Data collection and analysis: we collected maternal and neonatal outcomes in a metanalysis following the random-effects model.

Evidence synthesis: Two studies were found. The summary effect measure was 1.1 (C.I. 0.51-2.1) regarding the maternal outcomes, 2.6 (C.I. 0.91-7.44) regarding the neonatal outcomes, and 1.5 (C.I. 0.8-2.79) combined. There was no statistically significant difference between maternal and neonatal outcomes (P=0.2).

Conclusions: The results of our meta-analysis pointed towards a non-difference between immediate delivery and expectant management, in women with chronic hypertension.

Background: In assisted reproductive cycles (ART), the fine balance of controlling corpus luteum function is severely disrupted. To challenge this iatrogenic deficiency, clinicians aim to provide exogenous support. Several reviews have investigated progesterone route of administration, dosage and timing.

Methods: A survey about luteal phase support (LPS) after ovarian stimulation was conducted among doctors in charge in Italian II-III level ART centers.

Results: With regards to the general approach to LPS, 87.9% doctors declare to diversify the approach; the reasons for diversifying (69.7%) were based on the type of cycle. For all the most important administration routes (vaginal, intramuscular, subcutaneous) it appears that in frozen cycles there is a shift towards higher dosages. The 90.9% of the centers use vaginal progesterone, and when a combined approach is required, in 72.7% of cases vaginal administration is combined with injective route of administration. When Italian doctors were asked about the beginning and duration of LPS, 96% of the centers start the day of the pickup or the day after, while 80% of the centers continue LPS until week 8-12. The rate of participation of the centers confirms the low perceived importance of LPS among Italian ART centers, while may be considered quite surprising the relatively higher percentage of centers that measures P level. Tailorization to women's needs is the new objective of LPS: self-administration, good tolerability are the main aspects for Italian centers.

Conclusions: In conclusion, results of Italian survey are consistent to results of main international surveys about LPS.

The aim of this paper was to study the top-cited per year (CPY) original articles published in the leading subspecialty journals in gynecologic oncology and in the leading general obstetrics and gynecology journals. We used the Web of Science and iCite databases to mine the original articles and review articles in the field of gynecologic oncology in the following journals: Gynecologic Oncology, The International Journal of Gynecological Cancer, The American Journal of Obstetrics and Gynecology and the Obstetrics & Gynecology. Top CPY articles from the four journals were analyzed and compared in a two-time point analysis. A total of 23,252 original articles and reviews were identified. The 100 Top-CPY articles were published from 1983 to 2021. Seventy (70%) in Gynecologic Oncology journal, 20 (20%) in The International Journal of Gynecological Cancer, eight (8%) in Obstetrics & Gynecology and two (2%) in The American Journal of Obstetrics and Gynecology. The most common study methodology was observational studies (20%), followed by guidelines/consensus papers (19%). The most common study topic was ovarian cancer (41%). North America originating authors composed 62% of the top CPY publications, followed by Europe (21%). The most common country of authorship was the United States (52%) followed by Canada (10%). CPY were similar in the publications before vs. after 2014 (P=.19). Study designs, study topics and continent of authorship were similar in both periods. The proportion of multi-center studies was higher after 2014 (66.6% vs. 28.8%, P=0.002) and the proportion of open access publications was higher after 2014 (66.6% vs. 15.4%, P<.001). Funded studies were more common after 2014 (75.0% vs. 53.8%, P=0.028). Ovarian cancer is the top CPY area of research in gynecologic oncology. This field is leaded by authors from the United States with multi-center studies proportion increasing in recent years. It is important to promote further high-quality research in other countries to disseminate knowledge and equality.

Background: Pelvic exenteration (PE) is an extensive surgery that is indicated in cases of recurrent advanced gynecological cancer with curative and sometimes palliative intent. The procedure is associated with both high morbidity and mortality and as such is considered a highly specialist procedure. The aim of the study was to analyze surgical outcomes in women who underwent PE for advanced gynecological malignancy in a tertiary cancer referral center over 11 years.

Methods: This is an observational retrospective single-center study. There were 17 patients included who underwent PE in Hull Royal Infirmary Hospital (Hull, UK) between 2010 and 2021. The main outcome measures were the perioperative complications, overall survival (OS), and recurrence free survival (RFS). Cumulative survival rates were reported at 1, 3 and 5 years. Univariate Cox regression analysis was undertaken to analyze factors that are prognostic for OS and RFS. Hazard Ratios (HR) with 95% confidence intervals (95% CI) were computed from the results of the Cox regression analyses. Kaplan-Meier survival curves were generated to visually display estimates of OS and RFS over the follow-up period.

Results: The median age at the time of surgery was 63.0 (IQR: 48.0-71.0). All patients received surgery with curative intent and complete tumor resection (R0) was achieved in 94.1% of cases. An overall 5-year survival was achieved in 63.7% of patients. Mean overall survival (OS) was 8.4 years (95% CI: 7.78-9.02). The RFS was 5.0 years (95% CI: 4.13-5.87). Both OS and RFS were significantly negatively affected by the hospital stay (P=0.020 and P=0.035, respectively), but not by the type of surgery (P=0.263 and P=0.826, respectively).

Conclusions: The results of the study demonstrated stable and comparable outcomes in patients undergoing pelvic exenteration.

Introduction: Canadian gynecological oncology (GYNONC) is constantly evolving. We aim to study the patterns in Canadian GYNONC research using a systematic search approach and bibliometric analysis.

Evidence acquisition: We used Web of Science to identify all relevant publications in the field of GYNONC by Canadian. We analyzed bibliometric data obtained from the iCite database. Publications were evaluated for specific characteristics including the province of all co-authors. We compared bibliometric metrics among provinces.

Evidence synthesis: Overall, 1511 publications, published in 138 different journals during 1973-2022 were analyzed. Of those, 23.5% (N.=355) were of interprovincial origin. Interprovincial publications were constantly increasing, now reaching 34.1%. Publications of interprovincial setting had higher RCR, CPY, FCR and NIH percentile scores when compared to any single province (P=0.009, P>0.001, P<0.001, and P<0.001, respectively). The proportion of publications in high impact factor journals were higher in the interprovincial setting: 35 (9.9%) vs. 48 (4.2%), P<0.001. Excluding the interprovincial publications there were 1156 publications. Half of the publications were authored by authors from Ontario (N.=587, 50.6%), 278 (24.1%) by authors from Quebec, and 161 (14.0%) by authors from British Columbia. The mean FCR was higher in British Columbia as compared to Ontario, Quebec and Manitoba (6.0±2.1 vs. 5.3±2.1, 5.3±1.5, and 4.1±3.0 respectively; P=0.006, P=0.034, and 0.037, respectively). Only Ontario, Quebec, British Columbia and Alberta had publications in high impact factor journals, with similar rate (P=0.806).

Conclusions: Interprovincial publications have the highest citation metrics in all domains. This underscores the importance of collaboration for the purpose of impactful research.

Background: Alongside health consequences, cesarean delivery (CD) has been associated with increased healthcare resource utilization (HCRU). A CD should be performed in case of placenta previa; in turn, the most appropriate mode of birth in women with a low-lying placenta (LLP) is still controversial. Since no previous data are available on the topic, the aim of this study was to evaluate the HCRU and economic impact on the Italian HC system of vaginal birth (VB) and CD in women with a LLP.

Methods: This retrospective study used patient-level real-world data of a cohort of women with a LLP confirmed at 28-30 weeks. A cost-minimization analysis (CMA) was conducted to compare VB and CD. Since Diagnosis-Related-Group payment may not reflect the actual use of hospital resources, a micro-costing analysis (MCA) was performed to more comprehensively evaluate the economic impact of VB and CD.

Results: The study included 86 women with a LLP at the third trimester scan, of which 49 (57%) had a VB and 37 (43%) underwent a CD. The CMA showed an economically marginal difference between VB and CD, especially when considering opportunity costs associated with the resources needed to look after women. However, the MCA identified charges for each VB being about half of those for each CD.

Conclusions: The use of patient-level real-world data allowed to generate basic information to assess the value of available interventions in case of LLP. A VB should be promoted in women with LLP, avoiding further burden on the HC system's limited resources.

Background: We investigated the potential association between Marfan Syndrome (MFS) and adverse obstetric outcomes using the National Inpatient Sample (NIS) database.

Methods: We utilized the International Classification of Diseases (ICD-10) system to identify relevant codes and extracted data from the NIS database covering the period 2016-2019. Descriptive statistics and χ² tests were employed to summarize and compare baseline characteristics. Univariate and multivariate regression analyses (adjusted for age, race, hospital region, smoking status, and alcohol misuse) were conducted to evaluate association between MFS and adverse obstetric outcomes. The regression analyses were summarized as Odds Ratios (OR) with 95% confidence intervals (CI).

Results: Among the 2,854,149 pregnant individuals, 179 had MFS. Baseline characteristics revealed significant associations between MFS and age, race, and hospital location. Univariate analysis showed MFS individuals had significantly increased risks of amniotic fluid/membrane abnormalities (AFAs, OR=1.64, 95% CI: 1.01-2.68, P=0.045) and postpartum hemorrhage (PPH, OR=3.73, 95% CI: 2.41-5.78, P<0.001). Several obstetric outcomes showed some trends towards increased (multiple gestation, placenta previa, and preterm labor) and decreased (premature rupture of membrane, gestational diabetes, and preeclampsia) obstetric risks with MFS; however, they were not statistically significant. Multivariate analysis showed MFS was significantly associated with increased risks of AFAs (adjusted OR=1.68, 95% CI: 1.03-2.74, P=0.037) and PPH (adjusted OR=3.62, 95% CI: 2.31-5.68, P<0.001).

Conclusions: MFS is associated with increased risks of adverse obstetric outcomes, specifically AFAs and PPH. These results highlight the importance of monitoring these specific pregnancy outcomes in MFS individuals to ensure optimal maternal-fetal health.

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: Indomethacin is administered as a tocolytic agent for threatening preterm labor <28weeks of gestation. Only a few, not conclusive, studies have investigated its nephrotoxicity in very low birth weight (VLBW) infants. We investigated whether indomethacin increases the incidence of acute kidney injury (AKI) among VLBW infants.

Methods: This is a retrospective study including all VLBW infants born at our center between January 1, 2005, and December 31, 2013. Indomethacin was administered to women with preterm labor and intact membranes. Neonatal AKI was defined according to KDIGO classification. Univariate analyses were performed comparing VLBW infants exposed to and not exposed to indomethacin. In the multivariable model, the association of indomethacin and AKI was adjusted for patent ductus arteriosus, use of nephrotoxic medications, birth weight, and gestational age.

Results: Five hundred seventy-five VLBW infants were included, 49 (8.5%) of whom were exposed to indomethacin in utero. The univariate analysis showed that infants exposed to indomethacin had lower birth weight, lower gestational age, and higher incidence of AKI than infants not exposed. The multivariable model adjusted for confounding factors confirmed an increased risk of AKI in relation to gestational age at birth <27 weeks, but not to indomethacin.

Conclusions: Our data suggest that extreme prematurity, but not the use of indomethacin, is associated with AKI.