Minerva obstetrics and gynecology最新文献

Introduction: Recurrent implantation failure (RIF) occurs when pregnancy is not achieved after multiple embryo transfers. The lack of standardized diagnostic criteria among clinicians makes RIF a particularly challenging condition, leading to the use of various procedures, including immunological ones, often without robust evidence. This study aims to provide an overview of the main characteristics of existing research on the role of interventions in relation to in vitro fertilization (IVF) outcomes in patients with RIF.

Evidence acquisition: A comprehensive bibliographic search was systematically conducted from inception to November 2024, focusing on studies that evaluated the impact of immunological treatments in RIF cases, comparing IVF outcomes between case and control groups.

Evidence synthesis: A total of 77 studies were included. The diagnostic criteria for RIF were heterogeneous, with only 36 studies (47%) defining RIF as three or more failed embryo transfers. Moreover, the studies generally had small sample sizes.

Conclusions: There is not yet sufficient evidence to support the routine use of immunological interventions in clinical practice for RIF. The existing research is marked by methodological inconsistencies, which limit the reliability and generalizability of the results.

Colposcopy has traditionally played a crucial role in the assessment and management of abnormal cervical cytology and human papillomavirus (HPV) -related lesions. However, with the reduction in high-risk (HR) HPV types due to vaccination, the role of colposcopy in the HPV vaccination era is being questioned. The aim of this narrative review was to highlight the latest evidence from the world of HPV vaccination and the future role of colposcopy in the HPV vaccination era. PubMed, MEDLINE, Scopus, Web of Science were searched for relevant articles up to June 2024. HPV vaccination may influence colposcopic practice by reducing HR-HPV vaccine type, colposcopy referrals, colposcopic positive predictive value for CIN 2+, and by changing referral patterns, colposcopic performance, and procedures. The relative incidence of HPV-negative adenocarcinoma and its precursors may be increasing, presenting a new challenge that may increase the difficulty of colposcopic assessment. The role of colposcopy in the management of cervical abnormalities will vary according to vaccination status, vaccine type and timing of vaccination. As this evolves, colposcopy will need to adapt to provide optimal care tailored to individual risk profiles and to maintain the key role in cervical cancer prevention that it has acquired over the past decades. There will certainly be a need to improve the quality and performance of colposcopy by reducing inter- and intra-observer variability in colposcopic practice, including more objective patient selection, greater knowledge, expertise and skill, with the aim of achieving reproducible, sensitive and less biased assessment of cervical appearance.

Introduction: The diminished ovarian reserve (DOR) relates to a condition in which the ovary experiences a decline in its typical reproductive capacity. Despite notable advancements in understanding the pathophysiology of reduced ovarian reserve in recent years, significant unresolved challenges remain, particularly concerning the optimal therapeutic approaches for this complex condition. The main aim of this study was to investigate the potential of platelet-rich plasma (PRP) in enhancing ovarian follicle numbers by assessing changes in ovarian reserve markers.

Evidence acquisition: A comprehensive literature search was conducted on the following databases: PubMed/MEDLINE, SCOPUS, The Cochrane Library, Science Direct and Web of Science. All the relevant studies published till October 2023 were screened. After removing duplicates, and full-text evaluation, 9 articles were eventually included in the present review.

Evidence synthesis: The pregnancy rate (PR) among patients with poor ovarian reserve (POR) ranged from 13% to 40%, indicating the potential effectiveness of PRP as a rejuvenating treatment. The live birth rate (LBR) ranged from 13% to 20%, comparable to or not lower than the LBR of a matched healthy population aged between 38 and 42 years. Furthermore, the data presented thus far support the notion that PRP may lead to an average clinical PR of 10% in women affected by premature ovarian insufficiency (POI) and perimenopause.

Conclusions: PRP can not be regarded as a gamete replacement therapy, but rather as an 'additional' therapeutic tool in the management of women with DOR or POR, as well as in peri-menopausal women. Additional qualitative studies are required to validate the existing evidence, as the literature currently lacks randomized controlled trials (RCTs) in this regard.

Endometriosis is a chronic gynecological condition which can lead to infertility in women during reproductive age. Endometriosis influences the assisted reproductive technology (ART) outcomes by its impact on oocyte and embryo quality, oocyte numbers and subsequently the embryo numbers and endometrial receptivity. There has been clinical dilemma as to whether it is predominantly the oocyte, or the endometrium which affects the pregnancy outcomes in women with endometriosis. In this review we provide an overview of the effect of endometriosis on the oocyte molecular mechanism, the overall effect of endometriosis and its various stages as well as the effect of endometrioma on the oocyte quality in autologous study models. We have also provided a review of the donor oocyte models to study the effect of endometriosis on the endometrium. While initial small donor oocyte-based model studies suggested a possible major detrimental impact of oocyte quality on ART outcomes in women with endometriosis, the more recent studies have found minimal or no impact of oocyte quality on treatment outcomes. There is growing evidence to suggest an important contributory role of reduced oocyte yield on ART success in women with endometriosis. There is a need to explore whether oocyte yield and not the oocyte quality or endometrial receptivity, is the main reason for lower success in women with endometriosis following ART.

Background: Antenatal universal screening for toxoplasmosis is recommended in most affluent countries worldwide. Despite evidence is not robust, detected cases are typically treated during pregnancy. Affected newborns are also treated to temper clinical consequences. However, this established mode of management warrants careful and continuous re-evaluation. The epidemiology of the infection is changing and there is the need to monitor the clinical scenario.

Methods: This is an observational retrospective study conducted at a referral hospital in Northern Italy. Every woman referred from January 2011 to December 2021 for suspected toxoplasmosis in pregnancy was eligible. All women were managed according to a local standardized protocol. Clinical and laboratory findings were obtained from patients' charts.

Results: Out of 347 women referred, 191 (55%) were discharged as false positive at initial assessment. We identified 141 women with suspected infection and 15 with confirmed infection. The number of women treated with antibiotics was 136 (96%) and 15 (100%), respectively. A total of 118 amniocenteses were performed, all of which were negative. There were two spontaneous miscarriages and five therapeutic terminations of pregnancy (of whom four were consequent to parental concerns related to the toxoplasmic infection), all among suspected cases. Vertical transmission occurred in a single case, a patient with confirmed infection diagnosed by seroconversion at 28 weeks' gestation. The course of this pregnancy was uneventful, and the infant is healthy at 7 years follow-up. Overall, the incidence of vertical transmission was 7% (95% CI: 1-30%) in confirmed cases and 0% (95% CI: 0-0.2%) in suspected cases.

Conclusions: The current policy of universal screening and prompt management of toxoplasmosis infection is efficient. However, undue invasive procedures and terminations of pregnancy could occur. Future studies are warranted to improve clinical management.

Background: The aim of this study was to analyze how antepartum pelvic floor muscle training (PFMT) plus perineal massage associated with postpartum PFMT have a significant impact on pelvic floor health during pregnancy and after delivery.

Methods: One thousand two hundred thirty-three women were enrolled from January 2019 to December 2021. They were divided into two groups: 786 women underwent postpartum PFMT only, 447 women experienced both prepartum perineal massage and PFMT and postpartum PFMT. The primary endpoint was to evaluate prepartum perineal massage and PFMT's impact on delivery. The second endpoint was the evaluation of Quality of Life and sexual function at 3- and 12-months follow-up after delivery.

Results: Women who underwent prepartum PFMT experienced significantly lower percentage of episiotomy, high-grade obstetric tear or instrumental delivery and higher percentage of intact perineum. Furthermore, prepartum PFMT appeared to improve sexual function at 3 months follow-up, and it was associated with an earlier first sexual intercourse after childbirth. The incidence of stress urinary incontinence was significantly higher in women who experienced PFMT only in postpartum, both at 3- and 12-months follow-up, while the other examined clinical parameters did not show a significant difference.

Conclusions: Prepartum PFMT has a role in preventing obstetric traumas and on improving Sexual Function and Quality of Live in the immediate postpartum. Moreover, prepartum PFMT in association with postpartum PFMT reduces the incidence of stress urinary incontinence in a higher percentage than postpartum PFMT only.

The corpus callosum (CC) is the most significant of the three cerebral commissures that join the human left and right hemispheres. Numerous vascular, chemical, genetic, and metabolic disturbances can impede the growth of the CC. Complete agenesis of the CC is the most prevalent abnormality. As a result of improvements in our knowledge and advancements in ultrasonography technology, an increasing number of congenital CC abnormalities have been identified. Prenatal magnetic resonance imaging is crucial to identify related central nervous system abnormalities. Counseling about the postnatal result is still difficult. This study sought to characterize the long-term consequences for children with isolated anomalies of CC detected during pregnancy, trying to provide the correct multidisciplinary approach to the pregnant woman also in terms of medical legal and ethical issues.

Background: This study aimed to compare the effectiveness of membrane sweeping and transcervical Foley catheters for the induction of labor after one previous cesarean delivery.

Methods: An open-label, prospective, randomized controlled trial was performed at Sibu Hospital, Sarawak, Malaysia between 15^th February 2018 and 30^th August 2018. Pregnant women aged 18 or above at term who had one previous uncomplicated lower segment cesarean section and required induction of labor were randomized to membrane sweeping or transcervical Foley catheter insertion.

Results: A total of 60 women were recruited in the study, of whom 30 were randomized to the membrane sweeping group and 30 to the Foley catheter group. The number of women who achieved a Bishop Score ≥8 was significantly higher in the Foley catheter arm than in the membrane sweeping arm (76.7% versus 43.3%; P=0.008). Compared with membrane sweeping, transcervical Foley catheter insertion significantly improved Bishop scores and allowed more women to achieve a favorable cervix that permitted an amniotomy by 48 hours of labor induction (P<0.05). The mode of delivery, intrapartum oxytocin use, maternal complications and neonatal outcomes were similar in both groups. No women had a uterine rupture or uterine hyperstimulation.

Conclusions: Although transcervical Foley catheter insertion is superior to membrane sweeping in terms of the efficacy of labor induction, both methods did not show a statistically significant difference in vaginal delivery rates and their overall complication rates were similar.