Obstetrics and Gynecology International最新文献

Introduction: There is a lack of studies on lipid levels in Vietnamese pregnant women. Our study aimed to describe serum lipid levels of healthy Vietnamese women in the third trimester and identify factors influencing these levels.

Method: A cross-sectional study on 1022 healthy females with singleton pregnancy intended to deliver at Bach Mai Hospital recruited from April 2023 to June 2024. Measure fasting serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides at 28-40 weeks of gestation by enzymatic colorimetric assays. Assess factors associated with maternal lipid levels by multivariable linear regression.

Results: Median (95% reference range) of TC, LDL-C, HDL-C, and triglycerides were 6.48 (4.39-8.88), 3.33 (1.59-5.52), 1.81 (1.25-2.53), 2.90 (1.65-6.06) mmol/L, respectively. Complicated pregnancy (n = 377) had higher triglycerides and lower cholesterol levels than the uncomplicated pregnancy (n = 645). Factors associated with TC were prepregnancy BMI and gestational age. For LDL-C: prepregnancy BMI, gestational age, and gestational diabetes mellitus (GDM). For HDL-C: prepregnancy BMI and GDM. For TG: prepregnancy BMI, gestational age, GDM, a history of hypertensive disorder in pregnancy, and a history of macrosomia.

Conclusion: We presented 95% reference range for the third trimester serum lipid levels in healthy Vietnamese women. Obstetric complications were associated with decreased LDL-C and HDL-C and increased TG, along with gestational age and prepregnancy BMI.

Introduction: Uterine fibroids are the most common anatomical cause of heavy menstrual bleeding. To which extent clinical practice variation is present in the treatment of fibroid-related heavy menstrual bleeding at the hospital level remains unclear. The aim of this study was to identify and evaluate the clinical practice variation in the treatment of fibroid-related heavy menstrual bleeding.

Material and methods: In this multicenter, retrospective database study, pseudonymized real-world data were collected from electronic health records using a natural language processing and text-mining data collection tool. Women ≤ 55 years, who presented as new patients at the gynecology outpatient clinic in 2019 with heavy menstrual bleeding and fibroids, were selected. Data were extracted from the first appointment in 2019 throughout December 2022. The primary outcome was the number of treatments initiated. Secondary outcomes were the type of treatments initiated, treatments initiated prior to hysterectomy, and time to hysterectomy.

Results: From four hospitals, 623 women were included. The median age was 46 (range: 23-55) years. Overall, a median of one treatment (range: 1-4) was initiated, which significantly differed between hospitals (p < 0.01). Pharmacological treatment was initiated most frequently, which differed significantly among hospitals (392/623 [62.9%], range: 49.1%-70.5%, p = 0.02). Minimally invasive therapies were initiated in 51.2% (319/623, range: 40.6%-58.9%, p < 0.01). Only 30/319 patients (9.4%) received a minimally invasive uterus-sparing treatment. Hysterectomy was performed in 123/319 patients (38.6%), with Hospital 1 being an outlier as 52.3% underwent hysterectomy, compared to 23.9%-36.4% in the other hospitals (p < 0.01).

Conclusions: Clinical practice variation is present in the treatment of heavy menstrual bleeding in Dutch women with fibroids. Organizational factors could partially explain clinical practice variation. Sharing data can aid in identifying, explaining, and acting on (un)warranted practice variation between healthcare clinics. While clinical practice variation remains inevitable, unwarranted practice variation should be limited by ameliorating guideline adherence, educational interventions, and patient counseling, to improve the quality, efficiency, and equity of care.

Background: Suboptimal sperm quality often poses a challenge to successful fertilization. This study hypothesizes that secretome could enhance sperm quality and increase the likelihood of successful pregnancy. This research aims to assess the impact of secretome on various sperm quality parameters, including concentration, motility, and DNA fragmentation, while considering patient-related factors such as age, duration of abstinence, and body mass index (BMI).

Method: An analysis involving 45 patients enrolled in the pregnancy program at Halim Fertility Center, Stella Maris Women's and Children's Hospital, Indonesia, from April to September 2023 was conducted. Semen samples from these patients were subjected to the swim-up method and divided into two groups: Group A, which underwent swim-up without secretome, and Group B, which underwent swim-up with the addition of secretome. DNA fragmentation analysis was performed on the sperm swim-up results from both groups. The sperm analysis data obtained before swim-up (pretreatment) with those of Group A and Group B were compared.

Result: The demographic data revealed an average age of 37.67 ± 5.36 years, abstinence duration of 4.00 ± 1.15 days, and BMI of 28.20 ± 3.49 kg/m² among the patients. No significant difference was observed in sperm concentration between pretreatment, Group A, and Group B (mil/mL) (36.2 ± 18.5; 36.3 ± 18.4; 36.6 ± 19.3). However, a significant difference was found in the rapid progressive motility of sperm across pretreatment, Group A, and Group B (%) (0.48 ± 1.32; 13.7 ± 8.3; 17 ± 8.3), as well as a significant reduction in DNA fragmentation in Group B compared to Group A (%) (3.48 vs. 4.39).

Conclusions: The findings suggest that secretome enhances rapid progressive motility and reduces DNA fragmentation rates without affecting sperm concentration.

Introduction: Hydrodissection (HD) is used in surgical blunt dissection covering its two types. The first one is volumetric with application of neutral fluids to obtain exclusive separation of tissue planes. The second one is hybrid with additional effect by addition of some pharmaceutics like vasoconstrictors to neutral fluid. In most reports dealing with ovarian endometrioma stripping, the hybrid HD is used.

Aim of the work: To assess application of volumetric HD in endometrioma stripping in respect to intraoperative and postoperative data including reproductive outcome.

Materials and methods: The prospective observational study was conducted in a group of 53 women qualified for laparoscopic enucleation of endometrial cysts. The patients were operated with two methods according to surgeon choice. First method was the enucleation proceeded by volumetric HD, and in the other one, classic stripping was performed. The patients operated with these methods constituted two groups accordingly. All the patients were asked to fulfill the questionnaires dealing with their reproductive data.

Results: Volumetric HD was not found to reduce surgery time, to diminish the frequency of ovarian stitching, and to reduce postoperative pain. Decrease in the AMH was lower in Group I, but it did not reach statistical significance (p = 0.19). Evacuation of intact endometrial cyst and removal of reduced resected tissue through endobag were more frequent in Group 1 (69.2% vs. 22.2%, p = 0.0006; 46.2% vs. 7.4% p = 0.0039, respectively). Very important fact was absence of mature ovarian cortex in all samples coming from Group 1. We did not observe the differences between the groups in reproductive outcome. Spontaneous conceiving was 63.1% in Group 1 vs. 63.6% in Group 2, and in-time deliveries were 47.3% in Group 1 vs. 50.0% in Group 2.

Conclusions: There are some positive postoperative changes after application of volumetric HD in endometrioma stripping, but it did not cause better reproduction outcome.

Endometriosis is a complex, estrogen-dependent disease with limited effective treatments that often focus on symptom management rather than addressing the underlying pathology. Current therapies, such as progestins and GnRH agonists, have significant side effects (weight gain, mood changes, decreased bone mineral density, and menopausal symptoms) and fail to prevent disease recurrence or address fertility concerns. The current study is the first to demonstrate the therapeutic potential of combined treatment with dydrogesterone (a progestin) and letrozole (an aromatase inhibitor) in a preclinical mouse model of endometriosis. Our results revealed that the dydrogesterone-letrozole combination reduced the volume of endometriotic lesions, suppressed cell proliferation, and decreased inflammation relative to the disease control, with trends suggesting greater effects than those observed with individual agents or standard treatments such as dienogest and leuprolide. The dydrogesterone-letrozole combination also exhibited a reduction in fibrosis, indicating a potential role in managing chronic endometriosis and associated symptoms such as pelvic pain and adhesions. These findings suggest that the dydrogesterone-letrozole combination may offer a broader therapeutic approach for endometriosis. Based on existing literature, dydrogesterone is thought to counteract estrogen-driven endometrial proliferation through progesterone receptor activation, while letrozole is believed to reduce estrogen biosynthesis by inhibiting aromatase, which may collectively influence lesion growth and inflammatory processes. Additional long-term studies are warranted to thoroughly assess the safety profile, clinical effectiveness, and overall therapeutic relevance of the dydrogesterone-letrozole combination for the treatment of endometriosis.

Background: Nonepithelial ovarian cancers (NEOCs) comprise a group of uncommon malignancies which can be challenging to treat. This broad term includes germ cell tumors, sex cord-stromal tumors, and rare types of ovarian cancer, such as small-cell carcinomas and sarcomas. It is imperative that these rare tumors are managed with accurate diagnosis, staging, and treatment in order to optimize patient outcomes. The aim of this study was to describe the prevalence, pathology, and therapeutic interventions for NEOC in a Sub-Saharan African setting.

Methods: This is a 5-year retrospective review of NEOC cases managed at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia, from September 2016 to September 2020. Data on NEOCs including clinical presentation, pathology, therapeutic interventions, staging status, type of surgery, histological subtype, and current disease status were extracted from patients' records. Data were collected using a structured data extraction format. Data were analyzed using Stata release 15 (College Station, TX: StataCorp LLC).

Results: The prevalence of NEOC was 17.3% (80 out of 264 cases of ovarian cancer). Among the types of NEOC, sex cord-stromal tumors were most common (46.2%) followed by germ cell tumors (43.8%). Of the germ cell tumors, yolk-sac tumor was the common histologic subtype, representing 15% of all NEOC cases. Sixty-five percent of cases were managed with staging surgery while 27% underwent fertility sparing surgery. There was no statistically significant association between patients' age and type of tumor (p = 0.08).

Conclusion: In this study, the prevalence of NEOC was 17.3%, which is higher than in other previous reports in the literature. Yolk-sac tumor was the most common histologic subtype among germ cell tumors.

Introduction/background: The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is a new prognostic biomarker combining CRP, serum albumin, and lymphocyte count that can be associated with the survival of cancer patients by assessing immune, nutritional, and inflammatory status as an important immune indicator. The association of CALLY index as a marker predicting survival of cancer patients with cervical cancer (CC) remains unclear. This study aimed to evaluate the prognostic value of the CALLY index with overall survival (OS) and recurrence-free survival (RFS) in patients with early-stage CC after radical hysterectomy.

Methodology: In this multicenter retrospective cohort study, we examined the medical profile of 806 women with early-stage CC who underwent Type II/III radical hysterectomy and bilateral pelvic lymphadenectomy at three centers affiliated to our center between 2012 and 2022. The CALLY index was calculated before treatment. OS and RFS were the primary endpoints. Kaplan-Meier and Cox models assessed the association between CALLY index and outcomes, adjusting for age, histology, tumor size, FIGO stage, grade, extent of lymphadenectomy, and adjuvant therapy. A CALLY index cutoff of 3 maximized discrimination (AUC 0.822; 95% CI, 0.75-0.90).

Results: Five-year OS was higher with CALLY index ≥ 3 vs. < 3 (82.1% vs. 71.2%; log rank p = 0.009), as was 5-year RFS (76.4% vs. 64.2%; p = 0.001). Multivariate analysis showed that CALLY index ≥ 3 was independently associated with improved OS (HR 0.87; 95% CI, 0.78-0.96; p = 0.001) and RFS (HR 0.86; 95% CI, 0.78-0.95; p = 0.001). In addition, age ≥ 45 years, nonsquamous histology, tumor size ≥ 3 cm, FIGO stage > IB, grade > G2, and LNR > 40% were significantly associated with poorer OS and RFS, whereas receiving adjuvant therapy was associated with a better prognosis.

Conclusions: Pretreatment CALLY index is an independent, readily obtainable prognostic biomarker for OS and RFS after radical hysterectomy in early-stage CC. This index can be useful as a predictor of the prognosis for patients with CC.

Objective: This study aimed to determine the relationship between isometric exercise test, roll-over test, levels of PAPP-A and β-hCG, and NLO in the early diagnosis of preeclampsia.

Materials and method: The 580 pregnant women filled out the personal information forms and performed the roll-over test and isometric exercise test.

Results: The roll-over test and isometric exercise test used in the diagnosis of preeclampsia had high levels of sensitivity and specificity and negative predictive values.

Conclusion: Thus, roll-over test and isometric exercise test, pregnancy-associated plasma protein A levels, and neutrophil-lymphocyte ratio are useful parameters for the early diagnosis of preeclampsia.

Background: The cGAS-STING pathway has established itself as a critical innate immune pathway that has the ability to significantly affect tumor initiation and progression. The expression, methylation, immunological functions, and prognostic importance of cGAS-STING pathway-related genes in cervical squamous cancer (CESC) patients have not yet been thoroughly elucidated.

Methods: First, we explored the expression of cGAS and STING in cervical carcinoma samples from TCGA by comparing the mRNA and protein levels of cGAS and STING in both TCGA cervical tumor patient samples and cervical tumor cell lines. Second, we examined the CD4⁺T and CD8⁺T cell infiltration in STING high and low samples and made Kaplan-Meier prognosis analysis of STING protein expression. Third, to verify the findings in TCGA public datasets, we retrospectively selected 40 cervical squamous carcinoma patients and 10 normal cervical tissues and evaluated cGAS and STING protein expression using immunohistochemistry (IHC). All patients have detailed clinical information, which includes age, FIGO stage, menstruation status, follow-up time, histology, tumor diameter, and serum tumor markers.

Results: In both cervical tumor patient samples and cell lines, we observed that cGAS is increased, whereas STING is decreased in tumors, which leads to decreased CD4⁺T and CD8⁺T cell infiltration and poor prognosis. Furthermore, the cGAS mRNA transcript showed a gradual increase and STING mRNA showed a decrease according to the tumor stage, tumor grade, metastasis status, and histology types. We confirmed the expression of cGAS and STING proteins in clinical cervical tumor samples using IHC. Mechanically, cGAS and STING showed different DNA methylation patterns, which might contribute to the differences in cGAS and STING mRNA and protein levels.

Conclusions: Our work identified different expressions and methylation patterns of cGAS and STING in cervical cancer and their correlation with immune T cell infiltration and prognosis. More mechanistic study is needed to understand the cGAS-STING pathway in cervical squamous tumor.

Objective: To clarify the characteristics of patients with cerebral palsy (CP) showing decreased fetal movement (DFM).

Methods: Among patients with CP between January 2009 and February 2021, we collected cases of DFM from the causal analysis report. We retrieved the clinical course and the causes of CP.

Results: Of 2834 cases of CP, 225 (8%) patients were included in this study. Some form of hypoxia was the most common cause (117 cases, 52%) followed by placental abruption (45 cases, 20%) and fetomaternal hemorrhage (FMH) (32 cases, 14%). The duration from DFM to delivery was longer in cases of FMH than in placental abruption (p < 0.001). The duration less than 6 h was only observed in one (4%) case of FMH, whereas it was observed in 32 (73%) cases of placental abruption. In contrast, the cases with durations of more than 24 h accounted for 36% (10/28) in FMH cases. Next, we focused on hypoxia cases. Marginal or velamentous insertion accounted for 21% (22/106) of the hypoxia cases. Umbilical artery pH and base excess were worse in cases of normal site insertion than those of marginal or velamentous insertion.

Conclusion: DFM was seen in 8% of patients with CP. FMH required more time from the DFMs to delivery than cases of placental abruption. Fetuses with a velamentous or marginal cord insertion may have a risk of CP.