Obstetrics and Gynecology International最新文献

Background: Currently, the World Health Organization guidelines recommend universal utilization of optimally timed first obstetric ultrasound (defined as ultrasound before 24 weeks) in low-middle income countries. However, there is inadequate evidence on this topic from these countries. Our study aimed to determine the rate of utilization of optimally timed first obstetric ultrasound among pregnant women who gave birth at three public hospitals in Ethiopia.

Methods: This was a multicenter prospective cross-sectional study conducted on the utilization of optimally timed first obstetric ultrasound among pregnant women who delivered at public hospitals in Ethiopia in 2020. Data were collected prospectively using a structured questionnaire. Data were analyzed using SPSS Version 20. Simple descriptive statistics, chi-squared test, and multiple regression analysis were performed as appropriate. p value less than 0.05 and adjusted odds ratio (AOR) with 95% CI were used to present result significance.

Results: A total of 385 participants were included in this study. Approximately 67.5% of pregnant mothers had optimally timed 1^st ultrasound. Compared to those having antenatal care (ANC) at health centers, those who started their ANC at private clinic were 1.7 times (95 CI: 1.8-7.9) more likely to have optimally timed ANC. Those who had their 1^st ANC at private hospital were 3.2 times (95 CI: 1.8-7.9) more likely to have optimally timed 1^st prenatal care. Those who had their first ANC at private health institutions and government hospitals were much more likely to have optimally timed 1^st prenatal ultrasound with the following AOR for government hospital and private MCH centers: AOR = 7.4 (95 CI: 2.7-23) and AOR = 4.9 (95 CI: 2.8-14.1), respectively. Those who had previous major obstetric problem were 5.2 times (95 CI: 2.7-9.9) more likely to have optimally timed ultrasound than those without major previous obstetric problem.

Conclusion: We found that one-third of pregnant women did not utilize optimally timed first obstetric ultrasound, despite obstetric ultrasound services being accessible at public health institutions. Place of first ANC contact and presence of prior major obstetric complication were associated with utilization of optimally dated first obstetric ultrasound.

Background: Despite its availability, cervical cancer screening services continue to remain underutilized in many regions. This study aimed to assess the prevalence and determinants of cervical cancer screening uptake among women in the north-central area of Bangladesh.

Methods: In this cross-sectional study, between May and October 2022, women aged 30-60 years attending a tertiary care hospital in Gazipur district were approached for inclusion. Face-to-face interviews were conducted using a semistructured questionnaire. A total of 252 women were consecutively recruited within the study period. The self-reported screening practice was recorded and verified by matching with identification numbers provided for screening by the hospital, and reasons for nonutilization were also collected.

Results: Only 12 women (4.76%) had ever been screened for cervical cancer. Lower knowledge scores (OR: 0.26 and 95% CI: 0.08-0.95) were associated with higher odds of nonutilization of cervical cancer screening services on multivariable analysis. Despite high awareness of symptoms and risk factors, only 15.08% knew that screening prevents cancer. The main reasons for not getting screened were fear of pain (98.33%) and feeling shy (52.50%).

Conclusion: Awareness-increasing programs are recommended to improve the utilization of cervical cancer screening among women.

Aim: This study aimed to evaluate the adverse maternal and neonatal outcomes among pregnant women with COVID-19 at King Salman Armed Forces Hospital in Tabuk and examine the relationship between the severity of COVID-19 infection and these outcomes.

Methods: This retrospective cohort study enrolled COVID-19-positive pregnant women. Demographic and obstetric information, clinical characteristics (including symptoms and preexisting comorbid conditions), and maternal and neonatal outcomes were collected from medical records, reviewed, and analyzed.

Results: The study included 138 COVID-19-positive women, with the majority of cases diagnosed in the third trimester (85.5%). Assessment of the severity of COVID-19 infection showed that a large proportion were asymptomatic (39.1%) or had mild disease (39.9%), while 14.5% had moderate disease and 6.5% experienced severe illness. Adverse maternal and neonatal outcomes included preeclampsia (5.1%), gestational diabetes (4.3%), placental abruption, premature rupture of membranes (2.9% each), maternal intensive care unit (ICU) admission (1.4%), preterm births (12.3%), low birth weight (15.2%), and neonatal ICU admission (10.1%). Additionally, the incidences of preeclampsia and maternal ICU admission were significantly higher in women with severe COVID-19 compared to those with milder or asymptomatic cases (p = 0.004 each). Neonatal ICU admission showed the highest incidence (33.3%) among severe cases (p = 0.031). Asthma was significantly linked to a higher risk of neonatal ICU admission (23.1% vs. 7.1%). Diabetes mellitus was associated with an increased rate of maternal ICU admission (13.3% vs. 0%). Hypertension showed significant associations with elevated rates of preeclampsia (35.7% vs. 1.6%), maternal ICU admission (14.3% vs. 0%), and neonatal ICU admission (35.7% vs. 7.3%).

Conclusion: COVID-19 infection during pregnancy was associated with several adverse maternal and neonatal outcomes, including preeclampsia, gestational diabetes, preterm birth, low birth weight, and increased ICU admissions. Severe maternal disease and existing comorbidities further elevated the risks of complications for both mother and newborn.

Background: To validate previous age subgrouping methods and provide an optimal age reference for women planning to delay in vitro fertilization (IVF).

Methods: From July 2014 to March 2018, 3012 patients that received IVF/intracytoplasmic sperm injection (ICSI) were continuously recruited in this retrospective, single-center study. We analyzed the relationships of baseline characteristics and IVF outcomes. A smooth fitting curve depicting the association of age and live birth was plotted using the generalized additive model (GAM) method. We also evaluated the association of age and live birth among different age groups (> 20, ≤ 35; > 35, ≤ 37; > 37, ≤ 40; and > 40).

Results: Age, duration of infertility, and baseline follicle-stimulating hormone (FSH) were significantly related to the live birth rate. The adjusted Odd Ratio (OR) value of age was 0.95 (P < 0.001), indicating the higher occurrence of no live birth with age increasing. The fitting curve showed that the live birth rate decreased with age. And 35.5 (34.5-36.5) was identified as the inflection point of the curve. The slopes before 35.5 and after 35.5 were significantly different (0.9 [0.9, 1.0], P < 0.001). When ≤ 35, live birth rate did not vary with age. For the ages of 35-37 and 37-40, the occurrence of negative outcome increased with age (aOR: 0.73 [0.53, 0.99], 0.80 [0.65, 1.00]; P = 0.0441, 0.0465, respectively).

Conclusion: The age of 35 can be referred to as the safe time point when the IVF success rate does not decline with age. And the risk of IVF failure increases rapidly in the period of 35-37 and 37-40.

Background: No studies have effectively clarified the relationship between uterine contractions and the act of acceleration or driving behaviors in pregnant women.

Aims: To confirm the effect of driving a motor vehicle on physiological changes in pregnant women, we examined uterine contractions while driving.

Materials and methods: Seventeen pregnant women with a gestational age of 30-35 weeks were enrolled in this study. Uterine contractions were monitored remotely using a mobile delivery monitoring device. Triaxial acceleration of the vehicle, vehicle velocity, and vehicle kinematics were monitored using a driving recorder.

Results: The average number of uterine contractions per 30 min in all participants was 1.0 (range, 0.26-2.0). When comparing the median vehicle velocity during a uterine contraction with that when there were no contractions, no significant difference was found (23 km/hour vs. 31 km/hour, p = 0.36). The prevalence of low velocity (20 km/hour or less) was significantly higher, and that of higher velocity (50 km/hour or more) was lower during a uterine contraction than with no contractions (p = 0.023 and 0.012, respectively). When comparing resultant vehicle acceleration, no significant differences were found between women with uterine contractions and those with no contractions. The distributions were similar before and immediately before a uterine contraction and with no contractions.

Conclusions: Driving a motor vehicle should be considered a normal activity of daily life in pregnant women and seems unlikely to predispose to preterm birth.

Background: This study aims to evaluate the impact of adjuvant chemotherapy on cancer-specific survival (CSS) and overall survival (OS) in patients with Stage IA ovarian clear cell carcinoma (OCCC) using data from the Surveillance, Epidemiology, and End Results (SEER) database.

Methods: We conducted a retrospective cohort study utilizing SEER data (2000-2021) to compare the prognosis of Stage IA OCCC patients who received adjuvant chemotherapy versus those who did not. Propensity score matching (PSM) was used to balance baseline characteristics between the groups. Competing risks regression and multivariate Cox regression analyses identified prognostic factors for CSS and OS.

Results: A total of 1422 Stage IA OCCC patients were identified. After PSM, 776 patients (388 in each group) were included. For patients aged ≤ 50 years, chemotherapy was linked to worse CSS (89.5% vs. 96.2%, p=0.007) and OS (89.3% vs. 95.9%, p=0.008). Conversely, in patients aged > 70 years, chemotherapy was associated with improved CSS (93.0% vs. 81.9%, p=0.038) and OS (86.0% vs. 72.4%, p=0.006). These trends remained after PSM. Multivariate analysis showed that chemotherapy had little impact on OS and CSS. Subgroup analysis further indicated that chemotherapy negatively affected CSS and OS in patients aged ≤ 50 years.

Conclusions: Adjuvant chemotherapy did not significantly improve survival outcomes in patients with Stage IA OCCC. However, its effects were age-dependent, with older patients (> 70 years) experiencing improved survival, while younger patients (≤ 50 years) exhibited worse outcomes. These findings underscore the importance of individualized treatment strategies for Stage IA OCCC.

Objective: Our study aimed to examine ultrasound and obstetric parameters, explore their interrelationships, and assess their predictive ability in determining the success of labor induction. Methodology: Women with uncomplicated singleton pregnancy at a gestational age of 40 weeks and 3 days with fetal cephalic presentation, having intact fetal membranes and unfavorable Bishop score (BS < 6) were recruited for the study. Ultrasound examination was performed to measure cervical length (CL), estimated fetal weight (EFW), and Doppler velocimetry of fetal cerebral vessels in each patient before induction. We proposed to combine the variables of CL, EFW, BS, and middle cerebral artery pulsatility index (MCA PI) to devise a model for the prediction of successful induction of labor (IOL). IOL was performed with intracervical prostaglandin E2 gel (3 g gel/0.5 mg dinoprostone) applied 6 h apart if needed, not more than 2 doses, followed by oxytocin infusion for up to 6 h. Successful induction was defined as the initiation of active labor at any stage of the induction process. Results: Among the 70 enrolled women, only 29 (41.4%) women responded to induction. CL, BS, and mean value of fetal MCA PI had significant differences in women who responded from those who did not respond to the IOL. The prediction model for the success of induction with the four variables of MCA PI, BS, and CL has a sensitivity of 100% and specificity of 90.2% (AUC 0.982, 95% CI: 0.96-1.00, p < 0.001) with the upper cutoff of 0.47. EFW showed to have no effect on the outcome parameter. Conclusion: A model comprising MCA PI, CL, and BS has an excellent prediction value to assess the response to IOL in women at term pregnancy. When a single parameter has to be evaluated, CL is the best maternal factor to predict the success of induction.

[This corrects the article DOI: 10.1155/2024/7309041.].

Introduction/Background: Management of advanced endometrial cancer (EC) presents a significant therapeutic challenge, with ongoing debate regarding optimal treatment sequencing. Primary cytoreductive surgeries (PCSs) with adjuvant therapy and neoadjuvant chemotherapy followed by interval Debulking surgery (NACT-IDS) are both employed as treatment strategies. This study analyses outcomes of both treatment strategies in Nottingham University Hospitals Cancer Centre. Methodology: We conducted a retrospective cohort analysis of patients with advanced EC (FIGO Stages III-IV) treated at our centre between 2013 and 2023. Patients who received either PCS with adjuvant therapy or neoadjuvant chemotherapy followed by interval Debulking surgery (NACT-IDS) are included in the study. Data collection included demographic characteristics, treatment approaches, surgical parameters, and outcome measures. Primary outcomes were progression-free survival (PFS) and overall survival (OS). Secondary outcomes included perioperative outcomes and recurrence patterns. Results: Treatment pathways included NACT-IDS (n = 8) and PCS with adjuvant therapy (n = 57). Stage IV disease was notably more prevalent in patients who received NACT-IDS therapy compared to the PCS group (75.0% versus 5.3%, p < 0.001). Analysis revealed a PFS duration of 18.5 months for NACT-IDS patients, whilst PCS patients demonstrated a longer duration of 35.5 months (HR 1.18, 95% CI: 0.56-2.48, p=0.328). Median OS was 22.0 months in the NACT-IDS group versus 41.0 months in the PCS group (HR 1.35, 95% CI: 0.64-2.83, p=0.145). Mean operative time was longer in the NACT-IDS group (239.7 vs 165.5 min, p=0.209). All NACT-IDS procedures were performed via open laparotomy compared to 49.1% in the PCS group (p < 0.001). Hospital stay was significantly longer in the NACT-IDS group (median 8 vs 3 days, p=0.036). Radiotherapy was administered to 25.0% (n = 2) of NACT-IDS patients and 59.6% (n = 34) of PCS patients. Recurrence rates were higher in the NACT-IDS group, 37.5%, compared to 33.3% in the PCS patients (p=0.823). Conclusion: This comprehensive analysis provides valuable insights into treatment outcomes and surgical parameters for advanced EC. Whilst the small sample size of the NACT-IDS cohort limits the ability to draw definitive conclusions, the study provides meaningful evidence that can inform clinical decision-making. The findings lay important groundwork for future prospective, multicentre studies aimed at optimising patient selection and treatment sequencing in this challenging disease.