Obstetrics and Gynecology International最新文献

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.

Background: Obstetric and gynaecological haemorrhage contributes significantly to morbidity and mortality globally. Pelvic arterial embolisation has been described as a management option for emergency haemorrhage not responsive to conservative measures. Despite encouraging outcomes, it is not widely utilised. Aim: This study aims to assess efficacy and early complications of pelvic arterial embolisation as a therapy for obstetric and gynaecological haemorrhage not controlled by conservative methods. Materials and Methods: This retrospective single-centre case series reviewed all cases of acute haemorrhage from obstetric or gynaecological causes referred for angiographic embolisation between 2014 and 2020. Results: Twelve patients underwent pelvic arterial embolisation with a 100% technical success rate and 91.6% clinical success rate. There were no major early complications. Conclusion: Pelvic arterial embolisation is a safe and effective option for obstetric and gynaecological haemorrhage not responsive to conservative management.

Background and Objective: Infertility is an unpredictable condition that presents various physical, psychological, and financial challenges. The uncertainty surrounding the success of treatment options can hinder individuals' ability to cope, potentially leading to adverse outcomes. This study aimed to explore the phenomenon of therapeutic deadlock in women experiencing infertility. Method: This descriptive phenomenological study was conducted from March to November 2024 at infertility centers affiliated with Hamadan University of Medical Sciences in Iran. A purposive sample was used, and 23 semistructured, in-depth, face-to-face interviews were conducted with women who had experienced primary infertility. The collected data were analyzed using the Colaizzi method. Findings: In exploring experiences of infertility, three main themes emerged. (1) Feelings that they were in a last desperate struggle: This theme includes exploring unconventional infertility treatments, seeking treatment with skepticism, and taking risks to achieve the goal. (2) Negative thoughts to overcome a deadlock: This encompasses thoughts of separation and suicidal thoughts. (3) Intentions to resist surrendering to fate: This theme highlights resistance through faith in god against feelings of surrendering to fate. Conclusion: This study examines the phenomenon of therapeutic deadlock among infertile women, highlighting how their cultural and social contexts shape their treatment choices. Despite facing hesitations and potential risks, these women seek treatment in various ways. When confronted with a deadlock in their journey, they often experience negative thoughts and employ different coping strategies, which range from resistance to faith in a higher power and sometimes surrendering to fate.

Introduction: The stress associated with infertility can impact an individual's sleep status by affecting the hypothalamus and pituitary axis, potentially leading to sleep disorders. On the other hand, sleep disorders can further contribute to the development of depression and anxiety. This study aims to investigate the factors that influence sleep quality in women undergoing intrauterine sperm insemination (IUI) treatment. Methods: This research involved a prospective cohort study conducted on 131 infertile women aged 18-45 years who sought services at the infertility clinic of Bent Al-Hoda Hospital in Bojnurd City and a private clinic between 2020 and 2023. Data were gathered using a demographic questionnaire, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), and the Pittsburgh Sleep Quality Index (PSQI). Participants completed these questionnaires at three different time points: 0, 14, and 30 days in relation to the time of IUI. Data analysis was carried out using repeated-measures analysis of variance and generalized linear models. Results: The average age of the participating women was 29.85 years, with a standard deviation of 5.75. The overall prevalence of sleep quality disorder was 30.5%. Most patients reported mild to moderate disturbances in the delay of falling asleep. While no significant difference was observed in the comparison of average sleep disturbance scores at three different times, an increasing trend in anxiety and depression was noted in the second stage, followed by a decreasing trend in the third stage. In the presence of other variables, anxiety and depression demonstrated a significant relationship with sleep disorder (p < 0.001). Conclusions: Approximately one-third of infertile women were found to be suffering from a sleep quality disorder. The study underscores the significant impact of depression and anxiety on sleep quality disorders among infertile women. As a recommendation, it is advised to address the psychological well-being of infertile patients within infertility treatment clinics.

Background: Endometriosis is a chronic condition that affects the endometrium, the lining of the uterus. The endometrium typically thickens and discharges during the menstrual cycle, resulting in menstruation. Endometriosis is characterized by developing endometrial-like tissue outside of the uterus, typically on the ovaries, fallopian tubes, and other pelvic structures. This tissue can become inflamed, resulting in various symptoms, such as discomfort. Endometriosis is characterized by heavy menstrual bleeding, fatigue, painful urination or bowel movements, and infertility. Endometriosis is a benign pathological condition frequently seen in the gynecology department. This study classified 28 lncRNAs associated with endometriosis and other gynecological disorders and examined the expression of lncRNA-ANRIL in the eutopic and ectopic endometrium of patients with Ems. Methods: Quantitative reverse transcription (qRT)-PCR was utilized to explore the differences in ANRIL expression between endometriosis tissues and normal ovarian epithelium. Using this technique, the expression of ANRIL in vivo was assessed in 30 endometriosis specimens. A human endometriosis cell line was subjected to in vitro ANRIL knockdown so that the biological roles of the line could be discovered. The Transwell assay was successful in identifying migration and invasion. Results: The expression of ANRIL was much higher in endometriosis tissues than in normal ovarian epithelial tissues, and this difference was found to be strongly associated with the endometriosis stage. Conclusions: There was a positive correlation between the expression of ANRIL and the occurrence of endometriosis. Additionally, there was a close association between the expression of ANRIL and the etiology and development of endometriosis. This offers a potential basis for the early detection and treatment of endometriosis.

Objective: Postural orthostatic tachycardia syndrome (POTS) affects up to 3 million people in the United States. Although 78%-83% of POTS patients are female, gynecologic comorbidity has not been well-studied. We created an online questionnaire to assess outcomes in female patients with POTS formerly followed at a single-center pediatric POTS program. Design: Cross-sectional study. Setting: Single-center pediatric POTS program. Population or Sample: All female patients ≤ 18 years at diagnosis. Methods: We developed and distributed The Long-Term POTS Outcomes Survey with questions about diagnosis, therapy, education, employment, social impact, quality of life (QoL), and gynecologic symptoms and management. Main Outcome Measures: Gynecologic symptoms and QoL. Results: Regular menstrual cycles were seen in 81/167 participants (49.1%). POTS symptoms worsened prior to and during menses in 118/167 subjects (72.4%); hormonal contraceptive therapy helped to control symptoms in 52/110 subjects (50%). Menorrhagia, polycystic ovary syndrome, and endometriosis were not reported in higher numbers compared to the general population. Conclusions: Menstrual flow disorders are not more prevalent in younger females with POTS. Symptoms often worsen perimenstrually, and hormone therapy can help to reduce symptom severity. Further research is needed to better define optimal hormone therapy in suppressing perimenstrual symptoms.