Obstetrics and Gynecology International最新文献

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.

Objectives: This study aims to investigate the five-year trend of minimally invasive hysterectomy and identify factors associated with increased intraoperative and postoperative complications within the last five years (2017-2021). Methods: A retrospective chart review was performed between March 30th and April 10th, 2022, which included women who underwent total laparoscopic hysterectomy (TLH), laparoscopic subtotal hysterectomy (LSH), laparoscopic-assisted vaginal hysterectomy (LAVH), and robotic-assisted hysterectomy for benign gynecologic conditions, during the period January 2017 to December 2021. Results: There was an increase in the rate of performing minimally invasive hysterectomy procedures from 35 cases (12.5%) in 2017 to 85 cases (30.5%) in 2021. In addition, abnormal uterine bleeding was the most reported indication for minimally invasive hysterectomy (n = 84; 30.1%). Estimated blood loss was a significant predictor for both intraoperative complications (p < 0.001) and postoperative complications (p=0.004). Conclusion: Within the last five years, there has been an increasing trend of minimally invasive hysterectomy procedures at the OB-GYN department in KAMC, Saudi Arabia. And estimated blood loss is a significant predictor of intraoperative and postoperative complications of minimally invasive hysterectomy.

Background: Cervical cancer remains a global public health concern occurring in most cases in developing countries. Furthermore, it is a highly preventable disease; it remains to be the most common cancer among Nepalese women. Assessing women's awareness of cervical cancer and identifying barriers to screening are of vital importance for the utilization of cervical cancer screening. Therefore, this study has been conducted to assess information regarding awareness, practice, and barriers to cervical cancer screening among the women of Kageshwori Manohara Municipality of Kathmandu district in Nepal. Methods: Community-based descriptive cross-sectional study was conducted among 249 women aged 30-60 years by using a systematic random sampling technique. Data were collected from 1st to 29th February 2024 through a self-constructed semistructured tool using a face-to-face interview technique. Descriptive statistics and the chi-square tests were used for statistical analysis. Results: Out of the total respondents, only 10.4% had adequate awareness regarding cervical cancer screening and 38.6% of the respondents had ever been screened for cervical cancer. Among the respondents who had ever been screened, the majority (86.5%) of their last time screening was within 5 years. A statistically significant association was found between levels of awareness with the age of the respondents (p=0.031), educational level (p=0.013), and number of children (p=0.003). However, no significant association was found with other variables such as age at marriage, ethnicity, occupation, and monthly family income. Absence of symptoms (54.6%), unaware of screening (17.7%), and feeling of embarrassment (11.6%) were the most mentioned barriers to practicing cervical cancer screening among the respondents. Conclusion: The result of this study showed most of the respondents had an inadequate level of awareness and low experience of practicing cervical cancer screening. Therefore, community-based awareness campaigns and screening health camps should be conducted to increase knowledge and practice of cervical cancer screening.

Objective: Malnutrition is a major concern in patients with advanced ovarian cancer, and this condition may be associated with poor treatment outcomes. This study aims to estimate the prevalence of malnutrition in advanced ovarian cancer patients and investigate its impact on both surgical and oncological outcomes. Materials and Methods: This retrospective study included 290 advanced-stage ovarian cancer patients (FIGO stage III-IV) who were not diagnosed with malnutrition. The median follow-up time was 36 months. Malnutrition was defined using the Geriatric Nutritional Risk Index (GNRI). Retrospective data on patient characteristics, treatment complications, and outcomes were recorded. Statistical analyses were performed using IBM SPSS Statistics for Windows (Version 26.0; IBM Corp., Armonk, NY, USA). Results: This study found that 137 of 290 patients (47.2%) had malnutrition. Anemia and chronic kidney disease (CKD) were frequently observed alongside malnutrition. Malnutrition impacts both surgical and oncological outcomes, including the rate of optimal debulking surgeries (35.8% in the malnourished group and 62.7% in the well-nourished group, p < 0.005) and the median length of hospital stay (10 days in the malnourished group and 7 days in the well-nourished group, p < 0.005). Additionally, well-nourished patients had a significant higher overall survival rate (43 months) compared to malnourished patients (30 months). Conclusion: Malnutrition is common among patients with advanced ovarian cancer and is associated with a lower rate of optimal surgery, longer hospital stays, and reduced overall survival rates.

Background: Human papillomavirus (HPV) is a major contributor to cervical cancer (CC), with Papanicolaou (Pap) smears and HPV testing serving as primary screening tools in developed countries. The effectiveness of these methods can vary based on a country's epidemiological and socioeconomic context. This study introduces an innovative, noninvasive method employing surgical gauze worn as a feminine pad for HPV detection, with the aim of simplifying and improving screening processes. Materials and Methods: A total of 184 participants, including individuals classified as healthy, with cervical precursor lesions, or as with confirmed CC, were enrolled. All participants underwent cytological and colposcopic evaluations, with biopsies taken in cases of abnormal results. Each participant wore the device for 8 h, after which DNA was extracted from the soiled devices and analyzed via PCR for mitochondrial and HPV-DNA. Sensitivity and specificity were calculated to assess the effectiveness of HPV detection. Sensitivity and specificity values for HPV detection were obtained. Analysis of diagnostic tests was performed by OpenEpi software. Results: The device was well-received, with high compliance among participants. PCR analysis revealed that 17.7% of healthy, 72.1% of precursor-lesion cases, and 97.1% of CC cases tested positive for HPV. The calculated sensitivity and specificity for detecting high-grade lesions (CIN2+ or CIN2/3 and CC) were 94.81% and 51.28%, respectively. For CC detection, sensitivity was 97.14% with a specificity of 54.39%. Conclusions: The use of this noninvasive device demonstrated a significant correlation with clinical outcomes, supporting its potential as an effective and accessible tool for HPV screening. This method offers a promising alternative to conventional screening techniques, particularly in settings where traditional methods face logistical and socioeconomic challenges.

Introduction: Female technology or 'femtech' is the availability of mobile applications (apps) to monitor specific aspects of women's health. It touts the benefits of technology to empower women with regards to their health, while also allowing close collaboration between patients and physicians. Endometriosis-specific apps is a channel by which female patients discover their endometriosis diagnosis. However, there is currently a paucity of high-quality and evidence-based endometriosis apps. This study assessed the current state and overall quality of such apps. Materials and Methods: This retrospective study assessed patient-centred endometriosis apps on the Apple iTunes Store, in January 2023, excluding certain categories such as conference guidance, gaming, private healthcare, and clinical trial apps. The key term "endometriosis" was used. All patient-centred apps were included. The apps were assessed using the APPLICATIONS scoring system, considering objective factors like pricing, subscriptions, literature references, in-app purchases, connectivity, advertisements, search fields, interoperability, and subjective elements such as navigation ease and presentation. The maximum score is 16 and all applications were assessed in English. Results: Out of the initial 22 apps, 12 (54.5%) were excluded, leaving 10 (45.5%) for analysis. Most apps lacked comprehensiveness, but two apps (LUNA-endometriosis and Frendo) stood out with high scores. These apps incorporated certified scoring systems, provided recommendations for tests and follow-up visits, and offered evidence-based literature on endometriosis. The remaining apps scored poorly, focusing on alternative treatments, healthy diets, or functioning solely as symptom diaries, with limited information on diagnosis and management. Only a few apps allowed booking follow-up visits, and most lacked the capability to export patient-specific data. Few apps measured the likelihood of endometriosis whilst others relied on previous diagnoses. The majority of apps were free, whilst in-app purchases centred around alternative treatments. Overall, the apps were user-friendly, featuring vibrant colours and intuitive interfaces. Conclusions: Only two patient-centred endometriosis apps scored highly in the APPLICATIONS scoring system as they were high-quality, evidence-based and incorporated valid medical recommendations. Other applications scored low as their recommendations lacked quality scientific evidence.