Obstetrics and Gynecology International最新文献

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.

Purpose: This study aimed to evaluate the effect of COVID-19 infection and vaccination on all the menstrual cycle parameters in the women of reproductive age group, 18-45 years, at a tertiary care hospital. Methods: A single-center, descriptive cross-sectional study was done from January 2, 2023, to June 24, 2023. Sampling was nonprobabilistic and purposeful. Participants were recruited via calls, in-person interviews, and online surveys. A total of 931 participants were recruited, of which 141 participants were eligible for the study. Descriptive statistics were performed for all variables. Pearson's chi-square test was done to compare categorical variables among different groups, and the Wilcoxon matched pair signed-rank test was done to compare the menstrual cycle patterns before and after COVID-19 infection and vaccination. Simple linear regression and multiple linear regression analysis were done wherever necessary. p < 0.05 was considered statistically significant. Results: A total of 931 participants were recruited, of which 141 participants were eligible for the study. The median age was 29 years. Those who reported menstrual abnormalities were mainly of the age group 18-27 (n = 62, 44.0%), resided in an urban locality (n = 123, 87.2%), and were employed (full-time/part-time) (n = 57, 40.4%). Of the 42 participants with menstrual changes, 27 (64.3%) participants experienced changes post-COVID-19 infection before their first vaccination dose and 15 (35.7%) after the first vaccination dose. In this group, 15 (35.7%) continue to experience abnormalities in their cycles. Analysis showed that participants having severe COVID-19 symptoms were more likely to have an earlier onset of menstrual abnormalities (beta = -2.072, p=0.040). Participants with an above-normal BMI were more likely to have increased pain/cramps during menses (beta = 0.236, p=0.0.013). Participants who were students/employed (beta = -0.365, p=0.001) with an above-normal BMI (beta = 0.182, p=0.024) were more likely to experience increased mood swings/tension/irritability. On comparing the onset and duration of menstrual abnormalities in the post-COVID-19 infection and postvaccination groups, it was found that the latter group had a late-onset and short-term effect, while the former group had an early-onset and long-term effect on menses. Conclusion: Our study shows that there is evidence of the onset of menstrual irregularities following COVID-19 infection and vaccination. The study revealed COVID-19 infection and vaccination influence menstrual cycles, the former posing a higher risk, but their effects on menstruation independent of one another are to be studied further.

Background: "No result" after PGT-A is a rare observation. Factors suspected to cause inconclusive diagnoses include poor embryo quality, day of biopsy, biopsy technique, and technical amplification failure due to diluted DNA material. This study aimed to highlight the predisposing factors that could lead to a "no result" observation after PGT-A. Results: This is a retrospective cohort study involving 177 patients and 1335 blastocysts, 1242 of which comprised the control (result) group and 93 comprised the study (no result) group. The predisposing factors studied were the number of blastocysts available for biopsy, the day of biopsy, the grade of the embryo, the degree of expansion of the blastocyst, and the grade of the trophectoderm on biopsy day. The rate of "no result" embryos did not depend on the degree of expansion of the embryo, the trophectoderm quality, the day of biopsy, or embryo grade (p=0.139, 0.34, 0.332, and 0.272, respectively). Regression analysis showed that the studied embryo characteristics were not significant predisposing factors. However, having more blastocysts to biopsy per patient was found to be a significant predictor of "no result" embryos. Conclusion: No clear embryo-related risk factors could be elucidated; however, the biopsy procedure and sample cellularity seem to be crucial components. In addition, having more embryos per patient to biopsy at a given time might increase the risk of having inconclusive biopsy results.

Objective: This study evaluated awareness and knowledge of planned oocyte cryopreservation (POC) among Turkish women across diverse sociocultural backgrounds. Design: This is a cross-sectional survey with a 56-item self-administered electronic questionnaire. Setting: Istanbul, Turkiye, June to September 2022. Population: The study evaluated 915 participants between 21 and 45 years. Methods: Women completed a 56-item self-administered online electronic questionnaire survey to identify their demographic information, perspective on family planning, future fertility expectations/plans, oocyte freezing, and degree of knowledge. Main Outcome Measures: Comparison of participants considering and not considering POC. Results: A total of 464 (50.7%) women indicated an intent to undergo POC in the future, with statistically significantly higher university graduates in the group clearly considering POC (p=0.044) and a higher rate of singles indicating an intent to POC. A total of 546 (59.7%) women planned to have children in the future; the participants considered the age of 39.37 (±5.01) as "old" for pregnancy; 748 (81.7%) of the participants thought that the information about age-related fertility decline and POC should be a part of the annual gynecological examination. The level of knowledge about family planning/postponing fertility and POC between the two groups showed that the group considering POC provided significantly more accurate responses to seven items (5th, 6th, 7th, 10th, 11th, 14th, and 17th questions). The group not considering POC answered correctly, "What is the rate of spontaneous female conception?" (p=0.047). Conclusion: The target population expected to benefit from POC in our country had low knowledge and awareness of age-related fertility decline and POC. Most women expected the information to be a part of the annual gynecological examination. The main determinants of the knowledge score and considering POC are education level and relationship status.

Objectives: To determine the effectiveness of perineal massage during the second stage of labour in preventing perineal trauma in nulliparous women. Methods: A randomized control trial involving 104 nulliparous women undergoing vaginal delivery. The participants were randomised into two arms (intervention-group 'A' and control-group 'B') in a 1:1 ratio. The intervention group had perineal massage and routine hands-on technique according to the hospital protocol while the control group received only hands-on technique. The primary outcome measure was the incidence of perineal tears during vaginal delivery, while the secondary outcome measures were the incidence of episiotomy during vaginal delivery, the mean duration of second stage of labour, and perineal pain score. Results: The baseline socio-demographic and maternal characteristics of the participants were similar in both arms. The incidence of perineal lacerations in the intervention group (massage group) was significantly lower than in the control group (27 (54%) vs. 40 (81.6%); p=0.003). Although the incidence of episiotomy (26% vs. 44.9%; RR = 0.66; 95% CI = 0.50-0.88; p=0.060) was not significantly different, mean perineal pain score at 4 h postpartum (4.3 ± 0.3 vs. 6.1 ± 0.50; p=0.03), mean perineal pain score at 24 h postpartum (2.2 ± 0.1 vs. 4.2 ± 0.3; p=0.02), and mean duration of second stage of labour (83.1 ± 17.5 min vs. 94.2 ± 18.9 min; p=0.002) were significantly lower in the intervention-group. There was no significant difference in the neonatal outcomes (head circumference, birth weight, and Apgar scores: p > 0.05) between the two groups. Conclusion: Intrapartum perineal massage significantly decreases the risk of overall perineal trauma, perineal pain, and duration of the second stage of labour among nulliparous parturients during the second stage of labour. Nulliparous women should be counselled on the potential benefits of intrapartum perineal massage, and obstetricians are encouraged to provide the technique to consenting women. Trial Registration: Pan African Clinical Trial Registry (PACTR): PACTR 202207835155214.