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Effect of adenomyosis on placenta-related obstetric complications 子宫腺肌症对胎盘相关产科并发症的影响。
IF 3.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-21 DOI: 10.1016/j.rbmo.2024.104414
Ran Matot , Uval Bar-Peled , Yossi Geron , Shir Danieli-Gruber , Yinon Gilboa , Lior Drukker , Haim Krissi , Adi Borovich , Sharon Perlman

Research question

What is the relationship between sonographic diagnosis of isolated adenomyosis and placenta-associated obstetric outcomes?

Design

In this 12-year retrospective cohort study (2010–2022), patients presenting with adenomyosis-related symptoms were assessed via ultrasound. The study included 59 women diagnosed with adenomyosis and 62 controls, leading to 203 births (90 in the adenomyosis group and 113 in the control group). Patients with endometriosis, uterine fibroids and anomalies, and those using assisted reproductive technology were excluded. The primary outcome focused on a composite of placenta-associated adverse outcomes, including preterm birth, small-for-gestational-age fetuses, hypertensive disorders of pregnancy, placental abruption and post-partum haemorrhage.

Results

No clinically significant differences in demographic characteristics were noted between the two groups. However, the adenomyosis group showed a significantly higher rate of adverse placental function outcomes (27%) compared with the control group (11%, P = 0.005). Adjusted analyses for maternal age, parity and aspirin usage revealed increased risk of hypertensive disorders (adjusted OR 5.91, 95% CI 1.50–30.0; P = 0.017) and adverse placental function outcomes (adjusted OR 3.44, 95% CI 1.53–8.09; P = 0.003) in the adenomyosis group.

Conclusion

Adenomyosis is significantly associated with increased risk of adverse placental function outcomes and hypertensive disorders of pregnancy. These findings suggest that adenomyosis may have a distinct impact on pregnancy, underscoring the need for further research to elucidate specific sonographic characteristics of adenomyosis and their effects on placental function.
研究问题:孤立性腺肌症的超声诊断与胎盘相关产科结果之间有什么关系?在这项为期 12 年(2010-2022 年)的回顾性队列研究中,通过超声波对出现子宫腺肌症相关症状的患者进行了评估。研究对象包括 59 名确诊为腺肌症的妇女和 62 名对照组妇女,共分娩了 203 例婴儿(腺肌症组 90 例,对照组 113 例)。患有子宫内膜异位症、子宫肌瘤和异常的患者以及使用辅助生殖技术的患者被排除在外。主要研究结果集中于胎盘相关不良后果的综合分析,包括早产、小于妊娠年龄胎儿、妊娠高血压疾病、胎盘早剥和产后出血:两组孕妇的人口统计学特征无明显临床差异。然而,与对照组(11%,P = 0.005)相比,子宫腺肌症组胎盘功能不良的发生率(27%)明显更高。对产妇年龄、奇偶数和阿司匹林使用情况进行调整分析后发现,子宫腺肌症组发生高血压疾病(调整后 OR 5.91,95% CI 1.50-30.0;P = 0.017)和胎盘功能不良结果(调整后 OR 3.44,95% CI 1.53-8.09;P = 0.003)的风险增加:结论:子宫腺肌症与胎盘功能不良和妊娠高血压疾病的风险增加密切相关。这些研究结果表明,子宫腺肌症可能会对妊娠产生独特的影响,因此有必要开展进一步研究,以阐明子宫腺肌症的具体声像图特征及其对胎盘功能的影响。
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引用次数: 0
Tailor-made embryo transfer considering embryonic developmental speed to overcome the dilemma of personalized embryo transfer. 考虑胚胎发育速度的定制胚胎移植,克服个性化胚胎移植的困境。
IF 3.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-21 DOI: 10.1016/j.rbmo.2024.104405
Yasuhiro Ohara, Hidehiko Matsubayashi, Shimpei Mizuta, Masakazu Doshida, Takumi Takeuchi, Tomomoto Ishikawa, Mika Handa, Tatsuya Miyake, Tsuyoshi Takiuchi, Tadashi Kimura

Research question: Does tailor-made embryo transfer (TmET), timed with respect to embryonic developmental speed, affect pregnancy outcomes in patients with recurrent implantation failure?

Design: Among 741 patients identified as receptive through endometrial receptivity testing, the clinical pregnancy rates and live birth rates were retrospectively compared between those who underwent standard personalized embryo transfer and those who underwent TmET in hormone replacement therapy cycles. Personalized embryo transfer was performed according to endometrial receptivity test results (standard personalized embryo transfer group) or considering embryonic developmental speed (TmET group). For TmET, the expansion grade of warmed blastocysts was estimated based on each patient's previous embryonic developmental pattern. The embryo transfer days were set so that estimated blastocyst grades 3, 4, 5 and 6 were transferred on days P+5, P+5.5, P+6.0 and P+6.5, respectively.

Results: In a propensity score matching analysis, the clinical pregnancy rate was significantly higher in the TmET group than the standard personalized embryo transfer group (P = 0.014), whereas the live birth rates were similar between the two groups (P = 0.65). In a subgroup analysis with euploid embryo transfers, the clinical pregnancy rate was significantly higher in the TmET group than the standard personalized embryo transfer group, although there was no difference in live birth rate between the two groups (P = 0.045 and P = 0.057, respectively).

Conclusions: For patients experiencing recurrent implantation failure and identified as receptive through endometrial receptivity testing, subsequent TmET strategies may further enhance pregnancy outcomes.

研究问题:根据胚胎发育速度确定时间的定制胚胎移植(TmET)是否会影响反复植入失败患者的妊娠结局?在741名通过子宫内膜接受性测试确定为接受胚胎的患者中,回顾性比较了接受标准个性化胚胎移植的患者与在激素替代疗法周期中接受TmET的患者的临床妊娠率和活产率。个性化胚胎移植是根据子宫内膜接受性测试结果(标准个性化胚胎移植组)或考虑胚胎发育速度(TmET 组)进行的。在 TmET 组,根据每位患者之前的胚胎发育模式估算温育囊胚的扩张等级。胚胎移植天数被设定为估计囊胚等级 3、4、5 和 6,分别在 P+5、P+5.5、P+6.0 和 P+6.5 天移植:在倾向得分匹配分析中,TmET 组的临床妊娠率明显高于标准个性化胚胎移植组(P = 0.014),而两组的活产率相似(P = 0.65)。在优倍体胚胎移植的亚组分析中,TmET组的临床妊娠率明显高于标准个性化胚胎移植组,但两组的活产率没有差异(分别为P = 0.045和P = 0.057):结论:对于反复种植失败并通过子宫内膜接受性测试确定为有接受能力的患者,后续的TmET策略可进一步提高妊娠结局。
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引用次数: 0
A prospective study examining the value of three-dimensional transvaginal ultrasonography during the diagnosis and evaluation of Asherman syndrome 一项前瞻性研究,探讨经阴道三维超声波检查在诊断和评估阿什曼综合征中的价值。
IF 3.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-21 DOI: 10.1016/j.rbmo.2024.104404
Rui Huang , Sijing Li , Yuting Zhao , YingTao Li , Mingyang Ge , Sotirios Saravelos , Xiaodan Lv , Qi Cheng , Xiaowu Huang , Enlan Xia , Tin-Chiu Li

Research question

What is the value of three-dimensional (3D) transvaginal ultrasonography (TVS) in the diagnosis and assessment of Asherman syndrome?

Design

This was a prospective study conducted at a hysteroscopy centre.

Results

A total of 685 participants were recruited, 65 dropped out and 620 were finally enrolled and analysed. The overall sensitivity, specificity and accuracy of 3D-TVS in the diagnosis of Asherman syndrome were 95.7%, 80.7% and 93.5%, respectively, and the sensitivity and accuracy were significantly higher than those of two-dimensional (2D) TVS (P < 0.001). The likelihood of 2D-TVS missing a case of mild intrauterine adhesions (IUA) was 43.7%, compared with only 6.2% for 3D-TVS. The frequency of involvement of each anatomical area by adhesions in decreasing order was right and left uterine side walls (both 80%), central or mid-cavity (31%), right cornual region (26%), left cornual region (23%), fundal wall (15%) and isthmus (4.5%). The correlation between 3D-TVS and hysteroscopy in each of the seven anatomical areas was analysed separately. The results showed good agreement with regard to the three uterine walls (fundus, left lateral and right lateral), with kappa values of 0.678–0.811. The likelihood of the IUA being severe in nature when there were five or more areas, three or four areas, or one or two areas was 82%, 37.1% and 6.3%, respectively (P < 0.001).

Conclusions

The diagnostic value of 3D-TVS is higher than that of 2D-TVS. In clinical practice, 3D-TVS should whenever possible replace 2D-TVS as the initial method of assessment to decide if hysteroscopy is necessary and to help with planning surgery.
研究问题:三维(3D)经阴道超声检查(TVS)在诊断和评估阿什曼综合征中的价值是什么?这是一项在宫腔镜中心进行的前瞻性研究:结果:共招募了 685 名参与者,其中 65 人退出,最终有 620 人加入并接受了分析。三维TVS诊断阿舍曼综合征的总体敏感性、特异性和准确性分别为95.7%、80.7%和93.5%,敏感性和准确性显著高于二维(2D)TVS(P < 0.001)。二维TVS漏诊轻度宫腔内粘连(IUA)的可能性为43.7%,而三维TVS仅为6.2%。各解剖区域受粘连影响的频率依次为子宫左右侧壁(均为 80%)、中央或中腔(31%)、右隅角区(26%)、左隅角区(23%)、宫底壁(15%)和峡部(4.5%)。分别分析了 3D-TVS 和宫腔镜在七个解剖区域的相关性。结果显示,三个子宫壁(宫底、左外侧和右外侧)的相关性良好,卡帕值为 0.678-0.811。当出现五个或更多区域、三个或四个区域、一个或两个区域时,IUA性质严重的可能性分别为82%、37.1%和6.3%(P < 0.001):结论:三维 TVS 的诊断价值高于二维 TVS。在临床实践中,3D-TVS应尽可能取代2D-TVS作为初步评估方法,以决定是否有必要进行宫腔镜检查,并帮助制定手术计划。
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引用次数: 0
Reduced endometrial glycolysis concomitant with increased lesional fibrosis in patients with adenomyosis who complained of heavy menstrual bleeding. 主诉月经出血量大的子宫腺肌症患者的子宫内膜糖酵解减少,同时病变纤维化增加。
IF 3.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-20 DOI: 10.1016/j.rbmo.2024.104406
Chenyu Mao, Xishi Liu, Sun-Wei Guo

Research question: What role, if any, does the extent of lesional fibrosis play in impaired glycolysis leading to adenomyosis-associated heavy menstrual bleeding (ADM-HMB)?

Design: Forty-eight patients with ADM-HMB were recruited, among them 25 reported moderate to heavy bleeding (MHB), and the remaining 23, excessive bleeding (EXB). The full-thickness uterine tissue columns were processed for Masson trichrome staining and immunohistochemistry analyses. The expression levels of HIF-1α, GLUT1, HK2, PFKFB3 and PKM2 proteins that are critically involved in glycolysis in endometrial epithelial cells cultured on substrates of different stiffness, and the levels of glycolysis were quantitated. A mouse experiment with induced adenomyosis and simulated menstrual bleeding was conducted to assess the effect of adenomyosis on immunoexpression of proteins involved in glycolysis and inflammation as well as on endometrial repair and bleeding.

Results: The endometrial staining of HIF-1α, GLUT1, HK2, PFKFB3 and PKM2 was significantly lower in the EXB group as compared with MHB patients, concomitant with higher extent of fibrosis. The expression of HIF-1α, GLUT1, HK2, PFKFB3 and PKM2 was significantly reduced when endometrial epithelial cells were cultured in stiff substrate, concomitant with reduced glycolysis. Mice with induced adenomyosis had reduced immunoexpression of Hif-1α, as well as those proteins each of which plays a vital, rate-limiting role in different steps of the glycolysis pathway, such as Glut1, Hk2, Pfkfb3 and Pkm2, and elevated fibrosis in endometrium, concomitant with disrupted endometrial repair and more bleeding.

Conclusions: Lesional fibrosis results in reduced endometrial glycolysis in eutopic endometrium and subsequent imbalance in pro-inflammatory and anti-inflammatory response, leading to ADM-HMB.

研究问题:病变纤维化程度在糖酵解受损导致子宫腺肌病相关性大量月经出血(ADM-HMB)中起什么作用(如果有的话)?招募了48名ADM-HMB患者,其中25人报告为中重度出血(MHB),其余23人报告为大量出血(EXB)。对全厚子宫组织柱进行马森三色染色和免疫组化分析。在不同硬度的基底上培养的子宫内膜上皮细胞中,与糖酵解密切相关的 HIF-1α、GLUT1、HK2、PFKFB3 和 PKM2 蛋白的表达水平以及糖酵解水平均被量化。通过诱导子宫腺肌症和模拟月经出血的小鼠实验,评估子宫腺肌症对参与糖酵解和炎症的蛋白质的免疫表达以及对子宫内膜修复和出血的影响:结果:与MHB患者相比,EXB组子宫内膜HIF-1α、GLUT1、HK2、PFKFB3和PKM2的染色显著降低,同时纤维化程度更高。在僵硬基质中培养子宫内膜上皮细胞时,HIF-1α、GLUT1、HK2、PFKFB3 和 PKM2 的表达明显降低,同时糖酵解减少。诱发子宫腺肌病的小鼠体内的Hif-1α以及在糖酵解途径的不同步骤中发挥重要限速作用的蛋白质(如Glut1、Hk2、Pfkfb3和Pkm2)的免疫表达量减少,子宫内膜纤维化程度升高,同时子宫内膜修复功能受到破坏,出血量增加:病变纤维化导致异位子宫内膜糖酵解减少,继而导致促炎和抗炎反应失衡,导致ADM-HMB。
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引用次数: 0
Use of federated learning to develop an artificial intelligence model predicting usable blastocyst formation from pre-ICSI oocyte images 利用联合学习技术开发人工智能模型,从人工授精前的卵母细胞图像预测可用囊胚的形成。
IF 3.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-13 DOI: 10.1016/j.rbmo.2024.104403
J.M.M. Hall , T.V. Nguyen , A.W. Dinsmore , D. Perugini , M. Perugini , N. Fukunaga , Y. Asada , M. Schiewe , A.Y.X. Lim , C. Lee , N. Patel , H. Bhadarka , J. Chiang , D.P. Bose , S. Mankee-Sookram , C. Minto-Bain , E. Bilen , S.M. Diakiw

Research question

Can federated learning be used to develop an artificial intelligence (AI) model for evaluating oocyte competence using two-dimensional images of denuded oocytes in metaphase II prior to intracytoplasmic sperm injection (ICSI)?

Results

The oocyte AI model demonstrated area under the curve (AUC) up to 0.65 on two blind test datasets. High sensitivity for predicting competent oocytes (83–88%) was offset by lower specificity (26–36%). Exclusion of confounding biological variables (male factor infertility and maternal age ≥35 years) improved AUC up to 14%, primarily due to increased specificity. AI score correlated with size of the zona pellucida and perivitelline space, and ooplasm appearance. AI score also correlated with blastocyst expansion grade and morphological quality. The sum of AI scores from oocytes in group culture images predicted the formation of two or more usable blastocysts (AUC 0.77).

Conclusion

An AI model to evaluate oocyte competence was developed using federated learning, representing an essential step in protecting patient data. The AI model was significantly predictive of oocyte competence, as defined by usable blastocyst formation, which is a critical factor for IVF success. Potential clinical utility ranges from selective oocyte fertilization to guiding treatment decisions regarding additional rounds of oocyte retrieval.

Design

In total, 10,677 oocyte images with associated metadata were collected prospectively by eight IVF clinics across six countries. AI training used federated learning, where data were retained on regional servers to comply with data privacy laws. The final AI model required a single image as input to evaluate oocyte competence, which was defined by the formation of a usable blastocyst (≥expansion grade 3 by day 5 or 6 post ICSI).
研究问题:能否利用联合学习开发一种人工智能(AI)模型,利用卵胞浆内单精子注射(ICSI)前处于分裂期 II 的去核卵母细胞的二维图像来评估卵母细胞的能力?在两个盲测数据集上,卵母细胞 AI 模型的曲线下面积(AUC)高达 0.65。预测合格卵母细胞的灵敏度较高(83%-88%),但特异性较低(26%-36%)。排除混杂的生物变量(男性因素不育和母亲年龄≥35 岁)后,AUC 可提高 14%,这主要是由于特异性提高了。AI 评分与透明带和脐周间隙的大小以及卵原细胞的外观相关。AI 评分还与囊胚扩增等级和形态质量相关。组培养图像中卵母细胞的 AI 评分总和可预测两个或更多可用囊胚的形成(AUC 0.77):结论:利用联合学习开发了一个评估卵母细胞能力的人工智能模型,这是保护患者数据的重要一步。人工智能模型对卵母细胞能力有明显的预测作用,卵母细胞能力是指可用囊胚的形成,而可用囊胚的形成是试管婴儿成功的关键因素。潜在的临床应用范围包括选择性卵母细胞受精,以及指导有关额外几轮卵母细胞检索的治疗决策:设计:六个国家的八家试管婴儿诊所共收集了 10,677 张卵母细胞图像及相关元数据。人工智能训练采用联合学习方式,数据保留在地区服务器上,以遵守数据隐私法。最终的人工智能模型需要单个图像作为输入,以评估卵母细胞的能力,其定义是形成可用的囊胚(ICSI 后第 5 或第 6 天≥扩展等级 3)。
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引用次数: 0
How to detect an inadvertent pregnancy during random start stimulations 如何在随机启动刺激过程中检测意外怀孕。
IF 3.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-03 DOI: 10.1016/j.rbmo.2024.104394
Baris Ata, Barbara Lawrenz, Human M. Fatemi
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引用次数: 0
Good laboratory practice for PGT-M: Turkish Society of Reproductive Medicine guidelines PGT-M 的良好实验室实践:土耳其生殖医学学会指南
IF 3.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-03 DOI: 10.1016/j.rbmo.2024.104378
Evrim Unsal , Suleyman Aktuna , Berna Arda , Basak Balaban , Volkan Baltaci , Asina Bayram , Gurkan Bozdag , Zafer Nihat Candan , Murat Cetinkaya , Serdar Ceylaner , Necati Findikli , Hale Goksever Celik , Cihan Halicigil , Semra Kahraman , Metin Kayacaglayan , Ipek Keles , Ayse Kurtoglu , Aylin Mutlu , Gulay Ozgon , Yavuz Emre Sukur , Baris Ata
This guideline was prepared by the Turkish Society of Reproductive Medicine to define the conditions and requirements for an outsourced preimplantation genetic testing (PGT) programme in line with the experience and needs of practitioners. This guideline is intended to be a reference document for assisted reproductive technology centres, genetic diagnosis centres, non-governmental organizations working on reproductive health, legal experts, consultants working on laboratory accreditation, academicians specializing in ethical issues, and policy makers. The Consortium aims to provide recommendations addressing the challenges of genetic testing, especially PGT for monogenic diseases (PGT-M) due to the high rate of consanguineous marriage in Turkey. For this purpose, this summary document specifically includes challenges and recommendations regarding PGT-M practice, and aims to identify and aid in prevention of errors leading to misdiagnosis. The recommendations can be modified to fit other locations.
本指南由土耳其生殖医学会编写,目的是根据从业人员的经验和需求,确定植入前基 因检测(PGT)外包项目的条件和要求。该指南旨在为辅助生殖技术中心、基因诊断中心、从事生殖健康工作的非政府组织、法律专家、从事实验室认证工作的顾问、专门研究伦理问题的学者以及政策制定者提供一份参考文件。联合会旨在提供建议,以应对基因检测所面临的挑战,特别是由于土耳其近亲结婚率较高而导致的单基因疾病的基因检测(PGT-M)。为此,本摘要文件特别包括了有关 PGT-M 实践的挑战和建议,旨在发现和帮助预防导致误诊的错误。这些建议可根据其他地区的情况进行修改。
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引用次数: 0
Front Matter - Continued TOC 前言 - 续目录
IF 3.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-01 DOI: 10.1016/S1472-6483(24)00521-2
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引用次数: 0
Outside Back Cover - Editorial Board 封底外页 - 编辑委员会
IF 3.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-01 DOI: 10.1016/S1472-6483(24)00532-7
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引用次数: 0
Inside Front Cover - Affiliations and First page of TOC 封面内页 - 隶属机构和目录首页
IF 3.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-08-01 DOI: 10.1016/S1472-6483(24)00520-0
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引用次数: 0
期刊
Reproductive biomedicine online
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