Gynecology and Obstetrics Clinical Medicine最新文献

Coronavirus disease 2019 (COVID-19) predilection for angiotensin-converting enzyme 2 (ACE2) receptors allows its entrance and replication; however, they are not biochemically required for viral fusion into the cell membrane. Testicular tissue has abundant ACE2 receptors, making it a target for the COVID-19 virus. Seminal fluid parameters are measures of male fertility. Changes in semen parameters have been caused by coronavirus disease and vaccines. Some attribute that effect to direct hematogenic spread to the testis; others propose that the excessive immunological response triggered by the infection causes a deleterious effect. An unsubstantiated claim questioned whether the SARS-CoV-2 vaccine could trigger an unintentional immunological response that would impair male fertility once receiving the vaccine. Extensive research confirms the transient nature of those changes that affect sperm motility and count with full recovery post-COVID-19 infection and after vaccination. The vaccine's safety was reaffirmed; however, there are currently no recommendations for screening sperm donors. Research is warranted to guarantee the safety of couples undergoing assisted reproduction.

Background

An affordable approach accepted worldwide to successfully treat mild maternal hyperglycemia in gestational diabetes (GDM), is diet-controlled therapy. As no elaborate research was available, this study was crafted to investigate morphometric stereological details and to determine the mean placental oxygen diffusion capacity for patients who were kept on diet therapy for mild gestational hyperglycemia.

Methods

A clinical trial (NCT04907708) was conducted from January 2018 to February 2019. A total of 70 women completed the study, out of which 35 served as healthy controls as Group A and 35 were diagnosed as mild gestational diabetics according to WHO criteria (Group B). These patients were kept on a restricted calorie diet with light exercise during gestation and were followed regularly during gestation. Soon after delivery, conserved placentas underwent complete gross, microscopic, and stereological investigations with the point and intersection -counting methods.

Results

Significant differences were observed for placental width and syncytial knots (p＜ ​0.010 and 0.025 respectively) between the groups on gross and light microscopy. Most of the parameters were non-significant, though numerically more in the GDM group. On stereological details, mean placental volume, mean placental components volumes (villi, inter-villous space, fetal capillary, and fetal connective tissue), mean villi and mean fetal capillary diameter, mean villi and capillary surface density and mean morphometric diffusing capacity of placenta showed non-significant results between the groups.

Conclusion

Minimal changes were observed in gross, microscopy, and morphometric stereological details in the placentae of GDM patients managed with nutritional therapy during gestation compared with the healthy controls.

Background

Maternal infection by SARS-CoV-2 may lead to adverse pregnancy outcomes and causes pathological changes in the placenta. However, consensus regarding characteristic pathological features is lacking. Researchof the placental histopathology in a cohort of women from Mizoram, India, was conducted to relate the SARS-CoV-2 infection's effectswith pregnancy and its outcome.

Materials and methods

The characteristics of 72 pregnant women diagnosed positive for SARS-CoV-2 who eventually delivered at Zoram Medical College Hospital, Mizoram, neonates’ well-being, and histopathological features of placentas were studied.

Results

Of 72 women in this study, 59 (81.9%) gave birth at full term. Among these births, 5 were normal vaginal deliveries, while the remaining 67 (93.1%) were delivered via cesarean section. The reasons for cesarean delivery were either related to SARS-CoV-2 infection (n ​= ​49), existing obstetric problems (n ​= ​15) or fetal-distress (n ​= ​5). All deliveries resulted in live births of COVID-negative babies, with 80.6% (n ​= ​58) of the newborns having a birth weight of over 2.5 ​kg. APGAR scores ranged from 4 to 6 in 61 (84.7%) of the babies, and 10 neonates required resuscitation, of which 8 were managed in the neonatal intensive care unit (NICU). The placental histopathology showed increased fibrin thrombi in 8 cases (11.1%), while 20 cases (28%) showed focal infarction, microcalcification levels were elevated in 16 cases (22.2%), and a small percentage of cases (1.4%) exhibited small fibrotic villi and inter-villus agglutination. Placental chorioangiosis was detected in 28 (38.9%) of the cases, while avascular villi were seen in 6 cases. Meconium-stained liquor was observed in a single case. Intervillous hemorrhage was found in 42 cases, whileintervillous inflammation and increased syncytial knots were present in 14 and 5 cases, respectively. The placenta pathology of 10 neonates who required resuscitation/NICU admission was not significantly different from that of the 62 neonates who did not require it. However, a higher proportion of placenta from the asymptomatic group showed no abnormality compared to the symptomatic group (p ​= ​0.046).

Conclusion

SARS-CoV-2 infection causes a range of morphological changes and lesions in the placenta, including chorangiosis, villositis, chorioamnionitis, fetal vascular malperfusion/thrombosis, fibrin-deposition, increased syncytial-knotting, increased microcalcification, increased villous agglutination, focal infarct, intervilloushemorrhage as well as inflammation. Placental histopathological findings from this study can provide additional information to the existing literature on the subject.

Introduction

Congenital heart disease (CHD) is one of the most common congenital malformations, and is a polygenic disease related to some major genes and involved in environmental factors. With the progress of science and technology, the progress was both in the studies of genetic patterns and testing methods. Understanding how each gene participates in normal and pathological anatomy is an important goal of CHD research. We reviewed the development of testing methods and CHD-related genes, to provide some enlightenment for the CHD prenatal diagnosis and hope to realize the intervention and treatment on the gene level of CHD in the future.

Background

Hypertensive disorders of pregnancy (HDP) are among obstetrics' most intriguing and yet unsolved problems. It is one of the major causes of maternal and perinatal morbidity and mortality. This study estimates the prevalence of hypertensive disorders of pregnancy, their associated risk factors and pregnancy complications in primiparous women.

Methods

All primigravida who gave birth in our hospital from December 2020 to December 2021 were included in the study. The prevalence, risk factors, mode of delivery, and maternal and fetal outcomes of hypertensive disorders of pregnancy in primigravidae were collected from the patient's medical records. Statistical analysis was done using the SPSS 18.0 software package. The Chi-square test was used to analyse the association between the risk factors and hypertensive disorders of pregnancy in primigravida.

Results

A total of 807 women were included in the study, and the mean age was 26.34 ​± ​3.84 years. The prevalence of hypertensive disorders of pregnancy in primigravidae was found to be 18.6%. Among the prevalent population, 79.3% of women had gestational hypertension. The findings indicate that hypertension in pregnancy has a significant relationship with risk factors such as increased maternal age (p ​< ​0.004), family history of hypertension in pregnancy (p ​< ​0.001), body mass index >30 ​kg/m²(p ​< ​0.001), hyperglycaemia in pregnancy (p ​< ​0.001), IVF pregnancy (p ​< ​0.004) and polycystic ovary syndrome (p ​< ​0.001). The most reported adverse maternal and perinatal outcomes were placental abruption (p ​< ​0.001), postpartum haemorrhage (p ​< ​0.001), prematurity (p ​< ​0.001), and fetal growth restriction (p ​< ​0.001).

Conclusion

The study emphasises the importance of knowledge and timely assessment of risk factors of HDP. It also highlights the need for pre-conceptional counselling, which includes early detection, careful monitoring and treatment of HDP for preventing morbidity and mortality related to this disorder and it should be followed up even in the postpartum period.

Objective

To investigate the clinical characteristics, management, and prognosis of deep vein thrombosis (DVT) during early pregnancy.

Methods

We conducted a retrospective study among women with DVT during their first trimester of pregnancy who were admitted to the obstetrics department of Peking University People's Hospital between March 2008 and May 2021.We analyzed clinical data of eight patients, including their general condition, obstetric characteristics, diagnosis, treatment, and gestational outcomes.

Results

Risk factors for DVT in the first trimester included personal history of DVT, thrombophilia and immune diseases, and DVT was more likely to affect the left leg. The main manifestation of DVT was pain or swelling of the affected limbs. D-dimer levels after anticoagulant treatment showed a downward trend compared with those before treatment (P ​= ​0.09), while D-dimer levels increased significantly after delivery compared with those before delivery (P ​= ​0.03). All the patients started on low-molecular-weight heparin (LMWH) therapy after a diagnosis of DVT. Temporary inferior vena cava (IVC) filters were implanted in 3 patients with mixed thrombosis before delivery, but were removed after the operation. Except for 1 case with thrombophilia who refused treatment, others underwent anticoagulation therapy from 6 weeks to 1 year postpartum. Seven patients achieved a successful delivery with live births.

Conclusion

During early pregnancy, DVT was more common in women with maternal risk factors. More cases of venous thromboembolism (VTE) were observed in the left leg. For women with a high risk of DVT, medical intervention, early identification, accurate diagnosis and precise treatment during early pregnancy should be promoted.

Background

Differentiated vulvar intraepithelial neoplasia (dVIN) is a non-human papilloma virus (HPV)-related high-grade precursor lesion to vulvar squamous cell carcinoma (vSCCa). Although TP53 gene mutations have been identified in 80% of dVIN, its role in dVIN pathogenesis as well as malignant transformation is still being poorly understood. Poor reproducible diagnostic criteria and ambiguous p53 immunostaining patterns, along with morphologic discordance still pose a diagnostic challenge.

Methods

A series of 60 cases of dVIN-related vSCCa along with adjacent dVIN were evaluated. Clinicopathological features as well as immunohistochemical results were recorded on the resection-confirmed dVIN-related vSCCa.

Results

The average age of the patients was 71 years. Thirty-five cases (58.4%) of dVIN-related vSCCa were moderately differentiated, fourteen cases (23.3%) were poorly differentiated, and the remaining eleven cases (18.3%) were well-differentiated. Twenty-nine cases (48.3%) were found to have lichen sclerosus adjacent to dVIN. In terms of p53 and p16 expression in dVIN-related vSCCa and the adjacent dVIN, fifty-five (91.7%) dVIN showed mutant p53 immunostaining pattern with strong positive expression in 80% cases (basal/para-basal expression) and null pattern expression in 11.7% cases. Five (8.3%) dVIN showed p53 wild-type staining pattern. The wild-type pattern were seen in 5% of vSCCa and p53 null pattern were seen in 13.3% vSCCa. Six cases demonstrated atypical staining patterns: two cases showed p53 null expression in dVIN but p53 overexpression in invasive carcinoma; three cases exhibited p53 null expression in invasive carcinoma, with the adjacent dVIN showing basal and para-basal mutant (2 cases) and wild-type (1 case) p53 expression patterns. A single case demonstrated p53 wild-type pattern in dVIN and overexpression in invasive carcinoma. In addition, 65% dVIN were p16 negative and 31.7% dVIN had patchy p16 staining.

Conclusion

Clinical and prognostic value of the ambiguous/inconsistent patterns are uncertain and molecular studies are needed for further characterization.

Genetic abnormalities, such as PTEN, PIK3CA, CTNNB1, ARID1A, and ERBB2, which frequently occur in endometrial cancer (EC), are potential therapeutic targets. In 2013, integrated genomic analysis conducted by The Cancer Genome Atlas identified four molecular subtypes, including POLE ultra-mutated, microsatellite instability hypermutated, copy-number low, and copy-number high, which strongly correlate with prognosis. Surrogate markers-based molecular classification methods have been developed to make these molecular classifications accessible and affordable, achieving classification into POLEmut, mismatch repair deficient (MMRd), p53abn, and no specific molecular profile (NSMP) with normal p53 expression. Although POLEmut EC has aggressive pathologic features, there are few cases of advanced and/or recurrence. Therefore, the possibility of de-escalating adjuvant therapy can be considered. Additionally, immune checkpoint inhibitors (ICI) may be a candidate for treating advanced and recurrent POLEmut EC because of their high immunogenicity. MMRd EC shows an intermediate prognosis between those of POLEmut and p53abn EC. MMRd EC is generally characterized by high immunogenicity similar to POLEmut EC, suggesting that ICI can also be a potential therapeutic agent. Among the four molecular subtypes, p53abn EC has the worst prognosis. However, some p53abn tumors have the molecular hallmark of homologous recombination deficiency and could be treated with poly (ADP-ribose) polymerase inhibitors. In addition, some p53abn tumors overexpress the human epidermal growth factor receptor 2, which can also be a potential therapeutic target. NSMP EC are a heterogeneous population because they lack characteristic molecular biological features. Approximately half of the NSMP EC show high expression of estrogen receptor/progesterone receptor, suggesting the possibility of hormonal therapy. In addition, the PI3K/AKT/mTOR pathway frequently altered in EC may be a therapeutic target. This review summarizes the molecular biological characteristics and potential therapeutic agents in molecularly featured EC. Several clinical trials are in progress to stratify EC into molecular classifications and demonstrate the efficacy and safety of molecularly matched treatment and management strategies.