Gynecology and Obstetrics Clinical Medicine最新文献

Background

Despite the intervention of free medical care services for street children by a dedicated clinic in Eldoret municipality, health care service of young street females (YSFs) is still deficient. The present study aimed to evaluate the impact of the community strategy package on the uptake of reproductive tract infections (RTI) health services among the target population.

Materials and methods

A pre-test-post-test quasi-experimental with a qualitative and quantitative approach was applied among the YSFs aged 10–24 years. The study used structured questionnaires and key informant interviews to collect data from the respondents.

Results

The study enrolled a total of 77 young street females in Eldoret municipality. A significantly higher proportion of respondents reportedly first sought treatment for RTI at a health facility after the implementation of the community strategy package (97.1%) when compared to the proportion of respondents who first sought treatment at a health facility in the pre-intervention phase (51.0%)(p＜0.001). Early seeking of treatment improved significantly after the introduction of the intervention; 72.0% and 94.1% of the respondents sought treatment early during the pre-intervention and post-intervention phase, respectively (p ​= ​0.011).

Conclusion

The study recommends the adoption of the community strategy as an intervention to increase the uptake of RTIs health services and promotion of the reproductive health of young street females.

Endometrial cancer is the most common gynecologic malignancy in developed countries. Pathologic confirmation of lymph node metastasis is important for risk stratification and the administration of adjuvant treatments. Therefore, comprehensive, systematic lymphadenectomy has been routinely performed but has been associated with various morbidities. Meanwhile, the concept of sentinel lymph node (SLN) mapping and biopsy has emerged and is now accepted as an alternative to conventional systematic lymphadenectomy in early-stage endometrial cancer. For better management of endometrial cancer, we conducted a literature review to summarize the role and diagnostic accuracy of the SLN mapping strategy in endometrial cancer. Evidence from the monumental and recent literature and ongoing clinical trials will be introduced.

Persistent infections with specific high-risk human papillomavirus (HR-HPV) strains are the leading cause of cervical cancer and precancerous lesions. HPV-16 and HPV-18 are associated with more than 70% of cervical cancer. However, with recent widespread vaccination efforts against cervical cancer, the infection rates of HPV-16 and HPV-18 have decreased across all age groups, while the infection rates of other HR-HPV strains have increased. The non-16/18 HR-HPV strains play an important role in cervical lesions. These strains can be identified with extended genotyping, and the 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines recommended an HPV-based testing to assess the risk of cervical disease in patients. We reviewed and analyzed the clinical benefits of applying extended HR-HPV genotyping, which was published by the International Agency for Research on Cancer (HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68), to cervical cancer screening. This review concluded that cervical cancer screening needs to include extended HR-HPV genotyping. The examination of extended HR-HPV genotyping in cervical intraepithelial lesions and cervical cancers can help guide clinical practices.

Brenner tumors is a very uncommon ovarian epithelial neoplasm, morphologically resembling the transitional cell neoplasm of urinary tract. It is further classified into three subtypes as a disease spectrum based on histological examination and tumorigenesis: benign Brenner tumors, borderline Brenner tumors (BBTs), and malignant Brenner tumors (MBTs). The etiology of these tumors is not well understood, and literature is limited due to the rarity of this entity, but recent advances, particularly in molecular alterations, have emerged. The scope of this review is to provide an update on the clinical, histopathological, and most recently, molecular characterizations of ovarian Brenner tumors.

Aim

To assess whether adverse pregnancy outcomes in women with adenomyosis are different according to the method of conception and the concurrent of uterine leiomyoma (UL).

Methods

We performed a retrospective study. Fifty-three singleton pregnancy cases complicated with adenomyosis were included in this study. In the study group, 15 women became pregnant with assisted reproductive technology (ART) and 21 women combined with UL. Pregnancy outcomes were compared between ART and non-ART, UL and non-UL groups.

Results

The prevalence for such complications as hypertensive disorder complicating pregnancy (HDCP)and postpartum hemorrhage (PPH)were significantly higher in the women conceived by ART (33.3% vs. 5.3%, P ​= ​0.023) and (53.3% vs. 23.7%, P ​= ​0.037),respectively. And women concurrent with UL of which the diameter≥4 ​cm were more likely to have severe PPH (44.4% vs. 0%, P ​= ​0.021).

Conclusion

ART may increase the risk of adverse pregnancy outcomes such as HDCP and PPH in women with adenomyosis and UL of which the diameter≥4 ​cm may further increase the risk of severe PPH.

Objective

To investigate the molecular classification of endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) patients treated with fertility-sparing treatment (FST), and its relationship with clinicopathological factors and treatment efficacy. Methods: A total of 52 ​EC and AEH patients who received FST and molecular classification tested by next generation sequencing in Peking University People's Hospital from June 2020 to December 2022, were retrospectively collected. We analyzed the relationship between molecular classification and clinicopathological factors and treatment outcomes.

Results

(1) Of the 52 patients, including 46 ​EC and 6 AEH patients, 42 (80.8%) achieved complete remission (CR) after FST, with a median time to achieve CR of 9 months. Ten cases (23.8%) had recurrence. (2) Patients were distributed into 4 molecular subgroups as 39 cases (75%) of copy number low (CNL) , 7 cases (13.5%) of microsatellite instability-high (MSI-H) , 4 cases (7.7%) of POLE mutations (POLEmut), and 2 cases (3.8%) of copy number high (CNH). Patients with MSI-H subgroup had more family history of tumor (6/7), more with loss of expression of mismatch repair (MMR) protein (7/7), and higher expression level of Ki-67 (3/3). (3) Patients with MSI-H subgroup had the lowest CR rate at 6 months (0/7, P ​= ​0.014), and survival analysis showed that such patients were less likely to achieve CR than those with CNL (P ​= ​0.022). For CNL patients, median 6-month CR rate was 40.6%. In addition, CR was obtained in 3 (3/4) POLEmut patients and 2 (2/2) CNH patients, respectively.

Conclusions

Molecular classification relates with the treatment response in patients with EC and AEH receiving FST. Patients with MSI-H subgroup have poor treatment efficacy, and patients with CNL need to be further divided to predict treatment benefit. There are also a few successful cases in POLEmut and CNH subtgroups, which needs further research.

Background

Little is known about potential urban-rural differences in adverse pregnancy outcomes. The purpose of this study is to look into the urban-rural differences in the trend of adverse maternal and neonatal outcomes.

Methods

We retrospectively assessed the pregnancy outcome of singleton pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 1st, 2020, and January 1st, 2022. Mothers were divided into two groups based on living residency: 1) urban groupand 2) rural group.Demographic factors, obstetrical factors, maternal comorbidities, and adverse maternal and neonatal outcomeswere extracted from the electronic data of each mother. The Chi-square testwas used to compare differences between the groups for categorical variables. Logistic regression models were used to assess the association of adverse pregnancy, childbirth, and neonatal outcome with living residency.

Results

Of 8888 mothers that gave birth during the study period, 2989 (33.6%) lived in rural areas. Adolescent pregnancy was more common in the rural area. Urban mothers had a higher education than rural mothers. Rural mothers were at higher risk for preterm birth aOR 1.81 (CI:1.24-2.99), post-term pregnancy aOR 1.5 (CI: 1.07-2.78), anemia aOR 2.02 (CI:1.07-2.34), low birth weight (LBW) aOR 1.89 (CI: 1.56-2.11), need for neonatal resuscitation aOR 2.66 (CI: 1.78-3.14), and neonatal intensive care unit (NICU) admission aOR 1.98 (CI:1.34-2.79). On the other hand, the risk of cesarean section was significantly lower compared to urban mothers aOR 0.58 (CI: 0.34-0.99).

Conclusions

Our study discovered that mothers living in rural areas had a higher risk of developing anemia, preterm birth, post-term pregnancies, LBW, need for neonatal resuscitation, and NICU admission, but a lower risk of cesarean section.

Background

Diagnosis of polycystic ovary syndrome (PCOS) depends on 2003 Rotterdam Criteria. According to these criteria there are four possible combinations resulting in various phenotypes. We aimed (i)to confirm that the levels of body mass index (BMI), anti-müllerian hormone (AMH) levels and insulin resistance (IR) are higher in PCOS patients and higher in phenotype-A among PCOS patients, and (ii)to determine cut-off values for the diagnosis of PCOS and phenotype-A.

Materials and methods

This study was conducted in an IVF Center, between November 2019 and January 2021. Data of infertile women participating in the study was evaluated retrospectively. Parameters such as menstruation pattern, clinical hyperandrogenism, age, BMI, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, thyroid stimulating hormone (TSH), prolactin, AMH, dehydroepiandrosterone sulphate (DHEA-S), fasting blood glucose, fasting insulin levels, antral follicle counts (AFC) and ovarian volumes were recorded for each patient. Women were grouped as PCOS and non-PCOS, and PCOS group was further divided into 4 sub-groups according to their phenotypes. Data of infertile patients with PCOS patients were compared with infertile non-PCOS patients and PCOS phenotypes were compared among each other.

Results

Data of 244 infertile patients was included in the study. BMI, AMH, AFC, and HOMA-IR were statistically higher in PCOS patients, compared to non-PCOS patients. We found the AMH level of >3.105 ​ng/ml to be having 90.8% sensitivity and 90% specificity to diagnose a patient as PCOS. Among different phenotypes, also BMI, AMH, and insulin resistance index (HOMA-IR) levels were significantly higher in infertile PCOS phenotype-A when compared to other three phenotypes (p:0.003, p:0.000, and p:0.000, respectively). The AMH cut-off value to estimate phenotype-A was found as 6.095 ​ng/ml with 69.2% sensitivity and 86.7% specificity. We did not found threshold levels of BMI and HOMA-IR with high sensitivity to identify phenotype-A.

Conclusion

Properly diagnosing PCOS and determining the phenotype are crucial due to the long-term health conditions. Therefore, we suggest that serum AMH level could be included in PCOS diagnosis criteria, and the value of 3.105 ​ng/ml would have a 90.8% sensitivity and 90% specificity. Also, to identify phenotype-A, AMH level could be used. Therefore, we speculate that AMH may serve to identify PCOS and PCOS phenotype-A in places where ultrasound imaging is not straightforward to perform or not easily accessible.