Gynecology and Obstetrics Clinical Medicine最新文献

Objective

To assess the impact of advanced maternal age on pregnancy and childbirth outcomes of singleton pregnancies.

Study design

We retrospectively assessed singleton pregnant mothers who gave birth at Khaleej-e-Fars Hospital in Bandar Abbas, Iran, from January 2020 to January 2022. Demographic and obstetrical factors include educational level, medical insurance, residency place, access to prenatal care facilities, number of prenatal care visits, smoking status, gestational age, parity, infertility, maternal comorbidities, preeclampsia, eclampsia, preterm birth, low birth weight (LBW), intrauterine growth restriction (IUGR), macrosomia, placenta abnormalities (previa/acreta), placenta abruption, chorioamnionitis, meconium fluid, fetal distress, methods of delivery, rate of cesarean section (CS), perineal lacerations, postpartum hemorrhage, childbirth injury, shoulder dystocia, congenital malformation, neonatal asphyxia, and unfavorable maternal and neonatal outcome were compared between two groups. The Chi-square test assessed the relationship between categorical factors and maternal age groups. The influence of advanced maternal age on the risk of unfavorable pregnancy outcomes was evaluated using bivariate and multivariate logistic regression.

Results

Of 8354 singleton deliveries, 22.2% belonged to advanced-age mothers. Advanced-age mothers had less education than those aged 20–34 years old. Chronic hypertension, cardiovascular disease, overt diabetes, and thyroid dysfunction were more prevalent among advanced-age mothers. Compared with mothers aged 20–34 years, mothers aged 35 years and higher had a significantly higher risk of gestational diabetes (aOR: 3.18, 95%CI: 1.56–6.95), preeclampsia (aOR: 2.91, 95%CI: 1.35–4.72), placenta abnormalities (aOR: 1.09, 95%CI: 0.77–1.94), CS (aOR: 3.16, 95%CI: 1.51–3.87), postpartum hemorrhage (aOR: 1.94, 95%CI: 1.24–2.61), intensive care unit admission (aOR: 1.36, 95% CI: 1.15–1.99), LBW (aOR: 1.35, 95%CI: 0.97–2.96), preterm birth (aOR: 2.36, 95%CI: 1.65–4.83), stillbirth (aOR: 1.18, 95%CI: 1.01–3.16), and neonatal intensive care admission (aOR: 2.09, 95%CI: 0.73–3.92). According to bivariate regression, the risk of meconium fluid was lower in advanced-age mothers; however, the result of multivariate logistic regression found no correlation between advanced age and the Incidence of meconium fluid.

Conclusion

Advanced-age mothers are at increased risk of adverse pregnancy and childbirth outcomes, which persist even after adjusting for several potential confounders.

Background

Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility. Clomiphene citrate, insulin-sensitizing drugs, aromatase inhibitors, gonadotropins, or laparoscopic ovarian drilling are various methods used for ovulation induction in women with PCOS. PCOS women with high levels of anti-mullerian hormone (AMH) and free androgen index (FAI) do not respond well to ovulation induction. This prospective observational study explores the relationship between FAI and AMH levels on ovarian response to clomiphene citrate in infertile women with PCOS.

Methods

This prospective observational study included 40 infertile with PCOS who underwent ovulation induction with clomiphene citrate with dose ranging from 50 to 150 ​mg. Participants were classified into four phenotypes by NIH(National Institute of Health) consensus panel criteria. The clinical and endocrine parameters of participants who were sensitive to clomiphene were compared to those who were resistant.

Results

The most common phenotype was A, with all three features of PCOS: hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. There was no significant difference in clinical and endocrine parameters among the different phenotypes of PCOS except AMH and FAI values. The mean FAI was 9.39 ​± ​1.11 and AMH 7.26 ​± ​0.48 (ng/ml) in clomiphene resistant and 5.31 ​± ​1.93 and 3.69 ​± ​1.84 (ng/ml) respectively in clomiphene-sensitive women. Women with FAI > 7.5 and AMH >7 ​ng/ml might be resistant to clomiphene.

Conclusion

FAI and AMH values were significantly higher in women resistant to clomiphene induction. AMH and FAI may help women with PCOS to tailor their ovulation induction protocol.

Objective

To study the factors associated with premenstrual syndrome (PMS) in emergency department (ED) nurses.

Methods

A multicenter cross-sectional study was conducted in female ED nurses in China. Data gathering questionnaires included the Daily Record of Severity of Problems, Chinese Nurses Stressor Scale, Social Support Rating Scale, and Self-Rating Anxiety Scale. All questionnaires were used to assess the symptoms prospectively over 2 months.

Results

A total of 289 ED nurses were recruited. The incidence of PMS was 67.47%. The most common symptoms were tiredness (76.90%), anger (76.90%), restlessness (75.40%), snoring (69.20%). Univariate analysis showed that the BMI and occupational stress score was significantly higher, and the age was significantly younger in the PMS group compared with the non-PMS group. According to the multiple linear regression, the symptoms of PMS were positively associated with the occupational stress score and anxiety score, and negatively with the level of education received.

Conclusions

occupational stress, anxiety, and education level may associated with the occurrence of PMS in ED nurses.

After decades of research, we still face great challenges on endometriosis in terms of diagnosis and management. Serum CA125 has been used in the clinical practice in endometriosis, and many large-scale clinical trials have been conducted or are underway to determine potential use of serum CA125 levels in endometriosis. In this article, relevant articles that addressed endometriosis associated with CA125 were searched for and retrieved from the databases PubMed, Embase and the Cochrane Library. Here we provide an in-depth literature review to depict CA125 dynamic expression in female reproductive tract and to highlight the practical value of CA125 in diagnosing endometriosis, distinguishing the severity of the disease, monitoring the effect of treatment and reflecting malignant transformation. So far, the development of a risk stratification system based on biomarker CA125 for endometriosis may help clinicians in making novel and more efficient strategies for the detection and treatment of endometriosis. In order to improve CA125 specificity and sensitivity, further research is needed to determine its diagnostic cut-off value.

Endometrial cancer (EC) is the fourth common cancer in women worldwide with its incidence rising each year. 10%–15% young patients are diagnosed of EC. For patients of childbearing age with early endometrial cancer or atypical hyperplasia, it is necessary to consider surgical removal of uterus after they have given birth. It is a big challenge for reproductive doctors and oncologists to help such patients get pregnant safely as soon as possible. In this article, we will review the latest progress in conservative treatment and candidates for fertility preservation, application of molecular detection, the fertility outcome and follow-up treatment which aims to stimulate more thinking.

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder in women of reproductive age, and its pathogenesis is still unclear. More and more studies have shown that PCOS patients were often accompanied by obesity, insulin resistance and chronic, low-grade inflammation, which were closely related to the endometrial dysfunction. Besides, obesity and insulin resistance also exacerbate inflammatory responses. Therefore, this review provides a summary of the effects of immune cells and inflammatory cytokines on the immune microenvironment of PCOS endometrium, and the impacts of obesity and insulin resistance on endometrial inflammatory homeostasis and possible drug interventions.

Aims

This research aims to explore the factors related to early spontaneous miscarriage after in vitro fertilization and embryo transfer (IVF-ET) pregnancy, and to provide guidance for improving pregnancy outcomes.

Methods

We retrospectively analyzed the data for clinical pregnant women (2591 cycles) undergoing IVF-ET at the reproductive center of Peking University People’s Hospital from January 2017 to December 2018; This included 544 ​ET cycles and 2047 frozen embryo transfer cycles. The analysis of factors associated with early miscarriage in the overall population of IVF/intracytoplasmic sperm injection (ICSI) pregnancies (including fresh and thawing cycles) was performed.

Results

The risk of early miscarriage in the 35–39 age group was 1.35 times higher than that in the <35 age group (OR ​= ​1.35 [1.05,1.73], p ​= ​0.02). In addition, the risk of early miscarriage was 3.88 times higher in the group ≥40 years old than in the group <35 years old (OR ​= ​3.88 [2.68,5.62], p ​< ​0.001). Endometrial thickness also affected the miscarriage rate; the early miscarriage risk with endometrial thickness ≥8.5 ​mm was 0.78 times than that of the <8.5 ​mm group (OR ​= ​0.78 [0.62,0.98], p ​= ​0.03). The early miscarriage rate during frozen embryo transfer was 1.48 times higher than that during fresh embryo transfer (OR ​= ​1.48 [1.08,2.02], p ​= ​0.01), while in the fresh cycle, the risk of early miscarriage with high-quality embryos was 0.5 times lower than that with non-high quality embryos (OR ​= ​0.5 [0.27,0.9], p ​= ​0.02). In the frozen cycle, the risk of early miscarriage in natural cycle transplantation was 0.73 times that in hormone replacement treatment (HRT) cycle transplantation (OR ​= ​0.73 [0.54,0.97], p ​= ​0.03) .

Conclusions

Advanced age is an independent risk factor for early miscarriage, while endometrial thickness at the date of transplantation is an independent protective factor. The risk of early miscarriage in fresh-cycle transplanted embryos is significantly lower than that in frozen embryos, and the number of high-quality embryos in the fresh cycle lowers the miscarriage rate significantly. Natural cycle transplantation has a lower rate of early miscarriage than hormone replacement therapy.