European Journal of Obstetrics and Gynecology and Reproductive Biology: X最新文献

英文中文

Vaginal NOTES adnexal surgery: Results of a retrospective cohort study in The Netherlands 阴道附体手术：荷兰一项回顾性队列研究的结果

IF 1.7 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X

Pub Date : 2025-08-05 DOI: 10.1016/j.eurox.2025.100422

Rebecca Henschen , Anouk J.M. Bus , Nicol A.C. Smeets , Marlies Y. Bongers , Martine M.L.H. Wassen

Objective

Vaginal natural orifice transluminal endoscopy (vNOTES) is a minimally invasive technique gaining popularity for several gynaecological procedures. This study presents the first 81 adnexal cases, performed in The Netherlands.

Design, setting, participants, and intervention

This retrospective cohort study included patients who underwent vNOTES adnexal surgery for benign indications at Zuyderland Medical Centre between March 2020 and August 2024. Baseline characteristics, surgical outcomes, and per- and postoperative outcomes were analysed. Two expert vaginal and endoscopic gynaecological surgeons performed all procedures.

Results

A total of 81 patients underwent adnexal surgery using vNOTES. Indications were definitive contraception (60.5 %; n = 49), ovarian cysts (18.5 %; n = 15), risk-reducing surgery for gene mutation carriers (16.0 %; n = 13), ectopic pregnancy (3.7 %; n = 3), and request for artificial menopause due to complaints (1.2 %; n = 1). Procedures performed were bilateral salpingectomy (60.5 %; n = 49), bilateral salpingo-oophorectomy (28.4 %; n = 23), unilateral salpingo-oophorectomy (4.9 %; n = 4), unilateral salpingectomy (3.7 %; n = 3), unilateral ovariectomy (1.2 %; n = 1), and unilateral salpingo-oophorectomy with unilateral salpingectomy (1.2 %; n = 1). The mean surgical time was 38.7 min (SD 17.9 min), with a mean blood loss of 26 mL (SD 42.4 mL). There was one (1.2 %) conversion to laparoscopy, and two (2.5 %) intra-operative complications without re-interventions. Most patients (88.8 %) were treated in a day-care setting. Four postoperative complications (4.9 %) were reported within six weeks after surgery.

Conclusion

This study shows that vNOTES is a safe and feasible, less invasive and scarless alternative to laparoscopic and open surgery for benign adnexal pathology. More evidence is needed to compare vNOTES adnexal surgery with laparoscopy.

Summation

vNOTES is a safe and feasible, less invasive alternative without abdominal scars compared to laparoscopic and open abdominal surgery for benign adnexal pathology.

目的阴道自然孔腔内窥镜（vNOTES）是一种微创技术，在许多妇科手术中越来越受欢迎。本研究介绍了在荷兰进行的首批81例附件病例。设计、环境、参与者和干预本回顾性队列研究包括在2020年3月至2024年8月期间在Zuyderland医疗中心因良性适应症接受vNOTES附件手术的患者。分析基线特征、手术结果、术前和术后结果。两名专家阴道和内窥镜妇科外科医生进行了所有手术。结果81例患者采用vNOTES进行了附件手术。适应症为明确避孕(60.5 %；N = 49)，卵巢囊肿(18.5 %；N = 15)，基因突变携带者的降低风险手术(16.0 %；N = 13)，异位妊娠(3.7 %；N = 3)，因抱怨要求人工绝经(1.2 %；n = 1)。手术包括双侧输卵管切除术(60.5 %；N = 49)，双侧输卵管卵巢切除术(28.4 %；N = 23)，单侧输卵管卵巢切除术(4.9 %；N = 4)，单侧输卵管切除术(3.7 %；N = 3)，单侧卵巢切除术(1.2 %；N = 1)，单侧输卵管卵巢切除术合并单侧输卵管切除术(1.2 %；n = 1)。平均手术时间38.7 min (SD 17.9 min)，平均失血量26 mL （SD 42.4 mL）。有1例（1.2 %）转为腹腔镜检查，2例（2.5 %）术中并发症，无再次干预。大多数患者（88.8% %）在日托环境中接受治疗。术后6周内出现4例术后并发症（4.9 %）。结论vNOTES是一种安全可行、创伤小、无疤痕的替代腹腔镜和开放手术治疗良性附件病变的方法。比较vNOTES附件手术与腹腔镜手术需要更多的证据。总结：与腹腔镜和开腹手术相比，vnotes是一种安全可行、无腹部疤痕的微创手术。

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引用次数: 0

Contraceptive use among post-abortion women in France: A quantitative study 法国堕胎后妇女避孕药具的使用：一项定量研究

IF 1.7 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X

Pub Date : 2025-07-22 DOI: 10.1016/j.eurox.2025.100419

Matthieu Calafiore , Charlotte Lebreton , Judith Ollivon , Marc Bayen , Nassir Messaadi , Sabine Bayen

Background

Voluntary termination of pregnancy (VTP) is a subject of ongoing debate throughout the world. The number of abortions continues to rise each year, with 234,300 recorded in France in 2022. This study aims to quantitatively assess changes in contraceptive methods before and after abortion among women in the Hauts-de-France region with a view to improving their care, promoting their sexual well-being and reducing the number of repeat abortions.

Method

A quantitative, retrospective, descriptive study was carried out using the records of women followed up by general practitioners in Hauts-de-France. The study ran from 15 March 2024–3 September 2024.

Results

A total of 63 questionnaires were analysed. Most participants were women aged between 26 and 35, living with a partner. Before the abortion, 56.3 % of the women were not using any contraception. After the abortion, 70.5 % of women changed their contraceptive method immediately, and 25 % did so within six months of the abortion. After the abortion and at 6 months, the results were stable overall, with most women choosing Long-Acting Reversible Contraception, but 11 % (n = 7) remaining without any contraception. Of the participants, 12 % (n = 7) had a repeat abortion, of whom 4 were using the pill, 1 was on a copper IUD, and 2 were not using any contraception.

Conclusion

After an abortion, most women opt for a contraceptive method, mainly implants and IUDs. It is important that every woman receives adequate information to make informed choices about family planning.

自愿终止妊娠（VTP）是世界范围内一个持续争论的话题。堕胎数量每年都在增加，2022年法国有234300例堕胎。这项研究的目的是定量评估上法兰西地区妇女堕胎前后避孕方法的变化，以期改善她们的护理，促进她们的性健康和减少重复堕胎的次数。方法采用上法兰西省全科医生随访的妇女病历进行定量、回顾性、描述性研究。研究时间为2024年3月15日至2024年9月3日。结果共分析问卷63份。大多数参与者是年龄在26到35岁之间的女性，与伴侣住在一起。流产前，56.3% 的妇女未采取任何避孕措施。堕胎后，70.5% %的妇女立即改变了避孕方法，25% %的妇女在堕胎后6个月内改变了避孕方法。流产后6个月，结果总体稳定，大多数妇女选择长效可逆避孕，但11% % （n = 7）仍未采取任何避孕措施。在参与者中，12 % （n = 7）有重复流产，其中4人使用避孕药，1人使用铜宫内节育器，2人未使用任何避孕措施。结论流产后，大多数妇女选择避孕方法，主要是植入物和宫内节育器。重要的是，每个妇女都应获得充分的信息，以便对计划生育作出知情的选择。

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引用次数: 0

Trigonometric characteristics of episiotomy & pregnancy variables 会阴切开术与妊娠变量的三角函数特征

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X

Pub Date : 2025-07-05 DOI: 10.1016/j.eurox.2025.100418

Richa Chouksey , Sai Snehitha Veluguleti , Deeksha Pandey

Introduction

Episiotomy, though simple and most common surgical procedure performed in labour theatre, has a lot of bearing on patients’ recovery postpartum. The episiotomy angle and length can influence probability of anal sphincter trauma, ease of delivery and post-delivery recovery in variable ways. We hypothesize that a universal measure of angle (60°) and length might not be ideal for all women. This aim of this cohort study was to establish association of episiotomy trigonometric characteristics (length and angle) with antepartum, intrapartum and postpartum factors.

Material & methods

A total of 504 pregnant women who delivered with an episiotomy after 34 weeks of gestation were included. Antenatal, intrapartum, and postpartum variables were collated. These women were examined for episiotomy length, angle, signs of infection/inflammation and pain using Visual Analogue Scale (VAS). All of them were followed up till they were discharged frm the hospital.

Results

A smaller episiotomy angle (<15°) was associated with significantly higher VAS score as compared to angle 35°-40°. We observed that as birth weight increases, mean episiotomy length and angle progressively increases. Longer head circumference was associated with longer length of episiotomies (p < 0.01). Instrumental deliveries were associated with higher length and angle of episiotomy.

Conclusion

We observed a relationship of trigonometric characteristics of episiotomy with variables like birth weight and HC. We feel the angle and length of episiotomy cannot be defined as a universal constant. It depends of maternal and fetal variables. We propose that episiotomy should be tailored for every patient to achieve the most optimal result for her.

Synopsis

This study reflects episiotomy practice at a tertiary care hospital. We must conduct larger studies to evaluate variables that influence the trigonometric characteristics of episiotomy.

会阴切开术是产房最常用的简单手术，但对患者的产后恢复有很大的影响。会阴切开术的角度和长度对肛门括约肌损伤的概率、分娩难易程度和产后恢复有不同的影响。我们假设，一个通用的角度（60°）和长度测量可能并不适合所有女性。本队列研究的目的是建立会阴切开术三角特征（长度和角度）与产前、产时和产后因素的关系。材料,方法对妊娠34周后行外阴切开术分娩的孕妇504例进行分析。整理了产前、产时和产后的变量。使用视觉模拟评分（VAS）检查这些妇女的会阴切开术长度、角度、感染/炎症迹象和疼痛。对他们所有人进行了随访，直到他们出院。结果与35°~ 40°角度相比，较小的会阴切开角度（15°）VAS评分明显较高。我们观察到随着出生体重的增加，平均会阴切开长度和角度逐渐增加。较长的头围与较长的会阴切开术长度相关（p <； 0.01）。器械分娩与会阴切开术的长度和角度有关。结论观察了会阴切开术的三角函数特征与出生体重、HC等变量的关系。我们认为，会阴切开术的角度和长度不能被定义为一个普遍的常数。这取决于母体和胎儿的变量。我们建议，外阴切开术应该为每个病人量身定制，以达到最理想的结果。本研究反映了一家三级医院会阴切开术的实践。我们必须进行更大规模的研究来评估影响会阴切开术三角特征的变量。

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引用次数: 0

Fetal MRI study of brain differences in early-onset fetal growth restriction versus healthy controls at 30 weeks of gestation 妊娠30周时早发性胎儿生长受限与健康对照组脑差异的胎儿MRI研究

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X

Pub Date : 2025-07-03 DOI: 10.1016/j.eurox.2025.100417

Lotte Meijerink , Inge van Ooijen , Fieke Terstappen , Thomas Alderliesten , Rutger A.J. Nievelstein , Femke Lammertink , Manon Benders , Mireille Bekker

Objective

To identify volumetric and diffusion-related brain differences expressed as apparent diffusion coefficient (ADC) values between early-onset brain-sparing fetal growth restriction (FGR) and healthy controls using magnetic resonance imaging (MRI) at 30 weeks of gestation.

Method

This prospective, observational, monocenter cohort study included singleton pregnancies with early-onset brain-sparing FGR at the University Medical Center Utrecht. FGR fetuses were compared to healthy controls from the Utrecht YOUth Cohort. Fetal MRI of the brain was performed including T2-weighted and diffusion weighted imaging (DWI) sequences. We measured 2D biometrics, 3D volumetrics using BOUNTI, and ADC values in multiple brain and placental regions. Values were corrected to 30 weeks of gestation.

Results

The study included 26 FGR fetuses at gestational age (GA) 26.3–32 weeks and 71 controls at GA 30.1–34 weeks. At 30 weeks, total brain volume (TBV) was significantly smaller in FGR (144.2 ± 11.5 vs 166.9 ± 17.5 milliliters, p < 0.001). After dividing all absolute volumes by TBV, only cerebellar volume remained significantly reduced (0.045 [0.00] vs 0.048 [0.01], p = 0.006). ADC values were lower in all brain regions except the cerebellum. Placental ADC values were also significantly lower in FGR.

Conclusion

Altered brain development in brain-sparing FGR is already present at 30 weeks of gestation. Lower brain volumes and ADC values may reflect the effects of altered perfusion, chronic hypoxia and microstructural changes in the brains of FGR fetuses. Future studies linking these MRI findings to long-term neurodevelopmental outcomes will aid in more personalized prognoses and might also inform the timing of delivery, ultimately enhancing clinical decision-making.

目的利用磁共振成像（MRI）技术，探讨孕30周早期脑保留胎儿生长受限（FGR）与健康对照组脑容量和弥散相关差异（ADC值）。方法这项前瞻性、观察性、单中心队列研究纳入了乌得勒支大学医学中心早发性脑保留FGR的单胎妊娠。将FGR胎儿与来自乌得勒支青年队列的健康对照进行比较。胎儿脑MRI包括t2加权和弥散加权成像（DWI）序列。我们测量了2D生物特征，使用BOUNTI测量了3D体积，以及多个脑和胎盘区域的ADC值。数值修正为妊娠30周。结果本研究纳入26例胎龄26.3 ~ 32周的FGR胎儿和71例胎龄30.1 ~ 34周的对照组。在30周时，FGR的总脑容量（TBV）明显较小（144.2 ± 11.5 vs 166.9 ± 17.5毫升，p <； 0.001）。将所有绝对容积除以TBV后，只有小脑容积仍显著减少（0.045 [0.00]vs 0.048 [0.01], p = 0.006）。ADC值在除小脑外的所有脑区均较低。FGR组胎盘ADC值也显著降低。结论保脑FGR在妊娠30周时已出现脑发育改变。较低的脑容量和ADC值可能反映了FGR胎儿大脑灌注改变、慢性缺氧和微结构改变的影响。未来的研究将这些MRI结果与长期神经发育结果联系起来，将有助于更个性化的预后，也可能为分娩时机提供信息，最终增强临床决策。

{"title":"Fetal MRI study of brain differences in early-onset fetal growth restriction versus healthy controls at 30 weeks of gestation","authors":"Lotte Meijerink , Inge van Ooijen , Fieke Terstappen , Thomas Alderliesten , Rutger A.J. Nievelstein , Femke Lammertink , Manon Benders , Mireille Bekker","doi":"10.1016/j.eurox.2025.100417","DOIUrl":"10.1016/j.eurox.2025.100417","url":null,"abstract":"<div><h3>Objective</h3><div>To identify volumetric and diffusion-related brain differences expressed as apparent diffusion coefficient (ADC) values between early-onset brain-sparing fetal growth restriction (FGR) and healthy controls using magnetic resonance imaging (MRI) at 30 weeks of gestation.</div></div><div><h3>Method</h3><div>This prospective, observational, monocenter cohort study included singleton pregnancies with early-onset brain-sparing FGR at the University Medical Center Utrecht. FGR fetuses were compared to healthy controls from the Utrecht YOUth Cohort. Fetal MRI of the brain was performed including T2-weighted and diffusion weighted imaging (DWI) sequences. We measured 2D biometrics, 3D volumetrics using BOUNTI, and ADC values in multiple brain and placental regions. Values were corrected to 30 weeks of gestation.</div></div><div><h3>Results</h3><div>The study included 26 FGR fetuses at gestational age (GA) 26.3–32 weeks and 71 controls at GA 30.1–34 weeks. At 30 weeks, total brain volume (TBV) was significantly smaller in FGR (144.2 ± 11.5 vs 166.9 ± 17.5 milliliters, p < 0.001). After dividing all absolute volumes by TBV, only cerebellar volume remained significantly reduced (0.045 [0.00] vs 0.048 [0.01], p = 0.006). ADC values were lower in all brain regions except the cerebellum. Placental ADC values were also significantly lower in FGR.</div></div><div><h3>Conclusion</h3><div>Altered brain development in brain-sparing FGR is already present at 30 weeks of gestation. Lower brain volumes and ADC values may reflect the effects of altered perfusion, chronic hypoxia and microstructural changes in the brains of FGR fetuses. Future studies linking these MRI findings to long-term neurodevelopmental outcomes will aid in more personalized prognoses and might also inform the timing of delivery, ultimately enhancing clinical decision-making.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"27 ","pages":"Article 100417"},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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