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

英文中文

Treatment strategies for intra-amniotic infection and/or inflammation in preterm labor cases 早产儿羊膜内感染和/或炎症的治疗策略

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X

Pub Date : 2025-06-08 DOI: 10.1016/j.eurox.2025.100408

Satoshi Yoneda , Noriko Yoneda , Hideki Niimi , Shigeru Saito

Spontaneous preterm birth (sPTB) is caused by multiple factors; however, the main cause is intra-amniotic infection and/or inflammation. The frequency of intra-amniotic infection/inflammation is higher in extremely sPTB (<28 weeks) and causes long-term cognitive impairments, such as cerebral palsy and mental retardation. The rate of intra-amniotic superinfections, such as Ureaplasma/Mycoplasma and bacteria, is high in sPTB < 27 weeks of gestation. Obstetrical strategies based on accurate information on intra-amniotic infection/inflammation are needed to prevent sPTB (particularly extremely sPTB) and improve the long-term prognosis of preterm infants. Our PCR method, which is sensitive and free from false positives, accurately identifies whether intra-amniotic infection is present. Appropriate antibiotic therapy against intra-amniotic infection (macrolides against Ureaplasma/Mycoplasma and beta-lactams against bacteria) in preterm labor (PTL) cases effectively prolongs the gestational period by 4 weeks. In contrast, the use of antibiotics shortens the gestational period in cases without intra-amniotic infection. We previously reported that 17-alpha-hydroxyprogesterone caproate (17OHP-C) effectively prolonged pregnancy by 4 weeks in PTL cases with mild intra-amniotic inflammation, but not in those with severe intra-amniotic inflammation. Treatment strategies based on accurate intra-amniotic information is expected to prolong pregnancy. However, obstetrical interventions are limited once severe clinical symptoms appear. In addition to the use of drugs to control uterine contractions, antibiotics and/or 17OHP-C may be necessary in the treatment of PTL cases following the accurate assessment of intrauterine infection and/or inflammation is confirmed.

自发性早产（sPTB）是由多种因素引起的；然而，主要原因是羊膜内感染和/或炎症。极度sPTB（28周）羊膜内感染/炎症的频率更高，并导致长期认知障碍，如脑瘫和智力低下。羊膜内重复感染的发生率，如脲原体/支原体和细菌，在sPTB <； 妊娠27周时较高。需要基于羊膜内感染/炎症的准确信息的产科策略来预防sPTB（特别是极度sPTB）并改善早产儿的长期预后。我们的PCR方法，这是敏感的，无假阳性，准确识别是否羊膜内感染存在。适当的抗生素治疗羊膜内感染（大环内酯类药物治疗脲原体/支原体和β -内酰胺类药物治疗细菌）在早产（PTL）病例有效延长妊娠期4周。相反，在没有羊膜内感染的情况下，抗生素的使用缩短了妊娠期。我们之前报道了17- α -羟孕酮己酸（17OHP-C）在轻度羊膜内炎症的PTL病例中有效延长妊娠4周，但在严重羊膜内炎症的患者中无效。基于准确的羊膜内信息的治疗策略有望延长妊娠期。然而，一旦出现严重的临床症状，产科干预是有限的。除了使用药物控制子宫收缩外，在准确评估宫内感染和/或炎症后，PTL病例的治疗可能需要抗生素和/或17OHP-C。

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引用次数: 0

Stress-induced developmental plasticity and spontaneous preterm birth: A justice-oriented eco-evo-devo review 应激诱发的发育可塑性与自发性早产：一项以正义为导向的生态进化研究综述

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X

Pub Date : 2025-06-08 DOI: 10.1016/j.eurox.2025.100409

Gabriella Mayne , Luwam Ghidei , Ayisha Buckley , Wei Perng , K. Joseph Hurt , David P. Tracer

Spontaneous preterm birth (<37 weeks’ gestation) is a leading cause of neonatal morbidity and mortality, with little global progress in prevention. Spontaneous preterm birth disproportionately affects communities marginalized by racism and socio-economic disadvantage. Maternal stress is a well-established risk factor for spontaneous preterm birth and is more prevalent in marginalized communities. Yet, maternal stress remains underutilized as a target for clinical intervention. In this review, we draw from ecological, evolutionary, and developmental (eco-evo-devo) biology, Black feminist theory, and reproductive justice to center the margins of those communities most burdened by both maternal stress and preterm birth. In doing so, we re-frame the importance of maternal stress mitigation in spontaneous preterm prevention. Through the lens of stress-induced developmental plasticity, environmental stressors may shorten gestation through evolutionarily conserved maternal-fetal-placental signaling pathways. Two features of this process are particularly relevant to clinical care: first, stress may impact gestational length in a dose-dependent manner; second, its effects may be reversible. Reducing maternal stress may be a highly feasible clinical opportunity to tangibly reduce spontaneous preterm birth and increase birth equity.

自然早产（妊娠37周）是新生儿发病和死亡的主要原因，全球在预防方面进展甚微。自然早产对因种族主义和社会经济劣势而被边缘化的社区的影响尤为严重。产妇压力是自然早产的一个公认的危险因素，在边缘化社区更为普遍。然而，作为临床干预的目标，产妇压力仍未得到充分利用。在这篇综述中，我们从生态、进化和发育（eco-evo-devo）生物学、黑人女权主义理论和生殖正义的角度来关注那些受母亲压力和早产负担最重的社区的边缘。在这样做的过程中，我们重新构建了减轻产妇压力在预防自发性早产中的重要性。通过应激诱导的发育可塑性，环境应激源可能通过进化保守的母胎胎盘信号通路缩短妊娠期。这一过程的两个特征与临床护理特别相关：首先，压力可能以剂量依赖的方式影响妊娠期长度；其次，它的影响可能是可逆的。减少产妇压力可能是一个非常可行的临床机会，切实减少自发性早产和增加生育公平。

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引用次数: 0

A comparison between laparoscopy and hysteroscopy approaches in the treatment of symptomatic isthmocele: A systematic review and meta-analysis 腹腔镜和宫腔镜治疗症状性峡部膨出的比较：一项系统综述和荟萃分析

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X

Pub Date : 2025-06-04 DOI: 10.1016/j.eurox.2025.100405

Zahra Ramezani , Saba Goodarzi , Pegah Rashidian , Shima Mohammadian , Hadis Rastad , Mona Esmi , Arman Shafiee , Mahmood Bakhtiyari

Objective

To compare the clinical outcomes of laparoscopy and hysteroscopy in the treatment of symptomatic isthmocele using a systematic review and meta-analysis.

Methods

A comprehensive search of PubMed, Scopus, and Web of Science was performed until November 11, 2024. Studies evaluating outcomes of laparoscopy or hysteroscopy intervention for treating symptomatic isthmocele were included in this study. A random-effects model was employed for heterogeneous data. The study is registered in PROSPERO with registration number CRD420251028603.

Results

Nine studies involving 797 patients were included. Hysteroscopy demonstrated significantly less intraoperative blood loss (SMD: −2.28, 95 % CI: −3.65 to −0.90) and shorter hospital stays (SMD: −2.62, 95 % CI: −3.52 to −1.72), but the operative time difference was non-significant. Both approaches were equally effective in symptom resolution and defect repair (OR: 0.80, 95 % CI: 0.21–2.97). However, laparoscopic repair was associated with better outcomes for dysmenorrhea improvement (OR: 3.46, 95 % CI: 1.42–8.45) and higher postoperative pregnancy rates (OR: 4.17, 95 % CI: 1.89–9.09). High heterogeneity was noted in some outcomes, reflecting variability in study designs and populations.

Conclusions

Both laparoscopy and hysteroscopy are effective in treating symptomatic isthmocele, with each approach offering distinct advantages. Hysteroscopy is less invasive with faster recovery and better fertility.

目的通过系统评价和meta分析比较腹腔镜和宫腔镜治疗症状性峡部膨出的临床效果。方法综合检索PubMed、Scopus、Web of Science，检索截止日期为2024年11月11日。本研究纳入了评估腹腔镜或宫腔镜干预治疗症状性峡部膨出的结果的研究。异质数据采用随机效应模型。该研究已在PROSPERO注册，注册号为CRD420251028603。结果纳入9项研究，共797例患者。宫腔镜检查显示术中出血量明显减少（SMD:−2.28,95 % CI:−3.65至−0.90），住院时间明显缩短（SMD:−2.62,95 % CI:−3.52至−1.72），但手术时间差异无统计学意义。两种方法在症状缓解和缺陷修复方面同样有效（OR: 0.80, 95 % CI: 0.21-2.97）。然而，腹腔镜修复与痛经改善的更好结果相关（OR: 3.46, 95 % CI: 1.42-8.45）和更高的术后妊娠率（OR: 4.17, 95 % CI: 1.89-9.09）。在一些结果中注意到高度异质性，反映了研究设计和人群的可变性。结论腹腔镜和宫腔镜均可有效治疗症状性峡部膨出，各有优势。宫腔镜侵入性小，恢复快，生育能力好。

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引用次数: 0

Focused ultrasound treatment of cervical human papillomavirus infection and squamous intraepithelial lesions: A narrative review 聚焦超声治疗宫颈人乳头瘤病毒感染和鳞状上皮内病变：叙述综述

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X

Pub Date : 2025-06-01 DOI: 10.1016/j.eurox.2025.100406

Vincent Y.T. Cheung

Focused ultrasound (FUS) appears to be a promising form of thermal ablation for treatment of cervical lesions, but evidence supporting its use is limited. This review evaluated the efficacy and safety of FUS treatment of cervical human papillomavirus (HPV) infection and squamous intraepithelial lesions (SIL). The overall efficacy of FUS on HPV clearance was 75.0–85.7 % at 3 months, 35.5–77.1 % at 6 months and 64.7–94.1 % at 12 months. Its efficacy on low grade SIL and high grade SIL regression were 83.3–96.8 % and 70.9–96.6 % at 6 months, respectively. Complications were uncommon. FUS appears to be an effective and safe treatment modality for cervical HPV and SIL.

聚焦超声（FUS）似乎是一种很有前途的宫颈病变热消融治疗形式，但支持其使用的证据有限。本综述评价了FUS治疗宫颈人乳头瘤病毒（HPV）感染和鳞状上皮内病变（SIL）的有效性和安全性。3个月时，FUS对HPV清除的总有效率为75.0-85.7 %，6个月时为35.5-77.1 %，12个月时为64.7-94.1 %。6个月时对低级别SIL和高级别SIL的疗效分别为83.3 ~ 96.8% %和70.9 ~ 96.6% %。并发症不常见。FUS似乎是一种有效和安全的治疗宫颈HPV和SIL的方式。

引用次数: 0

Cesarean Scar Pregnancy: Three case reports and literature review 剖宫产瘢痕妊娠：3例报告及文献复习

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X

Pub Date : 2025-06-01 DOI: 10.1016/j.eurox.2025.100407

Esther Ruiz Pérez , Cristina Álvarez Colomo , Victoria Pascual Escudero , Álvaro Sanz Díaz-Heredero , Lidia Casamayor Del Nogal , Marta Ibáñez Nieto , Sandra Canales Martínez , Jimena Bayón Pascual , Mónica Simón de la Fuente , Mónica Consuelo Horstmann Sendagorta

Introduction

Cesarean Scar Pregnancy (CSP) is defined as an ectopic pregnancy in which the gestational sac implants on the surgical scar of a previous cesarean section or isthmocele.

Despite its low incidence, the diagnosis presents a significant difficulty, and a false negative diagnosis can lead to serious complications that may require more aggressive treatments.

Objective

The main objective of this study is to present three clinical cases of patients with suspected ectopic pregnancy in the cesarean scar, including a review of the current literature on this condition.

Methods

The clinical case data were obtained from the patients’ medical records, including the results of the additional tests performed, as well as subsequent gynecology appointments. On the other hand, a literature review was conducted on ectopic pregnancies in the cesarean scar.

Results

During ultrasound examinations of patients with a history of previous cesarean sections, special attention should be paid to identifying the implantation site of the gestational sac to rule out CSP.

Due to the limited number of trials and case reports on CSP, there is no consensus on standardized treatment and management. The primary goal is to preserve patient's fertility and avoid severe complications such as massive hemorrhage or uterine rupture.

Conclusions

Cesarean Scar Pregnancy (CSP) should be considered among the diagnostic options when finding a gestational sac located in atypical situations in patients with a history of cesarean section.

Early diagnosis and treatment are crucial for achieving the best outcomes. A minimally invasive approach should be planned as first-line treatment in all situations where CSP is included in the differential diagnosis.

剖宫产瘢痕妊娠（CSP）被定义为妊娠囊植入先前剖宫产手术瘢痕或峡部的异位妊娠。尽管发病率很低，但诊断非常困难，假阴性诊断可能导致严重的并发症，可能需要更积极的治疗。目的本研究的主要目的是介绍三例疑似异位妊娠的剖宫产瘢痕患者的临床病例，包括对目前有关这种情况的文献进行回顾。方法从患者的医疗记录中获取临床病例资料，包括附加检查结果以及随后的妇科预约。另一方面，对剖宫产瘢痕的异位妊娠进行了文献综述。结果对有剖宫产史的患者进行超声检查时，应特别注意确定妊娠囊着床部位，以排除CSP。由于CSP的临床试验和病例报告数量有限，对CSP的标准化治疗和管理尚无共识。主要目的是保护患者的生育能力，避免严重的并发症，如大出血或子宫破裂。结论有剖宫产史的患者在发现非典型情况下的妊娠囊时应考虑瘢痕妊娠（CSP）。早期诊断和治疗对于取得最佳结果至关重要。在CSP被纳入鉴别诊断的所有情况下，应计划采用微创方法作为一线治疗。

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引用次数: 0

Trends and characteristics of triplet births in a tertiary maternity hospital in China: A retrospective study over two decades 中国某三级妇产医院三胞胎出生趋势和特点：20多年的回顾性研究

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X

Pub Date : 2025-06-01 DOI: 10.1016/j.eurox.2025.100394

Yanzhen Zhou, Jinxiu Lin, Zhaozhen Liu, Sheng Lin

Background

As triplet pregnancies were usually associated with poorer pregnancy outcomes and fetal reduction was coupled with procedure-related complications, many women with triplet pregnancies often opted for expectant management. This retrospective study reported the pregnancy outcomes of women with triplet pregnancies who did not receive artificial fetal reduction over a two-decade period (2002-2021).

Methods

Maternal and pregnancy data and perinatal outcomes, including 111 triplets, were obtained from women with triplet pregnancies who received expectant management at Fujian Maternity and Child Health Hospital, including 111 triplets. The patient cohort was divided into two subgroups(Period I, 2002-2011 vs. Period II, 2012-2021).

Results

Compared with those in the Period I group, participants in the Period II group reported a better educational background (28.8 vs. 13.8 %, p = 0.024), and occupation status (40.4 vs. 20.6 %, p = 0.012) and a greater percentage of primiparas (57.7 vs. 5.1 %, p < 0.005). However, compared with those in the Period II group, the period I group displayed significantly older gestation age at delivery(p = 0.001), heavier mean birth weight(1583.63 ± 62.14 vs.1830.51 ± 41.95 kg), higher rate of babies taken home(91.6 vs. 84.2 %,p = 0.049), and lower NICU admission rate(47.0 vs. 77.5 %, p < 0.005).

Conclusions

Due attention to triplet pregnancies might lower the rate of maternity complications, and antenatal medicines to prevent prematurity could not prolong birth week. Developed neonatal treatment and nursing are adapted to stratified management based on chorionicity. With advancements in maternal healthcare and neonatal treatment, and nursing, expectant management could be a considerable option. Maternal factors such as parity and maternal education status might be correlated with gestational age.

背景：由于三胞胎妊娠通常与较差的妊娠结局有关，并且胎儿减少与手术相关的并发症相结合，许多三胞胎妊娠的妇女通常选择保守治疗。本回顾性研究报告了二十年（2002-2021年）期间未接受人工胎位减少术的三胞胎妊娠妇女的妊娠结局。方法收集福建省妇幼保健院待产管理的三胞胎孕妇111例（其中111例为三胞胎）的孕产资料和围产期结局。患者队列分为两个亚组（第一阶段，2002-2011年和第二阶段，2012-2021年）。ResultsCompared与那些在我组,参与者在II组更好的教育背景(28.8 vs 13.8 % p = 0.024),和职业地位(40.4 vs 20.6 % p = 0.012)和一个更大比例的初产妇(57.7 vs 5.1 % p & lt; 0.005)。然而,与第二期组相比,这段时间我在交付组显示明显妊娠年龄老(p = 0.001),重的意思是出生体重(1583.63 ±62.14 vs.1830.51 ±41.95  公斤),更高的利率的婴儿带回家(91.6 vs 84.2 % p = 0.049),和更低的NICU入学率(47.0 vs 77.5 % p & lt; 0.005)。结论重视三胞胎妊娠可降低分娩并发症发生率，产前用药预防早产不能延长分娩周。发达的新生儿治疗和护理适应基于绒毛膜的分层管理。随着孕产妇保健和新生儿治疗和护理的进步，准妈妈管理可能是一个相当大的选择。胎次、受教育程度等母体因素可能与胎龄有关。

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