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

Introduction

Surgical management of endometrial cancer is a total hysterectomy, bilateral salphingo-oophorectomy and pelvic lymph node dissection (THBSO-PLND), which is a challenging surgery in the morbidly obese. Data on morbidly obese women undergoing robotic surgery is limited in Asia. We share our experience in Singapore and aim to demonstrate that robotic surgery is safe and effective in morbidly obese women with endometrial cancer.

Materials and Methods

We performed a retrospective analysis of patients with BMI > 40 kg/m2, who underwent robotic surgery from January 2016 to September 2023 at the Singapore General Hospital. We recruited a total of 33 patients who underwent robotic surgery for endometrial malignancy and analysed surgical outcomes, operative complications, and survival rates.

Results

The average age of patients was 53 years and mean BMI 45.7. The average operative time was 232 min and average blood loss 184 ml. 3 patients had THBSO while 27 underwent THBSO-PLND. None required conversion to laparotomy. 4 patients required a mini-laparotomy for the retrieval of bulky uterus. 12 required adhesiolysis. 6 patients had additional omentectomy done. The average inpatient stay was 4.8 days. The 1-year mortality rate is 0. However, 1 patient passed away 13 months after surgery due to complications from bowel obstruction and another passed away 39 months later due to disease recurrence. 1 patient readmitted on POD6 due to post-op ileus and another for port-site hematoma. Both were managed conservatively.

Conclusion

Robotic surgery is a safe and effective alternative surgical tool for women who are morbidly obese with endometrial cancer.

Background

Pregnant women are more vulnerable to the severe effects of COVID-19 compared to their non-pregnant peers. Early in the pandemic, there was a rise in cesarean deliveries and preterm births among infected pregnant women. This study aims to evaluate whether there were any changes in obstetric interventions during the first two waves of the pandemic in Belgium.

Methods

Between March 2020 and February 2021, the Belgian Obstetric Surveillance System (B.OSS) conducted an extensive, nationwide population-based registry study, that included nearly all births to women with a confirmed SARS-CoV-2 infection within six weeks before hospitalization in Belgium. The perinatal outcomes of these women were analyzed and compared with pre-pandemic regional perinatal data.

Results

A total of 923 SARS-CoV-2 infected pregnant women were admitted to the hospital; 9.3 % were hospitalized for severe COVID-19, while the remaining were hospitalized for obstetric reasons. Infected women had a higher median BMI, a higher incidence of diabetes, and a greater proportion were overweight or obese compared to the reference group (p < 0.001). While the majority of women gave birth vaginally, symptomatic women and those with a severe infection had slightly higher rates of cesarean delivery, though not statistically significant after adjusting for confounders. Only severely ill women had an increased risk of preterm delivery (aOR 2.3; 95 %CI [1.2–2.5]; p = 0.02) and of induced labor (OR 1.8; 95 %CI [1.1–2.8]; p = 0.01). The use of general anesthesia for cesarean delivery was more common in the infected group (OR 2.6; 95 %CI [1.6–4.1]; p < 0.001).

Conclusions

Obstetric interventions, such as cesarean delivery and induction, remained at pre-pandemic levels. However, a SARS-CoV-2 infection appears to have increased medically induced preterm delivery and the use of general anesthesia for cesarean delivery.

Objectives

Combined Apgar score includes utilization of interventions such as Continuous positive airway pressure, Oxygen, Mask and Bag ventilation, I ntubation and ventilation, Ne onatal chest compression, Drugs, and newborn assessment. It has been proposed as a substitute for conventional Apgar score which is the gold standard for evaluating newborns right after birth but is impacted by medical interventions and preterm. Combined Apgar scores were examined to check for correlation with CTG tracing and umbilical cord blood parameters which gives an objective assessment of fetal hypoxia, in response to the demand for a more accurate tool for evaluating the neonate and to be used for medico-legal purposes. The study's objectives were to (1) determine the association of combined Apgar scores with suspicious and pathological CTG (2) the association of umbilical cord parameters with low combined Apgar scores and the diagnostic performance of these parameters in predicting low combined Apgar scores.

Study design

A prospective observational cohort study was conducted in a tertiary care center in East India. 2350 consecutive laboring mothers who had completed 34 weeks of gestation underwent cardiotocography according to institutional protocol and those with suspicious and pathological CTG who delivered within 1 h of abnormal CTG were recruited. Arterial blood was analyzed and the newborn was evaluated immediately after delivery with a combined Apgar scoring system

Results

Of the 2350 women, 50.7 % and 49.3 %, respectively, exhibited suspicious and abnormal CTG tracings. CTG was reported to have low diagnostic accuracy and specificity, with a sensitivity of 66.7 % and 88.9 %, respectively, in detecting combined Apgar at 1 and 5 min. The combined Apgar score at five minutes showed a strong association with acidosis. There was a statistically significant correlation between low combined Apgar and excess lactate and base at one and five minutes. With 100 % sensitivity and 95 % specificity, high lactate levels > 4.1 mM/L were found to predict newborn encephalopathy.

Conclusion

Umbilical cord blood parameters were found to be correlated with low combined Apgar scores. Combined Apgar scores may be a more useful tool for neonatal assessment and long-term morbidity of newborns. Additional research is required to determine whether it can take the role of conventional Apgar scores in clinical practice.

Introduction

Pregnant women can choose from different prenatal genetic tests throughout their maternity journey. We aim to investigate the clinical, societal, and economic determinants influencing the selection of different options (non-invasive, invasive, or both).

Methods

A systematic survey focusing on maternity pathways was launched by the Region of Tuscany, Italy, to collect data on pregnant women’s experience, outcomes and satisfaction levels. Drawing from this survey, we retrospectively analyzed data on women who filled out the second-trimester questionnaire between March 2019 and February 2023 (n = 27,337), providing complete data on relevant variables. Logistic regression models were applied to identify the factors contributing to a higher likelihood of opting for non-invasive prenatal testing (NIPT) and invasive testing.

Results

Among the participants, 42.7 % chose only NIPT, 3.8 % opted for invasive tests exclusively, 1.3 % underwent both tests, and 52.2 % did not pursue any genetic testing. NIPT was more often chosen by older, Italian, highly educated, nulliparous women, who perceived better health, were employed (versus unemployed), had higher economic status, planned pregnancy, received hospital-based care (versus counseling center), under gynecologist supervision (versus midwife), not opted for combined testing and received pregnancy vaccinations. Conversely, invasive testing was more prevalent among older women but less common among those who were nulliparous, had Italian nationality, and had a perceived better health status. This group also tended to experience unplanned and high-risk pregnancy, did not take folate during pregnancy, received public hospital-based assistance, less frequently chose combined tests or NIPT, and had frequent delays in examinations.

Conclusions

Various factors beyond clinical considerations influence the selection of a prenatal test. Therefore, NIPT pathways should include balanced, high-quality information about benefits and limitations, ensuring laboratory specialists' active and integrated involvement in decision-making.

Objective

To determine the efficacy and safety of rectal diclofenac for relieving postoperative pain following diagnostic hystero-laparoscopy and dye test (dHLD).

Methods

A prospective, double-blind, placebo-controlled, randomized trial was conducted among women who underwent dHLD to evaluate fertility. The women received either rectal diclofenac with intramuscular pentazocine or intramuscular pentazocine with rectal placebo for postoperative analgesia. The median pain scores at different time points were assessed as the primary outcome measures using the Numerical Rating Scale for pain. The secondary outcome measures were analgesic consumption, time at which first analgesic was requested, satisfaction with pain relief and any adverse events.

Results

In total, 108 participants were analysed (54 in each group, 1:1 ratio). The median score for postoperative pain was lower for the diclofenac group compared with the placebo group at 4 h (52.53 vs 56.47; p = 0.507), 6 h (50.48 vs 58.52; p = 0.174), 8 h (51.42 vs 57.65; p = 0.296), 10 h (51.35 vs 57.65; p = 0.285) and 12 h (52.45 vs 56.55; p = 0.485) post surgery, although the difference was not significant (p > 0.05). Seventeen participants required rescue analgesia with 30 mg of pentazocine: 11 at 4 h post surgery [5 (62.5 %) vs 6 (66.7 %)], three at 6 h post surgery [2 (25.0 %) vs 1 (11.1 %)], two at 8 h post surgery [1 (12.5 %) vs 1 (11.1 %)], and one at 12 h post surgery [0 vs 1 (11.1 %)] for the diclofenac and placebo groups respectively (p = 0.713). There were no significant differences in postoperative adverse effect profiles, overall patient satisfaction, and need for rescue analgesia between the two groups (p > 0.05).

Conclusions

Postoperative use of rectal diclofenac and pentazocine is safe, but did not significantly improve pain scores, patient satisfaction and need for rescue analgesia following dHLD, compared with patients who received pentazocine and placebo. While a multi-modal approach to pain relief following dHLD does not appear to be significantly beneficial, a multi-centre study is needed to confirm or refute these findings.

Objectives

Vaginal assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) combines the benefits of vaginal and endoscopic surgery. This study presents the results of the first vaginal assisted NOTES hysterectomies (VANH) in The Netherlands.

Study design

A prospective cohort study was performed in two non-academic teaching hospitals in The Netherlands. Data was collected from patients who underwent a VANH for benign indications between August 2019 and April 2023. Baseline characteristics and data of intra- and postoperative surgical outcomes were recorded and analysed. The VANHs were performed by four experienced vaginal and endoscopic gynaecological surgeons.

Results

A total of 200 patients underwent a VANH. Indications were dysfunctional menstrual bleeding (61 %; n = 122), abnormal cervical cytology (15.5 %; n = 31), abdominal pain (11.5 %; n = 23), post ablation/sterilization pain syndrome (3.5 %; n = 7), uterine fibroids (5.0 %; n = 10), atypical endometrial hyperplasia (2.5 %; n = 5) and Lynch or BRCA gene mutation carriers (1.0 %, n = 2). The mean surgical time was 61.4 min ( ± 22.8 min) with a mean blood loss of 88 mL ( ± 89 mL) and a mean uterine weight of 150 g ( ± 112 g). In 2.0 % (n = 4) of the cases a conversion was necessary. Same day discharge (SDD) was feasible in 80.2 % (n = 105) of the patients planned in day-care. In 2.0 % (n = 4) an intra-operative complication and in 9.0 % (n = 18) a post-operative complication occurred.

Conclusion

This study shows vNOTES to be a safe and feasible surgical technique and can be safely implemented with appropriate patient selection and skilled surgeons. It highlights the importance of surgeon awareness of the challenges inherent in the initial stages of the implementation of a new surgical technique when performing their first vNOTES procedures. Additional randomized clinical trials are needed to show superiority of vNOTES compared to traditional surgery.

Background

Adverse drug reactions (ADRs) are a significant public health concern, particularly in limited resource settings where underreporting is prevalent due to various challenges. Mobile health applications (mHealth apps) offer a promising solution to enhance pharmacovigilance by facilitating easier and more efficient ADR reporting. However, despite the increasing availability and use of mHealth apps, there is a lack of evidence on healthcare professionals' willingness to adopt them for ADR reporting in resource-constrained environments. Therefore, this study aimed to assess the willingness of healthcare professionals in Ethiopia to utilize mobile health applications for adverse drug reaction reporting and identify associated factors.

Methods

We carried out a cross-sectional study involving 422 healthcare professionals working in institutional settings. We gathered data through a pretested questionnaire that participants completed themselves. We inputted the data using Epi Data V.4.6 and analyzed it using SPSS V.26. Our analysis involved conducting multivariable logistic regression to identify the factors influencing the likelihood of healthcare professionals using mobile applications to report adverse drug reactions.

Results

The study involved 389 healthcare professionals. Approximately 301 (77.4 %) of them expressed willingness to utilize mobile applications for reporting adverse drug reactions. The willingness to utilize mobile applications was significantly associated with the type of mobile phone (smart: AOR 3.56; 95 % CI 2.15–5.67), basic computer training (AOR 4.43; 95 % CI 2.27–8.64), mobile health-related training (AOR 1.96; 95 % CI 1.01–3.79), attitude (AOR 4.01; 95 % CI 2.19–7.35), perceived ease of use (AOR 2.91; 95 % CI 1.59–5.23), and perceived usefulness (AOR 2.10; 95 % CI 1.15–3.85).

Conclusions

Overall, there was a high proportion of healthcare professionals willing to use mobile devices for reporting drug adverse reactions. Their willingness correlated with factors such as the type of mobile phone, perceived ease of use, attitude, training, and perceived usefulness of mobile applications. With the increasing use of smartphones, motivation among healthcare professionals is rising. Basic computer and mHealth-related training are crucial for enhancing the acceptability of such applications and should be incorporated into future implementations. Taking these factors into account could offer insights into the design and implementation of mobile applications for adverse drug reactions in Ethiopia.

Introduction

Female sexual dysfunction (FSD) is a common health problem that is inadequately investigated in Arabic countries, especially Saudi Arabia.

Aim

To assess the prevalence and trace predictors of FSD in Saudi women who suffered from migraine headaches comparable to healthy women.

Patients and methods

A prospective cross-sectional, controlled study involved 400 Saudi women complaining of migraine (Case Group) and another 400 healthy-looking Saudi women (Control Group) during three months; from January 1^st, to March 31st 2023, in Jeddah city, Saudi Arabia. Data was collected by using a pre-structured Female Sexual Function Index (FSFI) questionnaire, Female Sexual Distress Scale (FSDS), Migraine Screen Questionnaire (MS-Q), with an evaluation of the severity of pain by Visual Analogue Scale (VAS), and its impact on daily activity by using both; Headache Impact Test (HIT-6) and Migraine Disability Assessment (MIDAS) Questionnaire.

Results

A total of 800 Saudi women were recruited. Their ages ranged from 18 to 45 years old. Women with abnormally low FSFI scores were 375 (93.75 %) out of 400 with migraine and 85 (21.25 %) out of 400 without migraine. The lowest FSFI scores were mainly for desire (2.75 ± 1.05) and arousal domains (3.0 ± 1.12) followed by sexual satisfaction (3.25 ± 1.30) and orgasmic domains (3.5 ± 1.15). The foremost predictive factor behind low FSFI scores and associated FSD in our study was migraine (P < 0.00001). Additional predictors of statistical significance were low educational level (P < 0.01), urban residency (P < 0.02), high parity (P < 0.02), chronic illness such as diabetes (P < 0.01), and bad habits such as smoking (P < 0.03)

Conclusion

A significant correlation exists between migraine and female sexual dysfunction (FSD). Desire and arousal dysfunctions were the most significantly affected domains followed by satisfaction and orgasmic problems.

Cosmetic and functional gynecology have gained popularity among patients, but the scientific literature in this field, particularly regarding the cosmetic aspect, is lacking. The use of evidence-based medicine is crucial to validate diagnostic tools and treatment protocols. However, the advent of artificial intelligence (AI) offers a promising solution to address this issue. ChatGPT, a sophisticated language model, can revolutionize AI in medicine, enabling accurate diagnosis, personalized treatment plans, and expedited research analysis. Cosmetic and functional gynecology can leverage AI to develop the field and improve evidence gathering. AI can aid in precise and personalized diagnosis, implement standardized assessment tools, simulate treatment outcomes, and assess under-skin anatomy through virtual reality. AI tools can assist clinicians in diagnosing and comparing difficult cases, calculate treatment risks, and contribute to standardization by collecting global evidence and generating guidelines. The use of AI in cosmetic and functional gynecology holds significant potential to advance the field and improve patient outcomes. This novel combination of AI and gynecology represents a groundbreaking development in medicine, emphasizing the importance of appropriate and correct AI usage.