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Application of adult stem cells in obstetrics and gynecology: A scoping review 成体干细胞在妇产科中的应用:综述
IF 1.5 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-22 DOI: 10.1016/j.eurox.2025.100367
Andi Kurniadi , Muhammad Ary Zucha , Ardhanu Kusumanto , Siti Salima , Ali Budi Harsono

Background

Advancements in regenerative medicine have led to the applicability of stem cell technology in various diseases. Stem cells that have self-renewable abilities may differentiate into several cell types to provide therapeutic potential. Among different stem cells, adult stem cells are considered as the safest with remarkable potential for therapeutic application. In this review, we provide current available evidence regarding the application of adult stem cells in medicine, especially in the field of obstetrics and gynecology.

Objective

This scoping review aims to map and describe the current research on adult stem cell application in obstetrics and gynecology.

Methods

We performed a systematic search on PubMed, Google Scholar, and Cochrane Library in August 2024 to identify research articles involving adult stem cells in the field of obstetrics and gynecology. We used the Deduplicate website to filter articles based on keywords that met our inclusion and exclusion criteria. The results were presented based on recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Results

We found 42 articles that met the inclusion criteria. Some studies were clinical studies, whereas the majority were preclinical studies. We categorized the articles into clinical and preclinical studies to understand their applicability in human subjects.

Conclusions

Adult stem cell therapy is a candidate treatment for several pathologies in obstetrics and gynecology. The promising results of adult stem cell therapy, especially in degenerative gynecologic diseases, may lead to further application of the technology in the near future.
再生医学的进步使得干细胞技术可以应用于各种疾病。具有自我再生能力的干细胞可以分化成多种细胞类型,以提供治疗潜力。在不同的干细胞中,成体干细胞被认为是最安全的,具有显著的治疗应用潜力。在这篇综述中,我们提供了目前可用的证据关于成体干细胞在医学上的应用,特别是在妇产科领域。目的综述成体干细胞在妇产科中的应用研究现状。方法于2024年8月系统检索PubMed、谷歌Scholar和Cochrane Library,检索涉及成体干细胞在妇产科领域的研究文章。我们使用Deduplicate网站根据符合纳入和排除标准的关键词来过滤文章。结果是根据系统评价的首选报告项目和范围评价的元分析扩展的建议提出的。结果42篇文章符合纳入标准。一些研究是临床研究,而大多数是临床前研究。我们将文章分为临床研究和临床前研究,以了解它们在人类受试者中的适用性。结论成体干细胞治疗是多种妇产科病理的候选治疗方法。成体干细胞治疗,特别是在退行性妇科疾病方面的有希望的结果,可能导致该技术在不久的将来进一步应用。
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引用次数: 0
Association between Apolipoprotein L1 genetic variants and risk of preeclampsia and preterm birth among U.S. Black women 载脂蛋白L1基因变异与美国黑人妇女子痫前期和早产风险之间的关系
IF 1.5 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2025-01-09 DOI: 10.1016/j.eurox.2025.100365
Shanshan Sheehy , David Friedman , Chunyu Liu , Kathryn L. Lunetta , Gary Zirpoli , Julie R. Palmer

Background

Preeclampsia and preterm birth disproportionally affects Black women, but the current understanding of genetic predisposition to preeclampsia and preterm birth is rudimentary. It has been hypothesized that carriers of high-risk genetic variants in the apolipoprotein L1 gene (APOL1) may have an increased risk of preeclampsia and preterm birth. These genetic variants are found only among individuals of recent African ancestry. Previous studies have been small and have yielded inconsistent results.

Objective

To examine whether APOL1 genetic variants are associated with risk of preeclampsia or preterm birth.

Study design

We conducted a retrospective case-control study of 6616 Black women from the Black Women’s Health Study, a cohort of self-identified Black women in the U.S. Genotype data on APOL1 risk alleles for this case control study were obtained through new genotyping and existing genetic data from a prior case control study of breast cancer using the Illumina Infinium Global Diversity Array or Multi Ethnic Genotyping Array. Primary analyses evaluated risk based on a recessive model, comparing women who carried two APOL1 risk alleles to women who carried zero or one risk allele. We used multivariable logistic regression models to examine associations among 1473 participants with a history of preeclampsia (cases) and 5143 parous women who had not experienced preeclampsia (controls), and among 1296 participants who had a history of preterm birth and 5320 without such history.

Results

The odds ratio (OR) of preeclampsia for two APOL1 risk alleles vs. zero or one risk allele was 0.99 (95 % confidence interval (CI): 0.74, 1.32) after adjustment for principal components, genotype platform, and age in 1995. For preterm birth, the comparable multivariable OR was 1.04 (95 % CI: 0.86, 1.25).

Conclusions

This large prospective study from a general population of Black women found no evidence of an association of APOL1 genotype with risk of either preeclampsia or preterm birth.
背景:先兆子痫和早产不成比例地影响黑人妇女,但目前对先兆子痫和早产的遗传易感性的了解是初步的。据推测,载脂蛋白L1基因(APOL1)的高危遗传变异携带者可能增加先兆子痫和早产的风险。这些基因变异只在最近的非洲血统的个体中发现。此前的研究规模较小,得出的结果也不一致。目的:探讨APOL1基因变异是否与先兆子痫或早产风险相关。研究设计:我们对来自黑人妇女健康研究的6616名黑人妇女进行了回顾性病例对照研究,这是一组自认为是美国黑人妇女的队列,该病例对照研究的APOL1风险等位基因的基因型数据是通过使用Illumina Infinium全球多样性阵列或多民族基因分型阵列从先前的乳腺癌病例对照研究中获得的新的基因分型和现有的遗传数据获得的。初步分析基于隐性模型评估风险,将携带两个APOL1风险等位基因的女性与携带零或一个风险等位基因的女性进行比较。我们使用多变量logistic回归模型来检查1473名有先兆子痫史的参与者(病例)和5143名没有先兆子痫的产妇(对照组),以及1296名有早产史的参与者和5320名没有先兆子痫史的参与者之间的相关性。结果:1995年对主成分、基因型平台和年龄进行调整后,两个APOL1风险等位基因与零风险等位基因或一个风险等位基因发生子痫前期的比值比(OR)为0.99(95 %置信区间(CI): 0.74, 1.32)。对于早产,可比多变量OR为1.04(95 % CI: 0.86, 1.25)。结论:这项针对黑人妇女的大型前瞻性研究没有发现APOL1基因型与先兆子痫或早产风险相关的证据。
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引用次数: 0
A national survey on Thai medical students’ attitudes towards abortion and their confidence in providing abortion services following the amendment to abortion law 一项关于泰国医科学生对堕胎的态度以及在堕胎法修订后他们对提供堕胎服务的信心的全国调查。
IF 1.5 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-29 DOI: 10.1016/j.eurox.2024.100364
Hathaipat Leetrakool , Thanathorn Wonglerttham , Sornchaya Sonthyanonth , Jen Sothornwit

Objectives

This study aimed to evaluate medical students' attitudes towards abortion and their confidence in providing abortion services in the future.

Material and methods

A national cross-sectional online survey was conducted among fifth and sixth-year medical students from 10 Thai universities. A self-administered questionnaire assessed their knowledge, attitudes, and confidence regarding abortion services. Of 340 questionnaires sent, 234 responses were received. We used descriptive statistics and multivariable analysis to explore agreement with abortion and confidence.

Results

The mean attitude score towards abortion was 72.68 ± 7.46 out of 85, with 75.6 % of students indicated a favorable attitude toward abortion. The most widely accepted reasons for abortion were serious congenital anomalies in the fetus (99.6 %) and pregnancy resulting from sexual crimes (98.7 %). However, only 42.8 % of the students were willing to provide abortion services, and 33.8 % felt confident in doing so. Additionally, 77.8 % believed that participating in abortion procedures during medical school would increase their confidence in providing these services. No factors were found to be significantly associated with agreement on abortion.

Conclusion

Although most medical students had a positive attitude towards abortion, only a minority expressed willingness and confidence in providing abortion care. These findings underscore the importance of incorporating hands-on experience in abortion procedures in medical school curricula.
目的:本研究旨在了解医学生对堕胎的态度及未来提供堕胎服务的信心。材料和方法:对来自泰国10所大学的五年级和六年级医学生进行了全国性的横断面在线调查。一份自我管理的问卷评估了他们对堕胎服务的知识、态度和信心。在发出的340份问卷中,收到234份回复。我们使用描述性统计和多变量分析来探讨流产和信心的一致性。结果:85名学生对堕胎的平均态度得分为72.68 ± 7.46,其中75.6% 的学生对堕胎持赞成态度。流产最普遍的原因是胎儿严重先天性异常(99.6% %)和性犯罪导致怀孕(98.7% %)。然而,只有42.8% %的学生愿意提供堕胎服务,33.8% %的学生有信心这样做。此外,77.8% %的人认为,在医学院期间参加堕胎手术会增加他们提供这些服务的信心。没有发现与同意堕胎有显著关联的因素。结论:医学生对人工流产持积极态度,但有意愿和信心提供人工流产护理的医学生占少数。这些发现强调了在医学院课程中纳入堕胎程序实践经验的重要性。
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引用次数: 0
Global, regional, and national prevalence and disability-adjusted life-years for endometriosis in 204 countries and territories, 1990–2019: Findings from a global burden of disease study 1990-2019年204个国家和地区子宫内膜异位症的全球、区域和国家患病率和残疾调整生命年:一项全球疾病负担研究的结果
IF 1.5 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-28 DOI: 10.1016/j.eurox.2024.100363
Dong Yi Shen , Jing Li , PanWei Hu , Cong Qi , Hong Yang

Introduction

This study aimed to analyze the worldwide, regional burden of endometriosis and its trends from 1990 to 2019, utilizing the latest data from Global Burden of Disease (GBD) 2019. GBD 2019 is a global database tool for comprehensive analysis and an important result of long-term collaboration among governments worldwide.

Methods

We utilized the Global Health Data Exchange Query tool to analyze endometriosis in prevalence numbers, age-standardized prevalence rates (ASPR), and disability-adjusted life-years (DALYs) from 1990 to 2019 in 204 countries and regions. Additionally, this study investigated the impacts of period, age, and cohort on the prevalence and DALYs of endometriosis from the global perspective and in the five sociodemographic index (SDI) regions.

Results

Among the 21 regions, the most significant reduction in the prevalence of endometriosis between 1990 and 2019 occurred in Central Latin America. In 204 countries, the most pronounced decline was observed in Guatemala. At the SDI level, with the increase of SDI, the ASPR of endometriosis in all regions worldwide showed an overall decreasing trend. The prevalence of endometriosis peaked between the ages of 25 and 29.

Discussion

The findings of this study reflect the temporal and spatial tendency of the burden of endometriosis during the study period, and provide a reference for health agencies around the world to formulate policies on endometriosis, so as to reduce the harm of endometriosis to women worldwide.
本研究旨在利用2019年全球疾病负担(GBD)的最新数据,分析1990年至2019年子宫内膜异位症的全球、区域负担及其趋势。GBD 2019是一个用于综合分析的全球数据库工具,也是世界各国政府长期合作的重要成果。方法:利用全球健康数据交换查询工具,分析204个国家和地区1990 - 2019年子宫内膜异位症的患病率、年龄标准化患病率(ASPR)和残疾调整生命年(DALYs)。此外,本研究从全球视角和5个社会人口指数(SDI)区域探讨了时期、年龄和队列对子宫内膜异位症患病率和DALYs的影响。结果:在21个地区中,1990年至2019年期间子宫内膜异位症患病率下降最显著的是中拉丁美洲。在204个国家中,危地马拉的下降最为明显。在SDI水平上,随着SDI的升高,全球各地区子宫内膜异位症的ASPR总体呈下降趋势。子宫内膜异位症的发病率在25岁到29岁之间达到高峰。讨论:本研究结果反映了研究期间子宫内膜异位症负担的时空变化趋势,为世界各国卫生机构制定子宫内膜异位症相关政策提供参考,以减少子宫内膜异位症对全球女性的危害。
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引用次数: 0
Machine learning applications in placenta accreta spectrum disorders 机器学习在胎盘增生谱系障碍中的应用。
IF 1.5 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-24 DOI: 10.1016/j.eurox.2024.100362
Mahsa Danaei , Maryam Yeganegi , Sepideh Azizi , Fatemeh Jayervand , Seyedeh Elham Shams , Mohammad Hossein Sharifi , Reza Bahrami , Ali Masoudi , Amirhossein Shahbazi , Amirmasoud Shiri , Heewa Rashnavadi , Kazem Aghili , Hossein Neamatzadeh
This review examines the emerging applications of machine learning (ML) and radiomics in the diagnosis and prediction of placenta accreta spectrum (PAS) disorders, addressing a significant challenge in obstetric care. It highlights recent advancements in ML algorithms and radiomic techniques that utilize medical imaging modalities like magnetic resonance imaging (MRI) and ultrasound for effective classification and risk stratification of PAS. The review discusses the efficacy of various deep learning models, such as nnU-Net and DenseNet-PAS, which have demonstrated superior performance over traditional diagnostic methods through high AUC scores. Furthermore, it underscores the importance of integrating quantitative imaging features with clinical data to enhance diagnostic accuracy and optimize surgical planning. The potential of ML to predict surgical morbidity by analyzing demographic and obstetric factors is also explored. Emphasizing the need for standardized methodologies to ensure consistent feature extraction and model performance, this review advocates for the integration of radiomics and ML into clinical workflows, aiming to improve patient outcomes and foster a multidisciplinary approach in high-risk pregnancies. Future research should focus on larger datasets and validation of biomarkers to refine predictive models in obstetric care.
本文综述了机器学习(ML)和放射组学在胎盘增生谱(PAS)疾病的诊断和预测中的新兴应用,解决了产科护理中的重大挑战。它强调了机器学习算法和放射学技术的最新进展,这些技术利用磁共振成像(MRI)和超声等医学成像模式对PAS进行有效的分类和风险分层。该综述讨论了各种深度学习模型的功效,如nnU-Net和DenseNet-PAS,这些模型通过高AUC分数显示出优于传统诊断方法的性能。此外,它强调了将定量影像学特征与临床数据相结合的重要性,以提高诊断准确性和优化手术计划。ML通过分析人口统计学和产科因素来预测手术发病率的潜力也被探讨。强调需要标准化的方法来确保一致的特征提取和模型性能,本综述提倡将放射组学和ML整合到临床工作流程中,旨在改善患者预后并促进高危妊娠的多学科方法。未来的研究应侧重于更大的数据集和生物标志物的验证,以完善产科护理的预测模型。
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引用次数: 0
Association of physical activity during pregnancy with labor and delivery in nulliparous patients 无产患者孕期体力活动与分娩的关系。
IF 1.5 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-24 DOI: 10.1016/j.eurox.2024.100361
Shuqun Ren , Qian Zhao , Liyin Luo , Xiaohong You , Aihong Jin

Background

Physical activity during pregnancy is a positive behavior for improving pregnancy outcomes, yet the relationship between physical activity during pregnancy and labor is still debated.

Objective

This study aimed to test our hypothesis that a higher level of physical activity during pregnancy is associated with a shorter labor duration.

Study design

This was a prospective cohort study of pregnant women with singleton pregnancies and no contraindications to physical activity during pregnancy. physical activity according to type and intensity were evaluated with the Chinese version of the Pregnancy Physical Activity Questionnaire. This questionnaire categorizes physical activities into different types and intensities and quantifies them. The primary study outcome was labor duration. The secondary outcomes were delivery mode, conversion from vaginal delivery to cesarean section, prolonged second stage of labor, perineal tears, episiotomy, and postpartum hemorrhage within 24 hours. Generalized additive models were used to identify both linear and nonlinear relationships between physical activity during pregnancy and labor. A segmented linear model was employed to calculate the saturation effect. Stratified logistic regression was used for subgroup analysis.

Results

In total, 226 women participated in the physical activity survey during pregnancy and gave birth at our hospital. The energy expenditure of physical activity during pregnancy was 145.70 (111.92, 181.69) weekly energy expenditure (MET-h•wk-1). After full adjustment for covariates, a nonlinear relationship was observed between physical activity during pregnancy and the duration of the first stage of labor. Different correlations were observed when the energy expenditure of physical activity during pregnancy was 142.28 MET-h•wk-1. In the two-part regression model, the inflection point of physical activity during pregnancy was at 142.28 MET-h•wk-1. When the energy expenditure of physical activity during pregnancy exceeded 142.28 MET-h•wk-1, each standard deviation increase in physical activity was associated with a decrease of 149.85 minutes in the duration of the first stage of labor (β:-149.85, 95 % CI: −247.54 to −52.17, P = 0.0080).

Conclusions

A nonlinear relationship between physical activity during pregnancy and duration of the first stage of labor ha been identified.When physical activity exceeds 142.28 MET-h•wk-1, each additional standard deviation reduces the first stage of labor by 149.85 minutes. Physical activity is not limited to exercise programs; daily activities such as cleaning, shopping, and walking to and from work are effective ways to increase energy expenditure and help individuals achieve the recommended level of physical activity.
背景:孕期体育锻炼是改善妊娠结局的积极行为,但孕期体育锻炼与分娩之间的关系仍存在争议。目的:本研究旨在验证我们的假设,即怀孕期间较高水平的体力活动与较短的分娩时间有关。研究设计:这是一项前瞻性队列研究,研究对象为单胎妊娠且孕期无体育活动禁忌症的孕妇。采用中文版《孕期体力活动问卷》对孕妇进行体力活动类型和强度的评价。该问卷将体育活动分为不同的类型和强度,并进行量化。主要研究结果为分娩时间。次要结局为分娩方式、由阴道分娩转为剖宫产、第二产程延长、会阴撕裂、会阴切开术、24 小时内产后出血。使用广义加性模型来确定怀孕期间体力活动与分娩之间的线性和非线性关系。采用分段线性模型计算饱和效应。亚组分析采用分层逻辑回归。结果:共有226名妇女参加了在我院妊娠和分娩期间的体力活动调查。妊娠期体力活动能量消耗为145.70(111.92,181.69)周能量消耗(MET-h•周-1)。在充分调整协变量后,观察到怀孕期间身体活动与分娩第一阶段持续时间之间存在非线性关系。当孕期体力活动的能量消耗为142.28 MET-h•周-1时,观察到不同的相关性。在两部分回归模型中,孕期体力活动的拐点为142.28 MET-h•wk-1。当孕期体力活动的能量消耗超过142.28 MET-h•周-1时,体力活动每增加一个标准差,分娩第一阶段持续时间减少149.85 分钟(β:-149.85, 95 % CI: -247.54 ~ -52.17, P = 0.0080)。结论:孕期体力活动与分娩第一阶段持续时间之间存在非线性关系。当体力活动超过142.28 MET-h•周-1时,每增加一个标准差,第一阶段劳动时间就会减少149.85 分钟。体育活动并不局限于锻炼项目;清洁、购物、步行上下班等日常活动是增加能量消耗和帮助个人达到建议的身体活动水平的有效方法。
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引用次数: 0
Artificial womb technology – A more physiologic solution to treating extreme prematurity 人工子宫技术——一种治疗极端早产的更生理性的解决方案。
IF 1.5 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-15 DOI: 10.1016/j.eurox.2024.100359
Felix R. De Bie , Chase C. Binion , Ryan M. Antiel
Treatment of extreme premature infants (EPI) is limited by developmental immaturity primarily of the lung. A paradigm shift towards a more physiologic treatment of EPI as fetal neonates or fetonates, by keeping them in a womb-like environment to allow continued organ maturation, is the rationale for artificial womb technology. In this review, we discuss the artificial placenta and womb technology, it’s rationale, the history of its development, the most recent preclinical models described in the literature and finally pertinent ethical considerations.
极端早产儿(EPI)的治疗主要受到肺发育不成熟的限制。人工子宫技术的基本原理是将EPI作为胎儿新生儿或胎儿进行更生理的治疗,通过将其保持在子宫样环境中以允许器官持续成熟。在本文中,我们讨论了人工胎盘和子宫技术,它的基本原理,它的发展历史,最新的临床前模型在文献中描述,最后相关的伦理考虑。
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引用次数: 0
Epidemiological, economic and humanistic burden of cervical intraepithelial neoplasia in Europe: A systematic literature review 欧洲宫颈上皮内瘤变的流行病学、经济和人文负担:系统的文献综述。
IF 1.5 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-12-12 DOI: 10.1016/j.eurox.2024.100360
Ugne Sabale , Miriam Reuschenbach , Jitender Takyar , Arju Dhawan , Adam Hall , D. Vittal , Gurkiran Saggu , Alessandro Ghelardi , Marta del Pino , Andrzej Nowakowski , Stefano Valente

Introduction

High-grade cervical intraepithelial neoplasia (CIN) is a premalignant lesion of the cervix caused by persistent human papillomavirus (HPV) infection, which can lead to cervical cancer. Despite ongoing primary prevention efforts, considerable burden of illness remains. This study assessed the epidemiological, economic, and humanistic burden associated with high-grade CIN among adult women in Europe.

Methods

Systematic literature reviews (SLRs) were conducted for epidemiological, economic, and humanistic burden, in adult women with high-grade CIN in the broader European region. Search strategies were aligned to Cochrane and PRISMA guidelines. Databases searched included Medline®, Embase®, and Cochrane databases (2012–2022). Conference proceedings were also searched (2018–2022). Outcomes of interest included incidence, prevalence, HPV genotype, cost burden, resource use and quality of life burden.

Results

Evidence from 41 epidemiological, 11 economic burden, and 8 humanistic burden studies was included. Incidence of high-grade CIN was 31–186/100,000 women-years in a screened population, with prevalence rates of 0.1–2.2 %. Incidence and prevalence of high-grade CIN peaked among women aged 25–39 years. In women with high-grade CIN, high-risk genotypes were among those most commonly identified, including HPV16/18 (57.0–58.7 %), HPV16 (47.4–52.0 %), HPV18 (4.0–15.0 %) and HPV 31/33/45 (38 %). Cost burden and healthcare resource utilization was higher for CIN3 vs. CIN2. High-grade CIN significantly impaired quality of life, across multiple domains vs. healthy population.

Conclusion

High-grade CIN was associated with considerable burden in Europe. These findings reveal the multifaceted nature of the impact incurred by women with high-grade CIN, and highlight some of the key areas of unmet need among this patient population.
宫颈高级别上皮内瘤变(CIN)是由持续的人乳头瘤病毒(HPV)感染引起的宫颈癌前病变,可导致宫颈癌。尽管正在进行初级预防工作,但仍然存在相当大的疾病负担。本研究评估了欧洲成年女性中与高级别CIN相关的流行病学、经济和人文负担。方法:对欧洲地区成年女性高级别CIN患者的流行病学、经济和人文负担进行系统文献回顾。搜索策略与Cochrane和PRISMA指南一致。检索的数据库包括Medline®、Embase®和Cochrane数据库(2012-2022)。还检索了会议记录(2018-2022)。研究结果包括发病率、患病率、HPV基因型、成本负担、资源使用和生活质量负担。结果:纳入了41项流行病学研究、11项经济负担研究和8项人文负担研究的证据。在筛查人群中,高级别CIN的发生率为31-186/10万女性年,患病率为0.1-2.2 %。高级别CIN的发病率和患病率在25-39岁的女性中最高。在高度CIN的女性中,高危基因型是最常见的,包括HPV16/18(57.0-58.7 %),HPV16(47.4-52.0 %),HPV18(4.0-15.0 %)和HPV 31/33/45(38 %)。CIN3的成本负担和医疗资源利用率高于CIN2。与健康人群相比,高级别CIN在多个领域显著损害了生活质量。结论:在欧洲,高级别CIN与相当大的负担相关。这些发现揭示了女性高级别CIN所产生的影响的多面性,并突出了该患者群体中未满足需求的一些关键领域。
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引用次数: 0
A new uterine endometrium preservation hysteroscopic myomectomy: Introduction of improved procedures and a retrospective analysis of 94 cases 新型子宫内膜保留宫腔镜子宫肌瘤剔除术:改进程序介绍和 94 例病例的回顾性分析
IF 1.5 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-14 DOI: 10.1016/j.eurox.2024.100354
Wataru Isono , Masanori Maruyama

Objective

To reduce the damage of uterine endometrium caused during hysteroscopic myomectomy (HM) for reproductive aged patients, a new uterine endometrium preservation hysteroscopic myomectomy (UEP-HM) has been developed. In this study, we introduced this technique with comparing to the conventional hysteroscopic myomectomy (C-HM).

Study Design

The data from 94 patients aged 42 or younger who underwent HM (38 cases with UEP-HM and 56 cases with C-HM) for treating single Type 1 or Type 2 submucosal leiomyoma (SL) were analysed retrospectively for comparing the characteristics of both patient and target SL. In this process, we defined the operation time 60 min or over as the longtime operation (LTO) and the SM sized 3 cm or over as the large submucosal leiomyoma (LSL) for detecting the influential factors, including this procedure, on the difficulty of HM. For assisting the prediction of operation time (OT), we investigated the relationship between the OT and the cube of average diameter (AD) of target SL referring with some past reports.

Results

Although when comparing UEP and control groups, parity, AD, the number of patients with Type 2 SL, OT, and the number of infertile patients showed significant difference, in the multivariate analysis only LSL showed the significant influence on the possibility of LTO. Next, we compared OT/Cube of AD, which calculated by dividing OT by the cube of AD for evaluating OT from the target SL size and confirmed that there was no difference in those 2 groups (3.7 ± 3.0 (95 %CI: 0.9 - 13.3, n = 38) vs. 3.9 ± 3.2 (95 %CI: 0.4 - 17.3, n = 56), p = 0.79).

Conclusions

The new UEP-HM can become an alternative method of C-HM without procedure-specific difficulty. In the future, to investigate the prognosis of this procedure, more patients and further analyses should be accumulated.
目的 为了减少宫腔镜子宫肌瘤剔除术(HM)对育龄患者子宫内膜的损伤,一种新的子宫内膜保留宫腔镜子宫肌瘤剔除术(UEP-HM)应运而生。研究设计回顾性分析了94例年龄在42岁或以下、接受宫腔镜子宫肌瘤剔除术(UEP-HM 38例,C-HM 56例)治疗单个1型或2型粘膜下子宫肌瘤(SL)的患者数据,以比较患者和目标SL的特征。在这一过程中,我们将手术时间在 60 分钟或以上的手术定义为长时间手术(LTO),将 3 厘米或以上的粘膜下大肌瘤定义为粘膜下大肌瘤(LSL),以检测包括该手术在内的影响 HM 难度的因素。为了帮助预测手术时间(OT),我们参考过去的一些报道,研究了 OT 与目标 SL 平均直径立方值(AD)之间的关系。结果虽然在比较 UEP 组和对照组时,奇偶数、AD、2 型 SL 患者人数、OT 和不孕患者人数均有显著差异,但在多变量分析中,只有 LSL 对 LTO 的可能性有显著影响。接下来,我们比较了OT/AD立方,即用OT除以AD立方来评估目标SL尺寸的OT,结果证实这两组没有差异(3.7 ± 3.0 (95 %CI: 0.9 - 13.3, n = 38) vs. 3.9 ± 3.2 (95 %CI: 0.4 - 17.3, n = 56), p = 0.79)。结论:新的 UEP-HM 可成为 C-HM 的替代方法,且无手术特异性困难。未来,为研究该手术的预后,应积累更多患者并进行进一步分析。
{"title":"A new uterine endometrium preservation hysteroscopic myomectomy: Introduction of improved procedures and a retrospective analysis of 94 cases","authors":"Wataru Isono ,&nbsp;Masanori Maruyama","doi":"10.1016/j.eurox.2024.100354","DOIUrl":"10.1016/j.eurox.2024.100354","url":null,"abstract":"<div><h3>Objective</h3><div>To reduce the damage of uterine endometrium caused during hysteroscopic myomectomy (HM) for reproductive aged patients, a new uterine endometrium preservation hysteroscopic myomectomy (UEP-HM) has been developed. In this study, we introduced this technique with comparing to the conventional hysteroscopic myomectomy (C-HM).</div></div><div><h3>Study Design</h3><div>The data from 94 patients aged 42 or younger who underwent HM (38 cases with UEP-HM and 56 cases with C-HM) for treating single Type 1 or Type 2 submucosal leiomyoma (SL) were analysed retrospectively for comparing the characteristics of both patient and target SL. In this process, we defined the operation time 60 min or over as the longtime operation (LTO) and the SM sized 3 cm or over as the large submucosal leiomyoma (LSL) for detecting the influential factors, including this procedure, on the difficulty of HM. For assisting the prediction of operation time (OT), we investigated the relationship between the OT and the cube of average diameter (AD) of target SL referring with some past reports.</div></div><div><h3>Results</h3><div>Although when comparing UEP and control groups, parity, AD, the number of patients with Type 2 SL, OT, and the number of infertile patients showed significant difference, in the multivariate analysis only LSL showed the significant influence on the possibility of LTO. Next, we compared OT/Cube of AD, which calculated by dividing OT by the cube of AD for evaluating OT from the target SL size and confirmed that there was no difference in those 2 groups (3.7 ± 3.0 (95 %CI: 0.9 - 13.3, n = 38) vs. 3.9 ± 3.2 (95 %CI: 0.4 - 17.3, n = 56), p = 0.79).</div></div><div><h3>Conclusions</h3><div>The new UEP-HM can become an alternative method of C-HM without procedure-specific difficulty. In the future, to investigate the prognosis of this procedure, more patients and further analyses should be accumulated.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"24 ","pages":"Article 100354"},"PeriodicalIF":1.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Preterm birth recurrence after spontaneous preterm birth between 16-28 weeks: A national cohort study 16-28 周自然早产后的早产复发:全国队列研究
IF 1.5 Q3 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-14 DOI: 10.1016/j.eurox.2024.100356
Annabelle L. Van Gils , Anita C. Ravelli , Esmé I. Kamphuis , Brenda M. Kazemier , Eva Pajkrt , Martijn A. Oudijk , Marjon A. De Boer

Objective

To assess the risk of recurrent preterm birth following spontaneous extreme preterm birth between 16+0 - 27+6 weeks.

Methods

A nationwide retrospective cohort study was conducted with data from the Perinatal Registry of the Netherlands. We included nulliparous women with a singleton pregnancy that ended in spontaneous preterm birth between 16+0 and 27+6 weeks of gestation without congenital anomalies or antenatal death between 2010–2014 and had a subsequent pregnancy in the 5 years following (2010–2019). The primary outcome of this study was recurrent preterm birth < 37 weeks.

Results

In total, 1011 women with linked pregnancies were included. The risk of preterm birth < 37 weeks with prior spontaneous birth between 16+0-19+6, 20+0-23+6, and 24+0-27+6 weeks was respectively 19.0 %, 29.5 % and 27.6 %. The risk of subsequent preterm birth < 24 weeks was 5.8 %, 7.2 % and 4.3 %. A short interpregnancy interval of 0–3 months was associated with increased odds for recurrent preterm birth < 32 weeks (OR 2.3 95 % CI 1.4–3.7) and preterm birth < 37 weeks (OR 1.8 95 % CI 1.2–2.6).

Conclusion

Patients with previous spontaneous preterm birth from 16 weeks GA onwards are at high risk for recurrent preterm birth and should be regarded as such in the consideration of preventive measures to prevent recurrent adverse pregnancy outcomes.
方法 利用荷兰围产期登记处的数据开展了一项全国性回顾性队列研究。我们纳入了在 2010-2014 年间因妊娠 16+0 周至 27+6 周之间的自发性早产而结束妊娠且无先天性畸形或产前死亡的单胎妊娠且在此后 5 年(2010-2019 年)内再次妊娠的无子宫妇女。本研究的主要结果是复发性早产< 37周。结果共纳入了1011名有关联妊娠的妇女。37周早产的风险分别为19.0%、29.5%和27.6%,而之前在16+0-19+6周、20+0-23+6周和24+0-27+6周自然分娩的风险分别为19.0%、29.5%和27.6%。24 周后发生早产的风险分别为 5.8%、7.2% 和 4.3%。结论:曾在妊娠 16 周后发生过自然早产的患者是复发性早产的高危人群,因此在考虑采取预防措施以防止再次发生不良妊娠结局时,应将其视为高危人群。
{"title":"Preterm birth recurrence after spontaneous preterm birth between 16-28 weeks: A national cohort study","authors":"Annabelle L. Van Gils ,&nbsp;Anita C. Ravelli ,&nbsp;Esmé I. Kamphuis ,&nbsp;Brenda M. Kazemier ,&nbsp;Eva Pajkrt ,&nbsp;Martijn A. Oudijk ,&nbsp;Marjon A. De Boer","doi":"10.1016/j.eurox.2024.100356","DOIUrl":"10.1016/j.eurox.2024.100356","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the risk of recurrent preterm birth following spontaneous extreme preterm birth between 16<sup>+0</sup> - 27<sup>+6</sup> weeks.</div></div><div><h3>Methods</h3><div>A nationwide retrospective cohort study was conducted with data from the Perinatal Registry of the Netherlands. We included nulliparous women with a singleton pregnancy that ended in spontaneous preterm birth between 16<sup>+0</sup> and 27<sup>+6</sup> weeks of gestation without congenital anomalies or antenatal death between 2010–2014 and had a subsequent pregnancy in the 5 years following (2010–2019). The primary outcome of this study was recurrent preterm birth &lt; 37 weeks.</div></div><div><h3>Results</h3><div>In total, 1011 women with linked pregnancies were included. The risk of preterm birth &lt; 37 weeks with prior spontaneous birth between 16<sup>+0</sup>-19<sup>+6</sup>, 20<sup>+0</sup>-23<sup>+6</sup>, and 24<sup>+0</sup>-27<sup>+6</sup> weeks was respectively 19.0 %, 29.5 % and 27.6 %. The risk of subsequent preterm birth &lt; 24 weeks was 5.8 %, 7.2 % and 4.3 %. A short interpregnancy interval of 0–3 months was associated with increased odds for recurrent preterm birth &lt; 32 weeks (OR 2.3 95 % CI 1.4–3.7) and preterm birth &lt; 37 weeks (OR 1.8 95 % CI 1.2–2.6).</div></div><div><h3>Conclusion</h3><div>Patients with previous spontaneous preterm birth from 16 weeks GA onwards are at high risk for recurrent preterm birth and should be regarded as such in the consideration of preventive measures to prevent recurrent adverse pregnancy outcomes.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"24 ","pages":"Article 100356"},"PeriodicalIF":1.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
European Journal of Obstetrics and Gynecology and Reproductive Biology: X
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