Obstetrics and Gynecology Science最新文献

Objective: To develop a web-based risk assessment system to predict cesarean section (CS) due to dystocia at admission in nulliparous term singleton vertex pregnancies, tailored for Korean women.

Methods: This case-control study analyzed the data of 126 women with CS due to dystocia and 490 women who had vaginal deliveries. Eight predictors-gestational age, maternal age, maternal height, pre-gestational body mass index, birth weight, fetal sex, cervical dilatation at admission, and maternal-fetal ratio-were identified using multivariate logistic regression. The system integrated both logistic regression and risk-scoring models simultaneously to provide individualized risk probabilities and categorical risk levels.

Results: The model demonstrated strong predictive accuracy, with an area under the receiver operating characteristic curve (AUC) of 0.86. Risk stratification classified the patients into low-, intermediate-, and high-risk groups, corresponding to CS rates of 1.6, 47.6, and 50.8%, respectively (P<0.001).

Conclusion: This dual-output, user-friendly, and admission-based web system enhances interpretability and supports personalized counseling and evidence-based decision-making. Specifically designed for Korean women, it enables the early identification of high-risk cases and may help reduce unnecessary operative interventions. Therefore, further multicenter studies are warranted.

Adenomyosis, a prevalent yet frequently underdiagnosed uterine disorder, poses significant challenges for women of reproductive age, especially those seeking fertility. Although hysterectomy remains the definitive treatment, fertility-sparing interventions such as adenomyomectomy have gained traction despite ongoing debates regarding their efficacy and safety. This review synthesizes the current evidence on reproductive and perinatal outcomes following adenomyomectomy, evaluates its risks and benefits and provides evidence-based clinical recommendations. We reviewed the diagnosis and treatment of adenomyosis, with a particular focus on fertility-sparing surgery, and summarized the pregnancy outcomes and obstetric risks after adenomyomectomy, including recommendations for prenatal care. Adenomyomectomy may improve fertility in carefully selected patients; however, it carries substantial obstetric risks including placenta accreta spectrum, preterm birth, and life-threatening hemorrhage. While it offers a viable alternative to hysterectomy, its use should be restricted to women with severe symptoms or those who have failed assisted reproductive technology cycles and should be managed within a framework of shared decision-making and high-risk obstetric care. Future research should address diagnostic standardization, long-term reproductive outcomes, and strategies to mitigate surgical complications.

Placenta accreta spectrum (PAS) is defined by abnormal placental adherence or invasion into the myometrium or adjacent organs and is a leading cause of massive obstetric hemorrhage. Its global incidence is increasing due to rising cesarean delivery rates, uterine surgeries, and the use of assisted reproductive technologies. This review summarizes the current knowledge regarding PAS, including its pathophysiology, risk factors, diagnostic methods, treatment options, and pregnancy outcomes after conservative management. The underlying pathogenesis is related to defective decidualization at the endometrial-myometrial interface, which is commonly associated with uterine scarring. Prenatal diagnosis relies on a thorough clinical history and imaging tools such as ultrasound and magnetic resonance imaging. Management strategies depend on fertility preservation goals and range from hysterectomy to conservative approaches such as leaving the placenta in situ. Effective management requires early risk identification, prenatal screening, referral to specialized centers, and delivery planning by a multidisciplinary team. Despite recent advances in imaging and surgical techniques, PAS remains the leading cause of maternal mortality and morbidity worldwide. There is a critical need for multicenter studies, standardized risk stratification tools, and long-term followup studies to optimize care and improve maternal and reproductive outcomes.

Objective: Dysregulation of leukocyte cell number as a cause of heavy menstrual bleeding (HMB) has not been investigated much. The present study compares the changes in the number of uterine natural killer (uNK) cells, T cells, and macrophages in endometrial samples from women with normal menstrual cycles versus those with HMB.

Methods: We analyzed endometrial tissue from 98 patients (73 with HMB; 25 with normal cycles) using immunohistochemistry to semi-quantitatively estimate the degree of cluster of differentiation (CD)56+, CD8+, CD4+, and CD68+ cell infiltration.

Results: No statistically significant differences were observed in the CD4+, CD8+, CD56+, or CD68+ cell counts between women with HMB and controls during either the proliferative or secretory phases of the menstrual cycle. CD56+ natural killer cells were relatively reduced in the HMB group during the proliferative phase, with higher counts in the control group (P=0.071). CD68+ macrophages/high-power field (hpf) showed a strong positive correlation with CD4+ T cells (r, 0.481; P<0.001), CD8+ T cells (r, 0.641; P<0.001), and CD56+ uNK cells (r, 0.404; P<0.001). CD8+ cells/hpf demonstrated a significant positive correlation with uterine volume, CD4+ cells/hpf, CD68+ cells/hpf, and CD56+ cells/hpf.

Conclusion: Although no single immune cell type was independently associated with HMB compared with controls, the observed significant correlations among CD4+, CD8+, CD56+, and CD68+ highlight the interconnected nature of endometrial immune activity.

The incidence of endometrial cancer (EC) is rising, increasingly affecting younger women desiring fertility preservation. While the International Federation of Gynecology and Obstetrics staging system guides early-stage EC treatment, its prognostic and predictive accuracies are limited, highlighting the need for more precise tools. Molecular classification, particularly mismatch repair (MMR) status and microsatellite instability (MSI), has emerged as a promising strategy for risk stratification and personalized management. This narrative review synthesizes evidence on the role of MMR and MSI as prognostic and predictive biomarkers in early-stage EC. Using a structured narrative approach, we critically examined studies investigating molecular subtypes, especially MMR deficiency (MMRd), and their association with clinicopathological features, treatment responses, and oncological outcomes. Findings indicate that molecular profiling provides key insights beyond traditional pathology. MMRd is associated with less favorable outcomes, including higher recurrence and reduced response to hormonal or fertility-sparing therapies, potentially increasing treatment failure rates. Distinct responses to adjuvant radiation have been observed in MMRd tumors. Regarding nodal involvement, MSI has been associated with increased occult lymph node metastases, while both p53-abnormal and MMRd groups show higher rates of sentinel lymph node positivity than other subtypes. Overall, the MSI/MMRd status appears to be pivotal for improving prognosis and guiding personalized treatment of early-stage EC. Integrating molecular classification into clinical practice may optimize patient selection for conservative therapies, refine lymph node staging strategies, and inform adjuvant treatment decisions. Large prospective studies are essential to validate these findings and facilitate the adoption of standardized guidelines for individualized care.

This narrative review evaluates innovations in assisted reproductive technology (ART) for female infertility, focusing on efficacy, safety, and long-term outcomes. The key objectives include synthesizing advancements such as artificial intelligence (AI)-driven embryo selection, preimplantation genetic testing (PGT), vitrification, and time-lapse imaging, along with their clinical applications. Evidence indicates that PGT can improve implantation and live birth rates per transfer in selected patient groups, that is, those with recurrent pregnancy loss or advanced maternal age. Evidence of AI-assisted selection is promising, but predominantly retrospective, with the potential to improve the efficiency of embryo selection, but has not yet been proven across a variety of clinical settings. However, safety concerns, including ovarian hyperstimulation syndrome, multiple pregnancies, and potential long-term maternal and offspring health risks, persist. Critical reflections highlight ethical dilemmas (e.g., "designer babies", embryo disposition), psychological stressors for patients, and disparities in ART access due to socioeconomic factors. This review underscores the need for personalized protocols, robust longitudinal studies on child development, and equitable policy frameworks. These conclusions advocate for interdisciplinary collaboration to balance technological innovation with ethical integrity, psychological support, and global accessibility.

Objective: Preeclampsia (PE) is a leading cause of maternal and perinatal morbidity and mortality worldwide. Identifying reliable biomarkers may improve risk prediction and disease stratification. To evaluate serum Netrin-1 and urinary kidney injury molecule-1 (KIM-1) levels in preeclamptic women compared with those in healthy pregnant women and to assess their association with disease severity and maternal-fetal outcomes.

Methods: A prospective observational study was conducted at a tertiary care referral center in Western Rajasthan between September 2023 and March 2025, enrolling 118 pregnant women (59 PE cases and 59 controls). Serum Netrin-1 and urinary KIM-1 levels were correlated with PE severity, maternal complications, and fetal outcomes.

Results: Preeclamptic women had significantly higher serum Netrin-1 (844.55±195.27 pg/mL) and urinary KIM-1 (1.57±0.75 ng/mg creatinine) levels than controls (378.24±127.75 pg/mL and 0.62±0.29 ng/mg; P<0.0001). Biomarker levels were higher in patients with severe PE and maternal complications. Receiver operating characteristic curve analysis demonstrated excellent diagnostic accuracy for serum Netrin-1 (area under the curve [AUC], 0.993) and very good accuracy for urinary KIM-1 (AUC, 0.916).

Conclusion: Serum Netrin-1 and urinary KIM-1 levels are promising biomarkers for PE diagnosis and risk stratification. Serum Netrin-1 levels show excellent discriminatory potential and may support clinical risk prediction.

Objective: This study investigated Cripto-1 expression, a crucial regulator of epithelial-mesenchymal transition (EMT) and trophoblast differentiation, in term placentas from pregnancies complicated by fetal growth restriction (FGR), compared with healthy term placentas. We hypothesized that Cripto-1 expression is reduced in FGR placentas, reflecting impaired EMT.

Methods: A retrospective cohort study was conducted using 153 term placental samples collected between 2016 and 2020 at the Clinical Hospital Center Rijeka, Croatia. This study included 122 placentas from pregnant women with FGR and 31 placentas from gestational age-matched controls. Cripto-1 expression was evaluated using tissue microarrays and the immunohistochemical index was calculated by multiplying the staining intensity reaction by the percentage of positive cells. Clinical data were retrieved from medical records and included maternal age, parity, preeclampsia status, serum beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A levels, ultrasound fetal biometry, Doppler measurements of the umbilical artery and fetal circulation, fetal sex, weight, fetoplacental ratio, and placental histopathological findings.

Results: Maternal age, parity, and neonatal birth weight differed significantly between the FGR and control groups. However, no statistically significant differences in Cripto-1 expression were detected between the FGR and healthy placentas. Additionally, Cripto-1 expression was not associated with any of the clinical or biochemical parameters measured in the FGR group.

Conclusion: Cripto-1 expression did not differ significantly between placentas with FGR, suggesting that its role may be more relevant in early placental development. Further studies are warranted to determine its value as an early biomarker of placental dysfunction.

Objective: Despite recent improvements, fertility knowledge among Japanese individuals remains substantially lower than in other countries. This study aimed to evaluate fertility knowledge among women with pregnancy and childbirth experience and assess differences based on employment status, given the increasing intersection of professional careers and reproductive decision making.

Methods: A cross-sectional, multicenter questionnaire survey was administered to postpartum women at seven hospitals. The questionnaire assessed clinical and socioeconomic characteristics and incorporated the Cardiff fertility knowledge scale-Japanese version (CFKS-J). Participants were categorized as employed or non-employed and CFKS-J scores were calculated for both groups. Factors associated with greater fertility knowledge in each group were analyzed.

Results: Of the 963 postpartum women who participated in this study, 81% were employed during pregnancy. Employed participants had significantly higher fertility knowledge scores (60.0±21.5) than non-employed participants (55.8±22.8; P=0.03). Healthcare workers had the highest knowledge about fertility. Common misconceptions included the effects of mumps, obesity, and sexually transmitted diseases on fertility.

Conclusion: Employed pregnant women had greater fertility knowledge than non-employed women. Factors linked to knowledge acquisition included education and the workplace environment. Improving access to fertility education among socially isolated groups, including the unemployed, remains essential.