Obstetrics and Gynecology Science最新文献

There is a growing interest in using artificial intelligence (AI) technology to obtain information on the risk and safety of drugs in pregnancy. Inadvertent drug exposure in pregnant women is inevitable in acute or chronic diseases, especially in unplanned pregnancies. According to the Korean mother safe counselling center database (2010-2023), many Korean pregnant women and their families asked about the teratogenicity of their exposed drugs. The most frequently used drug was topiramate (n=2,018), followed by isotretinoin (n=1,972), dexamethasone (n=1,279), and doxycycline (n=1,119). Unexpectedly, thalidomide, a notorious teratogen that causes phocomelia, was included. It has been withdrawn from general prescriptions since 1961, except for the treatment of multiple myeloma. Her partner used it for the treatment of multiple myeloma. In this study, we evaluated the usefulness of AI Chat generative pretrained transformer (Chat GPT) by comparing information between AI and a literature review on isotretinoin, a well-known teratogen to which Korean pregnant women are frequently exposed. ChatGPT provides general information on teratogenicity for pregnant women and medical providers rather than on their exposure. Thus, AI can induce unnecessary termination of pregnancy due to misinformation and misperception in cases of notorious teratogens such as isotretinoin. Therefore, counseling on the teratogenicity of medication exposure in pregnancy must be performed with ChatGPT, as well as a literature review. Further studies are required to obtain more individualized information using AI in the field of teratology.

Objective: To evaluate the impact of intravenous ferric carboxymaltose (FCM) compared to iron sucrose (ISC) in perimenopausal women with heavy menstrual bleeding (HMB) and anemia.

Methods: This prospective, open-label, randomized controlled trial enrolled perimenopausal women (40-50 years) with HMB and hemoglobin levels between 6-10 g/dL, intolerant or non-compliant to oral iron therapy. The study compared FCM and ISC by assessing hematological parameters, including hemoglobin, ferritin, and iron levels, over a 12-week period. The patients were followed up at 3, 6, and 12 weeks after initiation. The adverse effects were also evaluated.

Results: The study included 60 perimenopausal women, with 30 in each group. The baseline patient characteristics were comparable. FCM demonstrated a statistically significant higher mean increase in hemoglobin (4.97 g/dL) than ISC (4.63 g/dL) over 12 weeks. The proportion of patients achieving correction of anemia (hemoglobin ≥12 g/dL) was higher in the FCM group (75.9% vs. 65.5%). Serum ferritin levels were significantly higher in the FCM group after 3 weeks. Adverse effects were minimal and comparable between the groups. Although the direct cost of FCM is high, its ability to be administered in larger doses may result in lower total costs.

Conclusion: In perimenopausal women with heavy menstrual bleeding and iron deficiency anemia, FCM and ISC show comparable efficacy in increasing hemoglobin levels with similar side effect profiles. This study highlights the potential benefits of FCM and calls for further exploration of these therapies in diverse patient populations.

Objective: The performance of large language models (LLMs) and their potential utility in obstetric and gynecological education are topics of ongoing debate. This study aimed to contribute to this discussion by examining the recent advancements in LLM technology and their transformative potential in artificial intelligence.

Methods: This study assessed the performance of generative pre-trained transformer (GPT)-3.5 and -4 in understanding clinical information, as well as its potential implications for obstetric and gynecological education. Obstetrics and gynecology residents at three hospitals underwent an annual promotional examination, from which 116 of the 170 questions over 4 years (2020-2023) were analyzed, excluding 54 questions with images. The scores achieved by GPT-3.5, -4, and the 100 residents were compared.

Results: The average scores across all 4 years for GPT-3.5 and -4 were 38.79 (standard deviation [SD], 5.65) and 79.31 (SD, 3.67), respectively. For groups first-year resident, second-year resident, and third-year resident, the cumulative annual average scores were 79.12 (SD, 9.00), 80.95 (SD, 5.86), and 83.60 (SD, 6.82), respectively. No statistically significant differences were observed between the scores of GPT-4.0 and those of the residents. When analyzing questions specific to obstetrics, the average scores for GPT-3.5 and -4.0 were 33.44 (SD, 10.18) and 90.22 (SD, 7.68), respectively.

Conclusion: GPT-4 demonstrated exceptional performance in obstetrics, different types of data interpretation, and problem solving, showcasing the potential utility of LLMs in these areas. However, acknowledging the constraints of LLMs is crucial and their utilization should augment human expertise and discernment.

Objective: Several graft options can be used to construct a neovagina. This study aimed to evaluate the efficacy of creating a neovagina using a fresh human amnion in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.

Methods: Ten patients were analyzed retrospectively. Anatomical success was defined by a postoperative vaginal length ≥5 cm, and a width sufficient to comfortably accommodate the insertion of two fingers. Functional success was achieved when a score of >26.5 was attained on the Arabic validated version of the functional sexual function index (FSFI).

Results: Overall, the mean vaginal length before surgery was 2.15±0.85 cm (range, 1.5-4.5). The mean vaginal length after surgery was 5.5±0.53 cm (range, 5-6), and all patients (n=10) achieved anatomical success. The FSFI score after surgery was 29.2±2.4, and eight patients achieved functional success. The mean operative time and estimated blood loss were 83.5±50.31 minutes (range, 42-210) and 122.0±75.69 mL (range, 20-250), respectively. None of the patients required intraoperative blood transfusion or experienced injury to vital organs. Four patients developed postoperative leukocytosis within 48 hours, and one patient experienced chronic pelvic pain that lasted more than 6 months postoperatively. No major postoperative complications, such as pelvic abscesses, open wounds, chronic vaginal discharge, or reoperation, were reported.

Conclusion: In conclusion, surgical dissection of the vesicorectal space and utilization of fresh human amnion to create a neovagina over a vaginal mold are technically feasible and safe, and are linked to favorable anatomical and functional outcomes in MRKH patients with vaginal agenesis.

Objective: This study aimed to explore the impact of high-intensity focused electromagnetic therapy (HIFEMT) on the pelvic floor muscles (PFM), sexual function, and quality of life (QoL) among postmenopausal women.

Methods: Fifty postmenopausal women with PFM weakness and sexual dysfunction were randomly allocated into two equal groups. The HIFEMT group participated in the PFM training program in addition to HIFEMT, whereas the control group performed PFM training only. For 12 weeks, HIFEMT was scheduled twice a week, while PFM training was performed daily. At baseline and after 12 weeks, PFM strength and endurance were assessed using a perineometer, sexual function was examined using the female sexual function index (FSFI), and QoL was assessed through the menopause-specific quality of life questionnaire (MENQOL).

Results: The HIFEMT and control groups showed significant increases in PFM strength and endurance and FSFI scores, and significant declines in MENQOL compared with baseline measures (P<0.05). Compared to the control group, the HIFEMT group showed substantial improvements in all measured variables after 12 weeks (P<0.05).

Conclusion: Addition of HIFEMT to PFM training improved the PFM strength, endurance, sexual function, and QoL in postmenopausal women with PFM weakness and sexual dysfunction.

Thyroid disorders are considered to be linked to various health issues, including gynecologic cancers. Studying this association is crucial in clinical practice. This approach was applied through searches in Scopus, WOS, PubMed, and Google Scholar. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed. The quality assessment was checked. The meta-analyses were performed using R-4.3.2 (R Core Team, Vienna, Austria) and SPSS version 28 (SPSS Inc., Armonk, NY, USA). The results demonstrated that 19 studies investigated the association between thyroid disorders and gynecologic cancers in adult females. The studies were categorized into two groups: group 1 examined thyroid status in various gynecologic cancers, while group 2 comprised casecontrol studies examining gynecologic cancer incidence in females with thyroid disorders compared to control. Among females with gynecologic cancers, 13% (95% confidence interval [CI], 10-17%) had hypothyroidism. When comparing hypothyroidism and hyperthyroidism across studies, the overall percentage for hypothyroidism was 14% (95% CI, 9-22%), while for hyperthyroidism, it was 3% (95% CI, 2-5%). The odds ratio for hypothyroidism in females with uterine cancer was 2.65 (P<0.05). Additionally, hypothyroidism showed a significant risk ratio of 1.3 (P<0.05) for different gynecologic cancers. However, hyperthyroidism was significantly associated with increased ovarian cancer mortality (risk ratio [RR], 2.14; P=0.03); conversely, hypothyroidism showed no significant relationship (RR, 1.35; P=0.26). The findings concluded that hypothyroidism is significantly associated with various gynecologic cancers, suggesting a potential role in its pathogenesis. Conversely, hyperthyroidism is linked to an increased risk of ovarian cancer mortality. Further research is needed to clarify whether hyperthyroidism predisposes females to ovarian cancer.

Objective: The primary objective of this study was to compare the detection rate of high-risk human papillomavirus (HPV) infection between self-sampling to collect vaginal specimens and clinician sampling to collect cervical specimens, as well as the correlation between the two techniques. The secondary objective was to assess satisfaction with selfsampling for HPV testing.

Methods: From October 2021 to September 2022, women positive for HPV 16/18 and other 12 high-risk HPV genotypes and cytological Ascus were enrolled. All participants were instructed on the method for self-collection of HPV samples. Self-collected vaginal samples and clinician-collected cervical samples were subjected to HPV DNA typing.

Results: Paired self- and clinician-collected specimens were obtained from 104 women with positive HPV-positive results. The detection rate of high-risk HPV infection was comparable between the two techniques: 79/98 (80.6%) vs. 81/98 (82.7%) for the self-sampling and clinician-sampling techniques, respectively (McNemar's test; P=0.774). The agreement in detecting HPV infection was substantial, with a kappa coefficient of 0.75. More than 90% of the participants rated self-collection as satisfactory to very satisfactory because of its convenience and safety. Regarding methods of further follow-up, 51% of the participants chose self-sampling, whereas the remaining participants preferred collection by clinicians. No intervention-related complications were observed.

Conclusion: The self-sampling technique for HPV testing was as effective as the clinician-sampling technique, and both techniques were substantially correlated in detecting high-risk HPV infection. The self-sampling method appears to be highly satisfactory and may provide better compliance for the detection of cervical HPV infection.

In May 2023, the United States Food and Drug Administration approved a Pfizer©-sponsored (Pfizer, New York, NY, USA) bivalent respiratory syncytial virus prefusion F protein-based vaccine (RSVpreF) RSV vaccine (AbrysvoTM [Pfizer]) for use during pregnancy to prevent neonatal/infant RSV infection. In February of 2022, trials sponsored by GSK© (Brentford, England, UK) on a similar RSVpreF vaccine were halted because of the identification of a safety signal related to preterm births. As these vaccines use identical pre-fusion F-protein technology, we sought to synthesize the existing data on their effectiveness and safety. We identified all randomized controlled trials and used RevMan 5.4.1 (The Cochrane Collaboration, England, UK) to perform the analysis with 95% confidence intervals and risk ratios (RRs). We found many maternal side effects were more prevalent in the RSVpreF group, with more local reactions, blood disorders, fatigue, joint pain, cardiac disorders, headache, fever, gastrointestinal disorders and pregnancy complications. The vaccinated group demonstrated significant reductions in RSV-lower respiratory tract cases (RR, 0.44 [0.33, 0.57]; P<0.00001), severe respiratory illness (RR, 0.29 [0.19, 0.44]; P<0.00001), and hospitalizations (RR, 0.40 [0.24, 0.67]; P=0.0005). RSVpreF vaccination was associated with a higher incidence of preterm delivery (RR, 1.24 [1.08, 1.44]; P=0.003). No significant difference in neonatal deaths was observed (RR, 1.42 [0.70, 2.89]; P=0.34). In conclusion, RSVpreF vaccination results in systemic adverse events and an increase in preterm delivery. Vaccination appears to have acceptable short-term newborn safety, but is not related to a significant decrease in neonatal death.