Obstetrics and Gynecology Science最新文献

Advances in artificial intelligence (AI) and biomedical imaging have transformed reproductive medicine, offering new avenues for precision, efficiency, and objectivity in assisted reproductive technology (ART). Traditional embryo selection and ovarian stimulation monitoring rely mainly on subjective interpretation, which is often influenced by inter- and intra-observer variability. In contrast, AI-enhanced models have demonstrated consistent performance, reduced human-dependent discrepancies, and improved reproducibility of clinical decisions. Among emerging technologies, fluorescence lifetime imaging microscopy enables real-time, label-free metabolic assessment of gametes and embryos by quantifying the intrinsic fluorescence lifetimes of nicotinamide adenine dinucleotide phosphate and flavine adenine dinucleotide. These metabolic signatures correlate with developmental competence, providing a non-invasive tool to evaluate embryo quality beyond the morphological criteria. Recent innovations have extended AI and imaging technologies to self-operated reproductive health monitoring. Studies support AI-powered self-assessment of ovarian follicles using smartphone-compatible ultrasound devices and automated follicle segmentation. This development has potential for improving ovarian stimulation tracking, patient engagement, and personalizing treatment protocols in clinical and low-resource settings. The integration of AI, advanced image processing, and metabolic imaging is a promising frontier in reproductive medicine. These tools enhance the precision of embryo and follicle evaluation, while establishing foundations multimodal platforms that combine clinical, morphological, and metabolic data to optimize ART outcomes.

Objective: Endometriosis is the presence of endometrial tissue outside of the uterine cavity. Certain markers have been used to evaluate the severity of endometriosis. This study aimed to explore the correlation between red blood cell (RBC) indices and the severity of endometriosis.

Methods: This was a cross-sectional study including 200 patients with endometriosis (stage I-II and stage III-IV groups) and 100 patients with other benign ovarian tumors who underwent laparotomy at the Department of Obstetrics and Gynaecology, Margono Regional Public Hospital, between 2021 and 2024. Blood tests were evaluated before surgery and the severity of endometriosis was determined during surgery using the revised American Society for Reproductive Medicine classification.

Results: Among the obtained RBC indices, mean hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) values were significantly lower in subjects with stage III-IV endometriosis than in those with stage I-II endometriosis and the control group (P=0.000, P=0.000, P=0.006, and P=0.010, respectively). The mean red cell distribution width (RDW) was significantly higher in the stage III-IV group than in the stage I-II and control groups (P=0.000). In addition, univariate analysis indicated that lower preoperative RBC indices (Hb ≤11.9 g/dL, Hct ≤37.1%, MCV ≤82.6 fL, MCH ≤26.6 pg) and higher RDW ≥14.9% were independent risk factors for stage III/IV endometriosis.

Conclusion: Lower RBC indices, including pre-operative Hb, Hct, MCV, and MCH, were significantly associated with the severity of endometriosis, which is potentially caused by dysregulation of iron metabolism and inflammation.

Objective: We aimed to introduce the clinical experience with a new surgical technique, single-port access laparoscopic fundusectomy, and a more efficient uterus-sparing surgical method for treating multiple fibroids in patients without a pregnancy plan.

Methods: We performed single-port access laparoscopic myomectomy in 228 patients and single-port access laparoscopic fundusectomy in 35 patients and compared the surgical outcomes.

Results: Significant differences in the surgical outcomes were observed between the two operating.

Methods: . Operating time was 150.71±24.5 minutes in the fundusectomy group than 172.13±61.30 minutes in the multiple myomectomy group (P-value 0.042). Estimated blood loss was lesser (198.29±90.53 mL) in the fundusectomy group than (314.04±344.56 mL) in the multiple myomectomy group (P-value 0.049).

Conclusion: This experience suggests that single-port access laparoscopic fundusectomy is more effective than single-port access laparoscopic myomectomy in terms of operating time and estimated blood loss.

Objective: This study aimed to compare the outcomes of excision (conization) and active surveillance in women under 35 years of age diagnosed with cervical intraepithelial neoplasia 2 (CIN 2) on disease regression to normal cervical cytology and the effectiveness of nonsurgical management.

Methods: This retrospective cohort study was conducted at CHA University Ilsan Medical Center. Women under 35 diagnosed with CIN 2 were included and divided into two groups based on the management strategy: excisional treatment or active surveillance. Data on patient outcomes, including the regression time to normal cytology, were retrospectively collected and analyzed.

Results: The follow-up period ranged from 2.73 months to 42.6 months, with a median follow-up period of 6.8 months. Management strategies between the excisional procedure and active surveillance were not associated with the cytological normalization from CIN 2 (P=0.32). The median time to achieve normal cytology was 7.4 months (95% confidence interval [CI], 6.08-8.77) in the excision group and 12.8 months (95% CI, 10.34-15.22) in the active surveillance group (P=0.22). This trend was observed across the following age groups: 20-24, 25-29, and 30-34 years (20-24, P=0.96; 25-29, P=0.67; and 30-34, P=0.99).

Conclusion: There was no significant difference between the excisional procedure and active surveillance in terms of achieving normalized cytology from CIN 2. Active surveillance is a feasible option for managing CIN 2 in women under 35 years of age.

Objective: To compare the effectiveness of intrauterine lidocaine and warm isotonic sodium chloride solution as distension media for pain reduction during office hysteroscopy.

Methods: This triple-blind randomized controlled trial included 100 patients undergoing diagnostic office hysteroscopy. They were randomized into either the isotonic sodium chloride solution group, which underwent hysteroscopy using warmed isotonic sodium chloride solution as the distension medium, or the lidocaine group, which underwent hysteroscopy using 5 mL of 2% lidocaine diluted in warmed isotonic sodium chloride solution as the distension medium. The primary outcome was the pain visual analog scale score during and after the procedure.

Results: The pain score reported throughout the procedure (during insertion, visualization and withdrawal) and 15 minutes after the procedure was significantly lower in women in the lignocaine group compared to the other group (1.9±1.0 vs. 3.1±0.8, 1.5±0.8 vs. 2.5±0.8, 1.7±0.8 vs. 2.8±0.7, and 1.1±0.2 vs. 1.7±0.8, respectively). Regarding complications, there were no differences between the two study groups in reported vaginal bleeding (1 vs. 2) or vasovagal reaction (0 vs. 1) with no reported cases of uterine perforation or creation of false tract. Regarding side effects, there were a significantly lower number of women who experienced lower abdominal pain, nausea and headache in the lignocaine group compared to others.

Conclusion: The addition of lidocaine to isotonic sodium chloride solution as the distension medium during office hysteroscopy was associated with low pain scores during and after the procedure, short procedure time, reduced need for additional analgesia, high patient satisfaction, and low procedural difficulty scores.

Objective: To compare obstetric and perinatal outcomes between assisted reproductive technology (ART)-conceived and spontaneously conceived twin pregnancies using a nationwide Korean cohort.

Methods: This retrospective cohort study used Korean National Health Insurance Service data from October 2017 to December 2021. Twin pregnancies were identified via International Classification of Diseases, 10th revision codes and classified by conception type based on embryo transfer procedure codes. Outcomes included miscarriage, preeclampsia, placenta previa, gestational diabetes mellitus (GDM), emergency cesarean section (CS), intrauterine growth restriction (IUGR), and macrosomia. Multivariable logistic regression was used to calculate adjusted odds ratios (aORs), controlling for maternal age and comorbidities. Subgroup analyses stratified by maternal age were also performed.

Results: Among 36,013 twin pregnancies, those conceived via ART showed higher risks of placenta previa (aOR, 1.81; 95% confidence interval [CI], 1.57-2.08), preeclampsia (aOR, 1.31; 95% CI, 1.17-1.47), GDM (aOR, 1.32; 95% CI, 1.22-1.43), emergency CS (aOR, 1.21; 95% CI, 1.08-1.34), and IUGR (aOR, 1.18; 95% CI, 1.07-1.31). In women ≥35 years, risks were more pronounced for preeclampsia (aOR, 1.38; 95% CI, 1.19-1.61) and emergency CS (aOR, 1.22; 95% CI, 1.06-1.42).

Conclusion: Twin pregnancies conceived via ART are associated with significantly increased risks of obstetric and perinatal complications compared with spontaneous conceptions. Given the growing utilization of ART, these findings underscore the importance of individualized prenatal care and vigilant perinatal monitoring in ART-conceived twin pregnancies, particularly among women of advanced maternal age.

Objective: To compare laparoscopic mesh sacrocolpopexy (LSC) and laparoscopic lateral suspension (LLS) for preventing post hysterectomy vault prolapse.

Methods: This randomized trial included 40 women who were scheduled for a hysterectomy. The patients were randomly assigned to two groups in a 1:1 ratio: group I underwent LSC immediately after hysterectomy and group II (n=20) underwent LLS immediately after hysterectomy.

Results: Postoperative pelvic organ prolapse quantification measurements (anterior vaginal points anterior vaginal wall points A and posterior vaginal wall points B, vaginal apex point C, and posterior vaginal points anterior prolapse and posterior prolapse) were significantly better in the LSC group, with a lower rate of postoperative vault prolapse beyond the introitus (P=0.047). Both groups showed similar estimated blood loss, urinary tract infection, wound infection, and urinary retention rates. However, LSC was associated with significantly higher postoperative pain scores at 24 hours and 48 hours and a longer hospital stay (P<0.05).

Conclusion: Although LSC demonstrated more favorable anatomical outcomes and a lower incidence of postoperative vault prolapse beyond the introitus than LLS, these findings should be interpreted with caution because of the limited sample size. Both procedures showed comparable safety profiles, although the LSC was associated with greater postoperative pain and longer hospitalization times. Given the study's exploratory design, small cohort, and short follow-up period, further large-scale multicenter studies are needed to confirm these preliminary observations and to better inform clinical practice regarding the optimal surgical approach for preventing post hysterectomy vault prolapse.

This study aimed to explore the utility of ChatGPT in streamlining statistical analyses within medical research, evaluating its capabilities in data management, exploratory data analysis (EDA), statistical test selection, and result interpretation. It also addresses the critical need for appropriate disclosures and ethical considerations when integrating artificial intelligence (AI) tools into a scientific workflow. We review the current landscape of AI adoption in medical research, focusing on the role of ChatGPT in statistical analysis. Practical examples from lecture materials demonstrate its application in generating virtual datasets, performing data cleaning, conducting EDA, and assisting in the selection of appropriate statistical tests. Furthermore, guidelines for transparently disclosing AI tool usage in scientific manuscripts in accordance with the International Committee of Medical Journal Editors recommendations are discussed. ChatGPT demonstrates considerable potential for accelerating various stages of statistical analysis, from initial data preparation to the interpretation of results. Its ability to rapidly generate virtual data for practice, assist in comprehensive data cleaning, and provide immediate insights through EDA can substantially enhance research efficiency. Although capable of suggesting statistical methods and interpreting outputs, human intervention remains crucial for verifying assumptions and ensuring calculation accuracy. ChatGPT can serve as a powerful assistant in medical statistical analyses, enabling researchers to conduct analyses more efficiently. However, its use requires careful data preprocessing, human verification of results, and transparent reporting to maintain scientific rigor and reproducibility. Adherence to ethical guidelines and journal policies regarding AI tool disclosure is paramount.