Obstetrics and Gynecology Science最新文献

Preterm birth (PTB), defined as birth occurring before 37 weeks of gestation, remains a major global public health challenge, affecting approximately 10% of pregnancies worldwide and contributing significantly to neonatal morbidity and mortality. Despite extensive research, the etiology of PTB is multifactorial and not yet fully understood, with ongoing debates regarding the contributions of inflammation, hormonal dysregulation, genetic predisposition, and environmental factors such as microbial dysbiosis. Recent studies have highlighted the role of the vaginal microbiome in pregnancy outcomes, particularly its association with PTB. This review consolidates current findings on the vaginal microbiome's influence on PTB, addressing microbial dysbiosis as a key risk factor. Despite differences in ethnicity, gestational age at sample collection, and analytical methodologies, a common observation is that a decrease in Lactobacillus species is associated with an increased risk of PTB. These differences influence study outcomes by affecting variations in microbial composition, host immune regulation, genetic predisposition, and environmental influences. However, a consistently observed trend is that a Lactobacillus-dominant vaginal microbiome is generally associated with a lower risk of PTB across diverse populations. This review also discusses the limitations of existing research and suggests directions for future microbiome studies.

This systematic review aimed to summarize all available data and evaluate the roles of E-cadherin, N-cadherin, associated molecules, and signaling pathways in the pathogenesis of endometriosis. The search was conducted on PubMed, Cochrane Library, ClinicalTrials.gov, Scopus, Embase, and Google Scholar electronic databases. Twenty-two studies were included in the qualitative analyses. Several studies reported reduced E-cadherin expression in the ectopic and eutopic endometrium of patients with endometriosis, compared with that in the endometrium of patients without endometriosis (healthy comparison group and patients with non-malignant gynecological diseases). Moreover, some of the included studies reported higher E-cadherin concentration in endometriotic lesions than in the eutopic endometrium of patients with endometriosis. Similar results were obtained for β-catenin concentration. Some studies found that the expression levels of N-cadherin, ZEB1, ZEB2, TWIST, vimentin, SNAIL, SLUG, matrix metalloproteinases-9, and hypoxia-inducible factor-1α were higher in patients with endometriosis and that the E-cadherin levels were lower in ovarian and endometrial carcinomas than in endometriosis. These findings support the transplantation theory of endometriosis pathogenesis and highlight the potential therapeutic value of modulating E-cadherin and N-cadherin expression. Further research should be conducted to explore targeted treatment strategies for endometriosis.

Objective: To estimate the learning curve of laparoscopic articulated instrument (LAI) surgery by analyzing data from a multi-institutional gynecologic surgery cohort using surgical time as the primary metric for evaluation.

Methods: A total of 400 patients scheduled to undergo gynecologic surgery (adnexal surgery, myomectomy, hysterectomy, and cancer surgery) using LAI were prospectively enrolled at 14 institutes in the Republic of Korea between November 2021 and April 2022 (KGOG 4002). After excluding patients who did not undergo surgery with LAI (n=43), those in whom LAI was rarely used (n=11), and those operated on by surgeons with prior LAI experience (n=147), 199 patients were included in the analysis. Changes in surgical time according to the surgery index were evaluated using linear regression analysis.

Results: Fifty-four adnexal surgeries, 40 myomectomies, 68 hysterectomies, and 37 cancer surgeries were performed by 24 surgeons. Each surgeon performed between one and 24 surgeries. Surgical time did not decrease as the surgery index increased for any type of surgery. Among surgeons who performed ≥10 surgeries, surgical time similarly showed no decrease with increasing surgery index.

Conclusion: In gynecologic surgery using LAI, surgical time did not decrease despite accumulating surgical experience.

This short communication describes a woman in her 30s with cauda equina syndrome (CES) following a vaginal delivery. She presented with urinary retention, bowel incontinence, and radiating pain in the lower extremities. Magnetic resonance imaging demonstrated a herniated intervertebral disc at the L5/S1 level, leading to surgical intervention. This report highlights the rare occurrence of postpartum CES and underscores the importance of prompt diagnosis, distinguishing it from more common postpartum conditions, and timely management to prevent permanent neurological deficits.

Objective: To evaluate the postnatal outcomes of referred cases with abnormal findings in the fetal gallbladder (GB) or cysts in the fetal liver.

Methods: This retrospective study included pregnant women referred to a tertiary referral unit, the fetal therapy center at Ulsan Asan Medical Center in Korea, between June 2005 and October 2022. Persistent non-visualization of the fetal gallbladder (NVFGB) was defined as non-visualization at least twice using an ultrasound scan. Antenatal ultrasound findings were obtained from the medical records, and the clinical, radiological, and surgical findings of the babies were reviewed.

Results: A total of 113 referred patients were evaluated. Most enlarged and small GBs were identified as normal or GB stones, sludge, septate GB, or choledochal cysts (CDC). NVFGB was identified postnatally in 77.5% of cases. Persistent NVFGB was identified postnatally as biliary atresia (3/14; 21.4%), hepatic parenchymal disease with cholestasis (2/14; 14.2%), or isolated GB agenesis (6/14; 42.8%). The majority of cysts in the fetal liver cases with visualization of the fetal GB were identified as CDC. Half of the patients (2/4) with CDC who underwent NVFGB were confirmed to have biliary atresia.

Conclusion: Except for persistent NVFGB, most abnormal ultrasound findings in fetal GB were associated with good postnatal outcomes. Cysts in the fetal liver with visualization of the fetal GB did not result in serious adverse outcomes. NVFGB, especially persistent NVFGB with or without cysts in the fetal liver, should be followed up closely prenatally and postnatally.

Objective: In this study, the expression and clinical significance of vascular endothelial growth factor (VEGF), hypoxia inducible factor-1α (HIF-1α), and matrix metalloproteinase-2 (MMP2) in the placental villi of patients experiencing recurrent spontaneous abortion were investigated.

Methods: Fifty-one patients with recurrent spontaneous abortion (RSA) and 50 control individuals were enrolled (between January 2022 and December 2023). The messenger RNA (mRNA) and protein levels of VEGF, HIF-1α, and MMP2 in the placental villi of all enrolled patients were assessed using quantitative real-time polymerase chain reaction and western blot techniques. Additionally, the correlation between VEGF, HIF-1α, and MMP2 expression was analyzed using Pearson correlation coefficient.

Results: The results revealed that the levels of VEGF mRNA and protein in the placental villi of patients with RSA were significantly lower than those in the control group, and this difference was statistically significant. Conversely, the mRNA and protein levels of HIF-1α and MMP2 were significantly higher in the RSA patient group than in the control group. Furthermore, the study revealed a negative correlation between the expression of VEGF and MMP2 in the placental villi of patients with RSA, and a positive correlation was observed between the expression of HIF-1α and MMP2.

Conclusion: The downregulated expression of VEGF and upregulated expression of HIF-1α and MMP2 in the placental villi of patients with RSA may contribute to the pathogenesis of RSA. However, further investigation is required to elucidate the specific molecular regulatory mechanisms.

Objective: Natural orifice transluminal endoscopic surgery (NOTES) for hysterectomy conventionally requires CO2 pneumoperitoneum via a transvaginal port, presenting challenges such as gas leakage and increased procedural complexity. We introduced isobaric NOTES hysterectomy (iNH) as an alternative to transvaginal NOTES hysterectomy (vNH) to eliminate the need for CO2 pneumoperitoneum.

Methods: Between December 2014 and July 2018, 137 patients with benign uterine conditions underwent iNH or single-port laparoscopy-assisted vaginal hysterectomies (SP-LAVH). Clinical outcomes were retrospectively compared.

Results: Of 137 patients, 59 underwent iNH and 78 underwent SP-LAVH. All iNH procedures were completed without conversion, except for one hybrid NOTES case, with no intraoperative complications reported in the iNH group. While the median operative times and uterine weights were comparable between the groups, iNH demonstrated significantly lower median blood loss, reduced hemoglobin changes on postoperative day 1, and shorter hospital stay than SP-LAVH.

Conclusion: Using a single-hole vaginal platform without pneumoperitoneum, iNH combines the simplicity of vaginal hysterectomy with the visual advantages of vNH. Therefore, it is a distinct method within the transvaginal hysterectomy spectrum. Further studies are warranted to delineate the specific iNH advantages over conventional pneumoperitoneum-based vNOTES.

Objective: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is less invasive than conventional transabdominal laparoscopic surgery for benign gynecological indications. When adopting this procedure for risk-reducing salpingo-oophorectomy (RRSO) in women with hereditary breast and ovarian cancer (HBOC), the ventral side of the uterus becomes a blind area, which is a challenge. To clarify the effects of this blind area on the treatment outcome of HBOC, we examined the clinical data of RRSO using conventional procedures for women with germline BRCA1/2 pathogenic variants who were treated at our institution.

Methods: A retrospective chart review was performed. The clinical data of patients who underwent RRSO using the conventional procedure between September 2011 and July 2024 were extracted. All included patients were preoperatively examined using vaginal ultrasonography, contrast-enhanced pelvic magnetic resonance imaging, and carcinoma antigen-125 level measurements to exclude ovarian cancer development.

Results: A total of 267 patients underwent RRSO at our institution. The mean age at RRSO was 50.1 years. Five cases of occult invasive cancer (1.9%) and 10 cases of serous tubal intraepithelial carcinoma (3.7%) were identified postoperatively. One patient (0.37%) showed macroscopic peritoneal dissemination in the omentum. None of the 252 patients without occult cancer developed peritoneal cancer during the mean observational time of 62.4 months. No patient presented with peritoneal lesions ventral to the uterus.

Conclusion: Macroscopic tumors on the peritoneum ventral to the uterus were rare when strict preoperative screening for ovarian cancer was performed. vNOTES can be safely adopted for RRSO in patients with HBOC, without evident disadvantages.

Objective: Monochorionic (MC) pregnancies are often complicated by shared placental and circulatory structures, resulting in conditions such as twin-twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), and a twin-reversed arterial perfusion (TRAP) sequence. This study aimed to evaluate perinatal outcomes following radiofrequency ablation (RFA) for selective fetal reduction in complicated MC pregnancies at a tertiary care center in India.

Methods: This retrospective cohort study analyzed 100 MC pregnancies that underwent RFA for selective fetal reduction between January 2016 and December 2023. The indications included TTTS, sFGR (stages II and III), discordant anomalies, TRAP, and elective reduction. The key outcomes assessed were live birth rates, procedural success, and complications, including preterm prelabor rupture of membranes (PPROM) and co-twin survival. Data were compared between the two intervention periods to evaluate improvements over time.

Results: Procedural success was achieved in all patients with no intraoperative complications. The median gestational age at the time of the procedure was 22 weeks. The overall live birth rate was 85% and the discharge survival rate was 79%. PPROM occurred in 18% of patients, whereas fetal death was observed in 15%, predominantly in patients with TTTS. Post-procedure magnetic resonance imaging detected cerebral injury in 2% of surviving twins. Logistic regression analysis did not identify any significant predictors of co-twin death.

Conclusion: RFA is an effective technique for selective fetal reduction in MC pregnancies, offering favorable survival outcomes, even in a resource-limited setting.