Obstetrics and Gynecology Science最新文献

Objective: To analyze the microbiological and clinical characteristics of vulvovaginitis in girls, distinguishing between the premenarcheal and postmenarcheal groups in a tertiary center in South Korea.

Methods: This retrospective cohort study included 195 patients under 20 years of age diagnosed with vulvovaginitis at a tertiary hospital between 2014 and 2023. The patients were categorized into premenarcheal (n=95) and postmenarcheal (n=100) groups. Data on initial symptoms, microbial cultures, and treatment methods were analyzed.

Results: The most common initial symptom was vaginal discharge, reported in 63.1% of cases. Culture results showed a 51.3% positivity rate for any microorganism, with a prevalence of gram-negative rods (32.8%) and gram-positive cocci (14.4%). The most frequently isolated microorganisms were Escherichia coli (17.9%), Candida albicans (7.7%), and Enterococcus faecalis (6.7%). Gram-negative rods were more common in the premenarcheal group (37.1% vs. 25.0%; p=0.01). No significant differences were observed in the prevalence of gram-positive cocci and Candida species between the two groups (16.8% vs. 12.0%, p=0.22; 6.3% vs. 13.0%, p=0.09; respectively). The susceptibilities of grampositive microorganisms to penicillin, oxacillin, clindamycin, vancomycin, and tetracycline were 58.8%, 58.3%, 94.7%, 100.0%, and 73.7%, respectively. The susceptibilities of gram-negative microorganisms to amoxicillin/clavulanic acid, ciprofloxacin, ceftriaxone, and nitrofurantoin were 89.3%, 85.3%, 76.0%, and 100.0%, respectively.

Conclusion: This study identified differences in the microbial profiles associated with vulvovaginitis between premenarcheal and postmenarcheal girls. Age-specific and history-based clinical approaches tailored to menarcheal status are warranted to improve the management and outcomes of pediatric and adolescent vulvovaginitis.

Emerging evidence indicates that dysfunction of the gamma-aminobutyric acid (GABA)ergic pathway may contribute to the pathophysiology of polycystic ovary syndrome (PCOS), and GABA demonstrates potential in the management of PCOS symptoms. This systematic review aimed to determine the role of the GABAergic pathway in PCOS and evaluate the impact of GABA on improving the condition. Web of Science, Embase, Scopus, Cochrane, and PubMed databases were systematically searched for experimental studies, clinical trials, animal studies, and cellular investigations. The search was conducted for relevant English-language manuscripts, published up to February 2024, using keywords, such as "polycystic ovary syndrome", PCOS, "gamma-aminobutyric acid" and GABA. Quality assessment of the included studies was performed using the Cochrane Collaboration's tool and the Newcastle-Ottawa scale. The results indicate that GABAergic dysfunction adversely affects gonadotrophin-releasing hormone neuronal activity, leading to hormonal imbalances and reproductive issues. Prenatal androgen exposure and kisspeptin signaling influence GABAergic transmission to GnRH neurons, thereby linking GABA to the pathogenesis of PCOS. Additionally, GABAergic signaling affects peripheral tissues relevant to PCOS, including the immune system, gut-brain axis, and ovaries. GABA supplementation has demonstrated potential benefits in enhancing metabolic and reproductive health, such as reducing insulin resistance and modulating sex hormone levels, as supported by animal models and clinical studies involving females with PCOS. The GABAergic signaling pathway may represent a promising therapeutic target for the management of PCOS. Nevertheless, further studies are required to validate these findings and deepen our understanding of the role of GABA in the pathogenesis and treatment of PCOS.

Objective: To evaluate the incidence of sentinel lymph node (SLN) metastasis observed in patients with presumed low- and intermediate-risk endometrial cancer (EC) and change in stage and adjuvant therapy resulting from SLN analysis. Secondary objectives include assessing the rates of detection of SLN using indocyanine green (ICG) dye and complication rates.

Methods: Between March 2017 and December 2023, 210 patients were included in the study. A total of 412 SLNs were detected in 210 patients using intracervical ICG dye injections.

Results: The pathologically confirmed detection rate was >95%. A total of 25 patients (11.9%) exhibited positive sentinel metastasis detected through pathological and immunohistochemical analysis, with in five (2.4%), micro-metastasis in six (2.9%), and macro-metastasis in 14 patients (6.7%). SLN metastasis with micro- and macro-metastases changed to stage III; therefore, adjuvant therapy was administered in the form of chemotherapy and radiation therapy. Of the 210 patients, 186 (88.5%) remained at low and intermediate risk after the final histopathological analysis. The other 24 patients exhibited SLN metastasis, high-grade EC, higher-stage detection, or high risk on molecular profiling.

Conclusion: A change in stage was observed in 11.9% of patients, and adjuvant therapy was administered to 20 patients, of whom 16 received adjuvant therapy based solely on SLN involvement (in the form of micro- and macro-metastasis), thus preventing undertreatment. Overtreatment was reduced in six patients who were classified as high-grade and non-endometrioid types with SLN metastases.

Objective: Since coronavirus disease 2019 (COVID-19) vaccination began, abnormal uterine bleeding (AUB) has occurred at a high rate. This study assessed the association between COVID-19 vaccination and AUB.

Methods: In this retrospective cohort study, we analyzed mobile application data on menstrual cycles to investigate differences in the prevalence, duration, and amount of intermenstrual bleeding (IMB) after COVID-19 vaccination. We also analyzed the duration of menstruation, menstrual cycle length, and associated symptoms after the COVID-19 vaccination. Additionally, we investigated the prevalence of IMB according to the vaccine type.

Results: After vaccination, IMB prevalence increased to 3.35% (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.46-1.76; p<0.0001) and IMB duration increased by 0.43 days (95% CI, 0.25-0.60; p<0.0001). The proportion of respondents whose amount of IMB was heavier than regular menstruation increased (OR, 2.96; 95% CI, 1.47-5.93; p=0.002). Menstrual duration decreased by -0.01 days (95% CI, -0.023 to 0.003; p=0.114), and menstrual cycle length increased by 1.39 days (95% CI, 1.30-1.48; p<0.0001). The proportion of participants who answered that there was a difference in menstruation amount increased (OR, 1.52; 95% CI, 1.41-1.64; p<0.0001). The prevalence of IMB increased regardless of the vaccine type.

Conclusion: There were statistically significant differences in the prevalence, duration and amount of IMB, menstrual duration, menstrual cycle length, and menstrual amount after COVID-19 vaccination. However, these values were not clinically meaningful and could be regarded as within the normal menstruation range.

Vaginal dryness and dyspareunia are frequent complaints among postmenopausal women. Studies have shown that isoflavones reduce the severity of menopausal symptoms. This study aimed to evaluate the effects of isoflavones on vaginal dryness and dyspareunia in postmenopausal women. PubMed, ScienceDirect, and Cochrane Library electronic databases were searched until June 15, 2024. Revman 5.4 software (The Nordic Cochrane Centre, Copenhagen, Denmark) was used to analyze the data. Ten randomized controlled trials (RCTs), totaling 675 participants, were included in the isoflavone treatment, and the duration was between 4 and 48 weeks. For the meta-analysis, four and two RCTs were conducted to analyze vaginal dryness and dyspareunia in postmenopausal women before and after isoflavone treatment, respectively. The analysis results for vaginal dryness showed a significant change after isoflavone therapy, whereas those for dyspareunia did not show a significant change. The random-effects estimation of the mean difference was -1.29, and 95% confidence interval (CI) was -2.53 to -0.04 (p=0.04) for vaginal dryness, and -0.82, with a 95% CI of -3.51 to 1.87 (p=0.55) for dyspareunia. This meta-analysis concluded that isoflavones have a significant effect on relieving vaginal dryness but have no impact on dyspareunia in postmenopausal women. Numerous larger, long-term trials are needed to fully assess their effects and efficacy.

This systematic review and meta-analysis aimed to summarize the pregnancy outcomes of women diagnosed with genital tuberculosis (GTB) who spontaneously conceived or underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) after being treated with antitubercular therapy (ATT). Publications from the PubMed, Medline, Embase, Ovid, Scopus, Web of Science, and Google Scholar databases were searched from December 20, 2021 to March 5, 2022. The outcomes are presented as pooled averages with 95% confidence intervals. The inconsistency index (I2) test was used to measure the heterogeneity between studies. The certainty of the evidence was assessed using GRADEPro (https://www.gradepro.org/). Of the numerous articles identified, 33 met the inclusion criteria and were included in this systematic review. Generally, there was a significant increase in pregnancy rates among patients who underwent IVF compared with those who underwent ATT (37.9% vs. 23.8%; p=0.02). Conversely, there was no significant difference in pregnancy rates between patients who underwent IUI and those who conceived spontaneously (18.1% vs. 23.8%; p=0.65). In cases in which no abnormalities were found on hysterosalpingography or hysterolaparoscopy, pregnancy rates were comparable between spontaneous and IVF conceptions (48.4% vs. 49.2%). There were no significant differences in pregnancy or live birth rates between patients with GTB and those with other infertility factors undergoing IVF treatment (p>0.05). ATT, which is administered during the early stages of GTB is effective in achieving pregnancy outcomes comparable to IVF. However, in patients with advanced-stage disease, IVF is a superior treatment modality, resulting in increased pregnancy rates.

Objective: We aimed to compare gene expression levels in myometrial tissues and serum from pregnant women undergoing cesarean section (CS) with and without uterine contractions. The myometrial activator protein-1 (AP-1) transcription factor family (JUN, FOS, and fos-related antigen-2 [FOSL2]) was evaluated as a contraction-related marker in maternal circulation to predict labor timing.

Methods: Samples were collected from pregnant women undergoing CS. Uterine contractions were observed in the experimental group (n=10) but not in the control group (n=10). Gene expression of JUN, FOS, and FOSL2 was analyzed in serum and myometrial samples using droplet digital polymerase chain reaction, and statistical analysis was performed using GraphPad software (GraphPad Software, San Diego, CA, USA).

Results: Given the non-normal data distribution, JUN, FOS, and FOSL2 gene expression levels increased in the CS group with uterine contractions. However, this increase was not statistically significant in either tissue or serum samples. Nevertheless, the correlation of JUN messenger RNA expression between maternal circulation and myometrial tissue was statistically significant in the CS group with contractions (p<0.01).

Conclusion: This is the first study to investigate AP-1 transcription factor expression in matched tissue and serum samples in relation to uterine contractility. The increased expression of JUN, FOS, and FOSL2 in the CS group with contractions suggests these genes may play a key role in initiating or propagating human labor, indicating that contractionassociated AP-1 could serve as a biomarker for labor timing.

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. Chat GPT 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 Chat GPT, as well as a literature review. Further studies are required to obtain more individualized information using AI in the field of teratology.

Objective: To examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on maternal, fetal, and infant mortality in South Korea using national statistics, in order to inform policy development and enhance maternal and child health outcomes with the provided data.

Methods: Pregnancy-related mortality in women, as well as deaths of infants, in South Korea was identified using cause-of-death statistics from Statistics Korea. Records from death certificates, cremation reports on infant and fetal deaths, and the complementary cause-of-death investigation system were reviewed for the 2012-2022 period. The classification criteria for cause of death followed the recommendations of World Health Organization and the Korean standard classification of diseases and causes of death.

Results: The maternal mortality rate decreased from 11.3 per 100,000 live births in 2018 to 9.9 in 2019, rose to 11.8 in 2020, and fell to 8.8 in 2021. The actual number of maternal deaths declined from 37 in 2018 to 23 in 2021 due to fewer births. The fetal death rate increased from 11.3 per 1,000 live births in 2018 to 11.6 in 2019, continuing to rise to 12.0 in 2021. The number of fetal deaths dropped from 3,743 in 2018 to 3,152 in 2021.

Conclusion: Despite the COVID-19 pandemic, Korea experienced a sharp decline in births as well as in maternal, infant, and fetal deaths. However, maternal, infant, and fetal mortality rates remained at similar levels.

Endometriosis, a prevalent but debilitating condition affecting women, poses significant challenges in diagnosis and management. The current 2024 guideline, developed by the Korean Society of Endometriosis (KSE), builds upon the 2018 KSE guideline. This guideline aims to provide customized recommendations tailored to Korea's unique clinical aspects and medical environment, and addresses key areas such as diagnosis, medical and surgical management, considerations for special populations, and its complex relationship with cancer.