Taiwanese Journal of Obstetrics & Gynecology最新文献_第7页

The Pumpkin method — An innovative uterus-preserving surgery for large complex adenomyosis: A preliminary experience 南瓜法-一种创新的子宫保留手术治疗大型复杂bb0：初步经验

IF 2.2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology

Pub Date : 2025-11-01 DOI: 10.1016/j.tjog.2025.07.024

Chiao-Hsin Kung , Leo Leung-Chit Tsang , Wen-Hsin Chen , Yu-Min Chou , Ching-Chang Tsai , Fu-Tsai Kung

Objective

To introduce and evaluate the surgical feasibility, safety, and recovery outcomes of the “Pumpkin method,” a novel, multiflap adenomyomectomy technique for patients with large and complex adenomyosis.

Materials and methods

This prospective observational study enrolled 10 consecutive women with large, refractory adenomyosis (unresponsive to hormonal therapy) and fertility concerns. All patients underwent uterus-preserving laparotomic surgery using the newly developed “Pumpkin method,” involving multiple longitudinal uterine incisions to excise adenomyotic tissue. The resulting arch bridge-like flaps were reconstructed using interrupted and mattress sutures, forming a “pumpkin-like” appearance resembling Yayoi Kusama's sculptural art. Preoperative and postoperative evaluations included magnetic resonance imaging (MRI), and serum cancer antigen 125 (CA-125) and anti-Müllerian hormone (AMH) levels.

Results

Six-month postoperative MRI demonstrated significant adenomyosis regression (residual lesions ≤2 cm) with preserved uterine morphology, adequate myometrial thickness, and an intact endometrium. CA-125 levels decreased significantly (P = 0.008), indicating reduced adenomyotic tumor activity, while AMH levels remained stable (P = 0.110), suggesting preservation of the ovarian reserve. At a mean follow-up of 30.5 months, nine patients reported sustained improvement in menstrual symptoms. One patient achieved an uncomplicated term twin pregnancy; however, one patient required a hysterectomy 30 months after surgery due to recurrent symptoms.

Conclusion

The “Pumpkin method” provides a feasible and effective approach for adenomyosis debulking, combining multiflap excision with meticulous reconstruction to restore uterine anatomy without major technical difficulties. Further studies with larger cohorts are warranted to validate reproductive outcomes and long-term efficacy.

目的介绍并评价“南瓜法”的手术可行性、安全性和恢复效果。“南瓜法”是一种新型的多瓣子宫肌瘤切除术技术，用于治疗大而复杂的子宫肌瘤。材料和方法这项前瞻性观察性研究连续招募了10名患有大的、难治性bbb（对激素治疗无反应）和生育问题的女性。所有患者均采用新开发的“南瓜法”进行保留子宫的剖腹手术，涉及多个纵向子宫切口切除腺肌病组织。由此产生的拱桥状皮瓣使用中断和床垫缝合重建，形成类似于草间弥生雕塑艺术的“南瓜状”外观。术前和术后评估包括磁共振成像（MRI）、血清癌抗原125 （CA-125）和抗勒氏杆菌激素（AMH）水平。结果术后6个月MRI显示明显的子宫腺肌症消退（残余病变≤2 cm），子宫形态保留，肌层厚度充足，子宫内膜完整。CA-125水平显著降低（P = 0.008），表明腺肌瘤活性降低，而AMH水平保持稳定（P = 0.110），提示卵巢储备功能保留。在平均30.5个月的随访中，9名患者报告月经症状持续改善。1例获得无并发症的足月双胎妊娠；然而，一名患者在手术后30个月因症状复发而需要子宫切除术。结论“南瓜法”提供了一种可行、有效的方法，结合多瓣切除和精细重建，恢复子宫解剖结构，无重大技术困难。进一步的研究需要更大的队列来验证生殖结果和长期疗效。

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引用次数: 0

Developing a transfer learning model for the prediction of Down syndrome from first-trimester ultrasound images 开发一种迁移学习模型，用于从妊娠早期超声图像预测唐氏综合征

IF 2.2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology

Pub Date : 2025-11-01 DOI: 10.1016/j.tjog.2025.08.001

Chen-Yu Chen , Ci-An Wang , Jhuang-Hao Cyue , Chie-Pein Chen , Fang-Ju Sun , Yi-Yung Chen , Liang-Kai Wang , Chao-Wei Chang , Bing-Yan Tsai , Kuo-Ping Chen

Objective

Down syndrome is the most common chromosomal disorder, frequently associated with increased nuchal translucency (NT) and an absent nasal bone (NB) during first-trimester ultrasound. This study aims to develop a transfer learning (TL) model for the automated detection of fetuses at high risk for Down syndrome.

Materials and methods

An artificial intelligence (AI)-based classification framework was developed using TL with the AlexNet architecture and integrated with gradient-weighted class activation mapping (Grad-CAM) to automatically detect NT and NB features in first-trimester ultrasound images. The model was trained on a dataset comprising 1056 images of normal fetuses and 12 images of fetuses with Down syndrome. To enhance training consistency and model generalizability, image cropping and class weighting techniques were applied.

Results

To address class imbalance, the 12 Down syndrome images were augmented using rotation, mirroring, and brightness adjustments, resulting in 96 anatomically faithful images. The model achieved excellent performance, with an accuracy of 98.3 %. The area under the receiver operating characteristic curve (AUC) was 0.98, and the sensitivity, specificity, positive predictive value, and negative predictive value were 89.47 %, 100 %, 100 %, and 97.96 %, respectively. Grad-CAM visualization indicated that the NT and NB regions were the most influential features in the model’s decision-making, providing valuable insights into its diagnostic reasoning.

Conclusion

This TL model enhances the early detection of Down syndrome from first-trimester ultrasound images, improving diagnostic accuracy and reducing the reliance on manual measurements.

目的：唐氏综合征是最常见的染色体疾病，妊娠早期超声检查常伴有颈透明度增高（NT）和鼻骨缺失（NB）。本研究旨在开发一种迁移学习（TL）模型，用于唐氏综合征高危胎儿的自动检测。材料与方法基于人工智能（AI）的分类框架，采用TL和AlexNet架构，结合梯度加权类激活映射（Grad-CAM），自动检测孕早期超声图像中的NT和NB特征。该模型在包含1056张正常胎儿图像和12张唐氏综合症胎儿图像的数据集上进行训练。为了提高训练的一致性和模型的可泛化性，采用了图像裁剪和类加权技术。结果12张唐氏综合征图像通过旋转、镜像和亮度调整进行增强，得到了96张解剖学上真实的图像。该模型取得了优异的性能，准确率达到98.3%。受试者工作特征曲线下面积（AUC）为0.98，敏感性为89.47%，特异性为100%，阳性预测值为100%，阴性预测值为97.96%。Grad-CAM可视化显示，北侧和新侧区域是模型决策中最具影响力的特征，为其诊断推理提供了有价值的见解。结论该TL模型增强了早期妊娠超声图像对唐氏综合征的发现，提高了诊断准确性，减少了对人工测量的依赖。

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引用次数: 0

Genetic analysis of a fetus with mosaic trisomy 15 with false-negative result in prenatal amniotic fluid karyotype analysis 在产前羊水核型分析中出现假阴性结果的镶嵌型15三体胎儿的遗传分析

IF 2.2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology

Pub Date : 2025-11-01 DOI: 10.1016/j.tjog.2025.04.021

Xiang Li , Yuanmei Peng , Weiwu Liu , Jujie Song , Guosheng Deng

Objective

To investigate the cause of a false-negative result in prenatal amniotic fluid karyotype analysis for a fetus with mosaic trisomy 15, and to propose a cytomolecular genetic strategy for detecting mosaicism in amniotic fluid.

Case Report

Amniocentesis was performed on a second-trimester pregnant woman presenting with a single umbilical artery and alpha-thalassemia carrier status. Multiplex ligation-dependent probe amplification (MLPA-P245) suggested mosaic trisomy 15, whereas conventional karyotype analysis showed a normal result. Further genetic testing, including copy number variation sequencing (CNV-seq), fluorescence in situ hybridization (FISH), and short tandem repeat (STR) analysis, was performed to exclude maternal cell contamination. MLPA-P245 revealed elevated signals for chromosome 15, indicating mosaic trisomy 15 (approximately 40–50%). CNV-seq detected an 81.83 Mb duplication in 15q11.2q26.3, consistent with ~60% mosaicism, while FISH confirmed ~8% mosaic trisomy 15. Parental karyotypes were normal. After genetic counseling, the patient chose pregnancy termination.

Conclusion

Cellular overgrowth during culture may lead to false-negative karyotype results in mosaic trisomy detection. A combined diagnostic approach using karyotype analysis, CNV-seq, and FISH is recommended to improve the accuracy of mosaicism detection in amniotic fluid samples.

目的探讨15嵌合三体胎儿产前羊水核型分析假阴性的原因，并提出一种检测羊水嵌合的细胞分子遗传学策略。病例报告羊膜穿刺术进行了中期妊娠妇女表现为单一脐带动脉和α -地中海贫血携带者状态。多重连接依赖探针扩增（MLPA-P245）提示花叶型15三体，而常规核型分析显示正常。进一步的基因检测，包括拷贝数变异测序（CNV-seq）、荧光原位杂交（FISH）和短串联重复序列（STR）分析，以排除母细胞污染。MLPA-P245显示15号染色体信号升高，表明15号染色体为马赛克三体（约40-50%）。CNV-seq在15q11.2q26.3中检测到81.83 Mb的重复，符合~60%的嵌合，而FISH证实了~8%的嵌合三体15。亲本核型正常。经遗传咨询，患者选择终止妊娠。结论培养过程中细胞过度生长可能导致花叶三体检测核型假阴性。建议采用核型分析、CNV-seq和FISH相结合的诊断方法来提高羊水样本中嵌合体检测的准确性。

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引用次数: 0

Impact of sacrocolpopexy on sexual function and de novo stress urinary incontinence 骶阴道固定术对性功能和新生压力性尿失禁的影响

IF 2.2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology

Pub Date : 2025-11-01 DOI: 10.1016/j.tjog.2025.09.002

Wei-Ting Chao, Chia-Hao Liu, Peng-Hui Wang

引用次数: 0

Effect of low-dose aspirin in women with pregestational diabetes mellitus: A propensity score matching study 低剂量阿司匹林对妊娠期糖尿病妇女的影响：倾向评分匹配研究

IF 2.2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology

Pub Date : 2025-11-01 DOI: 10.1016/j.tjog.2024.11.014

Seon Ui Lee , Sae Kyung Choi , Ju Myung Song , Jinseon Han , Suein Choi , Seunghoon Han , In Yang Park

Objective

Aspirin is recommended for women with pregestational diabetes mellitus (PGDM) because they are at a high risk for preeclampsia. However, previous studies have predominantly examined the effect of aspirin on high-risk groups, with few investigations of its effect on PGDM alone. Therefore, the aim of this study was to investigate the overall efficacy and safety of low-dose aspirin in women with PGDM.

Materials and methods

The dataset consisted of 40,713 records of women who received antenatal care between January 2011 and December 2021 at eight hospitals in different regions. We excluded patients who were not diagnosed with PGDM, had multiple pregnancies, had absent newborn records, were prescribed aspirin for less than 30 days, and had a dose of aspirin less than 100 mg during pregnancy. In total, 207 patients with PGDM were included in the analysis. We further excluded patients in whom aspirin was initiated at an unknown gestational age. To address the potential for selection bias and confounding variables, we employed propensity score matching (PSM) using the “nearest neighbor” method.

Results

Our study included 192 patients (aspirin group: N = 37; control group: N = 155). No difference was observed in maternal prognosis between the aspirin and control groups. Aspirin did not prevent preeclampsia, fetal growth restriction, or preterm birth. However, the aspirin group exhibited a higher rate of large-for-gestational-age (LGA) births than the control group (41 % vs. 16 %, p = 0.02). No significant obstetric differences were observed between the aspirin and control groups. In multivariate logistic regression analysis, LGA births were significantly associated with aspirin treatment (Odds ratio 3.51, 95 % confidence interval: 1.16–11.8).

Conclusion

The use of low-dose aspirin in women with PGDM may be associated with an increased risk of LGA births. Because of the retrospective nature of this study, a large-scale prospective study is needed to verify these results.

目的：阿司匹林被推荐用于妊娠期糖尿病（PGDM）患者，因为她们是子痫前期的高危人群。然而，以往的研究主要是研究阿司匹林对高危人群的影响，很少单独研究阿司匹林对PGDM的影响。因此，本研究的目的是探讨低剂量阿司匹林对PGDM女性患者的总体疗效和安全性。资料和方法该数据集包括2011年1月至2021年12月在不同地区的8家医院接受产前护理的40,713名妇女的记录。我们排除了未被诊断为PGDM、多胎妊娠、无新生儿记录、服用阿司匹林少于30天、怀孕期间阿司匹林剂量少于100毫克的患者。总共有207例PGDM患者被纳入分析。我们进一步排除了在未知胎龄时开始服用阿司匹林的患者。为了解决潜在的选择偏差和混淆变量，我们使用“最近邻”方法使用倾向得分匹配（PSM）。结果共纳入192例患者，其中阿司匹林组37例，对照组155例。阿司匹林组与对照组在产妇预后方面无差异。阿司匹林不能预防先兆子痫、胎儿生长受限或早产。然而，阿司匹林组的大胎龄（LGA）出生率高于对照组（41%对16%，p = 0.02）。在阿司匹林组和对照组之间没有观察到明显的产科差异。在多因素logistic回归分析中，LGA出生与阿司匹林治疗显著相关（优势比3.51,95%可信区间：1.16-11.8）。结论低剂量阿司匹林可能与妊娠期糖尿病妇女LGA分娩风险增加有关。由于本研究的回顾性，需要进行大规模的前瞻性研究来验证这些结果。

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引用次数: 0

Transvaginal robotic-assisted natural orifice laparoscopic hysterectomy for benign gynecologic disease: Determining appropriate candidates 经阴道机器人辅助的自然孔口腹腔镜子宫切除术用于良性妇科疾病：确定合适的候选人

IF 2.2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology

Pub Date : 2025-11-01 DOI: 10.1016/j.tjog.2024.12.035

Wei-Li Lin , Yu-Ying Su , Kit-Sum Mak , Cindy Hsuan Weng , Yi-Ting Huang , Kai-Yun Wu , Jie Chin Lim , Chin-Jung Wang

Objective

The purpose of this study is to examine the feasibility and identify the candidates of transvaginal robotic-assisted laparoscopic hysterectomy (tVRALH) for gynecologic benign diseases.

Materials and methods

A total of 154 robotic-assisted laparoscopic hysterectomy (RALH) and 57 tVRALH procedures were reviewed for individual patient demographics and operative outcomes. Operative blood loss (BL), operating time (OT), intraoperative blood transfusion, surgical complication, and postoperative hospitalization length were evaluated based on corresponding clinical characteristics including age, body mass index (BMI), history of vaginal delivery and cesarean delivery, previous abdominal surgery and specimen weight.

Results

Patients in the tVRALH group had a lower BMI (p = 0.033), a higher proportion of history of vaginal delivery (p < 0.001), a lower proportion of history of cesarean delivery (p = 0.004), lighter uterine weight (p < 0.001), less BL (p < 0.005), and shorter OT (p < 0.001) compared to RALH group. There was no significant difference between the two groups in terms of the requirement for blood transfusion, overall incidence of operative complications, or length of postoperative stay. However, patients who underwent tVRALH experienced a higher incidence of transient hematuria (12.3 % vs. 0.6 %, p < 0.001). Multivariate regression analysis confirmed that BMI and the uterine weight were significantly associated with the OT and the BL in the RALH group. The history of cesarean delivery was also significantly associated with the OT. No parameter was observed to be significantly associated with the BL and the OT in the tVRALH group.

Conclusion

The history of vaginal delivery and uterine size may influence a surgeon's decision to choose tVRALH for treating patients with benign uterine diseases. Additionally, surgeons should be aware of the potential occurrence of transient intraoperative hematuria during the procedure.

目的探讨经阴道机器人辅助腹腔镜子宫切除术（tVRALH）治疗妇科良性疾病的可行性和候选方案。材料和方法对154例机器人辅助腹腔镜子宫切除术（RALH）和57例tVRALH手术进行了回顾性分析，以了解个体患者的人口统计学特征和手术结果。根据年龄、体重指数（BMI）、阴道分娩史、剖宫产史、既往腹部手术史、标本重量等相应临床特征评价手术出血量（BL）、手术时间（OT）、术中输血、手术并发症、术后住院时间。结果tVRALH组患者BMI较低（p = 0.033），阴道分娩史比例较高（p < 0.001），剖宫产史比例较低（p = 0.004），子宫重量较轻（p < 0.001）， BL较少（p < 0.005）， OT时间较短（p < 0.001）。两组在输血需求、手术并发症总发生率和术后住院时间方面无显著差异。然而，接受tVRALH治疗的患者出现一过性血尿的发生率更高（12.3%对0.6%,p < 0.001）。多因素回归分析证实，RALH组BMI和子宫重量与OT和BL有显著相关。剖宫产史也与OT显著相关。在tVRALH组中，没有观察到与BL和OT有显著相关的参数。结论阴道分娩史和子宫大小可能影响外科医生选择tVRALH治疗良性子宫疾病的决定。此外，外科医生应注意在手术过程中可能发生的短暂性术中血尿。

{"title":"Transvaginal robotic-assisted natural orifice laparoscopic hysterectomy for benign gynecologic disease: Determining appropriate candidates","authors":"Wei-Li Lin , Yu-Ying Su , Kit-Sum Mak , Cindy Hsuan Weng , Yi-Ting Huang , Kai-Yun Wu , Jie Chin Lim , Chin-Jung Wang","doi":"10.1016/j.tjog.2024.12.035","DOIUrl":"10.1016/j.tjog.2024.12.035","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study is to examine the feasibility and identify the candidates of transvaginal robotic-assisted laparoscopic hysterectomy (tVRALH) for gynecologic benign diseases.</div></div><div><h3>Materials and methods</h3><div>A total of 154 robotic-assisted laparoscopic hysterectomy (RALH) and 57 tVRALH procedures were reviewed for individual patient demographics and operative outcomes. Operative blood loss (BL), operating time (OT), intraoperative blood transfusion, surgical complication, and postoperative hospitalization length were evaluated based on corresponding clinical characteristics including age, body mass index (BMI), history of vaginal delivery and cesarean delivery, previous abdominal surgery and specimen weight.</div></div><div><h3>Results</h3><div>Patients in the tVRALH group had a lower BMI (<em>p</em> = 0.033), a higher proportion of history of vaginal delivery (<em>p</em> < 0.001), a lower proportion of history of cesarean delivery (<em>p</em> = 0.004), lighter uterine weight (<em>p</em> < 0.001), less BL (<em>p</em> < 0.005), and shorter OT (<em>p</em> < 0.001) compared to RALH group. There was no significant difference between the two groups in terms of the requirement for blood transfusion, overall incidence of operative complications, or length of postoperative stay. However, patients who underwent tVRALH experienced a higher incidence of transient hematuria (12.3 % vs. 0.6 %, p < 0.001). Multivariate regression analysis confirmed that BMI and the uterine weight were significantly associated with the OT and the BL in the RALH group. The history of cesarean delivery was also significantly associated with the OT. No parameter was observed to be significantly associated with the BL and the OT in the tVRALH group.</div></div><div><h3>Conclusion</h3><div>The history of vaginal delivery and uterine size may influence a surgeon's decision to choose tVRALH for treating patients with benign uterine diseases. Additionally, surgeons should be aware of the potential occurrence of transient intraoperative hematuria during the procedure.</div></div>","PeriodicalId":49449,"journal":{"name":"Taiwanese Journal of Obstetrics & Gynecology","volume":"64 6","pages":"Pages 990-995"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145475631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Community mobile health clinics’ availability is associated with cervical cancer screening in rural and urban areas: A national cohort study in Taiwan 社区流动诊所的可用性与农村和城市地区宫颈癌筛查相关：台湾的一项全国性队列研究

IF 2.2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology

Pub Date : 2025-11-01 DOI: 10.1016/j.tjog.2025.08.002

Ching-Ching Claire Lin , Chen-Chih Tai , Peiyin Hung , Yu-Chi Tung , Shao-Yi Cheng , Wen-Chu Huang

Objective

Despite free cervical screening in Taiwan, by 2022, less than 50 % of eligible women had undergone screening, raising concerns about spatial access to these services. Mobile health clinics (MHCs) have been implemented to improve access to primary care. This study aimed to investigate whether the MHC availability was associated with cervical cancer screening rate in rural and urban Taiwan.

Materials and methods

This retrospective cohort study used 2016–2019 National Health Insurance Research Database to identify 6,754,863 women aged ≥30 years eligible for cervical cancer screening at 2017. Each individual was followed up for three years using 2017–2019 outpatient claims to assess cervical cancer screening uptake. Primary exposure variables include residence urban/rural classification and MHC availability, categorized by place of residence. Chi-square tests and multivariable logistic regression were used to compare screening across exposure groups.

Results

In 2017, MHCs were available to 5 % of urban and 29 % of rural residents. Cervical screening rates were slightly higher in urban areas with versus without MHCs (48.24 % vs 47.99 %; p=.006), but slightly lower in rural areas with MHCs (48.09 % vs 48.32 %; p<0.001). Multivariable regression showed higher odds of screening uptake among women living in urban areas with MHCs, and among women living in rural areas regardless of MHC availability, compared to those in urban areas without MHCs.

Conclusions

Cervical cancer screening uptake in Taiwan remained low, with the lowest screening rates in urban areas without MHCs. Expanding the reach and effectiveness of mobile health services might help improve cancer screening rates in Taiwan.

尽管台湾实行免费子宫颈筛查，但到2022年，只有不到50%的符合条件的妇女接受了筛查，这引起了人们对这些服务的空间可及性的担忧。已经实施了流动保健诊所，以改善获得初级保健的机会。本研究旨在探讨台湾农村和城市的MHC可得性是否与子宫颈癌筛查率相关。材料和方法本回顾性队列研究使用2016-2019年国家健康保险研究数据库，确定2017年符合宫颈癌筛查条件的6,754,863名年龄≥30岁的女性。使用2017-2019年门诊索赔对每个人进行了为期三年的随访，以评估宫颈癌筛查的接受情况。主要暴露变量包括居住地城市/农村分类和MHC可得性，按居住地分类。卡方检验和多变量logistic回归用于比较不同暴露组的筛查情况。结果2017年，城市居民健康中心覆盖率为5%，农村居民健康中心覆盖率为29%。宫颈筛查率在有MHCs的城市地区略高于没有MHCs的城市地区（48.24% vs 47.99%; p= 0.006），但在有MHCs的农村地区略低（48.09% vs 48.32%; p= 0.001）。多变量回归显示，与没有MHC的城市地区相比，居住在有MHC的城市地区的妇女和居住在农村地区的妇女接受筛查的几率更高，无论MHC是否可用。结论台湾地区宫颈癌筛查率较低，未发现MHCs的城市地区筛查率最低。扩大流动医疗服务的覆盖面和有效性可能有助于提高台湾的癌症筛查率。

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引用次数: 0

Borderline ovarian tumors: Recurrence patterns and management in a single-institution retrospective study 交界性卵巢肿瘤：复发模式和管理在单机构回顾性研究

IF 2.2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology

Pub Date : 2025-11-01 DOI: 10.1016/j.tjog.2025.05.018

Mehmet Tunç , Hüseyin Akıllı , Emre Günakan , Asuman Nihan Haberal , Ali Haberal , Ali Ayhan

Objective

We aimed to evaluate the factors associated with disease recurrence, recurrence patterns, and obstetric outcomes of borderline ovarian tumors (BOT). The primary outcome was to identify prognostic factors for disease recurrence—the secondary outcomes included recurrence sites and obstetric results.

Materials and methods

This study included patients diagnosed with BOT at Başkent University. Data were obtained from patient files and hospital records. Histopathological results were re-evaluated based on the new 2020 World Health Organization classification. Stage I or II disease is considered as early-stage disease, while stage III was deemed as advanced. Risk factors for disease recurrence were assessed for early-stage and advanced-stage diseases. Survival was measured from the time of diagnosis.

Results

A total of 142 patients were included with a median follow-up time of 100.5 (range: 20–266) months. Recurrence occurred in 24 (16.9 %) patients with a 5-year recurrence-free survival rate of 86.3 %, and no deaths recorded. The main site of tumor recurrence was the same ovary (12/24, 50 %). In multivariate analysis, cystectomy was identified as a risk factor for recurrence in the early stage (HR: 4.28; 95 % CI: 1.40–13.08, p = 0.011). The pregnancy rate was 76.7 % among 43 patients who attempted to conceive. There was no significant difference in obstetric outcomes between unilateral salpingo-oophorectomy (USO) and cystectomy (p = 0.223).

Conclusion

The risk of recurrence in patients with BOT was higher in those who underwent cystectomy, while obstetric outcomes were similar between cystectomy and USO. Fertility-sparing surgery appears to be an appropriate choice for young women, offering satisfactory obstetric outcomes even in advanced-stage disease.

目的探讨与交界性卵巢肿瘤（BOT）疾病复发、复发模式和产科结局相关的因素。主要结局是确定疾病复发的预后因素，次要结局包括复发部位和产科结果。材料和方法本研究纳入了在美国肯特大学诊断为BOT的患者。数据来自患者档案和医院记录。根据新的2020年世界卫生组织分类重新评估组织病理学结果。I期或II期为早期，III期为晚期。评估早期和晚期疾病复发的危险因素。从诊断时开始测量生存期。结果共纳入142例患者，中位随访时间100.5个月（范围：20 ~ 266个月）。24例（16.9%）患者复发，5年无复发生存率为86.3%，无死亡记录。肿瘤复发部位主要为同侧卵巢（12/24,50%）。在多因素分析中，膀胱切除术被确定为早期复发的危险因素（HR: 4.28; 95% CI: 1.40-13.08, p = 0.011）。43例尝试怀孕的患者，妊娠率为76.7%。单侧输卵管卵巢切除术（USO）与膀胱切除术的产科结局无显著差异（p = 0.223）。结论行膀胱切除术的BOT患者复发风险较高，而膀胱切除术与USO的产科结局相似。保留生育能力的手术似乎是年轻妇女的适当选择，即使在晚期疾病中也能提供令人满意的产科结果。

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引用次数: 0

Successful management of parvovirus B19-associated maternal mirror syndrome: A case report and review of the literature 细小病毒b19相关母体镜像综合征的成功治疗：一例报告和文献回顾

IF 2.2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology

Pub Date : 2025-11-01 DOI: 10.1016/j.tjog.2025.05.019

Daniela Anna Iaccarino , Cristina Sigismondi , Gaia Scandella , Giulia Fierro , Patrizia Ronca , Francesca Rossi , Paola Fenili , Giovanna Mangili , Luisa Patanè

Objective

Maternal mirror syndrome (MMS), or Ballantyne syndrome, is a rare complication of pregnancy characterized by maternal symptoms that parallel fetal hydrops. Though originally associated with rhesus isoimmunization, MMS can result from diverse immune and non-immune conditions, including Parvovirus B19 (PVB19) infection. This report emphasizes the importance of early recognition and management of MMS secondary to PVB19 infection.

Case report

A 38-year-old G2P1 patient at 27 + 2 weeks was diagnosed with severe fetal anemia and hydrops via ultrasound and underwent intrauterine blood transfusions (IBT). The patient subsequently developed MMS, showing significant anasarca, altered liver function, and an elevated sFLT/PLGF ratio. Treatment with albumin and furosemide effectively stabilized her condition. Delivery occurred via cesarean section at 32 weeks following preterm premature rupture of membranes, with the neonate requiring NICU admission and intensive care.

Conclusion

Timely diagnosis and treatment of MMS due to PVB19 can significantly improve maternal and neonatal outcomes in complex cases.

目的：母体镜像综合征（MMS）或Ballantyne综合征是一种罕见的妊娠并发症，其特征是母体症状与胎儿水肿相似。虽然最初与恒河猴等免疫有关，但MMS可由多种免疫和非免疫条件引起，包括细小病毒B19 （PVB19）感染。本报告强调早期识别和管理PVB19感染继发MMS的重要性。一例38岁的G2P1患者在27 + 2周时通过超声诊断为严重胎儿贫血和水肿，并接受了宫内输血（IBT）。患者随后发展为MMS，表现出明显的缺血、肝功能改变和sFLT/PLGF比值升高。白蛋白和速尿治疗有效地稳定了她的病情。在早产胎膜早破后32周通过剖宫产分娩，新生儿需要NICU住院和重症监护。结论及时诊断和治疗PVB19所致MMS可显著改善复杂病例的母婴结局。

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引用次数: 0

Cervical pessary for short cervix: A simple solution or an overstated promise? 短宫颈的宫颈托：一个简单的解决方案还是一个夸大的承诺？

IF 2.2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology

Pub Date : 2025-11-01 DOI: 10.1016/j.tjog.2025.09.001

Chia-Hao Liu, Wei-Ting Chao, Peng-Hui Wang

引用次数: 0