Journal of Obstetrics and Gynecology of India最新文献

Background: Embryo quality assessment plays a pivotal role in assisted reproductive technology (ART) for selecting viable embryos for implantation. Accurate evaluation is essential for improving success rates in fertility treatments. Traditional assessment methods rely on subjective visual grading by embryologists, which can lead to inconsistencies. The application of deep learning in this domain offers the potential for objective and reproducible assessments.

Materials and methods: This study investigates the use of deep learning models to classify embryo images as good or not good at the day-3 and day-5 stages. A dataset obtained from Hung Vuong Hospital in Ho Chi Minh City was used to train and evaluate four convolutional neural network (CNN) architectures: VGG-19, ResNet-50, InceptionV3, and EfficientNetV2. Performance metrics, including accuracy, precision, and recall, were used to assess model effectiveness.

Results: Among the tested models, EfficientNetV2 demonstrated superior performance, achieving an accuracy of 95.26%, a precision of 96.30%, and a recall of 97.25%. These results indicate that deep learning models, particularly EfficientNetV2, can provide highly accurate and consistent assessments of embryo quality.

Conclusion: The high classification accuracy of EfficientNetV2 underscores its potential as a valuable tool for fertility specialists. By offering objective and consistent evaluations, this approach can enhance fertility treatment efficiency and support prospective parents in their reproductive journey.

Fallopian tube prolapse following hysterectomy is an uncommon condition that can be mistaken for vaginal vault granulation tissue or vaginal vault cancer. We present two cases of post-hysterectomy fallopian tube prolapse that were successfully treated using a combination of laparoscopic and vaginal approaches. Performing hysterectomy combined with routine salpingectomies can prevent fallopian tube prolapse and offer additional protection against tubal and ovarian cancers.

Purpose: To evaluate the perinatal outcome of early severely alloimmunised pregnancies.

Methods: This was a prospective observational comparative study of all Rh alloimmunised women who required IUT in less than 26 weeks of gestation. Outcome measures such as abortion, stillbirth, perinatal survival, and neonatal outcomes were compared with those who required IUT after 26 weeks gestation. Thinner needle (22G) and intrahepatic route preferentially were used for early transfusions.

Results: Out of forty-four patients, 22 required transfusion at early gestation. A total of 152 IUT's were given in both groups. Mean number of IUT's was 4.5 ± 2 and 2.2 ± 1.4 in early and late group, respectively. There were two abortions in early group. One stillbirth occurred each in early & late groups while there were three neonatal deaths in late group. Hydropic foetuses were more likely to survive when they were treated early in gestation (80% vs. 66%). Take-home baby rate was 86.3% in early group which was higher than in late transfusion group (82.6%).

Conclusion: Proper technique and appropriate skill can reduce early IUT complications and improve survival. Results can be as good as those of foetuses who have late transfusions. Hydrops foetuses are more likely to survive if diagnosed and treated early.

Introduction: Ovarian cancer (OV) stands as the deadliest female reproductive system malignancy. Globally, OV ranks as the seventh most prevalent cancer in women, with an estimated 240,000 new cases annually and being the second most common malignancy among women in Egypt.

Objectives: We investigate the efficacy of cytoreductive surgery in achieving complete tumor removal (R0 resection) in OV, compared to neoadjuvant chemotherapy followed by surgery.

Method: This randomized controlled trial at Women Health Hospital, Asyut University, Egypt from 2020 to 2023. Eighty patients were randomized (1:1) to primary surgery (Group I) or NACT (Group II), followed by further randomization (1:1) within each group to bevacizumab-containing chemotherapy or chemotherapy alone. The primary outcome was the rate of complete tumor removal (R0 resection). Secondary outcomes included surgical complexity, operative time, complications, and survival rates.

Results: Baseline demographic characteristics were similar between the groups (no statistically significant differences). The mean age for group I and group II were (56.3 and 57.23, respectively). Whereas, the BMI for group I and group II were (32.56 and 33.2, respectively). In addition, both groups achieved no significant difference of complete tumor removal (31 vs. 27). However, group II demonstrated significantly shorter operative times (182.34 vs. 219.85 min, p = 0.047), required fewer blood transfusions (9 vs. 21, p value 0.006), and experienced shorter hospital stays (6.13 vs. 11.9 days, p value < 0.001) compared to group I. Notably, no significant differences emerged in complication rates, progression-free survival (11.20 vs. 11.19 months), or overall survival (11.69 vs. 11.76 months) between the groups.

Conclusion: Our study demonstrates that optimal cytoreduction is more feasible with NACT, with less surgical complexity, shorter operative duration, less blood transfusion and short hospital stay.Clinical Trials registration The study was registered on clincaltrail.gov with number: NCT04257786.

Supplementary information: The online version contains supplementary material available at 10.1007/s13224-024-02061-w.

Background: The simultaneous occurrence of uterovaginal and rectal prolapse, i.e. dual prolapse, is uncommon. However, these two conditions can be managed concurrently through a combination of perineal, abdominal and laparoscopic approaches. In this article, we present a series of four cases wherein a perineal approach was utilized successfully.

Method: All 4 patients had varying degrees of uterine prolapse, cystocele and rectocele along with external rectal prolapse. They all had completed their families and provided consent for hysterectomy. One patient underwent vaginal hysterectomy and pelvic floor repair along with the Delorme procedure for rectal prolapse, while the remaining three patients had vaginal hysterectomy and anterior colporrhaphy and posterior colpoperineorrhaphy with levatorplasty.

Results: Follow-up evaluation 6 months after surgery revealed complete resolution of symptoms with no vault prolapse and rectal prolapse on examination. It is worth noting that all surgeries were performed under spinal anaesthesia, making this approach suitable for candidates who are at high risk during general anaesthesia, thereby allowing for simultaneous treatment of uterovaginal and rectal prolapse via perineal repair techniques. Also, assistance from surgeons was taken only in one case where Delorme procedure was performed, and in rest 3 cases, satisfactory surgical outcomes were seen following a good posterior colpoperineorrhaphy.

Conclusion: Concomitant repair of both uterovaginal and rectal prolapse can be successfully performed by combining vaginal hysterectomy along with a good posterior colpoperineorrhaphy or Delorme procedure under spinal anaesthesia.

Background: This study was conducted to explore the impact of male age, sperm concentration and motility, on the blastocyst expansion, inner cell mass and trophectoderm grade of the blastocyst along with beta-HCG positivity and viability of pregnancy following a frozen embryo transfer.

Materials and methods: Data from Indore Infertility Clinic from January 2021 to December 2023 were utilized. ICSI cycles with a single frozen embryo transfer were used for analysis. Statistical analyses were performed using STATA-13/IC software and Microsoft Excel Professional Plus 2021.

Results: No significant correlation was found between male age and sperm concentration or motility. A positive correlation between sperm concentration and motility was observed in autologous sperm samples. There was no significant association between male age, sperm concentration and sperm motility with blastocyst expansion, inner cell mass grade or trophectoderm grade. No significant association was found between male age, sperm concentration and sperm motility with beta-HCG. A significant association was observed between inner cell mass grade and beta-HCG positivity. No significant association was found between cardiac activity and blastocyst morphology, male age, sperm concentration and motility.

Conclusion: This study did not reveal any significant associations between male age, semen parameters and blastocyst morphology. No association was found between male age, semen parameters to beta-HCG positivity and pregnancy viability. A significant association was found between quality of inner cell mass and beta-HCG positivity in autologous semen sample cases.

Background: The precise interpretation of thyroid function tests during pregnancy needs population-based trimester-specific data among pregnant women. This study was to determine trimester-specific reference range for free triiodothyronine (FT3), free thyroxine (FT4) and thyrotropin (TSH) among pregnant women in India.

Methods: In this prospective observational study, asymptomatic pregnant women with single fetus were enrolled from each trimester. Serum FT3, FT4, TSH and anti-thyroperoxidase (anti-TPO) antibodies were estimated using electrochemiluminescence technique.

Results: Among 918 pregnant women, 82 women were excluded due to the presence of anti-TPO antibodies (76) and overt hypothyroidism (6). Among the remaining 836 women, 279 (33.3%) were in first trimester, 309 (36.9%) in second and 248 (29.6%) in third trimester. The 5th and 95th percentile values for each trimester were used as reference ranges. For all three hormones, the reference ranges for the first, second and third trimesters were: FT3 (1.59-3.64, 1.60-3.50 and 1.44-3.28 pg/dl), FT4 (0.64-1.12, 0.64-1.05 and 0.60-1.01 ng/dl) and TSH (0.21-4.95, 0.23-4.90 and 0.14-4.59 µIU/ml). The mean and median values for TSH between each trimester showed no statistically significant difference. No specific trend was seen for FT3 and TSH with advancing gestation. FT4 showed a decreasing trend with advancing trimester (P value: first versus second = 0.01, first versus third = 0.00003 and second versus third = 0.004). The reference range (N = 836) irrespective of trimester for thyroid hormones was: FT3 (1.53-3.46 pg/dl), FT4 (0.63-1.08 ng/dl) and TSH (0.19-4.72 µIU/ml).

Conclusion: The trimester-specific reference levels of TSH among pregnant women from India are significantly higher than 4 mIU/L (American Thyroid Association 2017).

Background: Recognizing the importance of postpartum testing for dysglycaemia after gestational diabetes mellitus (GDM), follow-up visit is recommended by all guidelines; unfortunately, dropout rate for follow-up is very high.

Objective: Comparison of diagnostic accuracy of early OGTT on day 2 or 3 postpartum with late OGTT at 6-12 weeks for predicting dysglycaemia in women with GDM in index pregnancy.

Methods: A total of 250 women with GDM underwent early WHO OGTT testing at 2-3 days postpartum, repeated at 6-12 weeks postpartum. Diagnostic accuracy, sensitivity, specificity, AUC, NPV, and PPV of early OGTT were calculated with 6-12 weeks OGTT as the gold standard.

Results: Of the 250 women, 100% completed glucose testing at 2-3 days postpartum while 86% returned at 6-12 weeks for repeat testing despite repetitive phone calls. At 2-3 days of testing, 26.80% women had impaired fasting glucose (IFT), 26.40% women had impaired glucose tolerance (IGT), and 3.20% women had DM. At 6-12 weeks testing, 25% had IFT, 29.81% had IGT. Early OGTT had a sensitivity of 86.15%, specificity of 91.61%, AUC of 0.89, NPV of 93.57%, PPV of 82.35% for predicting dysglycaemia. 51.6% were found to be suffering from metabolic syndrome during 2nd postpartum visit.

Conclusion: Early OGTT has the advantage of 100% coverage of women with GDM and may have comparable accuracy to conventional OGTT at 6-12 weeks postpartum in detecting impaired glucose status. Counselling and appropriate intervention before discharge may support prevention or delay the progression of diabetes and associated metabolic disorders.

Aim: The clinical profile of the disease in southern Nigeria is less reported. This study aims to describe the clinical characteristics and intra-hospital outcomes of PPCM in Ibadan, south-west Nigeria.

Materials and methods: We reviewed 69 cases of PPCM seen in Nigerian Women at the University College Hospital Ibadan between 2006 and 2021.

Results: The mean age at presentation was 30.5 ± 6.7 years (age range 18 - 46 years). The mean BMI was 23.5 kg/M². Most were from the low socio-economic group (47/68.1%) and presented postpartum. The majority were primipara; twin pregnancy was seen in four (5.8%), and PIH occurred in 10 (14.5%) cases. Heart failure was the most typical mode of presentation. Over 90% of the women had spontaneous vertex delivery. Fetal death was recorded in three (4.3%). Two women died. Both presented with severe heart failure and died within few days on admission.

Conclusion: PPCM in Ibadan, Nigeria, is relatively a disease of primipara from poor homes and in unbooked pregnant women. Improvement in maternal health will be invaluable in prevention of the condition in Nigeria.

Graphical abstract:

Endometriosis is considered 'silent disease' but is debilitating that impacts quality of life. It is chronic, benign condition which is oestrogen dependent and has chronic inflammatory component. Endometriosis is associated with menstruation with increased sensitivity to oestrogen receptors and with low progesterone levels. Locally produced prostaglandins from endometriotic lesions leads to pain. There is delay in diagnosis by several years, as symptoms are not specific. This can lead to decline in fertility and quality of life. Imaging techniques and bio markers are not very specific but definitive diagnosis can be with Laparoscopy and histopathology. The first line of therapy will be medical, for relief of pain and fertility. Surgery is advised after failure of medical therapy, for severe degree of disease and deep infiltrating endometriosis (DIE). Assisted reproductive technology (ART) therapy is proposed for improved fertility outcome after surgery. Recurrence is known to occur after therapy.