Australian & New Zealand Journal of Obstetrics & Gynaecology最新文献_第7页

Conventional in vitro fertilisation rather than intracytoplasmic sperm injection when only one oocyte is retrieved: Time to overcome irrational fears 当只取出一个卵细胞时，采用常规体外受精，而不是卵胞浆内单精子注射：是时候克服非理性恐惧了。

IF 1.4 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2024-02-28 DOI: 10.1111/ajo.13806

Valerio Pisaturo, Marco Reschini, Cristina Guarneri, Elena Sanzani, Alessio Paffoni, Edgardo Somigliana

Background

The use of intracytoplasmic sperm injection (ICSI) currently extends beyond male factor infertility, notably replacing conventional in vitro fertilisation (IVF) in scenarios like limited oocyte availability, where it is used as a precaution against complete fertilisation failure. While existing studies on the use of conventional IVF in such situations provide some reassurance, the available evidence is somewhat insufficient and ICSI is commonly used.

Aims

To evaluate whether conventional IVF can be a feasible option when only one oocyte is retrieved.

Materials and Methods

A retrospective study was performed to evaluate the fertilisation rate with conventional IVF in women retrieving only one oocyte and whose partner had normal semen. The study aimed at evaluating whether the fertilisation rate was aligned with the threshold indicated by recognized IVF laboratory performance indicators (Vienna Consensus). Clinical pregnancy and live birth rates were secondary outcomes.

Results

Out of 304 cycles with a single oocyte inseminated with conventional IVF, 209 achieved normal fertilisation and 82 did not. Thirteen had no mature oocytes. The fertilisation rate was 69% (95% CI: 63–74%) and increased to 72% (95% CI: 66–77%) when immature oocytes were excluded. The fertilisation rate surpassed the minimum competency threshold of the Vienna Consensus (60%), even if below the benchmark value (75%). Clinical pregnancy and live birth rates per oocyte retrieval were 10% and 8%, respectively. Univariate and multivariate analyses failed to identify any predictive factor of fertilisation.

Conclusion

Conventional IVF with one oocyte met Vienna Consensus standards even if it fell short of higher benchmarks.

背景：卵胞浆内单精子显微注射（ICSI）的应用目前已超出了男性因素不育症的范围，尤其是在卵母细胞有限的情况下取代了传统的体外受精（IVF），作为受精完全失败的一种预防措施。尽管关于在这种情况下使用常规体外受精的现有研究提供了一些保证，但现有的证据还有些不足，而且 ICSI 是常用的方法。目的：评估在只能取到一个卵母细胞的情况下，常规体外受精是否是一种可行的选择：进行了一项回顾性研究，以评估仅取回一个卵母细胞且伴侣精液正常的女性使用常规体外受精的受精率。该研究旨在评估受精率是否符合公认的试管婴儿实验室绩效指标（维也纳共识）所指出的阈值。临床妊娠率和活产率是次要结果：结果：在 304 个使用传统试管婴儿技术进行单卵母细胞人工授精的周期中，209 个周期实现了正常受精，82 个周期未实现正常受精。13个周期没有成熟卵母细胞。受精率为 69%（95% CI：63-74%），排除未成熟卵母细胞后，受精率增至 72%（95% CI：66-77%）。受精率超过了维也纳共识的最低合格阈值（60%），即使低于基准值（75%）。每次取卵的临床妊娠率和活产率分别为 10%和 8%。单变量和多变量分析未能发现任何受精的预测因素：结论：使用单个卵母细胞的常规体外受精即使达不到更高的基准，也符合维也纳共识标准。

{"title":"Conventional in vitro fertilisation rather than intracytoplasmic sperm injection when only one oocyte is retrieved: Time to overcome irrational fears","authors":"Valerio Pisaturo, Marco Reschini, Cristina Guarneri, Elena Sanzani, Alessio Paffoni, Edgardo Somigliana","doi":"10.1111/ajo.13806","DOIUrl":"10.1111/ajo.13806","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The use of intracytoplasmic sperm injection (ICSI) currently extends beyond male factor infertility, notably replacing conventional <i>in vitro</i> fertilisation (IVF) in scenarios like limited oocyte availability, where it is used as a precaution against complete fertilisation failure. While existing studies on the use of conventional IVF in such situations provide some reassurance, the available evidence is somewhat insufficient and ICSI is commonly used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate whether conventional IVF can be a feasible option when only one oocyte is retrieved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A retrospective study was performed to evaluate the fertilisation rate with conventional IVF in women retrieving only one oocyte and whose partner had normal semen. The study aimed at evaluating whether the fertilisation rate was aligned with the threshold indicated by recognized IVF laboratory performance indicators (Vienna Consensus). Clinical pregnancy and live birth rates were secondary outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 304 cycles with a single oocyte inseminated with conventional IVF, 209 achieved normal fertilisation and 82 did not. Thirteen had no mature oocytes. The fertilisation rate was 69% (95% CI: 63–74%) and increased to 72% (95% CI: 66–77%) when immature oocytes were excluded. The fertilisation rate surpassed the minimum competency threshold of the Vienna Consensus (60%), even if below the benchmark value (75%). Clinical pregnancy and live birth rates per oocyte retrieval were 10% and 8%, respectively. Univariate and multivariate analyses failed to identify any predictive factor of fertilisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Conventional IVF with one oocyte met Vienna Consensus standards even if it fell short of higher benchmarks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984626","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

A survey of cost, access and outcomes for cannabinoid-based medicinal product use by Australians with endometriosis 对澳大利亚子宫内膜异位症患者使用大麻类药用产品的成本、获取途径和结果的调查。

IF 1.4 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2024-02-28 DOI: 10.1111/ajo.13804

Andrew Proudfoot, Sarah Duffy, Justin Sinclair, Jason Abbott, Mike Armour

People with endometriosis use cannabis to manage their symptoms. This study aimed to identify costs, modes of administration, product composition, and self-reported effectiveness for those accessing medicinal cannabis in Australia. There were 192 survey responses analysed. Most (63.5%) used a ‘cannabis clinic’ doctor, incurring an initial consultation cost of $100–$200+ (10.2% Medicare bulk-billed) and median cannabinoid medicine costs of $300AUD per month. Cost was a major barrier to access, necessitating reducing dosage (76.1%) and/or consuming illicit cannabis (42.9%), despite a prescription. Most (77%) medical consumers used two or more cannabis products, with delta-9-tetrahydrocannabinol predominant oil and flower products most frequently prescribed.

子宫内膜异位症患者使用大麻来控制症状。本研究旨在确定在澳大利亚使用药用大麻的成本、给药方式、产品成分和自我报告的有效性。共分析了 192 份调查回复。大多数人（63.5%）使用 "大麻诊所 "医生，初次咨询费用为 100-200 澳元以上（10.2% 的医疗保险批量收费），大麻药物费用中位数为每月 300 澳元。尽管有处方，但费用是获取药物的主要障碍，导致不得不减少剂量（76.1%）和/或服用非法大麻（42.9%）。大多数（77%）医疗消费者使用两种或两种以上的大麻产品，其中以δ-9-四氢大麻酚为主的大麻油和花产品最常被处方。

引用次数: 0

Clinical utility of maternal TORCH screening in fetal growth restriction: A retrospective two-centre study 母体 TORCH 筛查在胎儿生长受限中的临床实用性：一项双中心回顾性研究。

IF 1.4 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2024-02-21 DOI: 10.1111/ajo.13802

Christine A. Wade, Naomi Atkinson, Natasha E. Holmes, Lisa Hui

Objective

The aim of this study was to evaluate the indications for maternal TORCH (Toxoplasma gondii, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV)) serology, with a focus on the yield in isolated fetal growth restriction (FGR).

Materials and Methods

A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. TORCH testing ordered for pregnancy losses and stillbirth was excluded.

Results

Medical records of 718 pregnancies were reviewed, representing 760 fetuses. Isolated FGR was the indication for TORCH screening in 71.2% of pregnancies. Screens ordered for isolated FGR were positive in 7.4% (95% CI 5.5–10.0%). There were 49 positive maternal immunoglobulin M (CMV = 34, Toxoplasma = 15). Two acute maternal infections during pregnancy were diagnosed (CMV = 1, Toxoplasma = 1), with both screens ordered to assess symptomatic maternal illness. There was one neonatal CMV infection, born to a woman with symptomatic primary CMV. No maternal or neonatal rubella or HSV infections were identified. We found a diagnostic yield of TORCH screening for isolated FGR of 0.0% (95% CI 0.00–0.8%). An estimated AUD$64 269.75 was expended on maternal TORCH screens in this study.

Conclusion

Maternal TORCH testing for isolated FGR is of no diagnostic yield and should be abandoned.

研究目的本研究旨在评估孕产妇 TORCH（弓形虫、风疹、巨细胞病毒（CMV）和单纯疱疹病毒（HSV））血清学检测的适应症，重点关注分离胎儿生长受限（FGR）的检测率：澳大利亚墨尔本两家医院对 2014 年 1 月至 2018 年 12 月间的产前 TORCH 检测进行了回顾性审查。不包括因妊娠失败和死胎而进行的 TORCH 检测：回顾了 718 例妊娠的医疗记录，代表 760 个胎儿。在 71.2% 的妊娠中，孤立性 FGR 是 TORCH 筛查的指征。7.4%（95% CI 5.5-10.0%）的孕妇因孤立性 FGR 而接受筛查，结果呈阳性。母体免疫球蛋白 M 阳性的有 49 例（CMV = 34 例，弓形虫 = 15 例）。诊断出 2 例孕期急性母体感染（CMV = 1 例，弓形虫 = 1 例），两次筛查都是为了评估无症状的母体疾病。有一名新生儿感染了 CMV，是由一名患有无症状原发性 CMV 的妇女所生。未发现孕产妇或新生儿风疹或 HSV 感染。我们发现，TORCH筛查对孤立性FGR的诊断率为0.0%（95% CI 0.00-0.8%）。在这项研究中，用于孕产妇 TORCH 筛查的费用估计为 64 269.75 澳元：结论：针对孤立性 FGR 的母体 TORCH 检测没有诊断价值，应予以放弃。

{"title":"Clinical utility of maternal TORCH screening in fetal growth restriction: A retrospective two-centre study","authors":"Christine A. Wade, Naomi Atkinson, Natasha E. Holmes, Lisa Hui","doi":"10.1111/ajo.13802","DOIUrl":"10.1111/ajo.13802","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study was to evaluate the indications for maternal TORCH (<i>Toxoplasma gondii</i>, rubella, cytomegalovirus (CMV), and herpes simplex virus (HSV)) serology, with a focus on the yield in isolated fetal growth restriction (FGR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. TORCH testing ordered for pregnancy losses and stillbirth was excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Medical records of 718 pregnancies were reviewed, representing 760 fetuses. Isolated FGR was the indication for TORCH screening in 71.2% of pregnancies. Screens ordered for isolated FGR were positive in 7.4% (95% CI 5.5–10.0%). There were 49 positive maternal immunoglobulin M (CMV = 34, <i>Toxoplasma</i> = 15). Two acute maternal infections during pregnancy were diagnosed (CMV = 1, <i>Toxoplasma</i> = 1), with both screens ordered to assess symptomatic maternal illness. There was one neonatal CMV infection, born to a woman with symptomatic primary CMV. No maternal or neonatal rubella or HSV infections were identified. We found a diagnostic yield of TORCH screening for isolated FGR of 0.0% (95% CI 0.00–0.8%). An estimated AUD$64 269.75 was expended on maternal TORCH screens in this study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Maternal TORCH testing for isolated FGR is of no diagnostic yield and should be abandoned.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13802","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139914104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A step closer to parenthood with non-obstructive azoospermia: Unveiling the impact of microdissection testicular sperm extraction in Australia's largest single-centre study 非梗阻性无精子症患者离为人父母更近了一步：在澳大利亚最大的单中心研究中揭示显微解剖睾丸取精术的影响。

IF 1.4 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2024-02-17 DOI: 10.1111/ajo.13800

Hossam Elzeiny, Franca Agresta, John Stevens, David K. Gardner

Background

Non-obstructive azoospermia (NOA) diagnosis poses challenges for couples seeking parenthood. Microdissection testicular sperm extraction (MD-TESE) excels in retrieving testicular sperm cells for NOA cases. However, limited live birth data in Australian NOA patients hinders accurate counselling.

Aims

This study aimed to determine the likelihood of infertile couples with a male partner diagnosed with NOA conceiving biological children using MD-TESE / intracytoplasmic sperm injection (ICSI).

Materials and methods

A retrospective cohort study included 108 NOA men treated at a public fertility unit and a private fertility centre (May 2009–May 2022). Primary outcome: live birth rate (LBR); secondary outcomes: sperm retrieval rate, pregnancy rate, and neonatal outcomes.

Results

Among 108 patients undergoing MD-TESE, the positive sperm retrieval rate (PSRR) was 64.8% (70/108). Histology best predicted sperm retrieval success, with hypo-spermatogenesis yielding a 94.1% PSRR. Age, testicular volume, and hormonal parameters had no significant impact. Mean male age: 35.4 years; mean partner age: 32.7 years. Fertilisation rate: 50.7%. LBR per initiated cycle: 58.7% (37/63); per embryo transfer: 63.8% (37/58); per initially diagnosed NOA man: 34.3% (37/108). Cumulative LBR: 74.1% (43/58); twin rate: 10.8% (4/37). No neonatal deaths or defects were observed among 47 live offspring.

Conclusion

This study provides valuable data for counselling NOA couples on the probability of conceiving biological offspring. MD-TESE and ICSI yielded favourable PSRR (64.8%) and LBR (63.8%). However, couples should be aware that once NOA is confirmed, the chance of taking home a baby is 34%.

背景：非梗阻性无精子症（NOA）的诊断为寻求生育的夫妇带来了挑战。显微解剖睾丸精子提取术（MD-TESE）在提取无精子症病例的睾丸精子细胞方面表现出色。目的：本研究旨在确定男性伴侣被诊断为NOA的不育夫妇通过MD-TESE/卵胞浆内单精子显微注射（ICSI）怀上亲生子女的可能性：主要结果：活产率（LBR）；次要结果：取精率、妊娠率和新生儿结局：在 108 名接受 MD-TESE 的患者中，阳性取精率为 64.8%（70/108）。组织学最能预测取精成功率，低精子生成率为 94.1%。年龄、睾丸体积和激素参数没有明显影响。男性平均年龄：35.4 岁；伴侣平均年龄：32.7 岁。受精率50.7%.每个启动周期的 LBR58.7% (37/63)；每次胚胎移植：63.8% (37/58)；每名最初诊断为 NOA 的男性：34.3% (37/108)。累积 LBR：74.1%（43/58）；双胎率：10.8%（4/37）：10.8% (4/37).47 名活产后代中未发现新生儿死亡或缺陷：这项研究为向 NOA 夫妇提供有关怀上亲生后代概率的咨询提供了有价值的数据。MD-TESE和ICSI的PSRR（64.8%）和LBR（63.8%）结果良好。然而，夫妇们应该意识到，一旦确认无精子症，带回一个孩子的几率只有 34%。

{"title":"A step closer to parenthood with non-obstructive azoospermia: Unveiling the impact of microdissection testicular sperm extraction in Australia's largest single-centre study","authors":"Hossam Elzeiny, Franca Agresta, John Stevens, David K. Gardner","doi":"10.1111/ajo.13800","DOIUrl":"10.1111/ajo.13800","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Non-obstructive azoospermia (NOA) diagnosis poses challenges for couples seeking parenthood. Microdissection testicular sperm extraction (MD-TESE) excels in retrieving testicular sperm cells for NOA cases. However, limited live birth data in Australian NOA patients hinders accurate counselling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to determine the likelihood of infertile couples with a male partner diagnosed with NOA conceiving biological children using MD-TESE / intracytoplasmic sperm injection (ICSI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>A retrospective cohort study included 108 NOA men treated at a public fertility unit and a private fertility centre (May 2009–May 2022). Primary outcome: live birth rate (LBR); secondary outcomes: sperm retrieval rate, pregnancy rate, and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 108 patients undergoing MD-TESE, the positive sperm retrieval rate (PSRR) was 64.8% (70/108). Histology best predicted sperm retrieval success, with hypo-spermatogenesis yielding a 94.1% PSRR. Age, testicular volume, and hormonal parameters had no significant impact. Mean male age: 35.4 years; mean partner age: 32.7 years. Fertilisation rate: 50.7%. LBR per initiated cycle: 58.7% (37/63); per embryo transfer: 63.8% (37/58); per initially diagnosed NOA man: 34.3% (37/108). Cumulative LBR: 74.1% (43/58); twin rate: 10.8% (4/37). No neonatal deaths or defects were observed among 47 live offspring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides valuable data for counselling NOA couples on the probability of conceiving biological offspring. MD-TESE and ICSI yielded favourable PSRR (64.8%) and LBR (63.8%). However, couples should be aware that once NOA is confirmed, the chance of taking home a baby is 34%.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747858","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

Perfusion magnetic resonance imaging in Asherman syndrome 阿瑟曼综合征的灌注磁共振成像。

IF 1.4 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2024-02-16 DOI: 10.1111/ajo.13799

Rebecca Deans, Daniel Moses, Toos Anthony Sach, Thierry Vancaillie, Bill Ledger, Jason A. Abbott

Background

Microvascular scarring compromises the functionality of the endometrium, and vascular flow at the junctional zone (JZ) may be the key to understanding poor reproductive outcomes in women with Asherman syndrome (AS).

Aims

To investigate whether vascular perfusion of the uterus, measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is impaired in women with intrauterine adhesions (IUA) and AS.

Materials and Methods

A prospective observational cohort pilot study of 23 women with IUA treated with hysteroscopic synecholysis and a control group of two patients with cervix cancer were subject to DCE-MRI with gadolinium to assess uterine vascularity. Twelve regions of interest (ROIs) were allocated on the DCE-MRI image incorporating the JZ, with control ROI placed at the psoas muscle. Individual ROIs were compared to the mean total perfusion (TP) in the same uterus. Pre- and post-operative perfusion analyses were performed on five women. Receiver operator curves (ROC) were used to analyse MRI as a predictor of IUA.

Results

There was no significant difference in perfusion; a trend toward reduced perfusion was observed in women with IUA compared to the controls. The ROC was predictive of higher-grade and inoperable IUA.

Conclusions

Reduced perfusion on DCE-MRI as assessed by ROC predicted higher-stage AS. The results of this study support further investigation of DCE-MRI as a prognostic tool for AS prior to surgical intervention to assist in providing prognostic guidance for women suffering from AS.

背景：微血管瘢痕损害了子宫内膜的功能，而交界区（JZ）的血管流动可能是了解阿什曼综合征（AS）妇女不良生殖结局的关键。目的：研究动态对比增强磁共振成像（DCE-MRI）测量的子宫血管灌注在宫腔内粘连（IUA）和AS妇女中是否受损：一项前瞻性观察性队列试验研究对23名接受宫腔镜溶栓术治疗的IUA妇女和两名宫颈癌患者组成的对照组进行了钆剂DCE-MRI检查，以评估子宫血管情况。在结合 JZ 的 DCE-MRI 图像上分配了 12 个感兴趣区（ROI），对照组的 ROI 位于腰大肌。将单个 ROI 与同一子宫的平均总灌注（TP）进行比较。对五名妇女进行了术前和术后灌注分析。使用接收器操作曲线（ROC）分析核磁共振成像对 IUA 的预测作用：结果：灌注量无明显差异；与对照组相比，IUA妇女的灌注量呈下降趋势。ROC可预测更高等级和无法手术的IUA：结论：根据 ROC 评估，DCE-MRI 上的灌注减少可预测较高分期的 AS。本研究的结果支持在手术干预前将DCE-MRI作为强直性脊柱炎的预后工具进行进一步研究，以帮助为患有强直性脊柱炎的妇女提供预后指导。

{"title":"Perfusion magnetic resonance imaging in Asherman syndrome","authors":"Rebecca Deans, Daniel Moses, Toos Anthony Sach, Thierry Vancaillie, Bill Ledger, Jason A. Abbott","doi":"10.1111/ajo.13799","DOIUrl":"10.1111/ajo.13799","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Microvascular scarring compromises the functionality of the endometrium, and vascular flow at the junctional zone (JZ) may be the key to understanding poor reproductive outcomes in women with Asherman syndrome (AS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To investigate whether vascular perfusion of the uterus, measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is impaired in women with intrauterine adhesions (IUA) and AS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A prospective observational cohort pilot study of 23 women with IUA treated with hysteroscopic synecholysis and a control group of two patients with cervix cancer were subject to DCE-MRI with gadolinium to assess uterine vascularity. Twelve regions of interest (ROIs) were allocated on the DCE-MRI image incorporating the JZ, with control ROI placed at the psoas muscle. Individual ROIs were compared to the mean total perfusion (TP) in the same uterus. Pre- and post-operative perfusion analyses were performed on five women. Receiver operator curves (ROC) were used to analyse MRI as a predictor of IUA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was no significant difference in perfusion; a trend toward reduced perfusion was observed in women with IUA compared to the controls. The ROC was predictive of higher-grade and inoperable IUA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Reduced perfusion on DCE-MRI as assessed by ROC predicted higher-stage AS. The results of this study support further investigation of DCE-MRI as a prognostic tool for AS prior to surgical intervention to assist in providing prognostic guidance for women suffering from AS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13799","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Perinatal outcomes after regional analgesia during labour 分娩区域镇痛后的围产期结果。

IF 1.4 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2024-02-13 DOI: 10.1111/ajo.13797

Janna Lawson, Lahiru Amaratunge, Melody Goh, Roshan J. Selvaratnam

Background

Regional analgesia is a common and effective form of in-labour analgesia. However, there are concerns whether it is associated with adverse maternal and neonatal outcomes.

Aims

To examine the association between regional analgesia and maternal and neonatal outcomes.

Materials and Methods

A retrospective population-based cohort study of singleton term births in Victoria, Australia, between 2014 and 2020. Women who received regional analgesia were compared with women who did not. Multivariable logistic and linear regressions were used.

Results

There were 107 013 women who received regional analgesia and 214 416 women who did not. Compared to women who did not receive regional analgesia, regional analgesia was associated with an increased risk of instrumental birth (adjusted odds ratio (aOR) = 3.59, 95% CI: 3.52–3.67), caesarean section (aOR = 2.30, 95% CI: 2.24–2.35), longer duration of the second stage of labour (β coefficient = 26.6 min, 95% CI: 26.3–27.0), Apgar score below seven at five minutes (aOR = 1.30, 95% CI: 1.21–1.39), need for neonatal resuscitation (aOR = 1.44, 95% CI: 1.40–1.48), need for formula in hospital (aOR = 1.68, 95% CI: 1.65–1.72), and the last feed before discharge not exclusively from the breast (aOR = 1.59, 95% CI: 1.56–1.62).

Conclusion

Regional analgesia use in labour was associated with adverse maternal and neonatal outcomes. These findings may add to the risk–benefit discussion regarding regional analgesia for pain relief and highlight the importance of shared decision-making. Further large prospective studies and randomised controlled trials will be useful.

背景：区域镇痛是一种常见且有效的分娩镇痛方式。目的：研究区域镇痛与产妇和新生儿结局之间的关系：对 2014 年至 2020 年期间在澳大利亚维多利亚州出生的单胎足月新生儿进行基于人群的回顾性队列研究。接受区域镇痛的产妇与未接受区域镇痛的产妇进行了比较。采用多变量逻辑回归和线性回归：结果：接受区域镇痛的产妇有 107 013 人，未接受区域镇痛的产妇有 214 416 人。与未接受区域镇痛的产妇相比，区域镇痛与器械助产（调整后的几率比（aOR）= 3.59，95% CI：3.52-3.67）、剖腹产（aOR = 2.30，95% CI：2.24-2.35）、第二产程持续时间延长（β系数 = 26.6 分钟，95% CI：26.3-27.0）、5 分钟时 Apgar 评分低于 7 分（aOR = 1.30，95% CI：1.21-1.39）、新生儿复苏需求（aOR = 1.44，95% CI：1.40-1.48）、住院期间配方奶需求（aOR = 1.68，95% CI：1.65-1.72）、出院前最后一次喂养不完全是母乳（aOR = 1.59，95% CI：1.56-1.62）：结论：分娩时使用区域镇痛与产妇和新生儿的不良结局有关。这些研究结果可能会增加有关区域镇痛的风险-收益讨论，并强调共同决策的重要性。进一步的大型前瞻性研究和随机对照试验将非常有用。

{"title":"Perinatal outcomes after regional analgesia during labour","authors":"Janna Lawson, Lahiru Amaratunge, Melody Goh, Roshan J. Selvaratnam","doi":"10.1111/ajo.13797","DOIUrl":"10.1111/ajo.13797","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Regional analgesia is a common and effective form of in-labour analgesia. However, there are concerns whether it is associated with adverse maternal and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To examine the association between regional analgesia and maternal and neonatal outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A retrospective population-based cohort study of singleton term births in Victoria, Australia, between 2014 and 2020. Women who received regional analgesia were compared with women who did not. Multivariable logistic and linear regressions were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 107 013 women who received regional analgesia and 214 416 women who did not. Compared to women who did not receive regional analgesia, regional analgesia was associated with an increased risk of instrumental birth (adjusted odds ratio (aOR) = 3.59, 95% CI: 3.52–3.67), caesarean section (aOR = 2.30, 95% CI: 2.24–2.35), longer duration of the second stage of labour (β coefficient = 26.6 min, 95% CI: 26.3–27.0), Apgar score below seven at five minutes (aOR = 1.30, 95% CI: 1.21–1.39), need for neonatal resuscitation (aOR = 1.44, 95% CI: 1.40–1.48), need for formula in hospital (aOR = 1.68, 95% CI: 1.65–1.72), and the last feed before discharge not exclusively from the breast (aOR = 1.59, 95% CI: 1.56–1.62).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Regional analgesia use in labour was associated with adverse maternal and neonatal outcomes. These findings may add to the risk–benefit discussion regarding regional analgesia for pain relief and highlight the importance of shared decision-making. Further large prospective studies and randomised controlled trials will be useful.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725040","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

ANZJOG in 2024 2024 年的 ANZJOG。

IF 1.7 4区医学 Q2 Medicine

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2024-02-04 DOI: 10.1111/ajo.13801

Scott W. White

Welcome to the 64th volume of the Australian and New Zealand Journal of Obstetrics and Gynaecology. We are now well into a new year which brings much work to progress for our Journal in 2024. It is my hope that during this year we will continue to grow ANZJOG as a leading source of clinically relevant scientific literature, providing guidance to those in clinical roles and driving the work of those undertaking research in obstetrics and gynaecology and related disciplines. I wish to diversify the ways in which our community interacts with our publication by providing content which is more accessible in an increasingly media-saturated world and to provide clinical context to the published research, allowing it to drive evidence-based practice at the bedside.

This issue features several invited editorials to draw attention to current topics of relevance to our field. In the first, a group of world-leading journal editors, led by Vincenzo Berghella, discuss the problem of trustworthiness in women's health and how to address it.¹ Poor experimental design, flawed statistical analysis, and deliberate research fraud, among other factors, contribute to erroneous conclusions being drawn from published research. This is not just of academic significance, with flawed studies contributing to inappropriate clinical practice, either in response to the individual studies themselves, to the systematic reviews and meta-analyses in which they are included, or to the clinical guidelines developed based on this evidence. Deliberate research misconduct is difficult to detect even with the most robust peer-review processes, but poor research design and statistical methodology errors can be reduced with appropriate research training and support, a task for those of us in senior academic positions to take on and implement.

Endometriosis remains a topical and potentially contentious issue, and Jason Abbott reflects on the Australian National Action Plan in his editorial discussing recent achievements and the remaining challenges in this area.² Endometriosis is a common and potentially debilitating condition which has traditionally been (and may continue to be) underdiagnosed or delayed in diagnosis due to societal expectations of what is normal, steeped in what was a misogynistic view of women's health. The National Action Plan aims to address the ongoing challenges in endometriosis care, and RANZCOG has key roles in the Plan, particularly in terms of evidence review, guideline development, and clinical implementation, all of which are currently in progress.

Kothari et al³ discuss the importance of considering fathers in maternity care, highlighting the important contributions paternal factors make to fertility, obstetric, perinatal, and longer-term offspring outcomes. This editorial also acknowledges the benefits from paternal involvement in maternity

欢迎阅读《澳大利亚和新西兰妇产科杂志》第 64 卷。我们已经进入了新的一年，在新的一年里，我们将为2024年的期刊开展大量工作。我希望在这一年里，我们能继续将《澳新妇产科杂志》发展成为临床相关科学文献的主要来源，为临床工作者提供指导，并推动妇产科及相关学科研究人员的工作。我希望通过提供在媒体日益饱和的世界中更容易获取的内容，使我们的社区与我们的刊物互动的方式多样化，并为发表的研究提供临床背景，使其能够推动床旁的循证实践。在第一篇社论中，以 Vincenzo Berghella 为首的一组世界领先期刊编辑讨论了妇女健康领域的可信度问题以及如何解决这一问题。1 实验设计不当、统计分析有缺陷、故意研究造假等因素都会导致从已发表的研究中得出错误的结论。这不仅具有学术意义，有缺陷的研究还会导致不恰当的临床实践，无论是针对单项研究本身，还是针对纳入这些研究的系统综述和荟萃分析，或是基于这些证据制定的临床指南。即使有最健全的同行评审程序，也很难发现蓄意的研究不端行为，但通过适当的研究培训和支持，可以减少不良的研究设计和统计方法错误。子宫内膜异位症是一种常见的、可能使人衰弱的疾病，由于社会对正常疾病的期望，以及对妇女健康的厌女观，这种疾病历来（并可能继续）诊断不足或延误诊断。国家行动计划》旨在应对子宫内膜异位症护理方面持续存在的挑战，新西兰皇家妇产科协会在该计划中发挥了关键作用，尤其是在证据审查、指南制定和临床实施方面，所有这些工作目前都在进行中。Kothari 等人3 讨论了在孕产妇护理中考虑父亲因素的重要性，强调了父亲因素对生育、产科、围产期和后代长期结局的重要贡献。这篇社论也承认了父亲参与孕产妇护理的益处，以及父亲因目睹产科并发症和新生儿家庭过渡时期的潜在压力而产生心理疾病的风险。我们将母亲作为一个独特的个体置于'以妇女为中心的护理'的焦点，这是非常正确的，科塔里等人提出了将这一观点扩展到父亲的理由，可以称之为'以家庭为中心的护理'，承认父亲在妊娠和分娩中的特殊地位。很显然，这种模式应包括单身女性、性别和性取向不同的夫妇等在不同个人情况下怀孕、生产和为人父母的人，并为他们提供个性化的服务，而不是助长有问题的异性恋。Lu 等人讨论了妊娠期亲密伴侣暴力筛查的障碍。4 Thomas 等人探讨了出生时被指定为女性的 LGBTQI 人士的医疗保健经历，指出了这一具有独特和不同医疗保健需求的群体在获得熟练和敏感护理方面的障碍。5 Blazé 等人讨论了父母吸烟对母乳喂养的影响，指出父母在怀孕期间和之后吸烟会增加围产期并发症并错过母乳喂养的益处，从而使这些后代处于双重不利地位。Lai 和 Cohn 评估了地区初级保健中早期药物流产的有效性和安全性，鉴于越来越多地使用药物方法进行早期流产，以及澳大利亚最近对米非司酮-米索前列醇处方限制的修改，这是一项重要的工作。第一篇文章由 Medeiros 等人撰写，对围产期死亡管理方面成功的 IMPROVE 计划的在线改编进行了评估。

{"title":"ANZJOG in 2024","authors":"Scott W. White","doi":"10.1111/ajo.13801","DOIUrl":"10.1111/ajo.13801","url":null,"abstract":"<p>Welcome to the 64th volume of the <i>Australian and New Zealand Journal of Obstetrics and Gynaecology</i>. We are now well into a new year which brings much work to progress for our <i>Journal</i> in 2024. It is my hope that during this year we will continue to grow <i>ANZJOG</i> as a leading source of clinically relevant scientific literature, providing guidance to those in clinical roles and driving the work of those undertaking research in obstetrics and gynaecology and related disciplines. I wish to diversify the ways in which our community interacts with our publication by providing content which is more accessible in an increasingly media-saturated world and to provide clinical context to the published research, allowing it to drive evidence-based practice at the bedside.</p><p>This issue features several invited editorials to draw attention to current topics of relevance to our field. In the first, a group of world-leading journal editors, led by Vincenzo Berghella, discuss the problem of trustworthiness in women's health and how to address it.<span><sup>1</sup></span> Poor experimental design, flawed statistical analysis, and deliberate research fraud, among other factors, contribute to erroneous conclusions being drawn from published research. This is not just of academic significance, with flawed studies contributing to inappropriate clinical practice, either in response to the individual studies themselves, to the systematic reviews and meta-analyses in which they are included, or to the clinical guidelines developed based on this evidence. Deliberate research misconduct is difficult to detect even with the most robust peer-review processes, but poor research design and statistical methodology errors can be reduced with appropriate research training and support, a task for those of us in senior academic positions to take on and implement.</p><p>Endometriosis remains a topical and potentially contentious issue, and Jason Abbott reflects on the Australian National Action Plan in his editorial discussing recent achievements and the remaining challenges in this area.<span><sup>2</sup></span> Endometriosis is a common and potentially debilitating condition which has traditionally been (and may continue to be) underdiagnosed or delayed in diagnosis due to societal expectations of what is normal, steeped in what was a misogynistic view of women's health. The National Action Plan aims to address the ongoing challenges in endometriosis care, and RANZCOG has key roles in the Plan, particularly in terms of evidence review, guideline development, and clinical implementation, all of which are currently in progress.</p><p>Kothari <i>et al</i><span><sup>3</sup></span> discuss the importance of considering fathers in maternity care, highlighting the important contributions paternal factors make to fertility, obstetric, perinatal, and longer-term offspring outcomes. This editorial also acknowledges the benefits from paternal involvement in maternity","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13801","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ultrasound-guided Lipiodol® hysterosalpingography: A prospective study on pregnancy and complication rates 超声引导下 Lipiodol® 子宫输卵管造影术：关于妊娠和并发症发生率的前瞻性研究。

IF 1.4 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2024-02-01 DOI: 10.1111/ajo.13794

Glen Lo, Dana Hince, Neil Johnson, Paul L. Hofman, Jasmin Sekhon, Emmeline Lee

Background

Fluoroscopic hysterosalpingography (HSG) with Lipiodol® is safe and has a therapeutic effect on fertility: transient in endometriosis-related infertility and sustained in unexplained infertility. Ultrasound is replacing fluoroscopy as the preferred imaging modality for HSG due to comfort and radiation safety (no ionising radiation). The safety of ultrasound-guided Lipiodol® HSG is uncertain.

Aims

Prospectively observe pregnancy and complication rates after ultrasound-guided Lipiodol® HSG.

Materials and Methods

A single-centre prospective study of women with unexplained infertility undergoing ultrasound-guided Lipiodol® uterine bathing and tubal flushing after tubal patency confirmed with ExEm® Foam HyFoSy (hysterosalpingo-foam-sonography). Pregnancy outcomes at six months and serum and urinary thyroid function at one, three and eight weeks were recorded. Pain scores were recorded during and immediately after HSG. Descriptive statistics are reported.

Results

Fifty-two participants were enrolled between July 2019 and April 2021, median age 33 years (range 21–45). Only 45 (87%, 45/52) completed the Lipiodol® HSG; 5/7 experienced intravasation during initial HyFoSy. Of 30 women at follow-up, 57% had biochemical (17/30, 95% CI 37%–75%), 53% clinical (16/30 95% CI 34%–72%) and 35% ongoing pregnancies (11/30, 95% CI 20%–56%). The rate of subclinical hypothyroidism (SCH) at two months was 41% (7/17). One intravasation event occurred during Lipiodol® HSG (2%, 1/45). Median pain score was 5/10 (range 0–9, interquartile range 2.5–7). No anaphylaxis, infection or oil embolism was observed.

Conclusion

Outpatient ultrasound-guided Lipiodol® HSG was safe, with pregnancy rates comparable to previous studies of fluoroscopic guidance. Rates of intravasation and SCH were also similar, confirming the need to monitor thyroid function.

背景：使用 Lipiodol® 进行透视子宫输卵管造影（HSG）是安全的，对生育有治疗作用：对子宫内膜异位症相关不孕症有短暂疗效，对不明原因不孕症有持续疗效。由于舒适和辐射安全（无电离辐射），超声波正取代透视成为 HSG 的首选成像方式。目的：前瞻性观察超声引导下利必多®HSG术后的妊娠率和并发症发生率：单中心前瞻性研究：对不明原因不孕的妇女进行超声引导下 Lipiodol® 宫腔冲洗和输卵管冲洗，然后用 ExEm® 泡沫 HyFoSy（子宫输卵管造影）确认输卵管通畅。记录了六个月的妊娠结果以及一周、三周和八周的血清和尿甲状腺功能。记录了 HSG 期间和之后的疼痛评分。报告了描述性统计结果：52 名参与者于 2019 年 7 月至 2021 年 4 月间入组，中位年龄为 33 岁（21-45 岁不等）。只有 45 人（87%，45/52）完成了 Lipiodol® HSG；5/7 在最初的 HyFoSy 过程中出现了内侵。在随访的 30 名妇女中，57% 有生化指标（17/30，95% CI 37%-75%），53% 有临床指标（16/30 95% CI 34%-72%），35% 正在怀孕（11/30，95% CI 20%-56%）。两个月后出现亚临床甲状腺功能减退症（SCH）的比例为 41%（7/17）。在 Lipiodol® HSG 过程中发生了一起浸润事件（2%，1/45）。疼痛评分中位数为 5/10（范围 0-9，四分位间范围 2.5-7）。未观察到过敏性休克、感染或油栓塞：结论：门诊超声引导下的 Lipiodol® HSG 是安全的，妊娠率与之前的透视引导研究相当。浸润率和SCH的发生率也相似，这也证实了监测甲状腺功能的必要性。

{"title":"Ultrasound-guided Lipiodol® hysterosalpingography: A prospective study on pregnancy and complication rates","authors":"Glen Lo, Dana Hince, Neil Johnson, Paul L. Hofman, Jasmin Sekhon, Emmeline Lee","doi":"10.1111/ajo.13794","DOIUrl":"10.1111/ajo.13794","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fluoroscopic hysterosalpingography (HSG) with Lipiodol® is safe and has a therapeutic effect on fertility: transient in endometriosis-related infertility and sustained in unexplained infertility. Ultrasound is replacing fluoroscopy as the preferred imaging modality for HSG due to comfort and radiation safety (no ionising radiation). The safety of ultrasound-guided Lipiodol® HSG is uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Prospectively observe pregnancy and complication rates after ultrasound-guided Lipiodol® HSG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A single-centre prospective study of women with unexplained infertility undergoing ultrasound-guided Lipiodol® uterine bathing and tubal flushing after tubal patency confirmed with ExEm® Foam HyFoSy (hysterosalpingo-foam-sonography). Pregnancy outcomes at six months and serum and urinary thyroid function at one, three and eight weeks were recorded. Pain scores were recorded during and immediately after HSG. Descriptive statistics are reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-two participants were enrolled between July 2019 and April 2021, median age 33 years (range 21–45). Only 45 (87%, 45/52) completed the Lipiodol® HSG; 5/7 experienced intravasation during initial HyFoSy. Of 30 women at follow-up, 57% had biochemical (17/30, 95% CI 37%–75%), 53% clinical (16/30 95% CI 34%–72%) and 35% ongoing pregnancies (11/30, 95% CI 20%–56%). The rate of subclinical hypothyroidism (SCH) at two months was 41% (7/17). One intravasation event occurred during Lipiodol® HSG (2%, 1/45). Median pain score was 5/10 (range 0–9, interquartile range 2.5–7). No anaphylaxis, infection or oil embolism was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Outpatient ultrasound-guided Lipiodol® HSG was safe, with pregnancy rates comparable to previous studies of fluoroscopic guidance. Rates of intravasation and SCH were also similar, confirming the need to monitor thyroid function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13794","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mucinous ovarian carcinoma: A survey of practice in Australia and New Zealand 粘液性卵巢癌：澳大利亚和新西兰的实践调查。

IF 1.4 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2024-02-01 DOI: 10.1111/ajo.13792

Niveditha Rajadevan, Ariane Flinkier, Hugo Saunders, Yeh Chen Lee, Clare Scott, Pearly Khaw, Prue Allan, Claire Davies, John Andrews, Michelle Wilson, Janine M Lombard, Michelle Harrison, Heshani Nesfield, Anna DeFazio, Tarek Meniawy, Kylie L Gorringe

Background

Mucinous ovarian carcinoma (MOC) is a rare ovarian cancer with limited evidence to support clinical care.

Aims

We undertook a clinician survey to better understand current practice in treating MOC in Australia and New Zealand, and to determine any features associated with variation in care. In addition, we aimed to understand future research priorities.

Methods

A RedCap survey was distributed to clinician members of the Australia New Zealand Gynaecological Oncology Group (ANZGOG). Questions included respondent demographics, three case studies and future research priorities. Clinicians were asked questions specific to their speciality.

Results

Respondents (n = 47) were commonly experienced gynae-oncology specialists, most often surgical (38%) or medical (30%) oncologists. There was good consensus for surgical approaches for stage I disease; however, variation in practice was noted for advanced or recurrent MOC. Variation was also observed for medical oncologists; in early-stage disease there was no clear consensus on whether to offer chemotherapy, or which regimen to recommend. For advanced and recurrent disease a wide range of chemotherapy options was considered, with a trend away from an ovarian-type toward gastrointestinal (GI)-type regimens in advanced MOC. This practice was reflected in future research priorities, with ‘Is a GI chemotherapy regimen better than an ovarian regimen?’ the most highly ranked option, followed by ‘Should stage 1C patients receive chemotherapy?’

Conclusions

Although the number of respondents limited the analyses, it was clear that chemotherapy selection was a key point of divergence for medical oncologists. Future research is needed to establish well-evidenced guidelines for clinical care of MOC.

背景：粘液性卵巢癌（MOC）是一种罕见的卵巢癌，支持临床治疗的证据有限。目的：我们开展了一项临床医生调查，以更好地了解澳大利亚和新西兰目前治疗粘液性卵巢癌的做法，并确定与治疗差异相关的任何特征。此外，我们还旨在了解未来的研究重点：我们向澳大利亚-新西兰妇科肿瘤组织（ANZGOG）的临床医生成员发放了一份RedCap调查问卷。问题包括受访者的人口统计学特征、三项病例研究和未来研究重点。临床医生被问及与其专业相关的问题：受访者（n = 47）通常都是经验丰富的妇科肿瘤专家，最常见的是外科肿瘤专家（38%）或内科肿瘤专家（30%）。对于 I 期疾病的手术方法已达成良好共识；但对于晚期或复发性 MOC，实践中存在差异。内科肿瘤学家的做法也不尽相同；对于早期疾病，是否提供化疗或推荐哪种化疗方案没有明确的共识。对于晚期和复发性疾病，则考虑了多种化疗方案，在晚期 MOC 中，化疗方案有从卵巢型向胃肠道（GI）型转变的趋势。这种做法反映在未来的研究重点中，"胃肠道化疗方案比卵巢化疗方案更好吗？"是排名最高的选项，其次是 "1C 期患者是否应该接受化疗？尽管受访者人数限制了分析结果，但化疗选择显然是肿瘤内科医生分歧的关键点。未来的研究需要为 MOC 的临床治疗制定有据可依的指南。

{"title":"Mucinous ovarian carcinoma: A survey of practice in Australia and New Zealand","authors":"Niveditha Rajadevan, Ariane Flinkier, Hugo Saunders, Yeh Chen Lee, Clare Scott, Pearly Khaw, Prue Allan, Claire Davies, John Andrews, Michelle Wilson, Janine M Lombard, Michelle Harrison, Heshani Nesfield, Anna DeFazio, Tarek Meniawy, Kylie L Gorringe","doi":"10.1111/ajo.13792","DOIUrl":"10.1111/ajo.13792","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mucinous ovarian carcinoma (MOC) is a rare ovarian cancer with limited evidence to support clinical care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>We undertook a clinician survey to better understand current practice in treating MOC in Australia and New Zealand, and to determine any features associated with variation in care. In addition, we aimed to understand future research priorities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A RedCap survey was distributed to clinician members of the Australia New Zealand Gynaecological Oncology Group (ANZGOG). Questions included respondent demographics, three case studies and future research priorities. Clinicians were asked questions specific to their speciality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Respondents (<i>n</i> = 47) were commonly experienced gynae-oncology specialists, most often surgical (38%) or medical (30%) oncologists. There was good consensus for surgical approaches for stage I disease; however, variation in practice was noted for advanced or recurrent MOC. Variation was also observed for medical oncologists; in early-stage disease there was no clear consensus on whether to offer chemotherapy, or which regimen to recommend. For advanced and recurrent disease a wide range of chemotherapy options was considered, with a trend away from an ovarian-type toward gastrointestinal (GI)-type regimens in advanced MOC. This practice was reflected in future research priorities, with ‘Is a GI chemotherapy regimen better than an ovarian regimen?’ the most highly ranked option, followed by ‘Should stage 1C patients receive chemotherapy?’</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although the number of respondents limited the analyses, it was clear that chemotherapy selection was a key point of divergence for medical oncologists. Future research is needed to establish well-evidenced guidelines for clinical care of MOC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13792","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139652247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diverse presentations of Cushing's syndrome during pregnancy – A case series 妊娠期库欣综合征的多种表现形式--病例系列。

IF 1.4 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Australian & New Zealand Journal of Obstetrics & Gynaecology

Pub Date : 2024-01-29 DOI: 10.1111/ajo.13793

Natasha Stoinis, Katherine Creeper, Jessica Phillips, Dorothy Graham, Ee Mun Lim

Background

Cushing's syndrome (CS) encompasses various causes of hypercortisolism including adrenocorticotropic hormone (ACTH) secreting pituitary adenoma with or without bilateral adrenal hyperplasia, an adrenal adenoma or carcinoma, ectopic ACTH or corticotrophin-releasing hormone (CRH) secretion by a neoplasm or exogenous corticosteroid therapy. The diagnosis of CS in pregnancy presents a challenge due to overlapping clinical features of pregnancy (weight gain, striae, acne). If untreated, CS in pregnancy is associated with increased risk of maternal and fetal complications.

Aims

With fewer than 250 cases currently published, we aim to review the clinical presentations, diagnostic methods, management, and outcomes of patients with CS in pregnancy to help optimise our clinical practice.

Materials and methods

This is a single-centre, retrospective review of woman with documented hypercortisolism receiving antenatal care at a tertiary maternity hospital in Perth between 2006 to 2022. Data were collated from electronic and chart reviews. OMNI calculator was used for birthweight calculations. Local ethics and patient consent were obtained.

Results

Five women and seven pregnancies were identified. Four women had a pituitary source of ACTH-dependent CS as confirmed by brain magnetic resonance imaging. One woman had an ectopic source of ACTH. Two women were diagnosed during pregnancy. All pregnancies occurring prior to treatment of the Cushing's disease were complicated by secondary hypertension and diabetes.

Conclusion

CS represents a rare and difficult to diagnose condition in pregnancy. When untreated, maternal and fetal outcomes are compromised. Close monitoring of the associated complications with involvement of a multidisciplinary team are recommended.

背景：库欣综合征（Cushing's Syndrome，CS）包括各种原因引起的皮质醇增多症，包括伴有或不伴有双侧肾上腺增生的促肾上腺皮质激素（ACTH）分泌型垂体腺瘤、肾上腺腺瘤或癌、由肿瘤或外源性皮质类固醇治疗引起的异位促肾上腺皮质激素（ACTH）或促肾上腺皮质激素释放激素（CRH）分泌。由于妊娠期的临床特征（体重增加、条纹、痤疮）与妊娠期 CS 相似，因此诊断妊娠期 CS 是一项挑战。目的：目前发表的病例不到 250 例，我们旨在回顾妊娠合并 CS 患者的临床表现、诊断方法、管理和结果，以帮助优化我们的临床实践：这是一项单中心回顾性研究，研究对象是2006年至2022年期间在珀斯一家三级妇产医院接受产前检查的皮质醇增多症孕妇。数据来自电子和病历审查。计算出生体重时使用了 OMNI 计算器。已获得当地伦理和患者同意：结果：共发现五名妇女和七名孕妇。经脑磁共振成像证实，四名妇女的垂体源性促肾上腺皮质激素依赖性 CS。一名妇女有异位的 ACTH 来源。两名妇女在怀孕期间被确诊。所有在库欣病治疗前发生的妊娠都并发了继发性高血压和糖尿病：CS是一种罕见且难以诊断的妊娠期疾病。如果不及时治疗，母体和胎儿的预后都会受到影响。建议在多学科团队的参与下密切监测相关并发症。

{"title":"Diverse presentations of Cushing's syndrome during pregnancy – A case series","authors":"Natasha Stoinis, Katherine Creeper, Jessica Phillips, Dorothy Graham, Ee Mun Lim","doi":"10.1111/ajo.13793","DOIUrl":"10.1111/ajo.13793","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cushing's syndrome (CS) encompasses various causes of hypercortisolism including adrenocorticotropic hormone (ACTH) secreting pituitary adenoma with or without bilateral adrenal hyperplasia, an adrenal adenoma or carcinoma, ectopic ACTH or corticotrophin-releasing hormone (CRH) secretion by a neoplasm or exogenous corticosteroid therapy. The diagnosis of CS in pregnancy presents a challenge due to overlapping clinical features of pregnancy (weight gain, striae, acne). If untreated, CS in pregnancy is associated with increased risk of maternal and fetal complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>With fewer than 250 cases currently published, we aim to review the clinical presentations, diagnostic methods, management, and outcomes of patients with CS in pregnancy to help optimise our clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>This is a single-centre, retrospective review of woman with documented hypercortisolism receiving antenatal care at a tertiary maternity hospital in Perth between 2006 to 2022. Data were collated from electronic and chart reviews. OMNI calculator was used for birthweight calculations. Local ethics and patient consent were obtained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five women and seven pregnancies were identified. Four women had a pituitary source of ACTH-dependent CS as confirmed by brain magnetic resonance imaging. One woman had an ectopic source of ACTH. Two women were diagnosed during pregnancy. All pregnancies occurring prior to treatment of the Cushing's disease were complicated by secondary hypertension and diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CS represents a rare and difficult to diagnose condition in pregnancy. When untreated, maternal and fetal outcomes are compromised. Close monitoring of the associated complications with involvement of a multidisciplinary team are recommended.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55429,"journal":{"name":"Australian & New Zealand Journal of Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajo.13793","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139572222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0