Introduction: Aerobic exercise has been confirmed to alleviate primary dysmenorrhea (PD) in adolescents and young women. However, the effect of the aerobic exercise type and dosage on PD alleviation was unclear. This research aims to assess the effect of aerobic exercise on PD and investigate the dose-response relationships.
Material and methods: Systematic literature searches of Web of Science, Embass, Cochrane Library, PubMed, PsycNET, CINAHL, CNKI, Baidu Scholar, Google Scholar, and other Complimentary Medicine Database. PICOS standards were adopted in this research: participants were nonathlete women with PD; intervention was aerobic exercise of at least one menstruation cycle; comparator was any comparator; outcomes were pain intensity or pain duration; and study type was randomized controlled trials. The Cochrane Collaboration risk of bias tool was used to assess the quality of the research. Random-effect meta-analysis was conducted for pain intensity and pain duration, with prespecified subgroup analyses based on aerobic exercise components. The strength of the evidence was assessed using GRADE. This systematic review and meta-analysis was registered in PROSPERO (CRD42024533544).
Results: The study identified 16 eligible studies, with 15 involving adolescents, totaling 918 participants aged 15 to 43, with an average age of 21.26 ± 13.15. The results confirmed that aerobic exercise can alleviate PD's pain intensity (standard mean difference (SMD) = -1.728 (p = 0.00), 95% CI [-2.26 to -1.31]) and pain duration (weighted mean difference (WMD) = -12.53 h, p = 0.01, 95% CI: -21.38 to -3.68). However, the heterogeneity of these two results was high. Subgroup analysis showed that Pilates (SMD = -3.17, 95% CI [-4.26 to -2.07]), low intensity (SMD = -1.64, 95% CI [-2.10 to -1.19]), 31-45 min duration (SMD = -3.05, 95% CI [-5.36 to -0.75]), ≤2 times per week frequency (SMD = -2.24, 95% CI [-3.36 to -1.12]), and a period cycle of 2 menstrual cycles (SMD = -2.21, 95% CI [-3.13 to -1.28]) had the maximum effect size.
Conclusions: Aerobic exercise was able to alleviate pain intensity and pain duration in adolescents and young women with PD. Moderate-quality evidence indicates that Pilates, low intensity, 46-60 min, ≤two times per week, or two menstrual cycles showed more efficiency in alleviating PD. Due to the limited data, future research should prioritize conducting randomized controlled trials of aerobic exercise interventions in younger age groups to develop personalized treatment strategies for adolescents.
More women with congenital heart disease (CHD) are pursuing pregnancy. Their cardiac condition may impact the pregnancy and necessitate interventions during childbirth. We aimed to investigate labor onset and delivery mode in women with CHD relative to women without heart disease and explore the time trends of induced labor and cesarean deliveries.
In a nationwide cohort in Norway from 1994 to 2014, we compared childbirths of women with mild, moderate/severe, or other CHD to childbirths of women without heart disease. Associations between maternal CHD and labor onset and delivery mode were estimated using log-binomial regression. Time trends were assessed using Joinpoint regression.
Among 1 218 452 childbirths, 2425 (20 per 10 000) had mild maternal CHD, 603 (5 per 10 000) moderate/severe maternal CHD, and 522 (4 per 10 000) other maternal CHD. Mild maternal CHD was associated with induced labor (aRR 1.11, 95% CI 1.01–1.22) and cesarean delivery (aRR 1.27, 95% CI 1.18–1.39), and the associations were stronger with moderate/severe CHD (induced labor: aRR 1.34, 95% CI 1.13–1.58; cesarean delivery: aRR 1.80, 95% CI 1.57–2.05) and other CHD (induced labor: aRR 1.39, 95% CI 1.17–1.66; cesarean delivery: aRR 1.62, 95% CI 1.39–1.89). From the first seven years (1994–2000) to the last (2008–2014), the cesarean delivery occurrence rose about 2% per year in childbirths without maternal heart disease and with mild maternal CHD (from 12.4% to 16.4% and from 14.2% to 21.2%, respectively), but remained stable in childbirths with moderate/severe maternal CHD (23.3% to 25.6%). For induced labor, there was a 2% increase per year in childbirths without maternal heart disease, contrasting a 3%–4% increase in those with mild and moderate/severe maternal CHD.
Maternal CHD was associated with higher risks of induced labor and cesarean delivery. From 1994 to 2014, the increase in induced labor was steeper in childbirths of women with CHD than in those of women without heart disease. The occurrence of cesarean deliveries rose in childbirths of women with mild CHD but was stable in childbirths of women with moderate/severe CHD.
In response to the increasing rates of induction of labor (IOL), outpatient IOL has emerged as a potential approach to enhance women's satisfaction while reducing costs and staffing requirements. There is a growing interest in oral misoprostol as an outpatient IOL method, particularly in the Nordic region. This study aims to evaluate the clinical outcomes and feasibility of implementing IOL with oral misoprostol as an outpatient procedure.
This multicenter, prospective cohort study is part of the Labor Induction Inpatient and Outpatient (LINO) project (ClinicalTrials.gov Identifier: NCT04746248). Women with low-risk pregnancies undergoing IOL with oral misoprostol were offered outpatient treatment as an alternative to the standard inpatient approach. The primary outcome was the proportion of births and adverse events occurring before or within 30 min after admission, comparing outpatient and inpatient groups. Secondary outcomes included maternal and neonatal safety and efficacy endpoints.
During the study period, 212 women were included in the study: 123 (58.0%) in the outpatient group and 89 (42.0%) in the inpatient group. No births occurred before admission to the hospital or within the first 30 min after admission. Adverse events were rare, and there were no significant differences in safety outcomes between the groups. The duration from hospital admission to giving birth was significantly shorter among women in the outpatient group as compared to the inpatient group (12.3 h vs. 28.1 h, p = 0.001). In the outpatient group, 76.4% of the women completed the misoprostol treatment as outpatients.
In this study of 212 women undergoing IOL with oral misoprostol, we found similar safety outcomes between women who chose outpatient IOL and those who chose inpatient IOL. The outpatient group had significantly shorter hospital stays before giving birth, and more than three in four women in the outpatient group completed the misoprostol treatment as outpatients. While larger studies are needed to draw definitive conclusions, our study suggests that implementing oral misoprostol in an outpatient IOL protocol may represent a safe and feasible alternative.
To report the progress of the human living uterus transplant research project in Singapore.
The uterus transplant research project began in 2012 with a collaboration between the Swedish and Singapore teams. Ethics approval was obtained from the SingHealth Centralised Institutional Review Board, the SingHealth Transplant and the Singapore General Hospital Biomedical Ethics Committee to perform 5 uterus transplant procedures in a collaborative multi-site research study at the Singapore General Hospital. Regulatory approval was obtained from the Ministry of Health, Singapore. A suitable recipient–donor pair was identified. The living donor was the perimenopausal mother-in-law of the recipient who had Mayer–Rokitansky–Kuster–Hauser syndrome. They underwent the requisite matching process as well as robust medical, psychiatric and psychosocial assessments. The recipient then underwent in vitro fertilization (IVF) treatment resulting in 6 frozen blastocysts. Preparations were made for the transplant surgery on 25 November 2023 in Singapore General Hospital, aided by the 3 Uterus transplant experts from the Swedish Team, for whom temporary registration was granted by the Singapore Medical Council.
This first uterus transplant procedure involved an operative time of 10 h and 30 min for the donor. The synchronized recipient surgery lasted 6 h and 20 min. Surgery was by midline laparotomy in both the living donor and recipient. The total warm ischemic time of the graft was 45 min, and the cold ischemic time was 1 h 45 min (total ischemic time 2 h 30 min). The patient's first menstruation occurred 38 days after the uterus transplant procedure. Cytomegalovirus infection was detected 6 weeks postoperatively for which she was aggressively treated. Serial cervical biopsies showed no rejection and Doppler ultrasound of the transplanted uterus showed good uterine blood flow.
To date the Living Donor Uterus Transplant Research Project in Singapore has progressed with a uterus transplant surgery involving a living donor performed by a multidisciplinary team. The recipient had a menstrual period 38 days postoperatively. Further study of the outcomes from this procedure will inform the safety and efficacy of uterus transplant in the Singapore context.
Graft optimization is a necessity in order to develop uterus transplantation from brain-dead donors, as a complement to living donors, as these grafts are rare and the last organs retrieved in multiple organ donation. The aim of this study was to assess the feasibility and interest of hypothermic machine perfusion (HMP) in uterus transplantation using a porcine model; secondary outcomes were the evaluation of the graft's tolerance to a prolonged cold ischaemia time and to find new biomarkers of uterus viability.
Fifteen uterus allotransplantations were performed in a porcine model, after 18 h of cold ischaemia, divided in three groups: Static cold storage in a HTK solution, HMP (with the VitaSmart (™) machine Bridge to Life Ltd.) with a UW-MP solution, and static cold storage in a UW solution. The main outcome was macroscopic: uterine arteries pulsatility, recoloration, and bleeding at the cut. Secondary outcomes were histological analyses (Zitkute and inflammation scores), caspase3 immunohistochemistry and plasmatic dosage of biomarkers.
14/15 allotransplantations were performed according to the protocol and met the criteria of macroscopic vitality. Grafts treated with HMP (MP did not show significantly more tissue) damage than the recipient's uterus, contrary to grafts in static cold storage, independently of the solution used. This difference disappeared one and 3 h after uterus transplantation. Plasma dosages before and after uterus transplantation did not allow to identify a new biomarker of uterus viability.
HMP is feasible in a porcine model, without inflicting damage on the grafts during cold ischaemia time. Grafts exposed to HMP seemed to better endure reperfusion phenomena, but this advantage did not last over time.
Introduction: Intrauterine devices (IUDs) are highly effective contraceptives. Despite their effectiveness, pregnancies can occur during IUD use, and the management of such cases, particularly when the pregnancy is desired, remains controversial.
Material and methods: We conducted a systematic review and meta-analysis to evaluate outcomes in women who unintentionally conceived while using IUDs and chose to continue their pregnancies. We searched PubMed, Embase, and Cochrane databases to identify studies comparing women who removed their IUD after pregnancy discovery to those who retained it. The primary outcomes assessed were miscarriage, bleeding during pregnancy, and preterm delivery. Secondary outcomes included cesarean delivery, chorioamnionitis, congenital malformations, intrauterine growth restriction, preterm premature rupture of membranes, and stillbirth. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the binary outcomes using random-effects models to account for variability across studies. The certainty of evidence was measured using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Results: From 3719 records, 4 cohorts were included. Among the 693 pregnant women analyzed, 402 had their IUD removed, while 291 retained the device. The analysis focused on copper IUDs, with most studies reporting removal during the first trimester and after ultrasound evaluation, although gaps in standardized reporting practices and removal methods were noted. Significant benefits were observed for the IUD-removed group, including reduced incidences of bleeding during gestation (OR 0.42; 95% CI 0.24 to 0.73; p < 0.01. Moderate certainty of evidence), and miscarriage (OR 0.29; 95% CI 0.17 to 0.48; p < 0.01. Moderate certainty of evidence). There was no significant difference in preterm delivery rates (OR 0.78; 95% CI 0.34 to 1.76; p = 0.55).
Conclusions: This meta-analysis, based on data from cohort studies with moderate certainty of evidence, indicates that removing an IUD after pregnancy diagnosis may reduce the odds of miscarriage and bleeding during gestation. However, further high-quality research is needed to evaluate outcomes in pregnancies associated with hormonal IUDs, as well as critical factors such as gestational age at diagnosis, timing of IUD removal, and the position of the gestational sac relative to the device.
Ectopic pregnancy (EP) is a serious clinical gynecological emergency. Patients with EP history are at higher risk of EP resulting from IVF/ICSI (IVF-EP). Besides, studies have suggested that previous EP treatments may affect the incidence of IVF-EP. However, this result does not consider possible confounding factors due to the number of previous EP. Therefore, we assessed the impact of salpingectomy on the risk and characteristics of IVF-EP in patients with different previous spontaneous EP.
This retrospective cohort study included 43 647 patients receiving their first IVF/ICSI treatments at our center from January 2013 to June 2022. Cohorts were assigned according to the number of previous spontaneous EP by propensity score matching. After propensity score matching, there were 3252 participants in the no previous EP history cohort (NEP cohort), 3252 in the one EP history cohort (One-EP cohort), and 1571 in the 2 or more EP history cohort (> = 2 EP cohort). To assess the effect of previous salpingectomy on IVF-EP, One-EP cohort and > =2 EP cohort were divided into three subcohorts separately, according to their tubal statuses.
The IVF-EP rate was significantly higher in patients with EP history (NEP cohort: 1.3% vs. One-EP cohort: 2.2% vs. >=2 EP cohort: 2.0%, p = 0.023). In subcohort analysis, patients with different tubal statuses presented no statistical differences in IVF-EP rate (both in One-EP cohort and > =2 EP cohort). Considering the interaction between tubal status and number of previous EP, binary logistic regression was performed and it was demonstrated that bilateral salpingectomy might reduce the risk of IVF-EP in patients with recurrent EP history but increase the risk of non-tubal IVF-EP, while the history of spontaneous EP increased both IVF-EP and non-tubal IVF-EP rate.
Previous EP history was associated with a higher risk of IVF-EP and non-tubal IVF-EP. Salpingectomy reduced the overall risk of IVF-EP in patients with EP history, while bilateral salpingectomy increased the risk of non-tubal IVF-EP.
Raising the temperature of abdominal wall endometriosis lesions contributes to an effective ablation; however, providing sufficient protection to the surrounding tissues remains a challenge. In this study, we aimed to combine ultrasound and single-port laparoscopic images to not only achieve complete ablation of abdominal wall endometriosis lesions but also protect surrounding tissues from damage. The adverse events and complications were Common Terminology Criteria for Adverse Events grade 1 or Society of Interventional Radiology classification grade A.
This historical study included 30 patients with abdominal wall endometriosis who underwent ultrasound and single-port laparoscopic-guided microwave ablation at the Ultrasonography and Gynecology Department of the Wuhan Central Hospital between October 2017 and February 2022. Ultrasonography and magnetic resonance imaging were used to evaluate the number, size, and depth of the lesions. Pain levels were assessed using a visual analog scale. Subsequently, ultrasound and single-port laparoscopic-guided microwave ablation of the lesions was performed, and patients were followed up to monitor the lesion volume and pain.
One patient experienced an intra-abdominal wall burn that was detected by single-port laparoscopy, and ablation was stopped immediately. No other complications were recorded. Following surgery, the lesion volume decreased and was lower than the preoperative lesion volume at 1 year postoperatively (1.6 ± 1.3 vs. 4.0 ± 3.6 cm3; p < 0.05). Visual analog scale scores revealed that, compared with preoperative levels, pain was reduced significantly at all postoperative time points (p < 0.01). The recurrence rate was 16.7% (5/30).
The addition of single-port laparoscopy to ultrasound-guided microwave ablation may allow greater protection of the surrounding tissues, particularly in cases involving deep lesions, and may, therefore, represent a promising clinical treatment strategy.
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