Archives of Gynecology and Obstetrics最新文献

Background: Fetal magnetocardiography (fMCG) is the most accurate method to assess fetal heart rhythm and conduction. New quantum sensor technology makes it possible to use less expensive devices. The aim of the study is to measure cardiac time intervals of healthy fetuses with a new technology, optically pumped magnetometry (OPM), and compare these results with conventional SQUID-based fMCG and postnatal ECGs.

Methods: The recordings were made using an OPM-based fMCG system and a person-sized magnetic shield, established at German Heart Center,TUM University, Munich, Germany. The subjects were 57 healthy women with uncomplicated singleton pregnancies, studied at a mean gestational age of 32 ± 3.7 weeks with an overall range of 25-40 weeks. The P, PR, QRS, QT, QTc, and RR intervals were measured and compared with published data from previous fMCG devices and postnatal ECG.

Results: The P, PR, and QRS intervals increased with gestational age, but the QT and QTc intervals did not. The measured values of the OPM device were consistent with those from previously published data SQUID values. U-waves were seen in 17.3% of subjects. Eleven subjects were studied by fMCG after 30 weeks' gestation and by ECG within 17 weeks of birth. In this cohort, the P-wave duration, QRS duration, and QTc increased after birth, but the PR and QT intervals did not.

Conclusion: The results obtained with our innovative OPM-based fMCG system are comparable to previously available measurements obtained by other technologies. The data establish prediction intervals for OPM-based fMCG waveforms in normal fetuses, which is essential for future clinical application. The technology can be used to recognize fetuses with rhythm or conduction abnormalities that might not be evident by echocardiography. To our knowledge, this is the first report comparing fetal cardiac time intervals measured by OPM-based fMCG with postnatal ECG. Lengthening of cardiac intervals consistent with increased chamber size was seen postnatally.

Background/aim: To assess the sensitivity of the fetal aortic isthmus (AoI) Doppler changes in predicting the adverse perinatal outcome with pregestational and gestational diabetes mellitus compared with other Doppler parameters.

Materials and methods: This prospective case-control study was undertaken between Agust 2023 and May 2024 in Ankara Etlik City Hospital perinatology department. Maternal age, gravidity, parity, maternal body mass index (BMI), gestational age at ultrasonographic examination, fetal AoI, umbilical artery (UA), middle cerebral artery (MCA), and uterine artery (UtA) Doppler parameters were compared between four groups: Pregestational diabetes mellitus (PGDM) (n = 30), diet-regulated gestational diabetes mellitus (DRGDM) (n = 30), insulin-regulated GDM (IRGDM) (n = 30), and controls (n = 75). HbA1c values were evaluated only in pregnancies complicated by diabetes mellitus. The composite adverse perinatal outcomes (CAPO) was defined as Apgar score at 5 min < 7, cord blood pH < 7, sepsis, phototherapy for neonates, respiratory distress syndrome (RDS), mechanical ventilation, neonatal intensive care unit (NICU) admission, hypoglycemia.

Results: Maternal age and BMI levels were significantly higher in the PGDM group (p < 0.001). HbA1c levels were significantly higher in the PGDM group compared to other diabetic groups (p < 0.001). While most Doppler parameters were similar across groups, PGDM cases had higher rates of prematurity (40%), cesarean delivery (90%), NICU admission (60%), and CAPO (63.3%) compared to controls (p < 0.01 for all). HbA1c was positively correlated with MCA S/D, AoI-PSV, and AoI S/D (p < 0.05). ROC analysis showed that AoI Ta-max and EDV had modest predictive value for CAPO (AUC = 0.627 and 0.638, respectively; p < 0.05).

Conclusions: The AoI Doppler flow measurements may serve as a potential adjunctive marker in the assessment of adverse perinatal outcomes in pregnancies complicated by diabetes mellitus. However, further large-scale prospective studies are warranted to validate its clinical applicability and establish its role in routine obstetric practice.

Background: Accessory cavitated uterine mass (ACUM) is a rare Mullerian anomaly that predominantly affects young women, presenting with refractory dysmenorrhea. Despite 3D ultrasound and MRI being the gold standard for diagnosis, diagnostic delays and accuracy limitations continue to hinder timely management. The deep intra-myometrial location of this anomaly poses significant surgical challenges in achieving complete excision while preserving healthy myometrium.

Case presentation: A 22-year-old nulliparous woman presented with incapacitating cyclical pelvic pain and was diagnosed with ACUM. She underwent surgical management using a novel robotic-assisted technique.

Technique: The procedure utilised robotic-integrated intraoperative ultrasound via a drop-in probe, enabling real-time identification of lesion margins, vascular mapping, and confirmation of complete lesion excision. This approach minimised loss of healthy myometrium and preserved endometrial cavity integrity.

Outcome: The patient reported complete symptom resolution postoperatively. Integration of real-time intraoperative ultrasound within the robotic platform enhanced surgical precision, reduced surgical trauma, and has the potential to improve reproductive outcomes.

Conclusion: Robotic-assisted excision of ACUM with intraoperative ultrasound guidance represents an innovative and precise surgical technique. This approach addresses the key challenges of lesion localisation and myometrial preservation, offering a promising strategy for managing this rare condition in women of reproductive age.

Introduction: Hysterectomy is a frequently employed treatment modality in gynaecological diseases. In the context of various approaches to vaginal hysterectomy, laparoscopically-assisted vaginal hysterectomy (LAVH) could eventually improve the safety in cases where patients without genital prolapse present with preoperative peritoneal adhesions. The present analysis examined intraoperative and immediate postoperative adhesions-related outcomes.

Methods: Monocentric, comparative, retrospective study of a single cohort of women without genital prolapse who underwent LAVH for benign gynaecological conditions between January 2010 and December 2019. Patients without peritoneal adhesions were compared with patients with adhesions, as diagnosed at the beginning of the procedure. Mann-Whitney-U test was used for the comparative analysis.

Results: Among 1,638 patients, 562 patients (34.3%) had preoperative adhesions. Main indications were for myoma (71%) and adenomyosis (14.9%). The mean operation time in the adhesion group was significantly longer than in the no-adhesion group (106 ± 44 min vs. 90 ± 35 min; p < 0.001). Adhesiolysis was required in 88% within the adhesion group (n = 495). No significant differences were observed regarding mean estimated intraoperative blood loss (87 ± 100 ml vs. 90 ± 95 ml; p = 0, 418), uterine weight (220 ± 227 g vs. 230 ± 203 g; p = 0, 38), or morcellation (52% vs. 55.8%; p = 0, 142). Most patients in both groups did not experience complications (95% vs. 97.2%). Laparoconversion due to technical difficulties in performing the endocopic surgery or due to the presence of adhesions was rarely needed (1.6% vs. 0.6%). The intraoperative complication rate was low but significantly different in both groups (2% vs. 0.7%; p = 0.02), including bowel injuries (n = 6 vs. n = 3) and urinary bladder injuries (n = 4 vs. n = 5). %), which were diagnosed immediately and treated successfully. The postoperative complication rate was similar in both groups (3.4% vs. 2.1%; p = 0.138), mainly urinary tract infection. All adverse events were treated successfully; second laparoscopic surgery was conducted in five patients with adhesions and in nine patients without adhesions for haematoma removal.

Conclusion: LAVH could be considered a safe and feasible surgical approach for women without genital prolapse who have preoperative peritoneal adhesions and require vaginal hysterectomy for benign gynaecological conditions. This approach facilitates the localisation and treatment of adhesions at the commencement of surgery, as well as the control of possible injuries that may arise during the procedure, and is associated with a low complication rate.

Objective: To evaluate the residual risk of clinically significant copy number variations (CNVs) in fetuses with ultrasonographic soft markers by its various types after excluding theoretically non-invasive prenatal screening (NIPS)-detectable abnormalities.

Methods: This study included 2005 fetuses with soft markers undergoing chromosomal microarray analysis (CMA) between 2015 and 2024. Theoretically NIPS-detectable findings were categorized into three subgroups: 3-chromosome NIPS, 5-chromosome NIPS, and genome-wide NIPS. The residual risk was calculated and compared with a low-risk control cohort. We further assessed their clinical outcomes.

Results: The overall diagnostic yield of clinically significant CMA findings in fetuses with soft markers was 6.38%. Overall, the residual risk was 4.67% for 3-chromosome NIPS, 4.19% for 5-chromosome NIPS, and 3.25% for genome-wide NIPS. Except for isolated single umbilical artery (genome-wide NIPS), echogenic intracardiac focus, and aberrant right subclavian artery (all NIPS models), the residual risk was significantly higher for most soft marker types when compared with the control cohort. Among fetuses with normal CMA results and successful follow-up, a significantly lower rate of normal infant was identified in fetuses with four types of soft markers (mild ventriculomegaly, echogenic bowel, short femur length, and mild pyelectasis) compared with the control cohort.

Conclusion: The residual risk in fetuses with multiple soft markers and most isolated soft markers (absent or hypoplastic nasal bone, mild ventriculomegaly, thickened nuchal fold, echogenic bowel, short femur length, mild pyelectasis, and choroid plexus cysts) was higher than that in low-risk pregnancies. CNV analysis is recommended for such fetuses, regardless of whether NIPS has been performed previously.

Introduction: Anonymous (or confidential) forensic evidence collection (AFC; German: Anonyme Spurensicherung [ASS]) following sexual offenses plays a critical role in the initial care of affected individuals. Comprehensive execution of this procedure presents a significant challenge in the clinical routine care of gynecologists, as legal requirements, court-admissible documentation of injuries, and forensic evidence preservation often lead to uncertainty. The implementation of forensic evidence collection as a statutory health insurance benefit, following the Measles Protection Act (Masernschutzgesetz), has been effective in North Rhine-Westphalia since March 1, 2025, and is currently being formalized in contractual agreements. The objective of this study is to track the utilization of AFC, raise awareness of this topic, and identify common problems associated with its execution.

Materials and methods: Systematic compilation of annual case numbers for anonymous forensic evidence collection (AFC) was performed from June 2011 to December 2024 at the Department of Obstetrics and Gynecology, University Hospital Cologne. This was followed by a statistical evaluation of the percentage increase and the annual mean values.

Results: A total of 177 cases were documented at the University Hospital Cologne. Between 2012 and 2024, the annual case numbers increased from eight to 25 cases. The average number of cases examined annually during the observation period was 13.15. This corresponds to an average annual increase of approximately 17%, totaling 215% over 11 years, when considering 2012 as the first complete year for data analysis. Frequent issues encountered in clinical practice include improper storage (until transport to the Institute of Legal Medicine) and incorrect labeling of collected samples.

Conclusions: The observed increase in the number of alleged victims of sexual violence requiring examination supports the health policy assumption that structured and correct forensic evidence collection is becoming increasingly vital. Adequate funding for the examination and the storage of evidence carriers is mandatory for long-term quality assurance. This is the only way to ensure optimal support and care for presumed victims in these stressful situations.