Archives of Gynecology and Obstetrics最新文献

Introduction: Pregnancies in women with chronic medical conditions are characterized by a higher maternal and perinatal complication rate during pregnancy, childbirth, and the postpartum period. The German Maternity Guideline does not provide specific recommendations for the care of these women. The aim of this study was to evaluate the care of pregnant women with pre-existing medical conditions in German perinatal centers (Level 1 and 2) and perinatal care level 3 hospitals.

Materials and methods: Based on guidelines and literature, seven topics were identified: preconception counseling, timing of consultation, care for pregnant women with rare diseases, participation in continuing education, multidisciplinary case conferences, resources for patient counseling, and transfer of the patient to another center. Representatives of all perinatal centers were contacted by email and invited to participate. The anonymous online survey was conducted using the SoSci Survey platform.

Results: Of 310 centers, 103 (33.2%) representatives responded. 62.2% (n = 64) reported managing 11-30 pregnant women with pre-existing conditions per month. 22.1% (n = 23) of all centers regularly care for pregnant women with rare diseases, and 46.6% offer preconception counseling. University hospitals offer these services more frequently. Regular case conferences are held in 34.0% of centers, and 80.6% of medical staff regularly participate in continuing education on the topic.

Conclusion: According to the results of our survey, 76.7% (n = 79) of perinatal centers regularly care for patients with pre-existing conditions, while only 22.1% care for patients with rare diseases. The findings highlight the need to implement standardized recommendations and targeted resource allocation to ensure optimal care for this patient group.

Background: Endometriosis is one of the most common chronic diseases in women, with a prevalence of up to 10%. The disease particularly affects women of reproductive age. Endometriosis has a significant impact on the patient's quality of life (QoL). In the current study, we aimed to evaluate the role of early diagnosis of endometriosis on patients' QoL.

Methods: In this longitudinal prospective study, 205 women with endometriosis who were referred to the gynecology department of Amir al-Mominin Hospital (Zabol-Iran) in 2021 were evaluated. Patients were divided into two groups based on the time of diagnosis, including early diagnosis and late diagnosis. An Endometriosis Health Profile (EHP) questionnaire was used to collect information about QoL before and 18 months after treatment. Data were analyzed using SPSSv.26 software and significance level was considered less than 0.05.

Results: In both groups with early and late diagnosis, the QoL scores improved without significant difference (p = 0.303). There was a significant difference between lower stages (1 and 2) and higher stages (3 and 4) in terms of treatment effects on patients' QoL, and higher stages of endometriosis affected patients' QoL before and after treatment more than lower stages (P values < 0.05).

Conclusion: Early or late diagnosis of endometriosis doesn't affect patients' QoL and patients benefit from treatment regardless of the time of diagnosis.

Purpose: In early-stage ovarian cancer, sentinel lymph node (SLN) mapping using double injection into the utero-ovarian and infundibulo-pelvic ligaments has been postulated. Cervical injection, commonly used in other gynaecologic tumors, may provide a simpler alternative to utero-ovarian injection for pelvic-SLN detection. This study aims to demonstrate whether cervical and utero-ovarian injections drain to the same pelvic SLN using different tracers for each injection site: technetium-99m (^99mTc) at cervix and indocyanine green into the utero-ovarian ligament.

Methods: This prospective trial enrolled endometrial cancer patients scheduled for SLN biopsy from July 2023 to May 2024. Each hemipelvis was considered a case. ^99mTc was injected at the cervix preoperatively. If ^99mTc migration occurred, indocyanine green was injected into the utero-ovarian ligament intraoperatively. Concordance of migration was determined in those hemipelvis with both ^99mTc-cervical and indocyanine green utero-ovarian migration.

Results: Seventeen patients (34 hemipelvis) were included. Migration from both injection sites occurred in 17 hemipelvis, identifying the same pelvic-SLN in all cases, being the concordance rate of 100%. Migration of ^99mTc or indocyanine green from cervical injection was detected in 91.2% (95% CI 81.6-100%), whereas migration of indocyanine green injection from the utero-ovarian ligament was detected in 73.9% (95% CI 56-91.9%); these detection rates were not significantly different (p = 0.077).

Conclusions: Lymphatic migration from the cervix to the pelvis seems to be comparable to the migration from the utero-ovarian ligament to the pelvis, with both pathways converging at the same SLN.

Purpose: This systematic review and meta-analysis aimed to evaluate the association between anti-Müllerian hormone (AMH) as a biomarker of ovarian reserve and various thyroid function tests, including thyroid-stimulating hormone (TSH), free T3 (FT3), free T4 (FT4), T3, T4, and thyroid autoantibodies, such as thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb), in various female populations.

Methods: A comprehensive literature search was conducted across six electronic databases and original observational studies examining the correlation between AMH levels and at least one TFT, TPOAb, or TgAb.

Results: Forty studies with 14,009 participants were included in the quantitative synthesis. The pooled results showed that AMH levels were not significantly correlated with TSH levels in the overall population or diverse subgroups. However, after adjusting for publication bias, a small, but significant, positive correlation was observed. Meta-regression analyses identified estradiol, FT3, and follicle-stimulating hormone (FSH) as significant moderators of AMH-TSH association in various populations. AMH was significantly positively correlated with FT3 (r = 0.177) and FT4 (r = 058), negatively correlated with T3 (r = - 0.202) and T4 (r = - 0.216) in the overall population, and significantly positively correlated with TPOAb in the normal population (r = 0.348). AMH levels were not significantly correlated with TgAb levels. Meta-regression revealed body mass index and FT4 as moderators in AMH-FT4 and AMH-TPOAb correlations.

Conclusion: These findings highlight the complex relationship between AMH and thyroid function markers with potential moderators influencing these associations. Further well-controlled longitudinal studies are required to clarify the underlying mechanisms and clinical implications of these associations across reproductive stages and metabolic profiles.

This review delves into the role of exosomes in immune regulation within the context of preeclampsia (PE), a pregnancy condition marked by high blood pressure and widespread inflammation. PE hampers the invasion of trophoblasts and disrupts placental function, contributing to inflammation and maternal organ dysfunction. Exosomes are small extracellular vesicles that mediate cell-to-cell communication by transferring proteins, lipids, and nucleic acids. This review highlights their role in immune regulation during pregnancy, especially their altered behavior in PE. Normally, exosomes support communication between the mother and fetus, promoting immune tolerance. In PE, however, exosomal activity and content undergo significant changes, potentially intensifying the inflammatory state. Further investigation into the in vivo immune-modulatory actions of exosomes, especially those from preeclamptic placentas, may provide insights into the pathogenesis of PE and uncover novel therapeutic targets for treatment.

Background: Hydrometrocolpos (HMC) is a rare prenatal ultrasound abnormality, presenting in two distinct types: urinary-type and secretory-type. The urinary variation is intricately linked to cloacal malformation (CM), thereby posing a heightened risk of perinatal adverse events. Additionally, children affected by this type often face long-term challenges that impact their quality of life. Therefore, predicting the presence of CM in HMC fetuses is of great clinical significance.

Case presentation: We present a case involving hydrometrocolpos accompanied by oligohydramnios. Prenatally, the condition was strongly indicative of CM based on imaging manifestations and intrauterine procedures, a suspicion that was later confirmed through postnatal autopsy.

Conclusion: Due to the extremely low incidence of HMC, current literature primarily consists of case reports, and there are no studies that comprehensively analyze the prognosis of the disease. This research fills this gap by statistically analyzing the present case as well as 164 prenatal HMC cases reported in the previous literature. Gestational age (GA) at initial detection, the presence of fetal ascites, urinary tract dilatation, anorectal imaging abnormalities, and Müllerian anomalies are meaningful predictors of CM in HMC fetuses. Intrauterine procedures can be used to preserve organ function in complete lower urinary tract obstruction and oligohydramnios secondary to HMC. In addition, biochemical analysis of HMC fluid can differentiate between urinary-type HMC and secretory-type HMC. This study provides valuable insights into the prognostic factors and management strategies for HMC, which could guide clinical decision-making in prenatal care.

Opportunistic salpingectomy is defined as the removal of both fallopian tubes as part of a surgical procedure planned for other reasons. The goal is primary prevention of ovarian cancer. The procedure is offered to patients who are not known to be at increased risk of developing ovarian cancer. This is in contrast to high-risk patients with a germline mutation, particularly BRCA1/2, for whom risk-reducing salpingo-oophorectomy is generally recommended. Premalignant cells and early occult cancers have been detected in RRSO specimens in the fimbrial funnel region, but not on the ovarian surface. The presence of mitoses, nuclear atypia, and staining in response to p53 mutation in these serous intraepithelial carcinomas (STIC) indicates the initial genetic changes in the fallopian tube mucosa that subsequently lead to the development of advanced peritoneal carcinomas. The identification of STICs has challenged the traditional view of the pathogenesis of the largest subset of epithelial ovarian cancers, namely the high-grade serous cancers of the ovary, fallopian tubes, and peritoneum. In a position statement published in 2015, the German Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Kommission Ovar recommended that patients be informed of the latest findings on the development and potential benefits of bilateral salpingectomy at the time of hysterectomy. This may reduce the risk of developing ovarian cancer later in life. However, the scientific evidence has not been deemed sufficient to justify a general recommendation. In the same year, the Austrian AGO published a statement recommending the broad use of opportunistic salpingectomy without reservation. This review examines the current status of molecular pathology studies, recent evidence on the clinical implications of STIC, new data on the use of opportunistic salpingectomy, and published patient outcomes since then. The question of whether the potential benefit of opportunistic salpingectomy, outweighs the potential harms associated with surgical morbidity, which have not been conclusively excluded, should be revisited in light of these recent data.

Purpose: Although thoracic endometriosis (TE) represents the most common manifestation of extra-pelvic endometriosis, it is a rare condition and currently there is no established clinical guideline for the management of this condition. The study's primary objective was to assess patient satisfaction with the treatment provided. A secondary objective was to investigate the efficacy of different treatment modalities in terms of symptom and lesion recurrence.

Methods: A retrospective review of the clinical records of all women with TE who had been referred to our institution, a tertiary referral center, was conducted between January 2000 and September 2021. A frequency analysis was performed for all the variables examined in the study. The Kaplan-Meier method was adopted to analyse the time from thoracic surgery to PNX recurrence. Lastly, an intention-to-treat analysis was performed.

Results: Regarding clinical presentation, 50% of women (30/60; 95% CI 36.8-63.2) experienced at least one episode of pneumothorax (PNX). A total of 61.7% of the women in the study underwent surgical intervention, while 36.6% received pharmacological treatment. The cumulative recurrence rate of the first PNX following surgery was 0.26 (0.13-0.41) and 0.82 (0.44-0.95) at six months and 240 months, respectively. At the follow-up assessment, regardless of the administered treatment modality, over half of the women included in the study reported being satisfied with their treatment (PGIC). Additionally, most of them described their overall condition as having improved since the onset of the treatment (PGIS).

Conclusion: Both surgical and pharmacological treatments are valuable options for TE. Rather than being considered mutually exclusive, these approaches should be viewed as complementary.

Purpose: To compare different endoscopic techniques, such as hysteroscopy with morcellator and traditional resectoscopy, and different surgical settings, such as operating room setting and outpatient setting, for patients with abnormal uterine bleeding (AUB) and suspected endometrial polyps.

Metho: In this prospective study, 180 women diagnosed with endometrial polyps on ultrasound were enrolled. Patients were divided into three groups: 1) resectoscopy under anesthesia in an operating room setting; 2) morcellation with anesthesia in an operating room setting; and 3) outpatient morcellation without anesthesia. The main outcomes included procedure completion rates, operative time, patient satisfaction, and pain intensity using the Visual Analog Scale (VAS). Additionally, histological analysis was conducted for all cases.

Results: Among the 180 patients, all procedures were completed in Groups 1 and 2, while Group 3 had a 96.7% completion rate. Procedure duration was the shortest in Group 3 (average 6.5 min), significantly less than in Group 1 (p value < 0.05; CI 95%). Pain was manageable in all groups, with VAS scores < 4 for most patients in the outpatient setting. Histology confirmed benign polyps in most cases, and malignant or premalignant conditions were around 3% of procedure.

Conclusion: Outpatient "see-and-treat" hysteroscopy with morcellator, performed without anesthesia, proved feasible, safe, and cost-effective, with minimal discomfort and comparable diagnostic accuracy to traditional methods. This technique offers a practical approach for the management of AUB, enabling efficient treatment while reducing costs and resource usage, and may be considered as a preferred option in appropriate patients.

Purpose: PROM after 37 weeks of gestation occurs in approximately 10% of pregnancies. When spontaneous onset of labour does not follow, induction is recommended to decrease the risk of infection for both mother and child. However, there is no clear consensus on whether induction before 24 h after PROM results in fewer complications compared to induction after > 24 h.

Material and methods: This retrospective observational study analysed the outcomes of 3174 women with PROM admitted to the delivery room of LMU Women's Hospital between 10/2015 and 09/2020. We evaluated whether timing of labour induction was associated with maternal or newborn postpartum infection rates.

Results: Comparing women with spontaneous onset of labour to those who underwent induction, no significant differences were found in maternal CRP or leukocyte levels, fever, endometritis, or Group B streptococcus colonization. However, intrapartum antibiotic therapy was significantly higher in the induction group. When the induction group was subdivided based on the interval from PROM to induction, no significant differences were observed in maternal infection parameters, need for antibiotics, postpartum length of hospital stay, or endometritis. For newborn infections, a significant difference in CRP levels was found, with higher levels in the groups with "induction < 12 h" and "> 24 h".

Conclusion: The presented data suggests that waiting for spontaneous contractions within the first 24 h after PROM was not associated with the risk of infection if no initial signs for infection are present. However, beyond 24 h, the risk of infection increased. These findings support current recommendations regarding the timing of induction after PROM.