Archives of Gynecology and Obstetrics最新文献

Purpose: Maternal anemia during pregnancy is associated with adverse obstetrical outcomes. This study aimed to assess maternal and neonatal outcomes in women with anemia in twin pregnancies, compared to women with normal hemoglobin levels.

Methods: A multicenter retrospective cohort study was conducted including women with twin pregnancies who delivered at 24-42 weeks between 2005 and 2021. Maternal and neonatal outcomes were compared between those who had diagnosis of maternal anemia upon admission for labor (hemoglobin < 11 g/dL), to those who have normal hemoglobin level. The primary outcome was composite adverse neonatal outcomes. Univariate analysis was followed by multivariate analysis to control potential confounders.

Results: During the study period, there were 5,530 twin deliveries; 5,004 women met the inclusion criteria. The maternal anemia prevalence upon admission was 16.8% (n = 840). After controlling for potential confounders, we found an independent association between maternal anemia in twin pregnancies and composite adverse neonatal outcomes for both twins-aOR 1.81 (1.55-2.12) for twin A and aOR 1.77 (1.51-2.06) for twin B. Anemia was also independently associated with higher risk for preterm delivery, cesarean delivery, maternal blood product transfusion and NICU admission for both twins.

Conclusions: Maternal anemia in twin pregnancies is associated with an increased risk of adverse maternal and neonatal outcomes. Clinicians should be aware of this condition, consider appropriate interventions for correcting the anemia, and ensure close monitoring of both the mother and the neonates. Further research is warranted to evaluate the effectiveness of anemia correction strategies in reducing obstetric burden.

Purpose: To characterise the effect of polycystic ovary syndrome (PCOS) on embryo morphokinetics via time-lapse imaging, including absolute time points, relative time intervals, and ratios representing cleavage synchronicity.

Methods: This single-centre retrospective observational study examined patients aged 18-45 years undergoing in vitro fertilisation/intracytoplasmic sperm injection with time-lapse imaging (09/2016-12/2019; n = 1433 two-pronuclear oocytes). A group with PCOS (n = 48 embryos) was compared to a control group with uterine, tubal factor or idiopathic infertility (n = 400 embryos). Times from the two-cell stage to blastocyst expansion, eight intervals for embryonic cell cycle (ECC) duration and synchronicity and four cleavage synchronicity (CS) and DNA replication time ratios were analysed.

Results: PCOS patients were younger (P = 0.023) with higher anti-Müllerian hormone levels (P < 0.001) than controls. No statistically noticeable influence of PCOS on absolute times was observed. The intervals from the 3- to 4-cell (synchronicity of cell cycle 2, s2; P = 0.013), the 5- to 8-cell (synchronicity of cell cycle 3, s3; P = 0.032) and the 4- to 8-cell stage (ECC3; P = 0.043) were longer in the PCOS group. The relative CS ratio from the 2- to 8-cell stage (CS2-8) was lower (P = 0.003) and from the 2- to 4-cell stage (CS2-4) was higher (P = 0.001) in PCOS embryos.

Conclusion: Whilst absolute times remained unaffected, relative morphokinetic intervals and ratios, potentially indicating poorer cleavage synchronicity, were altered in PCOS embryos. This is the first study examining the influence of PCOS on relative morphokinetic ratios.

Background: Placenta accreta spectrum (PAS) is a high-risk obstetric condition associated with hemorrhage, urologic injury, and peripartum hysterectomy. Rising cesarean delivery rates continue to increase its prevalence. Variation in surgical management and limited multidisciplinary involvement may contribute to adverse maternal outcomes.

Objective: To evaluate whether the implementation of a multidisciplinary team (MDT) protocol for PAS was associated with improved perioperative outcomes.

Study design: This retrospective cohort study included 417 women diagnosed with PAS from 2011 to 2022 at a tertiary center. In 2019, a structured MDT protocol was adopted, incorporating standardized imaging, preoperative conference, routine bilateral ureteral catheter (UC) placement, and on-site urologic support. Outcomes of MDT-managed patients (n = 108) were compared with pre-MDT patients (n = 309). Multivariable logistic regression and generalized linear models adjusted for maternal age, gravidity, prior cesarean delivery, placenta previa, PAS grade, surgical urgency, gestational age, and year of delivery.

Results: After adjustment, MDT care was associated with lower odds of urologic injury (aOR 0.34; 95% CI 0.12-0.82), surgical complications (aOR 0.39; 95% CI 0.18-0.78), transfusion (aOR 0.41; 95% CI 0.14-0.93), and hysterectomy (aOR 0.22; 95% CI 0.05-0.91). Adjusted estimated blood loss decreased by 260 mL (95% CI - 480 to - 70), and length of stay was reduced by 0.9 days (95% CI - 1.4 to - 0.3). Results remained consistent in sensitivity analyses limited to 2017-2022.

Conclusion: Implementation of an MDT protocol was associated with reduced perioperative morbidity, supporting multidisciplinary management as a potentially safer strategy for high-risk PAS surgery.

Background: Insulin autoimmune syndrome (IAS), or Hirata disease, is a rare autoimmune disorder characterized by the presence of autoantibodies targeting insulin, leading to episodes of postprandial hypoglycemia. First identified in Japan, the condition was historically seen primarily in the Asian population, but with global recognition and improved diagnostic tools, its prevalence has expanded. While IAS is often self-limiting and resolves with dietary modifications and discontinuation of triggering medications, its management in the context of assisted reproductive technology (ART) remains understudied.

Case presentation: This case report discusses a 28-year-old female diagnosed with IAS who underwent oocyte cryopreservation following a fertility assessment revealing low serum AMH levels. Despite a history of severe hypoglycemia, which was managed with rituximab and resolved within a month, and the presence of elevated insulin and insulin autoantibodies, she successfully completed ovarian stimulation without experiencing hypoglycemic episodes.

Discussion: Close monitoring of glucose levels and insulin autoantibody concentrations was essential for successful oocyte retrieval. This case underscores the importance of careful monitoring and individualized care for patients with IAS undergoing ART as autoimmune flare-ups and hypoglycemia can still occur even when the disease is in remission.

Conclusion: A multidisciplinary approach involving reproductive endocrinologists and fertility specialists is critical for safe management of such patients.

Purpose: This study was conducted to investigate the changes in the uterine biophysical profile (UBP) before and after intrauterine administration of Autologous Blood Cell Derivatives (ABCD).

Methods: This prospective observational study investigates endometrial receptivity in frozen embryo transfer (FET) cycles. It focuses on patients with thin endometrium (TEM), a basal serum FSH below 10 IU/L, and good-quality frozen embryos. The study utilizes the UBP to evaluate endometrial receptivity both before and after the ABCD procedure.

Results: The study involved 33 women with TEM undergoing FET cycles. ABCD was administered during the first, second, and third or later FET cycles in 21.21%, 45.45%, and 33.33% of patients, respectively. Following ABCD administration, significant improvements were observed in UBP scores (from 9.06 to 14.85), EMT (from 6.6 mm to 8.67 mm), blood flow to zone III (from 0.85 mm to 3.36 mm), and uterine artery pulsatility index (PI) (from 0.7 to 0.97). Odds ratio analysis showed an association between pregnancy and endometrial layering (OR = 2.12), though it was not statistically significant. Multivariate analysis revealed that the UBP score predicted pregnancy with 68% accuracy, while the ROC analysis yielded an accuracy of 54%. A UBP threshold score of 20 offered 100% specificity, making it a potentially reliable predictor of successful implantation.

Conclusions: This study demonstrates that ABCD growth factors significantly enhance endometrial development in women with TEM, resulting in improved UBP scores, reduced EMT, lower uterine artery PI, and increased uterine blood flow. A UBP score cutoff of 20 demonstrated 95% sensitivity, highlighting its potential as a reliable prognostic tool in infertility treatment.

Purpose: Preeclampsia is a major obstetric disorder. Machine learning (ML) models incorporating angiogenic biomarkers show promise in predicting related adverse outcomes, but refinement is needed for clinical use. This study aimed to reduce features to a clinically meaningful set and to develop and validate predictive endpoints for preeclampsia-associated outcomes.

Methods: A model with a reduced feature set was derived from a training cohort of 1,634 patients (2, 412 visits) and then tested on a validation cohort of 402 patients (540 visits). Three machine learning models were developed to predict (1) adverse outcomes overall, (2) delivery within 14 days before 34 weeks of gestation, and (3) delivery within 7 days after 34 weeks, using 13 features versus 114 originally.

Results: Reduced-feature models demonstrated comparable accuracy to original models across all endpoints. Model 1 (any adverse outcome) achieved an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.92 (95% CI: 0.88-0.96) in training and 0.89 (95% CI: 0.84-0.93, p = 0.31) in the validation cohort, respectively. For delivery within 14 days, the AUROC was 0.92 (95% CI: 0.87-0.96) in training and 0.85 (95% CI: 0.78-0.92) in validation (p = 0.13). Delivery within 7 days showed AUROCs of 0.79 (95% CI: 0.70-0.87) and 0.80 (95% CI: 0.75-0.85) (p = 0.78).

Conclusion: A machine learning model with a significantly reduced number of features can accurately predict clinically relevant preeclampsia outcomes. The identified endpoints (timing of delivery and adverse events) could support clinical decision-making and help reduce maternal and neonatal morbidity and mortality.

Purpose: To evaluate the association between ultrasonographically measured umbilical coiling index (UCI) at 18-24 weeks of gestation and adverse perinatal outcomes in primigravid pregnancies.

Methods: This prospective study included 461 primigravid women with singleton pregnancies. UCI was measured at 3 cord segments and classified as hypocoiled (< 0.20), normocoiled (0.20-0.40), or hypercoiled (> 0.40) using percentile distribution and ROC-derived thresholds. Maternal characteristics, delivery outcomes, fetal well-being, placental measurements, cord blood gas values, and neonatal outcomes were compared using Kruskal-Wallis, Mann-Whitney U, and chi-square tests (p < 0.05 was significant).

Results: Of the 461 patients, 72 (15.6%) were hypocoiled, 244 (52.9%) normocoiled, and 145 (31.5%) hypercoiled. No significant differences were found in maternal age, BMI, gestational age at delivery, hypertension, diabetes, or placental abruption. Birth weight was lowest in the hypocoiled group (p < 0.001). Umbilical artery pH was significantly lower in the hypercoiled group (p < 0.001). Both hypo and hypercoiled groups showed significantly reduced placental weight/thickness (p < 0.001) and higher rates of non-reassuring non-stress tests (34.7 and 28.3% vs. 9.0%, p < 0.001). Meconium-stained amniotic fluid (p = 0.003), oligohydramnios (p < 0.001), and intrauterine growth restriction (p < 0.001) were more common in abnormal coiling groups. Five-minute Apgar scores were significantly lower in both abnormal groups (p < 0.001). No association was found with fetal death (p = 0.575).

Conclusion: Both decreased and excessive umbilical cord coiling in the second trimester are associated with impaired fetal growth and adverse perinatal outcomes. Routine second-trimester UCI assessment may help identify high-risk pregnancies.

Purpose: To evaluate the acceptance of micronutrient therapy in women with symptoms related to a pathological neurostress profile and to explore its association with patient-reported outcomes such as perceived efficacy, side effects, compliance, and perceived lack of information.

Methods: This retrospective observational study included women aged ≥ 18 years who underwent neurostress testing followed by micronutrient therapy. The study was conducted at the Department of Obstetrics and Gynecology, University Hospital Bern. Patients were invited to complete the validated ACCEPT© questionnaire to assess their level of treatment acceptance. Descriptive statistics and non-parametric tests were applied, and correlations were analyzed using Spearman's rho.

Results: Eighty-one women participated. Overall treatment acceptance was high, with a median ACCEPT© score of 88.9 (Q1 = 66.6, Q3 = 100). Acceptance of drug-related constraints scored high (median = 100), whereas acceptance of treatment duration was lower (median = 66.6). Side effects were well tolerated (median = 100), and perceived efficacy was rated positively (median = 100). General acceptance correlated significantly with perceived efficacy (p < 0.001) and side effects (p < 0.001), but not with compliance (p = 0.084). A negative correlation was found with the perceived lack of information (p = 0.043).

Conclusion: Micronutrient therapy in women with a pathological neurostress profile was highly accepted, particularly regarding treatment-related constraints and side effects. Acceptance was closely linked to perceived efficacy, highlighting the importance of patient-centered communication and expectation management.

Purpose: This study evaluates treatment intensity, tolerability, and survival outcomes in early breast cancer patients with high body surface area (BSA) receiving capped chemotherapy doses.

Methods: We retrospectively analyzed 730 patients with early breast cancer who received neoadjuvant or adjuvant chemotherapy with anthracycline/cyclophosphamide and taxane-based regimens at the University Hospital Tübingen between 2014 and 2021. Institutional policy capped dosing at BSA 2.0 m². To identify patients with clinically relevant dose reduction (≥ 5%), we classified those with BSA > 2.1 m² as the high-BSA group. We assessed relative dose intensity (RDI), adverse events leading to treatment modifications, and survival outcomes using Kaplan-Meier analyses and Cox proportional hazards regression.

Results: Among 730 patients, 61 (8.4%) had BSA > 2.1 m². High-BSA patients received significantly lower median RDI (83.9% vs. 92.6%, p < 0.001). Consistent with reduced dose intensity, treatment tolerability was good: blood and lymphatic system disorders (8.2% vs. 24.5%, p = 0.006) and gastrointestinal disorders (0.0% vs. 11.1%, p = 0.002) occurred less frequently, and fewer patients required subsequent dose reductions (37.7% vs. 58.3%, p = 0.008). Despite this favorable tolerability profile, 5-year overall survival (85.5% vs. 94.3%, p = 0.015) and disease-free survival (74.3% vs. 91.0%, p = 0.008) were inferior in the high-BSA group. This association persisted in multivariate analysis (OS: HR 3.25; DFS: HR 2.17), though obesity-related effects could not be separated due to collinearity.

Conclusions: In this cohort with consistent dose capping at BSA 2.0 m², patients with high BSA represent an at-risk population with reduced chemotherapy intensity, inferior survival, but good treatment tolerability. Lower rates of blood and lymphatic system disorders and gastrointestinal disorders and fewer dose reductions suggest these patients may have tolerated full weight-based doses. While the contributions of obesity-related prognostic factors and potential underdosing could not be separated, these findings support ASCO guideline recommendations against routine dose capping in curative settings.