Archives of Gynecology and Obstetrics最新文献

Purpose: To analyze complications and potential risk factors associated with immediate prepectoral direct-to-implant breast reconstruction (DTIBR).

Methods: 295 patients (326 operated breasts) with DTIBR between March 2021 and December 2023 were included in this prospective study. Postoperative complications (postoperative bleeding, seroma, infection, necrosis, wound dehiscence, implant exchange/loss) were analyzed for potential risk factors by descriptive and logistic regression analyses.

Results: The implant was covered by TiLOOP® Bra Pocket in 227 breasts (69.6%), by "dual-plane" technique in 20 breasts (6.1%), by acellular dermal matrix (ADM) in 1 breast (0.3%). No additional support was used for 78 breasts (23.9%). The use of mesh did not increase the risk for complications. Major complications requiring surgical revision occurred due to postoperative bleeding in 22 (6.7%), seroma in 2 (0.6%), infection in 13 (4.0%), necrosis in 10 (3.1%), and wound dehiscence in 10 (3.1%) breasts. Thirteen (4.0%) implants were exchanged, and 5 (1.5%) were explanted without substitution. One patient had to switch to autologous reconstruction due to skin necrosis. The main reasons for the removal/exchange of implants were infections (11 breasts, 3.4%) and necrosis (4 breasts, 1.2%). The risk for necrosis, infection, and wound dehiscence was mainly associated with the type of incision, especially skin-reducing incisions, and body mass index (BMI) ≥ 30 kg/m².

Conclusion: Severe complications occurred primarily in patients with a BMI ≥ 30 kg/m² and when skin-reducing surgical techniques were performed.

Trial registry: This study was retrospectively registered at the German Clinical Trials Register (DRKS) on 20.06.2024.

Drks-id: DRKS00034493. https://drks.de/search/de/trial/DRKS00034493 .

Purpose: To explore the effects of high-altitude hypoxia on the microenvironment of oocyte development and fertilization potential, we compared the metabolomic patterns of follicular fluid from women living in different altitude areas and traced their oocyte maturation and subsequent development.

Methods: A total of 315 clinical cases were collected and divided into three groups according to their residence altitudes: 138 cases in low-altitude (< 2300 m) group, 100 cases in middle-altitude (2300-2800 m) group and 77 cases in high-altitude (> 2800 m) group. The clinical outcomes were statistically estimated, including hormonal level, oocyte maturation, in vitro fertilization, and embryo development. Meanwhile, a metabolomic analysis was performed on the follicular fluid of women from different groups using ultra-high-performance liquid chromatography and high-resolution mass spectrometry and differential metabolites were analyzed through the KEGG pathway.

Results: The clinical data indicated that the physical condition and reproductive hormone secretion were similar among different groups. Although personalized gonadotropin-releasing hormone strategies were applied, the numbers of antral follicles and obtained oocytes were not impacted by the residence altitude change. In in vitro culture, the maturing rate, fertility rate and cleavage rate of high-altitude group were compared with the other groups. However, the rates of high-quality embryo, formative blastocyst, and available blastocyst were gradually decreased with the rise of residence altitude. Metabolome analysis identified 1193 metabolites in female follicular fluid. Differential analysis indicated that metabolic components in follicular fluid were remarkably changed with the elevation of residence altitude. These differential metabolites were closely related with amino acid metabolism, protein digestion and absorption, oocyte meiosis and steroid biosynthesis.

Conclusion: The residence altitude alters the microenvironment of follicular fluid, which could damage the oocyte developmental potential. This study provides diagnostic basis and therapeutic targets for research on female oocyte and embryo development.

Purpose: To evaluate the performance of NIPT-plus in detecting fetal aneuploidies and CNVs and analyze the factors influencing adverse pregnancy outcomes.

Methods: The retrospectively analyzed 8726 pregnant women who underwent NIPT-plus for fetal screening were classified into low- (who tested voluntarily) and high-risk (women with advanced age, abnormal ultrasound, abnormal serological screening, or a combination of indications) groups. Basic maternal information, prenatal findings, and pregnancy outcomes were recorded. NIPT-plus performance was assessed for various chromosomal abnormalities and the association between the fetal fraction and adverse pregnancy outcomes.

Results: Thirty-six (0.4%) patients had failed tests; 144 (1.65%) positive cases were detected, of which, 107 (74.31%) opted for invasive testing, and 51 were verified as true positives. The total positive predictive value was 45.45% and 48.65% in the low- and high-risk groups, respectively, and the difference was not significant. Among the subsequent cases with abnormal ultrasound monitoring, two false-negative cases were identified, and pathogenic CNV diagnosis was confirmed through amniocentesis, resulting in pregnancy termination. Fetal fraction was not associated with an increased adverse pregnancy outcome risk; however, ethnic differences may affect pregnancy outcomes.

Conclusion: NIPT-plus technology use is no longer restricted to high-risk pregnant women, and it may produce false-positive results. The stakeholders should be aware of this limitation. The uncertainties and potential risks of the test results should be explained to the test takers to enable informed decision making and to minimize unnecessary anxiety and concerns. Ethnicity may influence adverse pregnancy outcomes in local multiracial settings.

Objective: To evaluate the rates of adverse perinatal outcomes among women who conceived after fertility treatments with and without diet-controlled GDM.

Methods: In this retrospective population-based cohort study, all pregnancies of non-diabetic and diet-controlled GDM women who conceived after fertility treatments (in-vitro fertilization - IVF and ovulation induction - OI) and delivered between the years 1996-2016 in a tertiary medical center, were included. Pregnancies of women with pre-gestational diabetes mellitus, and those complicated with gestational diabetes mellitus A2, multiple pregnancies, congenital malformations and those lacking prenatal care, were excluded. Demographical, clinical, and obstetrical characteristics were recorded, and pregnancy complications and adverse perinatal outcomes were compared between the groups. Multivariate logistic regression models were used to control for confounders. Statistical analyses were performed using logistic regression to control for potential confounders. A p-value of < 0.05 was considered statistically significant.

Results: During the study period, 6254 deliveries met the inclusion criteria, 10.23% of them (n = 640) had diet-controlled GDM. Pregnancies with diet-controlled GDM were found to be associated with significantly higher rates of hypertensive disorders of pregnancy (15.6% vs. 9.8%, p < 0.001), polyhydramnios (5.9% vs. 2.7%, p < 0.001), and cesarean deliveries (40.8% vs. 31.9%, p < 0.001). Diet-controlled GDM was also found to be an independent protective factor against perinatal mortality (aOR = 0.22, 95% Cl 0.05-0.92, P = 0.04) possibly due to the more intensive monitoring and management typically provided to women undergoing fertility treatments. This close care may mitigate some of the risks associated with ART, leading to improved perinatal outcomes.

Conclusion: Among pregnancies achieved after fertility treatments, diet-controlled GDM was associated with reduced perinatal mortality and higher rates of certain pregnancy complications. These findings highlight the importance of close monitoring and careful management of women with diet-controlled GDM, as it may help mitigate risks associated with ART pregnancies. Further research is needed to understand the mechanisms behind these outcomes and to optimize management strategies for this specific population.

Objective: This study was designed to assess the complications raised in different suture-passing techniques when fixating the Sacrospinous ligament for pelvic organ prolapse (POP).

Search strategy: We searched PubMed, Embase, Scopus, Web of Sciences, ProQuest, Google Scholar, and Cochrane Library, and performed a systematic review meta-analysis to assess complications when implementing different suture passings in fixating the sacrospinous ligament.

Selection criteria: The inclusion and exclusion criteria for literature screening were predetermined to allow for a more rigorous process. Interventions should include sacrospinous fixation (SSF) as a point of attachment for POP. To eliminate confounding bias and effect modification, at least one arm must include SSLF without mesh or graft.

Data collection and analysis: The primary endpoint used was the need for reoperation, nerve injury, hematoma, and the need for blood transfusion. The secondary endpoint was study screening. For eligible articles, data were extracted and summarized independently by two reviewers.

Main results: The systemic review used the data from 125 studies, including 10,216 cases. The reoperation rate was 1.2% overall, with higher rates in the Shutt Suture Punch System, Laurus, and Anchorsure. The nerve injury rate was 3.8%, with Capio having the highest rate. The hematoma rate was 1.7%, with Laurus and Raz anchoring showing higher rates. Blood transfusion rates were higher with Modified Deschamps and Deschamps devices.

Conclusions: Complications related to suture passing are increased when suture capturing is the method applied in passing the suture through the sacrospinous ligament.

Background: Celiac disease (CD) is an inflammatory enteropathy that has been associated to obstetric and gynecological disorders. However, it is still not adequately tested by gynecologists due to the misconception that it is solely a gastrointestinal disease. This underestimation requires the development of targeted interventions.

Purpose: This study aims to evaluate the association between CD and obstetric/gynecological complications, highlight the importance of informing patients about CD manifestations, and assess the patient satisfaction with the information provided by healthcare professionals on the disease.

Methods: A digital survey was administered to celiac women via the Italian Celiac Association's website.

Results: We analyzed 493 questionnaires. Obstetric and gynecological disorders led to the diagnosis of CD in 11.7% of interviewed. The study revealed that untreated CD patients are more predisposed to miscarriages (41.8% vs 34% before/after diagnosis, respectively, p = 0.111), anemia in pregnancy (71.4% vs 40.4% before/after diagnosis, respectively, p < 0.001) and the risk of low birth weight (newborns weighing < 1500 g were 4.0% before and 1.1% after the gluten-free diet, p = 0.028). Women with CD, both before and after gluten-free diet, had higher infertility rates (about 19%) than the general population. Additionally, 73% of interviewees were dissatisfied with the information they received from health professionals about the reproductive implications of CD.

Conclusion: Our research contributes to a deeper understanding of the intersection between CD and reproductive outcomes, highlighting the main obstetric and gynecological problems related to it. It emphasizes the importance of patient's perspective and the need for greater awareness about celiac disease from healthcare workers.

Introduction: To evaluate the effectiveness of paracetamol and ibuprofen as non-opioid treatments for postpartum pain control after vaginal delivery.

Materials and methods: This randomized controlled study at a university-affiliated medical center involved parturient who received blindly oral tablets of either 1000 mg of paracetamol or 400 mg of ibuprofen, post-vaginal birth. Pain levels were assessed using a numeric rating scale (NRS) at four time points: before treatment, and 1, 4, and 6 h post-treatment (T0, T1, T4, and T6, respectively). We also compared the need for additional analgesia, breastfeeding initiation, mobilization, and urination following the delivery between the groups. To ensure statistical power, the study was designed to detect differences of one point on the NRS with at least 37 women per group.

Results: A total of 107 women participated, including paracetamol (n = 52) and ibuprofen (n = 55) groups. Demographics and perinatal outcomes were similar across groups. No significant differences were found in the interval between delivery and request for pain control (8 ± 6-10.5 and 11 ± 6-16 h for the paracetamol and the ibuprofen, respectively, P = .13). Pain levels on the NRS were similar for both groups at all intervals. There were also no group differences in the time to the initiation of breastfeeding, mobilization, urination, or the need for additional analgesia.

Conclusion: Both, paracetamol and ibuprofen, can be considered equivalent and effective non-opioid alternatives for postpartum pain control. REGISTRY AT CLINICALTRIALS.GOV: (NCT04653506), https://register.

Clinicaltrials: gov/prs/beta/studies/S000AFOR00000066/recordSummary .

Objective: To evaluate the feasibility and accuracy of a novel ultrasonographic screening method for an aberrant right subclavian artery (ARSA) using the novel "full rectangle" method.

Methods: This prospective study was conducted at a tertiary care center, September 2022 to February 2023. The study included unselected pregnant women at 14-38 weeks of gestation referred for routine or targeted anomaly scans. All participants underwent scanning by two experienced sonographers to ascertain the presence or absence of aberrant right subclavian artery (ARSA) using both conventional and novel "full rectangle sign" methods for validation purposes. This is a novel screening method for ARSA that demonstrates the retro-tracheal course at the level of the supra-aortic vessels, forming what we term the "full rectangle sign".

Results: A cohort of 138 patients was enrolled. The "full rectangle" sign was discerned in 6 fetuses with ARSA (4.3%), while the typical three-sided figure of the right subclavian artery was demonstrated in the remaining 132 fetuses (95.7%). The novel method demonstrated 100% feasibility and complete concordance with the conventional method.

Conclusion: The study results indicate that the full rectangle sign serves as an effective and dependable screening tool for identifying ARSA. It offers the advantage of a clear, unobstructed view at a level unaffected by sternum shadowing and eliminates confusion with the azygous vein.

Introduction: Considering the inconclusive evidence regarding the clinical benefits of specific birthing positions, emphasis has been placed on adhering to women's preferences during the second stage of labour. Therefore, the present study aimed to assess the association between birthing position, the freedom to choose a birth position during the second stage of labour, and women's subjective satisfaction with childbirth.

Methods: We performed a cross-sectional survey of women 8 or 12 months after a vaginal birth in a hospital. The women were recruited via two cooperating health insurance companies. Multivariate analyses were conducted to assess the strength of the association between birthing position and maternal satisfaction with childbirth, with a particular focus on interactions with self-determination.

Results: In total, the data from 761 women were analysed. The supine position was the most frequently reported birthing position in the second stage of labour at 77.5%. Notably, 39.0% and 30.5% of the women who gave birth in the dorsal and lateral supine positions, respectively, stated that the birth position was not chosen voluntarily. The regression models show a significant negative association between supine birthing position and satisfaction with childbirth, which is significantly related to self-determination. The most common reason for the adoption of a specific birthing position was instructions from medical staff.

Discussion: The data provide insight into the perceived satisfaction with childbirth depending on the birthing position, whereby the relevance of self-determination is particularly evident. At the same time, self-determination is often not given, which is associated with reduced birth satisfaction.

Objective: The aim of this study was to examine the obstetrical and neonatal outcomes in patients with gestational diabetes mellitus (GDM) who had postprandial glucose monitoring 1 vs. 2 h following meals.

Study design: In this prospective cohort study, we included patients with GDM who were referred to our medical center between July 2019 and June 2021. Patients chose the timing of postprandial glucose monitoring based on their own preferences. Obstetrical and neonatal outcomes, as well as patient satisfaction, were compared between patients who performed postprandial glucose monitoring 1 and 2 h after meals (PPG1 vs. PPG2). The primary outcome was birth weight. The study was powered to detect a 250 g increase in birth weight.

Results: Overall, 99 patients were included: 50 in the PPG1 group and 49 in the PPG2 group. Baseline characteristics were comparable between the groups. Neonates in the PPG1 and PPG2 groups had similar birth weights (3319 ± 355 vs. 3319 ± 520 g, respectively, p = 0.99). Glycemic control, mode of delivery, gestational age at delivery, and satisfaction rates were also similar between the study groups.

Conclusion: In patients with GDM, performing1 vs. 2 h following meals resulted in similar obstetrical and neonatal outcomes and similar satisfaction rates. We therefore recommend counseling patients to choose either strategy based on their personal preference.