Pub Date : 2024-09-26DOI: 10.1007/s00404-024-07748-z
Azharuddin Sajid Syed Khaja, Mohd Saleem, Mubashir Zafar, Soha Moursi, Ghorashy Eltayeb Yousif Mohammed, Syed Monowar Alam Shahid, Sahar Hammam, Safia Moussa, Mohammed Salem Alharbi, Ahmed Nawi Alshammari
Background and aim
The present meta-analysis aims to investigate a potential link between pelvic inflammatory disease (PID) and an increased risk of genitourinary cancers (ovarian, cervical, uterus, and vagina cancers). While previous research has hinted at a possible link, this meta-analysis seeks to delve deeper into the available evidence. Understanding this association is crucial for preventive strategies and improving clinical management practices.
Methodology
A comprehensive literature search was conducted across various databases, covering studies published between 2016 and 2024. We included 13 observational studies meeting stringent criteria, followed by meticulous data extraction and quality assessment. Meta-analytical techniques were then employed to calculate pooled odds ratios (ORs), adjusted hazard ratios (HRs), and 95% confidence intervals (CIs), with heterogeneity assessed using the I2 statistic.
Results
Our analysis revealed significant findings, underscoring the association between PID and increased risks of genitourinary cancers. Specifically, individuals with a history of PID demonstrated notably higher odds of developing ovarian cancer (OR = 1.477, 95% CI 1.033–2.207), uterine cancer (OR = 1.263, 95% CI 0.827–2.143), cervical cancer (OR = 1.000, 95% CI 0.900–1.100), and vaginal cancer (OR = 2.500, 95% CI 1.400–4.000) compared to those without such a history. The overall heterogeneity across studies was high (I2 = 82.92%), suggesting varying trends across different populations and study designs.
Conclusion
This meta-analysis provides updated evidence supporting a significant association between PID and an increased risk of cervical, ovarian, and uterine cancers. Early detection and management of PID are crucial in potentially mitigating the risk of these cancers.
背景和目的:本荟萃分析旨在研究盆腔炎(PID)与泌尿生殖系统癌症(卵巢癌、宫颈癌、子宫癌和阴道癌)风险增加之间的潜在联系。虽然以往的研究已经暗示了两者之间可能存在的联系,但这项荟萃分析试图深入研究现有的证据。了解这种关联对于制定预防策略和改进临床管理实践至关重要:我们在各种数据库中进行了全面的文献检索,涵盖了 2016 年至 2024 年间发表的研究。我们纳入了 13 项符合严格标准的观察性研究,随后进行了细致的数据提取和质量评估。然后采用元分析技术计算汇总的几率比(ORs)、调整后的危险比(HRs)和95%置信区间(CIs),并使用I2统计量评估异质性:我们的分析结果表明,PID与泌尿生殖系统癌症风险增加之间存在重要关联。具体而言,与无PID病史者相比,有PID病史者患卵巢癌(OR = 1.477,95% CI 1.033-2.207)、子宫癌(OR = 1.263,95% CI 0.827-2.143)、宫颈癌(OR = 1.000,95% CI 0.900-1.100)和阴道癌(OR = 2.500,95% CI 1.400-4.000)的几率明显更高。各研究之间的总体异质性很高(I2 = 82.92%),表明不同人群和研究设计的趋势各不相同:这项荟萃分析提供了最新证据,证明PID与宫颈癌、卵巢癌和子宫癌风险增加之间存在显著关联。及早发现和治疗 PID 对降低罹患这些癌症的风险至关重要。
{"title":"Association between pelvic inflammatory disease and risk of ovarian, uterine, cervical, and vaginal cancers—a meta-analysis","authors":"Azharuddin Sajid Syed Khaja, Mohd Saleem, Mubashir Zafar, Soha Moursi, Ghorashy Eltayeb Yousif Mohammed, Syed Monowar Alam Shahid, Sahar Hammam, Safia Moussa, Mohammed Salem Alharbi, Ahmed Nawi Alshammari","doi":"10.1007/s00404-024-07748-z","DOIUrl":"10.1007/s00404-024-07748-z","url":null,"abstract":"<div><h3>Background and aim</h3><p>The present meta-analysis aims to investigate a potential link between pelvic inflammatory disease (PID) and an increased risk of genitourinary cancers (ovarian, cervical, uterus, and vagina cancers). While previous research has hinted at a possible link, this meta-analysis seeks to delve deeper into the available evidence. Understanding this association is crucial for preventive strategies and improving clinical management practices.</p><h3>Methodology</h3><p>A comprehensive literature search was conducted across various databases, covering studies published between 2016 and 2024. We included 13 observational studies meeting stringent criteria, followed by meticulous data extraction and quality assessment. Meta-analytical techniques were then employed to calculate pooled odds ratios (ORs), adjusted hazard ratios (HRs), and 95% confidence intervals (CIs), with heterogeneity assessed using the I<sup>2</sup> statistic.</p><h3>Results</h3><p>Our analysis revealed significant findings, underscoring the association between PID and increased risks of genitourinary cancers. Specifically, individuals with a history of PID demonstrated notably higher odds of developing ovarian cancer (OR = 1.477, 95% CI 1.033–2.207), uterine cancer (OR = 1.263, 95% CI 0.827–2.143), cervical cancer (OR = 1.000, 95% CI 0.900–1.100), and vaginal cancer (OR = 2.500, 95% CI 1.400–4.000) compared to those without such a history. The overall heterogeneity across studies was high (<i>I</i><sup>2</sup> = 82.92%), suggesting varying trends across different populations and study designs.</p><h3>Conclusion</h3><p>This meta-analysis provides updated evidence supporting a significant association between PID and an increased risk of cervical, ovarian, and uterine cancers. Early detection and management of PID are crucial in potentially mitigating the risk of these cancers.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 5","pages":"2577 - 2585"},"PeriodicalIF":2.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1007/s00404-024-07728-3
Abdelrahman Yousif, Zuber D. Mulla, Julia Pudar, Muneer Elshaikh, Remonda Khalil-Moawad, Mohamed A. Elshaikh
Background
We aimed to study the impact of first-degree family history on patients with endometrial cancer.
Methods
We conducted a retrospective chart review from January 1990 to June 2016, comparing stage I endometrial cancer patients with and without a sporadic family history of cancers. We collected the patients’ demographic information, tumor characteristics, and treatment plans. During the follow-up period, patient information on tumor recurrence and survival was collected. The chi-square test was used to assess the associations between categorical variables. The Cox proportional hazards regression model was used to estimate multivariate-adjusted hazard ratios (95% confidence interval (CI)).
Results
Among the 1737 patients with stage I endometrial cancer, 709 had a positive first-degree family history of cancers and 1028 had negative family history (FH) of cancers. Patients with positive FH were more likely to be older, have stage IB disease, and receive adjuvant radiotherapy; however, the difference was not statistically significant. At 5 years follow up, patients with a positive family history had longer time to recurrence (TTR) than their negative FH counterparts. Maternal family history of cancer was the most common, followed by a sister’s history of cancer, paternal history, brother’s history, and offspring history of cancer. Breast, endometrial, and colon cancers are the most common cancers among first-degree relatives.
Conclusion
Endometrial cancer patients with sporadic first-degree FH of cancers share similar demographics and tumor characteristics compared to their counterpart with slightly increased likelihood to be older, with stage IB disease and have a longer TTR compared to their negative counterpart.
{"title":"First-degree family history of cancers in patients with stage I endometrial carcinoma. Prevalence and prognostic impact","authors":"Abdelrahman Yousif, Zuber D. Mulla, Julia Pudar, Muneer Elshaikh, Remonda Khalil-Moawad, Mohamed A. Elshaikh","doi":"10.1007/s00404-024-07728-3","DOIUrl":"10.1007/s00404-024-07728-3","url":null,"abstract":"<div><h3>Background</h3><p>We aimed to study the impact of first-degree family history on patients with endometrial cancer.</p><h3>Methods</h3><p>We conducted a retrospective chart review from January 1990 to June 2016, comparing stage I endometrial cancer patients with and without a sporadic family history of cancers. We collected the patients’ demographic information, tumor characteristics, and treatment plans. During the follow-up period, patient information on tumor recurrence and survival was collected. The chi-square test was used to assess the associations between categorical variables. The Cox proportional hazards regression model was used to estimate multivariate-adjusted hazard ratios (95% confidence interval (CI)).</p><h3>Results</h3><p>Among the 1737 patients with stage I endometrial cancer, 709 had a positive first-degree family history of cancers and 1028 had negative family history (FH) of cancers. Patients with positive FH were more likely to be older, have stage IB disease, and receive adjuvant radiotherapy; however, the difference was not statistically significant. At 5 years follow up, patients with a positive family history had longer time to recurrence (TTR) than their negative FH counterparts. Maternal family history of cancer was the most common, followed by a sister’s history of cancer, paternal history, brother’s history, and offspring history of cancer. Breast, endometrial, and colon cancers are the most common cancers among first-degree relatives.</p><h3>Conclusion</h3><p>Endometrial cancer patients with sporadic first-degree FH of cancers share similar demographics and tumor characteristics compared to their counterpart with slightly increased likelihood to be older, with stage IB disease and have a longer TTR compared to their negative counterpart.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 5","pages":"2595 - 2602"},"PeriodicalIF":2.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1007/s00404-024-07750-5
Jingping Wu
Purpose
To assess the value of routine mid-trimester fetal ultrasound scans in detecting FCs, as well as the related ultrasound and clinical follow-up outcomes.
Methods
A retrospective analysis was conducted on 1064 fetuses who underwent standardized ultrasound screening during the mid-trimester. During the examination, high-frequency ultrasound was used to examine the fetal spine. Different frequency ultrasound probes were used to compare and analyze the detection rates of FCs. We conducted follow-up ultrasound observations on all FCs and conducted long-term follow-up observations in terms of the motor function of the children after birth.
Results
Among 1064 fetuses detected by ultrasound, a total of 910 fetuses were completely evaluated using high-frequency and low-frequency ultrasound, and 24 FCs were found. In all 24 cases of FCs, 7 cases were detected using low-frequency ultrasound, while high-frequency ultrasound detected all cases. There was a significant difference in the detection rates between the two groups (χ2 = 26.323, P = 0.000). Of all the 24 FCs, 21 cysts disappeared spontaneously (87.5%); one fetus was induced for abortion due to a concurrent cleft lip; after multiple ultrasound examinations, it was found that the cyst persisted in one fetus; one case was not followed up by ultrasound. There was no statistically significant difference in the start of sitting and crawling time between the control group and the FCs group.
Conclusion
Routine mid-trimester fetal ultrasound scan detect FCs, particularly when high-frequency ultrasound probes were routinely applied. Most FCs detected by prenatal ultrasound spontaneously disappear and have no impact on the motor function of the fetus after birth (with the conus medullaris located at or above the L3 level). The shortest time interval from the detection to the disappearance of the cyst was 11 days.
目的:评估常规孕中期胎儿超声扫描在检测 FCs 方面的价值,以及相关的超声和临床随访结果:方法:对1064名在妊娠中期接受标准化超声筛查的胎儿进行了回顾性分析。在检查过程中,使用高频超声检查胎儿脊柱。我们使用不同频率的超声探头来比较和分析 FC 的检出率。我们对所有 FC 胎儿进行了超声随访观察,并对婴儿出生后的运动功能进行了长期随访观察:结果:在超声检测出的 1064 个胎儿中,共有 910 个胎儿接受了高频和低频超声的完整评估,发现了 24 个 FC 胎儿。在所有 24 例 FC 中,低频超声检测出 7 例,而高频超声则检测出所有病例。两组的检出率有明显差异(χ2 = 26.323,P = 0.000)。在所有 24 个 FC 中,21 个囊肿自然消失(87.5%);1 个胎儿因并发唇裂而引产;多次超声检查后发现 1 个胎儿的囊肿仍然存在;1 个病例未进行超声随访。对照组与 FCs 组在开始坐立和爬行的时间上没有统计学差异:结论:常规孕中期胎儿超声扫描可检测出FCs,尤其是在常规应用高频超声探头的情况下。大多数产前超声检测到的 FCs 会自动消失,对胎儿出生后的运动功能没有影响(髓袢位于 L3 水平或以上)。从检测到囊肿消失的最短时间间隔为 11 天。
{"title":"Utility of routine mid-trimester fetal ultrasound scan in detecting filar cysts and follow-up outcomes","authors":"Jingping Wu","doi":"10.1007/s00404-024-07750-5","DOIUrl":"10.1007/s00404-024-07750-5","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the value of routine mid-trimester fetal ultrasound scans in detecting FCs, as well as the related ultrasound and clinical follow-up outcomes.</p><h3>Methods</h3><p>A retrospective analysis was conducted on 1064 fetuses who underwent standardized ultrasound screening during the mid-trimester. During the examination, high-frequency ultrasound was used to examine the fetal spine. Different frequency ultrasound probes were used to compare and analyze the detection rates of FCs. We conducted follow-up ultrasound observations on all FCs and conducted long-term follow-up observations in terms of the motor function of the children after birth.</p><h3>Results</h3><p>Among 1064 fetuses detected by ultrasound, a total of 910 fetuses were completely evaluated using high-frequency and low-frequency ultrasound, and 24 FCs were found. In all 24 cases of FCs, 7 cases were detected using low-frequency ultrasound, while high-frequency ultrasound detected all cases. There was a significant difference in the detection rates between the two groups (χ<sup>2</sup> = 26.323, <i>P</i> = 0.000). Of all the 24 FCs, 21 cysts disappeared spontaneously (87.5%); one fetus was induced for abortion due to a concurrent cleft lip; after multiple ultrasound examinations, it was found that the cyst persisted in one fetus; one case was not followed up by ultrasound. There was no statistically significant difference in the start of sitting and crawling time between the control group and the FCs group.</p><h3>Conclusion</h3><p>Routine mid-trimester fetal ultrasound scan detect FCs, particularly when high-frequency ultrasound probes were routinely applied. Most FCs detected by prenatal ultrasound spontaneously disappear and have no impact on the motor function of the fetus after birth (with the conus medullaris located at or above the L3 level). The shortest time interval from the detection to the disappearance of the cyst was 11 days.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 5","pages":"2553 - 2559"},"PeriodicalIF":2.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-25DOI: 10.1007/s00404-024-07719-4
Nassir Habib, Matteo Giorgi, Tania Tahtouh, Amel Hamdi, Gabriele Centini, Alberto Cannoni, Georges Bader
Objective
To investigate the relationship between the anatomical position of the anterior arm of the mesh, measured by ultrasound through the bladder neck–mesh distance technique and the surgical outcomes after laparoscopic sacrocolpopexy (SCP) for apical prolapse.
Study design
It was a retrospective analysis of prospectively collected data in a tertiary care hospital. Between January 2019 and September 2019, 63 women who underwent laparoscopic SCP due to apical prolapse were included. Bladder neck–mesh distance was measured immediately after surgery. The pelvic floor was evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) System before, 1 month, and 2.7 years (mid-term) after the surgery. Post-operative stress urinary incontinence (SUI) and Patient Global Impression of Improvement (PGI-I) scores were also assessed. The correlation between bladder neck–mesh distance and the post-operative outcomes was investigated using the Spearman rank correlation coefficient.
Results
At mid-term follow-up visit, bladder neck–mesh distance was inversely correlated with the correction of apical prolapse and post-operative SUI. No correlation was detected with the anterior compartment prolapse correction. PGI-I scores were high in all patients at mid-term follow-up, irrespective of bladder neck–mesh distance values.
Conclusion
The shorter the bladder neck–mesh distance, the better the outcome for apical compartment repair. Bladder neck–mesh distance had no correlation with the anterior anatomical correction. Shorter bladder neck–mesh distance values were positively correlated to better PGI-I scores and a higher risk of SUI.
目的通过膀胱颈-网片距离技术,用超声波测量网片前臂的解剖位置,研究网片前臂的解剖位置与腹腔镜骶尾部脱垂(SCP)术后手术效果之间的关系:研究设计:这是对一家三级医院前瞻性收集数据的回顾性分析。纳入了2019年1月至2019年9月期间,63名因子宫尖脱垂而接受腹腔镜骶骨外翻术(SCP)的女性。术后立即测量膀胱颈-网眼距离。在术前、术后1个月和术后2.7年(中期),使用盆腔器官脱垂定量(POP-Q)系统对盆底进行评估。此外,还对术后压力性尿失禁(SUI)和患者总体改善印象(PGI-I)评分进行了评估。使用斯皮尔曼等级相关系数研究了膀胱颈-网眼距离与术后结果之间的相关性:结果:在中期随访中,膀胱颈网距离与顶端脱垂矫正和术后 SUI 成反比。与前室脱垂矫治无相关性。无论膀胱颈网距离值如何,中期随访时所有患者的PGI-I评分都很高:结论:膀胱颈-网眼距离越短,顶腔修复的效果越好。结论:膀胱颈网眼距离越短,顶腔修复的效果越好。膀胱颈网眼距离与前部解剖矫正没有相关性。较短的膀胱颈网距离值与较好的 PGI-I 评分和较高的 SUI 风险呈正相关。
{"title":"Post-operative outcomes associated with anterior mesh location after laparoscopic sacrocolpopexy","authors":"Nassir Habib, Matteo Giorgi, Tania Tahtouh, Amel Hamdi, Gabriele Centini, Alberto Cannoni, Georges Bader","doi":"10.1007/s00404-024-07719-4","DOIUrl":"10.1007/s00404-024-07719-4","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the relationship between the anatomical position of the anterior arm of the mesh, measured by ultrasound through the bladder neck–mesh distance technique and the surgical outcomes after laparoscopic sacrocolpopexy (SCP) for apical prolapse.</p><h3>Study design</h3><p>It was a retrospective analysis of prospectively collected data in a tertiary care hospital. Between January 2019 and September 2019, 63 women who underwent laparoscopic SCP due to apical prolapse were included. Bladder neck–mesh distance was measured immediately after surgery. The pelvic floor was evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) System before, 1 month, and 2.7 years (mid-term) after the surgery. Post-operative stress urinary incontinence (SUI) and Patient Global Impression of Improvement (PGI-I) scores were also assessed. The correlation between bladder neck–mesh distance and the post-operative outcomes was investigated using the Spearman rank correlation coefficient.</p><h3>Results</h3><p>At mid-term follow-up visit, bladder neck–mesh distance was inversely correlated with the correction of apical prolapse and post-operative SUI. No correlation was detected with the anterior compartment prolapse correction. PGI-I scores were high in all patients at mid-term follow-up, irrespective of bladder neck–mesh distance values.</p><h3>Conclusion</h3><p>The shorter the bladder neck–mesh distance, the better the outcome for apical compartment repair. Bladder neck–mesh distance had no correlation with the anterior anatomical correction. Shorter bladder neck–mesh distance values were positively correlated to better PGI-I scores and a higher risk of SUI.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 5","pages":"2717 - 2724"},"PeriodicalIF":2.1,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1007/s00404-024-07745-2
A. P. Souka, V. Maritsa, P. Antsaklis, A. Pilalis, G. Daskalakis
Purpose
To construct reference charts for cervical length (CL) in pregnancy based on longitudinal measurements and to assess the value of measuring cervical length after 24 weeks of gestation.
Methods
CL was measured transvaginally in singleton pregnancies at 5 to 41 weeks. Pregnancies with more than one measurement were used for creating the CL chart, whereas any measurement after 24 weeks was considered for assessing the correlation of CL with preterm delivery.
Results
The dataset consisted of 12,601 pregnancies and 33,899 observations. Gestational age was the main predictor of CL (R2 = 67.3%). Further adjustments in the fixed effects part for maternal characteristics (age, BMI, smoking status, parity, history of miscarriage, and cervical surgery) improved the prediction ability (R2 = 78.4%). CL was predictive of spontaneous preterm delivery before 37 weeks when measured at any gestation between 24 and 35 weeks and it was predictive of spontaneous preterm delivery before 32 weeks when measured between 28 and 31 weeks (AUC = 0.68).
Conclusion
Gestational age is the main predictor of CL followed by maternal characteristics and history. CL assessment between 24 and 35 + 6 weeks can enhance our ability to predict spontaneous preterm delivery.
{"title":"Cervical length evolution in pregnancy and prediction of preterm delivery","authors":"A. P. Souka, V. Maritsa, P. Antsaklis, A. Pilalis, G. Daskalakis","doi":"10.1007/s00404-024-07745-2","DOIUrl":"10.1007/s00404-024-07745-2","url":null,"abstract":"<div><h3>Purpose</h3><p>To construct reference charts for cervical length (CL) in pregnancy based on longitudinal measurements and to assess the value of measuring cervical length after 24 weeks of gestation.</p><h3>Methods</h3><p>CL was measured transvaginally in singleton pregnancies at 5 to 41 weeks. Pregnancies with more than one measurement were used for creating the CL chart, whereas any measurement after 24 weeks was considered for assessing the correlation of CL with preterm delivery.</p><h3>Results</h3><p>The dataset consisted of 12,601 pregnancies and 33,899 observations. Gestational age was the main predictor of CL (R<sup>2</sup> = 67.3%). Further adjustments in the fixed effects part for maternal characteristics (age, BMI, smoking status, parity, history of miscarriage, and cervical surgery) improved the prediction ability (R<sup>2</sup> = 78.4%). CL was predictive of spontaneous preterm delivery before 37 weeks when measured at any gestation between 24 and 35 weeks and it was predictive of spontaneous preterm delivery before 32 weeks when measured between 28 and 31 weeks (AUC = 0.68).</p><h3>Conclusion</h3><p>Gestational age is the main predictor of CL followed by maternal characteristics and history. CL assessment between 24 and 35 + 6 weeks can enhance our ability to predict spontaneous preterm delivery.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 5","pages":"2477 - 2485"},"PeriodicalIF":2.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1007/s00404-024-07742-5
Ari Weiss, Tzuria Peled, Reut Rotem, Hen Y. Sela, Sorina Grisaru-Granovsky, Misgav Rottenstreich
Purpose
This study aimed to assess maternal and neonatal outcomes in patients with polyhydramnios attempting trial of labor after cesarean (TOLAC) compared to those undergoing planned repeat cesarean delivery (PRCD).
Methods
A multi-center retrospective cohort study was conducted and included women with term singleton viable pregnancies following a single low-segment transverse cesarean delivery (CD) with a polyhydramnios diagnosis (maximal vertical pocket > 8 cm and/or Amniotic Fluid Index > 24 cm) within 14 days before birth who delivered between the years 2017 and 2021. Maternal and neonatal outcomes were compared between those attempting TOLAC and those opting for PRCD. The primary outcome was composite adverse maternal. Univariate analysis was followed by multivariate analysis to control for potential confounders.
Results
Out of 358 included births with a previous CD, 208 (58.1%) attempted TOLAC, while 150 had PRCD (41.9%). The successful vaginal birth after cesarean (VBAC) rate was 82.2%, and no cases of uterine rupture, hysterectomy, or maternal intensive care unit admission occurred in either group. After controlling for potential confounders, no independent association between TOLAC and composite adverse maternal (adjusted odds ratio [aOR] 0.62, 95% confidence interval [CI] 0.32–1.20, p = 0.16) and neonatal (aOR 0.89, 95% CI 0.51–1.53, p = 0.67) adverse outcomes was demonstrated.
Conclusion
In patients with a term diagnosed polyhydramnios, TOLAC appears to be a reasonable alternative associated with favorable outcomes. Larger prospective studies are needed to refine management strategies and enhance maternal and neonatal outcomes in this context.
{"title":"Trial of labor following cesarean among patients with polyhydramnios: a multicenter retrospective study","authors":"Ari Weiss, Tzuria Peled, Reut Rotem, Hen Y. Sela, Sorina Grisaru-Granovsky, Misgav Rottenstreich","doi":"10.1007/s00404-024-07742-5","DOIUrl":"10.1007/s00404-024-07742-5","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aimed to assess maternal and neonatal outcomes in patients with polyhydramnios attempting trial of labor after cesarean (TOLAC) compared to those undergoing planned repeat cesarean delivery (PRCD).</p><h3>Methods</h3><p>A multi-center retrospective cohort study was conducted and included women with term singleton viable pregnancies following a single low-segment transverse cesarean delivery (CD) with a polyhydramnios diagnosis (maximal vertical pocket > 8 cm and/or Amniotic Fluid Index > 24 cm) within 14 days before birth who delivered between the years 2017 and 2021. Maternal and neonatal outcomes were compared between those attempting TOLAC and those opting for PRCD. The primary outcome was composite adverse maternal. Univariate analysis was followed by multivariate analysis to control for potential confounders.</p><h3>Results</h3><p>Out of 358 included births with a previous CD, 208 (58.1%) attempted TOLAC, while 150 had PRCD (41.9%). The successful vaginal birth after cesarean (VBAC) rate was 82.2%, and no cases of uterine rupture, hysterectomy, or maternal intensive care unit admission occurred in either group. After controlling for potential confounders, no independent association between TOLAC and composite adverse maternal (adjusted odds ratio [aOR] 0.62, 95% confidence interval [CI] 0.32–1.20, <i>p</i> = 0.16) and neonatal (aOR 0.89, 95% CI 0.51–1.53, <i>p</i> = 0.67) adverse outcomes was demonstrated.</p><h3>Conclusion</h3><p>In patients with a term diagnosed polyhydramnios, TOLAC appears to be a reasonable alternative associated with favorable outcomes. Larger prospective studies are needed to refine management strategies and enhance maternal and neonatal outcomes in this context.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 5","pages":"2469 - 2476"},"PeriodicalIF":2.1,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1007/s00404-024-07743-4
Wei Luo, Bin He, Daiwen Han, Lixing Yuan, Jun Tang, Ling Pang, Kai Zhao, Fene Zou, Ting Hu, Shanling Liu
Purpose: This study aimed to establish suitable threshold values for biochemical indicators in low-risk pregnant women who underwent second trimester screening and design strategies for consecutive prenatal testing to increase trisomy 21 detection.
Methods: This study examined singleton pregnant women who underwent double, triple, or quadruple screening in the second trimester over six years. To obtain adequate detection efficiency for low-risk pregnancies, threshold values for serum biochemical indicators were established, and a cost-effectiveness assessment of the improved contingent screening strategy was conducted.
Results: Participants were included in serum double- (n = 88,550), triple- (n = 29,991), and quadruple-screening (n = 15,004) groups. Threshold values were defined as having a free beta subunit of human chorionic gonadotropin (free β-hCG) multiple of the median (MoM) ≥ 2.50, alpha-fetoprotein (AFP) MoM ≤ 0.50, or unconjugated estriol (uE3) MoM ≤ 0.70 for low risk. Low-risk pregnancies, comprising 1.35% (988/73,183), 4.45% (1,171/26,286), and 11.91% (1,559/13,085) of the double-, triple-, and quadruple-screening groups, respectively, underwent further non-invasive prenatal screening. In the double-, triple-, and quadruple-screening groups, we detected 11.76% (2/17), 40.00% (2/5), and 66.67% (2/3) of trisomy 21 cases with false negative results, respectively, with the overall detection rates of 85.00% (85/100), 90.63% (29/32), and 95.24% (20/21), respectively, and decreased ratio of overall costs of 5.26%, 16.63%, and 24.36%, respectively.
Conclusion: Utilizing threshold values of AFP, free β-hCG, and uE3 to trigger further non-invasive prenatal screening may increase trisomy 21 detection in pregnancies deemed low risk in the second trimester while reducing the overall costs of screening strategies.
{"title":"Improved contingent screening strategy increased trisomy 21 detection rate in the second trimester.","authors":"Wei Luo, Bin He, Daiwen Han, Lixing Yuan, Jun Tang, Ling Pang, Kai Zhao, Fene Zou, Ting Hu, Shanling Liu","doi":"10.1007/s00404-024-07743-4","DOIUrl":"https://doi.org/10.1007/s00404-024-07743-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to establish suitable threshold values for biochemical indicators in low-risk pregnant women who underwent second trimester screening and design strategies for consecutive prenatal testing to increase trisomy 21 detection.</p><p><strong>Methods: </strong>This study examined singleton pregnant women who underwent double, triple, or quadruple screening in the second trimester over six years. To obtain adequate detection efficiency for low-risk pregnancies, threshold values for serum biochemical indicators were established, and a cost-effectiveness assessment of the improved contingent screening strategy was conducted.</p><p><strong>Results: </strong>Participants were included in serum double- (n = 88,550), triple- (n = 29,991), and quadruple-screening (n = 15,004) groups. Threshold values were defined as having a free beta subunit of human chorionic gonadotropin (free β-hCG) multiple of the median (MoM) ≥ 2.50, alpha-fetoprotein (AFP) MoM ≤ 0.50, or unconjugated estriol (uE3) MoM ≤ 0.70 for low risk. Low-risk pregnancies, comprising 1.35% (988/73,183), 4.45% (1,171/26,286), and 11.91% (1,559/13,085) of the double-, triple-, and quadruple-screening groups, respectively, underwent further non-invasive prenatal screening. In the double-, triple-, and quadruple-screening groups, we detected 11.76% (2/17), 40.00% (2/5), and 66.67% (2/3) of trisomy 21 cases with false negative results, respectively, with the overall detection rates of 85.00% (85/100), 90.63% (29/32), and 95.24% (20/21), respectively, and decreased ratio of overall costs of 5.26%, 16.63%, and 24.36%, respectively.</p><p><strong>Conclusion: </strong>Utilizing threshold values of AFP, free β-hCG, and uE3 to trigger further non-invasive prenatal screening may increase trisomy 21 detection in pregnancies deemed low risk in the second trimester while reducing the overall costs of screening strategies.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this study was to report three cases of early severe ovarian hyperstimulation syndrome (OHSS) in patients undergoing a GnRH antagonist protocol triggered with GnRH agonist (GnRH-a), leading to hospitalization and the need for peritoneal drainage. Additionally, a review of the existing literature on this topic is provided.
Design
This is a retrospective case series and a literature review.
Setting
This study was conducted at obstetrics and gynecology department of tertiary academic referral hospitals, Israel.
Participants
This study included three patients presented with severe OHSS symptoms, including abdominal distension, ascites, and hemoconcentration.
Main outcome measures
The main focus of the treatment was to address the symptoms and prevent any further complications. The outcome was the complete recovery of the patients.
Results
The presented cases detail instances of severe OHSS following oocyte retrieval, utilizing GnRH-a for triggering. Case 1 involved a 33-year-old patient with a history of polycystic ovary syndrome (PCOS), Case 2 featured a 22-year-old patient with familial adenomatous polyposis (FAP), and Case 3 included a 41-year-old patient with a history of depressive disorder. All patients receiving supportive care, including infusions and medications, exhibited gradual improvement during hospitalization, with complete resolution observed during the 20-day post-hospitalization check-up.
Conclusions
These three cases highlight the occurrence of severe early OHSS following a GnRH antagonist protocol triggered with GnRH-a in the absence of human chorionic gonadotropin (hCG) administration for trigger or luteal-phase support. Clinicians must be aware that a GnRH-a trigger followed by a freeze-all approach does not guarantee the complete elimination of OHSS in all patients.
{"title":"Severe ovarian hyperstimulation syndrome following sole gonadotropin-releasing hormone (GnRH) agonist trigger: a case series and literature review","authors":"Roza Berkovitz-Shperling, Nivin Samara, Reut Meir, Omri Dominsky, Foad Azam, Ido Feferkorn","doi":"10.1007/s00404-024-07740-7","DOIUrl":"10.1007/s00404-024-07740-7","url":null,"abstract":"<div><h3>Objective</h3><p>The aim of this study was to report three cases of early severe ovarian hyperstimulation syndrome (OHSS) in patients undergoing a GnRH antagonist protocol triggered with GnRH agonist (GnRH-a), leading to hospitalization and the need for peritoneal drainage. Additionally, a review of the existing literature on this topic is provided.</p><h3>Design</h3><p>This is a retrospective case series and a literature review.</p><h3>Setting</h3><p>This study was conducted at obstetrics and gynecology department of tertiary academic referral hospitals, Israel.</p><h3>Participants</h3><p>This study included three patients presented with severe OHSS symptoms, including abdominal distension, ascites, and hemoconcentration.</p><h3>Main outcome measures</h3><p>The main focus of the treatment was to address the symptoms and prevent any further complications. The outcome was the complete recovery of the patients.</p><h3>Results</h3><p>The presented cases detail instances of severe OHSS following oocyte retrieval, utilizing GnRH-a for triggering. Case 1 involved a 33-year-old patient with a history of polycystic ovary syndrome (PCOS), Case 2 featured a 22-year-old patient with familial adenomatous polyposis (FAP), and Case 3 included a 41-year-old patient with a history of depressive disorder. All patients receiving supportive care, including infusions and medications, exhibited gradual improvement during hospitalization, with complete resolution observed during the 20-day post-hospitalization check-up.</p><h3>Conclusions</h3><p>These three cases highlight the occurrence of severe early OHSS following a GnRH antagonist protocol triggered with GnRH-a in the absence of human chorionic gonadotropin (hCG) administration for trigger or luteal-phase support. Clinicians must be aware that a GnRH-a trigger followed by a freeze-all approach does not guarantee the complete elimination of OHSS in all patients.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 5","pages":"2297 - 2304"},"PeriodicalIF":2.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-024-07740-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1007/s00404-024-07727-4
Linda Aukia, E. Juulia Paavonen, Linnea Karlsson, Juho Pelto, Laura Perasto, Hasse Karlsson, Päivi Polo-Kantola
Purpose
To investigate sleep duration and sleep loss during antenatal period and assess associative factors, including maternal characteristic and mood symptoms.
Methods
A cohort of 3038 women was enrolled. Self-reported sleep duration and sleep loss, the latter being calculated from preferred sleep need and actual sleep duration, were measured in early, mid- and late pregnancy, and at delivery. The associations with age, BMI, parity, education, smoking, napping, and depressive and anxiety symptoms were evaluated.
Results
Sleep duration was longest in early pregnancy and shortest at delivery (7.93 h–7.76 h, p < 0.001). The proportion of short sleepers (< 6 h) increased from 1.4% to 5.9% throughout the studied period (p < 0.001). Mean sleep loss remained stable in early- and mid-pregnancy, lowering in late pregnancy (p < 0.001) and increasing again until delivery (p = 0.003). The number of women with notable sleep loss (> 2 h) was similar during the first three measurement points (9.4%, 8.9% and 9.5%), but increased until delivery (14.1%, p < 0.001). Older, multiparous, and more-depressive women slept less (p < 0.001, p < 0.001, p = 0.017). Women with higher BMI were more likely to sleep < 6 h in late pregnancy (p = 0.012). Multiparous, more-depressive, and higher-BMI women reported more sleep loss (p < 0.001, p < 0.001, p = 0.049).
Conclusion
We confirmed earlier reported decrease in sleep duration at the end of pregnancy. As a novel finding, we showed a notable increase in sleep loss during the last month of pregnancy. Various factors were associated with both short sleep and sleep loss, especially multiparity, napping and depressive symptoms.
{"title":"Sleep duration and sleep loss during pregnancy: a longitudinal FinnBrain birth cohort study","authors":"Linda Aukia, E. Juulia Paavonen, Linnea Karlsson, Juho Pelto, Laura Perasto, Hasse Karlsson, Päivi Polo-Kantola","doi":"10.1007/s00404-024-07727-4","DOIUrl":"10.1007/s00404-024-07727-4","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate sleep duration and sleep loss during antenatal period and assess associative factors, including maternal characteristic and mood symptoms.</p><h3>Methods</h3><p>A cohort of 3038 women was enrolled. Self-reported sleep duration and sleep loss, the latter being calculated from preferred sleep need and actual sleep duration, were measured in early, mid- and late pregnancy, and at delivery. The associations with age, BMI, parity, education, smoking, napping, and depressive and anxiety symptoms were evaluated.</p><h3>Results</h3><p>Sleep duration was longest in early pregnancy and shortest at delivery (7.93 h–7.76 h, <i>p</i> < 0.001). The proportion of short sleepers (< 6 h) increased from 1.4% to 5.9% throughout the studied period (<i>p</i> < 0.001). Mean sleep loss remained stable in early- and mid-pregnancy, lowering in late pregnancy (<i>p</i> < 0.001) and increasing again until delivery (<i>p</i> = 0.003). The number of women with notable sleep loss (> 2 h) was similar during the first three measurement points (9.4%, 8.9% and 9.5%), but increased until delivery (14.1%, <i>p</i> < 0.001). Older, multiparous, and more-depressive women slept less (<i>p</i> < 0.001, <i>p</i> < 0.001, <i>p</i> = 0.017). Women with higher BMI were more likely to sleep < 6 h in late pregnancy (<i>p</i> = 0.012). Multiparous, more-depressive, and higher-BMI women reported more sleep loss (<i>p</i> < 0.001, <i>p</i> < 0.001, <i>p</i> = 0.049).</p><h3>Conclusion</h3><p>We confirmed earlier reported decrease in sleep duration at the end of pregnancy. As a novel finding, we showed a notable increase in sleep loss during the last month of pregnancy. Various factors were associated with both short sleep and sleep loss, especially multiparity, napping and depressive symptoms.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 5","pages":"2541 - 2552"},"PeriodicalIF":2.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1007/s00404-024-07732-7
Giovanni Pecorella, Radmila Sparic, Andrea Morciano, Ivana Babovic, Gaetano Panese, Andrea Tinelli
Background
Pelvic floor stability is influenced by various biomechanical, anatomical, and physiological factors. Understanding these dynamics is crucial for improving the treatment of pelvic organ prolapse (POP) and related conditions.
Objective
To analyze the key factors affecting pelvic floor integrity and explore both non-surgical and surgical interventions to enhance stability and treatment outcomes.
Methods
This review draws from biomechanical research to assess the role of the uterosacral ligament in pelvic support, while also examining the potential of both traditional and emerging therapeutic approaches, including non-surgical interventions like vitamin C supplementation.
Results
- The uterosacral ligament demonstrates superior strength and stiffness, making it essential for structural support of pelvic organs.
- Non-surgical interventions, such as vitamin C supplementation, show potential in improving ligament integrity and preventing pelvic floor disorders.
- Emerging surgical techniques, including tendon-based procedures and injectable fibrous hydrogel composites, offer promising improvements in outcomes for patients with pelvic organ prolapse.
- Additional factors such as muscle strength and neural deficiencies contribute to the complexity of pelvic floor biomechanics, indicating the need for multifaceted treatment approaches.
Conclusion
This analysis provides a comprehensive framework for understanding and managing pelvic floor stability by integrating biomechanical, physiological, and anatomical insights. The findings highlight the potential for personalized treatment strategies to improve patient outcomes in pelvic floor disorders.
背景:盆底稳定性受各种生物力学、解剖学和生理学因素的影响。了解这些动态因素对于改善盆腔器官脱垂(POP)及相关疾病的治疗至关重要:分析影响盆底完整性的关键因素,并探讨非手术和手术干预措施,以提高稳定性和治疗效果:方法:本综述通过生物力学研究评估子宫骶骨韧带在骨盆支撑中的作用,同时探讨传统和新兴治疗方法的潜力,包括补充维生素 C 等非手术干预措施:- 结果:子宫骶骨韧带具有超强的强度和刚度,对骨盆器官的结构支撑至关重要。- 维生素 C 补充剂等非手术干预措施在改善韧带完整性和预防盆底疾病方面显示出潜力。- 新出现的手术技术,包括基于肌腱的手术和可注射纤维水凝胶复合材料,有望改善盆腔器官脱垂患者的治疗效果。- 肌肉力量和神经缺陷等其他因素增加了盆底生物力学的复杂性,表明需要采取多方面的治疗方法:这项分析通过整合生物力学、生理学和解剖学观点,为理解和管理盆底稳定性提供了一个全面的框架。研究结果凸显了个性化治疗策略的潜力,可改善盆底疾病患者的治疗效果。
{"title":"Fortifying the foundation: assessing the role of uterine ligament integrity in uterine prolapse and beyond","authors":"Giovanni Pecorella, Radmila Sparic, Andrea Morciano, Ivana Babovic, Gaetano Panese, Andrea Tinelli","doi":"10.1007/s00404-024-07732-7","DOIUrl":"10.1007/s00404-024-07732-7","url":null,"abstract":"<div><h3>Background</h3><p>Pelvic floor stability is influenced by various biomechanical, anatomical, and physiological factors. Understanding these dynamics is crucial for improving the treatment of pelvic organ prolapse (POP) and related conditions.</p><h3>Objective</h3><p>To analyze the key factors affecting pelvic floor integrity and explore both non-surgical and surgical interventions to enhance stability and treatment outcomes.</p><h3>Methods</h3><p>This review draws from biomechanical research to assess the role of the uterosacral ligament in pelvic support, while also examining the potential of both traditional and emerging therapeutic approaches, including non-surgical interventions like vitamin C supplementation.</p><h3>Results</h3><p>- The uterosacral ligament demonstrates superior strength and stiffness, making it essential for structural support of pelvic organs.</p><p>- Non-surgical interventions, such as vitamin C supplementation, show potential in improving ligament integrity and preventing pelvic floor disorders.</p><p>- Emerging surgical techniques, including tendon-based procedures and injectable fibrous hydrogel composites, offer promising improvements in outcomes for patients with pelvic organ prolapse.</p><p>- Additional factors such as muscle strength and neural deficiencies contribute to the complexity of pelvic floor biomechanics, indicating the need for multifaceted treatment approaches.</p><h3>Conclusion </h3><p>This analysis provides a comprehensive framework for understanding and managing pelvic floor stability by integrating biomechanical, physiological, and anatomical insights. The findings highlight the potential for personalized treatment strategies to improve patient outcomes in pelvic floor disorders.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 5","pages":"2333 - 2343"},"PeriodicalIF":2.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}