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The influence of antenatal betamethasone timing on neonatal outcome in late preterm infants: a single-center cohort study. 产前倍他米松时间对晚期早产儿新生儿预后的影响:一项单中心队列研究。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-09 DOI: 10.1007/s00404-024-07714-9
Thomas Brückner, Anke Redlich

Purpose: Many pregnancies continue after antenatal corticosteroid exposure. Since long-term effects on late preterm neonatal outcome remain controversial, it remains unknown whether pregnant women who are at risk for preterm birth during the late preterm period and had prior antenatal corticosteroid exposure would benefit from an additional course of antenatal corticosteroids. We evaluated the need for future trials on this topic by comparing short term effects from antenatal betamethasone to long-term effects. We also examined the value of a risk-adapted approach.

Methods: We observed neonatal outcomes in late preterm infants (34/0-36/0 weeks of gestation) who were exposed to antenatal betamethasone either up to 10 days prior birth (n = 8) or earlier in pregnancy (n = 89). We examined a real world population from the University Hospital Magdeburg (Germany) between 01 January 2012 and 31 December 2018, and a simulated high-risk population that was derived from the original data.

Results: The indicators for relevant adverse outcomes did not differ in the unselected population. In the simulated high-risk population, recent antenatal corticosteroid administration significantly reduced the incidence of relevant cardiorespiratory morbidities (OR = 0.00, p = 0.008), and reduced the number needed to treat from 3.7 to 1.5.

Conclusion: The superiority of recent antenatal corticosteroid administration in the late preterm period over earlier exposure strongly depended on the prevalence of respiratory disease. Before considering clinical trials on additional antenatal corticosteroid courses in the late preterm period, antenatal assessment tools to predict respiratory morbidity need to be developed.

目的:许多孕妇在产前接触皮质类固醇后继续妊娠。由于对早产晚期新生儿预后的长期影响仍存在争议,因此对于那些在早产晚期有早产风险且之前曾接触过产前皮质类固醇的孕妇来说,是否会从额外的产前皮质类固醇疗程中获益仍是一个未知数。通过比较产前倍他米松的短期效果和长期效果,我们评估了今后就这一主题进行试验的必要性。我们还研究了风险适应方法的价值:我们观察了晚期早产儿(妊娠34/0-36/0周)的新生儿结局,这些早产儿在出生前10天(8例)或妊娠早期(89例)接触过产前倍他米松。我们研究了马格德堡大学医院(德国)2012年1月1日至2018年12月31日期间的真实人群,以及根据原始数据得出的模拟高风险人群:结果:在未选择的人群中,相关不良后果的指标没有差异。在模拟高危人群中,近期产前使用皮质类固醇可显著降低相关心肺疾病的发病率(OR = 0.00,P = 0.008),并将需要治疗的人数从3.7降至1.5:结论:在早产儿晚期近期使用产前皮质类固醇比早期使用更有优势,这在很大程度上取决于呼吸系统疾病的发病率。在考虑对早产晚期进行额外的产前皮质类固醇疗程临床试验之前,需要开发产前评估工具来预测呼吸系统发病率。
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引用次数: 0
Comparative analysis of the efficacy and complications of mid-urethral slings when inserted either in isolation or in conjunction with pelvic organ prolapse surgery 尿道中段吊带单独使用或与盆腔器官脱垂手术同时使用的疗效和并发症比较分析。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-08 DOI: 10.1007/s00404-024-07691-z
Esther Ruiz Pérez, Sonia De Miguel Manso, Elena García García, Julio Alberto Gobernado Tejedor, Álvaro Sanz Díaz-Heredero, Lidia Casamayor Del Nogal, Sandra Canales Martínez, Jimena Bayón Pascual

Introduction

Stress urinary incontinence (SUI) is a highly prevalent condition that affects between 20 and 50% of the female population. Pelvic organ prolapse (POP) can coexist with SUI and both can be addressed through a vaginal approach. However, it is unclear whether simultaneous surgery for these two conditions can influence the outcome of incontinence treatment.

Objective

To evaluate the objective and subjective effectiveness of the transobturator suburethral (TO) band by comparing two groups: group A, of patients undergoing surgery for stress urinary incontinence (SUI) by insertion of TO mesh, and group B, formed for patients requiring simultaneous correction of pelvic organ prolapse (POP) in addition to TO mesh insertion.

Materials and methods

This is an observational, descriptive and retrospective study in which 91 patients participated: 33 (group A) underwent surgery for SUI and 58 (group B) underwent corrective surgery for pelvic organ prolapse (POP) and TO band simultaneously.

Variables included: total urinary continence, objective urinary continence, subjective urinary continence (satisfaction levels and two validated questionnaires (PGI-1 and ICIQ-SF)) and complications.

Results

Regarding total continence, from the seventh to the ninth year, statistically significant differences were observed, with total continence being higher in group A. Objective continence decreased in both groups during the follow-up period.

No significant differences were found between the two groups regarding subjective urinary continence (ICIQ-SF) and the degree of improvement after surgical treatment (PGI-1). The level of satisfaction after surgery was high in both groups. Regarding complications, there were no statistically significant differences.

Conclusions

Isolated surgery for SUI could be considered more effective in achieving total and objective continence. However, the insertion of the TO band in both cases improves subjective urinary continence and quality of life with great safety and without differences regarding complications.

简介压力性尿失禁(SUI)是一种高发疾病,影响着 20% 到 50% 的女性人口。盆腔器官脱垂(POP)可与 SUI 同时存在,两者均可通过阴道手术治疗。然而,目前还不清楚同时对这两种疾病进行手术是否会影响尿失禁的治疗效果:目的:通过比较两组患者,评估经尿道尿道下(TO)带的客观和主观效果:A 组是通过插入 TO 网片接受压力性尿失禁(SUI)手术的患者,B 组是在插入 TO 网片的同时需要矫正盆腔器官脱垂(POP)的患者:这是一项观察性、描述性和回顾性研究,共有 91 名患者参与:33名患者(A组)接受了SUI手术,58名患者(B组)同时接受了盆腔器官脱垂(POP)和TO网带的矫正手术。变量包括:总排尿连续性、客观排尿连续性、主观排尿连续性(满意度和两个有效问卷(PGI-1 和 ICIQ-SF))和并发症:在总尿失禁率方面,从第七年到第九年,两组之间存在显著的统计学差异,A 组的总尿失禁率更高。在主观尿失禁(ICIQ-SF)和手术治疗后的改善程度(PGI-1)方面,两组之间没有发现明显差异。两组患者术后的满意度都很高。在并发症方面,两组的差异无统计学意义:结论:孤立手术治疗 SUI 可以更有效地实现完全和客观的尿失禁。然而,在两种情况下,插入 TO 带都能改善主观尿失禁情况和生活质量,而且非常安全,在并发症方面也没有差异。
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引用次数: 0
The influence of decisional conflict on treatment decision in pelvic organ prolapse—data from the SHADE-POP trial 决策冲突对盆腔器官脱垂治疗决策的影响--来自 SHADE-POP 试验的数据。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-06 DOI: 10.1007/s00404-024-07723-8
Larissa E. Drost, Rachel D. M. de Jong, Marjan Stegeman, Arie Franx, M. Caroline Vos

Purpose

Women with symptomatic pelvic organ prolapse are facing the choice between several treatment options and a potentially difficult decision. The aim of this study was to examine the effect of decisional conflict, patient characteristics and other decision-related factors on treatment decision in women with pelvic organ prolapse.

Methods

Data from the SHADE-POP trial were used. Women with symptomatic pelvic organ prolapse who visited their gynaecologist for (new) treatment options were included. In all participants, demographical characteristics and validated questionnaires concerning decisional conflict (DCS), shared decision making (SDM-Q-9), information provision (SCIP-B), anxiety and depression (HADS) and satisfaction with care (PSQ-18) were collected 2 weeks after the visit. Analyses were performed using univariate and multivariate linear and logistic regression analyses.

Results

Ninety six women with pelvic organ prolapse facing a treatment decision were included. An increase in decisional conflict as experienced by patients was related to the choice of more conservative treatment, such as pelvic floor muscle training or pessary, instead of surgery (p = 0.02). Shared decision making, better information provision and satisfaction with care were related to lower levels of decisional conflict (p = 0.001).

Conclusion

Decisional conflict in women with pelvic organ prolapse favours conservative treatment instead of surgery. Gaining knowledge on the effect of decisional conflict, patient characteristics and other decision-related factors on treatment decision in pelvic organ prolapse will be a step towards a better-guided treatment decision and better patient-reported outcomes for this group of patients. NL 55737.028.15, 30-10-2016.

目的:患有无症状盆腔器官脱垂的妇女面临着多种治疗方案的选择,可能很难做出决定。本研究旨在探讨决策冲突、患者特征及其他决策相关因素对盆腔器官脱垂女性患者治疗决策的影响:方法:采用 SHADE-POP 试验的数据。方法:采用SHADE-POP试验的数据,纳入了到妇科医生处寻求(新)治疗方案的有症状盆腔器官脱垂妇女。在就诊两周后,收集所有参与者的人口统计学特征以及有关决策冲突(DCS)、共同决策(SDM-Q-9)、信息提供(SCIP-B)、焦虑和抑郁(HADS)以及护理满意度(PSQ-18)的有效问卷。分析采用单变量和多变量线性及逻辑回归分析:结果:共纳入了 96 名面临治疗决定的盆腔器官脱垂妇女。患者所经历的决策冲突的增加与选择更保守的治疗方法(如盆底肌肉训练或子宫环)而非手术有关(p = 0.02)。共同决策、更好的信息提供和对护理的满意度与较低程度的决策冲突有关(p = 0.001):结论:患有盆腔器官脱垂的妇女在决策冲突中倾向于保守治疗而非手术治疗。了解决策冲突、患者特征和其他决策相关因素对盆腔脏器脱垂治疗决策的影响,将有助于更好地指导治疗决策,并改善这类患者的治疗效果。NL 55737.028.15,30-10-2016。
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引用次数: 0
Pesticides in food: implications for menopausal women 食品中的杀虫剂:对更年期妇女的影响。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-06 DOI: 10.1007/s00404-024-07718-5
Fulvio A. Scorza, Josef Finsterer, Raphael Wuo-Silva, Feres Chaddad-Neto
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引用次数: 0
Fat grafting in breast surgery: a retrospective single-breast centre 6-year experience 乳房手术中的脂肪移植:单乳房中心 6 年经验回顾。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-05 DOI: 10.1007/s00404-024-07708-7
Sarantos Papadopoulos, Goran Vidovic, Joke Tio, Theodoros Moysiadis, Matteo Lioupis, Apostolos P. Athanasiadis, Abdallah Abdallah

Purpose

In recent years, fat grafting has gained importance as a valuable technique in breast surgery. As a breast center that has embraced this approach, we aimed to investigate the indications and complications of fat grafting.

Methods

In this retrospective study, we examined a total of 263 lipofilling treatments on 121 patients. Five groups were identified: the reconstruction group (72.7%), consisting of 24.8% autologous and 38% implant-based reconstructions after cancer, and correction of the tuberous breasts (10.7%). An almost equivalent group (10.7%), consisted of patients treated for cosmetic reasons. Patients after breast-conserving therapy amounted to 16.5%. Twenty patients (16.5%) were treated to alleviate pain.

Results

No major complications, and no cancer recurrence or metastasis were observed. One case of infection occurred at the injection site (infection rate: 0.38%). ANOVA showed statistically significant results for age (p < 0.001) and mean fat volume (p = 0.001). Posthoc analysis showed that the mean age of the tuberous group (21 years) was significantly smaller compared to all other categories (p < 0.001). Post-hoc analysis for fat volume indicated that the mean value for the cosmetic category (447.08 cc) was significantly greater than that of the breast-conserving and implant reconstruction categories (p = 0.009 and p = 0.030, respectively), while not significantly different from the tuberous and autologous reconstruction categories (p = 0.928 and p = 0.648, respectively).

Conclusions

Lipofilling has proven a valuable adjunct in reconstructive and aesthetic breast surgery with a low complication profile. The versatility of this low-cost technique and the low rate of complications make it a powerful asset of modern breast centers.

目的:近年来,脂肪移植作为乳房手术中的一项重要技术越来越受到重视。作为一家采用这种方法的乳腺中心,我们旨在调查脂肪移植的适应症和并发症:在这项回顾性研究中,我们共对 121 名患者进行了 263 次脂肪填充治疗。研究共分为五组:重建组(72.7%),其中24.8%为癌症后自体脂肪重建,38%为植入脂肪重建;结节性乳房矫正组(10.7%)。另一个几乎相当的组别(10.7%)由因美容原因接受治疗的患者组成。保乳治疗后的患者占 16.5%。20名患者(16.5%)接受了减轻疼痛的治疗:无重大并发症,无癌症复发或转移。注射部位出现一例感染(感染率:0.38%)。方差分析显示,年龄对治疗结果有显著的统计学意义(P 结论:脂肪填充是一种有效的辅助治疗方法:事实证明,脂肪填充在乳房整形和美容手术中是一种有价值的辅助手段,而且并发症较低。这种低成本技术的多功能性和低并发症发生率使其成为现代乳腺中心的强大资产。
{"title":"Fat grafting in breast surgery: a retrospective single-breast centre 6-year experience","authors":"Sarantos Papadopoulos,&nbsp;Goran Vidovic,&nbsp;Joke Tio,&nbsp;Theodoros Moysiadis,&nbsp;Matteo Lioupis,&nbsp;Apostolos P. Athanasiadis,&nbsp;Abdallah Abdallah","doi":"10.1007/s00404-024-07708-7","DOIUrl":"10.1007/s00404-024-07708-7","url":null,"abstract":"<div><h3>Purpose</h3><p>In recent years, fat grafting has gained importance as a valuable technique in breast surgery. As a breast center that has embraced this approach, we aimed to investigate the indications and complications of fat grafting.</p><h3>Methods</h3><p>In this retrospective study, we examined a total of 263 lipofilling treatments on 121 patients. Five groups were identified: the reconstruction group (72.7%), consisting of 24.8% autologous and 38% implant-based reconstructions after cancer, and correction of the tuberous breasts (10.7%). An almost equivalent group (10.7%), consisted of patients treated for cosmetic reasons. Patients after breast-conserving therapy amounted to 16.5%. Twenty patients (16.5%) were treated to alleviate pain.</p><h3>Results</h3><p>No major complications, and no cancer recurrence or metastasis were observed. One case of infection occurred at the injection site (infection rate: 0.38%). ANOVA showed statistically significant results for age (<i>p</i> &lt; 0.001) and mean fat volume (<i>p</i> = 0.001). Posthoc analysis showed that the mean age of the tuberous group (21 years) was significantly smaller compared to all other categories (<i>p</i> &lt; 0.001). Post-hoc analysis for fat volume indicated that the mean value for the cosmetic category (447.08 cc) was significantly greater than that of the breast-conserving and implant reconstruction categories (<i>p</i> = 0.009 and <i>p</i> = 0.030, respectively), while not significantly different from the tuberous and autologous reconstruction categories (<i>p</i> = 0.928 and <i>p</i> = 0.648, respectively).</p><h3>Conclusions</h3><p>Lipofilling has proven a valuable adjunct in reconstructive and aesthetic breast surgery with a low complication profile. The versatility of this low-cost technique and the low rate of complications make it a powerful asset of modern breast centers.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131687","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}
引用次数: 0
Obstetric violence: if you can recognize it, you can prevent it 产科暴力:如果你能识别它,你就能预防它。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-04 DOI: 10.1007/s00404-024-07722-9
Gianluca Montanari Vergallo, Lina De Paola, Gabriele Napoletano, Francesco Circosta, Giuseppe Gullo, Susanna Marinelli
{"title":"Obstetric violence: if you can recognize it, you can prevent it","authors":"Gianluca Montanari Vergallo,&nbsp;Lina De Paola,&nbsp;Gabriele Napoletano,&nbsp;Francesco Circosta,&nbsp;Giuseppe Gullo,&nbsp;Susanna Marinelli","doi":"10.1007/s00404-024-07722-9","DOIUrl":"10.1007/s00404-024-07722-9","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124643","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}
引用次数: 0
Comparing oncological outcomes of robotic versus open surgery in the treatment of endometrial cancer 比较机器人手术与开腹手术治疗子宫内膜癌的肿瘤学效果。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-04 DOI: 10.1007/s00404-024-07709-6
Manolis Nikolopoulos, Mark Pickering, Khaing Thu Thu, Vasileios Mitsopoulos, Anastasios Pandraklakis, Jonathan Lippiatt, Anni Innamaa, Ioannis Biliatis

Purpose

Robotic surgery has been incorporated in the treatment of endometrial cancer, with evidence suggesting that minimal access surgery offers advantages over laparotomy including less blood loss, lower rate of perioperative complications, and accelerated postoperative recovery. The laparoscopic approach to cervical cancer (LACC) study has recently demonstrated inferior survival outcomes in cervical cancer patients treated with minimal access surgery including robotic surgery. It is, therefore, imperative that further evaluation of the latter in endometrial cancer is performed.

Methods

A retrospective analysis of clinical data was performed. We compared two different types of surgery performed for the treatment of FIGO stage 1 to 3 endometrial cancer; open surgery performed in the years 2013–2015 vs robotic surgery performed in 2017–2019, after the implementation of the robotic program in our institution. Main outcome measures were recurrence-free survival and overall survival, with secondary outcomes including surgical morbidity and postoperative recovery.

Results

We compared 123 patients who had open surgery with 104 patients who underwent robotic surgery. One case from the second group was converted to open surgery due to the inability to complete it robotically. After a median follow-up of 68 months, there was no difference in recurrence-free survival or overall survival between the two groups.

Length of stay after an operation was significantly different with mean hospital stay of 1.6 days after robotic surgery and 5 days after open surgery (p = 0.001). No significant difference was identified in the rate of complications (p = 0.304).

Conclusion

Our analysis has demonstrated that robotic surgery offers better perioperative outcomes without compromising the oncological safety.

目的:有证据表明,与开腹手术相比,微创手术具有失血少、围手术期并发症发生率低、术后恢复快等优点。最近,宫颈癌腹腔镜治疗方法(LACC)研究表明,采用包括机器人手术在内的微创手术治疗宫颈癌患者的生存率较低。因此,当务之急是进一步评估后者在子宫内膜癌中的应用:方法:我们对临床数据进行了回顾性分析。我们比较了治疗 FIGO 1 至 3 期子宫内膜癌的两种不同手术方式:2013-2015 年实施的开放手术与本院实施机器人手术后于 2017-2019 年实施的机器人手术。主要结果指标为无复发生存率和总生存率,次要结果包括手术发病率和术后恢复情况:我们对 123 名接受开放手术的患者和 104 名接受机器人手术的患者进行了比较。第二组中有一例患者因机器人手术无法完成而转为开放手术。中位随访68个月后,两组患者的无复发生存率和总生存率没有差异。手术后的住院时间有显著差异,机器人手术后平均住院时间为1.6天,而开放手术后平均住院时间为5天(P = 0.001)。并发症发生率无明显差异(P = 0.304):我们的分析表明,在不影响肿瘤安全性的前提下,机器人手术能提供更好的围手术期效果。
{"title":"Comparing oncological outcomes of robotic versus open surgery in the treatment of endometrial cancer","authors":"Manolis Nikolopoulos,&nbsp;Mark Pickering,&nbsp;Khaing Thu Thu,&nbsp;Vasileios Mitsopoulos,&nbsp;Anastasios Pandraklakis,&nbsp;Jonathan Lippiatt,&nbsp;Anni Innamaa,&nbsp;Ioannis Biliatis","doi":"10.1007/s00404-024-07709-6","DOIUrl":"10.1007/s00404-024-07709-6","url":null,"abstract":"<div><h3>Purpose</h3><p>Robotic surgery has been incorporated in the treatment of endometrial cancer, with evidence suggesting that minimal access surgery offers advantages over laparotomy including less blood loss, lower rate of perioperative complications, and accelerated postoperative recovery. The laparoscopic approach to cervical cancer (<i>LACC</i>) study has recently demonstrated inferior survival outcomes in cervical cancer patients treated with minimal access surgery including robotic surgery. It is, therefore, imperative that further evaluation of the latter in endometrial cancer is performed.</p><h3>Methods</h3><p>A retrospective analysis of clinical data was performed. We compared two different types of surgery performed for the treatment of FIGO stage 1 to 3 endometrial cancer; open surgery performed in the years 2013–2015 vs robotic surgery performed in 2017–2019, after the implementation of the robotic program in our institution. Main outcome measures were recurrence-free survival and overall survival, with secondary outcomes including surgical morbidity and postoperative recovery.</p><h3>Results</h3><p>We compared 123 patients who had open surgery with 104 patients who underwent robotic surgery. One case from the second group was converted to open surgery due to the inability to complete it robotically. After a median follow-up of 68 months, there was no difference in recurrence-free survival or overall survival between the two groups.</p><p>Length of stay after an operation was significantly different with mean hospital stay of 1.6 days after robotic surgery and 5 days after open surgery (<i>p</i> = 0.001). No significant difference was identified in the rate of complications (<i>p</i> = 0.304).</p><h3>Conclusion</h3><p>Our analysis has demonstrated that robotic surgery offers better perioperative outcomes without compromising the oncological safety.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124642","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}
引用次数: 0
Required number of blastocysts transferred, and oocytes retrieved to optimize live and cumulative live birth rates in the first complete cycle of IVF for autologous and donated oocytes 在试管婴儿第一个完整周期中,为优化自体和捐赠卵母细胞的活产率和累积活产率,移植囊胚和提取卵母细胞的所需数量。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-04 DOI: 10.1007/s00404-024-07712-x
Sandra P. Cubillos-García, Francisco Revilla-Pacheco, Marcos Meneses-Mayo, Rosa E. Rodríguez-Guerrero, Silvio Cuneo-Pareto

Purpose

To investigate live birth rate (LBR) and cumulative live birth rate (CLBR) to achieve the first newborn per blastocyst transferred and oocyte retrieved in the first complete IVF cycle of autologous and donated oocytes and identify the possible success factors.

Methods

This was a retrospective cohort study of a private IVF center. There were 1867 cycles, 1241 of which were fresh transfers and 626, their subsequent thawing transfers.

Results

We found significant variables by binary logistic regression. For LBR, female infertility and the day of blastocyst transferred were relevant; however, for CLBR, the numbers of blastocysts available for future transfers, oocyte age, and maternal age were more critical. Oocyte age is a negative factor that begins to affect CLBR gradually beyond 36 years; from that age, there are significant worse results in polycystic ovary syndrome and poor responder patients.

Conclusion

The LBR and CLBR were optimized for oocyte recipients when eight oocytes were retrieved (63.6%; 87.9%); at most, fourteen oocytes should be assigned to avoid freezing surplus blastocysts. Thirteen autologous oocytes (69.2%; 92.3%) were ideal for optimization. CLBR optimized after three blastocysts in donor oocytes (81.8%) and four for autologous oocyte patients (80.9%). Our outcomes are valuable for doctors and infertile couples, and they give us information on what we can expect from a first complete IVF cycle.

目的:调查自体卵母细胞和捐赠卵母细胞在第一个完整试管婴儿周期中,每移植一个囊胚和取回一个卵母细胞获得第一个新生儿的活产率(LBR)和累积活产率(CLBR),并确定可能的成功因素:这是一项对一家私立试管婴儿中心进行的回顾性队列研究。共有 1867 个周期,其中 1241 个为新鲜移植,626 个为随后的解冻移植:通过二元逻辑回归,我们发现了一些重要的变量。对 LBR 而言,女性不孕症和囊胚移植日与之相关;但对 CLBR 而言,可用于未来移植的囊胚数量、卵母细胞年龄和母体年龄更为关键。卵母细胞年龄是一个负面因素,超过 36 岁后开始逐渐影响 CLBR;从这个年龄开始,多囊卵巢综合征和反应不佳患者的结果会明显变差:当取回 8 个卵母细胞(63.6%;87.9%)时,卵母细胞受体的 LBR 和 CLBR 达到最佳;最多应分配 14 个卵母细胞,以避免冷冻多余的囊胚。13 个自体卵母细胞(69.2%;92.3%)是理想的优化对象。供体卵母细胞(81.8%)和自体卵母细胞患者(80.9%)分别在 3 个囊胚和 4 个囊胚后,CLBR 达到最佳状态。我们的研究结果对医生和不孕夫妇都很有价值,它们为我们提供了关于第一个完整试管婴儿周期的预期信息。
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引用次数: 0
Assisted reproductive technology outcomes in women with congenital uterine anomalies: a systematic review 辅助生殖技术在先天性子宫畸形妇女中的应用效果:系统综述。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-04 DOI: 10.1007/s00404-024-07666-0
Francesco Fedele, Alessandro Bulfoni, Fabio Parazzini, Paolo Emanuele Levi-Setti, Andrea Busnelli

Purpose

The present systematic review aimed to assess the fecundity of women with congenital uterine anomalies (CUAs) undergoing assisted reproductive technology (ART).

Methods

The present systematic review of the literature was reported according to the PRISMA guidelines. We systematically searched PubMed, MEDLINE, Embase and Scopus, from database inception to 17th October 2023. Studies were deemed eligible only if they included women with CUAs clearly fitting into one of the categories of the ASRM Müllerian anomalies classification 2021.

Results

Data relevant to the reproductive outcomes of women with CUAs who underwent ART were extracted from 55 studies. Regarding Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, studies on gestational surrogacy reported a live birth rate (LBR) ranging from 37 to 54%. Uterus transplant, although still experimental, showed promising results. Most studies reported a negative impact of unicornuate uterus and partial or complete septate uterus on both the miscarriage rate (MR) and the live birth rate (LBR). The reproductive prognosis of women with unicornuate uterus was shown to be particularly poor in case of twin pregnancy. Uterus didelphys, bicornuate and arcuate uterus seem not to negatively impact the ART reproductive outcomes. Uterus didelphys was associated with an increased risk of preterm birth (PTB), cesarean section and low birth weight (LBW).

Conclusion

Women with CUAs should be informed regarding the impact (if any) of their congenital anomaly on both the chances of success of ART and on pregnancy-related complications. Elective single embryo transfer (eSET) should always be the first choice in patients with an increased baseline obstetric risk.

目的:本系统综述旨在评估接受辅助生殖技术(ART)治疗的先天性子宫畸形(CUAs)妇女的受孕率:本系统性文献综述按照 PRISMA 指南进行报告。我们系统地检索了 PubMed、MEDLINE、Embase 和 Scopus,检索时间从数据库建立之初至 2023 年 10 月 17 日。只有包含明显符合 ASRM 穆勒氏异常分类 2021 中某一类别的 CUAs 妇女的研究才被视为符合条件:从 55 项研究中提取了与接受 ART 的 CUAs 女性生殖结果相关的数据。关于Mayer-Rokitansky-Kuster-Hauser(MRKH)综合征,妊娠代孕研究报告的活产率(LBR)从37%到54%不等。子宫移植虽然仍处于试验阶段,但已取得了可喜的成果。大多数研究报告称,单角子宫、部分或完全隔膜子宫对流产率(MR)和活产率(LBR)均有负面影响。单角子宫妇女的生育预后在双胎妊娠中尤为糟糕。双角子宫、双角子宫和弧形子宫似乎不会对 ART 生殖预后产生负面影响。子宫二度发育与早产(PTB)、剖宫产和低出生体重(LBW)的风险增加有关:结论:患有先天性子宫发育异常的妇女应了解其先天性异常对 ART 成功率和妊娠相关并发症的影响(如有)。选择性单胚胎移植(eSET)应始终是产科风险基线升高患者的首选。
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引用次数: 0
The impact of Germany’s human papillomavirus immunization program on HPV-related anogenital diseases: a retrospective analysis of claims data from statutory health insurances 德国人类乳头瘤病毒免疫接种计划对人类乳头瘤病毒相关生殖器疾病的影响:对法定医疗保险理赔数据的回顾性分析。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-04 DOI: 10.1007/s00404-024-07692-y
Elizabeth Goodman, Miriam Reuschenbach, Tammo Viering, Agnes Luzak, Wolfgang Greiner, Monika Hampl, Christian Jacob

Purpose

Human papillomavirus (HPV) is the most common sexually transmitted infection, responsible for multiple HPV-related diseases, including almost all cervical cancers. The highly effective HPV vaccination has been recommended under the German HPV national immunization program (NIP) since 2007 and is reimbursed by health insurances. Vaccination uptake rates, however, remain suboptimal and data on the real-world impact of HPV vaccination in Germany are lacking. This study aims to demonstrate the population-level impact of Germany’s NIP on HPV-related anogenital diseases among young women.

Methods

Retrospective claims data analysis using a classic impact study design comparing disease prevalence among 28- to 33-year-old women before and after introduction of the HPV-immunization program in Germany. Claims data representing approximately two thirds of German health insurances were used. HPV-related disease outcomes included cervical cancer and high grade precancers (cervical intraepithelial neoplasia (CIN) 2+), anogenital warts, as well as vulvar, vaginal, and anal precancer/cancer.

Results

Significant declines were seen for CIN2+, anogenital warts, and vaginal precancer/cancer. Prevalence of CIN2+ declined 51.1% from 0.92% (95% CI = 0.78%, 1.08%) to 0.45% (95% CI = 0.38%, 0.53%). There was a 38.6% decline in anogenital warts prevalence from 0.44% (95% CI = 0.36%, 0.54%) to 0.27% (95% CI = 0.22%, 0.32%) and 75.0% decline in vaginal precancer/cancer prevalence from 0.04% (95% CI = 0.02%, 0.07%) to 0.01% (95% CI = 0.00%, 0.02%).

Conclusion

The German HPV-immunization program has led to significant declines in female anogenital disease among young women in Germany, highlighting the importance of the vaccination. Moreover, the data suggest that increasing vaccination coverage in Germany could further strengthen the public-health impact of its HPV-immunization program.

目的:人类乳头瘤病毒(HPV)是最常见的性传播感染,可导致多种与 HPV 相关的疾病,包括几乎所有的宫颈癌。自 2007 年以来,德国的 HPV 国家免疫计划(NIP)一直建议接种高效的 HPV 疫苗,并由医疗保险报销。然而,疫苗接种率仍然不尽如人意,德国也缺乏有关 HPV 疫苗接种实际影响的数据。本研究旨在证明德国国家免疫计划对年轻女性HPV相关生殖器疾病的人群影响:方法:采用经典的影响研究设计对索赔数据进行回顾性分析,比较德国引入 HPV 免疫接种计划前后 28 至 33 岁女性的疾病患病率。理赔数据约占德国医疗保险的三分之二。与 HPV 相关的疾病结果包括宫颈癌和高级别癌前病变(宫颈上皮内瘤变(CIN)2+)、生殖器疣以及外阴、阴道和肛门癌前病变/癌:结果:CIN2+、生殖器疣和阴道癌前病变/癌症的发病率明显下降。CIN2+ 发病率下降了 51.1%,从 0.92% (95% CI = 0.78%, 1.08%) 降至 0.45% (95% CI = 0.38%, 0.53%)。肛门尖锐湿疣发病率下降了 38.6%,从 0.44% (95% CI = 0.36%, 0.54%) 降至 0.27% (95% CI = 0.22%, 0.32%);阴道癌前病变/癌症发病率下降了 75.0%,从 0.04% (95% CI = 0.02%, 0.07%) 降至 0.01% (95% CI = 0.00%, 0.02%):德国人乳头瘤病毒免疫接种计划使德国年轻女性肛门生殖器疾病的发病率显著下降,凸显了疫苗接种的重要性。此外,数据还表明,在德国提高疫苗接种覆盖率可进一步加强其 HPV 免疫计划对公共卫生的影响。
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Archives of Gynecology and Obstetrics
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