Archives of Gynecology and Obstetrics最新文献

Aim

This randomized crossover study evaluated the 12 week efficacy of a 10 µg estradiol hemihydrate vaginal tablet versus a vaginal gel (available at Siriraj Hospital, Thailand) in postmenopausal women with vaginal atrophy. Secondary endpoints included the most bothersome symptom, vaginal health index (VHI), vaginal pH, female sexual function index, serum estradiol, endometrial thickness, ease of use, comfort, and satisfaction.

Methods

Ninety participants were randomized to receive either the 10 µg estradiol tablet or the gel daily for 2 weeks, followed by twice-weekly application for 10 weeks. Afterward, they switched to the alternate treatment for another 12 weeks using the same dosing regimen. Assessments of VHI, pH, vaginal maturation value (VMV), female sexual function index, endometrial thickness, and estradiol levels were conducted at baseline, 12 weeks, and 24 weeks.

Results

Eighty-five participants completed the study. At 12 weeks (intention-to-treat analysis), the gel significantly increased VMV compared with the tablet (60.16 ± 12.00 vs 51.62 ± 23.77; P = 0.035; 95% CI 0.54 to 16.46), although the 95% CI included the noninferiority margin of 15. Per-protocol analysis showed no significant difference between groups. VHI improved, and pH decreased more markedly with the gel at 12 weeks. By 24 weeks, there were no significant between-group differences in VMV, pH, or most bothersome symptom. Acceptability was high for both treatments, although 55.3% of participants indicated a preference for continued gel use.

Conclusions

Noninferiority of the 10 µg estradiol hemihydrate tablet relative to the gel could not be established. However, both treatments exhibited clinical benefits and high patient satisfaction, providing valuable insights for therapeutic decision-making in postmenopausal vaginal atrophy.

Purpose

Endometriosis appears in various forms and symptoms. With regard to the established endometriosis classifications, it is hardly possible to draw conclusions from the endometriosis to the symptoms caused by it. The objective of this study was to evaluate whether different endometriosis phenotypes are associated with distinct pain profiles.

Materials and methods

3329 patients underwent surgical treatment for endometriosis at the University Endometriosis Center Franconia of the Erlangen University between September 2011 and January 2024. They were grouped by phenotype [superficial (SE), deep (DIE) and adenomyosis (AM)] and assessed for pelvic pain, dyspareunia, dysuria and dyschezia. The study examined pain distribution across phenotypes and pain intensity among symptomatic patients (NRS > 0).

Results

Patients with SE only reported pelvic pain less frequently and with lower intensity than those with additional AM Groups SE/AM and SE/DIE/AM. Dyspareunia was less common in Group SE only vs. Group SE/AM; pain intensity was highest in AM only and lowest in Group SE/DIE. Dysuria was most frequent in Group SE/DIE/AM, with no significant intensity differences. Dyschezia was more frequent in Group SE/DIE/AM and less in Group SE only, again without significant intensity differences.

Conclusion

Pain frequency and intensity differed by endometriosis phenotype. SE showed the lowest pain frequency and pelvic pain intensity. AM, especially with other subtypes, was linked to higher frequency and intensity of pelvic pain, as well as more dyspareunia and dysuria. DIE was mainly associated with more frequent dyschezia, but not with increased pelvic pain intensity.

Objective

To develop a risk prediction model for preterm premature rupture of membranes (PPROM) after fetal endoscopy laser coagulation (FLC) for Twin-to-Twin Transfusion Syndrome (TTTS), identifying related influencing factors.

Methods

A retrospective analysis was conducted on 414 parturients from six Chinese hospitals treated with FLC for TTTS between January 2016 and January 2025. Patients were divided into non-occurrence (n = 263) and occurrence groups (n = 151) based on PPROM during pregnancy. Logistic regression identified predictors, establishing the risk prediction model.

Results

Univariate and multivariate logistic analyses revealed postoperative amniotic fluid leakage, operation time, and intraoperative amniotic fluid reduction rate as risk factors, while preoperative cervical canal length and Trocar insertion distance from the internal cervical OS were associated with reduced risk (all P < 0.05). ROC curve analysis showed an area under the curve of 0.802 (95% CI: 0.700–0.904), indicating good predictive efficacy. The goodness-of-fit test (P = 0.165 > 0.05) confirmed model fit, and calibration curves demonstrated acceptable accuracy. Clinical decision curves indicated net benefit.

Conclusion

This model, incorporating postoperative amniotic fluid leakage, operation time, intraoperative amniotic fluid reduction rate, preoperative cervical canal length, and Trocar insertion distance, effectively predicts PPROM risk after FLC for TTTS. It can assess risks clinically and guide interventions to prolong pregnancy and improve outcomes.

Background

Male breast cancer (BC) is a rare entity and represents a significant clinical challenge due to its late diagnosis and resulting poorer prognosis compared to female BC. As shown by prior studies, approximately 99% of male BC patients are hormone receptor-positive (HR +). This study aimed to evaluate the utilization and impact of adjuvant endocrine therapy (ET) in male early BC patients using a large German real-world claims dataset.

Patients and methods

Data were collected from a major German statutory health insurance provider (AOK Baden-Wuerttemberg) covering the period between January 1, 2010, and December 31, 2020. Male patients diagnosed with early BC who underwent breast surgery were included. ET use was determined by prescription records. The impact of ET on overall survival (OS) was assessed using univariable (log-rank) and multivariable (cox regression) analysis.

Results

Among 128 male early BC patients, 16% (n = 21) did not utilize adjuvant ET. On univariable analysis, ET was significantly associated with 5-year OS (74% with ET vs. 37% without ET; p < 0.0001). Multivariable analysis revealed ET use (Hazard Ratio [HR]: 0.31, 95% CI 0.14–0.69, p = 0.004) having a positive effect on OS, whereas age (HR: 1.04, 95% CI 1.00–1.09) and comorbidities (HR: 1.18, 95% CI 1.05–1.34, p = 0.007) were identified as negative predictive factors for OS.

Conclusion

A significant proportion of male patients with early BC does not use ET. However, the use of ET plays a key role in improving survival outcomes for male patients with early BC. Efforts to improve the use of ET, including patient education and management of side effects, are essential to optimize treatment outcomes.

Purpose

Despite labor laws, over 614 million workers exceed 48 work hours weekly. Excessive work has been linked to health problems, as has job satisfaction which also affects the individual’s quality of life (QoL). This study aims to investigate the impact of job satisfaction on QoL, with a focus on women. Given that occupational stress and job satisfaction have been associated with gynecologic and obstetric outcomes, these findings are of particular relevance to women’s health.

Methods

The study utilized data from the Bern Cohort Study 2014, a single-center, cross-sectional, observational trial. During the study, several background parameters were collected, while the IMPULS questionnaire was used to assess job satisfaction, and biofunctional status (BFS) and SF-36 assessed the QoL. The results were analyzed by non-parametric Spearman–Rho test, parametric Pearson correlation, and ANOVA, controlling for age, income, physical activity, sleep, relationship status, and sexual life.

Results

Our analysis depicted some interesting correlations. For women, an association between their emotional well-being and their energy and fatigue was established with aspects of their job satisfaction, such as variety, completeness and social environment. For men, an obvious association of job control was noted for their general health, energy and fatigue, and emotional well-being. Contrarily, for women job control had no influence on SF-36 parameters but was positively correlated with the systolic blood pressure and diastolic blood pressure (BFS parameters) revealing a rather opposite perception of job control than for men.

Conclusions

Our findings support a link between job satisfaction and QoL. Women consider important factors, such as variety, completeness, and social environment, particularly impacting their emotional well-being and energy levels, whereas for men, job control seems to have the greatest significance. For gynecologists and women’s health providers, recognizing the role of occupational factors may help integrate workplace exposures into patient history-taking and counseling, especially in the context of reproductive and pregnancy health.

Purpose

To develop and validate a prenatal prediction model for aortic coarctation (CoA) using morphologic, hemodynamic, and fetal growth parameters to enhance diagnostic accuracy and guide clinical decision-making.

Method

Eighty-three fetuses with suspected CoA were retrospectively analyzed. Key prenatal predictors were analyzed using multivariable logistic regression to construct a nomogram. Model performance was evaluated via area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).

Results

Of the 83 fetuses, 28 (33.7%) were postnatally confirmed with CoA. The final model identified abdominal-to-head circumference ratio × 100% (β = 0.90, 95% CI 0.22–1.58), maximum aortic arch z-score (β = − 0.85, 95% CI − 1.50 to − 0.19), ventricular septal defect (OR = 1.85, 95% CI 1.02–3.53), and abnormal atrial hemodynamics (OR = 0.73, 95% CI 0.38–1.39) as significant predictors. The model achieved an AUC of 0.86 (95% CI 0.78–0.94), with calibration plots demonstrating strong agreement between predicted and observed probabilities. DCA confirmed clinical utility across a wide threshold range.

Conclusions

This nomogram enhances CoA prediction by integrating structural and functional ultrasound markers. It offers strong diagnostic performance and practical value for prenatal risk stratification, potentially reducing false positives and unnecessary interventions.

Objectives

To determine metabolic and hormonal profiles in women with functional hypothalamic amenorrhea (FHA) with normal body mass index (BMI).

Methods

In FHA (n = 69) and controls (n = 69), matched for age and BMI lipid, fasting plasma glucose (FPG) and insulin (Ins) levels along with hormonal profile were determined.

Results

FHA showed slightly lower FPG (− 8.2%, p = 0.001) contrary to the controls with no differences in lipid profile. In the FHA group, BMI was positively correlated with Ins (r = 0.57, p < 0.001) and negatively with high-density lipoprotein cholesterol (HDL-C; r = − 0.58, p < 0.001). Regarding hormonal profile, FHA showed higher prolactin (PRL; + 61.6%) and thyroid-stimulating hormone (TSH; + 4.0%) levels compared to the controls (all p < 0.05). FHA had higher androgen levels reflected by higher total testosterone (TT; + 22.2%) and 17-hydroxyprogesterone (17-OHP; + 88.9%) levels (all p < 0.05) in contrary to the remainder.

Conclusion

FHA women with normal BMI present unfavorably altered hormonal profile reflected by hyperandrogenemia and slightly lower, but significant, FPG level. The findings confirm the importance of assessing both metabolic and hormonal panels in FHA women despite normal BMI.

Purpose

To develop a locally tailored ERAS program for 60–80-year-old patients with pelvic organ prolapse (POP) undergoing transvaginal mesh (TVM) surgery in low- and middle-resource countries.

Methods

In this multicenter randomized controlled trial conducted at seven tertiary hospitals, 262 women aged 60–80 scheduled for elective TVM surgery were randomly allocated (1:1) to receive either a comprehensive ERAS perioperative intervention or conventional perioperative management (131 participants per group). The primary outcomes were postoperative length of stay, pain scores, time to first flatus, removal of urinary catheter, first assisted walking, postoperative complications, readmission, emergency visit, in-hospital costs, PGI-I, QoR-15, PONV, and residual urine volume.

Results

ERAS group had significantly shorter postoperative length of stay (median 3.92 days vs. 4.99 days, HR = 1.42, 95% CI 1.11–1.82, P = 0.005), lower pain scores within 24 h, faster time to first flatus, removal of urinary catheter, and first assisted walking. There were no significant differences between the ERAS and conventional groups regarding postoperative complications, readmission, emergency visit, in-hospital costs, PGI-I, QoR-15, PONV, and residual urine volume. There was no 30-day postoperative readmission in both groups.

Conclusions

ERAS program can reduce length of stay and improve postoperative outcomes in patients undergoing vaginal reconstructive surgery. Recommend implementing ERAS for 60–80-year-olds in East Asia where TVM surgeries are still an option for POP.

Clinical registration

ChiCTR2200057422 (March 12, 2022).

Background

The burden of polycystic ovary syndrome is increasing worldwide, which places a heavy burden on society and healthcare systems. This study investigates the independent effects of age, period, and cohort on the polycystic ovary syndrome prevalence from 1990 to 2021 in China, Japan, Asia and World. And then predicts the future burden of polycystic ovary syndrome over the next decade.

Method

The data were collected from the Global Burden of Disease (GBD) 2021 study, and the average annual percent change (AAPC) and relative risks (RRs) analyzed by joinpoint regression and APC-IE model. And this study employed the BAPC model to predict future disease burdens in China and Japan.

Results

In 2021, there were 533.533*104 (95% CI: 376.054*104, 750.101*104) cases of PCOS in China, accounting for 28.69% of all cases in Asia and 14.56% globally. The ASPR of PCOS in China increased from 1990 to 2021, with an AAPC of 2.01 (95% CI: 1.99, 2.03), which was significantly higher than that of Japan (0.21; 95% CI: 0.20, 0.22), Asia (1.30; 95% CI: 1.28, 1.31) and the global average (0.81; 95% CI: 0.80, 0.82). The age-period-cohort analyses revealed that the relative risk (RR) of polycystic ovary syndrome increased with age, peaking at 20–24 years in Chinese women (RR = 1.591) and Japan women (RR = 1.64). And Japan showed a slight increase in the 35–39 age group (RR = 1.583). The period effect of polycystic ovary syndrome showed a consistent upward trend in China, Japan, Asia, and globally. And China experienced the most substantial increase from 1992–1996 (RR = 0.701) to 2017–2021 (RR = 1.271). The cohort effect of PCOS demonstrated a declining trend across regions, but China and Asia experienced an incline from 2002–2006 to 2007–2011 birth cohort. By 2036, the ASPR of PCOS in China is projected to increase by 27% from 2021, reaching 1961.45/100,000.

Conclusions

The prevalence of the PCOS in China has increased significantly over the past three decades. The age group with a high prevalence of polycystic ovary syndrome among Chinese women is 20–25 years old. And women in the new birth cohort are more likely to develop polycystic ovary syndrome. It is imperative that the government standardize the diagnosis and treatment of polycystic ovary syndrome and provide health education to the women.