Archives of Gynecology and Obstetrics最新文献

Background

In Germany, first-trimester abortions are legally restricted but allowed under certain conditions, including mandatory counseling and a reflection period. Accessibility concerns persist. To address gaps in medical training, we developed an interdisciplinary learning module on first-trimester abortion care.

Methods

We piloted the module in two sessions giving access to all medical students as an extracurricular learning opportunity. We conducted non-paired surveys across the medical school prior to the module and with our participants after the module to identify changes in attitudes as well as in intentions to treat.

Results

We received a total of 297 responses. Most of the students (94%) were in favor of legalizing abortion laws. However, only 30% self-assessed their knowledge as sufficient, 40% of the students showed the willingness to perform abortions within the consultation clause and 43% of the students agreed to consult patients on abortion provision but not perform them themselves. The right for practitioners to object the performance of abortions was highly agreed upon (78%). After our pilot sessions, we received 53 evaluation surveys from 118 participants. Students reported a significant increase in knowledge. We observed a significant increase in general support and intention to treat after our module.

Conclusions

Teaching about abortion is essential for our future healthcare providers. Overall, we see a great response to our new learning module and can hope for practice-changing effects on the provision of abortion care in the future. We integrated the module into our regular teaching catalogue.

Objective

This investigation aimed to assess the applicability of fertility-sparing surgery (FSS) for early-stage ovarian clear cell carcinoma (OCCC) while examining the clinical requirements for lymph node dissection and adjuvant chemotherapy.

Subjects

A total of 849 stage I patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Survival outcomes were evaluated through Kaplan–Meier methodology for both overall survival (OS) and disease-specific survival (DSS). Prognostic determinants were examined using multivariate regression modeling.

Results

Among the 849 patients, 84.3% (716 cases) underwent hysterectomy, and 15.7% (133 cases) received FSS. No significant difference was found in OS (90.6% vs. 87.2%, P = 0.257) or DSS (91.6% vs. 87.7%, P = 0.302) between FSS and hysterectomy cohort. Tumor diameter > 10 cm, stage IC and lymphadenectomy were independent prognostic factors for patients with stage I OCCC. Among patients with a tumor diameter ≤ 10 cm, those who underwent FSS had better OS (97.9% vs. 88.3%, P = 0.034) and DSS (97.9% vs. 88.3%, P = 0.044) than those who received hysterectomy. In stage IA patients, there were no significant differences in prognosis between the two operations. Neither lymphadenectomy nor chemotherapy did not demonstrate superior prognosis in the FSS cohort, whereas chemotherapy was associated with inferior OS (93.5% vs. 84.9%, P = 0.007) and DSS (93.5% vs. 85.5%, P = 0.007) in the hysterectomy cohort.

Conclusion

For patients with stage IC OCCC and a tumor diameter > 10 cm, the selection of FSS should be approached with caution. Given the limitations of the SEER database, larger-scale prospective cohort studies are required to validate the influence of lymphadenectomy and postoperative adjuvant chemotherapy on the prognosis of patients undergoing FSS.

Purpose

While in singleton pregnancies the maternal serum biomarkers used in the first-trimester screening for aneuploidies, particularly PAPP-A, may be, also, used as predictors of adverse perinatal outcomes, there is a scarcity of data regarding the association of first-trimester biomarkers with unfavorable pregnancy outcomes in twin pregnancies. The main purpose of our study was to evaluate the association of low PAPP-A levels in twin pregnancies with the subsequent development of perinatal complications.

Methods

454 twin pregnancies were recruited over a period of 11 years, and their data were analyzed retrospectively. First trimester assessment at 11 + 0–13 + 6 weeks included examination of fetal anatomy and markers of aneuploidy and measurement of the maternal serum concentration of PAPP-A and free b-hCG. The outcomes under investigation were preterm rupture of the membranes, preterm delivery earlier than 32, 34, and 36 weeks, gestational diabetes, hypertensive disease of the pregnancy (including pregnancy induced hypertension and pre-eclampsia), intrauterine demise, birth weight difference of more than 25% among the fetuses and composite adverse pregnancy outcome (which included preterm rupture of the membranes, preterm delivery earlier than < 36 weeks, hypertensive disease of the pregnancy, and gestational diabetes).

Results

Low first-trimester PAPP-A levels were related with preterm birth, whereas high levels were associated with hypertensive disorders of pregnancy. When using specific cut-off points such as low PAPP-A MoM < 5th and < 10th centile or high PAPP-A MoM > 90th and 95th centile, these associations were not significant.

Conclusions

Low first-trimester PAPP-A levels were related with preterm birth, whereas high levels were associated with hypertensive disorders of pregnancy. When specific cut-off points were investigated, these associations were not statistically significant.

Background

Although international recommendations strongly support regular physical activity during pregnancy due to the improved maternal and fetal outcomes, adherence to physical activity remains low, particularly in early gestation. Understanding activity patterns during the first trimester is crucial, as behaviors established in this phase often persist throughout pregnancy.

Objectives

To describe physical activity levels and adherence to international recommendations among low-risk pregnant women in the first trimester, using the Italian version of the Pregnancy Physical Activity Questionnaire (PPAQ).

Study Design

This cross-sectional observational study includes 498 low-risk singleton pregnant women between 11⁺³ and 13⁺⁶ weeks’ gestation, recruited at the University Hospital of Naples Federico II, Italy, between January 2022 and December 2023. Participants completed the Italian version of the PPAQ. Total energy expenditure was expressed in MET-h/week, and women were classified as exercisers (≥ 150 mines/week of moderate-intensity activity) or non-exercisers.

Results

Participants reported a median of 11.5 (IQR 8.2–15.0) h/week of total activity, corresponding to 155.7 (102.6–241.7) METs-h/week. While 51% met the threshold of ≥ 150 min/week of moderate-intensity activity when considering all activity domains, only 7.8% reached this target through sport or structured exercise alone. Walking represented the most common exercise (64.1% slow, 46.2% brisk, 25.6% uphill). Employment status was significantly associated with higher adherence to recommendations, whereas other sociodemographic factors showed no significant differences.

Conclusions

Structured exercise should be improved in the daily routine to optimize maternal and fetal health, although activity levels may appear adequate. Adherence to physical activity recommendations could be promoted by integrating validated tools such as the PPAQ into routine prenatal care and targeted interventions.

Background

Pregnant women living with HIV (PWLHIV) are at increased risk of infectious complications during pregnancy, and HIV-exposed but uninfected women are more susceptible to serious infectious diseases. Therefore, maternal immunization during pregnancy is an essential standard of care for this patient population. However, vaccination during pregnancy is suboptimal among these patients.

Methods

This is a single-center retrospective observational study, conducted at the University Hospital Federico II of Naples, Italy. We examined how our Center's vaccination uptake among PWLHIV changed after the introduction of in-hospital vaccine administration. To account for the small sample size and assess the robustness of the findings, Firth’s penalized logistic regression was performed as a sensitivity analysis.

Results

Between January 2021 and December 2024, 41 PWLHIV have been referred to the Regional Referral Centre for HIV in Pregnancy. Out of 38 eligible patients, 21 received the Tdap vaccine, resulting in an overall uptake of 55.3%. Following the introduction of in-hospital vaccine administration in January 2023, we observed a significant increase in pertussis-containing vaccine uptake among PWLHIV. Vaccine uptake increased from 20% (January 2021–December 2022) to 78.3% after the introduction of in-hospital vaccine administration (January 2023–December 2024), (p < 0.001). The sensitivity analysis using Firth’s penalized logistic regression confirmed the independent association between in-hospital vaccination and vaccine uptake (adjusted OR 11.45; 95% CI 2.45–68.32; p < 0.001).

Conclusions

We observed improved vaccine uptake after introducing vaccine administration within the hospital setting. We believe that this strategy might significantly improve vaccine administration among PWLHIV.

Objective

To evaluate the surgical efficacy and prognosis of radiofrequency ablation (RFA) in the treatment of microcystic congenital pulmonary airway malformation (CPAM) complicated by fetal hydrops, with the CLM volume ratio (CVR) exceeding 2.0 and refractory to conservative treatment with maternal steroid administration.

Methods

We collected data from fetal microcystic CPAM cases with CVR > 2.0, complicated by fetal hydrops, and refractory to maternal steroid therapy, who underwent RFA at our hospital from June 2020 to June 2024.

Results

The study comprised five fetuses, all diagnosed with microcystic CPAM complicated by fetal hydrops. All fetuses had a mean CVR of 3.8 (range, 2.2–5.3) and were complicated by fetal hydrops. All cases received two courses of maternal steroid before the RFA procedure. Among the five cases, three newborns were delivered at a mean gestational age of 36.6 weeks (range 35.2–38.7 weeks), and two cases of IUFD occurred postoperatively.

Conclusion

For microcystic CPAM complicated with fetal hydrops and refractory to maternal conservative steroid administration, ultrasound-guided RFA serves as an effective salvage option for intrauterine treatment. Nevertheless, intrauterine interventional procedures should be performed with extreme caution, given the potential risks of IUFD.

Purpose

Primary: To evaluate whether robotic-assisted laparoscopic surgery using the Senhance® Surgical System has the potential to reduce muscular demands compared to conventional laparoscopy. Secondary: To verify that the novel eye-tracking feature for zoom and the selection of functions in the Senhance® System menu is not associated with increased eyestrain or neck strain.

Methods

In a within-subject design, 2 experienced surgeons performed 11 robot-assisted and 12 conventional laparoscopic procedures. Muscular demands were monitored throughout surgical procedures by assessing the muscle activity via bipolar surface electromyography of seven muscles of the lower back, shoulder–neck, and forearms. Surgeons’ head, arm, and torso posture was assessed by gravimetrical position sensors. Furthermore, musculoskeletal discomfort, mental and physical workload, task difficulty and working precision were rated by the surgeons. In addition, a ten-item eyestrain questionnaire was administered after each surgical procedure.

Results

Four out of seven muscles were relieved when working with Senhance®. Only in the left shoulder–neck area there was a statistically significant increase in muscle activation associated with robotic-assisted surgery. Changes in surgeons’ posture related to the surgical technique corresponded to the changes in muscle activation. Furthermore, surgeons reported no musculoskeletal discomfort under both conditions and similar levels of workload (mental and physical), and task difficulty. Working precision was subjectively rated to be better during standard laparoscopy. No eyestrain occurred during any of the procedures.

Conclusion

This exploratory study identified the potential of the Senhance® Surgical System for ergonomic improvements and indicated no impairments by the novel eye-tracking feature on muscle demands and eyestrain. Follow-up studies with larger and more diverse indications are needed that also consider clinical outcomes, which were not part of the present study.

Purpose

Cardiovascular diseases are the leading causes of mortality in women worldwide, with hypertension being a major risk factor. While traditional blood pressure monitoring techniques rely on cuff-based measurements, wearable devices offer a promising alternative for continuous and non-invasive blood pressure tracking. This systematic review investigates the extent to which wearable blood pressure measurements can serve as surrogates for traditional sensors to be implemented in risk assessment tools in predicting cardiovascular risk in women.

Methods

A systematic search was conducted in databases including MEDLINE, Embase, Cochrane Library, Web of Science, Scopus and ClinicalTrials.gov. Studies published between 2010 and 2024 were included. Exclusion criteria were case reports or animal studies. Study selection was performed based on PRISMA guidelines. Data extraction focused on wearable devices, measurement approach, validation against gold-standard BP methods, and their predictive utility for cardiovascular outcomes.

Results

The systematic literature search revealed 14′863 results after removal of duplicates, of which 245 were selected for extraction. Most included studies used photoplethysmography, with pulse transit time and pulse wave velocity as core parameters, some using machine learning. Accuracy was moderate to high for diastolic blood pressure, but systolic blood pressure showed greater variability. Cardiovascular risk stratification showed promising results, though external validation was rare.

Conclusion

Wearable blood pressure monitoring technologies are maturing, with growing potential in preventive cardiovascular medicine in women. However, clinical implementation is limited by varying accuracy, need for calibration, and the lack of standardization. Further validation and longitudinal studies are needed to establish their role in cardiovascular risk prediction.

Background

Gestational Diabetes Mellitus (GDM) presents significant risks to both maternal and foetal health during pregnancy.

Purpose

This observational study aimed to investigate the association between clinical parameters and adverse pregnancy outcomes in women with GDM.

Methods

A cohort of 2174 GDM-diagnosed women was analysed, with 1705 experiencing no adverse outcomes and 469 developing complications such as preeclampsia, large for gestational age (LGA) infants, preterm birth, and shoulder dystocia. Clinical data, including maternal age, glucose levels, gestational age, body mass index (BMI), and treatment methods, were collected and analysed.

Results

Advanced maternal age, higher parity, increased weekly weight gain, and abnormal fasting glucose levels were associated with adverse pregnancy outcomes in women with GDM. In particular, early onset of GDM, elevated weekly weight gain, and abnormal fasting glucose levels were linked to an increased risk of developing preeclampsia and delivering LGA infants. However, no significant associations were found regarding shoulder dystocia. Furthermore, maternal age and weekly weight gain were identified as risk factors for preterm birth.

Conclusion

This study shows that in addition to well-known risk factors, abnormal fasting glucose levels are significantly linked to developing adverse pregnancy outcomes in women with GDM. Our data suggested that close monitoring of fasting glucose levels and controlling weight gain may significantly reduce the risk of adverse outcomes in pregnancies complicated by GDM.

Objective

Despite on-going research into the underlying pathology of hypertensive disorders in pregnancy, maternal mortality is hardly decreasing. Current antihypertensive therapy is aimed at controlling symptoms and preventing severe courses of pregnancy. Traditional management focuses on blood pressure (BP) control, but does not consider individual hemodynamic variations. Hemodynamically guided therapy offers a personalized approach that can improve BP control and outcomes by treating the underlying pathophysiology. The aim of this review is to provide an overview of hemodynamically guided antihypertensive therapy in hypertensive disorders of pregnancy and to present the results of recent intervention trials in this area.

Methods

Literature searches were conducted in the electronic databases PubMed, CENTRAL, and Google scholar from inception to May 2024 for studies that used maternal hemodynamic parameters like cardiac output (CO) or TPVR (total peripheral vascular resistance) to guide antihypertensive therapy in pregnant women with hypertensive disorders or at elevated risk for developing preeclampsia. The review included intervention studies.

Results

A total of five studies met the inclusion criteria. All studies showed improved BP control when the antihypertensive medication administered was matched to hemodynamic characteristics of the women being treated. Using a personalized approach, pregnancy complications were significantly reduced in patients with both hypo- or hyperdynamic circulation, even in patients with a history of preeclampsia.

Conclusion

The study shows that hemodynamically triggered antihypertensive therapy can improve outcomes for both mother and child in cases of hypertensive pregnancy disorders. However, further placebo-controlled studies are necessary before a final assessment of this therapy can be made.