Archives of Gynecology and Obstetrics最新文献

Purpose: Endometriosis (EMS) is a prevalent, inflammatory gynecological disorder with limited effective treatments and high recurrence rates. Given the central roles of inflammation, oxidative stress, pyroptosis, and angiogenesis in its pathogenesis, novel therapeutic strategies are urgently needed. This review aims to critically evaluate the potential of disulfiram (DSF), a repurposed antialcoholism drug, as a multifaceted therapeutic agent for EMS by analyzing its anti-inflammatory, antioxidant, anti-pyroptotic, and antiangiogenic properties.

Methods: A comprehensive literature review was conducted. Scientific databases (e.g., PubMed, Web of Science) were systematically searched for pre-clinical and clinical studies investigating the mechanisms of EMS pathogenesis and the pharmacological actions of DSF. The analysis focused on synthesizing evidence linking DSF's known biological effects to the key pathological drivers of EMS.

Results: The analysis demonstrates that DSF and its metabolites target multiple pathways implicated in EMS. Evidence confirms DSF's potent inhibitory effects on key inflammatory mediators and signaling pathways (e.g., NLRP3 inflammasome-mediated pyroptosis). Furthermore, DSF enhances cellular antioxidant defenses, reduces reactive oxygen species, and suppresses angiogenic factors, thereby potentially disrupting the establishment and survival of endometriotic lesions.

Conclusion: Disulfiram presents a promising, mechanistically grounded candidate for the treatment of endometriosis. Its unique ability to simultaneously modulate inflammation, oxidative stress, pyroptosis, and angiogenesis aligns closely with the multifactorial pathology of EMS. This review provides a strong rationale for future pre-clinical and clinical investigations to formally evaluate the efficacy and safety of DSF repurposing for this challenging disease.

Background: Epistaxis is common during pregnancy due to physiological changes, yet its clinical significance regarding obstetric outcomes is poorly understood. This study investigated the associations between epistaxis during pregnancy and maternal and neonatal outcomes.

Methods: We conducted a retrospective case-control study (2013-2022) at a single tertiary medical center. The study group included 104 pregnant women presenting with epistaxis, matched with 1924 controls based on age, ethnicity, and preexisting comorbidities. Multivariable logistic regression was used to identify independent predictors of adverse outcomes, including blood transfusion and preterm labor.

Results: Women with epistaxis experienced significantly higher rates of third-trimester vaginal bleeding (7.7% vs. 1.1%; p < 0.001), preterm labor (15.4% vs. 8.7%; p = 0.022), and blood transfusion requirements (4.8% vs. 1.6%; p = 0.014). In a multivariable model, third-trimester epistaxis emerged as an independent predictor for blood transfusion (OR 4.96, 95% CI 1.47- 14.38; p = 0.005), even after adjusting for delivery mode and initial hemoglobin levels. While univariate analysis associated epistaxis with preterm labor, this relationship did not remain significant in the multivariable model (p = 0.254). Most epistaxis episodes (81.7%) were mild and resolved spontaneously.

Conclusion: Epistaxis during pregnancy, particularly in the third trimester, is independently associated with a nearly fivefold increase in the odds of requiring a blood transfusion. While typically considered benign, epistaxis may serve as a clinical marker for systemic vascular susceptibility. These findings suggest that pregnant women presenting with epistaxis may benefit from enhanced clinical surveillance and interdisciplinary coordination to manage potential peripartum hemorrhagic complications.

Background: Female infertility is a critical global health concern, with a rising prevalence and significant psychosocial consequences. This study aimed to investigate the association between Systemic Inflammatory Response Index (SIRI) and female infertility.

Methods: This cross-sectional study enrolled 3059 reproductive-aged women (18-45 years) to examine the association between SIRI and female infertility using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2015 to 2020. Multivariable logistic regression generalized additive models (GAM), restricted cubic splines (RCS), and threshold effect analyses were leveraged. Machine learning approaches were also utilized to validate predictive performance and identify key features.

Results: Elevated SIRI was independently associated with increased odds of infertility. In the fully adjusted logistic model, each unit increase in SIRI corresponded to a 34% increase in infertility risk (OR 1.34, p = 0.001). Women in the highest SIRI quartile had more than double the odds of infertility compared to those in the lowest quartile (OR 2.08, p < 0.001), with a significant dose-response trend (p trend < 0.001). GAM and RCS models confirmed a monotonic and curvilinear association, respectively. Threshold analysis revealed a critical inflection point at SIRI = 1.66. Machine learning validation identified SIRI as one of the most influential predictors, with XGBoost achieving the highest (AUC = 0.866).

Conclusion: These findings support the role of chronic systemic inflammation in female infertility and highlight SIRI as a valuable biomarker for risk prediction and clinical assessment.

Objective: To analyze the difference in general clinical data, clinical manifestations, hysteroscopic manifestations, prognosis and fertility between patients with complex endometrial hyperplasia (CH) and simple endometrial hyperplasia (SH).

Material and methods: Collected the medical records of 616 premenopausal endometrial hyperplasia (EH) patients from January 2012 to October 2023, of which 419 SH patients and 197 CH patients were included in the study. All the patients were followed up at least 12 months, and asked about the follow-up treatment plan, review, pregnancy and reproductive outcome of the patients with reproductive needs.

Results: Obesity (P = 0.044), having diabetes or insulin resistance (P = 0.032) and polycystic ovary syndrome (PCOS) (P < 0.001) are risk factors for the occurrence of CH, while gravidity ≥ 1 (P = 0.045) is a protective factor for the occurrence of CH. Compared with the SH group, the reversal rate in the CH group was significantly lower (69.7% vs 83.6%, P < 0.001), while the rate of persistence, progression, recurrence and canceration were higher (P < 0.001). Compared with no treatment, oral progesterone (P < 0.001) and levonorgestrel-releasing intrauterine system (LNG-IUS) treatment (P < 0.001) could improve the prognosis of patients with EH. The live birth rate of the CH group was obviously lower than that of the SH group ( 42.3% VS 61.1%, P = 0.038). CH (OR = 2.68, 95%CI 1.12-6.39, P = 0.043) is an independent risk factor affecting the live birth rate of patients with EH.

Conclusion: Obesity, diabetes, insulin resistance, PCOS and nulligravidity are risk factors for patients with EH, while gravidity ≥ 1 served as a protective factor, particularly against CH. The type of hyperplasia is associated with a low live birth rate. The prognosis of EH patients is usually poor, with a low reversal rate and a long reversal time. However, LNG-IUS can improve their prognosis.

Background: The dynamic development towards robotic-assisted surgery particularly affects operative gynecology. The analysis of operative data from robotic-assisted procedures since the first application at a surgical center provides valuable insights into the introduction phase and integration of the DaVinci system into routine clinical operations, as well as their impact on patient care. The aim of this work was to specifically examine the learning curve progression and to present the trend of the professionalization process in implementing the methodology in gynecologic oncology.

Materials and methods: A retrospective data analysis was conducted of the first n = 107 patients who underwent surgery for a gynecological malignancy with the DaVinci surgical system at the University Medical Center Freiburg between 2020 and 2022. Classic operative parameters were evaluated, including preparation time, skin-to-skin time, console time, and the resulting learning curves of the surgeons and the operative team (including CUSUM analysis and linear regression models). Additionally, perioperative patient characteristics were recorded (e.g., blood loss, length of hospitalization, conversion rate).

Results: The average operative preparation time is 26.11 ± 8.13 min. The maximum value (CUSUM peak) is at approximately 20 performed procedures, indicating that the processes of operative preparation were mastered after this number of operations. The average skin-to-skin time is 172.84 ± 71.68 min (range 43-387 min), whereby after an initial reduction in skin-to-skin time within the first 30 cases, there was a slight increase in the further course with renewed reduction from approximately 65 procedures. The average console time for all tumor entities is 131.98 ± 63.74 min; for the most common operative indication (endometrial cancer, n = 61), it is 109.89 ± 52.04 min (range 48-221 min). In the surgeons' learning curves, the two surgeons with the most procedures show a CUSUM peak after 11 and 22 procedures, respectively. The average length of stay is 5.00 days (± 2.30). A total of two conversions occurred (conversion rate = 1.9%).

Discussion: Upon evaluation of the first n = 107 DaVinci operations, rapid learnability of robotic-assisted operations was demonstrated. The conversion rate was low at 1.9%. A positive effect on the learning curve of individual surgeons was evident after approximately 20 procedures. Both the preparation time and the skin-to-skin time could be rapidly reduced, so that integration into routine clinical operations was possible without problems.

Purpose: Maternal anemia during pregnancy is associated with adverse obstetrical outcomes. This study aimed to assess maternal and neonatal outcomes in women with anemia in twin pregnancies, compared to women with normal hemoglobin levels.

Methods: A multicenter retrospective cohort study was conducted including women with twin pregnancies who delivered at 24-42 weeks between 2005 and 2021. Maternal and neonatal outcomes were compared between those who had diagnosis of maternal anemia upon admission for labor (hemoglobin < 11 g/dL), to those who have normal hemoglobin level. The primary outcome was composite adverse neonatal outcomes. Univariate analysis was followed by multivariate analysis to control potential confounders.

Results: During the study period, there were 5,530 twin deliveries; 5,004 women met the inclusion criteria. The maternal anemia prevalence upon admission was 16.8% (n = 840). After controlling for potential confounders, we found an independent association between maternal anemia in twin pregnancies and composite adverse neonatal outcomes for both twins-aOR 1.81 (1.55-2.12) for twin A and aOR 1.77 (1.51-2.06) for twin B. Anemia was also independently associated with higher risk for preterm delivery, cesarean delivery, maternal blood product transfusion and NICU admission for both twins.

Conclusions: Maternal anemia in twin pregnancies is associated with an increased risk of adverse maternal and neonatal outcomes. Clinicians should be aware of this condition, consider appropriate interventions for correcting the anemia, and ensure close monitoring of both the mother and the neonates. Further research is warranted to evaluate the effectiveness of anemia correction strategies in reducing obstetric burden.

Purpose: To characterise the effect of polycystic ovary syndrome (PCOS) on embryo morphokinetics via time-lapse imaging, including absolute time points, relative time intervals, and ratios representing cleavage synchronicity.

Methods: This single-centre retrospective observational study examined patients aged 18-45 years undergoing in vitro fertilisation/intracytoplasmic sperm injection with time-lapse imaging (09/2016-12/2019; n = 1433 two-pronuclear oocytes). A group with PCOS (n = 48 embryos) was compared to a control group with uterine, tubal factor or idiopathic infertility (n = 400 embryos). Times from the two-cell stage to blastocyst expansion, eight intervals for embryonic cell cycle (ECC) duration and synchronicity and four cleavage synchronicity (CS) and DNA replication time ratios were analysed.

Results: PCOS patients were younger (P = 0.023) with higher anti-Müllerian hormone levels (P < 0.001) than controls. No statistically noticeable influence of PCOS on absolute times was observed. The intervals from the 3- to 4-cell (synchronicity of cell cycle 2, s2; P = 0.013), the 5- to 8-cell (synchronicity of cell cycle 3, s3; P = 0.032) and the 4- to 8-cell stage (ECC3; P = 0.043) were longer in the PCOS group. The relative CS ratio from the 2- to 8-cell stage (CS2-8) was lower (P = 0.003) and from the 2- to 4-cell stage (CS2-4) was higher (P = 0.001) in PCOS embryos.

Conclusion: Whilst absolute times remained unaffected, relative morphokinetic intervals and ratios, potentially indicating poorer cleavage synchronicity, were altered in PCOS embryos. This is the first study examining the influence of PCOS on relative morphokinetic ratios.

Background: Placenta accreta spectrum (PAS) is a high-risk obstetric condition associated with hemorrhage, urologic injury, and peripartum hysterectomy. Rising cesarean delivery rates continue to increase its prevalence. Variation in surgical management and limited multidisciplinary involvement may contribute to adverse maternal outcomes.

Objective: To evaluate whether the implementation of a multidisciplinary team (MDT) protocol for PAS was associated with improved perioperative outcomes.

Study design: This retrospective cohort study included 417 women diagnosed with PAS from 2011 to 2022 at a tertiary center. In 2019, a structured MDT protocol was adopted, incorporating standardized imaging, preoperative conference, routine bilateral ureteral catheter (UC) placement, and on-site urologic support. Outcomes of MDT-managed patients (n = 108) were compared with pre-MDT patients (n = 309). Multivariable logistic regression and generalized linear models adjusted for maternal age, gravidity, prior cesarean delivery, placenta previa, PAS grade, surgical urgency, gestational age, and year of delivery.

Results: After adjustment, MDT care was associated with lower odds of urologic injury (aOR 0.34; 95% CI 0.12-0.82), surgical complications (aOR 0.39; 95% CI 0.18-0.78), transfusion (aOR 0.41; 95% CI 0.14-0.93), and hysterectomy (aOR 0.22; 95% CI 0.05-0.91). Adjusted estimated blood loss decreased by 260 mL (95% CI - 480 to - 70), and length of stay was reduced by 0.9 days (95% CI - 1.4 to - 0.3). Results remained consistent in sensitivity analyses limited to 2017-2022.

Conclusion: Implementation of an MDT protocol was associated with reduced perioperative morbidity, supporting multidisciplinary management as a potentially safer strategy for high-risk PAS surgery.

Background: Insulin autoimmune syndrome (IAS), or Hirata disease, is a rare autoimmune disorder characterized by the presence of autoantibodies targeting insulin, leading to episodes of postprandial hypoglycemia. First identified in Japan, the condition was historically seen primarily in the Asian population, but with global recognition and improved diagnostic tools, its prevalence has expanded. While IAS is often self-limiting and resolves with dietary modifications and discontinuation of triggering medications, its management in the context of assisted reproductive technology (ART) remains understudied.

Case presentation: This case report discusses a 28-year-old female diagnosed with IAS who underwent oocyte cryopreservation following a fertility assessment revealing low serum AMH levels. Despite a history of severe hypoglycemia, which was managed with rituximab and resolved within a month, and the presence of elevated insulin and insulin autoantibodies, she successfully completed ovarian stimulation without experiencing hypoglycemic episodes.

Discussion: Close monitoring of glucose levels and insulin autoantibody concentrations was essential for successful oocyte retrieval. This case underscores the importance of careful monitoring and individualized care for patients with IAS undergoing ART as autoimmune flare-ups and hypoglycemia can still occur even when the disease is in remission.

Conclusion: A multidisciplinary approach involving reproductive endocrinologists and fertility specialists is critical for safe management of such patients.