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Correction: The effect of pregnancy pilates-assisted childbirth preparation training on urinary incontinence and birth outcomes: a randomized-controlled study. 更正:孕期普拉提辅助分娩准备训练对尿失禁和分娩结果的影响:随机对照研究。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-15 DOI: 10.1007/s00404-024-07822-6
Gonca Buran, Serap Erim Avcı
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引用次数: 0
Association of body mass index with pathologic agreement of preoperative and postoperative tumor grade in endometrial cancer. 体重指数与子宫内膜癌术前和术后肿瘤分级的病理学一致性的关系。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-15 DOI: 10.1007/s00404-024-07829-z
Samantha Taylor, Peter Scalia, Raanan Meyer, Melica Nourmoussavi Brodeur, Shannon Salvador, Susie Lau, Walter Gotlieb, Gabriel Levin

Objective: We aim to study association of BMI of EC patients, with the level of agreement between preoperative and postoperative tumor grade.

Methods: A retrospective study. We included patients with EC diagnosed in an outpatient clinic which had surgical staging as in our division. We categorized patients into BMI categories according to the World Health Organization; (BMI < 18.5 kg/m2), (BMI 18.5-24.9 kg/m2), (BMI 25-29.9 kg/m2), (BMI 30-34.9 kg/m2), (BMI 35-39.9 kg/m2), and (BMI ≥ 40 kg/m2). We further dichotomized the study population for obesity, defined as BMI ≥ 30.0. We analyzed agreement between preoperative and postoperative tumor grade, stratified by patient's BMI.

Results: Overall, 623 women met study inclusion criteria, with a median age of 64 [interquartile range (IQR) 57-72]. Among the study cohort, the median BMI was 30.7 [IQR 25.6-38.8], with 330 (53.0%) patients being obese. EC grade 1 was diagnosed preoperatively in 353 (56.7%), grade 3 in 148 (23.8%), and grade 2 in 122 (19.6%). Endometrioid histology was diagnosed in 463 (74.3%), serous in 78 (12.5%), mixed histotype in 51 (8.2%), clear cell in 20 (3.2%) and carcinosarcoma in 11 (1.8%). In 68.7% (n = 428), there was no change in postoperative grade, and in 24.9% (n = 155), there was upgrading of tumor, and in 6.4% (n = 40), there was a tumor downgrade. There were 3 (0.5%) cases in which no tumor was found on final pathology. The rate of no change was higher in preoperative grade 3 (89.9%) vs. grades 1 (63.5%) and grade 2 (58.2%), p < .001). There was no difference in grading agreement when obese patients were compared to non-obese, p = .248. There was no difference in grading agreement when comparing the various BMI categories, with no change proportion ranging between 58.2% in BMI 30.0-34.9 mg/kg2 and 79.7% in BMI 35.0-39.9 mg/kg2, p = .104. ROC analysis of BMI as predictor of no-change yielded an area under the curve of 0.466 (95% confidence interval 0.418-0.515) with a maximal performance at a BMI of 33.8 mg/kg2. The agreement between preoperative and postoperative tumor grade among all patients was kappa = 0.517. The agreement did not differ when compared between obese patients (kappa = 0.456) and non-obese (kappa = 0.575).

Conclusion: Our study found no significant association between BMI and the agreement between preoperative and postoperative tumor grading in EC.

目的我们旨在研究心血管疾病患者的体重指数与术前和术后肿瘤分级的一致性:回顾性研究。我们将在门诊确诊的心肌梗死患者纳入研究范围。根据世界卫生组织的标准,我们将患者的体重指数分为:(BMI 2)、(BMI 18.5-24.9 kg/m2)、(BMI 25-29.9 kg/m2)、(BMI 30-34.9 kg/m2)、(BMI 35-39.9 kg/m2)和(BMI ≥ 40 kg/m2)。我们进一步对研究人群进行了肥胖二分法,即 BMI ≥ 30.0。我们分析了术前和术后肿瘤分级的一致性,并根据患者的 BMI 进行了分层:共有 623 名妇女符合研究纳入标准,中位年龄为 64 岁[四分位数间距 (IQR) 57-72]。研究队列中,BMI 中位数为 30.7 [IQR 25.6-38.8],肥胖患者为 330 人(53.0%)。353例(56.7%)患者术前诊断为EC 1级,148例(23.8%)为3级,122例(19.6%)为2级。463例(74.3%)确诊为子宫内膜样组织学,78例(12.5%)确诊为浆液性组织学,51例(8.2%)确诊为混合组织学,20例(3.2%)确诊为透明细胞,11例(1.8%)确诊为癌肉瘤。68.7%(428 例)的患者术后等级无变化,24.9%(155 例)的患者肿瘤升级,6.4%(40 例)的患者肿瘤降级。最终病理检查未发现肿瘤的病例有 3 例(0.5%)。术前 3 级(89.9%)与术前 1 级(63.5%)和术前 2 级(58.2%)相比,术前 3 级无变化的比例更高,P 2;BMI 为 35.0-39.9 mg/kg2 时,术前 3 级无变化的比例为 79.7%,P = .104。对预测无变化的 BMI 进行 ROC 分析,结果显示曲线下面积为 0.466(95% 置信区间为 0.418-0.515),在 BMI 为 33.8 mg/kg2 时达到最大值。所有患者术前和术后肿瘤分级的一致性为 kappa = 0.517。肥胖患者(kappa = 0.456)和非肥胖患者(kappa = 0.575)之间的一致性没有差异:结论:我们的研究发现,体重指数(BMI)与EC患者术前和术后肿瘤分级的一致性无明显关联。
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引用次数: 0
Development and validation of a cost-effective DIY simulation model for McDonald cerclage training. 开发并验证用于麦当劳环扎培训的经济高效的 DIY 仿真模型。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-14 DOI: 10.1007/s00404-024-07812-8
Johanna Buechel, Adam Kalisz, Saskia-Laureen Herbert, Anne Scherer-Quenzer, Bettina Blau-Schneider, Teresa Starrach, Katrina Kraft, Achim Wöckel, Ulrich Pecks, Matthias Kiesel

Purpose: The prevention of preterm birth is a challenging task for obstetricians. Cervical cerclage, used as both a primary and secondary prevention method for spontaneous preterm birth, is a crucial surgical intervention. It is essential that obstetricians can learn this procedure in a simulated environment before performing the stitches on high-risk patients. This study aimed to develop a simulator based on 3D printing and evaluate its validity for clinical training.

Methods: The objectives of this study were (1) to design and construct a cost-effective simulator for McDonald cerclage with two different cervix models-a closed cervix and a cervix with bulging membranes-using common material from a DIY store and 3D printing technology and (2) to validate its effectiveness through feedback from learners and experts in cervical cerclage. The self-made simulator was evaluated by obstetricians using a questionnaire with Likert scale.

Results: Obstetricians and gynecologists assessed the simulator and found it useful for learning and practicing cervical cerclage. The simulator was deemed valuable for skill training.

Conclusion: Cervical cerclage is a complex procedure that should be mastered through simulation rather than initial practice on real patients. Our simulator is a cost-effective model suitable for various clinical settings. It has been validated by obstetricians for both preventive and therapeutic cerclage, demonstrating its efficacy for training in cerclage techniques. Future research should focus on less skilled obstetricians and gynecologists and investigate how repeated use of the simulator can enhance their performance in cerclage stitching.

目的:对于产科医生来说,预防早产是一项具有挑战性的任务。宫颈环扎术可作为自发性早产的一级和二级预防方法,是一项重要的手术干预措施。产科医生在对高危患者进行缝合之前,必须在模拟环境中学习这一手术。本研究旨在开发一种基于 3D 打印技术的模拟器,并评估其在临床培训中的有效性:本研究的目的是:(1) 利用 DIY 商店的普通材料和 3D 打印技术,设计并建造一个具有成本效益的麦克唐纳宫颈环扎术模拟器,模拟两种不同的宫颈模型--闭合的宫颈和膜膨出的宫颈;(2) 通过宫颈环扎术学习者和专家的反馈来验证其有效性。产科医生使用李克特量表问卷对自制模拟器进行了评估:结果:产科医生和妇科医生对模拟器进行了评估,认为它有助于学习和练习宫颈环扎术。结论:宫颈环扎术是一项复杂的手术:宫颈环扎术是一项复杂的手术,应该通过模拟来掌握,而不是在真正的病人身上进行初步练习。我们的模拟器是一种经济有效的模型,适用于各种临床环境。它已通过产科医生对预防性和治疗性宫颈环扎术的验证,证明了其在宫颈环扎技术培训方面的有效性。未来的研究应重点关注技术水平较低的妇产科医生,研究反复使用模拟器如何提高他们的环扎缝合技术。
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引用次数: 0
Should we restrict food intake during labor? A randomized controlled trial. 分娩时是否应该限制食物摄入量?随机对照试验
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-13 DOI: 10.1007/s00404-024-07820-8
Gil Shechter Maor, Rona Bogin Greenfield, Sivan Farladansky-Gershnabel, Dana Sadeh Mestechkin, Hanoch Schreiber, Tal Biron-Shental, Omer Weitzner

Purpose: To evaluate whether consuming food during labor influences its outcomes.

Methods: This randomized controlled study included healthy, laboring patients at 37-41 weeks of gestation. After epidural anesthesia, patients were randomized into groups of eating at will versus drinking clear fluids only. The primary composite outcome included unplanned cesarean delivery, the need for general anesthesia, asphyxia, postpartum fever, and prolonged postpartum admission (more than 5 days). Secondary outcomes included the need for oxytocin, length of the second stage of labor, postpartum analgesia requirements, and early maternal and neonatal outcomes. Sample size analysis indicated that 126 patients needed to be randomized to detect a statistically significance difference between the groups.

Results: A total of 129 patients were randomized: 58 to the fluids-only group and 71 to the food group. The groups had similar basic characteristics. The composite outcome of complications attributed to eating during labor and delivery was comparable between groups. Labor progression and the need for oxytocin augmentation were similar in both groups. The groups had comparable fetal heart rate tracings, modes of delivery, maternal and neonatal outcomes, and complications. None of the patients in the study experienced aspiration or an indication for general anesthesia.

Conclusion: While our data suggest that eating during labor does not adversely affect labor progression or outcomes, we recommend a cautious approach, allowing patients autonomy while considering individual risk factors.

Trial registration: The study has been registered in the primary clinical trial registry on 02/12/2023. ISRCTN trial number ISRCTN11794106, registration number 44513. https://www.isrctn.com/ISRCTN11794106 .

目的:评估分娩时进食是否会影响分娩结果:这项随机对照研究包括妊娠 37-41 周的健康产妇。硬膜外麻醉后,患者被随机分为随意进食组和仅饮用清水组。主要综合结果包括意外剖宫产、需要全身麻醉、窒息、产后发烧和产后入院时间延长(超过 5 天)。次要结果包括催产素需求、第二产程时间、产后镇痛需求以及早期产妇和新生儿预后。样本量分析表明,需要对 126 名患者进行随机分组,才能检测出两组之间存在统计学意义上的差异:结果:共有 129 名患者被随机分组:结果:共有 129 名患者被随机分配到只输液组和食物组,其中只输液组 58 人,食物组 71 人。两组的基本特征相似。两组患者在分娩过程中因进食引起并发症的综合结果相当。两组的产程进展和催产素使用需求相似。两组的胎儿心率描记、分娩方式、孕产妇和新生儿结局以及并发症均具有可比性。研究中没有一名患者出现吸入或全身麻醉指征:结论:虽然我们的数据表明,分娩过程中进食不会对产程进展或结果产生不利影响,但我们建议采取谨慎的方法,在考虑个体风险因素的同时允许患者自主进食:该研究已于 2023 年 12 月 2 日在主要临床试验注册中心注册。ISRCTN 试验编号为 ISRCTN11794106,注册编号为 44513。https://www.isrctn.com/ISRCTN11794106 。
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引用次数: 0
Davydov-Moore vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome: sexual and surgical outcomes. 戴维多夫-摩尔阴道成形术治疗 Mayer-Rokitansky-Küster-Hauser 综合征:性生活和手术效果。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-13 DOI: 10.1007/s00404-024-07830-6
Magdalena Piróg, Magdalena Bednarczyk, Katarzyna Barabasz, Olga Kacalska-Janssen, Robert Jach

Purpose: The aim of this study was to compare surgical and sexual outcomes after Davidov-Moore vaginoplasty in women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH).

Methods: In the case-series study, we described seven women, at a median age of 22.6 ± and BMI 22.8 ± 2.3 kg/m2. We measured peri- and postsurgical parameters, including surgery-related neovaginal length and sexual initiation time. Sexual outcomes were measured using the Female Sexual Function Index (FSFI) before and 6 months after vaginoplasty.

Results: All surgical procedures were performed successfully, with one minor perioperative bleeding. The mean time of vaginoplasty was 82.1 min and the mean duration of hospitalization was six days. After a 6-month follow-up, vaginal length was 8.1-times longer than before surgery (10 vs. 81 mm). The time from the surgery to the initiation of vaginal intercourse was between 17 to 22 weeks. The mean FSFI score indicated good results, with no women below 23 score, and was 4.3- times higher when compared with the pre-surgical one (6.7 vs 29.1). Contrary to the FSFI score before surgery, the post-surgical FSFI revealed higher scores in all six different domains: desire (2.5-times), arousal (4.1-times), lubrication (3.8-times), orgasm (3.4-times), satisfaction (3.3-times) and comfort (11-times).

Conclusion: Laparoscopic Davydov-Moore vaginoplasty might be considered as a safe procedure with satisfactory anatomic and sexual outcomes. It should be considered as a treatment option for the creation of neovagina in women with MRKH.

目的:本研究旨在比较 Mayer-Rokitansky-Küster-Hauser 综合征(MRKH)女性患者在接受 Davidov-Moore 阴道成形术后的手术效果和性生活质量:在病例系列研究中,我们描述了七名女性,中位年龄(22.6±)岁,体重指数(BMI)(22.8±2.3 kg/m2)。我们测量了手术前后的参数,包括手术相关的新阴道长度和性生活开始时间。在阴道成形术前和术后 6 个月,我们使用女性性功能指数(FSFI)对性功能结果进行了测量:结果:所有手术均顺利完成,只有一次围手术期轻微出血。阴道成形术的平均时间为 82.1 分钟,平均住院时间为 6 天。随访 6 个月后,阴道长度是手术前的 8.1 倍(10 毫米对 81 毫米)。从手术到开始阴道性交的时间为 17-22 周。平均 FSFI 评分显示效果良好,没有女性低于 23 分,是手术前的 4.3 倍(6.7 vs 29.1)。与手术前的 FSFI 分数相反,手术后的 FSFI 在所有六个不同领域的得分都更高:欲望(2.5 倍)、唤醒(4.1 倍)、润滑(3.8 倍)、高潮(3.4 倍)、满意(3.3 倍)和舒适(11 倍):结论:腹腔镜达维多夫-摩尔阴道成形术可被视为一种安全的手术,其解剖和性功能效果令人满意。结论:腹腔镜达维多夫-摩尔阴道成形术可被视为一种安全的手术,其解剖和性生活效果令人满意,应被考虑作为MRKH女性建立新阴道的一种治疗方案。
{"title":"Davydov-Moore vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome: sexual and surgical outcomes.","authors":"Magdalena Piróg, Magdalena Bednarczyk, Katarzyna Barabasz, Olga Kacalska-Janssen, Robert Jach","doi":"10.1007/s00404-024-07830-6","DOIUrl":"https://doi.org/10.1007/s00404-024-07830-6","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to compare surgical and sexual outcomes after Davidov-Moore vaginoplasty in women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH).</p><p><strong>Methods: </strong>In the case-series study, we described seven women, at a median age of 22.6 ± and BMI 22.8 ± 2.3 kg/m<sup>2</sup>. We measured peri- and postsurgical parameters, including surgery-related neovaginal length and sexual initiation time. Sexual outcomes were measured using the Female Sexual Function Index (FSFI) before and 6 months after vaginoplasty.</p><p><strong>Results: </strong>All surgical procedures were performed successfully, with one minor perioperative bleeding. The mean time of vaginoplasty was 82.1 min and the mean duration of hospitalization was six days. After a 6-month follow-up, vaginal length was 8.1-times longer than before surgery (10 vs. 81 mm). The time from the surgery to the initiation of vaginal intercourse was between 17 to 22 weeks. The mean FSFI score indicated good results, with no women below 23 score, and was 4.3- times higher when compared with the pre-surgical one (6.7 vs 29.1). Contrary to the FSFI score before surgery, the post-surgical FSFI revealed higher scores in all six different domains: desire (2.5-times), arousal (4.1-times), lubrication (3.8-times), orgasm (3.4-times), satisfaction (3.3-times) and comfort (11-times).</p><p><strong>Conclusion: </strong>Laparoscopic Davydov-Moore vaginoplasty might be considered as a safe procedure with satisfactory anatomic and sexual outcomes. It should be considered as a treatment option for the creation of neovagina in women with MRKH.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613650","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
Comparison of different histomorphological grading systems in vulvar squamous cell carcinoma. 外阴鳞状细胞癌不同组织形态学分级系统的比较。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-09 DOI: 10.1007/s00404-024-07809-3
Gilbert Georg Klamminger, Annick Bitterlich, Meletios P Nigdelis, Bashar Haj Hamoud, Erich Franz Solomayer, Mathias Wagner

Background: Histopathological biomarkers of carcinomas and their prognostic relevance, such as Broder's grading system (based on the total number of undifferentiated cells) or Bryne's grading system (rating morphological features at the tumor invasive front), have been repeatedly and successfully put to test. Since most studies focus on head and neck cancers or oral carcinomas, for squamous cell carcinoma of the vulva, no standardized and agreed on pathological tumor grading system, yielding prognostic significance, could be determined so far.

Material and methods: To determine prognostic associations of different grading systems with regard to groin lymph node metastasis, 73 cases of vulvar carcinomas (VC) were re-examined within our study and Broder's and Bryne's grading system individually performed. To sub-classify between HPV-associated or HPV-independent VC, immunohistochemical p16 stainings were performed. Statistical relationships were evaluated using Spearman correlation and logistic regression analysis, validation was achieved by employment of the likelihood ratio test (LRT) and assessment of ROC curves/AUC values.

Results: Within our cohort, Broder's grade I (40≈55%) and Bryne's grade II (48≈66%) were the most frequently assigned histological gradings. We determined a positive correlation of Bryne's grading with the extent of lymph node involvement in HPV-associated tumors and demonstrated the feasibility of Bryne's grading to predict the presence of carcinoma cells within groin lymph nodes (LRT p = 0.0066; AUC value≈0.91) in this cohort. On the other hand, our data suggest that especially HPV-independent tumors may not sufficiently be characterized by current standardly performed grading approaches.

Conclusion: Since only Bryne's grading system correlated positively with lymph node involvement in HPV-associated squamous cell carcinoma of the vulva, we propose to include it by name next to the distinct tumor entity on the histopathological report, allowing not only the interpretation of its prognostic relevance but also future research attempts.

背景:癌症的组织病理学生物标志物及其预后相关性,如 Broder 分级系统(基于未分化细胞的总数)或 Bryne 分级系统(评定肿瘤浸润前沿的形态特征),已被反复成功地应用于测试。由于大多数研究都集中在头颈部癌或口腔癌上,对于外阴鳞状细胞癌,迄今为止还没有一个标准化的、一致认可的、具有预后意义的肿瘤病理分级系统:为了确定不同分级系统与腹股沟淋巴结转移的预后关系,我们重新检查了 73 例外阴癌(VC),并分别采用了 Broder 和 Bryne 分级系统。为了将外阴癌细分为HPV相关型和HPV非相关型,对其进行了免疫组化p16染色。统计关系采用斯皮尔曼相关分析和逻辑回归分析进行评估,验证采用似然比检验(LRT)和 ROC 曲线/AUC 值评估:在我们的队列中,布罗德分级 I 级(40≈55%)和布莱尼分级 II 级(48≈66%)是最常见的组织学分级。我们确定布氏分级与 HPV 相关肿瘤的淋巴结受累程度呈正相关,并证明布氏分级可用于预测腹股沟淋巴结内是否存在癌细胞(LRT p = 0.0066;AUC 值≈0.91)。另一方面,我们的数据表明,目前标准的分级方法可能无法充分描述不依赖于 HPV 的肿瘤的特征:结论:由于只有Bryne分级系统与HPV相关外阴鳞状细胞癌的淋巴结受累呈正相关,因此我们建议在组织病理学报告中将其命名为肿瘤实体,这样不仅可以解释其预后相关性,还能为未来的研究提供参考。
{"title":"Comparison of different histomorphological grading systems in vulvar squamous cell carcinoma.","authors":"Gilbert Georg Klamminger, Annick Bitterlich, Meletios P Nigdelis, Bashar Haj Hamoud, Erich Franz Solomayer, Mathias Wagner","doi":"10.1007/s00404-024-07809-3","DOIUrl":"https://doi.org/10.1007/s00404-024-07809-3","url":null,"abstract":"<p><strong>Background: </strong>Histopathological biomarkers of carcinomas and their prognostic relevance, such as Broder's grading system (based on the total number of undifferentiated cells) or Bryne's grading system (rating morphological features at the tumor invasive front), have been repeatedly and successfully put to test. Since most studies focus on head and neck cancers or oral carcinomas, for squamous cell carcinoma of the vulva, no standardized and agreed on pathological tumor grading system, yielding prognostic significance, could be determined so far.</p><p><strong>Material and methods: </strong>To determine prognostic associations of different grading systems with regard to groin lymph node metastasis, 73 cases of vulvar carcinomas (VC) were re-examined within our study and Broder's and Bryne's grading system individually performed. To sub-classify between HPV-associated or HPV-independent VC, immunohistochemical p16 stainings were performed. Statistical relationships were evaluated using Spearman correlation and logistic regression analysis, validation was achieved by employment of the likelihood ratio test (LRT) and assessment of ROC curves/AUC values.</p><p><strong>Results: </strong>Within our cohort, Broder's grade I (40≈55%) and Bryne's grade II (48≈66%) were the most frequently assigned histological gradings. We determined a positive correlation of Bryne's grading with the extent of lymph node involvement in HPV-associated tumors and demonstrated the feasibility of Bryne's grading to predict the presence of carcinoma cells within groin lymph nodes (LRT p = 0.0066; AUC value≈0.91) in this cohort. On the other hand, our data suggest that especially HPV-independent tumors may not sufficiently be characterized by current standardly performed grading approaches.</p><p><strong>Conclusion: </strong>Since only Bryne's grading system correlated positively with lymph node involvement in HPV-associated squamous cell carcinoma of the vulva, we propose to include it by name next to the distinct tumor entity on the histopathological report, allowing not only the interpretation of its prognostic relevance but also future research attempts.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613646","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
Assessment of the development of the central nervous system in fetuses with fetal growth restriction. 评估胎儿生长受限的中枢神经系统发育情况。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-08 DOI: 10.1007/s00404-024-07804-8
Xiaohan Wang, Chunli Wang, Wenming Yang, Qing Yao, Linhui Zuo

Objectives: To evaluate the development of the central nervous system in fetuses with fetal Growth Restriction.

Methods: A total of 146 pregnant women who underwent prenatal ultrasonography in Cangzhou People's Hospital from January 2022 to May 2024 were selected, all with singleton pregnancies. Among them, 73 fetuses were in the fetal growth restriction group, with ages ranging from 20 to 33 + 6 weeks. The indicators for evaluating the cerebral sulci included the depth and angle of the parietooccipital sulci, the width and depth of the sylvian fissure, the width of the uncovered insula, uncover insular ratio, the depth of the calcarine sulci, and the head circumference. The hemodynamic indicators comprised the ratio of the umbilical artery resistance index, the umbilical artery pulse index, the middle cerebral artery resistance index, the middle cerebral artery pulse index, and the cerebral placental blood flow pulse index. The above parameters were analyzed statistically.

Results: In this study, the depth of the parietooccipital sulci, the depth of the calcarine sulci, and the width of the sylvian fissure were smaller in the fetal growth restriction group than those in the control group, and the angle of the parietooccipital sulci and the width of the uncovered insula were larger than those in the control group (all P < 0.05). The fetal middle cerebral artery resistance index, middle cerebral artery pulsation index and cerebroplacental pulsation ratio in the FGR group were lower than those in the control group (all P < 0.05).

Conclusions: The development of the cerebral cortex in FGR fetuses is slower than that in normal fetuses, and the alteration of fetal hemodynamics might be one of the reasons for the delayed development of the cerebral cortex in FGR fetuses.

目的: 评估胎儿生长受限胎儿的中枢神经系统发育情况:评估胎儿生长受限胎儿的中枢神经系统发育情况:选取 2022 年 1 月至 2024 年 5 月在沧州市人民医院进行产前超声检查的 146 例孕妇,均为单胎妊娠。其中,胎儿生长受限组 73 例,胎龄为 20~33+6 周。评估脑沟的指标包括顶枕沟的深度和角度、颅裂的宽度和深度、未覆盖岛叶的宽度、未覆盖岛叶比率、钙沟深度和头围。血液动力学指标包括脐动脉阻力指数比值、脐动脉脉搏指数、大脑中动脉阻力指数、大脑中动脉脉搏指数和大脑胎盘血流脉搏指数。对上述参数进行统计分析:本研究中,胎儿生长受限组的顶枕沟深度、钙沟深度和颅裂宽度均小于对照组,顶枕沟角度和无盖岛宽度大于对照组(均为P 结论:胎儿生长受限组的大脑皮层发育明显优于对照组:FGR胎儿大脑皮层的发育比正常胎儿慢,胎儿血流动力学的改变可能是FGR胎儿大脑皮层发育延迟的原因之一。
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引用次数: 0
Real-world data of perioperative complications in prepectoral implant-based breast reconstruction: a prospective cohort study. 前胸植入物乳房再造术围手术期并发症的真实数据:前瞻性队列研究。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-07 DOI: 10.1007/s00404-024-07807-5
Moritz Hamann, Elena Bensmann, Anne Andrulat, Jasmin Festl, Gitti Saadat, Evelyn Klein, Dimitrios Chronas, Michael Braun

Purpose: To analyze complications and potential risk factors associated with immediate prepectoral direct-to-implant breast reconstruction (DTIBR).

Methods: 295 patients (326 operated breasts) with DTIBR between March 2021 and December 2023 were included in this prospective study. Postoperative complications (postoperative bleeding, seroma, infection, necrosis, wound dehiscence, implant exchange/loss) were analyzed for potential risk factors by descriptive and logistic regression analyses.

Results: The implant was covered by TiLOOP® Bra Pocket in 227 breasts (69.6%), by "dual-plane" technique in 20 breasts (6.1%), by acellular dermal matrix (ADM) in 1 breast (0.3%). No additional support was used for 78 breasts (23.9%). The use of mesh did not increase the risk for complications. Major complications requiring surgical revision occurred due to postoperative bleeding in 22 (6.7%), seroma in 2 (0.6%), infection in 13 (4.0%), necrosis in 10 (3.1%), and wound dehiscence in 10 (3.1%) breasts. Thirteen (4.0%) implants were exchanged, and 5 (1.5%) were explanted without substitution. One patient had to switch to autologous reconstruction due to skin necrosis. The main reasons for the removal/exchange of implants were infections (11 breasts, 3.4%) and necrosis (4 breasts, 1.2%). The risk for necrosis, infection, and wound dehiscence was mainly associated with the type of incision, especially skin-reducing incisions, and body mass index (BMI) ≥ 30 kg/m2.

Conclusion: Severe complications occurred primarily in patients with a BMI ≥ 30 kg/m2 and when skin-reducing surgical techniques were performed.

Trial registry: This study was retrospectively registered at the German Clinical Trials Register (DRKS) on 20.06.2024.

Drks-id: DRKS00034493. https://drks.de/search/de/trial/DRKS00034493 .

目的:分析与胸前即刻直接植入乳房重建术(DTIBR)相关的并发症和潜在风险因素。方法:这项前瞻性研究纳入了2021年3月至2023年12月期间接受DTIBR的295名患者(326个手术乳房)。通过描述性分析和逻辑回归分析,对术后并发症(术后出血、血清肿、感染、坏死、伤口裂开、假体置换/丢失)的潜在风险因素进行了分析:227 例乳房(69.6%)使用了 TiLOOP® 胸袋覆盖假体,20 例乳房(6.1%)使用了 "双平面 "技术,1 例乳房(0.3%)使用了非细胞真皮基质(ADM)。78个乳房(23.9%)未使用额外的支撑物。使用网片不会增加并发症的风险。需要进行手术翻修的主要并发症有:22 例(6.7%)术后出血、2 例(0.6%)血清肿、13 例(4.0%)感染、10 例(3.1%)坏死、10 例(3.1%)伤口裂开。13例(4.0%)患者更换了假体,5例(1.5%)患者在未更换假体的情况下进行了手术。一名患者因皮肤坏死不得不改用自体重建。移除/更换假体的主要原因是感染(11 例乳房,3.4%)和坏死(4 例乳房,1.2%)。坏死、感染和伤口开裂的风险主要与切口类型(尤其是缩减皮肤的切口)和体重指数(BMI)≥ 30 kg/m2有关:结论:严重并发症主要发生在体重指数(BMI)≥ 30 kg/m2的患者和采用减张皮肤手术技术的患者:本研究于2024年6月20日在德国临床试验注册中心(DRKS)进行了回顾性注册:https://drks.de/search/de/trial/DRKS00034493 .
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引用次数: 0
Impact of HIV infection on cervical intraepithelial neoplasia detection in pregnant and non-pregnant women in Germany: a cross-sectional study. 艾滋病病毒感染对德国孕妇和非孕妇宫颈上皮内瘤变检测的影响:一项横断面研究。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-07 DOI: 10.1007/s00404-024-07813-7
Irena Rohr, Anna Sophie Skof, Michaela Heinrich-Rohr, Fabian Weiss, Jan-Peter Siedentopf, Katharina von Weizsäcker, Irene Alba Alejandre, Wolfgang Henrich, Jalid Sehouli, Charlotte K Metz

Purpose: Women living with HIV (WLWH) are frequently affected by cervical dysplasia caused by Human Papillomavirus (HPV) and invasive cervical cancer (CxCa). CxCa screening programs can include colposcopy, cytology, and HPV testing. These methods, however, have limitations in effectively stratifying cervical dysplasia. This study aimed to evaluate the applicability of an innovative mRNA-based multiplexed expression-quantifying assay in the detection and assessment of cervical dysplasia in WLWH.

Methods: The QuantiGene-Molecular-Profiling-Histology Assay (QG-MPH) was used to detect and quantify HPV oncogene and cellular biomarker mRNA expression. These results were included in the Risk Score (QG-MPH RS) calculations that inform about the presence and severity of dysplasia. QG-MPH RS results were compared to the highly sensitive Multiplexed Papillomavirus Genotyping (MPG) Assay and clinical results obtained by cytology, colposcopy and histology. For a standardized nomenclature of clinical results, the clinical ASSIST Score was used.

Results: Of 241 WLWH, including 96 pregnant women, a concordance between the QG-MPH RS and the ASSIST Score was found to 36.3% (49/135) in non-pregnant WLWH and 67.1% (57/85) in pregnant WLWH. The QG-MPH method demonstrated high specificity for detecting high-risk HPV (HR-HPV) genotypes and high-grade cervical dysplasia, achieving 89.6% and 82.4%, respectively, including pregnant and non-pregnant WLWH.

Conclusion: The QG-MPH assay shows potential for improving the detection and management of HPV-related cervical dysplasia in WLWH, including pregnant women. Its high specificity, however, is tempered by its tendency to overestimate dysplasia severity in certain cases, indicating that further research is needed to refine its use as a reliable diagnostic tool for this high-risk population.

目的:感染艾滋病毒的妇女(WLWH)经常受到人类乳头瘤病毒(HPV)引起的宫颈发育不良和浸润性宫颈癌(CxCa)的影响。宫颈癌筛查项目包括阴道镜检查、细胞学检查和 HPV 检测。然而,这些方法在对宫颈发育不良进行有效分层方面存在局限性。本研究旨在评估一种基于 mRNA 的创新型多重表达定量检测方法在检测和评估 WLWH 宫颈发育不良中的适用性:方法:采用定量基因分子成纤维组织学检测法(QG-MPH)检测并量化HPV癌基因和细胞生物标志物mRNA的表达。这些结果被纳入风险评分(QG-MPH RS)计算中,以告知是否存在发育不良及其严重程度。QG-MPH RS 结果与高灵敏度的多重乳头状瘤病毒基因分型(MPG)检测法以及细胞学、阴道镜检查和组织学检查的临床结果进行了比较。为了对临床结果进行标准化命名,采用了临床 ASSIST 评分:结果:在 241 名 WLWH(包括 96 名孕妇)中,QG-MPH RS 与 ASSIST 评分的一致性在非孕妇 WLWH 中为 36.3%(49/135),在孕妇 WLWH 中为 67.1%(57/85)。QG-MPH 方法在检测高危型 HPV(HR-HPV)基因型和高级别宫颈发育不良方面表现出很高的特异性,在怀孕和未怀孕的 WLWH 中分别达到 89.6% 和 82.4%:结论:QG-MPH 检测法具有改善 WLWH(包括孕妇)HPV 相关宫颈发育不良的检测和管理的潜力。然而,其特异性较高,但在某些情况下容易高估发育不良的严重程度,这表明还需要进一步的研究来完善它,使其成为这一高风险人群的可靠诊断工具。
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引用次数: 0
Impact of meconium-stained amniotic fluid thickness on maternal infectious morbidity: a comprehensive clinical and microbiological analysis. 胎粪染色羊水厚度对孕产妇感染性发病率的影响:临床和微生物学综合分析。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-07 DOI: 10.1007/s00404-024-07808-4
Raneen Abu Shqara, Lior Lowenstein, Maya Frank Wolf

Purpose: The aim of this study was to investigate the correlation between the thickness of meconium-stained amniotic fluid (MSAF) and maternal infectious morbidity.

Methods: A retrospective study of 15,950 term singleton pregnancies at a tertiary hospital (2020-2024). Women were categorized into four groups based on the presence and thickness of MSAF: clear, light, intermediate, and thick. The co-primary outcomes were clinical chorioamnionitis and puerperal endometritis, defined as a composite maternal infectious morbidity. In women with intrapartum fever (IPF), chorioamniotic swabs were obtained and compared according MSAF thickness. Multivariate analysis identified predictors of a composite maternal infections and adverse neonatal outcomes.

Results: Of the cohort, 13,745 had clear amniotic fluid, and 2,205 had MSAF (561 light, 1,426 intermediate, 218 thick). The incidence of maternal infections increased with MSAF thickness, with thick MSAF showing the highest rates of clinical chorioamnionitis (4.1%, p < 0.001) and endometritis (1.4%, p = 0.039). In IPF cases, thicker MSAF was associated with a higher prevalence of positive swab cultures, particularly of Enterobacteriaceae (61.9%). Group B Streptococcus (GBS) remained consistent across all MSAF groups. Multivariate analysis showed that MSAF levels were associated with increased maternal infectious morbidity (p < 0.001). Additional risk factors for maternal infections included nulliparity (p < 0.001), catheter balloon insertion (p = 0.004), prolonged ROM (p < 0.001), and cesarean delivery (p < 0.001). In contrast, only intermediate (p < 0.001) and thick MSAF (p < 0.001) correlated with adverse neonatal outcomes.

Conclusion: Greater severity of MSAF is associated with increased maternal infectious morbidity, especially infections related to Enterobacteriaceae. Studies about preventive measures in cases of thick MSAF are warranted.

目的:本研究旨在探讨胎粪染色羊水(MSAF)厚度与孕产妇感染性发病率之间的相关性:方法:对一家三甲医院的 15950 例足月单胎妊娠(2020-2024 年)进行回顾性研究。根据 MSAF 的存在和厚度将孕妇分为四组:透明组、轻度组、中度组和重度组。共同主要结果是临床绒毛膜羊膜炎和产褥期子宫内膜炎,定义为孕产妇感染性疾病的综合发病率。在产褥热(IPF)产妇中,采集绒毛膜羊膜拭子并根据 MSAF 厚度进行比较。多变量分析确定了产妇综合感染和新生儿不良结局的预测因素:13,745 名产妇的羊水是透明的,2,205 名产妇的羊水为 MSAF(轻度 561 例、中度 1,426 例、重度 218 例)。产妇感染的发生率随 MSAF 厚度的增加而增加,厚 MSAF 显示临床绒毛膜羊膜炎的发生率最高(4.1%,p 结论:MSAF 的严重程度越高,产妇感染的发生率就越高:MSAF 的严重程度与孕产妇感染发病率的增加有关,尤其是与肠杆菌科细菌有关的感染。有必要对厚重的 MSAF 病例进行预防措施研究。
{"title":"Impact of meconium-stained amniotic fluid thickness on maternal infectious morbidity: a comprehensive clinical and microbiological analysis.","authors":"Raneen Abu Shqara, Lior Lowenstein, Maya Frank Wolf","doi":"10.1007/s00404-024-07808-4","DOIUrl":"https://doi.org/10.1007/s00404-024-07808-4","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to investigate the correlation between the thickness of meconium-stained amniotic fluid (MSAF) and maternal infectious morbidity.</p><p><strong>Methods: </strong>A retrospective study of 15,950 term singleton pregnancies at a tertiary hospital (2020-2024). Women were categorized into four groups based on the presence and thickness of MSAF: clear, light, intermediate, and thick. The co-primary outcomes were clinical chorioamnionitis and puerperal endometritis, defined as a composite maternal infectious morbidity. In women with intrapartum fever (IPF), chorioamniotic swabs were obtained and compared according MSAF thickness. Multivariate analysis identified predictors of a composite maternal infections and adverse neonatal outcomes.</p><p><strong>Results: </strong>Of the cohort, 13,745 had clear amniotic fluid, and 2,205 had MSAF (561 light, 1,426 intermediate, 218 thick). The incidence of maternal infections increased with MSAF thickness, with thick MSAF showing the highest rates of clinical chorioamnionitis (4.1%, p < 0.001) and endometritis (1.4%, p = 0.039). In IPF cases, thicker MSAF was associated with a higher prevalence of positive swab cultures, particularly of Enterobacteriaceae (61.9%). Group B Streptococcus (GBS) remained consistent across all MSAF groups. Multivariate analysis showed that MSAF levels were associated with increased maternal infectious morbidity (p < 0.001). Additional risk factors for maternal infections included nulliparity (p < 0.001), catheter balloon insertion (p = 0.004), prolonged ROM (p < 0.001), and cesarean delivery (p < 0.001). In contrast, only intermediate (p < 0.001) and thick MSAF (p < 0.001) correlated with adverse neonatal outcomes.</p><p><strong>Conclusion: </strong>Greater severity of MSAF is associated with increased maternal infectious morbidity, especially infections related to Enterobacteriaceae. Studies about preventive measures in cases of thick MSAF are warranted.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602917","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
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Archives of Gynecology and Obstetrics
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