Archives of Gynecology and Obstetrics最新文献

Objective: To evaluate the residual risk of clinically significant copy number variations (CNVs) in fetuses with ultrasonographic soft markers by its various types after excluding theoretically non-invasive prenatal screening (NIPS)-detectable abnormalities.

Methods: This study included 2005 fetuses with soft markers undergoing chromosomal microarray analysis (CMA) between 2015 and 2024. Theoretically NIPS-detectable findings were categorized into three subgroups: 3-chromosome NIPS, 5-chromosome NIPS, and genome-wide NIPS. The residual risk was calculated and compared with a low-risk control cohort. We further assessed their clinical outcomes.

Results: The overall diagnostic yield of clinically significant CMA findings in fetuses with soft markers was 6.38%. Overall, the residual risk was 4.67% for 3-chromosome NIPS, 4.19% for 5-chromosome NIPS, and 3.25% for genome-wide NIPS. Except for isolated single umbilical artery (genome-wide NIPS), echogenic intracardiac focus, and aberrant right subclavian artery (all NIPS models), the residual risk was significantly higher for most soft marker types when compared with the control cohort. Among fetuses with normal CMA results and successful follow-up, a significantly lower rate of normal infant was identified in fetuses with four types of soft markers (mild ventriculomegaly, echogenic bowel, short femur length, and mild pyelectasis) compared with the control cohort.

Conclusion: The residual risk in fetuses with multiple soft markers and most isolated soft markers (absent or hypoplastic nasal bone, mild ventriculomegaly, thickened nuchal fold, echogenic bowel, short femur length, mild pyelectasis, and choroid plexus cysts) was higher than that in low-risk pregnancies. CNV analysis is recommended for such fetuses, regardless of whether NIPS has been performed previously.

Introduction: Anonymous (or confidential) forensic evidence collection (AFC; German: Anonyme Spurensicherung [ASS]) following sexual offenses plays a critical role in the initial care of affected individuals. Comprehensive execution of this procedure presents a significant challenge in the clinical routine care of gynecologists, as legal requirements, court-admissible documentation of injuries, and forensic evidence preservation often lead to uncertainty. The implementation of forensic evidence collection as a statutory health insurance benefit, following the Measles Protection Act (Masernschutzgesetz), has been effective in North Rhine-Westphalia since March 1, 2025, and is currently being formalized in contractual agreements. The objective of this study is to track the utilization of AFC, raise awareness of this topic, and identify common problems associated with its execution.

Materials and methods: Systematic compilation of annual case numbers for anonymous forensic evidence collection (AFC) was performed from June 2011 to December 2024 at the Department of Obstetrics and Gynecology, University Hospital Cologne. This was followed by a statistical evaluation of the percentage increase and the annual mean values.

Results: A total of 177 cases were documented at the University Hospital Cologne. Between 2012 and 2024, the annual case numbers increased from eight to 25 cases. The average number of cases examined annually during the observation period was 13.15. This corresponds to an average annual increase of approximately 17%, totaling 215% over 11 years, when considering 2012 as the first complete year for data analysis. Frequent issues encountered in clinical practice include improper storage (until transport to the Institute of Legal Medicine) and incorrect labeling of collected samples.

Conclusions: The observed increase in the number of alleged victims of sexual violence requiring examination supports the health policy assumption that structured and correct forensic evidence collection is becoming increasingly vital. Adequate funding for the examination and the storage of evidence carriers is mandatory for long-term quality assurance. This is the only way to ensure optimal support and care for presumed victims in these stressful situations.

Introduction: Postpartum sexual health and practice need to be integrated into the current maternal healthcare services to address sexual health problems. However, postpartum sexual practice has received little attention and is not often discussed by healthcare providers during prenatal and postnatal care, even though evidence is scarce on the spatial distribution of early resumption of postpartum sexual intercourse in Ethiopia.

Objective: The current study aimed to demonstrate the median time to resumption of postpartum sexual intercourse and the spatial distribution of early resumption of postpartum sexual intercourse in Ethiopia.

Methods: A cross-sectional study was employed based on the Ethiopian demographic and health survey 2016 data, and 6456 postpartum period women were included. Arc GIS version 10.7 and SaTScan version 9.6 software were used. Mixed-effect analysis was done by STATA version 14 software. Bivariate analysis was done, and variables with a p value < 0.2 were taken as candidates for multilevel multivariable logistic regression. Intra Class Correlation Coefficient (ICC), Proportion Change in Variance (PCV), and Median Odds Ratio (MOR) were used for model comparison, and Adjusted Odds Ratio (AOR) with respect to a 95% confidence interval was used for declaring statistical significance. In the multivariable analysis, a p value ≤ 0.05 was considered as a cut point of statistical significance with the outcome variable.

Results: The spatial distribution of early resumption of postpartum sexual intercourse was not random. Not married (Adjusted Odds Ratio (AOR = 0.31; 95% CI 0.25, 0.39), sex of child female (AOR = 0.87; 95% CI 0.81,0.93), protestant in religion (AOR = 0.68; 95% CI 0.58, 0.79), ever breastfeeding (AOR = 1.35; 95% CI 1.12, 1.63), and multiparity (AOR = 1.16; 95%, 1.03, 1.30) were variables significantly associated with early resumption of postpartum sexual intercourse.

Conclusions: The spatial distribution of early resumption of postpartum sexual intercourse was not random. We need to give attention to those hotspot areas and factors significantly associated with early resumption of postpartum sexual intercourse. Reproductive and maternal health program managers and policymakers need to pay attention to those hotspot areas and significant variables to achieve the Sustainable Development Goal.

Background: Current therapeutic strategies for thin endometrium have inherent limitations, and zero-time exercise (ZTEx), a professionally guided fragmented low-intensity exercise, may serve as a novel adjunctive intervention for its management.

Methods: This was a single-center randomized sham-controlled trial. Eligible patients undergoing ART were randomly divided into an experimental group (receiving ZTEx intervention) and a control group (receiving sham intervention). The ZTEx intervention was delivered over 12 weeks, featuring fragmented, low-intensity exercises under professional guidance. Key indicators of endometrial health-including endometrial thickness and endometrial receptivity-related parameters-were monitored throughout the intervention period.

Results: After 12 weeks of intervention, ANCOVA (adjusted for baseline values) revealed that the experimental group had a significantly greater endometrial thickness than the control group (6.67 ± 1.15 mm vs. 5.88 ± 1.17 mm, P < 0.001). Concurrently, multiple endometrial receptivity-related indices improved significantly in the experimental group (all P < 0.05), including uterine artery hemodynamic parameters (pulsatility index [PI], resistance index [RI], systolic/diastolic ratio [S/D]) and vascularization indices (vascularization index [VI], flow index [FI], vascularization-flow index [VFI]).No exercise-related adverse events were reported over the course of the trial, confirming the safety profile of ZTEx.

Conclusions: Supported by rigorous statistical analyses, ZTEx effectively enhances endometrial thickness and receptivity in ART patients with thin endometrium. Its key advantages-safety, feasibility, and no need for additional time or equipment-make it a promising adjuvant intervention in clinical ART settings.

Background: Given the concerns regarding maternal and neonatal safety, the application of enhanced recovery after surgery (ERAS) in cesarean delivery remains controversial and has not been adopted in some regions. This study aims to conduct a meta-analysis to compare the ERAS pathway with conventional postoperative care, in order to provide evidence on the safety and efficacy of the ERAS protocols.

Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, and CBM were searched from their inception until February 2025. Randomized controlled trials (RCTs) published in English or Chinese that compared the ERAS and standard care in cesarean section were eligible for inclusion. Two reviewers independently extracted the data and assessed the risk of bias using the Cochrane risk-of-bias tool. The analyses were conducted using RevMan 5.4 software, and the results were presented as forest plots.

Results: Out of 2817 records screened, 10 RCTs comprising 1934 participants met the inclusion criteria. The pooled analyses indicated that ERAS protocols significantly reduced the length of hospital stay (MD -14.13, 95% CI -25.36 to -2.90; p = 0.01), hospitalization costs (MD -447.85, 95% CI -687.04 to -208.66; p = 0.0002), time to first flatus (MD -9.82, 95% CI -13.54 to -6.10; p < 0.00001), time to first stool (MD -15.35, 95% CI -19.10 to -11.60; p < 0.00001), pain sores (MD -1.54, 95% CI -2.10 to -0.99; p < 0.00001), and postpartum hemorrhage (MD -47.75, 95% CI -69.94 to -25.55; p < 0.0001). No statistically significant differences were observed between ERAS and conventional standard recovery in terms of postoperative nausea and vomiting (PONV), urinary retention, postoperative infection, deep venous thrombosis (DVT), 30 days readmission rates, and NICU admission rates.

Conclusions: The adoption of ERAS protocols in cesarean delivery is associated with accelerated postoperative recovery without compromising maternal or neonatal safety. Nevertheless, these findings should be approached with caution due to the limited number and heterogeneity of the studies included.