Archives of Gynecology and Obstetrics最新文献

Background

Cardiovascular diseases (CVD) are the leading cause of death among women, with risk increasing after menopause. Lipid levels are key biomarkers, yet conventional blood tests remain invasive and underutilized. Non-invasive technologies and machine learning (ML) may offer new approaches to lipid monitoring and risk assessment using wearable devices and biosensors.

Objective

This systematic review investigates the availability, accuracy, and clinical applicability of minimally and non-invasive lipid monitoring methods and ML-based cardiovascular risk estimation in adults.

Methods

A systematic search was conducted in MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov (2010–2024). Studies in English were included; case reports and animal studies were excluded. Data extraction focused on devices, measurement approach, and predictive utility for cardiovascular outcomes. Methodological heterogeneity was addressed through narrative synthesis and thematic grouping (Thomas in Cochrane Handb Syst Rev Interv, 2024).

Results

From 14,863 records, 37 studies were included. Near-infrared, saliva-based, and smartphone-enabled fingertip devices showed promising accuracy. ML models using wearable-derived physiological data demonstrated moderate success in predicting cardiovascular risk and lipid levels.

Conclusion

Minimally and non-invasive lipid monitoring and ML-based risk prediction may support accessible, personalized cardiovascular risk management. Despite encouraging findings, validation in large-scale, long-term studies is essential before clinical adoption.

Trial registration

Title registration number (on PROSPERO): CRD420251105896

Key message

Transcervical radiofrequency ablation is a low-risk, uterus-preserving option for symptomatic fibroids in women with obesity with significant improvement of bleeding disorder, including ≥ 40 kg/m². Obesity should not preclude offering TFA.

Objective

To evaluate the safety and effectiveness of transcervical radiofrequency ablation (TFA) for uterine fibroids in women with obesity.

Methods

Retrospective multicenter cohort at two German Fibroid Centers. From 574 consecutive TFA cases, we included patients with BMI ≥ 30 kg/m² and ≥ 6-month follow-up; those with incomplete data were excluded. Fibroids were characterized by ultrasound. TFA (Sonata®) was performed per instructions for use. Outcomes were perioperative complications and patient-reported improvement in abnormal uterine bleeding (AUB).

Results

Sixty patients were analyzed (age 43.59 ± 6.52 years; BMI 35.72 ± 6.72 kg/m²). Mean operative and ablation times were 33.65 and 9.91 min, respectively. One intraoperative bleeding event (1.7%) was controlled with a balloon catheter; no postoperative complications occurred. Mean follow-up was 17.08 months (6–54). Overall, 42/60 (70.0%) reported AUB improvement. By BMI category: 30–34.9 kg/m² 25/39 (64.1%), 35–39.9 kg/m² 5/7 (71.4%), ≥ 40 kg/m² 12/14 (85.7%) (p = 0.3168). Considering the initial assessment, 48/60 (80.0%) improved; six later recurred, yielding 42/60 (70.0%) at last follow-up.

Conclusion

TFA showed a very low complication rate and clinically meaningful bleeding improvement in women with obesity, with comparable outcomes across BMI strata, including ≥ 40 kg/m². Obesity is not a barrier to safe, effective TFA. Prospective, BMI-stratified studies with validated bleeding measures and objective endpoints are warranted.

Purpose

Atypical endometrial hyperplasia (AEH) is a known precursor to endometrioid endometrial carcinoma. However, occult carcinoma may already be present at diagnosis, complicating surgical planning. Accurate preoperative risk stratification is crucial, especially for guiding the selective use of sentinel lymph node biopsy. This study aimed to identify predictors of occult carcinoma and develop a model to estimate the risk of malignancy.

Methods

We conducted a retrospective case–control study of 101 women diagnosed with AEH who underwent hysterectomy between 2010 and 2024 at Galilee Medical Center. Clinical, metabolic, and imaging data were extracted. Patients were stratified based on the final pathology into two groups: those with occult carcinoma and those with AEH only. Multivariable logistic regression was employed to identify independent predictors and construct a predictive model.

Results

Occult endometrial carcinoma was identified in 37 women (36.6%). Women with occult endometrial carcinoma were older and more likely to present with postmenopausal bleeding. Occult carcinoma was more frequently detected after Pipelle biopsy than after hysteroscopy or dilation and curettage (43.2% vs. 17.2%). In multivariable analysis, Pipelle biopsy (OR 4.68), hyperlipidemia (OR 5.86), obesity (OR 2.97), and increasing age (OR 1.07 per year) were independently associated with occult carcinoma. A predictive model estimated individual risk ranging from 5.6% to 95.0% according to accumulation of risk factors.

Conclusion

Older age, biopsy method, obesity, hyperlipidemia, and bleeding presentation are independently associated with an occult endometrial carcinoma in women with atypical endometrial hyperplasia. The proposed model may support preoperative risk stratification and counseling, but it requires external validation before clinical use, including decisions regarding sentinel lymph node biopsy.

Purpose

This study sought to determine the relationship between cervical cancer recurrence and post-treatment change in standardized uptake value (SUV) of 18F-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) in the cervix and lymph nodes.

Methods

This retrospective cohort study included patients who received curative intent radiation therapy for biopsy-proven stage I–IVA locally advanced cervical cancer at a single tertiary referral center from 2009 to 2021. The exposure was percent change in SUV from pre- to post-treatment FDG-PET scans at the cervix and lymph nodes. The primary outcome was recurrence rate, and secondary outcomes were overall and progression-free survival. Firth’s penalized logistic regression and Cox proportional hazards models were used to assess associations.

Results

55 patients met eligibility criteria. Recurrence rate was 27% (15/55); of these, 33% had local recurrence (5/55) and 67% had distant recurrence (10/55). Median percent decrease of cervical SUV after treatment in those with and without recurrence was similar (71.4 vs 68.8, p = 0.89); this remained consistent when analyzing those with local recurrence only (70.5, p = 0.95). When the percent decrease in cervical SUV was examined in intervals (< 25%, 25–50%, 50–75%, > 75%), this was also not predictive of local (p = 0.91) or overall (p = 0.75) recurrence. Median percent decrease at the most avid and distant lymph node in those with and without recurrence was not significantly different (p > 0.05). Neither change in cervical nor lymph node SUV was associated with overall or progression-free survival.

Conclusion

Changes in SUV after treatment may not be a reliable stand-alone marker for predicting recurrence or survival in locally advanced cervical cancer after treatment with radiation therapy.

Objectives

To estimate the success rates and risks of vaginal birth after cesarean delivery (VBAC) based on the number of prior successful VBACs.

Methods

A retrospective cohort study of women with one cesarean section in the past who attempted vaginal delivery between 2013 and 2022, using data from our Medical Center registry. Outcomes were compared based on the number of prior successful VBACs.

Results

Among 2912 deliveries meeting the eligibility criteria, the success rate of VBAC increased with the number of prior VBACs: 73.2% for those with no prior VBAC, rising to 92.3%, 94.7%, 94.0%, and 97.0% for individuals with 1, 2, 3, 4, and 5 or more prior VBACs, respectively. The history of at least one prior VBAC was associated with a 5.17-fold higher likelihood of achieving VBAC success. However, no significant differences in success rates were observed between groups with higher numbers of prior VBACs (≥ 2) compared to individuals with only one prior VBAC. In addition, the duration of hospitalization for both mother and neonate was longer in cases with no prior VBAC history. There was also a higher risk of requiring blood transfusion in the group without a prior history of VBAC.

Conclusions

Women with prior successful VBAC have a high likelihood of achieving another successful VBAC. After two prior VBACs, the success rate remains stable. In addition, women with one or more previous VBACs experience a reduced risk of blood transfusion and shorter hospitalization durations for both the mother and newborn.