Archives of Gynecology and Obstetrics最新文献

Introduction: According to the World Health Organization, adolescent pregnancy is defined as pregnancies of women aged 19 and below. The study aims to analyze the rates of adolescent pregnancies and maternal and fetal outcomes among births within the hospital and compare them with adult pregnancies.

Methods: The study is conducted retrospectively in one of Turkey's socio-economically underdeveloped provinces. The study comprises 16,985 women: 1719 adolescents and 15,266 adults who gave birth in the hospital between January 1, 2020, and December 31, 2023. All data were recorded in the SPSS 28.0 program, and the Kolmogorov-Smirnov test, Chi-Square test, ANOVA, and Independent Simple T-test were applied to analyze the data.

Results: In the study, the adolescent pregnancy rate is found to be 10,1%. The mean maternal age (p = 0.000), gravida (p = 0.000), parity (p = 0.000), and number of abortions (p = 0.002) are significantly higher in the adult group. No difference is found between the groups in terms of gestational age (p = 0.067). Newborn birth weight was significantly higher in the adult group (p = 0.000). Cesarean section rates are higher in the adult group (p = 0.001). No difference is found in terms of stillbirth rates. No difference is found between the groups in terms of pre-eclampsia (p = 0.792). No difference is found between the groups in terms of preterm birth (p = 0.664).

Conclusion: In conclusion, it came out that, according to the results of the study, the rates of premature birth, pre-eclampsia, and stillbirth in adolescents and the first and fifth-minute Apgar scores are similar to adults. However, newborn birth weights are lower in the babies of adolescent pregnant women. In addition, cesarean section rates are higher in the adult group.

Infertile women may request to embark on a new course of Assisted Reproductive Technologies (ART) in pursuit of a second child while still breastfeeding their first child. Breastfeeding is a time of profound hormonal changes that may interfere with ovarian physiology and uterine receptivity. Prolactin and oxytocin can mediate a plethora of potential detrimental effects. However, robust evidence to advise in favor or against ART during breastfeeding is lacking. In this narrative review, we reviewed the literature with the intent to shed light on this neglected issue. Possible adverse effects on ART success emerged for ovulatory mechanisms, folliculogenesis, uterine contractions, uterine peristalsis, and early embryo development. A negative impact of exogeneous hormones on infant health might be considered only for stimulation cycles. Overall, most concerns can be claimed for the clinical setting of ovarian stimulation, followed by the one of embryo transfer in a natural cycle and, finally, by the embryo transfer in a hormone replacement treatment preparation. However, in general, it seems wise to wait for breastfeeding to be discontinue before re-embarking on IVF, also considering that a too short interpregnancy interval may be deleterious to pregnancy outcomes. On the other hand, one must also recognize that available evidence is insufficient to deny access to treatments for women requesting earlier access. These women must be informed regarding the non-fully reassuring evidence.

Purpose: Dyslipidemia has been linked to adverse pregnancy outcomes in observational studies. This study aimed to explore how variations in lipid levels during the first trimester might influence early pregnancy loss (EPL).

Methods: Blood samples from pregnant women were analyzed to examine the relationship between EPL and lipid metabolism using logistic regression and restricted cubic splines (RCS). Sensitivity analysis was conducted to verify the robustness of the results.

Results: Elevated low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels at most times of 4-9 weeks of gestation were associated with a higher risk of EPL, regardless of whether the control group was successful pregnancy or live birth. Specifically, taking the successful pregnancy group as a control example, increased EPL risks were observed in the highest quartile of plasma TC at 4 weeks (OR = 2.18, 95%: 1.14-4.21) and 7 weeks (OR = 4.30, 95%: 1.87-9.93) of pregnancy. Significant EPL risks were also noted in the third (Q3) and fourth (Q4) quartiles of LDL-C at 4 weeks (Q3, OR = 2.98, 95%: 1.47-6.08; Q4, OR = 2.66, 95%: 1.27-5.55) and 7 weeks (Q3, OR = 3.12, 95%: 1.44-6.73; Q4, OR = 5.17, 95%: 2.14-12.49). High TC levels (> 3.25-3.78 mmol/L) and high LDL-C levels (> 1.92-2.04 mmol/L) were linked to an increased risk of EPL compared to lower levels of TC (≤ 2.91-3.05 mmol/L) and LDL-C (≤ 1.64-1.75 mmol/L).RCS analysis further confirmed this finding that plasma TC and LDL-C levels at 4 and 7 weeks of gestation may have a linear relationship with the risk of EPL. By the way, triglyceride levels at 6 and 8 weeks of gestation were associated with a higher risk of EPL, whereas high-density lipoprotein cholesterol (HDL-C) levels at 5 and 9 weeks of gestation have a completely opposite relationship with EPL risk.

Conclusions: Elevated cholesterol levels during the first trimester are associated with an increased risk of early pregnancy loss, emphasizing the need for lipid monitoring during pregnancy and even before pregnancy.

Purpose: We explored the effect of beta-thalassemia major on pregnancy and delivery outcomes in non-endemic area, utilizing USA population database.

Methods: This is a retrospective study utilizing data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A cohort of all deliveries between 2011 and 2014 was created using ICD-9 codes. The patients with beta-thalassemia major were identified and matched to patients without beta-thalassemia based on age, race, income quartile, and type of health insurance at a ratio of 1:20. The baseline characteristics were compared between the groups using Chi-square and Fischer's exact tests, as appropriate. The univariate and multivariate analyses were conducted for pregnancy, delivery and neonatal outcomes to estimate the unadjusted and adjusted odds ratio, respectively.

Results: Out of 3,070,656 pregnancies over the study period, beta-thalassemia major complicated 445 pregnancies. The patients with beta-thalassemia were more likely to have thyroid disorders and previous C-section (p-value < 0.05). There were no differences in pregnancy outcomes such as gestational hypertension, preeclampsia, gestational diabetes, and placenta previa. C-section was 30% more likely to be the method of birth (aOR 1.30, 95%CI 1.03-1.63) and there was more than three-fold increase in rate of blood transfusion (aOR 4.69, 95% CI 3.02-7.28) among participants with beta-thalassemia major. Mothers with beta-thalassemia, almost, were 70% more likely to have a neonate small for gestational age (aOR 1.68, 95%CI 1.07-2.62).

Conclusions: Women with beta-thalassemia major are more likely to give birth by C-section, require blood transfusion and have small for gestational age neonates. Counseling patients with beta-thalassemia about these risks and increased antenatal surveillance is advised.

Purpose: This updated systematic review and meta-analysis aims to evaluate the impact of a birthing ball (BB) exercises on low-risk parturients during labor, offering a more comprehensive understanding through a larger sample size, robust analysis, and focus on relevant endpoints that were underexplored in previous studies due to limited data.

Methods: We searched PubMed, Embase, Scopus, and Cochrane Central for randomized controlled trials (RCTs) comparing BB (also named Swiss ball) exercises with no intervention or standard care in parturients undergoing low-risk labor. Risk ratios (RR) and mean differences (MD) were calculated using a random-effects model. I² heterogeneity was assessed. All statistical analyses were performed using Review Manager 5.4.

Results: We included 10 RCTs with 1,008 parturients, 51.2% of whom were assigned to BB exercises. In the pooled analysis, the BB group showed significantly lower cesarean section rates (MD 0.55, p = 0.007, I² = 32%), reduced pain scores at 4 and 8 cm dilation by approximately 20% (p < 0.001), and a reduction of over two hours in the duration of the first stage of labor (MD -130.12 min, p < 0.001). There were no significant differences between groups in the duration of the second stage of labor (p = 0.090) and in the incidence of instrumental delivery, amniotomy, labor induction, oxytocin use, or epidural analgesia.

Conclusions: BB exercises significantly reduced cesarean section rates, alleviated labor pain, and shortened the first stage of labor, supporting their use as a safe and effective non-pharmacological intervention in low-risk labor management.

Purpose: To study characteristics and identify factors associated with full manuscript publication of oral abstracts presented at gynecologic surgery societies' annual meetings.

Study design: We reviewed all oral abstracts presented at four major gynecologic surgery meetings in 2018. Oral abstracts subsequently published as peer-reviewed manuscripts were compared to those that were not published. Descriptive statistical analysis and multivariable regression analyses were conducted to identify factors associated with peer-reviewed manuscript publication.

Results: A total of 396 oral presentation abstracts from the four nationally recognized gynecologic societies were identified. The overall journal publication rate was 47.4% (188/396). The rate of publication of oral abstracts was 35.1% (72/205) for those presented at AAGL, 73.8% (62/84) for AUGS, 53.2% (42/79) for SGO and 42.9% (12/28) for SGS. In multivariable regression analysis, last author's H-index [aOR 95% CI 1.02 (1.00-1.03)], academic center affiliation [aOR 95% CI 2.29 (1.20-4.37)], and randomized controlled trials [aOR 95% CI 2.47 (1.12-5.47)] were associated with journal publication. Of the published articles, the median time to publication was 3.0 years [1.0-5.0], the median journal impact factor was 3.9 [1.8-4.8], the median relative citation ratio was 1.0 [0.4-1.9], and the median number of citations per year was 2.0 [1.0-4.1].

Conclusions: In the field of gynecologic surgery, several factors, including the last researcher's H-index, academic affiliation, randomized controlled trial design and type of societal meeting are associated with increased odds of an oral abstract ultimately reaching full manuscript peer-reviewed publication. These findings can serve researchers in the fields of gynecologic surgical subspecialties.

Background: Chlamydia trachomatis genital infection is one of the most common sexually transmitted bacterial infections with severe detrimental effects on pregnant women and fetuses. CTGI increases the risk of ectopic pregnancy, exogenous fetal infection, and respiratory complications such as bronchitis and pneumonia. According to the different published reports, this systematic review and meta-analysis study aimed to evaluate the global prevalence of CTGI in pregnant women.

Methods: Initial searching was applied using valid databases of PubMed, ScienceDirect, Embase, WoS, Scopus, and Google Scholar using MeSH keywords (by October 2023). Following duplicate detection and data exclusion, the Title and Abstract of other remaining papers were evaluated (primary screening). Full-texts of selected papers were assessed (secondary screening) and eligible studies were included for data extraction (total No of investigated pregnant women and the number of positive cases). The PRISMA approach was used for paper selection, and the quality assessment was determined according to the STROBE checklist. Data meta-analysis, heterogeneity, publication bias, and the factors affecting heterogeneity index were analyzed using CMA software. The findings were presented in the Forest Plot diagram and Static tables. Besides, heterogeneity was analyzed using I² test and diffusion bias was demonstrated in Funnel Plot.

Results: Among 1061 selected articles, 44 eligible investigations were enrolled for meta-analysis. The global prevalence of chlamydia trachomatis genital infection (CTGI) was found 8.4% (95% CI 5.8 - 12.1). Meta-regression analysis showed that following the increase in sample size and year of paper publication, the prevalence of Chlamydia trachomatis genital infection in pregnant women decreased significantly (p < 0.05).

Conclusion: The global prevalence of Chlamydia trachomatis genital infection in pregnant women is considerably influenced by some interfering factors including Age, Socioeconomic status, Geographic region, and Individual behaviors. Thus, the implementation of more comprehensive health programs for prevention, screening, and treatment seems necessary, especially for high-risk pregnant cases.

Purpose: Our primary objective was to characterize clinical and procedural factors affecting sample size in chorionic villus sampling (CVS).

Methods: This retrospective, single-site cohort study included singleton pregnancies undergoing transabdominal (TA) and transcervical (TC) CVS between 2020 and 2023. Prenatal and maternal data were obtained from the electronic medical record. Differences by approach and sample size in relation to demographic and pregnancy characteristics were assessed. Linear regression was used to identify factors associated with yield.

Results: Data from 240 CVS procedures were included (n = 91 TC CVS and n = 149 TA CVS). Sample size was significantly larger in TC compared to TA approach (37.1 mg vs 32.4 mg, p = 0.04). In unadjusted models, BMI was associated with a lower sample yield (p = 0.01); use of a TC approach was associated with higher sample size yield (p < 0.01); and lateral placenta was associated with significantly larger samples (p = 0.02). After adjusting for approach and placental location, higher BMI remained associated with smaller sample size (parameter estimate: - 0.47 mg (95% CI: - 0.86, - 0.08); p = 0.03).

Conclusion: CVS remains an important prenatal diagnostic tool in early gestation. We find that higher BMI is associated with a smaller sample yield despite differences in approach and placental location.