Archives of Gynecology and Obstetrics最新文献

This report describes a 32-year-old primigravida diagnosed with bilateral anterior sacral meningoceles without bony defect of the sacrum during pregnancy. The patient remained asymptomatic throughout the pregnancy, with regular monitoring via transvaginal ultrasound and MRI. An elective cesarean section was planned at 38 weeks. However, the patient presented in obstructed labor at 42 weeks and underwent an emergency cesarean section, resulting in the birth of a healthy infant. This case is unique as it involves bilateral anterior meningoceles without sacral anomalies. Anterior sacral meningoceles are rare findings in pregnancy. Anterior sacral meningoceles are either congenital with bony defect of the sacrum or acquired lesions due to connective tissue disorders characterized by the herniation of the meninges through the sacral foramina. In pregnancy, these lesions pose unique challenges due to potential complications such as rupture, infection, or obstructed labor. Management strategies vary, and individualized approaches with close monitoring and patient counseling are crucial in determining the appropriate mode and timing of delivery.

Purpose

The incidence of women giving birth at advanced maternal age is increasing. Literature regarding the long-term implications of delivery at advanced maternal age is limited. This study aimed to investigate whether advanced maternal age at first delivery correlates with elevated long-term risk of endocrine morbidities.

Methods

This retrospective population-based study included women who gave birth between 1991 and 2021. Participants were categorized by age at first delivery: < 30, 30–35, 35–40, and > 40 years. Women with pre-existing endocrine disorders before pregnancy were excluded. Kaplan–Meier survival curves assessed cumulative incidence of endocrine disorders, while Cox proportional hazards models calculated adjusted hazard ratios (HR), accounting for confounders including fertility treatments, ethnicity, gestational diabetes mellitus, and hypertensive disorders.

Results

A total of 77,746 women were included. Advanced maternal age at first delivery was significantly associated with increased risk for endocrine morbidity, particularly diabetes and hyperlipidemia, both showing a clear age-related progression. No significant differences were observed for thyroid, parathyroid disorders, or obesity. Kaplan–Meier curves showed the highest endocrine morbidity risk among women delivering after age 40 (log-rank p < 0.001). After adjustment, hazard ratios were: 30–35 years aHR 1.29 (95% CI 1.19–1.40, p < 0.001), 35–40 years aHR 1.27 (95% CI 1.10–1.47, p < 0.001), and > 40 years aHR 1.15 (95% CI 0.86–1.54, p = 0.339), compared to women < 30 years.

Conclusions

Advanced maternal age at first delivery is independently associated with an increased risk of long-term endocrine morbidity, particularly diabetes and hyperlipidemia. This graded association underscores the need for long-term follow-up and preventive care in these women.

Purpose

To evaluate the predictive value of the Gestational Sac Ellipticity Index (EI), a quantitative measure of sac irregularity, for subsequent early embryonic demise within the first trimester, when measured at or before 7 weeks of gestation.

Methods

This single-center retrospective cohort study included 340 singleton pregnancies with initial transvaginal ultrasound at ≤ 7 weeks. The EI was calculated as 1 − (short axis/long axis). Propensity score matching (PSM) was used to balance baseline characteristics. Univariate and multivariate logistic regression, receiver operating characteristic (ROC) analysis, decision curve analysis (DCA), and net reclassification improvement (NRI) were performed to assess the predictive performance and incremental value of EI.

Results

After PSM, 85 embryonic demise cases were matched with 85 continued pregnancies. The EI was significantly higher in the demise group (median 0.35 vs. 0.18, p < 0.001). Each 0.1 increase in EI was associated with an adjusted odds ratio of 1.78 (95% CI: 1.25–2.54) for demise. The area under the ROC curve (AUC) for EI was 0.794 (95% CI: 0.728–0.860). An optimal cut-off value of 0.275 yielded a sensitivity of 81.2% and specificity of 67.1% for predicting embryonic demise. Adding EI to a baseline model (maternal age, mean sac diameter, crown-rump length, cardiac activity) significantly improved the AUC from 0.856 to 0.884 (p = 0.009), with NRI = 0.312 (p = 0.002). Subgroup analyses confirmed EI's predictive value even when fetal cardiac activity was present and at earlier gestational ages.

Conclusion

In this cohort, the Gestational Sac Ellipticity Index, when measured at or before 7 weeks, was found to be an independent predictor of first-trimester embryonic demise and showed incremental value over existing markers. An EI cut-off of 0.275 provided a basis for risk stratification, suggesting its potential for further investigation as a tool in early pregnancy assessment protocols, pending external validation.

Objective

To evaluate procedure-related preterm birth (PTB) following third-trimester selective termination (ST) in DC twins and to compare delivery timing with expectantly managed discordant DC twins and non-anomalous DC twins.

Methods

A retrospective cohort study was conducted of all DC twin pregnancies undergoing third-trimester ST (> 28 weeks) at a tertiary care center (2003–2023). Pregnancies were classified as having procedure-related complications (delivery ≤ 4 weeks) or uneventful (delivery > 4 weeks). Comparator cohorts included expectantly managed discordant DC twins and non-anomalous DC twins. Outcomes included timing of delivery, cumulative incidence of PTB, and risk factor analysis.

Results

90 women with DC twin pregnancies elected for ST and 85 procedures were completed. Outcome was available for 81 cases; 48 (59.3%) delivered ≤ 4 weeks after ST and 33 (40.7%) delivered later. Clinical chorioamnionitis was more common within the group delivered ≤ 4 weeks (35.4% vs. 0%; p = 0.001). Cumulative PTB incidence showed accelerated delivery between 32 and 34 weeks after ST. Independent risk factors for delivery ≤ 4 weeks included polyhydramnios (OR 5.68) and reduction of the presenting fetus (OR 6.51). Comparator cohorts exhibited substantially lower PTB incidence.

Conclusion

Third-trimester ST in DC twins is associated with high PTB risk, but excellent co-twin survival. The first 4 weeks after ST represent a critical vulnerability period, and risk is strongly influenced by identifiable preprocedural factors. These findings support individualized counseling, later scheduling in high-risk pregnancies, should be considered.

The rapid digitalization of healthcare is transforming medical care strategies. Individuals carrying (likely) pathogenic TP53 germline variants (P/LP TP53) require complex surveillance protocols. To support these individuals, we provided the adapted PatientConcept app to adults with a P/LP TP53 variant and their relatives. We analyzed the value of this adapted app for this cohort, as well as general aspects of Internet use, web-based healthcare options, mental and physical health, and fear of progression. (FOP). From a larger study consisting of 70 carriers and 43 relatives, 25 affected individuals and no relatives installed the app. App users tended to be younger and physically fitter but reported higher levels of psychological distress and FOP compared to non-users. Users rated their distress as high and expressed interest in an on-demand intervention tool offering concise information sessions. Overall, users were satisfied with the app, finding it useful and easy to understand, though they identified areas for improvement. Many app features were underutilized, indicating a need for further adaptation to the target group. Most users obtained medical information online, considering it helpful but often unreliable and difficult to evaluate. Nevertheless, app users felt confident in their ability to use the Internet for health-related search. Our study demonstrates the feasibility and acceptance of an app for individuals with LFS, supporting their surveillance and health behaviors.

Purpose

Climate change is increasing global temperatures, with mid-latitude regions experiencing significant warming. Pregnant individuals are particularly vulnerable to heat exposure, which has been linked to adverse outcomes, such as preterm birth and low birth weight. However, research in temperate regions like Germany is scarce. This scoping review examines studies on the association between heat exposure and pregnancy complications in Germany.

Methods

Following the JBI methodology for scoping reviews, a systematic literature search was conducted in eight databases, including PubMed and Scopus. Studies analyzing pregnancy complications in relation to heat events in Germany were included. Studies without systematic temperature data collection or focusing on long-term child development after birth were excluded.

Results

Only four studies met the inclusion criteria. Two reported significant associations between heat exposure and preterm birth, though at different pregnancy stages. One study on low birth weight found no clear correlation, while another identified a strong link between high temperatures and pregnancy-related edema. Differences in exposure definitions and outcome measures limited comparability.

Conclusions

Despite the heterogeneity in study designs and findings, the results from the small number of studies could indicate that heat exposure may contribute to adverse pregnancy outcomes in Germany, particularly preterm birth. To strengthen the evidence base, future research should focus on standardizing exposure definitions and employing robust methodologies. These findings underscore the need for public health strategies to mitigate the risks associated with rising temperatures for pregnant individuals.

Purpose

Accurate preoperative evaluation of tumor sizes is essential for guiding optimal treatment planning in cervical cancer. This study aimed to compare the accuracy of preoperative tumor size measurement between magnetic resonance imaging (MRI) and ultrasound.

Methods

A retrospective study was performed involving 925 patients diagnosed with cervical cancer who underwent primary surgical treatment between January 2020 and June 2025. The accuracy of these two imaging modalities was assessed by comparing their measurements to the maximum tumor diameter determined through postoperative pathological analysis.

Results

The Bland–Altman analysis showed that both ultrasound (mean difference: 1.50 mm) and MRI (mean difference: 0.61 mm) overestimated tumor size. In the paired subgroup of 757 patients who underwent both imaging modalities, the agreement rates between imaging and pathology for categorizing tumors into size groups were 65.8% for ultrasound and 67.6% for MRI (p = 0.360). Although MRI showed a significantly smaller mean measurement bias than ultrasound (0.73 mm vs. 1.37 mm; p = 0.012), the proportion of large errors (> 10 mm) was not significantly different. Multivariate analysis indicated that tumors > 40 mm assessed by ultrasound (OR = 2.85) or MRI (OR = 2.72) were significantly associated with increased likelihood of measurement discrepancies > 10 mm.

Conclusion

While MRI exhibited a lower measurement error compared to ultrasound, both modalities showed comparable performance in tumor size staging. Furthermore, for tumors exceeding 40 mm in diameter as determined by preoperative imaging, clinicians are advised to integrate clinical examination to enhance the accuracy of staging.

Purpose

This phase 3, open-label, single-arm, prospective, multicenter clinical trial investigated the use of CMVIG to prevent maternal–fetal transmission.

Methods

Pregnant women with confirmed recent primary CMV infection with gestational age ≤ 14 weeks were treated with biweekly i.v. 200 U/kg BW CMVIG until at least GW 17. An amniocentesis was performed between GW 19–22.

Results

Fourty eight women were treated with a mean (range) number of 5.1 (4–7) infusions of CMVIG. Maternal–fetal transmission at AC was found in 11 cases (22.9%), of them 9 in the periconceptional (n = 37, 24.3%) and 2 in the first trimester subgroup (n = 11, 18.2%). One additional maternal–fetal transmission was diagnosed at birth (total 12 cases, 25.0%).

Twenty three mothers, fetuses and newborns (24.0% of 96 total lives) experienced 27 serious adverse events, including the maternal–fetal transmissions. Of these, 18, 6 and 3 events were classified as mild, moderate and severe, respectively. Sixty three of the total lives (65.6%) experienced 386 adverse events (AEs) after the start of the treatment, predominantly of mild severity. Twenty one mild AEs in 6 women were related to the CMVIG administration. The only adverse drug reaction that was observed in more than one woman was headache (4 = 8.3%). No AEs were observed that led to death, abortion, trial withdrawal, CMVIG dose interruption, infusion rate or dose reduction. The newborn data were comparable to the general population, without evidence for an increased risk of premature birth or growth retardation.

Conclusion

Despite a favorable safety profile, the benefit of treatment with CMVIG to prevent a maternal–fetal CMV transmission could not be demonstrated in our trial.

Purpose

Polycystic ovary syndrome (PCOS) is recognised as a potential risk factor for chronic non communicable diseases (NCD). Although international guidelines recommend proactive NCD risk prevention, actual practice may be suboptimal. This study aimed to identify unmet clinical needs regarding information, risk assessment and satisfaction with care related to NCD risk factors among women with PCOS.

Methods

An eight-domain questionnaire was developed based on the 2018 ESHRE guideline, covering demographics, PCOS diagnostic criteria, aesthetics, metabolism, reproduction, mental health and NCD prevention /monitoring. The present analysis focused on metabolic disorders, guideline-recommended risk screenings, patients’ satisfaction with care and overall satisfaction with management by healthcare providers (HCPs).

Results

Of 2029 respondents, 1943 answered metabolic-related items. 66.3% without known metabolic disease (MD) reported never having undergone screening for MD. 34.3% received advice from gynaecologist, 58.9% from general practitioner (GP) concerning MD. 41.1% (n = 271) did not receive counselling. Among 1839 respondents, 32.5% reported gynaecologist-led risk discussions. Annual screening occurred in 30.5% (body weight), 46.8% (blood pressure), 5.8% (gynaecologist) to 21.4 (GP) for serum cholesterol and 25.4% for diabetes. 1.0% had been consulted on obstructive sleep apnoea (OSA), 17.5% on endometrial cancer. Satisfaction with gynaecologist counselling was low (Mean 34.7), 79.4% expressed a desire for more advice.

Conclusion

Women with PCOS remain at high risk for NCDs (CVD, diabetes, endometrial cancer, OSA), yet experience substantial gaps in risk awareness, monitoring, and counseling. Addressing these deficiencies through improved clinical practice, education and adopting holistic PCOS management that balances NCD prevention with infertility concerns, is essential for safeguarding long-term health.