Archives of Gynecology and Obstetrics最新文献

Background

Platelet-rich plasma (PRP) is used as an adjunctive treatment in various medical fields, including orthopaedics, plastic surgery, dermatology, and wound healing. However, PRP application in reproductive medicine, particularly for fertility restoration, remains controversial, specifically for women with diminished ovarian reserve (DOR), premature ovarian insufficiency (POI), and pre-menopause. This systematic review aimed to comprehensively evaluate the existing literature on autologous PRP use for ovarian rejuvenation, with a focus on refining and standardising PRP protocols and identifying appropriate candidate populations.

Methods

A comprehensive literature search was conducted on the autologous PRP use using Cochrane, Embase, PubMed, MEDLINE, NCBI, and Google Scholar databases. Studies on PRP application in reproductive medicine were identified and classified into two categories: DOR and POI. The PRP preparation protocol was assessed, and the results were compared. This narrative systematic review, carried out in compliance with PRISMA 2020 guidelines, combined results, although meta-analysis was not feasible due to significant variation in study design, PRP preparation, and outcome measures.

Results

Several studies reported restoration of menstruation following intraovarian PRP administration in women with POI. In women with DOR, studies reported changes in ovarian reserve markers, including increases in serum anti-Müllerian hormone (AMH) levels and reductions in follicle-stimulating hormone (FSH) levels; however, these changes were not consistently associated with higher antral follicle counts or oocyte yield. Instead, sseveral studies reported higher proportions of mature oocytes and pregnancy and live birth outcomes, particularly following repeated PRP treatment cycles in women with long-standing ovarian dysfunction.

Conclusions

Intraovarian PRP may have a potential role in activating dormant follicles in a selected subset of women with poor ovarian response. However, the current evidence remains limited and heterogeneous, supporting its use only within structured clinical or research protocols until higher-quality, standardised studies are available.

Objective

This analysis aimed to characterize exceptional responder with long-term PARP inhibitor therapy (ExR-LT) in platinum-sensitive recurrent ovarian cancer.

Methods

This analysis included ExR-LT. ExR-LTs are defined as patients that received a continuous maintenance therapy for recurrent ovarian cancer with olaparib or niraparib for at least 5 years and showed an exceptional response. Exceptional response was defined as progression-free survival (PFS) of at least 5 years. This analysis has a retrospective and descriptive character.

Results

23 patients were included. The median duration of PARPi therapy was 7.1 years (range 5.3; 10.5). The longest treatment duration was reached in the BRCA1 mutation (BRCA1m) cohort with a mean duration of 8 years (range 5.3; 10.5 years). The majority of patients (16 patients, 69.7%) reported adverse events (AE) during PARPi therapy. 12 patients (52.2%) had mild AE (CTCAE 1 or 2), 4 patients (17.4%) reported more severe AE (CTCAE 3). 14 patients needed a dose reduction due to treatment-related AE (60.1%). The most common indications for dose reduction were anemia (17.4%), headache and limb pain (17.4%), and fatigue (13%). Four patients (17.4%) required an interruption of PARPi therapy. Ten patients received a dose reduction within the first 6 months and two patients after one and 1.3 years of PARPi therapy. No dose adjustments were necessary between 1.5 and 4 years. After 4 years, 3 patients (13%) received a late dose reduction. 8.6% had another cancer diagnosed before, 4.3% simultaneously, and 13% after the ovarian cancer diagnosis.

Conclusion

ExR-LTs present with heterogenic clinical and genetic characteristics. Clinical management is complex because of a high rate of AE and need of dose reductions at various points in time. Close monitoring for AE, recurrences and secondary malignancies must be carried out throughout the entire time of treatment.

Purpose

The aim of this study was to investigate the effect of oral administration of a combination of alpha- lipoic acid (ALA) and myo-inositol (Myo) on serum and endometrial inflammation of women with unexplained recurrent pregnancy loss (uRPL).

Methods

Serum and endometrial levels of Nacht leucine-rich-repeat protein-3 (NLRP-3) and High Mobility Group Box 1 (HMGB-1) were analyzed by ELISA in women with unexplained Recurrent Pregnancy Loss (uRPL) (n = 31) and in control women who had had at least one uncomplicated pregnancy at term (n = 10) before and after daily oral administration of a commercial combination of ALA and Myo.

Results

uRPL women had higher serum levels (p < 0.01) and endometrial content (p < 0.0001) of HMGB-1 than controls while no difference was observed regarding NALP3. Oral administration of ALA and Myo for three months significantly decreased pre-treatment serum levels of NLRP-3 (p < 0.0001) and HMGB-1 (p < 0.0001), as well as endometrial content of NLRP-3 (p < 0.001) and HMGB-1 (p < 0.0001) in uRPL women, similar to those found in controls.

Conclusion

Women with uRPL have increased systemic and endometrial inflammation than controls. Oral administration of ALA and Myo could modulate serum and endometrial levels of NLRP-3 and HMGB-1 in uRPL women.

Introduction

Treatment strategies for endometriosis have traditionally been biomedical. There is a need for a more multidimensional understanding of endometriosis and more targeted and individualized treatment interventions, including psychological approaches.

Methods

The aims of this study were twofold: (1) to identify key biopsychosocial characteristics in individuals attending a tertiary clinic for endometriosis and (2) to inform the development of future, targeted, and efficacious interventions by examining the importance of psychological processes central to two scientific models, pain catastrophizing and fear of movement from the fear-avoidance model, and psychological inflexibility from the psychological flexibility model.

Results

Psychosocial variables, more specifically perceived control and powerlessness, social support, and depression, were of particular importance to the symptom structure in this patient population. In contrast, biological factors appeared to have low relevance within this network. When aiming to inform the development of future, promising psychological interventions for endometriosis, psychological inflexibility emerged as the most important psychological process variable in the symptom network.

Conclusions

A multidimensional approach based on the biopsychosocial model appears valuable for understanding endometriosis. Treatment interventions grounded in the psychological flexibility model may hold promise for this patient population, a possibility that warrants further investigation in future studies.

Purpose

To assess d-dimer levels during pregnancy and postpartum period and evaluate the appropriateness of commonly used cut-offs for ruling out pulmonary embolism (PE) in this population.

Methods

Secondary analysis of the prospective PPH 1300 study conducted at the University Hospital Zurich, including 1309 women between 25 + 0 and 42 + 3 weeks of gestation without acute thromboembolic events. d-Dimer levels were measured at admission for delivery and 24–48 h postpartum, stratified into four gestational age groups.

Results

Median d-dimer values were 1.56 mg/L (IQR 1.20–2.12) antepartum and 1.78 mg/L (IQR 1.25–2.84) postpartum. Antepartum, 99.3% of women had levels ≥ 0.5 mg/L and 88.8% ≥ 1.0 mg/L; postpartum, 98.8% and 88.1% exceeded these cut-offs, respectively. Antepartum values showed an increasing trend with gestational age, whereas postpartum values remained uniformly elevated. No clinically relevant thromboembolic events occurred during the index hospitalization.

Conclusions

Nearly all pregnant and postpartum women exceed conventional d-dimer thresholds also in the absence of thromboembolism. Standard cut-offs of 0.5 and 1.0 mg/L are therefore unsuitable in obstetric practice, limiting the applicability of general diagnostic algorithms, such as YEARS and Geneva, unless specifically adapted. Trimester- and postpartum-adjusted thresholds or alternative biomarkers are needed to reduce unnecessary imaging and improve clinical management.

Purpose

To determine whether there is an association between cervical length > 25 millimeters (mm) and a decrease in cervical length before 24 weeks of gestation with an increased risk of recurrent spontaneous preterm birth (sPTB).”

Methods

This retrospective cohort study includes women with a singleton pregnancy, a previous sPTB before 34 weeks of gestation, serial cervical length measurements and a shortest midpregnancy cervical length of > 25 mm. Participants received care according to local protocols for the prevention of preterm birth in two academic hospitals in the Netherlands between February 2005 and September 2021. Exclusion criteria were fetal structural anomalies, signs of threatened preterm birth or treatment with a cerclage or pessary. Cervical length measurements were grouped in three timepoints in pregnancy that were chosen a priori: 14 + 0 to 18 + 6 weeks (CL1); 19 + 0 to 20 + 6 weeks (CL2); and 21 + 0 to 23 + 6 weeks (CL3). Outcome measures included percentage of sPTB (< 37, < 34 and < 28 weeks of gestation) with 95% confidence intervals (95% CI) and Odds Ratio’s (OR). Association between decrease in cervical length and sPTB were calculated using logistic regression.

Results

In total, 469 pregnancies were included. Overall, sPTB recurred in 21.1% (95% CI 17.4–24.8%), 9.0% (95% CI 6.4–11.6%) and 1.9% (95% CI 0.7–3.2%) before 37, 34 and 28 weeks of gestation, respectively. Women with a cervical length of > 25–30 mm in CL3 were at higher risk to deliver before 37 weeks, compared to women with a cervical length > 30 mm (44.7% versus 18.5%, OR 3.6, 95% CI 1.91–6.66). The decrease in cervical length between timepoint CL1, CL2 and CL3 had no association with a recurrent sPTB.

Conclusions

Women with a history of sPTB before 34 weeks of GA and a cervical length of > 25–30 mm before the 24 weeks of gestation have an almost four times higher risk for a recurrent sPTB, compared to those with a longer cervical length. No association was found between decrease in cervical length and the risk of sPTB. Future studies should assess whether women with a history of sPTB and a cervical length of > 25–30 mm benefit from cerclage and cutoff values could be revised accordingly.

Introduction

Unilateral pectineal suspension (UPS) is a novel method for mesh-free apical prolapse correction. Short-term follow-up results 6 months after isolated UPS have been very encouraging, resulting in excellent apex stability and high patient satisfaction in a cohort of 47 patients with mostly advanced prolapse.

Methods

In order to assess the long-term outcome after isolated UPS, all 47 patients from the original patient cohort treated with isolated UPS were invited for a scheduled follow-up examination after a minimum follow-up period of two years to determine whether the result of the primary surgery remained stable. We analyzed the outcome with regard to apex stability, residual defects, and procedure-related morbidity.

Results

UPS as a stand-alone procedure showed high stability at the apex. Throughout the two-year follow-up period, only two patients (4.3%) required secondary surgery for apical recurrence. Increasing age correlated significantly with apical recurrence. Six patients became symptomatic in the anterior and/or the posterior compartment while the apex remained stable (13.0%). With increasing age, the probability of secondary surgery also appeared to rise, however, this was not statistically significant. There was no method-related morbidity.

Conclusion

UPS is a valuable concept for mesh-free apical prolapse correction. Two-year follow-up after isolated UPS shows stable results at the apex. A combined approach may be valuable to reduce the potential necessity of secondary surgery in the anterior / posterior compartment.

Objective

To evaluate the association between maternal anti-Ro and anti-La antibody levels and the occurrence of congenital heart block (CHB) in fetuses and newborns.

Methods

This retrospective cohort study included 182 pregnant women with positive anti-Ro and/or anti-La antibodies who received prenatal care at our tertiary center between 2002 and 2022. Maternal clinical, laboratory, and obstetric variables were analyzed.

Results

Thirteen fetuses (7.1%) were diagnosed with CHB. Mothers of affected fetuses had significantly higher anti-Ro (median 240 vs. 42; p < 0.001) and anti-La (median 150 vs. 10; p < 0.001) levels. Anti-La positivity was more frequent in the CHB group (76.9% vs. 42.6%; p = 0.017). Lower complement C4 levels (p = 0.008) and disease duration of less than 1 year since diagnosis (p = 0.008) were also associated with CHB. Preconception hydroxychloroquine and prednisone use were less frequent in affected pregnancies (p = 0.044 and p = 0.039, respectively).

Conclusion

Higher maternal anti-Ro and anti-La antibody levels were significantly associated with fetal CHB. Preconception hydroxychloroquine may provide a protective effect. Early diagnosis and specialized care are essential for optimizing neonatal outcomes.

Objective

To assess the level of awareness, attitudes, and implementation of sustainability practices among gynecologists in Germany, and to identify barriers to sustainable behavior within the field.

Background

Climate change increasingly affects gynecological and obstetric care. The world health organization (WHO) and the International federation of gynecology and obstetrics (FIGO) have emphasized the need for stronger climate action in healthcare. In response, the German society for gynecology and obstetrics (DGGG) established a working group on sustainability. However, empirical data on sustainability awareness among gynecologists worldwide are lacking. Understanding current attitudes is essential for developing targeted strategies to enhance sustainability in clinical and academic settings.

Methods

A cross-sectional, nationwide online survey was conducted from February to June 2024 in Germany using a self-developed questionnaire. The survey assessed sustainability awareness, perceived relevance of climate change, and implementation of environmentally sustainable measures in both clinical and private practice contexts. Descriptive and comparative statistical analyses were performed.

Results

Most respondents reported a high level of awareness regarding climate change, with female participants rating their individual contribution more strongly. Sustainable measures such as waste separation and the reduction of single-use packaging were more frequently implemented in private practices than in hospitals. A large proportion of participants reported using environmentally friendly transportation and avoiding short-haul flights. Virtual participation in conferences was common, and many respondents expressed willingness to pay higher fees for sustainable conference formats. The main barriers to implementation were time constraints, financial limitations, and a lack of sustainable alternatives.

Conclusion

Sustainability awareness among gynecologists in Germany is increasing, particularly in personal and outpatient practice contexts. Greater dissemination of information and stronger professional networks are needed to promote sustainable practices and strengthen the contribution of gynecology and obstetrics to climate protection in healthcare.

Background

Maternal HIV infection is associated with increased risks of pregnancy complications and adverse perinatal outcomes, particularly in high-prevalence settings like South Africa. The COVID-19 pandemic disrupted healthcare access, potentially exacerbating challenges in antenatal care and HIV management. To our knowledge, limited South African data exist regarding the impact of maternal HIV on birth complications and perinatal birth outcomes especially during the COVID-19 pandemic.

Aim

This study thus evaluates the impact of maternal HIV on pregnancy and perinatal outcomes before and during the COVID-19 pandemic using archived chart records from a tertiary hospital in KwaZulu-Natal, South Africa.

Methods

A retrospective analysis of 8456 birth records from March 2019 to December 2020 was conducted, categorized into pre-pandemic and pandemic periods. Data were stratified by maternal HIV status and analyzed for demographics, antenatal care attendance, ART regimens, labor characteristics, and birth outcomes. Statistical tests, including Chi-square and logistic regression, were used to assess associations between HIV status and outcomes.

Results

Hospital attendance declined during the COVID-19 period, especially among women living with HIV, whose age ranged between 19 and 35 years, and were multigravida, and multiparous. Antenatal care attendance was suboptimal and worsened during the COVID-19 period. ART coverage remained high with maintained viral suppression. Women living with HIV had shorter “active labor” and higher elective cesarean rates during the COVID-19 period. Preterm birth risk was also higher pre-pandemic among women living with HIV but not significantly different during COVID-19 period. Birth weights were lower in HIV-exposed infants pre-pandemic with a non-significant shift during COVID-19 period. Sepsis incidence increased among women living with HIV during COVID-19 period. No maternal deaths were reported.

Conclusion

A decline in hospital attendance was noted during the COVID-19 period among women living with HIV, with antenatal care attendance being suboptimal and exacerbated. Maternal HIV remains a critical factor influencing birth outcomes, necessitating sustained focus on tailored care during crises to protect vulnerable populations.