Archives of Gynecology and Obstetrics最新文献

The question of how to deal with a pregnancy, whether desired or unwanted, is a complex biological, ethical, social, and medical issue going back for millennia. Every form of regulatory approach to this issue is culturally and temporally specific and is therefore subject to continuous change. Our look at its history and the medical, legal, and religious background begins in ancient times, progresses through history, and ends with a focus on the second half of the nineteenth century and especially the twentieth century in Germany. These ethical, moral, and medical questions are likely to have been discussed in a similar way in other parts of the Western world.

Objective

Overweight and obesity are associated with adverse pregnancy outcomes, yet higher body mass index (BMI) has paradoxically been linked to reduced risk of perineal lacerations, including obstetric anal sphincter injury (OASI). The role of gestational weight gain (GWG) in this context is not well established. The objective of this study was to evaluate the association between GWG and perineal injury among overweight and obese primiparous women.

Methods

A retrospective cohort study was conducted at a tertiary center between 2012–2023, including primiparous women with singleton, term (≥ 37 weeks), vertex vaginal deliveries and pre-pregnancy BMI ≥ 25.0 kg/m². Women were categorized by GWG based on Institute of Medicine guidelines: below (Group A), within (Group B), or above recommendations (Group C). Exclusion criteria included cesarean delivery, diabetes, multiple gestations, stillbirth, preterm birth, non-vertex presentation, and maternal age < 18 or > 45 years. Perineal injury was defined as any perineal laceration or episiotomy. Univariate and multivariable logistic regression analyses were performed.

Results

Among 5,082 deliveries, 13.1% were in Group A, 28.2% in Group B, and 58.7% in Group C. Episiotomy rates were higher in Group C versus Groups A/B (38.7% vs. 34.7%/34.5%; p = 0.011), while overall perineal injury (87.2%–88.5%, p = 0.652) and OASI rates (0.5–1.0%, p = 0.428) did not differ. In multivariate analysis, GWG was not associated with perineal injury. Independent risk factors included epidural analgesia (OR = 1.39, 95% CI 1.10–1.75), vacuum-assisted delivery (VAD) (OR = 2.83, 95% CI 2.07–3.86), higher birthweight (OR = 1.06 per 100 gr., 95% CI 1.03–1.08), and advanced gestational age (OR = 1.13, 95% CI 1.04–1.23).

Conclusion

GWG was not associated with perineal injury, whereas VAD, epidural analgesia, increased birthweight, and advanced gestational age were independent risk factors.

Purpose

Knowledge, attitudes, and practices (KAP) studies are widely used public health research tools to assess what people know, how they feel, and how they behave toward health conditions, providing insights into awareness gaps and guiding targeted interventions. Overweight and obesity in women of childbearing age are linked to a higher risk of polycystic ovary syndrome (PCOS). This study aimed to investigate the KAP toward obesity and PCOS among women with overweight or obesity of childbearing age.

Methods

This cross-sectional study included women of childbearing age with overweight or obesity, defined as body mass index (BMI) ≥ 24.0 kg/m² or waist circumference ≥ 85 cm according to Chinese adult criteria, from November 2022 to April 2023. Structural equation modeling (SEM) assessed the relationships between knowledge, attitude, and practice.

Results

Among 740 valid questionnaires, 51.08% were aged 18–30 years. Knowledge, attitude, and practice scores were 13.55 ± 5.06, 27.27 ± 2.19, and 50.14 ± 6.49, respectively. Positive correlations were found between knowledge and attitude (r = 0.313, P < 0.001), knowledge and practice (r = 0.454, P < 0.001), and attitude and practice (r = 0.415, P < 0.001). SEM showed significant associations between knowledge and attitude (β = 0.13, P < 0.001), between knowledge and practice (β = 0.46, P < 0.001), and between attitude and practice (β = 0.90, P < 0.001).Knowledge was indirectly associated with practice through attitude (β = 0.12, P < 0.001).

Conclusion

Women of childbearing age with overweight or obesity demonstrated insufficient knowledge, neutral attitudes, and moderate practices concerning obesity and PCOS. Targeted educational interventions focusing on enhancing knowledge and fostering positive attitudes toward healthy lifestyles and PCOS management would be helpful to mitigate the risk and impact of PCOS in this population.

Background

Isthmocele is a defect at the site of the cesarean section scar and is increasingly being recognized as a common complication following cesarean delivery. It may cause abnormal uterine bleeding, pelvic pain, and fertility issues. This study aimed to identify risk factors associated with isthmocele formation after the first cesarean section.

Methods

This prospective cohort study included 262 women aged 14–50 years who underwent their primary cesarean section at Arash Women’s Hospital from 2021 to 2024. Previous cesarean deliveries, the history of myomectomy, repeated uterine curettage, and age outside the 14–50 years were exclusion criteria. Demographic, obstetric, surgical, and postoperative data were collected. A transvaginal ultrasound was used for the detection of an isthmocele. Univariate and multivariate logistic regression analyses were performed to identify associated factors with isthmocele formation.

Results

Isthmocele was detected in 19% (n = 50) of patients. Women with isthmocele had higher gestational age at delivery (39.2 ± 0.9 vs. 38.5 ± 1.7 weeks; p = 0.04), shorter delivery intervals (4.6 ± 1.3 vs. 5.2 ± 0.9 years; p = 0.01), more frequent retroverted uterus (28% vs. 11.3%; p = 0.003) and locking suture repair (20% vs. 7.1%; p = 0.005). In multivariable analysis, gestational age (OR = 1.71, 95% CI 1.19, 2.45) and retroverted uterus (OR = 2.82, 95% CI 1.25, 6.35) increased the odds of isthmocele, while longer inter-delivery intervals were protective (OR = 0.65, 95% CI 0.44, 0.97).

Conclusions

Isthmocele is a frequent complication after primary cesarean section. Modifiable factors, such as the timing of delivery, management of infection, inter-pregnancy interval, and surgical technique, should be considered in reducing the risk.

Objective

Early detection of major cardiac defects is crucial for the management and prognosis of affected pregnancies. This study evaluated the effectiveness of routine first-trimester ultrasounds in detecting major cardiac defects in singleton pregnancies.

Methods

This retrospective study (2015–2023) at a tertiary center included 35,230 singleton pregnancies undergoing routine ultrasounds at 11–14, 20–24, 28–34, and 34–38 weeks. High-resolution equipment and standardized protocols were used to assess fetal nuchal translucency and cardiac structure.

Results

Among the 35,230 pregnancies studied, 270 cases (0.8%) of major heart defects were identified. Hypoplastic left heart syndrome (HLHS) was detected in 31 cases with a 90% detection rate, while ventricular septal defects (VSD) were the most common, found in 128 cases with a lower detection rate of 16%. Pregnancy outcomes varied significantly with gestational age: 55.9% of early detections (11–13 weeks) led to termination, while 63.9% of mid-term detections (18–22 weeks) resulted in live births. The first-trimester ultrasound scans demonstrated 100% sensitivity and Negative Predictive Value (NPV), with a specificity of 93.85% and a Positive Predictive Value (PPV) of 90.27%. The Kappa value of 0.917 indicated moderate agreement between early and later scans. Notably, early diagnosis (11–13 weeks) was associated with a higher rate of pregnancy terminations, while later diagnoses corresponded to higher live birth rates.

Conclusion

Routine first-trimester ultrasounds effectively detect major cardiac defects early. However, the high sensitivity but low specificity necessitates follow-up scans to confirm findings and reduce false positives, ultimately enhancing prenatal care.

Purpose

To evaluate the incidence of associated structural anomalies, chromosomal/genetic abnormalities, infections and outcomes of fetuses with ventriculomegaly (VM).

Methods

Retrospective multicenter cohort study of 627 pregnancies with fetal VM. VM was classified as mild, moderate, or severe and isolated or non‐isolated. Genetic, obstetric and outcome data were collected and compared according to VM categories.

Results

The incidences of associated structural anomalies were 21.9%, 53.1% and 63.9% in mild, moderate and severe VM, respectively (p = 0.032 mild vs. moderate-severe). The incidences of genetic abnormality and fetal infection of the total VM group were 16.1% and 0.8%, respectively, with no significant differences between the VM categories (p > 0.05). The incidences of pathogenic genetic variant in the mild, moderate and severe VM were 13.5% (5/37), 16.7% (3/18) and 38.1% (8/21), respectively (p = 0.032 mild vs. severe). Fetal MRI identified additional CNS anomalies in 5.6% of cases. The incidences of surviving babies with neurological morbidities were significantly higher in fetuses with non-isolated VM groups than in isolated VM groups (p < 0.001).

Conclusion

The prognosis of fetuses with VM mostly depends on the severity and the associated anomalies. In all types of fetal VMs additional genetic investigations are valuable.

Purpose

Recognizing metabolic heterogeneity in gestational diabetes mellitus (GDM) and body mass index (BMI)-linked phenotypes, we evaluated whether combining hemoglobin A1c (HbA1c, reflecting fasting glycaemia) and 1,5-anhydroglucitol (1,5-AG, reflecting post-load glucose excursions) improves early prediction and whether performance differs by BMI.

Methods

In this multicenter retrospective study, pregnant women who had 1,5-AG and HbA1c measured before 20 weeks of gestation at two tertiary centers in Japan were included. Spearman’s correlation was used to assess associations between glycemic markers and glucose levels. Predictive performance for GDM was evaluated using ROC analysis, and stratified analyses were conducted by pre-pregnancy BMI.

Results

Among 191 participants, 45 (24.1%) developed GDM: 35.1 ± 4.9 years, pre-pregnancy BMI 22.9 ± 4.3 kg/m², and sampling at 14.3 [IQR 14.0–14.7] weeks. HbA1c correlated with fasting glucose (r = 0.35) while 1,5-AG correlated inversely with 2-h glucose (r =  − 0.39). They themselves were not significantly correlated (r =  − 0.13). As single predictors, performance depended on BMI: in ≥ 25.0 kg/m², HbA1c outperformed 1,5-AG (AUC 0.776 vs 0.618); in BMI < 25.0 kg/m², 1,5-AG outperformed HbA1c (AUC 0.704 vs 0.640). In both BMI strata, the dual-marker model was superior (AUC 0.833 and 0.803, respectively) and provided more balanced sensitivity, accuracy, and F1. Pre-pregnancy BMI correlated positively with fasting plasma glucose (r = 0.47) but not with 1-h or 2-h glucose (r = 0.20 and r = 0.16, respectively), supporting BMI-related metabolic variation.

Conclusion

Combining 1,5-AG and HbA1c enhances early prediction of GDM by capturing complementary glycemic abnormalities linked to BMI-specific metabolic phenotypes.

Purpose

Evidence on the relationship between fertility treatment and non-gynecologic cancers remains limited. This study synthesizes available research on the association between fertility treatments and the risk of non-gynecologic cancers in women with infertility.

Methods

We systematically searched MEDLINE, EMBASE, and the Cochrane Library for studies involving women with infertility who received fertility treatment, compared with untreated women or the general population. Primary outcomes included the incidence of thyroid, colorectal, gastric, and lung cancers. Subgroup analyses were conducted by type of ovarian stimulation drug, in vitro fertilization (IVF) status, parity, length of follow-up, and choice of reference group.

Results

Fifteen studies met the inclusion criteria. Fertility treatment was positively, though imprecisely, associated with thyroid cancer (relative risk [RR] = 1.22; 95% confidence interval [CI]: 0.95–1.57). No increased risk of colorectal cancer was observed among treated women. Clomiphene citrate use was associated with a higher risk of thyroid cancer (RR = 1.28; 95% CI: 1.07–1.54) and a lower risk of colorectal cancer (RR = 0.79; 95% CI: 0.65–0.96).

Conclusion

Fertility medications may increase the risk of thyroid cancer while potentially reducing the risk of colorectal cancer in women with infertility. Given the small number of studies and their heterogeneity, these findings should be interpreted cautiously. Further research is needed to clarify these associations.

Purpose

The main purpose of this review is to examine the outcomes of pregnancy following different metabolic and bariatric surgical procedures.

Methods

A comprehensive literature search was conducted in PubMed for studies published between 2014 and 2024, focusing on pregnancy outcomes after bariatric surgery. The review analyzed outcomes across different surgical procedures: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric banding (AGB), and biliopancreatic diversion with duodenal switch (BPD-DS).

Results

Metabolic and bariatric surgery demonstrates significant benefits in reducing obesity-related pregnancy complications, including decreased rates of gestational diabetes and hypertensive disorders. However, procedure-specific risks were identified: RYGB showed increased risks of internal herniation and nutritional deficiencies; SG demonstrated more stable glycemic profiles with lower rates of complications; AGB required ongoing adjustment during pregnancy; and BPD-DS presented the highest risk of nutritional deficiencies. Small-for-gestational-age births were more common after malabsorptive procedures compared to restrictive ones. The traditional recommendation of waiting 12–24 months before conception appears oversimplified, with evidence suggesting procedure-specific timing considerations may be more appropriate.

Conclusions

While all bariatric procedures improve pregnancy outcomes compared to untreated obesity, the choice of procedure for women of reproductive age should carefully consider the balance between metabolic benefits and potential risks to maternal and fetal health. Individualized, procedure-specific approaches to post-surgical care and pregnancy timing are recommended.

Purpose

Shoulder dystocia (SD) is a serious delivery complication, often occurring without identifiable risk factors. Accurate risk assessment is essential for educated decisions regarding the mode of delivery. This study aimed to develop and validate a machine learning-based model for SD prediction.

Methods

We conducted a retrospective analysis of term singleton vaginal deliveries at a single academic hospital over 10 years. Exclusion criteria included cesarean deliveries and multiple gestations. Maternal and fetal characteristics were compared between SD and non-SD cases. Eleven features were selected for model development. Missing values in normally distributed variables were imputed using mean values. To address class imbalance, repeated random sampling of non-SD cases was performed. Data were split into training and test sets (70:30) and standardized. Multiple machine learning models—including logistic regression, decision tree, random forest, support vector machine, XGBoost, and CatBoost—were evaluated using cross-validation and area under the ROC curve (AUC).

Results

Among 51,628 deliveries, 94 (0.18%) involved SD. SD was associated with higher BMI, shorter stature, and increased diabetes rates (all p < 0.05). Mean birthweight was significantly higher in the SD group (3751 g vs 3287 g, p < 0.01). The CatBoost model achieved the highest performance (AUC = 0.83, 95% CI 0.77–0.89). Key predictive features were sonographic estimated fetal weight (EFW, 55.6% of the model’s decision-making weight), maternal BMI (20.1%), and clinical EFW (7.9%).

Conclusion

Our machine learning-based model predicted SD with an AUC of 0.83 and may support clinicians in delivery planning.