Archives of Gynecology and Obstetrics最新文献

Objective

To examine the impact of a new image enhancement technique on biparietal diameter (BPD), head and abdominal circumference (HC and AC), and femur length (FL) measurements as well as the estimated fetal weight (EFW).

Methods

In this retrospective study, the second and third trimester biometry (BPD, HC, AC, and FL) images that were taken with two GE Voluson E22 ultrasound machines between May and July 2025 were collected. Each measurement was retrospectively obtained using the following settings in sequence: the radiant mode turned off and with the radiant mode turned on minimum, medium, and maximum levels. The measurements were made using automated caliper placement technology. The EFW was calculated using the Hadlock formula. Only the cases where each of the measurements were adequately identified by the automated measurement system were used in the study. Comparisons among the measurements taken without the radiant mode and with the three levels of the radiant mode were then made.

Results

The study population consisted of 298 women. The median gestational age was 23 weeks. The automated measurement system was able to place the calipers correctly for all required measurements in 253 (84.9%) cases. These cases were then used for further analysis. A comparison of the measurements done without radiant mode and those with the aid of radiant technology showed that BPDs were slightly larger and the FLs were shorter. The HCs and ACs remained unchanged with all three radiant settings. The EFWs also remained unchanged with the minimum radiant setting but were lower with both the medium and maximum radiant setting. The changes were most pronounced with the maximum setting. The average bias was between − 0.11% and 1.51%. The widest range of biases was found for the estimated fetal weight when a maximum radiant mode was used. In this case, 95% of the biases were within − 6.1 and 9.0%.

Conclusion

The radiant mode can affect the automated fetal biometry, particularly using the maximum mode. Although the average effect is modest, biases may be clinically relevant, especially if other factors increase the extent of the bias.

Purpose

The aim of this study was to compare fetal pancreas size at second trimester ultrasound screening of growth-restricted and normal weight fetuses.

Methods

One hundred sixty-six fetuses between 18 + 0 and 21 + 6 weeks of gestation were included in this retrospective study. 83 fetuses with a birth weight below the 10th centile were included in the study group which was further subdivided into two subgroups depending on the presence (subgroup 1) or absence (subgroup 2) of prenatal signs of fetal growth restriction. The control group consisted of 83 normal fetuses matched for sex and gestational age at examination. The pancreatic diameter (PD) was measured in a standard 2D plane of the fetal abdomen. Statistical analyses comprised descriptive statistics, reliability testing, and multivariable modelling to explore group differences and covariate effects on pancreatic diameter.

Results

The diameter of the pancreas was increased in the LBW group compared to the control group [3.7 mm vs. 3.1 mm (p < 0.001)]. The ratio of abdominal circumference (AC) to pancreatic diameter was significantly smaller in the LBW group [41.51 vs. 50.62 (p < 0.001)]. The result was consistent in the subgroup analysis. The difference of the median PD and ratio of AC/PD is greatest in subgroup 1 compared to the control group [PD: 4.2 mm vs. 3.1 mm (p < 0.001) and AC/PD-ratio 35.33 vs. 51.88 (p < 0.001)].

Conclusion

The diameter of the fetal pancreas, as measured in this study, is a valuable parameter for the detection of small for gestational age and growth-restricted fetuses. Further studies are needed to further validate our results and their implication for clinical decision-making.

Diminished ovarian reserve (DOR) and luteal phase defect (LPD) are common endocrine disorders affecting the fertility of women of reproductive age. Traditionally, these conditions have been considered and treated independently. However, clinical observations frequently reveal that patients with DOR also exhibit features of LPD, suggesting a potential pathophysiological link between them. This review aims to explore the interplay between DOR and LPD from a novel perspective by integrating epidemiological data, current diagnostic and therapeutic practices, and recent insights into molecular mechanisms. Special emphasis is placed on the role of hypothalamic–pituitary–gonadal (HPG) axis dysfunction, oxidative stress–inflammatory microenvironment imbalance, and key signaling pathways, such as PI3K/Akt/mTOR, in mediating their interaction. We propose a central hypothesis: LPD may not merely be a complication of DOR; rather, intrinsic features of LPD—such as insufficient or prematurely withdrawn progesterone secretion—may exert negative feedback on the HPG axis and exacerbate oxidative damage within the ovarian microenvironment, thereby actively contributing to the onset or progression of DOR. Based on this hypothesis, we further suggest that treating LPD—particularly through luteal phase support therapy—may have benefits beyond improving endometrial receptivity. Such interventions could potentially modulate the endocrine milieu at both the systemic and local ovarian levels, thereby playing a role in managing DOR and possibly improving antral follicle count (AFC). These insights open up new directions for future therapeutic strategies targeting DOR.

Objective

To analyze the correlation between lipid levels and the severity of polycystic ovary syndrome (PCOS) and its predictive value for pregnancy outcome.

Methods

This retrospective study included 275 PCOS patients treated with ovulation induction therapy and 234 healthy controls (used only for baseline comparisons). Lipid levels were correlated with disease phenotype and sex hormones using Spearman/Pearson coefficients. Binary logistic regression and ROC curves assessed the predictive value of lipid levels for pregnancy failure.

Results

There were statistically significant differences between the two groups in glycemic indexes (fasting blood glucose (FBG), fasting insulin (FINS), homeostatic model assessment for insulin resistance (HOMA-IR)) and sex hormone indexes (testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), anti-Müllerian hormone (AMH)). The levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (Apo B) were significantly elevated in patients with PCOS and were closely correlated with the severity of the disease. In addition, these four lipid parameters were significantly positively correlated with T, LH, FSH, and AMH, and significantly negatively correlated with E2. Elevated levels of T, LH, TG, LDL-C, and Apo B were independent risk factors for pregnancy failure after ovulation induction treatment. TG assisted in predicting pregnancy failure after ovulation induction therapy in PCOS patients with an AUC of 0.861 (sensitivity 75.61%, specificity 85.53%); LDL-C assisted in predicting pregnancy failure after ovulation induction therapy in PCOS patients with an AUC of 0.868 (sensitivity 75.61%, specificity 83.55%); and Apo B assisted in predicting pregnancy failure after ovulation induction therapy in PCOS patients with an AUC of 0.836 (sensitivity 74.80%, specificity 86.84%).

Conclusion

Lipid levels were significantly correlated with the severity of disease in PCOS patients, and TG, LDL-C, and Apo B levels assisted in predicting the occurrence of pregnancy failure after ovulation induction therapy.

Background

Human chorionic gonadotropin (hCG) is a glycoprotein hormone critical for reproduction, particularly in pregnancy maintenance and fertility treatments. Beyond reproduction, hCG may influence immune regulation, cancer biology, and neurological processes.

Objective

This review critically examines the current evidence regarding the potential neurological effects of hCG, synthesizing findings from experimental and clinical studies to assess its proposed roles in neuroinflammation, oxidative stress, and blood–brain barrier modulation.

Result

Dysregulated hCG levels—arising from pregnancy complications, assisted reproductive technologies (ART), or hCG-secreting tumors—have been associated with markers of neurotoxicity, including neuroinflammation, oxidative stress, and altered blood–brain barrier integrity. Evidence remains largely associative, and causal mechanisms linking hCG to neurobiological vulnerability are not yet established. Proposed pathways include modulation of immune cell activity, neurotransmitter signaling, and endothelial function.

Conclusion

hCG exhibits a dual nature: essential for reproduction and immune adaptation, yet potentially neurotoxic under dysregulated conditions. This review synthesizes mechanistic hypotheses, highlights knowledge gaps, and underscores the need for rigorous longitudinal and experimental studies to clarify hCG’s impact on the nervous system.

Graphical abstract

Objective

Preserving ovarian reserve function during single-port laparoscopic ovarian cystectomy is crucial for women of reproductive age. This study aimed to evaluate the hemostatic efficacy and impact on ovarian reserve of three different hemostatic methods in LESS (laparoendoscopic single-site) ovarian cystectomy.

Methods

Patients with unilateral ovarian cysts were divided into three groups based on hemostatic methods: the oxidized cellulose polymer group, the suture group, and the bipolar coagulation group. All participants underwent standardized LESS ovarian cystectomy. Intraoperative hemostatic effects within 10 min, intraoperative blood loss, and postoperative hemoglobin reduction were observed. Blood samples were collected before surgery, 1 month and 6 months after surgery to measure anti-Müllerian hormone (AMH) levels via radioimmunoassay. Vaginal ultrasound was performed preoperatively and 6 months postoperatively to obtain ovarian stromal peak systolic velocity (PSV) and antral follicle count (AFC).

Results

All three hemostatic methods demonstrated equivalent hemostatic efficacy (P > 0.05). However, significant differences emerged in ovarian reserve outcomes, at 6-month evaluation, oxidized cellulose polymer demonstrated superior preservation: AMH decline was 5.9% (Δ–0.22 ng/mL) with a 15.4% advantage over bipolar coagulation (mean difference Δ–0.80 ng/mL; P < 0.001). Although there was no statistically significant difference in the decline of anti-Müllerian hormone (AMH) levels between the oxidized cellulose polymer group and the suture group (P = 0.749), the suture group still exhibited a greater reduction compared to the oxidized cellulose polymer group (Δ–0.27 ng/mL). However, in the endometriosis subgroup, the suture group demonstrated a significantly greater decline in AMH levels compared to the oxidized cellulose polymer group (P = 0.006). Oxidized cellulose polymer again demonstrated superior preservation over suturing in AFC (mean decline ratio 0.11, 95% CI 0.10–0.14) and PSV (mean decline ratio 0.051, 95% CI 0.043–0.062), particularly in endometriosis patients where these differences were statistically significant (P < 0.05).

Conclusion

In LESS ovarian cystectomy, while bipolar coagulation, suturing, and oxidized cellulose polymer show equivalent hemostatic efficacy, the oxidized cellulose polymer demonstrates superior preservation of ovarian reserve function (AMH, AFC, and PSV parameters) with significantly less surgical trauma and greater technical simplicity. These findings strongly support the preferential use of oxidized cellulose polymer, particularly for fertility-preserving procedures in reproductive-age women, with added benefits for endometriosis patients who show heightened vulnerability to ovarian reserve compromise.

Clinical trial registration

ChiCTR2500102270

Objective

To clarify the association between mesenchymal stromal cell exosomes (MSC-exosomes) and recurrent spontaneous abortion (RSA) Clarify the biological characteristics of MSC-exosomes and their potential regulatory functions in pregnancy maintenance.

Methods

By using the literature review method combined with the published relevant experimental research results, the biological characteristics of MSC-exosomes were systematically sorted out and analyzed to explore their potential mechanism of action in the process of pregnancy maintenance. The results show that MSC-exosomes can participate in the key processes of pregnancy maintenance by regulating the immune microenvironment at the maternal-fetal interface, promoting local angiogenesis and maintaining the normal physiological functions of trophoblast cells. The content of MSC-exosomes in the body shows a dynamic changing trend during pregnancy. A large number of studies have confirmed that MSC-exosomes are closely related to the establishment and maintenance of normal pregnancy and the occurrence and development of pathological pregnancy.

Conclusion

In-depth exploration of the intrinsic association and mechanism of action between MSC-exosomes and RSA can provide a new perspective for the study of the pathogenesis of RSA, and at the same time offer potential biomarkers and therapeutic targets for the clinical diagnosis and targeted therapy of RSA, which has significant theoretical value and clinical significance.

Purpose

This study assessed geographic variations in the supply, demand, and adequacy of the United States (US) obstetrics and gynecology physician (OGP) workforce.

Methods

This was a cross-sectional analysis of OGPs using the Health Workforce Simulation Model. Supply and demand were defined as the numbers of full-time equivalent (FTE) OGPs working and needed, respectively. Adequacy was defined as the ratio of supply to demand. Comparisons were made using Chi-squared tests, and linear regression was used to analyze OGP workforce trends.

Results

From 2025 to 2037, the demand for OGPs is projected to increase (52,620–54,020 FTEs, 2.7% increase, p < 0.001) while the supply of OGPs is projected to decrease (49,170–44,130 FTEs, 10.3% decrease, p < 0.001). As a result, OGP workforce adequacy is projected to decrease over the study period from 93.4% to 81.7% (P < 0.001). By 2037, the West had the lowest OGP workforce adequacy and the Northeast had the highest adequacy (74.4% vs 98.6%, P < 0.001). Non-metropolitan areas were projected to have lower OGP workforce adequacy than metropolitan areas (51.4% vs 85.1%, p < 0.001). The states with the lowest projected OGP workforce adequacy were Utah (49.3%), Idaho (51.5%), and Arizona (58.3%) in 2037.

Conclusion

OGP workforce supply is expected to fall short of anticipated demand, with uneven geographic distribution across the US. Addressing this imbalance will require strategic planning to expand the OGP workforce equitably, especially in non-metropolitan areas, the West, and certain identified states like Utah and Idaho.

Approximately half of the women in developed countries drive motor vehicles and the consequences of road traffic-related injuries involving pregnant women can be severe. This case report describes a rare injury of a parietal bone fracture in a fetus resulting from improper seatbelt use during a motor vehicle accident. A 36-year-old woman at 35 weeks of gestation was involved in a traffic accident while seated in the front seat wearing a seatbelt, but in an improper way for pregnant women. Transabdominal ultrasonography revealed a displaced fracture of the fetus’s right parietal bone with an overlying scalp hematoma. Despite initial conservative management, persistent fetal tachycardia and decelerations necessitated an emergency cesarean delivery resulting in live birth. This case underscores the importance of correct three-point seatbelt usage during pregnancy to prevent maternal and fetal injuries.

Introduction

Endometriomas are common in endometriosis and may coexist with deep pelvic disease. This study aimed to assess the association between endometrioma size and other endometriosis localizations using the #ENZIAN classification.

Study design

This multicenter study included women who underwent laparoscopic surgery for endometriomas between 2021 and 2024, with available surgical reports defining the #ENZIAN classification. Endometriomas were categorized as O1/2 (< 7 cm) or O3 (≥ 7 cm). Other endometriosis localizations were compared between the study groups.

Results

A total of 269 women underwent surgery for endometriosis involving endometriomas. Of these, 42 had #ENZIAN O3 endometriomas, with a significantly higher rate of unilateral cysts compared to women with #ENZIAN O1/2 (92.8% vs. 68.2%, p = 0.0011). After excluding bilateral cases, 194 women with unilateral endometriomas were analyzed: 39 with #ENZIAN O3 and 155 with #ENZIAN O1/2. Women with O3 lesions were significantly younger (31.5 ± 5.9 vs. 34.5 ± 6.6 years; p = 0.011). The rate of adenomyosis (#ENZIAN F-A) was significantly lower in the O3 group (41% vs. 69%, p = 0.0012), as was rectal involvement (#ENZIAN C; 7.7% vs. 23.8%, p = 0.025). The prevalence of severe pelvic wall disease (T/B ≥ 2) did not differ significantly between groups.

Conclusion

Smaller endometriomas (O1/2) are associated with more extensive pelvic disease, including higher rates of adenomyosis, rectal involvement, and pelvic adhesions, whereas larger endometriomas (O3) may represent a more localized disease phenotype. These findings support the use of the #ENZIAN classification for more accurate preoperative assessment and individualized surgical planning.