Archives of Gynecology and Obstetrics最新文献

Background

Although international recommendations strongly support regular physical activity during pregnancy due to the improved maternal and fetal outcomes, adherence to physical activity remains low, particularly in early gestation. Understanding activity patterns during the first trimester is crucial, as behaviors established in this phase often persist throughout pregnancy.

Objectives

To describe physical activity levels and adherence to international recommendations among low-risk pregnant women in the first trimester, using the Italian version of the Pregnancy Physical Activity Questionnaire (PPAQ).

Study Design

This cross-sectional observational study includes 498 low-risk singleton pregnant women between 11⁺³ and 13⁺⁶ weeks’ gestation, recruited at the University Hospital of Naples Federico II, Italy, between January 2022 and December 2023. Participants completed the Italian version of the PPAQ. Total energy expenditure was expressed in MET-h/week, and women were classified as exercisers (≥ 150 mines/week of moderate-intensity activity) or non-exercisers.

Results

Participants reported a median of 11.5 (IQR 8.2–15.0) h/week of total activity, corresponding to 155.7 (102.6–241.7) METs-h/week. While 51% met the threshold of ≥ 150 min/week of moderate-intensity activity when considering all activity domains, only 7.8% reached this target through sport or structured exercise alone. Walking represented the most common exercise (64.1% slow, 46.2% brisk, 25.6% uphill). Employment status was significantly associated with higher adherence to recommendations, whereas other sociodemographic factors showed no significant differences.

Conclusions

Structured exercise should be improved in the daily routine to optimize maternal and fetal health, although activity levels may appear adequate. Adherence to physical activity recommendations could be promoted by integrating validated tools such as the PPAQ into routine prenatal care and targeted interventions.

Background

Pregnant women living with HIV (PWLHIV) are at increased risk of infectious complications during pregnancy, and HIV-exposed but uninfected women are more susceptible to serious infectious diseases. Therefore, maternal immunization during pregnancy is an essential standard of care for this patient population. However, vaccination during pregnancy is suboptimal among these patients.

Methods

This is a single-center retrospective observational study, conducted at the University Hospital Federico II of Naples, Italy. We examined how our Center's vaccination uptake among PWLHIV changed after the introduction of in-hospital vaccine administration. To account for the small sample size and assess the robustness of the findings, Firth’s penalized logistic regression was performed as a sensitivity analysis.

Results

Between January 2021 and December 2024, 41 PWLHIV have been referred to the Regional Referral Centre for HIV in Pregnancy. Out of 38 eligible patients, 21 received the Tdap vaccine, resulting in an overall uptake of 55.3%. Following the introduction of in-hospital vaccine administration in January 2023, we observed a significant increase in pertussis-containing vaccine uptake among PWLHIV. Vaccine uptake increased from 20% (January 2021–December 2022) to 78.3% after the introduction of in-hospital vaccine administration (January 2023–December 2024), (p < 0.001). The sensitivity analysis using Firth’s penalized logistic regression confirmed the independent association between in-hospital vaccination and vaccine uptake (adjusted OR 11.45; 95% CI 2.45–68.32; p < 0.001).

Conclusions

We observed improved vaccine uptake after introducing vaccine administration within the hospital setting. We believe that this strategy might significantly improve vaccine administration among PWLHIV.

Objective

To evaluate the surgical efficacy and prognosis of radiofrequency ablation (RFA) in the treatment of microcystic congenital pulmonary airway malformation (CPAM) complicated by fetal hydrops, with the CLM volume ratio (CVR) exceeding 2.0 and refractory to conservative treatment with maternal steroid administration.

Methods

We collected data from fetal microcystic CPAM cases with CVR > 2.0, complicated by fetal hydrops, and refractory to maternal steroid therapy, who underwent RFA at our hospital from June 2020 to June 2024.

Results

The study comprised five fetuses, all diagnosed with microcystic CPAM complicated by fetal hydrops. All fetuses had a mean CVR of 3.8 (range, 2.2–5.3) and were complicated by fetal hydrops. All cases received two courses of maternal steroid before the RFA procedure. Among the five cases, three newborns were delivered at a mean gestational age of 36.6 weeks (range 35.2–38.7 weeks), and two cases of IUFD occurred postoperatively.

Conclusion

For microcystic CPAM complicated with fetal hydrops and refractory to maternal conservative steroid administration, ultrasound-guided RFA serves as an effective salvage option for intrauterine treatment. Nevertheless, intrauterine interventional procedures should be performed with extreme caution, given the potential risks of IUFD.

Purpose

Primary: To evaluate whether robotic-assisted laparoscopic surgery using the Senhance® Surgical System has the potential to reduce muscular demands compared to conventional laparoscopy. Secondary: To verify that the novel eye-tracking feature for zoom and the selection of functions in the Senhance® System menu is not associated with increased eyestrain or neck strain.

Methods

In a within-subject design, 2 experienced surgeons performed 11 robot-assisted and 12 conventional laparoscopic procedures. Muscular demands were monitored throughout surgical procedures by assessing the muscle activity via bipolar surface electromyography of seven muscles of the lower back, shoulder–neck, and forearms. Surgeons’ head, arm, and torso posture was assessed by gravimetrical position sensors. Furthermore, musculoskeletal discomfort, mental and physical workload, task difficulty and working precision were rated by the surgeons. In addition, a ten-item eyestrain questionnaire was administered after each surgical procedure.

Results

Four out of seven muscles were relieved when working with Senhance®. Only in the left shoulder–neck area there was a statistically significant increase in muscle activation associated with robotic-assisted surgery. Changes in surgeons’ posture related to the surgical technique corresponded to the changes in muscle activation. Furthermore, surgeons reported no musculoskeletal discomfort under both conditions and similar levels of workload (mental and physical), and task difficulty. Working precision was subjectively rated to be better during standard laparoscopy. No eyestrain occurred during any of the procedures.

Conclusion

This exploratory study identified the potential of the Senhance® Surgical System for ergonomic improvements and indicated no impairments by the novel eye-tracking feature on muscle demands and eyestrain. Follow-up studies with larger and more diverse indications are needed that also consider clinical outcomes, which were not part of the present study.

Purpose

Cardiovascular diseases are the leading causes of mortality in women worldwide, with hypertension being a major risk factor. While traditional blood pressure monitoring techniques rely on cuff-based measurements, wearable devices offer a promising alternative for continuous and non-invasive blood pressure tracking. This systematic review investigates the extent to which wearable blood pressure measurements can serve as surrogates for traditional sensors to be implemented in risk assessment tools in predicting cardiovascular risk in women.

Methods

A systematic search was conducted in databases including MEDLINE, Embase, Cochrane Library, Web of Science, Scopus and ClinicalTrials.gov. Studies published between 2010 and 2024 were included. Exclusion criteria were case reports or animal studies. Study selection was performed based on PRISMA guidelines. Data extraction focused on wearable devices, measurement approach, validation against gold-standard BP methods, and their predictive utility for cardiovascular outcomes.

Results

The systematic literature search revealed 14′863 results after removal of duplicates, of which 245 were selected for extraction. Most included studies used photoplethysmography, with pulse transit time and pulse wave velocity as core parameters, some using machine learning. Accuracy was moderate to high for diastolic blood pressure, but systolic blood pressure showed greater variability. Cardiovascular risk stratification showed promising results, though external validation was rare.

Conclusion

Wearable blood pressure monitoring technologies are maturing, with growing potential in preventive cardiovascular medicine in women. However, clinical implementation is limited by varying accuracy, need for calibration, and the lack of standardization. Further validation and longitudinal studies are needed to establish their role in cardiovascular risk prediction.

Background

Gestational Diabetes Mellitus (GDM) presents significant risks to both maternal and foetal health during pregnancy.

Purpose

This observational study aimed to investigate the association between clinical parameters and adverse pregnancy outcomes in women with GDM.

Methods

A cohort of 2174 GDM-diagnosed women was analysed, with 1705 experiencing no adverse outcomes and 469 developing complications such as preeclampsia, large for gestational age (LGA) infants, preterm birth, and shoulder dystocia. Clinical data, including maternal age, glucose levels, gestational age, body mass index (BMI), and treatment methods, were collected and analysed.

Results

Advanced maternal age, higher parity, increased weekly weight gain, and abnormal fasting glucose levels were associated with adverse pregnancy outcomes in women with GDM. In particular, early onset of GDM, elevated weekly weight gain, and abnormal fasting glucose levels were linked to an increased risk of developing preeclampsia and delivering LGA infants. However, no significant associations were found regarding shoulder dystocia. Furthermore, maternal age and weekly weight gain were identified as risk factors for preterm birth.

Conclusion

This study shows that in addition to well-known risk factors, abnormal fasting glucose levels are significantly linked to developing adverse pregnancy outcomes in women with GDM. Our data suggested that close monitoring of fasting glucose levels and controlling weight gain may significantly reduce the risk of adverse outcomes in pregnancies complicated by GDM.

Objective

Despite on-going research into the underlying pathology of hypertensive disorders in pregnancy, maternal mortality is hardly decreasing. Current antihypertensive therapy is aimed at controlling symptoms and preventing severe courses of pregnancy. Traditional management focuses on blood pressure (BP) control, but does not consider individual hemodynamic variations. Hemodynamically guided therapy offers a personalized approach that can improve BP control and outcomes by treating the underlying pathophysiology. The aim of this review is to provide an overview of hemodynamically guided antihypertensive therapy in hypertensive disorders of pregnancy and to present the results of recent intervention trials in this area.

Methods

Literature searches were conducted in the electronic databases PubMed, CENTRAL, and Google scholar from inception to May 2024 for studies that used maternal hemodynamic parameters like cardiac output (CO) or TPVR (total peripheral vascular resistance) to guide antihypertensive therapy in pregnant women with hypertensive disorders or at elevated risk for developing preeclampsia. The review included intervention studies.

Results

A total of five studies met the inclusion criteria. All studies showed improved BP control when the antihypertensive medication administered was matched to hemodynamic characteristics of the women being treated. Using a personalized approach, pregnancy complications were significantly reduced in patients with both hypo- or hyperdynamic circulation, even in patients with a history of preeclampsia.

Conclusion

The study shows that hemodynamically triggered antihypertensive therapy can improve outcomes for both mother and child in cases of hypertensive pregnancy disorders. However, further placebo-controlled studies are necessary before a final assessment of this therapy can be made.

Purpose

This study aimed to evaluate the rate and severity of allergic events associated with the use of indocyanine green (ICG) in sentinel lymph node biopsy (SLNB) for patients with early-stage vulvar cancer. The research question focused on whether ICG administration poses a significant risk of allergic reactions, especially in patients with a history of allergies to iodinated contrast.

Methods

We conducted a retrospective study after prospective multicenter recruitment endorsed by the Spanish Investigational Network Gynecologic Oncology Group. Data on patient demographics, history of allergic reactions, and ICG administration were collected. A systematic literature review was performed to assess existing studies on ICG-related allergic reactions in SLNB.

Results

Among the 75 patients, 66 (75%) have been exposed to iodinated contrasts and 2 (3%) had a documented iodinated contrast allergy with a mild reaction. There were no intraoperative complications. During the postoperative period, there were only minor complications (15 (20.0%) grade I and 13 (17.3%) grade II of Clavien–Dindo classification), and none associated with the injection of ICG or allergen-based that could be related. The systematic review of 11 studies involved 206 patients and 354 groins. The history of allergy to iodinated contrast was not recorded in any of them. We observed no patients with adverse reactions related to this tracer after peritumoral injection.

Conclusion

Our findings suggest that peritumoral ICG injection for SLNB in early-stage vulvar cancer could be safe. This study reinforces the potential for ICG to be a reliable tracer in vulvar cancer staging.

Background

Vulvar carcinoma (VC), a rare cancer, recurs in over a third of women, usually within 2 years. Treatment options other than repeat surgery and radiotherapy are often required in the recurrence setting. Systemic chemotherapy is an option but is generally associated with stressful side effects. In the palliative setting, electrochemotherapy (ECT) is a better-tolerated alternative, which provides local tumor control while obviating systemic side effects.

Objective

To descriptively analyze a case series of patients with inoperable locally advanced or locoregionally recurrent VC receiving bleomycin-based ECT.

Methods

Descriptive analysis of prospectively collected data from a case series. Postmenopausal women with locally advanced or locoregionally recurrent VC were eligible for inclusion. Bleomycin was administered at 15 mg/m² body surface as a single 1-min intravenous injection; 8 min later, electrochemical treatment using sterile disposable electrodes was performed under anesthesia for ≤ 30 min. Postoperatively, patients received pain medication to mitigate muscle soreness.

Results

15 patients were included in the study. Median patient age at ECT was 81 (range, 51–100) years. Recurrences (1–5) were present in 12 patients. Surgery and radiotherapy were not justifiable options in 3 patients. In our clinical observation, ECT was well tolerated by all patients for the management of pain, itching, odor, and secretion. This allowed for time to be gained until further treatment became necessary or disease progression occurred.

Conclusions

In our clinical experience, bleomycin-based ECT is an oncologically efficacious and better-tolerated alternative to systemic chemotherapy or immunotherapy in patients with recurrent VC in a palliative setting with limited capacity to undergo treatment.

Objective

To evaluate current diagnostic criteria, risk stratification, and management practices for fetal intra-abdominal umbilical vein varix (FIUVV) among maternal–fetal medicine and obstetric ultrasound specialists in Israel.

Methods

A national web-based survey was distributed to specialists, collecting data on diagnostic parameters, classification of severity, surveillance protocols, and delivery timing recommendations. Responses were analyzed descriptively.

Results

45 specialists (85% response) from 18 centers participated. Diagnosis was most commonly based on FIUVV diameter, with 9 mm the most frequent cutoff, though substantial variation in criteria existed. Severity assessment relied mainly on vessel diameter, flow abnormalities, and thrombus presence. Most respondents recommended detailed anatomical survey and fetal echocardiography. Surveillance and delivery timing recommendations were tailored to risk level, with earlier induction and increased surveillance favored in high-risk cases. However, considerable variability existed among respondents regarding both the frequency of monitoring and the timing of delivery.

Conclusions

Considerable heterogeneity exists in FIUVV diagnosis and management in Israel. Consensus definitions and standardized protocols are needed to improve clinical care and enable comparative research.