Archives of Gynecology and Obstetrics最新文献

Purpose: There is an ongoing discussion on whether the benefits of term elective labor induction outweigh its potential risks. This study evaluated the utility of a comprehensive clinical examination in identifying low-risk pregnancies suitable for expectant management beyond gestational age 40‒41 weeks and compared their outcomes with earlier labor induction by indication.

Methods: Pregnant women (n = 722) with ≥ 40 + 0 gestational weeks referred to a tertiary hospital were included in this prospective cohort. The study population was divided into the primary induction group (induction before 42 + 0 gestational weeks) and the expectant management group (spontaneous labor onset or induction at 42 + 0 gestational weeks), by decision based on a primary consultation. The Chi-square test and logistic regression were applied. The outcome measures were composite adverse fetal outcome (admission to a neonatal intensive care unit, metabolic acidosis, or Apgar score < 7 at 5 min), treatment with intrapartum antibiotics, intrapartum maternal fever ≥ 38 °C, intrapartum cesarean section, and postpartum hemorrhage ≥ 1500 ml.

Results: The main outcome measures did not differ significantly between the primary induction group (n = 258) and the expectant management group (n = 464): composite adverse fetal outcome (OR = 2.29, 95% CI = 0.92-5.68; p = 0.07), intrapartum cesarean section (OR = 1.00, 95% CI = 0.64-1.56; p = 1.00), postpartum hemorrhage ≥ 1500 ml (OR = 1.89, 95% CI = 0.92-3.90; p = 0.09), intrapartum maternal fever ≥ 38 °C (OR = 1.26, 95% CI = 0.83-1.93; p = 0.28), or treatment with intrapartum antibiotics (OR = 1.25, 95% CI = 0.77-2.02; p = 0.37).

Conclusion: A comprehensive clinical examination at 40‒41 gestational weeks can identify pregnancies that might be managed expectantly until 42 gestational weeks obtaining similar outcomes to those induced earlier.

Purpose: The aim of this cross-sectional study was to investigate the psychosocial burdens of patients with ovarian cancer during the COVID-19 pandemic.

Methods: Ovarian cancer patients answered a quantitative survey assessing their resilience (BRS) and quality of life (FACT-G7) as well as clinical (first- vs. ≥ second-line treatment), demographic (age < 65 vs. ≥ 65 years) and COVID-19 pandemic-related psychosocial impairment, i.e. anxiety (GAD7); depression (PHQ2); global physical, mental, and social health (PROMIS items). Analyses of variance were applied to compare psychological impairment between patients on first- vs. ≥ second-line treatment and between patients aged < vs. ≥ 65 years at start of treatment. Multiple linear regression analyses were performed to evaluate predictors of patients' resilience and quality of life based on demographic, clinical, and psychosocial variables.

Results: Most of the 93 patients rated their physical and mental health, and satisfaction with social activities as good. Eighty-seven (91.4%) were somewhat or very concerned about the pandemic. Patients on first-line therapy reported a better quality of life (p = 0.03) and better general health (p = 0.014) than those on at least second-line therapy. Patients < 65 years old reported significantly more concern about the pandemic than older patients (p = 0.008). Predictors of resilience were severity of anxiety (GAD-7) and mental health. Predictors of quality of life were general health, severity of depression (PHQ-2), and type of therapy.

Conclusions: Patients in first line of treatment and younger patients could benefit from support in coping with pandemic-related burdens, meaning that attention should be paid to potential psychological distress, which should be treated alongside the cancer.

Purpose: Adult granulosa cell tumors (aGCTs) are a rare type of ovarian malignancy. While most aGCTs have an indolent course, up to 25% experience recurrence. Identifying markers for disease recurrence is crucial for optimal management.

Methods: Our study consisted of a total of 55 patients, comprising primary non-recurrent aGCTs (n = 30), aGCT recurrences without corresponding primary tumors (n = 19), and primary aGCTs which later recurred along with their matched recurrences (n = 6). Immunohistochemical analysis was conducted for CD73, Ki67, and p53, along with TERT mutation analysis on selected tissue samples.

Results: Immunohistochemical analysis revealed higher Ki67 proliferation index in recurrent aGCTs compared to non-recurrent cases. Mutational p53 staining was only present in recurrent cases. CD73 expression did not differ significantly between primary non-recurrent and recurrent aGCTs. A notably increased occurrence of TERT promoter mutations was identified in recurrent aGCTs (14/25, 56%) in contrast to primary non-recurrent instances (8/27, 29.6%) (p = 0.05). In primary non-recurrent aGCTs with identified TERT mutations, the C250T locus was impacted in 2 cases, while the C228T locus was affected in 6 cases. Recurrent aGCT cases predominantly exhibited TERT C228T mutation in 13 out of 14 patients. Among the six pairs of primary and recurrent aGCTs studied, four pairs displayed TERT mutations in both primary and recurrence samples. Moreover, cases with TERT mutations exhibited a higher Ki67 index.

Conclusion: Identifying patients with high Ki67 and mutational p53 together with TERT mutations may help predict potential recurrence in aGCT cases.

Purpose: For unexpected low-prognosis patients (Group 1 and Group 2) defined by POSEIDON criteria, how to maximize the live birth rate while controlling the multiple birth rate by tailoring the embryo transfer number and quality?

Methods: This was a retrospective study, including patients from Poseidon Group 1 (N = 672) and Group 2 (N = 503) who underwent cleavage-stage embryo transfer. Logistic regression was used for the comparative analysis of clinical outcomes among subgroups divided by the number and quality of embryos.

Results: For Group 1, compared to transferring a single good-quality embryo (GQE), a good-quality embryo with a poor-quality embryo (GQE + PQE) did not significantly improve the live birth rate, although increasing in value (40.5% vs 31.9%, P = 0.272), meanwhile obviously raised the multiple birth rate to 28.1% (P = 0.042). For Group 2, double embryo transfer (DET) was associated with a higher live birth rate than single embryo transfer (SET) (22.4% vs 6.3%, P = 0.001) and further analysis indicated that the similar trend observed in the GQE + PQE group compared to the GQE group (26.1% vs 8.5%, P = 0.017) with statistical significance, but without a significant increase in the multiple birth rate (8.3%, P = 1.000).

Conclusions: The study indicated that  a single good-quality cleavage-stage embryo was an option for patients in Poseidon Group 1 to avoid the risk of multiple pregnancies. DET with mixed quality cleavage-stage embryo might be an alternative for Poseidon Group 2, given that it improved the pregnancy outcomes while controlling the multiple birth rates.

Purpose: To evaluate the role of secondary cytoreduction in patients with platinum-sensitive recurrent ovarian cancer.

Methods: The PubMed, Medline, Embase, Cochrane Library and Web of Science databases were searched. Randomized controlled trials (RCTs) that compare secondary cytoreduction plus chemotherapy with chemotherapy alone in patients with platinum-sensitive relapsed ovarian cancer were selected. Pooled hazard ratios (HR) with 95% confidence intervals (CIs) were calculated.

Results: There was no difference in overall survival (OS) between the surgery group and no surgery group (HR = 0.89; 95% CI 0.77, 1.04; p = 0.14), but secondary cytoreduction showed a significant improvement in progression-free survival (PFS) (HR = 0.67; 95% CI 0.54, 0.76; p < 0.00001). A subgroup analysis comparing the complete gross resection subpopulation with the no surgery group achieved a significant longer OS (HR = 0.70, 95% CI 0.58-0.85; p = 0.0003) and a greater PFS benefit (HR = 0.56, 95% CI 0.48-0.66; p < 0.00001). In addition, as compared with incomplete resection, the OS benefit of complete gross resection was more evident (HR = 0.51, 95% CI 0.37-0.69; p < 0.0001).

Conclusions: In women with platinum-sensitive recurrent ovarian cancer, although secondary cytoreduction followed by chemotherapy resulted in longer PFS than chemotherapy alone, it did not lead to significant benefit in OS. However, when complete gross resection was achieved, it significantly prolonged OS and provided a greater PFS benefit.

Purpose: Ovarian cancer is the fifth most common cancer in women and the leading cause of death of all gynecological malignancies. Prognosis is determined by optimal surgical outcome (macroscopic complete resection) most commonly achieved in tertiary hospitals. We investigated whether tertiary versus non-tertiary hospital as the location of an initial diagnostic intervention for histological confirmation before cytoreductive surgery versus immediate primary debulking surgery impacts outcome in patients with advanced ovarian cancer.

Methods: We analyzed 115 patients who underwent cytoreductive surgery at a German tertiary center: 60 patients underwent primary debulking surgery (PDS) and 55 patients had a diagnostic intervention for histological confirmation before debulking surgery (PHC).

Results: Although there was no prognostic difference between the two subgroups, the median time to chemotherapy was longer in the PHC group (46 days) compared to the PDS group (26 days; p < 0.0001), equally seen comparing non-tertiary versus tertiary PHC groups (p: 0.0001), its impact confirmed in a multivariate analysis (PFS: HR: 1.03, 95%CI: 1.01-1.05, p: 0.007; OS: HR: 1.04, 95%CI: 1.02 -1.06, p: < 0.001) of the PHC group only. In total, 9/10 patients with port-site metastases after diagnostic laparoscopy were initially treated at non-tertiary hospitals, resulting in a lower PFS compared to patients without port-site metastases after laparoscopy (HR 0.21, 95%CI 0.06-0.733, p: 0.014).

Conclusions: In conclusion, patients with ovarian cancer undergoing treatment solely at a tertiary center have some clinical benefits and improved outcome, given the shorter time to chemotherapy and potential impact of port-site metastases. This supports centralization of oncological treatment.

Objective: To investigate pregnancy outcomes following hysteroscopic adhesiolysis (HA) in patients with recurrent pregnancy loss (RPL) or infertility.

Design: Retrospective cohort study.

Setting: University-affiliated hospital.

Subjects: According to the inclusion and exclusion criteria of this study, finally, a total of 461 subjects were included.

Interventions: HA performed using either an electrosurgical instrument or hysteroscopic scissors.

Main outcome measures: Pregnancy outcomes post-HA.

Results: A total of 461 patients were included in the study, with follow-up periods ranging from 1 to 6 years. The mean age was 29.48 ± 3.25 years. Hysteroscopic scissors demonstrated greater efficiency in restoring the uterine cavity compared to electrosurgical instruments (88.1% vs. 80.0%, p = 0.025). Post-HA, the pregnancy rate was approximately 75.3% (347/461), with a live birth rate of 55.9% (251/449). No significant differences were found between the electrosurgical instrument and hysteroscopic scissors groups regarding improvements in menstrual flow or fertility outcomes (all p > 0.05). Kaplan-Meier time-dependent cumulative curves for pregnancy and live birth rates after HA indicated that over 50% of patients achieved pregnancy within one year, with the pregnancy rate plateauing at 2 years and the live birth rate at 3 years.

Conclusion: Our findings suggest that HA can improve fertility outcomes for patients with RPL or infertility within 2 to 3 years following surgery. Hysteroscopic scissors proved more effective than electrosurgical instruments in restoring the uterine cavity, although no differences were observed between the techniques in terms of menstrual flow or fertility improvements. All in all, our study suggests that standardized HA procedures, the implementation of proactive intraoperative and postoperative measures to prevent the recurrence of intrauterine adhesions (IUA), and an active conception plan following HA are key factors in improving reproductive outcomes for these patients with RPL or infertility.