Archives of Gynecology and Obstetrics最新文献

Objective

To evaluate procedure-related preterm birth (PTB) following third-trimester selective termination (ST) in DC twins and to compare delivery timing with expectantly managed discordant DC twins and non-anomalous DC twins.

Methods

A retrospective cohort study was conducted of all DC twin pregnancies undergoing third-trimester ST (> 28 weeks) at a tertiary care center (2003–2023). Pregnancies were classified as having procedure-related complications (delivery ≤ 4 weeks) or uneventful (delivery > 4 weeks). Comparator cohorts included expectantly managed discordant DC twins and non-anomalous DC twins. Outcomes included timing of delivery, cumulative incidence of PTB, and risk factor analysis.

Results

90 women with DC twin pregnancies elected for ST and 85 procedures were completed. Outcome was available for 81 cases; 48 (59.3%) delivered ≤ 4 weeks after ST and 33 (40.7%) delivered later. Clinical chorioamnionitis was more common within the group delivered ≤ 4 weeks (35.4% vs. 0%; p = 0.001). Cumulative PTB incidence showed accelerated delivery between 32 and 34 weeks after ST. Independent risk factors for delivery ≤ 4 weeks included polyhydramnios (OR 5.68) and reduction of the presenting fetus (OR 6.51). Comparator cohorts exhibited substantially lower PTB incidence.

Conclusion

Third-trimester ST in DC twins is associated with high PTB risk, but excellent co-twin survival. The first 4 weeks after ST represent a critical vulnerability period, and risk is strongly influenced by identifiable preprocedural factors. These findings support individualized counseling, later scheduling in high-risk pregnancies, should be considered.

The rapid digitalization of healthcare is transforming medical care strategies. Individuals carrying (likely) pathogenic TP53 germline variants (P/LP TP53) require complex surveillance protocols. To support these individuals, we provided the adapted PatientConcept app to adults with a P/LP TP53 variant and their relatives. We analyzed the value of this adapted app for this cohort, as well as general aspects of Internet use, web-based healthcare options, mental and physical health, and fear of progression. (FOP). From a larger study consisting of 70 carriers and 43 relatives, 25 affected individuals and no relatives installed the app. App users tended to be younger and physically fitter but reported higher levels of psychological distress and FOP compared to non-users. Users rated their distress as high and expressed interest in an on-demand intervention tool offering concise information sessions. Overall, users were satisfied with the app, finding it useful and easy to understand, though they identified areas for improvement. Many app features were underutilized, indicating a need for further adaptation to the target group. Most users obtained medical information online, considering it helpful but often unreliable and difficult to evaluate. Nevertheless, app users felt confident in their ability to use the Internet for health-related search. Our study demonstrates the feasibility and acceptance of an app for individuals with LFS, supporting their surveillance and health behaviors.

Purpose

Climate change is increasing global temperatures, with mid-latitude regions experiencing significant warming. Pregnant individuals are particularly vulnerable to heat exposure, which has been linked to adverse outcomes, such as preterm birth and low birth weight. However, research in temperate regions like Germany is scarce. This scoping review examines studies on the association between heat exposure and pregnancy complications in Germany.

Methods

Following the JBI methodology for scoping reviews, a systematic literature search was conducted in eight databases, including PubMed and Scopus. Studies analyzing pregnancy complications in relation to heat events in Germany were included. Studies without systematic temperature data collection or focusing on long-term child development after birth were excluded.

Results

Only four studies met the inclusion criteria. Two reported significant associations between heat exposure and preterm birth, though at different pregnancy stages. One study on low birth weight found no clear correlation, while another identified a strong link between high temperatures and pregnancy-related edema. Differences in exposure definitions and outcome measures limited comparability.

Conclusions

Despite the heterogeneity in study designs and findings, the results from the small number of studies could indicate that heat exposure may contribute to adverse pregnancy outcomes in Germany, particularly preterm birth. To strengthen the evidence base, future research should focus on standardizing exposure definitions and employing robust methodologies. These findings underscore the need for public health strategies to mitigate the risks associated with rising temperatures for pregnant individuals.

Purpose

Accurate preoperative evaluation of tumor sizes is essential for guiding optimal treatment planning in cervical cancer. This study aimed to compare the accuracy of preoperative tumor size measurement between magnetic resonance imaging (MRI) and ultrasound.

Methods

A retrospective study was performed involving 925 patients diagnosed with cervical cancer who underwent primary surgical treatment between January 2020 and June 2025. The accuracy of these two imaging modalities was assessed by comparing their measurements to the maximum tumor diameter determined through postoperative pathological analysis.

Results

The Bland–Altman analysis showed that both ultrasound (mean difference: 1.50 mm) and MRI (mean difference: 0.61 mm) overestimated tumor size. In the paired subgroup of 757 patients who underwent both imaging modalities, the agreement rates between imaging and pathology for categorizing tumors into size groups were 65.8% for ultrasound and 67.6% for MRI (p = 0.360). Although MRI showed a significantly smaller mean measurement bias than ultrasound (0.73 mm vs. 1.37 mm; p = 0.012), the proportion of large errors (> 10 mm) was not significantly different. Multivariate analysis indicated that tumors > 40 mm assessed by ultrasound (OR = 2.85) or MRI (OR = 2.72) were significantly associated with increased likelihood of measurement discrepancies > 10 mm.

Conclusion

While MRI exhibited a lower measurement error compared to ultrasound, both modalities showed comparable performance in tumor size staging. Furthermore, for tumors exceeding 40 mm in diameter as determined by preoperative imaging, clinicians are advised to integrate clinical examination to enhance the accuracy of staging.

Purpose

This phase 3, open-label, single-arm, prospective, multicenter clinical trial investigated the use of CMVIG to prevent maternal–fetal transmission.

Methods

Pregnant women with confirmed recent primary CMV infection with gestational age ≤ 14 weeks were treated with biweekly i.v. 200 U/kg BW CMVIG until at least GW 17. An amniocentesis was performed between GW 19–22.

Results

Fourty eight women were treated with a mean (range) number of 5.1 (4–7) infusions of CMVIG. Maternal–fetal transmission at AC was found in 11 cases (22.9%), of them 9 in the periconceptional (n = 37, 24.3%) and 2 in the first trimester subgroup (n = 11, 18.2%). One additional maternal–fetal transmission was diagnosed at birth (total 12 cases, 25.0%).

Twenty three mothers, fetuses and newborns (24.0% of 96 total lives) experienced 27 serious adverse events, including the maternal–fetal transmissions. Of these, 18, 6 and 3 events were classified as mild, moderate and severe, respectively. Sixty three of the total lives (65.6%) experienced 386 adverse events (AEs) after the start of the treatment, predominantly of mild severity. Twenty one mild AEs in 6 women were related to the CMVIG administration. The only adverse drug reaction that was observed in more than one woman was headache (4 = 8.3%). No AEs were observed that led to death, abortion, trial withdrawal, CMVIG dose interruption, infusion rate or dose reduction. The newborn data were comparable to the general population, without evidence for an increased risk of premature birth or growth retardation.

Conclusion

Despite a favorable safety profile, the benefit of treatment with CMVIG to prevent a maternal–fetal CMV transmission could not be demonstrated in our trial.

Purpose

Polycystic ovary syndrome (PCOS) is recognised as a potential risk factor for chronic non communicable diseases (NCD). Although international guidelines recommend proactive NCD risk prevention, actual practice may be suboptimal. This study aimed to identify unmet clinical needs regarding information, risk assessment and satisfaction with care related to NCD risk factors among women with PCOS.

Methods

An eight-domain questionnaire was developed based on the 2018 ESHRE guideline, covering demographics, PCOS diagnostic criteria, aesthetics, metabolism, reproduction, mental health and NCD prevention /monitoring. The present analysis focused on metabolic disorders, guideline-recommended risk screenings, patients’ satisfaction with care and overall satisfaction with management by healthcare providers (HCPs).

Results

Of 2029 respondents, 1943 answered metabolic-related items. 66.3% without known metabolic disease (MD) reported never having undergone screening for MD. 34.3% received advice from gynaecologist, 58.9% from general practitioner (GP) concerning MD. 41.1% (n = 271) did not receive counselling. Among 1839 respondents, 32.5% reported gynaecologist-led risk discussions. Annual screening occurred in 30.5% (body weight), 46.8% (blood pressure), 5.8% (gynaecologist) to 21.4 (GP) for serum cholesterol and 25.4% for diabetes. 1.0% had been consulted on obstructive sleep apnoea (OSA), 17.5% on endometrial cancer. Satisfaction with gynaecologist counselling was low (Mean 34.7), 79.4% expressed a desire for more advice.

Conclusion

Women with PCOS remain at high risk for NCDs (CVD, diabetes, endometrial cancer, OSA), yet experience substantial gaps in risk awareness, monitoring, and counseling. Addressing these deficiencies through improved clinical practice, education and adopting holistic PCOS management that balances NCD prevention with infertility concerns, is essential for safeguarding long-term health.

Objective

This study aimed to identify and validate key biomarkers for PE-AKI and to explore potential therapeutic candidates through an integrated bioinformatic and experimental approach.

Methods

Data was obtained from transcriptome sequencing of 12 mouse tissue samples and 8 human cell samples. Differential expression analysis identified differentially expressed genes (DEGs) in mouse and human PE kidney injury. The intersection of DEGs was used to identify candidate genes. Key genes were further identified through protein–protein interaction (PPI) networks, followed by subcellular localization, functional enrichment, molecular regulatory network construction, drug prediction, and molecular docking. The expression of key genes was validated in LPS-induced PE mouse models and blood samples from PE and PE-AKI patients.

Results

IL-6, CXCL2, and CEBPB were identified as key genes. They were significantly upregulated in both experimental and clinical PE-AKI samples and were co-enriched in pivotal inflammatory pathways, including interferon-gamma/alpha response and TNF-α signaling via NF-κB. Immune infiltration analysis revealed significant alterations in 28 immune cell types in the PE-AKI model. A comprehensive molecular regulatory network, encompassing 35 transcription factors and 93 miRNAs, was constructed. Drug prediction and molecular docking identified deptropine and clotrimazole as high-affinity candidates capable of stably binding all three key genes. Clinically, CXCL2 and CEBPB demonstrated promising diagnostic value for PE-AKI, with AUCs of 0.770 and 0.790, respectively.

Conclusion

IL-6, CXCL2, and CEBPB are identified as key mediators in PE-AKI. Among them, CXCL2 and CEBPB show particular promise as diagnostic biomarkers, a finding that warrants further validation in larger, multi-center cohorts to confirm their utility in stratifying disease severity.

Objectives

This study analyzed clinical pregnancy outcomes in patients undergoing in vitro fertilization-embryo transfer with donor sperm (IVF-D) using different ovulation induction protocols, to provide reference data for selecting appropriate protocols.

Methods

Data from 1801 cycles in patients who underwent IVF-D in Peking University Third Hospital between June 2010 and June 2021 were retrospectively analyzed. Participants were divided into three groups based on the controlled ovarian hyperstimulation protocol: follicular-phase ultralong gonadotropin-releasing hormone agonist (GnRH-a), luteal-phase GnRH-a long, and gonadotropin-releasing hormone antagonist (GnRH-ant) protocol groups.

Results

Significant differences were observed among the groups in gonadotropin (Gn) starting dose, Gn administration duration, total Gn dose, estradiol level on the day of human chorionic gonadotropin (hCG) administration (hCG day), progesterone level on hCG day, luteinizing hormone level on hCG day, endometrial thickness on hCG day, and number of embryos transferred (p < 0.05). We also found significant group differences in the number of eggs retrieved, two pronucleizygotes, and cleavages (p < 0.05), but not in high-quality embryos (p < 0.05). Clinical pregnancy and live birth rates significantly differed among the three groups (p < 0.05), whereas ectopic pregnancy, early miscarriage, and multiple pregnancy rates did not (p < 0.05).

Conclusion

In fresh embryo transfer cycles, the GnRH-ant protocol required the shortest duration of Gn administration and lowest total Gn dose, whereas the GnRH-a long protocol had the highest clinical pregnancy rate. Therefore, the GnRH-a long protocol is considered the preferred method for female patients who can undergo fresh transfers during IVF-D cycles.

Background

Gestational diabetes mellitus (GDM) is a prevalent metabolic complication that arises during pregnancy, posing significant health risks for both mother and fetus. The placenta is not only affected by GDM but also actively contributes to its pathogenesis and maternal–fetal outcomes. This complex interaction makes it difficult to fully understand the etiology of GDM and its effects on the placenta. In this study, we aimed to clarify the pathogenesis of GDM by evaluating the role of inflammation and describing the macroscopic and histopathological changes in placentas affected by GDM.

Methods

This study compared 50 singleton pregnancies complicated by GDM with 50 normoglycemic pregnancies. All deliveries occurred at term. Placentas were examined both macroscopically and microscopically. Immunohistochemical staining was performed for the following markers: CD4, CD8, CD68, CD80, CD86, and CD206.

Results

Placental weight and diameter were significantly higher in the GDM group compared to the control group (p < 0.001). GDM placentas showed a significantly higher frequency of chorangiosis, villous edema, villous immaturity, and ischemic changes (p < 0.001). Immunohistochemical analysis revealed increased expression of CD4, CD8, CD68, CD80, and CD86, while CD206 expression was significantly reduced in the GDM group (p < 0.001).

Discussion

These findings support the central role of placental inflammation and macrophage polarization shifts in the pathogenesis of GDM. They also highlight potential targets for developing new diagnostic biomarkers and anti-inflammatory or immunomodulatory therapeutic strategies.

Purpose

This study investigated adherence to vitamin and dietary supplement intake, satisfaction with healthcare-provided information, and knowledge of essential micronutrients among women seeking fertility treatment and pregnant women in Germany.

Methods

An anonymous online survey (34 questions) assessed sociodemographics, supplement intake, knowledge and motivations. Adherence and satisfaction were measured by MARS-D (Medication Adherence Rating Scale) and SIMS-D (Satisfaction with Information about Medicines Scale).

Results

Among 254 participants, 93.7% reported supplement use, and 86.6% began intake preconceptionally. On average, participants consumed two (2.0 ± 1.36) supplements concurrently. Most multiple micronutrient supplements (MMS) contained folic acid (100%) and iodine (86.2%) at recommended doses, other nutrients varied considerably. Participants knew two (1.81 ± 1.43) out of six micronutrients prior to information provision, increasing to three (2.94 ± 1.65) afterwards. Satisfaction with information (SIMS-D: 7.46 ± 5.92) was low, whereas adherence was high (MARS-D: 27.16 ± 3.06). Higher information satisfaction was associated with pregnancy (p = 0.007), younger age (p = 0.009), and lower educational level (p = 0.024). Adherence was linked to trimester (p = 0.007) and region (p = 0.013), with higher MARS-D scores in the first trimester and among participants from North Rhine-Westphalia. Key motivations were protecting the child and preventing deficiencies; main barriers included lack of awareness and feeling overwhelmed by preparation oversupply.

Conclusions

Despite high adherence, knowledge and satisfaction with information remain limited. The wide variability in MMS formulations may pose risks of over- or underdosage. Combining personalized consultations with trustworthy media resources is essential to assess individual needs and provide detailed recommendations.