Archives of Gynecology and Obstetrics最新文献

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.

Purpose

Endometriosis (EMS) is a prevalent, inflammatory gynecological disorder with limited effective treatments and high recurrence rates. Given the central roles of inflammation, oxidative stress, pyroptosis, and angiogenesis in its pathogenesis, novel therapeutic strategies are urgently needed. This review aims to critically evaluate the potential of disulfiram (DSF), a repurposed antialcoholism drug, as a multifaceted therapeutic agent for EMS by analyzing its anti-inflammatory, antioxidant, anti-pyroptotic, and antiangiogenic properties.

Methods

A comprehensive literature review was conducted. Scientific databases (e.g., PubMed, Web of Science) were systematically searched for pre-clinical and clinical studies investigating the mechanisms of EMS pathogenesis and the pharmacological actions of DSF. The analysis focused on synthesizing evidence linking DSF's known biological effects to the key pathological drivers of EMS.

Results

The analysis demonstrates that DSF and its metabolites target multiple pathways implicated in EMS. Evidence confirms DSF's potent inhibitory effects on key inflammatory mediators and signaling pathways (e.g., NLRP3 inflammasome-mediated pyroptosis). Furthermore, DSF enhances cellular antioxidant defenses, reduces reactive oxygen species, and suppresses angiogenic factors, thereby potentially disrupting the establishment and survival of endometriotic lesions.

Conclusion

Disulfiram presents a promising, mechanistically grounded candidate for the treatment of endometriosis. Its unique ability to simultaneously modulate inflammation, oxidative stress, pyroptosis, and angiogenesis aligns closely with the multifactorial pathology of EMS. This review provides a strong rationale for future pre-clinical and clinical investigations to formally evaluate the efficacy and safety of DSF repurposing for this challenging disease.

Background

Epistaxis is common during pregnancy due to physiological changes, yet its clinical significance regarding obstetric outcomes is poorly understood. This study investigated the associations between epistaxis during pregnancy and maternal and neonatal outcomes.

Methods

We conducted a retrospective case–control study (2013–2022) at a single tertiary medical center. The study group included 104 pregnant women presenting with epistaxis, matched with 1924 controls based on age, ethnicity, and preexisting comorbidities. Multivariable logistic regression was used to identify independent predictors of adverse outcomes, including blood transfusion and preterm labor.

Results

Women with epistaxis experienced significantly higher rates of third-trimester vaginal bleeding (7.7% vs. 1.1%; p < 0.001), preterm labor (15.4% vs. 8.7%; p = 0.022), and blood transfusion requirements (4.8% vs. 1.6%; p = 0.014). In a multivariable model, third-trimester epistaxis emerged as an independent predictor for blood transfusion (OR 4.96, 95% CI 1.47- 14.38; p = 0.005), even after adjusting for delivery mode and initial hemoglobin levels. While univariate analysis associated epistaxis with preterm labor, this relationship did not remain significant in the multivariable model (p = 0.254). Most epistaxis episodes (81.7%) were mild and resolved spontaneously.

Conclusion

Epistaxis during pregnancy, particularly in the third trimester, is independently associated with a nearly fivefold increase in the odds of requiring a blood transfusion. While typically considered benign, epistaxis may serve as a clinical marker for systemic vascular susceptibility. These findings suggest that pregnant women presenting with epistaxis may benefit from enhanced clinical surveillance and interdisciplinary coordination to manage potential peripartum hemorrhagic complications.

Background

Female infertility is a critical global health concern, with a rising prevalence and significant psychosocial consequences. This study aimed to investigate the association between Systemic Inflammatory Response Index (SIRI) and female infertility.

Methods

This cross-sectional study enrolled 3059 reproductive-aged women (18–45 years) to examine the association between SIRI and female infertility using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2015 to 2020. Multivariable logistic regression generalized additive models (GAM), restricted cubic splines (RCS), and threshold effect analyses were leveraged. Machine learning approaches were also utilized to validate predictive performance and identify key features.

Results

Elevated SIRI was independently associated with increased odds of infertility. In the fully adjusted logistic model, each unit increase in SIRI corresponded to a 34% increase in infertility risk (OR 1.34, p = 0.001). Women in the highest SIRI quartile had more than double the odds of infertility compared to those in the lowest quartile (OR 2.08, p < 0.001), with a significant dose–response trend (p trend < 0.001). GAM and RCS models confirmed a monotonic and curvilinear association, respectively. Threshold analysis revealed a critical inflection point at SIRI = 1.66. Machine learning validation identified SIRI as one of the most influential predictors, with XGBoost achieving the highest (AUC = 0.866).

Conclusion

These findings support the role of chronic systemic inflammation in female infertility and highlight SIRI as a valuable biomarker for risk prediction and clinical assessment.

Graphical abstract

Objective

To analyze the difference in general clinical data, clinical manifestations, hysteroscopic manifestations, prognosis and fertility between patients with complex endometrial hyperplasia (CH) and simple endometrial hyperplasia (SH).

Material and methods

Collected the medical records of 616 premenopausal endometrial hyperplasia (EH) patients from January 2012 to October 2023, of which 419 SH patients and 197 CH patients were included in the study. All the patients were followed up at least 12 months, and asked about the follow-up treatment plan, review, pregnancy and reproductive outcome of the patients with reproductive needs.

Results

Obesity (P = 0.044), having diabetes or insulin resistance (P = 0.032) and polycystic ovary syndrome (PCOS) (P < 0.001) are risk factors for the occurrence of CH, while gravidity ≥ 1 (P = 0.045) is a protective factor for the occurrence of CH. Compared with the SH group, the reversal rate in the CH group was significantly lower (69.7% vs 83.6%, P < 0.001), while the rate of persistence, progression, recurrence and canceration were higher (P < 0.001). Compared with no treatment, oral progesterone (P < 0.001) and levonorgestrel-releasing intrauterine system (LNG-IUS) treatment (P < 0.001) could improve the prognosis of patients with EH. The live birth rate of the CH group was obviously lower than that of the SH group ( 42.3% VS 61.1%, P = 0.038). CH (OR = 2.68, 95%CI 1.12–6.39, P = 0.043) is an independent risk factor affecting the live birth rate of patients with EH.

Conclusion

Obesity, diabetes, insulin resistance, PCOS and nulligravidity are risk factors for patients with EH, while gravidity ≥ 1 served as a protective factor, particularly against CH. The type of hyperplasia is associated with a low live birth rate. The prognosis of EH patients is usually poor, with a low reversal rate and a long reversal time. However, LNG-IUS can improve their prognosis.

Background

The dynamic development towards robotic-assisted surgery particularly affects operative gynecology. The analysis of operative data from robotic-assisted procedures since the first application at a surgical center provides valuable insights into the introduction phase and integration of the DaVinci system into routine clinical operations, as well as their impact on patient care. The aim of this work was to specifically examine the learning curve progression and to present the trend of the professionalization process in implementing the methodology in gynecologic oncology.

Materials and methods

A retrospective data analysis was conducted of the first n = 107 patients who underwent surgery for a gynecological malignancy with the DaVinci surgical system at the University Medical Center Freiburg between 2020 and 2022. Classic operative parameters were evaluated, including preparation time, skin-to-skin time, console time, and the resulting learning curves of the surgeons and the operative team (including CUSUM analysis and linear regression models). Additionally, perioperative patient characteristics were recorded (e.g., blood loss, length of hospitalization, conversion rate).

Results

The average operative preparation time is 26.11 ± 8.13 min. The maximum value (CUSUM peak) is at approximately 20 performed procedures, indicating that the processes of operative preparation were mastered after this number of operations. The average skin-to-skin time is 172.84 ± 71.68 min (range 43–387 min), whereby after an initial reduction in skin-to-skin time within the first 30 cases, there was a slight increase in the further course with renewed reduction from approximately 65 procedures. The average console time for all tumor entities is 131.98 ± 63.74 min; for the most common operative indication (endometrial cancer, n = 61), it is 109.89 ± 52.04 min (range 48–221 min). In the surgeons' learning curves, the two surgeons with the most procedures show a CUSUM peak after 11 and 22 procedures, respectively. The average length of stay is 5.00 days (± 2.30). A total of two conversions occurred (conversion rate = 1.9%).

Discussion

Upon evaluation of the first n = 107 DaVinci operations, rapid learnability of robotic-assisted operations was demonstrated. The conversion rate was low at 1.9%. A positive effect on the learning curve of individual surgeons was evident after approximately 20 procedures. Both the preparation time and the skin-to-skin time could be rapidly reduced, so that integration into routine clinical operations was possible without problems.

Purpose

Maternal anemia during pregnancy is associated with adverse obstetrical outcomes. This study aimed to assess maternal and neonatal outcomes in women with anemia in twin pregnancies, compared to women with normal hemoglobin levels.

Methods

A multicenter retrospective cohort study was conducted including women with twin pregnancies who delivered at 24–42 weeks between 2005 and 2021. Maternal and neonatal outcomes were compared between those who had diagnosis of maternal anemia upon admission for labor (hemoglobin < 11 g/dL), to those who have normal hemoglobin level. The primary outcome was composite adverse neonatal outcomes. Univariate analysis was followed by multivariate analysis to control potential confounders.

Results

During the study period, there were 5,530 twin deliveries; 5,004 women met the inclusion criteria. The maternal anemia prevalence upon admission was 16.8% (n = 840). After controlling for potential confounders, we found an independent association between maternal anemia in twin pregnancies and composite adverse neonatal outcomes for both twins—aOR 1.81 (1.55–2.12) for twin A and aOR 1.77 (1.51–2.06) for twin B. Anemia was also independently associated with higher risk for preterm delivery, cesarean delivery, maternal blood product transfusion and NICU admission for both twins.

Conclusions

Maternal anemia in twin pregnancies is associated with an increased risk of adverse maternal and neonatal outcomes. Clinicians should be aware of this condition, consider appropriate interventions for correcting the anemia, and ensure close monitoring of both the mother and the neonates. Further research is warranted to evaluate the effectiveness of anemia correction strategies in reducing obstetric burden.

Purpose

To characterise the effect of polycystic ovary syndrome (PCOS) on embryo morphokinetics via time-lapse imaging, including absolute time points, relative time intervals, and ratios representing cleavage synchronicity.

Methods

This single-centre retrospective observational study examined patients aged 18–45 years undergoing in vitro fertilisation/intracytoplasmic sperm injection with time-lapse imaging (09/2016–12/2019; n = 1433 two-pronuclear oocytes). A group with PCOS (n = 48 embryos) was compared to a control group with uterine, tubal factor or idiopathic infertility (n = 400 embryos). Times from the two-cell stage to blastocyst expansion, eight intervals for embryonic cell cycle (ECC) duration and synchronicity and four cleavage synchronicity (CS) and DNA replication time ratios were analysed.

Results

PCOS patients were younger (P = 0.023) with higher anti-Müllerian hormone levels (P < 0.001) than controls. No statistically noticeable influence of PCOS on absolute times was observed. The intervals from the 3- to 4-cell (synchronicity of cell cycle 2, s2; P = 0.013), the 5- to 8-cell (synchronicity of cell cycle 3, s3; P = 0.032) and the 4- to 8-cell stage (ECC3; P = 0.043) were longer in the PCOS group. The relative CS ratio from the 2- to 8-cell stage (CS2-8) was lower (P = 0.003) and from the 2- to 4-cell stage (CS2-4) was higher (P = 0.001) in PCOS embryos.

Conclusion

Whilst absolute times remained unaffected, relative morphokinetic intervals and ratios, potentially indicating poorer cleavage synchronicity, were altered in PCOS embryos. This is the first study examining the influence of PCOS on relative morphokinetic ratios.