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Prognostic impact of microscopic residual disease after neoadjuvant chemotherapy in patients undergoing interval debulking surgery for advanced ovarian cancer. 晚期卵巢癌间期切除手术患者接受新辅助化疗后微小残留病灶对预后的影响。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-13 DOI: 10.1007/s00404-024-07775-w
Violante Di Donato, Giuseppe Caruso, Tullio Golia D'Augè, Giorgia Perniola, Innocenza Palaia, Federica Tomao, Ludovico Muzii, Angelina Pernazza, Carlo Della Rocca, Giorgio Bogani, Pierluigi Benedetti Panici, Andrea Giannini

Purpose: To determine the prognostic impact of microscopic residual disease after neoadjuvant chemotherapy (NACT) in patients undergoing interval debulking surgery (IDS) for advanced epithelial ovarian cancer (AEOC).

Methods: Patients affected by FIGO stage IIIC-IV ovarian cancer undergoing IDS between October 2010 and April 2016 were selected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier analysis.

Results: In total, 98 patients were identified. Four patients (4.1%) were considered inoperable. Overall, 67 patients (out of 94; 71.3%) had macroscopic disease, equating Chemotherapy Response Score (CRS) 1 and 2, 7 (7.4%) had microscopic residuals, equating CRS3, rare CRS2, while 20 (21.3%) had both microscopic and macroscopic disease. Median OS and PFS were, respectively, 44 and 14 months in patients with no macroscopic residual disease (RD = 0) compared to 25 and 6 months, in patients with RD > 0 (OS: p = 0.001; PFS: p = 0.002). The median PFS was 9 months compared to 14 months for patients with more or less than 3 areas of microscopic disease at final pathologic evaluation (p = 0.04). The serum Ca125 dosage after NACT was higher in patients with RD > 0 compared to those without residue (986.31 ± 2240.7 µg/mL vs 215.72 ± 349.5 µg/mL; p = 0.01).

Conclusion: Even in the absence of macroscopic disease after NACT, the persistence of microscopic residuals predicts a poorer prognosis among AEOC patients undergoing IDS, with a trend towards worse PFS for patients with more than three affected areas. Removing all fibrotic residuals eventually hiding microscopic disease during IDS represents the key to improving the prognosis of these patients.

目的:探讨新辅助化疗(NACT)后显微镜下残留疾病对晚期上皮性卵巢癌(AEOC)间期剥离手术(IDS)患者预后的影响:方法:选取2010年10月至2016年4月期间接受IDS手术的FIGO IIIC-IV期卵巢癌患者。采用卡普兰-梅耶尔分析法估算无进展生存期(PFS)和总生存期(OS):结果:共发现 98 例患者。4名患者(4.1%)被认为无法手术。总体而言,67名患者(94人中占71.3%)有大体病变,相当于化疗反应评分(CRS)1和2;7名患者(7.4%)有微小残留,相当于CRS3和罕见的CRS2;20名患者(21.3%)既有微小病变又有大体病变。无大体残留病灶(RD = 0)患者的中位 OS 和 PFS 分别为 44 个月和 14 个月,而 RD > 0 患者的中位 OS 和 PFS 分别为 25 个月和 6 个月(OS:P = 0.001;PFS:P = 0.002)。在最终病理评估中,显微镜下病变区域多于或少于3个的患者的中位生存期为9个月,而显微镜下病变区域多于或少于3个的患者的中位生存期为14个月(P = 0.04)。与无残留的患者相比,RD > 0的患者在NACT后的血清Ca125剂量更高(986.31 ± 2240.7 µg/mL vs 215.72 ± 349.5 µg/mL; p = 0.01):结论:即使NACT术后没有大面积病变,微小残留物的持续存在也预示着接受IDS治疗的AEOC患者预后较差,受影响区域超过三个的患者PFS有变差的趋势。在 IDS 期间清除所有纤维化残留物并最终隐藏微小病变是改善这些患者预后的关键。
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引用次数: 0
Clinical characteristics and outcomes of preterm versus term uterine rupture: a nationwide observational study. 早产与过期子宫破裂的临床特征和结局:一项全国性观察研究。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-11 DOI: 10.1007/s00404-024-07762-1
Shunya Sugai, Yusuke Sasabuchi, Hideo Yasunaga, Toshiaki Isogai, Kosuke Yoshihara, Koji Nishijima

Objective: To assess and compare the clinical aspects of uterine rupture by dividing the gestational age at uterine rupture occurrence into < 37-week (preterm) and ≥ 37-week (term) groups.

Methods: This retrospective cohort study analyzed data from 187 acute-care hospitals across Japan and included patients who experienced uterine rupture. Data were sourced from the Diagnosis Procedure Combination inpatient database, spanning July 2010 to March 2022. The patients' characteristics, in-hospital procedures, and outcomes were compared between those with uterine rupture at  < 37 and  ≥ 37 weeks of gestation. The main outcomes were hysterectomy, complications, proportion of blood transfusions, and postoperative length of stay.

Results: A total of 298 patients were identified, with 161 in the preterm group and 137 in the term group. Placenta accreta spectrum occurred more frequently in the preterm group than in the term group (18.0% vs. 6.6%, respectively; P = 0.003). Vacuum delivery (19.0% vs. 0.6%, P < 0.001) and uterine fundal pressure (2.9% vs. 0.0%, P = 0.004) were more likely to be applied in the term group. The maternal need for mechanical ventilation (26.3% vs. 12.4%, P = 0.003), the proportion of disseminated intravascular coagulation (40.1% vs. 25.5%, P = 0.009), and the requirement for platelet transfusions (32.8% vs. 15.5%, P < 0.001) were greater in the term. The postoperative hospital stays were also longer in the term group.

Conclusion: This study shows that individual characteristics vary with the gestational age at uterine rupture, and maternal morbidity is notably higher in term compared to preterm ruptures.

目的通过将子宫破裂发生时的胎龄划分为不同的阶段,评估和比较子宫破裂的临床表现:这项回顾性队列研究分析了日本 187 家急诊医院的数据,其中包括经历过子宫破裂的患者。数据来源于诊断程序组合住院患者数据库,时间跨度为 2010 年 7 月至 2022 年 3 月。结果比较了子宫破裂患者的特征、住院过程和结果:共发现 298 例患者,其中早产组 161 例,足月组 137 例。早产组胎盘早剥谱的发生率高于足月组(分别为 18.0% 和 6.6%;P = 0.003)。真空分娩(19.0% 对 0.6%,P 结论:该研究表明,早产儿的个体特征随早产率的变化而变化:这项研究表明,子宫破裂时的个体特征随胎龄而变化,与早产儿相比,足月儿的孕产妇发病率明显更高。
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引用次数: 0
Effect of postpartum pessary use on pelvic floor function: a prospective multicenter study. 产后使用避孕药对盆底功能的影响:一项前瞻性多中心研究。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-10 DOI: 10.1007/s00404-024-07758-x
Franziska Beer, Madeleine Kuppinger, Frank Schwab, Markus Hübner, Brenda Kiefner, Anna Nacke, Ute Kelkenberg, Sabine Schütze, Anna Lindner, Lars Hellmeyer, Wolfgang Janni, Melanie Metz, Miriam Deniz

Purpose: This study evaluates the restitution of pelvic floor function in postpartum women using the Restifem® pessary in a preventive and therapeutic approach.

Methods: In this multicentre study all postpartum women independently of their parity, mode of delivery and existing pelvic floor symptoms were offered to use the Restifem® pessary from 6 weeks postpartum for 3 to 6 months. They completed the validated German pelvic floor questionnaire (GPFQpp) via online survey at 6 weeks, 6 months and 12 months postpartum and were divided, by their own choice, into users and non-users of the pessary.

Results: Initially 857 women were enrolled. After 6 weeks 137 pessary users and 133 non-users, after 12 months 53 pessary users and 45 non-users submitted a completed questionnaire. Pessary users had significantly higher (worse) scores in all domains of the GPFQpp at 6 weeks postpartum. At 12 months postpartum pessary users still had a significantly higher bladder score, compared to non-users. There was a greater improvement in the bladder score (p = 0.005) and the pelvic organ prolapse score (p < 0.001) from 6 weeks to 12 months postpartum, among pessary users compared to non-users.

Conclusion: Pessary users had a significantly greater improvement in pelvic floor function from 6 weeks to 12 months postpartum, compared to non-users. This effect might be in part due to wearing the pessary but also due to greater scope for recovery, given the higher level of pelvic floor dysfunction in the pessary user group.

Trial registration: The trial was registered in the German Clinical Trials Register (DRKS00024733) on 19 of April 2021.

目的:本研究以预防和治疗为目的,评估了产后妇女使用 Restifem® 避孕套恢复盆底功能的情况:在这项多中心研究中,所有产后妇女,无论其胎次、分娩方式和现有盆底症状如何,均可在产后 6 周起使用 Restifem® 息肉垫 3 至 6 个月。她们在产后6周、6个月和12个月时通过在线调查完成了经过验证的德国盆底问卷(GPFQpp),并根据自己的选择被分为使用和未使用栓剂的妇女:最初有 857 名妇女参加了调查。6 周后,137 名使用避孕药的妇女和 133 名未使用避孕药的妇女提交了完整的调查问卷;12 个月后,53 名使用避孕药的妇女和 45 名未使用避孕药的妇女提交了完整的调查问卷。在产后 6 周时,使用避孕药的妇女在 GPFQpp 各方面的得分都明显较高(较低)。产后 12 个月时,与未使用避孕药者相比,使用避孕药者的膀胱得分仍然明显较高。膀胱得分(p = 0.005)和盆腔器官脱垂得分(p 结论:使用子宫环者的膀胱得分明显高于未使用者:在产后 6 周至 12 个月期间,与未使用泌尿器者相比,使用泌尿器者的盆底功能改善幅度更大。这种效果部分可能是由于佩戴了子宫环,但也可能是由于使用子宫环组的盆底功能障碍程度更高,因此恢复的空间更大:该试验于2021年4月19日在德国临床试验注册中心(DRKS00024733)注册。
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引用次数: 0
Characterization of newborn gut microbiota according to the pre-gestational maternal nutritional status and delivery mode. 根据孕前母体营养状况和分娩方式确定新生儿肠道微生物群的特征。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-10 DOI: 10.1007/s00404-024-07772-z
Gabriele Luiza Caprara, Otávio von Ameln Lovison, Andreza Francisco Martins, Juliana Rombaldi Bernardi, Marcelo Zubaran Goldani

Purpose: The aim of this study is to characterize the composition of the newborn gut microbiota based on the maternal pre-pregnancy nutritional status and the delivery mode.

Methods: A biological sample was collected from the anal mucosa of the newborns between 24 and 48 h after delivery, as it was not possible to collect a meconium sample at that time. A general data collection questionnaire was administered. The microbiome of the samples was analyzed by next-generation sequencing of the hypervariable regions v3-v4 of the 16S gene. Alpha diversity analyses were performed using the Observed Richness and Shannon diversity index metrics and Beta diversity analyses were conducted using Nonmetric multidimensional scaling with Weighted Unifrac, Differential abundance analysis was performed using a Negative Binomial Wald Test with maximum likelihood estimation for coefficients of Generalized Linear Models.

Results: Newborns of obese mothers exhibited lower alpha diversity compared to newborns of mothers with adequate BMI (body mass index). We observed variation in the composition of the microbial community in newborn stool samples, both from mothers with overweight/obesity and those with adequate pre-pregnancy BMI. We observed a visible correlation between the mode of delivery and the newborn's microbiota. We found variation in the overall composition of the microbial community in the stools of newborns, regardless of the delivery mode.

Conclusions: The results of our study demonstrate differences in the microbiota of neonates born via cesarean section compared to those born vaginally as well as differences in newborns of mothers with overweight/obesity compared to those with an adequate pre-pregnancy BMI.

目的:本研究旨在根据母体孕前的营养状况和分娩方式确定新生儿肠道微生物群的组成特征:方法:由于当时无法采集胎粪样本,因此在产后 24 至 48 小时之间从新生儿肛门粘膜采集生物样本。并发放了一份一般数据收集问卷。通过对 16S 基因的 v3-v4 超变区进行新一代测序,对样本的微生物组进行了分析。使用观察丰富度和香农多样性指数指标进行α多样性分析,使用加权Unifrac非度量多维尺度进行β多样性分析,使用负二项式Wald检验和最大似然估计广义线性模型系数进行丰度差异分析:结果:与体重指数(BMI)适中的母亲的新生儿相比,肥胖母亲的新生儿表现出较低的α多样性。我们观察到新生儿粪便样本中微生物群落的组成存在差异,其中既有来自超重/肥胖母亲的样本,也有来自孕前体重指数适当母亲的样本。我们观察到分娩方式与新生儿微生物群之间存在明显的相关性。我们发现,无论分娩方式如何,新生儿粪便中微生物群落的整体组成都存在差异:我们的研究结果表明,剖腹产新生儿的微生物群与阴道分娩新生儿的微生物群存在差异,超重/肥胖母亲的新生儿与孕前体重指数适当的母亲的新生儿也存在差异。
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引用次数: 0
Retraction Note: The effect of uterine massage after vaginal delivery on the duration of placental delivery and amount of postpartum hemorrhage. 撤稿说明:阴道分娩后子宫按摩对胎盘娩出时间和产后出血量的影响。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-09 DOI: 10.1007/s00404-024-07768-9
Pinar Kadirogullari, Berna Aslan Cetin, Mustafa Goksu, Hale Cetin Arslan, Kerem Doga Seckin
{"title":"Retraction Note: The effect of uterine massage after vaginal delivery on the duration of placental delivery and amount of postpartum hemorrhage.","authors":"Pinar Kadirogullari, Berna Aslan Cetin, Mustafa Goksu, Hale Cetin Arslan, Kerem Doga Seckin","doi":"10.1007/s00404-024-07768-9","DOIUrl":"https://doi.org/10.1007/s00404-024-07768-9","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Retraction Note: Ovarian stimulation after dehydroepiandrosterone supplementation in poor ovarian reserve: a randomized clinical trial. 撤稿说明:卵巢储备不良者补充脱氢表雄酮后的卵巢刺激:随机临床试验。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-09 DOI: 10.1007/s00404-024-07767-w
Mohamed Elprince, Eman A Kishk, Ola M Metawie, Magda M Albiely
{"title":"Retraction Note: Ovarian stimulation after dehydroepiandrosterone supplementation in poor ovarian reserve: a randomized clinical trial.","authors":"Mohamed Elprince, Eman A Kishk, Ola M Metawie, Magda M Albiely","doi":"10.1007/s00404-024-07767-w","DOIUrl":"https://doi.org/10.1007/s00404-024-07767-w","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of low HER2 expression on response to CDK4/6 inhibitor treatment in advanced HR + /HER2- breast cancer: a multicenter real-world data analysis. HER2低表达对晚期HR + /HER2-乳腺癌CDK4/6抑制剂治疗反应的影响:多中心真实世界数据分析。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-07 DOI: 10.1007/s00404-024-07761-2
Damian J Ralser, Verena Kiver, Erich-Franz Solomayer, Caroline Neeb, Jens-Uwe Blohmer, Alina V Abramian, Nicolai Maass, Florian Schütz, Cornelia Kolberg-Liedtke, Carolin Müller, Anna-Christina Rambow

Purpose: CDK4/6 inhibitors (CDK4/6i) represent the first-line therapy approach of choice for patients with hormone receptor-positive, HER2-negative advanced breast cancer (HR + /HER-ABC). Approximately 50% of HR + /HER2-ABC displays low HER2 expression (HER2 low). Recent data emerging from the DESTINY-Breast04 trial demonstrated practice-changing efficacy of the antibody-drug conjugate trastuzumab deruxtecan (T-DXd) in patients with low HER2 expression. Here, we aimed to analyze the impact of low HER2 expression on CDK4/6i therapy response in a well-characterized multicenter HR + /HER-ABC cohort.

Methods: Patients diagnosed with HR + /HER2-ABC who were treated with CDK4/6i in clinical routine between November 2016 and December 2020 at four certified German Breast Cancer Centers were retrospectively identified. The cohort was stratified according to graduation of positivity in HER2 immunohistochemistry (IHC; HER2 zero = IHC score 0 and HER2 low = IHC score 1 + , 2 + /fluorescence in situ hybridization negative). Subgroups were analyzed with regard to progression-free survival (PFS) following CDK4/6i initiation.

Findings: The study cohort comprised n = 448 patients. For n = 311 patients, HER2 status from the metastatic site was available. n = 91 (29.3%) cases were HER2 zero and n = 220 cases (70.7%) were HER2 low. There was no significant difference in PFS between the two groups (PFS: 17 months versus 18 months, log-rank p = 0.42). Further, we examined the influence of HER2 expression changes between primary and metastatic tissue (n = 171; HER2 gain/HER2 loss/HER2 stable expression) on CDK4/6i treatment response. Again, there was no significant difference between these three groups, respectively (PFS: 16 months versus 13 months versus 17 months, log-rank p = 0.86).

Conclusions: In our analysis, HER2 status did not have a significant impact on treatment response to CDK4/6i.

目的:CDK4/6 抑制剂(CDK4/6i)是激素受体阳性、HER2 阴性晚期乳腺癌(HR + /HER-ABC)患者的首选一线治疗方法。约 50% 的 HR + /HER2-ABC 患者 HER2 表达较低(HER2 低)。DESTINY-Breast04试验的最新数据显示,抗体药物共轭物曲妥珠单抗德鲁司坦(T-DXd)对HER2低表达患者具有改变临床实践的疗效。在此,我们旨在分析低HER2表达对CDK4/6i治疗反应的影响:回顾性鉴定2016年11月至2020年12月期间在德国四家认证乳腺癌中心接受CDK4/6i临床常规治疗的HR + /HER2-ABC患者。根据 HER2 免疫组化(IHC;HER2 零 = IHC 得分为 0,HER2 低 = IHC 得分为 1 +、2 + /荧光原位杂交阴性)阳性率的分级对组群进行分层。研究人员根据CDK4/6i启动后的无进展生存期(PFS)对亚组进行了分析:研究队列由 n = 448 名患者组成。91例(29.3%)HER2为零,220例(70.7%)HER2为低。两组患者的 PFS 无明显差异(PFS:17 个月对 18 个月,log-rank p = 0.42)。此外,我们还研究了原发组织和转移组织(n = 171;HER2 增高/HER2 降低/HER2 稳定表达)的 HER2 表达变化对 CDK4/6i 治疗反应的影响。同样,这三组之间分别没有明显差异(PFS:16个月对13个月对17个月,log-rank p = 0.86):在我们的分析中,HER2状态对CDK4/6i的治疗反应没有显著影响。
{"title":"Impact of low HER2 expression on response to CDK4/6 inhibitor treatment in advanced HR + /HER2- breast cancer: a multicenter real-world data analysis.","authors":"Damian J Ralser, Verena Kiver, Erich-Franz Solomayer, Caroline Neeb, Jens-Uwe Blohmer, Alina V Abramian, Nicolai Maass, Florian Schütz, Cornelia Kolberg-Liedtke, Carolin Müller, Anna-Christina Rambow","doi":"10.1007/s00404-024-07761-2","DOIUrl":"https://doi.org/10.1007/s00404-024-07761-2","url":null,"abstract":"<p><strong>Purpose: </strong>CDK4/6 inhibitors (CDK4/6i) represent the first-line therapy approach of choice for patients with hormone receptor-positive, HER2-negative advanced breast cancer (HR + /HER-ABC). Approximately 50% of HR + /HER2-ABC displays low HER2 expression (HER2 low). Recent data emerging from the DESTINY-Breast04 trial demonstrated practice-changing efficacy of the antibody-drug conjugate trastuzumab deruxtecan (T-DXd) in patients with low HER2 expression. Here, we aimed to analyze the impact of low HER2 expression on CDK4/6i therapy response in a well-characterized multicenter HR + /HER-ABC cohort.</p><p><strong>Methods: </strong>Patients diagnosed with HR + /HER2-ABC who were treated with CDK4/6i in clinical routine between November 2016 and December 2020 at four certified German Breast Cancer Centers were retrospectively identified. The cohort was stratified according to graduation of positivity in HER2 immunohistochemistry (IHC; HER2 zero = IHC score 0 and HER2 low = IHC score 1 + , 2 + /fluorescence in situ hybridization negative). Subgroups were analyzed with regard to progression-free survival (PFS) following CDK4/6i initiation.</p><p><strong>Findings: </strong>The study cohort comprised n = 448 patients. For n = 311 patients, HER2 status from the metastatic site was available. n = 91 (29.3%) cases were HER2 zero and n = 220 cases (70.7%) were HER2 low. There was no significant difference in PFS between the two groups (PFS: 17 months versus 18 months, log-rank p = 0.42). Further, we examined the influence of HER2 expression changes between primary and metastatic tissue (n = 171; HER2 gain/HER2 loss/HER2 stable expression) on CDK4/6i treatment response. Again, there was no significant difference between these three groups, respectively (PFS: 16 months versus 13 months versus 17 months, log-rank p = 0.86).</p><p><strong>Conclusions: </strong>In our analysis, HER2 status did not have a significant impact on treatment response to CDK4/6i.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fragmented QRS in patients with preeclampsia. 子痫前期患者的 QRS 波形破碎。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-05 DOI: 10.1007/s00404-024-07755-0
Fikriye Karanfil Yaman, Şükran Doğru, Mustafa Karanfil, Huriye Ezveci, Emine Arslan, Fatih Akkuş, Ali Acar

Purpose: This study aims to investigate the prevalence, clinical correlates, and prognostic implications of fragmented QRS complexes (fQRS) in pregnant women with preeclampsia (PE), shedding light on the potential role of electrocardiographic markers in identifying cardiac involvement in hypertensive disorders of pregnancy.

Methods: Patients with PE and age-matched low-risk control patients were recruited at a tertiary hospital between January 2015 and January 2023. A comprehensive assessment, including heart rate, PR duration, QRS duration, corrected QT duration, and fragmented QRS, was conducted by 12-lead electrocardiography. Baseline clinical characteristics, laboratory parameters, and electrocardiographic findings were compared between the study groups.

Result: 128 preeclampsia patients and 122 age- and comorbidity-matched controls were included in the study. The prevalence of fQRS was significantly higher in preeclamptic women compared to normotensive controls (14.1% vs. 3.3%, p = 0.04). ALT levels of pregnant women with preeclampsia and without preeclampsia groups were 43,77 (35.25-48.22) and 23,18 (13.75-33.00) (p: 0.038), respectively. In univariate regression analyses, Na and fragmented QRS were found to be associated with preeclampsia. (p: 0.016 and 0.009, respectively). After multivariable adjustment for variables, Na and fragmented QRS remained strongly associated with preeclampsia (OR: 4.787 (1.556-14.720), p: 0.06; 0.941 (0.893-0.992), p: 0.023, respectively).

Conclusion: This study provides compelling evidence of an association between preeclampsia and fragmented QRS complexes, implicating electrolyte imbalances and hemodynamic stress as potential contributors to myocardial electrical instability in hypertensive disorders of pregnancy. Further research is warranted to validate these findings and improve risk stratification and clinical outcomes in affected women. Number: 2023/4705 Retrospectively Registered.

目的:本研究旨在调查子痫前期(PE)孕妇中片段QRS复合体(fQRS)的患病率、临床相关性和预后意义,从而揭示心电图标记物在识别妊娠期高血压疾病心脏受累方面的潜在作用:方法:2015 年 1 月至 2023 年 1 月期间,一家三甲医院招募了 PE 患者和年龄匹配的低风险对照组患者。通过 12 导联心电图进行综合评估,包括心率、PR 持续时间、QRS 持续时间、校正 QT 持续时间和 QRS 分段。结果:128 名子痫前期患者和 122 名年龄和合并症匹配的对照组患者被纳入研究。与血压正常的对照组相比,子痫前期妇女的 fQRS 患病率明显更高(14.1% 对 3.3%,P = 0.04)。子痫前期孕妇组和非子痫前期孕妇组的ALT水平分别为43.77(35.25-48.22)和23.18(13.75-33.00)(P:0.038)。在单变量回归分析中,发现 Na 和 QRS 分裂与子痫前期相关。(P:分别为 0.016 和 0.009)。在对变量进行多变量调整后,Na 和 QRS 破碎仍与子痫前期密切相关(OR:分别为 4.787(1.556-14.720),p:0.06;0.941(0.893-0.992),p:0.023):本研究提供了令人信服的证据,证明子痫前期与 QRS 波群片段化之间存在关联,这意味着电解质失衡和血液动力学应激是导致妊娠期高血压疾病心肌电不稳定的潜在因素。为了验证这些发现并改善受影响妇女的风险分层和临床预后,有必要开展进一步的研究。编号:2023/4705 追溯注册。
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引用次数: 0
The association of delivery during a war with the risk for postpartum depression, anxiety and impaired maternal-infant bonding, a prospective cohort study. 战争期间分娩与产后抑郁、焦虑和母婴关系受损风险的关系,一项前瞻性队列研究。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-05 DOI: 10.1007/s00404-024-07715-8
Hadar Klapper-Goldstein, Gali Pariente, Tamar Wainstock, Sharon Dekel, Yair Binyamin, Talya Lanxner Battat, Orit Wissotzky Broder, Tamar Kosef, Eyal Sheiner

Objective: To examine the impact of war conditions on maternal mental health postpartum outcomes, specifically depression and anxiety, as well as on maternal-infant bonding (MIB).

Study design: A prospective cohort study was performed on women who gave birth in a tertiary medical center during (October-November 2023) and before (March-May 2020) the Israel-Hamas War. All participants completed validated self-reported questionnaires: The Edinburgh Postnatal Depression Scale (EPDS ≥ 10), State-Trait Anxiety Inventory (STAI > 39) and the Postpartum Bonding Questionnaire (PBQ ≥ 26).

Results: A total of 502 women were included in the study, with 230 delivering during the war and 272 delivered before. The rates of postpartum depression (PPD) were higher in women delivering during the war (26.6% vs. 12.4%, p < 0.001), while multivariable regression revealing a two-fold higher risk (adjusted OR 2.35, 95% CI 1.16-4.74, p = 0.017). The rate of postpartum anxiety (PPA) risk was also higher (34.3% vs 17.0%, p < 0.001), reaching a trend towards significance when accounting for other risk factors (adjusted OR 2.06, 95% CI 0.97-4.36, p = 0.058). Additionally, delivery during the war was associated with specific factors of impaired maternal-infant bonding (MIB), although it did not increase the overall impaired MIB (PBQ ≥ 26) (10.2 ± 14.1 vs 8.3 ± 6.9, p = 0.075).

Conclusion: The study revealed an increased risk of PPD, a marginally risk for PPA, and some aspects of impaired MIB among women delivering during the war. Maternal mental illness in the postpartum period has negative impacts on the entire family. Therefore, comprehensive screening and adequate resources should be provided for women delivering in war-conflict zones.

目的:研究战争条件对产妇产后心理健康结果(尤其是抑郁和焦虑)以及母婴关系(MIB)的影响:研究设计:对以色列-哈马斯战争期间(2023 年 10 月至 11 月)和战争前(2020 年 3 月至 5 月)在一家三级医疗中心分娩的产妇进行前瞻性队列研究。所有参与者都填写了经过验证的自我报告问卷:爱丁堡产后抑郁量表(EPDS ≥ 10)、状态-特质焦虑量表(STAI > 39)和产后结合问卷(PBQ ≥ 26):共有 502 名妇女参与了研究,其中 230 人在战争期间分娩,272 人在战争前分娩。战争期间分娩的妇女产后抑郁症(PPD)发病率较高(26.6% 对 12.4%,P 结论:研究显示,战争期间分娩的妇女产后抑郁症发病率较高:研究显示,战争期间分娩的产妇患 PPD 的风险增加,患 PPA 的风险略微增加,并且在某些方面出现了 MIB 损伤。产后产妇精神疾病会对整个家庭造成负面影响。因此,应为战争冲突地区的产妇提供全面筛查和充足的资源。
{"title":"The association of delivery during a war with the risk for postpartum depression, anxiety and impaired maternal-infant bonding, a prospective cohort study.","authors":"Hadar Klapper-Goldstein, Gali Pariente, Tamar Wainstock, Sharon Dekel, Yair Binyamin, Talya Lanxner Battat, Orit Wissotzky Broder, Tamar Kosef, Eyal Sheiner","doi":"10.1007/s00404-024-07715-8","DOIUrl":"https://doi.org/10.1007/s00404-024-07715-8","url":null,"abstract":"<p><strong>Objective: </strong>To examine the impact of war conditions on maternal mental health postpartum outcomes, specifically depression and anxiety, as well as on maternal-infant bonding (MIB).</p><p><strong>Study design: </strong>A prospective cohort study was performed on women who gave birth in a tertiary medical center during (October-November 2023) and before (March-May 2020) the Israel-Hamas War. All participants completed validated self-reported questionnaires: The Edinburgh Postnatal Depression Scale (EPDS ≥ 10), State-Trait Anxiety Inventory (STAI > 39) and the Postpartum Bonding Questionnaire (PBQ ≥ 26).</p><p><strong>Results: </strong>A total of 502 women were included in the study, with 230 delivering during the war and 272 delivered before. The rates of postpartum depression (PPD) were higher in women delivering during the war (26.6% vs. 12.4%, p < 0.001), while multivariable regression revealing a two-fold higher risk (adjusted OR 2.35, 95% CI 1.16-4.74, p = 0.017). The rate of postpartum anxiety (PPA) risk was also higher (34.3% vs 17.0%, p < 0.001), reaching a trend towards significance when accounting for other risk factors (adjusted OR 2.06, 95% CI 0.97-4.36, p = 0.058). Additionally, delivery during the war was associated with specific factors of impaired maternal-infant bonding (MIB), although it did not increase the overall impaired MIB (PBQ ≥ 26) (10.2 ± 14.1 vs 8.3 ± 6.9, p = 0.075).</p><p><strong>Conclusion: </strong>The study revealed an increased risk of PPD, a marginally risk for PPA, and some aspects of impaired MIB among women delivering during the war. Maternal mental illness in the postpartum period has negative impacts on the entire family. Therefore, comprehensive screening and adequate resources should be provided for women delivering in war-conflict zones.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating the accuracy and reliability of non-piezo portable ultrasound devices in postpartum care. 评估非压电便携式超声设备在产后护理中的准确性和可靠性。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-04 DOI: 10.1007/s00404-024-07744-3
Ruben Plöger, Charlotte Behning, Adeline Walter, Agnes Wittek, Ulrich Gembruch, Brigitte Strizek, Florian Recker

Introduction: The early diagnosis of hemorrhage via postpartum ultrasound is crucial to initiate therapy and, thus, prevent maternal death. In these critical situations rapid availability and simple transport of ultrasound devices is vital, paving the way for a  new generation of portable handheld ultrasound devices (PUD) consisting of transducers and tablets or smart phones. However, evidence to confirm the diagnostic accuracy of these new devices is still scarce.

Methods: The accuracy and reliability of these new devices in relation to established standard ultrasound devices is analyses in this pilot study by comparing diagnoses and by applying statistical analysis via Bland-Altman plots, intraclass correlation coefficients (ICC), and Pearson correlation coefficients (PCC). One hundred patients of a university hospital were included in this study.

Results: In all cases, the same diagnosis was made regardless of the applied ultrasound device, confirming high accuracy. There was a high correlation (PCC 0.951) and excellent agreement (ICC 0.974) in the assessment of the cavum, while the assessment of the diameters of the uterus showed only a good correlation and a good agreement. Subgroup analysis for maternal weight, mode of delivery and day after delivery was performed  CONCLUSION: The same diagnosis independent of the used devices and excellent results of the cavum assessment promote the use of PUDs in a clinical setting. The slightly lower accuracy in the measurement of the uterus may be caused by the PUD's small acoustic window, reflecting one of its weaknesses. Therefore, the patient may benefit from the short time to diagnosis and the unbound location of examination, either in the delivery room, on the ward, or at home.

导言:通过产后超声波对大出血进行早期诊断对于启动治疗,从而防止产妇死亡至关重要。在这些危急情况下,超声波设备的快速可用性和简便运输至关重要,这为由传感器和平板电脑或智能手机组成的新一代便携式手持超声波设备(PUD)铺平了道路。然而,证实这些新设备诊断准确性的证据仍然很少:本试验研究通过比较诊断结果,并通过布兰德-阿尔特曼图、类内相关系数(ICC)和皮尔逊相关系数(PCC)进行统计分析,分析了这些新设备与现有标准超声设备的准确性和可靠性。一家大学医院的 100 名患者参与了这项研究:在所有病例中,无论使用哪种超声设备,诊断结果都是相同的,证明了诊断的高度准确性。宫腔评估的相关性高(PCC 0.951),一致性好(ICC 0.974),而子宫直径评估的相关性和一致性较好。对产妇体重、分娩方式和产后天数进行了分组分析 结论:与所使用的设备无关的相同诊断结果和出色的宫腔评估结果促进了 PUD 在临床中的应用。子宫测量的准确性稍低可能是由于 PUD 的声窗较小,这反映了其弱点之一。因此,诊断时间短、检查地点不受限制(可在产房、病房或家中进行)可能会使患者受益。
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Archives of Gynecology and Obstetrics
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