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Challenging biases in delivery mode decisions for women with pelvic fracture history: a call for evidence-based practices and patient-centered care. 挑战有骨盆骨折史的妇女在决定分娩方式时的偏见:呼吁循证实践和以患者为中心的护理。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-31 DOI: 10.1007/s00404-024-07705-w
Maya Guhan, Oluwarotimi S Nettey

Pelvic fractures significantly impact young individuals, with a prevalence of 20 per 100,000, leading to long-term complications such as chronic pain and genitourinary dysfunction. Notably, women with a history of pelvic fractures face increased cesarean section (C-sections) rates during childbirth. This editorial investigates the factors contributing to higher C-section rates in these women, including provider assumptions about delivery complications and systemic hospital biases. Despite these trends, evidence suggests that vaginal delivery can be successful, especially when considering factors like pelvic displacement and the timing of delivery post-fracture. We advocate for education programs to challenge provider biases, transparent patient communication, and evidence-based practices prioritizing patient-centered care. Addressing these issues can enhance maternal and fetal outcomes, supporting women in making informed decisions about their delivery options.

骨盆骨折对年轻人的影响很大,发病率为十万分之二十,会导致慢性疼痛和泌尿生殖系统功能障碍等长期并发症。值得注意的是,有骨盆骨折病史的妇女在分娩时面临的剖腹产(C-sections)率会增加。这篇社论调查了导致这些产妇剖腹产率较高的因素,包括提供者对分娩并发症的假设和医院的系统性偏见。尽管存在这些趋势,但有证据表明阴道分娩是可以成功的,尤其是在考虑到骨盆移位和骨折后分娩时机等因素时。我们主张通过教育计划来挑战医疗服务提供者的偏见,与患者进行透明的沟通,并以循证实践为基础,优先考虑以患者为中心的护理。解决这些问题可以提高孕产妇和胎儿的预后,帮助妇女就分娩选择做出明智的决定。
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引用次数: 0
Correction: Real-world prevalence of microsatellite instability testing and related status in women with advanced endometrial cancer in Europe. 更正:欧洲晚期子宫内膜癌妇女接受微卫星不稳定性检测的实际情况及相关状况。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-01 DOI: 10.1007/s00404-024-07620-0
Sneha S Kelkar, Vimalanand S Prabhu, Jingchuan Zhang, Yoscar M Ogando, Kyle Roney, Rishi P Verma, Nicola Miles, Christian Marth
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引用次数: 0
Letter to the Editor: Allert et al. "The influence of epidural anesthesia in pregnancies with scheduled vaginal breech delivery at term: a hospital-based retrospective analysis" in the Archives of Gynecology and Obstetrics (published online: 20th November 2023). 致编辑的信:Allert等人在《妇产科档案》(Archives of Gynecology and Obstetrics)上发表的 "硬膜外麻醉对足月阴道臀位分娩妊娠的影响:基于医院的回顾性分析"(在线发表日期:2023年11月20日)。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-01 Epub Date: 2024-04-30 DOI: 10.1007/s00404-024-07517-y
Massimiliano Lia, Holger Stepan
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引用次数: 0
Pregnancy cholestasis typically occurs in the third trimester of pregnancy and is a significant clinical condition 妊娠胆汁淤积症通常发生在妊娠的第三个三个月,是一种重要的临床症状。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-10-01 DOI: 10.1007/s00404-024-07736-3
Ayça Kubat Küçükyurt, Nil Atakul, Yağmur Solak

Aim

The aim of this study is to determine the albumin/bilirubin ratio index and the aspartate aminotransferase (AST)/alanine aminotransferase ratio (ALT) index in patients diagnosed with cholestasis during pregnancy, and to demonstrate their correlation with liver damage. Additionally, potential strategies to prevent liver damage will be elucidated.

Materials and method

Our study is a retrospective study. A total of 4019 pregnant women aged between 18 and 40 years, presenting with itching complaints at 32–36 weeks of gestation, were screened at the Department of Obstetrics and Gynecology, Istanbul Training and Research Hospital of Health Sciences University between January 1, 2018, and December 31, 2023. Among them, 104 pregnant women without any other accompanying diseases were diagnosed with Gestational Cholestasis. Among the 104 diagnosed women, 78 met the inclusion criteria and were included in the study. Twenty-six women were excluded from the study due to missing albumin and total bilirubin values or due to blood samples being taken at different times. The serum albumin/bilirubin ratio index and the alanine aminotransferase/aspartate aminotransferase ratio index were calculated and statistically compared between pregnant women diagnosed with cholestasis and healthy pregnant women at the same gestational week.

Findings

We found that AST, ALT, albumin, and total bilirubin levels were significantly higher in pregnant women diagnosed with cholestasis compared to the control group (p < 0.05). The AST/ALT index in the case group was significantly lower compared to the control group. However, there were no significant differences found between the case and control groups regarding the albumin/total bilirubin index and ALBI grade. When comparing ALBI grades in cases, no significant differences were found in terms of patients' age, gestational week, AST, ALT, and AST/ALT index. When compared according to ALBI grades, the albumin level was higher in patients with ALBI grade I compared to grade II, and in patients with grade II compared to grade III. The total bilirubin level was significantly higher in patients with ALBI grade III compared to grades I and II, but there was no significant difference between grades I and II. No significant differences were found among the groups separated according to ALBI grades when FBA values were compared.

Conclusion

In this study, the negative correlation between lower AST/ALT ratio and FBA values in patients with severe cholestasis suggests the need for careful consideration regarding future liver damage. The lack of difference in ALBI score between the case and control groups, as well as the absence of correlation with FBA values, indicates the necessity to evaluate ALBI score based on patients' long-term prognosis.

目的:本研究旨在确定妊娠期胆汁淤积症患者的白蛋白/胆红素比值指数和天门冬氨酸氨基转移酶(AST)/丙氨酸氨基转移酶比值(ALT)指数,并证明它们与肝损伤的相关性。此外,还将阐明预防肝损伤的潜在策略:我们的研究是一项回顾性研究。2018年1月1日至2023年12月31日期间,健康科学大学伊斯坦布尔培训与研究医院妇产科共筛查了4019名年龄在18至40岁之间、妊娠32至36周时出现瘙痒主诉的孕妇。其中,104 名无其他伴随疾病的孕妇被确诊为妊娠期胆汁淤积症。在这104名确诊孕妇中,78名符合纳入标准,被纳入研究。有 26 名妇女因白蛋白和总胆红素值缺失或在不同时间采集血样而被排除在研究之外。我们计算了血清白蛋白/胆红素比值指数和丙氨酸氨基转移酶/天门冬氨酸氨基转移酶比值指数,并对确诊患有胆汁淤积症的孕妇和同一孕周的健康孕妇进行了统计比较:我们发现,与对照组相比,确诊为胆汁淤积症的孕妇的 AST、ALT、白蛋白和总胆红素水平明显升高(p 结论:胆汁淤积症孕妇的 AST、ALT、白蛋白和总胆红素水平与对照组相比明显升高(p):在本研究中,重度胆汁淤积症患者的 AST/ALT 比值和 FBA 值较低,两者之间呈负相关,这表明需要慎重考虑未来的肝损伤问题。病例组和对照组的 ALBI 评分没有差异,与 FBA 值也没有相关性,这表明有必要根据患者的长期预后评估 ALBI 评分。
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引用次数: 0
Fetal heart diseases and neonatal mortality: Risk factors and management 胎儿心脏病和新生儿死亡率:风险因素和管理。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-30 DOI: 10.1007/s00404-024-07759-w
Mucize Eric Ozdemir, Oya Demirci, Pinar Kumru, Omer Gokhan Eyisoy, Ozge Burcin Topcu Bas, Busra Cambaztepe, Karolin Ohanoglu, Ilker Kemal Yucel

Purpose

Fetal heart diseases significantly contribute to neonatal mortality. Improved prenatal diagnostics enable defect detection before delivery, emphasizing the need for a personalized approach to address anomalies and predict outcomes. Categorizing diseases into risk classes aids obstetricians in counseling and delivery decisions. This study classifies fetal heart diseases by severity, examining factors related to maternal, fetal, and delivery that affect neonatal mortality. The aim is to identify key determinants of neonatal mortality and create an individual approach to assess and manage risks in the first days of a newborn's life.

Methods

A prospective study from 2019 to 2023 at a tertiary care institute involved pregnant women diagnosed with fetal heart disease. 382 women were categorized into three groups based on potential risk for hemodynamic instability at birth: Group-1 (no or low risk, n = 114), Group-2 (moderate risk, n = 201), and Group-3 (high risk, n = 67). Antenatal follow-up used fetal echocardiography. The study explored the association between maternal–fetal-delivery-related factors and neonatal mortality, with statistical significance set at p < 0.05.

Results

Significant associations with neonatal mortality were found in cases with birth weight < 2500 g (p = 0.002), presence of genitourinary system anomaly (p = 0.001), group-2 and 3 heart disease (p < 0.001), and induction of labor (p = 0.01).

Conclusion

Factors influencing neonatal mortality in fetal heart disease cases include heart disease severity (group-3 heart disease), low birth weight, and extracardiac anomalies. While labor induction with prostaglandin ± oxytocin appears to elevate neonatal mortality, this observation requires further validation with larger sample sizes. Obstetricians should consider selective use of prostaglandin for labor induction.

目的胎儿心脏病是导致新生儿死亡的重要原因。产前诊断技术的改进可在分娩前发现缺陷,这就强调了采用个性化方法来处理异常和预测预后的必要性。将疾病分为不同的风险等级有助于产科医生做出咨询和分娩决定。这项研究按严重程度对胎儿心脏病进行分类,研究影响新生儿死亡率的产妇、胎儿和分娩相关因素。其目的是确定新生儿死亡率的关键决定因素,并在新生儿出生后的最初几天制定个性化的风险评估和管理方法:方法:2019 年至 2023 年在一家三级医疗机构进行的前瞻性研究涉及被诊断患有胎儿心脏病的孕妇。根据出生时血流动力学不稳定的潜在风险,将 382 名妇女分为三组:1组(无风险或低风险,n = 114)、2组(中度风险,n = 201)和3组(高风险,n = 67)。产前随访采用胎儿超声心动图。研究探讨了产妇-胎儿-分娩相关因素与新生儿死亡率之间的关系,统计显著性以 p 为标准:在出生体重的病例中发现了与新生儿死亡率的显著相关性 结论:影响胎儿心脏病新生儿死亡率的因素包括心脏病严重程度(3 类心脏病)、低出生体重和心外畸形。虽然使用前列腺素±催产素进行引产似乎会增加新生儿死亡率,但这一观察结果需要更大样本量的进一步验证。产科医生应考虑有选择地使用前列腺素进行引产。
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引用次数: 0
Ovarian reserve does not influence natural conception: insights from infertile women 卵巢储备并不影响自然受孕:不孕妇女的启示。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-28 DOI: 10.1007/s00404-024-07741-6
Giulia Galati, Marco Reschini, Alessandra Chine’, Laura Benaglia, Paola Vigano’, Edgardo Somigliana, Paolo Vercellini, Ludovico Muzii

Purpose

There is several albeit not univocal evidence suggesting that ovarian reserve is not related to the chance of natural pregnancy, provided that the remnant follicular pool is sufficient to ensure regular menstrual cycles. Nevertheless, available studies have some methodological limitations, and the issue cannot be considered definitively ascertained.

Methods

To further address this issue, we retrospectively selected infertile women whose infertility diagnostic work-up was unremarkable (unexplained infertility-cases) and matched them by age and study period to a group of infertile women who were diagnosed with severe male infertility (controls). If ovarian reserve impacts on natural fertility, one had to expect lower ovarian reserve among women with unexplained infertility. Tested biomarkers included AMH, AFC and day 2–3 serum FSH. The primary aim was the frequency of women with serum AMH < 0.7 ng/ml.

Results

Two-hundred fifty-two women with unexplained infertility and 252 women with male infertility were included. All biomarkers of ovarian reserve did not differ between the study groups. AMH levels < 0.7 ng/mL were observed in 26 (10%) women with unexplained infertility and 35 (14%) women with male infertility (p = 0.28). The adjusted OR was 0.76 (95% CI: 0.44–1.33). Significant differences did not also emerge when repeating this dichotomous analysis using other biomarkers and other thresholds for the definition of low-ovarian reserve.

Conclusion

This study confirms that ovarian reserve is unremarkable to natural conception. Physicians and patients should be aware of this concept to avoid inappropriate counseling and undue clinical decisions.

目的:有一些证据表明,卵巢储备与自然怀孕的几率无关,但前提是剩余卵泡库足以确保月经周期规律。然而,现有的研究在方法上存在一定的局限性,因此这一问题还不能被认为是明确的:为了进一步解决这一问题,我们回顾性地选择了不孕症诊断结果无异常的不孕妇女(不明原因不孕症病例),并按年龄和研究时期将她们与一组被诊断为严重男性不育症的不孕妇女(对照组)进行配对。如果卵巢储备对自然生育力有影响,那么我们就必须预期不明原因不孕妇女的卵巢储备较低。测试的生物标志物包括AMH、AFC和第2-3天血清FSH。主要目的是检测血清 AMH 的女性频率:共纳入 252 名不明原因不孕症妇女和 252 名男性不育症妇女。研究组之间卵巢储备的所有生物标志物均无差异。AMH水平 结论:这项研究证实,卵巢储备功能对自然受孕没有显著影响。医生和患者应了解这一概念,以避免不恰当的咨询和不当的临床决定。
{"title":"Ovarian reserve does not influence natural conception: insights from infertile women","authors":"Giulia Galati,&nbsp;Marco Reschini,&nbsp;Alessandra Chine’,&nbsp;Laura Benaglia,&nbsp;Paola Vigano’,&nbsp;Edgardo Somigliana,&nbsp;Paolo Vercellini,&nbsp;Ludovico Muzii","doi":"10.1007/s00404-024-07741-6","DOIUrl":"10.1007/s00404-024-07741-6","url":null,"abstract":"<div><h3>Purpose</h3><p>There is several albeit not univocal evidence suggesting that ovarian reserve is not related to the chance of natural pregnancy, provided that the remnant follicular pool is sufficient to ensure regular menstrual cycles. Nevertheless, available studies have some methodological limitations, and the issue cannot be considered definitively ascertained.</p><h3>Methods</h3><p>To further address this issue, we retrospectively selected infertile women whose infertility diagnostic work-up was unremarkable (unexplained infertility-cases) and matched them by age and study period to a group of infertile women who were diagnosed with severe male infertility (controls). If ovarian reserve impacts on natural fertility, one had to expect lower ovarian reserve among women with unexplained infertility. Tested biomarkers included AMH, AFC and day 2–3 serum FSH. The primary aim was the frequency of women with serum AMH &lt; 0.7 ng/ml.</p><h3>Results</h3><p>Two-hundred fifty-two women with unexplained infertility and 252 women with male infertility were included. All biomarkers of ovarian reserve did not differ between the study groups. AMH levels &lt; 0.7 ng/mL were observed in 26 (10%) women with unexplained infertility and 35 (14%) women with male infertility (<i>p</i> = 0.28). The adjusted OR was 0.76 (95% CI: 0.44–1.33). Significant differences did not also emerge when repeating this dichotomous analysis using other biomarkers and other thresholds for the definition of low-ovarian reserve.</p><h3>Conclusion</h3><p>This study confirms that ovarian reserve is unremarkable to natural conception. Physicians and patients should be aware of this concept to avoid inappropriate counseling and undue clinical decisions.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-024-07741-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ovarian tissue cryopreservation and transplantation as a natural means to delay menopause 将卵巢组织冷冻保存和移植作为推迟绝经期的自然手段。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-28 DOI: 10.1007/s00404-024-07752-3
Koray Gorkem Sacinti, Rowaida Sadat, Sinan Ozkavukcu, Meltem Sonmezer, Murat Sonmezer

Ovarian tissue cryopreservation and transplantation (OTCT) offers hope for preserving fertility and endocrine functions in patients undergoing gonadotoxic treatments. Advancements in techniques for the procedure have transformed OTCT from an experimental procedure into a viable option. There is a growing interest in utilizing OTCT to delay menopause and alleviate associated health issues. Menopausal transition affects women globally, leading to symptoms and long- term health risks. OTCT has the potential to restore endocrine functions, reducing menopause-related symptoms while mitigating health consequences such as osteoporosis and cardiovascular diseases. Although the use of OTCT for delaying menopause is not clinically proven, the discussion around shows potential for future utilization. In essence, the remarkable advancements in OTCT have bestowed upon us the ability to safeguard fertility and sustain the delicate endocrine functions of the ovaries. However, it is the tantalizing prospect of utilizing this technique to postpone menopause and alleviate its associated symptoms that truly captivates the imagination. Further research is imperative to substantiate the clinical efficacy of OTCT; nonetheless, its potential in menopausal therapy is both promising and warrants comprehensive exploration. This review highlights advancements and the feasibility of OTCT to postpone menopause as an alternative approach to currently used conventional menopause therapy methods.

卵巢组织冷冻保存和移植(OTCT)为接受性腺毒性治疗的患者保留生育能力和内分泌功能带来了希望。手术技术的进步使卵巢组织冷冻保存和移植从一种实验性手术变成了一种可行的选择。人们对利用 OTCT 推迟更年期和缓解相关健康问题的兴趣与日俱增。更年期过渡影响着全球妇女,导致各种症状和长期健康风险。OTCT 有可能恢复内分泌功能,减轻更年期相关症状,同时减轻骨质疏松症和心血管疾病等健康后果。尽管将 OTCT 用于推迟绝经期尚未得到临床验证,但围绕 OTCT 的讨论显示了未来使用的潜力。从本质上讲,OTCT 的卓越进步赋予了我们保障生育能力和维持卵巢微妙内分泌功能的能力。然而,利用这种技术推迟更年期并缓解相关症状的诱人前景才真正吸引了人们的想象力。要证实 OTCT 的临床疗效,进一步的研究势在必行;然而,它在更年期治疗方面的潜力是巨大的,值得全面探索。本综述重点介绍了OTCT作为目前使用的传统更年期治疗方法的替代方法,在推迟更年期方面取得的进展和可行性。
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引用次数: 0
A comprehensive diagnostic approach to differentiate intrauterine arteriovenous malformation in cases of enhanced myometrial vascularity 在子宫肌层血管增强的病例中鉴别宫内动静脉畸形的综合诊断方法。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-28 DOI: 10.1007/s00404-024-07754-1
Carolina Ercolino, Enrico Ferrazzi, Manuela Wally Ossola, Eugenia Di Loreto, Pierpaolo Biondetti, Serena Carriero, Ottavio Cassardo, Carolina Lanza, Francesco D’Ambrosi

Purpose

The differentiation between conditions such as uterine arteriovenous malformation, pseudoaneurysm, gestational trophoblastic disease, and retained trophoblastic tissue can be challenging. Ultrasound imaging and Doppler interrogation are the primary diagnostic tools to assess cases of enhanced myometrial vascularity and differentiate intrauterine vascular anomalies. However, some cases remain of difficult differentiation. This study aims to analyze suspected cases and describe their diagnostic management and outcomes.

Methods

We reviewed post-abortion cases that underwent pelvic transvaginal U/S imaging and Doppler examinations due to suspected uterine vascular anomalies. CT scans were performed in cases in which ultrasound did not reach a diagnosis. Simple follow-up, medical or surgical therapy, or embolization of uterine arteries were performed according to the final diagnosis.

Results

From 2015 to 2022, we retrieved from electronic ultrasound records 22 cases of suspected vascular malformations. In eight cases, first-line U/S at admission excluded the suspected anomaly. In Five of the remaining 14 patients, uterine vascular anomalies were excluded upon a second-level  U/S based on angio-Doppler imaging and Doppler peak velocity interrogation. Nine cases underwent CT scan, and a digital angiography and embolization were performed in eight of these cases, of whom only two had a documented uterine arteriovenous malformation.

Conclusion

Our triage proved that only two out of 22 suspected cases had a uterine arteriovenous malformation. This diagnosis is frequently misused in clinical practice. Our data confirm that enhanced myometrial vascularity should be used to encompass the spectrum of possible differential diagnosis. A precise step-by-step diagnostic method is of paramount importance to prevent unnecessary interventions.

目的:区分子宫动静脉畸形、假性动脉瘤、妊娠滋养细胞疾病和滋养细胞组织滞留等情况具有挑战性。超声成像和多普勒检查是评估子宫肌层血管增强病例和区分宫内血管异常的主要诊断工具。然而,仍有一些病例难以区分。本研究旨在分析疑似病例,并描述其诊断处理和结果:我们回顾了因怀疑子宫血管异常而接受盆腔经阴道U/S成像和多普勒检查的人工流产后病例。在超声检查未能确诊的病例中进行了 CT 扫描。根据最终诊断结果进行简单的随访、药物或手术治疗或子宫动脉栓塞:2015年至2022年,我们从电子超声记录中检索到22例疑似血管畸形病例。其中8例患者入院时的一线U/S检查排除了疑似畸形。其余14例患者中,有5例在进行二级U/S检查时,根据血管多普勒成像和多普勒峰值速度检查排除了子宫血管畸形。9 例患者接受了 CT 扫描,其中 8 例患者接受了数字血管造影和栓塞治疗,只有 2 例患者被证实为子宫动静脉畸形:结论:我们的分诊结果表明,22 例疑似病例中只有 2 例患有子宫动静脉畸形。这一诊断在临床实践中经常被误用。我们的数据证实,增强的子宫肌层血管应被用来涵盖可能的鉴别诊断范围。精确的逐步诊断方法对于防止不必要的干预至关重要。
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引用次数: 0
Comparison of 2-year reproductive outcomes of tubal ectopic pregnancies treated with surgery, methotrexate or expectant management 采用手术、甲氨蝶呤或期待疗法治疗输卵管异位妊娠的 2 年生殖效果比较。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-27 DOI: 10.1007/s00404-024-07747-0
Fahri Burçin Fıratlıgil, Sadun Sucu, Serap Topkara Sucu, Merve Ayas Ozkan, Yildiz Akdas Reis, Murat Levent Dereli, Sadullah Ozkan, Yaprak Engin-Ustun

Introduction

To compare the 2-year reproductive outcomes of tubal ectopic pregnancies (EP) treated with surgery, methotrexate (MTX) or expectant management.

Materials and methods

This case–control study was conducted retrospectively at the Obstetrics-Gynecology and Perinatology Clinics of Etlik Zubeyde Hanim Women’s Health Education and Training Hospital. 985 of 1156 patients, who were managed between January 2015 and December 2019 for a tubal EP, tried to conceive in 2 years after treatment: 366 patients underwent surgical treatment; 549 patients were treated with MTX, and 70 patients had expectant management. Clinical data and fertility outcomes were retrieved by medical and hospital records. We compared the three groups based on the 2-year reproductive outcomes of three treatment modalities of tubal EP.

Results

There was a significant difference in the frequency of no pregnancy in patients who underwent surgery compared to patients who received expectant management and MTX therapy (p < 0.001). The frequency of no pregnancy was higher in patients who underwent surgery. There was no significant difference between expectant management and MTX therapy (p = 0.411). In the reproductive outcomes of patients who underwent surgery, the incidence of viable pregnancies was statistically lower than in the group treated with expectant management and MTX therapy (p = 0.003).

Conclusions

Patients with an EP often have a future desire to have children, the treatment options are also important. The earlier the diagnosis is made, the more likely it is that expectant management or MTX treatment will be considered. With these two treatment methods, the likelihood of having a child in the future is higher than with surgical treatment.

简介:目的:比较采用手术、甲氨蝶呤(MTX)或期待疗法治疗输卵管异位妊娠(EP)的 2 年生殖结局:目的:比较采用手术、甲氨蝶呤(MTX)或期待疗法治疗输卵管异位妊娠(EP)的两年生育结果:这项病例对照研究在 Etlik Zubeyde Hanim 妇女健康教育和培训医院的妇产科和围产期诊所进行。在2015年1月至2019年12月期间接受输卵管EP治疗的1156名患者中,有985人在治疗后2年内尝试怀孕:366名患者接受了手术治疗;549名患者接受了MTX治疗,70名患者接受了期待治疗。临床数据和生育结果均来自医疗和住院记录。我们根据输卵管EP三种治疗方式的2年生育结果对三组患者进行了比较:结果:与接受期待疗法和MTX治疗的患者相比,接受手术治疗的患者未孕频率有明显差异(P 结论:接受手术治疗的患者未来可能会怀孕,而接受期待疗法和MTX治疗的患者未来可能不会怀孕:输卵管伞端造口术患者通常都有生育的愿望,因此治疗方案也很重要。诊断越早,越有可能考虑期待疗法或 MTX 治疗。采用这两种治疗方法,未来生育的可能性要高于手术治疗。
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引用次数: 0
Evaluation of outcomes and risk factors for recurrent preeclampsia in a subsequent pregnancy 评估再次怀孕时子痫前期复发的结果和风险因素。
IF 2.1 3区 医学 Q2 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-27 DOI: 10.1007/s00404-024-07751-4
Qingwen Nie, Boxin Zhou, Yafei Wang, Minqing Ye, Dunjin Chen, Fang He

Purpose

The aim was to evaluate the pregnancy outcomes and identify risk factors for recurrent preeclampsia (PE).

Methods

Retrospective analysis of patients discharged with PE between January 1, 2010, and January 1, 2023, from two tertiary referral hospitals. They were classified into recurrent and non-recurrent groups based on the presence of PE in subsequent pregnancies.

Results

Among 519 women who had a subsequent pregnancy after a history of PE, 153 developed recurrent PE while 366 did not. The recurrent cases included 81 preterm PE, of which 41 were early-onset PE (EOPE). Recurrent PE correlated significantly with prior EOPE, HELLP syndrome, placental abruption, and stillbirth, as well as with current chronic hypertension (CH) and type 2 diabetes. The recurrent group showed a 5.8-fold higher risk of preterm birth (PTB) compared to the non-recurrent group (50.7% vs. 8.7%). Notably, 58.1% of the PTBs in the non-recurrent group were spontaneous. Logistic regression identified previous EOPE (aOR: 4.22 [95% CI: 2.50–7.13]) and current CH (aOR: 1.86 [95% CI: 1.09–3.18]) as independent contributors for recurrent PE. Furthermore, recurrent preterm PE shared the same risk factors: previous EOPE (aOR: 5.27 [95% CI: 2.82–9.85]) and current CH (aOR: 2.99 [95% CI: 1.57–5.71]). The morbidity of CH in subsequent pregnancy peaked at 31.9% when women with a history of EOPE delivered within three years.

Conclusion

Previous EOPE and current CH were sequentially crucial risk factors for the development of PE and preterm PE during the next pregnancy. This may clarify risk stratification in prenatal management for women with a history of PE.

目的:旨在评估妊娠结局并确定子痫前期(PE)复发的风险因素:对两家三级转诊医院2010年1月1日至2023年1月1日期间出院的子痫前期患者进行回顾性分析。方法:对两家三级转诊医院 2010 年 1 月 1 日至 2023 年 1 月 1 日期间出院的 PE 患者进行回顾性分析,并根据其后次妊娠是否出现 PE 将其分为复发组和非复发组:结果:在 519 名曾患过 PE 后再次怀孕的妇女中,有 153 人复发 PE,366 人未复发。复发性 PE 包括 81 例早产 PE,其中 41 例为早发性 PE(EOPE)。复发性 PE 与之前的 EOPE、HELLP 综合征、胎盘早剥、死胎以及目前的慢性高血压(CH)和 2 型糖尿病密切相关。与非复发性组(50.7% 对 8.7%)相比,复发性组的早产(PTB)风险高出 5.8 倍。值得注意的是,在非复发性组中,58.1% 的早产是自发性的。逻辑回归发现,既往 EOPE(aOR:4.22 [95% CI:2.50-7.13])和当前 CH(aOR:1.86 [95% CI:1.09-3.18])是导致 PE 复发的独立因素。此外,复发性早产 PE 还具有相同的风险因素:既往 EOPE(aOR:5.27 [95% CI:2.82-9.85])和当前 CH(aOR:2.99 [95% CI:1.57-5.71])。有 EOPE 病史的妇女在三年内分娩时,其妊娠合并心脏病的发病率最高,达到 31.9%:结论:既往的EOPE和目前的CH是下一次妊娠发生PE和早产PE的关键风险因素。结论:既往 EOPE 和当前 CH 是导致下一次妊娠发生 PE 和早产 PE 的先后关键风险因素,这可以明确对有 PE 病史的妇女进行产前管理时的风险分层。
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Archives of Gynecology and Obstetrics
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