Archives of Gynecology and Obstetrics最新文献

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.

Objective

We aimed to evaluate the association between maternal age and the incidence of perineal injury including obstetric anal sphincter injuries (OASI) in nulliparous women.

Study design

A retrospective cohort population-based study was conducted at a tertiary university-affiliated center from January 2011 to December 2020. This study included all nulliparous women with singleton pregnancies at term (37–41 weeks of gestation) in vertex and occiput anterior presentation who received epidural analgesia during labor. Exclusion criteria included stillbirth, chronic and obstetric maternal conditions (hypertension, diabetes mellitus, etc.), and deliveries complicated by instrumental vaginal delivery and episiotomy were excluded. The primary outcome was the incidence of perineal injury, defined as any spontaneous perineal tear, and/or OASI.

Results

During the study period, a total of 39,596 nulliparouss women delivered vaginally at our center. Of them 3410 (8.61%) met the inclusion criteria, with 843 (24.7%) in the 20–25 age group and 2567 (75.3%) in the 30–35 age group. Significant differences were observed between the two age groups in terms of ethnicity, maternal weight before pregnancy and at delivery, gestational glucose challenge test results, gestational age at delivery, duration of the second stage of labor, and birth weight. The incidences of perineal injury and OASI were significantly higher in the 20–25 age group compared to the 30–35 age group (perineal injuries: 58% vs. 53.2%; p value: 0.015; OASI: 0.9% vs 0.4%, p value: 0.04). In the multivariable logistic regression analysis assessing the association between maternal age and perineal injury, the overall odds ratio for perineal injury in relation to the younger age category was calculated as 1.22 (CI 1.03–1.44; p value: 0.023), indicating a higher risk of perineal injury in the 20–25 age group compared to the 30–35 age group.

Conclusion

This study suggests that younger maternal age is independently associated with an increased risk of perineal injury and OASI among nulliparous women.

Objective

To evaluate maternal and neonatal outcomes in primiparous patients presenting with decreased fetal movements (DFM), comparing immediate induction of labor with expectant management.

Study design

This retrospective cohort study included nulliparous patients with singleton pregnancies who presented to our obstetric triage unit between 39 + 0 and 39 + 6 weeks of gestation with a subjective complaint of DFM, a reassuring fetal assessment, and a normal biophysical profile. Patients were offered labor induction. Those who agreed formed the induction group, while those who declined and were discharged home comprised the control group. Maternal and neonatal outcomes were compared.

Results

A total of 413 patients were included: 282 in the induction group and 131 in the expectant management group. Gestational age at delivery was lower in the induction group (39.4 ± 0.3 vs. 40.1 ± 0.3 weeks, p < 0.001). No significant differences were observed in birthweight, cesarean delivery rates, or neonatal intensive care unit (NICU) admission. The induction group had significantly fewer neonates with cord pH < 7.15 (2.5% vs. 6.9%, p = 0.034), and a shorter duration of neonatal hospitalization (2.0 ± 0.2 vs. 2.3 ± 0.5 days, p = 0.034); however, 5-min Apgar scores were similar between the groups. Total maternal hospitalization duration was significantly longer in the induction group (3.6 ± 0.6 vs. 2.2 ± 0.5 days, p < 0.001), though postpartum stay was slightly shorter (2.0 ± 0.2 vs. 2.2 ± 0.1 days, p < 0.001).

Conclusion

Among primiparous patients presenting with DFM between 39 + 0 and 39 + 6 weeks, labor induction was associated with earlier delivery and improved umbilical cord pH without increasing maternal or neonatal complications.

Purpose

Ovarian cancer (OC) is frequently diagnosed at a late, advanced stage, resulting in poor survival outcomes. PARP inhibitors like niraparib have shown significant efficacy in high-grade OC, particularly in tumors with homologous recombination deficiency, including BRCA mutations. This study aimed to evaluate dose modifications, safety, tolerability, and the impact on quality of life associated with niraparib in real-world clinical practice.

Methods

This non-interventional, register-based study included patients with platinum-sensitive recurrent OC who received niraparib as part of the compassionate-use program (CUP) in Germany. Clinical baseline characteristics, treatment data, adverse events (AEs), and quality-of-life measures were collected both prospectively and retrospectively across 14 centers. Data analysis was performed using descriptive statistical methods.

Results

Overall, 68 female patients were enrolled in the CUP register. Most patients had good performance status, with no significant comorbidities or concomitant medications. The most frequently reported AEs associated with niraparib were thrombocytopenia, fatigue, and nausea. Approximately half of patients required dose adjustments. AEs were less common in patients with normal physical examination findings, better ECOG performance status, and absence of comorbidities. Prior use of PARP inhibitors or previous treatment-related side effects increased the likelihood of AEs during niraparib therapy. The median treatment duration was 182 days, with disease progression being the most common reason for discontinuation.

Conclusion

Niraparib treatment within the German CUP demonstrated favorable safety and tolerability profiles, supporting its effectiveness in a real-world setting for patients with recurrent OC. These findings are consistent with results from clinical trials, further reinforcing the role of niraparib in this patient population.