Archives of Gynecology and Obstetrics最新文献

Introduction

Gonadotropin-releasing hormone (GnRH) receptor antagonists in combination therapy offer a promising advancement in the medical management of uterine fibroids. While effective for symptom control, limited data exist on their impact on surgical outcomes, particularly during laparoscopic myomectomy. This case series describes the surgical findings in three patients who received preoperative Relugolix combination therapy (Relugolix–CT: relugolix–estradiol–norethisterone acetate) compared to no pretreatment.

Materials and methods

We conducted a retrospective review of 24 patients who underwent laparoscopic myomectomy over a 6-month period. Three patients received a preoperative course of Relugolix–CT for 3, 6, and 9 months, respectively, while 21 patients underwent surgery without pretreatment.

Results

Blood loss was lower in the Relugolix–CT group (216.6 mL ± 189.7) vs. the no-pretreatment group (354.8 mL ± 131.9. Operating time was similar (148.3 vs. 148.1 min), as was duration of inpatient stay (1.3 vs. 2.0 days). No complications occurred in either group. Notably, in all cases with Relugolix–CT pretreatment, no distortion or fibrosis of the fibroid pseudocapsule was noted, allowing for complete resection of the fibroids.

Conclusions

This case series suggests that preoperative Relugolix–CT does not adversely affect surgical planes or operative outcomes. Although preliminary, these findings suggest benefits for surgical optimisation and support further investigation in larger, controlled studies.

Purpose

The aim of this study was to assess the effectiveness of the GnRHa trigger in the PPOS and GnRH antagonist protocols when using a GnRH agonist (GnRHa) trigger.

Methods

This retrospective cohort study conducted at Bahçeci Fulya IVF Center (January 2022–January 2024) included 802 patients undergoing ovarian stimulation with a starting dose of 300 IU gonadotropins using either a GnRH antagonist (n = 372) or PPOS protocol (n = 430), followed by a GnRHa trigger. The primary outcome was oocyte yield; secondary outcomes included pregnancy rates following the initial frozen embryo transfer (FET).

Results

Baseline characteristics, including female age, BMI, and infertility duration, were comparable between groups. Although PPOS was associated with a shorter stimulation duration [10 (9–11) vs. 10 (10–11) days, p = 0.002], lower progesterone levels on trigger day [1.3 (0.74–1.48) vs. 1.5 (0.83–1.63) ng/ml, p = 0.002], and higher LH levels [4 (1.89–5.2) vs. 3.3 (1.4–4.1) IU, p < 0.001], oocyte yield and embryological outcomes were similar (p > 0.05 for all). Clinical pregnancy rates [63.6% vs. 63.8%, p = 0.95] and live birth rates [51.7% vs. 52.2%, p = 0.87] were also comparable. Regression analysis identified embryo quality (p = 0.003), but not stimulation protocol (p = 0.766), as a significant predictor of live birth.

Conclusion

PPOS and GnRH antagonist protocols provide similar oocyte yield and live birth rates following GnRHa trigger. These findings indicate that progestin use in PPOS is not associated with inferior clinical outcomes in the setting of GnRHa trigger; however, the underlying mechanisms and long-term efficacy require further investigations.

Placenta accreta spectrum (PAS) is a serious obstetric complication, characterized by the placenta accreta and increta to the uterine wall, which fails to detach spontaneously from the uterine following childbirth, potentially resulting in severe hemorrhage and additional complications. The incidence of PAS is increasing in the world, which is mainly attributed to a global escalation in cesarean section rates, underscoring the critical need to elucidate its molecular pathogenesis and to devise efficacious clinical interventions. Recent studies have identified novel molecular mechanisms that have significantly enhanced our comprehension of disease pathophysiology and informed predictive and therapeutic strategies. Here, we review the principal molecular pathogenesis of PAS, explore the potential translation of these findings into clinical applications, and assess the impact of emerging technologies on advancing research in this domain.

Objective

To evaluate the prognostic and predictive significance of supradiaphragmatic lymph node (SDLN) positivity detected by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients undergoing primary cytoreductive surgery for advanced epithelial ovarian cancer.

Methods

A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and registered with PROSPERO. Studies reporting on overall survival (OS), progression-free survival (PFS), and complete cytoreduction (R0) in patients with and without 18F-FDG PET/CT-detected SDLN metastases were identified through comprehensive database searches conducted on December 18, 2024. Data from five retrospective, single-center studies comprising a total of 605 patients were included in the quantitative synthesis. Meta-analyses were performed using a random-effects model.

Results

SDLN positivity on 18F-FDG PET/CT was significantly associated with worse survival outcomes and lower resection rates. The pooled hazard ratio (HR) for OS was 1.60 (95% CI 1.19–2.25, p = 0.002) and for PFS 1.53 (95% CI 1.19–1.96; p = 0.0009), indicating poorer prognosis in SDLN-positive patients. The odds of achieving complete cytoreduction were significantly reduced in this group (OR = 0.32, 95% CI 0.15–0.68, p = 0.003). While heterogeneity was low for progression-free and overall survival (I² = 0%), moderate heterogeneity was observed in the analysis of complete cytoreduction (I² = 54%). None of the included studies provided histologic confirmation of 18F-FDG PET/CT-positive SDLNs.

Conclusions

18F-FDG PET/CT-detected SDLN positivity is associated with worse survival and lower resectability in advanced ovarian cancer. Due to lacking histologic confirmation and retrospective data, prospective validation is needed.