Archives of Gynecology and Obstetrics最新文献

Background

In breast care, ultrasound examination is a very important tool used to detect breast tumors, to monitor core needle biopsies, for preparing surgical operations, and for tracking postoperative developments. So far, stationary high-end ultrasound devices (SHUD) based on piezoelectric technology are most commonly used but lack the mobility and thus the possibility to practice point-of-care ultrasound (POCUS) in senology. In contrast, handheld ultrasound devices based on silicon chips (HHUD) offer a high mobility and different penetration depths through its all-in-one probe principle and thus may improve patient treatment. Therefore, this study investigates the diagnostic reliability of breast lesions examined with HHUD based on silicon chips versus those examined with SHUD based on conventional piezoelectric technology.

Methods

Each patient received an ultrasound examination using SHUD (Voluson S10, GE Healthcare) and HHUD (Butterfly iQ, Butterfly Network) in a random order. The morphologic descriptors and the BI-RADS categories, as well as the histological results, in the case of the biopsy, were compared, and the agreement rate and the Cohen’s kappa were analyzed. A quantitative analysis of the lesions’ sizes examined by the two devices was assessed statistically through intra-class correlation coefficient (ICC), Bland–Altman plots, and Pearson correlation coefficient (PCC). Subgroup analysis was performed in lesions’ type, skin-to-lesion distance, and lesions’ volume.

Results

105 lesions found in 84 females were analyzed regarding the reliability of SHUD and HHUD. The BI-RADS categories matched perfectly between both the devices and the available histological outcomes. The agreements of the measured diameters were excellent (ICC 0.926–0.969). The subgroup analysis revealed a slightly superior agreement for malignant cases, for lesions over 0.5 ml and for a skin-to-lesion distance over 5 mm.

Conclusion

The categories and measurements from HHUD matched closely with those obtained using conventional SHUD. This research demonstrates that HHUD offers a good alternative to SHUD for breast lesion evaluation which becomes especially useful during point-of-care applications.

Purpose

Lipedema is a chronic disorder that affects the subcutaneous adipose tissue of the lower and upper limbs and results in painful fat accumulations. During the reproductive life span, about 11% of women are affected; however, there are a high number of suspected undiagnosed and thus untreated cases.

Methods

The aim of this systematic review was to evaluate the association between hormones and the pathophysiological mechanisms of lipedema development. Inclusion criteria were: lipedema, lipoedema, estrogen, estrogen antagonists, female sex hormones, hormones, insulin, puberty, pregnancy, menopause, subcutaneous fat tissue, and subcutaneous adipose connective tissue.

Results

The literature search yielded 121 hits; after deduplication, 64 records were screened. After abstract and full-text screening 15 publications were suitable for being included in the systematic review. Overall, four different pathophysiological hypotheses were postulated: (1) general hormonal imbalance, (2) changes in growth hormone balance, (3) metabolic imbalance such as changes in adipose stem cells in relation to adipokines or leptin in association with the transcription factor PPARγ, and (4) changes in estrogen metabolism as well as alterations in the function of estrogen receptors.

Conclusion

Lipedema appears to be a multifactorial condition primarily driven by hormonal dysregulation—especially involving estrogen—alongside metabolic and possible genetic components. The findings support the reclassification of lipedema as a hormonally influenced disorder distinct from obesity, emphasizing the need for further research into diagnostic biomarkers, targeted therapies, and the role of genetic susceptibility.

Purpose

To investigate sexual health in breast cancer survivors and their partners, focusing on sexual satisfaction, changes in satisfaction with partner sexuality before vs. after the diagnosis, and unmet informational needs on sexual health in the context of breast cancer.

Methods

Breast cancer patients and their partners were surveyed at a single time point 1–5 years after having completed primary therapy for breast cancer as part of a cross-sectional study. Study participants completed self-report-questionnaires covering personal characteristics, a question on satisfaction with partner sexuality before (retrospective assessment) versus after the diagnosis (based on the Sexual Medicine Questionnaire for Chronic Diseases (SFCE)), the EORTC (European Organisation for Research and Treatment of Cancer) Sexual Health Questionnaire (EORTC QLQ-SH22) together with the EORTC Quality of Life Core Questionnaire (EORTC QLQ-C30), and a questionnaire assessing sexual health care. Descriptive statistics were used to summarize demographic and clinical data. For group comparisons, dyadic dependencies were accounted for, applying paired t tests when normality (Shapiro–Wilk test) was met and Wilcoxon signed-rank test otherwise.

Results

A total of 128 participants (64 patients, 64 partners) were enrolled. Sexual satisfaction did not differ between patients (M = 55, SD = 20.9) and partners (M = 56.7, SD = 20) (t test, p = 0.46). A positive correlation was found between patients’ and partners’ sexual satisfaction (r = 0.62, p < 0.0001). Satisfaction with partner sexuality was lower after diagnosis (p < 0.001, r = 0.54)—with both patients and partners being less satisfied after the diagnosis (M = 2.58, SD = 0.95) than before (M = 3.14, SD = 0.74). Overall, 75% of the study participants reported not having received information about sexual health issues related to breast cancer, while 64% expressed a desire for more information.

Conclusion

The findings of this study highlight the importance of considering couple dynamics in breast cancer care. Patients and partners have unmet needs concerning sexual health in the context of breast cancer. Addressing sexuality may improve quality of life and psychosocial adjustment. Future research should include larger, more diverse samples and focus on assessing sexuality and sexual health as multidimensional constructs in line with WHO (World Health Organization) definitions.

This case report describes the prenatal diagnosis of the extremely rare Blepharo-Cheilo-Dontic syndrome. After sonographic diagnosis of the bilateral cleft lip and palate and the persistent open eyelids, amniocentesis with subsequent molecular genetics confirmed the sonographically presumed de-novo mutation of the CDH1 gene and the Blepharo-Cheilo-Dontic Syndrome. After multidisciplinary counseling the patients termined the pregnancy.

Growing evidence suggests that women with endometriosis may be particularly vulnerable to disordered eating behaviors (DEBs) and clinically defined eating disorders (EDs). This narrative review aims at integrating and critically analyzing the current evidence regarding the relationship between endometriosis and EDs, as well as highlighting the psychosocial and neurobiological vulnerabilities of women with endometriosis to DEBs. A large-scale genetic study showed a nearly threefold increase in the odds of EDs in women with endometriosis, and a significant genetic correlation. Although the prevalence of formal ED diagnoses appears low in small clinical samples, DEBs such as emotional eating, binge tendencies, and maladaptive dietary restriction, are common and strongly associated with pain intensity, and borderline BMI. Psychological factors, including body image disturbance, heightened self-criticism, emotional dysregulation, and the need for control further contribute to the vulnerability to EDs. At the biological level, the dysregulation of leptin, endocannabinoids, dopamine, brain-derived neurotrophic factor, and inflammatory cytokines, molecules involved in both appetite regulation and some aspects of the pathophysiology of endometriosis, suggests overlapping neuroimmune pathways that may link endometriosis to DEBs and EDs. Clinical management must, therefore, integrate screening for DEBs, supervised and personalized dietary counseling, balanced exercise prescription, and psychological interventions targeting pain coping, emotion regulation, and body image. A multidimensional, biopsychosocial framework is essential to prevent the onset or exacerbation of EDs in women with endometriosis.

Introduction

We aimed to develop a machine learning model for first-trimester prediction of gestational diabetes mellitus (GDM) in twin pregnancies using a prospective international, multi-center cohort and identify useful predictive markers.

Methods

Pregnant women with two live fetuses were enrolled at 11 + 0 to 13 + 6 weeks’ gestation and followed until delivery. GDM was diagnosed at 24–28 weeks’ gestation using the two-stage GCT and OGTT tests. Biochemical, biophysical, and blood assessments were conducted at three periods during pregnancy. Multiple machine learning models evaluated demographic, clinical, and laboratory parameters, including maternal factors (BMI, age, medical history), sonographic markers (crown rump length, estimated fetal weight, uterine artery pulsatility index), and blood and biochemical markers (placental growth factors, blood glucose, cell counts). LightGBM, XGBoost, and logistic regression models were compared using area under the curve (AUC) analysis.

Results

Among 596 women, 99 (16.6%) developed GDM. LightGBM demonstrated superior performance (AUC = 0.72, 95% CI 0.69–0.75). First-trimester high BMI was the strongest predictor, followed by elevated white blood cell counts and platelet levels. Detection rates (DR) were 28% and 42% at 10% and 20% false positive rates (FPR), respectively. Previous GDM was associated with an increased risk for GDM.

Discussion

GDM in twins is associated with certain characteristics of the first-trimester. Information from later trimesters has a limited impact. The GDM probability risk score increased with the severity of the treatment. An app to predict this score is available at: twin-pe.math.biu.ac.il.

Purpose

The objective of this study was to explore whether a history of termination of pregnancy (TOP) in births after 2015 in a high income setting is still linked to preterm birth (PTB) and peripartal complications.

Methods

35,897 singleton births from a perinatal center with approximately 5000 births per year between 2015 and 2022 were analyzed. Patients with a history of first trimester TOP (TOP < 15 weeks) were compared to those who had never had a TOP. A two-step statistical approach using Chi-squared analysis and forward-step multiple logistic regression was used to explore the relationship.

Results

4132 individuals (11.51%) had a history of first trimester TOP. Our findings suggest an association between past TOP and a higher risk for PTB (OR = 1.44, 95% CI [1.25–1.67], p < 0.001). This increases with the number of TOP, six or more TOP were associated with the highest odds ratio for spontaneous PTB (OR = 5.21, 95% CI [1.88–14.46], p = 0.002). The risk for PTB did not differ between methods. Furthermore, our data suggest an association between past TOP and placental retention (OR = 1.25, 95% CI [1.03–1.52],p = 0.022).

Conclusion

These findings underscore the importance of still recognizing prior TOP as a risk factor in obstetric care. The results may inform targeted counseling and the development of preventative strategies to mitigate maternal and fetal morbidity.

Purpose

Thoracoamniotic shunting (TAS) in fetuses with macrocystic congenital pulmonary airway malformation (CPAM) is mostly performed with pigtail shunts like the rocket shunt or the Harrison fetal bladder stent. The aim of this study was to assess the prenatal course, perinatal outcome and complications of TAS for severe macrocystic CPAM using the Somatex^® intrauterine shunt.

Methods

This was a two center (Cologne/Bonn) observational retrospective study of fetuses that underwent TAS using the Somatex^® intrauterine shunt for severe macrocystic CPAM with and without hydrops between 2016–2024. Outcome parameters were perinatal survival, complications, gestational age at delivery and visibility of the shunt outside the skin after birth.

Results

During the study period, 25 fetuses were treated with the Somatex^® shunt (13 = Cologne, 12 = Bonn), including 24 singletons and one fetus of a monochorionic-diamniotic twin pregnancy Mean gestational age at intervention was 24.7 weeks (range 19–30). The mean diameter of the dominant cyst within the lesion was 34 mm (range 18–55). Fetal hydrops prior to TAS (ascites and fetal scalp oedema) was present in 36% (9/25). Dislocation in the further course of pregnancy occurred in 8% (2/25) with the need for reintervention in two cases. Resolution of hydrops and regression of the lesion occurred in 96% (24/25). Mean gestational age at delivery was 38.3 weeks (range 26–41), the preterm birth rate < 37 weeks was 20% (5/25), 12% (3/25) were due to PPROM. Live birth rate was 100% and 92% (23/25) of neonates survived the neonatal period. Of the 12 liveborns delivered at the two study centers, in one case the shunt (8.3%) was dislocated in the amniotic cavity, 5 (41.7%) had a visible shunt outside the skin, whereas in the other 6 (50.0%) cases the shunt was covered with skin at birth.

Conclusions

TAS in macrocystic CPAM with the Somatex^® shunt has a high technical success rate leading to high neonatal survival rates even in cases associated with hydrops. The intrauterine course and neonatal outcome are comparable to TAS for fetal macrocystic CPAM using other types of shunts. Therefore, the choice of the shunt in macrocystic CPAM can be made freely at the discretion of the physician in charge, the availability of devices and economic factors. Due to the short length of 25 mm and its straight design, the outer end of the Somatex^® shunt is covered by skin at birth in up to 50% of cases, which may complicate its removal.

Purpose

Maternity care is a central component of any healthcare system and is largely provided by midwives. Considering increasing cost pressures and growing demand for efficiency within the German healthcare system, the development of efficient, digitally supported care models are both encouraged and actively promoted, especially in pregnancy. However, to date, no such model has been sustainably established in the field of maternity care. In particular, the perspectives of midwives have largely been neglected.

Methods

As part of an initial needs assessment for the Participatory Design of a digitally supported maternity care model, this study uses a cross-sectional web-based questionnaire to explore midwives’ perceptions of their current work situation, use of digital tools and digital pregnancy care.

Results

92.2% of participants (n = 129) perceive increasing strain on maternity care in Germany (5-point Likert; M = 4.49, SD = ± 0.69). 87.6% use a variety of digital tools in their professional environment, yet unvalidated and unauthorized solutions. Self-perceived digital competence is high (10-point NRS; 7.09 ± 1.48). The intention to use the technology decreases in parallel with the level of awareness, being highest for the electronic patient record (5-point Likert; 72.1%; 3.84 ± 0.97) and lowest for artificial intelligence (38.8%; 3.17 ± 1.05).

Conclusion

The study highlights midwives’ openness to digital solutions, their active, though informal, use of such tools, and emphasizes the need to integrate their perspectives into the development of certified, sustainable digital care models in maternity care within an increasingly strained healthcare system.