BMC Women's Health最新文献

Background: This is a multicentre, European, prospective trial evaluating the diagnostic accuracy of One Step Nucleic Acid Amplification (OSNA) compared to sentinel lymph nodes histopathological ultrastaging in endometrial cancer patients.

Methods: Centres with expertise in sentinel lymph node mapping in endometrial cancer patients in Europe will be invited to participate in the study. Participating units will be trained on the correct usage of the OSNA RD-210 analyser and nucleic acid amplification reagent kit LYNOAMP CK19 E for rapid detection of metastatic nodal involvement, based on the cytokeratin 19 (CK19) mRNA detection. Endometrial cancer patients ≥ 18 years listed for surgical treatment with sentinel lymph node mapping, with no history of other types of cancer and who provide a valid written consent will be considered potentially eligible for the study. However, they will only be enrolled if a successful sentinel lymph node mapping is retrieved. Each node will be processed according to the study protocol and assessed by both OSNA and ultrastaging.

Discussion: The accuracy of OSNA (index test) will be assessed against sentinel lymph node histopathological ultrastaging (reference test). This European study has the potential to be the largest study on the use of OSNA in endometrial cancer to date. OSNA could represent a modern diagnostic alternative to sentinel lymph node ultrastaging with the added benefits of standardisation and fast results.

Trial registration: The study was registered in the German Clinical Trial Register - Nr. DRKS00021520, registration date 25th of May 2020, URL of the trial registry record: https://drks.de/search/en/trial/DRKS00021520 .

Background: Embryo implantation involves two key elements: a good quality embryo and receptive endometrium. Endometrial receptivity abnormalities are known as one of the possible causes of recurrent implantation failure (RIF), especially when the embryo is euploid. This study was aimed to evaluate the impact of age and other clinical factors on endometrial receptivity in women with RIF.

Methods: 68 women with RIF (defined as at least three unsuccessful transfers of good quality embryo of at least 1BB category of blastocysts) and 49 controls (women undergoing IVF treatment because of idiopathic infertility or male factor) were included to the study. After preparation of the endometrium by the hormone replacement therapy endometrial biopsies were taken from each patient and sequenced with beREADY test TAC targeting 67 biomarker genes for endometrial receptivity. Depending on the test result patients were classified into one of four different groups: pre-receptive (n = 16), early-receptive (n = 54), receptive (n = 44) and late-receptive (n = 3).

Results: In women with RIF pre-receptive endometrium has been detected substantially more often than in controls - 13 (19,1%) vs. 3 (6,1%) patients (p = 0,043). Early-receptive endometrium was diagnosed in the majority of patients with idiopathic infertility - 12 (66.7%) vs. 6 (33.3%) women (p = 0.042) and with polycystic ovary syndrome (PCOS) - 12 (70,6%) vs. 3 (17.7%) women (p = 0,0447). We found significant association between abnormal endometrial receptivity and patient's age and duration of infertility. Young women were diagnosed significantly more often as normal or late-receptive, whereas older women with longer history of infertility as early-receptive and pre-receptive.

Conclusions: In patients with RIF in comparison to other women undergoing IVF procedures, patient's age and infertility duration are the most important factors related to endometrial receptivity abnormalities, indicating that older women with a longer history of infertility may benefit the most from endometrial receptivity testing.

Trial registration: Not applicable.

Background: The C-reactive protein-triglyceride glucose index (CTI) is a promising new marker for evaluating the severity of inflammation. Endometriosis (EM) is a prevalent chronic inflammatory condition influenced by estrogen, primarily affecting women of reproductive age. However, no study has demonstrated an association between the CTI and EM.

Methods: This cross-sectional study sourced data from females 20-50 years of age from the National Health and Nutrition Examination Survey (NHANES) 1996-2006, and included those with self-reported diagnoses of EM and sufficient information to calculate the CTI, computed as 0.412 × ln (C-reactive protein [CRP]) + ln (triglycerides [mg/dL] × fasting plasma glucose [mg/dL]/2). Multivariate logistic regression, restricted cubic splines, and subgroup analyses were performed to examine the association between the CTI and EM.

Results: Data from 2235 women (175 [7.82%] with EM, 2060 [92.18%] without EM [controls]), were included: those with EM exhibited a tendency toward higher CTI (p = 0.005), and CTI was positively associated with the prevalence of EM (p = 0.011). In Model 1, a 1 mg/dL increment in CTI was associated with a 56% higher prevalence of EM (odds ratio [OR] 1.563 [95% confidence interval (CI) 1.295-1.885]; P < 0.001). This association in Model 2 (OR 1.609 [95% CI 1.334-1.941]; p < 0.001) and Model 3 (OR 1.565 [95% CI 1.246-1.966]; p < 0.001) remained significant. Notably, individuals in the uppermost remnant cholesterol tertile exhibited a notably higher prevalence of EM than those in the lowest tertile (OR 3.029, p = 0.051). Restricted cubic splines revealed a nonlinear positive association between CTI and the prevalence of EM. In addition, greater EM prevalence was observed with CTI in those > 40 years of age (OR 1.57 [95% CI 1.16-2.13]), body mass index ≥ 25 kg/m² (OR 1.38 [95% CI 1.06-1.80]), smoking ≥ 100 cigarettes (OR 1.43 [95% CI 1.06-1.96]), married or living with partner (OR 1.41 [95% CI 1.09-1.85]), and oral contraceptive use (OR 1.35 [95% CI 1.07-1.69]).

Conclusions: CTI was positively associated with EM in women in the United States. Use of the CTI as an indicator of inflammation may provide new insights for the prevention and management of EM.

Background: In Malawi, women in prisons make up 2.7% of the total prison population. However, the experiences of women incarcerated are not well documented in the literature. We aim to describe the experiences of women incarcerated in a Malawian prison facility. We will concentrate on the qualitative findings that highlight the unique perspectives of these women, including those in which they are imprisoned alongside their children, as well as the larger implications for child welfare and prison policy.

Methods: A qualitative approach using descriptive study design was used to explore the experiences of incarcerated women in prisons in Malawi. In-depth interviews were conducted with seven incarcerated women (n = 7). The interviews followed a semi-structured interview guide, and the data were analyzed manually using thematic analysis.

Results: The following four themes emerged from the data: the burden of conviction, prison as a traumatic environment, health insecurity and perceptions regarding release from prison. Participants reported that being convicted caused significant psychosocial stress. The incarcerated women stated that they are subjected to inhumane and degrading treatment. The prison conditions are poor. The nutrition is inadequate for both incarcerated women and their children. Incarcerated women look forward to their release, citing that they have been transformed and are optimistic about their new lives. Prison living made them calmer and more patient. Others express concern that the stigma of incarceration will inhibit their ability to reconnect with the community upon release.

Conclusion: Understanding women's experiences in Malawian prisons can inform policy and improve standards of living for incarcerated women in Malawian prisons.

Purpose: Perimenopause is associated with an increased risk of anxiety disorders, largely due to hormonal changes affecting the body's regulatory feedback mechanisms. This study aims to provide a comprehensive analysis of the global burden of anxiety disorders among perimenopausal women.

Methods: Data from the 2021 Global Burden of Disease (GBD) database were utilized to assess disability-adjusted life years associated with anxiety disorders linked to perimenopause. We calculated trends using the estimated average percent change, and future projections were made using the Bayesian age-period-cohort model to estimate disability-adjusted life year trends for anxiety disorders from 2022 to 2035.

Results: Between 1990 and 2021, the global age-standardized disability-adjusted life year rate for anxiety disorders among perimenopausal women increased from 625.51 (95% uncertainty interval: 429.1-891.09) to 677.15 (95% uncertainty interval: 469.45-952.72), indicating a rising trend with an estimated average percent change of 0.081 (95% confidence interval: 0.0043-0.143). Regional differences were noted, with anxiety disorder burdens varying across areas with different sociodemographic index levels. Projections suggest that by 2035, the global burden of anxiety disorders in perimenopausal women will rise to 1,180.43 per 100,000, a 40.67% increase compared with 2021 levels.

Conclusion: The burden of anxiety disorders during perimenopause is a growing global concern, with a significant increase anticipated in the coming years. Targeted prevention and intervention strategies are urgently needed to mitigate this rising burden and improve mental health outcomes during perimenopause.

Background: Uterine cystic adenomyosis is a rare form of focal adenomyosis that is primarily located within the myometrium. In this case report, we present a unique case of adult uterine cystic adenomyosis found outside the uterus following laparoscopic myomectomy.

Case presentation: The patient was a 36-year-old Chinese woman who had previously undergone laparoscopic surgery at our hospital to remove a 4 cm diameter diameter uterine fibroid six years prior. She returned to our hospital due to excessive menstruation and intermittent right lower abdominal pain for one year. Pelvic computed tomography revealed an endometriotic cyst on the right posterior side of the uterus seemingly connected to the uterine cavity. During surgery, we successfully removed a large well-defined cyst filled with typical chocolate-like fluid located outside the uterus with its root deeply embedded in the myometrium. Following surgery, we administered gonadotropin-releasing hormone analogs for six cycles without any observed recurrence.

Conclusion: This study describes an unusual occurrence of large adult uterine cystic adenomyosis located outside the uterus after laparoscopic myomectomy, potentially supporting the theory that endometrial injury invagination may be responsible for this condition.

Background: Menarche, a milestone in a woman's reproductive journey, is influenced by various factors such as lifestyle and dietary habits. Recent studies have corroborated this claim and prompted further investigation. This study explores the connection between menarche timing with lifestyle and dietary habits among three generations of women from the Sakaldiha block of Chandauli district and presents valuable insights into the role of diet and lifestyle in this crucial reproductive event.

Methods: The study is based on primary data collected using multistage stratified random sampling. A comparative analysis of the mean age at menarche across independent variables has been conducted using the one-way analysis of variance (ANOVA) technique. Additionally, a multiple regression model has been developed to investigate the association between menarcheal age and various dietary, lifestyle and socio-economic factors among 400 respondents.

Results: The average age of menarche for respondents was 14.29 years (95% CI: 14.12, 14.45), which has decreased by 1.66 years from 14.89 years (95% CI: 14.63, 15.15) in women over 40 years of age to 13.23 years (95% CI: 12.97, 13.49) in the < 20 years age group. The study additionally found that dietary and lifestyle factors had an impact on the age of menarche, with those who regularly consumed junk food, occasionally ate meat/fish or eggs, completely avoided curd or buttermilk and engaged in non-resting leisure activities experiencing an earlier onset of menarche.

Conclusion: The study shows that diet and lifestyle affect age at menarche, with current generations experiencing an earlier onset of menstruation. The effect of socioeconomic status remains inconclusive.

Background: The postpartum period remains a very important period during which contraceptive needs can be met and a significant reduction of maternal and foetal morbi-mortality achieved. This study aimed to evaluate past contraceptive experience and identify factors associated with the desire for postpartum family planning among women in late pregnancy.

Methods: We conducted a cross-sectional survey from September 2020 to December 2021 in four major health facilities of the Nkongsamba Health District, Cameroon, and consecutively included all pregnant women in late pregnancy, who came for antenatal follow-up in these health facilities. Data were collected using a semi-structured interviewer-administered questionnaire. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) for the factors associated with desire for postpartum family planning. Two-tailed p-values < 0.05 were considered statistically significant.

Results: Among the 1074 participants, 41.71% [95% CI: 38.78-44.70] reported a future desire for modern postpartum contraception. The self-reported prevalence of use of modern contraception in the past in the study population was 48.87% [95%CI: 45.86-51.88]. Only 17.64% [95%CI: 14.59-21.16] of women had adopted a modern contraceptive method other than the barrier methods in the past. Among pregnant women who had used modern contraception in the past, 11.50% [95%CI: 9.02-14.55] reported to have had their modern contraceptive experience with long-acting reversible contraceptives (LARCs). The prevalence of unintended pregnancy (current pregnancy) was 40.04% [37.15-43.00], with 11.55% being unwanted, and 28.49% mistimed. Compared to their respective counterparts, participants ≤ 30 years old (AOR = 0.71[0.52-0.99]), with monthly revenue below 100 thousand FCFA (AOR = 0.45[0.32-0.62]), who were single (AOR = 0.38[0.27-0.54]), had lower odds for desire of postpartum family planning. In contrast, women who were Christians (AOR = 2.13[1.27-3.58]), with a history of use of modern contraception before conception (AOR = 2.80[2.02-3.90]), and had a current unintended term pregnancy had higher odds of desiring postpartum contraception (AOR = 2.91[2.13-3.99]).

Conclusion: The desire for postpartum family planning is still low among pregnant women. This desire for postpartum family planning depends on sociodemographic factors and past contraceptive practices.

Background: Bacterial vaginosis (BV) is a prevalent vaginal condition among reproductive-age women, characterized by off-white, thin vaginal discharge with a fishy odor. It increases susceptibility to sexually transmitted diseases (STDs) and pelvic inflammatory disease (PID). BV involves a shift in vaginal microbiota, with reduced lactobacilli and increased anaerobic bacteria. Standard treatment with oral metronidazole has been shown to have a limited long-term efficacy, possibly due to biofilm persistence. Alternative treatments, such as lactic acid vaginal gel, aim to restore vaginal pH and lactobacilli. This pilot study compares the efficacy and tolerability of lactic acid gel to standard oral metronidazole for acute BV treatment in non-pregnant women.

Methods: A total of 32 women with acute BV were recruited and assigned to either the treatment group (n = 16) where they applied a lactic acid vaginal gel for 12 days, or the control group (n = 16) which received 500 mg oral metronidazole twice daily for seven days. A number of objective and subjective parameters including the Amsel score, the Nugent score and a subjective symptom score were recorded at day 0, three weeks, three months, and six months after the study start.

Results: In the short-term, lactic acid vaginal gel showed inferior clinical (Amsel criteria) and microbiological (Nugent score) cure rates compared to metronidazole. However, it performed equally well regarding subjective symptom improvement and BV recurrence prevention after up to six months.

Conclusion: Lactic acid vaginal gel was generally very well tolerated and showed mixed but promising results as a stand-alone treatment for acute BV.

Trial registration number: NCT02042287 (22.01.2014).

Introduction: Ovarian adenomyoma is a rare gynecological tumor with a high misdiagnosis rate, leading many patients to undergo unnecessary surgeries that may affect fertility. Menstrual abdominal pain is the most common symptom, and auxiliary examinations often cannot clarify its nature. It often relies on intraoperative diagnosis, and surgical resection can achieve good therapeutic effects.

Case presentation: A 50-year-old woman presented with lower abdominal pain during her menstrual period for the past two months. She had a previous medical history of uterine adenomyomectomy, ovarian cystectomy, and a cesarean section. Ultrasound revealed a 5.7 × 3.8 × 4.3 cm mass on the posterior wall of the uterus, a 9.9 × 5.6 × 8.2 cm hypoechoic mass in the right posterior part of the uterus, and a 2.8 × 2.2 × 2.7 cm anechoic mass in the left ovary. CA125 (Carbohydrate antigen 125) 191.80U/ml (0-30). MRI (magnetic resonance imaging) imaging confirmed a 7.9 × 6.2 × 7.2 cm fibroid on the right posterior wall of the uterus. Consider partial degeneration of multiple uterine fibroids and benign cystic degeneration in the lower left abdomen. Surgical resection was performed smoothly, and the diagnosis was confirmed by postoperative pathology.

Conclusion: Ovarian adenomyoma is a rare benign gynecologic tumour with a high rate of misdiagnosis. When a patient presents with recent lower abdominal pain or dysmenorrhea, a history of endometriosis or myomectomy, and MRI findings showing irregular bleeding patterns in a pelvic mass, the possibility of extrauterine adenomyosis should be considered. Minimally invasive treatment options, such as single-port laparoscopy or vaginal dissection, may offer advantages, but caution should be exercised due to the potential for malignant tumors. Preserving fertility is something worth exploring. We hope to provide warnings to more gynaecologists and reduce misdiagnosis and unnecessary treatment.