European journal of obstetrics, gynecology, and reproductive biology最新文献

{"title":"Prediction of perinatal mortality in early-onset fetal growth restriction: A post hoc analysis of the Dutch STRIDER trial to predict perinatal mortality in early-onset fetal growth restriction","authors":"Leah I. Prins ,&nbsp;Claartje M. Bruin ,&nbsp;Esmée M.N. Kornaat ,&nbsp;Anouk Pels ,&nbsp;Sanne J. Gordijn ,&nbsp;Christiana A. Naaktgeboren ,&nbsp;Wessel Ganzevoort","doi":"10.1016/j.ejogrb.2024.11.008","DOIUrl":"10.1016/j.ejogrb.2024.11.008","url":null,"abstract":"<div><h3>Objective</h3><div>Early-onset fetal growth restriction affects about 0.3% of pregnancies, posing high perinatal risks due to placental insufficiency. Early-onset fetal growth restriction often coincides with early-onset pre-eclampsia, associated with significant mortality and morbidity. Clinical management varies among clinicians, with emphasis on intensive monitoring and timely delivery. Our objective was to improve clinical prediction of perinatal mortality in early-onset fetal growth restriction for parental counseling.</div></div><div><h3>Study design</h3><div>This was a secondary analysis of prospective cohort data from the Dutch STRIDER trial. The study included 215 pregnant women diagnosed with severe early-onset fetal growth restriction between 20 + 0 and 29 + 6 weeks of gestation, from tertiary and secondary antenatal care centers in The Netherlands. Maternal and fetal characteristics were collected at inclusion, including sonographic and laboratory measurements. Analysis was performed using univariable and multivariable binary logistic regression to create a prediction model for perinatal mortality. The main outcome measures were fetal demise and neonatal mortality up to discharge.</div></div><div><h3>Results</h3><div>215 Participants were included for this analysis. Perinatal mortality occurred in 84 (39 %) cases; 51 (24 %) were fetal and 33 (15 %) neonatal. Fetal abdominal circumference, gestational age at diagnosis, estimated fetal weight Multiple of Median, absent or reversed end-diastolic flow of the umbilical artery, umbilical artery pulsatility index Multiple of Median, non-Caucasian ethnicity, male sex, placental growth factor level and uterine artery pulsatility index were independent predictors of perinatal mortality. Randomization allocation (sildenafil or placebo) had no predictive value for mortality. The prediction model including gestational age at diagnosis, estimated fetal weight Multiple of Median and umbilical artery pulsatility index Multiple of Median showed an area under the receiver operating characteristic curve of 0.840 (P &lt; 0.01). Placental growth factor was measured in a subset of patients and was an independent prognostic factor and performed significantly better within the predictive model, however it did not improve the predictive value of the model.</div></div><div><h3>Conclusions</h3><div>Prediction of perinatal mortality in early-onset fetal growth restriction is feasible with commonly available tests and measurements and could support decision making in management of pregnancy. However, implementation in practice requires further studies.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"304 ","pages":"Pages 23-29"},"PeriodicalIF":2.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe uterine haemorrhagic complications from gestational trophoblastic neoplasia","authors":"M. Galea ,&nbsp;P. Descargues ,&nbsp;T. Hajri ,&nbsp;P. Rousset ,&nbsp;M. Devouassoux-Shisheboran ,&nbsp;A. Msika ,&nbsp;B. You ,&nbsp;F. Golfier ,&nbsp;P.A. Bolze","doi":"10.1016/j.ejogrb.2024.11.016","DOIUrl":"10.1016/j.ejogrb.2024.11.016","url":null,"abstract":"<div><h3>Objective</h3><div>Gestational trophoblastic neoplasia are highly vascularized infiltrating lesions that can lead to severe haemorrhagic complications. The aim of this study was to describe the characteristics of patients with gestational trophoblastic neoplasia who experienced uterine haemorrhagic complications, and their management.</div></div><div><h3>Study design</h3><div>This retrospective study analysed the histories of 2099 patients with gestational trophoblastic neoplasia registered at the French Reference Centre for Trophoblastic Disease between 1999 and 2023.</div></div><div><h3>Results</h3><div>Among 2099 patients with a confirmed diagnosis of gestational trophoblastic neoplasia, 38 patients who experienced uterine haemorrhagic complications requiring interventional treatment were identified. Among them, 23 (61%) had a low-risk tumour and 15 (39%) had a high-risk tumour according to their International Federation of Gynecology and Obstetrics score. Twenty (53%) patients experienced haemoperitoneum and 18 (47%) patients experienced massive vaginal bleeding. Seventeen (45%) patients experienced uterine rupture. Haemorrhagic treatment consisted of surgery for 26 (70%) patients, exclusive uterine embolization for six (16%) patients, embolization followed by surgery for four (11%) patients, and embolization after failure to control bleeding by aspiration for one (3%) patient. Of the five deaths (13%), one (3%) was related to the uterine haemorrhagic complication. Three of 15 (20%) patients treated conservatively reported subsequent pregnancies.</div></div><div><h3>Conclusion</h3><div>There are no established guidelines for managing severe uterine haemorrhagic complications. The availability of interventional radiology resources could allow for increased use of fertility-preserving procedures, with encouraging results regarding subsequent pregnancies.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"304 ","pages":"Pages 30-34"},"PeriodicalIF":2.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142651139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal effect of breast cancer on endometrial cancer risk: A two-sample Mendelian randomization study","authors":"Meng Wang ,&nbsp;Lan Li ,&nbsp;Jing Li ,&nbsp;Yongwei Li ,&nbsp;Zhuoli Wang ,&nbsp;Yuan Guo ,&nbsp;Guochao Mao","doi":"10.1016/j.ejogrb.2024.11.013","DOIUrl":"10.1016/j.ejogrb.2024.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Observational studies have indicated a higher incidence of endometrial cancer in individuals with breast cancer. However, to date, there is a dearth of Mendelian randomization (MR) studies that explore the causal relationship between breast cancer and the risk of endometrial cancer.</div></div><div><h3>Material and methods</h3><div>We conducted MR to investigate the causal relationship between breast cancer and endometrial cancer risk in European populations.</div></div><div><h3>Results</h3><div>A total of 112 valid instrumental variables (IVs) were included in the analysis. Our research has revealed a compelling causal association between genetic predisposition for breast cancer and an augmented likelihood of developing endometrial cancer (Inverse variance weighted (IVW) method, odds ratio (OR) = 1.105, 95 % confidence interval (CI): 1.025 to 1.181, <em>p</em> = 0.003; Weighted median method, OR = 1.109, 95 % CI: 1.020 to 1.205, <em>p</em> = 0.015; Weighted mode method, OR = 1.101, 95 % CI: 1.013 to 1.195, <em>p</em> = 0.025).</div></div><div><h3>Conclusion</h3><div>To our knowledge, this study is the first to report a causal association between breast cancer and endometrial cancer risk. Robust results were obtained through rigorous testing for heterogeneity and pleiotropy. Our findings indicate a causal effect of breast cancer on the risk of endometrial cancer.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"304 ","pages":"Pages 16-22"},"PeriodicalIF":2.1,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicenter cohort study analysing the implementation of a new guideline for women with pregnancy of unknown location or ectopic pregnancy in the Netherlands","authors":"L.M.A. Madder ,&nbsp;E.C.F. Stark ,&nbsp;J.M. Woolderink ,&nbsp;P.J.Q. Van der Linden ,&nbsp;J.R. Dijkstra ,&nbsp;L. van Boven ,&nbsp;M. Keizer ,&nbsp;H. Groen ,&nbsp;M.A.C. Versluis ,&nbsp;K. van der Tuuk","doi":"10.1016/j.ejogrb.2024.10.058","DOIUrl":"10.1016/j.ejogrb.2024.10.058","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluation of the implementation of a new guideline for diagnosis and treatment of women with pregnancy of unknown location (PUL) or ectopic pregnancy (EP).</div></div><div><h3>Design</h3><div>Multicenter retrospective cohort study.</div></div><div><h3>Setting</h3><div>Six hospitals in the Northern part of the Netherlands.</div></div><div><h3>Population and methods</h3><div>Women above 18-years old with a final diagnosis of PUL or EP between January 2012 to April 2020.</div></div><div><h3>Main outcome measures</h3><div>Diagnostic findings, type of treatment and outcomes, before and after implementation of the guideline. User interpretation of the guidelines.</div></div><div><h3>Results</h3><div>1306 women with PUL (N = 289) or EP (N = 1017) were included. The amount of women diagnosed with PUL has significantly (P &lt; 0.001) increased between the previous guideline (16.6 %; 115/693) and the new guideline (28.4 %;174/693). A significantly lower percentage of women, after implementation of the new guideline, underwent surgical management (odds ratio [OR] = 0.516, 95 % confidence interval [CI] 0.399 – 0.668P &lt; 0.001) versus treatment with MTX (odds ratio [OR]<!--> <!-->=<!--> <!-->2.529, 95<!--> <!-->% confidence interval [CI] 1.719<!--> <!-->–<!--> <!-->3.723, P<!--> <!-->&lt;<!--> <!-->0.001). The overall success of treatment with MTX was 80.5 % (N = 103) compared to 95.2 % (N = 907) of surgery (P &lt; 0.007). There was no observed difference in adverse events or guideline adherence between the guidelines.</div></div><div><h3>Conclusion</h3><div>The implementation of the new guideline contributes to an increase in women diagnosed with PUL and treated with MTX. Treatment with MTX caused more complications and a lower treatment success compared to women undergoing surgery. This did not lead to an increase in adverse events between the guidelines. The overall adherence to the guidelines was equal.</div></div><div><h3>Key message</h3><div>Implementation of the new guideline contributes to an increase in women diagnosed with PUL and conservative treatment with methotrexate (a drug with a higher risk of complications and a lower successful treatment compared to surgery), however this did not lead to an increase in adverse events between the old and new guideline.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"304 ","pages":"Pages 41-46"},"PeriodicalIF":2.1,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We need to take a broader view of the function of the pelvic floor","authors":"Bruno Bordoni","doi":"10.1016/j.ejogrb.2024.11.011","DOIUrl":"10.1016/j.ejogrb.2024.11.011","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Page 366"},"PeriodicalIF":2.1,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified surelift anterior-apical transvaginal mesh for advanced urogenital prolapse: Retrospective surgical, functional and sonographic outcomes at 3 years","authors":"Tsia-Shu Lo ,&nbsp;Fazlin Harun ,&nbsp;Lan-Sin Jhang ,&nbsp;Wu-Chiao Hsieh ,&nbsp;Yiap Loong Tan ,&nbsp;Aisha Alzabedi","doi":"10.1016/j.ejogrb.2024.11.009","DOIUrl":"10.1016/j.ejogrb.2024.11.009","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluates the outcomes of modified transvaginal mesh (TVM) Surelift in managing advanced pelvic organ prolapse (POP) over a 3-year follow-up period, focusing on surgical success, functional improvement, and sonographic findings.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on 99 women who underwent Surelift System surgery for advanced POP Stage III and IV between July 2018 to January 2020. Objective evaluation included Pelvic Organ Prolapse Quantification (POP-Q), multichannel urodynamic (UDS), and introital 2D ultrasonographic measurement. Subjective evaluation uses validated questionnaires of Incontinence Impact Questionnaire-7(IIQ-7), Urogenital Distress Inventory-6(UDI-6), Pelvic Organ Prolapse Distress Inventory 6(POPDI-6), Colorectal Anal Distress Inventory-8(CRADI-8) and Pelvic organ prolapse/ Urinary Incontinence Sexual Questionnaire (PISQ-12). Outcomes were examined at 3 months, yearly and at 3 years postoperative. Secondary outcome included de novo or persistent urodynamic stress incontinence (USI) and surgical complications.</div></div><div><h3>Results</h3><div>Eighty-five women were included in the final analysis. At 3 years postoperative, the objective cure rate was 94.1 % and subjective cure rate of 91.8 %. Ultrasonography revealed initial mesh elongation and thickening at first year, resolving by the third year, while the distance between the bladder neck and mesh remained stable. Significant improvement in POP-Q components (Aa,Ba,C,Ap,Bp and TVL of p &lt; 0.001), UDS (p &lt; 0.001) and all validated Quality of Life (QoL) questionnaires (p &lt; 0.001) were seen. De Novo USI and persistent USI occurred in 31.5 %. Complications included vaginal mesh exposure requiring excision in 4.7 % of patients, and one intraoperative bladder injury corrected promptly.</div></div><div><h3>Conclusion</h3><div>The Surelift System TVM demonstrates safety and efficacy in treating advanced anterior-apical POP, achieving high cure rates, secured mesh placement, and minimal complications at 3 years post-operative.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"304 ","pages":"Pages 1-8"},"PeriodicalIF":2.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictions of live birth in IVF programs of patients with recurrent implantation failure","authors":"Oleksandra Kozyra ,&nbsp;Mykhailo Medvediev ,&nbsp;Andrea Tinelli","doi":"10.1016/j.ejogrb.2024.11.007","DOIUrl":"10.1016/j.ejogrb.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>When a high-quality embryo is implanted into the uterus, but the pregnancy is not established as shown by the ultrasound visualization of an intrauterine gestational sac, this is known as “implantation failure.” Cases when more than two times implantation failure occurred was defined as recurrent implantation failure (RIF). Additional testing is done at this stage of infertility treatment to avoid a repeat of the same result with a future in vitro fertilization (IVF) effort.</div></div><div><h3>Aim of the study</h3><div>The study aimed to evaluate predictive value of using embryo transfer personalization because of the implantation window study in combination with preimplantation genetic testing in patients with recurrent implantation attempts.</div></div><div><h3>Methods</h3><div>Briefly describe the main methods or treatments applied: Ninety-three infertile women make up the sample for this prospective cohort study. In regard to treatment results, the study intends to assess the predictive importance of patient characteristics, screening indicators, and several features of IVF cycles, such as the quantity, quality, and developmental stage of the transferred embryos. Statistical methods employed include the calculation of the median (Me) and interquartile range (IQR) for continuous variables. The Mann-Whitney <em>U</em> test was used to discern differences between unrelated samples, while categorical variables were presented as absolute and percentage values. The Pearson’s Chi-squared test assessed differences between groups. Logistic regression, utilizing both enter and backward Wald methods, was applied to establish associations with binary outcomes.</div></div><div><h3>Results</h3><div>The integration of individualized embryo transfer and preimplantation genetic testing (PGT) significantly enhanced the likelihood of live births by 3.4 times in patients experiencing recurrent implantation failure (RIF), with a statistical significance of p = 0.026. In contrast, employing PGT alone increased the probability of live births by 1.5 times; however, this result was not statistically significant (p = 0.439). The predictive model for live birth in patients with RIF, based on our study findings, is defined as follows: the probability of live birth = 1.936 + [1.014 if PGT-A embryos are utilized for transfer] + [1.742 if endometrial preparation is tailored according to the Wellbeing Index (WI)] − [1.860 in cases of secondary infertility] − [1.891 when a male factor is involved].</div></div><div><h3>Conclusions</h3><div>The determination of the implantation window (IW) and PGT of the embryo are efficient methods of live birth achievement for patients with RIF.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 331-336"},"PeriodicalIF":2.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital vs formal teaching of vaginal breech delivery: Which is the residents’ choice?","authors":"Giovanna Salvani ,&nbsp;Barbara Matarrelli ,&nbsp;Federico Prefumo ,&nbsp;Maurizio Rosati ,&nbsp;Claudio Meloni ,&nbsp;Claudio Celentano","doi":"10.1016/j.ejogrb.2024.11.004","DOIUrl":"10.1016/j.ejogrb.2024.11.004","url":null,"abstract":"<div><h3>Objective(s)</h3><div>A critical area of obstetrics that demands proficient training is the management of breech deliveries. There was a notable decline in the number of vaginal breech deliveries in the following years, establishing CS as the preferred method of delivery for such cases. Cohort studies using targeted screening and skilled practitioners demonstrated little differences between the two delivery. Skills acquisition at the patient’s bedside is very difficult to obtain, particularly in the youngest trainees. Simulation teaching has largely become a part of the training curricula for many obstetrics and gynecology residency programs.</div></div><div><h3>Study design</h3><div>This was a prospective, randomized, controlled, single-center study. Residents were randomly assigned in two groups with similar characteristics. Group A attended a formal lecture. Group B received the study material and recording of the lecture as digital home learning. Lecture and simulation focused on vaginal breech delivery. After one month both groups underwent a simulation test addressed to assist a vaginal breech birth. Four supervisors evaluated all videos. Time needed for birth, and evaluation scales as Objective Structured Clinical Examination were recorded. A questionnaire was completed online using Google Forms with 6 questions. The primary outcome was to compare the evaluation for each item and globally within groups. A secondary outcome was the evaluation of questionnaire results within the two groups.</div></div><div><h3>Results</h3><div>Thirty-two participants were recruited and randomized. None of the participants withdrew from the study. For the primary outcome, all examined variables (Time, Rumping, Legs, Body, Arms, Head, Total Point) did not present differences in supervisors’ evaluations. For the secondary outcome, Group B showed higher values in two questions.</div></div><div><h3>Conclusion(s)</h3><div>The major finding of our study is that digital learning and formal lecture presented similar results on resident knowledge. Teaching programs involving mannequin simulation − both high and low fidelity − are reproducible and efficient for skill retain in obstetric emergencies, particularly in low incidence emergencies. The main limitation of our study was the small sample size. In addition, it is possible that a scenario without deviation or a lecture more focused on possible deviation from normal could modify residents’ results facing breech delivery.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 345-348"},"PeriodicalIF":2.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multi-cycle approach via DuoStim is beneficial to treat couples indicated to PGT-M plus PGT-A. A propensity score matching-based case series","authors":"Alberto Vaiarelli ,&nbsp;Danilo Cimadomo ,&nbsp;Claudia Blancafort ,&nbsp;Elisabetta Trabucco ,&nbsp;Erminia Alviggi ,&nbsp;Roberta Vallefuoco ,&nbsp;Claudia Livi ,&nbsp;Francesca Benini ,&nbsp;Stefano Canosa ,&nbsp;Joaquín Llácer ,&nbsp;Alessandro Ruffa ,&nbsp;Andrea Borini ,&nbsp;Antonio Capalbo ,&nbsp;Laura Rienzi ,&nbsp;Gianluca Gennarelli ,&nbsp;Filippo Maria Ubaldi","doi":"10.1016/j.ejogrb.2024.11.003","DOIUrl":"10.1016/j.ejogrb.2024.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>To compare DuoStim versus a conventional approach in patients indicated to Preimplantation-Genetic-Testing for both monogenic conditions and aneuploidies (PGT-M + PGT-A).</div></div><div><h3>Study design</h3><div>Retrospective case-control study. In 5 years, 132 couples indicated to PGT-M + PGT-A who obtained ≤5 blastocysts after a first retrieval were suggested to undergo a second stimulation in the same ovarian cycle. Of them, 55 accepted, while 77 preferred the standard approach. Propensity-Score-Matching method was adopted to produce two matched groups of 41 patients per arm. The primary outcome was the cumulative-live-birth-rate (cLBR) per couple within 1 year from the first oocyte retrieval.</div></div><div><h3>Results</h3><div>In the DuoStim arm, 100 % of the patients underwent two ovarian stimulations. In the conventional approach group, 85 % discontinued the treatment after a failed first cycle (N = 28/33, 95 %CI:69.1–93.4 %). After DuoStim, 16 couples had ≥ 1 healthy LB (1-year cLBR: 39 %, 95 %CI:25.7–54.3 %),<!--> <!-->19 % of them delivered 2 healthy babies after singleton pregnancies (N = 3/16, 95 %CI:6.6–43 %) and 68 % have surplus transferable blastocysts (N = 11/16, 95 %CI:44.4–85.8 %). In the control, 9 couples obtained a healthy LB (1-year cLBR: 22 %, 95 %CI:12.0–36.7 %), and only 1 have<!--> <!-->surplus transferable blastocysts. Overall, couples opting for DuoStim obtained 3.9 ± 2.5 blastocysts of which 1.2 ± 1.3 transferable, while couples opting for the conventional approach obtained 2.3 ± 2.1 blastocysts of which 0.8 ± 1.0 transferable.</div></div><div><h3>Conclusions</h3><div>DuoStim may minimize treatment discontinuation and increase the probability to obtain transferable blastocysts in the studied population. Nevertheless, larger prospective studies are required. Also, the suitability of a threshold set at 5 blastocysts should be further validated.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 272-278"},"PeriodicalIF":2.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy and safety between intravenous labetalol and intravenous hydralazine for hypertensive disorders in pregnancy: A systematic review and meta-analysis of 19 randomized controlled trials","authors":"Ocílio Ribeiro Gonçalves ,&nbsp;Lucas Cael Azevedo Ramos Bendaham ,&nbsp;Gabriel Henrique Simoni ,&nbsp;Giovana Schlichta Adriano Kojima ,&nbsp;Hilária Saugo Faria ,&nbsp;Victoria Städler de Abreu ,&nbsp;Arlindo Bispo da Silva Júnior ,&nbsp;Victor Gonçalves Soares ,&nbsp;Bianca Leal Ribeiro ,&nbsp;Benjamim Barbosa de Azevedo ,&nbsp;Keliany Carla Duarte de Araújo Melo ,&nbsp;Cynthia Dantas de Macedo Lins","doi":"10.1016/j.ejogrb.2024.11.002","DOIUrl":"10.1016/j.ejogrb.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypertensive disorders during pregnancy elevate the likelihood of unfavorable outcomes for both mother and fetus. In cases of acute hypertension, several pharmacological interventions are available to lower blood pressure, such as hydralazine, a direct arteriolar vasodilator, and labetalol, a combined alpha and beta-blocker.</div></div><div><h3>Objectives</h3><div>This systematic review and <em>meta</em>-analysis of randomized controlled trials (RCTs) aims to compare the efficacy and safety of intravenous labetalol and intravenous hydralazine for acute hypertensive disorders during pregnancy.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase and Cochrane for studies comparing labetalol versus hydralazine in pregnant patients. The primary outcomes were median arterial blood pressure (MABP), diastolic blood pressure (DBP) and systolic blood pressure (SBP). We performed statistical analyses using R 4.1.1. Heterogeneity was examined with the Cochran Q test and I² statistics. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI), were computed with a random-effects model.</div></div><div><h3>Results</h3><div>Nineteen RCTs were included in this <em>meta</em>-analysis, comprising 2,261 patients. Among them, 1,131 (50 %) received treatment with labetalol. There was no statistically significant difference between groups in terms of SBP (MD −1.74; 95 % CI −6.72 to 3.23; p = 0.49; I² = 93 %), MABP (MD −0.72; 95 % CI −2.34 to 0.90; p = 0.39; I² = 0 %), DBP (MD 0.25; 95 % CI −4.72 to 5.21; p = 0.92; I² = 96 %), tachycardia (RR 0.42; 95 % CI 0.15 to 1.18; p = 0.099; I² = 41 %), and placenta abruption (RR 0.42; 95 % CI 0.15 to 1.16; p = 0.093; I² = 0 %). However, labetalol significantly reduced maternal hypotension (RR 0.26; 95 % CI 0.21 to 0.33; p &lt; 0.001; I² = 41 %) compared with hydralazine.</div></div><div><h3>Conclusion</h3><div>This systematic review and <em>meta</em>-analysis of RCTs found that labetalol and hydralazine were efficient for hypertension disorders in pregnancy. However, labetalol reduced the incidence of maternal hypotension.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"303 ","pages":"Pages 337-344"},"PeriodicalIF":2.1,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}