Gynecologic and Obstetric Investigation最新文献

{"title":"Maternal and Perinatal Outcomes Associated with Intrapartum Antibiotic Regimens in Women with Prolonged Membrane Rupture and Unknown Group B Streptococcus Status: A Retrospective Comparative Study.","authors":"Raneen Abu Shqara, Shany Or, Gabriela Goldinfeld, Lior Lowenstein, Maya Frank Wolf","doi":"10.1159/000546792","DOIUrl":"10.1159/000546792","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to compare maternal, neonatal, and microbiological outcomes among patients with unknown group B Streptococcus (GBS) status and prolonged rupture of membranes (ROM ≥18 h) who received intrapartum prophylaxis with either ampicillin or clindamycin.</p><p><strong>Design: </strong>A retrospective comparative cohort.</p><p><strong>Materials: </strong>A total of 1,507 term singleton pregnancies with ROM ≥18 h and unknown GBS colonization status were included in the study: 1,418 received ampicillin, and 89 received clindamycin due to reported penicillin allergy.</p><p><strong>Setting: </strong>The study was conducted in a tertiary university-affiliated hospital in northern Israel, from March 2020 to May 2024.</p><p><strong>Methods: </strong>Patients were stratified by antibiotic regimen. The co-primary outcomes were clinical chorioamnionitis and neonatal intensive care unit (NICU) admission. Secondary outcomes included maternal complications (intrapartum fever, endometritis, cesarean delivery) and neonatal morbidities (Apgar <7, cord pH <7.1, respiratory distress, and ventilation support). Post-delivery chorioamniotic membrane swabs were cultured. Multivariate logistic regression was used to identify independent predictors of outcomes.</p><p><strong>Results: </strong>Compared to ampicillin, clindamycin treatment was associated with higher rates of clinical chorioamnionitis (14.6% vs. 2.3%, p < 0.001), intrapartum fever (28.1% vs. 4.1%, p < 0.001), maternal sepsis (2.2% vs. 0.3%, p = 0.011), puerperal endometritis (13.5% vs. 2.6%, p < 0.001), cesarean delivery (36.0% vs. 18.1%, p < 0.001), and postpartum antibiotic use (14.6% vs. 5.4%, p < 0.001). Among neonates of patients treated with clindamycin compared to ampicillin, the rates were higher for NICU admission (19.1% vs. 4.4%, p < 0.001), Apgar <7 at 5 min (4.5% vs. 0.8%, p = 0.001), cord pH <7.1 (7.9% vs. 2.0%, p < 0.001), respiratory distress (13.5% vs. 5.4%, p < 0.001), and ventilation support (invasive 2.2% vs. 0.2%, p = 0.019; non-invasive 7.9% vs. 1.1%, p < 0.001). Hypoxic brain injury occurred more frequently in the clindamycin group (2.2% vs. 0.1%, p = 0.016). GBS was isolated more often in chorioamniotic cultures of patients treated with clindamycin (19.1% vs. 1.1%, p < 0.001). In multivariable analysis, clindamycin treatment (adjusted odds ratio [aOR] 7.7, 95% CI: 3.8-15.5, p < 0.001) and artificial ROM (aOR 2.6, 95% CI: 1.1-6.3, p = 0.031) were independently associated with clinical chorioamnionitis. Clindamycin treatment was also independently associated with NICU admission (aOR 3.71, 95% CI: 1.9-7.1, p < 0.001). Other factors associated with NICU admission were the presence of meconium-stained amniotic fluid (aOR 3.28, 95% CI: 1.7-6.2, p < 0.001), clinical chorioamnionitis (aOR 3.11, 95% CI: 1.3-7.2, p = 0.009), and umbilical cord pH <7.1 (aOR 4.76, 95% CI: 1.9-11.4, p < 0.001).</p><p><strong>Limitations: </strong>Limitations include ","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274720","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":"Correlation between Plane Assessment of Prolapse Degree and Pelvic Organ Prolapse Quantification Scores after Three-Dimensional Reconstruction of Female Pelvic Organ Prolapse.","authors":"Lifan Shen, Huijun Bai, Xueyu Sun, Ping Liu, Chunlin Chen","doi":"10.1159/000546464","DOIUrl":"10.1159/000546464","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to combine dynamic magnetic resonance imaging (MRI) with three-dimensional (3D) reconstruction and form a plane based on osseous structures to evaluate the degree of pelvic organ prolapse (POP). The correlation of this novel evaluation approach with the POP-Q system was assessed.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 71 POP patients with POP-Q stage ≥II. The dynamic MRI images of those patients were reconstructed in three dimensions. A plane was created by using the midpoint of the line between the inferior margins of the two pubic bones and the starting points of the superior margins of the bilateral sacrotuberous ligaments (the pubic inferior midpoint - sacrotuberous ligament starting point superior edge plane). Distances from the lowest point of the anterior vaginal wall, cervix, and rectal ampulla to this evaluation plane were measured, modeled, and categorized. The consistency and correlation of the categorized results with POP-Q scores were verified by performing a kappa analysis and Spearman's rank correlation analysis, respectively.</p><p><strong>Results: </strong>The highest consistency with POP-Q scores was found in the prolapse of the central pelvic cavity (kappa = 0.713, p < 0.05), followed by the anterior POP (kappa = 0.427, p < 0.05), and posterior POP (kappa = 0.261, p < 0.05), with all showing statistically significant differences. The strongest positive correlation was observed between central POP and POP-Q scores (r = 0.864, p < 0.01), followed by posterior POP and POP-Q scores (r = 0.710, p < 0.01), with both exhibiting a strong positive correlation. Anterior POP and POP-Q scores showed a moderate positive correlation (r = 0.586, p < 0.01).</p><p><strong>Conclusions: </strong>The results of the proposed evaluation method were highly consistent in the anterior and central pelvic cavities and strongly correlated in the central and posterior pelvic cavities. In particular, the assessment of the posterior cavity showed a strong positive correlation with that of the POP-Q system. The evaluation plane demonstrated high consistency and correlation with the POP-Q system.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173527","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":"Impact of Localization of Diffuse Adenomyosis on Frozen Embryo Transfer Outcomes and Perinatal Outcomes: A Prospective Cohort Study of 585 Patients.","authors":"Sunita Sharma, Sourav RoyChoudhury, Meenakshi Karan, Kishan Shaw, Pranab Paladhi, Prithwis Palchaudhuri, Dibyendu Datta, Ratna Chattopadhyay, Arup Kumar Majhi","doi":"10.1159/000546437","DOIUrl":"10.1159/000546437","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to investigate the impact of localization of diffuse adenomyosis on reproductive outcomes after frozen embryo transfer (FET).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This prospective cohort study was conducted between January 2019 and December 2022. A total of 585 infertile women undergoing the first FET cycle were recruited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants/materials, setting, methods: &lt;/strong&gt;The study population included 368 women with diffuse adenomyosis where 167 women had diffuse adenomyosis of outer myometrium (OM) (group A) and 201 women had diffuse adenomyosis of the junctional zone (JZ) (group B). 217 women with male infertility were taken as controls. Adenomyosis was diagnosed on transvaginal ultrasound using MUSA criteria where diffuse adenomyosis patients with two or more features were included. These patients were further divided based on the localization of adenomyotic lesions in OM or JZ. All the patients underwent FET cycle. Pregnancy outcomes and complications were compared between different groups. Additionally, adenomyosis patients as a whole were compared with the control group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Women with diffuse adenomyosis have similar (p &gt; 0.05) pregnancy rates (36.14% vs. 35.94%), biochemical pregnancy rates (11.27% vs. 3.84%), and clinical pregnancy rates (32.06% vs. 35.02%) but higher miscarriage rates (22.03% vs. 9.21%; OR: 2.79, 95% CI: 1.14-6.79, p = 0.024) and a lower live birth rates (20.65% vs. 29.95%; OR: 0.61, 95% CI: 0.41-0.89, p = 0.011) than women without adenomyosis. However, women with diffuse adenomyotic lesions affecting the JZ (group B) exhibited significantly lower positive pregnancy (26.37% vs. 47.9%; OR: 0.39, 95% CI: 0.25-0.60, p &lt; 0.0001), clinical pregnancy (23.38% vs. 42.51%; OR: 0.41, 95% CI: 0.26-0.65, p = 0.0001), and live birth (16.42% vs. 25.75%; OR: 0.57, 95% CI: 0.34-0.94, p = 0.029) compared to those with adenomyosis of the OM (group A) but comparable (p &gt; 0.05) biochemical pregnancy (11.32% vs. 11.25%) and miscarriage (23.4% vs. 21.13%). Pregnancy complications were comparable between the adenomyosis groups; however, there was a significantly higher incidence of pregnancy complications, particularly gestational hypertension (OR: 6.41, 95% CI: 1.79-22.92, p = 0.0042), IUGR (OR: 9.08, 95% CI: 2.01-40.99, p = 0.0041), and preterm labor (OR: 9.41, 95% CI: 3.09-28.62, p = 0.0001) in adenomyosis patients compared to the controls.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;It is an observational prospective study, and the study included patients with endometriosis as a comorbidity. The population size is limited to ascertain the effect of diffuse adenomyosis on pregnancy complications, particularly between subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study emphasizes the importance of evaluation and localization of adenomyotic lesions before initiating ART, which can aid in effective counseling and personalized treatment strategies ","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173628","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":"Analysis of Lymph Node Metastasis and Risk Factors in 424 Patients with Low-Grade Endometrioid Endometrial Carcinomas.","authors":"Lina Cao, Xiaoyuan Lu, Yijun Wang, Luyao Wang","doi":"10.1159/000546522","DOIUrl":"10.1159/000546522","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to explore the lymph node metastasis (LNM) and related risk factors of low-grade endometrioid endometrial carcinomas (EECs) and analyse the efficacy of related risk factors in predicting LNM.</p><p><strong>Design: </strong>Data from 424 patients with low-grade EEC treated between January 2019 and June 2024 were retrospectively analysed, according to the International Federation of Gynecology and Obstetrics (FIGO) 2009.</p><p><strong>Methods: </strong>Univariate and multivariate logistic regression analyses were used to examine the factors associated with LNM. Receiver operating characteristic (ROC) curves were plotted to assess the predictive efficacy of independent risk factors for LNM.</p><p><strong>Results: </strong>The rate of LNM was 7.8% (33/424). Histological grade, tumour size, depth of myometrial invasion, cervical stromal invasion, lymphovascular space invasion (LVSI), microcystic, elongated, fragmented (MELF) pattern, carbohydrate antigen 125 (CA125), carbohydrate antigen 199, and human epididymis protein 4 were associated with LNM. However, only LVSI, MELF pattern, depth of myometrial invasion, and CA125 were identified as independent risk factors. The area under the ROC curve for CA125 and depth of myometrial invasion was 0.796 and 0.734, respectively. The optimal cut-off value for CA125 was 31.36 U/mL, with a maximum Youden index of 53.9%. Combining CA125 with depth of myometrial invasion improved diagnostic accuracy compared to either parameter alone.</p><p><strong>Limitations: </strong>This is a single-center retrospective study.</p><p><strong>Conclusions: </strong>LNM is more likely with independent risk factors. Combining CA125 and depth of myometrial invasion enhances diagnostic accuracy for LNM. This study provides valuable insights for predicting LNM risk in low-grade EEC patients and guiding stratified management.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173573","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":"Mendelian Randomization Analyses Reveal Causal Relationships between Brain Structural Connectivity and Risk of Polycystic Ovary Syndrome.","authors":"Huimin Niu, Lian Xia, Xinyi Zhang, Chuning Lin, Yao Ge, Yuan Chen, Feng Sun, Feng Jiang, Chuyan Wu","doi":"10.1159/000546487","DOIUrl":"10.1159/000546487","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the relationship between brain structural connectivity and polycystic ovary syndrome (PCOS).</p><p><strong>Design: </strong>Two-sample Mendelian randomization (2SMR) was conducted by querying a relevant European population genome-wide association studies (GWAS) database about the anatomical connections of the brain and polycystic ovarian syndrome from the Ieu Open GWAS Project database. Two hundred six brain structural connectivity-related single-nucleotide polymorphisms (SNPs) were evaluated as instrumental variables (IVs).</p><p><strong>Methods: </strong>To investigate the potential causal effect between brain structure and PCOS, we applied several statistical models, including inverse variance weighting (IVW), weighted median (WME), MR-Egger regression, simple mode, and weighted mode approaches.</p><p><strong>Results: </strong>IVW analysis indicated significant associations between certain white matter tracts and PCOS risk, including the connection between the right default mode network and the amygdala (OR = 1.559; 95% CI = 1.028-2.36; p = 0.037), as well as the pathway linking the right somatomotor and limbic networks (OR = 1.800; 95% CI = 1.077-3.009; p = 0.025). Additionally, negative correlations with PCOS risk were observed in white matter tracts involving limbic-control and limbic-thalamic connections across both hemispheres, as well as in the left somatomotor-control circuit. Horizontal pleiotropy was not detected by heterogeneity tests or sensitivity analyses that used the leave-one-out approach.</p><p><strong>Limitations: </strong>More research involving bigger and more heterogeneous cohorts is necessary to evaluate the functional consequences of anatomical brain changes in PCOS.</p><p><strong>Conclusion: </strong>The structural integrity of white matter tracts linking the right default mode network to the amygdala and connecting the right somatomotor and limbic networks appears to be causally associated with the development of PCOS.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-15"},"PeriodicalIF":2.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127498","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":"Endometrial Metabolism of 17β-Estradiol during the Window of Implantation in Women with Recurrent Implantation Failure.","authors":"Linda B P M Stevens Brentjens, Bert Delvoux, Janneke E den Hartog, Darina Obukhova, Sofia Xanthoulea, Andrea Romano, Ron J T van Golde","doi":"10.1159/000546442","DOIUrl":"10.1159/000546442","url":null,"abstract":"<p><strong>Objectives: </strong>Alterations in 17β-estradiol metabolism are known to potentially impair endometrial receptivity. Previous pioneering studies have investigated the role of endometrial steroid metabolism by determining steroid hormone levels and steroid-metabolizing enzyme activity in endometrial biopsies of patients undergoing IVF. The activity of oxidative and reductive 17β-hydroxysteroid dehydrogenases (17β-HSDs), which catalyze the interconversion between estrone and 17β-estradiol, was found to be similar between IVF patients who - after fresh embryo transfer in the cycle following endometrial biopsy - did and did not become pregnant. However, inhibition of the reductive enzyme 17β-hydroxysteroid dehydrogenase type 1 (17β-HSD1), the most prominent 17β-HSD type in 17β-estradiol formation, was found to differ between groups. The primary objective of this study was to determine oxidative and reductive 17β-HSD enzyme activity in the endometrium of two well-defined groups: IVF patients with recurrent implantation failure (RIF) and control patients.</p><p><strong>Design: </strong>This is a prospective observational study of IVF patients with RIF (n = 52) and controls (n = 25). Patients undergoing treatment because of pre-implantation genetic testing, a severe male factor, or bilateral tubal pathology were recruited as controls since these conditions did not suggest an endometrial contribution to infertility.</p><p><strong>Participants/materials, setting, methods: </strong>Endometrial biopsies were obtained 5-8 days after a positive urine ovulation test in a natural cycle using a Pipelle catheter. Activity of oxidative and reductive enzymes, inhibition of 17β-HSD1, 5, 7, and 12, and immunostaining of 17β-HSD7 were performed. The formation of 17β-estradiol by reduction of estrone (reductive enzymes), formation of estrone by oxidation of 17β-estradiol (oxidative enzymes), and inhibition of specific 17β-HSD enzymes were determined using high-performance liquid chromatography. Formalin-fixed paraffin-embedded tissue was used for immunostaining. The Student's t test and Mann-Whitney U test were used for statistical analysis. Multivariate analysis was used to determine the influence of confounders.</p><p><strong>Results: </strong>No differences were found in activity of oxidative and reductive 17β-HSD enzymes in RIF patients and controls. Combined inhibition of 17β-HSD5, 7, and 12 was significantly lower in the RIF group compared to controls (p = 0.04). Inhibition of 17β-HSD1 and 17β-HSD7 combined was also significantly lower (more production of 17β-estradiol remained) in the RIF group compared to controls (p < 0.01). However, solely inhibiting 17β-HSD1 or 17β-HSD7 showed no significant difference between groups. Immunostaining revealed the expression of 17β-HSD7 in all endometrial samples.</p><p><strong>Limitations: </strong>Results should be interpreted carefully due to possible cycle-to-cycle variation, challenges to translate in vitro fi","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-12"},"PeriodicalIF":2.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077603","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":"Continued versus Discontinued Oxytocin in the Active Phase of Induced Labor in Term Pregnancies: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Uzair Jafar, Umer Hassan, Fatima Usama, Huzefa Habib, Syed Aftab Haider Kamran, Muhammad Usman Khan, Mehnahil Raza, Muhammad Ubaidullah Arshad, Muhammad Moiz Javed, Andrea Etrusco, Mislav Mikuš, Antonio Simone Laganà","doi":"10.1159/000546438","DOIUrl":"10.1159/000546438","url":null,"abstract":"<p><strong>Introduction: </strong>Oxytocin has long been used for the induction of labor, but it can be associated with fetal and maternal complications that could potentially be reduced by discontinuing the treatment during labor. We performed this meta-analysis to determine whether discontinuation of oxytocin, once the active phase of induced labor is achieved, affects the second stage of labor and the rate of various maternal and fetal outcomes.</p><p><strong>Methods: </strong>We searched for randomized controlled trials (RCTs) comparing discontinuing oxytocin after the active stage of labor is established versus continuing to give oxytocin throughout the labor process using databases like PubMed, Embase, the Cochrane Library, and <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link> from the inception till February 1, 2025. Results were pooled using RevMan 5.4, and the effect metric was the risk ratio (RR). Our systematic review and meta-analysis was registered with PROSPERO (CRD42024534076).</p><p><strong>Results: </strong>Pooled analysis of fifteen RCTs included in our review showed that discontinuation of oxytocin, once the active stage of labor is established, did not reduce the primary outcome of incidence of cesarean delivery (RR = 0.91; 95% CI, 0.77-1.07; p = 0.21). The incidence of uterine tachysystole, postpartum hemorrhage, and non-reassuring fetal heart rate was significantly lower in the oxytocin discontinuation group compared to oxytocin continuation. The rates of uterine rupture, vaginal instrument use, epidural use, and neonatal intensive care unit admission did not differ among both groups. The duration of the active stage of labor was significantly prolonged in the oxytocin-discontinued group; however, the duration of the second stage of labor and total delivery time remained comparable between the two groups.</p><p><strong>Conclusions: </strong>Discontinuation of oxytocin during the active phase of labor did not reduce the incidence of cesarean section or neonatal morbidity. We therefore recommend an individualized approach regarding oxytocin discontinuation while factoring in patient-specific factors. New large-scale RCTs focusing on identifying subgroups that might benefit from one approach over the other are required to provide more reliable results.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077595","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":"Shore-Up, a Novel Technique with Tensor Threads in Women with Stress Urinary Incontinence: A Pilot Study.","authors":"Cristina Pages-Garcia, Begona Pellicer-Iborra, Maria Coret-Cebamanos, Laura Fuentes-Aparicio","doi":"10.1159/000546004","DOIUrl":"10.1159/000546004","url":null,"abstract":"<p><strong>Background: </strong>Stress urinary incontinence (SUI) commonly affects women's quality of life. The widespread recommendation of using non-absorbable meshes has delayed a more definitive surgical solution. Newer, less invasive biomaterial treatments show promise.</p><p><strong>Objective: </strong>Our aim was to describe and evaluate a new urethral suspension technique called \"shore-up,\" performed with APTOS® resorbable tensor threads on an outpatient procedure.</p><p><strong>Design: </strong>A pilot study was conducted.</p><p><strong>Participants: </strong>32 SUI women, unresponsive to conservative treatment, participated in the study.</p><p><strong>Settings: </strong>The study was conducted at the HM IMI Clinic, Toledo, Spain.</p><p><strong>Method: </strong>Patients completed validated incontinence questionnaires (Sandvik and ISCQ SF) before and at 1, 2, 6, and 12 months post-procedure. A blinded analysis of results was conducted.</p><p><strong>Results: </strong>Women with SUI of different degrees: mild (3/32), moderate (19/32), severe (8/32), and very severe (2/32) showed a significant improvement (p < 0.05) in scores on both tests. After 12 months, a success rate of 72% (23/32) without SUI was observed, 16% with mild (5/32) and 12% with moderate SUI (4/32). None of them required hospitalization or post-surgical assistance, and the most frequent complications were extrusion of the final thread end through the vagina in 33% (9/32), transient dyspareunia in 6% (4/31), and early suture dehiscence in 6% (2/32).</p><p><strong>Conclusion: </strong>The shore-up technique is a promising, minimally invasive option for managing SUI, offering high efficacy, safety, and patient satisfaction.</p><p><strong>Limitations: </strong>This is a small study, and further research is recommended to confirm these findings (ethic code 23.02.2155-GHM).</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077639","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":"Cabergoline's Promise in Endometriosis: Restoring Molecular Balance to Improve Reproductive Potential.","authors":"Niloofar Shahgholi, Zahra Noormohammadi, Ashraf Moini, Morteza Karimipoor","doi":"10.1159/000546198","DOIUrl":"10.1159/000546198","url":null,"abstract":"<p><strong>Objectives: </strong>Endometriosis is a chronic gynecological condition characterized by abnormal angiogenesis and cell adhesion processes driven by VEGF-VEGFR-2 signaling. cabergoline, a dopamine agonist, has been shown to inhibit angiogenesis in endometriosis. This study investigates the therapeutic potential of cabergoline in modulating these pathways to mitigate endometriotic lesion progression and improve oocyte quality.</p><p><strong>Design: </strong>A randomized, placebo-controlled study was conducted, involving two groups of participants: one receiving cabergoline treatment and the other receiving a placebo.</p><p><strong>Methods: </strong>Eutopic endometrial tissue from women diagnosed with endometriosis was analyzed. VEGFR-2, FAK, PXN, ITGB3, and ITGAV expression levels were measured using qPCR. DNA methylation at the VEGFR-2 promoter was assessed using high-resolution melting analysis to examine epigenetic modifications. Western blot analysis was performed to evaluate the phosphorylation status of tyrosine residue 951 on the VEGFR-2 receptor, which is implicated in cell migration and survival. Oocyte quality was also assessed in both groups.</p><p><strong>Results: </strong>Cabergoline treatment reduced the expression levels of VEGFR-2, FAK, PXN, ITGB3, and ITGAV, with ITGAV showing a statistically significant decrease (p = 0.0174). Hypomethylation of the VEGFR-2 promoter was observed in the treatment group (p = 0.3566). However, phosphorylation of tyrosine residue 951 on VEGFR-2 significantly increased in the cabergoline-treated group (p = 0.004). Notably, oocyte quality significantly improved in the cabergoline group (p = 0.0318). A strong correlation was found between reduced VEGFR-2 expression (p = 0.0184), decreased promoter methylation (p = 0.0159), and downregulation of PTK2 expression (p = 0.0057), all of which are associated with improved oocyte quality.</p><p><strong>Limitations: </strong>The sample size was limited, and additional long-term studies are needed to confirm the therapeutic potential of cabergoline in endometriosis treatment.</p><p><strong>Conclusions: </strong>Cabergoline may enhance oocyte quality by modulating key regulators of the angiogenic pathway. These findings suggest its potential role in the management of endometriosis-related infertility, warranting further clinical investigation.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-16"},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997490","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":"Artificial Intelligence Applied to Ultrasound Diagnosis of Pelvic Gynecological Tumors: A Systematic Review and Meta-Analysis.","authors":"Axel Geysels, Giulia Garofalo, Stefan Timmerman, Lasai Barreñada, Bart De Moor, Dirk Timmerman, Wouter Froyman, Ben Van Calster","doi":"10.1159/000545850","DOIUrl":"10.1159/000545850","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study wasto perform a systematic review on artificial intelligence (AI) studies focused on identifying and differentiating pelvic gynecological tumors on ultrasound scans.</p><p><strong>Methods: </strong>Studies developing or validating AI models for diagnosing gynecological pelvic tumors on ultrasound scans were eligible for inclusion. We systematically searched PubMed, Embase, Web of Science, and Cochrane Central from their database inception until April 30, 2024. To assess the quality of the included studies, we adapted the QUADAS-2 risk of bias tool to address the unique challenges of AI in medical imaging. Using multilevel random-effects models, we performed a meta-analysis to generate summary estimates of the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. To provide a reference point of current diagnostic support tools for ultrasound examiners, we descriptively compared the pooled performance to that of the well-recognized ADNEX model on external validation. Subgroup analyses were performed to explore sources of heterogeneity.</p><p><strong>Results: </strong>From 9,151 records retrieved, 44 studies were eligible: 40 on ovarian, 3 on endometrial, and 1 on myometrial pathology. Overall, 95% were at high risk of bias - primarily due to inappropriate study inclusion criteria, the absence of a patient-level split of training and testing image sets, and no calibration assessment. For ovarian tumors, the summary AUC for AI models distinguishing benign from malignant tumors was 0.89 (95% CI: 0.85-0.92). In lower risk studies (at least three low-risk domains), the summary AUC dropped to 0.87 (95% CI: 0.83-0.90), with deep learning models outperforming radiomics-based machine learning approaches in this subset. Only five studies included an external validation, and six evaluated calibration performance. In a recent systematic review of external validation studies, the ADNEX model had a pooled AUC of 0.93 (95% CI: 0.91-0.94) in studies at low risk of bias. Studies on endometrial and myometrial pathologies were reported individually.</p><p><strong>Conclusion: </strong>Although AI models show promising discriminative performances for diagnosing gynecological tumors on ultrasound, most studies have methodological shortcomings that result in a high risk of bias. In addition, the ADNEX model appears to outperform most AI approaches for ovarian tumors. Future research should emphasize robust study designs - ideally large, multicenter, and prospective cohorts that mirror real-world populations - along with external validation, proper calibration, and standardized reporting.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-22"},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019796","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}