International Journal of Gynecology & Obstetrics最新文献

{"title":"Leveraging a criteria-based audit approach to identify challenges and develop strategies to improve management of postpartum hemorrhage: A case study from the Dominican Republic.","authors":"Paxton Voigt, Beralis Ramos, Sasha Hernandez, Roberlina Hernandez, Manuel Jimenez, Cayetano Collado, Taraneh Shirazian","doi":"10.1002/ijgo.70038","DOIUrl":"https://doi.org/10.1002/ijgo.70038","url":null,"abstract":"<p><strong>Objective: </strong>Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality worldwide. This case study aims to assess current PPH at our study site hospital, identify strategies to enhance management based on audit findings, and pilot test the feasibility and acceptability of these strategies.</p><p><strong>Methods: </strong>A criteria-based audit (CBA) was conducted at La Maternidad Renee Klang Viuda Guzman Hospital in Santiago, Dominican Republic from November 2021 to September 2022. The audit assessed current practice through surveys of 59 healthcare workers and a retrospective review of 10 PPH cases, using eight evidence-based criteria. Audit findings informed the development of a PPH toolkit, protocol, and simulation-based training program (SBT). The toolkit's impact was evaluated through surveys, and SBT effectiveness was assess through post-training feedback from participants.</p><p><strong>Results: </strong>The baseline audit revealed 25% compliance with evidence-based criteria. Key gaps included maternal risk assessment, provider training, and protocol use. Targeted strategies, including a PPH toolkit, protocol and SBT, were implemented. Of the 13 toolkit users, 92% felt it improved timely management. Post-SBT surveys showed that participants rated the training highly, with significant improvements in communication, teamwork, and self-reported competence in PPH management.</p><p><strong>Conclusion: </strong>CBAs are effective in identifying care barriers in middle-income settings. The PPH toolkit and SBT were well received and improved both technical and non-technical skills, offering a scalable model for improving PPH management in low-resource settings.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response: Weight-based versus fixed-dose oxytocin infusion for preventing uterine atony during cesarean section in laboring patients: A randomized trial.","authors":"Asha Tyagi, Poonam Bodh","doi":"10.1002/ijgo.70084","DOIUrl":"https://doi.org/10.1002/ijgo.70084","url":null,"abstract":"","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gynecological surgery in patients with kidney failure on chronic kidney replacement therapy: A binational data linkage study of morbidity and mortality outcomes.","authors":"Mina Khair, Dharmenaan Palamuthusingam, Carmel M Hawley, Elaine M Pascoe, Usama Shahid, David W Johnson, Magid Fahim","doi":"10.1002/ijgo.70064","DOIUrl":"https://doi.org/10.1002/ijgo.70064","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates postoperative outcomes of patients with kidney failure on chronic kidney replacement therapy after gynecological surgery.</p><p><strong>Methods: </strong>This binational data-linkage study identified patients with kidney failure via the Australia and New Zealand Dialysis and Transplant Registry who underwent major gynecological surgeries between 2000 and 2015. The primary outcome was postoperative mortality. Secondary outcomes included infective, medical, and wound complications, transfusion requirement, intensive care unit (ICU) admissions, readmissions, length of stay, and dialysis/transplant-specific outcomes. Univariable and multivariable logistic and negative binomial regression models were used.</p><p><strong>Results: </strong>Among the 403 patients included, 30.5% underwent abdominal hysterectomy, 19.1% vaginal hysterectomy and 50.4% ovarian surgery. Thirty-day mortality and morbidity rates were 1.2% (95% confidence interval [CI]: 0.5-3.0) and 30.8% (95% CI: 26.3-35.6), respectively. Compared with abdominal hysterectomy, vaginal hysterectomy was associated with fewer transfusions (adjusted odds ratios [aOR]: 0.40, 95% CI: 0.16-0.98), ICU admissions (aOR: 0.28, 95% CI: 0.09-0.80), and shorter stays (IRR: 0.74, 95% CI: 0.55-0.99). Of all kidney replacement therapies, postoperative mortality was highest in patients on peritoneal dialysis (6.9%, 95% CI: 1.2-24.2, P = 0.026). This cohort also required more transfusions (aOR: 2.84, 95% CI: 1.12-7.21) and had longer stays (IRR: 1.58, 95% CI: 1.07-2.33). Kidney transplant recipients had fewer ICU admissions (aOR: 0.22, 95% CI: 0.09-0.52) and shorter stays (IRR: 0.75, 95% CI: 0.58-0.96). Emergency admissions and older age correlated with poorer outcomes.</p><p><strong>Conclusion: </strong>Patients on chronic kidney replacement therapy undergoing gynecological surgery demonstrated low postoperative mortality but substantial morbidity. Further research is needed to evaluate risk-mitigating strategies.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of twin pregnancies: Remaining challenges and unanswered questions.","authors":"Nir Melamed, Jon Barrett, Amir Aviram, Elad Mei-Dan","doi":"10.1002/ijgo.70070","DOIUrl":"https://doi.org/10.1002/ijgo.70070","url":null,"abstract":"<p><p>Several professional societies have published guidelines on twin pregnancies over the past few years. These documents provide recommendations on antenatal surveillance and management of twin pregnancies. At the same time, these guidelines identify several key areas where evidence is limited and additional research is needed. In the present review, we summarize available evidence regarding some of these key areas, including the screening and prevention of preterm birth, the definition and management of fetal growth restriction, the diagnosis and management of gestational diabetes, the optimal maternal gestational weight gain, and the mode and timing of delivery. In addition, we describe several online tools related to these areas that can empower individuals with twin pregnancies and assist care providers in counseling these patients.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of surgical outcomes in transcervical resection of myoma.","authors":"Elizabeth Joan E Ocampo, Macario F Reandelar, Peng-Hui Wang","doi":"10.1002/ijgo.70015","DOIUrl":"https://doi.org/10.1002/ijgo.70015","url":null,"abstract":"<p><strong>Objective: </strong>To verify identified predictors of surgical outcomes in transcervical resection of myoma (TCRM) in Filipino women.</p><p><strong>Methods: </strong>A retrospective analytical cross-sectional study was done on 474 women who underwent TCRM between 2010 and 2020, in St Luke's Medical Center, Philippines. Ethical exemption was granted by the Institutional Ethics Committee. Identified predictors of prolonged operative time (>60 min)-increased blood loss (>70 mL), fluid overload, uterine perforation, and incomplete resection-in published research studies were analyzed.</p><p><strong>Results: </strong>Univariate analysis revealed that European Society for Gynecological Endoscopy (ESGE) type 2, and myoma size ≥5 cm, myoma number ≥3 were associated with prolonged operative time. ESGE type 2 and myoma size ≥5 cm were associated with increased blood loss and incomplete resection. Myoma size ≥5 cm, an intraoperative fluid deficit of 1000 mL (hypotonic) or 2500 mL (isotonic), and prolonged operative time were correlated with fluid overload. ESGE type 2 is associated with uterine perforation. Only a Lasmar score ≥5 was significantly associated with all the aforementioned unfavorable surgical outcomes. Multivariate analysis showed that a Lasmar score ≥5 (odds ratio [OR] 6143.26; 95% confidence interval [CI] 456-82 680; P < 0.001) and myoma size ≥5 cm (OR 21.56; 95% CI 1.67-277; P = 0.019) were independent predictors of adverse surgical outcomes.</p><p><strong>Conclusion: </strong>This study verified that the Lasmar classification can predict TCRM complexity with cut-off values of 5 for both Lasmar score and myoma size. We recommend that the use of the Lasmar scoring classification preoperatively may be beneficial in TCRM in Filipino women.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of web-based calculator to predict cesarean delivery after induction of labor.","authors":"Malini Sukayogula, Maimoona Ahmed, Parthbhai Donga, Ananta Ghimire","doi":"10.1002/ijgo.70069","DOIUrl":"https://doi.org/10.1002/ijgo.70069","url":null,"abstract":"<p><strong>Objective: </strong>To externally validate a prediction model for the risk of a cesarean section after induction of labor (IOL) using a web-based cesarean risk calculator in a tertiary perinatal center and to compare the performance of three calculators in predicting the cesarean risk after IOL based on their sensitivity and specificity.</p><p><strong>Methods: </strong>This was a prospective observational study of 577 women over a period of 1 year at a tertiary perinatal center in India. Women with singleton-term pregnancies with intact membranes that underwent induction were included. We used three prediction tools; Levine's, Rossi's and Irwinda's calculators for predicting cesarean rates. The variables were entered directly into the calculators at the start of IOL, producing an individualized risk of cesarean delivery. The mode of delivery was the primary outcome variable. Area under the ROC curve (AUC), calibration plots and decision making curve analysis were used for comparison.</p><p><strong>Results: </strong>Out of 577 mothers who underwent IOL, 345 (59.79%) women had a vaginal birth and 232 (40.21%) underwent cesarean section. The Levine calculator reached the maximum discriminative capacity (AUC: 0.785) for our population, followed by Rossi (AUC: 0.7723) and Irwinda (AUC: 0.6608). Levine's calculator slightly overestimated the risk of cesarean section at lower thresholds but underestimated the risk at higher threshold probabilities whereas Rossi's calculator underestimated the risk of cesarean section at all threshold probabilities above 11%.</p><p><strong>Conclusion: </strong>The Levine and Rossi calculators have the greatest potential for use in clinical settings. However, these cannot be used individually for clinical decision making without prospective studies evaluating their clinical impact on pregnant women undergoing IOL.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic repair of uterine rupture after delivery: A comprehensive evaluation of the uterine rupture management, with a proposal surgical method.","authors":"Giovanni Pecorella, Martina Licchelli, Gaetano Panese, Andrea Morciano, Radmila Sparic, Ioannis Kosmas, Filippo De Rosa, Antonio Malvasi, Andrea Tinelli","doi":"10.1002/ijgo.70066","DOIUrl":"https://doi.org/10.1002/ijgo.70066","url":null,"abstract":"<p><p>Uterine rupture constitutes a critical obstetric emergency that presents substantial risks to both the maternal and fetal populations. This investigation evaluated the surgical interventions available for uterine rupture, emphasizing laparoscopic repair subsequent to uterine rupture. Laparoscopic repair serves as a fertility-sustaining alternative to conventional laparotomy, demonstrating comparable operative durations of 80 min (interquartile range [IQR] 60-114) for laparoscopic procedures versus 78 min (IQR 58-114) for laparotomy interventions. Nevertheless, laparoscopic approaches confer significant advantages, including a reduced incidence of intensive care unit (ICU) admissions (14.2% vs. 40% for laparotomy), a diminished requirement for blood transfusions (14.2% vs. 60%), and abbreviated hospital stays (median of 3 days vs. 5 days for laparotomy). The investigation explored the contentious discourse surrounding single-layer versus double-layer suturing methodologies, noting that barbed sutures significantly decrease uterine closure times (224 ± 46 vs. 343 ± 75 s for traditional sutures). Single-layer suturing is advocated as sufficient for maintaining uterine integrity in suitably selected cases. The necessity of meticulous postoperative monitoring, particularly concerning the assessment of recurrence in subsequent pregnancies, is emphasized, with recurrence rates varying from 4.8% to 19.4%. Finally, authors also proposed a feasible laparoscopic technique to repair a uterine rupture (the \"CHEESE\" method [closure of hemodynamically stable, early uterine rupture, via endoscopic surgery after spontaneous delivery]), appropriate for hemodynamically stable patients with minor ruptures. This review underscores the progressive role of minimally invasive techniques in the management of uterine rupture and seeks to optimize clinical outcomes for both maternal and neonatal health.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A practical guideline on the fertility-sparing treatment of patients with endometrial carcinoma and atypical endometrial hyperplasia.","authors":"Ursula Catena, Kirsten Louise Tryde Macklon, Alexandros Rodolakis, Giovanni Scambia","doi":"10.1002/ijgo.70059","DOIUrl":"https://doi.org/10.1002/ijgo.70059","url":null,"abstract":"","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes toward conservative management of pelvic organ prolapse and stress urinary incontinence with vaginal pessaries: A national survey among Israeli obstetricians and gynecologists.","authors":"Nadav Cohen, Reut Rotem, Adi Y Weintraub, May Shafir, Yael Barkan, Noga Porat, Ariel Zilberlicht","doi":"10.1002/ijgo.70052","DOIUrl":"https://doi.org/10.1002/ijgo.70052","url":null,"abstract":"<p><strong>Objective: </strong>To explore the views of Israeli gynecologists regarding the use of vaginal pessaries for management of pelvic organ prolapse (POP) and stress urinary incontinence (SUI), which are common medical conditions that affect women and can significantly impact their quality of life.</p><p><strong>Methods: </strong>An electronic survey containing questions assessing knowledge, training, and attitudes regarding the use of vaginal pessaries for POP and SUI was distributed among Israeli gynecologists. Data were collected and recorded anonymously. Descriptive statistics were used to summarize the responses.</p><p><strong>Results: </strong>A total of 700 emails were sent, with a response rate of 53% (371 responses). The majority of respondents (76.4%, n = 283) consulted a urogynecologist before and after fitting a pessary; however, 60.4% (n = 224) felt that any gynecologist should be able to follow up on such cases. When stratified by years of experience, physicians with fewer than 10 years of experience were more likely to offer pessary treatment (31.6%, n = 117 vs. 19.1%, n = 71, P < 0.01). However, those who did not offer pessaries felt more uncertain about fitting them and were more likely to report a lack of experience (24.8%, n = 92 vs. 13.6%, n = 50, P < 0.01, and 18.0%, n = 67 vs. 6.2%, n = 23, P < 0.01, respectively).</p><p><strong>Conclusions: </strong>Our survey highlights a gap in knowledge and training among Israeli gynecologists regarding the conservative management of POP and SUI with vaginal pessaries. There is a clear desire among physicians to acquire these skills. The establishment of formal training programs is crucial to bridging this gap and improving women's health outcomes.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of Doppler studies in predicting non-reassuring fetal heart rate monitoring following induction of labor.","authors":"Eldar Volpert, Daniel Tairy, Liliya Tamayev, Yossi Mizrachi, Jacob Bar, Eran Weiner, Giulia Barda","doi":"10.1002/ijgo.70048","DOIUrl":"https://doi.org/10.1002/ijgo.70048","url":null,"abstract":"<p><strong>Objective: </strong>We studied whether Doppler flow measurements before initiation of induction of labor (IOL) can predict non-reassuring fetal heart rate (NRFHR) monitoring in women at 38-41 weeks of gestation.</p><p><strong>Materials and methods: </strong>We performed a prospective observational study in a single tertiary medical center between November 2017 and December 2019. Women undergoing induction of labor were included. Each woman underwent sonographic studies before initiating IOL. The pregnancy outcome in those who developed NRFHR and those with reassuring FHR during labor were compared and correlated with baseline Doppler flow indices and method of induction.</p><p><strong>Results: </strong>Overall, 219 women were included, of whom 133 underwent IOL with prostaglandin E2 and 86 with a Foley catheter balloon. On multivariate logistic regression analysis, a lower MCA-PI percentile was associated with NRFHR in women that were induced with prostaglandin E2.</p><p><strong>Conclusion: </strong>A lower middle cerebral artery pulsatility index value might represent a lower placental reserve and, therefore, a higher risk of NRFHR monitoring during labor. This finding might assist in selecting the appropriate method of IOL.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}