International Journal of Gynecology & Obstetrics最新文献

{"title":"Postpartum uterine necrosis with spontaneous endometrial prolapse after B-Lynch suture: A case report.","authors":"Li Shen, Yun Cao, Ning Gu, Ling Chen, Qian Meng, Yimin Dai","doi":"10.1002/ijgo.70105","DOIUrl":"https://doi.org/10.1002/ijgo.70105","url":null,"abstract":"<p><p>Postpartum uterine necrosis is a rare and serious complication. The uterine tissue becomes devascularized and then causes endometrial necrosis and even myometrial necrosis, usually combing with uterine infection. To clear the infection, hysterectomy was performed in the majority of uterine necrosis cases. We reported a case of a 26-year-old patient underwent a cesarean section after failure induction of labor with the full dilatation of cervix. The B-Lynch compression suture was performed to avoid persistent haemorrhage. The patient presented with recurrent fever, abdominal pain and vaginal discharge. The computed tomography scan revealed uterine empyema and uterine perforation of the anterior wall. The broad spectrum antibiotics were given to treat with infection. An irregularly shaped prolapse from the vagina was noted on the fifty-fourth day postpartum. Transvaginal debridement was performed and necrotizing tissues weighted about 100 g was removed. The pathological findings revealed degeneration and necrosis of the uterine muscle and fibrinoid exudation. Postpartum uterine necrosis is a rare condition that can lead to life-threatening complications and the most treatment option is the surgery of hysterectomy. As cases of partial uterine necrosis with symptom of endometrial prolapse, treated with direct appropriate antibiotic therapy, removing the necrotizing tissue that reserved the uterine may be a selective option.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700428","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":"Association of HPV16/18 genotype infection with the Silva pattern classification system in human papilloma virus-associated endocervical adenocarcinomas.","authors":"Changning Zhang, Hang Zhou, Yanna Liu, Yu Dai, Zhi Cao, Yakun Wang, Xinyue Li, Jian Yin, Li Zhong, Xun Zhang, Li Sun, Wen Chen","doi":"10.1002/ijgo.70081","DOIUrl":"https://doi.org/10.1002/ijgo.70081","url":null,"abstract":"<p><strong>Objective: </strong>Persistent high-risk human papillomavirus (HR-HPV) infection is an essential risk factor for HPV-associated adenocarcinomas (HPVA). A three-tier pattern system (the Silva pattern) for endocervical adenocarcinoma (ECA) associated with tumor metastasis and recurrence was described by Elvio G. Silva nearly 10 years ago. However, there are no studies on the association between HPV genotypes and Silva patterns.</p><p><strong>Methods: </strong>The Silva pattern classification was performed on 240 surgical HPVA specimens according to the 2020 World Health Organization classification of female genital tract cancers. HPV DNA was detected using the SPF₁₀-DEIA-LiPA₂₅ assay for all specimens and an attribution algorithm was used to calculate the attribution rate of HPV16/18.</p><p><strong>Results: </strong>Out of all HPVA cases, 29 patients (12.1%) were found to have tumors with Silva pattern A, 122 (50.8%) had pattern B tumors, and 89 (37.1%) had pattern C (representing the worst morphological behavior, poorest prognosis and highest risk of mortality). The crude prevalence of HPV16 and 18 was 46.9% and 44.7%, respectively. The attribution of HPV16 in Silva patterns A, B, and C was 58.0%, 51.7%, and 33.8%, respectively (P = 0.123). Similarly, the attribution of HPV18 was found to be 29.8%, 39.7%, and 49.5% in patterns A, B, and C, respectively. Notably, there was a statistically significant positive linear relationship between the prevalence of HPV18 and the Silva pattern from A to C (P = 0.002).</p><p><strong>Conclusion: </strong>HPV16 and 18 are the most prevalent HPV subtypes in patients with HPVA. HPVA patients who are infected with HPV18 exhibit worse morphological behavior compared to those with the HPV16 genotype.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700421","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":"Letter to the Editor: Considerations beyond adenomyosis as a cause of surgical failure in treating dyspareunia in rectovaginal septum endometriosis.","authors":"Juan Diego Villegas-Echeverri, Jorge F Carrillo","doi":"10.1002/ijgo.70102","DOIUrl":"https://doi.org/10.1002/ijgo.70102","url":null,"abstract":"","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691974","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":"Off-label use of drugs in pregnancy: A critical review of guidelines, current practices, and a clinical perspective.","authors":"Vitalba Gallitelli, Rita Franco, Sofia Guidi, Simona Zaami, Marco Parasiliti, Annalisa Vidiri, Federica Perelli, Francesco Plotti, Georgios Eleftheriou, Alberto Mattei, Giovanni Scambia, Anna Franca Cavaliere","doi":"10.1002/ijgo.70076","DOIUrl":"https://doi.org/10.1002/ijgo.70076","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this narrative review was twofold: to delineate the usage patterns of the main off-label drugs during pregnancy (i.e., misoprostol, nifedipine, and corticosteroids) and to offer a medical examiner's perspective on the use of these medications.</p><p><strong>Methods: </strong>An extensive review of the literature was performed to assess the off-label use of corticosteroids, nifedipine, and misoprostol in pregnancy.</p><p><strong>Results: </strong>Overall, 503 records about the use of off-label medicines during pregnancy were identified. After the exclusion of papers published in languages other than English and experimental studies in animals, 340 studies were considered eligible. Studies with medicines other than corticosteroids, misoprostol, and nifedipine were removed, leaving a total of 240 articles. From the remaining records, 24 reports were not retrieved. The research strategy allowed the final identification of 76 references.</p><p><strong>Conclusion: </strong>Off-label drug use in obstetrics has transitioned from being an exception to a routine, scientifically validated practice. While its application is justified by clinical outcomes and international protocols, healthcare providers must navigate a strict framework of ethical and legal responsibility.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676887","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 association between additional radiotherapy after systemic chemotherapy and the prognosis of stage FIGO 2018 IVB cervical cancer.","authors":"Ai Miyoshi, Fumiaki Isohashi, Makoto Fujii, Tadashi Iwamiya, Masahiko Takemura, Yoshikazu Nagase, Takeshi Yokoi, Emi Yoshioka, Kimihiko Ito, Eri Yamabe, Kanji Masuhara, Tomoko Tsujie, Tadashi Kimura, Michiko Kodama","doi":"10.1002/ijgo.70077","DOIUrl":"https://doi.org/10.1002/ijgo.70077","url":null,"abstract":"<p><strong>Objective: </strong>Systemic platinum-based chemotherapy is the first-line treatment of choice for metastatic cervical cancer. While subsequent radiotherapy after primary chemotherapy is a potential option, its benefit remains unclear. This multicenter retrospective study aimed to evaluate whether post-chemotherapy radiotherapy improves the prognosis of metastatic cervical cancer.</p><p><strong>Methods: </strong>We retrospectively analyzed 46 eligible patients, including 22 patients receiving chemotherapy-alone and 24 patients receiving chemotherapy followed by subsequent radiotherapy. Medical records were retrospectively reviewed for patient characteristics, subsequent treatment modality, adverse events during the treatment course, metastasis site, recurrence or progression, and recurrence sites. Fisher exact test or chi-squared test, the Mann-Whitney U test, log-rank test, and Cox proportional hazards model were used.</p><p><strong>Results: </strong>The 2-year overall survival (OS) rate for all patients was 47%, with the median OS of 24.8 months. Patients receiving chemotherapy alone (chemotherapy-alone group) had a 2-year OS rate of 23%, while those receiving subsequent radiotherapy (chemotherapy-radiotherapy group) had a significantly higher OS rate of 67% (HR = 2.83, P = 0.006). The 2-year progression-free survival (PFS) rates were 9% and 33%, respectively (HR = 3.25, P = 0.010). Serious adverse events occurred in 46.2% of the chemotherapy-alone group and 29.2% of the chemotherapy-radiotherapy group during subsequent treatment (P = 0.249).</p><p><strong>Conclusion: </strong>Post-chemotherapy radiotherapy may improve the prognosis of metastatic cervical cancer without increasing serious adverse events. Further prospective studies are warranted to validate these findings.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676855","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":"CO₂ laser therapy versus topical imiquimod for the treatment of vulvar high-grade intraepithelial lesions: A retrospective cohort study.","authors":"Elizabeth Svoboda, Mélanie Benoit, Chelsea Almadin, Valérie Archer-Déjoie, Coralie Michaud, Julie Lacaille, Laurence Simard-Émond, Annick Pina, François Gougeon, Marie-Hélène Mayrand","doi":"10.1002/ijgo.70083","DOIUrl":"https://doi.org/10.1002/ijgo.70083","url":null,"abstract":"<p><strong>Objectives: </strong>To compare topical imiquimod with CO₂ laser therapy for the treatment of a first episode of vulvar high-grade squamous intraepithelial lesions (vHSIL), to identify serious adverse effects of both treatment modalities, and to examine risk factors for treatment failure.</p><p><strong>Methods: </strong>This retrospective chart-based cohort study included 47 patients initially treated with topical imiquimod or CO₂ laser therapy between 2017 and 2021. The primary outcome was treatment failure, defined as the need for repeat treatment. Cumulative incidence curves were used to compare the probability of treatment failure over time by treatment group. Potential risk factors for treatment failure, including age, treatment type, lesion focality, and smoking, were examined using Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs).</p><p><strong>Results: </strong>Sixty-six percent (31/47) of patients were initially treated with topical imiquimod and 34% (16/47) with CO₂ laser. Both groups were similar in age, lesion focality, human papillomavirus vaccination, and smoking status. During a follow-up of 62.3 person-years, 52% (16/31) of patients treated with imiquimod and 56% (9/16) of patients treated with CO₂ laser experienced treatment failure. Age over 52 years was associated with a higher risk of treatment failure (aHR 3.07, 95% CI 1.25-7.53). The association was positive but not significant for multifocal versus unifocal lesions and for smokers versus non-smokers. No serious adverse effects were observed with either treatment modality.</p><p><strong>Conclusion: </strong>Topical imiquimod has similar efficacy and safety to CO₂ laser therapy for initial the treatment of vHSIL. Older age is associated with an increased risk of treatment failure.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673774","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":"Obstetric and neonatal outcomes in clinically diagnosed placental abruption with and without placental histopathologic confirmation-A retrospective study.","authors":"Noa Gonen, Liat Mor, Daniel Rabinovich, Ilia Kleiner, Letizia Schreiber, Giulia Barda, Eran Weiner, Elad Barber","doi":"10.1002/ijgo.70079","DOIUrl":"https://doi.org/10.1002/ijgo.70079","url":null,"abstract":"<p><strong>Objective: </strong>Placental abruption is a major obstetrical complication bearing potentially life-threatening consequences. Though the diagnosis of placental abruption is a clinical one, the nonspecific nature of common presenting symptoms, mainly vaginal bleeding and contractions, pose a challenge, and the contribution of placental pathology has been debated. In this study, we assessed the clinical significance of related placental lesions by comparing obstetric and neonatal outcomes among cases of placental abruption with versus without supporting histopathologic placental lesions.</p><p><strong>Methods: </strong>We retrospectively analyzed placental abruption cases diagnosed during an 8-year period at a single tertiary center. Maternal, neonatal, and placental outcomes were compared between cases of placental abruption with versus without histopathologic placental lesions. The primary outcome was a composite of severe neonatal morbidity and included 1 ≤ of the following: seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, periventricular leukomalacia, necrotizing enterocolitis, blood transfusion or neonatal death.</p><p><strong>Results: </strong>A total of 305 clinical placental abruption cases were included: 95 in the placental abruption with histopathologic lesions group (31.3%) and 210 without such lesions (68.8%). The group with histopathologic lesions was characterized by higher rates of vaginal bleeding at presentation and prematurity (P = 0.012 and P < 0.001, respectively). Additionally, this group had substantially higher rates of composite severe neonatal outcomes (the primary outcome) (P = 0.005) and concurrent maternal vascular malperfusion lesions (P < 0.001).</p><p><strong>Conclusion: </strong>Our findings shed light on the association between placental abruption-related histopathologic lesions and adverse obstetric and neonatal outcomes. Thus, histopathologic examination can be advocated in suspected placental abruption, as patients with related placental lesions may require closer follow-up in subsequent pregnancies.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663534","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":"Enhancing perinatal outcome evaluation with the Composite Adverse Perinatal Outcome (CAPO) index: A modified Delphi study.","authors":"Ruiheng Peng, He Bai, Yani Wu, Mingxia Qian, Jun Zhang, Liqiang Zheng","doi":"10.1002/ijgo.70073","DOIUrl":"https://doi.org/10.1002/ijgo.70073","url":null,"abstract":"<p><strong>Objective: </strong>To develop a perinatal outcomes measurement tool by extending the Weighted Adverse Outcome Score (WAOS).</p><p><strong>Methods: </strong>An open-ended survey of five experienced experts was conducted to compile an initial list of WAOS extension components in the preliminary round, and the results were consolidated to form a Delphi questionnaire. A two-round modified e-Delphi survey of 29 obstetricians, neonatologists, scientists, and policymakers was conducted. During Delphi rounds, panelists rated the importance, scientific evidence, and feasibility of the proposed component. Severity scores were also assigned based on the WAOS criteria. After consensus was reached, the extension components were integrated with the original WAOS to create the Composite Adverse Perinatal Outcome (CAPO).</p><p><strong>Results: </strong>In the preliminary round, an initial list of nine potential extension outcomes for WAOS was proposed. Six outcomes were further proposed after Delphi round 1. Consensus was reached after two Delphi rounds, resulting in 13 additional outcomes apart from WAOS. Each outcome was assigned a severity score ranging from 75 to 490 points. The final CAPO included seven maternal outcomes (postpartum hemorrhage, severe pre-eclampsia, deep vein thrombosis, disseminated intravascular coagulation, amniotic fluid embolism, placenta previa, morbidly adherent placenta) and six neonatal outcomes (preterm birth, low birth weight, meconium peritonitis, meconium aspiration syndrome, congenital malformation, neonatal sepsis), in addition to the 10 outcomes included in the WAOS.</p><p><strong>Conclusions: </strong>Our study developed the CAPO index, which includes 23 maternal and neonatal outcomes, for a comprehensive evaluation of perinatal health. Further implementation and validation in clinical and research settings are anticipated.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663511","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: Comparing letters written by humans and ChatGPT: A preliminary study.","authors":"Shigeki Matsubara","doi":"10.1002/ijgo.70085","DOIUrl":"https://doi.org/10.1002/ijgo.70085","url":null,"abstract":"","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656947","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":"Improved cervical screening using HPV type restriction and cycle threshold limit setting with the AmpFire assay: A prospective screening cohort of women with and without HIV in Botswana.","authors":"Rebecca Luckett, Doreen Ramogola-Masire, Sikhulile Moyo, Annika Gompers, Anna Modest, Natasha Moraka, Thanolo Kashamba, Leabaneng Tawe, Farzad Noubary, Louise Kuhn, Surbhi Grover, Scott Dryden-Peterson, Greta Dreyer, Joseph Makhema, Matthys H Botha, Michele R Hacker, Roger Shapiro","doi":"10.1002/ijgo.70074","DOIUrl":"https://doi.org/10.1002/ijgo.70074","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the performance of HPV type restriction and cycle threshold (Ct)-limit setting to optimize detection of cervical intraepithelial neoplasia (CIN) with primary HPV testing.</p><p><strong>Methods: </strong>Baseline cervical screening at time of entry into a prospective longitudinal cohort of women with and without HIV was conducted from February 2021 to July 2022 in Botswana. All women underwent HPV testing of 15 individual types using the AmpFire assay; all HPV-positive and a random subset of HPV negative had histopathology collected. Performance parameters of HPV type restriction groupings were calculated, and sensitivity by individual HPV type Ct-value limits were plotted.</p><p><strong>Results: </strong>Among 2964 women who underwent primary HPV screening, 1293 (43.6%) tested HPV-positive. Among women with HIV (WWH), HPV types 16/18/33 were associated with the greatest burden of CIN2+/CIN3+ (53%/56%). In WWH, grouping by HPV types separately reported in commercial assays (16/18/45) had low sensitivity (44% [CI: 36%-52%]) but high specificity (86% [CI: 84%-88%]) for CIN2+; 8-type HPV restriction (16/18/31/33/35/45/52/58) improved sensitivity (79% [CI: 72%-86%]) and maintained reasonable specificity (67% [CI: 65%-70%]) for CIN2+. Similar results were seen in women without HIV. Ct-limit setting for medium oncogenic HPV types (31,33,35,52,58) maintained a sensitivity of 72% in WWH while reducing over-detection of non-pathogenic HPV.</p><p><strong>Conclusion: </strong>Eight-type HPV restriction and Ct-limit setting are promising strategies for improving the performance of primary HPV screening. A potential strategy to improve 8-type HPV restriction would be to treat all with HPV 16/18/45; treat HPV 31/33/35/52/58 if below the type-specific Ct limit and repeat HPV testing in 1-year for other positive HPV results.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656985","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}