Journal of gynecology obstetrics and human reproduction最新文献

{"title":"Nomograms for Predicting Risk and Prognosis of Liver Metastases in Ovarian Cancer Patients.","authors":"Feng Jiang, Chunfang Yao","doi":"10.1016/j.jogoh.2025.102918","DOIUrl":"https://doi.org/10.1016/j.jogoh.2025.102918","url":null,"abstract":"<p><strong>Aims: </strong>Liver metastases (LiM) commonly manifest in ovarian cancer (OC) patients. We intended to establish nomograms for predicting the risk and prognostic factors in OCLiM patients.</p><p><strong>Methods: </strong>Data from the SEER database (Nov 2022, Sub 1992-2020) were analyzed, excluding patients with missing data on liver metastases, survival months, race, AJCC T stage, marital status, rural/urban status, and metastases to bone, brain, or lung. Logistic and Cox regression analyses identified risk and prognostic factors for liver metastases. Predictive nomograms were developed from the multivariable regression results. The nomograms were evaluated using Harrell's C-index, ROC curve, calibration curve, DCA, NRI, and IDI. Moreover, the efficacy of the treatment in the new risk stratification subgroups was demonstrated by Kaplan-Meier (KM) curves.</p><p><strong>Results: </strong>Among 17,056 OC patients, 5.67% (n = 967) had liver metastases. Nomograms were constructed based on identified risk and prognostic factors, with dynamic web-based nomograms developed for clinical use. The nomogram demonstrated C-index values of 81.9% (training) and 82.9% (validation) for predicting liver metastases. For OS and CSS, the C-index values were 73.3% and 73.7% (training), and 73.3% and 72.8% (validation), respectively. The ROC curves for OS at 1-, 3-, 5-year showed AUC values of 84.1%, 79.8%, 75.9% (training) and 82.9%, 78.5%, 82.2% (validation), respectively. For CSS, AUC values at 1-, 3-, and 5-year were 84.5%, 80.2%, 76.1% (training) and 82.6%, 78.0, 82.0% (validation), respectively. The calibration and DCA curves confirmed favorable performance. NRI and IDI analyses showed superiority over the Grade and AJCC stage systems. Surgery improved prognosis in the low-risk group, while chemotherapy was more effective in both low- and medium-risk groups.</p><p><strong>Conclusions: </strong>we developed nomograms and risk stratification systems to assist clinicians in the individualized prediction, risk stratification, and prognostic assessment of OCLiM patients.</p>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":" ","pages":"102918"},"PeriodicalIF":1.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074725","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":"Modelling the cost effectiveness and budget impact of uterine botulinum toxin injections versus conventional treatment in severe dysmenorrhoea: A French Perspective.","authors":"Jean Martial Kouame, Jason Robert Guertin, Éric Bautrant, Christine Levêque, Carole Siani","doi":"10.1016/j.jogoh.2025.102912","DOIUrl":"https://doi.org/10.1016/j.jogoh.2025.102912","url":null,"abstract":"<p><strong>Objective: </strong>To assess the cost-effectiveness sand the budgetary impact of the combination of botulinum toxin (BT) + conventional treatment (CT) (hormonal treatments + analgesics) compared with CT alone in patients suffering from severe dysmenorrhoea, using a Markov model.</p><p><strong>Methods: </strong>A Markov model was developed to estimate, from the perspective of French Health Insurance (HI), the cost effectiveness and the budgetary impact of BT+CT compared with CT alone. The main health states in the model were based on Visual Analogue Scale (VAS) scores and expert opinion. All model parameters were derived from a cohort of patients treated for 12 months at the Centre de Recherche de la Santé et de la Femme (CRSF) for severe dysmenorrhoea in 2021. A Cost-Utility Analysis (CUA) was carried out to assess the quality of life of patients, crucial in this context, in which the direct healthcare costs were considered in and Budget Impact Analysis (BIA). The main decision-making criteria were the Incremental Cost-Utility Ratio (ICUR) for the CUA and the net impact for the BIA. Deterministic and probabilistic univariate sensitivity analyses were performed to assess the robustness of our results.</p><p><strong>Results: </strong>Over the 1-year time horizon (main analysis), the costs and quality-adjusted life year (QALY) of BT+CT versus CT alone were equal to €1895.65 vs €3055.20 and 2.03 QALYs vs 1.23 QALYs, respectively. Consequently, the ICUR equalled -€1651.5/QALY, which shows that, although the initial costs of BT are higher than those of CT, the reduced follow-up costs associated with the long-term efficacy of BT make it the most effective and economically dominant option at 1, 5 and 10 years. Sensitivity analyses show that 100% of Monte Carlo iterations are below the willingness-to-pay threshold of €30,000¹/QALY, making BT+CT an efficient strategy that could be adopted and reimbursed.</p><p><strong>Conclusion: </strong>In the absence of a reference treatment for the management of severe dysmenorrhoea, BT+CT offering an improvement in quality of life, as well as a reduction in follow-up costs. It is therefore the most cost-effective strategy over 10 years.</p>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":" ","pages":"102912"},"PeriodicalIF":1.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074724","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":"Success of outpatient hysterectomy: V-Notes versus Vaginal hysterectomy","authors":"Clara Dujardin ,&nbsp;Michel Cosson ,&nbsp;Helene Behal ,&nbsp;David Vandendriessche ,&nbsp;Margaux Merlier ,&nbsp;Geraldine Giraudet","doi":"10.1016/j.jogoh.2025.102916","DOIUrl":"10.1016/j.jogoh.2025.102916","url":null,"abstract":"<div><h3>STUDY OBJECTIVE</h3><div>Vaginal hysterectomy (VH) is the approach of choice for benign uterine conditions and is suitable for outpatient care. Many studies suggest that the vaginal natural orifice transluminal endoscopic surgery (V-Notes) technique is reliable and safe for outpatient surgery, but the literature includes only pilot studies with small cohorts. The aim is to assess the V-Notes technique compared to VH in outpatient settings with a larger cohort.</div></div><div><h3>METHOD</h3><div>This is a retrospective cohort study including patients who underwent V-Notes or VH, scheduled as outpatient procedures, at Lille University Hospital between 2016 and 2022.</div><div>Baseline characteristics and surgical outcomes were compared. The primary outcome was the success of outpatient surgery. Secondary outcomes were intraoperative and postoperative complication rates and factors limiting outpatient feasibility.</div></div><div><h3>MEASUREMENTS AND MAIN RESULTS</h3><div>373 patients were included, 204 underwent V-Notes and 169 VH. In the V-Notes group there were more nulliparous women (27.9% vs 14.8 %, <em>p</em> &lt; 0.002), more larger uteri (&gt;280 g) (30.8% vs 12.9 %, <em>p</em> &lt; 0.001) and more salpingectomy performed (98% vs 79.9 %, <em>p</em> &lt; 0.001), compared with the VH group. The outpatient success rate did not differ significantly between the two groups (83.3% vs 79.9 %, <em>p</em> = 0.39, adjusted <em>p</em> = 0.50), even after adjusting for nulliparity, salpingectomy, and uterine weight greater than 280 g (adjusted OR 1.24), with no differences in complications or factors limiting outpatient feasibility.</div></div><div><h3>CONCLUSION</h3><div>V-Notes hysterectomy is a safe outpatient procedure, showing no differences for outpatient care success compared to VH, even for patients with larger uteri or nulliparity, while allowing for more salpingectomies. Additionally, the V-Notes approach appears promising for hysterectomies in nulliparous women or those with large uteri.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 4","pages":"Article 102916"},"PeriodicalIF":1.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052738","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":"Vaginal versus laparoscopic suture for vaginal cuff closure in total robot-assisted laparoscopic hysterectomy: A multicentric comparative study","authors":"Henri Wohrer ,&nbsp;Sixtine Bernard ,&nbsp;Victor Gaultier ,&nbsp;Clementine Gonthier ,&nbsp;Geoffroy Canlorbe ,&nbsp;Juan Pablo Estevez ,&nbsp;Martin Koskas","doi":"10.1016/j.jogoh.2025.102911","DOIUrl":"10.1016/j.jogoh.2025.102911","url":null,"abstract":"<div><h3>Background</h3><div>Vaginal cuff closure is an important step in hysterectomy. To date, the literature and data on this procedure are inconsistent, and the optimal approach (i.e., vaginal or laparoscopic) for closing the vagina at the end of laparoscopic robot-assisted hysterectomy remains unclear. Vaginal cuff complications are rare, but their prevention is an important issue.</div></div><div><h3>Objective</h3><div>The objective of the present study was to compare early postoperative complications in patients who underwent robot-assisted hysterectomy between the robot-assisted closure group and the transvaginal closure group.</div></div><div><h3>Methods</h3><div>In this observational, retrospective, multicentre study, patients who underwent total robot-assisted hysterectomy between January 2016 and March 2021 were included. Two groups (robot-assisted and transvaginal closure groups) were compared in terms of the rate of rehospitalization within the first 30 postoperative days, for all causes and for vaginal scar-related complications.</div></div><div><h3>Results</h3><div>Among the 328 patients included, 185 and 143 underwent robot-assisted and transvaginal closure, respectively. Patients in the transvaginal closure group had a significantly greater risk of rehospitalization for all causes (9.8 % vs. 3.2 %; <em>p</em> = 0.02) and for vaginal cuff complications (8.4 % vs. 2.6 %, <em>p</em> = 0.04). According to the univariate analysis, obesity, HIV infection, blood loss &gt; 500 mL and transvaginal closure were associated with a higher incidence of rehospitalization within 30 days. Multivariate analysis revealed that transvaginal closure (<em>p</em> = 0.01) and obesity (<em>p</em> = 0.03) were significantly associated with a greater risk of rehospitalization.</div></div><div><h3>Conclusion</h3><div>Compared with transvaginal closure, robot-assisted vaginal closure in robot-assisted total hysterectomy is associated with a reduction in all-cause rehospitalization as well as a reduction in rehospitalization due to vaginal cuff complications. Rates of rehospitalization for vaginal abscess or bleeding could be reduced by avoiding transvaginal closure.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102911"},"PeriodicalIF":1.7,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052742","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":"Advocating a specific risk calculation of trisomy 18 in case of low maternal serum markers during screening for fetal Down syndrome","authors":"Emeline Gernez ,&nbsp;Corinne Sault ,&nbsp;Nicolas Chatron ,&nbsp;Marion Beaumont ,&nbsp;Estelle Roland ,&nbsp;Gilles Renom","doi":"10.1016/j.jogoh.2025.102915","DOIUrl":"10.1016/j.jogoh.2025.102915","url":null,"abstract":"<div><h3>Background</h3><div>In France, legislation concerning pregnancy monitoring only considers screening for Down syndrome (T21), while the contingent introduction of the circulating cell free DNA test (DPNI) also allows screening for trisomies 13 and 18 with similar performances.</div></div><div><h3>Methods</h3><div>We retrospectively studied more than 800,000 patients among whom 7971 presented serum markers suggestive of T18 (but without increased risk of T21), of which 438 benefited from NIPT and of a complete pregnancy follow-up.</div></div><div><h3>Results</h3><div>We show that the use of a specific risk calculation for T18 would have improve the relevance of the prescription.</div></div><div><h3>Conclusion</h3><div>The generalization of this calculation would allow an optimization of the management of patients presenting a suggestive biochemical profile without significantly increasing the number of NIPT prescribed.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102915"},"PeriodicalIF":1.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023444","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":"Predictors for negative large loop excision of the transformation zone (LLETZ) in a primary HPV screened population","authors":"Victoria L Parker ,&nbsp;Emma Long ,&nbsp;Kay Ellis ,&nbsp;Madeleine C Macdonald ,&nbsp;Julia E Palmer","doi":"10.1016/j.jogoh.2025.102913","DOIUrl":"10.1016/j.jogoh.2025.102913","url":null,"abstract":"<div><h3>Objective</h3><div>To assess rates of histologically negative large loop excisions of the transformation zone (LLETZ) and potential predictive factors within a single UK Colposcopy Unit.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>Jessop Wing Colposcopy Unit, Sheffield, U.K.</div></div><div><h3>Population</h3><div>Patients coded upon the Colposcopy database as having undergone a LLETZ procedure.</div></div><div><h3>Methods</h3><div>Univariate (Chi squared, <em>t</em>-test) and multivariate logistic regression analysis.</div></div><div><h3>Main outcome measures</h3><div>Histological negative LLETZ sample.</div></div><div><h3>Results</h3><div>2,969 patients underwent a LLETZ procedure; 291 (10 %) procedures resulted in a negative LLETZ. Older age group (<em>p</em> &lt; 0.0001), referral with negative cytology high risk human papillomavirus (hrHPV) detected (<em>p</em> &lt; 0.0001), unsatisfactory colposcopy (<em>p</em> &lt; 0.0001), repeat LLETZ (<em>p</em> &lt; 0.0001), and biopsy and treat procedures (<em>p</em> = 0.0005) were found significant predictors of negative LLETZ. Patients with negative LLETZ were significantly less likely to have had a 'select &amp; treat' procedure (<em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>Due to the increased sensitivity of HPV testing in combination with cytology for the detection of high-grade disease, it is more likely a negative LLETZ will occur following positive biopsy. This may be due to the detection of small volume high-grade disease removed by the punch biopsy alone, spontaneous regression of disease, or resolution due to localised immune responses and healing. As increasing age and unsatisfactory colposcopy are significant risk factors for obtaining a negative LLETZ, the authors recommend further studies are conducted in this more challenging referral population.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102913"},"PeriodicalIF":1.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006596","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":"2D-transperineal ultrasound in delivery room: Contribution in assessing labor progress, predicting outcome of labor and recognizing obstetric anal sphincter injuries (OASIS). A systematic review","authors":"Siegfried Nebel ,&nbsp;Delphine Vardon ,&nbsp;Michel Dreyfus ,&nbsp;Anne-Cécile Pizzoferrato","doi":"10.1016/j.jogoh.2025.102910","DOIUrl":"10.1016/j.jogoh.2025.102910","url":null,"abstract":"<div><h3>Aims</h3><div>Ultrasound is used in the delivery room to assess fetal head position, engagement during labor, and anal sphincter injuries in the immediate postpartum period. The transperineal approach allows for direct visualization of the structures of interest without altering anatomical landmarks. Various ultrasound measurements during labor have been described in the literature, and their use varies widely across maternity units. Our objective was to conduct a systematic review of the literature on relevant ultrasound parameters for the management of labor and delivery.</div></div><div><h3>Material and methods</h3><div>We reviewed articles indexed in MEDLINE from 1990 to 2022, selecting those that evaluated transperineal ultrasound during labor for term singleton fetuses in cephalic presentation.</div></div><div><h3>Results</h3><div>We identified 124 articles out of 394 references, including 4 randomized controlled trials, 108 prospective studies, 6 cross-sectional studies, and 6 retrospective studies. The Angle of Progression (AOP) is better documented and appears more reliable than the Head-Perineum Distance (HPD) for diagnosing engagement, monitoring labor, and predicting its outcome. The HPD is easier to perform but shows inconsistencies in the literature. The Head Progression Distance (HPrD) shows good performance but requires further studies before routine use, as does Head-Symphysis Distance (HSD). Recent studies show a growing interest in ultrasound biofeedback of fetal head progression to improve pushing efforts as well as screening for Obstetrical Anal Sphincter Injuries (OASIS).</div></div><div><h3>Conclusions</h3><div>Transperineal ultrasound is a minimally invasive technique that can be used routinely in the delivery room. It can aid in monitoring labor, predicting the mode of delivery, and may serve as valuable biofeedback to optimize pushing during expulsion.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102910"},"PeriodicalIF":1.7,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006600","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":"Exploring the influence of perineal biometrics and stiffness measured by elastography during pregnancy on perineal tears : A pilot study","authors":"Marine Lallemant ,&nbsp;Tiguida Kadiaké ,&nbsp;Arnaud Lejeune ,&nbsp;Michel Cosson ,&nbsp;Jérôme Chambert ,&nbsp;Emmanuelle Jacquet ,&nbsp;Nicolas Mottet","doi":"10.1016/j.jogoh.2025.102904","DOIUrl":"10.1016/j.jogoh.2025.102904","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to describe the biometrics and elasticity of the perineal body and the anal sphincter in the ninth month of pregnancy and explore their association with the risk of perineal tears during childbirth.</div></div><div><h3>Methods</h3><div>In this prospective observational study, pregnant women at 36–40 weeks of gestation were included. Using transperineal 2D-mode ultrasound and shear wave elastography (SWE), we measured the biometrics and stiffness of the perineal body (PB), external anal sphincter (EAS), internal anal sphincter (IAS), and anal mucosa (AM) at rest and during Valsalva maneuvers.</div></div><div><h3>Results</h3><div>Of the 16 women, five (31.2 %) were nulliparous and 10 (62.5 %) underwent a perineal tear. All were first degree perineal tears. Women with perineal tear had statistically a higher perineal body area at rest (0.9 ± 0.1 cm² versus 0.7 ± 0.1 cm², <em>p</em> = 0.03), a thicker EAS at 9 o'clock at rest (0.6 ± 0.2 cm vs 0.4 ± 0.1 cm, <em>p</em> = 0.03), a smaller anteroposterior diameter (1.7 ± 0.2 cm vs 2 ± 0.2 cm, <em>p</em> = 0.047), a smaller lateral diameter (1.4 ± 0.2 cm vs 1.6 ± 0.1 cm, <em>p</em> = 0.05) and a thinner IAS in average at rest (0.2 ± 0.0 cm vs 0.3 ± 0.0 cm, <em>p</em> = 0.007) and at 12 o'clock at rest (0.2 ± 0.1 cm vs 0.3 ± 0.0 cm, <em>p</em> = 0.002). The PB, EAS, IAS and AM elastic modulus in the ninth month of pregnancy tended to be higher in women with a perineal tear.</div></div><div><h3>Conclusion</h3><div>Assessing perineal and anal sphincter biometrics and stiffness via ultrasound and SWE is feasible and may indicate a risk of perineal tears.</div></div><div><h3>Trial registration</h3><div>The study was registered on (NCT05556304).</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102904"},"PeriodicalIF":1.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978721","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":"Prognosis for fetuses with isolated severe growth retardation from 23 gestational weeks with an initial assessment unfavorable to an active management","authors":"Thibault Wartelle ,&nbsp;Camille Le Ray ,&nbsp;Emmanuelle Cohen ,&nbsp;Héloise Torchin ,&nbsp;François Goffinet","doi":"10.1016/j.jogoh.2025.102905","DOIUrl":"10.1016/j.jogoh.2025.102905","url":null,"abstract":"<div><h3>Objective</h3><div>To study perinatal outcomes for newborns with early, isolated, severe FGR, for whom initial active management was considered unreasonable or impossible at an obstetric-pediatric assessment and to identify the determinants associated with a course that made active management reasonable.</div></div><div><h3>Material and methods</h3><div>This retrospective observational single-center study occurred in a level-3 university hospital maternity unit. It included all pregnancies with a singleton fetus presenting isolated FGR &lt;3rd percentile at 23 weeks or more of gestation with an obstetric-pediatric assessment (OPA) initially unfavorable to active management. The main outcome measure was perinatal mortality. Characteristics of the women and pregnancies were compared between the groups “OPA became favorable” versus “OPA remained unfavorable”.</div></div><div><h3>Results</h3><div>Among the 80 cases included, 48 (60%) of the children died, 38 (47.5%) before birth, 2 (2.5%) in the delivery room, and 8 (10%) in the NICU. Overall, the OPA for 32 (40%) became favorable. There were 44 (91.7%) perinatal deaths when the OPA remained unfavorable versus 4 (12.5%) when it became favorable (<em>P</em>&lt;0.001). The median gestational age at the first OPA (25 weeks) did not differ between the groups. The patients in the OPA became favorable group had initially abnormal uterine Doppler findings less often (56.2% vs 85.4%, <em>P</em>=0.001), absent diastole or reverse flow umbilical artery less often (9.4% vs 33.3%, <em>P</em>=0.0016), less preeclampsia (6.2% vs 31.2%, <em>P</em>=0.009) and a higher estimated fetal weight (520 [491-546] g vs 487 [449-523] g, <em>P</em>=0.005).</div></div><div><h3>Conclusion</h3><div>In fetuses with early severe FGR, the risk of perinatal death was very high when the initial OPA was unfavorable. Initial OPA without preeclampsia and umbilical reverse diastolic flow were associated with higher probability that the OPA became favorable.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102905"},"PeriodicalIF":1.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965484","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 in in-vitro fertilization (IVF): A new era of precision and personalization in fertility treatments","authors":"David B. Olawade ,&nbsp;Jennifer Teke ,&nbsp;Khadijat K. Adeleye ,&nbsp;Kusal Weerasinghe ,&nbsp;Momudat Maidoki ,&nbsp;Aanuoluwapo Clement David-Olawade","doi":"10.1016/j.jogoh.2024.102903","DOIUrl":"10.1016/j.jogoh.2024.102903","url":null,"abstract":"<div><div><em>In-vitro</em> fertilization (IVF) has been a transformative advancement in assisted reproductive technology. However, success rates remain suboptimal, with only about one-third of cycles resulting in pregnancy and fewer leading to live births. This narrative review explores the potential of artificial intelligence (AI), machine learning (ML), and deep learning (DL) to enhance various stages of the IVF process. Personalization of ovarian stimulation protocols, gamete selection, and embryo annotation and selection are critical areas where AI may benefit significantly. AI-driven tools can analyze vast datasets to predict optimal stimulation protocols, potentially improving oocyte quality and fertilization rates. In sperm and oocyte quality assessment, AI can offer precise, objective analyses, reducing subjectivity and standardizing evaluations. In embryo selection, AI can analyze time-lapse imaging and morphological data to support the prediction of embryo viability, potentially aiding implantation outcomes. However, the role of AI in improving clinical outcomes remains to be confirmed by large-scale, well-designed clinical trials. Additionally, AI has the potential to enhance quality control and workflow optimization within IVF laboratories by continuously monitoring key performance indicators (KPIs) and facilitating efficient resource utilization. Ethical considerations, including data privacy, algorithmic bias, and fairness, are paramount for the responsible implementation of AI in IVF. Future research should prioritize validating AI tools in diverse clinical settings, ensuring their applicability and reliability. Collaboration among AI experts, clinicians, and embryologists is essential to drive innovation and improve outcomes in assisted reproduction. AI's integration into IVF holds promise for advancing patient care, but its clinical potential requires careful evaluation and ongoing refinement.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 3","pages":"Article 102903"},"PeriodicalIF":1.7,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903225","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}