Minerva obstetrics and gynecology最新文献

{"title":"Cohort study of adverse pregnancy outcomes based on ROTEM profiles in early pregnancy.","authors":"Patrick Maher, Dan Katz, Omara Afzal, Sylviah Nyamu, Lynne Richardson","doi":"10.23736/S2724-606X.25.05675-1","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05675-1","url":null,"abstract":"<p><strong>Background: </strong>Hypercoagulability exceeding normal physiological changes in pregnancy may lead to adverse outcomes in select populations, but most prior studies have tested women outside of pregnancy. Rotational thromboelastometry (ROTEM), which performs a comprehensive clotting evaluation, may demonstrate abnormalities during early pregnancy that contribute to adverse outcomes. This study evaluated the relationship between ROTEM coagulation profiles during pregnancy with the outcome of miscarriage.</p><p><strong>Methods: </strong>This was a prospective cohort study from a single center. Patients in early pregnancy (less than 20 weeks) were recruited from the obstetric clinic and the Emergency Department for ROTEM testing using extrinsic thromboelastometry (EXTEM), intrinsic thromboelastometry (INTEM), and natural thromboelastometry (NATEM) tracings. The cohort was followed to determine pregnancy outcomes for association with ROTEM clot formation kinetics. Results were analyzed using univariate analysis and multiple linear regression, controlling for patient age and estimated gestational age (EGA) in weeks.</p><p><strong>Results: </strong>Over the study, 98 patients were recruited with 14 lost to follow-up and 7 having elective abortion. Miscarriage occurred in 26 patients, with live delivery without complications occurring in 51 patients. Both groups had similar mean patient age and racial and ethnic breakdown. ROTEM results were similar between groups on univariate analysis. After controlling the patient age and estimated gestational age, only EXTEM clotting time (CT) results differed between groups.</p><p><strong>Conclusions: </strong>In patients tested during early pregnancy, ROTEM profiles were not associated with adverse pregnancy outcomes in this cohort except for EXTEM CT. This suggests that ROTEM clotting profiles may not be useful in identifying patients at higher risk for adverse pregnancy outcomes.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polycystic ovary syndrome as a risk factor for cancer.","authors":"Alessandro Gambera, Giulia Rodondi, Giulia Oliveri, Federico Ferrari, Michele Vignali, Anna Fichera, Franco Odicino","doi":"10.23736/S2724-606X.25.05719-7","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05719-7","url":null,"abstract":"<p><strong>Introduction: </strong>Polycystic ovary syndrome (PCOS) is a common endocrinological disorder and is frequently associated with other medical conditions such as hyperinsulinemia and obesity. The aim of this review is to identify the role of PCOS as a potential risk factor for endometrial, breast and ovarian cancer.</p><p><strong>Evidence acquisition: </strong>A literature search was conducted including most relevant peer-reviewed articles regarding the possible association between PCOS and gynecological cancer published from 1996 to the present.</p><p><strong>Evidence synthesis: </strong>A narrative synthesis was performed. PCOS is linked to an increased risk of endometrial cancer. However, the risk varies based on factors like BMI, parity, and phenotype. The association between PCOS and ovarian cancer is uncertain. Some studies suggest a two-fold increased risk, particularly in women with infertility or treated for infertility, but more recent reviews find no clear association. The role of androgen and estrogen imbalances in different ovarian cancer types remains debated. Even the link between PCOS and breast cancer is unclear. While high androgen levels are theorized to play a role, local hormone conversion and factors like weight, environment, and genetics are likely more important.</p><p><strong>Conclusions: </strong>The association between PCOS and gynecological cancers is complex. Further reviews and new studies that control individual confounding factors are needed to accurately establish the real oncological risk of PCOS.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterus transplantation: from mice to human clinical procedure.","authors":"Panagiotis Tsiartas, Randa Akouri, Milan Milenkovic, Elias Tsakos, Mats Brännström","doi":"10.23736/S2724-606X.25.05721-5","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05721-5","url":null,"abstract":"<p><p>Uterus transplantation (UTx) emerged as a groundbreaking solution for women facing absolute uterine factor infertility (AUFI), offering hope for childbearing since the first proof-of-concept of UTx in 2014 by the first live birth from a woman with uterine graft. This review provides a comprehensive overview of the evolution of UTx from foundational animal research to current clinical trials and cases. Recent advancements in surgical techniques, including a shift towards robotic approaches, have improved graft removal and transplantation, though challenges persist in optimizing immunosuppressive strategies and rejection monitoring. Given the absence of Fallopian tube transplantation in UTx, in vitro fertilization (IVF) is an integral part of the process. This review delves into the intricacies of combining UTx with IVF, addressing crucial questions about the timing of oocyte retrieval, cryopreservation of oocytes or embryos, and the optimal timing for the first embryo transfer post-UTx. The significance of the International Society Uterus Transplantation (ISUTx) registry is highlighted for evaluating overall success rates, complications, and live births. Examining the long-term health outcomes for donors, recipients, partners, and children born from transplanted grafts, the review acknowledges the life-giving nature of UTx. Cost considerations are explored, anticipating a potential decrease in costs with enhanced efficiency. The discussion emphasizes the evolving landscape of UTx, proposing a scheme for program setup and outlining future directions. This comprehensive analysis marks a significant milestone in the field, transitioning UTx from experimental to mainstream clinical practice. As criteria widen and outcomes improve, UTx is poised to become a realistic and accessible alternative for treating AUFI, representing a significant advancement in reproductive medicine worldwide.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunological interventions in recurrent implantation failure: a systematic review and SWOT analysis.","authors":"Giosuè G Incognito, Erika Pittana, Danilo Cimadomo, Alessandro Ruffa, Oriana Osetti, Marilena Taggi, Ilenia Mappa, Giuseppe Gullo, Marco Palumbo, Giuseppe Rizzo, Laura Rienzi, Filippo Maria Ubaldi, Alberto Vaiarelli","doi":"10.23736/S2724-606X.25.05657-X","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05657-X","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrent implantation failure (RIF) occurs when pregnancy is not achieved after multiple embryo transfers. The lack of standardized diagnostic criteria among clinicians makes RIF a particularly challenging condition, leading to the use of various procedures, including immunological ones, often without robust evidence. This study aims to provide an overview of the main characteristics of existing research on the role of interventions in relation to in vitro fertilization (IVF) outcomes in patients with RIF.</p><p><strong>Evidence acquisition: </strong>A comprehensive bibliographic search was systematically conducted from inception to November 2024, focusing on studies that evaluated the impact of immunological treatments in RIF cases, comparing IVF outcomes between case and control groups.</p><p><strong>Evidence synthesis: </strong>A total of 77 studies were included. The diagnostic criteria for RIF were heterogeneous, with only 36 studies (47%) defining RIF as three or more failed embryo transfers. Moreover, the studies generally had small sample sizes.</p><p><strong>Conclusions: </strong>There is not yet sufficient evidence to support the routine use of immunological interventions in clinical practice for RIF. The existing research is marked by methodological inconsistencies, which limit the reliability and generalizability of the results.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between maternal serum analytes and third trimester fetal growth restriction.","authors":"Anna Ung, Chieko Kimata, Andrea M Siu, Kelly Yamasato","doi":"10.23736/S2724-606X.25.05664-7","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05664-7","url":null,"abstract":"<p><strong>Background: </strong>Given associations between abnormal maternal serum analytes and small for gestational age, 3^rd trimester fetal growth ultrasounds are commonly obtained despite lack of evidence. We evaluated associations between isolated abnormal analytes, 3^rd trimester fetal growth restriction, and neonatal complications.</p><p><strong>Methods: </strong>This retrospective, single institution cohort study included women with analytes from 2010-2019. Multiple gestation, delivery <28 weeks gestation, and those with another indication for a 3^rd trimester US were excluded. Fetal growth restriction prevalence at the first 3^rd trimester US with abnormal analytes was calculated, as well as its association with small for gestational age. Associations between abnormal analytes and neonatal outcomes (small for gestational age, intensive care, umbilical artery pH <7.0, 5-minute APGAR <7, preterm delivery, neonatal death) were also evaluated.</p><p><strong>Results: </strong>Among 11,092 pregnancies, 1136 had isolated abnormal analytes, of which 613 had 3^rd trimester ultrasounds. Of these, 10 (1.6%) had growth restriction at the first 3^rd trimester ultrasound, and 99 (16.1%) were small for gestation. Abnormal analytes were associated with increased small for gestational age, intensive care admit, and preterm delivery. Only 9.1% of small for gestational age neonates had growth restriction at the first 3^rd trimester ultrasound.</p><p><strong>Conclusions: </strong>Third trimester fetal growth restriction is uncommon with isolated abnormal analytes, and early 3^rd trimester ultrasound for this indication may commonly miss small for gestational age. These findings contribute to 1) evidence-based fetal surveillance in this setting, and 2) knowledge regarding potential implications on growth restriction detection by replacing serum analyte screening with cell free fetal DNA.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of platelet-rich plasma infusion in infertile women undergoing assisted reproduction: a systematic umbrella review of the best clinical evidence.","authors":"Flavia Costanzi, Ermanno Greco, Sara Fusco, Gianluca Dani, Giuseppe Grimaldi, Silvia Cacioppo, Ilaria Listorti, Pier F Greco","doi":"10.23736/S2724-606X.25.05656-8","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05656-8","url":null,"abstract":"<p><strong>Introduction: </strong>To date, the application of platelet-rich plasma (PRP) to women in assisted reproductive technologies is a potential therapeutic method that has been developed. This umbrella review is designed to summarize the best evidence regarding the treatment potential of PRP in infertile patients.</p><p><strong>Evidence acquisition: </strong>A systematic literature search was conducted on the main database (PubMed, the Cochrane Library and Web of Science) for systematic reviews and meta-analyses describing the effect of PRP on fertility outcomes. The retrieved data was extracted, and the quality of the included studies was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) tool.</p><p><strong>Evidence synthesis: </strong>Seven systematic reviews were finally included. The quality of evidence was high in one review, moderate to low in five, and low in one. In terms of ovarian PRP, antral follicular count (AFC) and the number of retrieved oocytes were shown to have significant differences. Nonetheless, the livebirth rates did not demonstrate a clinically relevant improvement. Concerning endometrial PRP, an improvement in the clinical pregnancy rate both in cases of repeated implantation failure and thin endometrium was suggested; nonetheless, no effect on live birth rates and miscarriage rates was detected. Results of laboratory tests showed transient rises of AMH and fall in FSH with ovarian PRP, but this effect was not consistent over time.</p><p><strong>Conclusions: </strong>This umbrella review showed that PRP infusion was a potential technique for improving particular reproductive outcomes according to the available literature, particularly on premature ovarian insufficiency, poor ovarian response and recurrent implantation failure patients. However, the overall quality of the studies is low, and future studies should concentrate on more robust methodologies and higher standards of evidence and on the standardization of PRP protocols and the evaluation of both short- and long-term results to establish more clear recommendations for its use in assisted reproductive technologies.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted hysterectomy for endometrial cancer.","authors":"Ahmad Awada, Nia Byrd, Sarfraz Ahmad","doi":"10.23736/S2724-606X.25.05680-5","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05680-5","url":null,"abstract":"<p><p>Robotic-assisted surgery (RAS) has revolutionized the treatment of endometrial cancer (EC), providing a less invasive alternative to traditional open methods. In early-stage EC, RAS has shown similar oncological results compared to conventional techniques while offering notable improvements in perioperative outcomes, such as shorter hospital stays, less post-operative pain, and faster recovery times. Additionally, the robotic platform has seen widespread adoption in gynecologic oncology due to its ability to address the limitations of conventional laparoscopy, especially reduced conversion rate from minimally invasive surgery (MIS) to open/laparotomy. This approach is particularly beneficial for high-risk groups, including obese and elderly patients, where it has proven to be both safe and effective, presenting a favorable risk-benefit profile. Furthermore, robotic-assisted sentinel lymph node (SLN) mapping, utilizing the FireFly^® fluorescence imaging system with indocyanine green (ICG) dye, offers exceptional accuracy in detecting SLNs, enhancing the precision of nodal mapping, thereby decreasing the need for more invasive lymphadenectomy and reducing associated morbidity. It is essential to recognize physiological challenges that can arise during RAS, particularly when steep Trendelenburg position combined with pneumoperitoneum (increased intra-abdominal pressure due to CO<inf>2</inf> insufflation), can significantly affect both cardiovascular and respiratory systems. Although the upfront costs of robotic surgery are relatively higher, the long-term benefits, such as fewer complications and faster recoveries, make it a cost-effective solution. This review examines current evidence supporting the use of RAS as a standard option for managing patients with EC and its positive impact on their outcomes across diverse risk categories.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of colposcopy in HPV vaccination era.","authors":"Jacopo DI Giuseppe, Leonardo Natalini, Carolina Marzocchini, Irene Lubinski, Jasmine Saee, Luca Giannella, Giovanni Delli Carpini, Andrea Ciavattini","doi":"10.23736/S2724-606X.24.05592-1","DOIUrl":"10.23736/S2724-606X.24.05592-1","url":null,"abstract":"<p><p>Colposcopy has traditionally played a crucial role in the assessment and management of abnormal cervical cytology and human papillomavirus (HPV) -related lesions. However, with the reduction in high-risk (HR) HPV types due to vaccination, the role of colposcopy in the HPV vaccination era is being questioned. The aim of this narrative review was to highlight the latest evidence from the world of HPV vaccination and the future role of colposcopy in the HPV vaccination era. PubMed, MEDLINE, Scopus, Web of Science were searched for relevant articles up to June 2024. HPV vaccination may influence colposcopic practice by reducing HR-HPV vaccine type, colposcopy referrals, colposcopic positive predictive value for CIN 2+, and by changing referral patterns, colposcopic performance, and procedures. The relative incidence of HPV-negative adenocarcinoma and its precursors may be increasing, presenting a new challenge that may increase the difficulty of colposcopic assessment. The role of colposcopy in the management of cervical abnormalities will vary according to vaccination status, vaccine type and timing of vaccination. As this evolves, colposcopy will need to adapt to provide optimal care tailored to individual risk profiles and to maintain the key role in cervical cancer prevention that it has acquired over the past decades. There will certainly be a need to improve the quality and performance of colposcopy by reducing inter- and intra-observer variability in colposcopic practice, including more objective patient selection, greater knowledge, expertise and skill, with the aim of achieving reproducible, sensitive and less biased assessment of cervical appearance.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"219-236"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights of the May-June 2025 issue.","authors":"Antonio La Marca","doi":"10.23736/S2724-606X.25.05800-2","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05800-2","url":null,"abstract":"","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":"77 3","pages":"145-147"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is menopausal hormone therapy still a modern social issue? Women's experience in a northern Italian city.","authors":"Carmen I Aquino, Viviana Stampini, Elena Osella, Libera Troìa, Clarissa Rocca, Maurizio Guida, Fabrizio Faggiano, Valentino Remorgida, Daniela Surico","doi":"10.23736/S2724-606X.24.05500-3","DOIUrl":"10.23736/S2724-606X.24.05500-3","url":null,"abstract":"","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"259-260"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}