Minerva obstetrics and gynecology最新文献

{"title":"Dysgerminoma of the ovary.","authors":"Lior Friedrich, Raanan Meyer, Perry Tamar, Gabriel Levin","doi":"10.23736/S2724-606X.24.05483-6","DOIUrl":"10.23736/S2724-606X.24.05483-6","url":null,"abstract":"<p><strong>Introduction: </strong>Dysgerminoma is a histologic subtype of malignant ovarian germ cell tumor (MOGCT). Most publications describing dysgerminoma are of small cohorts. Large cohorts usually describe MOGCT as a group, and therefore, drawing specific conclusions regarding dysgerminomas is challenging. In this study, we sought to highlight and review the most recently published data on dysgerminoma.</p><p><strong>Evidence acquisition: </strong>We performed an electronic search in PubMed, using a range of medical subject heading terms (MeSH), including English language articles only, published earliest in 2010. Papers including \"germ cell tumors,\" and \"dysgerminoma\" were included. We excluded reviews, meta-analyses, and case reports. We followed the PRISMA guidelines to prepare this review. All included articles were reviewed by two reviewers (LF, GL).</p><p><strong>Evidence synthesis: </strong>We found that dysgerminomas mostly present in an early stage of the disease and therefore harbor a favorable prognosis. Most dysgerminomas occur in women of reproductive age, in which fertility-sparing treatment is safe. While complete staging surgery for all patients is debatable, adjuvant chemotherapy seems to be beneficial. Long-term follow-up by a gynecologic oncologist is necessary as recurrence may occur.</p><p><strong>Conclusions: </strong>Since most studies are small and retrospective, the development of multicenter prospective studies protocols is of utmost importance to study future lines of therapy.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"137-144"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492595","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":"Contraception use and counseling among patients at increased risk for adverse pregnancy outcomes.","authors":"Zarah Rosen, Allison Payne, Katherine Leung, Stephen Wagner, Ben Brown, Anna Whelan","doi":"10.23736/S2724-606X.25.05565-4","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05565-4","url":null,"abstract":"<p><strong>Background: </strong>Numerous studies indicate that non-White individuals and/or those who are of low socioeconomic status (SES) are preferentially prescribed long-acting reversible contraception more frequently than their white counterparts. This cohort is also more likely to have medical and obstetric complications that put them at high risk for adverse pregnancy outcomes due to the systematic racism within the medical system and its interaction with underlying conditions. Medical complications themselves may be a risk factor for contraceptive coercion. We looked to evaluate if contraceptive use and patient perception of contraceptive counseling is impacted by obstetric risk factors for adverse pregnancy outcomes, and if this varies by SES or race/ethnicity.</p><p><strong>Methods: </strong>This is a retrospective analysis of the National Survey of Family Growth (NSFG) 2017-2019 cohort. Participants were grouped into categories of either high or low risk for adverse birth outcomes. The primary outcome was contraceptive choice. Bivariate comparison was performed using complex survey weighting. Secondary outcomes included participant ratings of provider counseling and respect. Multivariable regression was performed for use of long-acting reversible contraceptives, accounting for demographic variables that were significantly different between groups.</p><p><strong>Results: </strong>A total of 1655 participants met inclusion criteria for this analysis. Of these participants, 310 were at risk for adverse pregnancy outcomes as defined by study criteria. Participants at risk for adverse pregnancy outcomes were more likely to receive public assistance, have fewer years of formal education, and were less likely to report having \"good\" or \"excellent health\". There were no differences in the types of contraceptives used in the last 12 months between those at high risk for adverse pregnancy outcomes and those with low risk. Between groups, there were no differences of participant ratings of provider counseling and respect.</p><p><strong>Conclusions: </strong>Participants in the NSFG reported no differences in contraceptive methods when comparing those at high risk for adverse pregnancy outcomes as compared to those with low risk.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674275","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":"Early gestational diabetes mellitus and the effect of metformin use on perinatal outcomes: a systematic review.","authors":"Gianna Wilkie, Allison Payne, Becky Baltich Nelson, Anna R Whelan","doi":"10.23736/S2724-606X.25.05591-5","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05591-5","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to perform a systematic review to assess whether metformin therapy in patients diagnosed with gestational diabetes mellitus (GDM) in early pregnancy is associated with improved perinatal outcomes. We searched Ovid MEDLINE, Scopus, and Cochrane library (inclusive of ClinicalTrials.gov) from inception through November 29, 2023. We included all randomized trials that assessed metformin use in early GDM.</p><p><strong>Evidence acquisition: </strong>The 3665 results produced from the database searches were imported into Covidence, a systematic review screening tool, and duplicates were removed. The remaining 2731 citations were screened by title and abstract against predetermined inclusion and exclusion criteria by 2 independent reviewers with discrepancies resolved after group discussion. After screening was completed, 46 studies underwent full text review, with 1 study eligible for inclusion.</p><p><strong>Evidence synthesis: </strong>The included study showed no difference in a composite adverse perinatal outcome between those diagnosed with early GDM and treated with metformin (59.3%) vs. placebo (57.1%).</p><p><strong>Conclusions: </strong>There is a paucity of data regarding the management of early GDM and the lack of standardization in its definition for this condition.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674288","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":"Morbidity and mortality in modern gynecologic surgical practice.","authors":"Claudia Mallory, Myriam Girgis, Wei How Lim","doi":"10.23736/S2724-606X.25.05620-9","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05620-9","url":null,"abstract":"<p><strong>Background: </strong>Surgical audits are quality improvement initiatives developed to enhance the quality of surgical care and to highlight sub-optimal local practices. The aim of this audit was to collate necessary data to track and analyze gynecological surgery complications for quality assurance in operative care.</p><p><strong>Methods: </strong>A retrospective study of all patients who underwent both elective and emergency gynecological surgery across two health care institutions was undertaken over a 10-year period.</p><p><strong>Results: </strong>The incidence of complications and mortality was low in a review of over 9000 gynecological surgeries. Patients who underwent major surgeries such as operative laparoscopies and hysterectomies, which made up of 30% of all surgeries, had a longer postoperative mean length of stay - one variable noted was majority of these patients live in remote areas. Other morbidities such as postoperative pneumonia, bradycardia and hypotension related intensive care admissions were associated with obesity and medical co-morbidities. There was no statistical difference in operative complication between elective and emergency surgeries.</p><p><strong>Conclusions: </strong>The morbidity and mortality associated with modern gynecological surgery occurred infrequently, especially postoperative venous thromboembolism and wound site infection. Implementation of an enhanced recovery after surgery program and an increasing trend in minimally invasive surgery were key practices contributing to this low rate. Future assessments should include comparison of outcomes against local and international outcome databases such as the American College of Surgeons National Surgical Quality Improvement Program for further evaluation.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674291","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":"Ovulation induction in anovulatory PCOS women.","authors":"Marialaura Diamanti, Antonio La Marca","doi":"10.23736/S2724-606X.24.05633-1","DOIUrl":"10.23736/S2724-606X.24.05633-1","url":null,"abstract":"<p><p>Polycystic ovary syndrome (PCOS) is a prevalent endocrine-metabolic disorder characterized by hyperandrogenism, chronic anovulation, and polycystic ovarian morphology, affecting 6-10% of women during their reproductive years. It is a leading cause of female infertility, impacting up to 40% of cases. First described in 1935, PCOS manifests with various clinical features, including hirsutism, amenorrhea, and metabolic disturbances. Additionally, PCOS patients exhibit hormonal imbalances and ovarian dysfunction, contributing to the overall clinical picture. Notably, PCOS is linked to metabolic comorbidities like hepatic steatosis, glucose intolerance, dyslipidemia, type 2 diabetes mellitus (T2DM), and hypertension. This review explores the key aspects of PCOS, providing an overview of ovulation induction strategies, including lifestyle modifications, pharmacological interventions, and emerging approaches. The review synthesizes findings from relevant studies. Effective management of PCOS necessitates early detection and intervention to prevent progression to severe health conditions. Evidence underscores the importance of addressing oxidative stress and low-grade inflammation in treatment plans. A holistic approach, including individualized medication, diet, and lifestyle modifications, is crucial for improving insulin resistance, promoting weight loss, enhancing ovulation rates, and addressing broader metabolic concerns. Key therapeutic strategies include insulin sensitizers like metformin, ovulation induction agents like clomiphene citrate (CC) and aromatase inhibitors (AIs) such as letrozole, and the use of gonadotropins for resistant cases. Combining these treatments with dietary and lifestyle interventions, such as an anti-inflammatory diet, nutritional education, and personalized exercise programs, can enhance treatment outcomes. Through an integrated approach, significant improvements in metabolic health and reproductive function for women with PCOS are possible.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567760","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":"Induction of labor with repeated prostaglandin administration after failure of dinoprostone vaginal insert: a retrospective study comparing dinoprostone and misoprostol.","authors":"Matteo Mancarella, Diego Costa Torro, Giulia Moggio, Valentina E Bounous, Nicoletta Biglia","doi":"10.23736/S2724-606X.23.05414-3","DOIUrl":"10.23736/S2724-606X.23.05414-3","url":null,"abstract":"<p><strong>Background: </strong>Induction of labor in women with unfavorable cervix can be started with cervical ripening by dinoprostone vaginal insert. In cases of unsuccessful response, management is unclear: a possible option is a repeated induction with prostaglandins. The aim of this study was to assess the results of a second induction by either dinoprostone or misoprostol, comparing those treatments.</p><p><strong>Methods: </strong>A retrospective analysis was carried out on a cohort of 109 women with unsuccesful response to a first attempt of induction with dinoprostone vaginal insert, who required a second stimulation by either dinoprostone vaginal gel (56 patients) or oral misoprostol (53 patients). The outcomes assessed where the rates of active labor and vaginal delivery, and secondarily maternal and perinatal adverse events.</p><p><strong>Results: </strong>Overall 70.6% of patients reached active labor and 62.4% had a vaginal delivery; the efficacy of the double induction was similar for dinoprostone vaginal gel and oral misoprostol, with active labor in 69.6% and 71.7% (P=0.83), and vaginal delivery in 62.5% and 62.3% of patients (P=0.99) respectively. The incidence of adverse events was low, with no perinatal complications and similar rates of maternal complications, notably major post-partum hemorrhage in 1.8% and 3.8% of patients (P=0.61) for dinoprostone and misoprostol respectively.</p><p><strong>Conclusions: </strong>Dinoprostone vaginal gel and oral misoprostol as a second cycle of induction appear to be both effective in achieving active labor and vaginal delivery after failure of dinoprostone vaginal insert, without a significant rate of adverse events.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"19-26"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139576205","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":"Computerized cardiotocography and fetal heart response to maternal coffee intake: a prospective study.","authors":"Marco La Verde, Maria G Vastarella, Fabiana Savoia, Carlo Capristo, Maria M Marrapodi, Marina Tesorone, Davide Lettieri, Pasquale De Franciscis, Nicola Colacurci, Maddalena Morlando","doi":"10.23736/S2724-606X.24.05406-X","DOIUrl":"10.23736/S2724-606X.24.05406-X","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to determine the effect of caffeine on fetal heart rate (FHR) as determined by computerized cardiotocography (cCTG) parameters.</p><p><strong>Methods: </strong>Term pregnancies that performed a fetal antepartum cCTG were included. Two physicians recorded coffee habits before the cCTG, and pregnant women were divided into two groups: the coffee group and the control group. Furthermore, cCTG' parameters were compared between the two groups.</p><p><strong>Results: </strong>One hundred thirty-four pregnant women were enrolled. Based on maternal coffee habits, 82 pregnant women were allocated to the coffee group, while 52 were in the control group. The two groups shared similar demographic and obstetric characteristics. The mean daily coffee intake was 1.4±0.6 cups. Coffee group fetuses evidenced a lower FHR baseline, 135±9.9 bpm, versus the control group, 138±8.0 bpm, (P value = 0.03). Other cCTG parameters did not show statistical differences. Multivariate analysis demonstrated no confounding factors. A subanalysis that evaluated the daily amount of coffee consumed or the half-life of caffeine found no difference in cCTG measures.</p><p><strong>Conclusions: </strong>Maternal caffeine consumption did not influence fetal cardiac reactivity after absorption.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"4-11"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792820","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 use of combined hormonal contraceptive for in-vitro fertilization cycle priming is not associated with decreased pregnancy rate in frozen embryo transfer cycles: a cohort study.","authors":"Kristy K Cho, Chen Jing, Niamh M Tallon","doi":"10.23736/S2724-606X.23.05408-8","DOIUrl":"10.23736/S2724-606X.23.05408-8","url":null,"abstract":"<p><strong>Background: </strong>The objectives of this study are to evaluate the cycle outcomes from IVF treatment preceded by oral contraceptive pills (OCP) priming compared to estradiol pretreatment and to determine if there is a role for OCP priming for those undergoing frozen embryo transfers.</p><p><strong>Methods: </strong>The study took place at a university-affiliated fertility center in Canada. The study included in-vitro fertilization (IVF) antagonist cycles from Jan 2016 to Jun 2019. Those with protocol deviation or treatment cancellation were excluded.</p><p><strong>Results: </strong>There were 2237 cycles by 1958 patients; 27% of cycles utilized OCP priming. The average age in the OCP group was 34 years old compared to 36.5 in the estradiol group (P<0.01). AMH was reported in 43% of patients and was 3.7ng/mL in the OCP group versus 2.2 ng/mL in the estradiol group (P<0.01). The number of oocytes (15.2 vs. 12.5) and number of blastocysts (4.6 vs. 3.3) were higher in the OCP group (P all <0.01). After adjusting for age and AMH with linear regression for the 978 cycles with recorded AMH (24% with OCP prime), a significantly higher number of oocytes (13.8 vs. 11.9, P=0.002) was still noted in the OCP group. There were 866 euploid embryo transfer cycles (28% with OCP prime). There were no significant differences in implantation (77% vs. 76%) or ongoing pregnancy rates (56% vs. 54%) between those who had a frozen embryo transfer after OCP primed compared to estradiol primed stimulation cycles (P all >0.6).</p><p><strong>Conclusions: </strong>There were no differences in pregnancy outcomes from euploid frozen blastocyst transfers after OCP primed antagonist cycles compared to estradiol pretreatment. In fact, the use of OCP pretreatment was associated with increased oocyte yield, keeping in mind demographic differences with the OCP pretreatment group being younger with higher anti-Müllerian hormone and a higher prevalence of PCOS. Thus, OCP priming should still be considered in specific populations, such as those with oligo-ovulation or adequate ovarian reserve.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"12-18"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425082","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 January-February 2025 issue.","authors":"Antonio La Marca","doi":"10.23736/S2724-606X.25.05768-9","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05768-9","url":null,"abstract":"","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":"77 1","pages":"1-3"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812059","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":"What's new on female genital mutilation/cutting? Recent findings about urogynecologic complications, psychological issues, and obstetric outcomes.","authors":"Alessandro Libretti, Christian Corsini, Valentino Remorgida","doi":"10.23736/S2724-606X.23.05344-7","DOIUrl":"10.23736/S2724-606X.23.05344-7","url":null,"abstract":"<p><p>Female genital mutilation/cutting (FGM/C or FGM) are injuries to the female genital organs for non-medical reasons. Every year, over 4 million girls are at risk of FGM. Complications of this practice are very common and some of them are still under investigation. The purpose of this short narrative review is to highlight and summarize the main ones. Psychologic and psychiatric sequelae, chronic vulvar pain, urogenital symptoms, pelvic organs prolapse, sexual disfunction, cervical dysplasia and infections resulted as chronic sequalae of FGM. Severe pain, excessive bleeding, and tissues swelling are acute consequences of FGM. Rates of caesarean section, time of second stage of delivery, post-partum blood loss (but not major hemorrhage), peri-clitoral and perineal injuries and episiotomy rates are higher in pregnant women with FGM, when compared with those non victims of mutilation. The female genital mutilation practice is often cause of severe urogynecologic, psychologic and obstetrics sequelae. Although several studies have been carried out on FMG complications and treatments, long term sequelae are still very common and deserve major attention and further research.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"56-61"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9925493","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}