Valerio Carletti, Veronica Yacoub, Herbert C Valensise, Francesco Maneschi
{"title":"Induction of labor in high-risk nulliparous women with unfavorable cervix.","authors":"Valerio Carletti, Veronica Yacoub, Herbert C Valensise, Francesco Maneschi","doi":"10.23736/S2724-606X.24.05462-9","DOIUrl":"10.23736/S2724-606X.24.05462-9","url":null,"abstract":"<p><strong>Background: </strong>Inducing labor by ensuring a good maternal-fetal outcome is a challenge. The aim of the study was to evaluate the success rate, safeness, and time to delivery after the induction of labor (IOL), with the alternately first use of dinoprostone or Foley balloon, in high-risk pregnancy nulliparous women with unfavorable Bishop Score (BS).</p><p><strong>Methods: </strong>This is a retrospective study of high-risk nulliparous women who underwent the IOL, either with dinoprostone or the Foley balloon method. In the former case, if the labor has not started after dinoprostone removal, oxytocin infusion started. In Foley group, the BS was re-evaluated after Foley removal, and IOL continued with the use of dinoprostone (if BS<6) or oxytocin (if BS>6). Here, too, if no labor occurred after dinoprostone removal, Oxytocin was administered. Delivery mode, fetal and maternal complications were recorded. The time to delivery was tracked.</p><p><strong>Results: </strong>A total of 261 women were enrolled in the study. The CS rate was similar between groups (37.56% vs. 35.93%; P=0.81). Time to delivery was statistically lower in dinoprostone group (26.82h), as opposed to Foley (47.4h) (P<0.0001). Body Mass Index (BMI) of women who underwent Cesarean section (CS) was significantly higher than women who gave birth by vaginal delivery (VD), 26.80 vs. 27.40, P=0.012.</p><p><strong>Conclusions: </strong>IOL in high-risk pregnancy nulliparous women resulted in equal rate of CS between the two groups. Dinoprostone first use resulted in a shorter time to delivery, with no maternal-fetal side effects. There is then no need to prolong IOL and raise maternal stress, as this will not yield better outcomes.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"103-111"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291097","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}
Federica Savasta, Alessandro Libretti, Livio Leo, Libera Troìa, Valentino Remorgida
{"title":"Barbed suture in laparoscopic myomectomy.","authors":"Federica Savasta, Alessandro Libretti, Livio Leo, Libera Troìa, Valentino Remorgida","doi":"10.23736/S2724-606X.24.05494-0","DOIUrl":"10.23736/S2724-606X.24.05494-0","url":null,"abstract":"<p><p>Uterine myomas are the most common benign gynecological tumors among women of reproductive age. The laparoscopic approach, when feasible, is considered the most suitable and safe technique for intervention. Typically, uterine muscular wall defects are sutured with absorbable filaments. However, performing intra-corporeal knots during laparoscopic procedures demands significant surgical abilities and experience. While laparoscopic myomectomies are often recommended, they pose a high risk of hemorrhage. Barbed sutures may address the challenges of laparoscopic knotting due to their inherent barbs, leading to filament cohesion with tissues. This characteristic could potentially reduce the total operative time and blood loss during surgery. In consideration of the latest literature meta-analysis on the topic, published in 2018 and cited in the present work, six papers were included in this review, excluding case reports, reviews and articles without a control group. The objective of this narrative review is to explore the literature and establish the safety profile of barbed suture compared to conventional laparoscopic sutures. Additionally, given the potential for postoperative adhesion formation with the use of barbed sutures, the review also emphasizes reproductive outcomes. Consistent with previous literature, patients undergoing barbed suture laparoscopic myomectomy experienced significantly lower suturing time and blood loss. Regarding obstetric outcomes, all studies analyzing this aspect concluded that barbed sutures in myomectomy are as safe as, and represent an easier alternative to, conventional sutures. Importantly, these findings did not adversely affect pregnancy outcomes.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"128-136"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291195","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 March-April 2025 issue.","authors":"Antonio La Marca","doi":"10.23736/S2724-606X.25.05774-4","DOIUrl":"https://doi.org/10.23736/S2724-606X.25.05774-4","url":null,"abstract":"","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":"77 2","pages":"63-66"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111373","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}
Sarah Sears, Diana Mitchell, Anne Sammarco, David Sheyn
{"title":"Relationship between patient safety indicator events and hospital location for inpatient hysterectomy.","authors":"Sarah Sears, Diana Mitchell, Anne Sammarco, David Sheyn","doi":"10.23736/S2724-606X.24.05431-9","DOIUrl":"10.23736/S2724-606X.24.05431-9","url":null,"abstract":"<p><strong>Background: </strong>Previous studies suggest surgical quality outcomes are similar between rural and urban hospitals, but data about gynecology in rural hospitals is sparse.</p><p><strong>Methods: </strong>This was a retrospective cohort study utilizing the National Inpatient Sample database from the Agency of Healthcare Research and Quality. Patients who underwent benign hysterectomy for non-prolapse indications between 2012-2016 were identified using ICD-9 and 10 codes. Patients were stratified into rural or urban non-teaching groups; urban teaching hospitals were the referent group. The primary outcome was the rate of patient safety indicator (PSI) events. PSI events were identified using ICD-9 and 10 codes. Statistical analysis was performed using analysis of variance and uni- and multivariate Poisson regressions.</p><p><strong>Results: </strong>154,810 patients met all inclusion criteria. The cumulative rate of PSI events was 11.9% at rural hospitals, 13.9% at urban non-teaching hospitals and 16.9% at urban teaching hospitals, P<0.001. The most common PSI events were postoperative metabolic derangement, hemorrhage, and accidental puncture. The rate of transfusion was highest in urban teaching hospitals (6.7%) and similar for rural (5.1%) and urban non-teaching hospitals (5.5%), P<0.001. The rate of genitourinary tract injury was between 1.4-1.6%, and similar across sites, P=0.89. After adjusting for confounders, the risk of PSI events was similar across locations. The risk of transfusion was lower at rural hospitals (aRR=0.84, 95% CI: 0.74-0.94).</p><p><strong>Conclusions: </strong>Hysterectomy performed at rural hospitals, typically thought of as having low surgical volume compared to urban hospitals, is associated with similar risk of PSI events and lower risk of transfusion.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"67-74"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175541","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}
Maria I Yarmolinskaya, Olga B Glavnova, Natalia V Vorokhobina, Ludmila I Velikanova, Ekaterina V Malevanaya
{"title":"New characteristics of polycystic ovary syndrome phenotypes according to gas chromatography-mass spectrometry-based study of urinary steroid metabolome.","authors":"Maria I Yarmolinskaya, Olga B Glavnova, Natalia V Vorokhobina, Ludmila I Velikanova, Ekaterina V Malevanaya","doi":"10.23736/S2724-606X.24.05461-7","DOIUrl":"10.23736/S2724-606X.24.05461-7","url":null,"abstract":"<p><strong>Background: </strong>The most common cause of hyperandrogenism in women is polycystic ovary syndrome (PCOS), the prevalence of which among women of reproductive age ranges from 8.0 to 21%. The clinical manifestations of PCOS are diverse, and the degree of metabolic and hormonal disorders depends on the PCOS phenotype. The non-classic congenital adrenal hyperplasia (NCCAH) ranks second in the structure of diseases associated with hyperandrogenism. PCOS and NCCAH have a similar clinical picture and laboratory parameters, which requires differential diagnosis.</p><p><strong>Methods: </strong>Urinary steroid profiles were studied by gas chromatography-mass spectrometry.</p><p><strong>Results: </strong>We revealed differences in glucocorticoid and androgen metabolism in women with different PCOS phenotypes, which is reflected in the clinical manifestation of the disease. It was evaluated the activity of enzymes involved in the metabolism of steroid hormones. In patients with NCCAH, it was found that polycystic ovarian changes are secondary and develop due to the presence of prolonged adrenal hyperandrogenism.</p><p><strong>Conclusions: </strong>The results obtained are important for understanding the mechanisms of disorders in various variants of hyperandrogenism and determining further tactics for managing patients.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"93-102"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627146","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}
Ana M Fernández-Alonso, Isabel M Fernández-Alonso, Ignacio Rodríguez, Faustino R Pérez-López
{"title":"Age and phytoestrogen use, but not resilience, influence urinary incontinence in postmenopausal women.","authors":"Ana M Fernández-Alonso, Isabel M Fernández-Alonso, Ignacio Rodríguez, Faustino R Pérez-López","doi":"10.23736/S2724-606X.24.05440-X","DOIUrl":"10.23736/S2724-606X.24.05440-X","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to determine factors involved in urinary incontinence (UI), and psychological resilience in postmenopausal women.</p><p><strong>Methods: </strong>In this cross-sectional study, 137 postmenopausal women (aged 50-75 years) filled out the 4-item International Consultation on Incontinence Questionnaire short form (ICIQ-SF), the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), the 10-item Connor-Davidson Resilience Scale (CD-RISC), and a questionnaire containing personal data. We designed a directed acyclic graph (DAG) to identify covariates related to urinary incontinence and resilience in postmenopausal women.</p><p><strong>Results: </strong>The mean age of all surveyed women was 58.7±5.1 years, the majority were Caucasian (92.7%). There was an inverse correlation between item-1 ICIQ-SF scores and CD-RISC Scores. Women with severe UI had a higher median total ICIQ-SF score and lower total CD-RISC Scores as compared to those with nil or mild (P<0.05 for both). Odds ratios of sociodemographic and clinical characteristics indicate that phytoestrogen use (OR: 10.80; 95% CI 2.42-48.13) and economic problems (OR: 2.46; 95% CI 1.22-4.93) were associated with UI. However, a multivariable logistic model only identified urinary incontinence significantly associated with phytoestrogen use and age (P<0.05). The effect of other variables was attenuated in the model when controlling for population confounders, and significance was not achieved.</p><p><strong>Conclusions: </strong>Urinary incontinence was significantly associated with economic problems, phytoestrogen use, and depressive symptoms compared to women without urinary complaints. The multivariable logistic model confirmed age and phytoestrogen use as causal factors for urinary incontinence.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"75-84"},"PeriodicalIF":1.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391749","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}
Lior Friedrich, Raanan Meyer, Perry Tamar, Gabriel Levin
{"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":"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}
Matteo Mancarella, Diego Costa Torro, Giulia Moggio, Valentina E Bounous, Nicoletta Biglia
{"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}