Taiwanese Journal of Obstetrics & Gynecology最新文献

{"title":"Advanced high-grade serous carcinoma of the ovary after IVF treatment in a 38-year-old nulligravida: A case report of diagnostic challenges in the presence of OHSS","authors":"Yun-Yao Huang ,&nbsp;Tsung-Hsien Lee","doi":"10.1016/j.tjog.2025.04.017","DOIUrl":"10.1016/j.tjog.2025.04.017","url":null,"abstract":"<div><h3>Objective</h3><div>When there is massive ascites in a patient who has recently undergone IVF treatment, differentiating OHSS from ovarian cancer can be challenging. A detailed evaluation combining clinical history, ultrasound characteristics, and laboratory findings is essential. In cases where these initial evaluations are inconclusive, advanced imaging and histopathological examination may be necessary to achieve an accurate diagnosis.</div></div><div><h3>Case report</h3><div>We report the case of a 38-year-old nulligravida woman with no family history of breast or ovarian cancer who presented with progressive exertional dyspnea and massive ascites six weeks after completing two cycles of in vitro fertilization (IVF) at a private fertility clinic. She was initially diagnosed and treated for ovarian hyperstimulation syndrome (OHSS)at the clinic, a known complication of controlled ovarian stimulation at the clinic. However, her symptoms persisted and progressed beyond the typical 10–14-day resolution period for mild-to-moderate OHSS.</div><div>Upon presentation to our internal thoracic outpatient department, physical examination and imaging revealed right-sided pleural effusion and estimated ascites more than 2000 mL. Abdominal computed tomography demonstrated a large, multilocular, hypodense cystic mass measuring 12 × 12 cm originating from the right adnexa, accompanied by bilateral pleural effusions and diffuse ascites, raising suspicion for an underlying ovarian malignancy. The patient underwent thoracentesis and paracentesis twice within a seven-day interval, each time draining over 200 mL of pleural fluid and 2500 mL of ascitic fluid. Despite repeatedly negative cytological findings, the clinical course and radiologic features warranted surgical exploration.</div><div>Laparotomy confirmed the diagnosis of high-grade serous carcinoma of the ovary with extensive peritoneal and pleural metastases. Given the patient's strong desire for fertility preservation, a suboptimal debulking procedure was performed, including right salpingo-oophorectomy, left salpingectomy, left ovarian cystectomy, tumor debulking, omentectomy, and enterolysis. Postoperatively, she commenced chemotherapy with carboplatin and paclitaxel. Although BRCA1/2 testing was negative, she was found to carry a homologous recombination repair (HRR) mutation, and maintenance therapy with a PARP inhibitor is being considered. Additionally, adoptive immunotherapy with cytokine-induced killer (CIK) cells is under evaluation as part of a multimodal treatment approach.</div></div><div><h3>Conclusions</h3><div>This case highlights the diagnostic challenges in differentiating OHSS from malignancy in IVF patients with persistent and atypical symptoms. Comprehensive diagnostic approaches, including imaging and surgical exploration, are crucial for accurate diagnosis and appropriate management.</div></div>","PeriodicalId":49449,"journal":{"name":"Taiwanese Journal of Obstetrics & Gynecology","volume":"64 5","pages":"Pages 868-873"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027639","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":"Optimizing frozen embryo transfer for low-quality embryos: Comparing outcomes in natural cycle and hormone therapy cycle - A retrospective analysis","authors":"Tsun-Wen Hsiao ,&nbsp;Jen-Yu Wen ,&nbsp;Yi-Lun Lin ,&nbsp;Yi-Ting Chen ,&nbsp;Yi-Chen Chen ,&nbsp;Ming-Ting Chung ,&nbsp;Yung-Chieh Tsai","doi":"10.1016/j.tjog.2024.07.025","DOIUrl":"10.1016/j.tjog.2024.07.025","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to analyze potential disparities in clinical outcomes in two distinct regimens of frozen embryo transfer (FET): the natural cycle (NC-FET) and hormone therapy cycle (HT-FET), within the initial FET cycle of patients, according to embryo quality.</div></div><div><h3>Materials and Methods</h3><div>A retrospective cohort study was conducted on 970 women who underwent a total of 1365 FET cycles at our hospital between January 2010 and October 2020. Excluding cases with missing data and multiple FET cycles, the final analysis included 670 women. Of these, 121 women underwent NC-FET, while 549 women received HT-FET after estrogen priming. The two groups were further stratified based on the quality of transferred embryos into a high-quality embryo group and a low-quality embryo group. Clinical outcomes including implantation rate, clinical pregnancy rate, live birth rate and miscarriage rate were compared using statistical analysis such as Pearson's Chi-square, Fisher's exact test, and Student's t-test. Logistic regression analysis was employed to estimate the adjusted odds ratio between NC-FET and HT-FET cycles, while accounting for potential risk factors.</div></div><div><h3>Results</h3><div>No statistically significant differences were observed in clinical outcomes between NC-FET and HT-FET. Subgroup analysis, after adjusting for age, number of transferred embryos, gravida, and parity, revealed no significant differences in clinical outcomes for patients with high-quality embryos. Patients transferred with high-quality embryos in HT-FET group exhibited a significantly higher implantation rate (45 %, 95 % CI: 0.41–0.50) than those in the NC-FET group (34 %, 95 % CI: 0.26–0.43; p = 0.034). On the other hand, patients transferred with low-quality embryos demonstrated a significantly higher live birth rate in the NC-FET group (adjusted odds ratio 2.57, 95 % CI 1.12–5.91).</div></div><div><h3>Conclusion</h3><div>Opting for NC-FET for low-quality embryos may yield a more favorable live birth rate compared to the HT-FET regimen.</div></div>","PeriodicalId":49449,"journal":{"name":"Taiwanese Journal of Obstetrics & Gynecology","volume":"64 5","pages":"Pages 776-782"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027676","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":"Genetic insights and clinical outcomes in fetal ventriculomegaly: A retrospective analysis","authors":"Ling Zeng ,&nbsp;Meiqi Yi ,&nbsp;Ting Wang ,&nbsp;Jian Hu ,&nbsp;Hui Li ,&nbsp;Chengcheng Zhang ,&nbsp;Yanyi Yao ,&nbsp;Nian Liu ,&nbsp;Yayun Qin ,&nbsp;Runhong Xu ,&nbsp;Lijun Liu,&nbsp;Jieping Song","doi":"10.1016/j.tjog.2025.05.016","DOIUrl":"10.1016/j.tjog.2025.05.016","url":null,"abstract":"<div><h3>Objective</h3><div>Fetal ventriculomegaly (VM) is a common ultrasound finding with potential implications for pregnancy outcomes. There are few studies on the prevalence of genetic abnormalities in fetal VM. We aim to investigate the chromosomal and monogenic abnormalities risk and evaluate outcomes of fetal VM.</div></div><div><h3>Materials and methods</h3><div>We analyzed data from 211 pregnancies with fetal VM. Chromosomal abnormalities were assessed using karyotyping and/or CMA/CNV-Seq, and monogenic variations were detected through whole exome sequencing (WES) in cases with negative initial results. Pregnancy outcomes were also evaluated.</div></div><div><h3>Results</h3><div>The mean gestational age at VM detection was 27.0 weeks. Chromosomal abnormalities were detected in 13.3 % of cases overall, with a refined positive rate of 9.0 % after excluding polymorphisms and VUS CNVs. Subgroup analysis of 106 isolated VM cases revealed no significant differences in chromosomal abnormalities between unilateral and bilateral VM or between mild and moderate VM. Futhermore, 55 fetuses underwent WES, revealing pathogenic or likely pathogenic variants in 20 % of cases. Non-isolated VM cases showed a significantly higher rate of monogenic abnormalities (<em>P</em> = 0.01). Pregnancy outcomes indicated that isolated VM cases had a higher rate of normal development (89.2 %) compared to non-isolated cases (58.6 %), which also had higher rates of induced labor, stillbirths, and neonatal deaths. Ultrasound follow-up of 123 fetuses without chromosomal abnormalities showed that mild VM predominantly resolved or remained stable, while severe VM had a significantly higher progression rate compared to moderate VM.</div></div><div><h3>Conclusion</h3><div>The study highlights the importance of distinguishing between isolated and non-isolated VM in prenatal diagnostics. Severe VM is associated with higher progression rates, while WES provides valuable insights into monogenic abnormalities, particularly in non-isolated cases. These findings underscore the need for comprehensive prenatal evaluation to better inform clinical decision-making and predict pregnancy outcomes.</div></div>","PeriodicalId":49449,"journal":{"name":"Taiwanese Journal of Obstetrics & Gynecology","volume":"64 5","pages":"Pages 822-830"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027631","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":"The size of expanded blastocyst is not associated with the embryo ploidy status: A retrospective review of 434 embryos","authors":"Ching-Jung Lin ,&nbsp;Ya-Li Huang ,&nbsp;Ping-Lun Lin ,&nbsp;Yen-Chen Wu ,&nbsp;Chi-Huang Chen","doi":"10.1016/j.tjog.2025.01.010","DOIUrl":"10.1016/j.tjog.2025.01.010","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates the relationship between embryo development duration, blastocyst inner diameter, and ploidy status.</div></div><div><h3>Material and methods</h3><div>A retrospective observational study was conducted in a university-based reproductive center from August 2021 to July 2023. After excluding cases with missing data, 434 embryos from 121 cycles involving 96 patients were analyzed. Embryos cultured in time-lapse incubator system following ICSI. Laser ablation performed on day 4 for preimplantation genetic testing for aneuploidy (PGT-A). Based on PGT-A results, the embryos were classified as euploidy, aneuploidy and mosaicism. The Gardner grading system, day 3 and day 5/6 KIDScore, and measurements of time from insemination to fully expanded blastocyst ready for hatching (tHB) and blastocyst inner diameter were recorded. Kruskal–Wallis test was applied for measuring the data without normal distribution.</div></div><div><h3>Results</h3><div>Blastocysts were categorized into euploidy, aneuploidy, and mosaicism groups. The tHB differed significantly: euploidy (109.27 ± 10.57 h), aneuploidy (114.26 ± 10.90 h), and mosaicism (110.47 ± 10.41 h) (p &lt; 0.001). Blastocyst inner diameter showed no significant difference: euploidy (133.6 ± 7.8 μm), aneuploidy (133.7 ± 8.3 μm), and mosaicism (133.7 ± 8.4 μm) (p = 0.75). Higher day 5/6 KIDScore correlated with increased euploidy likelihood, while day 3 scores showed no significant impact. Subgroup analysis revealed similarities in duration, diameter, and KIDScore among various types of aneuploid embryos, including those with single, two or three chromosomal abnormalities, as well as complex aneuploidy. Mosaic embryos were classified into low (30–50 %) and high (50–80 %). Low mosaic embryos resembled euploid ones in most parameters, unlike high mosaic embryos.</div></div><div><h3>Conclusion</h3><div>Blastocyst inner diameter showed no significant association with ploidy status post-assisted hatching for PGT-A. Euploid embryos reached full expansion faster, while aneuploid and mosaic embryos took longer. Low mosaic embryos resembled euploid embryos, unlike high mosaic ones. Therefore, tHB and day 5/6 KIDScore could aid in selecting high-quality embryos for genetic testing post-assisted hatching.</div></div>","PeriodicalId":49449,"journal":{"name":"Taiwanese Journal of Obstetrics & Gynecology","volume":"64 5","pages":"Pages 783-789"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027682","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":"Cervical pessary for preterm-birth prevention among pregnant women with a short cervix: A prospective cohort study","authors":"Thoai Ngoc Nguyen ,&nbsp;Ngoc-Trinh Thi Nguyen ,&nbsp;Chuong Hoang Nguyen ,&nbsp;Khanh-Trang Nguyen Huynh ,&nbsp;Diem-Tuyet Thi Hoang","doi":"10.1016/j.tjog.2025.01.011","DOIUrl":"10.1016/j.tjog.2025.01.011","url":null,"abstract":"<div><h3>Objective</h3><div>Congenital abnormalities or secondary factors are reasons for cervical insufficiency. The Arabin pessary has been widely adopted in several countries to manage the condition. However, its usage has yet to be prevalent in Vietnam. This study aimed to evaluate the success rate of delivery (at 34 weeks or later) after Arabin pessary in pregnant women with a short cervical length (&lt;25 mm) at Hung Vuong Hospital and adverse events.</div></div><div><h3>Materials and methods</h3><div>A prospective cohort study was conducted on 176 pregnant women, involving singleton pregnancies with gestational ages ranging from 24 to 32 weeks and cervical lengths less than 25 mm. The participants who agreed to the Arabin pessary were monitored periodically, and any adverse events were recorded until spontaneous labor occurred.</div></div><div><h3>Results</h3><div>From January to October 2022, pregnant women with Arabin pessary placement were followed until delivery at Hung Vuong Hospital. The success rate (birth at 34 weeks or later) was 88.1 % (95 % CI: 82.3–92.5), and the full-term birth rate (at 37 weeks or later) was 64.8 %. Adverse effects included vaginal discharge (29.7 %), fungal vaginitis (8.7 %), and urinary tract infection (5.8 %); neonates admitted to the NICU accounted for 11.4 %. Regression analysis revealed a significant association between a history of preterm birth and the incidence of preterm birth before 34 weeks (OR = 3.4, 95 % CI [1.1–10.5], p = 0.02).</div></div><div><h3>Conclusions</h3><div>The success birth rate (delivered from 34 weeks or later) was high when placing the cervical pessary in pregnant women with a short cervical length &lt;25 mm. The history of preterm birth was associated with the rate of delivery before 34 weeks of gestation. The results of this cohort study underscore the need for further investigation in large-scale advanced studies to establish a higher level of evidence and ensure the best outcomes for maternal and child health.</div></div>","PeriodicalId":49449,"journal":{"name":"Taiwanese Journal of Obstetrics & Gynecology","volume":"64 5","pages":"Pages 790-795"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027683","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":"Low-level mosaicism for 45,X in 45,X/46,XY at amniocentesis in a twin pregnancy with a favorable fetal outcome","authors":"Chih-Ping Chen","doi":"10.1016/j.tjog.2025.07.013","DOIUrl":"10.1016/j.tjog.2025.07.013","url":null,"abstract":"","PeriodicalId":49449,"journal":{"name":"Taiwanese Journal of Obstetrics & Gynecology","volume":"64 5","pages":"Pages 917-919"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026410","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":"Mosaicism for trisomy 2 in a single colony at amniocentesis in a pregnancy with a favorable outcome","authors":"Chih-Ping Chen","doi":"10.1016/j.tjog.2025.07.004","DOIUrl":"10.1016/j.tjog.2025.07.004","url":null,"abstract":"","PeriodicalId":49449,"journal":{"name":"Taiwanese Journal of Obstetrics & Gynecology","volume":"64 5","pages":"Page 889"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026494","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":"The role and potential effects of relaxation exercises in the treatment of primary dysmenorrhea","authors":"Wei-Ting Chao,&nbsp;Chia-Hao Liu,&nbsp;Peng-Hui Wang","doi":"10.1016/j.tjog.2025.07.016","DOIUrl":"10.1016/j.tjog.2025.07.016","url":null,"abstract":"","PeriodicalId":49449,"journal":{"name":"Taiwanese Journal of Obstetrics & Gynecology","volume":"64 5","pages":"Pages 765-766"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027674","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":"KELIM score and BRCA status are unreliable to predict the completeness of cytoreduction during interval debulking surgery with hyperthermic intraperitoneal chemotherapy for ovarian cancers","authors":"Yu-Min Fan ,&nbsp;Jian-Syun Chen ,&nbsp;Hsiao-Li Kuo ,&nbsp;Tzu-Chien Chen ,&nbsp;Kung-Liahng Wang ,&nbsp;Jen-Ruei Chen","doi":"10.1016/j.tjog.2025.05.015","DOIUrl":"10.1016/j.tjog.2025.05.015","url":null,"abstract":"<div><h3>Objective</h3><div>The gold standard for treating primary advanced ovarian, primary peritoneal, and fallopian tubal cancers (OC) is optimal debulking surgery plus adjuvant chemotherapy. Neoadjuvant chemotherapy followed by optimal interval debulking surgery (NACT/IDS) with hyperthermic intraperitoneal chemotherapy (HIPEC) provides better survival outcomes than without HIPEC in current literature. The modeled CA-125 elimination rate constant k (KLEM) score reflects the response of NACT before IDS. A BRCA mutation may indicate a better response to chemotherapy and improved outcomes in OC. However, the correlation between these two factors and the completeness of cytoreduction (CC) during IDS/HIPEC has been less extensively discussed.</div></div><div><h3>Material and methods</h3><div>We retrospectively enrolled 17 HIPEC cases, including 10 NACT/IDS and seven secondary cytoreductive surgery (SCS) cases after database searching and chart review. The KELIM score was calculated in the NACT/IDS group for predicting the residual status of surgery.</div></div><div><h3>Results</h3><div>The survivorship between NACT/IDS and SCS was similar. There is no major surgical complication, morbidity or mortality after HIPEC. In the IDS group, five cases reached CC scores of 0 (however, two of these cases had an unfavorable KELIM score), four cases reached a CC of 1, and one case had a CC of 2, but with a favorable KELIM score. In the SCS group, three cases reached a CC of 0, two reached a CC of 1, and two reached a CC of 2. There was no serious post-operative morbidity or mortality after HIPEC. The KELIM score showed a weak correlation with the CC score. Two cases with BRCA 1/2 mutation showed unfavorable KELIM scores and only one case reached CC of 0.</div></div><div><h3>Conclusion</h3><div>After the maturation of the HIPEC techniques, this procedure is safe and feasible. Currently, there are no reliable pre-operative markers, including KELIM score or BRCA1/2 status, which could predict the CC score after surgery.</div></div>","PeriodicalId":49449,"journal":{"name":"Taiwanese Journal of Obstetrics & Gynecology","volume":"64 5","pages":"Pages 796-801"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145027684","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":"High-level mosaicism for 45,X in 45,X/46,XY at amniocentesis in a pregnancy with positive non-invasive prenatal testing for Turner syndrome, a 45,X placenta, hypospadias and unilateral cryptorchidism in the fetus without adverse fetal outcome and perinatal progressive decrease of the 45,X cell line","authors":"Chih-Ping Chen","doi":"10.1016/j.tjog.2025.07.003","DOIUrl":"10.1016/j.tjog.2025.07.003","url":null,"abstract":"","PeriodicalId":49449,"journal":{"name":"Taiwanese Journal of Obstetrics & Gynecology","volume":"64 5","pages":"Pages 886-888"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026493","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}