Journal of Obstetrics and Gynecology of India最新文献

{"title":"Introducing Birth Companion in Labour: A Quality Improvement Initiative.","authors":"Tamkin Khan, Ayesha Ahmad, Bushra Fatima, Saman Furqan, Enas Mushtaq, Tabassum Nawab, Aparna Sharma","doi":"10.1007/s13224-023-01780-w","DOIUrl":"10.1007/s13224-023-01780-w","url":null,"abstract":"<p><strong>Background: </strong>Birth companion (BC) has been globally recognised as an essential component of childbirth care. As our institution did not allow BC in labour, this study was planned as a quality improvement (QI) project to introduce the concept. We aimed to achieve birth companionship from existing 0 to 100% over a period of six months.</p><p><strong>Intervention: </strong>QI team was constituted, and an initial brainstorming session conducted. A fishbone diagram was drawn to analyse issues that need addressal before implementation of the initiative. The framework was defined, and team members assigned their roles and responsibilities. A series of five successive Plan-Do-Study-Act (PDSA) cycles were carried out over a period of six months, which included introduction of the concept, dissemination of information, infrastructural changes in labour room and introducing column for documentation in birth register. To achieve sustainability, comprehensive group counselling sessions were started for women during antenatal period, and sensitisation classes were regularly conducted for newly inducted trainees and faculty.</p><p><strong>Result: </strong>Birth companionship was achieved in 98% of cases.</p><p><strong>Conclusion: </strong>The QI tools helped in preparation and planning of changes by breaking down a large problem into smaller sections and covering all aspects of challenges in a systematic manner using team-based approach. National directives and recommendations, sensitisation of leadership and training of stakeholders were found to be important facilitators. Robust systems of monitoring and successive PDSA cycles were needed for continuous improvement and sustainability of the idea.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"73 Suppl 1","pages":"1-10"},"PeriodicalIF":0.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10616060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Placental Vascularization Indices and Shear Wave Elastography in Fetal Growth Restriction.","authors":"Anagha Menon, Jyoti Meena, Smita Manchanda, Seema Singhal, Swati Shivhare, Sunesh Kumar","doi":"10.1007/s13224-023-01826-z","DOIUrl":"10.1007/s13224-023-01826-z","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the role of placental vascularisation indices using 3D-Power Doppler and placental elasticity using Shear Wave Elastography (SWE) in Fetal Growth Restricted (FGR) pregnancies and to assess their correlation with perinatal outcomes.</p><p><strong>Methods: </strong>This prospective case-control study was conducted from June 2018-2020. Thirty women with FGR and thirty controls (24-36 weeks) underwent grayscale and Doppler ultrasonography followed by measurement of vascularisation indices and SWE from the central and peripheral parts of fetal and maternal surfaces of the placenta. Participants were followed till delivery and perinatal outcomes were noted.</p><p><strong>Results: </strong>Vascularisation indices were significantly reduced among FGR vs. controls: Vascularisation Index (VI): 20.90 ± 5.46 vs. 31.49 ± 3.89, Flow Index (FI): 26.29 ± 1.70 vs. 30.85 ± 2.02, Vascularisation- Flow Index (VFI): 7.06 ± 2.42 vs. 12.37 ± 2.43, <i>p</i> < 0.001. The mean placental SWE (17.36 ± 1.50 kPa) in FGR pregnancies was significantly higher as compared to controls (4.14 ± 1.14 kPa), <i>p</i> < 0.001. Neonatal polycythaemia and hyperbilirubinemia were significantly increased in FGR pregnancies with higher SWE value. Receiver operating characteristic curve-based cut-off of VI for intensive care requirement was 23.0 (sensitivity: 75%, specificity: 71%) and for tachypnea was 22.8 (73% sensitivity and specificity). The cut-off of FI for low birth weight was 25.7 (sensitivity: 69.6%, specificity: 71.4%).</p><p><strong>Conclusion: </strong>This study demonstrates that increased placental stiffness and reduced vascularisation in FGR indicate possible placental pathology. Both modalities help in predicting perinatal complications. Hence, vascularisation indices and SWE reflect the extent of placental insufficiency and can be useful adjuncts in diagnosis.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"73 Suppl 1","pages":"75-82"},"PeriodicalIF":0.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of Post-hysterectomy Vault Prolapse and Surgical Management.","authors":"Hemangi J Kansaria, Tulika Chouhan","doi":"10.1007/s13224-023-01757-9","DOIUrl":"10.1007/s13224-023-01757-9","url":null,"abstract":"<p><strong>Purpose of study: </strong>To study the epidemiology and various methods of repair of vaginal vault prolapse in selected group of patients and the benefits of various modes of treatment in the management of vault prolapse.</p><p><strong>Methods: </strong>Thirty-seven patients with grade lll or lV vault prolapse were enrolled in our study. Sacrospinous fixation was performed in 37 patients. High risk factors for prolapse, surgical results and complications were evaluated.</p><p><strong>Results: </strong>In the current study, maximum cases of vault prolapse, 67.6%, were in the age group of 51-60 years. Out of 37 patients, 18.9% had a history of chronic cough secondary to bronchial asthma or past history of tuberculosis And 13.5% had a bowel dysfunction (chronic constipation). Vaginal vault prolapse most commonly was seen following vaginal hysterectomy (43.3%) as compared to total abdominal hysterectomy (29.7%). Most common surgery was performed for post-hysterectomy vault prolapse being sacrospinous fixation in the current study. In total, 29.7% of the patients had early post-operative complications like urinary tract infection (16.2%), urinary retention (5.4%) and buttock pain (5.4%), and 2.7% had vaginal cuff cellulitis. Dyspareunia is a common complication post-operatively following sacrospinous fixation, due to shortening of vaginal length post-procedure.</p><p><strong>Conclusion: </strong>Only 29.7% patients had complications, among which most common complication was urinary tract infection, which was treated with injectable antibiotics, urinary retention and buttock pain being the less common complication. Dyspareunia was present only in 18.9% cases post-operatively due to vaginal shortening associated with the procedure. Sacrospinous fixation is a safe and effective procedure.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13224-023-01757-9.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"73 Suppl 1","pages":"124-129"},"PeriodicalIF":0.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10616018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction Models for Adverse Pregnancy Outcomes in India: Methodological Considerations for an Emerging Topic.","authors":"Gavin Pereira","doi":"10.1007/s13224-021-01617-4","DOIUrl":"https://doi.org/10.1007/s13224-021-01617-4","url":null,"abstract":"<p><p>Stillbirth is over-represented in lower and lower-middle-income countries and understandably this has motivated greater research investment in the development of prediction models. Prediction is particularly challenging for pregnancy outcomes because only part of the population is represented in observational research. Notably, unrecognised pregnancies and miscarriages are typically excluded from the development of prediction models and the consequences of such selection are not well understood. Other methodological challenges in developing stillbirth prediction models are within the control of the researcher. Identifying whether the intended model is for aetiological explanation versus prediction, attainment of a sufficiently large representative sample, and internal and external validation are among such methodological considerations. These considerations are discussed in relation to a recently published study on prediction of stillbirth after 28 weeks of pregnancy for women with hypertensive disorders of pregnancy in India. The predictive ability of this model amounts to the flip of a coin. Future screening based on such a model may be expensive, increase psychological distress among patients and introduce additional iatrogenic perinatal morbidities from over-treatment. Future research should address the methodological considerations described in this article.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"73 5","pages":"461-463"},"PeriodicalIF":0.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Action Taken in Response to Stillbirth Audit: A Success Story.","authors":"Manisha Kumar, Manju Puri, Millo Suka, Nupur Chawla, Gagan Preet Kaur, Reena Yadav, Kiran Agrawal, Ratna Biswas","doi":"10.1007/s13224-023-01808-1","DOIUrl":"10.1007/s13224-023-01808-1","url":null,"abstract":"<p><strong>Objectives: </strong>Study the impact of intra-facility interventions on the modifiable factors causing stillbirths (SB), using point-of-care quality improvement (POCQI) methodology.</p><p><strong>Material and methods: </strong>Stillbirth data during the 9 months pre-intervention period were reviewed to identify the common preventable causes. Two interventions, namely, ultrasound at 34-36 weeks gestation and intrapartum monitoring on a common customized labor chart for all health-care providers, were done. Post-intervention data were collected to observe the impact of the interventions.</p><p><strong>Results: </strong>The stillbirth rate reduced from 212/5940 deliveries (35.7/1000) in the pre-intervention period to 165/5993 deliveries (27.7/1000) in the post-intervention period (<i>p</i> = 0.011). The intra-facility failure to identify FGR significantly reduced in the post-intervention group (<i>p</i> = 0.033), leading to 63% (RR 0.37) reduction in its risk. Using a common customized labor chart led to a significant decline in the inadequate monitoring as a provider-related cause of stillbirth (<i>p</i> < 0.001) leading to its 42% decline as contributor to modifiable cause of SB (RR 0.48).</p><p><strong>Conclusion: </strong>Reviewing the perinatal death surveillance response (PDSR) data, identifying gaps in care, and using improvement methodology for instituting corrective measures play an important role in reducing intramural stillbirths.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"73 Suppl 1","pages":"61-68"},"PeriodicalIF":0.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10616033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of P16 Immunohistochemistry Positive Staining and Its Correlation to Clinical and Radiological Staging of Squamous Cell Carcinoma of the Cervix.","authors":"Hossam H El Sokkary, Eman Sheta","doi":"10.1007/s13224-023-01772-w","DOIUrl":"10.1007/s13224-023-01772-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cervical cancer is the fourth most common genital tract cancer and fourth common cause of death among the causes of neoplasm-related mortality in women worldwide. Squamous cell carcinoma is the most common type and constitutes about 90% of all pathological types of cervical cancer. Cyclin-dependent kinase inhibitor 2A (CDKN2A; p16) is a gene that is located on chromosome 9 that encodes a protein (P16) that inhibits cyclin-dependent kinases 4 and 6 which are inhibitors of retinoblastoma protein; the net result is reactivation of retinoblastoma protein and arrest of cell cycle in G1 phase. So, expression of p16 protein within cancer cell may denote good prognosis. The presence of a soft marker that can detect hidden advanced stages in apparently clinically and radiologically early resectable stages of cervical cancer and can replace life-threatening preoperative lymphadenectomy is of great importance. Is P16 protein which when expressed is associated with good prognosis in other cancer can be this soft marker?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim of the study: &lt;/strong&gt;The aim of this study is to estimate the prevalence of cyclin-dependent kinase inhibitor 2A (CDKN2A; p16) immunohistochemistry positive staining in squamous cell carcinoma of the cervix and to correlate its positivity  to clinical and radiological disease stage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods: &lt;/strong&gt;An analytical cross-sectional observational prospective and retrospective study was conducted on 60 invasive squamous cell cervical cancer patients from gyne-oncology unit at Al Shatby university hospital after taking a written consent and following approval by Alexandria medical school institutional ethics committee. Inclusion criteria included all patients with invasive squamous cell carcinoma of the cervix prospective and retrospective from January 2019 till June 2022 diagnosed by taking wedge, punch and cone biopsy followed by histopathological examination that confirmed the diagnosis and showed grading and types of squamous cell carcinoma. Clinical examination, vaginal ultrasonographic scanning, computerized axial tomography and magnetic resonance imaging were carried out to all cases, and data were recorded for clinical and radiological staging purposes. All data were collected, coded, tabulated and statistically analyzed to estimate the prevalence of p16 positivity in the study cases and to correlate its positivity with clinical and radiological disease stage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;In relation to prevalence of p16 immunostaining, 34 cases (56.7%) were positive in comparison with 26 cases (43.3%) being negative. Considering correlation between early resectable stage and late nonresectable stage with P16 positive and negative staining, the result showed the following: 32 cases (53.3%) were resectable, 30 cases (88.2%) of them were P16 positive immunostaining compared to 2 cases (7.7%) being P16 negative immunostaining while nonresectable cases were 28 cas","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"73 Suppl 1","pages":"142-149"},"PeriodicalIF":0.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10616005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Voices from Health Care Providers: Assessing the Impact of the Indian Assisted Reproductive Technology (Regulation) Act, 2021 on the Practice of IVF in India.","authors":"Jaydeep Tank,&nbsp;Prabha Kotiswaran,&nbsp;Parikshit Tank,&nbsp;Dev Tank,&nbsp;Jash Tank","doi":"10.1007/s13224-023-01815-2","DOIUrl":"https://doi.org/10.1007/s13224-023-01815-2","url":null,"abstract":"<p><p>The regulatory vacuum in the field of ART in India was filled when in December 2021, the Assisted Reproductive Technology (Regulation) Act, 2021 (ART Act) (https://egazette.nic.in/WriteReadData/2021/232025.pdf) and the Surrogacy (Regulation) Act, 2021 (SR Act) were passed. We surveyed medical professionals to understand their knowledge, attitude and perception towards the Acts and to offer an initial, snapshot assessment of their impact on the medical community. The government has already signalled its intent to implement the Acts and has published several notifications/gazettes to clarify and amend the issues surrounding the Acts (https://artsurrogacy.gov.in/NationalArtSurrogacy/faces/HomePage.xhtml#). We hope that these responses will help to voice the thoughts, concerns and suggestions from of ART service providers for ART to further clarify and rationalise the laws. Infertility is already a much stigmatised problem which deserves to be a higher public health priority. While the laws are a welcome step, changes in both laws is are the need of the hour to make ART more accessible, available and affordable to the millions of couples who need these services and for the health care providers who to be able to deliver them.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"73 4","pages":"301-308"},"PeriodicalIF":0.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10221637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elective Single Cleavage-Stage Embryo Transfer in IVF Patients with Suboptimal Ovarian Response is Not Detrimental to Cumulative Pregnancy and Reduces Multiple Pregnancy Rates.","authors":"Alessio Paffoni, Sabrina Cesana, Laura Corti, Hilda Wyssling, Alessandro Kunderfranco, Marco Claudio Bianchi","doi":"10.1007/s13224-023-01768-6","DOIUrl":"10.1007/s13224-023-01768-6","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether elective single embryo transfer in patients with suboptimal response to ovarian stimulation is detrimental to pregnancy rates compared to double embryo transfer.</p><p><strong>Methods: </strong>A case-control retrospective study was performed in a cohort of couples undergoing IVF at the Infertility Unit of the ASST Lariana with ≤ 9 oocytes and at least 2 viable embryos. A total of 424 women were analyzed in the \"double embryo transfer\" group (<i>n</i> = 212) and elective \"single embryo transfer\" group (<i>n</i> = 212); they were matched 1:1 for female age, ovarian reserve and number of previous cycles. Cumulative clinical pregnancy rate per oocyte retrieval was the main outcome.</p><p><strong>Results: </strong>The cumulative pregnancy rate per cycle, including the fresh embryo and subsequent frozen embryo transfers, was 26% and 26%, respectively. Considering the main confounding factors, a binomial logistic model indicated that the cumulative clinical pregnancy rate was not significantly affected when a single embryo transfer was performed in women recovering up to nine oocytes.</p><p><strong>Conclusion: </strong>Live birth rate was similar between the two groups, while twin pregnancies were significantly reduced in women receiving single embryo transfer suggesting that elective single embryo transfer in patients with a limited number of embryos is not detrimental to pregnancy rates.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"73 4","pages":"329-335"},"PeriodicalIF":0.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Inception-ResNet: A Novel Approach for Personalized Prediction of Cumulative Pregnancy Outcomes in Vitro Fertilization Treatment (IVF).","authors":"Gaurav Majumdar, Abhishek Sengupta, Priyanka Narad, Harshita Pandey","doi":"10.1007/s13224-023-01773-9","DOIUrl":"10.1007/s13224-023-01773-9","url":null,"abstract":"<p><strong>Background: </strong>Infertility is one of the major causes of socioeconomic stress worldwide due to social stigma and stressful lifestyles. Despite technological advances, couples still undergo several IVF cycles for conceiving without knowing their true prognosis which is causing a huge social and medical impact, and the live birth rate continues to be relatively low (~ 25%). A prediction model that predicts IVF prognosis accurately considering the pre-treatment parameters before starting the IVF cycle will help clinicians and patients to make better-informed choices.</p><p><strong>Methods: </strong>In this study, clinical details of 2268 patients with 79 features who underwent IVF/ICSI procedure from January 2018 to December 2020, at the Center of IVF and Human Reproduction, Sir Ganga Ram Hospital were retrospectively collected. The machine learning model was developed considering features such as maternal age, number of IVF cycle, type of infertility, duration of infertility, AMH, indication for IVF, sperm type, BMI, embryo transfer, and β-hCG value at the end of a fresh cycle and/or one subsequent frozen embryo transfer cycle was selected as the measure of outcome.</p><p><strong>Results: </strong>Compared to other classifiers, for an 80:20 train-test split with feature selection, the proposed Deep Inception-Residual Network architecture-based neural network gave the best accuracy (76%) and ROC-AUC score of 0.80. For tabular datasets, the applied approach has remained unexplored in previously made studies for reproductive health.</p><p><strong>Conclusion: </strong>This model is the starting point for providing a personalized prediction of a successful outcome for an infertile couple before they enter the IVF procedure.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13224-023-01773-9.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"73 4","pages":"343-350"},"PeriodicalIF":0.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10239177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Non-Cavity-Distorting Intramural Fibroids on IVF Outcomes in Patients with Recurrent IVF Failure: Does Myomectomy Change IVF Outcomes ?","authors":"Ugur Deger, Ekin Altinbas, Melis Karabay, Yagmur Karatas, Zeynep Deniz, Ceyda Buyuker, Sule Yildirim Kopuk, Bulent Tiras, Yigit Cakiroglu","doi":"10.1007/s13224-023-01750-2","DOIUrl":"10.1007/s13224-023-01750-2","url":null,"abstract":"<p><strong>Background: </strong>Uterine fibroids are the most common benign smooth muscle tumors of the uterus. However, there is no consensus on whether myomectomy improves IVF success in women with non-cavity-distorting intramural fibroids. The aim of this study was to compare the IVF and pregnancy outcomes of women who had non-cavity-distorting intramural fibroids and underwent myomectomy vs women who had intramural fibroids, but did not undergo myomectomy.</p><p><strong>Methods: </strong>A retrospective cohort study at Acibadem Maslak Hospital, IVF Center, between 2019 and 2020. Data of 128 women aged between 25 and 43 years who have at least 2 intramural non-cavity-distorting fibroids of 2-6 cm in size were used. All patients had at least two IVF failure. The intervention group comprised women who decided to proceed to myomectomy before IVF (Group 1, <i>n</i> = 56). The control group was established women with intramural fibroids who reject myomectomy (Group 2, <i>n</i> = 71).</p><p><strong>Results: </strong>In regard to IVF result parameters and perinatal outcomes, there was no statistically significant difference between the two groups. Between study groups, there were no statistically significant differences in the perinatal outcomes. Myomectomy surgery did not increase miscarriage and biochemical pregnancy rate (odds ratio (OR) 0.9; 95% confidence interval (CI) 2.8-3.7).</p><p><strong>Conclusion: </strong>Myomectomy does not impact on pregnancy or live birth rates substantially, according to the results of this study.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"73 4","pages":"322-328"},"PeriodicalIF":0.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10295014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}