Archives of Gynecology and Obstetrics最新文献

{"title":"Should we restrict food intake during labor? A randomized controlled trial","authors":"Gil Shechter Maor,&nbsp;Rona Bogin Greenfield,&nbsp;Sivan Farladansky-Gershnabel,&nbsp;Dana Sadeh Mestechkin,&nbsp;Hanoch Schreiber,&nbsp;Tal Biron-Shental,&nbsp;Omer Weitzner","doi":"10.1007/s00404-024-07820-8","DOIUrl":"10.1007/s00404-024-07820-8","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate whether consuming food during labor influences its outcomes.</p><h3>Methods</h3><p>This randomized controlled study included healthy, laboring patients at 37–41 weeks of gestation. After epidural anesthesia, patients were randomized into groups of eating at will versus drinking clear fluids only. The primary composite outcome included unplanned cesarean delivery, the need for general anesthesia, asphyxia, postpartum fever, and prolonged postpartum admission (more than 5 days). Secondary outcomes included the need for oxytocin, length of the second stage of labor, postpartum analgesia requirements, and early maternal and neonatal outcomes.</p><p>Sample size analysis indicated that 126 patients needed to be randomized to detect a statistically significance difference between the groups.</p><h3>Results</h3><p>A total of 129 patients were randomized: 58 to the fluids-only group and 71 to the food group. The groups had similar basic characteristics. The composite outcome of complications attributed to eating during labor and delivery was comparable between groups. Labor progression and the need for oxytocin augmentation were similar in both groups. The groups had comparable fetal heart rate tracings, modes of delivery, maternal and neonatal outcomes, and complications. None of the patients in the study experienced aspiration or an indication for general anesthesia.</p><h3>Conclusion</h3><p>While our data suggest that eating during labor does not adversely affect labor progression or outcomes, we recommend a cautious approach, allowing patients autonomy while considering individual risk factors.</p><h3>Trial registration</h3><p>The study has been registered in the primary clinical trial registry on 02/12/2023. ISRCTN trial number ISRCTN11794106, registration number 44513. https://www.isrctn.com/ISRCTN11794106.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 6","pages":"2983 - 2989"},"PeriodicalIF":2.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Davydov-Moore vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome: sexual and surgical outcomes.","authors":"Magdalena Piróg, Magdalena Bednarczyk, Katarzyna Barabasz, Olga Kacalska-Janssen, Robert Jach","doi":"10.1007/s00404-024-07830-6","DOIUrl":"https://doi.org/10.1007/s00404-024-07830-6","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to compare surgical and sexual outcomes after Davidov-Moore vaginoplasty in women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKH).</p><p><strong>Methods: </strong>In the case-series study, we described seven women, at a median age of 22.6 ± and BMI 22.8 ± 2.3 kg/m². We measured peri- and postsurgical parameters, including surgery-related neovaginal length and sexual initiation time. Sexual outcomes were measured using the Female Sexual Function Index (FSFI) before and 6 months after vaginoplasty.</p><p><strong>Results: </strong>All surgical procedures were performed successfully, with one minor perioperative bleeding. The mean time of vaginoplasty was 82.1 min and the mean duration of hospitalization was six days. After a 6-month follow-up, vaginal length was 8.1-times longer than before surgery (10 vs. 81 mm). The time from the surgery to the initiation of vaginal intercourse was between 17 to 22 weeks. The mean FSFI score indicated good results, with no women below 23 score, and was 4.3- times higher when compared with the pre-surgical one (6.7 vs 29.1). Contrary to the FSFI score before surgery, the post-surgical FSFI revealed higher scores in all six different domains: desire (2.5-times), arousal (4.1-times), lubrication (3.8-times), orgasm (3.4-times), satisfaction (3.3-times) and comfort (11-times).</p><p><strong>Conclusion: </strong>Laparoscopic Davydov-Moore vaginoplasty might be considered as a safe procedure with satisfactory anatomic and sexual outcomes. It should be considered as a treatment option for the creation of neovagina in women with MRKH.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of different histomorphological grading systems in vulvar squamous cell carcinoma","authors":"Gilbert Georg Klamminger,&nbsp;Annick Bitterlich,&nbsp;Meletios P. Nigdelis,&nbsp;Bashar Haj Hamoud,&nbsp;Erich Franz Solomayer,&nbsp;Mathias Wagner","doi":"10.1007/s00404-024-07809-3","DOIUrl":"10.1007/s00404-024-07809-3","url":null,"abstract":"<div><h3>Background</h3><p>Histopathological biomarkers of carcinomas and their prognostic relevance, such as Broder’s grading system (based on the total number of undifferentiated cells) or Bryne’s grading system (rating morphological features at the tumor invasive front), have been repeatedly and successfully put to test. Since most studies focus on head and neck cancers or oral carcinomas, for squamous cell carcinoma of the vulva, no standardized and agreed on pathological tumor grading system, yielding prognostic significance, could be determined so far.</p><h3>Material and methods</h3><p>To determine prognostic associations of different grading systems with regard to groin lymph node metastasis, 73 cases of vulvar carcinomas (VC) were re-examined within our study and Broder’s and Bryne’s grading system individually performed. To sub-classify between HPV-associated or HPV-independent VC, immunohistochemical p16 stainings were performed. Statistical relationships were evaluated using Spearman correlation and logistic regression analysis, validation was achieved by employment of the likelihood ratio test (LRT) and assessment of ROC curves/AUC values.</p><h3>Results</h3><p>Within our cohort, Broder’s grade I (40≈55%) and Bryne’s grade II (48≈66%) were the most frequently assigned histological gradings. We determined a positive correlation of Bryne’s grading with the extent of lymph node involvement in HPV-associated tumors and demonstrated the feasibility of Bryne’s grading to predict the presence of carcinoma cells within groin lymph nodes (LRT <i>p</i> = 0.0066; AUC value≈0.91) in this cohort. On the other hand, our data suggest that especially HPV-independent tumors may not sufficiently be characterized by current standardly performed grading approaches.</p><h3>Conclusion</h3><p>Since only Bryne’s grading system correlated positively with lymph node involvement in HPV-associated squamous cell carcinoma of the vulva, we propose to include it by name next to the distinct tumor entity on the histopathological report, allowing not only the interpretation of its prognostic relevance but also future research attempts.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 6","pages":"3091 - 3097"},"PeriodicalIF":2.1,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the development of the central nervous system in fetuses with fetal growth restriction","authors":"Xiaohan Wang,&nbsp;Chunli Wang,&nbsp;Wenming Yang,&nbsp;Qing Yao,&nbsp;Linhui Zuo","doi":"10.1007/s00404-024-07804-8","DOIUrl":"10.1007/s00404-024-07804-8","url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate the development of the central nervous system in fetuses with fetal Growth Restriction.</p><h3>Methods</h3><p>A total of 146 pregnant women who underwent prenatal ultrasonography in Cangzhou People’s Hospital from January 2022 to May 2024 were selected, all with singleton pregnancies. Among them, 73 fetuses were in the fetal growth restriction group, with ages ranging from 20 to 33 + 6 weeks. The indicators for evaluating the cerebral sulci included the depth and angle of the parietooccipital sulci, the width and depth of the sylvian fissure, the width of the uncovered insula, uncover insular ratio, the depth of the calcarine sulci, and the head circumference. The hemodynamic indicators comprised the ratio of the umbilical artery resistance index, the umbilical artery pulse index, the middle cerebral artery resistance index, the middle cerebral artery pulse index, and the cerebral placental blood flow pulse index. The above parameters were analyzed statistically.</p><h3>Results</h3><p>In this study, the depth of the parietooccipital sulci, the depth of the calcarine sulci, and the width of the sylvian fissure were smaller in the fetal growth restriction group than those in the control group, and the angle of the parietooccipital sulci and the width of the uncovered insula were larger than those in the control group (all <i>P</i> &lt; 0.05). The fetal middle cerebral artery resistance index, middle cerebral artery pulsation index and cerebroplacental pulsation ratio in the FGR group were lower than those in the control group (all <i>P</i> &lt; 0.05).</p><h3>Conclusions</h3><p>The development of the cerebral cortex in FGR fetuses is slower than that in normal fetuses, and the alteration of fetal hemodynamics might be one of the reasons for the delayed development of the cerebral cortex in FGR fetuses.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 6","pages":"2963 - 2971"},"PeriodicalIF":2.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world data of perioperative complications in prepectoral implant-based breast reconstruction: a prospective cohort study","authors":"Moritz Hamann,&nbsp;Elena Bensmann,&nbsp;Anne Andrulat,&nbsp;Jasmin Festl,&nbsp;Gitti Saadat,&nbsp;Evelyn Klein,&nbsp;Dimitrios Chronas,&nbsp;Michael Braun","doi":"10.1007/s00404-024-07807-5","DOIUrl":"10.1007/s00404-024-07807-5","url":null,"abstract":"<div><h3>Purpose</h3><p>To analyze complications and potential risk factors associated with immediate prepectoral direct-to-implant breast reconstruction (DTIBR).</p><h3>Methods</h3><p>295 patients (326 operated breasts) with DTIBR between March 2021 and December 2023 were included in this prospective study. Postoperative complications (postoperative bleeding, seroma, infection, necrosis, wound dehiscence, implant exchange/loss) were analyzed for potential risk factors by descriptive and logistic regression analyses.</p><h3>Results</h3><p>The implant was covered by TiLOOP® Bra Pocket in 227 breasts (69.6%), by “dual-plane” technique in 20 breasts (6.1%), by acellular dermal matrix (ADM) in 1 breast (0.3%). No additional support was used for 78 breasts (23.9%). The use of mesh did not increase the risk for complications. Major complications requiring surgical revision occurred due to postoperative bleeding in 22 (6.7%), seroma in 2 (0.6%), infection in 13 (4.0%), necrosis in 10 (3.1%), and wound dehiscence in 10 (3.1%) breasts. Thirteen (4.0%) implants were exchanged, and 5 (1.5%) were explanted without substitution. One patient had to switch to autologous reconstruction due to skin necrosis. The main reasons for the removal/exchange of implants were infections (11 breasts, 3.4%) and necrosis (4 breasts, 1.2%). The risk for necrosis, infection, and wound dehiscence was mainly associated with the type of incision, especially skin-reducing incisions, and body mass index (BMI) ≥ 30 kg/m².</p><h3>Conclusion</h3><p>Severe complications occurred primarily in patients with a BMI ≥ 30 kg/m² and when skin-reducing surgical techniques were performed.</p><h3>Trial Registry</h3><p>This study was retrospectively registered at the German Clinical Trials Register (DRKS) on 20.06.2024. DRKS-ID: DRKS00034493. https://drks.de/search/de/trial/DRKS00034493.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 6","pages":"3077 - 3089"},"PeriodicalIF":2.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of HIV infection on cervical intraepithelial neoplasia detection in pregnant and non-pregnant women in Germany: a cross-sectional study","authors":"Irena Rohr,&nbsp;Anna Sophie Skof,&nbsp;Michaela Heinrich-Rohr,&nbsp;Fabian Weiss,&nbsp;Jan-Peter Siedentopf,&nbsp;Katharina von Weizsäcker,&nbsp;Irene Alba Alejandre,&nbsp;Wolfgang Henrich,&nbsp;Jalid Sehouli,&nbsp;Charlotte K. Metz","doi":"10.1007/s00404-024-07813-7","DOIUrl":"10.1007/s00404-024-07813-7","url":null,"abstract":"<div><h3>Purpose</h3><p>Women living with HIV (WLWH) are frequently affected by cervical dysplasia caused by Human Papillomavirus (HPV) and invasive cervical cancer (CxCa). CxCa screening programs can include colposcopy, cytology, and HPV testing. These methods, however, have limitations in effectively stratifying cervical dysplasia. This study aimed to evaluate the applicability of an innovative mRNA-based multiplexed expression-quantifying assay in the detection and assessment of cervical dysplasia in WLWH.</p><h3>Methods</h3><p>The QuantiGene-Molecular-Profiling-Histology Assay (QG-MPH) was used to detect and quantify HPV oncogene and cellular biomarker mRNA expression. These results were included in the Risk Score (QG-MPH RS) calculations that inform about the presence and severity of dysplasia. QG-MPH RS results were compared to the highly sensitive Multiplexed Papillomavirus Genotyping (MPG) Assay and clinical results obtained by cytology, colposcopy and histology. For a standardized nomenclature of clinical results, the clinical ASSIST Score was used.</p><h3>Results</h3><p>Of 241 WLWH, including 96 pregnant women, a concordance between the QG-MPH RS and the ASSIST Score was found to 36.3% (49/135) in non-pregnant WLWH and 67.1% (57/85) in pregnant WLWH. The QG-MPH method demonstrated high specificity for detecting high-risk HPV (HR-HPV) genotypes and high-grade cervical dysplasia, achieving 89.6% and 82.4%, respectively, including pregnant and non-pregnant WLWH.</p><h3>Conclusion</h3><p>The QG-MPH assay shows potential for improving the detection and management of HPV-related cervical dysplasia in WLWH, including pregnant women. Its high specificity, however, is tempered by its tendency to overestimate dysplasia severity in certain cases, indicating that further research is needed to refine its use as a reliable diagnostic tool for this high-risk population.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 6","pages":"3099 - 3110"},"PeriodicalIF":2.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of meconium-stained amniotic fluid thickness on maternal infectious morbidity: a comprehensive clinical and microbiological analysis.","authors":"Raneen Abu Shqara, Lior Lowenstein, Maya Frank Wolf","doi":"10.1007/s00404-024-07808-4","DOIUrl":"https://doi.org/10.1007/s00404-024-07808-4","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to investigate the correlation between the thickness of meconium-stained amniotic fluid (MSAF) and maternal infectious morbidity.</p><p><strong>Methods: </strong>A retrospective study of 15,950 term singleton pregnancies at a tertiary hospital (2020-2024). Women were categorized into four groups based on the presence and thickness of MSAF: clear, light, intermediate, and thick. The co-primary outcomes were clinical chorioamnionitis and puerperal endometritis, defined as a composite maternal infectious morbidity. In women with intrapartum fever (IPF), chorioamniotic swabs were obtained and compared according MSAF thickness. Multivariate analysis identified predictors of a composite maternal infections and adverse neonatal outcomes.</p><p><strong>Results: </strong>Of the cohort, 13,745 had clear amniotic fluid, and 2,205 had MSAF (561 light, 1,426 intermediate, 218 thick). The incidence of maternal infections increased with MSAF thickness, with thick MSAF showing the highest rates of clinical chorioamnionitis (4.1%, p < 0.001) and endometritis (1.4%, p = 0.039). In IPF cases, thicker MSAF was associated with a higher prevalence of positive swab cultures, particularly of Enterobacteriaceae (61.9%). Group B Streptococcus (GBS) remained consistent across all MSAF groups. Multivariate analysis showed that MSAF levels were associated with increased maternal infectious morbidity (p < 0.001). Additional risk factors for maternal infections included nulliparity (p < 0.001), catheter balloon insertion (p = 0.004), prolonged ROM (p < 0.001), and cesarean delivery (p < 0.001). In contrast, only intermediate (p < 0.001) and thick MSAF (p < 0.001) correlated with adverse neonatal outcomes.</p><p><strong>Conclusion: </strong>Greater severity of MSAF is associated with increased maternal infectious morbidity, especially infections related to Enterobacteriaceae. Studies about preventive measures in cases of thick MSAF are warranted.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-altitude hypoxia exposure alters follicular metabolome and oocyte developmental potential in women.","authors":"Zhengfang Xiong, Xiaolei Liu, Qingdi Wang","doi":"10.1007/s00404-024-07695-9","DOIUrl":"https://doi.org/10.1007/s00404-024-07695-9","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the effects of high-altitude hypoxia on the microenvironment of oocyte development and fertilization potential, we compared the metabolomic patterns of follicular fluid from women living in different altitude areas and traced their oocyte maturation and subsequent development.</p><p><strong>Methods: </strong>A total of 315 clinical cases were collected and divided into three groups according to their residence altitudes: 138 cases in low-altitude (< 2300 m) group, 100 cases in middle-altitude (2300-2800 m) group and 77 cases in high-altitude (> 2800 m) group. The clinical outcomes were statistically estimated, including hormonal level, oocyte maturation, in vitro fertilization, and embryo development. Meanwhile, a metabolomic analysis was performed on the follicular fluid of women from different groups using ultra-high-performance liquid chromatography and high-resolution mass spectrometry and differential metabolites were analyzed through the KEGG pathway.</p><p><strong>Results: </strong>The clinical data indicated that the physical condition and reproductive hormone secretion were similar among different groups. Although personalized gonadotropin-releasing hormone strategies were applied, the numbers of antral follicles and obtained oocytes were not impacted by the residence altitude change. In in vitro culture, the maturing rate, fertility rate and cleavage rate of high-altitude group were compared with the other groups. However, the rates of high-quality embryo, formative blastocyst, and available blastocyst were gradually decreased with the rise of residence altitude. Metabolome analysis identified 1193 metabolites in female follicular fluid. Differential analysis indicated that metabolic components in follicular fluid were remarkably changed with the elevation of residence altitude. These differential metabolites were closely related with amino acid metabolism, protein digestion and absorption, oocyte meiosis and steroid biosynthesis.</p><p><strong>Conclusion: </strong>The residence altitude alters the microenvironment of follicular fluid, which could damage the oocyte developmental potential. This study provides diagnostic basis and therapeutic targets for research on female oocyte and embryo development.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the clinical utility of NIPT-plus and analysis of adverse pregnancy outcomes","authors":"Le Zhang,&nbsp;Bozhen Chang,&nbsp;Lixia Wang,&nbsp;Gulinazi Mijiti,&nbsp;Kuerlan Bahetibieke,&nbsp;Shuyuan Xue","doi":"10.1007/s00404-024-07811-9","DOIUrl":"10.1007/s00404-024-07811-9","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the performance of NIPT-plus in detecting fetal aneuploidies and CNVs and analyze the factors influencing adverse pregnancy outcomes.</p><h3>Methods</h3><p>The retrospectively analyzed 8726 pregnant women who underwent NIPT-plus for fetal screening were classified into low- (who tested voluntarily) and high-risk (women with advanced age, abnormal ultrasound, abnormal serological screening, or a combination of indications) groups. Basic maternal information, prenatal findings, and pregnancy outcomes were recorded. NIPT-plus performance was assessed for various chromosomal abnormalities and the association between the fetal fraction and adverse pregnancy outcomes.</p><h3>Results</h3><p>Thirty-six (0.4%) patients had failed tests; 144 (1.65%) positive cases were detected, of which, 107 (74.31%) opted for invasive testing, and 51 were verified as true positives. The total positive predictive value was 45.45% and 48.65% in the low- and high-risk groups, respectively, and the difference was not significant. Among the subsequent cases with abnormal ultrasound monitoring, two false-negative cases were identified, and pathogenic CNV diagnosis was confirmed through amniocentesis, resulting in pregnancy termination. Fetal fraction was not associated with an increased adverse pregnancy outcome risk; however, ethnic differences may affect pregnancy outcomes.</p><h3>Conclusion</h3><p>NIPT-plus technology use is no longer restricted to high-risk pregnant women, and it may produce false-positive results. The stakeholders should be aware of this limitation. The uncertainties and potential risks of the test results should be explained to the test takers to enable informed decision making and to minimize unnecessary anxiety and concerns. Ethnicity may influence adverse pregnancy outcomes in local multiracial settings.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 6","pages":"2973 - 2981"},"PeriodicalIF":2.1,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal outcomes in pregnancies achieved after fertility treatments with and without diet-controlled GDM","authors":"Baraah Abu Karen,&nbsp;Naama Steiner,&nbsp;Reut Rotem,&nbsp;Yael Baumfeld,&nbsp;A. Y. Weintraub,&nbsp;Tamar Eshkoli","doi":"10.1007/s00404-024-07780-z","DOIUrl":"10.1007/s00404-024-07780-z","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the rates of adverse perinatal outcomes among women who conceived after fertility treatments with and without diet-controlled GDM.</p><h3>Methods</h3><p>In this retrospective population-based cohort study, all pregnancies of non-diabetic and diet-controlled GDM women who conceived after fertility treatments (in-vitro fertilization - IVF and ovulation induction - OI) and delivered between the years 1996–2016 in a tertiary medical center, were included. Pregnancies of women with pre-gestational diabetes mellitus, and those complicated with gestational diabetes mellitus A2, multiple pregnancies, congenital malformations and those lacking prenatal care, were excluded. Demographical, clinical, and obstetrical characteristics were recorded, and pregnancy complications and adverse perinatal outcomes were compared between the groups. Multivariate logistic regression models were used to control for confounders. Statistical analyses were performed using logistic regression to control for potential confounders. A p-value of &lt; 0.05 was considered statistically significant.</p><h3>Results</h3><p>During the study period, 6254 deliveries met the inclusion criteria, 10.23% of them (n = 640) had diet-controlled GDM. Pregnancies with diet-controlled GDM were found to be associated with significantly higher rates of hypertensive disorders of pregnancy (15.6% vs. 9.8%, p &lt; 0.001), polyhydramnios (5.9% vs. 2.7%, p &lt; 0.001), and cesarean deliveries (40.8% vs. 31.9%, p &lt; 0.001). Diet-controlled GDM was also found to be an independent protective factor against perinatal mortality (aOR = 0.22, 95% Cl 0.05–0.92, P = 0.04) possibly due to the more intensive monitoring and management typically provided to women undergoing fertility treatments. This close care may mitigate some of the risks associated with ART, leading to improved perinatal outcomes.</p><h3>Conclusion</h3><p>Among pregnancies achieved after fertility treatments, diet-controlled GDM was associated with reduced perinatal mortality and higher rates of certain pregnancy complications. These findings highlight the importance of close monitoring and careful management of women with diet-controlled GDM, as it may help mitigate risks associated with ART pregnancies. Further research is needed to understand the mechanisms behind these outcomes and to optimize management strategies for this specific population.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"310 6","pages":"2899 - 2906"},"PeriodicalIF":2.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}