Archives of Gynecology and Obstetrics最新文献

{"title":"Fortifying the foundation: assessing the role of uterine ligament integrity in uterine prolapse and beyond","authors":"Giovanni Pecorella,&nbsp;Radmila Sparic,&nbsp;Andrea Morciano,&nbsp;Ivana Babovic,&nbsp;Gaetano Panese,&nbsp;Andrea Tinelli","doi":"10.1007/s00404-024-07732-7","DOIUrl":"10.1007/s00404-024-07732-7","url":null,"abstract":"<div><h3>Background</h3><p>Pelvic floor stability is influenced by various biomechanical, anatomical, and physiological factors. Understanding these dynamics is crucial for improving the treatment of pelvic organ prolapse (POP) and related conditions.</p><h3>Objective</h3><p>To analyze the key factors affecting pelvic floor integrity and explore both non-surgical and surgical interventions to enhance stability and treatment outcomes.</p><h3>Methods</h3><p>This review draws from biomechanical research to assess the role of the uterosacral ligament in pelvic support, while also examining the potential of both traditional and emerging therapeutic approaches, including non-surgical interventions like vitamin C supplementation.</p><h3>Results</h3><p>- The uterosacral ligament demonstrates superior strength and stiffness, making it essential for structural support of pelvic organs.</p><p>- Non-surgical interventions, such as vitamin C supplementation, show potential in improving ligament integrity and preventing pelvic floor disorders.</p><p>- Emerging surgical techniques, including tendon-based procedures and injectable fibrous hydrogel composites, offer promising improvements in outcomes for patients with pelvic organ prolapse.</p><p>- Additional factors such as muscle strength and neural deficiencies contribute to the complexity of pelvic floor biomechanics, indicating the need for multifaceted treatment approaches.</p><h3>Conclusion </h3><p>This analysis provides a comprehensive framework for understanding and managing pelvic floor stability by integrating biomechanical, physiological, and anatomical insights. The findings highlight the potential for personalized treatment strategies to improve patient outcomes in pelvic floor disorders.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279831","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":"Reference charts for fetal corpus callosum length in the early second trimester: a prospective cross-sectional study","authors":"Nizamettin Bozbay,&nbsp;Merve Nur Taşpınar,&nbsp;Aybike Tazegül Pekin","doi":"10.1007/s00404-024-07730-9","DOIUrl":"10.1007/s00404-024-07730-9","url":null,"abstract":"<div><h3>Objective</h3><p>This study aimed to establish normal reference ranges for fetal corpus callosum (CC) measured by prenatal ultrasonography (USG) between 16 and 25 weeks of gestation in healthy fetuses.</p><h3>Material and method</h3><p>A total of 809 fetuses in the second trimester were evaluated by transabdominal USG. All measurements were obtained by a single clinician.</p><h3>Results</h3><p>Based on the correlation analysis, a significant positive correlation was found between gestational week and CC (<i>r</i> = 0.907, <i>p</i> &lt; 0.001).</p><h3>Conclusion</h3><p>We anticipate that the reference intervals obtained from healthy fetuses will help clinicians who are interested in neurosonography to detect CC abnormalities at an early stage.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279833","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":"Using Doppler ultrasound to assess fetal cardiac function and pregnancy outcomes in obstetric antiphospholipid syndrome pregnancies: a case–control study","authors":"Bingyan Wang,&nbsp;Qianqian Wang,&nbsp;Dongmei Yu,&nbsp;Nan Zhang,&nbsp;Zhibin Wang,&nbsp;Xinrui Sun,&nbsp;Meixin Liu,&nbsp;Xiaoting Su","doi":"10.1007/s00404-024-07731-8","DOIUrl":"10.1007/s00404-024-07731-8","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aimed to evaluate fetal left ventricular function (LVF) in pregnant women with obstetric antiphospholipid syndrome (OAPS) by Doppler ultrasound and developed a clinical nomogram to predict adverse perinatal outcomes.</p><h3>Methods</h3><p>In this prospective observational study, 105 pregnant women were enrolled and divided into the OAPS cohort (<i>n</i> = 60) and the control cohort (<i>n</i> = 45). Fetal cardiac function parameters were collected and compared between two cohorts. Univariate and multivariate analysis was conducted to select the risk factors associated with adverse perinatal outcomes, and a clinical nomogram was developed based on these selected risk factors. The predictive performance of corresponding indicators for adverse perinatal outcomes was evaluated using receiver operating characteristic (ROC) curve analysis.</p><h3>Results</h3><p>The OAPS cohort revealed an increase in the isovolumic relaxation time (IVRT) and myocardial performance index (MPI), a decrease in the ejection time (ET), middle cerebral artery pulsatility index (MCA-PI) and cerebroplacental ratio (CPR) compared to the control cohort. Through univariate and multivariate analysis, gravidity, CPR, and MPI were the risk factors associated with adverse perinatal outcomes. A model predicting adverse perinatal outcomes in OAPS pregnant women was constructed based on these three factors and visualized as a nomogram. The nomogram could accurately predict adverse perinatal outcomes with an area under the curve of 0.923 (95% CI: 0.858–0.982). This performance was better than evaluating individual factors such as MPI (0.825, 95% CI: 0.739–0.911) and CPR (0.816, 95% CI: 0.705–0.927) for efficacy.</p><h3>Conclusion</h3><p>MPI can be used to assess fetal LVF and predict adverse perinatal outcomes. We developed a nomogram to predict adverse perinatal outcomes in OAPS women. This imaging-based evidence can provide timely clinical intervention, enabling personalized clinical decision-making.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142259334","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":"The efficacy of mifepristone-misoprostol regimen versus misoprostol-only for medication abortion at 22 + 0/7 to 30 + 0/7 weeks’ gestation","authors":"Or Touval, Avital Ellert, Yair Daykan, Ron Schonman, Zvi Klein, Yael Yagur","doi":"10.1007/s00404-024-07737-2","DOIUrl":"https://doi.org/10.1007/s00404-024-07737-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Objective</h3><p>This study aimed to compare duration of medication abortion after pretreatment with mifepristone versus misoprostol-only regimens at 22 + 0/7 to 30 + 0/7 weeks.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This retrospective cohort study included patients admitted for medication abortion from 2014 to 2022. Patients underwent feticide due to genetic or anatomical abnormalities at gestational age of 22 + 0/7 to 30 + 0/7 weeks. Excluded from this study were patients admitted at gestational age &lt; 22 + 0/7 or &gt; 30 + 0/7 weeks, with multiple gestation, with diagnosis of intrauterine fetal demise before feticide, with contraindication for vaginal delivery, and who were administered a medical regimen other than the mifepristone-misoprostol or misoprostol-only protocol. Information collected included patients’ demographics, clinical outcomes, additional procedural interventions, and complications. Data of patients treated with mifepristone-misoprostol versus misoprostol-only were compared.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The study group included 46 patients in the mifepristone-misoprostol group and 35 in the misoprostol-only group. Median interval from first dose of misoprostol to fetal expulsion was shorter in the mifepristone-misoprostol group (10.6 vs. 15.3 h; <i>p</i> = 0.007) with shorter duration of hospitalization (3.5 ± 1.1 vs. 4.1 ± 1.2 days; <i>p</i> = 0.013). Study groups did not differ in terms of complications. Patients in the mifepristone-misoprostol group had a younger gestational age (23.8 ± 1.69 vs. 25.37 ± 2.4 weeks; <i>p</i> = 0.002). However, multivariable Cox regression found that mifepristone was independently associated with shorter abortion time (OR 1.7, 95% CI 1.03–2.9, <i>p</i> = 0.03).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Medication abortion with mifepristone-misoprostol was associated with shorter time to fetal expulsion at gestational ages 22 + 0/7 to 30 + 0/7 weeks, compared with misoprostol-only regimen.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142259333","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":"Characteristics and pregnancy outcomes of subtypes of gestational diabetes mellitus based on HOMA-IR and BMI","authors":"Li Jiang,&nbsp;An-qiong Li","doi":"10.1007/s00404-024-07733-6","DOIUrl":"10.1007/s00404-024-07733-6","url":null,"abstract":"<div><h3>Aim:</h3><p>To identify the characteristics and pregnancy outcomes across different subgroups of gestational diabetes mellitus (GDM) categorized by insulin resistance index and body mass index (BMI) in early pregnancy.</p><h3>Methods:</h3><p>This retrospective study included 1804 women who underwent a 75 g-OGTT during 22–28 weeks of gestation, categorized into normal glucose tolerance (NGT) (1487) and GDM (317 [17.57%] of the total cohort). Metabolic parameters were assessed, and equation of homeostatic model assessment (HOMA) were utilized to compute indices of insulin resistance (HOMA-IR), β-cell secretory (HOMA-B), and insulin sensitivity (HOMA-%S) in early and mid-pregnancy. The cut-off value of HOMA-IR (1.61) in early pregnancy was determined via ROC curve analysis. This value, combined with pre-pregnancy BMI, further categorized NGT and GDM into six subgroups respectively, based on HOMA-IR levels (≥ 1.61 or &lt; 1.61) and BMI categories (&lt; 18.5 kg/m², 18.5–25 kg/m², or ≥ 25 kg/m²).</p><h3>Results:</h3><p>In comparison to women with NGT, those with GDM were notably older, had higher pre-BMI, fasting plasma glucose (FPG), insulin, and lipid levels in early pregnancy. They also exhibited more pronounced insulin resistance in both early and mid-pregnancy, leading to poorer outcomes. Following an oral glucose load, the peaks of glucose and insulin were out of sync in GDM and its subgroups, accompanied by further increases in HOMA-IR, HOMA-B, and a decrease in HOMA-%S, except for the GDM subgroup with HOMA-IR &lt; 1.61/BMI &lt; 18.5 kg/m². Conversely, glucose and insulin secretion in NGT and its subgroups peaked synchronously at 60 min. GDM women with HOMA-IR ≥ 1.61/18.5 kg/m² ≤ BMI &lt; 25 kg/m² had higher rates of neonatal jaundice (34.5% vs 13.9%, <i>p</i> &lt; 0.0001), LGA (28.9% vs 13.2%, <i>p</i> = 0.001), macrosomia (9.8% vs 3.7%, <i>p</i> = 0.025) compared to peers, while in GDM women with HOMA-IR ≥ 1.61/BMI ≥ 25 kg/m², the rates of LGA and macrosomia were 26.6% and 8.4%, respectively. The GDM subgroup with HOMA-IR &lt; 1.61/BMI &lt; 18.5 kg/m² exhibited the highest rates of premature rupture of membrane (46.7%) and postpartum hemorrhage (20%), predominantly with vaginal delivery and a 1 min Apgar score of 4.5% in GDM women with HOMA-IR &lt; 1.61/18.5 kg/m² ≤ BMI &lt; 25 kg/m².</p><h3>Conclusion:</h3><p>GDM and its subgroups displayed severe insulin resistance and poorer insulin sensitivity, leading to an increased risk of adverse pregnancy outcomes. GDM women with higher IR and normal or over weight were more likely to experience LGA and macrosomia, while those with lower IR and underweight were prone to premature rupture of membrane and postpartum hemorrhage during vaginal delivery.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142259022","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":"Racial and ethnic differences in access to and outcomes of elective induction of labor in low-risk pregnancies: a scoping review","authors":"Siddhi Mathur,&nbsp;Alisha V. Olsthoorn","doi":"10.1007/s00404-024-07735-4","DOIUrl":"10.1007/s00404-024-07735-4","url":null,"abstract":"<div><h3>Purpose</h3><p>Elective induction of labor (IOL) has been increasingly performed since growing data suggesting its safety and potential improved maternal and neonatal outcomes. Recommendations of elective IOL for patients from racial or ethnic minority backgrounds given the data showing increased risk of stillbirth for some populations has been met with criticism. This scoping review aims to determine if there are racial disparities in access to elective IOL and maternal and neonatal outcomes.</p><h3>Methods</h3><p>A review of the literature on IOL that appeared in English journals was performed using MEDLINE and EMBASE. The search strategy included the combination of key terms “induction of labour” and “race” or “ethnicity” in titles, abstracts, or keywords.</p><h3>Results</h3><p>A total of 8 studies were identified and included. The articles were heterogenous in the race or ethnicity distinctions they used for analysis. Three out of 4 studies that analyzed the rate of elective IOL by race found that White patients were more likely to receive the intervention. Three out of 4 studies that analyzed outcomes of IOL found no difference, while one study found Black patients benefit most from IOL at 38 weeks compared to other races that had the lowest risk of complications with IOL at 39 weeks.</p><h3>Conclusion</h3><p>Racial and ethnic disparities exist with White patients being most likely to access this intervention. The majority of data points to similar outcomes, suggesting no increased harm to elective IOL for a particular group. However, the optimal timing of elective IOL given disproportionate stillbirth risk remains to be elucidated.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142259023","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":"Relationship between maternal serum sFlt-1 level and placenta accreta spectrum disorders in the third trimester","authors":"Fangchao Zhang,&nbsp;Li Xia,&nbsp;Lin Zeng,&nbsp;Huanyu You,&nbsp;Qingao Liu,&nbsp;Yan Wang","doi":"10.1007/s00404-024-07734-5","DOIUrl":"10.1007/s00404-024-07734-5","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aims to evaluate whether the third-trimester soluble fms-like tyrosine kinase-1 (sFlt-1) serum levels could be related to placenta accreta spectrum (PAS) disorders and the severity of postpartum blood loss.</p><h3>Methods</h3><p>This was a nested case–control study which compared serum sFlt-1 level between gravid women with or without PAS disorders. Spearman correlation analysis was conducted to explore the relationship between sFlt-1 level and the volume of postpartum blood loss. Confounding factors were adjusted to avoid the impact on the results.</p><h3>Results</h3><p>Sixty gravid women were enrolled: 36 women in the PAS group and 24 women in the non-PAS group. Women in the PAS group had a median sFlt-1 level of 9407.1 [2745.9–21,691.5] pg/ml, whereas women in the non-PAS group had a median sFlt-1 level of 25,779.2 [14317.1–35,626.7] pg/ml, (p &lt; 0.001). The sFlt-1 level was negatively related to the volume of postpartum blood loss (r =  − 0.358, p = 0.041). After adjusting for maternal age and gestational age at blood taking, sFlt-1 level showed no significant relationship with PAS disorders (p = 0.245) and postpartum blood loss (p = 0.526).</p><h3>Conclusion</h3><p>Third-trimester sFlt-1 serum level is not independently associated with PAS disorders or postpartum blood loss after adjusting for confounding factors.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-024-07734-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142259336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limb-girdle muscular dystrophy in pregnancy: a narrative review","authors":"H. Shafeeq Ahmed","doi":"10.1007/s00404-024-07738-1","DOIUrl":"10.1007/s00404-024-07738-1","url":null,"abstract":"<div><p>Limb-girdle muscular dystrophy (LGMD) poses unique challenges for women during pregnancy, necessitating comprehensive care and tailored management strategies. The present narrative review aims to examine the unique challenges and management strategies required for women with LGMD during pregnancy. With over 30 genetic subtypes identified and the potential for additional discoveries through advanced diagnostic techniques, preconception counseling plays a crucial role in informing prospective parents about reproductive risks and available options. Baseline assessments, including cardiac and pulmonary evaluations, are essential to guide antenatal care, alongside genetic testing for precise diagnosis and counseling. Optimizing maternal health through respiratory exercises, cardiac monitoring, and individualized exercise and nutrition plans is paramount to avoid potential complications. During pregnancy, close monitoring of maternal and fetal well-being is important, with collaborative care between obstetricians and specialists. An individualized approach to delivery mode considering factors such as muscle strength, pelvic size, and fetal presentation is crucial. While vaginal delivery has been proven to be possible, the need for an emergency cesarean delivery should always be kept in mind. Regional anesthesia is preferred, with proactive planning for potential respiratory support. Bupivacaine has been shown to be effective with epidural catheters that may be used for prolonged relief with opioids like morphine and fentanyl, while also evaluating the patients’ respiratory function. Postpartum considerations include pain management, mobility support, breastfeeding assistance, and emotional support. Early mobilization and tailored physiotherapy regimens may promote optimal recovery, while comprehensive breastfeeding guidance is needed to address challenges related to muscle weakness. Access to mental health resources and support networks is essential to helping individuals cope with the emotional demands of parenthood alongside managing LGMD. By addressing the unique needs of pregnant individuals with LGMD, healthcare providers can optimize maternal and fetal outcomes while supporting individuals in their journey to parenthood.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142259335","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":"Retrospective study on the outcomes and satisfaction with endometrial ablation by bipolar energy (NovaSure®) for the treatment of heavy menstrual bleeding","authors":"Covadonga Alvarez López, Aida González Paredes, Sonia Martínez Morales, Maria Teresa Aguilar Romero, Mónica Gutiérrez Simón, Jorge Fernández Parra, Alicia Hernández Gutiérrez","doi":"10.1007/s00404-024-07726-5","DOIUrl":"https://doi.org/10.1007/s00404-024-07726-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>To determine the effectiveness, safety, and participant satisfaction with endometrial ablation by bipolar energy (NovaSure^®) in the treatment of heavy menstrual bleeding (HMB), and to investigate factors associated with poorer outcomes.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Multicenter retrospective observational study based on medical record review of the outcomes related to endometrial ablation by the bipolar-energy technique procedure to treat HMB in the setting of three university teaching hospitals in Spain.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 333 women were included in the study. Most bipolar-energy ablations were successful (85.12%; <i>n</i> = 269 out of 316), with amenorrhea the most frequent outcome (39.6%, <i>n</i> = 131 out of 316). The majority of participants had no complications (95.5%; <i>n</i> = 317 out of 332), and of those who did, only 2.1% were related to the technique. No further treatment was required for HMB in 82.8% of women (<i>n</i> = 274 out of 331), and surgery was avoided in 91.8%; only 5.9% of women underwent ablation-related hysterectomy. In women with previous transverse cesarean sections (CS), 91.0% avoided subsequent surgical treatment. Eighty-six percent of women (<i>n</i> = 221 out of 257) were satisfied with the procedure.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Bipolar-energy ablation is very effective and safe for the treatment of HMB and yielded a high rate of participant satisfaction in our setting. The presence of comorbidities or previous CS may slightly reduce the effectiveness of the method, while performing concomitant surgery (mainly curettage) increases the rate of complications. Notably, despite the known increased risk of hysterectomy, most participants with previous CSs who underwent ablation avoided major surgery.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142211648","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":"Factors affecting gasless reduced-port laparoscopic myomectomy (GRP-LM) using a subcutaneous abdominal wall lifting method: a retrospective analysis of a large cohort of 966 cases in Japan.","authors":"Hiroe Ito, Yasukazu Sagawa, Junko Nakagawa, Tomoyoshi Akaeda, Kiyoaki Tsutsumi, Keiichi Isaka","doi":"10.1007/s00404-024-07706-9","DOIUrl":"https://doi.org/10.1007/s00404-024-07706-9","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the usefulness of gasless reduced-port laparoscopic myomectomy (GRP-LM) using a subcutaneous abdominal wall lifting method.</p><p><strong>Methods: </strong>In GRP-LM, after lifting the abdominal wall by a subcutaneous abdominal wall lifting method, a 1.5-cm incision is made in the lateral abdomen, Lap Protector^® is placed. The operation is performed by two surgeons, one who inserts multiple forceps from the Lap Protector and performs the operation, and an assistant who operates the laparoscope and uterine manipulator. The surgical outcome of GRP-LM and the factors that affect it were investigated.</p><p><strong>Results: </strong>GRP-LM was performed in 966 patients. Complications (0.5%) and blood transfusions (0.3%) were remarkably rare, and there were no cases of conversion to open surgery. With regard to the correlation between the number of fibroids extracted and each factor, the number of fibroids extracted correlated with fibroid weight and operation time, but not with blood loss. The average number of sutures per case was 21, and the average suture and ligation time per suture was 77 s. Comparing the cost of GRP-LM with that of the conventional insufflation LM, a saving of $875 was possible with GRP-LM.</p><p><strong>Conclusion: </strong>GRP-LM is a suitable for multiple fibroids, and is cosmetic and economical, because it allows rapid and reliable suture and ligation, despite having only one port for the procedure.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153063","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}