Journal of clinical gynecology and obstetrics最新文献

{"title":"Bulbocavernosus Reflex as an Objective Measure of Improvement Following Directed Pelvic Floor Rehabilitation for Treatment of Urinary Incontinence","authors":"A. Hilton, Z. Selzler, P. Kasar, H. Barbier, C. Cross, M. Bradley, Adam V. Levy","doi":"10.14740/jcgo871","DOIUrl":"https://doi.org/10.14740/jcgo871","url":null,"abstract":"Background: Abnormal bulbocavernosus reflex latency and subsequent improvement is an objective measure of improvement after directed pelvic floor physical therapy. The aim of the study was to utilize bulbocavernosus reflex testing as an objective measure of pelvic floor rehabilitation success in the treatment of urinary incontinence (UI) in a large screened population. Methods: This was a retrospective case series of 95 women with UI who were found to have abnormal bulbocavernosus reflex tests (UroVal System), then treated with guided pelvic floor exercise program for 6 - 12 weeks that included electrical stimulation. Charts were reviewed for demographics, prior treatment, baseline and post-treatment bulbocavernosus reflex latencies, pre-and post-treatment anal manometry, number of daily incontinence episodes, pad counts, patient perception of improvement using satisfaction at the conclusion and at 6 - 24 months post-treatment. Pre-to-post mean differences were calculated using paired t -tests with 95% bootstrap confidence based on 10,000 permutations. Results: Significant differences were found in pre-and post-treatment bulbocavernosus reflex latency (85.0 vs. 35.4 ms, P < 0.001), anal manometry (40.2 vs. 56.4 ms, P < 0.001), pad counts (1.0 vs. 0.1 per day, P < 0.001), and incontinence episodes (1.8 vs. < 1.0 per day, P < 0.001). Perceived improvement was 80% (standard deviation (SD) 17.8%) at the conclusion of treatment. At 6 to 24 months post-treatment, satisfaction persisted at 93% (SD 12.5%). Conclusions: The bulbocavernosus reflex is an effective objective screening tool to establish pelvic neuromuscular dysfunction. Abnormal bulbocavernosus reflex latency and subsequent improvement after guided pelvic floor rehabilitation is an objective measure that can be used in conjunction with the patient’s subjective improvement.","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45930285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Aberrant Uterine Arteries and Clinical Significance With Uterine Embolization","authors":"S. Sangari, Surinder Kumar, R. Baidya, E. Mtui","doi":"10.14740/jcgo883","DOIUrl":"https://doi.org/10.14740/jcgo883","url":null,"abstract":"","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47141389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol for a Prospective Cohort Study to Evaluate Changes in Sexuality in Patients With Primary Cervical Cancer Using Patient-Reported Outcomes (JGOG9004, SARAH Study), and Our Approaches to Solving the Unmet Needs of Patients With Gynecological Cancer","authors":"Hitomi Sakai, Y. Itani, Yoichi Kobayashi, M. Asai-Sato, K. Tasaki, S. Nagao, M. Futagami, Makoto Yamamoto, E. Fujimoto, Y. Ikeda, Megumi Yokota, N. Hayashi, Motoki Matsuura, T. Nagasawa, Yumi Ishidera, Shinya Sato, T. Hamano, N. Suzuki, Y. Yoshida","doi":"10.14740/jcgo892","DOIUrl":"https://doi.org/10.14740/jcgo892","url":null,"abstract":"Objective: Sexuality is a crucial quality of life (QOL) issue for patients with cancer. In patients with cervical cancer, sexuality is affected by both the disease and the therapy for it. This study aims to explore changes in sexuality following cancer treatment in Japanese patients with cervical cancer, using scales such as the Female Sexual Function Index (FSFI) for sexual dysfunction and the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression. Methods: This multicenter prospective cohort study is being performed in 33 hospitals of the Japanese Gynecologic Oncology Group (JGOG), evaluating patients with stage IA - IIIB primary cervical cancer who are scheduled to undergo surgery or radiation therapy, including concurrent chemoradiation, with curative intent. Patients can visit the uniform resource locator (URL) listed in the email to complete the survey. The online survey is performed at baseline and at 1 year following curative surgery or radiation therapy. As of March 31, 2023, 200 participants have been recruited for this ongoing study. Discussion: The results of this study are expected to highlight sexuality as an unmet need among patients with cervical cancer. Conducting the study may facilitate discussions between patients and healthcare providers regarding sexual issues.","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48616629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for Thyroid Disorder in First Trimester of Pregnancy: A Cross-Sectional Study","authors":"Sumnima Mainali, S. Kayastha, Sagar Devkota, Priyanka Yadav, Bishal Bharati, Sristi Upadhyay, Sailuja Maharjan, Sarbagya Manandhar, Laxman Timilsina","doi":"10.14740/jcgo880","DOIUrl":"https://doi.org/10.14740/jcgo880","url":null,"abstract":"Background: Alteration in thyroid function is very common among females, in particular during pregnancy. The majority of them are clinically veiled, and with considerable differences in outcome of mother and fetus, even more serious maternal and fetal outcome if present during the first trimester. So, we conducted this study to explore the magnitude of thyroid problems during first trimester of pregnancy at a tertiary health care facility in Nepal and highlight the benefits of its early diagnosis. Methods: This was a cross-sectional study conducted over a period of 1 year among 160 pregnant females in their first trimester, attending to the outpatient department of a tertiary care center. Blood samples were collected from all the patients for thyroid function test which included measurement of serum levels of thyroid-stimulating hormone (TSH), free thyroxine (fT4), and free tri-iodothyronine (fT3). Pregnant females with previously diagnosed thyroid disorders or currently under medications were excluded. Results: Among the 160 patients included in the study, 25.83 years was the mean age. The mean body mass index (BMI) was 24.62 kg/m 2 and most of the patients were overweight (40.625%). Of the patients 53.12% were primigravida and 46.87% were multigravida. Based on the thyroid function tests, 91.25% were found to be euthyroid, 3.125% were hyperthyroid and 5.625% were hypothyroid. The prevalence of subclinical hyperthyroidism and overt hyperthyroidism was found to be 60% and 40% respectively and that of subclinical hypothyroidism and overt hypothyroidism was 55.6% and 44.4% respectively. None of the patients had symptoms of thyroid disorder (neither hyperthy-roidism nor hypothyroidism). The correlation between BMI and TSH among the pregnant females included in the study was statistically significant when tested by using Karl Pearson correlation coefficient (r = 0.164, P = 0.038). Conclusions: Based on this study, around one in every 12 pregnant women had thyroid disorder. Early identification of thyroid disorders and prompt initiation of treatment is very essential for the health of mother and fetus due to the significant maternal or fetal morbidity and mortality associated with thyroid disorders. Thus, routine screening for thyroid disorder should be considered during pregnancy.","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49376159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Scoring and Outcome of Gestational Trophoblastic Disease Patients","authors":"Auttaya Ratanakaew, Phornsawan Wasinghon","doi":"10.14740/jcgo876","DOIUrl":"https://doi.org/10.14740/jcgo876","url":null,"abstract":"Background: Gestational trophoblastic neoplasia (GTN) uses prognostic scores to predict the development of resistance to single-agent chemotherapy. Requiring combination chemotherapy, high-risk patients are defined as those with an International Federation of Gynecology and Obstetrics (FIGO) score ≥ 7. Treatment at a specialized center based on an appropriate and prompt diagnosis is needed for the reduction of untimely death as well as to improve the survivability of patients. This study aimed to study for classifying definitions of low-risk, high-risk, and ultra-high-risk prognostic scores. Also, the outcomes of gestational trophoblastic patients and brain metastasis have been observed. Methods: The study was observational design. The medical records of 56 gestational trophoblastic patients who visited the Buddhachi-naraj Phitsanulok Hospital between 2012 and 2022 were collected and reviewed. The patients had been classified into three groups: low-risk, high-risk, and ultra-high-risk. The low-risk was stage I - III with a score < 7, while the high-risk was defined as FIGO stage II-III with a score ≥ 7. Also, a risk score ≥ 13 was defined as ultra-high risk. Results: Among the 56 patients in this study, 47 patients were at low-risk, accounting for 83.9%, while nine patients were at high-risk (16.1%). No patient had a score of more than 12, defined as ultra-high-risk. All patients had been alive for at least 10 years after diagnosis with brain metastasis stage IV. The incidence of high-risk GTN patients was displayed in 9/56 (16.1%) with lung and brain metasta - sis. The high-risk score of GTN with brain metastasis showed an incidence rate of GTN patients among 1/56 (1.78%). The ultra-high-risk group was not presented. Conclusions: Multimodality treatment has benefits for stage IV patients and high-risk groups. However, ultra-high-risk patients with a prognostic score higher than 12 or ≥ 13 have slightly increased mor - tality rates. A high-risk group FIGO stage IV with brain metastasis is alive in this study.","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43662208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Cardioversion During Pregnancy: A Retrospective Analysis of the National Inpatient Sample","authors":"Mohammad Al-Akchar, Mohamed Alhajji, K. Sawalha, O. L. Garcia, Obada Tarabichi, Michael Buhnerkempe, M. Bhattarai, Y. Elmasry, A. Agarwal, M. Labedi","doi":"10.14740/jcgo884","DOIUrl":"https://doi.org/10.14740/jcgo884","url":null,"abstract":"Background: Rising incidence of cardiac arrhythmias among pregnant women is an increasing concern in the United States. Although pregnancy rates continue to decline in the United States, maternal morbidity and mortality remain on the rise. The purpose of this study was to investigate the relationship between the use of electric car-dioversion for pregnant women and the potential maternal and fetal morbidity and mortality. Methods: Patient data were obtained from the National Inpatient Sample (NIS) from 1993 to 2019. The data included patients that had an ICD-9 diagnosis with either a normal or high risk pregnancy. Patients were separated by whether they had a procedure to restore cardiac rhythm. Results and conclusion: Our retrospective study showed that pregnant patients who underwent cardioversion did experience a higher rate of mortality (odds ratio = 6.40; 95% confidence interval: 1.95 - 20.96; P = 0.002), with no difference in perinatal outcomes. There was no difference in perinatal outcomes.","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44998158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine Therapy in an Adolescent Patient at 35 Weeks of Gestation With Status Asthmaticus","authors":"Armand Tadjali, Matt C Smithhart, R. Pope, H. Chapa","doi":"10.14740/jcgo855","DOIUrl":"https://doi.org/10.14740/jcgo855","url":null,"abstract":"","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49361693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Typical Morphological Features on Prenatal Ultrasound of Fetuses With Trisomy 13 (Patau’s Syndrome)","authors":"D. Tran, Anh Linh Dang, Thi Bich Van Nguyen, Van Anh Tran, Thi Hue Nguyen, Thi Minh Huong Le, Thuy Linh Tran, Toan Anh Ngo, Thi Ngoc Lan Hoang, Phuong Thao Le, Thi Tuyet Nhung Ngo, Thi Quyen Le, Thi Trang Nguyen","doi":"10.14740/jcgo848","DOIUrl":"https://doi.org/10.14740/jcgo848","url":null,"abstract":"Background: Trisomy 13 (Patau’s syndrome) is a devastating chromosomal abnormality with a poor prognosis. Fetal ultrasound is an effective screening method for early detection of trisomy 13. This study aimed to describe the typical morphological features detected on prenatal ultrasound in fetuses with trisomy 13 at Vietnam National Hospital of Obstetrics and Gynecology from 2012 to 2021. Methods: This was a retrospective, descriptive cross-sectional study of 50 fetuses with trisomy 13, compared to 4,166 normal fetuses. Maternal age and medical history were collected. Fetal ultrasound was performed in the first and second trimesters, and major structural abnormalities were recorded. The data were analyzed using descriptive statistics. Results: Trisomy 13 was detected in 98% of fetuses on ultrasound in the first and second trimesters. Of the 23 fetuses examined in the first trimester, 18 had increased nuchal translucency (NT ≥ 3 mm). The major structural abnormalities detected in fetuses with trisomy 13 included facial malformations (53.85%), brain anomalies (26.92%), heart defects (26.92%), abdominal wall abnormalities (23.08%), and kidney anomalies (26.92%). Nine cases of trisomy 13 (18%) were not detected on ultrasound. Conclusions: Increased NT and major structural abnormalities are suggestive signs for early screening of trisomy 13 by ultrasound. The combination of fetal ultrasound with other prenatal screening methods provides good results for the early detection of fetal abnormalities. This study provides important information on the typical morphological features detected on prenatal ultrasound in fetuses with trisomy 13, which can aid in counseling and decision-making for affected families.","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41338110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Solitary Fibrous Tumor in the Vulva","authors":"I. Kudawara, Naohiro Yasuda, A. Okagaki","doi":"10.14740/jcgo852","DOIUrl":"https://doi.org/10.14740/jcgo852","url":null,"abstract":"Solitary fibrous tumor (SFT) is a rare soft tissue tumor that is composed of fibroblastic tumor cells and collagenous stroma with NAB2-STAT 6 gene rearrangement. Vulvar SFTs are extremely rare. We report a case of vulvar SFT and review the current literature. A 71-year-old woman presented with a slow-growing mass in her left labia majora. The patient also complained of urinary stream diversion. Physical examination revealed a tumor in the left labia majora, which manifested as a rubbery, immobile, and tender mass. Computed tomographic images showed an enhanced vulvar mass. Magnetic resonance imaging (MRI) demonstrated a well-defined tumor with heterogeneous intermediate signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images. The tumor measured 68 × 45 × 57 mm on MRI and was located in the labia majora. Percutaneous needle biopsy revealed an SFT. Immunohisto-chemically, the tumor cells were positive for STAT6 and CD34. Local excision was performed with negative surgical margins. Preoperative needle biopsy was useful for diagnosis and planning a surgical strategy. Local resection of the vulvar SFT improved symptoms of urinary stream diversion. There was no tumor recurrence during the 4 years following the surgery.","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48203228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rh-Isoimmunization in a Primigravida Skydiver","authors":"H. Chapa, Carley Hagar, Armand Tadjali, E. Perli","doi":"10.14740/jcgo845","DOIUrl":"https://doi.org/10.14740/jcgo845","url":null,"abstract":"There is a paucity of data on risks of skydiving while pregnant. Although the American College of Obstetricians and Gynecologists states to avoid the activity in pregnancy, women may underestimate potential complications from it and may continue to skydive while pregnant or may do so inadvertently if unaware of their pregnancy. We present a unique case of a primigravida who completed 100 jumps at 10,000 feet throughout her gestation, as she was unaware of her pregnant state, associated with Rh-isoimmunization presumably from chronic placental abruption. A 20-year-old Caucasian female presented to an urgent care center for abdominal cramping thought to be secondary to constipation. A urine pregnancy test was performed due to irregular menstruation history. Although the patient denied being pregnant, urine chorionic gonadotrophic hormone testing was positive with physical examination suggesting 32 - 34 weeks of gestation. The patient was a professional skydiving photographer with 100 logged jumps from the start of her pregnancy (by estimated gestational age calculation). She stated irregular vaginal bleeding every 4 - 6 weeks throughout the time of pregnancy, which she interpreted as her menstruation. Her abdominal discomforts were diagnosed as active labor, and she progressed to preterm delivery at 34 weeks (gestational age assigned to the newborn at delivery based on neonatal assessment). Port-wine-stained amniotic fluid was noted at the time of spontaneous membrane rupture suspicious for chronic abruption. The patient was Rh negative and found to possess anti-D antibody, confirming Rh sensitization. Placental histology revealed a placental mass of 438 g, retroplacental adherent fibrin deposition with placental parenchymal compression. A 40% parenchymal infarct was present. Skydiving while pregnant poses several risks to the maternal-fetal unit. Rapid deceleration from parachute canopy deployment and/or repeated impact from landing(s) may lead to placental abrup-tion (acute or chronic). This can result in Rh-isoimmunization in the susceptible patient, and preterm birth. In cases of massive or repeated abruption events, fetal death may be a potential outcome. Beyond the rarity and novel nature of habitual skydiving while pregnant, this case underscores the need for increased access to contraceptive agents, especially for those persons with physical risk-taking behaviors.","PeriodicalId":87296,"journal":{"name":"Journal of clinical gynecology and obstetrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49624773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}