The latest medical research on Obstetrics And Gynecology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about obstetrics and gynecology gathered by our medical AI research bot.

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Use of intracytoplasmic sperm injection (ICSI) in normospermic men may result in lower clinical pregnancy and live birth rates.

Australian and New Zealand Journal

While intracytoplasmic sperm injection (ICSI) was developed for overcoming male infertility, it is increasingly being used for non-male factor indications, without consensus regarding the safety and efficacy of this approach.

To determine whether ICSI offers any benefit compared to standard in vitro fertilisation (IVF), in the setting of normal semen parameters.

Retrospective analysis of reproductive outcomes in 3363 stimulated cycles (IVF = 1661; ICSI = 1702), in patients treated between 2009-2015, was performed. Selected couples had no male factor infertility. Couples with abnormal semen parameters (based on WHO 2010 guidelines), presence of anti-sperm antibodies and low oocyte yield of ≤4 oocytes, were excluded. The outcomes analysed included: (1) fertilisation rate (FR); (2) clinical pregnancy rate (CPR); and (3) live birth rate (LBR), by method of fertilisation used (IVF vs ICSI) and controlling for significant confounders.

FR, CPR and LBR were significantly higher in the IVF group compared with ICSI (67.1% vs 62.3%, 23.06% vs 16.8%, 17.22% vs 13.2%, respectively). Pregnancy rate with ICSI was approximately 30% lower than with IVF, even when controlling for significant factors such as day of embryo transfer and number of embryos transferred. This translates to one less pregnancy in every 15 cycles where ICSI was used without clear indication.

Our data suggest that ICSI may be detrimental to clinical outcomes and contributes to the wider understanding of use of ICSI in normospermic men.

Risk assessment for antenatal depression among women who have undergone female genital mutilation or cutting: Are we missing the mark?

Australian and New Zealand Journal

Although prohibited by specific legislation in Australia, patterns of global migration underscore the importance for local clinicians to recognise and manage potential complications associated with female genital mutilation/cutting (FGM/C). The incidence of antenatal depression in Australia is 10% and may be higher among those with a history of FGM/C (RANZCOG 2 statement: Perinatal Anxiety and Depression, 2012). The phenomenon of cultural embedding could represent a protective factor against an increase in mental health problems among these women.

To determine whether women who have undergone FGM/C are at greater risk of depression in the antenatal period as defined by the Edinburgh Postnatal Depression Scale (EPDS).

A multicentre retrospective case-control study was performed. Participants who had delivered at either of two hospitals, had migrated from FGM/C-prevalent countries and who had undergone FGM/C were assessed and compared with the control group, case-matched by language and religion.

Eighty-nine cases were included with an equal number of matched controls. No significant difference in the EPDS score was demonstrated when analysed as a continuous variable (P = 0.41) or as a categorical variable with a cut-off score of 12 (P = 0.12). There was no difference in the number of women who identified as having thoughts of self-harm between the two groups.

There was no identified increase in the risk of antenatal depression among women who have undergone FGM/C from high-prevalence countries. Consideration must be given to the utility of the EPDS in this population, as well as factors such as cultural embedding.

Birth outcomes in Aboriginal mother-infant pairs from the Northern Territory, Australia, who received 23-valent polysaccharide pneumococcal vaccination during pregnancy, 2006-2011: The PneuMum randomised controlled trial.

Australian and New Zealand Journal

Pregnant women and infants <6 months old have a high baseline risk for pneumococcal disease compared to the general population, particularly among Indigenous populations living in poverty and low-resource settings. Efficacy trials of pneumococcal vaccination in pregnancy examining adverse birth outcomes are lacking.

We report adverse birth events as secondary outcomes from the 'PneuMum' randomised controlled trial of 23-valent pneumococcal polysaccharide vaccination (23vPPV) in pregnancy (August 2006-January 2011).

Australian Aboriginal women aged 17-39 years with singleton uncomplicated pregnancies were randomised (1:2 ratio) to receive 23vPPV or no 23vPPV in pregnancy at 30-36 weeks gestation. We compared risks of stillbirth, preterm birth, low birthweight (LBW), and small for gestational age (SGA) between vaccinated and unvaccinated pregnant women. Cox proportional hazard ratios (HRs) were calculated on an intention-to-treat basis.

Among 227 enrolled participants, 75 (33%) received 23vPPV in pregnancy. Risk differences in adverse birth outcomes between 23vPPV vaccinated and unvaccinated pregnant women were; preterm birth 9% vs 4% (HR 2.79; 95% CI 0.94-8.32) P = 0.07; LBW 9% vs 5% (HR 2.09; 95% CI 0.76-5.78) P = 0.15; and SGA 15% vs 17% (HR 1.02; 95% CI 0.50-2.06) P = 0.96. There were no stillbirths.

We found a numerically higher rate of preterm births among women who received 23vPPV in pregnancy compared to unvaccinated pregnant women. Although further investigation with larger participant numbers is needed to better evaluate this safety signal, the contribution of safety results from smaller studies using appropriate data analysis methodologies is critical, particularly as more clinical trials in pneumococcal vaccination in pregnancy are progressing.

Burden of surgical site infection following cesarean section in sub-Saharan Africa: a narrative review.

International Journal of Epidemiology

Cesarean section (CS) is the most common operative procedure performed in sub-Saharan Africa (SSA), accounting for as much as 80% of the surgical w...

Screening for trisomies by cfDNA testing of maternal blood in twin pregnancy: update of The Fetal Medicine Foundation results and meta-analysis.

Ultrasound in Obstetrics and Gynecology

To report on the routine clinical implementation of cell-free DNA (cfDNA) analysis of maternal blood for trisomies 21, 18 and 13 in twin pregnancy and to define the performance of the test by combining our results with those identified in a systematic review of the literature.

The data for the prospective study were derived from screening for trisomies 21, 18 and 13 in twin pregnancies at 10 + 0 to 14 + 1 weeks' gestation. Two populations were included; first, self-referred women to the Fetal Medicine Centre in London or Brugmann University Hospital in Brussels and, second, women selected for the cfDNA test after routine first-trimester combined testing at one of two National Health Service hospitals in England. This dataset was used to determine the performance of screening for the three trisomies. Search of MEDLINE, EMBASE, CENTRAL (The Cochrane Library), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP) was carried out to identify all peer-reviewed publications on clinical validation or implementation of maternal cfDNA testing for trisomies 21, 18 and 13 in twin pregnancy. A meta-analysis was then performed using our data and those in the studies identified by the literature search.

In our dataset of 997 twin pregnancies with a cfDNA result and known outcome, the test classified correctly 16 (94.1%) of the 17 cases of trisomy 21, nine (90.0%) of the 10 cases of trisomy 18, one (50.0%) of the two cases of trisomy 13 and 962 (99.4%) of the 968 cases without any of the three trisomies. The literature search identified seven relevant studies, excluding our previous papers because their data are included in the current study. In the combined populations of our study and the seven studies identified by the literature search, there were 56 trisomy-21 and 3718 non-trisomy-21 twin pregnancies; the pooled weighted detection rate (DR) and false-positive rate (FPR) were 98.2% (95% CI, 83.2-99.8%) and 0.05% (95% CI, 0.01-0.26%), respectively. In the combined total of 18 cases of trisomy 18 and 3143 non-trisomy-18 pregnancies, the pooled weighted DR and FPR were 88.9% (95% CI, 64.8-97.2%) and 0.03% (95% CI, 0.00-0.33%), respectively. For trisomy 13, there were only three affected cases and two (66.7%) of these were detected by the cfDNA test at a FPR of 0.19% (5/2569).

The performance of cfDNA testing for trisomy 21 in twin pregnancy is similar to that reported in singleton pregnancy and is superior to that of the first-trimester combined test or second-trimester biochemical testing. The number of cases of trisomies 18 and 13 is too small for accurate assessment of the predictive performance of the cfDNA test. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Etiology and perinatal outcome in periviable fetal growth restriction associated with structural or genetic anomalies.

Ultrasound in Obstetrics and Gynecology

To investigate the aetiology and the perinatal outcome of fetuses diagnosed with periviable fetal growth restriction (FGR) associated with structural defects or genetic anomalies.

Retrospective study conducted at a referral Fetal Medicine unit. Singleton pregnancies seen between 2005 and 2018 in which FGR, defined by fetal abdominal circumference ≤3rd percentile for the gestational age, was diagnosed between 22+0 -25+6 weeks of gestation were enrolled. The study group included periviable FGR associated with genetic or structural anomalies ("anomalous FGR"), while the control group consisted in structurally and genetically normal FGR ("non-anomalous FGR"). The results of the genetic tests, of the TORCH screening and of the post-mortem examination as well as the perinatal outcomes were investigated.

Of 255 cases, 188 fetuses were eligible, of whom 52 (28%) were anomalous FGR and 136 (72%) non-anomalous FGR. Confirmed genetic abnormalities accounted for 17/52 cases (33%) of anomalous FGR, with trisomy 18 constituting over 50% (9/17, 53%). The most common structural defects associated with FGR were CNS abnormalities (13/35, 37%). Overall, 12 cases survived the neonatal period. No differences were found in terms of perinatal survival between anomalous and non-anomalous FGR.

Of anomalous FGR, most are associated with structural defects. The association of structural abnormality with a genetic defect and FGR at periviable gestation was invariably lethal, while the combination of periviable FGR and structural defect in the absence of a confirmed genetic abnormality was associated with survival into infancy in four out of five cases, with an overall chance of perinatal survival of one in three. These data can be used for the counselling of the prospective parents. This article is protected by copyright. All rights reserved.

Evaluation of the quality and reliability of middle cerebral artery and umbilical artery Doppler images within an international randomized controlled trial.

Ultrasound in Obstetrics and Gynecology

To determine the image quality and the reliability of an objective scale of the middle cerebral artery (MCA) and the umbilical artery (UA) Doppler evaluation within a multicenter randomized controlled trial: "Revealed versus concealed criteria for placental insufficiency in unselected obstetric population in late pregnancy: Ratio 37" METHODS: 20 patients were randomly selected (2 images per patient, UA and MCA) from each of the 6 participating centres. A total of 240 images were evaluated by 6 different experts and scored on an objective scale of 6 items. The inter- and intra-rater reliability was assessed by Fleiss-modified kappa statistic for ordinal scales.

For MCA, 89.2% of the images were on average considered perfect (score of 6) or almost perfect (score of 5). Regarding UA, this figure was 85%. The intra-rater reliability and its 95% CI was 0.9 (95% CI 0.88-0.92) and 0.9 (0.88-0.93) for the MCA and UA, respectively. The inter-rater reliabilities were 0.85 (0.81-0.89) and 0.84 (0.8-0.89).

MCA and UA ultrasound images can be correctly evaluated by an objective scale. Over 85% of the images obtained within a multicentre study by a broad range of operators were almost perfect. The intra and inter-rater reliability were substantially good. This article is protected by copyright. All rights reserved.

Association between mucopolysaccharidosis Type VII and hydrops fetalis.

Ultrasound in Obstetrics and Gynecology

Hydrops Fetalis (HF) is a serious pregnancy complication defined by edema in two or more fetal compartments, typically in the first or second trime...

The risk of perinatal death at term.

BJOG

Preventing stillbirth has been increasingly recognised as an issue in obstetric care over recent years. Death of a normally formed baby at term is ...

Effectiveness of spontaneous ovulation as monitored by urinary luteinizing hormone versus induced ovulation by administration of human chorionic gonadotropin in couples undergoing gonadotropin stimulated intrauterine insemination (IUI): a randomized controlled trial.

BJOG

To compare effectiveness of spontaneous ovulation monitored by urinary luteinizing hormone (LH) versus induced ovulation by administration of human chorionic gonadotropin (hCG) in couples undergoing gonadotropin stimulated IUI.

Clinical pregnancy rate. Secondary outcomes - ongoing pregnancy, live birth, multiple pregnancy and miscarriage rates.

A total of 392 couples were randomized with 196 in each arm. The clinical pregnancy rate per woman randomised was 14/196 (7.1%) in the LH arm vs. 15/196 (7.6%) in the hCG arm; P = 0.847 which was not statistically significant. Similarly, the ongoing pregnancy rates (13/196 (6.6%) vs. 14/196 (7.1%); P = 0.84) and the live birth rates (13/196 (6.6%) vs. 14/196 (7.1%); P = 0.84) between the two groups did not show any significant difference. The duration of stimulation and gonadotrophin dosage also did not differ significantly between the two methods.

There was no significant difference in clinical pregnancy rates when urinary LH and hCG trigger as methods to time insemination were compared in women undergoing gonadotropin stimulated IUI. This article is protected by copyright. All rights reserved.

The pathophysiology of septate uterus.

BJOG

Pathophysiology of septate uterus remains a challenge. The systematic review of Rikken et al (BJOG, 2019, xxxx) represents a useful effort to summa...

A prospective review of perinatal mortality at Hospital Nacional Guido Valadares (HNGV).

Australian and New Zealand Journal

Timor-Leste has one of the highest perinatal mortality rates in the Asia-Pacific region. Consistent and accurate data collection improves understanding of perinatal outcomes and facilitates the development of interventions to reduce stillbirths and early neonatal deaths.

(1) To identify changes in the rates of stillbirth and early neonatal deaths from previous published data. (2) To determine if prospective data collection and the application of the simplified Causes Of Death and Associated Conditions (CODAC) classification allows better identification of perinatal deaths in Timor-Leste.

A prospective audit of perinatal deaths of women delivering at Hospital Nacional Guido Valadares (HNGV) was undertaken from January to June 2016 inclusive. The hospital birth registry, maternal and neonatal records were reviewed to determine the most likely aetiology and classification of perinatal deaths using the simplified CODAC system.

One hundred and ten stillbirths and 28 early neonatal deaths were identified. Fifty-four percent of perinatal deaths occurred antepartum, 26% intrapartum and 20% were early neonatal deaths. Cause of death among stillbirths could not be ascertained in 40% of cases. Intrapartum asphyxia was the commonest identified aetiology of intrapartum and early neonatal deaths.

There has been limited improvement in the rate of stillbirths and early neonatal deaths at HNGV. Intrapartum hypoxia and maternal hypertensive conditions were the most common identified aetiologies highlighting areas where targeted interventions may help reduce high perinatal mortality rates. Aetiology of perinatal deaths, particularly antepartum stillbirths was difficult to discern even when well-tested classification systems are used.