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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Mercaptopurine and Metabolites in Breast Milk.Breastfeed Med
A 35-year-old pregnant woman visited our outpatient clinical questioning the safety of once daily 50 mg mercaptopurine (MP) during pregnancy and la...
Diagnosis of fetal non-chromosomal abnormalities on routine ultrasound examination at 11-13 weeks' gestation.Ultrasound in Obstetrics and Gynecology
To examine the performance of the routine 11-13 weeks scan in detecting fetal non-chromosomal abnormalities.
This was a retrospective study of prospectively collected data from 100,997 singleton pregnancies attending for a routine ultrasound examination for fetal anatomy, according to a standardized protocol, at 11-13 weeks' gestation. All continuing pregnancies had an additional scan at 18-24 weeks and 71,754 had a scan at either 30-34 or 35-37 weeks. The final diagnosis of fetal abnormalities was based on the results of postnatal examination in the case of livebirths and on the findings of the last ultrasound examination in the cases of pregnancy termination, miscarriage or stillbirth. The performance of the 11-13 weeks scan in the detection of fetal abnormalities was determined.
The study population contained 1,720 (1.7%) fetal abnormalities, including 474 (27.6%) detected in the first-trimester scan, 926 (53.8%) detected in the second-trimester scan and 320 (18.6%) detected in the third-trimester or postnatally. At 11-13 weeks' gestation we diagnosed all cases of acrania, alobar holoprosencephaly and encephalocele, tricuspid or pulmonary atresia, pentalogy of Cantrell and ectopia cordis, exomphalos, gastroschisis and body stalk anomaly and >50% of cases of open spina bifida, hypoplastic left heart syndrome, atrioventricular septal defect, complex heart defects and left atrial isomerism (interrupted inferior vena cava with normal intracardiac anatomy), lower urinary tract obstruction, amputations of extremities, arthrogryposis or fetal akinesia deformation sequence and lethal skeletal dysplasia. Common abnormalities that were detected in <10% of cases at 11-13 weeks include ventriculomegaly, agenesis of the corpus callosum, isolated cleft lip, congenital pulmonary airways malformation, ventricular septal defect, abdominal cysts, unilateral renal agenesis or multicystic kidney, hydronephrosis, duplex kidneys, talipes and hypospadias.
A routine 11-13 weeks, carried out according to a standardized protocol, can identify many severe non-chromosomal fetal abnormalities. A summary statistic of the performance of the first-trimester scan is futile because some abnormalities are always detectable, whereas others are either non-detectable or sometimes detectable. To maximize prenatal detection of abnormalities additional scans in both the second and third trimester are necessary. This article is protected by copyright. All rights reserved.
The effectiveness and safety of introducing condom-catheter uterine balloon tamponade for postpartum hemorrhage at secondary level hospitals in Uganda, Egypt and Senegal: a stepped wedge, cluster-randomized trial.BJOG
Assess the effectiveness of introducing condom-catheter uterine balloon tamponade (UBT) for postpartum hemorrhage (PPH) management in low- and middle-income settings.
Combined incidence rate (IR) of PPH-related invasive surgery and/or maternal death.
There were 28,183 and 31,928 deliveries in the control and intervention periods, respectively. UBT was used for 9/1357 and 55/1037 women diagnosed with PPH in control and intervention periods, respectively. PPH-related surgery or maternal death occurred in 19 women in the control period (IR=6.7/10,000 deliveries) and 37 in the intervention period (IR=11.6/10,000 deliveries). The adjusted IR ratio was 4.08 (95% confidence interval: 1.07-15.58). Secondary outcomes, including rates of transfer and blood transfusion, were similar in the trial periods.
Introduction of condom-catheter UBT in these settings did not improve maternal outcomes and was associated with an increase in the combined incidence of PPH-related surgery and maternal death. The lack of demonstrated benefit of UBT introduction with respect to severe outcomes warrants reflection of its role. This article is protected by copyright. All rights reserved.
Human uterine transplantation: a review of outcomes from the first 45 cases.BJOG
Uterine transplantation restores reproductive anatomy in women with absolute uterine factor infertility and allows the opportunity to conceive, exp...
Associated ileocaecal location is a marker for greater severity of low rectal endometriosis.BJOG
To determine whether ileocaecal endometriosis (ICE) is a marker of low rectal endometriosis (LRE) severity.
Univariate and multivariate analysis of anatomical, postoperative clinical, and long-term outcomes according to presence of ICE.
Mean number and type of deep infiltrating endometriosis (DIE) lesions, the existence of an associated endometrioma and mean total American Society for Reproductive Medicine (ASRM) score.
The prevalence of ICE was 25.6%. Primary end-point data showed that women with ICE had a significantly higher adjusted number of DIE lesions (OR = 1.43, 95% CI: 1.02 to 3.03; P = 0.048), higher prevalence of endometriomas (OR = 1.91, 95% CI: 1.04 to 3.51; P = 0.044), more associated DIE sigmoid lesions (OR = 2.12, 95% CI: 1.07 to 3.91; P = 0.025), and a higher mean total ASRM score (OR = 2.07, 95% CI: 1.12 to 4.14; P = 0.025). Women with ICE resected during the surgical procedure for LRE did not have more adverse postoperative clinical outcomes than ICE-negative patients.
ICE was significantly associated with greater LRE severity. In a complete surgical resection strategy, combining resection of ICE and LRE did not appear to increase postoperative rates of complications, morbidity, or recurrence nor did it seem to impair long-term clinical outcomes. This article is protected by copyright. All rights reserved.
Safety profile and oncological outcomes of gastric gastrointestinal stromal tumors (GISTs) robotic resection: single center experience.Int J Med
Though usefulness of robot assisted surgery has been largely reported and accepted, robot assisted gastrointestinal stromal tumors (GIST) treatment is rare. Hence, the aim of this study is to report a single center evaluation on gastric GIST's robotic resection.
Six patients were analyzed focusing on safe (conversion/complications rate; hospital stay), oncological (margin resection, recurrence rate) and feasible (operative time, technical tip and tricks) profile of robotic-assisted GIST surgery.
The mean operative time and hospital stay was 173 ± 39 minutes and 3 ± 1 days respectively. The conversion rate (to open or laparoscopy) was nil and no intra and post-operative (mean follow-up 12 months) complications were registered. In all cases, the resections were classified as R0.
This study supports the usefulness of robotic-assisted surgery as the anatomical hand sewn reconstruction might avoid the stomach distortion and the oncological (100% R0) and safety profile outcomes encourage its use. However, further studies with larger sample size are recommended to confirm the outcomes of this study.
Development and validation of prediction models for the QUiPP App v.2: a tool for predicting preterm birth in women with symptoms of threatened preterm labor.Ultrasound in Obstetrics and Gynecology
To develop enhanced prediction models to update the QUiPP app, a tool for predicting spontaneous preterm birth in women with symptoms of threatened preterm labour (TPTL), incorporating risk factors, transvaginal ultrasound assessment of cervical length (CL, mm) and cervicovaginal fluid quantitative fetal fibronectin test results (qfFN).
Participants were pregnant women between 23+0 and 34+6 weeks' gestation with symptoms of TPTL, recruited as part of four prospective cohort studies carried out at 16 UK hospitals between October 2010 and October 2017. The training set comprised all women where outcomes were known at May 2017 (n=1032). The validation set comprised women where outcomes were gathered between June 2017 and March 2018 (n=506). Parametric survival models were developed for three combinations of predictors: risk factors plus qfFN test, risk factors plus CL only, and risk factors plus both tests. The best models were selected using the Akaike and Bayesian information criteria. The estimated probability of delivery before 30, 34 or 37 weeks' gestation and within 1 or 2 weeks of testing was calculated and Receiver Operating Characteristic (ROC) curves were created to demonstrate the diagnostic ability of the prediction models.
Predictive statistics were similar in training and validation sets. Areas under the ROC curves (validation set) demonstrated good prediction at all time points, particularly in the combination of risk factors plus qfFN model: 0.96 (<30 weeks); 0.85 (<34 weeks); 0.77 (<37 weeks); 0.91 (<1 week) and 0.92 (<2 weeks).
Validation of these prediction models suggests the QUiPP v.2 app can reliably calculate risk of preterm delivery in women with TPTL. Use of the QUiPP app in practice could lead to better targeting of intervention, while providing reassurance and avoiding unnecessary intervention in women at low risk. This article is protected by copyright. All rights reserved.
Triaging women with a pregnancy of unknown location using a two-step triage protocol including the M6 model: a clinical implementation study.Ultrasound in Obstetrics and Gynecology
The M6 risk prediction model has been shown to have good triage performance for stratifying women with a PUL as being at low or high-risk of harboring an ectopic pregnancy. There is evidence that M6 has better overall test performance than the hCG ratio (serum hCG at 48 hours/hCG at presentation) and older models such as the M4 model. M6 was published as part of a two-step protocol using an initial progesterone ≤2nmol/l to identify likely failing pregnancies (step 1), followed by M6 (step 2). This study validated the triage performance of this protocol in clinical practice by evaluating (1) the number of protocol-related adverse events and (2) how patients are effectively triaged.
This was a prospective multi-centre interventional study of 3272 women with a PUL carried out between January 2015 and January 2017 in four district general hospitals and four university teaching hospitals in the United Kingdom. We defined the final pregnancy outcome as: a failed PUL (FPUL), an intrauterine pregnancy (IUP) or an ectopic pregnancy (EP) (including persistent PUL (PPUL)). FPUL and IUP were grouped as low-risk and EP and PPUL as high-risk PUL. Patients had a serum progesterone and hCG level at 0 hours and repeat hCG at 48 hours. In seven centres, if the initial progesterone was ≤2nmol/l, patients were discharged with a follow-up urine pregnancy test in two weeks to confirm a negative result. If the progesterone was >2nmol/l or had not been taken, a 48 hour hCG level was taken and results entered into the M6 model. Patients were managed according to their predicted outcome: those classified with pregnancies likely to resolve (FPUL) were advised to perform a urine pregnancy test in two weeks and those with a likely IUP were invited for a scan a week later. When a women with a PUL was classified as high-risk (i.e. those with a risk of EP ≥ 5%) were reviewed clinically within 48 hours. One centre used a progesterone cut-off ≤10nmol/l and was analysed separately. If the recommended management protocol was not adhered to, this was recorded as an 'unscheduled visit (participant reason)', 'unscheduled visit (clinician reason)' or 'differences in timing (blood test/ultrasound)'. The classifications outlined in UK Good Clinical Practice guidelines were used to evaluate adverse events. Data were analysed with descriptive statistics.
Data was available for main analysis in 2625/3272 women with PUL (317 met the exclusion criteria or were lost to follow-up, 330 were evaluated with a progesterone cut-off of ≤10nmol/l). Progesterone results were available for 2392 (91%). 407 (15.5%) patients were classified as low-risk at step 1 (progesterone ≤2nmol/l), of which 7 (1.7%) were ultimately diagnosed with an EP. For 279/2218 remaining women with a PUL, M6 was not used or the outcome was already known usually on the basis of an ultrasound scan before a second hCG level was taken (30 were EP). 1038 women with a PUL were classified as low-risk at step 2, of which 8 (0.8%) were EP. 901 women with a PUL were classified as high-risk at step 2, of which 275 (30.5%) were EP. 275/320 (85.9%) EP were correctly classified as high-risk. Overall, 1445/2625 PUL (55.0%) were classified as low-risk, of which 15 (1.0%) were EP. None of these 15 EP ruptured.
This study has shown that the two-step protocol incorporating the M6 model effectively triaged a majority of women with a PUL as being at low-risk of an EP, minimizing the follow-up required for these patients after just two visits. There were few misclassified EP and none of these women came to significant clinical harm or suffered a serious adverse clinical event. The two-step protocol, incorporating the M6 model, is an effective and clinically safe way of rationalizing the management of women with a PUL. This article is protected by copyright. All rights reserved.
Long-term outcome of postmenopausal women with non-atypical endometrial hyperplasia on endometrial sampling.Ultrasound in Obstetrics and Gynecology
To assess the long-term outcome of post-menopausal women diagnosed with non-atypical endometrial hyperplasia (NEH).
It is a retrospective study of women aged 55 and older who underwent endometrial sampling in our large academic medical center between 1997 and 2008. Women diagnosed with NEH were included in the study group and were compared to women diagnosed with atrophic endometrium on endometrial sampling. Outcome data was obtained through February 2018. The main outcomes were the risk of progression to endometrial carcinoma and the risk of persistent endometrial hyperplasia (EH). Logistic regression was used to identify covariates that remained significant risk factors for cancer progression.
1808 women aged 55 and older underwent endometrial sampling during the study period. The median surveillance time was 10.0 years. 73 women were found to have NEH and they were compared to 742 women with atrophic endometrium (AE). When compared to women with AE, women with NEH had a significantly higher BMI (33.9 vs. 30.6, p=0.01), a higher rate of progression to type 1 endometrial cancer and persistent endometrial hyperplasia (8.2% vs. 0.8%, p<0.0001 and 21.9% vs 0.7% respectively, p<0.0001). They also had a higher rate of progression to all types of uterine cancer or persistent hyperplasia (32.9% vs 3.4%, p<0.0001). Women with NEH also had significantly higher rate of future surgical intervention (50.7% vs 15.4%, p<0.0001) and future hysterectomy (34.3% vs. 9.6%, p<0.0001). On logistic regression analysis, NEH, BMI>35, thick endometrium on ultrasound and diabetes remained significant risk factors for progression to cancer.
Postmenopausal women with NEH are at significant risk for persistent endometrial hyperplasia (EH) and progression to uterine cancer, at higher rates than rates previously reported. Guidelines for the appropriate management of postmenopausal women with NEH are needed to decrease the rate of persistent disease or progression to cancer. This article is protected by copyright. All rights reserved.
Utilisation of teratogenic medicines before and during pregnancy in Australian women.Australian and New Zealand Journal
Given the potential hazards of teratogenic medicines, to a fetus exposed in utero, monitoring their use around pregnancy is imperative.
To measure utilisation of teratogenic medicines (Therapeutic Goods Administration's category D or X) in women who gave birth in New South Wales, Australia, during pregnancy and the 24 months prior.
We used linked population-based datasets including dispensing and perinatal data for all deliveries in NSW between 2005 and 2012. We included pregnancies among concessional beneficiaries only, with complete ascertainment of dispensing claims. Pre-pregnancy and during-pregnancy periods were based on birth dates and gestational age. We determined prevalence of exposure using percent of pregnancies in which women had at least one dispensed teratogenic medicine in three-month time periods.
The study included 191 588 pregnancies (145 419 women). Prevalence of exposure to D/X medicines anytime during pregnancy was 2.0% (<20 pregnancies category X), decreasing from pre-pregnancy (3.8-6.0%) to first trimester (1.5%), further decreasing in second and third trimesters (0.8% and 0.6% respectively). We observed large reductions in antibiotic prevalence but only modest reductions for psychotropics and antilipidemic agents (all category D). Our results suggest higher use of potentially teratogenic medicines (category D) than those strictly contraindicated for use (category X), during pregnancy. Overall, use was higher in the first trimester than the rest of pregnancy. The high prevalence of potentially contraindicated psychotropics in all three trimesters may suggest a higher benefit-to-risk ratio and warrants future research focusing on the reasons for their prescribing to pregnant women.
The vaginal microbiome in uterine transplantation.BJOG
Women with congenital absolute uterine factor infertility (AUFI) often need vaginal restoration to optimise sexual function. Given their lack of pr...
Association between maternal alcohol consumption during pregnancy and risk of preterm delivery: the Japan Environment and Children's Study.BJOG
Examine the association between maternal alcohol consumption during pregnancy and the risk of preterm delivery.
Medical record-based preterm delivery.
Alcohol consumption during the second and third trimesters, but not during the first trimester, was associated with increased risk of preterm delivery. Heavy alcohol consumption (≥300 g ethanol/week) during the second and third trimesters was associated with a four-fold higher risk compared with non-drinkers (multivariable OR = 4.52; 95% CI: 1.68-12.2). Light alcohol consumption (1-149 g ethanol/week) tended to be associated with lower risk of preterm delivery (multivariable OR = 0.78; 95% CI: 0.60-1.00).
Heavy alcohol consumption during the second and third trimesters was associated with increased risk of preterm delivery among pregnant women. This article is protected by copyright. All rights reserved.