Prediction of Preeclampsia by Midtrimester Uterine Artery Doppler Velocimetry in High-Risk and Low-Risk Women

Objective

To observe the role of uterine artery Doppler flow velocimetry at midtrimester in prediction of preeclampsia.

Method

179 women carrying <16 weeks of pregnancy, with singleton fetus and without any fetal anomaly were recruited and were divided in high-risk and low-risk group. Doppler velocimetry of uterine artery was done at 24–26 weeks. Any notch in uterine artery, unilateral or bilateral, or RI > 0.6, was considered abnormal. Women were followed up and development of preeclampsia noted.

Result

Sensitivity and specificity of abnormal uterine artery Doppler study for prediction of preeclampsia were 73.33 and 86.48 % in high-risk and 57.14 and 95.83 % in low-risk group, respectively. Relative risk with 95 % confidence interval was 5.427 (2.272–12.958) in high-risk and 13.65 (5.669–32.865) in low-risk women.

Conclusion

Doppler velocimetry of uterine artery at 24 weeks can be used as a reliable screening test for prediction of preeclampsia in both high-risk and low-risk women.     

Laparoscopy vs Minilaparotomy in Women with Symptomatic Uterine Myomas: A Prospective Randomized Study

ObjectiveTo compare outcomes in patients with symptomatic uterine myomas who underwent laparoscopic (LPS) or minilaparotomic (MLPT) myomectomy.DesignProspective randomized study (Canadian Task Force classification II-2).SettingUniversity hospital.PatientsEighty patients with no more than 3 uterine myomas of maximal diameter of 7 cm.InterventionEither LPS or MLPT myomectomy.Measurements and Main ResultsMean blood loss, mean duration of postoperative ileus, and mean decrease in hemoglobin were significantly lower in the LPS compared with the MLPT group (p < .001). Mean operative time was not significantly longer in the LPS group compared with the MLPT group. Duration of hospitalization was significantly shorter in the LPS compared with the MLPT group (p < .001). No intraoperative complications were observed during MLPT. In 1 patient, conversion from LPS to MLPT was necessary because of difficulty in reconstructing the uterine wall.ConclusionLaparoscopic myomectomy is a suitable alternative to MLPT in women with 1 to 3 myomas. However, preoperative careful evaluation of the size and sites of the myomas is necessary to avert conversion and prevent complications.     

年轻妇女子宫内膜癌临床病理分析

目的探讨年轻妇女子宫内膜癌的临床病理特征,指导个体化治疗.方法对15例年龄＜40岁的年轻妇女子宫内膜癌(研究组)与同期的122例年龄≥40岁的子宫内膜癌(对照组)进行回顾性对照研究,比较两组的临床病理特征.结果年轻妇女子宫内膜癌占同期子宫内膜癌总数的10.95%;研究组和对照组刮宫病理检查,未提示子宫内膜癌者所占比例,分别为13.33%和4.10%(P＞0.05),Ⅰ型子宫内膜癌所占比例分别为93.33%和77.87%(P＞0.05);研究组和对照组G1级所占比例分别为86.67%和48.36%(P＜0.05),Ⅰ期所占比例分别为93.33%和61.48%(P＜0.05);研究组雌、孕激素受体阳性率均高于对照组(P＜0.05).结论年轻妇女子宫内膜癌具有不同于一般子宫内膜癌的临床病理特征,具有较好的预后因素,保守治疗有望改善其生活质量.     

A Validation Study of Home Uterine Activity Monitoring Technology in Western Australia

EDITORIAL COMMENT: We accepted this paper for publication because it shows that there is technology available to reliably record uterine contractions and that the information can be transferred by a telecommunications system. As the authors indicate there is no consensus in the literature concerning the usefulness of home monitoring in the prevention of prematurity and whether the newer methods of biochemical monitoring will prove superior. Final judgement must be deferred until data are presented regarding testing this methodology on high and low-risk patients in their homes including those in areas remote from hospital.
Summary: Home uterine activity monitoring has been developed as an 'early warning' device to detect premature uterine activity, thereby encouraging earlier referral and tocolysis of women at risk of preterm delivery. This ambulatory monitoring system, utilizing a ring-guard tocodynamometer, was piloted in Western Australia to determine if it can reliably record and transmit antenatal uterine activity data in an Australian environment. Pregnant women were readily able to correctly apply and use the ambulatory monitoring device. The information collected was able to be transmitted using standard Australian telecommunications systems within our hospital environment. Validation studies with the ambulatory monitor and current external tocodynamometry hardware were performed. The ring-guard tocodynamometer detected more uterine activity at gestations less than 32 weeks compared with conventional external tocodynamometers. As term approached, however, the sensitivity of the ring-guard tocodynamometer decreased. A cross-sectional profile of antenatal uterine activity was developed for women at low risk of delivering preterm. A gradual increase in the number, duration and amplitude of uterine contractions as pregnancy advanced was observed.     

Pain Trajectories and Predictors: A 7-Year Longitudinal Study of Women With Vulvodynia

IntroductionA significant proportion of women report a reduction of symptoms over time—even without treatment—yet the natural progression of vulvodynia and which factors may explain decrease vs persistence of pain remain unclear.AimTo identify subgroups of pain trajectories in women with vulvodynia and to predict these different trajectories by treatments undertaken, pain characteristics, and psychosocial factors.MethodsData on pain intensity, treatments undertaken, pain characteristics, and psychosocial factors were collected 3 times over a 7-year period from 173 women who screened positive for vulvodynia. Latent class growth analysis was conducted to identify homogeneous subgroups with distinct pain trajectories. A multivariate binomial logistic regression was used to examine whether treatments, pain characteristics, and psychosocial factors predicted these trajectories.Main Outcome MeasureThe main outcome was pain intensity (0–10), measured at 3 time points with the numerical rating scale.Results2 pain trajectories were identified: 1 where pain persisted (28.9%), and 1 where pain decreased over time (71.1%). Whether a treatment had been undertaken was not predictive of the course of pain over time. Women who were older at first pain onset, had pain at another location than the entrance of the vagina, and reported more anxiety were more likely to have a persistent pain trajectory relative to the decreased pain trajectory.Clinical ImplicationsFindings suggest that the evolution of pain differs among women with vulvodynia depending on pain characteristics and anxiety.Strengths & LimitationsStrengths of the study include the 7-year longitudinal design to examine the natural history of provoked vestibulodynia and the inclusion of biopsychosocial factors as predictors of pain trajectories. However, women with major medical and psychiatric illnesses or deep dyspareunia were not included, and, thus, these factors could not be examined as predictors.ConclusionAssessing baseline characteristics associated with different pain trajectories during medical visits could have positive implications for the management of vulvodynia.Pâquet M, Vaillancourt-Morel M-P, Jodouin J-F, et al. Pain Trajectories and Predictors: A 7-Year Longitudinal Study of Women With Vulvodynia. J Sex Med 2019;16:1606–1614.     

A Proposed Alliance of Midwives and Family Practitioners in the Care of Low-Risk Pregnant Women

ABSTRACT: Only 63.4 percent of family practitioners have hospital privileges for obstetrics, and this number is declining. Family practitioners who do not practice obstetrics also are less involved in child care and tend to treat only one member of the family. Teaming up with nurse-midwives and functioning as midwives may be a way for doctors to overcome the barriers to practicing maternity care, including the disruptive nature of obstetrics on their personal and professional lives, high mal-practice insurance rates, and lack of adequate reimbursement from insurers when care must be transferred to an obstetrician. Midwives and family practitioners often have common philosophies of maternity care that could be advantageous to both practitioners and families in their childbearing years.     

First and Third Trimester Uterine Scar Thickness in Women With Previous Caesarean: A Prospective Comparative Study

Background

Lower uterine segment (LUS) thickness in the third trimester of gestation is associated with the risk of uterine scar defect at delivery. It was suggested that first trimester residual myometrial thickness (RMT) could also predict uterine scar defect at delivery.

The Use of Complementary and Alternative Medicine During Pregnancy: A Longitudinal Study of Australian Women

Abstract: Background: The use of complementary and alternative medicine is increasingly prevalent in contemporary Western societies. The objective of this study was to explore trends and patterns in complementary and alternative medicine practitioner consultations and the use of complementary and alternative medicine consumption before, during, and after pregnancy and between pregnancies. Methods: Analysis focused on data from 13,961 women from the younger cohort of the Australian Longitudinal Study on Women’s Health collected between 1996 and 2006. Chi‐square tests were employed for the cross‐sectional analysis of categorical variables and t tests for continuous variables. Generalized estimating equations were used to conduct multivariate longitudinal analysis. Results: Complementary and alternative medicine use among pregnant and nonpregnant women continued to increase over the 10‐year period. Although pregnancy status was not predictive of the use of alternative treatments, pregnant women employed these therapies or modalities for the relief of pregnancy‐related complaints and symptoms. Analysis also revealed that women used complementary and alternative treatments selectively during pregnancy. Conclusions: This study highlights the need for further research that is sensitive to the consumption of specific complementary and alternative therapies or modalities and to the wider contexts within which women perceive risk associated with their use of complementary and alternative treatments. (BIRTH 38:3 September 2011)     

Abnormal Uterine Bleeding in Pre-Menopausal Women

BackgroundAbnormal uterine bleeding is the direct cause of a significant health care burden for women, their families, and society as a whole. Up to 30% of women will seek medical assistance for this problem during their reproductive years. This guideline replaces previous clinical guidelines on the topic and is aimed to enable health care providers with the tools to provide the latest evidence-based care in the diagnosis and the medical and surgical management of this common problem.ObjectiveTo provide current evidence-based guidelines for the diagnosis and management of abnormal uterine bleeding (AUB) among women of reproductive age.OutcomesOutcomes evaluated include the impact of AUB on quality of life and the results of interventions including medical and surgical management of AUB.MethodsMembers of the guideline committee were selected on the basis of individual expertise to represent a range of practical and academic experience in terms of location in Canada, type of practice, subspecialty expertise, and general gynaecology background. The committee reviewed relevant evidence in the English medical literature including published guidelines. Recommendations were established as consensus statements. The final document was reviewed and approved by the Executive and Council of the SOGC.ResultsThis document provides a summary of up-to-date evidence regarding diagnosis, investigations, and medical and surgical management of AUB. The resulting recommendations may be adapted by individual health care workers when serving women with this condition.ConclusionsAbnormal uterine bleeding is a common and sometimes debilitating condition in women of reproductive age. Standardization of related terminology, a systematic approach to diagnosis and investigation, and a step-wise approach to intervention is necessary. Treatment commencing with medical therapeutic modalities followed by the least invasive surgical modalities achieving results satisfactory to the patient is the ultimate goal of all therapeutic interventions.EvidencePublished literature was retrieved through searches of MEDLINE and the Cochrane Library in March 2011 using appropriate controlled vocabulary (e.g. uterine hemorrhage, menorrhagia) and key words (e.g. menorrhagia, heavy menstrual bleeding, abnormal uterine bleeding). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English and published from January 1999 to March 2011. Searches were updated on a regular basis and incorporated in the guideline to February 2013.Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.ValuesThe quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table).Benefits, harms, and costsImplementation of the guideline recommendations will improve the health and well-being of women with abnormal uterine bleeding, their families, and society. The economic cost of implementing these guidelines in the Canadian health care system was not considered.     

Prediction of Hypoxic Acidemia in Last 2 Hours of Labour in Low-Risk Women

ObjectivePrediction of hypoxic acidemia in neonates using cardiotocogram (CTG) features continues to be challenging. The objective of this study was to explore the association between contraction frequency and fetal heart rate characteristics with hypoxic acidemia in low-risk women in labour.MethodsCases were singleton, vertex, in labour with umbilical artery pH ≤7.05. Controls were the next consecutive birth with pH ≥7.15, matched for gestational age, maternal age, and parity. Obstetrical complications and maternal comorbidities were excluded. CTG features were tabulated for the last 2 hours of labour. “Cut-off points” above which acidemia is more likely were calculated for significant variables (Canadian Task Force Classification II-2).ResultsA total of 190 case-control pairs were included. Among cases we observed greater marked variability, tachycardia, variable and late decelerations, and fewer accelerations and early decelerations. A conditional logistic regression model included tachycardia, accelerations, total decelerations, and contractions. Tachycardia and total decelerations (variable, late) were significant. Tachycardia was most specific in predicting neonatal acidemia, whereas total (variable, late) decelerations were most sensitive. Late decelerations alone and total (variable, late) decelerations were similarly predictive for detecting neonatal acidemia using receiver-operating characteristic analysis; tachycardia was least discriminatory. Acidemic neonates were more likely to have CTGs with ≥11 late decelerations, ≥15 total decelerations (variable, late), and at least 80 minutes of tachycardia in the last 2 hours of labour.ConclusionTachycardia, late decelerations, and total (variable, late) decelerations were associated with acidosis in our population. Identifying “cut-off” points for the frequency of significant CTG features should be explored as a potential screening tool for neonatal acidemia.     

Sexual Activity and Related Factors of Older Women in Hunan,China: A Cross-Sectional Study

BackgroundSexuality has an important impact on people's physical and mental health, but current research on the sexual activity of older Chinese women has many limitations and more detailed studies are needed.AimThe objective was to determine the prevalence of sexual activity and related factors in women aged 55 to 85 years in Hunan, China.MethodsBased on the data from the Hunan Provincial Women Health Needs Survey in 2018, we conducted a secondary analysis of 2,401 older women aged 55 and above. The dependent variable was sexual activity, and independent variables included sociodemographic characteristics, health behaviors, reproductive and chronic medical history, and psychological characteristics. All statistical analyses were performed using SPSS 26.0. Chi-square test was used to assess the association between categorical variables, and binary logistic regression was used to examine factors related to sexual activity.OutcomesSexual activity and related factors.ResultsThe prevalence of sexual activity among older women was 12.5% (301/2401) in the past month. Having a partner (OR = 1.484; 95% CI, 1.048-2.101; P = .026), jogging (OR = 2.061; 95% CI, 1.391-3.054; P < .001), dancing (OR = 1.477; 95% CI, 1.106-1.974; P = .008), vegetarian-based diet (OR = 2.197; 95% CI, 1.334-3.618; P = .002), meat-based diet (OR = 2.196; 95% CI, 1.144-4.216; P = .018) were positively associated with being sexually active. Whereas, aging (OR = 0.781; 95% CI, 0.647-0.942; P = .010), living in the urban (OR = 0.628; 95% CI, 0.488-0.808; P < .001), hypertension (OR = 0.702; 95% CI, 0.520-0.949; P = .021), and anxiety (OR = 0.680; 95% CI, 0.475-0.972; P = .034) were negatively associated with being sexually active.Clinical ImplicationsHealth care workers need to be aware that older women still have sexual activity and understand the needs of older women for sex education, take the initiative to discuss safe sex with them, and solve their sexual problems.Strengths and LimitationsThis is one of the largest studies to determine the prevalence of sexual activity among older women in China and its related factors. In addition, new factors such as exercise types and eating habits related to sexual activity were discovered. The limitation of this study is that it did not use a specific questionnaire to assess the sexual activity and did not consider physical tenderness other than sexual intercourse.ConclusionsSome older women still have had sexual activity in the past month and factors such as lifestyles that can be changed and chronic diseases that can be self-managed were found to predict sexual activity.Li T, LuoY, Meng Y, et al. Sexual Activity and Related Factors of Older Women in Hunan, China: A Cross-Sectional Study. J Sex Med 2022;19:302–310.     

Abnormal Uterine Bleeding in Women with Infertility

Purpose of Review

Abnormal uterine bleeding (AUB) is a common gynecologic complaint of reproductive-age women that necessitates careful evaluation due to potential underlying structural and systemic abnormalities. The majority of studies on AUB and infertility examine these topics separately, despite emerging evidence that many etiologies of AUB influence fertility. This review aims to provide an updated perspective on the diagnosis and management of AUB in the context of the infertility evaluation.

Recent Findings

The FIGO PALM-COEIN classification of AUB allows for the precise identification of systemic and structural causes to guide management. Pelvic ultrasound continues to be an accessible first-line imaging technique with high sensitivity for detecting structural etiologies of abnormal bleeding, particularly when used with color Doppler or 3D imaging. Notably, recent studies suggest that many of the endometrial pathologies that lead to AUB can also negatively impact endometrial receptivity, perhaps contributing to infertility in some women.

Summary

While the impact of systemic causes of AUB, such as ovulatory dysfunction, on infertility is widely recognized, the extents to which endometrial disorders and discrete structural lesions affect fertility are not entirely understood. More research is needed to assess the impact of structural abnormalities and their treatment on subsequent fertility outcomes in women with AUB.

     

New Evidence to Support Antibiotic Prophylaxis in Meconium-Stained Amniotic Fluid in Low-Risk Women in Labor a Prospective Cohort Study

Purpose of study

To assess the maternal and perinatal complications associated with meconium-stained amniotic fluid (MSAF) in low-risk women in labor.

Methods

This prospective cohort study was conducted at CMC Hospital, Vellore, India. Two hundred low-risk women who had artificial or spontaneous rupture of membranes after admission with MSAF were included in the study. Two hundred similar women with clear liquor were taken as controls. The primary outcomes considered were the incidence of chorioamnionitis and endomyometritis in the mothers. The secondary outcomes included postpartum hemorrhage and retained placenta in the mothers and respiratory distress, meconium aspiration, sepsis, and NICU admission in the newborn. Statistical analysis was done using Fischer exact test. Odds ratio, 95% confidence interval, and P value were estimated.

Results

Compared to controls, those with MSAF had significantly higher rates of chorioamnionitis (2 vs. 8%, P = 0.006) and endomyometritis (3 vs. 9.5% P = 0.007). Among the secondary end points, only neonatal respiratory distress (8.5 vs. 1.5%; P = 0.001) and meconium aspiration (4 vs. 0%; P = 0.007) were found to be significantly increased in the meconium group.

Conclusion

Statistically significant increased incidence of chorioamnionitis and endomyometritis in women with MSAF in labor established in our study strongly supports the use of prophylactic antibiotics in these women to prevent immediate and long-term consequences.

     

Thirteen Years of Experience with Opportunistic Bilateral Salpingectomy During TLH in Low-Risk Premenopausal Women

Background

Opportunistic bilateral salpingectomy (OBS), also called as prophylactic salpingectomy or risk-reducing salpingectomy is the concurrent removal of the fallopian tubes in premenopausal women. Though there are some studies comparing the intraoperative complications and effect of salpingectomy on ovarian reserve, limited data are available on long-term follow-up after OBS.

Purpose of the Study

To evaluate the surgical outcome of routine bilateral salpingectomy during total laparoscopic hysterectomy (TLH) in terms of intraoperative and postoperative complications. We also evaluated the incidence and reoperation rate for adnexal pathology after TLH.

Methods

A retrospective study of 1470 patients undergoing total laparoscopic hysterectomy (TLH) with opportunistic bilateral salpingectomy (OBS) over 13 years was carried out at Paul’s Hospital.

Results

The mean age of the subjects was 43.6?±?4.2 years, mean body mass index was 27?±?5.4 kg/m², and median parity was 2 (range 0–7). 43% of women had at least one previous surgery. The most common indication for surgery was fibroid uterus (67%, n?=?985). The total complication rate was 4.4% (n?=?65). One specimen showed paratubal borderline serous malignancy. The follow-up period ranged from 6 months to 13 years during which 17 (1.1%) women had adnexal pathology, and eight women (1.1%) needed resurgery for it. No ovarian malignancies were reported on follow-up.

Conclusions

OBS is a simple and short surgical step during TLH without increasing morbidity. OBS eliminates the risk of future diseases of tubal origin, and there might be a possible reduction in incidence and reoperation rate for future ovarian pathologies.

     

Rh阴性孕妇的产前免疫血液学检查及妊娠结局分析

目的:探讨Rh阴性孕妇产前免疫血液学检查和结局分析。方法:回顾性分析2010年1月至2016年12月期间在我院孕检及分娩的22880例孕妇中有Rh阴性孕妇287例(1.25%),用血清学方法确认血型D抗原阴性、Rh系统其他抗原表现型及抗体筛选;对有抗-D抗体孕妇进一步做抗体效价及分娩后根据新生儿黄疸指数做新生儿溶血病检测。部分Rh阴性孕妇于孕37周做预存式自体备血。结果:Rh阴性孕妇287例中,有12例(4.18%)检出抗-D抗体,抗原表现型均为ccee,且均有完整生育史。90例有1胎生育史中检出抗-D抗体10例(11.11%),15例有2胎生育史中检出抗-D抗体2例(13.33%)。287例孕妇生育290个新生儿中有8个发生胎儿新生儿Rh溶血病,发生率占2.75%(8/290)。12例抗-D抗体孕妇中1例宫内有溶血,出生后治疗无效死亡,7例出生后发现新生儿黄疸,经换血等治疗后治愈,其余4例新生儿无黄疸出现。146例Rh阴性孕妇孕37周实施了预存式自体备血,剖宫产与经阴道分娩产妇比较自体备血与未自体备血者产后出血量,显示两组差异均无统计学意义(P0.05)。结论:有完整生育史且抗原表现型为"ccee"Rh阴性孕妇发生抗-D同种免疫反应可能会加大,但新生儿结局差异很大;Rh阴性孕妇分娩前可根据自身状况做预存式自体备血。