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1.
Raoul Orvieto Simion Meltcer Jacob Rabinson Jacob Ashkenazi 《International journal of gynaecology and obstetrics》2009,104(1):53-55
Objective
To examine whether body mass index (BMI) influences the outcome of in vitro fertilization (IVF).Methods
We studied 516 IVF cycles, 438 undergone by nonobese (BMI ≤ 30) and 78 by obese (BMI > 30) women who all had an a priori favorable prognosis (age < 40 years and first, second, or third IVF cycle).Results
Pregnancy was achieved in 122 (27.9%) nonobese and 12 (15.4%) obese women. The obese women required significantly longer stimulation and more gonadotropin ampoules, and had lower peak estradiol levels and a significantly lower fertilization rate; obese poor responders had a significantly lower pregnancy rate than nonobese poor responders; and the prevalence of poor responders was significantly higher among obese than nonobese women (28.2% vs 16.9%, P < 0.04).Conclusion
While the likelihood of poor responders was increased among obese women, reasonable conception rates were achieved in nonobese poor responders, and were comparable to the rates in nonobese and obese normal responders. 相似文献2.
Michael J. Turner Chro Fattah Norah O’Connor Nadine Farah Mairead Kennelly Bernard Stuart 《European journal of obstetrics, gynecology, and reproductive biology》2010,151(2):168-170
Objective
We compared the incidence of spontaneous miscarriage in women categorised as obese, based on a Body Mass Index (BMI) >29.9 kg/m2, with women in other BMI categories.Study design
In a prospective observational study conducted in a university teaching hospital, women were enrolled at their convenience in the first trimester after a sonogram confirmed an ongoing singleton pregnancy with fetal heart activity present. Maternal height and weight were measured digitally and BMI calculated. Maternal body composition was measured by advanced bioelectrical impedance analysis.Results
In 1200 women, the overall miscarriage rate was 2.8% (n = 33). The mean gestational age at enrolment was 9.9 weeks. In the obese category (n = 217), the miscarriage rate was 2.3% compared with 3.3% in the overweight category (n = 329), and 2.3% in the normal BMI group (n = 621). There was no difference in the mean body composition parameters, particularly fat mass parameters, between those women who miscarried and those who did not.Conclusions
In women with sonographic evidence of fetal heart activity in the first trimester, the rate of spontaneous miscarriage is low and is not increased in women with BMI > 29.9 kg/m2 compared to women in the normal BMI category. 相似文献3.
Katsikis I Karkanaki A Misichronis G Delkos D Kandaraki EA Panidis D 《European journal of obstetrics, gynecology, and reproductive biology》2011,156(2):181-185
Objective
To evaluate LH levels in women with the classic (1990 criteria) and the newer (2003 criteria) PCOS phenotypes, and to examine the impact of BMI and insulin resistance indices on hormone levels.Study design
In this controlled clinical study 936 women with PCOS, classified as classic (n = 729) and newer (n = 207), and 204 controls were included. All women were divided into normal-weight (BMI < 25 kg/m2) and overweight plus obese (BMI ≥ 25 kg/m2). Serum LH, FSH, anthropometrics, androgens, fasting insulin and glucose, HoMA-IR, number of follicles, and ovarian volume were assessed.Results
Women with classic PCOS presented significantly higher LH and LH/FSH ratios, and lower glucose/insulin levels than those with the newer phenotype and controls. Overweight plus obese women of all groups had lower LH levels than normal-weight women. Independent positive correlations between LH and androgens and negative correlation between LH and BMI were found.Conclusions
The higher LH concentrations of the classic phenotypes of PCOS could be attributed to the higher androgen levels, which desensitize the hypothalamus to the negative feedback regulation by progesterone. Moreover, the lower LH levels of overweight plus obese women of all groups could be attributed to the increased peripheral aromatization of androgens to estrogens in adipose tissue leading to suppression of LH secretion.Condensation
Both normal-weight and overweight women with classic PCOS phenotypes present higher LH levels and LH-to-FSH ratios than women with similar BMI but the newer phenotypes. 相似文献4.
5.
Subramaniam A Kim KH Bryant SA Zhang B Sikes C Kimball KJ Kilgore LC Huh WK Straughn JM Alvarez RD 《Gynecologic oncology》2011,122(3):604-607
Objective
Minimally invasive surgery offers advantages for management of obese patients, but technical difficulty often deters its utilization. Compared to laparotomy, robotic surgery should allow comparable staging and improved surgical outcomes. Therefore, we evaluated outcomes in robotic and laparotomy cohorts of obese women with endometrial cancer at our institution.Methods
Retrospective robotic and laparotomy cohorts of obese women (BMI ≥ 30 kg/m2) undergoing surgical management of primary endometrial cancer from March 2006 to March 2009 were formulated utilizing a computerized database. Patient demographics, operative statistics, peri-operative complications, and pathologic details were collected in an intent to treat analysis. Chi-square or Fisher's exact test and t-test were used for statistical analysis.Results
73 women underwent robotic surgical management, 11% converted to laparotomy. Mean BMI (39.8 vs. 41.9, p = 0.152), number of co-morbidities (2.49 vs. 2.62, p = 0.690), number of previous surgeries (0.97 vs. 0.94, p = 0.841), and lymphadenectomies performed (65.8% vs. 56.7%, p = 0.227) were similar between cohorts. Total lymph nodes obtained were not statistically different between cohorts (8.01 vs. 7.24, p = 0.505). Total operative time and room time was significantly longer for robotic surgery; however, estimated blood loss, the percentage of patients receiving transfusion, hospital length of stay, wound complications (4.1% vs. 20.2%, p = 0.002) and other complications (9.6% vs. 29.8%, p = 0.001) were improved for the robotic cohort.Conclusions
Robotic management of obese women with endometrial cancer yields acceptable staging results and improved surgical outcomes. Although operating time is longer, hospital time is shorter. Robotic surgery may be an ideal approach for these patients. 相似文献6.
Jason Bell Susan BellAnjel Vahratian Awoniyi O. Awonuga 《European journal of obstetrics, gynecology, and reproductive biology》2011,154(1):16-19
Objective
To test the hypothesis that there is no difference in perioperative morbidity and the type of uterine incisions between vertical skin incisions (VSI) and low transverse skin incisions (LTSI) at the time of cesarean delivery in morbidly obese women.Study design
Retrospective cohort study of morbidly obese women (BMI > 35 kg/m2) who underwent cesarean delivery between June 2004 and December 2006.Results
During the study, 424 morbidly obese women underwent cesarean section. Patients with VSI were older (31.0 ± 6.2 years vs. 26.7 ± 5.8 years), heavier (48.2 ± 9.1 kg/m2 vs. 41.7 ± 6.7 kg/m2), and more likely to have a classical than a low transverse uterine incision (65.9% vs. 7.3%), p < 0.001. After controlling for confounders, women with VSI did not have an increase in perioperative morbidity, but underwent more vertical uterine incisions (adjusted odds ratio = 18.49, 95% CI: 6.44, 53.07).Conclusion
VSI and LTSI are safe in morbidly obese patients undergoing cesarean section, but there is a tendency for increased vertical uterine incisions in those who underwent VSI. 相似文献7.
Objective
The aim of this study is to evaluate the feasibility of laparoscopic extraperitoneal pelvic lymphadenectomy (LEPL) in gynecologic malignancies.Methods
Twenty-nine women with cervical, ovarian or endometrial cancer underwent laparoscopic extraperitoneal pelvic lymphadenectomy between July 2008 and December 2010. The operating time, nodal yield, blood loss and complications were recorded.Results
The number of patients with cervical, ovarian and endometrial carcinoma was 14, 3 and 12, respectively. The median age of patients was 48.9 ± 12.6 years. The median body mass index was 25.6 ± 4.8. Conversion to the transperitoneal laparoscopic approach was necessary in 6 patients for peritoneal tears causing CO2 gas leakage. Among the remaining 23 patients, the median operating time for laparoscopic extraperitoneal pelvic lymphadenectomy was 69 min (range 50-126 min), and the median estimated blood loss was 20 ml (range 5-105 ml). The median total number of resected nodes was 26 (range 14-42), and complications related to the procedure were rare.Conclusions
Laparoscopic extraperitoneal pelvic lymphadenectomy is a feasible and safe procedure. It can be used in gynecologic malignancies. 相似文献8.
Pratibhasri A. Vardhana Cary Dicken Drew V. Tortoriello Michelene Chu Enrico Carmina Rogerio A. Lobo 《International journal of gynaecology and obstetrics》2009,104(2):121-328
Objective
To determine which adipocytokines are differentially expressed as a function of body mass index (BMI), to compare expression of adipocytokines in abdominal subcutaneous and omental fat, and to correlate these findings with serum levels, BMI, and parameters of insulin resistance.Methods
Serum and subcutaneous (sc) and omental (om) tissue were obtained from lean and obese ovulatory women undergoing gynecologic surgery. We determined adipocytokine expression in sc versus om abdominal fat and related this to increasing BMI.Results
Serum leptin was higher and adiponectin lower in overweight subjects. Adipocytokines had higher expression in sc abdominal versus om adipose tissue with the most significant difference observed for leptin (P = 0.01). As BMI increased, sc leptin expression increased and adiponectin expression decreased. The leptin/adiponectin ratio correlated significantly with BMI (R = 0.84, P = 0.0001).Conclusion
Increased adipocytokine expression correlates with BMI. Abdominal sc tissue has greater adipocytokine expression overall. The serum leptin/adiponectin ratio is highly correlated with BMI. These data may help in our understanding of how obesity affects women in a variety of ways. 相似文献9.
Farah N Stuart B Donnelly V Kennelly MM Turner MJ 《European journal of obstetrics, gynecology, and reproductive biology》2011,157(1):14-17
Objective
To identify the maternal body composition parameters that independently influence birth weight.Study design
A longitudinal prospective observational study in a large university teaching hospital. One hundred and eighty-four non-diabetic caucasian women with a singleton pregnancy were studied. In early pregnancy maternal weight and height were measured digitally in a standardised way and the body mass index (BMI) was calculated. At 28 and 37 weeks’ gestation maternal body composition was assessed using segmental multifrequency bioelectrical impedance analysis. At delivery the baby was weighed and the clinical details were recorded.Results
Of the women studied, 29.2% were overweight and 34.8% were obese. Birth weight did not correlate with maternal weight or BMI in early pregnancy. Birth weight correlated with gestational weight gain (GWG) before the third trimester (r = 0.163, p = 0.027), but not with GWG in the third trimester. Birth weight correlated with maternal fat-free mass, and not fat mass at 28 and 37 weeks gestation. Birth weight did not correlate with increases in maternal fat and fat-free masses between 28 and 37 weeks.Conclusions
Contrary to previous reports, we found that early pregnancy maternal BMI in a non-diabetic population does not influence birth weight. Interestingly, it was the GWG before the third trimester and not the GWG in the third trimester that influenced birth weight. Our findings have implications for the design of future intervention studies aimed at optimising gestational weight gain and birth weight.Condensation
Maternal fat-free mass and gestational weight gain both influence birth weight. 相似文献10.
Unterscheider J McMenamin M Cullinane F 《European journal of obstetrics, gynecology, and reproductive biology》2011,157(2):141-144
Objectives
To audit caesarean sections performed at full cervical dilatation over a three year period in a tertiary referral centre in Ireland. To evaluate (i) the rate of caesarean deliveries in the second stage of labour, (ii) the indication for delivery and (iii) the associated fetal and maternal morbidity in this cohort of women.Study design
This cohort study was carried out in the University Hospital Galway (UHG). Medical records of 136 consecutive women with singleton cephalic pregnancies at term, identified from the hospital database, who underwent a second stage caesarean section (CS) between 1 January 2006 and 31 December 2008, were reviewed retrospectively and demographic and outcome data were collected.Results
During the study period 2801/10,202 (27.5%) babies were delivered by CS. One hundred and thirty six CS (4.8%) were performed at full dilatation. The rate of CS during the second stage increased from 0.9% in 2006 to 1.8% in 2008. The majority of women were nulliparous (76.5%) and in spontaneous labour (64%). 44.1% of women had a second stage CS without a trial of instrumental delivery. 41.3% of public deliveries were attended by a consultant. The majority of babies (54%) were delivered because of a prolonged second stage with a mean duration of 146 min from full dilatation to delivery. Twenty-four of 59 primiparous women (40.7%), who underwent CS because of a prolonged second stage, did not receive oxytocin. 13.2% of babies were admitted to the neonatal intensive care unit. Estimated blood loss was documented in 67% of cases (n = 91); 14.3% of women (n = 13) had a postpartum haemorrhage greater than or equal to 1000 mls. 23% of these women (n = 3) required a blood transfusion. The overall blood transfusion rate was 2.2%. 50% of women had a hospital stay of greater than four days.Conclusions
There is a worrying rise in the overall rate of CS at full dilatation. Audit of the second stage CS rate is a useful measure of clinical standards. Strategies for improved care include increased consultant presence, meticulous documentation and ongoing training of junior obstetric staff to ensure safe intrapartum care.Condensation
The increase of second stage caesarean sections requires urgent strategies for improved care including increased consultant presence, meticulous documentation and training of junior obstetric staff. 相似文献11.
Wassim Badiou Philippe-Jean Bousquet Xavier Monroziès Renaud de Tayrac 《European journal of obstetrics, gynecology, and reproductive biology》2010,152(2):168-171
Objective
Our purpose was to determine if prolonged second-stage labour independently increases postpartum anal incontinence.Study design
360 primiparous women were studied retrospectively after vaginal delivery of term cephalic singletons, including a group with short second-stage labour (<30 min, n = 163) and a group with a prolonged second stage (>90 min, n = 197). A quality of life questionnaire on anal incontinence (FIQOL) was sent out at 15 months after delivery.Results
184 women (96 with short second-stage labour and 88 with a prolonged second stage) answered the questionnaire (response rate 51%). Flatus incontinence was reported after prolonged second-stage labour in 9.1% of women vs 15.6% after short second stage (p = 0.18). Fecal incontinence was reported after prolonged second-stage labour in 2.3% vs 5.2% after a short second stage (p = 0.45).Conclusion
We suggest that prolonged second stage of labour should not be associated with an increased risk of postpartum incontinence. 相似文献12.
T. Eftekhar B. Hajibaratali F. Ramezanzadeh M. Shariat 《International journal of gynaecology and obstetrics》2006,94(2):114-118
Objective
To assess the prevalence of postpartum stress urinary incontinence (SUI); the relationship between postpartum SUI and mode of delivery; and the association between SUI and other obstetric factors.Method
In this prospective study, 1000 primiparas with no history of UI were recruited and followed up for 4 months after delivery. The χ2 and Fisher's Exact tests were used to calculate the effects of the nominal variables.Result
The prevalence of postpartum SUI was 14.1%, and the mode of delivery was significantly associated with SUI. The prevalence rates were 15.9% after vaginal delivery, 10.7% after elective cesarean section (CS), and 25% after CS performed for obstructed labor. The prevalence of postpartum SUI was similar following spontaneous vaginal delivery and CS performed for obstructed labor (P = .21). Meanwhile, elective CS with no trial of labor was found to be associated with a significantly lower prevalence of postpartum SUI (P = .01; χ2 = 12.42). A maternal body mass index greater than 30 before pregnancy and fetal weight higher than 3000 g appeared to be associated with an increased rate of SUI (P = .001; χ2 = 17.6 and P = .000; χ2 = 22.5, respectively).Conclusion
Elective CS significantly reduced the rate of postpartum SUI. 相似文献13.
Jara Ben-Nagi Amy Walker Joseph Yazbek 《International journal of gynaecology and obstetrics》2009,106(1):30-34
Objective
To compare endometrial tissue samples from cesarean scar (CS) sites and from the posterior uterine wall to better understand the pathophysiology of implantation into a CS.Methods
Endometrial samples were taken from both a CS site and the posterior wall in premenopausal women with CSs, and from the posterior wall in premenopausal women who had spontaneous vaginal deliveries (SVDs) only.Results
In the secretory phase, there were significantly fewer leukocytes at CS sites than in the endometrium of women who had SVDs only (P < 0.05). Significant differences in leukocytic infiltration and cell proliferation between the proliferative and secretory phases were only found in women who had SVDs only (P < 0.05).Conclusion
Leukocyte recruitment to the endometrium during the secretory phase may be affected by the presence of a CS. 相似文献14.
Kyong Wook Yi Man Sik Park Sun Haeng Kim 《International journal of gynaecology and obstetrics》2009,105(1):39-42
Objective
To investigate the relationship between endometriosis severity and body mass index (BMI).Methods
Of 481 women seen for endometriosis at a university hospital in Korea, 153 had stage I, 113 had stage II, 110 had stage III, and 105 had stage IV disease. The patients' BMIs were categorized according to World Health Organization criteria for Asian-Pacific populations.Results
Women with early or mild endometriosis (stages I or II) had a significantly higher BMI than those with advanced disease (stages III or IV) (P < 0.001). After adjusting for age, parity, and menstrual factors, an association between BMI and disease stage remained significant (P < 0.001).Conclusion
Women with advanced-stage endometriosis had lower BMIs than those with minimal or mild disease, and BMI was significantly associated with disease severity. 相似文献15.
Raja-Khan N Shuja SA Kunselman AR Hogeman CS Demers LM Gnatuk CL Legro RS 《European journal of obstetrics, gynecology, and reproductive biology》2011,155(1):49-53
Objective
To examine changes in brachial artery conductance (BAC) during reactive hyperemia in women with polycystic ovary syndrome (PCOS) compared to controls.Study design
This is a pilot case-control study performed at a single academic medical center. Changes in BAC during reactive hyperemia were evaluated in 31 women with PCOS and 11 healthy control women. Fasting glucose, insulin, lipids and androgen levels were also determined. A mixed-effects model was used to compare the PCOS curve to the control curve for change in BAC from baseline during reactive hyperemia.Results
Body mass index (BMI) and testosterone levels were significantly increased in the PCOS group compared to controls (P < 0.05). In addition, the PCOS group had higher total and LDL cholesterol levels (P = 0.05 and 0.09, respectively). Change in BAC from baseline during reactive hyperemia was significantly increased in the PCOS group compared to controls even after adjusting for age, BMI and LDL cholesterol levels (P < 0.0001). There were no significant differences between the two groups in age, blood pressure, or fasting glucose or insulin levels.Conclusions
Brachial artery conductance during reactive hyperemia is significantly increased in women with PCOS compared to controls and may be a novel early indicator of increased cardiovascular risk in women with PCOS. 相似文献16.
Bela Kudish Shobha Mehta Evie Russell 《International journal of gynaecology and obstetrics》2010,111(1):28-31
Objective
To identify the main determinants of mode of delivery preference among urban dwelling women of lower socioeconomic status (SES).Methods
Over a 12-month period, a self-completion 36-item questionnaire was administered to a convenience sample of 308 women within the first 3 postpartum days. Non-parametric tests were used for analysis.Results
Study participants were mostly African American (> 85%), single mothers (> 75%), and unemployed (≥ 55%). Among the women, 85.7% had vaginal delivery (VD) and 14.3% had cesarean delivery (CD). Women who preferred CD (10%) were more likely to be concerned about a vaginal tear/episiotomy during VD, forceps, and a "big" baby compared with women who preferred VD, for whom “pushing the baby out myself” and “fear of cesarean” were the most important factors. In the final model of 7 factors, the 3 main factors found to positively impact maternal preference for CD were a vaginal cut during VD (P < 0.001), higher mean BMI (P = 0.001), and cesarean as the most recent delivery type (P < 0.001). The total explained variance by this model was 46%.Conclusions
Short-term complications of a VD, higher BMI, and a previous cesarean delivery are the most significant factors that impact the preferences of women of lower SES for future mode of delivery. 相似文献17.
Outcome of loop electrosurgical excision for HIV-positive women in a low-resource outpatient setting
Chumnan Kietpeerakool Prapaporn Suprasert Jatupol Srisomboon 《International journal of gynaecology and obstetrics》2009,105(1):10-13
Objective
To assess outcome in HIV-positive women undergoing the loop electrosurgical excision procedure (LEEP).Method
A prospective study was conducted with 789 outpatients undergoing LEEP at Chiang Mai University Hospital between October 2004 and June 2008.Results
The 70 HIV-positive women (8.9%) were younger (P < 0.001) and had a lower parity (P < 0.001) than the remaining women. The proportion of women undergoing LEEP for persistent low-grade lesions was higher (8.6% vs 1.9%) and the prevalence of margin involvement was higher (60.0% vs 49.4%) among the HIV-positive women. After adjusting for age, parity, menopausal status, size of excised lesion, and histopathologic result, HIV infection was not significantly associated with LEEP complications (adjusted odds ratio, 0.41; 95% confidence interval, 0.15-1.15).Conclusion
The higher risk of resection margin involvement in HIV-infected women was not associated with LEEP complications. 相似文献18.
Iglesias DA Westin SN Rallapalli V Huang M Fellman B Urbauer D Frumovitz M Ramirez PT Soliman PT 《Gynecologic oncology》2012,125(2):336-342
Objective
We sought to evaluate whether preoperative body mass index (BMI) impacts surgical outcomes, complication rates, and/or recurrence rates in women undergoing pelvic exenteration.Methods
All women who underwent pelvic exenteration for gynecologic indications at our institution from 1993 through 2010 were included. Women were stratified into 3 groups based on BMI. Baseline characteristics, surgical outcomes, early (< 60 days) and late (≥ 60 days) postoperative complications, and recurrence/survival outcomes were collected. Multivariate logistic regression analyses were performed. Kaplan-Meier survival curves were compared using log-rank test.Results
161 patients were included (59 normal weight, 44 overweight, 58 obese). Median follow-up times were 22, 29, and 25 months. Most patients underwent total pelvic exenteration (68%); 64.6% had a vaginal reconstruction. On multivariate analysis, both overweight and obese patients had a higher risk of early superficial wound separation compared to normal weight patients — OR 10.74 (3.33-34.62, p < 0.001) and OR 4.35 (1.40-13.52, p = 0.011), respectively. Length of surgery was significantly longer for overweight (9.6 h, OR 1.26, 1.02-1.55, p = 0.032) and obese (10.1 h, OR 1.24, 1.04-1.47, p = 0.014) patients than for normal weight patients (8.7 h). Late postoperative complications for patients in the normal weight, overweight, and obese groups were 47.5%, 45.5%, and 43.1% (p = 0.144). There were no differences in time to recurrence (p = 0.752) or overall survival (p = 0.103) between groups.Conclusion
Although operative times were longer and risk for superficial wound separation was significantly higher, pelvic exenteration appears to be feasible and safe in overweight and obese women with overall complication rates and survival outcomes comparable to normal weight women. 相似文献19.
Objective
The purpose of this study was (1) to investigate the association between BMI self-reported at three time points (during their 20s, 5 years before diagnosis, and post-diagnosis) and mortality among 388 women with newly diagnosed epithelial ovarian cancer and (2) weight change between these 3 time points and mortality.Methods
Women completed interview-administered questionnaires on average 9 months post-diagnosis. Women were followed 5 years after diagnosis or until death, whichever came first. Cox proportional hazard regression was used to estimate associations between BMI during the 20s, BMI 5 years prior to diagnosis, BMI post-diagnosis (i.e., at the time of interview) and weight changes between these time points and mortality.Results
The 5-year survival rate was 54% (178 deaths, 146 from ovarian cancer). BMI measured continuously at all three time points was associated with a higher risk of ovarian cancer mortality (P ≤ 0.05). The strongest association was observed with BMI in the 20s and all-cause mortality comparing women with BMI ≥ 25 kg/m2 to BMI < 25 kg/m2 (HR = 1.82; 95% CI, 1.02-3.27; P for trend = 0.045). For weight change from the 20s to 5 years prior to diagnosis and ovarian cancer specific mortality, we observed a 68% higher risk of ovarian cancer mortality (HR = 1.68; 95% CI, 1.11-2.55; P for trend = 0.015, comparing women with < 10 lbs weight gain to women with ≥ 10 lbs weight gain).Conclusion
BMI prior to and after diagnosis and weight gain throughout adulthood is associated with ovarian cancer mortality. 相似文献20.
Qiu J Lv L Lin X Long L Zhu D Xu R Deng X Li Z Zhu L Kim C Liu Q Zhang Y 《European journal of obstetrics, gynecology, and reproductive biology》2011,159(1):224-229