Gynecology Hospital Research Articles

Osteoporosis Awareness, Self-Efficacy and Health Beliefs Among Staff in an Obstetrics and Gynecology Hospital: A Cross-Sectional Study

Osteoporosis Awareness, Self-Efficacy and Health Beliefs Among Staff in an Obstetrics and Gynecology Hospital: A Cross-Sectional Study

Parents' perspective on unplanned return visits to the pediatric emergency department: A cross-sectional study.

The aim of this study was to investigate the factors leading to more than one time visit to the pediatric emergency department within 72h, parental wishes and experiences with emergency nurses from the parents' perspective. A cross-sectional study was conducted between April 15, 2023 and April 14, 2024 with 596 parents of children aged between 0 and 18years who had return visits to the pediatric emergency department of a gynaecology and pediatrics hospital in the Western Black Sea Region of Türkiye within 72h after the first visit. Following the acquisition of written informed consent from the parents, the data were collected using the Descriptive Characteristics of Children and Experiences of Parents Information Form. From the perspective of the parents, the most common reasons for an unplanned return visit to the pediatric emergency department were that the child's health had deteriorated (24.1%), the child required further tests (23.8%), and the child had developed a different health condition (18.7%). During the first visit to the pediatric emergency department, parents most frequently wished to be allowed to be with the child (24.2%), to touch the child during the procedures (20.5%), to receive up-to-date information about the child's condition (20.2%). In line with these results, it is thought that the frequency of unplanned return visits to pediatric emergency departments can be reduced by implementing adequate, accurate and effective planned discharge training in pediatric emergency departments. Pediatric emergency nurses can benefit from the perspectives of parents in their professional practices to improve the quality of care and reduce the number of unplanned return visits to the emergency department.

A 10-year Retrospective Analysis on HPV Genotype Switching in a Tertiary Center in China: Infection Characterization and Clinical Outcome.

This study aims to investigate the phenomenon of human papillomavirus (HPV) genotype switching (HGS), assess the potential influencing factors, and evaluate the clinical impact on the severity of cervical lesions. A total of 2569 HPV positive female patients with records of more than two follow-up visits were included from the gynecology department at the Obstetrics and Gynecology Hospital of Fudan University, covering the period from May 2012 to September 2022. Patients' age, treatments, vaccination, HPV genotypes before and after HGS, and the final pathology results from colposcopy were recorded. Multifactorial analyses and correlation tests were performed. Single HPV infections accounted for 67% of the total population, while multiple HPV infections comprised 33%. The most prevalent genotypes in single HPV infections were HPV52 (18.6%), HPV16 (12.28%), HPV58 (11.72%), HPV53 (8.63%), and HPV81 (6.81%). Among cases of multiple infections, the most common genotype combinations were HPV52 + HPV53 (3.02%), HPV52 + HPV58 (3.13%), and HPV52 + HPV81 (3.02%). HGS was detected in 38.2% of the total cases (458/1200). The status of medication treatment was not found to correlate with the occurrence of HGS. However, age, surgical treatment status, vaccination status, and the genotype of HPV infection may be correlated with HGS. HPV52, HPV58, HPV53, HPV56, and HPV81 showed a positive association with the occurrence of HGS transitioning from multiple infections to a single infection (HGS-MS) (p < 0.05). In contrast, HPV52, HPV16, HPV58, HPV39, HPV56, and HPV18 significantly influenced the occurrence of HGS from one single infection to another (HGS-SS) (p < 0.05), albeit negatively. Notably, only one type of HGS, HGS-MS, demonstrated a positive correlation with the severity of cervical lesions. Our findings suggest that HPV genotype switching from multiple infections to single infections is associated with cervical intraepithelial neoplasia (CIN). Different patterns of HGS could result from specific HPV genotype infections, particularly HPV16. HGS-MS is revealed to plays a catalytic role in the progression of cervical lesions.

Development and validation of a risk prediction model for gestational diabetes mellitus in women of advanced maternal age during the first trimester.

With the global rise in advanced maternal age (AMA) pregnancies, the risk of gestational diabetes mellitus (GDM) increases. However, few GDM prediction models are tailored for AMA women. This study aims to develop a practical risk prediction model for GDM in AMA women. Data were obtained from a prospective observational cohort of AMA pregnant women from the Obstetrics and Gynecology Hospital in Shanghai, China. Singleton pregnancies with complete OGTT results at 24-28 weeks were selected and divided into training (70%) and validation (30%) sets. First-trimester predictors, including demographic, metabolic parameters, and clinical history, were evaluated for statistical significance. A multivariate logistic regression model was developed, with performance evaluated using receiver operating characteristic (ROC) curves and calibration plots. Predictors were primarily incorporated as categorical variables in a nomogram to enhance model convenience. A model using continuous predictors was also tested for comparison. A total of 1904 AMA women were included, with GDM incidence rates of 18.3% (243/1333) in the training set and 19.3% (110/571) in the validation set. Significant predictors for GDM diagnosis at 24-28 weeks included maternal age, GDM history, first-trimester fasting plasma glucose, mean arterial pressure, and triglyceride levels. The categorical model achieved an area under the ROC curve of 0.717 (95% CI: 0.682-0.753) in the training set and 0.702 (95% CI: 0.645-0.758) in the validation set. The Hosmer-Lemeshow test indicated good calibration (p = .97 in the training set; p = .66 in the validation set). The model with category and continuous predictors exhibited similar performance. This study developed and validated a practical early risk prediction nomogram for GDM in AMA women, using commonly available clinical data. The model shows good predictive performance and is resource-efficient, making it suitable for real-world clinical implementation.

How to estimate the probability of a live birth after one or more complete IVF cycles? the development of a novel model in a single-center.

To develop a predictive tool in the form of a Nomogram based on the Cox regression model, which incorporates the impact of the length of treatment cycles on the outcome of live birth, to evaluate the probability of infertile couples having a live birth after one or more complete cycles of In Vitro Fertilization (IVF), and to provide patients with a risk assessment that is easy to understand and visualize. A retrospective study for establishing a prediction model was conducted in the reproductive center of Shenzhen Zhongshan Obstetrics & Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital). A total of 4413 patients who completed ovarian stimulation treatment and reached the trigger were involved. 70% of the patients were randomly placed into the training set (n = 3089) and the remaining 30% of the patients were placed into the validation set (n = 1324) randomly. Live birth rate (LBR) and cumulative LBR (CLBR) were calculated for one retrieval cycle and the subsequent five frozen embryo transfer (FET) cycles. Proportional Hazards (PH) Assumption test was used for selecting the parameter in the predictive model. A Cox regression model was built based on the basis of training set, and ROC curves were used to test the specificity and sensitivity of the prediction model. Subsequently, the validation set was applied to verify the validity of the model. Finally, for a more intuitive assessment of the CLBR more intuitively for clinicians and patients, a Nomogram model was established based on predictive model. By calculating the scores of the model, the clinicians could more effectively predict the probability for an individual patient to obtain at least one live birth. In the fresh embryo transfer cycle, the LBR was 38.7%. In the first to fifth FET cycle, the optimal estimate and conservative estimate CLBRs were 59.95%, 65.41%, 66.35%, 66.58%, 66.61% and 56.81%, 60.84%, 61.50%, 61.66%, 61.68%, respectively. Based on PH test results, the potential predictive factors for live birth were insemination method, infertility factors, serum progesterone level (R = 0.043, p = 0.059), and luteinizing hormone level (R = 0.015, p = 0.499) on the day initiated with gonadotropin, basal follicle-stimulating hormone (R = -0.042, p = 0.069) and BMI (R = -0.035, p = 0.123). We used ROC curve to test the predictive power of the model. The AUC was 0.782 (p < 0.01, 95% CI: 0.764-0.801). Then the model was verified using the validation data. The AUC was 0.801 (p < 0.01, 95% CI: 0.774-0.828). A Nomogram model was built based on potential predictive factors that might influence the event of a live birth. The Cox regression and Nomogram prediction models effectively predicted the probability of infertile couples having a live birth. Therefore, this model could assist clinicians with making clinical decisions and providing guidance for patients. N/A.

Evaluation of the association between thyroid-stimulating hormone with handgrip strength and dynapenia in euthyroid postmenopausal women.

To examine the association between serum thyroid-stimulating hormone (TSH) levels with handgrip strength (HGS) and dynapenia in euthyroid postmenopausal women. This was an exploratory cross-sectional study among 385 participants from the Department of Obstetrics, Gynecology, and Reproduction of the Dexeus Women's University Hospital, Barcelona, Spain. Age, age at menopause, adiposity, alcohol consumption, body mass index (BMI), and smoking status were recorded. TSH was determined by electrochemiluminescence immunoassay. HGS was measured using a digital dynamometer, and physical activity was assessed by the International Physical Activity Questionnaire. Dynapenia was considered when HGS was <20 kg. A directed acyclic graph was designed to identify confounding variables. Multivariable linear and logistic regression models were adjusted by age, age at menopause, adiposity, BMI, glomerular filtration rate, glycated hemoglobin, physical activity, and smoking status. Multivariable linear regression model showed that age ( β = -0.22; 95% CI, -0.28 to -0.16), adiposity ( β = -0.15; 95% CI, -0.22 to -0.07), BMI ( β = 0.15; 95% CI, 0.04-0.25), glomerular filtration rate ( β = -0.04; 95% CI, -0.07 to -0.01), and physical activity ( β = 0.79; 95% CI, 0.07-1.5) were significantly associated with HGS. Instead, serum TSH levels were not significantly associated ( β = 0.21; 95% CI, -0.10 to 0.51). Multivariable logistic regression model showed that dynapenia was associated with age (OR, 1.20; 95% CI, 1.12-1.31) and glomerular filtration rate (OR, 1.03; 95% CI, 1.00-1.05). No significant association between TSH and dynapenia was observed (OR, 0.98; 95% CI, 0.78-1.23). In this study of postmenopausal women, normal TSH levels were not associated with low HGS or dynapenia.

Age-stratified association between preconception body mass index and risk of macrosomia at delivery

Objective: To investigate the impact of preconception body mass index (BMI) on neonatal birth weight and the risk of macrosomia in pregnant women across various age groups. Methods: A cohort study was conducted, selecting pregnant women who underwent their initial prenatal assessment at Beijing Obstetrics and Gynecology Hospital from September 1st, 2018 to March 31st, 2020. Relevant data were collected from the hospital's electronic medical record system. Logistic regression nested cubic spline was used to analyze the nonlinear association between preconception BMI and neonatal birth weight. Binary logistic regression was also employed to assess the association between preconception BMI and macrosomia risk. Results: (1) A total of 13 015 pregnant women were examined, revealing an incidence of macrosomia of 6.33% (824/13 015). The preconception BMI of pregnant women in the macrosomia group was significantly higher than that in the non-macrosomia group [(23.1±3.4) vs (21.6±3.1) kg/m2], and the age was significantly higher than that in the non-macrosomia group [(32.1±3.6) vs (31.7±3.7) years], the differences were statistically significant (all P<0.05). (2) Preconception BMI was positively correlated with neonatal birth weight. Pregnant women with preconception BMI of 15.0 kg/m2, 20.0 kg/m2, and 25.0 kg/m2 had decreased birth weight of 121 g (95%CI: 35-183 g) and increased birth weights of 78 g (95%CI: 54-102 g) and 182 g (95%CI: 151-213 g), respectively, compared to those with a preconception BMI of 18.0 kg/m2. (3) For each 1.0 kg/m2 increase in preconception BMI, the risk of macrosomia increased by 14% (OR=1.14, 95%CI: 1.11-1.16; P<0.001). When stratified by age, it was observed that elevated preconception BMI significantly increased the incidence of macrosomia in women aged 27-38 years. Among them, the risk of delivering macrosomia among 37 years old pregnant women was most affected by preconception BMI (OR=1.33, 95%CI: 1.17-1.51; P<0.001). (4) The stability and sensitivity analysis results showed that the preconception BMI of pregnant women with a preconception BMI of 18.0-<25.0 kg/m2 had a significant impact on the risk of macrosomia (OR=1.23, 95%CI: 1.17-1.29; P<0.001), while the preconception BMI of other preconception BMI stratification pregnant women had no significant impact on the risk of macrosomia (all P>0.05). Hypertension disorders in pregnancy, gestational diabetes mellitus and abnormal blood lipid during pregnancy were not the mediators associated with preconception BMI and macrosomia. After excluding three factors respectively, the impact of preconception BMI on the risk of macrosomia was the same as before (OR=1.14, 95%CI: 1.11-1.16; P<0.001). Conclusions: Preconception BMI is linked to neonatal birth weight and the risk of macrosomia, which is influenced by the pregnant woman's age. Both factors should be considered when evaluating the risk of macrosomia in clinical practice.

Correlation between uterine volume and intrauterine adhesion: a propensity score matching analysis

Objective: To investigate the correlation between uterine volume and intrauterine adhesion (IUA). Methods: From June 2018 to November 2019, totally 7 007 patients who underwent hysteroscopy in outpatient operating rooms of Gynecological Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital were retrospectively analyzed. Patients of reproductive age with IUA without uterine fibroids and adenomyosis were selected as IUA group, and patients of reproductive age without uterine fibroids and adenomyosis without IUA during the same period were selected as the control group. The propensity score matching (PSM) method was used to perform 1∶1 matching for the two groups of patients, matching variables included age, height, weight, body mass index (BMI), gravidity, parity, and number of abortion curettage. Whether there was any difference in uterine volume between the two groups of patients was compared, and whether uterine volume was an influencing factor of IUA was explored. The patients in IUA group were also categorized into mild, moderate and severe to explore whether uterine volume influenced the severity of IUA. Results: (1) After inclusion and exclusion criteria, 351 patients were included in IUA group and 2 986 patients in the control group. With PSM, 327 patients in IUA group and 327 patients in the control group were finally enrolled in this study. There were no statistically significant differences in age, height, weight, BMI, gravidity, parity, and number of abortion curettage between the two groups of patients after matching (all P>0.05). (2) After PSM, there was a significant difference between the uterine volume of IUA group (median: 44.23 cm3) and the uterine volume of the control group (median: 57.20 cm3; P<0.001). (3) Reduced uterine volume (OR=0.961, 95%CI: 0.952-0.970) was an independent risk factor for IUA (P<0.001). (4) Uterine volume had a significant effect on the severity of IUA (P<0.001), the larger the uterine volume (B=-0.030, 95%CI: -0.044 to -0.017), the less severe the IUA. Conclusions: Reduced uterine volume is an independent risk factor for IUA, and uterine volume has a significant effect on the severity of IUA. In patients with small uterine volume size, primary and secondary prevention of IUA should be emphasized.

Effectiveness of a Web-Based Medication Education Course on Pregnant Women's Medication Information Literacy and Decision Self-Efficacy: Randomized Controlled Trial.

Medication-related adverse events are common in pregnant women, and most are due to misunderstanding medication information. The identification of appropriate medication information sources requires adequate medical information literacy (MIL). It is important for pregnant women to comprehensively evaluate the risk of medication treatment, self-monitor their medication response, and actively participate in decision-making to reduce medication-related adverse events. This study aims to examine the effectiveness of a medication education course on a web-based platform in improving pregnant women's MIL and decision self-efficacy. A randomized controlled trial was conducted. Pregnant women were recruited from January to June 2021 in the Department of Obstetrics and Gynecology of a large hospital in a major city in central China. A total of 108 participants were randomly divided into a control group (CG), which received routine prenatal care from nurses and physicians, and an intervention group (IG), which received an additional 3-week web-based medication education course based on the theory of planned behavior as part of routine prenatal care. Participants completed a Medication Information Literacy Scale and a decision self-efficacy questionnaire at baseline, upon completion of the intervention, and at a 4-week follow-up. Generalized estimation equations (GEE) were used to analyze the main effect (time and grouping) and interaction effect (grouping×time) of the 2 outcomes. The CONSORT-EHEALTH (V 1.6.1) checklist was used to guide the reporting of this randomized controlled trial. A total of 91 pregnant women (48 in the IG and 43 in the CG) completed the questionnaires at the 3 time points. The results of GEE indicated that there was no statistically significant difference in time×group interactions of MIL between the 2 groups (F2=3.12; P=.21). The results of the main effect analysis showed that there were statistically significant differences in MIL between the 2 groups at T1 and T2 (F1=17.79; P<.001). Moreover, the results of GEE indicated that there was a significant difference in decision self-efficacy regarding the time factor, grouping factor, and time×group interactions (F2=21.98; P<.001). The results of the simple effect analysis indicated a statistically significant difference in decision self-efficacy between the 2 groups at T1 (F1=36.29; P<.001) and T2 (F1=36.27; P<.001) compared to T0. Results showed that MIL and decision self-efficacy in the IG were found to be significantly higher than those in the CG (d=0.81; P<.001 and d=1.26; P<.001, respectively), and they remained significantly improved at the 4-week follow-up (d=0.59; P<.001 and d=1.27; P<.001, respectively). Web-based medication education courses based on the theory of planned behavior can effectively improve pregnant women's MIL and decision self-efficacy, and they can be used as supplementary education during routine prenatal care. Chinese Clinical Trial Registry ChiCTR2100041817; https://www.chictr.org.cn/showproj.html?proj=66685.

The Impact of Increased Maternal Body Mass Index on Fetomaternal Outcome in Labour and Delivery

Background: Maternal obesity during pregnancy is now seen as one of the most common risk factors that can lead to negative outcomes for both mothers and their babies. Obesity is becoming a more significant concern in the field of obstetrics, and it is imperative that we prioritize its management. Objective: The aim of the study is to evaluate and compare the fetomaternal outcome among pregnant women with different BMI. Materials and Methods: This cross sectional analytical study was conducted on the admitted patients with full term singleton pregnancy in labour in the Department of Obstetrics &amp; Gynecology of Sir Salimullah Medical College and Mitford Hospital from July 2021 to January 2022. A total of 150 pregnant women with full term singleton pregnancy in labour were selected fulfilling the inclusion and exclusion criteria. Informed written consent was taken from each respondent. All data relevant to variables of the study was collected in a data collection sheet. Results: Study revealed a significant difference between normal and overweight BMI in Anaemia, with 34 (45.33%) vs 12 (16%) p&lt;0.001. Gestational Diabetes Mellitus 4 (5.33%) vs 13 (17.33%), respectively p 0.02, Preeclampsia 5 (6.67%) vs 14 (18.67%), respectively p 0.02, Large for Gestational Age 2 (2.67%) vs 11 (14.7%), respectively p 0.009, and Small for Gestational Age 12 (16.0) vs 4 (5.33%), respectively p 0.03. Macrosomia (&gt;4.0kg), APGAR score &lt; 7 at 1min and NICU admission were significantly higher in overweight/obese mother compare to normal weight group (p&lt;0.05). Conclusion: Overweight/obese during pregnancy carries high maternal and fetal risks. Increase in the need for induction of labor, instrumental delivery, caesarean section was associated with pregnancies complicated with overweight/obese.

Fertility-sparing treatment outcomes using immune checkpoint inhibitors in endometrial cancer patients with Lynch syndrome.

To evaluate the efficacy of immune checkpoint inhibitors (ICIs) for fertility-sparing treatment in Lynch syndrome-associated endometrial cancer (LS-EC). Four LS-EC cases received programmed cell death protein 1 (PD-1) inhibitors for fertility preservation at the Obstetrics and Gynecology Hospital of Fudan University from 2017 to 2023. The clinical data and long-term outcomes were retrospectively reviewed. Case 1, carrying germline MLH1 mutation, was diagnosed with Stage IIAmMMRd (International Federation of Gynecology and Obstetrics 2023) endometrial cancer (EC) at 38 years old. She received PD-1 inhibitor treatment and achieved a pathological complete response (CR) at 42 weeks. Case 2, carrying MLH1 mutation, underwent colorectal cancer surgery at 22 years and was diagnosed with EC and synchronous ovarian cancer at 39 years. After 24-week PD-1 treatment, CR of EC and ovarian cancer was achieved. Case 3, carrying MSH2 mutation, was diagnosed with endometrial atypical hyperplasia (EAH) at 35 years. After receiving 7-month progestin, she had the progressed disease with Stage IA2mMMRd EC and colon cancer was found soon after. She received PD-1 treatment for 18 weeks and achieved a CR of EC. She conceived naturally with full term delivery. Case 4, carrying MSH2 mutation, had a recurrence of Stage IBmMMRd EC 15 months after CR from EAH treated with progestin at 40 years. She received PD-1 treatment for 18 weeks and achieved CR. No recurrence was found in all cases after 3-41 months of follow-up after CR. ICIs might be an effective choice for LS-EC patients desiring fertility preservation.

Do Human Papilloma Virus and Cytological Testing Results Before Colposcopy Alter the Pathological Grading of Colposcopy Acetic Acid Visual Examination?: A Retrospective Study.

To understand whether human papillomavirus (HPV) and cytological testing (TCT [ie, "thinprep" cytological testing]) results can provide more information beyond visual information for vaginal colposcopy examinations to upgrade or downgrade the visual diagnosis of vaginal colposcopy. Data from 519 patients, who underwent vaginal colposcopy at the Beijing Obstetrics and Gynecology Hospital (Beijing, China) between January and June 2020, were included. Preoperative HPV and TCT results were statistically analyzed, and were divided into 3 groups according to postoperative cervical tissue pathological diagnosis: negative; low-grade squamous intraepithelial (LSIL); and high-grade squamous intraepithelial lesion (HSIL). Positive and negative predictive values for cervical inflammation, LSIL, and HSIL in patients diagnosed using vaginal colposcopy, based on cervical pathological grouping, and differences in HPV and TCT results among patients who underwent vaginal colposcopy, were analyzed. The age of patients diagnosed with cervicitis, LSIL, and HSIL using colposcopy gradually decreased, and the proportion of HPV16/18 infection in the HSIL group was significantly higher than the other 2 groups. There were significant differences in TCT results among the groups. According to pathological results from cervical tissue specimens, among all groups diagnosed using colposcopy, the age of the HSIL group was significantly younger than that of the other groups, and the proportion of patients with a TCT greater than LSIL was significantly higher than that of the other groups. HPV did not provide additional information for vaginal colposcopy. Young(er) patients and those with a TCT greater than LSIL may consider upgrading the vaginal colposcopy diagnosis based on imaging information.

A Prospective Observational Study of Cesarean Sections in Tertiary Care Hospital for Maternal and Fetal Outcome after Anesthesia-Related Complications in Obstetric Operation Theatre

Background: In this study, we wanted to assess the type of anesthesia and reason for selecting the particular anesthesia, monitoring anesthesia-related perioperative complications, its effects on maternal and neonatal health, determine the most preferred mode of anesthesia used for cesarean section, determine the incidence of perioperative anesthesia-related complication and outcome after anesthesia-related complications, and maternal and fetal outcome in terms of morbidity and mortality after anesthesia. Materials and Methods: This was a hospital-based prospective observational study conducted among 735 consecutive cases undergoing cesarean section under general anesthesia (GA)/regional anesthesia both elective and emergency in the department of obstetrics and gynecology of a tertiary care hospital, over a period of one year, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: Hypotension was the most frequent complication associated with spinal anesthesia. The percentage of patients having intraoperative hypotension in GA (11.1%) was lower than the percentage of patients having intraoperative hypotension in spinal anesthesia (19.2%). This difference is significant with a P value of &lt; 0.01. Twenty-eight patients at the end of surgery complained of pain because of wearing of spinal level. Two cases of bronchospasm and two cases of shivering were seen in the immediate postextubation period in patients of GA. Twenty-four (3.3%) neonates had low appearance, pulse, grimace, activity, and respiration (APGAR) score and 59 (8%) neonates required Neonatal intensive care unit (NICU) admission. Fifteen neonates required resuscitation because of poor cry. Six were managed with bag and mask ventilation, four neonates required temporary intubation, and five neonates were shifted intubated to NICU. Conclusions: Spinal anesthesia is the choice of anesthesia for category 2 and onward cesarean sections. GA is the choice for category 1 cesarean section. Intraoperative hypotension is the commonest complication with all types of anesthesia, but if treated well is associated with no adverse outcomes. The maternal outcome is good with all types of anesthesia. Category 1 cesarean section is associated with low APGAR and increased NICU admissions in neonates. Pre-existing illness in the mother changes the choice of anesthesia.

Effect of Donor Sperm on Quality of Life in Patients with Severe Oligoasthenosperm After ICSI Failure.

To explore the effects of donor sperm on reproductive quality of life, sleep quality and erectile function in patients with severe oligoasthenospermia after the failure of intracytoplasmic sperm injection (ICSI), and to provide targeted reference for intervention. From January 2021 to December 2023, patients with severe oligoasthenospermia who received assisted pregnancy treatment in Obstetrics and Gynecology Hospital Affiliated to Tongji University were selected as the study objects. Among them, 82 cases using sperm donor assisted pregnancy after ICSI failure were set as the observation group, and 82 cases using propensity score 1:1 matching ICSI failure after ICSI assisted pregnancy were set as the control group. The levels of serum total testosterone, reproductive quality of life, sleep quality and erectile function of the two groups were compared using the general data questionnaire, FertiQoL, Pittsburgh Sleep Quality Index (PSQI) and International erectile Function Index -5(IIEF-5). There was no significant difference in social demographic data and serum total testosterone level between the two groups after matching propensity score (P>0.05). The total score of FertiQoL and PSQI in the observation group were higher than those in the control group, and the incidence of erectile dysfunction was higher than that in the control group, with statistical significance (P<0.05). The use of donor sperm for pregnancy after ICSI failure in patients with severe oligoasthenospermia has a great impact on their reproductive life, sleep quality and erectile function. Medical staff should pay attention to the quality of life and erectile function of these patients, and formulate targeted measures to help these patients cope positively.

The effect of education provided by midwives to patients who will undergo endometrial biopsy on anxiety

Aim: This study aimed to determine the effect of education provided by a midwife to patients undergoing endometrial biopsy on anxiety levels. Material and Methods: The sample of the pre-test post-test measurement randomized controlled study consisted of 64 women who applied to Pursaklar State Hospital Gynecology Outpatient Clinic between June and December 2023, with planned endometrial biopsy due to abnormal uterine bleeding. Data of the study were collected using "Personal Information Form" and "Beck Anxiety Scale". Pre-test was applied to women in both groups. Education was provided to women in the experimental group by a midwife researcher face-to-face, interactive, question-answer, and demonstration methods within 30-40 minutes, using the Biopsy Education Booklet prepared in accordance with literature review. After the procedure, post- test Beck Anxiety Scale was administered to both groups. Study data were analyzed using the Statistical Package for the Social Sciences-SPSS 26 software package. The significance value of statistical tests was evaluated as p

Association of higher serum follicle-stimulating hormone levels with successful microdissection testicular sperm extraction outcomes in nonobstructive azoospermic men with reduced testicular volumes

Abstract To investigate the impact of preoperative serum follicle-stimulating hormone (FSH) levels on the probability of testicular sperm retrieval, we conducted a study of nonobstructive azoospermic (NOA) men with different testicular volumes (TVs) who underwent microdissection testicular sperm extraction (micro-TESE). A total of 177 NOA patients undergoing micro-TESE for the first time from April 2019 to November 2022 in Shenzhen Zhongshan Obstetrics and Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital, Shenzhen, China) were retrospectively reviewed. The subjects were divided into four groups based on average TV quartiles. Serum hormone levels in each TV group were compared between positive and negative sperm retrieval subgroups. Overall sperm retrieval rate was 57.6%. FSH levels (median [interquartile range]) were higher in the positive sperm retrieval subgroup compared with the negative outcome subgroup when average TV was &lt;5 ml (first quartile [Q1: TV &lt;3 ml]: 43.32 [17.92] IU l−1 vs 32.95 [18.56] IU l−1, P = 0.048; second quartile [Q2: 3 ml ≤ TV &lt;5 ml]: 31.31 [15.37] IU l−1 vs 25.59 [18.40] IU l−1, P = 0.042). Elevated serum FSH levels were associated with successful micro-TESE sperm retrieval in NOA men whose average TVs were &lt;5 ml (adjusted odds ratio [OR]: 1.06 per unit increase; 95% confidence interval [CI]: 1.01–1.11; P = 0.011). In men with TVs ≥5 ml, larger TVs were associated with lower odds of sperm retrieval (adjusted OR: 0.84 per 1 ml increase; 95% CI: 0.71–0.98; P = 0.029). In conclusion, elevated serum FSH levels were associated with positive sperm retrieval in micro-TESE in NOA men with TVs &lt;5 ml. In men with TV ≥5 ml, increases in average TVs were associated with lower odds of sperm retrieval.

Clinicopathological features and prognostic analysis of synchronous mucinous metaplasia and neoplasia of the female genital tract

Objective: Synchronous mucinous metaplasia and neoplasia of the female genital tract (SMMN-FGT) occurring at multiple sites during the same period of time is extremely rare, and the aim of this study was to investigate the clinicopathologic features of SMMN-FGT and its relationship with prognosis. Methods: We retrospectively analyzed the clinicopathological features and follow-up records of 25 cases of SMMN-FGT diagnosed from January 2012 to October 2022 in the case database of Obstetrics and Gynecology Hospital of Fudan University. Results: The median age at onset was 46 years old, respectively. Clinical manifestations included irregular vaginal bleeding or drainage, pelvic pain, and ovarian cysts, etc. Germline genetic test confirmed Peutz-Jeghers syndrome (P-J syndrome) in two patients. All patients underwent surgery, and 13 patients had postoperative adjuvant radiotherapy and/or chemotherapy. The most frequent site of lesion was the cervix (21 cases), with 11, 10 and 16 cases occurring in the endometrium, fallopian tubes and ovaries, respectively. Six cases involved three sites simultaneously, and only one case had all four sites involved at the same time. Among the 9 cases with P53 mutation phenotype, 6 cases had gastric-type mucinous adenocarcinoma, 2 cases had lobular endocervical glandular hyperplasia, and 1 case had mucinous adenocarcinoma, whereas all the minimally deviated adenocarcinomas had wild phenotype of P53. The median follow-up time was 59 months, during which 3 cases died and 6 cases developed local recurrence or distant metastasis. According to our analysis, postoperative recurrence or metastasis was correlated with the FIGO stage of the disease, the number of lesion sites and the severe degree of the uterine lesions (P＜0.05). Conclusions: SMMN-FGT has a relatively good clinical prognosis, and even advanced patients can benefit from surgery and adjuvant therapy. In young patients, the ovaries may be preserved if no evidence of lesions are seen after adequate evaluation. In SMMN-FGT, gastric-type mucinous adenocarcinoma occurring in the cervix may have a better prognosis than gastric-type mucinous adenocarcinoma of the cervix alone, so the accurate diagnosis of SMMN-FGT is critical for clinical management.

The effect of nursing care during pregnancy termination on women’s prenatal grief, depression, anxiety, stress and coping levels: A randomized controlled study

ABSTRACT The termination of pregnancy is considered an emotionally devastating experience. Early intervention and counseling are essential to prevent adverse complications following pregnancy loss. This study aimed to determine the effect of nursing care based on Swanson’s Theory of Caring on women’s prenatal grief, depression, anxiety, stress, and coping levels during pregnancy termination. The training and counseling program, based on Swanson’s Theory of Caring, included hospital care, a mobile application, and telephone follow-ups. We conducted this prospective randomized controlled experimental study in the gynecology and obstetrics clinic of a tertiary university hospital in Türkiye between September 2021 and May 2022. The study sample consisted of 50 women (intervention group: 25, control group: 25) whose pregnancy was terminated in the second trimester. The women were assigned to groups according to a randomization list created by a statistician. Data collection tools included a Personal Information Form, the Perinatal Grief Scale, the Depression, Anxiety, and Stress Scale, the Coping and Adaptation Process Scale, and the Numerical Rating Scale. We collected the data during hospitalization, between the 6th and 8thweeks after discharge, and at the 12thweek. We performed a chi-square test, a paired samples t-test, and an independent samples t-test on the IBM Statistical Package for the Social Sciences Statistics 26. The intervention group had lower mean perinatal grief (54.76 ± 19.49), depression (2.56 ± 2.39), anxiety (2.08 ± 2.10), and stress (3.52 ± 1.78) scores and higher mean coping and adjustment scores (140.48 ± 11.47) than the control group(p < .05). The intervention group also had a lower perception of labor pain, shorter discharge time, and a higher level of readiness for a new pregnancy (p < .05). The program that we applied in the study was effective in managing the pregnancy termination and post-discharge period in the population we studied.

Feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) panhysterectomy: a polycentric retrospective study

ObjectivesTo investigate the feasibility and safety of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) panhysterectomy.MethodsA retrospective analysis was conducted on the data of 75 patients who underwent panhysterectomy for hysteromyoma in the Department of Obstetrics and Gynecology of Tongxiang Maternal and Child Health Hospital; Department of Gynecology, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University and Department of Gynecology, The First Affiliated Hospital of USTC from June 2019 to June 2020. According to the operation mode, the patients were divided into two groups: the traditional multi-port laparoscopic surgery (MPLS) group (n = 45) and the Transvaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) group (n = 30). The operation duration, intraoperative blood loss, postoperative exsufflation time, postoperative activity time, hospital stay, treatment cost, 6 h activities of daily living (ADL) score after the operation, cosmetic score, visual analog score, and complications were observed in the two groups.ResultsPerioperative period related indicators: Compared with the MPLS group, the total treatment cost and cosmetic score of the V-NOTES group were significantly better than those of the MPLS group, but the operation duration was longer, and the HB decreased more significantly (P < 0.05). However, there was no significant difference in intraoperative blood loss, postoperative exsufflation time, postoperative activity time, 6 h ADL score after the operation, and hospital stay between the two groups (P > 0.05). Postoperative pain: The VAS score 1 h, 6 h, 12 h, and 24 h after the operation was lower in the V-NOTES group than in the MPLS group (P < 0.05). Postoperative complications: The complication rate of the V-NOTES group was significantly lower than that of the MPLS group (P < 0.05).ConclusionsIn treating panhysterectomy patients, both V-NOTES and MPLS can achieve satisfactory efficacy and prognosis, and both have advantages and disadvantages. Specifically, the V-NOTES surgery has significant advantages such as a lower treatment cost, lower incidence of postoperative complications, less pain, and more beautiful wounds.

Subclinical/overt hypothyroidism may be associated with diminished ovarian reserve in infertile women independent of thyroid autoimmunity

ObjectiveTo investigate the association between thyroid dysfunction or thyroid autoimmunity (TAI) and diminished ovarian reserve (DOR).MethodsA total of 2,867 women undergoing their first in-vitro fertilization (IVF) cycle at Shenzhen Zhongshan Obstetrics &amp;amp; Gynecology Hospital between January 1, 2013 and June 30, 2021, were enrolled in this study. The participants had documented thyroid and ovarian reserve metrics. They were categorized into three groups based on their thyroid function: normal thyroid function (N = 2,540), subclinical/overt hypothyroidism (SCH/OH) (N = 290), and subclinical/overt hyperthyroidism (N = 37). Anti-Mullerian hormone (AMH) and antral follicle count (AFC) were assessed and collected. Women with AMH &amp;lt;1.2 ng/mL and AFC &amp;lt; 5 were diagnosed with DOR. Basic characteristics and ovarian reserve-related parameters were compared among the three groups. The association between thyroid function and ovarian reserve function was further analyzed using logistical regression analyses. In addition, the euthyroid population was stratified using a thyroid-stimulating hormone (TSH) threshold of 2.5 µIU/mL, and the ovarian reserve-related parameters were compared among women with low-normal TSH (TSH &amp;lt; 2.5 µIU/mL), high-normal TSH (2.5 µIU/mL ≤ TSH ≤ 4.2 µIU/mL) and SCH/OH.ResultsWomen with SCH/OH had lower AMH levels (2.79 ng/mL vs. 3.41 ng/mL, P &amp;lt; 0.001) and a significantly higher prevalence of AMH level &amp;lt; 1.2ng/mL (17.2% vs. 12.1%, P = 0.015) compared to those with normal thyroid function. The prevalence of DOR was also higher among women with SCH/OH (10.0% vs. 6.5%, P = 0.036). There were no significant differences in ovarian reserve between women with normal thyroid function and those with subclinical/overt hyperthyroidism. Logistic regression analyses showed that the odds ratio (OR) of women with SCH/OH suffering from DOR was 1.666 (95% CI: 1.079-2.572) compared to those with normal thyroid function, after adjusting for TAI status and basic clinical characteristics. When the euthyroid group was stratified according to TSH levels, women with SCH/OH showed significantly lower AMH levels compared to women with low-normal TSH (2.79 ng/mL vs. 3.44 ng/mL, P &amp;lt; 0.001) and a significantly higher prevalence of DOR (10.0% vs. 6.0%, P = 0.010). Logistic regression analyses showed that the women with SCH/OH had an increased prevalence of DOR (OR: 1.819, 95% CI: 1.158-2.858) compared to those with low-normal TSH, after adjusting for TAI status and basic clinical characteristics. However, the OR for DOR among women with high-normal TSH was not significantly elevated compared to those with low-normal TSH (OR: 1.310, 95% CI: 0.936-1.832).ConclusionSCH/OH may be associated with DOR, irrespective of TAI status.