Nulliparous Women Research Articles

Affective cognition in response to infant stimuli in pregnant compared with non-pregnant women

ABSTRACT Physiological, neurocognitive, and psychological changes facilitates adaptation to motherhood. This cross-sectional study aimed to examine differences between pregnant and non-pregnant women in affective cognitive and psychophysiological responses to infant stimuli. We hypothesized that pregnant women would display (I) reduced negative emotional reactivity and perception of distressed infant stimuli, (II) increased attention toward infants compared to adults, and (III) greater psychophysiological response to infant distress. The sample comprised 22 pregnant women (22–38 weeks gestation) and 18 non-pregnant nulliparous women. Four computerized tasks were administered to measure affective cognitive processing of infant stimuli, while recording facial expressions, electrodermal activity, and eye gazes. Results indicated that pregnant women exhibited fewer negative facial expressions, reported less frustration when exposed to distressed infant cries, and showed greater attention to emotional infant faces compared to non-pregnant women, but the differences did not remain statistically significant after correction for multiple comparisons. No differences were observed in psychophysiological responses. The findings indicate a possible pregnancy-mediated effect regarding the cognitive processing of infant stimuli, potentially as preparation for motherhood. Future research with larger samples and longitudinal design is needed to understand the predictors, timing, and plasticity of cognitive changes during pregnancy.

Post abortion contraception: A follow up study in women undergoing first and second trimester abortion at a tertiary care centre

: Worldwide 75 million women need post abortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. Majority of them do not wish to conceive in near future and are receptive towards using contraception. Contraceptive counselling and basket of choices should be made available to all women undergoing abortion and her right to decline or postpone this care should be respected while recognizing that each woman has a unique unmet need of contraception.: To compare the acceptance and continuation of various contraceptive choices offered after first and second trimester abortion. : A retrospective study was conducted at a tertiary care hospital in which women who underwent first and second trimester abortion over a period of one year were interviewed regarding their acceptance and continuation of the contraceptive method till six months post abortion.: A total of 378 women underwent first and second trimester abortions over one year, of which 61.3% had resulted from failure of contraception. Women were grouped into Group A for those undergoing first trimester and Group B for women undergoing second trimester abortion for study purpose. Average age of women in group A was 28.9 years and in group B was 26.5 years. Mean period of gestation of pregnancy in group A was 7.5weeks and in group B was 19.5 weeks. In group A 96% parous women had conceived as a result of failure of contraception of which 90% were using natural method (Coitus Interruptus). Group B majority (76.3%) women were nulliparous and early parous (P1, P2) and indication for termination of pregnancy in them were gross congenital anamolies (GCA) in fetus while in rest of multiparous were due to failure of contraception. With group A 53.1% nulliparous women did not opt for any contraception whereas 48.6% primiparous and second parous opted for long acting reversible contraception(LARC) –Intrauterine contraceptive device(IUCD) in contrast to 66% multiparous opting for permanent sterilization at the time of abortion. In group B 45.3% nulliparous and early parous opted for depot medroxy progesterone acetate (DMPA) and 64.2% multigravidas underwent permanent sterilization. : Post abortion care must include counselling and choice of contraceptive basket. Women with future reproductive plans preferred LARC after first trimester abortion whereas DMPA was most acceptable method of contraception after second trimester abortion. Women were most satisfied with LARC and permanent methods compared to methods that required daily intake of pills. There is need of effective contraceptive choices according to the reproductive plans of the women to reduce the burden, morbidity and mortality associated with abortions.

Trends in severe postpartum haemorrhage among nulliparous women with spontaneous onset of labour: A population-based cohort study.

To investigate the incidence of severe postpartum haemorrhage among nulliparous women with a spontaneous onset of labour at term from 2000 to 2020. Population-based cohort study. National, using the Medical Birth Registry of Norway. Women (n = 330 244) who gave birth to their first singleton child in a cephalic presentation after a spontaneous onset of labour at term. Cross-tabulations and regression analysis with generalised linear models were used to assess time trends and adjust for potential confounding factors. We also stratified the analyses by maternal age groups, obstetric interventions, mode of delivery and institution size. Time trends were analysed using periods of 5 or 6 years as a unit, and the period from 2000 to 2004 was used as the reference. Severe postpartum haemorrhage (PPH) was defined as blood loss of >1500 mL within 24 h and/or in combination with blood transfusion. Severe PPH occurred in 7601/330 244 (2.30%) women. The incidence increased from 1.24% in 2000-2004 to 3.83% in 2015-2020 (adjusted relative risk, aRR 2.90; 95% CI 2.70-3.12). Changes in maternal characteristics or obstetric interventions did not explain the increase, and we found similar increases across institutions of all sizes. The incidence of severe PPH among nulliparous women increased almost threefold over 21 years. The current high incidence warrants urgent efforts to assess unknown risk factors, the health care provided and health system factors that may contribute to the increase, to inform improvements in care.

Risk of Obstetric Anal Sphincter Injury by Delivering Provider

Introduction and Hypothesis: Obstetric anal sphincter injuries (OASIs) complicate 5.8% of vaginal deliveries. Our objective was to assess if the primary delivery provider, a nurse-midwife versus physician obstetrician, is associated with OASIs. Methods: We performed a secondary analysis of the Consortium of Safe Labor, a multicenter, retrospective cohort study. Included were nulliparous women with singleton, vaginal delivery at ≥37 weeks from 2002 to 2008. Women were excluded if delivery was complicated by shoulder dystocia or from sites without midwife deliveries. Student’s t-tests, chi-squared analysis, and Fisher’s exact test were used as appropriate. Multivariable logistic regression and propensity score-matching analyses were performed. Results: Of 228,668 births at 19 sites, 2735 births from 3 sites met the inclusion criteria: 1551 physician and 1184 midwife births. Of all births, 4.2% (n = 116) were complicated by OASIs. Physician patients were older, more often White, privately insured, with higher BMI, more medical co-morbidities, and labor inductions/augmentations. Midwife patients had higher fetal gestational age and infant birth weights (all p < 0.05). OASIs were more common in physician compared to midwife births (5.9% vs. 2.0%, p < 0.0001). This difference persisted in multivariable logistic regression. OASIs were 2.4 (95%CI 1.5–3.9) times more likely with physician delivery when controlling for maternal heart disease, episiotomy, increasing maternal age, decreasing maternal BMI, non-White race, and increasing birthweight. The AUC was 0.78. With propensity score matching, OASI rates remained higher amongst physician births (6.6% vs. 1.8%, p < 0.0001; aOR 3.8 (95%CI 2.0–7.1)). Conclusion: OASIs were more common in physician compared to midwife deliveries even when controlling for other associated factors.

Prospective Validation of First-Trimester Screening for Preterm Preeclampsia in Nulliparous Women (PREDICTION Study).

Fetal Medicine Foundation (FMF) studies suggest that preterm preeclampsia can be predicted in the first trimester by combining biophysical, biochemical, and ultrasound markers and prevented using aspirin. We aimed to evaluate the FMF preterm preeclampsia screening test in nulliparous women. We conducted a prospective multicenter cohort study of nulliparous women recruited at 11 to 14 weeks. Maternal characteristics, mean arterial blood pressure, PAPP-A (pregnancy-associated plasma protein A), PlGF (placental growth factor) in maternal blood, and uterine artery pulsatility index were collected at recruitment. The risk of preterm preeclampsia was calculated by a third party blinded to pregnancy outcomes. Receiver operating characteristic curves were used to estimate the detection rate (sensitivity) and the false-positive rate (1-specificity) for preterm (<37 weeks) and for early-onset (<34 weeks) preeclampsia according to the FMF screening test and according to the American College of Obstetricians and Gynecologists criteria. We recruited 7554 participants including 7325 (97%) who remained eligible after 20 weeks of which 65 (0.9%) developed preterm preeclampsia, and 22 (0.3%) developed early-onset preeclampsia. Using the FMF algorithm (cutoff of ≥1 in 110 for preterm preeclampsia), the detection rate was 63.1% for preterm preeclampsia and 77.3% for early-onset preeclampsia at a false-positive rate of 15.8%. Using the American College of Obstetricians and Gynecologists criteria, the equivalent detection rates would have been 61.5% and 59.1%, respectively, for a false-positive rate of 34.3%. The first-trimester FMF preeclampsia screening test predicts two-thirds of preterm preeclampsia and three-quarters of early-onset preeclampsia in nulliparous women, with a false-positive rate of ≈16%. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02189148.

Elective induction of labor versus expectant management at 39 weeks among low-risk nulliparous pregnant women: A randomized controlled trial in India (ELITE-39 trial).

The aim of the present open label randomized controlled trial was to compare the rate of cesarean section (CS) after elective induction with that of expectant management in low-risk nulliparous women at 39 weeks. This randomized controlled trial from a tertiary maternity care center enrolled low risk nulliparous pregnant women at 38-38+4 weeks between April 1, 2019 and December 31, 2021. Participants were randomized into either the elective induction group (e-IOL) or the expectant management (EM) group though computer generated block randomization. The primary outcome was cesarean rate and the secondary outcome include adverse maternal and perinatal outcome between e-IOL and EM groups. We performed intention to treat analysis. A total of 360 women were enrolled into the present study. Analysis was performed for 179 women in the e-IOL group and 180 women in the EM group. The baseline demographic characteristics including Bishop score were comparable between the groups. The CS rate in both groups was 17.3% (31/179) and 25% (45/180), which is comparable (P = 0.08). There was one intrapartum stillbirth in the e-IOL group, and two babies succumbed in the neonatal period in the EM group. The maternal and perinatal outcomes between the groups were not found to be significantly different. Elective induction of low-risk nulliparous women at 39 weeks was not associated with increased cesarean section rate. The maternal and perinatal outcomes were comparable. Large, multicentric real time randomized controlled trials are needed to understand the benefit of elective induction in low-risk nulliparous women. This should include centers with large volume of deliveries especially from emerging countries also.

Transvaginal Ultrasound Versus Bishop Score in Predicting Labour Dystocia at Full-Term Nullipara Undergoing Labour Induction

Objective: Precise assessment of cervical conditions before labor induction is crucial for predicting the success of normal vaginal delivery. The cervix primary condition has a significant value in determining the succession of induction of labour. Traditionally, assessment of cervix before induction has been based on a cervix digital examination using Bishop's scoring method.This study compares transvaginal ultrasonographic (TVS) cervical assessment with the traditional Bishop score in nulliparous women undergoing labor induction, aiming to evaluate their predictive abilities for labor dystocia. Materials and methods: In a prospective observational study of 200 pregnant women at Al Hussein University Hospital between October 2022 and July 2023, cervical length, funneling, and posterior cervical angle were measured using transvaginal ultrasound. The Bishop score was recorded before induction. Statistical analyses, including Student's "t"-test and ROC curve, were conducted using SPSS. Results: 68% delivered via normal vaginal delivery (NVD) and 32% via cesarean section (CS). The NVD group exhibited significantly higher Bishop scores (6.82±1.36 vs 3.70±0.94), lower cervical length (25.46±3.99 vs 37.34±2.09),and higher cervical angle (121.39±5.70 vs 89.01±6.09), than the CS group. ROC curve analysis revealed that a Bishop score ≥4.5 had 89% sensitivity and 87.5% specificity, a cervical angle ≥ 92.5 had 98.5% sensitivity and 95.3% specificity, and a cervical length ≥31.5 had 96.9% sensitivity and 97.1% specificity for predicting NVD. Conclusion: The posterior cervical angle, alongside cervical length, proves to be a more sensitive indicator for predicting labor dystocia during induction compared to the traditional Bishop score.  

Feasibility of Office-based Operative Hysteroscopy by a Tissue Removal System without Anesthesia

To investigate the feasibility of operative hysteroscopy by a hysteroscopic tissue removal system (HTRS) without anesthesia in women with endometrial polyps (EP) or retained products of conception (RPOC). Prospective observational cohort study. University-affiliated department of Obstetrics and Gynecology. Consenting women aged >18 years diagnosed with EP or RPOC from 9/2022 to 8/2023 confirmed by a prior office hysteroscopy. Office-based vaginoscopic operative hysteroscopy without anesthesia using the Mini-Elite Truclear HTRS. Oral misoprostol was prescribed for cervical ripening. The patients rated intraoperative and 5-minute postoperative pain levels on a visual analog scale, with mild pain defined as a score of 0-4, moderate as 5-7, and severe as 8-10. A successful procedure was defined as complete removal of the pathology. Fifty patients were included in this pilot study, and 47 (94.0%) procedures were completed successfully, including 21/24 (87.5%) cases of EP and all cases of RPOC (26/26, p=.06). No intra- or postoperative complications occurred. The intraoperative pain levels were rated as mild, moderate, and severe by 26 (52.0%), 16 (32.0%) and 8 (16.0%) patients, respectively. Severe intraoperative pain was more common in nulliparous women and those >10 years from their last vaginal delivery, and not associated with patient age, menopausal status, presence of abnormal uterine bleeding, or pathology size. Severe postoperative pain, reported by 5 (10.0%) patients, was significantly associated with removal of EP compared with RPOC, longer operative time, and nulliparity or >10 years from the last vaginal delivery. The procedure was considered acceptable by 46 (92.0%) patients, and 45 (90.0%) would recommend it to a friend/relative. Office-based operative hysteroscopy by the HTRS is successful and well tolerated by most women, especially for RPOC removal.

Level of Knowledge of Post-Transplant Women About Breastfeeding During Immunosuppression

The number of women treated with immunosuppressants is increasing. Often, these women are of childbearing age. Consequently, they must face the decision of whether to breastfeed when they do have a child. Although available studies recommend breastfeeding during immunosuppression, patients appear to need more knowledge to enable the decision-making process. This study aimed to investigate the knowledge of women after transplantation about breastfeeding during immunosuppression and their source of information. We performed a cross-sectional study from February 1 through August 31, 2022, with 45 female graft recipients (28 post-kidney and 17 post-liver transplantation) of childbearing age (15-49 years). The women were polled during their routine outpatient appointments and then divided into 2 groups: parous women (group 1, n = 26) and nulliparous women (group 2, n = 19). Most of the patients (84%) were administered tacrolimus-based regimens. Thirty-seven women voiced concerns about the possible harm to their babies through immunosuppressants in their breast milk (82%). The average score for knowledge of the benefits of breastfeeding was 51%; 58% in group 1, and 41% in group 2. Among parous women, 5 breastfed on immunosuppression, 15 did not, and the remainder did not take immunosuppression during breastfeeding. The decision regarding breastfeeding was influenced mainly by counseling from gynecologists (75%) and transplantologists (56%). Women's knowledge about the benefits of breastfeeding and the possibility of it during immunosuppression is not satisfactory.

The impact of screening for preeclampsia and preterm birth in nulliparous women: The PREVENTION-pilot study

The impact of screening for preeclampsia and preterm birth in nulliparous women: The PREVENTION-pilot study

Non-pathological lower urinary tract symptoms in late pregnancy in Teaching Hospital, Anuradhapura, Sri Lanka

Non-pathological lower urinary tract symptoms in late pregnancy in Teaching Hospital, Anuradhapura, Sri Lanka

Quantitative 3D Analysis of Levator Ani Muscle Subdivisions in Nulliparous Women: MRI Feasibility Study.

The levator ani muscle (LAM) is crucial for pelvic floor stability, yet its quantitative MRI assessment is only a recent focus. Our study aims to standardize the quantitative analysis of the LAM morphology within the 3D Pelvic Inclination Correction System (3D-PICS). We analyzed 35 static MR datasets from nulliparous women examining the pubovisceral (PVM), iliococcygeal (ICM), coccygeal (COC), and puborectal muscle (PRM). The PVM consists of three origin-insertion pairs, namely the puboanal (PAM), puboperineal (PPM) and pubovaginal muscle (PVaM). The analysis included a quantitative examination of the morphology of LAM, focusing on the median location (x/y/z) (x: anterior-posterior, y: superior-inferior, z: left-right) of the origin and insertion points (a), angles (b) and lengths (c) of LAM. Inter-rater reliability was calculated. Interindividual variations in 3D coordinates among muscle subdivisions were shown. In all, 93% of all origin and insertion points were found within an SD of <8 mm. Angles to the xz-plane range between -15.4° (right PRM) and 40.7° (left PAM). The PRM is the largest pelvic muscle in static MRI. The ICC indicated moderate-to-good agreement between raters. The accurate morphometry of the LAM and its subdivisions, along with reliable inter-rater agreement, was demonstrated, enhancing the understanding of normal pelvic anatomy in young nulliparous women.

Unique presentation of previable HELLP syndrome

Introduction: Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is a serious complication of pregnancy characterized by hemolysis, elevated liver enzymes, and low platelets. This condition typically affects pregnant women in the third trimester or postpartum states, with only a handful of reported cases in previable pregnancies. The symptoms of HELLP syndrome can mimic those of other critical conditions during pregnancy, such as acute fatty liver of pregnancy (AFLP), thrombotic thrombocytopenic purpura (TTP), hemolytic-uremic syndrome (HUS), systemic lupus erythematosus (SLE), and antiphospholipid syndrome (APS), making early diagnosis crucial to prevent maternal and fetal harm. Case Report: We report the case of a 23-year-old nulliparous woman who developed HELLP syndrome at 21 weeks gestation. We highlight the importance of recognizing early onset HELLP syndrome and differentiating it from other potential diagnoses to ensure prompt and appropriate treatment. Conclusion: This case of previable HELLP syndrome in a nulliparous patient without other risk factors highlights the importance of early detection and intervention as life saving measures. By understanding the clinical and laboratory findings specific to HELLP syndrome, healthcare providers can improve maternal and fetal outcomes in cases of this rare and serious complication of pregnancy.

0692 Medication Use and Restless Legs Syndrome in Pregnancy Among Nulliparous Women

0692 Medication Use and Restless Legs Syndrome in Pregnancy Among Nulliparous Women

Impact of Pregnancy on Breast Cancer Features and Prognosis.

pregnancy-associated breast cancer (PABC) affects one in 3000 pregnancies, often presenting with aggressive features. We retrospectively evaluated a cohort of 282 young BC patients (≤45 years old) treated between 1995 and 2019, dividing them into three groups: nulliparous women, women with PABC (diagnosed within 2 years since last pregnancy) and women with BC diagnosed > 2 years since last pregnancy. This last group was further stratified according to the time between pregnancy and BC. The analysis encompassed histological factors (tumor size, histotype, grading, nodal involvement, multifocality, lympho-vascular invasion, hormone receptor expression, Ki-67 index, and HER2 expression), type of surgery and recurrence. Age at diagnosis was younger in nulliparous than in parous women (p < 0.001). No significant differences were noticed regarding histological characteristics and recurrences. At univariate analysis, nodal involvement (OR = 2.4; p < 0.0001), high tumor grade (OR = 2.6; p = 0.01), and lympho-vascular invasion (OR = 2.3; p < 0.05), but not pregnancy (OR = 0.8; p = 0.30), influenced DFS negatively. Multivariate analysis confirmed nodal involvement as the only negative independent prognostic factor for a worse DFS (OR = 2.4; p = 0.0001). in our experience, pregnancy is not an independent adverse prognostic factor for BC DFS.

Early prediction of gestational diabetes mellitus using maternal demographic and clinical risk factors

ObjectiveTo build and validate an early risk prediction model for gestational diabetes mellitus (GDM) based on first-trimester electronic medical records including maternal demographic and clinical risk factors.MethodsTo develop and validate a GDM prediction model, two datasets were used in this retrospective study. One included data of 14,015 pregnant women from Máxima Medical Center (MMC) in the Netherlands. The other was from an open-source database nuMoM2b including data of 10,038 nulliparous pregnant women, collected in the USA. Widely used maternal demographic and clinical risk factors were considered for modeling. A GDM prediction model based on elastic net logistic regression was trained from a subset of the MMC data. Internal validation was performed on the remaining MMC data to evaluate the model performance. For external validation, the prediction model was tested on an external test set from the nuMoM2b dataset.ResultsAn area under the receiver-operating-characteristic curve (AUC) of 0.81 was achieved for early prediction of GDM on the MMC test data, comparable to the performance reported in previous studies. While the performance markedly decreased to an AUC of 0.69 when testing the MMC-based model on the external nuMoM2b test data, close to the performance trained and tested on the nuMoM2b dataset only (AUC = 0.70).

Low-dose aspirin for the prevention of preterm birth in nulliparous women: systematic review and meta-analysis

ObjectiveThe objective was to assess the efficacy and safety of low-dose aspirin for the prevention of preterm birth in nulliparous women.Data sourcesWe searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to June 2022.Study eligibility criteriaRandomized controlled trials that compared aspirin to placebo in nulliparous women were eligible.MethodsThis study was reported in accordance with the PRISMA 2020 checklist. The primary outcomes of this study were the rates of preterm birth at less than 37 weeks and less than 34 weeks of gestation. The secondary outcomes included postpartum hemorrhage, placental abruption, cesarean section, any hypertensive disorder of pregnancy and small for gestational age. Relative risks with their 95% confidence intervals were calculated for analysis. Heterogeneity was assessed by Cochran’s Q test and Higgins’s I2. A random-effects model was used when I2 was > 50% to generate the RR and 95% CI; otherwise, a fixed-effects model was used. The risk of publication bias was assessed by funnel plots. We performed sensitivity analysis by sequentially omitting each included study to confirm the robustness of the analysis.ResultsSeven studies with a total of 29,029 participants were included in this review. Six studies were assessed as having a low risk of bias or an unclear risk of bias, and one study was judged as having a high risk of bias. In nulliparous women, low-dose aspirin was associated with a significant reduction in the rate of preterm birth at less than 34 weeks of gestational age (RR 0.84,95% CI: 0.71–0.99; I2 = 0%; P = 0.04), but we did not observe a significant difference in the rate of preterm birth at less than 37 weeks of gestation (RR 0.96,95% CI: 0.90–1.02; I2 = 31%; P = 0.18). Low-dose aspirin was associated with a significant increase in the rates of postpartum hemorrhage (RR 1.32,95% CI: 1.14–1.54; I2 = 0%; P = 0.0003), placental abruption (RR 2.18,95% CI: 1.10–4.32; I2 = 16%; P = 0.02) and cesarean section (RR 1.053, 95% CI: 1.001–1.108; I2 = 0%; P = 0.05) in nulliparous women. We also did not observe a significant effect of low-dose aspirin on the rates of any hypertensive disorder of pregnancy (RR 1.05, 95% CI: 0.96–1.14; I2 = 9%; P = 0.28) or small for gestational age (RR 0.96, 95% CI: 0.91–1.02; I2 = 0%; P = 0.16) in nulliparous women. Funnel plots indicated that no significant publication bias existed in this meta-analysis. Except for preterm birth at less than 34 weeks of gestation, placental abruption and cesarean section, the sensitivity analysis showed similar results, which confirmed the robustness of this meta-analysis.ConclusionsLow-dose aspirin might reduce the risk of preterm birth at less than 34 weeks of gestation in nulliparous women. The use of low-dose aspirin in nulliparous women increased the risk of postpartum hemorrhage and might increase the risk of placental abruption and cesarean section.

Assessing the effect of childbearing on blood DNA methylation through comparison of parous and nulliparous females

BackgroundPregnancy and childbirth have been connected to modified risk of a wide variety of conditions in later life, including neurodegenerative disorders and cancers. The presence, extent, and direction of the effect that childbearing status has on decreasing or increasing the risk of these conditions differs depending on the disease. The mechanisms by which pregnancy and childbirth modify the risk of diseases are still unknown. DNA methylation (DNAm) alterations that occur during pregnancy and persist after childbirth may help us understand this phenomenon.ResultsBlood DNAm was available from 89 women (28 parous; 61 nulliparous) at ages 18 and 26 years in the Isle of Wight birth cohort; no significant differences in the population characteristics were present between the analyzed population and the full cohort. We performed an epigenome-wide association study on 389,355 CpGs and identified 184 CpGs to be significantly differentially methylated between parous and nulliparous women after adjusting for confounders and multiple testing. Of these CpGs, 105 had regression coefficients in the same direction in an independent Mexico City based ELEMENT cohort, of which 13 were significant (replication P < 0.05). These 13 CpGs were associated with 16 unique genes. DNAm levels tracked with gene expression in 3 of the replicated genes, one of which (TM2D3) was differentially expressed in parous vs nulliparous women. Gene disease association analysis identified a network of parous-associated diseases.ConclusionsOur results suggest that pregnancy and childbirth lead to DNAm changes in parous women and these changes persist at least 6 months and up to 8 years postpartum. Parous-related CpG sites may play a role in how childbearing status modifies risk of later life diseases in women. Further studies are needed to explore the linkage and mechanism.

Radical vaginal trachelectomy: long-term oncologic and fertility outcomes in patients with early cervical cancer

ObjectiveRadical vaginal trachelectomy is a fertility-preserving treatment for patients with early cervical cancer. Despite encouraging oncologic and fertility outcomes, large studies on radical vaginal trachelectomy are lacking.MethodDemographic, histological, fertility, and...

Ultrasound Morphometry of the Pelvic Floor Muscles in Women of Reproductive Age

Biometric studies in nulliparous women conducted to date are limited by small sample sizes. The pelvic floor muscles perform an important function throughout a woman’s life. They provide fixation and maintenance of the pelvic organs, stretches during childbirth, ensuring the formation of the birth canal, and are a potential site for the formation of a hernia in the female body. Impaired function of this muscle group can lead to either excessive muscle contraction (chronic pelvic pain syndrome) or excessive stretching (pelvic organ prolapse). The purpose of the study is to assess the morphometric properties of the pelvic floor muscles in nulliparous women using 3D ultrasound scanning (sonography). Material and methods. The observation group consisted of 60 women of middle reproductive age who applied for an appointment with an obstetriciangynecologist with complaints of pain of various types localized in the perineum and pelvis, decreased desire and quality of sexual life, clinically confirmed by a diagnosis of incompetence of the pelvic floor muscles. The control group consisted of 30 women without dysfunction of the pelvic floor muscles according to clinical examination. The main criterion for inclusion of patients in the study was reproductive age - 18–45 years and natural childbirth in obstetric and gynecological history. Results. We found that the absence of visible sonographic markers of changes in the myofascial structures of the pelvis is not a prognostically significant criterion for muscle dysfunction, since predominantly changes in morphometric parameters are a reliable sign of the formation of pelvic floor muscle failure. Conclusion. The ultrasound morphometry method, which allows one to assess dynamic changes in the size of muscle and fascial structures, can be used in the clinical practice of an obstetrician-gynecologist. Early diagnosis of a violation of the structure of pelvis myofascial complex will allow early implementation of measures aimed at prevention and timely treatment.