To examine the effect of tubal flushing on the fertility outcome of patients with tubal ectopic pregnancy (EP) undergoing salpingectomy.
This prospective cohort study included 93 patients who received unilateral salpingectomy for tubal EP. Tubal flushing via hysteroscopic hydrotubation was performed after surgery on only 42 patients in the cohort. All patients were followed up for their fertility outcomes by phone interview.
Intrauterine pregnancy (IUP) was documented in 48 cases. The cumulative IUP rate was 64.6% in the patients who received tubal flushing, and 54.7% in the patients without tubal flushing (p = 0.071). The median time from salpingectomy to IUP was 13.0 months in the patients with tubal flushing and 27.1 months in those without tubal flushing (p = 0.007). Recurrent ectopic pregnancy (REP) was documented in three (7.1%) of the patients who received tubal flushing and two (3.9%) that did not (p = 0.823).
Tubal flushing via hysteroscopic hydrotubation after unilateral salpingectomy may improve subsequent IUP after EP but cannot prevent REP.
The study protocol was registered to the Chinese Clinical Trial Registry at https://www.chictr.org.cn/ (Identifier No.: ChiCTR2100052941).
The management of early-stage endometrial cancer (EC) consists of surgery followed by tailored adjuvant therapy, largely based on the risk of loco-regional recurrence. We evaluated the frequency and site of first relapse in patients who received vaginal brachytherapy (VBT) or pelvic external beam radiotherapy (EBRT) for early-stage EC. These data were stratified retrospectively according to the European Society of Gynaecological Oncology–European Society of Radiotherapy and Oncology–European Society of Pathology (ESGO-ESTRO-ESP, 2020) intermediate risk endometrial cancer (IR-EC) and high-intermediate risk endometrial cancer (HIR-EC) classifications.
The central radiotherapy prescribing system within the West of Scotland Cancer Network was analyzed to identify International Federation of Gynaecology & Obstetrics (FIGO) Stage I–II EC patients who commenced VBT, at a dose of 2100 cGy for 3 fractions, and/or EBRT, at 4500 cGy for 25 fractions, between 1st January 2017 and 31st December 2019. Clinical follow-up was conducted until death or for a maximum of five years (data lock 31st December 2022). Imaging was performed if recurrence was suspected. Statistical analysis was implemented using R statistical software (v4.4.1).
In total, 282 patients were identified. The median age was 69 years (range: 37–92 years), and the median follow-up was 33 months (range: 0–68 months). Stage distribution: ⅠA (25.2%), ⅠB (57.4%), and Ⅱ (17.4%). The pathology subtype was predominantly endometrioid (93.6%), but 6.4% of patients had non-endometrioid histology with no myometrial invasion. IR-EC patients comprised 51.1% of the series; all received VBT and no adjuvant chemotherapy. The HIR-EC cohort comprised 48.9% of the series; just over half received EBRT, and adjuvant chemotherapy was delivered to 15.9%. By the end of the study, 37 (13.1%) patients had relapsed, and 41 (14.5%) had died, 22/41 (53.7%) of which were attributable to EC. Recurrences were documented in 11.1% of the IR-EC patients and 15.2% of the HIR-EC patients. Vaginal, pelvic, and distant relapses per risk group and treatment were: 2.1%, 7.6%, and 6.9% in IR-EC (VBT-treated), respectively; 3.1%, 16.9%, and 6.2% in the HIR-EC (VBT-treated), respectively; 0%, 6.9%, and 9.6% in the HIR-EC (EBRT-treated), respectively. None reached statistical significance (p = 0.34, Fisher’s exact test). Salvage therapy for locoregional recurrence was performed in 3.5% (10/282) of patients, and virtually all pelvic relapses were symptomatic.
Vaginal relapse rates were very low (1.8%). However, pelvic recurrences occurred in 16.9% of the HIR-EC (VBT-treated) patients, suggesting that external beam radiotherapy should be considered to optimize loco-regional control in this group.
Postpartum women often experience musculoskeletal pain due to physiological and biomechanical changes during pregnancy and childbirth, which can result in disability. This study assessed the prevalence of neck and upper limb pain and disability in postpartum women, as well as the factors associated with these conditions.
A descriptive cross-sectional study was conducted to collect data from postpartum women through an online self-administered questionnaire. The questionnaire included items on the demographic variables, the Nordic Musculoskeletal Symptoms Questionnaire, the Neck Disability Index, the Disabilities of the Arm, Shoulder, and Hand scale, as well as the Pain Intensity Numeric Rating Scale.
Among a sample of 400 postpartum women aged 20–50 years, 82.5% reported experiencing pain in at least one part of their upper body. Neck pain was the most prevalent (65.5%), followed by pain in the shoulders (63.3%), arms (58.3%), and hands (57.0%). Cesarean section delivery and moderate-to-severe pain intensity were identified as significant risk factors for developing mild disability among women who reporting neck pain. Upper limb pain and being aged 41–50 years were significant risk factors for mild disabilities among postpartum women.
Disability was prevalent among the sample of postpartum women, highlighting the importance of healthcare providers in addressing this issue.
Lymphovascular space invasion (LVSI) is recognized as a significant prognostic factor in endometrial cancer. Systemic inflammation, as reflected by neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR) indices, may reflect or contribute to tumor progression. Increased endometrial thickness (ET) may also promote local invasion. Our study aims to discover the relationship between these parameters.
In this prospective study, we examined 161 patients with endometrial carcinoma treated at the Azienda Ospedaliera Universitaria Vanvitelli in Naples, Italy. The variables examined included inflammatory indices such as NLR, MLR, and PRL, as well as ultrasound-measured ET (mm). Statistical analysis was performed to compare the groups with and without LVSI and to evaluate the association between inflammatory indices, ET, and the presence of LVSI.
The LVSI-positive group showed statistically significantly higher average values for all analyzed parameters. Logistic regression analysis revealed an interdependence between NLR, MLR, PLR, ET, and LVSI. Multivariate logistic regression confirmed that ET is a significant predictor of LVSI.
The results of our analysis suggest an interaction between inflammation, ET, and LVSI in endometrial cancer. Logistic regression demonstrated that ET is a significant predictor of positive LVSI, while the other inflammatory indices showed a less defined correlation.
NCT05657483, https://clinicaltrials.gov/ct2/show/NCT05657483.
Perimenopausal women often require hormone replacement therapy (HRT), which is associated with an increased risk of developing breast nodules compared to women in other age groups. Consequently, this study aimed to identify risk factors for breast nodule development in perimenopausal women and to develop a predictive model to mitigate these risks.
This prospective cohort study included 436 perimenopausal women who underwent breast ultrasound examinations at the Affiliated Hospital of Guizhou Medical University, China. Clinical data were collected, with 304 cases (70%) assigned to the modeling group, while the remaining 132 cases (30%) were allocated to the validation group using a computerized randomization method. Subsequently, participants in each group were categorized into either the control group or the disease group based on the presence or absence of breast nodules. Risk factors associated with the occurrence of breast nodules in perimenopausal women from the modeling group were analyzed using univariate analysis and multivariate logistic regression. A nomogram predictive model was subsequently constructed using R software. The predictive accuracy and discriminative ability of the model for perimenopausal breast nodules were evaluated in both the modeling and validation groups using goodness-of-fit curves and receiver operating characteristic (ROC) analysis.
Factors exhibiting significant differences in the univariate analysis were included in the multivariate logistic regression model. The results revealed that family relationships, the modified Kupperman score, depression, dietary status, estradiol (E2), triglycerides (TG), and total cholesterol (TC) were independent risk factors for the development of breast nodules during perimenopause. In contrast, elevated high follicle-stimulating hormone (FSH) levels were identified as a protective factor against perimenopausal breast nodules. A nomogram predictive model was developed to assess the predictive validity of breast nodules occurrence during perimenopause, using goodness-of-fit curves. The results showed χ2 = 4.936, p = 0.764 for the training group, and χ2 = 8.642, p = 0.071 for the testing group. The model’s discrimination was evaluated by the ROC curve, with the results showing an area under the curve (AUC) of 0.941 for the training model, along with a specificity of 91.7%, and sensitivity of 96.4%. In the testing model, the AUC was also 0.941, with a sensitivity of 90.2% and specificity of 98.4%.
Poor family relationships, unhealthy dietary habits, severe menopausal symptoms, severe depression, elevated estrogen levels, and elevated blood lipid levels were identified as independent risk factors for the development of breast nodules during perimenopause. In contrast, high FSH levels serve as a protective factor against perimenopausal breast nodules. The predictive model developed using this approach demonstrates strong predictive accuracy and discriminative power.
Giving birth is one of the challenges that women of reproductive age encounter when their ovarian reserve has decreased or been lost. Platelet-rich plasma (PRP) may be advantageous for women experiencing a poor ovarian response (POR). To evaluate the efficacy of administering autologous PRP injections into the ovary in improving ovarian reserve, oocyte and embryo production, and live birth rates in patients with a poor prognosis.
The trial comprised 234 women in their reproductive years who had a diagnosis of POR and the Bologna criteria. These women received intraovarian PRP injections. The age range of the cases was between 30 and 44 years. Each ovary received a multifocal intramedullary injection of 3–4 mL of PRP. The effectiveness of PRP was evaluated in all patients, with a six-month follow-up to assess follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Mullerian hormone (AMH). An evaluation was conducted on the metrics of in vitro fertilization (IVF) results and indications of ovarian reserve.
Subsequent to PRP treatment, there was a rise in both the quantity of antral follicles count (AFC) and the concentration of AMH in the bloodstream. After receiving PRP injection, 21 women (9.0%) became pregnant without any intervention, 9 women (3.8%) were excluded in the study anymore, 192 women (82.0%) attempted IVF treatment with developing antral follicles, 4 of whom have premature ovulation and 12 women (5.1%) who did not have antral follicles did not need any more therapy. Out of the 188 women who had IVF, 126 (67.0%) successfully developed embryos and 106 of them had the embryos transferred. Among these, 42 (39.6% per transfer) achieved pregnancy, and 39 (36.8% per transfer) had a continuing pregnancy resulting in a live birth.
Autologous PRP injection into the ovary may be investigated as another experimental therapeutic option for women with POR.
Current research on the characteristics of missed miscarriage (MM) in women over the age of 35 is limited. This study investigates the role of serum metabolites for MM among women in this age group.
This study included a total of 80 women over the age of 35 who experienced MM and 66 women over the age of 35 with healthy pregnancies, conducted between March 2021 and June 2022. General information, including age, gestational age, body mass index (BMI), gravidity, live birth, history of spontaneous miscarriage, drug or radiation exposure, occupation, and pregnancy-related complications, was collected. The recorded serum indicators included total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), lactate dehydrogenase (LDH), and gamma-glutamyl transferase (GGT). Potential risk factors for MM in the case-cohort were identified using univariate and multivariate logistic regression analyses. The diagnostic relevance of serum markers for MM was examined through receiver operating characteristics (ROC) curve analysis.
The incidence of MM increased with higher LDL and GGT values (p < 0.05). The area under the curve (AUC) was 0.709 for LDL and 0.792 for GGT. An LDL value >2.31 identified MM with a sensitivity of 72.5% and a specificity of 66.7%, while a GGT value >15.5 identified MM with a sensitivity of 78.8% and a specificity of 72.7%. However, the combined diagnostic accuracy of the two indicators was superior of that of either single index (AUC = 0.880, sensitivity = 92.5%, specificity = 72.7%; Z = 4.238, 2.813, p < 0.001, p < 0.01).
In women over the age of 35, serum LDL and GGT are high-risk factors for MM, each potentially playing a significant role in its diagnosis. The combination of these two markers may improve diagnostic accuracy. The preliminary results of this study warrant further investigation through a well-designed, multicenter prospective study.
This review aims to provide an overview of the factors contributing to central obesity, particularly in postmenopausal women, who are affected at a global rate of 26%. It emphasizes the heterogeneity of adipocytes, the impact of prenatal genetic factors, and the role of estrogenic neuroendocrine regulation. Additionally, the review explores the paradoxical functions of visceral fat and identifies the primary depots that may contribute to its overall function.
Estrogen deficiency is a key factor in central adiposity among postmenopausal women, leading to a reduction in subcutaneous adipose tissue (SAT) and an increase in visceral adipose tissue (VAT) compared to premenopausal women. This deficiency deactivates pro-opiomelanocortin (POMC) neurons and steroidogenic factor-1 (SF1) neurons via estrogen receptor alpha (ERα), desensitizes vagal cholecystokinin-A (CCK-A) receptors, and hyperactivates the hypothalamic-pituitary-ovary (HPO) axis, resulting in increased food intake and decreased energy expenditure. The differences between VAT and SAT, such as expandability, anatomic location, free fatty acid (FFA) mobility, facilitate energy transfer from SAT to VAT, thereby contributing to central obesity. VAT also compensates for estrogen deficiency by releasing estradiol, inflammatory and anti-inflammatory adipocytokines, and increasing 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) activity, which potentiates glucocorticoid functions and ultimately leading to the development of metabolic syndromes. VAT is heterogeneous, including distinct depots such as mesenteric, gonadal, and perirenal fat. Mesenteric fat may play a significant role in body weight regulation and insulin resistance, while other fat depots interact more closely with surrounding organs to regulate various physiological functions. Understanding VAT heterogeneity is crucial for identifying adiposopathy markers associated with various metabolic syndromes. This knowledge can inform holistic, personalized therapeutic and bodybuilding approaches, helping patients to mitigate the risks associated with current hormone therapies.
The ratio of SAT to VAT is shaped by a combination of prenatal genetics, neuroendocrine regulation, and postnatal epigenetic factors influenced by environmental energy availability and estrogen deficiency. VAT accumulation exhibits paradoxical roles, aiding adaption to energy surplus stress while simultaneously contributing to postmenopausal syndromes. Within VAT, heterogeneity exists, with mesenteric fat depots playing a key role in its overall function. Long-term protective strategies during the perimenopausal and menopausal periods may include energy restriction and the maintenance of normal estrogen levels. Personalized diets and estrogen supplementation hold promise in alleviating associated syndromes. Further exploration of the relationship between mesenteric fat, VAT accumulation, and menopausal syndromes could help clarify existing contradictory evidence and position mesenteric fat as a potential target for effective interventions aimed at alleviating postmenopausal symptoms with fewer side effects.
Visceral fat accumulation in postmenopausal women is a consequence of energy stress due to estrogen deficiency, followed by the energy transfer from SAT to VAT. The heterogeneity of VAT suggests that its components may have different roles in body weight regulation. Mesenteric fat may play a major role among the depots.
Abdominal wall endometriosis, which can affect the rectus abdominis muscle, has been documented in association with cesarean section scars or along pathways formed by abdominopelvic surgeries. Our study aimed to assess the risk of developing abdominal wall endometriomas following surgical interventions (cesarean section, myomectomy) on the uterine wall.
Between 2011 and 2021, a total of 19,574 patients underwent cesarean section delivery through a Pfannenstiel incision. The average age of patients was 36 (20–58) years. On average, 1.5 to 2.0 years after cesarean section, 204 patients developed abdominal wall endometrioma (Group I). The control group (Group II) comprised 204 patients who had undergone cesarean section by the same method but did not develop scar endometriosis. During the same period, 200 patients underwent myomectomy with a similar incision for intramural and submucosal myomas (Group III). Postoperatively, these patients were also monitored for the development of endometrioma. One of the patients who underwent myomectomy also had surgery for an ectopic pregnancy at the same time. The data analysis included descriptive statistical methods, such as calculating the mean ± standard deviation, median (min–max), and frequencies (n (%)). The Shapiro-Wilk normality test, Kruskal-Wallis test, Dunn’s multiple comparison test, Chi-Square test, and Fisher-Freeman-Halton exact test were applied. The results were evaluated for statistical significance at a level of p < 0.05.
Abdominal wall endometriomas developed in 204 of 19,574 patients who delivered by cesarean section (1.04%). Endometrioma development was significantly higher in Group I, where estrogen levels were elevated (p < 0.001). The most common complaints among the patients were swelling and cyclical pain in the abdominal wall. 9 of the 204 patients who had previously developed abdominal wall endometriomas experienced recurrence (4.41%). An abdominal wall endometrioma developed in the patient who underwent myomectomy and surgery for ectopic pregnancy simultaneously (0.5%).
Endometrioma is a multifactorial condition. High estrogen levels, surgical techniques, and an increased imbalance between estrogen and progesterone levels can trigger inflammation and lead to the development of endometriomas. We suggest that further detailed studies are needed to better understand these mechanisms.
Continuous advancements in comprehensive tumor treatment strategies have significantly improved survival rates of patients. The ovary is a crucial organ essential for maintaining women’s quality of life and fertility. Safeguarding ovarian function during radiotherapy for cervical cancer has become a prominent focus of current clinical research. The aim of this study is to explore the key factors involved in ovarian protection during radiotherapy for cervical cancer.
This study involved a comprehensive analysis of literature from 2015 to 2024 on ovarian function preservation during radiotherapy for cervical cancer, to identify technical trends. Additionally, patient data from Zhejiang Cancer Hospital from 2011 to 2018 was collected, focusing on patients who underwent radiotherapy to preserve ovarian function. Specifically, data from 10 patients with IA–IIB stage cervical cancer who underwent bilateral ovarian transposition (OT) and radiotherapy at our hospital between 2016 and 2018 was analyzed. Intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and helical tomotherapy (HT) radiotherapy plans will be design for these patients to evaluate strategies for optimal ovarian protection. The optimal radiotherapy plan was determined through comparisons of dosimetric parameters.
(1) A literature review indicated that only 24 detailed reports on ovarian protection during cervical cancer radiotherapy have been published in the past 10 years. It has been established that ovarian protection presents a positive significance for cervical cancer patients, with OT being a necessary condition. Nevertheless, no standardized unified dose limit for ovarian radiation has been established. (2) After screening, a total of 77 patients with complete follow-up data from 2011 to 2018 were selected for the study. Following serum hormone level tests, 73 patients presented normal ovarian function prior to radiotherapy, while 4 demonstrated signs of impaired function. Three months after radiotherapy, 26 patients maintained normal ovarian function, 13 exhibited impaired function, and 38 showed a decline in function. One year later, 45 patients maintained normal ovarian function, 13 had impaired function, and 19 experiences further deteriorated function. The overall success rate amounted to 75.3%, and favorable clinical outcomes were observed. (3) Compared to IMRT and VMAT, HT reduced the maximum dose (Dmax) of the right ovary and demonstrated dosimetric advantages in terms of Dmax of the planning target volume (PTV), as well as in 30 Gy (V30) and 40 Gy (V40) of the bladder, and Dmax of the spinal cord. These differences were statistically significant. Compared with HT, IMRT and VMAT had advantages in the minimum dose (Dmin) of PTV and the mean dose (Dmean) of the left femoral head, and the differences were statistically significant. Compared with VMAT, most dosimetric results of IMRT were similar and the differences were not statistically significant, but IMRT had an advantage in the conformity index (CI) of PTV (p = 0.016).
Following receiving a certain radiation dose, the ovaries may undergo a temporary functional decline or even complete failure. The key to protecting the ovarian function during cervical cancer radiotherapy lies in successful OT, precise delineation of ovarian tissue, determination of dose limits for patients across different age groups, as well as the application of HT and specialized IMRT techniques.
Heavy menstrual bleeding (HMB) significantly impacts women’s quality of life (QoL). However, despite the high prevalence of HMB, culturally adapted screening tools remain scarce in Turkey. This study aimed to adapt and validate the SAMANTA questionnaire for non-pregnant Turkish women of reproductive age.
This two-stage methodological study was conducted between January and June 2023. The adaptation process involved translating the SAMANTA questionnaire and culturally aligning it to Turkish healthcare practices. Psychometric testing was conducted on 148 women aged 18–45 years recruited from outpatient gynecological services at a tertiary care institution. Reliability was assessed through internal consistency (Cronbach’s alpha) and test-retest reliability (intraclass correlation coefficient, ICC). Validity was evaluated by examining correlations between questionnaire scores and external measures of HMB severity and QoL.
The Turkish SAMANTA questionnaire exhibited satisfactory internal consistency, reflected by a Cronbach’s alpha of 0.713, and an ICC of 0.668, reflecting moderate reproducibility across the test-retest assessment. Significant correlations with external measures, including HMB severity (r = 0.762), supported its criterion validity. Over half of the participants (50.7%) scored ≥3, indicating the presence of HMB symptoms. Responses highlighted the substantial impact of HMB on daily activities, emotional well-being, and social engagement.
The Turkish SAMANTA questionnaire represents a reliable and culturally appropriate tool for screening HMB. The straightforward design and cultural adaptation make the Turkish SAMANTA questionnaire suitable for identifying women who may require further clinical evaluation. Future research should explore its utility in various clinical contexts, including primary care, and community health initiatives.
Labor induction is a common procedure in obstetrics, with various methods employed to facilitate the process. This study aimed to compare the effects of labor induction using the double-balloon catheter (DBC) and dinoprostone (D), two widely used methods in clinical practice.
Randomized controlled trials (RCTs) were identified from the Cochrane Library, SinoMed, PUBMED, and Embase up to March 2024. Two researchers independently screened and extracted the literature according to the inclusion and exclusion criteria. After evaluating the literature, Revman 5.4 software was used to analyze the data. The time to the onset of active labor and the rate of cesarean deliveries were the key outcomes. The secondary outcomes included assisted vaginal delivery, failure to progress rate, failed induction rate, incidence of nonreassuring fetal heart rate, neonatal asphyxia incidence, neonatal intensive care unit (NICU) admission rate, improvement in time to onset of active labor, time to vaginal delivery, Bishop score, need for oxytocin administration, presence of postpartum hemorrhage, vaginal delivery within 24 hours, and uterine hyperstimulation rate.
The total of 7 RCTs involving 2267 patients were included, with 1127 treated with DBC, and 1140 treated with D. Our meta-analysis showed no significant difference between the two groups in terms of cesarean delivery [odds ratio (OR) = 1.10, 95% confidence interval (95% CI): 0.91, 1.32, p = 0.34], time to onset of active labor [mean difference (MD) = 0.66, 95% CI: –4.72, 6.03, p = 0.81], presence of nonreasuring fetal heart, success rate of induction, improvement in Bishop score, rate of progress in labor, vaginal delivery rate within 24 hours, time to vaginal delivery, postpartum hemorrhage, and assisted vaginal delivery. Although the oxytocin administration rate (OR = 3.96, 95% CI: 3.18, 4.93, p < 0.00001) was lower, D was more likely to cause uterine hyperstimulation, leading to a higher rate of neonatal asphyxia (OR = 0.39, 95% CI: 0.18, 0.85, p = 0.02).
Compared to DBC, D was more likely to cause uterine hyperstimulation, leading to a higher rate of neonatal asphyxia.
Numerous surgical techniques have been proposed to enhance the stability of intrauterine system (IUS) and reduce the incidence of displacement and expulsion, however, challenges remain. We aim to explore improved therapeutic strategies for levonorgestrel-releasing intrauterine system (LNG-IUS) displacement or expulsion cases.
This study proposes a novel method utilizing a specialized fixation needle to anchor the Mirena intrauterine device (IUD) within the uterine muscle layer. From June 2022 to December 2022, patients underwent hysteroscopic suturing for Mirena fixation, serving as the control group. From January 2023 to June 2023, 38 patients underwent hysteroscopic anchoring of Mirena using a specialized fixation needle, constituting the experimental group.
A total of 59 patients were included in the study. The experimental group included 38 patients, aged 31 to 51 years, with a median age of 41.5 (interquartile range: 36, 46) years. Comparison of treatment outcomes between the two groups showed significant improvements in Visual Analog Scale (VAS) scores, Pictorial Blood Assessment Chart (PBAC) scores, and hemoglobin (Hb) levels after treatment in both the experimental and control groups (all p < 0.001). Moreover, in the control group, 90.48% (19/21) of patients had normal contraceptive device positions during postoperative follow-up. In the control group, 2 patients (9.52%) experienced IUD displacement postoperatively. While, in the experimental group, 97.37% (37/38) of patients had normal contraceptive device positions during postoperative follow-up. However, 2.63% (1/38) experienced sudden excessive menstrual bleeding and IUD expulsion at 3 months postoperatively, requiring total hysterectomy.
Hysteroscopic anchoring of the LNG-IUSs using a specialized fixation needle addresses the issue of device expulsion, offering a more straightforward and accessible alternative to traditional hysteroscopic suturing methods. Moreover, similar to hysteroscopic suturing of Mirena, this technique effectively relieves dysmenorrhea and heavy menstrual bleeding symptoms in patients.
Gestational diabetes mellitus (GDM) and preeclampsia (PE) significantly increase the risk of adverse pregnancy outcomes. However, the effect on the risk of adverse pregnancy outcomes of GDM in combination with PE remains undetermined. Therefore, this study aimed to investigate the risk of adverse outcomes in pregnant women with GDM and PE.
This retrospective cohort study was conducted at a single center. To explore the correlations between the occurrence of PE and adverse pregnancy outcomes, the enrolled population was divided into two groups: GDM and non-GDM. Risk factors associated with PE were analyzed using a binary logistic regression model.
This study comprised 27,181 pregnant women (5412 GDM cases and 21,769 non-GDM cases). The prevalence of PE was significantly higher in the GDM group than in the non-GDM group (p < 0.05). The presence of GDM, pre-pregnancy body mass index (pp-BMI) >24 kg/m2, and excessive gestational weight gain (GWG) were demonstrated to contribute to an increased risk of developing PE (p < 0.05). Pregnant women with GDM exhibited a significantly higher risk of preterm birth. Additionally, the risk of preterm birth, cesarean section, and fetal growth restriction increased further when PE occurred alongside GDM.
Overall, pp-BMI >24 kg/m2 and excessive GWG were risk factors for PE. Pregnant women with GDM have a higher risk of developing PE, and co-occurrence of PE further increases the risk of adverse pregnancy outcomes. Therefore, attention and management of this population are needed during pregnancy.
Labor pain management is a critical aspect of maternal care, with methods broadly classified as pharmacological and non-pharmacological. While pharmacological approaches such as epidural anesthesia offer effective pain relief, they may prolong labor and lead to other complications. Acupressure, rooted in traditional Chinese medicine, presents a non-invasive alternative that alleviates anxiety, enhances maternal cooperation, and potentially expedites labor, albeit with limited analgesic efficacy.
This comprehensive review analyzed studies on the use of acupressure for labor pain management, evaluating its effectiveness, mechanism of action, and impact on maternal and neonatal outcomes.
Acupressure was associated with a significant reduction in labor pain, with visual analog scale (VAS) scores decreasing by approximately 2 points compared to control groups. Acupressure also shortened labor duration by an average of 50 and 15 minutes in the first and second stages, respectively, improved maternal satisfaction (85% of women reported greater comfort), and, in some studies, reduced cesarean section rates. Mechanistically, acupressure alleviates pain through the gate control theory, stimulation of endogenous opioid release, and modulation of pain-related brain regions, such as the anterior cingulate cortex and insula. However, the analgesic effects of acupressure were found to be incomplete and reliant on accurate acupoint identification.
Acupressure is a safe, accessible, and effective complementary method for labor pain management with additional benefits for maternal satisfaction and neonatal outcomes. While not a full substitute for pharmacological analgesia, integrating acupressure into clinical practice could provide a holistic approach to labor care. Future research should focus on standardizing methodologies and exploring their application in diverse populations.