A Study on the Identification of High-Risk Factors and the Establishment of a Prediction Model for Uterine Rupture in an Unscarred Uterus During Pregnancy.

Objective: The diagnosis of uterine rupture was often delayed or misdiagnosed, leading to maternal morbidity and fetal mortality. The current study was performed to retrospectively identify high-risk factors of uterine rupture in an unscarred uterus (USU), and to establish a model to predict uterine rupture in USU during pregnancy. Methods: This was a retrospective multi-center study including five regional medical centers from the inception of each medical center to December 31 2021. Out of 547 325 deliveries, 28 patients with USU who had a uterine rupture during pregnancy were recruited. The following clinical characteristics were collected and analyzed: 1) general clinical characteristics; 2) clinical manifestations; 3) high-risk factors; 4) therapeutic strategies; 5) prognosis of mothers and infants. Results: In patients with a number of gravidities ≥2, the number of artificial abortions, the number of parities, and the amount of intraoperative blood loss were significantly increased (P = .002, .029, and .023). In patients with a previous history of artificial abortion, the number of parities, the probability of hysterectomy, and the incidence of intraoperative blood loss (>1000ml) were significantly increased (P < .001, .030 and .040, respectively). Additionally, multiparous patients had advanced maternal age, an increased number of gravidities, and a higher incidence of vaginal bleeding symptoms with significant differences (P = .042, .001, and .031). Based on the above results, we further developed a prediction model of uterine rupture in an unscarred uterus using Logistic binary regression analysis and the formula was as follows: Logit (P) = -9.112 + (-0.199) × maternal age + 0.374 × gestational age + 1.720 × parity + (-1.162) × number of artificial abortions. Conclusion: The number of gravidities ≥2, previous history of artificial abortion and multipara were associated with adverse outcomes in patients of uterine rupture in USU. A mathematical prediction formula was developed based on the parameters of maternal age, gestational age, number of parities, and number of artificial abortions. The risk of uterine rupture in USU can be predicted with two steps using formula I and formula II developed by us.

Clinical characteristics of uterine rupture without previous Cesarean section: A 25-year retrospective study.

AIM: To investigate the clinical characteristics and risk factors of uterine rupture without preceding Cesarean section. METHODS: The medical records of all deliveries at the Women's Hospital, Zhejiang University School of Medicine between 1992 and 2017 were reviewed. All cases of uterine rupture without previous Cesarean delivery were included. Two types of uterine rupture, incomplete and complete, were distinguished. The clinical characteristics of each patient were collected and analyzed, including demographic information, clinical manifestation, operative records, site of rupture, pregnancy and labor complication, obstetrics risk factors, and birth outcome. RESULTS: There were 222 418 deliveries in total during the study period. Nineteen cases of uterine rupture without previous Cesarean section were identified. As a result, the incomplete rupture group had significant advanced gestational age, decreased maternal gravidity, lower incidence of dilation and curettage, and lower perinatal mortality rate. In aspect of the rupture site, the involvement of the lower segment of the uterus was significantly more common in the incomplete rupture group. In the complete rupture group, the participants with a gestation age less than 28 weeks were more likely to have a history of dilation and curettage than those with a gestation age over 28 weeks. CONCLUSIONS: The history of dilation and curettage is the major risk factor of uterine rupture without Cesarean section. Our findings imply that obstetricians should be cautious of spontaneous uterine rupture in pregnant women who has a history of dilation and curettage.

Second curettage versus conventional chemotherapy in avoiding unnecessary chemotherapy and reducing the number of chemotherapy courses for patients with gestational trophoblastic neoplasia: A systematic review and meta-analysis.

BACKGROUND: Chemotherapy is the recommended treatment for gestational trophoblastic neoplasia (GTN). Second curettage had been advocated to avoid unnecessary chemotherapy and to reduce the courses of chemotherapy; however, consensus has not been reached as there are arguments claiming its inability of inducing complete regression. OBJECTIVES: The present study was performed to clarify the effectiveness of second curettage for avoiding unnecessary chemotherapy and lowering the number of chemotherapy courses in patients with post-molar GTN. SEARCH STRATEGY: Seven predominant electronic databases were searched, including four English databases and three Chinese databases, from the inception of each database until January 31, 2023. SELECTION CRITERIA: Studies were included if they were: (1) human, (2) explicitly indicated exposure to second curettage, (3) explicitly indicated control to conventional chemotherapy, (4) explicitly indicated the participants were patients with gestational trophoblastic neoplasia (GTN), and (5) compared the outcome of interest as the number of the course of chemotherapy. DATA COLLECTION AND ANALYSIS: Two authors extracted and analyzed the data independently. Disagreements were reconciled by reviewing the full text by a third author. The data of study location, data collection, study design, number of participants, intervention strategy, control strategy, the follow-up period, outcome, adverse events were analyzed. MAIN RESULTS: With regard to avoiding unnecessary chemotherapy, the overall pooled effect size of the second curettage group had a significant advantage over the conventional chemotherapy group with an OR of 0.02 (95% CI: 0.00-0.06). Meanwhile, for reducing the number of chemotherapy courses, the overall pooled effect size of the second curettage group had significant advantage over the conventional chemotherapy group with a mean difference of -2.11 (95% CI: -3.72 to -0.51). CONCLUSION: The second curettage group had a significant advantage over the conventional chemotherapy group in avoiding unnecessary chemotherapy and reducing the number of chemotherapy courses. Further larger multi-center randomized controlled trials should be conducted to confirm our results and to clarify the optimal patients' group for second curettage in patients with post-molar GTN.

Risk factors for adverse pregnancy outcomes in Chinese women: a meta-analysis.

Objective: This study examined the associated risk factors of adverse pregnancy outcomes among Chinese females and furnished some fundamental principles and recommendations for enhanced prevention of adverse pregnancy and preservation of women's well-being. Methods: A systematic review was conducted by retrieving the MEDLINE (The National Library of Medicine), Embase, PubMed, and Cochrane databases. The relevant risk factors for adverse pregnancy in Chinese women were retrieved from May 2017 to April 2023. Use Review Manager for data analysis. Calculate the merge effect based on data attributes using mean difference (MD) or odds ratio (or) and 95% confidence interval (CI). The meta-analysis was registered at INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols, 202340090). Results: A total of 15 articles were included, with a total of 946,818 Chinese pregnant women. Moreover, all the literature was scored by the NOS (Newcastle-Ottawa Scale), and all literatures were ≥7 points, which were evaluated as high quality. There are seven risk factors related to adverse pregnancy in Chinese women: parity, pregnancy frequency, education level, smoking, gestational diabetes, gestational weeks, and age. Moreover, the main risk factors for adverse pregnancy are pregnancy frequency, education level, gestational diabetes mellitus, and age. Conclusion: The pregnancy frequency, education level, gestational diabetes mellitus, and age were significantly associated with the adverse pregnancy in Chinese women, whereas gestational weeks, smoking, and parity had no significant effect on adverse pregnancy.

Serum androgen profiles in women with premature ovarian insufficiency: a systematic review and meta-analysis.

OBJECTIVE: This meta-analysis aims to investigate serum androgen profiles (testosterone, dehydroepiandrosterone sulfate, androstenedione, and sex hormone-binding globulin) in women with premature ovarian failure and to establish if there is evidence of diminished androgen levels in these women. METHODS: Various Internet sources of PubMed, Cochrane library, and Medline were searched systematically until February, 2018. Out of a pool of 2,461 studies, after applying the inclusion/exclusion criterion, 14, 8, 10, and 9 studies were chosen for testosterone, dehydroepiandrosterone sulfate, androstenedione, and sex hormone-binding globulin, respectively, for this meta-analysis. The effect measure was the standardized mean difference with 95% confidence interval (95% CI) in a random-effects model. RESULTS: The testosterone concentrations in premature ovarian insufficiency were compared with fertile controls: stamdard mean difference (IV, random, 95% CI) -0.73 [-0.99, -0.46], P value < 0.05. The dehydroepiandrosterone sulfate concentrations in premature ovarian insufficiency compared to fertile controls: standard mean difference (IV, random, 95% CI) -0.65 [-0.92, -0.37], P value < 0.05. Androstenedione in premature ovarian insufficiency were compared with fertile controls: standard mean difference (IV, random, 95% CI) -1.09 [-1.71, -0.48], P value < 0.05. Sex hormone-binding globulin levels did not show statistical significance. The dehydroepiandrosterone sulfate levels were reduced in premature ovarian insufficiency cases, but still showed a higher level than in postmenopausal women. CONCLUSIONS: Women with premature ovarian insufficiency are at risk for decreased concentrations of testosterone, dehydroepiandrosterone sulfate, and androstenedione. Dehydroepiandrosterone sulfate levels were more reduced in postmenopausal controls when compared with premature ovarian insufficiency cases.