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Fertility and Sterility Jul 2018To evaluate the impact of antibiotic therapy for chronic endometritis (CE) on IVF outcome. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the impact of antibiotic therapy for chronic endometritis (CE) on IVF outcome.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Infertile women with history of recurrent implantation failure, defined as two or more failed ETs, undergoing one or more IVF cycle(s).
INTERVENTION(S)
The review was registered in PROSPERO (CRD42017062494) before the start of the literature search. Observational studies were identified by searching electronic databases. The following comparators were included: women with CE receiving antibiotics vs. untreated controls; women with cured CE vs. women with persistent CE; and women with cured CE vs. women with normal endometrial histology (negative for CE). The summary measures were reported as odds ratio (OR) with 95% confidence interval (CI).
MAIN OUTCOME MEASURE(S)
Clinical pregnancy rate (CPR), ongoing pregnancy rate/live birth rate (OPR/LBR), implantation rate (IR), miscarriage rate.
RESULT(S)
A total of 796 patients (from five studies) were included. Women receiving antibiotic therapy (without the histologic confirmation of CE cure) did not show any advantage in comparison with untreated controls (OPR/LBR, CPR, and IR). Patients with cured CE showed higher OPR/LBR (OR 6.81), CPR (OR 4.02), and IR (OR 3.24) in comparison with patients with persistent CE. In vitro fertilization outcome was comparable between women with cured CE and those without CE (OPR/LBR, CPR, and IR). Miscarriage rate was not significantly different between groups.
CONCLUSION(S)
Chronic endometritis therapy may improve IVF outcome in patients suffering from recurrent implantation failure. A control biopsy should always confirm CE resolution before proceeding with IVF.
Topics: Abortion, Habitual; Chronic Disease; Embryo Implantation; Endometritis; Female; Fertilization in Vitro; Humans; Infertility, Female; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Recurrence; Treatment Outcome
PubMed: 29908776
DOI: 10.1016/j.fertnstert.2018.03.017 -
Hernia : the Journal of Hernias and... Oct 2021Hemipelvectomy is a major operation in which significant portions of the pelvic girdle and lower extremity are resected. The development of hernia following... (Review)
Review
PURPOSE
Hemipelvectomy is a major operation in which significant portions of the pelvic girdle and lower extremity are resected. The development of hernia following hemipelvectomy is a complex surgical challenge with limited published guidelines for management. We present our experience with three cases of hernia repair following internal hemipelvectomy and review the previously described ten cases of similar patients.
METHODS
A systematic review of the current literature regarding hernias in the setting of hemipelvectomy was performed. A comprehensive search strategy on MEDLINE/PUBMED database searching for the key words of hemipelvectomy and hernia was used.
RESULTS
There were 13 reported cases of incisional hernia after hemipelvectomy. The indication for hemipelvectomy was sarcoma in 77% of cases. The median time to presentation for hernia repair was 3 years following initial resection. Mesh repair was used in 77%. Identified risk factors for the development of incisional hernia included chemoradiation, wound infection, multiple operations, and weight gain. There was one event of hernia recurrence with a mean follow-up of 16 months.
CONCLUSION
Hernia in the setting of hemipelvectomy is an infrequently reported problem. General principles in management are similar to all hernia repairs and include local approximation of tissues, avoidance of contamination or wound infection, and use of prosthetic mesh when local tissue is inadequate for a tension-free repair.
Topics: Hemipelvectomy; Hernia; Hernia, Ventral; Herniorrhaphy; Humans; Neoplasm Recurrence, Local; Recurrence; Surgical Mesh
PubMed: 32700157
DOI: 10.1007/s10029-020-02258-8 -
Arab Journal of Urology Mar 2019: To conduct a systematic review of the literature on vesicovaginal fistula (VVF), including reporting on the aetiology, in both developed and underdeveloped countries;... (Review)
Review
: To conduct a systematic review of the literature on vesicovaginal fistula (VVF), including reporting on the aetiology, in both developed and underdeveloped countries; diagnosis; intraoperative prevention; and management. : We conducted a systematic review of the literature on VVF through the PubMed and the Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted from 1985 to 2018 in English, using the keywords 'fistula' and 'vesicovaginal fistula'. Prospective studies were preferred; however, retrospective studies and case reports were used when no prospective studies were available. All authors' extracted relevant data related to the proposed review of VVF and carefully examined collected articles. : In all, 116 relevant articles were identified and 43 articles were included in this systematic review. The outcome of surgical reconstruction was >90%, but the outcome may be suboptimal in radiotherapy (RT)-induced VVFs. Absolute indications for an abdominal approach included: ureteric involvement, the need for concomitant bladder augmentation, severe vaginal stenosis, and an inability to tolerate the dorsal lithotomy position (e.g. due to muscular spasticity). Typically, it was recommended to wait at least 3 months to allow the inflammatory response to subside before definitive surgery. Early fistula repair can be performed in the absence of infection and in patients who have not received pelvic RT. : VVF is rare in developed countries. Surgical treatment is the primary method of repair. The outcome of surgical reconstruction exceeds 90%, but the outcome may be suboptimal in RT-induced VVFs. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RT: radiotherapy; (S)UI: (stress) urinary incontinence; UVF: ureterovaginal fistula; VVF: vesicovaginal fistula.
PubMed: 31258945
DOI: 10.1080/2090598X.2019.1590033 -
JAMA Network Open Apr 2023Reproductive system and mental health disorders are commonly comorbid in women. Although the causes of this overlap remain elusive, evidence suggests potential shared... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Reproductive system and mental health disorders are commonly comorbid in women. Although the causes of this overlap remain elusive, evidence suggests potential shared environmental and genetic factors associated with risk.
OBJECTIVE
To investigate the comorbidity between psychiatric and reproductive system disorders, both as broad diagnostic categories and among specific pairs of diagnoses.
DATA SOURCE
PubMed.
STUDY SELECTION
Observational studies published between January 1980 and December 2019 assessing prevalence of psychiatric disorders in women with reproductive system disorders and prevalence of reproductive system disorders in women with psychiatric disorders were included. The study did not include psychiatric and reproductive disorders triggered by life events (eg, trauma, infection, surgery) to address potential confounding.
DATA EXTRACTION AND SYNTHESIS
A search yielded 1197 records, of which 50 met the inclusion criteria for the qualitative and 31 for the quantitative synthesis in our study. A random-effects model was used for data synthesis and Egger test and I2 to assess study bias and heterogeneity. Data were analyzed from January to December 2022. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline.
MAIN OUTCOMES AND MEASURES
Psychiatric and reproductive system disorders.
RESULTS
A total of 1197 records were identified, of which 50 met the inclusion criteria for qualitative and 31 for quantitative synthesis. Diagnosis of a reproductive system disorder was associated with a 2- to 3-fold increased odds of having a psychiatric disorder (lower bound odds ratio [OR], 2.00; 95% CI, 1.41-2.83; upper bound OR; 2.88; 95% CI, 2.21-3.76). The analysis focused on specific diagnoses described in the literature and found that polycystic ovary syndrome was associated with increased odds of depression (population-based studies OR, 1.71; 95% CI, 1.19-2.45; clinical studies OR, 2.58; 95% CI, 1.57-4.23) and anxiety (population-based studies OR, 1.69; 95% CI, 1.36-2.10; clinical studies OR, 2.85; 95% CI, 1.98-4.09). Chronic pelvic pain was also associated with both depression (OR, 3.91; 95% CI, 1.81-8.46) and anxiety (OR, 2.33; 95% CI, 1.33-4.08). Few studies investigated risk of other reproductive system disorders in women with psychiatric disorders, or reverse associations (risk of reproductive system disorder among women with a psychiatric diagnosis).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, a high rate of reported co-occurrence between psychiatric and reproductive disorders overall was observed. However, data for many disorder pairs were limited. The available literature focused overwhelmingly on affective disorders in polycystic ovary syndrome, overlooking a substantial portion of disease overlap. As such, the associations between the majority of mental health outcomes and conditions of the female reproductive system are largely unknown.
Topics: Female; Humans; Polycystic Ovary Syndrome; Mental Health; Comorbidity; Anxiety Disorders; Anxiety
PubMed: 37071426
DOI: 10.1001/jamanetworkopen.2023.8685 -
The Cochrane Database of Systematic... Aug 2016Chorioamnionitis is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims at reducing the adverse effects of chorioamnionitis by dilution of the... (Review)
Review
BACKGROUND
Chorioamnionitis is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims at reducing the adverse effects of chorioamnionitis by dilution of the infective organisms or by an anti-microbial effect of the fluid infused.
OBJECTIVES
The objective of this review was to determine the effect of amnioinfusion on clinical and sub-clinical chorioamnionitis, fetal well-being, fetal heart rate characteristics and perinatal and maternal morbidity and mortality.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2016), PubMed, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (6 July 2016) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised clinical trials (RCTs) of amnioinfusion (treatment group) versus no amnioinfusion in women with chorioamnionitis.We would have also considered trials comparing amnioinfusion with sham amnioinfusion; different types or volumes of amnioinfusion fluid but none were identified.Cluster-RCTs and quasi-RCTs were eligible for inclusion but none were identified. We identified one study published in abstract form but it did not contain any numerical data and has therefore been excluded. Studies using a cross-over design are not an appropriate study design and thus were not eligible for inclusion in this review.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed potential studies for inclusion and assessed trial quality. Both review authors independently extracted data and data were checked for accuracy.
MAIN RESULTS
We included one small trial (with data from 34 participants) comparing transcervical amnioinfusion with no amnioinfusion. The trial was considered to be at a high risk of bias overall, due to small numbers, inconsistency in the reporting and lack of information on blinding. Meta-analysis was not possible. Transcervical amnioinfusion was with room temperature saline at 10 mL per minute for 60 minutes, then 3 mL per minute until delivery versus no amnioinfusion. All women received intrauterine pressure catheter, acetaminophen and antibiotics (ampicillin or, if receiving Group B beta streptococcal prophylaxis, penicillin and gentamycin). We did not identify any trials that used transabdominal amnioinfusion.Compared to no amnioinfusion, transcervical amnioinfusion had no clear effect on the incidence of postpartum endometritis (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.29 to 7.87; absolute risk 176/1000 (95% CI 34 to 96) versus 118/1000;low-quality evidence). Nor was there a clear effect in the incidence of neonatal infection (RR 3.00, 95% CI 0.13 to 68.84; absolute risk 0/1000 (95% CI 0 to 0) versus 0/1000; low-quality evidence). The outcome of perinatal death or severe morbidity (such as neonatal encephalopathy, intraventricular haemorrhage, admission to intensive/high care) was not reported in the included trial.In terms of this review's secondary outcomes, the rate of caesarean section was the same in both groups (RR 1.00, 95% CI 0.35 to 2.83; absolute risk 294/1000 (95% CI 103 to 832) versus 294/1000; low-quality evidence). There was no clear difference in the duration of maternal antibiotic treatment between the amnioinfusion and no amnioinfusion control group (mean difference (MD) 16 hours, 95% CI -1.75 to 33.75); nor in the duration of hospitalisation (MD 3.00 hours, 95% CI -15.49 to 21.49). The study did not report any information about how many babies had a low Apgar score at five minutes after birth.Women in the amnioinfusion group had a lower temperature at delivery compared to women in the control group (MD -0.38°C, 95% CI -0.74 to -0.02) but this outcome was not pre-specified in the protocol for this review.The majority of this review's secondary outcomes were not reported in the included study.
AUTHORS' CONCLUSIONS
There is insufficient evidence to fully evaluate the effectiveness of using transcervical amnioinfusion for chorioamnionitis and to assess the safety of this intervention or women's satisfaction. We did not identify any trials that used transabdominal amnioinfusion. The evidence in this review can neither support nor refute the use of transcervical amnioinfusion outside of clinical trials. We included one small study that reported on a limited number of outcomes of interest in this review. The numbers included in this review are too small for meaningful assessment of substantive outcomes, where reported. For those outcomes we assessed using GRADE (postpartum endometritis, neonatal infection, and caesarean section), we downgraded the quality of the evidence to low - with downgrading decisions based on small numbers and a lack of information on blinding. The included study did not report on this review's other primary outcome (perinatal death or severe morbidity).The reduction in pyrexia, though not a pre-specified outcome of this review, may be of relevance in terms of benefits to the fetus of reduced exposure to heat. We postulate that the temperature reduction found may be a direct cooling effect of amnioinfusion with room temperature fluid, rather than reduction of infection. Larger trials are needed to confirm and extend the findings of the trial reviewed here. These should be randomised controlled trials; participants, women with chorioamnionitis; interventions, amnioinfusion; comparisons, no amnioinfusion; outcomes, maternal and perinatal outcomes including neurodevelopmental measures.Further research is justified to determine possible benefits or risks of amnioinfusion for chorioamnionitis, and to investigate possible benefits of reducing temperature in fetuses considered at risk of neurological damage. Research should include randomised trials to examine transcervical or transabdominal amnioinfusion compared with no infusion for chorioamnionitis and examine outcomes listed in the methods of this review.
Topics: Amniotic Fluid; Anti-Bacterial Agents; Cervix Uteri; Cesarean Section; Chorioamnionitis; Endometritis; Female; Humans; Infant, Newborn; Infections; Length of Stay; Perinatal Death; Pregnancy
PubMed: 27556818
DOI: 10.1002/14651858.CD011622.pub2 -
Revista Da Associacao Medica Brasileira... 2023
Meta-Analysis
Topics: Female; Humans; Endometritis; Reproduction; Chronic Disease
PubMed: 37851720
DOI: 10.1590/1806-9282.20230792 -
Journal of Women's Health (2002) Jan 2024Endometriosis is a common chronic disorder, which leads to dysmenorrhea, dyspareunia, pelvic chronic pain, and infertility. It affects ∼6% to 10% of the general... (Meta-Analysis)
Meta-Analysis
Endometriosis is a common chronic disorder, which leads to dysmenorrhea, dyspareunia, pelvic chronic pain, and infertility. It affects ∼6% to 10% of the general female population. However, the etiology of endometriosis remained unclear. We aimed to systematically assess the association between pelvic inflammatory disease (PID) and the risk of endometriosis. Eligible studies published until May 21, 2022, were retrieved from the PubMed, EMBASE, and Web of Science databases. The studies were included based on the following criteria: (1) original articles on the association between PID and risk of endometriosis; (2) randomized controlled trials and cross-sectional, case-control, and cohort studies; and (3) studies involving humans. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the studies included in this systematic review. The association between PID and risk of endometriosis was evaluated using the overall odds ratio (OR) and correlative 95% confidence interval (CI). The meta-analysis included 14 studies with 747,733 patients. The mean prevalence of PID in women with endometriosis was 33.80%. Our quantitative synthesis revealed that endometritis was associated with a significantly increased risk of endometriosis (OR: 1.63, 95% CI: 1.53-1.74, = 59%). We study a statistically significant association between PID and the risk of endometriosis. In particular, endometritis might play an important role in endometriosis, based on the lower heterogeneity of the subgroup analysis. This finding suggests that reducing the incidence of endometritis might aid in the prevention and treatment of endometriosis.
Topics: Female; Humans; Endometriosis; Pelvic Inflammatory Disease; Endometritis; Cross-Sectional Studies; Pelvic Pain
PubMed: 37851499
DOI: 10.1089/jwh.2023.0300 -
International Urogynecology Journal Aug 2015Pelvic organ prolapse (POP) in pregnancy is a rare condition with decreasing incidence and improved management and outcome world-wide recently. Systematic review of the... (Review)
Review
INTRODUCTION AND HYPOTHESIS
Pelvic organ prolapse (POP) in pregnancy is a rare condition with decreasing incidence and improved management and outcome world-wide recently. Systematic review of the literature for cases of POP in pregnancy published since 1990 was carried out to identify common factors in presentation, management and outcomes. One case from our own practice was added to the analysis.
METHODS
An extensive search of the Pubmed/Medline, Scopus and Google Scholar databases was performed to identify all cases of POP in pregnancy since 1990. Published case reports of POP in pregnancy were reviewed and summarized in tables to find similarities in history, course, management and outcome of the pregnancies.
RESULTS
Of the 43 cases and one case series, 41 case studies were eligible for analysis. Two types of POP in pregnancy were identified: preexisting is less common (14 vs 27 cases), often resolves during pregnancy (5 out of 14) and always recurs after delivery (14 out of 14); acute onset of POP in pregnancy rarely resolves in pregnancy (2 out of 27), but often resolves after delivery (18 out of 27). Most patients were managed with bed rest (20 out of 41), pessary (15 out of 41), manual reduction (6 out of 41) and local treatment (6 out of 41). The most common complications reported include preterm labour (14 out of 41), cervical ulcerations (9 out of 41), infection (3 out of 41) and obstructed labour (4 out of 41). About a half of the women delivered vaginally (22 out of 41), caesarean section due to prolapse was required in 15 cases.
CONCLUSIONS
Two distinct entities were identified based on similarities regarding onset, course and outcome of POP in pregnancy. Concise recommendations for practice were derived from the analysis of case studies published since 1990.
Topics: Bed Rest; Cesarean Section; Dystocia; Female; Humans; Obstetric Labor, Premature; Pelvic Organ Prolapse; Pessaries; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious
PubMed: 25600351
DOI: 10.1007/s00192-014-2595-3 -
Expert Review of Gastroenterology &... Oct 2022As an emerging minimally invasive technology, endoscopic ultrasound (EUS) has been reported to treat pelvic abscess instead of surgical or image-guided percutaneous... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
As an emerging minimally invasive technology, endoscopic ultrasound (EUS) has been reported to treat pelvic abscess instead of surgical or image-guided percutaneous drainage (PCD) under certain conditions. The aim of this study was to assess the efficacy and safety of EUS-guided drainage for patients with pelvic abscesses.
METHODS
We conducted a comprehensive literature search on PubMed, Embase, Cochrane Library, and Web of Science databases (inception-March 2022). The main outcomes were technical success, clinical success, and complications. Comprehensive meta-analysis software was used to calculate the pooled event rate.
RESULTS
Twelve studies containing 272 patients were included. These pelvic abscesses most frequently developed after abdominal and pelvic surgery (n = 180, 66.2%), inflammatory bowel disease (n = 32, 11.8%), and other inflammatory conditions. Respectively, the pooled technical and clinical success rate was 100% and 88.7% [95% confidence interval (CI): 83.8-92.2%, I = 1.0%, p < 0.001]. After excluding an individual study, the pooled rate of complications changed from 11.5% (95% CI: 7.4-17.4%, I = 38.8%, p < 0.001) to 8.2% (95% CI: 5.0-13.3%, I = 0, p < 0.001).
CONCLUSIONS
EUS-guided drainage of the pelvic abscess was feasible, effective, and safe. Further randomized-controlled studies with large-sample sizes were required in the future.
Topics: Humans; Abscess; Treatment Outcome; Endosonography; Drainage; Abdominal Abscess; Ultrasonography, Interventional
PubMed: 36170047
DOI: 10.1080/17474124.2022.2130247 -
International Urogynecology Journal Jan 2022Sacrocolpopexy and sacrospinous ligament fixation (SSLF) have been used for the restoration of apical support. Studies comparing sacrocolpopexy and SSLF have reported... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION AND HYPOTHESIS
Sacrocolpopexy and sacrospinous ligament fixation (SSLF) have been used for the restoration of apical support. Studies comparing sacrocolpopexy and SSLF have reported conflicting results. We aim to assess the current evidence regarding efficiency and the complications of sacrocolpopexy compared with SSLF.
METHODS
We searched PubMed, Embase, and Cochrane Library and performed a systematic review meta-analysis to assess the two surgical approaches.
RESULTS
5Five randomized controlled trials, 8 retrospective studies, and 2 prospective studies including 4,120 cases were identified. Compared with abdominal sacrocolpopexy (ASC), SSLF was associated with a lower success rate (88.32% and 91.45%; OR 0.52; 95% CI 0.29-0.95; p = 0.03), higher recurrence (11.58% and 8.32%; OR 1.97; 95% CI 1.04-3.46; p = 0.04), and dyspareunia rate (14.36% and 4.67%; OR 3.10; 95% CI 1.28-7.50; p = 0.01). Patients in this group may benefit from shorter operative time (weighted mean difference -25.08 min; 95% CI -42.29 to -7.88; p = 0.004), lower hemorrhage rate (0.85% and 2.58%; OR 0.45; 95% CI 0.25-0.85; p = 0.009), wound infection rate (3.30% and 5.76%; OR 0.55; 95% CI 0.39-0.77; p = 0.0005), and fewer gastrointestinal complications (1.33% and 6.19%; OR 0.33; 95% CI 0.15-0.76; p = 0.009).
CONCLUSION
Both sacrocolpopexy and SSLF offer an efficient alternative to the restoration of apical support. When anatomical durability and sexual function is a priority, ASC may be the preferred option. When considering factors of mesh erosion, operative time, gastrointestinal complications, hemorrhage, and wound infections, SSLF may be the better option.
Topics: Female; Gynecologic Surgical Procedures; Humans; Ligaments; Pelvic Organ Prolapse; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 34081163
DOI: 10.1007/s00192-021-04823-w