Introduction Deep infiltrating endometriosis (DIE) is associated with substantial impairment in health-related quality of life (HRQoL), affecting pain, emotional well-being, sexual functioning, and daily activities. Previous studies have shown that laparoscopic surgical excision may improve HRQoL in women with symptomatic DIE. However, evidence simultaneously assessing disease-specific and generic HRQoL using minimal clinically important differences (MCID) -based interpretation in Latin American women with DIE remains limited. We therefore aimed to evaluate changes in HRQoL at 6 and 12 months after laparoscopic excision of DIE in two high-volume Latin American referral centers, using the Endometriosis Health Profile-30 (EHP-30), including its sexual intercourse module, and the EuroQol-5D (EQ-5D), applying their MCID thresholds. Materials and Methods This prospective cohort study was conducted at two academic referral centers in Colombia and Argentina between 2021 and 2023. Women with imaging-confirmed deep infiltrating endometriosis undergoing laparoscopic excision after failed medical therapy, or as first-line treatment due to organ involvement, were included. HRQoL was assessed preoperatively and at 6 and 12 months postoperatively using the validated EHP-30, including its sexual intercourse module, and EQ-5D questionnaires. Surgical findings were classified using the Enzian classification system, complications according to Clavien–Dindo, and HRQoL changes were interpreted using established MCID thresholds. Results Of 159 eligible patients, 120 completed baseline and at least one postoperative assessment. Mean age was 36.7 years, and 47.5% had previous endometriosis surgery. At 6 months, all EHP-30 domains improved significantly (p <.001), with the greatest median reductions in pain (−29.54; 95% CI, −36.36 to −27.27), control and powerlessness (−29.17; 95% CI, −41.66 to −20.83), and sexual functioning (−20.00; 95% CI, −30 to −10). Improvements were sustained at 12 months, with changes meeting or exceeding the published MCID thresholds in all domains, except control and powerlessness, which fell just short of one of the two available thresholds. The EQ-5D index improved at 6 months (+0.28; 95% CI, 0.21–0.42) and 12 months (+0.35; 95% CI, 0.18–0.42; both p <.001), exceeding the proposed MCID at both timepoints. Major postoperative complications (Clavien–Dindo grade ≥ III) occurred in 8.3% of patients. Conclusion This Latin American cohort showed sustained, clinically meaningful improvements in multiple HRQoL domains, including sexual functioning, after laparoscopic excision of DIE. Interpreting changes from validated disease-specific and generic instruments against MCID thresholds supports the role of surgical excision in symptomatic DIE refractory to medical therapy.
Objective To evaluate the clinical efficacy and safety of a novel hysteroscopic myomectomy technique, RoBEEM (Roller ball Enucleation followed by Excision Method), developed to expand the indications of transcervical resection of myomas (TCR). Design Retrospective consecutive case series. Setting Uterine Myoma Endoscopic Surgery Center, Sano Hospital, Hyogo, Japan. Participants A total of 631 TCR procedures were performed in 613 patients between January 2016 and December 2024 for submucosal myomas ≥ 4cm in diameter or with a resected weight ≥ 35g. Interventions RoBEEM integrates myoma pseudocapsule dissection with a roller ball electrode and centripetal cutting with a loop electrode. Supporting techniques include SSCI (Single-Sheath Continuous Irrigation), thumbing, and sequential slice removal. Main Outcome Measures Complete resection rate, resection efficiency (g/min), intraoperative complications, and postoperative outcomes. Results One-stage complete resection was achieved in 576 of 631 procedures (91.2%). The median myoma diameter was 5.2cm; resection efficiency was 1.1g/min and significantly higher for large myomas. Among 53 FIGO type 3 cases, 47 achieved one-stage complete resection (88.7%). No perforations occurred during dissection with the roller ball. Fifteen patients reported pregnancy, of whom eight delivered. Conclusion RoBEEM achieved a high rate of single-session complete resection for large or complex submucosal myomas. These findings indicate that RoBEEM can broaden the practical applicability of hysteroscopic myomectomy, allowing appropriately selected patients who would otherwise undergo more invasive surgery to be managed hysteroscopically.
Background:Placental insufficiency remains a leading cause of adverse perinatal outcomes. The cerebroplacental ratio (CPR) has emerged as a hemodynamic marker reflecting fetal adaptive responses to hypoxia. Its predictive value in term pregnancies requiring obstetric intervention to achieve delivery (labor induction or augmentation) requires further characterization. Objectives:Building on this background, our goal was to evaluate the association between middle cerebral artery (MCA) Doppler parameters and CPR with maternal and neonatal outcomes in term pregnant women undergoing labor induction or augmentation. Methods:This cross-sectional study enrolled 314 singleton term pregnancies (≥37 weeks) admitted for labor induction or augmentation at Kosar Hospital, Urmia, Iran (April 2022-January 2023). Participants underwent pre-induction Doppler ultrasonography.We assessed MCA pulsatility index (PI), umbilical artery (UA) PI, and CPR (MCA-PI/UA-PI). Primary outcomes included mode of delivery, 5-minute Apgar score, umbilical cord arterial pH, and neonatal intensive care unit (NICU) admission. We employed Chi-square tests, multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis. Results:Mean maternal age was 30.01 ± 7.42 years with gestational age of 39.29 ± 1.02 weeks. Cesarean delivery occurred in 116 cases (36.9%). Abnormal CPR (<1.08) was identified in 51 participants (16.2%). Abnormal CPR was significantly associated with higher cesarean rates (72.5% vs. 30.0%; adjusted odds ratio [OR]=6.12, 95% confidence interval [CI]: 3.18-11.78), increased NICU admission (9.8% vs. 1.1%; P = 0.001), and reduced cord arterial pH (7.17 ± 0.06 vs. 7.20 ± 0.05; P = 0.007). However, sensitivity analysis restricted to objective cesarean indications (failure to progress and failed induction) showed attenuation of this association (OR=4.56; 95% CI: 2.34-8.89), suggesting the primary cesarean association may be partially influenced by clinician knowledge of CPR status. CPR demonstrated moderate discriminative ability compared to individual Doppler indices (area under the curve for cesarean delivery: 0.71; 95% CI: 0.64-0.78). Conclusions:Low CPR in term pregnancies undergoing labor induction or augmentation shows a significant association with adverse perinatal outcomes. However, the association with cesarean delivery should be interpreted cautiously given the lack of clinician blinding, which may have substantially inflated this relationship. CPR demonstrates moderate discriminative ability for objective neonatal outcomes (cord pH, NICU admission), which are less susceptible to observer bias. The moderate area under the curve (0.71-0.78) and low sensitivity (32-63%) indicate that CPR has limited value as a standalone screening test, and many fetuses destined for adverse outcomes will have normal CPR values. CPR should not be used to guide clinical decision-making in isolation. Well-designed prospective trials with clinician blinding are essential to establish whether CPR-guided management improves perinatal outcomes and to quantify the true predictive value of this marker independent of observer bias.
Objective:To report on a series of 12 cases of fetal pleural effusion (FPE), focusing on the relationship between intra-thoracic pressure (ITP) and intra-amniotic pressure (IAP) and its impact on the efficacy of thoraco-amniotic shunting (TAS). Methods:This single-center case series study included patients with FPE undergoing TAS or amnioreduction (AR). ITP and IAP were measured before and after the initial thoracocentesis and AR. Results:TAS was performed 21 times, and AR was performed 7 times. The median gestational age at thoracocentesis was 28 weeks and 2 days (18 wk 1 d-33 wk 2 d). The median FPE volume normalized to the estimated fetal weight was 30 (15 -81) mL/kg. The median pre-thoracocentesis ITP was 15 (12 -28) mmHg, and the post-thoracocentesis ITP was 10 (5 -19) mmHg. In four patients with hydrops, TAS alone did not improve hydrops. However, hydrops improved after AR in three of these patients. In these cases, the IAP decreased following AR. The post-AR IAP was higher than the post-thoracocentesis ITP in the patients whose hydrops did not improve, whereas the post-AR IAP was lower than or equal to the post-thoracocentesis ITP in the patients whose hydrops improved. Conclusion:FPE reduction and hydrops improvement after TAS may require the IAP to be lower than the ITP.
Background Early-onset preeclampsia (EOPE) is a severe pregnancy complication associated with significant maternal and neonatal morbidity. Although the imbalance of angiogenic factors is known to play a critical role in its pathogenesis, traditional single-marker assays often lack the precision required for individualized risk stratification. This study aimed to develop a precision risk stratification framework for EOPE by integrating angiogenic pathway-related proteomics with clinical features using an ensemble learning approach. Methods A prospective case-control study was conducted involving 240 pregnant women (120 EOPE and 120 healthy controls). Plasma concentrations of 15 angiogenic pathway proteins were quantified. A robust feature selection strategy combining LASSO regression and the Boruta algorithm identified five key biomarkers: sFlt-1, PlGF, Endoglin, VEGF-A, and P-selectin. An ensemble learning model was constructed using a Stacking strategy (incorporating Random Forest, XGBoost, and LightGBM) to integrate these proteomic markers with clinical metadata (BMI and Mean Arterial Pressure). Model interpretability was addressed using SHAP (SHapley Additive exPlanations) analysis. Results The ensemble model demonstrated superior predictive performance, achieving an Area Under the Curve (AUC) of 0.95 (95% CI: 0.92–0.98) in the validation cohort, significantly outperforming the traditional sFlt-1/PlGF ratio (AUC = 0.82). SHAP analysis identified the sFlt-1/PlGF ratio and Endoglin as the top contributors, revealing complex non-linear interactions between circulating biomarkers and maternal hemodynamics. Based on the model scores, participants were successfully stratified into high, moderate, and low-risk tiers. The high-risk group exhibited a 4.2-fold increase in the incidence of adverse maternal and fetal outcomes compared to the low-risk group. Conclusion The integration of angiogenic proteomics and clinical features via ensemble learning provides a high-performance and interpretable tool for the precision risk stratification of EOPE. This multi-dimensional approach facilitates early identification of high-risk individuals, potentially enabling more targeted clinical interventions and improved obstetric outcomes.
