Reproductive outcomes after fertility-sparing interventions for symptomatic adenomyosis: a systematic review and meta-analysis
Notice bibliographique
Résumé
OBJECTIVE: To systematically review studies on reproductive outcomes following fertility-sparing interventions. METHODS: Various electronic databases were searched and studies reporting reproductive outcomes following fertility-sparing interventions for adenomyosis from January 2000 to July 2023 were included. The outcomes were presented as frequency with percentages, and the pooled proportions were calculated with a 95% confidence interval (CI). Subgroup and sensitivity analyses were performed if significant heterogeneity was present. The risk of bias was evaluated using the Newcastle Ottawa Scale quality assessment tool. RESULTS: A total of 32 articles comprising 2501 participants were included (no RCTs were identified and included). The pooled pregnancy rates were 50.1% (95% CI: 40.0-60.2%) and 52.0% (32.4-71.6%) after adenomyomectomy and image-guided thermal ablation, respectively. The delivery rates were 39.5% (29.9-49.2%) and 32.5% (26.0-38.9%) for adenomyomectomy and thermal ablation, respectively. The pregnancy loss rates were 19.8% (12.2-27.5%) and 39.5% (13.8-65.1%) for adenomyectomy and thermal ablation, respectively. The spontaneous miscarriage rates were 16.3% (9.7-22.9%) and 27.1% (8.1-46.1%) after adenomyomectomy and thermal ablation, respectively. The rates of adverse pregnancy outcomes were 21.4% (7.5-35.3%) and 1.0% (-1.6-3.7%) after adenomyomectomy and thermal ablation, respectively. The preterm delivery rates were 18.4% (2.9-33.9%) and 0.3% (-1.0-1.7%) for adenomyomectomy and thermal ablation, respectively. The IVF-ET conception rates were 40.5% (28.8-52.1%) after adenomyomectomy and 27.5% (-17.3-72.2%) after thermal ablation. The cesarean section rates were 99.6% (98.3-100.8%) and 44.6% (13.4-75.9%) after adenomyomectomy and thermal ablation, respectively. However, as only one article reporting the reproductive outcomes after UAE met the inclusion criteria, meta-analysis could not be performed for UAE. CONCLUSION: The reproductive outcomes following fertility-sparing interventions are promising for women with adenomyosis who desire fertility. However, limited available evidence, potential selection bias, and heterogeneity among the included articles are confounding factors that might influence the assessment of outcomes. REGISTRATION: This systematic review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (under identifier CRD42020199586) in August 2020.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,040 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,020 | 0,031 |
| Bibliométrie | 0,009 | 0,007 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».