Am J Obstet Gynecol
· 2026 Jun · PMID 41621521
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BACKGROUND AND OBJECTIVE: To describe gynecologic resident practice patterns and learning curves at a single academic institution as they prepare for the Essentials in Minimally Invasive Gynecologic Surgery manual skills...BACKGROUND AND OBJECTIVE: To describe gynecologic resident practice patterns and learning curves at a single academic institution as they prepare for the Essentials in Minimally Invasive Gynecologic Surgery manual skills exam and compare their performance metrics during practice to those of third-year residents and surgeons trained in minimally invasive gynecologic surgery. This information could provide guidance on implementing a structured Essentials in Minimally Invasive Gynecologic Surgery preparation curriculum. STUDY DESIGN: This is a prospective observational study of gynecologic resident physicians from April 2023 to March 2025 at a single institution. Residents and their coach recorded details of their Essentials in Minimally Invasive Gynecologic Surgery practice sessions, including time-to-completion, the number of sessions, and accuracy metrics for each task repetition. Time-to-completion of skills was compared to the number of repetitions to create composite learning curves. RESULTS: The median number of repetitions for each task ranged from 5 to 12. The median number of hours spent practicing was 10. Learning curves showed the greatest rate of improvement in the first 3 to 5 repetitions. First-year residents had steeper initial learning curves than more senior residents. All residents passed the Essentials in Minimally Invasive Gynecologic Surgery manual skills exam. CONCLUSION: This training program improved performance metrics for gynecologic residents preparing for the Essentials in Minimally Invasive Gynecologic Surgery manual skills exam. Residents needed relatively short periods of practice to achieve desired scores. Based on our findings, training programs are feasible and effective and should be initiated early in training before debut in the operating room to maximize the learning opportunities that surgical education via simulation offers.
Hu S, Wang X, Xu H
… +11 more, Xiong J, Gu Y, Cao X, Zhou L, Fan Y, Wang S, Bai X, Shi H, Zhu Q, Chen L, Shi Z
Am J Obstet Gynecol
· 2026 Jun · PMID 41617120
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BACKGROUND: Induction of labor is a commonly used obstetric method for terminating pregnancy in cases of delayed or expired pregnancy or complications, with cervical maturity being a key determinant of success. Balloon-i...BACKGROUND: Induction of labor is a commonly used obstetric method for terminating pregnancy in cases of delayed or expired pregnancy or complications, with cervical maturity being a key determinant of success. Balloon-induced labor is a safe, effective, and cost-effective induction of labor method. While clinical factors such as parity, cervical Bishop score, prepregnancy body mass index, are known to influence outcomes. Emerging evidence suggests that vaginal microbiota may also play a critical role through activation of local complement mediators and inflammatory signalling that accelerates cervical ripening. Additionally, genetic factors may influence both preterm birth risk and vaginal microbiota composition. However, the specific impact of vaginal microbiota and genetic factors on balloon-induced labor outcomes remains unclear and requires further investigation. OBJECT: To explore the impact of the vaginal microbiota prior to delivery on the maternal and fetal outcomes of planned induced labor through metagenomic sequencing and genome-wide association studies. STUDY DESIGN: A multicenter prospective cohort study was conducted from October 2022 to June 2024 across 5 hospitals, enrolling 635 pregnant women undergoing planned sequential induction of labor using cervical balloons combined with oxytocin. The clinical data throughout the entire pregnancy and labor period, as well as samples of vaginal and cervical secretions before the induction of labor, were collected. Firstly, the characteristics of the vaginal microbiota in all pregnant women were analyzed through metagenomic sequencing, and then the impact of vaginal microbiota differences on the maternal and fetal outcomes of planned induced labor was studied. Subsequently, a nested case-control study was performed, based on human whole genome sequencing combined with genome-wide association studies analysis on vaginal secretion samples, to investigate the role of genetic factors in planned induced labor. Finally, vaginal microbiota transplantation in pregnant rats was conducted to verify the effects of vaginal microbiota on the maternal and fetal outcomes of labor. RESULTS: Among the participants, 167 delivered within 24 hours, 318 delivered within 24-72 hours, 50 failed induction, and 100 underwent cesarean section for miscellaneous indications. Vaginal microbiota analysis in parturients revealed that the probability of delivery within 24 hours is negatively correlated with Lactobacillus iners (L. iners) abundance, while failed induction is negatively correlated with Ralstonia mannitolilytica abundance. Cesarean section probability is positively correlated with Lactobacillus crispatus (P=0.03). Additionally, the time from balloon placement to delivery is positively correlated with L. iners (P=0.002) and negatively correlated with Lactobacillus crispatus (P=0.08, not fully significant). Genome-wide association studies analysis shows that single-nucleotide polymorphisms associated with adverse pregnancy outcomes are mainly concentrated on chromosomes 1, 4, 8, and 10. Vaginal microbiota transplantation experiments showed that pregnant rats transplanted with vaginal bacteria from women who delivered within 24 hours had the shortest delivery time, while those transplanted with vaginal bacteria from women who failed to induced labor had the longest delivery time and some experienced dystocia. CONCLUSION: This study reveals that, in addition to genetic factors, the outcomes of planned labor induction, especially the total duration of labor and the success rate of induction, are closely related to the vaginal microbiota in women during the late stages of pregnancy. The study provides new evidence to explain the different outcomes of labor induction.
Gurney JM, Tuominen A, Saavalainen J
… +4 more, Gissler M, Niinimäki M, Heikinheimo O, Saavalainen L
Am J Obstet Gynecol
· 2026 Jun · PMID 41581635
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BACKGROUND: Understanding of the impact of endometriosis on adverse early pregnancy outcomes has evolved in recent decades and has been partly attributed to endocrine dysfunction and chronic inflammation. However, data f...BACKGROUND: Understanding of the impact of endometriosis on adverse early pregnancy outcomes has evolved in recent decades and has been partly attributed to endocrine dysfunction and chronic inflammation. However, data from population-based cohort studies which include all pregnancy outcomes, with long-term follow-up, are lacking. OBJECTIVE: This longitudinal cohort study aimed to investigate the association between endometriosis and early pregnancy outcomes including miscarriage, ectopic pregnancy, induced abortion, and molar pregnancy. STUDY DESIGN: We conducted a retrospective registry study including all 10,105 people in Finland born after 1972 with a first surgical diagnosis of endometriosis between 1998 and 2012 in the Finnish Care Register for Health Care. We also included 19,526 age- and residence-matched individuals. We collected all registered pregnancies of the study cohorts-both prior to and following surgical diagnosis of endometriosis-from Finnish registries from age 15 until the occurrence of sterilization, bilateral oophorectomy, sequential unilateral oophorectomies, hysterectomy, death, emigration, or the end of the study period, whichever occurred first. We calculated the cumulative incidence and incidence rate of pregnancy. For the specific pregnancy outcomes, we calculated their proportions, risk per 100 pregnancies, and risk ratios adjusting for age, gravidity, and education level. In the endometriosis cohort, there were 256,906 person-years of follow-up, and in the reference cohort, 503,286 person-years. RESULTS: We identified 19,141 pregnancies in 7731 (76.5%) ever-pregnant participants with endometriosis and 43,478 pregnancies in 15,421 (79.0%) ever-pregnant reference participants during a median follow-up time of 26.4 years (interquartile range, 22.5-29.6). The mean number of registry-identified pregnancies per person in the endometriosis cohort was 1.89 (standard deviation, 1.64), compared to 2.23 (1.92) in the reference cohort (P<.001). Of the pregnancies with known outcomes-that is, excluding pregnancies which were ongoing at the end of the study period-72.0% vs75.7% were births (P<.001), 15.6% vs10.4% were miscarriages (P<.001), 3.5% vs1.5% were ectopic pregnancies (P<.001), 8.8% vs12.3% were induced abortions (P<.001), and 0.1% vs0.1% were molar pregnancies (P=.99) in the endometriosis and in the reference cohorts, respectively. Individuals with endometriosis had lower pregnancy rates compared to the reference cohort, with an incidence rate ratio of 0.87 (95% confidence interval, 0.86-0.89) when adjusted for education level and birth year. Conversely, they experienced significantly higher age-adjusted risks of miscarriage (adjusted risk ratio 1.51; 1.43-1.60) and ectopic pregnancy (2.45; 2.21-2.71). The risk of induced abortion was lower in those with endometriosis (0.69; 0.65-0.74), and there was no significant difference in the risk of molar pregnancy (1.03; 0.60-1.56). CONCLUSION: Individuals with surgically verified endometriosis had a lower lifetime incidence of pregnancy compared to those without endometriosis. Among pregnancies in those with endometriosis, there were fewer births and induced abortions, but a higher risk of early pregnancy loss due to increased proportions of miscarriage and ectopic pregnancy.
Maternal mortality is an important public health concern that has gained increasing attention since the late 20th and early 21st centuries. Though low- and middle-resource countries are impacted most disparately by mater...Maternal mortality is an important public health concern that has gained increasing attention since the late 20th and early 21st centuries. Though low- and middle-resource countries are impacted most disparately by maternal mortality burden, the United States holds the highest maternal mortality ratio among similarly high-resource countries. As global health initiatives decreased the worldwide maternal mortality ratio, the United States experienced an increase in maternal mortality ratio in the same timeframe. Though the cause of this increase is multifactorial, a likely contributor may be limited access to family planning in the United States, which has one of the highest rates of unintended pregnancy among similar-resource countries. This review assesses medical literature to characterize the association between family planning and maternal mortality, as well as summarize common etiologies identified among studies to explain this relationship. We additionally found that, while access to family planning programs is associated with a decrease in maternal mortality, few studies completed in the United States unique health and political environment provide clear empirical evidence of maternal mortality burden reduction associated with family planning. A deeper understanding of the impact of family planning in the United States will be of interest to stakeholders and policymakers in the effort to decrease adverse maternal health outcomes.
Ilves S, Jokinen V, Katainen R
… +7 more, Siili E, Bützow R, Heikinheimo O, Pasanen A, Karhu A, Välimäki N, Aaltonen LA
Am J Obstet Gynecol
· 2026 May · PMID 41548634
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BACKGROUND: Chromosomal aberrations in tumors are key indicators of genomic instability and important drivers of neoplasia. While chromosomal changes in uterine leiomyomas have been studied for decades, comprehensive eva...BACKGROUND: Chromosomal aberrations in tumors are key indicators of genomic instability and important drivers of neoplasia. While chromosomal changes in uterine leiomyomas have been studied for decades, comprehensive evaluation of chromosomal aberrations in uterine leiomyomas on the scale of modern tumor research has been lacking. OBJECTIVE: To comprehensively characterize somatic chromosomal aberrations in uterine leiomyoma, providing a missing layer of stratified data for research toward detailed understanding of the genesis of this important tumor type. STUDY DESIGN: In this retrospective study, we analyzed 1963 uterine leiomyomas from 629 patients using single-nucleotide polymorphism array data. Our goal was to identify subtype-specific chromosomal rearrangement patterns across 9 known uterine leiomyoma subtypes named after the respective driver gene: MED12, HMGA2, HMGA1, FH, YEATS4, oSRCAP, COL4A5/6, PLAG1, and NEDDYLATION, as well as tumors lacking known driver mutations. We identified recurrently deleted and gained chromosomal regions from single-nucleotide polymorphism array data and integrated these findings with gene expression and long-read sequencing data. Complex chromosomal rearrangements resembling chromothripsis were assessed through breakpoint analysis. Our findings were also scrutinized with respect to clinical background information and inherited uterine leiomyoma risk. RESULTS: Approximately 39% (or 50% among tumors selected as one per patient) of uterine leiomyomas harbored chromosomal aberrations. Uterine leiomyoma subtypes displayed unique chromosomal features: fumaratedehydratase-driven and mediator complex subunit12-driven tumors were largely chromosomally stable, FH tumors harboring almost exclusively only focal 1q deletions and MED12 tumors being enriched for 7q22 deletions. Meanwhile, HMGA2, HMGA1, PLAG1, and COL4A5/6 subtypes frequently displayed extensive chromosomal aberrations. Complex chromosomal rearrangements were particularly frequent in HMGA1 and PLAG1 tumors and were typically encountered on chromosomes with known uterine leiomyoma driver genes. YEATS4 tumors harbored deletions of chromosome 16. UNKNOWN tumors were heterogeneous as expected, some exhibiting multiple large deletions in 1p, 14q, and 15q or 1p, 14q, and 22q. Chromosomal gains were rare and enriched to chromosome 1. Differential expression analysis revealed known recurrent alterations in uterine leiomyomas as well as new loci for future scrutiny, such as CDKN2C in HMGA2 tumors. Clinical characteristics were examined, notably linking chromosomal aberrations and complex chromosomal rearrangements to larger tumors and younger age at hysterectomy in select subtypes. Examined overall, somatic aberrations at germline predisposition loci preferred a loss of the protective allele. CONCLUSION: This study revealed uterine leiomyoma subtypes to have distinct chromosomal aberration landscapes. Our large sample collection, detailed subclassification, and extensive expression data integration enabled the identification of rare aberrations and subtype-specificity not previously feasible. Further research is implicated in studying the recurrently aberrant regions to identify the specific targets. This study shows, once again, the benefits for accurate subtype information in leiomyoma research and provides a new framework for further studies, toward comprehensive knowledge on the tumorigenesis and potential subtype-specific diagnostic and therapeutic strategies.