Archives Of Gynecology And Obstetrics[JOURNAL]
Sun
200 papers
Phototoxicity of brightfield live-cell imaging on murine ovarian follicles.
Stadter M, Dittrich R, Häberle L … +6 more , Lotz L, Brey S, Bleisinger N, Schmid B, Beckmann MW, Dietl AK
Arch Gynecol Obstet · 2026 Jul · PMID 42393487 · Full text
PURPOSE: Within the female reproductive tract, fertilization and embryo development occur in the complete absence of light. Light exposure during the in vitro manipulation of ovarian follicles negatively affects follicle...
PURPOSE: Within the female reproductive tract, fertilization and embryo development occur in the complete absence of light. Light exposure during the in vitro manipulation of ovarian follicles negatively affects follicle viability. Laboratory conditions involve exposure to varying wavelengths, intensities, and light sources. METHODS: In our study, we observed the effect of recurring light exposure on murine ovarian follicle viability subsequently assessed by evaluating increase in diameter, changes in morphology, and results from the LIVE/DEAD assay. A time-lapse approach allowed for effective observation of follicle interactions and viability, with no relevant movement or loss of focus throughout the imaging period. RESULTS: However, follicles exposed to light showed a significant increase in granulosa cell death, as indicated by the LIVE/DEAD assay. No significant difference was observed in regard to morphology. CONCLUSION: Brightfield time-lapse provides a valuable tool for identifying early predictive signs and key milestones in follicle development, which may enhance in vitro follicle culture techniques and improve patient treatment outcomes, but simultaneously carries a risk of phototoxicity that must be considered when applying this method.
First-trimester lipoprotein(a) and longitudinal renal biomarker trajectories preceding preeclampsia: a pilot cohort study.
Lozoya-Angulo ME, Cañizares-Hernández FG, Requena-López S … +3 more , Noguera-Velasco JA, Sánchez-Romero J, de Paco-Matallana C
Arch Gynecol Obstet · 2026 Jul · PMID 42390652 · Publisher ↗
PURPOSE: To evaluate whether early vascular susceptibility, reflected by first-trimester lipoprotein(a), together with longitudinal renal biomarker trajectories across pregnancy, is associated with the subsequent develop...
PURPOSE: To evaluate whether early vascular susceptibility, reflected by first-trimester lipoprotein(a), together with longitudinal renal biomarker trajectories across pregnancy, is associated with the subsequent development of preeclampsia. METHODS: Retrospective analysis of prospectively collected data from a high-risk pregnancy cohort. Maternal serum inflammatory (interleukin-6, C-reactive protein), lipid (lipoprotein(a), triglycerides, total cholesterol), and renal (uric acid, cystatin C) biomarkers were measured at 11-13, 19-22, and 32 weeks of gestation. Longitudinal changes were assessed using population-averaged models including trimester, preeclampsia status, and their interaction, adjusted for maternal age and body mass index. First-trimester lipoprotein(a) was evaluated using adjusted logistic regression. RESULTS: Among 119 women, 20 developed preeclampsia. First-trimester lipoprotein(a) concentrations were higher in women who later developed preeclampsia and were independently associated with increased risk (OR 2.38; p < 0.001). Longitudinal analyses showed significant trimester-by-preeclampsia interactions for uric acid and cystatin C (both p = 0.03), indicating progressive divergence across pregnancy. Inflammatory biomarkers showed early between-group differences without significant longitudinal divergence. CONCLUSIONS: Our findings suggest that preeclampsia may be associated with both early maternal vascular susceptibility and progressive alterations in renal biomarkers during pregnancy. Elevated first-trimester lipoprotein(a) may reflect an underlying vascular phenotype, while divergent renal biomarker trajectories highlight the dynamic evolution of the disease before clinical onset, although these findings require validation in larger prospective studies.
Correction: Intraoperative hemodynamics and anesthetic implications in superobese parturients undergoing cesarean delivery: a retrospective cohort analysis.
Kaushik T, Hackney A, Bryant A … +4 more , Baker E, Abongwa S, Wagener BM, Frölich MA
Arch Gynecol Obstet · 2026 Jul · PMID 42390615 · Full text
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Ophthalmic artery Doppler: reference values in low-risk pregnant women.
Campana-Rüegg L, Hofmann M, Wawrla-Zepf J … +4 more , von Mering R, Gonser M, Ochsenbein-Kölble N, Vonzun L
Arch Gynecol Obstet · 2026 Jul · PMID 42384303 · Publisher ↗
INTRODUCTION: Ophthalmic artery (OA) Doppler has been described as an independent parameter in predicting preeclampsia (PE). Considering that vasoconstriction occurs in the pathogenesis of PE and causes increased pulse w...
INTRODUCTION: Ophthalmic artery (OA) Doppler has been described as an independent parameter in predicting preeclampsia (PE). Considering that vasoconstriction occurs in the pathogenesis of PE and causes increased pulse wave reflection, it is not surprising that OA waveform changes appear in PE. It was found that of these waveform changes, the 2nd systolic peak (P2) and the peak ratio [PR = P2/P1 (P1 = 1st systolic peak)] showed the best performance in prediction and complementary diagnosis of PE. The aim of this study was to determine reference values for OA-Doppler indices in the 1st, 2nd, and 3rd trimesters and at term in low-risk pregnant women of a mixed European population. MATERIALS/METHODS: This is a prospective single-center cohort study conducted from 2020 to 2024. Only healthy pregnant women who gave informed consent were included. Women at high risk for PE or who developed PE were excluded. OA Doppler was performed according to a strict protocol at 4 distinct gestational-week (GW) intervals: 11-14 GW, 20-24 GW, 30-34 GW, and at term. The following systolic waveform parameters were focused on: P1, P2, and PR. Reference values were generated for these waveform parameters for these study intervals in the 1st, 2nd, and 3rd trimesters and at term. RESULTS: A total of 255 women were included in this study. Of these, 62% were Caucasian, 7% Asian, 8% Afro-Caribbean, and 33% mixed or of unknown ethnicity. In this population, the PR averaged over the study intervals was 0.56, with no significant differences between the 4 study intervals or between the right and left eyes. CONCLUSION: This study presents systolic OA-Doppler reference values in low-risk pregnant women of an ethnically diverse European tertiary-care obstetric population. OA-Doppler reference values are stable throughout the four selected time points in pregnancy. These findings may pave the way for further investigations on OA-Doppler values as a predictive and diagnostic tool for PE.
Diagnostic and treatment delay in women with cancer in pregnancy: a case-based study.
Liang LS, Greiber IK, Karlsen MA … +7 more , Pedersen BW, Nielsen BB, Have MK, Helmig RB, Schmidt MC, Strandbygaard J, Storgaard L
Arch Gynecol Obstet · 2026 Jul · PMID 42384080 · Publisher ↗
PURPOSE: More advanced stages at diagnosis and lower survival rates are seen in women diagnosed with cancer during pregnancy compared to non-pregnant women with similar cancers. This study aims to investigate diagnostic...
PURPOSE: More advanced stages at diagnosis and lower survival rates are seen in women diagnosed with cancer during pregnancy compared to non-pregnant women with similar cancers. This study aims to investigate diagnostic and treatment delays, cancer stage, and survival in Danish pregnant cancer patients. METHODS: Patients from the Danish cancer in pregnancy database were included. Cancer diagnosis, treatment, and obstetrical data were collected from the database. Time to treatment was compared to national cancer patient pathways. Cancer stages at diagnosis were compared to epidemiological studies identified through a systematic literature search. Survival was compared to data from NORDCAN, a Nordic cancer statistics database. RESULTS: The study included 74 patients diagnosed with cancer in pregnancy. The median total delay was 43.5 days (IQR 27.75-94.75) with a patient delay of three days (IQR 0-31), a diagnostic delay of 15 days (IQR 8-35), and a treatment delay of 9.5 days (IQR 0-19). Time from cancer suspicion to start of treatment fell within recommended national cancer patient pathway intervals in 80.0% of cases. Breast cancer and melanoma in pregnancy tended to have more advanced stages at diagnosis compared to non-pregnant patients. The 1- and 5-year mortality rates were 5.4% and 17.6%, respectively. CONCLUSION: Our findings suggest that pregnant cancer patients presented with advanced stages at diagnosis and lower survival rates compared to non-pregnant patients with similar cancers. Our results indicate that the main contributor to the delay in cancer in pregnancy in Denmark is delayed suspicion of cancer.
One-year outcome after laser treatment of vulvar lichen sclerosus: a prospective observational trial.
Gamper M, Zivanovic I, Bischofberger H … +1 more , Viereck V
Arch Gynecol Obstet · 2026 Jul · PMID 42384057 · Publisher ↗
PURPOSE: To assess the 12-month efficacy of a novel non-ablative dual Nd:YAG/Er:YAG laser therapy for vulvar lichen sclerosus (LS) and to evaluate the impact of crossover laser treatment following initial topical cortico...
PURPOSE: To assess the 12-month efficacy of a novel non-ablative dual Nd:YAG/Er:YAG laser therapy for vulvar lichen sclerosus (LS) and to evaluate the impact of crossover laser treatment following initial topical corticosteroid therapy. METHODS: This study presents the 1-year data of a prospective observational trial. Between baseline and 6 months, women with vulvar LS were randomized to receive either dual Nd:YAG/Er:YAG laser therapy or topical clobetasol propionate. Between 6 and 12 months, optional steroid or laser therapies were offered. RESULTS: In the laser group, 34 of 44 patients (77%) required no additional treatment between 6 and 12 months, indicating sustained treatment effects. The total LS score improved significantly during this period (mean change -0.35 ± 0.60; 95% CI -0.56 to -0.14; p = 0.004), while other parameters showed non-significant improvements. In the corticosteroid group, 20 of 22 patients (91%) opted for a crossover to laser therapy. Following three laser sessions, the total LS score improved markedly (mean change -1.50 ± 0.83; 95% CI -1.89 to -1.11; p < 0.001), primarily driven by a reduction in atrophy (p < 0.001). Patient-reported improvement (PGI-I) increased from 45 to 77% (p = 0.008). At the 12-month follow-up, outcomes were comparable between the two study groups. CONCLUSION: Non-ablative dual Nd:YAG/Er:YAG laser therapy resulted in significant and sustained clinical improvement in vulvar LS over 12 months. Crossover to laser therapy after initial corticosteroid treatment further enhanced both objective and subjective outcomes. CLINICAL TRIAL IDENTIFICATION NUMBER: NCT03926299; date of registration: 24 April 2019.
Evaluation of the concept of students learning practical gynecological and obstetric skills at a large German university hospital, using the example of the Homburg university women's clinic.
Findeklee S, Kasoha M, Olmes GL … +5 more , Diedrich K, Georgescu MT, Sima RM, Solomayer EF, Hamoud BH
Arch Gynecol Obstet · 2026 Jun · PMID 42371169 · Full text
INTRODUCTION: The teaching and practical training of future doctors play an important role in the university curriculum. MATERIAL AND METHODS: At the Women's Clinic of Saarland University Hospital in Homburg, we develope...
INTRODUCTION: The teaching and practical training of future doctors play an important role in the university curriculum. MATERIAL AND METHODS: At the Women's Clinic of Saarland University Hospital in Homburg, we developed a five-day block placement concept that focused on learning practical gynecological and obstetric skills rather than simply imparting theoretical knowledge. The student`s satisfaction with the block placement was assessed using a non-standardized questionnaire with the two items "How do you rate your learning outcomes from the placement?" and "The placement increased my interest in gynecology and obstetrics". The assessment was based on a scale of 1 to 6. OUTCOME: A total of 205 out of 220 students (93.2%) from the winter semester 2022/2023 participated in the evaluation and completed the questionnaire. 198 students (96.6%) rated the satisfaction with their perceived learning from the block internship as very good (1) or good (2), and 201 students (98%) reported an increase in their interest in the subject area. DISCUSSION: An overwhelming majority of students rated the practical teaching concept as very good or good, which speaks to the success of this practical teaching format. Nevertheless, the study also has several limitations. For example, only one cohort of medical students was surveyed. Furthermore, when establishing a new teaching concept, there is a risk that participants in an evaluation will not respond objectively, but rather according to the criterion of social desirability. We suggest our practice-oriented block placement concept, which focuses on learning skills relevant to the future medical profession, as a possible curriculum for undergraduate teaching in gynecology and obstetrics, to inspire students for the field.
Is a history of cesarean section a predictive factor for the failure of medical management in spontaneous abortion?
Pertez-Machluf R, Youran Kimhi M, Yedidia Moser R … +6 more , Arbib N, Daykan Y, Weitzner O, Schonman R, Klein Z, Yagur Y
Arch Gynecol Obstet · 2026 Jun · PMID 42363970 · Publisher ↗
OBJECTIVES: This study aims to evaluate the risk factors for failure of medical treatment for first-trimester spontaneous abortion and the specific role of prior cesarean delivery (CD). METHODS: This retrospective cohort...
OBJECTIVES: This study aims to evaluate the risk factors for failure of medical treatment for first-trimester spontaneous abortion and the specific role of prior cesarean delivery (CD). METHODS: This retrospective cohort study analyzed data from patients who underwent medical management of first-trimester spontaneous abortion using mifepristone and misoprostol at a tertiary medical center between 2019 and 2022. Data collected included demographic, clinical, and sonographic parameters, with comparisons made between patients with successful and unsuccessful treatment outcomes. Univariable and multivariable logistic regression analyses were conducted. RESULTS: Among the 716 patients included in the study, treatment failure was observed in 29.5%. In multivariable analysis, prior CD was independently associated with an increased risk of treatment failure (aOR 1.97; 95%CI 1.25-3.12; p = 0.004). Additionally, advanced gestational age was also associated with an increased likelihood of failure (aOR 1.02 per day; 95%CI 1.00-1.03; p = 0.009). In subgroup analyses, patients with prior CD had higher failure rates compared with those without prior CD (43.2% vs 27.4%, p = 0.002). Among patients without prior CD, gestational age > 70 days was associated with higher failure rates compared with ≤ 70 days (35.2% vs 24.3%, p = 0.006). In this subgroup (no prior CD and gestational age ≤ 70 days), the presence of bleeding during treatment was associated with lower failure rates (12.5% vs 25.6%, p = 0.001). CONCLUSION: Prior cesarean delivery was independently associated with an increased risk of treatment failure following medical management of first-trimester spontaneous abortion. Advanced gestational age was also associated with increased failure rates. Further studies are needed to refine treatment protocols and explore approaches for patients with prior CD.
Spontaneous miscarriage and later lifestyle in predicting hazard of premature mortality: a cohort study in UK Biobank.
Hu Y, Tang R, Li X … +5 more , Wang X, Ma H, Heianza Y, Qi L, Liang Z
Arch Gynecol Obstet · 2026 Jun · PMID 42363949 · Publisher ↗
OBJECTIVE: To prospectively assess the association of spontaneous miscarriage with the hazard of premature mortality and to examine the interaction between spontaneous miscarriage and lifestyle in relation to premature m...
OBJECTIVE: To prospectively assess the association of spontaneous miscarriage with the hazard of premature mortality and to examine the interaction between spontaneous miscarriage and lifestyle in relation to premature mortality. METHODS: A total of 231,148 participants from the UK Biobank were included. The unhealthy lifestyle was defined as an unhealthy diet, smoking, irregular physical activity, and an abnormal body mass index. Cox proportional hazards models were used to evaluate the associations. RESULTS: During a median follow-up time of 12.3 years, 11,672 premature mortalities were documented. Compared to women who did not have a spontaneous miscarriage, the multivariable-adjusted hazard ratios (aHRs) for all-cause premature mortality according to the number of spontaneous miscarriages were 0.98 (95% confidence interval [CI] 0.93-1.04) for one, 1.16 (1.06-1.27) for two, and 1.24 (1.10-1.39) for three or more, respectively (P-trend < 0.001). In contrast, the ever-versus-never comparison (any miscarriage) was not significant after adjustment for lifestyle factors. We found a significant interaction on an additive scale between a greater number of spontaneous miscarriages and the unhealthy lifestyle score (P for additive interaction = 0.03) on the risk of premature mortality. CONCLUSIONS: Our findings indicate that recurrent spontaneous miscarriage (≥ 2 events) serves as a risk marker for higher hazard of all-cause premature mortality, particularly death from cardiovascular disease, whereas a single miscarriage and the ever-versus-never comparison showed no significant association after full adjustment. A postnatal unhealthy lifestyle may partly account for the observed association, suggesting that lifestyle modification could be a focus for future preventive strategies in this high-risk population.
Subtype-specific analysis of factors associated with assisted reproductive technology indication and live birth in patients with adenomyosis: a retrospective study.
Tanaka K, Ono Y, Ota H … +9 more , Miyashita D, Yoshihara T, Owada S, Sasatsu S, Ogi M, Okuda Y, Yamada H, Wada S, Yoshino O
Arch Gynecol Obstet · 2026 Jun · PMID 42360496 · Publisher ↗
PURPOSE: The magnetic resonance imaging (MRI)-based classification of adenomyosis subtypes helps predict reproductive and obstetric outcomes; however, background factors associated with use of assisted reproductive techn...
PURPOSE: The magnetic resonance imaging (MRI)-based classification of adenomyosis subtypes helps predict reproductive and obstetric outcomes; however, background factors associated with use of assisted reproductive technology (ART) and live birth within each individual subtype remain unclear. METHODS: We conducted a multicenter retrospective study of 199 premenopausal women (32-49 years) who underwent pelvic MRI and laparoscopic surgery and had histopathologic confirmation of adenomyosis (January 2010-May 2023). Patients were classified as intrinsic (n = 58), extrinsic (n = 61), or indeterminate (n = 80) subtype. Within each subtype, multivariate logistic regression tested independent associations of age, ART history, gravidity, parity, lesion thickness, and intraoperative findings-including pelvic endometriosis-with ART use and live birth. RESULTS: The extrinsic subtype had a higher proportion with ART history than the intrinsic subtype (32.8% vs 8.6%; p = 0.008). Live birth rate was lower in the indeterminate than the intrinsic subtype (60.0% vs 86.2%; p = 0.0048). In the extrinsic subtype, greater lesion thickness independently predicted lower odds of live birth (adjusted OR = 0.94 per 1-mm increase; 95% CI, 0.88-0.99; p = 0.048). In the indeterminate subtype, older age was associated with ART use (adjusted OR = 1.155 per year; 95% CI, 1.002-1.351; p = 0.047), and ovarian endometrioma was linked to reduced live birth (adjusted OR = 0.172; 95% CI, 0.054-0.508; p = 0.001). In the intrinsic subtype, women with live birth were older than those without, but age was not an independent factor. CONCLUSION: Adenomyosis lesion thickness and coexisting endometriosis are associated with ART indication and live birth outcomes in a subtype-specific manner and may support individualized counselling and management.
Global landscape of maternal hemorrhage mortality: a 40-year analysis based on GBD 2021 study.
Guo L, Hu J, Wang S … +3 more , Wang H, Liu L, Wang Y
Arch Gynecol Obstet · 2026 Jun · PMID 42360489 · Publisher ↗
BACKGROUND: Maternal hemorrhage (MH) is the leading direct cause of global maternal mortality, accounting for over a quarter of all maternal deaths. While significant progress has been made, the decline in MH-related mor...
BACKGROUND: Maternal hemorrhage (MH) is the leading direct cause of global maternal mortality, accounting for over a quarter of all maternal deaths. While significant progress has been made, the decline in MH-related mortality varies widely across regions, reflecting disparities in healthcare access and quality. This study leverages the Global Burden of Disease (GBD) 2021 database to analyze MH mortality trends and inequalities. METHODS: We analyzed MH mortality data from 1982 to 2021 for women aged 15-49. We assessed trends using crude data and age-standardized mortality rates, calculating the estimated annual percentage change (EAPC). We also employed an age-period-cohort (APC) model to examine the effects of age, period, and birth cohort on mortality. Countries were grouped into five categories based on their sociodemographic index (SDI). RESULTS: Globally, the absolute number of MH deaths decreased by 63.13% between 1982 and 2021. High-middle SDI regions showed the greatest improvement with a 91.76% decrease, while low-SDI regions had the most modest progress at 21.57%. By 2021, Nigeria, India, and Pakistan had the highest absolute number of deaths, while Sierra Leone, Chad, and Niger had the highest age-standardized mortality rates. The APC analysis revealed a persistent disparity: successive generations in low-SDI regions still face substantially higher risks compared to their counterparts in high-SDI settings. CONCLUSION: Our findings reveal significant global progress in reducing MH mortality, but also a growing health disparity, with the burden increasingly concentrated in low-SDI countries. This highlights the need for targeted policies that strengthen healthcare systems in vulnerable regions to achieve global equity in maternal health.
Comparison of three different hpv self-sampling tools - a subanalysis of the prospective, randomized hannover self-collection study.
Hempel S, Groß S, Steinkasserer L … +5 more , Theis L, Ziert Y, Koch A, Hillemanns P, Jentschke M
Arch Gynecol Obstet · 2026 Jun · PMID 42347973 · Full text
OBJECTIVE: Cervical cancer and its precursor lesions are treatable if detected early; however, screening participation for high-risk human papillomavirus infections (hr-HPV) remains low. In 2021, Germany recorded 4,544 n...
OBJECTIVE: Cervical cancer and its precursor lesions are treatable if detected early; however, screening participation for high-risk human papillomavirus infections (hr-HPV) remains low. In 2021, Germany recorded 4,544 new cervical cancer cases and 2,071 related deaths. The HaSCo study evaluates the feasibility of HPV self-testing to improve screening participation. This sub-study evaluates performance and acceptability of three self-testing tools. METHODS: This prospective, randomized sub-study examined Evalyn-Brush, FLOQSwabs, and first-void urine Colli-Pee among women aged 30-65 in Hannover, Germany. Addresses from the residents´ registration office were randomized into seven age groups and an 80/20 city-region distribution. A total of 19,995 women were assigned to opt-in (request a self-test) or opt-out (receive a test directly). Participation was requested from women without regular screening in the past two years. RESULTS: 1,860 samples were returned (9.3%). Colli-Pee (10.4%) and FLOQSwabs (10.1%) had similar return rates, while Evalyn showed significantly lower rates (7.4%). Screening frequency didn´t significantly affect return rates (p = 0.1825), although FLOQSwabs showed higher return rates among underscreened women. Invalid sample rates were low, highest for FLOQSwabs (1.67%). A total of 145 samples tested positive for hr-HPV (7.9%). Evalyn collected highest DNA content (p < 0.0001). Colli-Pee was most preferred, and 66.7% of participants favored self-testing. CONCLUSION: HPV self-tests were highly accepted and effective for collecting sufficient DNA material. Direct provision of user-friendly self-tests may support screening participation, particularly among underscreened women. All three devices performed strongly and appear suitable for integration into cervical cancer screening programs.
Fertility-sparing strategy in a rare case of uterine adenosarcoma and consecutive spontaneous pregnancy and livebirth.
Ziegler E, Altmann J, Schmitt WD … +3 more , Mechnser S, Sehouli J, Roser E
Arch Gynecol Obstet · 2026 Jun · PMID 42334466 · Full text
INTRODUCTION: We present the rare case of a 29-year-old patient with uterine adenosarcoma who received fertility-sparing treatment, subsequently conceived spontaneously, and gave birth to a healthy infant. CASE: In Augus...
INTRODUCTION: We present the rare case of a 29-year-old patient with uterine adenosarcoma who received fertility-sparing treatment, subsequently conceived spontaneously, and gave birth to a healthy infant. CASE: In August 2022, the nulliparous patient presented with acyclic uterine bleeding. Diagnostic hysteroscopy and targeted resection of a polyp located at the cervicouterine junction revealed uterine adenosarcoma without sarcomatous overgrowth (FIGO stage T1a). Imaging confirmed no residual tumor or metastasis. A fertility-sparing management strategy was chosen, avoiding hysterectomy but involving close oncological surveillance with quarterly MRI scans. During follow-up, a concurrent diagnosis of symptomatic endometriosis introduced therapeutic challenges. The patient spontaneously conceived in 2023 and delivered a healthy infant by cesarean section at term in 2024. Subsequent hysteroscopy and imaging in 2025 showed no evidence of recurrence, therefore fertility-preserving management was continued. PATIENT PERSPECTIVE: A short narrative of the patient's perspective on her initial diagnosis, possible fertility loss, and the emotional turmoil of pregnancy after uterine adenosarcoma is presented. DISCUSSION: Treating young patients diagnosed with uterine adenosarcoma poses a challenge to the treating physician due to the lack of guidelines and evidence regarding fertility-preserving treatment of this rare tumor. This report adds to the limited literature on successful pregnancy after uterine adenosarcoma and discusses indications and limitations of fertility-sparing treatment. CONCLUSION: Fertility preservation may be possible in selected early-stage uterine adenosarcoma cases without high-risk features such as sarcomatous overgrowth or myometrial invasion, with thorough counseling and strict follow-up. Further research is needed to develop standardized protocols and improve management in this context.
Differential impacts of pregnancy-induced hypertension and chronic hypertension on maternal and foetal health outcomes: a systematic review of outcomes and risk factors.
Ackah JA, Mensah WS, Chen X … +4 more , Dyer E, Chukwanugo UC, Ven Emery C, Akudjedu TN
Arch Gynecol Obstet · 2026 Jun · PMID 42329449 · Publisher ↗
INTRODUCTION: Hypertensive disorders complicate approximately 5-10% of pregnancies globally, significantly impacting maternal and foetal health. To address the distinct impacts of chronic hypertension and pregnancy-induc...
INTRODUCTION: Hypertensive disorders complicate approximately 5-10% of pregnancies globally, significantly impacting maternal and foetal health. To address the distinct impacts of chronic hypertension and pregnancy-induced hypertension (PIH) on foeto-maternal health, this review delineated their associated distinct risk factors and diagnostic markers, providing evidence-based insights to guide targeted, patient-centred management of hypertensive pregnancies. METHODS: A systematic search of Web of Science, PubMed, and SCOPUS was conducted using predefined criteria. Observational studies were rigorously screened and quality assessed. Data were extracted and narratively synthesised, with an emphasis on maternal and foetal outcomes, diagnostic modalities, and risk modifiers. RESULTS: The analysis confirmed that intrauterine foetal demise, intrauterine growth restriction, low birth weight, and neonatal as well as maternal mortality are major adverse outcomes of hypertensive pregnancies. The evidence demonstrates that whilst chronic hypertension and PIH confer considerable risk, PIH often results in more sudden and severe clinical deterioration, especially in the absence of vigilant prenatal monitoring and timely intervention. The findings underscored the value of targeted, patient-centred care: women with chronic hypertension benefit from early and sustained surveillance, whereas those with PIH require prompt escalation of monitoring following diagnosis, especially in the second trimester. Notably, comorbid systemic illnesses and advanced maternal age compound risks across hypertension categories, and diagnostic modalities, particularly ultrasound Doppler, are pivotal for early risk stratification and management. CONCLUSION: Effective management of hypertensive pregnancies requires early identification and individualised monitoring, recognising that chronic hypertension and pregnancy-induced hypertension differ in onset and progression, but both pose significant risks to maternal and foetal health.
Computerized CTG self-monitoring versus standard Doppler assessment in late-onset fetal growth restriction (cosmos): a pilot randomized controlled trial.
Nowacka U, Issat T, Krajewska K … +8 more , Norwa A, Mazanowska N, Kowalczyk-Buss J, Kozlowski S, Kuchcinska M, Laudański P, Jakimiuk A, Majewska A
Arch Gynecol Obstet · 2026 Jun · PMID 42323763 · Publisher ↗
PURPOSE: Late-onset fetal growth restriction (FGR) presents clinical management challenges, often requiring frequent in-hospital fetal surveillance. Telemedicine-based computerized cardiotocography (cCTG) performed at ho...
PURPOSE: Late-onset fetal growth restriction (FGR) presents clinical management challenges, often requiring frequent in-hospital fetal surveillance. Telemedicine-based computerized cardiotocography (cCTG) performed at home may offer a viable remote monitoring addition. METHODS: This single-center, open-label, a pilot randomized controlled pragmatic trial (COSMOS) was conducted in Warsaw, Poland, between 2022 and 2025. A total of 120 women with late-onset FGR, defined according to the Delphi criteria, were randomly assigned (1:1) to either a cCTG-based monitoring approach with protocol-mandated safety Doppler assessments or to standard hospital-based Doppler surveillance. The primary outcome was neonatal condition at birth (Apgar score at 5 min, umbilical artery pH). Secondary outcomes included emergency cesarean section for fetal compromise, maternal anxiety, measured using the Generalized Anxiety Disorder 7-item scale (GAD-7), number of antenatal visits, and a composite of adverse neonatal outcomes. The study protocol was registered at ClinicalTrials.gov (NCT05034861). RESULTS: There were no significant differences between groups in Apgar scores, umbilical cord arterial pH, or need for neonatal resuscitation. The rate of emergency cesarean delivery was lower in the cCTG-based group. Women in the cCTG-based group also reported significantly lower anxiety levels at delivery and required fewer antenatal visits, with no increase in adverse neonatal outcomes. CONCLUSIONS: Home-based computerized CTG within a pragmatic real-world framework appears feasible in pregnancies complicated by late-onset FGR. These findings support the potential of this approach to reduce hospital-based monitoring, maternal anxiety and in-person visits; however, these results should be considered hypothesis-generating and not indicative of clinical effectiveness. CLINICAL TRIALS REGISTRATION: Date 13.08.2021 NCT Number NCT05034861.
Pain and functional outcomes after surgical versus hormonal treatment in rectovaginal endometriosis: a retrospective cohort study.
Werner F, Velho RV, Mechsner S
Arch Gynecol Obstet · 2026 Jun · PMID 42323744 · Full text
PURPOSE: To compare changes in pain-related symptoms, bowel and bladder function, rectal bleeding, quality of life, and treatment satisfaction in women with rectovaginal endometriosis treated either surgically or with ho...
PURPOSE: To compare changes in pain-related symptoms, bowel and bladder function, rectal bleeding, quality of life, and treatment satisfaction in women with rectovaginal endometriosis treated either surgically or with hormonal treatment alone in a tertiary referral centre. METHODS: This retrospective cohort study included women with rectovaginal endometriosis treated at a tertiary endometriosis centre with either surgical excision or hormonal treatment alone after informed consent. Standardised questionnaires assessed pain, functional symptoms, quality of life, and treatment satisfaction. Symptom changes were categorised as improvement, stability, or worsening. Between-group comparisons were performed using Mann-Whitney U tests and Pearson's chi-square tests, with effect sizes reported (r or Cramér's V). The analysis was exploratory. RESULTS: A total of 210 women were included (surgical n = 164; hormonal n = 46). Baseline pain intensity did not differ significantly between groups, although bowel dysfunction and rectal bleeding were more prevalent in the surgical cohort. Following treatment, approximately 80% of women in both groups reported improvement in pelvic pain and dysmenorrhoea. Improvements in dyspareunia, dyschezia, and functional outcomes were observed in substantial proportions. Between-group comparisons revealed no statistically significant differences in change categories across pain, functional symptoms, quality of life, or treatment satisfaction (all p ≥ 0.08), with consistently small effect sizes. CONCLUSION: Both surgical and hormonal treatment were associated with substantial improvements in patient-reported outcomes in women with rectovaginal endometriosis. Direct comparison revealed no significant differences in outcome trajectories, supporting an individualised treatment approach.
The microbiology of amniotic fluid sludge: a systematic review and meta-analysis.
Shipitsyna E, Pachulia O, Khalenko V … +4 more , Kopteeva E, Sazonova A, Zhestkova N, Bespalova O
Arch Gynecol Obstet · 2026 Jun · PMID 42319487 · Publisher ↗
PURPOSE: Amniotic fluid sludge (AFS) is a sonographic finding associated with intra-amniotic infection and spontaneous preterm birth. The microbial composition of AFS remains poorly characterized. This systematic review...
PURPOSE: Amniotic fluid sludge (AFS) is a sonographic finding associated with intra-amniotic infection and spontaneous preterm birth. The microbial composition of AFS remains poorly characterized. This systematic review and meta-analysis aimed to consolidate existing data on microbial prevalence in AFS and identify consistent microbial patterns. METHODS: A systematic search of MEDLINE (PubMed), Dimensions, and OpenAlex was conducted from inception to February 11, 2026. Studies reporting the prevalence of microorganisms in AFS (minimum 10 cases) from pregnant women with AFS diagnosed via transvaginal ultrasound were included. Two reviewers independently performed screening, data extraction, and risk-of-bias assessment, with a third reviewer resolving discrepancies. Random-effects meta-analysis of proportions was used to pool overall and pathogen-specific prevalence. RESULTS: Four studies comprising 85 women met inclusion criteria. The pooled prevalence of any microorganism was 35% (95%CI 22-48%), with moderate heterogeneity (I = 36.8%). Ureaplasma spp. were the most frequently detected pathogens (pooled prevalence 17%, 95%CI 8-27%). Sensitivity analysis revealed that sampling technique was a source of heterogeneity in this dataset; excluding the single study using transvaginal amniocentesis reduced the pooled prevalence to 28% (95%CI 17-41%) and eliminated statistical heterogeneity (I = 0.0%). Transvaginally collected samples exhibited significantly greater microbial diversity (median 2 vs. 1 microorganism/sample, p = 0.005) and contained vaginal commensals, suggesting possible contamination. CONCLUSION: In transabdominal cohorts, the pooled prevalence of microorganisms (any) in amniotic fluid sludge was 28% (95%CI 17-41%), with Ureaplasma spp. emerging as the predominant pathogen when an infectious agent was identified. Transvaginal amniocentesis resulted in greater microbial diversity and detection of vaginal commensals, consistent with contamination. Our findings suggest that transabdominal sampling should be the preferred methodological approach for future studies of AFS microbiology.
Histological evaluation of hysterectomy specimens after NovaSure endometrial ablation in patients with atypical endometrial hyperplasia or endometrial carcinoma.
Schleicher OM, Hamzeh A, Gocke J … +8 more , Poeschke P, Stuebs FA, Burghaus S, Heindl F, Hartmann A, Beckmann MW, Matek C, Emons J
Arch Gynecol Obstet · 2026 Jun · PMID 42315802 · Full text
BACKGROUND: Treatment with NovaSure® endometrial ablation is approved for patients with heavy menstrual bleeding (HMB) without evidence of malignant or premalignant lesions. This analysis addresses the rare but clinicall...
BACKGROUND: Treatment with NovaSure® endometrial ablation is approved for patients with heavy menstrual bleeding (HMB) without evidence of malignant or premalignant lesions. This analysis addresses the rare but clinically relevant situation in which endometrial carcinoma (EC) or atypical hyperplasia (AEH) is identified histologically after endometrial ablation in premenopausal patients. OBJECTIVE: Histological evaluation of hysterectomy specimens with correlation to clinical parameters in patients undergoing hysterectomy after incidental histological diagnosis of AEH or EC following NovaSure® endometrial ablation. METHODS: A retrospective single-center analysis was conducted on more than 400 patients who underwent NovaSure® endometrial ablation at our center between January 2020 and February 2025. Patients with AEH or EC for whom subsequent hysterectomy specimens were available were included. Histological evaluation was performed and independently reviewed to assess residual endometrium, residual endometrial atypia or carcinoma, and ablation-related histomorphological changes. RESULTS: A total of 11 patients (AEH n = 8; EC n = 3) underwent subsequent hysterectomy after NovaSure® endometrial ablation. Six out of eight patients with AEH showed no residual atypia in the hysterectomy specimens (2/8 with focal residual atypia), and no residual invasive carcinoma was detected in any of the three carcinoma cases. Histopathological analysis showed pronounced postablative changes, including necrosis, fibrosis, zonation, and vascular and lymphatic alterations. CONCLUSION: This descriptive study provides a clinicopathological characterization of patients with EC or AEH who underwent hysterectomy after endometrial ablation. In these patients, no preprocedural evidence of endometrial pathology was present, and the diagnosis was established solely through routine histopathological examination of curettage specimens obtained immediately before the ablation procedure. Histological assessment revealed pronounced changes, highlighting specific diagnostic challenges and underscoring the importance of careful patient selection and thorough diagnostic evaluation before NovaSure® ablation. Within the limitations of this study, no evidence was found that prior endometrial ablation compromises oncological outcome.
Comparing clinical decision-making between colposcopists and large language models in cervical dysplasia management: a pilot prospective multicenter study.
Stalp JL, Schneider JA, Steinkasserer L … +5 more , Hachenberg J, Jentschke M, Hillemanns P, Wolff D, Denecke A
Arch Gynecol Obstet · 2026 Jun · PMID 42313159 · Full text
PURPOSE: This prospective multicenter study aimed to compare the decision-making abilities of board-certified colposcopists and two commercially available large language models (LLM), ChatGPT-4o and ChatGPT-5, in cervica...
PURPOSE: This prospective multicenter study aimed to compare the decision-making abilities of board-certified colposcopists and two commercially available large language models (LLM), ChatGPT-4o and ChatGPT-5, in cervical dysplasia management. METHODS: Twenty-three anonymized real-life patient cases with multiple-choice (MC) questions regarding treatment decisions were used to assess answer quality. Ten board-certified colposcopists and the two LLMs addressed the MC questions. The gold standard was defined by two guideline authors. LLMs were prompted to justify their responses. Concordance rates were calculated and compared across all questions and histopathological subgroups, including cervical intraepithelial neoplasia (CIN), unspecific histopathological results, and cervical cancer cases. RESULTS: Clinicians and LLMs achieved similar overall concordance rates compared to the gold standard (69.6% for clinicians, 69.6% for ChatGPT-4o, and 65.2% for ChatGPT-5). ChatGPT-5 outperformed clinicians in precancerous lesions (81.8% vs. 66.4%), while clinicians excelled in complex cases with unspecific histopathology (86% vs. 60%). Clinicians showed a tendency to overtreat low-grade lesions (CIN I), opting for more intensive surveillance. ChatGPT-4o performed better than ChatGPT-5 in cervical cancer cases, though both models struggled with these scenarios. CONCLUSION: This study highlights the potential of LLMs as decision support tools in cervical dysplasia management, particularly for straightforward cases like precancerous lesions. However, clinicians remain superior in handling complex or ambiguous cases. The tendency of clinicians to overtreat low-grade lesions may offer the potential to test the implementation of a decision support tool for those cases. While LLMs show promise, exploring open-ended clinical scenarios and integrating retrieval-augmented generation could enhance their practical application.
PTHrP-associated hypercalcemia in gynecologic malignancies: a scoping review.
Bohne SM, Wegwitz F, Kruse-Wieczorek J … +4 more , Langer L, Gallwas J, Ströbel P, Hasanov MF
Arch Gynecol Obstet · 2026 Jun · PMID 42307672 · Full text
PURPOSE: Parathyroid hormone-related peptide (PTHrP) is a peptide hormone that shares structural similarity with parathyroid hormone (PTH) and binds to the same receptor, leading to increased calcium levels. Humoral hype...
PURPOSE: Parathyroid hormone-related peptide (PTHrP) is a peptide hormone that shares structural similarity with parathyroid hormone (PTH) and binds to the same receptor, leading to increased calcium levels. Humoral hypercalcemia of malignancy (HHM) is typically mediated by tumor-derived PTHrP and accounts for the majority of cases of malignancy-associated hypercalcemia, whereas it is rarely observed in benign conditions. The purpose of this study was to systematically review the literature to map and provide a structured and transparent overview of reported cases of HHM in malignant gynecologic tumors. METHODS: A systematic literature search was conducted in PubMed/MEDLINE and Web of Science, complemented by manual reference screening and additional searches using Google Scholar, identifying relevant articles published between 1973 and 2025. Clinical and biochemical characteristics were extracted and analyzed descriptively. RESULTS: A total of 51 reported cases were identified, including 29 ovarian, 12 uterine, 5 vulvar, and 5 cervical tumors. Among the 29 cases in which serum PTHrP was measured, levels were elevated in 28 patients. In the remaining cases, suppressed PTH levels, exclusion of alternative causes, or indirect evidence from tissue immunohistochemistry (IHC) supported PTHrP involvement. Preoperative calcium levels ranged from 10.5 to 21.3 mg/dL. Following tumor resection, both PTHrP and calcium levels declined and normalized in most patients. CONCLUSION: These findings suggest that although rare, PTHrP-mediated hypercalcemia represents a clinically relevant paraneoplastic phenomenon in gynecologic malignancies. Prospective studies with standardized biochemical and tissue-based assessment are needed to clarify its epidemiology and clinical significance.
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