Archives Of Gynecology And Obstetrics[JOURNAL]
Sun
200 papers
Quality control monitoring of euploid frozen embryo transfers.
Awadalla MS
Arch Gynecol Obstet · 2026 Jun · PMID 42301376 · Publisher ↗
PURPOSE: The goal of this study is to determine factors associated with fetal heartbeat and live birth rate for euploid frozen embryo transfers. METHODS: This is a retrospective cohort study of IVF patients at a single p...
PURPOSE: The goal of this study is to determine factors associated with fetal heartbeat and live birth rate for euploid frozen embryo transfers. METHODS: This is a retrospective cohort study of IVF patients at a single private practice in Cincinnati, Ohio undergoing single frozen euploid embryo transfer from 1/1/2023 to 7/31/2025. Variables assessed are embryo transfer protocol, genetic testing laboratory, physician who performed the embryo transfer, and embryologist. The main outcomes of interest are fetal heartbeat and live birth rate per single euploid frozen embryo transfer. RESULTS: Fetal heartbeat rate was significantly associated with the frozen embryo transfer protocol (p < 0.01). Modified natural FET protocols without oral medication (such as letrozole) had the highest fetal heartbeat rate of 66% compared to the average fetal heartbeat rate of 52%. Fetal heartbeat rate was also associated with the genetic testing laboratory (p < 0.01) and the day of embryo biopsy (p < 0.01). Fetal heartbeat was not associated with any of the other modifiable measures evaluated including the embryologist performing the biopsy or the physician performing the embryo transfer. CONCLUSION: At our center, the highest ongoing pregnancy rate per euploid embryo is seen with modified natural FET protocols without oral medication (such as letrozole).
Safety and effectiveness of etonogestrel implant in Chinese women requiring contraception: a multicenter, prospective, observational study.
Liu X, Wang X, Xu X … +8 more , Zhou Y, Ma W, Jiang L, Qi Q, Li J, Yu T, Grunden JW, Xiong C
Arch Gynecol Obstet · 2026 Jun · PMID 42295466 · Publisher ↗
OBJECTIVE: To assess the overall safety and effectiveness of the etonogestrel implant radiopaque in real-world clinical settings in China. METHODS: A multicenter, prospective, single-arm, observational study was conducte...
OBJECTIVE: To assess the overall safety and effectiveness of the etonogestrel implant radiopaque in real-world clinical settings in China. METHODS: A multicenter, prospective, single-arm, observational study was conducted in women (aged ≥ 18 years) across 31 centers in China (March 2016-July 2021). The implant was prescribed as part of routine clinical practice. Primary outcomes included overall safety and topical (local) safety profile; secondary outcomes included participant and physician satisfaction and contraceptive effectiveness of the etonogestrel implant. RESULTS: Of 1,901 women using the etonogestrel implant, 45.4% completed the 3-year study. The mean (SD) age of the women was 32.1 (5.6) years and the mean (SD) implant exposure duration was 783.7 (388.7) days. Overall, 47.9% reported drug-related adverse events (AEs; excluding topical AEs), 1.1% reported serious AEs, and 10.4% reported topical AEs after insertion. Vaginal bleeding (15.6%) was the most frequent drug-related AE. At 36 months after insertion or upon removal, most women were satisfied (38.9%) or very satisfied (23.7%) with the implant. Among 96 physicians who completed questionnaires following the first insertion, 57.3% were very satisfied and 38.5% were satisfied. Most (98.9%) of the physicians reported satisfaction following their first removal procedure. Of them, 65.3% were very satisfied and 33.7% were satisfied. One (1.1%) physician was neither satisfied nor dissatisfied. One (0.05%) in-treatment pregnancy was reported. CONCLUSION: Safety findings from this study in China's real-world clinical setting were consistent with the clinical development program without unexpected safety signals. Observed contraceptive effectiveness was consistent with established evidence for the implant, with general satisfaction reported among Chinese women.
Pelvic actinomycosis: diagnostic challenges and management strategies based on a retrospective case series and literature review.
Tian S, Geng C, Wu Y … +4 more , Huang K, Chen S, Fan X, Fan W
Arch Gynecol Obstet · 2026 Jun · PMID 42287450 · Publisher ↗
BACKGROUND: Pelvic actinomycosis is a rare, chronic infection caused by Actinomyces species, most associated with prolonged intrauterine device (IUD) use. Due to its nonspecific clinical presentation, it is frequently mi...
BACKGROUND: Pelvic actinomycosis is a rare, chronic infection caused by Actinomyces species, most associated with prolonged intrauterine device (IUD) use. Due to its nonspecific clinical presentation, it is frequently misdiagnosed as malignancy or other inflammatory conditions. This study aims to analyze the clinical features, diagnostic approaches, and outcomes of pelvic actinomycosis through a retrospective review of four cases and a supporting literature review. CASE DESCRIPTION: We reviewed the medical records of four female patients diagnosed with pelvic actinomycosis between 2021 and 2025. Diagnostic modalities included imaging, physical examination, cervical cytology, endometrial biopsy, and histopathological analysis. Empirical antibiotic therapy was administered to confirmed cases. All patients had a history of prolonged IUD use. Imaging frequently revealed pelvic masses with inflammatory features. In all cases, Actinomyces was identified via cytology or histopathology. Three of the four patients were diagnosed preoperatively, thus preventing unnecessary surgical interventions. Long-term antibiotic therapy led to clinical resolution in most patients. CONCLUSION: Pelvic actinomycosis should be considered in women with chronic pelvic symptoms and a history of long-term IUD use. Early identification through cytology or biopsy can reduce surgical morbidity. Increased awareness and its inclusion in the gynecologic differential diagnosis may improve patient prognoses.
Hormonal therapy or chemotherapy for advanced endometrial cancer? A mixed-methods study assessing physicians' attitudes.
van Weelden WJ, Mesu J, Ottevanger PB … +2 more , Pijnenborg JMA, Aarts JWM
Arch Gynecol Obstet · 2026 Jun · PMID 42283876 · Publisher ↗
PURPOSE: Hormonal therapy and chemotherapy are common systemic therapy options in advanced and recurrent endometrial cancer. There is limited consensus on factors that affect therapy selection. This study aims to gain in...
PURPOSE: Hormonal therapy and chemotherapy are common systemic therapy options in advanced and recurrent endometrial cancer. There is limited consensus on factors that affect therapy selection. This study aims to gain insight into those factors at the level of clinical decision-making and at the level of patient- and tumor-specific factors. METHODS: We performed an international cross-sectional study among medical oncologists and gynecologists. The survey consisted of (1) statements about barriers and facilitators that affect the process of decision-making and (2) hypothetical vignette cases investigating three patients and tumor factors that were tested with three levels each. Results were analyzed with descriptive statistics and linear mixed-effects models. RESULTS: 167 physicians responded to the survey. The most important facilitating factors were: understanding the patient's personal context and the role of multidisciplinary tumor board discussions. The most important barrier was the lack of evidence for prediction of response to hormonal therapy and chemotherapy. The three patient and tumor factors included in the vignette cases were severity of symptoms, performance status, and progesterone-receptor (PR) expression in the tumor. PR expression and performance status were most discriminative, with high PR expression and poor performance status favoring hormonal therapy. CONCLUSION: The provision of personalized care in palliative treatment of endometrial cancer can be improved by multidisciplinary tumor board discussions with the personal context and preference of the patient in mind. The patient factors, severity of symptoms and WHO performance status, and the tumor factor, PR tumor expression, were most relevant for selecting hormonal therapy or chemotherapy.
Predicting postpartum hemorrhage in placenta accreta spectrum patients with prophylactic abdominal aorta balloon occlusion: a retrospective cohort study.
Zha Y, Zhao Y, Peng M … +17 more , Zhang H, Jiang T, Zhao S, Yang W, Xie Y, Liao E, Xie H, Zhao L, Ren W, Zhang N, Wei X, Bao J, Du H, Hu Y, Zeng W, Feng Y, Sun G
Arch Gynecol Obstet · 2026 Jun · PMID 42283873 · Publisher ↗
BACKGROUND: Prophylactic abdominal aortic balloon occlusion (AABO) is a hemostasis intervention for patients with placenta accreta spectrum (PAS). However, many PAS patients with prophylactic AABO still experience postpa...
BACKGROUND: Prophylactic abdominal aortic balloon occlusion (AABO) is a hemostasis intervention for patients with placenta accreta spectrum (PAS). However, many PAS patients with prophylactic AABO still experience postpartum hemorrhage (PPH). This study aimed to investigate the risk factors for PPH in PAS patients undergoing prophylactic AABO. METHODS: This retrospective study (2018-2024) was conducted at a tertiary hospital. PAS women undergoing prophylactic AABO before cesarean section were enrolled and divided into the PPH group and the non-PPH (NPPH) group. The clinical characteristics, ultrasound and magnetic resonance imaging (MRI) findings, and delivery outcomes were compared. The LASSO regression and multivariable logistic regression were used to identify risk factors for PPH and to construct a nomogram prediction model. RESULTS: In total, 126 women were included, of whom 56 experienced PPH (44.4%). Compared to those in the NPPH group, the PPH group had higher gravidity (P = 0.022) and parity (P = 0.002), fewer gestational weeks at cesarean (34.9 vs. 35.6, P = 0.026), higher ultrasound scores (7 vs. 11, P < 0.001) and MRI-based PAS grades (P < 0.001). By integrating the results of the two regression methods, we constructed the nomogram to predict PPH risk. The ROC curve of the nomogram showed moderate discriminative ability, with an AUC of 0.749 (95% CI: 0.664-0.834). CONCLUSIONS: Prophylactic AABO does not completely prevent the occurrence of PPH. The nomogram intergrating gravidity, parity, ultrasound score and MRI-based PAS grades can assist clinicians in identifying high-risk PAS patients at an early stage, which is beneficial for the preoperative assessment.
Indication-dependent heterogeneity in the effect of double-suture cerclage: concerns over indication classification and a call for stratified analysis.
Park YJ, Park MI
Arch Gynecol Obstet · 2026 Jun · PMID 42283865 · Full text
Abstract loading — click title to view on PubMed.
The impact of the 7th October war on preterm birth rates and neonatal outcomes: a retrospective comparative study from northern Israel.
Zidan Sweid R, Sharabi Nov A, Helfgot H … +2 more , Warsof SL, Ben-Shachar I
Arch Gynecol Obstet · 2026 Jun · PMID 42283844 · Publisher ↗
PURPOSE: Maternal psychological stress is associated with adverse obstetric and neonatal outcomes, including preterm birth and low birthweight. Warfare represents a significant source of acute and chronic stress, yet its...
PURPOSE: Maternal psychological stress is associated with adverse obstetric and neonatal outcomes, including preterm birth and low birthweight. Warfare represents a significant source of acute and chronic stress, yet its impact on pregnancy outcomes remains unclear. This study aimed to evaluate the association between a 6-month period of continuous wartime exposure following October 7, 2023, during the "Iron Swords" conflict and preterm birth, neonatal outcomes, and obstetric management. METHODS: This retrospective cohort study included all deliveries at ZIV Medical Center during the 6-month conflict period, compared with a pre-war cohort from 2021 until October 6, 2023. The primary outcome was preterm birth (< 37 weeks). Secondary outcomes included early preterm birth (< 34 weeks), labor induction, mode of delivery, maternal complications, and neonatal outcomes. Multivariate logistic regression was used to identify independent predictors of preterm birth. RESULTS: A total of 699 conflict-period deliveries were compared with 7821 pre-war deliveries. Preterm birth rates were similar (< 37 weeks: 6.6% vs. 5.5%; < 34 weeks: 2.1% vs. 1.5%). Labor induction was markedly lower during the conflict (oxytocin 23.7% vs. 38.7%; cervical ripening balloon 3.3% vs. 7.7%; prostaglandins 4.1% vs. 6.5%), accompanied by reduced postpartum hemorrhage (7.9% vs. 12%). Neonatal outcomes, including birthweight distribution, NICU admissions, and survival, were comparable or slightly improved. CONCLUSION: Prolonged wartime exposure was not associated with increased rates of preterm birth or adverse neonatal outcomes. Lower rates of obstetric intervention were observed during the conflict period and coincided with lower rates of maternal complications, although causality cannot be established.
Reply to: Indication-dependent heterogeneity in the effect of double-suture cerclage: concerns over indication classification and a call for stratified analysis.
Kahraman E, Köroğlu N, Aydın T … +1 more , Yüksel MA
Arch Gynecol Obstet · 2026 Jun · PMID 42277321 · Full text
Abstract loading — click title to view on PubMed.
Identification of chromosomal abnormalities in miscarriages using single-nucleotide polymorphism arrays.
Zhao W, Wang H, Liang B … +3 more , Huang H, Lin N, Xu L
Arch Gynecol Obstet · 2026 Jun · PMID 42271033 · Publisher ↗
PURPOSE: Chromosome abnormalities are a known cause of miscarriage. A detailed chromosomal study in miscarriages is delineated using high-throughput technologies. METHODS: 564 miscarriages were collected, and the chromos...
PURPOSE: Chromosome abnormalities are a known cause of miscarriage. A detailed chromosomal study in miscarriages is delineated using high-throughput technologies. METHODS: 564 miscarriages were collected, and the chromosomal abnormalities, including triploidy, trisomy, monosomy, uniparental disomy, and chromosomal deletions/duplications in miscarriages, were detected by high-throughput single-nucleotide polymorphism (SNP) array. RESULTS: There were 336 (59.6%) miscarriages with chromosomal abnormalities, including 325 (57.6%) miscarriages with pathogenic variants and 11 (2%) miscarriages with variations of unknown significance (VOUS). The remaining 228 (40.4%) miscarriages had no clinically relevant chromosomal variants. Among the 325 miscarriages with pathogenic variants, 23 miscarriages had triploidy and two miscarriages showed genome-wide uniparental disomy. Trisomy was found in 225 miscarriages and involved nearly every chromosome. Monosomy X was found in 39 miscarriages. Also, 32 miscarriages were with partial chromosomal deletions/duplications, particularly in 8p23 and Xp22 regions. CONCLUSIONS: Our results confirmed that trisomy and monosomy X are potentially the most common causes of miscarriage. We also showed that chromosomal pathogenic deletions/duplications are involved with miscarriage. However, still nearly 40% of miscarriages had no chromosomal variants detected by SNP array. This may be attributed to a single gene mutation that requires high-throughput sequencing.
Subtype matters: ovarian endometriosis impairs ovarian reserve and embryo quality-should these patients consider fertility preservation?
Meyer C, Staib C, Löb S … +7 more , Altides A, Schwab M, Büchel J, Scherer-Quenzer A, Kiesel M, Wöckel A, Herbert SL
Arch Gynecol Obstet · 2026 Jun · PMID 42270946 · Full text
RESEARCH QUESTION: Which patients with endometriosis suffer from diminished ovarian reserve as well as impaired embryo quality and therefore could benefit from medical freezing as part of fertility preservation strategie...
RESEARCH QUESTION: Which patients with endometriosis suffer from diminished ovarian reserve as well as impaired embryo quality and therefore could benefit from medical freezing as part of fertility preservation strategies? DESIGN: This retrospective study analyzed 205 patients who underwent follicle puncture at our center in preparation for IVF/ICSI treatment. All patients with laparoscopically confirmed endometriosis were classified according to rASRM and #ENZIAN. In total, 183 follicle punctures and 168 embryos were evaluated. Anti-Müllerian hormone (AMH) levels, the antral follicle count (AFC), the number of retrieved oocytes as well as the rate of mature oocytes and the fertilization rate were compared among the different subtypes of endometriosis. Embryo quality was assessed by the KIDScore™ on days 3 and 5. RESULTS: The analyses revealed significant differences in the AFC among patients with peritoneal (mean AFC: 16.43), deep-infiltrating (11.84) and ovarian endometriosis (10.85) (p = 0.006). The largest difference was observed between superficial and ovarian endometriosis (p = 0.004). The number of retrieved oocytes also differed significantly among the subgroups (p = 0.012), with the strongest contrast between deep-infiltrating (11.18) and ovarian endometriosis (8.14). Although the AFC, AMH and number of retrieved oocytes were strongly correlated, AMH alone did not differ significantly between the subgroups. The rate of mature oocytes was the lowest in patients with deep-infiltrating endometriosis but did not reach statistical significance. Patients with endometriomas presented the lowest fertilization rates and KIDScore™ values; however, only the difference in KIDScore™ D5 reached statistical significance (FR: p = 0.077, D3: p = 0.659, D5: p = 0.005). CONCLUSIONS: Endometriosis subtypes differ in their impact on the ovarian reserve. Patients with ovarian endometriosis exhibit a diminished ovarian reserve, reflected by a lower AFC, a lower number of retrieved oocytes and lower number of mature oocytes. Additionally, a lower embryo quality was also observed. These findings could not be replicated in patients with superficial or deep-infiltrating endometriosis. Our study highlights the importance of identifying the specific form of endometriosis. Given that diminished ovarian reserve and recued embryo quality were observed at the time of reproductive therapy, we propose that early elective oocyte cryopreservation may help prevent these adverse outcomes, particularly in patients with ovarian endometriosis. However, additional factors and fertility preservation strategies should be taken into account when considering its indication and fertility preservation strategy in patients with deep-infiltrating or superficial endometriosis.
Evaluating the role of follicular output rate in clinical and embryological outcomes in IVF: a prospective study.
Firdaus A, Mundkur AS, Poojari VG … +3 more , Kumar P, Vitthala S, Adiga PK
Arch Gynecol Obstet · 2026 Jun · PMID 42268430 · Publisher ↗
PURPOSE: To examine the association between follicular output rate (FORT) and embryological and clinical outcomes, including live birth rate, in patients undergoing in vitro fertilization (IVF). METHODS: This prospective...
PURPOSE: To examine the association between follicular output rate (FORT) and embryological and clinical outcomes, including live birth rate, in patients undergoing in vitro fertilization (IVF). METHODS: This prospective cohort study enrolled 166 patients undergoing IVF between October 2023 and January 2025. FORT was calculated as the ratio of pre-ovulatory follicles (16-24 mm) on trigger day to baseline antral follicle count (AFC; 3-9 mm), multiplied by 100. Patients were stratified into low, medium, and high FORT tertiles, and FORT was also evaluated as a continuous variable in multivariable logistic regression. An exploratory receiver operating characteristic (ROC) analysis was performed to assess discriminatory performance and to identify a data-derived reference threshold. All analyses were conducted separately for non-PCOS and PCOS cohorts. RESULTS: In non-PCOS patients (n = 136), the number of oocytes retrieved, mature oocytes, and good-quality embryos differed significantly across FORT tertiles (all p < 0.05). Clinical pregnancy rates were 14.9%, 27.8%, and 37.2% in the low, medium, and high FORT groups respectively (p = 0.045), with corresponding differences in live birth rates (p = 0.049). On multivariable analysis, FORT (OR 1.04; 95% CI 1.002-1.079; p = 0.039) and the number of available embryos (OR 1.35; 95% CI 1.082-1.676; p = 0.008) remained independently associated with clinical pregnancy. Exploratory ROC analysis yielded an AUC of 0.607 (95% CI 0.52-0.69). A data-derived reference threshold of FORT at 64.2% was associated with higher clinical pregnancy rates compared with lower FORT values (40.9% vs. 23.3%; p = 0.030; OR 2.27, 95% CI 1.14-4.55). No significant associations were observed in the PCOS subgroup, though this analysis was limited by small sample size (n = 30). CONCLUSIONS: FORT is significantly associated with embryological and clinical pregnancy outcomes, including live birth, in non-PCOS IVF patients. As a cycle-specific functional measure of follicular responsiveness, FORT may complement static ovarian reserve markers for counselling and outcome stratification. FORT values in the higher range (approximately ≥ 65%) were associated with improved clinical pregnancy rates, but the limited discriminatory performance of the ROC analysis underscores the need for external prospective validation of this cutoff before any clinical implementation.
Pre-delivery prediction of vaginal delivery in late-onset foetal growth restriction: development and internal validation of a model with decision curve analysis and bedside calculator.
Massalha M, Rottenstreich M, DeFrance B … +3 more , Malinowski K, Barrett JF, Ashwal E
Arch Gynecol Obstet · 2026 Jun · PMID 42265440 · Publisher ↗
PURPOSE: Foetal growth restriction (FGR) complicates 5-10% of pregnancies and is a major contributor to perinatal morbidity and mortality. In late-onset FGR, induction of labour is recommended; however, intrapartum caesa...
PURPOSE: Foetal growth restriction (FGR) complicates 5-10% of pregnancies and is a major contributor to perinatal morbidity and mortality. In late-onset FGR, induction of labour is recommended; however, intrapartum caesarean rates remain high (20-40%). Accurate counselling regarding the likelihood of vaginal delivery is essential, yet no validated prediction model exists for this population. We aim to develop and internally validate a pre-delivery prediction model for vaginal delivery in patients with late-onset FGR undergoing a trial of labour, and to assess its clinical utility. METHODS: This retrospective cohort study included singleton pregnancies with late-onset FGR managed at a tertiary centre (2017-2024). Eligible patients had no prior caesarean delivery, underwent attempted labour, and had complete Doppler assessment within 7 days of delivery. Logistic regression models were constructed using clinical and Doppler variables. Internal validation was performed using bootstrap resampling, and clinical utility was assessed with decision curve analysis. RESULTS: Among 477 patients, 378 (79.2%) achieved vaginal delivery. Nulliparity (OR 0.22, 95% CI 0.12-0.38; p < 0.001), pre-pregnancy BMI (OR 0.93 per kg/m, 95% CI 0.90-0.96; p < 0.001), abnormal cerebroplacental ratio (OR 0.47, 95% CI 0.28-0.78; p = 0.004), and pre-gestational diabetes (OR 0.28, 95% CI 0.10-0.78; p = 0.015) were independently associated with lower odds of vaginal delivery. The model demonstrated moderate discrimination (AUC 0.74, 95% CI 0.70-0.80) and good calibration, with net benefit above a 55% threshold. CONCLUSION: This four-variable model provides individualised prediction of vaginal delivery in late-onset FGR. External validation is required before clinical implementation.
NIPT-based prenatal screening of maternal Xq28 copy number variations in a cohort of 80,371 pregnancies.
Meng L, Xu Y, Liang Y … +11 more , Zhou R, Zhao J, Huo H, Zhang Q, Gao J, Liu T, Dai M, Du P, Wang Y, Hu P, Xu Z
Arch Gynecol Obstet · 2026 Jun · PMID 42260229 · Publisher ↗
PURPOSE: Copy number variation (CNVs) can result in various genomic diseases and variable clinical phenotypes. This study aimed to assess the feasibility and reliability of noninvasive prenatal testing (NIPT) for prenata...
PURPOSE: Copy number variation (CNVs) can result in various genomic diseases and variable clinical phenotypes. This study aimed to assess the feasibility and reliability of noninvasive prenatal testing (NIPT) for prenatal screening of maternal copy number variation (CNVs) involving the Xq28 recurrent region. METHODS: In this retrospective, single-center study, we analyzed the NIPT data of 80,371 pregnant women to detect the maternal CNVs from 2017 to 2022. Maternal CNVs involving the int22h1/int22h2-mediated chromosome Xq28 recurrent region detected by NIPT were focused on. Chromosomal microarray analysis (CMA) was then performed to validate NIPT results if the remaining maternal lymphocytes were available. RESULTS: A total of 48 (0.060%, 95% CI 0.045% ~ 0.079%) maternal CNVs involving int22h1/int22h2-mediated chromosome Xq28 recurrent region were identified by NIPT, including 29 (0.036%, 95% CI 0.025% ~ 0.052%) pathogenic deletions sizing from 128.1 kb to 93,244.3 kb, 17 (0.021%, 95% CI 0.013% ~ 0.034%) pathogenic duplications sizing from 442.5 kb to 2059.1 kb and two (0.002%, 95% CI 0.000% ~ 0.009%) variants of uncertain significance (VOUS) sizing from 215.2 kb to 326.1 kb. The detection rates of typical Xq28 recurrent microdeletions and microduplications were 0.005% (4/80,371, 95% CI 0.002% ~ 0.013%) and 0.006% (5/80,371, 95% CI 0.003% ~ 0.015%), respectively. Chromosomal microarray analysis (CMA) was performed to validate NIPT results in 22 cases for which remaining maternal lymphocytes were available. The positive predictive value (PPV) of NIPT for maternal CNV's detection in the 22 cases was 100.0% (95% CI 85.1% ~ 100.0%). CONCLUSIONS: This study illustrated the feasibility and potential of NIPT to detect maternal CNVs involving the Xq28 recurrent region.
Comparative in vivo assessment of surgical smoke particle exposure from different energy modalities during gynecologic laparoscopy.
El-Safadi S, Bautista CE, Meinhold-Heerlein I … +7 more , Schwandner T, Zeppernick F, Perales I, Pfiffer T, Plaikner A, Köhler C, Favero G
Arch Gynecol Obstet · 2026 Jun · PMID 42257875 · Full text
BACKGROUND: Minimally invasive surgery (MIS) is widely used in gynecology because of its perioperative advantages over open surgery. However, concerns regarding the oncologic safety of MIS in early-stage cervical cancer...
BACKGROUND: Minimally invasive surgery (MIS) is widely used in gynecology because of its perioperative advantages over open surgery. However, concerns regarding the oncologic safety of MIS in early-stage cervical cancer have renewed interest in potential mechanisms of tumor cell dissemination during laparoscopic procedures. Surgical smoke generated by electrosurgical instruments has emerged as one possible factor. Although composed mainly of water vapor, surgical plume contains particulate matter produced during thermal tissue destruction and has been associated with occupational exposure risks and impaired intraoperative visibility. Nevertheless, quantitative in vivo data on particle generation during laparoscopic surgery remain limited. OBJECTIVE: This prospective study is the first to quantify particle size and concentration in electrosurgical smoke during laparoscopic procedures, assessing their potential role in tumor recurrence. METHODS: Using advanced laser-based detection, particle emissions were measured during laparoscopic surgeries for benign diseases in 40 patients. Data were analyzed to assess correlations between particle load, surgical duration, and instrument type (monopolar vs. bipolar). RESULTS: Monopolar devices produced approximately 100 times more particles than bipolar instruments, highlighting a substantial disparity in emission. While bipolar tools generated significantly fewer and larger particles, monopolar energy produced mostly small ones (0.3-5 µm). The overwhelming particle load from monopolar electrosurgery was strongly correlated with longer operative times and more intensive instrument use. CONCLUSION: Monopolar electrosurgical instruments generated substantially higher concentrations of surgical smoke particles than bipolar devices during laparoscopic surgery, particularly in the fine particle range. Although measured during benign gynecologic procedures and without biological plume analysis, these findings provide important in vivo data on particle generation. Improved understanding of surgical smoke dynamics may inform strategies to reduce aerosol exposure and guide future investigations in minimally invasive gynecologic oncologic surgery, particularly in the context of cervical cancer.
Sexual functioning after total versus subtotal laparoscopic hysterectomy-long term follow up results after 7 years.
Brodkorb T, Elnahrawy A, Spaich S … +4 more , Sütterlin M, Berlit S, Tuschy B, Goerdt L
Arch Gynecol Obstet · 2026 Jun · PMID 42251612 · Full text
PURPOSE: The aim of this study was to evaluate sexual function in the long term after total laparoscopic hysterectomy (TLH) versus laparoscopic supracervical hysterectomy (LASH) in patients with benign indications. METHO...
PURPOSE: The aim of this study was to evaluate sexual function in the long term after total laparoscopic hysterectomy (TLH) versus laparoscopic supracervical hysterectomy (LASH) in patients with benign indications. METHODS: As part of a longitudinal follow-up, 74 patients who had originally participated in a prospective study on sexual function after TLH or LASH were surveyed again (TLH: n = 45; LASH: n = 29). The median follow-up period was 92 months (TLH) and 98 months (LASH). Sexual function was assessed using the validated Female Sexual Function Index (FSFI). Statistical analyses were performed using a 2 sample t test, Chi test and Fisher's exact test. RESULTS: Over the long term, there was no significant difference in the FSFI total score between TLH and LASH (22.51 vs. 22.25, p-value: 0.261). Within the TLH group, sexual function remained stable compared to baseline data (p = 0.20). In contrast, the LASH group showed a significant deterioration in the total score (p = 0.028), particularly in the lubrication (p = 0.007) over time. CONCLUSION: Both surgical methods ensure comparable sexual function. While TLH shows stable results over the years, LASH shows a significant decrease in some areas of sexual function, particularly with regard to lubrication. However, these differences do not result in a significantly worse overall outcome compared to TLH.
Postnatal water immersion after perinatal death: a clinical study of appearance preservation and autopsy validity.
Starrach T, Neumann JHL, Ehmann L … +7 more , Hahn L, Schouten E, Kehl S, Mahner S, Hasbargen U, Soliman S, Hübener C
Arch Gynecol Obstet · 2026 Jun · PMID 42234228 · Full text
OBJECTIVE: Perinatal loss is an emotionally devastating event for affected families. In some clinical settings, postnatal immersion of perinatally deceased infants in water is used to preserve the infant's external appea...
OBJECTIVE: Perinatal loss is an emotionally devastating event for affected families. In some clinical settings, postnatal immersion of perinatally deceased infants in water is used to preserve the infant's external appearance and facilitate parental farewell. The objective of this study was to evaluate possible effects of this practice on autopsy findings and diagnostic validity. METHODS: In this observational study, 28 infants after perinatal death with available autopsy data were analyzed. Fourteen infants were immersed in cold water after birth (water group) and fourteen infants were stored without water immersion (control group). Macroscopic appearance, degree of maceration, and microscopic findings in liver and lung tissue were assessed during autopsy. Descriptive analyses explored associations between maceration degree and the intervals between fetal death, birth, and autopsy. RESULTS: Infants immersed in water showed improved preservation of external appearance, including skin color, texture, and body posture. No macroscopic differences attributable to water immersion were observed during autopsy. No microscopic differences in the two investigated internal organs were observed between the water and control groups. Maceration grade assessed at autopsy showed no consistent increase with longer birth-autopsy intervals, whereas higher grades were more frequently observed with longer estimated intervals between fetal death and birth in both groups. CONCLUSION: In this observational cohort, postnatal immersion in water after perinatal death was not associated with impaired autopsy findings. Maceration was primarily related to the intrauterine interval between fetal death and delivery rather than postnatal storage conditions. These findings suggest that the water method may offer a simple approach to support parental farewell while maintaining the diagnostic reliability of perinatal autopsy. TRIAL REGISTRATION: Clinical Trials Register (DRKS) (trial registration number DRKS00031373, URL https://www.drks.de ), Registration Date: 27 February 2023.
A predictive model for spontaneous preterm birth and delivery within 7 days in women with threatened preterm labor: a prospective study integrating cervical length, quantitative PAMG-1, and clinical parameters.
Guo J, Zhong L, Xie X … +5 more , Xiong H, Chen Y, Wang L, Lai X, Zhang L
Arch Gynecol Obstet · 2026 Jun · PMID 42234186 · Publisher ↗
PURPOSE: To develop and internally validate predictive models for spontaneous preterm birth (sPTB) in women with threatened preterm labor (TPL). METHODS: This prospective observational study included 264 women with TPL b...
PURPOSE: To develop and internally validate predictive models for spontaneous preterm birth (sPTB) in women with threatened preterm labor (TPL). METHODS: This prospective observational study included 264 women with TPL between 24 + 0 and 36 + 0 weeks of gestation. Candidate predictors available at clinical assessment included demographic, obstetric, sonographic, inflammatory, and cervicovaginal biomarker variables. Least absolute shrinkage and selection operator (LASSO) regression with tenfold cross-validation and the one-standard-error criterion was used for variable selection. Model performance was evaluated using receiver operating characteristic analysis, calibration, bootstrap validation, and decision curve analysis. RESULTS: Eighty-four women (31.8%) experienced sPTB before 37 weeks, and 54 (20.5%) experienced sPTB within 7 days after sampling. Five predictors were retained in both final models: cervical length, quantitative PAMG-1 concentration, C-reactive protein, uterine contraction frequency, and mild vaginal bleeding or spotting. For sPTB before 37 weeks, the apparent AUC was 0.845 (95% CI 0.788-0.903), and the optimism-corrected AUC was 0.830. For 7-day sPTB, the apparent AUC was 0.939 (95% CI 0.900-0.978), and the optimism-corrected AUC was 0.929. The integrated models showed higher discrimination than cervical length alone, PAMG-1 alone, or cervical length plus PAMG-1. CONCLUSION: Integrated models combining cervical length, quantitative PAMG-1, C-reactive protein, uterine contraction frequency, and mild vaginal bleeding or spotting showed promising performance for predicting sPTB in women with TPL. Given the modest sample size and internal validation only, these findings should be considered preliminary and require external validation before clinical implementation.
Diagnostic yield of chromosomal microarray analysis and exome sequencing in fetuses with central nervous system anomalies, with long-term follow-up: a single-center study over a 17-year period.
Feodorovici K, Klinkhammer H, Strizek B … +2 more , Gembruch U, Geipel A
Arch Gynecol Obstet · 2026 Jun · PMID 42230359 · Full text
OBJECTIVE: To assess the diagnostic yield of chromosomal microarray analysis (CMA) and exome sequencing (ES) in fetuses with central nervous system (CNS) anomalies across two study periods (January 2008 to June 2016 and...
OBJECTIVE: To assess the diagnostic yield of chromosomal microarray analysis (CMA) and exome sequencing (ES) in fetuses with central nervous system (CNS) anomalies across two study periods (January 2008 to June 2016 and July 2016 to December 2024), and to evaluate long-term outcomes. METHODS: This retrospective study included cases with fetal CNS anomalies undergoing invasive testing by G-banded karyotyping and, in selected cases, additional CMA and/or ES. Fetuses were classified into four groups: isolated CNS malformations, isolated CNS plus (additional minor abnormalities and dynamic findings), complex CNS anomalies, and multisystem malformations. RESULTS: Among 780 cases, causative findings were identified in 23.8% (25/105) by CMA and 39.0% (73/187) by ES. Use of CMA/ES increased in the second study period (16.3% vs. 59.7%), resulting in more pathogenic findings (26 vs. 72 cases), whereas diagnostic yield among tested cases decreased without significance. The highest ES yield was observed in multisystem CNS anomalies; isolated CNS plus cases showed higher yields than truly isolated CNS cases. In an exploratory subgroup analysis, isolated CNS plus cases with polyhydramnios had a higher CMA/ES yield than truly isolated cases. Among 91 live-born children with follow-up, 49.5% (45/91) had global developmental delay, which was more frequent with pathogenic findings (90.0%, 18/20; p = 0.002) and increasing anomaly complexity (11.1 to 81.8%; p < 0.001). CONCLUSION: Uptake of CMA and ES increased over time and resulted in more etiologic diagnoses. In tested cases, both methods provided meaningful diagnostic yield in fetuses with CNS anomalies and may contribute to prognostic assessment and prenatal counseling.
The incremental yield of CMA over karyotype in fetal ventriculomegaly: a systematic review and meta-analysis.
Sapantzoglou I, Fasoulakis Z, Tasias K … +5 more , Rouvali A, Pegkou A, Theodora M, Daskalakis G, Antsaklis P
Arch Gynecol Obstet · 2026 Jun · PMID 42228177 · Publisher ↗
OBJECTIVE: The main objective of our study was to conduct a systematic literature review and a meta-analysis to evaluate the incremental yield of chromosomal microarray analysis compared to karyotyping in cases of fetal...
OBJECTIVE: The main objective of our study was to conduct a systematic literature review and a meta-analysis to evaluate the incremental yield of chromosomal microarray analysis compared to karyotyping in cases of fetal ventriculomegaly. METHODS: Our review was designed according to the PRISMA guidelines. It included all observational studies that reported the results of CMA testing in fetuses diagnosed with ventriculomegaly (both isolated and non-isolated),in fetuses with isolated ventriculomegaly, in fetuses with non-isolated ventriculomegaly, and in fetuses with mild isolated ventriculomegaly. RESULTS: 16 studies were included with a total of 2137 cases of affected fetuses that met the inclusion criteria for analysis. Combined data from these studies revealed an overall incremental yield of CMA over karyotyping of 7% (95% CI 4-10%) in cases with ventriculomegaly, 4% (95% CI 2-6%) in isolated cases, 10% (95% CI 6-16%) in non-isolated cases, and 2% (95% CI 1-4%) in mild isolated cases. CONCLUSIONS: Our findings may be useful in clinical practice to guide management options and the counseling of the couples to individualize patient care and facilitate clinicians when they come across such a common clinical entity.
Is perinatal outcome of planned vaginal birth in multiple pregnancy influenced by using epidural analgesia: a systematic review.
van der Wal EC, Duvekot JJ, Dons-Sinke IJJ … +3 more , Stolker RJ, Hoeks SE, van der Marel CD
Arch Gynecol Obstet · 2026 Jun · PMID 42228176 · Publisher ↗
PURPOSE: Epidural analgesia (EA) is considered safe and advantageous in twin deliveries, yet specific evidence to support this practice is scarce. This systematic review aims to identify the impact of EA on perinatal out...
PURPOSE: Epidural analgesia (EA) is considered safe and advantageous in twin deliveries, yet specific evidence to support this practice is scarce. This systematic review aims to identify the impact of EA on perinatal outcomes during planned vaginal twin deliveries. METHODS: A literature search was conducted to identify studies involving vaginal multiple delivery with EA. Newcastle-Ottawa scale quality assessments were performed, and baseline characteristics and perinatal outcomes were extracted. RESULTS: Seven retrospective cohort studies were included. Quality scores ranged from 5 to 8/8 stars. Baseline characteristics and reported outcome measures were heterogenous. When comparing EA to non-EA users, incidence of CS after vaginal trial of labor was similar in one study (13% vs 21%, OR 1.65 [0.70-3.90]), but lower in another study (7% vs 15%, OR 0.0435 [0.022-0.083]). A third study reported a beneficial effect of EA for the second twin only. Anesthesiologic strategies for emergency CS were not reported. Instrumental delivery was increased or similar for women in the EA group. Apgar scores for deliveries using EA were not reduced. Perinatal mortality for the second twin was similar. CONCLUSION: EA in planned vaginal twin delivery seems to be associated with a reduced incidence of CS, a higher risk of assisted delivery, and an increased second-stage length. However, evidence of the associated consequences for mothers and neonates is limited. Given the limited number of eligible studies and reported outcomes, further research is needed to definitively assess the current practice of routine epidural administration for multiple deliveries, and to correctly inform women of its risks/benefits.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe