Archives Of Gynecology And Obstetrics[JOURNAL]
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200 papers
Cervical length following cerclage as a predictor of spontaneous preterm birth.
Wolf MF, Kinog L, Tuma R … +3 more , Lowenstein L, Odeh M, Sgayer I
Arch Gynecol Obstet · 2026 May · PMID 42098365 · Full text
OBJECTIVE: We aimed to evaluate the association between serial transvaginal cervical length measurements following McDonald cerclage and spontaneous preterm birth (PTB). METHODS: This retrospective study included singlet...
OBJECTIVE: We aimed to evaluate the association between serial transvaginal cervical length measurements following McDonald cerclage and spontaneous preterm birth (PTB). METHODS: This retrospective study included singleton pregnancies with cerclage performed during 2010-2024. Cerclage was placed prophylactically (n = 109) based on obstetric history, or emergently (n = 46) due to ultrasound findings. Cervical length was measured by transvaginal ultrasound before and after cerclage, and at 2-week intervals until 32 weeks. RESULTS: For the prophylactic group, the median cervical length was shorter among those who delivered PTB < 37 weeks (n = 23) than term: at 21-22 + 6 weeks (2.5 vs. 3.9 cm, p = 0.042), 23-24 + 6 weeks (2.0 vs. 3.4 cm, p = 0.016), 25-26 + 6 weeks (3.0 vs. 3.8 cm, p = 0.042), and 31-32 + 6 weeks (2.4 vs. 3.4 cm, p = 0.015). In multivariable analysis adjusted for history of PTB, progesterone use, and gestational age at cerclage placement, shorter cervical length, at 23-24 + 6 weeks (adjusted odds ratio [aOR] 4.13, 95% confidence interval [CI] 1.23-13.89, p = 0.021) and at 25-26 + 6 weeks (aOR 3.39, 95% CI 1.08-10.64, p = 0.037), was independently associated with PTB < 37 weeks. Cervical length at 25-26 + 6 weeks was associated with PTB < 32 weeks (aOR 4.76, 95% CI 1.20-19.60, p = 0.027). For the emergency group, the median cervical length was shorter among those who delivered < 32 weeks than later, at 23-24 + 6 weeks (1.4 vs. 3.2 cm, p = 0.049) and 25-26 weeks (1.5 vs. 2.3 cm, p = 0.041). CONCLUSION: Serial cervical length monitoring after cerclage provides a clinically relevant prediction of spontaneous PTB.
Severe maternal morbidity in patients of advanced maternal age with and without metabolic syndrome.
Robb C, Strafella R, Ayar J … +5 more , Prizzi O, Htwe S, Weiss S, Drugge E, Dandolu V
Arch Gynecol Obstet · 2026 May · PMID 42084631 · Full text
PURPOSE: To estimate the burden of metabolic syndrome (MetS) on severe maternal morbidity (SMM) in women of advanced maternal age (AMA), quantify age-related escalation in SMM risk, and evaluate sociodemographic influenc...
PURPOSE: To estimate the burden of metabolic syndrome (MetS) on severe maternal morbidity (SMM) in women of advanced maternal age (AMA), quantify age-related escalation in SMM risk, and evaluate sociodemographic influences. METHODS: We retrospectively conducted a cross-sectional, population-level analysis of the Nationwide Inpatient Sample (Q4 2015-2019), a discharge-level database, to identify delivery hospitalizations among patients aged ≥ 35 years. MetS was defined by ICD-10 codes indicating ≥ 3 of the following: hypertension, type 2 diabetes, obesity, hypertriglyceridemia, or low high-density lipoprotein cholesterol. The primary outcome was SMM as defined by the Centers for Disease Control and Prevention; a secondary outcome excluded blood transfusion. Multivariable logistic regression adjusted for race, income quartile, primary payer, hospital characteristics, and substance use. Weighted adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. RESULTS: Among 3.1 million delivery hospitalizations, 556,609 (17.8%) occurred in AMA patients; 12,188 (2.2%) experienced SMM and 6,528 (1.2%) experienced nontransfusion SMM. SMM was significantly higher among patients with MetS compared to those without (7.37% vs 2.17%; nontransfusion SMM: 5.36% vs 1.16%). SMM rates increased with advancing age. After adjustment, MetS was associated with markedly increased odds of SMM (AOR 2.75, 95% CI 2.29-3.30) and nontransfusion SMM (AOR 3.59, 95% CI 2.90-4.44), both p < 0.001. CONCLUSION: MetS is associated with SMM risk among AMA patients, independent of sociodemographic factors, with risk increasing further at older maternal ages. This study quantifies the disproportionate burden of MetS in this high-risk population.
Trends and adverse pregnancy outcomes associated with post-traumatic stress disorder: a population-based study of delivery hospitalisations.
Quinn D, Donnelly M, Kane JPM … +2 more , Kent L, O'Neill C
Arch Gynecol Obstet · 2026 May · PMID 42069862 · Full text
PURPOSE: This study examined the prevalence of post-traumatic stress disorder (PTSD) diagnoses among pregnant women who delivered in hospitals in the United States between 2016 and 2020, and explored associations with ad...
PURPOSE: This study examined the prevalence of post-traumatic stress disorder (PTSD) diagnoses among pregnant women who delivered in hospitals in the United States between 2016 and 2020, and explored associations with adverse pregnancy outcomes, hospital length of stay, and hospital costs. METHODS: This cross-sectional study utilised survey-weighted data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to estimate sample characteristics and prevalence trends. Logistic regression models were used to analyse associations between PTSD and adverse pregnancy outcomes. Length of hospital stay and hospital costs were examined using negative binomial and generalised linear models with log link and gamma distribution, respectively. RESULTS: PTSD prevalence increased from 236.3 to 545.8 per 100,000 delivery hospitalisations between 2016 and 2020 (p < 0.001; average annual percentage change [AAPC] 23.0%). PTSD was associated with a higher prevalence of comorbidity, increased odds of preterm delivery (adjusted odds ratio [aOR] 1.13; 95% CI 1.08-1.18), and increased odds of fetal growth restriction (aOR 1.09; 95% CI 1.01-1.17, p = 0.03). Longer hospital stays and higher costs were also observed among women with PTSD. CONCLUSION: These findings highlight a rising prevalence of PTSD among pregnant women who delivered in hospitals in the United States over the study period. PTSD was associated with higher prevalence of comorbidity, and increased length of stay and hospital cost. Further research is warranted to investigate the reasons behind the trend, and to clarify the temporal relationship between prenatal PTSD and adverse pregnancy outcomes.
Does suture number matter in transvaginal cervical cerclage? A propensity score-weighted cohort study.
Kahraman E, Köroğlu N, Aydın T … +1 more , Yüksel MA
Arch Gynecol Obstet · 2026 May · PMID 42068375 · Full text
PURPOSE: To evaluate whether the number of sutures used during transvaginal cervical cerclage influences obstetric and neonatal outcomes when surgical technique, suture material, and perioperative management are standard...
PURPOSE: To evaluate whether the number of sutures used during transvaginal cervical cerclage influences obstetric and neonatal outcomes when surgical technique, suture material, and perioperative management are standardized. METHODS: This retrospective cohort study included 125 women who underwent transvaginal cervical cerclage using identical monofilament suture material. Cerclage was performed with either a single suture (n = 23) or a double suture (n = 102) in this non-randomized observational cohort. The primary outcome was term delivery (≥ 37 weeks' gestation). Secondary outcomes included gestational age at delivery and selected neonatal outcomes. To address non-random allocation and baseline group imbalance, propensity scores were estimated using pre-treatment maternal, obstetric, and clinical severity variables. Stabilized inverse probability of treatment weighting (IPTW) with truncation was applied, and doubly robust outcome models were used to estimate adjusted associations. Neonatal outcomes were analyzed at the pregnancy level to account for clustering in twin gestations. RESULTS: Women receiving double-suture cerclage presented at earlier gestational ages and with greater markers of cervical severity at baseline; however, after IPTW and doubly robust adjustment accounting for these baseline differences, no statistically significant difference in term delivery was observed. Secondary obstetric outcomes, including gestational age at delivery, were also comparable between groups after adjustment. Pregnancy-level neonatal outcomes, including NICU admission and neonatal mortality, did not differ meaningfully by suture number. Sensitivity analysis restricted to singleton pregnancies and stratified by cerclage indication yielded consistent results. CONCLUSION: After accounting for baseline cervical severity and clinical indication, single- and double-suture transvaginal cerclage was associated with comparable obstetric and neonatal outcomes under standardized surgical conditions. These findings suggest that cervical status at the time of cerclage placement, rather than the number of sutures applied, is the primary determinant of outcome.
The predictive role of Ki67 in pathological complete response (pCR) and invasive disease-free survival (IDFS) in HER2-positive breast cancer: a bi-centric retrospective cohort study of 244 cases.
Weydandt L, Agabejli S, Lia M … +3 more , Wimberger P, Aktas B, Link T
Arch Gynecol Obstet · 2026 May · PMID 42068346 · Full text
PURPOSE: The purpose of this study was to examine whether Ki67-scores have a predictive significance for pathological complete response (pCR) and invasive disease-free survival (IDFS) in HER2-positive breast cancer. METH...
PURPOSE: The purpose of this study was to examine whether Ki67-scores have a predictive significance for pathological complete response (pCR) and invasive disease-free survival (IDFS) in HER2-positive breast cancer. METHODS: This retrospective, bi-centric cohort study focused on HER2-positive early breast cancer patients undergoing neoadjuvant chemotherapy from 2015 to 2023. Multivariable logistic regression was used to find independent association between various clinical parameters, including Ki67, and pCR. Ki67-values were categorized into three groups (low ≤ 15%, intermediate 15-35%, high > 35%). Kaplan-Meier estimator calculated differences in IDFS. RESULTS: The study included 244 patients with known Ki67-expression. 147 patients (60.3%) achieved pCR. When categorized, 18 (7.4%) were Ki67 low, 114 (46.7%) Ki67 intermediate and 112 (45.9%) Ki67 high. No correlation between Ki67-score as continuous variable and pCR was observed (p = 0.25). HER2 immunohistochemistry (IHC) score 3 + significantly increased pCR compared to IHC score 2 + (63.2% vs. 45%, p = 0.031). Hormone receptor (HR)-positive tumors had a lower pCR rate (53.1% vs. 74.4%, p = 0.001) compared to HR-negative tumors. 5-year IDFS showed no difference between low Ki67 (88.9%; 95% CI 75.5-100%), intermediate Ki67 (82.0%; 95% CI 72.6-92.7%), and high Ki67 (80.9%, 95% CI 70.1-92.3%) subgroups (p = 0.7). CONCLUSION: In HER2-positive breast cancer, the Ki67-score showed no association with either pCR or IDFS, thereby questioning its clinical utility. Conversely the HER2 IHC-score and HR-status were predictive indicators for achieving pCR. Clinical decisions in patients with early HER2-positive breast cancer should not be influenced by Ki67-scores, especially not by using cut-offs.
Episiotomy and the risk of obstetric anal sphincter injury in nulliparous women with a prolonged second stage.
Bachar G, Rosenthal S, Gridish N … +4 more , Justman N, Khatib N, Solt I, Zipori Y
Arch Gynecol Obstet · 2026 Apr · PMID 42056611 · Full text
PURPOSE: This study aimed to evaluate whether episiotomy reduces obstetric anal sphincter injuries (OASIS) rates in nulliparous women with a second stage of labor lasting ≥ 3 h. METHODS: This retrospective study focused...
PURPOSE: This study aimed to evaluate whether episiotomy reduces obstetric anal sphincter injuries (OASIS) rates in nulliparous women with a second stage of labor lasting ≥ 3 h. METHODS: This retrospective study focused on nulliparous women at ≥ 36 weeks of gestation with singleton pregnancies who experienced a second stage of labor lasting ≥ 3 h and ultimately achieved spontaneous, non-operative, vaginal delivery between 2014 and 2024. Participants were categorized into two groups based on their episiotomy status. The primary outcome was the occurrence of OASIS, namely third- and fourth-degree perineal lacerations. RESULTS: The study included 1164 (58.3%) women who underwent episiotomy and 831 (41.7%) who did not. Women in the episiotomy group were significantly younger (27.79 ± 4.31 vs. 28.47 ± 4.51 years, p < 0.001), had a higher prevalence of hypertensive disorders (7.7% vs. 5.2%, p = 0.029), experienced a slightly longer second stage of labor (3.62 ± 0.4 vs. 3.53 ± 0.4 h, p < 0.001), and delivered newborns with higher birthweight (3366 ± 390 vs. 3284 ± 376 g, p < 0.001). The OASIS rates were comparable between the groups (1.9% vs. 2.2%, p = 0.82), consistent across all subtypes and in a subanalysis of women with a second stage of ≥ 4 h (2.9% vs. 2.5%, p = 0.59). In adjusted multivariable analysis, episiotomy was not associated with OASIS (adjusted OR 0.95, 95% CI 0.48-1.84). CONCLUSION: In nulliparous women with spontaneous vaginal delivery and a prolonged second stage (≥ 3 h), episiotomy was not associated with a reduced risk of OASIS, even when the second stage exceeded 4 h. Our findings support existing guidelines that advocate against routine episiotomy in this population.
Advanced fetal cardiac monitoring in gestational diabetes mellitus: HbA1c remains the relevant predictor of perinatal outcome under optimal metabolic control.
Kömmel LH, Ortlam H, Loewe RS … +8 more , Schürer C, Heimann Y, Schmidt A, Fiedler F, Weschenfelder F, Schleußner E, Groten T, Zöllkau J
Arch Gynecol Obstet · 2026 Apr · PMID 42056543 · Full text
PURPOSE: Perinatal complications can occur in gestational diabetes mellitus (GDM) despite adequate metabolic control and standard diagnostics. Metabolic alterations can cause structural and functional changes in the fetu...
PURPOSE: Perinatal complications can occur in gestational diabetes mellitus (GDM) despite adequate metabolic control and standard diagnostics. Metabolic alterations can cause structural and functional changes in the fetus, especially in the cardiovascular system, by affecting the autonomic nervous system and the cardiac conduction system. Advanced fetal cardiac monitoring may provide detailed insights into these processes and their impact on perinatal outcomes. METHODS: In this exploratory, prospective, single-center cohort study, 172 women with singleton pregnancies between 33 + 0 and 40 + 0 weeks were recruited (56 GDM, 116 controls). Non-invasive fetal ECG (fECG) and computerized cardiotocography (cCTG) assessed the fetal heart rate variability (HRV) and heart time intervals (HTI). Adverse perinatal outcomes (APO) were defined as a composite of the clinically relevant endpoints of operative delivery or emergency cesarean for fetal distress, NICU admission, umbilical cord pH < 7.1, and/or 5-min APGAR < 7. Predictive potential was evaluated using univariate and multivariate regression models. RESULTS: The median HbA1c in the GDM group was 5.32%, indicating overall good metabolic control. One hundred forty-five cCTGs and one hundred sixty-three fECGs provided data on HTI and fetal HRV parameters. HTI did not differ between GDM and controls. Although fetal HRV parameters differed, they did not add predictive value for APO. Only maternal metabolic status, as reflected by HbA1c, showed a measurable association with APO (OR 12.83, 95% CI 1.34-122.94). CONCLUSION: In well-controlled GDM pregnancies, HRV and HTI derived from fECG and cCTG do not enhance risk prediction for APO. Maternal HbA1c remains predictive for the perinatal risk, underscoring the importance of strict metabolic control.
Improving future care: the role of oncofertility education in medical curricula in Germany. Results of a nationwide survey of 346 medical students.
Altmann J, Dimitrova D, Stark E … +3 more , Einsiedel N, Heistermann L, Sehouli J
Arch Gynecol Obstet · 2026 Apr · PMID 42056266 · Full text
OBJECTIVE: To study the existing knowledge, interests, and attitudes of medical students regarding fertility preservation measures. DESIGN: A multi-center nationwide survey was conducted among medical students across Ger...
OBJECTIVE: To study the existing knowledge, interests, and attitudes of medical students regarding fertility preservation measures. DESIGN: A multi-center nationwide survey was conducted among medical students across Germany. The survey consisted of 15 multiple-choice questions and six questions asking participants their level of agreement of a statement. SUBJECTS: 346 medical students in Germany. MAIN OUTCOME MEASURES: A multiple-choice questionnaire was used to evaluate the existing knowledge, interest and attitudes of medical students regarding fertility preservation measures. RESULTS: Regarding the assessment of ovarian reserve, Anti-Müllerian hormone testing was known by 38.8% of students, while only 15.9% were familiar with the antral follicle count method. The most widely recognized fertility preservation (FP) method was oocyte cryopreservation (91.0%), followed by ovarian tissue cryopreservation (45.1%), ovarian transposition surgery prior to pelvic radiation (38.2%), and the use of gonadotropin-releasing hormone analogs for ovarian protection during chemotherapy (28.6%). Regarding reproductive technologies, such as IVF, ICSI, or hormonal stimulation, 87.5% of students expressed a positive opinion. Oocyte donation was perceived positively by 77.6%. The acceptance for uterus transplantation was high among participants with 61.4%. The acceptance for surrogacy was lower with 53.2% of respondents. Social freezing was positively received by most respondents (72.7%). 80.0% of respondents expressed interest in expanding their knowledge of fertility and cancer, and 65.9% desired additional training. CONCLUSIONS: To ensure high-quality fertility preservation counseling and the implementation of necessary FP measures for all cancer patients of childbearing age, it is crucial that future physicians are familiar with methods for assessing ovarian reserve and fertility preservation techniques. Strengthening oncofertility training in medical education will enhance future physicians' ability to provide informed counseling and timely referrals, ultimately improving patient care and quality of life. This study highlights the urgent need to systematically integrate fertility preservation and oncofertility into the curriculum of medical schools in Germany.
Benefits of minimal ethanol volume and retention without removal in transvaginal ethanol sclerotherapy for endometriomas.
Moon HS, Joo BS, Koo J … +3 more , Nam KI, Koo JB, Kim SG
Arch Gynecol Obstet · 2026 Apr · PMID 42053850 · Full text
PURPOSE: This study aims to introduce an effective protocol for transvaginal ethanol sclerotherapy, focussing on the aspiration of viscous cystic content and the amount of ethanol instilled in the cystic cavity according...
PURPOSE: This study aims to introduce an effective protocol for transvaginal ethanol sclerotherapy, focussing on the aspiration of viscous cystic content and the amount of ethanol instilled in the cystic cavity according to cyst size. METHODS: We retrospectively reviewed the medical records of 90 women who underwent transvaginal ethanol sclerotherapy from 2015 to 2022 at Good Moonhwa Hospital, Busan, Republic of Korea. The volume of ethanol used for sclerotherapy was determined based on the initial volume of aspirated cystic content, with a target limit of 30 cc, and the injected alcohol was retained within the cystic cavity. All patients were followed up on postoperative days 1 and 2, at 2 weeks, 4 weeks, 3 months, 6 months, 12 months, and every 6 months thereafter to assess the ovary, AMH level, complications, recurrence, and pregnancy outcome. RESULTS: The cyst size was 5.07 ± 1.56 cm. AMH levels increased in 22 cases (27.4%) and decreased in 68 cases (75.6%). Among the 68 cases that decreased, 38 cases (55.9%) showed a mild decrease of less than 30%. The change rates in AMH levels did not significantly correlate with cyst size, aspirated cyst volume, alcohol instillation volume, operation time, recurrence rate, or pregnancy outcome. The volume of alcohol instilled significantly correlated with operation time. Of the 44 patients (78.9%) who wished to conceive, 17 (38.6%) became pregnant (12 spontaneously and 5 via IVF-ET). Recurrence occurred in 6 cases (6.67%). CONCLUSION: This study demonstrates that our protocol for ethanol sclerotherapy not only significantly reduces the recurrence rate but also preserves ovarian reserve, as reflected by the minimal impact on AMH.
Induction of labor in women with prior cesarean section: outcomes in a selected low-risk population.
Kehl S, Weiss C, Düster H … +6 more , Bader S, Faschingbauer F, Schneider M, Beckmann MW, Dammer U, Pretscher J
Arch Gynecol Obstet · 2026 Apr · PMID 42053821 · Full text
PURPOSE: To investigate the impact of a previous cesarean section on maternal and perinatal outcomes in term pregnancies undergoing labor induction. METHODS: In this retrospective cohort study, women with singleton, low-...
PURPOSE: To investigate the impact of a previous cesarean section on maternal and perinatal outcomes in term pregnancies undergoing labor induction. METHODS: In this retrospective cohort study, women with singleton, low-risk term pregnancies and labor induction were compared according to the presence or absence of a previous cesarean delivery. The primary outcome was a composite of adverse maternal and perinatal events. Secondary outcomes included cesarean section rate, mode of vaginal delivery, and specific maternal or neonatal complications. RESULTS: The rate of composite adverse outcomes was comparable between groups (21.9% vs. 23.7%, p = 0.4826). However, placental abruption (1.3% vs. 0.3%, p = 0.0251), suspected triple I (1.9% vs. 0.4%, p = 0.0040), and shoulder dystocia (2.3% vs. 0.8%, p = 0.0265) occurred more frequently in women with a previous cesarean section. Abnormal cardiotocography (27.1% vs. 20.4%, p = 0.0058), operative vaginal delivery (17.8% vs. 11.9%, p = 0.0052), umbilical artery pH < 7.10 (4.9% vs. 2.8%, p = 0.0381), and the need for fetal blood sampling (8.7% vs. 5.0%, p = 0.0055) were also more common in this group. There was no difference in neonatal unit transfer (10.0% vs. 11.5%, p = 0.4328) or low Apgar scores (< 5 at 5 min: 0.3% vs. 0.4%, p = 1.0000). Cesarean section rates were similar (14.8% vs. 14.9%, p = 0.9692). In multivariable analysis, absence of prior vaginal delivery (OR = 3.460, p < 0.0001), higher maternal BMI (OR = 1.038, p < 0.0001), and older maternal age (OR = 1.033, p = 0.0002) were independently associated with adverse outcomes, whereas previous cesarean section was not. CONCLUSION: Labor induction in women with a prior cesarean section was not associated with increased risk for composite adverse maternal or perinatal outcomes. Nonetheless, TOLAC should be conducted in settings with immediate access to obstetric and neonatal intervention.
Role of placental glucose metabolism in steroidogenesis in healthy pregnancies at term.
Sajjad MU, Henriksen T, Haugen G … +1 more , Michelsen TM
Arch Gynecol Obstet · 2026 Apr · PMID 42050206 · Full text
BACKGROUND: The human placenta consumes, on average, one third of the glucose from maternal blood. However, the role of placental glucose consumption in the production of estradiol and progesterone remains unclear. We hy...
BACKGROUND: The human placenta consumes, on average, one third of the glucose from maternal blood. However, the role of placental glucose consumption in the production of estradiol and progesterone remains unclear. We hypothesized that placental glucose consumption in humans is associated with steroid production via a non-glycolytic pathway. METHODS: We included 41 healthy pregnancies at term. Blood samples were obtained from the maternal radial artery, uterine vein, and from the umbilical artery and vein during scheduled cesarean delivery. Blood flow in the uterine artery and umbilical vein was measured using Doppler ultrasound. Plasma concentrations of estradiol, progesterone, glucose, insulin, lactate, and ketones were analyzed. We calculated uteroplacental uptake and consumption of maternal glucose and ketones, and the loss of uteroplacental lactate in 6-carbon units as well as the release of steroid hormones into maternal circulation. RESULTS: Our data revealed a net placental release of estradiol and progesterone into maternal circulation [24.1 (5.34, 49.8) and 560.3 (61.2, 798.2) nmol/min, respectively]. The release of estradiol was positively associated with uteroplacental glucose uptake (ρ = 0.59, p < 0.001) and consumption (ρ = 0.43, p = 0.005), while progesterone exhibited similar associations (ρ = 0.61, p < 0.001; ρ = 0.43, p = 0.005). Notably, both hormones correlated positively with lactate-adjusted uteroplacental glucose consumption but not with acetate-equivalent uteroplacental ketone consumption. CONCLUSION: Placental release of estradiol and progesterone correlates with uteroplacental consumption of glucose that primarily occurs via non-glycolytic pathways in the third trimester placenta.
Walking through trimesters: a quantitative assessment of step counts before and during pregnancy and their impact on pregnancy outcomes.
Ovadia M, Nattiv N, Podorovsky Banker R … +6 more , Daykan Y, Schonman R, Biron Shental T, Kovo M, Yagur Y, Weitzner O
Arch Gynecol Obstet · 2026 Apr · PMID 42050160 · Full text
OBJECTIVE: To examine walking behavior during pregnancy and its association with obstetric and neonatal outcomes. METHODS: This retrospective cohort study included pregnant patients who delivered between 2020 and 2024 at...
OBJECTIVE: To examine walking behavior during pregnancy and its association with obstetric and neonatal outcomes. METHODS: This retrospective cohort study included pregnant patients who delivered between 2020 and 2024 at a tertiary medical center. Daily step counts were recorded via the Health Auto Expert mobile application from three months before conception until admission to the labor ward. Pregnancy and delivery data were obtained from medical records. The primary outcome was a composite of delivery complications by step-count category: Above-Average and Below-Average, based on the cohort mean. Secondary outcomes included postpartum complications, mode of delivery, and neonatal outcomes. RESULTS: The mean daily step count during pregnancy was 2539, declining progressively with gestation. Of 176 patients, 71 (40%) were Above-Average and 105 (60%) Below-Average. The Above-Average group had higher pre-pregnancy activity (4541.7 vs 2330.3 steps/day, p < 0.001) and higher maternal age. No significant differences were found in composite delivery or postpartum complications. Vacuum extraction was more frequent in the Above-Average group (15.5% vs 3.8%, p = 0.014), though not significant after adjustment. Median neonatal birth-weight percentile was 54.5, lower in the Above-Average group (44.0 [25.0-71.0] vs 60.0 [38.0-78.0], p = 0.024), without significance in multivariable analysis. CONCLUSIONS: Walking patterns declined across pregnancy. Step count was not associated with delivery complications or adverse maternal or neonatal outcomes. Walking during pregnancy appears safe and was not associated with adverse maternal or neonatal outcomes in this predominantly sedentary cohort of low-risk pregnancies.
Transvaginal ultrasonographic characteristics of different types of residual pregnancy tissue in patients with incomplete medication abortion.
Li Z, Chen M, Lu D … +1 more , Lu Q
Arch Gynecol Obstet · 2026 Apr · PMID 42050155 · Full text
OBJECTIVE: This retrospective study aimed to investigate the transvaginal ultrasound (TVUS) characteristics of different pathological types of retained products of conception (RPOC)-chorionic-decidual versus non-chorioni...
OBJECTIVE: This retrospective study aimed to investigate the transvaginal ultrasound (TVUS) characteristics of different pathological types of retained products of conception (RPOC)-chorionic-decidual versus non-chorionic-decidual-following incomplete medication abortion, to provide an imaging basis for individualized clinical management. METHODS: A total of 300 patients with incomplete medication abortion treated at Kunshan Traditional Chinese Medicine Hospital between January 2023 and June 2025 were enrolled. Based on histopathological examination, patients were categorized into a chorionic-decidual group (n = 214) and a non-chorionic-decidual group (n = 86). All patients underwent TVUS examination, which assessed uterine volume, residual tissue morphology (mass-like vs. patchy), echogenicity pattern (hyperechoic, hypoechoic, mixed), local blood flow distribution (graded by the Alder classification), and hemodynamic parameters (pulsatility index, PI; resistance index, RI). Receiver operating characteristic (ROC) analysis was performed to determine optimal cut-off values for PI and RI. Multivariable logistic regression was used to identify independent predictors of chorionic-decidual RPOC. RESULTS: The proportion of patients with increased uterine volume was significantly higher in the chorionic-decidual group than in the non-chorionic-decidual group (33.18% vs. 8.14%, P = 0.003). Residual tissue in the chorionic-decidual group predominantly presented as mass-like (80.84%), whereas in the non-chorionic-decidual group, it was mainly patchy (87.21%), with a significant intergroup difference (P < 0.001). Echogenicity in the chorionic-decidual group was primarily hypoechoic (28.97%) or mixed (55.61%), while the non-chorionic-decidual group showed predominantly hyperechoic signals (74.42%) (P < 0.001). Residual tissue in the chorionic-decidual group demonstrated significantly richer blood flow (Alder grades II-III: 89.72% vs. 10.47%, P < 0.001) and lower hemodynamic indices (PI: 0.87 ± 0.14 vs. 1.49 ± 0.20; RI: 0.62 ± 0.08 vs. 0.75 ± 0.12; both P < 0.001) compared to the non-chorionic-decidual group. Multivariable logistic regression identified mass-like morphology (OR = 12.34, 95% CI: 5.21-29.23, P < 0.001), mixed/hypoechoic echogenicity (OR = 8.76, 95%CI: 3.98-19.28, P < 0.001), and Alder grade II-III blood flow (OR = 15.67, 95%CI: 6.54-37.56, P < 0.001) as independent predictors of chorionic-decidual RPOC. ROC analysis suggested that PI and RI had good discriminatory ability within this cohort, with exploratory cut-offs of ≤ 1.12 for PI (sensitivity 87.4%, specificity 83.7%) and ≤ 0.68 for RI (sensitivity 84.6%, specificity 81.4%). These cut-off values are derived from the current dataset and require external validation. CONCLUSIONS: Within the selected cohort of patients requiring surgical evacuation, chorionic-decidual and non-chorionic-decidual RPOC exhibit distinct TVUS characteristics. Chorionic-decidual RPOC is characterized by vascular, mass-like lesions with hypoechoic/mixed echogenicity and low-resistance blood flow, while non-chorionic-decidual RPOC typically appears as avascular, patchy, hyperechoic foci with high-resistance flow. These findings demonstrate associations between sonographic patterns and histopathological types, within this surgically managed cohort, TVUS demonstrates associations with histopathological types that warrant further investigation in broader populations. Prospective validation in broader populations is warranted.
Intravaginal progesterone as a fertility-sparing treatment for symptomatic adenomyosis: preliminary results from a monocentric study.
De Cicco Nardone C, Sangiovanni MC, Sangiovanni GM … +5 more , Plotti F, Montera R, Luvero D, Angioli R, Terranova C
Arch Gynecol Obstet · 2026 Apr · PMID 42050103 · Full text
PURPOSE: Adenomyosis is a chronic uterine disorder characterised by ectopic endometrial tissue within the myometrium, frequently associated with dysmenorrhea, abnormal uterine bleeding (AUB), chronic pelvic pain (CPP), a...
PURPOSE: Adenomyosis is a chronic uterine disorder characterised by ectopic endometrial tissue within the myometrium, frequently associated with dysmenorrhea, abnormal uterine bleeding (AUB), chronic pelvic pain (CPP), and dyspareunia. No standardised guidelines are currently available for its management, and therapeutic options remain limited for women seeking fertility preservation. This study aimed to evaluate the efficacy of intravaginal progesterone in alleviating adenomyosis-related symptoms in patients seeking fertility preservation. METHODS: In this prospective monocentric observational study, 85 patients aged 22-50 years with ultrasound-confirmed symptomatic adenomyosis were enrolled between April 2020 and April 2024. Inclusion criteria were age 18-55 years, BMI 18-35, and a Visual Analogue Scale (VAS) score ≥ 7 for dysmenorrhea, AUB, CPP, or dyspareunia. All patients received 200 mg/day of intravaginal progesterone for 10 days per cycle. Symptom severity was assessed using VAS scores at baseline and at 6 months. Data were analysed using non-parametric statistical tests. RESULTS: Sixty-five patients completed the 6-month follow-up. Four patients conceived during treatment and were excluded from the final analysis. Statistically significant improvements were observed for all assessed symptoms (all p < 0.05). Median VAS scores decreased for dysmenorrhea (9 to 6, p < 0.001), AUB (8 to 6, p < 0.001), chronic pelvic pain (5.5 to 3.5, p < 0.001), and dyspareunia (2 to 0, p = 0.020). The overall treatment satisfaction was high, with a mean Likert score of 7.5 out of 10. CONCLUSION: Intravaginal progesterone appears to be an effective fertility-sparing treatment for symptomatic adenomyosis, providing significant relief across all primary symptoms, with high patient satisfaction. Larger controlled studies are warranted to confirm these preliminary findings and further define its role in clinical practice.
Comparing oxytocin alternatives for postpartum hemorrhage prevention in vaginal and caesarean births: a systematic review and meta-analysis.
Devi S, Suryavanshi MR, Chandrababu R
Arch Gynecol Obstet · 2026 Apr · PMID 42050041 · Full text
BACKGROUND: In this systematic review and meta-analysis, we aimed to explore the availability of alternatives to oxytocin for preventing postpartum haemorrhage (PPH) during vaginal births (VB) and caesarean births (CB)....
BACKGROUND: In this systematic review and meta-analysis, we aimed to explore the availability of alternatives to oxytocin for preventing postpartum haemorrhage (PPH) during vaginal births (VB) and caesarean births (CB). METHODS: We followed the Cochrane guidelines for the review, and reported the results using the PRISMA guidelines. Using a thorough search strategy, we retrieved original articles from SCOPUS, PubMed, Web of Science, and the Cochrane Library from January 2015 to February 2025. We analyzed the RCTs to compare Tranexamic Acid (TXA), carbetocin, and misoprostol with oxytocin for preventing PPH in both vaginal and caesarean births. The review's protocol has been officially registered with PROSPERO under the identifier CRD420251002602. RESULTS: A meta-analysis of 20 trials showed no statistically significant difference in reducing blood loss during vaginal births (SMD = - 0.21; 95% CI - 0.62 to 0.19; I = 96%). However, contrasting results were observed in cesarean births (SMD = - 0.82; 95% CI - 1.49 to - 0.16; p = 0.02). Correspondingly, no statistically significant difference was found in the occurrence of PPH in vaginal births (OR = 0.80; 95% CI 0.53 to 1.21; I = 98%), while significant variances were detected in cesarean births (OR = 0.58; 95% CI 0.43 to 0.80; I = 21%). Hemoglobin variation was notably lower in both vaginal and cesarean births (SMD = - 0.32; 95% CI - 0.49 to - 0.16; I = 93%) and (SMD = - 0.90; 95% CI - 1.52 to - 0.27; I = 96%), respectively. CONCLUSION: Considering the substantial heterogeneity and mostly non-significant pooled results, the current findings should be viewed as indicative rather than conclusive. Further rigorous, well-designed randomized controlled trials are necessary to better define their effectiveness, optimize dosing, and identify patient groups most likely to benefit.
A cohort study of fetal urinary tract abnormalities and chromosomal copy number variations: a retrospective analysis of 9-year data.
Chen L, Yang W, Liu L … +9 more , Shen H, Wang C, Wang R, Li Q, Liu Y, Di Z, Lv N, Huang X, Liu M
Arch Gynecol Obstet · 2026 Apr · PMID 42050002 · Full text
OBJECTIVE: To investigate the association between ultrasonically detected fetal urinary system abnormalities and chromosomal copy number variations (CNVs) in Heilongjiang Province, northeastern China. METHODS: Cohort stu...
OBJECTIVE: To investigate the association between ultrasonically detected fetal urinary system abnormalities and chromosomal copy number variations (CNVs) in Heilongjiang Province, northeastern China. METHODS: Cohort study: 183 fetuses with ultrasound-detected urinary system anomalies (invasive prenatal diagnosis, 2017.01-2025.09, Second Affiliated Hospital of Harbin Medical University) were enrolled. All underwent CNV analysis: 21 without karyotyping, 12 with abnormal karyotypes, 150 with normal karyotypes. The 150 normal-karyotype cases were split into isolated CAKUT (63, 42%) and non-isolated CAKUT (87, 58%) groups; CNV abnormalities were compared between groups. META-ANALYSIS: Studies on CNVs in CAKUT fetuses (2017.01-2025.09) were retrieved from PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Data, SinoMed. Pooled effect sizes were calculated via Stata 17.0. RESULTS: Among 162 fetuses who underwent conventional karyotyping, chromosomal aneuploidy occurred in 7.41% (12/162). In 150 karyotypically normal cases, pathogenic/likely pathogenic (p/lp) CNVs were detected in 7.33% (11/150): 3.17% (2/63) for isolated CAKUT and 10.34% (9/87) for non-isolated CAKUT (P = 0.120, non-significant). A meta-analysis of 30 studies (9284 pregnant women) demonstrated a weighted pooled incidence of p/lp CNVs of 6% (95% CI 0.05-0.07) in karyotypically normal CAKUT fetuses, with weighted pooled incidences of 5% (95% CI 0.03-0.06) for isolated CAKUT and 8% (95% CI 0.06-0.10) for non-isolated CAKUT. CONCLUSIONS: This is the first cohort study utilizing nine-year data from Heilongjiang Province, a cold region in northeastern China, to analyze the association between fetal urinary system anomalies and CNVs. In this region, the incidence of p/lp CNVs among CAKUT fetuses with normal karyotypes was 7.33%. Notably, seven pathogenic CNV fragments (deletions at 4p15.31, 5p13.1, 15q11.2, 16p11.2, Xq28, and Xp22.31; duplication at 11q15.5) previously unreported in Northeast China were identified, expanding the genetic spectrum associated with CAKUT in cold regions. The meta-analysis noted that the cumulative crude incidence of p/lp CNV in CAKUT fetuses was 5.71% (498/8,723) across all included studies. Both the cohort study and the meta-analysis showed a numerically higher incidence of p/lp CNVs in non-isolated CAKUT compared with isolated cases (10.34% vs. 3.17%, P = 0.120; 8% vs. 5% weighted pooled incidences from the meta-analysis, respectively), though this difference did not reach statistical significance in the cohort study. Thus, routine CNV screening is recommended for all CAKUT fetuses, particularly non-isolated cases, to comprehensively exclude genetic abnormalities, guiding clinical prenatal diagnosis and genetic counseling.
Placental mesenchymal dysplasia: diagnostic and management insights from a case report and literature review.
Luo Q, Qin Y, Zeng Z … +3 more , Huang Y, Sun X, Zheng W
Arch Gynecol Obstet · 2026 Apr · PMID 42049980 · Full text
BACKGROUND: Limited awareness of placental mesenchymal dysplasia (PMD) and the diagnostic challenges in differentiating it from partial hydatidiform moles on imaging often lead to inappropriate management. This study pre...
BACKGROUND: Limited awareness of placental mesenchymal dysplasia (PMD) and the diagnostic challenges in differentiating it from partial hydatidiform moles on imaging often lead to inappropriate management. This study presents a case report and literature review to elucidate the etiology, clinical features, and management of PMD. CASE PRESENTATION: The patient was admitted with a history of amenorrhea lasting over two months and experiencing vaginal bleeding for four days. Ultrasonography at 12 weeks of gestation revealed extensive cystic changes within the placenta, and was subsequently corroborated by magnetic resonance imaging. The differential diagnosis comprised placental structural abnormalities indicative of PMD or a hydatidiform mole. The patient opted to terminate the pregnancy citing concerns regarding an unfavorable prognosis. Placental pathology confirmed PMD. Fetal short tandem repeat analysis revealed a biparental diploid, whereas the placenta demonstrated androgenetic and biparental chimerism. Postoperative serial monitoring indicated a progressive decrease in serum β-hCG level, and no signs of gestational trophoblastic disease or other maternal complications were observed. CONCLUSION: PMD should be considered when prenatal ultrasonography reveals cystic placental lesions, typically manifested as cystic or hypoechoic regions within an enlarged placenta and often accompanied by mildly elevated maternal serum β-hCG levels. The fetal karyotype is typically normal, with a predominance of females. Pathological examination demonstrates a considerably enlarged placenta characterized by vesicular, grape-like structures on its surface. Some mothers may develop complications such as hypertensive disorders of pregnancy, while adverse perinatal outcomes-such as preterm delivery or stillbirth due to fetal distress or malformations-may also occur. However, a considerable proportion of maternal and fetal outcomes remains favorable. Enhanced maternal and fetal monitoring in PMD pregnancies has the potential to enhance perinatal outcomes.
Offspring long-term infectious morbidity following pregnancies with cervical cerclage.
Snir A, Schwarzman P, Wainstock T … +1 more , Sheiner E
Arch Gynecol Obstet · 2026 Apr · PMID 42045628 · Full text
INTRODUCTION: Cervical cerclage is an acceptable procedure in women with cervical insufficiency and is known to be effective in the prevention of preterm delivery. However, limited data exist regarding long-term health o...
INTRODUCTION: Cervical cerclage is an acceptable procedure in women with cervical insufficiency and is known to be effective in the prevention of preterm delivery. However, limited data exist regarding long-term health outcomes among offspring exposed to cerclage during pregnancy. Since the presence of a foreign body during pregnancy may change the vaginal microbiome, we aimed to study whether a cervical cerclage is associated with long-term infectious morbidity of the offspring. STUDY DESIGN: A retrospective population-based cohort study was performed at a tertiary medical center, including all singleton deliveries between the years 1991-2021. Long-term infectious morbidity was compared among offspring after pregnancies with and without cervical cerclage. The diagnoses of infectious morbidities were defined based on ICD-9 codes as recorded in community clinics and hospitalization files. A Kaplan-Meier survival curve was utilized to evaluate the cumulative incidence. A Cox proportional hazards model was used to control for confounders. RESULTS: Out of 356,356 offspring included in the analysis, 0.4% (n = 1416) were following pregnancies with cervical cerclage. Unadjusted analyses demonstrated no significant difference in total infectious morbidity between the groups (OR 1.0, 95% CI 0.9-1.1; p = 0.369, Table 1). Kaplan-Meier analysis showed no difference in cumulative incidence (log-rank test P-value = 0.19, Fig. 1). In the primary analysis, cerclage was not associated with long-term infectious morbidity. However, in a secondary model, after adjustment for confounders including gestational age, obesity and diabetes, cerclage exposure was associated with a modest reduction in the risk of long-term infectious morbidity (adjusted HR 0.9, 95% CI 0.87-0.99, p = 0.036). CONCLUSION: In this large population-based cohort, cervical cerclage was not associated with increased long-term infectious morbidity in offspring. A modest association with reduced infectious morbidity was observed after adjustment for confounding factors. These findings should be interpreted cautiously given the observational design and potential residual confounding.
The role of large language models in the diagnosis and management of obstetric patients: a pilot feasibility study using simulated obstetric cases.
Psilopatis I, Redling K, Filippi V … +4 more , Kappos S, Emons J, Mosimann B, Zwimpfer TA
Arch Gynecol Obstet · 2026 Apr · PMID 42045418 · Full text
OBJECTIVE: This feasibility study aimed to assess the potential of freely available large language models (LLMs) to support clinical decision-making in obstetrics. METHODS: Five fictional obstetric patient cases, encompa...
OBJECTIVE: This feasibility study aimed to assess the potential of freely available large language models (LLMs) to support clinical decision-making in obstetrics. METHODS: Five fictional obstetric patient cases, encompassing a range of clinical presentations (preeclampsia, fetal growth restriction, preterm premature rupture of membranes, vaginal bleeding, and abdominal trauma), were presented to three LLMs: Chat-GPT (OpenAI), Gemini (Google), and DeepSeek. The LLMs were tasked with evaluating the patient information, suggesting potential diagnoses, and outlining appropriate management strategies. The responses were qualitatively assessed, and subsequently, four expert obstetricians evaluated the LLMs' recommendations using the Global Quality Score (GQS). RESULTS: The LLMs demonstrated an ability to process complex obstetric scenarios and generate diagnostic and management considerations that often aligned with established clinical principles. In cases like preeclampsia and preterm premature rupture of membranes, the LLMs accurately identified key issues and proposed relevant management steps. For fetal growth restriction, vaginal bleeding, and abdominal trauma, they outlined appropriate evaluation frameworks and differential diagnoses. The responses varied in their level of detail and directness. DeepSeek received the highest GQS for all five cases in total, whereas Google Gemini was outperformed by the two other LLMs in the cases of vaginal bleeding and abdominal trauma. CONCLUSION: This preliminary feasibility assessment suggests that freely available LLMs can generate plausible-sounding responses to obstetric vignettes. Further rigorous evaluation using quantitative methods, real-world data, and exploration of integration strategies is warranted to fully understand their role in enhancing clinical decision-making and improving patient care in obstetric practice.
Possible role of hyperimmunoglobulin in reducing the risk of maternal-fetal transmission of cytomegalovirus in the valacyclovir era: a case series.
Barbiero A, Lilleri D, d'Angelo P … +10 more , Zavaglio F, Tavanti M, Biagioni S, Ipponi A, Cecchi M, Borchi B, Trotta MS, Pasquini L, Bartoloni A, Zammarchi L
Arch Gynecol Obstet · 2026 Apr · PMID 42045416 · Full text
INTRODUCTION: Valacyclovir is the only treatment option during pregnancy which has been demonstrated to be effective within a randomized clinical trial for prevention of transplacental cytomegalovirus (CMV) transmission....
INTRODUCTION: Valacyclovir is the only treatment option during pregnancy which has been demonstrated to be effective within a randomized clinical trial for prevention of transplacental cytomegalovirus (CMV) transmission. However, the use of high dose intravenous hyperimmunoglobulin (HIG) could reduce the rate of vertical transmission according to some observational studies. CASES PRESENTATION: We report three peculiar cases in which high dose HIG was administered in substitution to or in addition to valacyclovir to reduce the risk of transplacental transmission of CMV. Two were immunocompromised pregnant women-one with recurrent CMV reactivations due to solid organ transplant-related immunosuppression and one with primary CMV infection and lack of IgG production due to anti-CD20 treatment for multiple sclerosis-in which HIG was co-administered with valacyclovir. The third case involved an immunocompetent pregnant woman to whom HIG was administered in substitution to valacyclovir due to severe gastrointestinal side effects related to the latter medication. In all cases, the treatment was well tolerated and the newborns tested negative for CMV at birth. CONCLUSION: Together, these cases give an interesting perspective on the possible role of HIG in selected immunocompromised pregnant women with primary and non-primary CMV infection in addition to valacyclovir, and in immunocompetent pregnant women unable to tolerate valacyclovir or in whom the drug is contraindicated.
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