Archives Of Gynecology And Obstetrics[JOURNAL]
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200 papers
Unfavorably altered fibrin clot properties in women with unexplained infertility: association with pregnancy outcomes.
Piróg M, Jach R, Ząbczyk M … +1 more , Natorska J
Arch Gynecol Obstet · 2026 Apr · PMID 42043574 · Full text
OBJECTIVES: Ovarian stimulation (OS) and pregnancy were shown to be associated with a prothrombotic state. We sought to determine whether a positive pregnancy outcome is related to fibrin clot properties and thrombin gen...
OBJECTIVES: Ovarian stimulation (OS) and pregnancy were shown to be associated with a prothrombotic state. We sought to determine whether a positive pregnancy outcome is related to fibrin clot properties and thrombin generation in women with unexplained infertility (UI) after OS followed by intrauterine insemination (IUI). METHODS: We studied 70 women with UI, aged 30.7 ± 3.5 years, BMI 24.7 ± kg/m together with 70 controls who had healthy births matched for age and weight. We measured thrombin generation capacity, plasma fibrin clot permeability (K), and fibrinolytic potential (clot lysis time, CLT). In women with UI, after OS followed by IUI, pregnancy outcomes were recorded. RESULTS: UI women had prolonged lag time (+ 10.0%) and lower thrombin generation reflected by ETP (-17.8%) and formed clots less permeable (- 20.8%; K) and more resistant to lysis (+ 17.5% CLT) compared to controls (all p < 0.05). Women with UI and positive pregnancy outcome (n = 19, 27.1%) showed increased K (+ 67.9%) along with shorter CLT (- 15.9%) with no difference in thrombin generation, when compared to non-pregnant women. In women with UI ETP was associated with peak thrombin (r = 0.57, p = 0.02), whereas CLT was negatively correlated both with K (r = - 0.42, p = 0.001) and TSH (r = - 0.56, p = 0.04). CONCLUSIONS: Women with UI display unfavorably modified fibrin clot properties, especially those with negative pregnancy outcomes, which suggests the impact of fibrin clot characteristics on treatment results.
A risk-based model for unplanned cesarean delivery following induction of labor in term hypertensive nulliparas.
Krieger A, Axelrod M, Sibai B … +2 more , Mazaki-Tovi S, Bartal MF
Arch Gynecol Obstet · 2026 Apr · PMID 42029903 · Full text
PURPOSE: To develop a practical risk-stratification framework for unplanned cesarean delivery (CD) among term nulliparous individuals with hypertensive disorders of pregnancy (HDP) undergoing induction of labor (IOL). ME...
PURPOSE: To develop a practical risk-stratification framework for unplanned cesarean delivery (CD) among term nulliparous individuals with hypertensive disorders of pregnancy (HDP) undergoing induction of labor (IOL). METHODS: This was a retrospective cohort study at a single tertiary care center (January 2010-March 2025) of nulliparous individuals with singleton gestations diagnosed with HDP undergoing IOL at ≥ 37 + 0 weeks. We excluded multiple gestations, major fetal anomalies, planned CD, or intrauterine fetal death. We included demographic and pregnancy characteristics available prior to induction and evaluated association with unplanned CD. Stepwise backward logistic regression was used to build a model for identifying independent predictors of unplanned CD. Sensitivity, specificity, and likelihood ratios (LR) were calculated. RESULTS: Among 1,326 eligible individuals, 347 (26.2%) underwent unplanned CD. Independent predictors of CD were age > 35 years (adjusted odds ratio [aOR] 1.97, 95% CI 1.45-2.66), body mass index ≥ 30 kg/m (aOR 2.07, 95% CI 1.58-2.70), HDP with severe features (aOR 1.71, 95% CI 1.17-2.49), thrombocytopenia (aOR 2.66, 95% CI 1.17-6.06), and need for cervical ripening (aOR 1.63, 95% CI 1.23-2.16). Cesarean risk increased stepwise with accumulation of risk factors: 28.4% with ≥ 1 factor, 36.7% with ≥ 2, 44.7% with ≥ 3, and 64.7% with ≥ 4. The presence of ≥ 4 factors yielded a positive LR of 5.17 (95% CI 1.92-13.99). CONCLUSION: In term nulliparous individuals with HDP undergoing induction, approximately one in four require CD. A simple model based on five routinely available pre-induction factors enables individualized counseling and shared decision-making at the bedside.
The adverse prognostic impact of reduced chemotherapy dose intensity appears attenuated in early breast cancer patients with treatment-relevant neutropenia: a retrospective cohort study.
Eissler K, Engler T, Dannehl D … +7 more , Schönfisch B, Englisch J, Hartkopf AD, Brucker SY, Grischke EM, Volmer LL, Englisch A
Arch Gynecol Obstet · 2026 Apr · PMID 42012678 · Full text
PURPOSE: Maintaining a relative dose intensity (RDI) ≥ 85% during chemotherapy is established as a critical threshold for optimal outcomes in early breast cancer. This study investigates whether the prognostic impact of...
PURPOSE: Maintaining a relative dose intensity (RDI) ≥ 85% during chemotherapy is established as a critical threshold for optimal outcomes in early breast cancer. This study investigates whether the prognostic impact of reduced RDI differs based on the presence of chemotherapy-induced neutropenia requiring treatment modifications (rCIN). METHODS: We analyzed 730 patients with early breast cancer receiving anthracycline/cyclophosphamide and taxane-based chemotherapy at the University Hospital Tübingen between 2014 and 2021. rCIN was defined as any dose reduction > 15%, delay ≥ 5 days, or discontinuation attributed to neutropenia per Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Patients were stratified into four groups based on RDI (≥ 85% vs. < 85%) and rCIN status. Differences in overall survival (OS) and disease-free survival (DFS) were assessed by Kaplan-Meier analysis, and predictors of DFS were evaluated by Cox regression. RESULTS: rCIN occurred in 21.8% of patients, with 59.7% of rCIN patients receiving RDI < 85% versus 16.1% of non-rCIN patients (p < 0.001). Despite lower RDI, rCIN patients maintained similar pathological complete response rates after neoadjuvant therapy. In Kaplan-Meier analysis, patients with RDI < 85% without rCIN had significantly worse DFS and OS than the reference group with RDI ≥ 85% without rCIN (DFS p = 0.003; OS p = 0.002), while patients with RDI < 85% with rCIN showed comparable survival to high-RDI groups (all pairwise p > 0.170). Direct comparison between the two reduced-RDI groups was not statistically significant for either DFS or OS (DFS p = 0.055; OS p = 0.159). Cox regression confirmed RDI < 85% as a negative prognostic factor (HR 2.53; 95% CI 1.38-4.65; p = 0.003). The rCIN × RDI < 85% interaction term was not statistically significant (HR 0.44; 95% CI 0.12-1.60; p = 0.212). CONCLUSIONS: In this retrospective cohort, reduced RDI was associated with poorer outcomes, particularly in patients without rCIN. By contrast, patients with RDI < 85% and rCIN showed no significant differences in Kaplan-Meier survival, and similar pathological complete response rates were observed despite lower RDI in the neoadjuvant subgroup. These findings are hypothesis-generating and require confirmation in larger prospective studies.
Pregnancy outcomes after ultrasound- and physical examination-indicated cervical cerclage: a retrospective cohort study.
Manor-Bar C, Piura E, Klein Z … +6 more , Rubinshtein D, Biron-Shental T, Schreiber H, Kovo M, Daykan Y, Arbib N
Arch Gynecol Obstet · 2026 Apr · PMID 42012521 · Full text
OBJECTIVE: To compare pregnancy outcomes after emergency cervical cerclage according to indication: ultrasound-indicated versus physical examination-indicated cerclage. METHODS: This retrospective cohort study included s...
OBJECTIVE: To compare pregnancy outcomes after emergency cervical cerclage according to indication: ultrasound-indicated versus physical examination-indicated cerclage. METHODS: This retrospective cohort study included singleton pregnancies that underwent emergency cerclage using the McDonald technique at 18-23.6 weeks of gestation at a single tertiary center between 2017 and 2023. Cases were classified according to indication: ultrasound-indicated cerclage (cervical length ≤ 25 mm with a closed cervix) or physical examination-indicated cerclage (painless cervical dilation ≥ 1 cm with visible membranes). The primary outcome was early preterm birth, defined as delivery before 34 weeks of gestation. Secondary outcomes included pregnancy prolongation following cerclage and other obstetric outcomes. RESULTS: Among 52 emergency cerclage cases, 39 patients underwent ultrasound-indicated cerclage and 13 underwent physical examination-indicated cerclage. Maternal characteristics and gestational age at the time of the procedure were similar between groups. Previous hysteroscopy was more common in the physical examination-indicated cerclage group (p = 0.035). Overall, 84.6% of patients (44/52) delivered after 34 weeks of gestation, with no significant difference in gestational age at delivery between groups (p = 0.886). Pregnancy prolongation did not differ significantly between groups (15.5 ± 4.2 vs. 13.3 ± 6.2 weeks; p = 0.168). In multivariable analysis, cerclage indication was not independently associated with early preterm birth, whereas pre-cerclage cervical length remained an independent predictor (aOR 0.73, p = 0.02). CONCLUSION: Emergency cervical cerclage was associated with substantial pregnancy prolongation. No statistically significant differences were observed between indications, and pre-cerclage cervical length was the only independent predictor of early preterm birth. These findings support, but do not confirm, a potential pathophysiologic continuum of cervical insufficiency.
Management of incidental STIC lesions with and without BRCA mutations: a survey of current clinical practice in Austria, Germany, and Switzerland.
Kaufmann NA, Oppelt P, Grimm C … +7 more , Lastinger J, Eichinger T, Trautner P, Hartl A, Raidl S, Ramazanova D, Preuss CI
Arch Gynecol Obstet · 2026 Apr · PMID 42009836 · Full text
OBJECTIVE: The aim of this study was to assess current clinical practices, management, and follow-up care for women with an isolated serous tubal intraepithelial carcinoma (STIC) diagnosis in German-speaking countries. M...
OBJECTIVE: The aim of this study was to assess current clinical practices, management, and follow-up care for women with an isolated serous tubal intraepithelial carcinoma (STIC) diagnosis in German-speaking countries. METHODS: An online survey targeting all German-speaking gynecological centers was developed. The survey included single- and multiple-choice questions on hospital data, such as the number of cases per year and certification, as well as detailed questions on two scenarios: a BRCA1-positive patient undergoing prophylactic bilateral salpingo-oophorectomy and a patient with an incidental STIC finding after hysterectomy and bilateral salpingectomy. RESULTS: This survey was answered by 77 physicians. For a patient with a known BRCA1 mutation and STIC, 89.29% of respondents would perform further diagnostics. The most frequent diagnostic steps would be a CA-125 test (83.64%) and a CT abdomen (63.64%). Further surgery would be performed by 77.78% of respondents, including 75.93% without and 5.56% with lymph node staging. 79.25% would prefer laparoscopic surgery. The majority (90.57%) would not recommend adjuvant therapy. In a patient without a known mutation and STIC, 88.46% of respondents would recommend further examinations. 58.82% would carry out genetic panel testing. Another subsequent surgery would be performed by 76.47%, with 66.67% planning to perform surgery without lymph node staging. 53.06% of respondents would follow up patients for five years. Percentages are reported based on the number of valid responses for each item. CONCLUSION: This survey demonstrates differences in the clinical management of isolated STIC across German-speaking countries, highlighting discrepancies between guideline recommendations and real-world practices. THIS STUDY IS REGISTERED IN THE GERMAN CLINICAL TRIALS REGISTER UNDER : DRKS00033112.
Multidisciplinary team approach in placenta accreta surgery: concerns and clarifications.
Matsubara S
Arch Gynecol Obstet · 2026 Apr · PMID 42008139 · Full text
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Psychosocial impact of maternal mortality on bereaved families and health care providers: what do we know?
Alhaj D, Schmock S, Gerhold LL … +5 more , Wallwiener S, Zdanowicz J, Hanson C, Dudenhausen J, Königbauer J
Arch Gynecol Obstet · 2026 Apr · PMID 41991707 · Full text
INTRODUCTION: Maternal mortality remains a critical global health issue with profound psychosocial consequences that extend beyond the deceased woman to her family and the healthcare professionals (HCP) involved in her c...
INTRODUCTION: Maternal mortality remains a critical global health issue with profound psychosocial consequences that extend beyond the deceased woman to her family and the healthcare professionals (HCP) involved in her care. While substantial progress has been made in reducing maternal mortality worldwide, its social and psychological sequelae remain insufficiently studied, particularly in high-income countries. METHODS: This narrative review is based on a structured literature search conducted in PubMed and Google Scholar for studies published between 2000 and 2025. Study selection was guided by predefined inclusion criteria, and relevant articles were identified through keyword searches and snowballing. Data were extracted and analyzed using a narrative thematic approach focusing on psychosocial outcomes in families and HCP. RESULTS: The available evidence, predominantly derived from qualitative and mixed-methods studies in low- and middle-income countries-especially sub-Saharan Africa-demonstrates consistent patterns of psychological distress, social disruption, and long-term adverse outcomes among affected families. Children are particularly vulnerable to educational, emotional, and economic disadvantages following maternal death. For HCP, particularly midwives, maternal mortality is associated with significant emotional burden, including guilt, grief, and professional self-doubt, as well as social and occupational consequences. DISCUSSION: Despite the global relevance of maternal mortality, there is a marked lack of data from high-income settings. Existing findings suggest that both families and HCP experience substantial and enduring psychosocial impacts, yet structured institutional support systems are often lacking. CONCLUSION: Maternal mortality has far-reaching psychosocial consequences for families and HCP alike. The findings highlight the urgent need for targeted support interventions, structured training, and further research, particularly in high-income countries, to better understand and mitigate these effects.
Long-term clinical outcomes of ischial spine fascia fixation compared with sacrospinous ligament fixation: a prospective cohort study over 10 years.
Zhang Y, Zhang Z, Yin R … +2 more , Ren C, Zhu L
Arch Gynecol Obstet · 2026 Apr · PMID 41989581 · Full text
PURPOSE: To compare the long-term effects of ischial spine fascia fixation (ISFF) and sacrospinous ligament fixation (SLFF). METHODS: In a single-center prospective cohort study of 42 patients, 22 patients underwent ISFF...
PURPOSE: To compare the long-term effects of ischial spine fascia fixation (ISFF) and sacrospinous ligament fixation (SLFF). METHODS: In a single-center prospective cohort study of 42 patients, 22 patients underwent ISFF and 20 patients underwent SSLF. The follow-up period of more than 10 years included a total of 32 patients. The main outcomes are the subjective failure and retreatment rates. RESULTS: Fifteen of twenty patients (75%) in the SSLF group and seventeen of twenty-two patients (77.3%) in the ISFF group completed the last follow-up with a median follow-up time of 133 (120-156) months. The ISFF and SSLF groups achieved estimated subjective failure rate of 40.35% and 31.62%, respectively, at the postoperative period of 10 years. The retreatment rates for both the ISFF and SSLF groups remained consistent at 5 and 10-year intervals after surgery, with corresponding percentages of 16.49% and 11.11%. While the ISFF group exhibited marginally elevated subjective failure rates and re-treatment rates compared to the SSLF group, no statistically significant difference was observed. No patients had pain in the leg or hip over 10-year follow-up. CONCLUSION: ISFF is a safe approach that showed no statistically significant difference in recurrence results and improved quality of life scores compared to SSLF. Due to the relatively small sample size (N = 42), this study is underpowered to definitively claim equivalence or non-inferiority between the two procedures. This long-term study on native tissue transvaginal repair for POP indicates the clinical use of ISFF is safe and long-lasting.
Effect of home ultrasound in patients with previous late pregnancy loss: an interventional study.
Mor L, Eisenberg H, Tamayev L … +6 more , Tairy D, Oren B, Paz YG, Levy M, Weiner E, Barda G
Arch Gynecol Obstet · 2026 Apr · PMID 41986513 · Full text
PURPOSE: To evaluate the effect of incorporating twice-weekly telemedicine home ultrasound sessions on maternal anxiety and antenatal attachment in pregnant patients with a history of late pregnancy loss. METHODS: In thi...
PURPOSE: To evaluate the effect of incorporating twice-weekly telemedicine home ultrasound sessions on maternal anxiety and antenatal attachment in pregnant patients with a history of late pregnancy loss. METHODS: In this quasi-randomized trial, pregnant patients with a previous pregnancy loss beyond 20 weeks of gestation were randomized per day of enrollment to standard high-risk care (control) or additional twice-weekly home ultrasound sessions (intervention). Maternal anxiety and antenatal attachment were assessed at baseline, mid-pregnancy, and final prenatal visit using the State-Trait Anxiety Inventory Scale (STAI-S) and the Maternal Antenatal Attachment Scale (MAAS-2). The primary outcome was the STAI-S score at the final visit. A total of 50 participants (25 per group) were required to detect a 20% difference in the primary outcome. RESULTS: Demographics were comparable between groups. The intervention group demonstrated significantly lower STAI-S scores at mid-pregnancy (46.7 ± 9.3 vs. 52.0 ± 9.0; p = 0.023) and at the final visit (43.6 ± 11.8 vs. 51.5 ± 11.5; p = 0.004), and higher MAAS-2 scores at the final visit (79.5 ± 6.2 vs. 75.0 ± 6.9; p = 0.022). Attachment scores increased significantly during follow-up (4.8 ± 7.3 vs. - 0.36 ± 8.0; p = 0.023). Emergency department visits were fewer in the intervention group (3.1 ± 1.5 vs. 4.9 ± 3.3; p = 0.024). Regression analyses confirmed independent associations between home ultrasound use, reduced anxiety, and improved attachment. CONCLUSION: Telemedicine home ultrasound significantly reduced maternal anxiety and improved antenatal attachment in patients with prior late pregnancy loss. This reassurance strategy may also decrease unscheduled emergency visits, supporting its integration into standard prenatal management in this vulnerable population.
Prenatal genetic diagnostics and postnatal outcomes of fetal auricular dysplasia.
Zhu Y, Han X, Ouyang X … +5 more , Chu T, Li N, Yang J, Cheng X, Liu L
Arch Gynecol Obstet · 2026 Apr · PMID 41984209 · Full text
PURPOSE: Auricular dysplasia is a common fetal anomaly. Despite existing studies in postnatal populations, there remains a paucity of prenatal data on genetic etiology and prognostic analysis for this condition. This stu...
PURPOSE: Auricular dysplasia is a common fetal anomaly. Despite existing studies in postnatal populations, there remains a paucity of prenatal data on genetic etiology and prognostic analysis for this condition. This study aimed to analyze the genetic etiology and associated postnatal outcomes of auricular dysplasia, in order to provide guidance for prenatal genetic counseling. METHODS: This retrospective cohort study evaluated 105 singleton and 5 twin pregnancies with prenatally diagnosed auricular dysplasia between May 2019 and June 2024. Genetic investigations included chromosomal microarray (CMA), copy number variation sequencing (CNV-seq), and whole-exome sequencing (WES) to elucidate potential genetic etiologies. Longitudinal postnatal follow-up was systematically conducted to assess auricular morphology, auditory function, and associated systemic anomalies, providing comprehensive prognostic insights. RESULTS: Fetal auricular dysplasia predominantly manifests as unilateral involvement (with right-sided predominance), while bilateral cases are more frequently associated with concurrent multisystem developmental anomalies. Genetic analyses revealed trisomy 21 and CNVs of uncertain clinical significance, including 4q22.1 microdeletion, 3p12.2 microduplication, etc. In bilateral cases with multisystem anomalies, variants in SLC25A24, EFTUD2, and ABCA12 were identified. Postnatally, no pathogenic/likely pathogenic chromosomal or genetic variants were detected in isolated auricular dysplasia cases. However, in cases with concurrent systemic anomalies, compound heterozygous variants were identified in HSPA9 and ADGRV1. Follow-up data showed that 4 (12.90%) of prenatally diagnosed neonates exhibited no auricular malformations postnatally, and 12 (38.71%) had normal hearing, with auditory impairment mostly confined to the affected ear in unilateral cases. CONCLUSION: Isolated auricular dysplasia is generally not associated with genetic abnormalities. However, bilateral auricular dysplasia with concurrent multisystem developmental anomalies demonstrates a correlation with pathogenic gene variants. Prenatal ultrasound diagnosis of auricular dysplasia carries a potential for misdiagnosis, but isolated cases typically manifest postnatally with auricular malformations and ipsilateral hearing impairment. In contrast, bilateral auricular dysplasia accompanied by multisystem anomalies may serve as a prognostic indicator of adverse fetal outcomes, necessitating comprehensive genetic and systemic evaluations.
Fetal urinary ascites caused by bladder rupture due to paraurethral cyst: a rare case.
Zlotin MP, Tavor OL, Wiener Y … +3 more , Kotcherov S, Haboosheh A, Maymon R
Arch Gynecol Obstet · 2026 Apr · PMID 41973122 · Full text
Fetal urinary ascites is an uncommon prenatal finding most often associated with lower urinary tract obstruction (LUTO). We report a rare case of fetal urinary ascites caused by bladder rupture secondary to suspected ure...
Fetal urinary ascites is an uncommon prenatal finding most often associated with lower urinary tract obstruction (LUTO). We report a rare case of fetal urinary ascites caused by bladder rupture secondary to suspected urethral compression by a paraurethral cyst. A 26-year-old gravida 3 para 1 woman was referred at 32 weeks' gestation due to newly detected isolated fetal ascites and mild polyhydramnios. Detailed ultrasonography suggested bladder wall defect and a cystic structure adjacent to the right inguinal canal. Fetal MRI confirmed bladder rupture and supported the suspicion of LUTO. Conservative management was adopted due to stable fetal condition and preserved renal appearance. The ascites resolved spontaneously before delivery. A healthy female neonate was born at term, and the paraurethral cyst resolved spontaneously postnatally. This case highlights a rare etiology of fetal urinary ascites and demonstrates that expectant management may result in favorable outcomes in selected cases.
Recommendations from guidelines for the prevention of venous thromboembolism in pregnant women with inherited thrombophilia.
Rath W, Tsikouras P, Pecks U
Arch Gynecol Obstet · 2026 Apr · PMID 41961304 · Full text
Women with inherited thrombophilia represent more than 15% of the pregnant population. 20-50% of pregnancy-related venous thromboembolism (VTE) is associated with at least one inherited thrombophilia, which increases the...
Women with inherited thrombophilia represent more than 15% of the pregnant population. 20-50% of pregnancy-related venous thromboembolism (VTE) is associated with at least one inherited thrombophilia, which increases the risk of VTE up to 40-fold depending on the type of thrombophilia and the family history of VTE. Most societies consider homozygosity of factor V Leiden and the prothrombin gene mutation, compound heterozygosity of both, and severe deficiency of factor V Leiden and prothrombin gene mutation as "high risk" thrombophilia and heterozygous for factor V Leiden or the prothrombin gene mutation as "low risk" thrombophilia. Recommendations on pharmacological prophylaxis vary across international guidelines. According to expert consensus, pharmacological prophylaxis may be indicated if the risk threshold for VTE is > 3% balancing benefit against harm of heparin prophylaxis. In women with low-risk thrombophilia, guidelines recommend pharmacological prophylaxis ante- and postpartum only in cases with a positive family history of VTE or additional VTE risk factors. Most guidelines suggest heparin prophylaxis in women with homozygosity for factor V Leiden mutation or compound thrombophilia regardless of family history of VTE in the antenatal period and for 6 weeks after delivery. In women with protein S and protein C deficiencies, some guidelines advocate clinical surveillance rather than pharmacological prophylaxis antenatally, while postpartum pharmacological prophylaxis was recommended by all guidelines for women with a positive family history of VTE or with additional risk factors. Pharmacological prophylaxis in women with antithrombin deficiency remains a matter of debate and depends on the subtype and extent of antithrombin deficiency. There is yet no evidence from randomized, controlled trials that pharmacological prophylaxis significantly reduces the risk of VTE in women with inherited thrombophilia. Overestimation of the VTE risk and unnecessary use of heparin is an unsolved problem. Decision-making should also consider the increased risk of bleeding complications and wound hematoma associated with pharmacological thromboprophylaxis. Until there is more evidence for the benefit of pharmacological prophylaxis, the decision for or against prophylaxis remains a case-by-case decision taking into account the patient's individual risk profile and woman's preference.
Complete androgen insensitivity syndrome presenting with bilateral adnexal masses and mixed gonadal histopathology.
Yildiz AG, Kurt A, Cengiz ID … +2 more , Arslankoz S, Gultekin IB
Arch Gynecol Obstet · 2026 Apr · PMID 41957233 · Full text
PURPOSE: Complete androgen insensitivity syndrome (CAIS) is a rare X-linked recessive disorder due to androgenreceptor mutations, characterised by a 46,XY karyotype, female phenotype, and undescended testes. This reporta...
PURPOSE: Complete androgen insensitivity syndrome (CAIS) is a rare X-linked recessive disorder due to androgenreceptor mutations, characterised by a 46,XY karyotype, female phenotype, and undescended testes. This reportaims to illustrate the clinical management and the rare synchronous pathology of multiple gonadal tumors in a 60-year-old phenotypic female with long-standing CAIS. METHODS: A 60-year-old patient presented following the incidental detection of bilateral adnexal masses. Diagnosticevaluation included imaging (USG/MRI) to assess internal reproductive organs and gonadal morphology, alongsidehormonal analysis (LH, testosterone, and estradiol). A laparoscopic bilateral gonadectomy was performed to managethe suspected neoplasia. RESULTS: Imaging demonstrated the absence of the uterus and ovaries, confi rming bilateral solid gonadal lesions.Hormonal analysis showed elevated LH with normal testosterone and estradiol levels. Histopathology of the excisedtissues revealed a complex and heterogeneous presentation: the left gonad contained a Sertoli cell tumor, a Leydigcell tumor, and sclerotic seminiferous tubules; the right gonad showed a Sertoli cell adenoma. CONCLUSION: This rare synchronous pathology illustrates the signifi cant heterogeneity of neoplasia associated withCAIS. Current evidence supports individualized postpubertal gonadectomy to balance the risk of malignancy againstthe benefi ts of endogenous hormonal production. The fi ndings emphasize that long-term follow-up and tailoredsurgical timing are essential components in the clinical management of CAIS.
Complex vaginal natural orifice transluminal endoscopic surgery hysterectomy for symptomatic giant polymyomatous uteri in nulliparous women.
Barber MA, De La Torre D, Del Rosario S … +2 more , Eguiluz I, Cortés E
Arch Gynecol Obstet · 2026 Apr · PMID 41954781 · Full text
PURPOSE: Studies on vaginal natural orifice transluminal endoscopic surgery (vNOTES), which provides enhanced endoscopic vision via the vaginal route, are limited. Therefore, this study aimed to evaluate the feasibility,...
PURPOSE: Studies on vaginal natural orifice transluminal endoscopic surgery (vNOTES), which provides enhanced endoscopic vision via the vaginal route, are limited. Therefore, this study aimed to evaluate the feasibility, safety, and perioperative outcomes of vNOTES hysterectomy in symptomatic patients with giant polymyomatous uteri and no prior vaginal delivery. METHODS: A prospective single-centre case series was conducted between July 2023 and July 2025. Patients with symptomatic uterine myomatosis and a uterine size equivalent to a gestational age of ≥ 20 weeks with no prior vaginal deliveries were included. The operation time, preoperative and postoperative haemoglobin levels, uterine weight, complications, and length of hospital stay were analysed. RESULTS: Forty patients met the inclusion criteria. The mean operative time was 95 ± 28 min. The mean preoperative haemoglobin concentration was 11.8 ± 1.2 g/dL, whereas it was 10.9 ± 1.1 g/dL postoperatively. The mean uterine weight was 1,012 ± 312 g. The complication rate was 8%. The major complication rate was 4%. No procedures were converted to laparotomy. The median hospitalisation duration was 23.1 h. CONCLUSION: vNOTES hysterectomy appears to be a feasible minimally invasive approach for giant polymyomatous uteri in patients with no prior vaginal deliveries, with favourable perioperative outcomes in this prospective case series.
Mapping internal and lateral anterior intercostal artery perforator flaps with colour Doppler ultrasound: correlation between preoperative imaging and intraoperative findings in oncoplastic breast surgery.
Schmidt G, Mayo T, von Falkenhausen A … +2 more , Kiechle M, Müller D
Arch Gynecol Obstet · 2026 Apr · PMID 41954667 · Full text
PURPOSE: Anterior intercostal artery perforator (AICAP) flaps are valuable options for partial breast reconstruction, requiring reliable identification of dominant perforators for safe flap design. This study aimed to ev...
PURPOSE: Anterior intercostal artery perforator (AICAP) flaps are valuable options for partial breast reconstruction, requiring reliable identification of dominant perforators for safe flap design. This study aimed to evaluate the agreement between preoperative high-frequency colour Doppler ultrasound (CDUS) findings and intraoperative anatomy of internal and lateral intercostal perforators, and to map their anatomical distribution. METHODS: Sixty-four patients undergoing breast-conserving surgery were examined using high-frequency CDUS. The region from the midline to the mid-axillary line and from the fourth intercostal space to 4 cm below the inframammary fold was systematically scanned. Dominant perforators were measured, marked, and intraoperatively reassessed in 24 patients undergoing AICAP flap reconstruction. Vessel diameters, location, and additional perforators were recorded and spatial distribution was analysed. RESULTS: Preoperative CDUS identified lateral perforators as larger than internal (2.08 mm vs. 1.61 mm, p < 0.01), confirmed intraoperatively (1.69 mm vs. 1.10 mm, p < 0.01). Dominant perforators were located 3.63 cm lateral to the patient's midline and 1.32 cm inferior to the IMF (internal), and 0.53 cm medial to the anterior axillary line and 0.95 cm inferior to the IMF (lateral). In both internal and lateral regions, supplementary vessels were detected near the dominant perforators, contributing to increased perfusion security. CONCLUSIONS: High-frequency CDUS enables reproducible preoperative localisation of dominant IAICAP and LAICAP perforators and shows high agreement with intraoperative findings. Standardised ultrasound mapping may support structured flap planning and intraoperative orientation in oncoplastic breast reconstruction.
Correction: Severe ovarian hyperstimulation syndrome following sole gonadotropin-releasing hormone (GnRH) agonist trigger: a case series and literature review.
Berkovitz-Shperling R, Samara N, Meir R … +3 more , Dominsky O, Azem F, Feferkorn I
Arch Gynecol Obstet · 2026 Apr · PMID 41949773 · Full text
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Intrahepatic cholestasis of pregnancy and offspring neurodevelopment: bile acid-mediated mechanisms and long-term neurodevelopmental outcomes.
Dai S, Zhao H, Xie Y … +6 more , Chen Q, Chen Q, Li Y, Shan D, Tan X, Hu Y
Arch Gynecol Obstet · 2026 Apr · PMID 41949636 · Full text
PURPOSE: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by pruritus and elevated maternal serum total bile acids. While clinical management has focused on bile acid-based...
PURPOSE: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by pruritus and elevated maternal serum total bile acids. While clinical management has focused on bile acid-based risk stratification and delivery planning to reduce perinatal risks, emerging evidence suggests possible longer-term effects on offspring neurodevelopment. This review synthesizes current epidemiologic and mechanistic evidence linking ICP with offspring neurodevelopmental outcomes. METHODS: PubMed, Embase, and Web of Science were searched using controlled vocabulary and free-text terms. Relevant references were evaluated for inclusion in a stepwise approach. RESULTS: Large Nordic register-based studies report associations between in utero ICP exposure and increased risks of childhood neurodevelopmental diagnoses, particularly in earlier-onset disease. Follow-up cohorts suggest altered early-life growth trajectories related to biochemical severity. Mechanistically, elevated maternal bile acids are a plausible proximal exposure. Maternal bile acid overload can disrupt placental bile acid transport and handling, alter the feto-maternal bile acid gradient, and increase fetal bile acid burden. The placenta may further convert bile acid perturbations into inflammatory, oxidative stress, endoplasmic reticulum stress, and vasoactive signals that reshape the intrauterine milieu during sensitive windows of brain development. By contrast, downstream pathways involving microglial priming, neuroinflammation, and blood-brain barrier vulnerability are supported mainly by indirect evidence and require validation in pregnancy-relevant models. CONCLUSION: Current evidence supports a life-course perspective on ICP beyond established perinatal risks. Maternal bile acids and placental dysfunction provide a coherent mechanistic framework for possible neurodevelopmental effects, but pregnancy-relevant mechanistic studies and longitudinal cohorts with refined exposure assessment are still needed.
Fetal volvulus: is emergency surgery the only option?-a single-center case series and management considerations.
Holweg M, Lieber J, Kagan KO … +8 more , Wiechers C, Haase B, Delbrück M, Dietzel M, Jhala T, Slavetinsky C, Schmidt A, Fuchs J
Arch Gynecol Obstet · 2026 Apr · PMID 41949628 · Full text
BACKGROUND: Fetal intestinal volvulus is a rare intrauterine condition associated with potentially severe neonatal morbidity. Owing to its rarity, diagnostic features and management strategies remain heterogeneous and ar...
BACKGROUND: Fetal intestinal volvulus is a rare intrauterine condition associated with potentially severe neonatal morbidity. Owing to its rarity, diagnostic features and management strategies remain heterogeneous and are largely based on case reports and small case series. METHODS: We performed a retrospective single-center analysis of all patients diagnosed with intestinal volvulus between 2005 and 2022, comparing antenatally diagnosed fetal volvulus and postnatal presentation, diagnostic findings, management approaches, and outcomes. Given the rarity of fetal volvulus, the analysis was descriptive in nature. RESULTS: 45 patients with confirmed volvulus were analyzed, including seven fetal and 38 postnatal volvulus cases. Five fetal cases required postnatal surgical intervention, whereas two extremely preterm fetuses were managed conservatively with close prenatal surveillance and showed spontaneous regression of sonographic findings. Prenatal diagnosis relied mainly on ultrasound features, such as bowel distension and whirlpool sign. Outcomes in both groups were strongly influenced by gestational age and prematurity-related morbidity. CONCLUSION: Fetal volvulus presents with heterogeneous clinical courses and requires individualized, multidisciplinary decision-making. Conservative observation may be considered in selected stable cases diagnosed at extreme prematurity, whereas at more advanced gestational ages, signs of fetal deterioration may prompt consideration of delivery and postnatal surgical management. Due to the limited cohort size, no standardized treatment recommendations can be derived.
Quality of life after breast (reconstructive) surgery-an interim analysis of a prospective three-arm clinical trial with a 10-year follow-up (REKO 001).
Boeer B, Kandzi J, Schoenfisch B … +8 more , Marx M, Guergan S, Gruber I, Roehm C, Helms G, Hartkopf A, Brucker SY, Hahn M
Arch Gynecol Obstet · 2026 Apr · PMID 41945177 · Full text
BACKGROUND: Long-term health-related quality of life (HRQoL) plays an increasingly important role in breast cancer treatment. Women who are not eligible for breast-conserving therapy frequently opt for reconstruction, bu...
BACKGROUND: Long-term health-related quality of life (HRQoL) plays an increasingly important role in breast cancer treatment. Women who are not eligible for breast-conserving therapy frequently opt for reconstruction, but data on long-term health-related quality of life comparing different reconstructive surgeries is rare. METHODS: REKO 001-trial is a single-center, three-arm study with a prospective longitudinal design and 10-year follow-up, investigating which surgery is associated with the highest quality of life. Between January 2017 and March 2022, 227 patients underwent either mastectomy (74), implant-based (77), or Deep Inferior Epigastric Perforator (DIEP) or Fascio-Cutaneous Infragluteal (FCI) free flap (76) reconstruction. This initial follow-up analysis compared HRQoL (BREAST-Q, FACT-B) and postoperative complications 5 months after surgery. RESULTS: The DIEP/FCI group had the lowest preoperative BREAST-Q scores, but was the only group to show significant increases in many HRQoL domains within the first 5 months postoperatively. The mastectomy group showed significant decreases in some HRQoL domains. The implant-based group started with the highest BREAST-Q scores in most domains and had higher HRQoL scores than the mastectomy group. Radiotherapy and higher BMI significantly reduced HRQoL in some domains. The number of complications requiring inpatient treatment or reoperation within the first 5 months increased with extent of surgery (p = 0.037). CONCLUSION: For patients opting for DIEP/FCI reconstruction, an increase in HRQoL can be seen within the first 5 months after surgery, but they must accept the higher risk of complications and a decrease in abdominal well-being. Further follow-ups after 2, 5, 7, and 10 years are underway.
Misdiagnosis of different types of aneuploidy in preimplantation genetic testing (PGT): a systematic review and meta-analysis.
Jiang W, Hu Z, Han Y … +21 more , Shi J, Chen K, Lian Y, Li W, Hao P, Zhou Z, Wu Z, Li Y, Wu X, Li M, Deng L, Zheng H, Bi Z, Ding L, Pan X, Ma R, Tang Z, Mu J, Xie X, Li Y, Yan J
Arch Gynecol Obstet · 2026 Apr · PMID 41945151 · Full text
PURPOSE: Recent studies have reported that embryos diagnosed as aneuploid by preimplantation genetic testing (PGT) can still result in successful live births after transfer. This suggests that, in addition to mosaic embr...
PURPOSE: Recent studies have reported that embryos diagnosed as aneuploid by preimplantation genetic testing (PGT) can still result in successful live births after transfer. This suggests that, in addition to mosaic embryos, fully aneuploid embryos may also carry a risk of diagnostic error, potentially reducing the overall accuracy of PGT. Therefore, thoroughly investigating the risk and characteristics of aneuploidy misdiagnosis is crucial for optimizing PGT strategies and improving clinical outcomes in assisted reproductive technology (ART). METHODS: Relevant studies published from January 2000 to December 2024 were identified through PubMed and Web of Science. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). A diagnostic meta-analysis was conducted using a random-effects model to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs), combining sensitivity and specificity. Results were visualized using forest plots. RESULTS: A total of 22 studies were included to assess the discordance between trophectoderm (TE) biopsy and inner cell mass (ICM) or whole blastocyst (WB) results. The discordance rate for euploid embryo diagnosis was low (2.6%), whereas it was significantly higher for aneuploid embryos (9.2%). Segmental aneuploidies showed the highest discordance rate (17.4%). In the PGT-A population, misdiagnosis of segmental aneuploid embryos was particularly prominent (OR = 10.04, 95% CI: 7.60-13.27, I = 0%, P < 0.001). CONCLUSION: The results indicate that embryos with segmental aneuploidies have a significantly higher risk of misdiagnosis, especially in the PGT-A population. This highlights the need for caution when interpreting trophectoderm (TE) biopsy results involving segmental aneuploidies, to avoid misdiagnosis and the inadvertent discard of potentially viable embryos.
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