Archives Of Gynecology And Obstetrics[JOURNAL]
Sun
200 papers
Network analysis of patient-reported complaints in climacteric syndrome: a single-center study.
Choi SJ, Kang B, Kim CE … +1 more , Kim DI
Arch Gynecol Obstet · 2026 Apr · PMID 41935990 · Full text
BACKGROUND: This study analyzed medical records of patients with climacteric syndrome at a Korean medicine hospital and investigated the interrelationships among their symptoms using network analysis. METHODS: A retrospe...
BACKGROUND: This study analyzed medical records of patients with climacteric syndrome at a Korean medicine hospital and investigated the interrelationships among their symptoms using network analysis. METHODS: A retrospective chart review was conducted on 81 women (aged 45-60 years) who visited a women's health clinic between 1 January 2020 and 31 December 2021. Network analysis was performed on unstructured text from first-visit medical records to identify symptom patterns and compute centrality indices. RESULTS: The most common symptoms were 'pain', 'hot flush', 'facial blushing', 'fatigue', and 'sleep disorder'. Among them, pain and hot flush showed high node strength, betweenness centrality, and closeness centrality, which indicated their central role in symptom co-occurrence. Although there were no statistically significant differences in the frequency of symptoms between the premenopausal and postmenopausal groups, variations in symptom centrality and modular analysis results before and after menopause were noted, emphasizing the importance of detailed symptom analysis in clinical settings. CONCLUSIONS: By analyzing medical records of patients with climacteric syndrome, this study clarified symptom patterns in menopausal women, providing data for targeted and stage-specific treatments.
Comparative validation of a cost-effective in-house 3D-printed LLETZ simulator versus a commercial training model.
Scherer-Quenzer AC, Reinhart K, Diessner J … +7 more , Altides A, Buechel J, Blau-Schneider B, Sauer ST, Deschler-Baier B, Woeckel A, Kiesel M
Arch Gynecol Obstet · 2026 Apr · PMID 41934475 · Full text
PURPOSE: Traditional surgical training methods such as "learning-by-doing" raise ethical and methodological concerns. To improve training and reduce patient risk, a 3D-printed LLETZ simulator was developed. While initial...
PURPOSE: Traditional surgical training methods such as "learning-by-doing" raise ethical and methodological concerns. To improve training and reduce patient risk, a 3D-printed LLETZ simulator was developed. While initial studies showed advantages over a conventional model, they were limited to medical students and lacked comparison with a commercially available simulator. METHODS: A single-center study was conducted at the University Hospital Wuerzburg. 60 medical students without prior LLETZ experience and 10 gynecology residents with prior exposure were randomly assigned to train on either a commercial or the novel in-house simulator. Each participant performed five electrosurgical excisions. Performance was evaluated using LEEP scores, resection status (R0 resections), and blinded video assessments by two senior clinicians. Additionally, participants completed questionnaires, to capture subjective training impressions. RESULTS: The in-house simulator demonstrated superior performance compared to the commercial model. When analyzed separately, changes in LEEP scores over the five attempts were statistically significant for both simulators. The effect size was larger for the in-house simulator (η = 0.227) than for the conventional simulator (η = 0.10). Within-group analysis revealed no significant pairwise differences across all attempts for the commercial simulator. In contrast, several pairwise comparisons remained statistically significant for the in-house simulator (attempts 1 vs. 3, 1 vs. 4, 2 vs. 5, and 1 vs. 5), all with large effect sizes (Cohen's d > 1.1). Between-group comparison of individual LEEP scores showed a statistically significant difference in the fifth attempt (p = 0.002), with a large effect size (Cohen's d = 1.01) favoring the in-house simulator. Higher R0 resection rates were observed with the in-house simulator in the third (100% vs. 83.3%) and fourth attempts (96.7% vs. 73.3%). Blinded video assessments by two senior experts confirmed these findings, demonstrating higher checklist, Global Rating Scale (GRS), and overall mean scores for the in-house simulator from the third attempt onward (all p < 0.05; all Cohen's d > 0.8). Participant feedback further supported these results, indicating improved confidence, technical skills, and perceived educational value. CONCLUSION: This study demonstrated that the novel in-house 3D-printed simulator significantly outperformed the commercial model in objective surgical performance, learning progression and user satisfaction.
Intraoperative hemodynamics and anesthetic implications in superobese parturients undergoing cesarean delivery: a retrospective cohort analysis.
Kaushik T, Hackney A, Bryant A … +4 more , Baker E, Abongwa S, Wagener BM, Frölich MA
Arch Gynecol Obstet · 2026 Apr · PMID 41934472 · Full text
BACKGROUND: Obesity affects nearly 40% of reproductive-aged American women, with over 12% classified as severely obese. Higher maternal body mass index (BMI) is linked to increased cesarean rates; however, data on intrao...
BACKGROUND: Obesity affects nearly 40% of reproductive-aged American women, with over 12% classified as severely obese. Higher maternal body mass index (BMI) is linked to increased cesarean rates; however, data on intraoperative hemodynamics and anesthetic management, particularly in the superobese (BMI ≥ 50 kg/m), remain limited. METHODS: We conducted a retrospective cohort study of 2051 cesarean deliveries under neuraxial anesthesia, stratified by six BMI categories. The primary outcome was intraoperative hypotension based on serial noninvasive blood pressure (NIBP) readings. Secondary outcomes included neuraxial placement time, surgical duration, estimated blood loss (EBL), and neonatal Apgar scores. Multivariate regression, adjusted for comorbidities and neuraxial technique, assessed associations and outcome differences across BMI groups. RESULTS: Superobese parturients exhibited a delayed yet sustained decline in mean arterial pressure (MAP) following neuraxial anesthesia, showing a late-phase, vasopressor-resistant hypotensive pattern. Time from surgical procedure start to fetal delivery increased from 11.8 ± 9.1 min in normal weight versus 17.3 ± 9.3 min in superobese (p < 0.0001). Between BMI groups, anesthesia start to procedure start, which reflected positioning, IV optimization, and neuraxial placement, increased from 35.1 ± 9.4 min to 50.6 ± 15.9 min (p < 0.0001), while total procedure time increased from 57.7 ± 24.3 to 76.8 ± 27.4 min (p < 0.0001). EBL was significantly higher in the superobese patients: 902 ± 294 mL versus normal BMI patients: 712 ± 230 mL (p < 0.0001). 1-min Apgar scores declined with higher BMI, but 5-min scores were comparable across groups. CONCLUSIONS: Superobesity is associated with specific intraoperative negative outcomes during cesarean delivery under neuraxial anesthesia. Our study findings highlight the need for anticipatory anesthetic planning and tailored hemodynamic management strategies in high-BMI parturients to optimize maternal and neonatal outcomes.
Vaginal natural orifice transluminal endoscopic surgery versus laparoscopy for ovarian cystectomy: a prospective, open-label, randomized, non-inferiority pilot trial.
Tan K, Wei L, Wang X … +9 more , Deng Z, Chen D, Mao W, Ling Y, Peng X, Wei J, Wu H, Meng Y, Jiang L
Arch Gynecol Obstet · 2026 Apr · PMID 41931151 · Full text
PURPOSE: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an innovative minimally invasive procedure. The study aimed to evaluate whether vNOTES achieves non-inferior results compared to conventional l...
PURPOSE: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an innovative minimally invasive procedure. The study aimed to evaluate whether vNOTES achieves non-inferior results compared to conventional laparoscopy in patients undergoing ovarian cystectomy. METHODS: Participants with benign ovarian tumors were randomly assigned (1:1) to undergo laparoscopy or vNOTES. Randomization was stratified based on the size of the ovarian tumor. Patients and surgeons were aware of the allocated procedures. The primary outcome was the proportion of patients successfully treated by the allocated procedure (non-inferiority hypothesis, margin of 15%). The secondary outcomes included operative time, estimated blood loss, time for specimen retrieval, postoperative pain score, use of analgesics, time to first flatus, and perioperative complications. RESULTS: Sixty-four patients were randomly assigned to laparoscopy (n = 32) and vNOTES (n = 32) and were included in the intention-to-treat analysis. The success rates were 100% and 96.9%, respectively. Non-inferiority of vNOTES was demonstrated, as the lower limit of the one-sided 95% confidence interval for the stratified risk difference was -12.7%, which lies above the pre-specified non-inferiority margin of -15%. The vNOTES group exhibited lower pain scores, with a median difference of -1 (95% CI -1 - -1, p < 0.001). CONCLUSION: vNOTES demonstrates non-inferiority to laparoscopy for ovarian cystectomy in selected patients, with notable advantages in cosmetic outcomes and reduced postoperative pain. CLINICAL TRIAL IDENTIFICATION NUMBER: ChiCTR2300070890.
FIGO 2023 staging system with/without molecular classification vs. FIGO 2009 in 172 endometrial cancer patients.
Han Y, Han R, Jiang X … +3 more , Qu H, Lu J, Li H
Arch Gynecol Obstet · 2026 Apr · PMID 41931130 · Full text
OBJECTIVES: To evaluate the prognostic utility of the FIGO 2023 staging system with/without molecular classification vs. FIGO 2009 in endometrial cancer. METHODS: A total of 172 patients between 2015 and 2020 diagnosed w...
OBJECTIVES: To evaluate the prognostic utility of the FIGO 2023 staging system with/without molecular classification vs. FIGO 2009 in endometrial cancer. METHODS: A total of 172 patients between 2015 and 2020 diagnosed with endometrial cancer in our center were included in this study. Molecular classification subtypes were classified using DNA sequencing and immunohistochemistry. The clinical characteristics and patients' prognosis were analyzed. RESULTS: Of the 172 patients, 10 patients were classified to the POLEmut, 30 patients to the MMRd group, 106 patients to the NSMP group, and 26 patients to the p53abn group. Stage migration from FIGO 2009 to FIGO 2023 occurred in 27.3% of the patients (47/172). Among the 47 patients, upstaging from stage I to stage II was observed in 43 patients. The transition from stage III to the early stage occurred in 2 patients, with downstaging from stage III to IA3. 9 patients were restaged as IAm disease with the FIGO 2023 m system. Downstaging to stage IAm was observed in 7 patients due to the presence of POLE mutation. In addition, 14 patients had stage IICm disease with the FIGO 2023 m. Eight patients were upstaged to stage IICm due to the presence of p53 abnormality, while 6 patients already exhibited stage IIC disease based on the FIGO 2023 classification. Patients with endometrial cancer with POLE-EDM had the best prognosis in terms of RFS and OS; those with MMRd and NSMP exhibited intermediate prognosis, with no significant difference between the two groups; and those with p53abn had the worst prognosis. CONCLUSIONS: Molecular classification is prognostically essential in endometrial carcinoma. The integrated FIGO 2023 m system appears to enhance risk stratification relative to FIGO 2009 and non-molecular FIGO 2023. Formal comparison of staging systems is needed to confirm this improvement.
Obstetric outcomes in second-generation and migrant mothers: a cohort study in the Emilia-Romagna Region, Italy.
Cavagnis S, Caranci N, Perrone E
Arch Gynecol Obstet · 2026 Mar · PMID 41915068 · Full text
PURPOSE: The second generation (people born in the host country to foreign parents) has grown significantly in Italy. While migration is known to impact maternal and neonatal health negatively, evidence on outcomes for s...
PURPOSE: The second generation (people born in the host country to foreign parents) has grown significantly in Italy. While migration is known to impact maternal and neonatal health negatively, evidence on outcomes for second-generation mothers (SGMs) is limited. This study aimed to describe the socio-demographic characteristics and obstetric outcomes of SGMs, comparing them with first-generation and native mothers in an Italian region. METHODS: All deliveries in the Emilia-Romagna Birth Registry (2012-2023) were linked with the 15th Population Census (2011); this allowed the definition of migratory background. The outcomes included emergency and elective cesarean delivery, preterm birth, small for gestational age (SGA), and late antenatal care (ANC). Log-binomial models were used to estimate crude and adjusted prevalence ratios (aPR), also stratified by area of origin. RESULTS: 390,062 births were recorded; for 63%, it was possible to define the migratory background. Compared to native mothers, SGMs were younger and less educated; 79.5% held Italian citizenship. SGMs showed a lower risk of elective cesarean delivery (aPR 0.65, 95% CI 0.53-0.79) and higher risks of late ANC (aPR 1.91, 95% CI 1.69-2.15), emergency cesarean delivery (aPR 1.15, 95%CI 1.00-1.31), preterm birth (aPR 1.59, 95% CI 1.33-1.90), and SGA (aPR 1.15, 95% CI 0.99-1.33). Certain areas of origin, such as Sub-Saharan Africa, seemed to have an increased risk of negative outcomes. CONCLUSIONS: SGMs show worse social determinants and birth outcomes than natives. Currently, the second generation cannot be identified through administrative data; however, it merits greater attention, in terms of monitoring tools and health and social policies.
Screening-detected refractive errors in infants born after assisted reproductive technology: a prospective cohort study.
Zou X, Jalloh MA, Wang Z … +19 more , Zong Y, Jiang Y, Jiang T, You L, Qin R, Lv H, Liu Y, Sun T, Xu B, Han X, Liu X, Zhou K, Jin G, Ma H, Lin Y, Hu Z, Liu H, Du J, Li J
Arch Gynecol Obstet · 2026 Mar · PMID 41912950 · Full text
PURPOSE: Infants born after assisted reproductive technology (ART) have more adverse health outcomes than spontaneously conceived infants. Evidence on the impact of ART on the offspring's visual system, particularly refr...
PURPOSE: Infants born after assisted reproductive technology (ART) have more adverse health outcomes than spontaneously conceived infants. Evidence on the impact of ART on the offspring's visual system, particularly refractive errors (REs), remains limited and inconsistent. METHODS: The present study included 6847 infants from the Jiangsu Birth Cohort (JBC), which enrolled couples who conceived either through ART or spontaneously between 2015 and 2022 in Jiangsu Province, China. ART procedures and parental characteristics were collected prospectively, and REs were assessed at one year of age using the Spot Vision Screener. Poisson regression models were used to examine the association between ART and screening-detected REs. RESULTS: Screening-detected REs were identified in 369 infants born after ART (11.4%) and in 405 infants spontaneously conceived (11.2%). No overall association was observed between ART and the risk of REs (RR, 0.91; 95% CI 0.77-1.07). Infants born to parents with different infertility diagnoses or following specific ART procedures had similar risks of REs compared with spontaneously conceived infants. In the analyses restricted to ART-conceived infants, infants conceived using the gonadotropin-releasing hormone antagonist (GnRH-antagonist) protocol had a lower risk of REs (RR, 0.56; 95% CI 0.44-0.71) compared with those using the gonadotropin-releasing hormone agonist (GnRH-agonist) protocol. CONCLUSION: We observed no increased risk of screening-detected REs at one year of age in ART-conceived infants compared with spontaneously conceived infants, independent of parental infertility diagnoses or specific ART procedures. Among the ART-conceived infants, the use of the GnRH-antagonist protocol may be associated with a lower risk of screening-detected REs; however, this finding should be interpreted cautiously because protocol selection was clinically guided and residual confounding cannot be excluded.
Short-term maternal outcomes after intraoperative administration of prophylactic oxytocin during cesarean sections: a retrospective cohort study with a comparison of different administration protocols.
Busłowicz JT, Brüggmann D, Al Naimi A … +8 more , Hoock SC, Deuster E, Schaarschmidt W, Kämpf AK, Neef V, Zacharowski K, Louwen F, Hentrich AE
Arch Gynecol Obstet · 2026 Mar · PMID 41902958 · Full text
OBJECTIVE: The objective of this study was to evaluate the impact of different intraoperative prophylactic oxytocin regimens on maternal blood loss during cesarean section, and to compare effects in procedures performed...
OBJECTIVE: The objective of this study was to evaluate the impact of different intraoperative prophylactic oxytocin regimens on maternal blood loss during cesarean section, and to compare effects in procedures performed before versus after onset of labor. METHODS: This retrospective cohort study was conducted at a tertiary care center over 15 years (2006-2021). A total of 1996 cesarean sections were identified, of which 1504 women with complete pre- and postoperative hemoglobin values were included in hemoglobin delta analyses. All 1996 women were considered for descriptive and binary outcome analyses. The study population was stratified into four intraoperative oxytocin exposure groups (0 IU, 3 IU, > 3 up to ≤ 13 IU, and > 13 IU) and further analyzed according to timing before or after onset of labor. The primary outcome was perioperative hemoglobin delta, while secondary outcomes included estimated intraoperative blood loss and binary maternal outcomes such as transfusion, uterine atony, and B-Lynch procedure. RESULTS: In cesarean sections before onset of labor, very high intraoperative oxytocin doses (> 13 IU) were associated with significantly increased adjusted blood loss (+ 315 ml, p = 0.007), while intermediate doses (+ 270 ml, p = 0.009) also showed higher losses compared with no oxytocin. Hemoglobin decline was greater in the 3 IU and > 3 up to ≤ 13 IU groups, but not in the > 13 IU group. In cesarean sections after onset of labor, women receiving very high doses likewise had significantly higher blood loss (+ 170 ml, p = 0.004), whereas a modest reduction was observed with 3 IU (- 116 ml, p = 0.014). Estimated blood loss did not reliably correlate with hemoglobin decline, and no consistent dose-response benefit of higher oxytocin administration was observed. CONCLUSION: Very high intraoperative oxytocin doses were not associated with reduced blood loss and were frequently administered in women at increased bleeding risk, suggesting confounding by indication. These results should therefore be regarded as hypothesis-generating rather than definitive evidence to guide prophylactic dosing.
Tumor biology, treatment patterns, and recurrence in breast cancer patients aged 70-79 vs ≥ 80 years: a large-scale registry analysis.
Ganster F, Schrodi S, Braun M … +7 more , Seifert C, Mahner S, Kolben T, Wuerstlein R, Harbeck N, Beyer S, Burgmann M
Arch Gynecol Obstet · 2026 Mar · PMID 41902859 · Full text
PURPOSE: With increasing life expectancy, breast cancer (BC) in elderly women is rising, yet patients over 80 remain underrepresented in clinical trials. Understanding differences in the age groups is essential to avoid...
PURPOSE: With increasing life expectancy, breast cancer (BC) in elderly women is rising, yet patients over 80 remain underrepresented in clinical trials. Understanding differences in the age groups is essential to avoid over- and undertreatment. This analysis investigates age-specific tumor characteristics, treatment patterns and outcomes in women aged 70-79 versus ≥ 80 years. METHODS: This population-based analysis included BC patients treated at LMU Breast Center and Munich Red Cross Hospital between 2004 and 2015. Clinical data of 2699 women aged 70-79 and those ≥ 80 were compared to assess differences in tumor biology, treatment approaches and time to metastasis. RESULTS: Breast-conserving surgery rates remained stable over time, while sentinel lymph node biopsy use increased in both age groups. Patients aged ≥ 80 more frequently presented with larger tumors, underwent mastectomy, and received less systemic or axillary treatment, despite similarly high hormone-receptor positivity. Chemotherapy use peaked in 2009 and declined thereafter, whereas endocrine therapy (ET) increased steadily. Patients ≥ 80 received chemotherapy less often and more frequently ET alone. Across all biological subtypes, patients ≥ 80 were associated with higher rates of distant metastasis compared with those aged 70-79 years. CONCLUSION: Clinical and biological differences between women aged 70-79 and those ≥ 80 underscore the need for age-adapted, individualized BC management. Treatment decisions should carefully balance expected benefit against comorbidity burden and functional status. Refining age-specific treatment strategies may help to improve outcomes and quality of life, although this analysis cannot determine the effects of specific strategies in this growing patient population.
Predictors of adverse neonatal outcomes in low-risk nulliparous women at term with meconium-stained amniotic fluid.
Odeh M, Wolf MF, Rosen S … +2 more , Lowenstein L, Sgayer I
Arch Gynecol Obstet · 2026 Mar · PMID 41896427 · Full text
OBJECTIVES: Meconium-stained amniotic fluid (MSAF) has been linked to adverse neonatal outcomes, but most evidence comes from heterogeneous cohorts that included multiparous and high-risk women. Nulliparous women without...
OBJECTIVES: Meconium-stained amniotic fluid (MSAF) has been linked to adverse neonatal outcomes, but most evidence comes from heterogeneous cohorts that included multiparous and high-risk women. Nulliparous women without comorbidities are generally considered low risk, yet their outcomes in the presence of MSAF remain less well defined. This study aimed to identify predictors of adverse neonatal outcomes in low-risk nulliparous women at term with MSAF. DESIGN: A retrospective cohort study. PATIENTS: Seven hundred sixty low-risk nulliparous women with documented MSAF at term delivery between March 2020 and July 2024. SETTING: A tertiary, university-affiliated medical center. METHODS: Obstetric and neonatal data were extracted from electronic medical records. Maternal, intrapartum, and neonatal characteristics were compared between women with and without an adverse neonatal outcome. The latter was defined as the presence of at least one of the following: a 5-min Apgar score < 7, umbilical artery pH < 7.15, admission to the neonatal intensive care unit, the need for invasive ventilation, meconium aspiration syndrome, or neonatal death. Multivariable logistic regression was performed to identify independent predictors of adverse outcome. RESULTS: Among women with adverse neonatal outcomes (59, 7.8%) compared to those without adverse outcomes, the mean delivery was earlier (39.3 ± 2.5 vs 40.0 ± 1.0 weeks, p < 0.001) and the mean birthweight lower (3171.8 ± 698.8 g vs 3328.7 ± 413.2 g, p = 0.009). Prolonged rupture of membranes > 18 h was more common (11.9% vs 3.0%, p = 0.004), as was chorioamnionitis (22.0% vs 10.6%, p = 0.012). Meconium thickness was greater (p = 0.049). In multivariable logistic regression, early term delivery (adjusted odds ratio (aOR) 3.63, 95% CI 1.76-7.51), prolonged rupture of membranes > 18 h (aOR 4.27, 95% CI 1.93-9.47), moderate meconium (aOR 2.46, 95% CI 1.29-4.69), thick meconium (aOR 4.67, 95% CI 2.00-10.91), and chorioamnionitis (aOR 2.74, 95% CI 1.52-4.93) were independent predictors of an adverse neonatal outcome. LIMITATIONS: The retrospective single-center design and limited number of adverse neonatal events may restrict generalizability and preclude assessing risks for specific morbidities. CONCLUSIONS: Among low-risk nulliparous women with MSAF, early term delivery, prolonged rupture of membranes, greater meconium thickness, and chorioamnionitis were associated with adverse neonatal outcomes. These factors may assist in predicting risk and guiding intrapartum management, though validation in larger prospective studies is needed.
Effectiveness of evidence-based nursing protocols in managing postpartum hemorrhage after vaginal delivery: a prospective observational quality-improvement evaluation.
Chen Y, Ling M, Nan D … +4 more , Zhang Z, Liu S, Kou M, Pan X
Arch Gynecol Obstet · 2026 Mar · PMID 41886103 · Full text
OBJECTIVE: To investigate the effectiveness of evidence-based intervention strategies in managing postpartum hemorrhage following vaginal delivery. METHODS: This was a prospective, observational quality-improvement evalu...
OBJECTIVE: To investigate the effectiveness of evidence-based intervention strategies in managing postpartum hemorrhage following vaginal delivery. METHODS: This was a prospective, observational quality-improvement evaluation conducted among 120 women who experienced postpartum hemorrhage after vaginal delivery. Two nursing strategies were compared consecutively: a conventional nursing routine and a structured evidence-based nursing protocol developed from current literature and clinical guidelines. Outcomes assessed included postpartum blood loss, coagulation indicators [prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), and fibrinogen (FIB)], adverse events, self-care ability, nursing satisfaction, emotional status [Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)], and quality of life. RESULTS: Compared with the routine nursing phase, the evidence-based nursing phase was associated with lower bleeding volume at 0.5, 2, 12, and 24 h postpartum (P < 0.05). After 5 days of nursing care, PT, TT, and APTT were shorter, and FIB levels were higher (P < 0.05). The frequency of adverse events was lower (10.0% vs. 23.3%), while self-care ability, nursing satisfaction, and quality-of-life scores were higher. Both phases showed decreases in SAS and SDS scores, with greater improvement observed in the evidence-based phase (P < 0.05). CONCLUSION: An observational study of quality-improvement demonstrated a significant association between the implementation of a standardized evidence-based nursing protocol and reduced postpartum hemorrhage, improved coagulation profiles, lower incidence of adverse events, and improved psychosocial outcomes. These results should be validated in future randomized controlled trials.
Risk factors for combined vaginal-cesarean delivery in the vertex-vertex twins: a case-control study.
Manor I, Gabbai D, Baruch Y … +3 more , Yogev Y, Hiersch L, Attali E
Arch Gynecol Obstet · 2026 Mar · PMID 41886092 · Full text
PURPOSE: Twin pregnancies pose unique challenges during labor, particularly the risk of cesarean section for the second twin after vaginal delivery of the first-termed a combined vaginal-cesarean delivery. Although nonve...
PURPOSE: Twin pregnancies pose unique challenges during labor, particularly the risk of cesarean section for the second twin after vaginal delivery of the first-termed a combined vaginal-cesarean delivery. Although nonvertex presentation of the second twin is a recognized risk factor, predictors in vertex-vertex twin pregnancies remain unclear. The objective of this study was to identify maternal, pregnancy-related, intrapartum, and fetal risk factors associated with combined vaginal-cesarean delivery in twin pregnancies with vertex-vertex presentation. METHODS: A retrospective single-center case-control study was conducted at Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, between 2012 and 2023. The study included women with twin pregnancies in vertex-vertex presentation who attempted vaginal delivery. The case group comprised women who underwent combined vaginal-cesarean delivery (vaginal birth of the first twin followed by cesarean of the second), while controls delivered both twins vaginally. Maternal, pregnancy-related, intrapartum, and fetal variables were analyzed using univariate and multivariable logistic regression models. RESULTS: Among 503 twin deliveries meeting inclusion criteria, 22 (4.4%) resulted in combined vaginal-cesarean delivery. Maternal characteristics, labor features, and fetal parameters were similar between groups. Gestational diabetes mellitus was significantly more frequent among combined deliveries (31.8% vs. 10.8%; p = 0.009) and remained the only independent risk factor after adjustment (odds ratio 4.06; 95% CI 1.57-10.53; p = 0.004). No other associations were found between the delivery outcome and other factors, including maternal age, parity, previous cesarean delivery, preeclampsia, instrumental delivery of the first twin, gestational age at delivery, and intertwin birthweight discordance. CONCLUSIONS: In vertex-vertex twin pregnancies, successful vaginal delivery is achieved in approximately 95% of cases. Gestational diabetes mellitus independently increases the likelihood of cesarean delivery for the second twin, suggesting a possible metabolic influence on labor dynamics. Optimal glycemic control and vigilant intrapartum management may help minimize cesarean conversions. Larger multicenter studies are warranted to validate these findings and explore the effect of diabetes severity and treatment type.
Editorial Expression of Concern: Stimulation of the endometrium with high-grade blastocyst culture supernatant (SEHB) can improve pregnancy outcome for couples undergoing intracytoplasmic sperm injection (ICSI): a randomized clinical trial.
Tehraninejad ES, Tanha FD, Ghajarzadeh M … +3 more , Zandieh Z, Aziminekoo E, Zanjani HR
Arch Gynecol Obstet · 2026 Mar · PMID 41874716 · Full text
Abstract loading — click title to view on PubMed.
OPM-based fetal magnetocardiography: fetal cardiac time intervals in healthy pregnancies compared to postnatal ECGs.
Wacker-Gussmann A, Narushima K, Tardelli G … +9 more , Wakai RT, Strasburger JF, Wunderl L, Jensch T, Heckel R, Lobmaier SM, Nagdyman N, Ewert P, Fierlinger P
Arch Gynecol Obstet · 2026 Mar · PMID 41870678 · Full text
BACKGROUND: Fetal magnetocardiography (fMCG) is the most accurate method to assess fetal heart rhythm and conduction. New quantum sensor technology makes it possible to use less expensive devices. The aim of the study is...
BACKGROUND: Fetal magnetocardiography (fMCG) is the most accurate method to assess fetal heart rhythm and conduction. New quantum sensor technology makes it possible to use less expensive devices. The aim of the study is to measure cardiac time intervals of healthy fetuses with a new technology, optically pumped magnetometry (OPM), and compare these results with conventional SQUID-based fMCG and postnatal ECGs. METHODS: The recordings were made using an OPM-based fMCG system and a person-sized magnetic shield, established at German Heart Center,TUM University, Munich, Germany. The subjects were 57 healthy women with uncomplicated singleton pregnancies, studied at a mean gestational age of 32 ± 3.7 weeks with an overall range of 25-40 weeks. The P, PR, QRS, QT, QTc, and RR intervals were measured and compared with published data from previous fMCG devices and postnatal ECG. RESULTS: The P, PR, and QRS intervals increased with gestational age, but the QT and QTc intervals did not. The measured values of the OPM device were consistent with those from previously published data SQUID values. U-waves were seen in 17.3% of subjects. Eleven subjects were studied by fMCG after 30 weeks' gestation and by ECG within 17 weeks of birth. In this cohort, the P-wave duration, QRS duration, and QTc increased after birth, but the PR and QT intervals did not. CONCLUSION: The results obtained with our innovative OPM-based fMCG system are comparable to previously available measurements obtained by other technologies. The data establish prediction intervals for OPM-based fMCG waveforms in normal fetuses, which is essential for future clinical application. The technology can be used to recognize fetuses with rhythm or conduction abnormalities that might not be evident by echocardiography. To our knowledge, this is the first report comparing fetal cardiac time intervals measured by OPM-based fMCG with postnatal ECG. Lengthening of cardiac intervals consistent with increased chamber size was seen postnatally.
The role of cesarean section surgical techniques in the prevention of isthmocele formation: retrospective cohort study.
Horasanlı JE, Akkuş F
Arch Gynecol Obstet · 2026 Mar · PMID 41865166 · Full text
KEY MESSAGE: Compared with conventional locked double-layer closure, an unlocked double-layer, endometrium-sparing closure was associated with lower isthmocele prevalence, greater residual myometrial thickness, and fewer...
KEY MESSAGE: Compared with conventional locked double-layer closure, an unlocked double-layer, endometrium-sparing closure was associated with lower isthmocele prevalence, greater residual myometrial thickness, and fewer postcesarean symptoms. If these findings are confirmed in prospective studies, adopting this closure approach could help to reduce morbidity related to the niche in routine cesarean practice. BACKGROUND: Isthmocele, a cesarean scar defect associated with abnormal bleeding, pelvic pain, and diminished fertility, is becoming more well known as a result of the increasing prevalence of cesarean sections. Although the optimal closure technique is still a topic of debate, it is regarded as the most modifiable factor in the prevention of isthmocele. OBJECTIVE: To compare the effects of the traditional locked double-layer uterine closure technique with the new unlocked double-layer, endometrium-protective technique on isthmocele incidence, residual myometrial thickness (RMT), and post-CS symptoms. METHODS: From March 2023 to January 2025, a total of 180 women (97 conventional and 83 novel) who underwent low-segment cesarean sections at a tertiary care center were included in a retrospective comparative cohort study. At 12-24 weeks postpartum, residual myometrial thickness (RMT) and isthmocele presence were evaluated using saline-infusion sonohysterography. Independent predictors of RMT and isthmocele were identified through binary logistic and multiple linear regression analyses. RESULTS: The new method was linked to less need for additional hemostatic sutures (2.4% vs. 11.3%; OR = 5.18), as well as a shorter operating time (26 vs. 33 min, p = 0.001). Compared with the new lockless double-layer technique, traditional locked double-layer closure was associated with a significantly higher risk of isthmocele (39.2% vs. 7.2%; OR = 8.27, 95%CI 3.28-20.85; p = 0.001). Additionally, the mean RMT was greater (13.91 vs. 10.18 mm, p = 0.001). While linear regression connected the novel technique and higher parity to greater RMT and preoperative anemia to decreased healing, logistic regression found that suture technique was the only independent predictor of isthmocele. The novel group had significantly lower rates of postmenstrual spotting, dysmenorrhea, and chronic pelvic pain (p = 0.001 for all). CONCLUSIONS: Compared to the traditional locking technique, the locking, double-layer, endometrium-sparing uterine closure method, in which the first layer of the uterine incision is continuously sutured without locking and the second layer is reinforced with a continuous 'U'-shaped suture, results in a statistically significant reduction in isthmocele formation, increased residual myometrial thickness, shorter operative time, and fewer niche-related symptoms. This method appears to improve short-term uterine healing and niche-related symptoms; however, its impact on future reproductive and obstetric outcomes remains unknown and requires prospective validation. However, multicenter studies with extended follow-up periods are warranted to confirm these findings.
Retraction Note: Letrozole versus clomiphene citrate for superovulation in Egyptian women with unexplained infertility: a randomized controlled trial.
Ibrahim MI, Moustafa RA, Abdel-Azeem AA
Arch Gynecol Obstet · 2026 Mar · PMID 41854918 · Full text
Abstract loading — click title to view on PubMed.
Aortic isthmus Doppler hemodynamics and ımpacts on perinatal outcomes in pregestational and gestational diabetes mellitus.
Seyhanli Z, Karabay G, Filiz AA … +6 more , Duygulu Bulan D, Agaoglu RT, Aktemur G, Cakir BT, Yucel KY, Yilmaz ZV
Arch Gynecol Obstet · 2026 Mar · PMID 41854913 · Full text
BACKGROUND/AIM: To assess the sensitivity of the fetal aortic isthmus (AoI) Doppler changes in predicting the adverse perinatal outcome with pregestational and gestational diabetes mellitus compared with other Doppler pa...
BACKGROUND/AIM: To assess the sensitivity of the fetal aortic isthmus (AoI) Doppler changes in predicting the adverse perinatal outcome with pregestational and gestational diabetes mellitus compared with other Doppler parameters. MATERIALS AND METHODS: This prospective case-control study was undertaken between Agust 2023 and May 2024 in Ankara Etlik City Hospital perinatology department. Maternal age, gravidity, parity, maternal body mass index (BMI), gestational age at ultrasonographic examination, fetal AoI, umbilical artery (UA), middle cerebral artery (MCA), and uterine artery (UtA) Doppler parameters were compared between four groups: Pregestational diabetes mellitus (PGDM) (n = 30), diet-regulated gestational diabetes mellitus (DRGDM) (n = 30), insulin-regulated GDM (IRGDM) (n = 30), and controls (n = 75). HbA1c values were evaluated only in pregnancies complicated by diabetes mellitus. The composite adverse perinatal outcomes (CAPO) was defined as Apgar score at 5 min < 7, cord blood pH < 7, sepsis, phototherapy for neonates, respiratory distress syndrome (RDS), mechanical ventilation, neonatal intensive care unit (NICU) admission, hypoglycemia. RESULTS: Maternal age and BMI levels were significantly higher in the PGDM group (p < 0.001). HbA1c levels were significantly higher in the PGDM group compared to other diabetic groups (p < 0.001). While most Doppler parameters were similar across groups, PGDM cases had higher rates of prematurity (40%), cesarean delivery (90%), NICU admission (60%), and CAPO (63.3%) compared to controls (p < 0.01 for all). HbA1c was positively correlated with MCA S/D, AoI-PSV, and AoI S/D (p < 0.05). ROC analysis showed that AoI Ta-max and EDV had modest predictive value for CAPO (AUC = 0.627 and 0.638, respectively; p < 0.05). CONCLUSIONS: The AoI Doppler flow measurements may serve as a potential adjunctive marker in the assessment of adverse perinatal outcomes in pregnancies complicated by diabetes mellitus. However, further large-scale prospective studies are warranted to validate its clinical applicability and establish its role in routine obstetric practice.
Effect of adhesions on laparoscopically-assisted vaginal hysterectomy outcome: a 10-year retrospective, comparative study of 1683 consecutive cases.
Torres-de la Roche LA, Schulte AJ, De Wilde RL … +4 more , Devassy R, Tchartchian G, Krentel H, de Wilde MS
Arch Gynecol Obstet · 2026 Mar · PMID 41854909 · Full text
INTRODUCTION: Hysterectomy is a frequently employed treatment modality in gynaecological diseases. In the context of various approaches to vaginal hysterectomy, laparoscopically-assisted vaginal hysterectomy (LAVH) could...
INTRODUCTION: Hysterectomy is a frequently employed treatment modality in gynaecological diseases. In the context of various approaches to vaginal hysterectomy, laparoscopically-assisted vaginal hysterectomy (LAVH) could eventually improve the safety in cases where patients without genital prolapse present with preoperative peritoneal adhesions. The present analysis examined intraoperative and immediate postoperative adhesions-related outcomes. METHODS: Monocentric, comparative, retrospective study of a single cohort of women without genital prolapse who underwent LAVH for benign gynaecological conditions between January 2010 and December 2019. Patients without peritoneal adhesions were compared with patients with adhesions, as diagnosed at the beginning of the procedure. Mann-Whitney-U test was used for the comparative analysis. RESULTS: Among 1,638 patients, 562 patients (34.3%) had preoperative adhesions. Main indications were for myoma (71%) and adenomyosis (14.9%). The mean operation time in the adhesion group was significantly longer than in the no-adhesion group (106 ± 44 min vs. 90 ± 35 min; p < 0.001). Adhesiolysis was required in 88% within the adhesion group (n = 495). No significant differences were observed regarding mean estimated intraoperative blood loss (87 ± 100 ml vs. 90 ± 95 ml; p = 0, 418), uterine weight (220 ± 227 g vs. 230 ± 203 g; p = 0, 38), or morcellation (52% vs. 55.8%; p = 0, 142). Most patients in both groups did not experience complications (95% vs. 97.2%). Laparoconversion due to technical difficulties in performing the endocopic surgery or due to the presence of adhesions was rarely needed (1.6% vs. 0.6%). The intraoperative complication rate was low but significantly different in both groups (2% vs. 0.7%; p = 0.02), including bowel injuries (n = 6 vs. n = 3) and urinary bladder injuries (n = 4 vs. n = 5). %), which were diagnosed immediately and treated successfully. The postoperative complication rate was similar in both groups (3.4% vs. 2.1%; p = 0.138), mainly urinary tract infection. All adverse events were treated successfully; second laparoscopic surgery was conducted in five patients with adhesions and in nine patients without adhesions for haematoma removal. CONCLUSION: LAVH could be considered a safe and feasible surgical approach for women without genital prolapse who have preoperative peritoneal adhesions and require vaginal hysterectomy for benign gynaecological conditions. This approach facilitates the localisation and treatment of adhesions at the commencement of surgery, as well as the control of possible injuries that may arise during the procedure, and is associated with a low complication rate.
Retraction Note: Association between placental site and successful induction of labor among postdate primiparous women.
Taha OT, Ghoneim HM, Marzouk T … +1 more , Ali TYM
Arch Gynecol Obstet · 2026 Mar · PMID 41854899 · Full text
Abstract loading — click title to view on PubMed.
Is placental immune polarization the missing link in gestational diabetes?
Triunfo S
Arch Gynecol Obstet · 2026 Mar · PMID 41854763 · Publisher ↗
Abstract loading — click title to view on PubMed.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe