Archives Of Gynecology And Obstetrics[JOURNAL]
Sun
200 papers
Robotic-integrated intraoperative ultrasound for excision of accessory cavitated uterine malformation (ACUM): an innovative surgical technique.
Thippeswamy SP, Hablase R, Chatterjee J … +3 more , Faris R, Narayanan P, Chatterjee J
Arch Gynecol Obstet · 2026 Mar · PMID 41854755 · Full text
BACKGROUND: Accessory cavitated uterine mass (ACUM) is a rare Mullerian anomaly that predominantly affects young women, presenting with refractory dysmenorrhea. Despite 3D ultrasound and MRI being the gold standard for d...
BACKGROUND: Accessory cavitated uterine mass (ACUM) is a rare Mullerian anomaly that predominantly affects young women, presenting with refractory dysmenorrhea. Despite 3D ultrasound and MRI being the gold standard for diagnosis, diagnostic delays and accuracy limitations continue to hinder timely management. The deep intra-myometrial location of this anomaly poses significant surgical challenges in achieving complete excision while preserving healthy myometrium. CASE PRESENTATION: A 22-year-old nulliparous woman presented with incapacitating cyclical pelvic pain and was diagnosed with ACUM. She underwent surgical management using a novel robotic-assisted technique. TECHNIQUE: The procedure utilised robotic-integrated intraoperative ultrasound via a drop-in probe, enabling real-time identification of lesion margins, vascular mapping, and confirmation of complete lesion excision. This approach minimised loss of healthy myometrium and preserved endometrial cavity integrity. OUTCOME: The patient reported complete symptom resolution postoperatively. Integration of real-time intraoperative ultrasound within the robotic platform enhanced surgical precision, reduced surgical trauma, and has the potential to improve reproductive outcomes. CONCLUSION: Robotic-assisted excision of ACUM with intraoperative ultrasound guidance represents an innovative and precise surgical technique. This approach addresses the key challenges of lesion localisation and myometrial preservation, offering a promising strategy for managing this rare condition in women of reproductive age.
Residual risk of clinically significant copy number variations in fetuses with ultrasonographic soft markers following exclusion of non-invasive prenatal screening-detectable findings.
Liang Y, Zhou R, Liu T … +9 more , Gao J, Xu Y, Huang M, Meng L, Huo H, Zhang Q, Wu Y, Xu Z, Wang Y
Arch Gynecol Obstet · 2026 Mar · PMID 41848878 · Full text
OBJECTIVE: To evaluate the residual risk of clinically significant copy number variations (CNVs) in fetuses with ultrasonographic soft markers by its various types after excluding theoretically non-invasive prenatal scre...
OBJECTIVE: To evaluate the residual risk of clinically significant copy number variations (CNVs) in fetuses with ultrasonographic soft markers by its various types after excluding theoretically non-invasive prenatal screening (NIPS)-detectable abnormalities. METHODS: This study included 2005 fetuses with soft markers undergoing chromosomal microarray analysis (CMA) between 2015 and 2024. Theoretically NIPS-detectable findings were categorized into three subgroups: 3-chromosome NIPS, 5-chromosome NIPS, and genome-wide NIPS. The residual risk was calculated and compared with a low-risk control cohort. We further assessed their clinical outcomes. RESULTS: The overall diagnostic yield of clinically significant CMA findings in fetuses with soft markers was 6.38%. Overall, the residual risk was 4.67% for 3-chromosome NIPS, 4.19% for 5-chromosome NIPS, and 3.25% for genome-wide NIPS. Except for isolated single umbilical artery (genome-wide NIPS), echogenic intracardiac focus, and aberrant right subclavian artery (all NIPS models), the residual risk was significantly higher for most soft marker types when compared with the control cohort. Among fetuses with normal CMA results and successful follow-up, a significantly lower rate of normal infant was identified in fetuses with four types of soft markers (mild ventriculomegaly, echogenic bowel, short femur length, and mild pyelectasis) compared with the control cohort. CONCLUSION: The residual risk in fetuses with multiple soft markers and most isolated soft markers (absent or hypoplastic nasal bone, mild ventriculomegaly, thickened nuchal fold, echogenic bowel, short femur length, mild pyelectasis, and choroid plexus cysts) was higher than that in low-risk pregnancies. CNV analysis is recommended for such fetuses, regardless of whether NIPS has been performed previously.
Anonymous forensic evidence collection (AFC) after sexual offenses: a challenge in gynecological care-data from 13 years and 7 months at a University Hospital.
Herpel C, Bogus M, Mallmann P … +2 more , Banaschak S, Ludwig S
Arch Gynecol Obstet · 2026 Mar · PMID 41843160 · Full text
INTRODUCTION: Anonymous (or confidential) forensic evidence collection (AFC; German: Anonyme Spurensicherung [ASS]) following sexual offenses plays a critical role in the initial care of affected individuals. Comprehensi...
INTRODUCTION: Anonymous (or confidential) forensic evidence collection (AFC; German: Anonyme Spurensicherung [ASS]) following sexual offenses plays a critical role in the initial care of affected individuals. Comprehensive execution of this procedure presents a significant challenge in the clinical routine care of gynecologists, as legal requirements, court-admissible documentation of injuries, and forensic evidence preservation often lead to uncertainty. The implementation of forensic evidence collection as a statutory health insurance benefit, following the Measles Protection Act (Masernschutzgesetz), has been effective in North Rhine-Westphalia since March 1, 2025, and is currently being formalized in contractual agreements. The objective of this study is to track the utilization of AFC, raise awareness of this topic, and identify common problems associated with its execution. MATERIALS AND METHODS: Systematic compilation of annual case numbers for anonymous forensic evidence collection (AFC) was performed from June 2011 to December 2024 at the Department of Obstetrics and Gynecology, University Hospital Cologne. This was followed by a statistical evaluation of the percentage increase and the annual mean values. RESULTS: A total of 177 cases were documented at the University Hospital Cologne. Between 2012 and 2024, the annual case numbers increased from eight to 25 cases. The average number of cases examined annually during the observation period was 13.15. This corresponds to an average annual increase of approximately 17%, totaling 215% over 11 years, when considering 2012 as the first complete year for data analysis. Frequent issues encountered in clinical practice include improper storage (until transport to the Institute of Legal Medicine) and incorrect labeling of collected samples. CONCLUSIONS: The observed increase in the number of alleged victims of sexual violence requiring examination supports the health policy assumption that structured and correct forensic evidence collection is becoming increasingly vital. Adequate funding for the examination and the storage of evidence carriers is mandatory for long-term quality assurance. This is the only way to ensure optimal support and care for presumed victims in these stressful situations.
Spatial Distribution and Determinants of Early Resumption of Postpartum Sexual Intercourse among Postpartum Women in Ethiopia: A Multilevel Analysis.
Dagnaw M, Indracanti M, Asratie MH
Arch Gynecol Obstet · 2026 Mar · PMID 41840194 · Full text
INTRODUCTION: Postpartum sexual health and practice need to be integrated into the current maternal healthcare services to address sexual health problems. However, postpartum sexual practice has received little attention...
INTRODUCTION: Postpartum sexual health and practice need to be integrated into the current maternal healthcare services to address sexual health problems. However, postpartum sexual practice has received little attention and is not often discussed by healthcare providers during prenatal and postnatal care, even though evidence is scarce on the spatial distribution of early resumption of postpartum sexual intercourse in Ethiopia. OBJECTIVE: The current study aimed to demonstrate the median time to resumption of postpartum sexual intercourse and the spatial distribution of early resumption of postpartum sexual intercourse in Ethiopia. METHODS: A cross-sectional study was employed based on the Ethiopian demographic and health survey 2016 data, and 6456 postpartum period women were included. Arc GIS version 10.7 and SaTScan version 9.6 software were used. Mixed-effect analysis was done by STATA version 14 software. Bivariate analysis was done, and variables with a p value < 0.2 were taken as candidates for multilevel multivariable logistic regression. Intra Class Correlation Coefficient (ICC), Proportion Change in Variance (PCV), and Median Odds Ratio (MOR) were used for model comparison, and Adjusted Odds Ratio (AOR) with respect to a 95% confidence interval was used for declaring statistical significance. In the multivariable analysis, a p value ≤ 0.05 was considered as a cut point of statistical significance with the outcome variable. RESULTS: The spatial distribution of early resumption of postpartum sexual intercourse was not random. Not married (Adjusted Odds Ratio (AOR = 0.31; 95% CI 0.25, 0.39), sex of child female (AOR = 0.87; 95% CI 0.81,0.93), protestant in religion (AOR = 0.68; 95% CI 0.58, 0.79), ever breastfeeding (AOR = 1.35; 95% CI 1.12, 1.63), and multiparity (AOR = 1.16; 95%, 1.03, 1.30) were variables significantly associated with early resumption of postpartum sexual intercourse. CONCLUSIONS: The spatial distribution of early resumption of postpartum sexual intercourse was not random. We need to give attention to those hotspot areas and factors significantly associated with early resumption of postpartum sexual intercourse. Reproductive and maternal health program managers and policymakers need to pay attention to those hotspot areas and significant variables to achieve the Sustainable Development Goal.
Effect of zero-time exercise intervention on endometrial receptivity in women with thin endometrium a single-center randomized sham-controlled trial.
Jiang Z, Hua Y, Deng L … +6 more , Li Y, Xu S, Li M, Luo Y, Wang C, Liu G
Arch Gynecol Obstet · 2026 Mar · PMID 41838118 · Full text
BACKGROUND: Current therapeutic strategies for thin endometrium have inherent limitations, and zero-time exercise (ZTEx), a professionally guided fragmented low-intensity exercise, may serve as a novel adjunctive interve...
BACKGROUND: Current therapeutic strategies for thin endometrium have inherent limitations, and zero-time exercise (ZTEx), a professionally guided fragmented low-intensity exercise, may serve as a novel adjunctive intervention for its management. METHODS: This was a single-center randomized sham-controlled trial. Eligible patients undergoing ART were randomly divided into an experimental group (receiving ZTEx intervention) and a control group (receiving sham intervention). The ZTEx intervention was delivered over 12 weeks, featuring fragmented, low-intensity exercises under professional guidance. Key indicators of endometrial health-including endometrial thickness and endometrial receptivity-related parameters-were monitored throughout the intervention period. RESULTS: After 12 weeks of intervention, ANCOVA (adjusted for baseline values) revealed that the experimental group had a significantly greater endometrial thickness than the control group (6.67 ± 1.15 mm vs. 5.88 ± 1.17 mm, P < 0.001). Concurrently, multiple endometrial receptivity-related indices improved significantly in the experimental group (all P < 0.05), including uterine artery hemodynamic parameters (pulsatility index [PI], resistance index [RI], systolic/diastolic ratio [S/D]) and vascularization indices (vascularization index [VI], flow index [FI], vascularization-flow index [VFI]).No exercise-related adverse events were reported over the course of the trial, confirming the safety profile of ZTEx. CONCLUSIONS: Supported by rigorous statistical analyses, ZTEx effectively enhances endometrial thickness and receptivity in ART patients with thin endometrium. Its key advantages-safety, feasibility, and no need for additional time or equipment-make it a promising adjuvant intervention in clinical ART settings.
The efficacy and safety of enhanced recovery after surgery (ERAS) protocols in cesarean delivery: a meta-analysis of randomized controlled trials.
Lou J, Guo F
Arch Gynecol Obstet · 2026 Mar · PMID 41832375 · Full text
BACKGROUND: Given the concerns regarding maternal and neonatal safety, the application of enhanced recovery after surgery (ERAS) in cesarean delivery remains controversial and has not been adopted in some regions. This s...
BACKGROUND: Given the concerns regarding maternal and neonatal safety, the application of enhanced recovery after surgery (ERAS) in cesarean delivery remains controversial and has not been adopted in some regions. This study aims to conduct a meta-analysis to compare the ERAS pathway with conventional postoperative care, in order to provide evidence on the safety and efficacy of the ERAS protocols. METHODS: PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, and CBM were searched from their inception until February 2025. Randomized controlled trials (RCTs) published in English or Chinese that compared the ERAS and standard care in cesarean section were eligible for inclusion. Two reviewers independently extracted the data and assessed the risk of bias using the Cochrane risk-of-bias tool. The analyses were conducted using RevMan 5.4 software, and the results were presented as forest plots. RESULTS: Out of 2817 records screened, 10 RCTs comprising 1934 participants met the inclusion criteria. The pooled analyses indicated that ERAS protocols significantly reduced the length of hospital stay (MD -14.13, 95% CI -25.36 to -2.90; p = 0.01), hospitalization costs (MD -447.85, 95% CI -687.04 to -208.66; p = 0.0002), time to first flatus (MD -9.82, 95% CI -13.54 to -6.10; p < 0.00001), time to first stool (MD -15.35, 95% CI -19.10 to -11.60; p < 0.00001), pain sores (MD -1.54, 95% CI -2.10 to -0.99; p < 0.00001), and postpartum hemorrhage (MD -47.75, 95% CI -69.94 to -25.55; p < 0.0001). No statistically significant differences were observed between ERAS and conventional standard recovery in terms of postoperative nausea and vomiting (PONV), urinary retention, postoperative infection, deep venous thrombosis (DVT), 30 days readmission rates, and NICU admission rates. CONCLUSIONS: The adoption of ERAS protocols in cesarean delivery is associated with accelerated postoperative recovery without compromising maternal or neonatal safety. Nevertheless, these findings should be approached with caution due to the limited number and heterogeneity of the studies included.
Effect of orlistat and anti-androgen oral contraceptives on pregnancy outcomes in overweight or obese PCOS patients during comprehensive management.
Zhang M, Ruan X, Jiang L … +5 more , Li Y, Wang Z, Li Y, Liu A, Mueck AO
Arch Gynecol Obstet · 2026 Mar · PMID 41831044 · Full text
OBJECTIVE: To investigate the impact of comprehensive preconception management using combined oral contraceptives (COCs) and orlistat on live birth rates and pregnancy outcomes in overweight or obese women with polycysti...
OBJECTIVE: To investigate the impact of comprehensive preconception management using combined oral contraceptives (COCs) and orlistat on live birth rates and pregnancy outcomes in overweight or obese women with polycystic ovary syndrome (PCOS), aimed at optimizing preconception management strategies. METHODS: This prospective cohort study enrolled 235 overweight or obese PCOS women aged 20-40 years. Participants were categorized into three preconception management groups: a DRSP/EE monotherapy group (n = 37), a DRSP/EE + orlistat combination therapy group (n = 71), and a non-medication control group (n = 127). All groups received individualized comprehensive management. The primary outcomes were live birth rate and incidence of pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). Secondary outcomes encompassed adverse pregnancy outcomes (APO), cesarean section rate, and neonatal complications. RESULTS: The incidence of GDM was significantly lower in the combination therapy group (31.9%) compared to the control group (56.6%) (P < 0.01). The DRSP/EE monotherapy group (33.3%) showed a decreasing trend, but statistical significance was not maintained after adjustment for multiple comparisons. While no statistically significant differences were observed in HDP, live birth rates, or APO among the groups (P > 0.05), the combination group exhibited the most favorable trends, achieving the highest live birth rate (97.2%) and the lowest APO rate (21.1%) compared to the monotherapy and control groups. Similarly, neonatal outcomes (preterm delivery, low birth weight, macrosomia) were comparable across groups, though the combination group showed numerically lower rates of preterm delivery and macrosomia. Multivariable logistic regression identified body mass index (BMI), fasting plasma glucose (FPG), fasting insulin (FINS), and total testosterone (TT) as independent risk factors for GDM, whereas both medication regimens were identified as significant protective factors. CONCLUSION: This study demonstrates that preconception combination therapy with DRSP/EE and orlistat significantly reduces the risk of GDM in overweight or obese women with PCOS. DRSP/EE monotherapy also exhibits a potential protective trend, although the effect is less robust compared to the combination regimen. While differences in HDP and other pregnancy outcomes did not reach statistical significance, the combination therapy group yielded the most favorable clinical profile, achieving the numerically highest live birth rate and the lowest incidence of adverse pregnancy outcomes. Comprehensive management targeting BMI and metabolic indicators is crucial for improving pregnancy prognosis in this population.
Editorial Expression of Concern: Maternal serum leptin as a marker of preeclampsia.
El Shahat AM, Ahmed AB, Ahmed MR … +1 more , Mohamed HS
Arch Gynecol Obstet · 2026 Mar · PMID 41814081 · Full text
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Molecular insights into salpingitis-induced infertility and ectopic pregnancy: pathogenesis, biomarkers, and translational perspectives.
Li L, Li S, Zhou Y … +7 more , Wu D, Song H, Liu S, Kang S, Li Q, Liu S, Cong H
Arch Gynecol Obstet · 2026 Mar · PMID 41814063 · Full text
BACKGROUND: Salpingitis is a leading cause of female infertility and ectopic pregnancy worldwide. Despite advances in reproductive medicine, its early diagnosis and effective prevention of long-term sequelae remain chall...
BACKGROUND: Salpingitis is a leading cause of female infertility and ectopic pregnancy worldwide. Despite advances in reproductive medicine, its early diagnosis and effective prevention of long-term sequelae remain challenging due to its often silent clinical course and complex pathogenesis. OBJECTIVE: This review synthesizes current knowledge on the infectious, immunological, and molecular mechanisms underlying salpingitis, with an emphasis on diagnostic limitations and therapeutic challenges. METHODS: A comprehensive evaluation of recent literature was conducted focusing on pathogen-induced inflammation, host immune responses, molecular signaling pathways, and emerging diagnostic and therapeutic strategies, including omics-based biomarkers and molecular imaging approaches. RESULTS: Persistent inflammation, cytokine imbalance, and oxidative stress contribute to tubal scarring and ciliary dysfunction, ultimately leading to reproductive failure. While antibiotics are effective in treating acute infection, they do not prevent chronic complications. Advances in molecular diagnostics and non-invasive imaging show promise for early detection, although biomarker validation remains a major limitation. Rising antimicrobial resistance further complicates clinical management. CONCLUSION: Integrated approaches combining molecular diagnostics, imaging, and targeted therapies are essential to bridge laboratory research and clinical practice. Standardized diagnostic criteria, validated biomarkers, and improved reproductive health equity are critical to reducing the global burden of salpingitis.
LASSO regression-derived first-trimester (9-14 weeks) risk stratification model for gestational diabetes mellitus: development, validation, and open-access web tool in a retrospective Chinese cohort.
Wang X, Zhang J, Zhan S … +1 more , Xu X
Arch Gynecol Obstet · 2026 Mar · PMID 41811517 · Full text
BACKGROUND: Early identification of gestational diabetes mellitus (GDM) is critical for mitigating adverse maternal and neonatal outcomes. Existing prediction models face limitations in clinical utility due to inconsiste...
BACKGROUND: Early identification of gestational diabetes mellitus (GDM) is critical for mitigating adverse maternal and neonatal outcomes. Existing prediction models face limitations in clinical utility due to inconsistent variable selection and reliance on impractical biomarkers. This study aimed to develop and validate a resource-efficient GDM prediction model using routinely available first-trimester clinical indicators and deploy it as an open-access web tool. METHODS: A retrospective cohort of 1818 pregnancies from a Shanghai tertiary hospital (2023) was randomly divided into training (70%) and validation (30%) sets. Three predictor screening strategies (traditional logistic regression, least absolute shrinkage and selection operator (LASSO) regression with 1SE rule, and LASSO-MIN rule) were compared. The model performance was assessed by the area under the receiver operating characteristic (ROC) curves (AUC), the calibration curve, the clinical decision curve (DCA) and the clinical impact curve (CIC). The optimal model was visualized as a nomogram and deployed as an open access web calculator. RESULTS: The LASSO-1SE model achieved the best balance of accuracy and simplicity, with an AUC of 0.717 (95% CI 0.681-0.753), sensitivity 69.7%, specificity 64.9%, and high positive predictive value (PPV = 92.3%).The model showed robust calibration (Hosmer-Lemeshow P > 0.3) and clinical utility across risk thresholds in DCA and CIC. A nomogram and an open-access web calculator ( https://wangxiao0922.shinyapps.io/20250309/ ) were developed for risk stratification. CONCLUSIONS: This resource-efficient tool enables early GDM risk stratification using routine clinical variables, supporting timely intervention in diverse healthcare settings.
Transvaginal sonography-guided aspiration of benign ovarian cysts: a retrospective evaluation of safety, feasibility, and economic and environmental implications.
Endres H, Cioabla M, Ebner F … +6 more , Janni W, Juhasz-Boess I, Jung L, Lukac S, Upadhyay M, Dayan D
Arch Gynecol Obstet · 2026 Mar · PMID 41807630 · Full text
PURPOSE: To evaluate the safety, feasibility, and short-term reliability of transvaginal sonography-guided ovarian cyst aspiration in women with benign-appearing ovarian cysts and to explore its potential economic and en...
PURPOSE: To evaluate the safety, feasibility, and short-term reliability of transvaginal sonography-guided ovarian cyst aspiration in women with benign-appearing ovarian cysts and to explore its potential economic and environmental implications compared with minimally invasive surgical management. METHODS: This retrospective cohort study included women with sonographically benign ovarian cysts treated with transvaginal sonography-guided aspiration at a tertiary-care hospital between January 2024 and October 2025. Patient characteristics, cyst morphology according to International Ovarian Tumor Analysis (IOTA) Simple Rules, procedural feasibility, complications, and recurrence rates were analyzed. In addition, targeted literature reviews were performed to contextualize reported health care costs and carbon footprints of laparoscopic gynecologic procedures. RESULTS: Twenty-two women were included. The median age was 58 years (range 31-87), the median cyst diameter was 5.9 cm (range 2.8-10.0), and the median aspirated volume was 55 mL (range 9-600). All cysts fulfilled benign sonographic criteria, most commonly IOTA pattern B1 (77.3%), and were predominantly located in the Douglas space (77.3%). The procedure was technically feasible in 95% of cases and was performed under local anesthesia in all but one patient. No major intra or post-interventional complications occurred. One cyst recurrence (4.5%) was documented during follow-up, noting that most patients were assessed only via self-presentation. Literature data indicate substantially higher health care costs for laparoscopic and robotic gynecologic procedures compared with sonography-guided interventions. Published studies report a mean carbon footprint of approximately 42 kg COe per laparoscopic procedure, while no data are currently available for sonography-guided cyst aspiration. CONCLUSION: Transvaginal sonography-guided ovarian cyst aspiration appears to be a safe and feasible treatment option for carefully selected benign ovarian cysts, with low short-term recurrence and minimal morbidity. Available evidence suggests potential economic advantages and a likely lower environmental impact compared with minimally invasive surgery. Given the small sample size, this approach should be considered a complementary or alternative option in selected patients rather than a first-line treatment and warrants further evaluation in larger prospective studies.
Managing anxiety-related disorders from pregnancy to parenthood.
Scholten W, Saris I, Eigenhuis E … +6 more , de Koning L, Muntingh A, Schut B, Seldenrijk A, van Oppen P, Batelaan N
Arch Gynecol Obstet · 2026 Mar · PMID 41806009 · Full text
PURPOSE: Anxiety-related disorders (ARD), including posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), are highly prevalent mental health conditions. The peak prevalence of ARD in women coincid...
PURPOSE: Anxiety-related disorders (ARD), including posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), are highly prevalent mental health conditions. The peak prevalence of ARD in women coincides with the critical period of family planning, pregnancy, and child-rearing, affecting 1 in 5 women. This poses several challenges, including fears of passing anxiety on to children, worsening of symptoms during pregnancy or postpartum, and concerns about how therapy affects pregnancy outcomes. Clinicians frequently lack the expertise to adequately address these concerns. This may result in clinicians being cautious about starting treatment. This narrative review provides insights from the literature along with practical recommendations to facilitate decision-making with these challenges. METHODS: This narrative review provides a review of existing literature on ARD and pregnancy, synthesizing key findings from relevant theoretical and empirical studies. RESULTS: Results show that ARD tend to cluster within families, driven by both genetic and environmental factors. During pregnancy and postpartum, ARD are particularly prevalent, and maternal anxiety is associated with an increased risk of preterm birth and low birth weight. Psychotherapy, including exposure therapy, is effective and is overall beneficial for pregnant women, although in specific cases, it can also worsen the anxiety, with no known adverse effects on pregnancy outcomes. SSRI use requires consideration of risks and benefits. Preventive strategies to reduce anxiety vulnerability in offspring are scarce. CONCLUSION: In conclusion, addressing ARD in (prospective) parents is essential, given the potential negative impact on both parents and children. Clinical awareness is needed to optimize care for this population.
Outcomes and patient satisfaction after pelvic organ prolapse surgery with and without mesh: a retrospective cohort study with prospective follow-up.
Beer F, Schaufelberger P, Friedl TWP … +4 more , Lindner A, Schütze S, Janni W, Deniz M
Arch Gynecol Obstet · 2026 Mar · PMID 41790145 · Full text
PURPOSE: This retrospective cohort study with prospective follow-up evaluates patient satisfaction and complication rates following pelvic organ prolapse (POP) surgery, comparing three surgical approaches: transvaginal n...
PURPOSE: This retrospective cohort study with prospective follow-up evaluates patient satisfaction and complication rates following pelvic organ prolapse (POP) surgery, comparing three surgical approaches: transvaginal native tissue repair, transvaginal mesh repair, and laparoscopic sacrocolpopexy. METHODS: Long-term satisfaction and postoperative complications of patients who underwent POP surgery between 2014 and 2021 at the University Women's Hospital of Ulm were assessed via structured telephone interviews. Patient satisfaction was evaluated using the validated Freiburg Index of Patient Satisfaction (FIPS) questionnaire. RESULTS: Of 782 patients with POP surgery, 297 patients with primary surgeries at our clinic were included in the analysis. Patients of all three groups were highly satisfied according to FIPS with no significant difference (p = 0.058). Complication rate also did not differ significantly between the groups except for mesh erosions with 12.9% for transvaginal mesh repair and 2.0% for sacrocolpopexy (p = 0.027). Adverse events as pain, voiding difficulty, overactive bladder (OAB), and recurrence of POP requiring operative treatment had a significant impact on the satisfaction rate of patients. CONCLUSION: Patients of all three surgical approaches reported high satisfaction following POP surgery. Complication rate did not differ significantly except for mesh erosions. However, mesh erosions did not significantly impact patient satisfaction. TRAIL REGISTRATION: The trial was registered in the German Clinical Trials Register (DRKS00031971) on 1 June 2023.
Preoperative prognostic nutritional index and its impact on surgical-site infection after cesarean section: a retrospective case-control analysis.
Cetinel KO, İnce A, Tunc B … +3 more , Guler OM, Sivas MC, Arica G
Arch Gynecol Obstet · 2026 Mar · PMID 41787088 · Full text
PURPOSE: Surgical-site infections (SSI) remain a major complication of cesarean delivery, increasing maternal morbidity, hospital stay, and healthcare costs. Although several risk factors have been identified, the role o...
PURPOSE: Surgical-site infections (SSI) remain a major complication of cesarean delivery, increasing maternal morbidity, hospital stay, and healthcare costs. Although several risk factors have been identified, the role of maternal nutritional status-particularly the Prognostic Nutritional Index (PNI)-has not been well established in obstetric surgery. METHODS: This retrospective case-control study included 190 women who underwent cesarean delivery at a tertiary referral center between 2020 and 2025. Preoperative PNI was calculated using serum albumin and lymphocyte counts obtained within 24 h before surgery. SSI was defined according to the Centers for Disease Control and Prevention criteria. Demographic, perioperative, and postoperative variables were analyzed to evaluate associations between PNI, SSI status, infection severity, and inflammatory markers. RESULTS: A total of 190 women were analyzed, including 98 cases with surgical-site infection (SSI) and 92 controls without SSI. Although preoperative PNI was not an independent predictor of SSI, lower PNI values were associated with more severe infections requiring broad-spectrum antibiotics, longer hospitalization, and higher postoperative C-reactive protein (CRP) levels. A significant inverse correlation was observed between PNI and CRP among patients with SSI (r = - 0.338, p = 0.001). Longer operative duration and smoking were also associated with an increased risk of SSI. CONCLUSION: Although PNI was not an independent predictor of SSI, lower values were strongly associated with infection severity and systemic inflammation. Integrating PNI into preoperative risk assessment-alongside body mass index and operative time-may help identify high-risk women. Larger prospective studies are warranted to confirm these findings and to evaluate the impact of nutritional optimization on postoperative outcomes.
Editorial Expression of Concern: Does Cabergoline help in decreasing endometrioma size compared to LHRH agonist? A prospective randomized study.
Hamid AMSA, Madkour WAI, Moawad A … +2 more , Elzaher MA, Roberts MP
Arch Gynecol Obstet · 2026 Mar · PMID 41784847 · Full text
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Maternal serum NRF2 at 12 weeks as a biomarker for development of gestation diabetes mellitus.
Ge J, Jia X, Tang W … +2 more , Lu D, Wang L
Arch Gynecol Obstet · 2026 Mar · PMID 41779244 · Full text
OBJECTIVE: The main aim of this study is to evaluate value of maternal serum nuclear factor erythroid 2-related factor 2 (NRF2) levels at 12 weeks in predicting the development of gestational diabetes mellitus (GDM) at 2...
OBJECTIVE: The main aim of this study is to evaluate value of maternal serum nuclear factor erythroid 2-related factor 2 (NRF2) levels at 12 weeks in predicting the development of gestational diabetes mellitus (GDM) at 24-28 weeks' gestation. Other maternal variables were also evaluated, and their relationships with NRF2 levels were assessed. METHODS: We conducted a single-center prospective cohort study including 1,270 pregnant women who attended their first-trimester antenatal visit between October 2021 and October 2023. At 12 weeks, fasting serum was collected to measure NRF2 by enzyme-linked immunosorbent assay (ELISA) and thyroid hormones on an automated chemiluminescent platform. Clinical data included age, pre-pregnancy body mass index (BMI), blood pressure, fasting plasma glucose, and lipids. All participants underwent a 75-g oral glucose tolerance test (OGTT) at 24-28 weeks and GDM was diagnosed by International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Spearman correlation assessed associations between NRF2 and clinical variables. Receiver operating characteristic (ROC) analysis evaluated discrimination. Multivariable logistic regression identified independent predictors. RESULTS: Among 1,270 pregnant women enrolled, 177 (13.9%) developed GDM. At 12 weeks of gestation, women who later developed GDM had significantly lower serum NRF2 levels than those without GDM. They also showed higher fasting plasma glucose (FPG), mean arterial pressure (MAP), as well as lower free thyroxine (FT4) levels. ROC analysis demonstrated that serum NRF2 at 12 weeks had good predictive value for GDM, with an area under the curve (AUC) of 0.779 (95% confidence interval [CI] 0.745-0.812, p < 0.001). A combined model incorporating NRF2 with MAP, FT4, and FPG showed improved discrimination, with an AUC of 0.882 (95% CI 0.856-0.908, p < 0.001). In multivariable logistic regression, lower serum NRF2 (odds ratio [OR] = 0.948, 95% CI 0.938-0.957, p < 0.001), higher MAP (OR = 1.182, 95% CI 1.132-1.233, p < 0.001), higher FPG (OR = 3.911, 95% CI 2.471-6.190, p < 0.001), and lower FT4 (OR = 0.639, 95% CI 0.562-0.726, p < 0.001) were identified as independent predictors of GDM, whereas other baseline parameters were not significant. CONCLUSION: Decreased maternal serum NFR2 levels at 12 weeks' gestation appear to be associated with an increased risk of developing GDM later in pregnancy. Combining this marker, together with FT4, MAP and potentially FPG may serve as a useful first-trimester screening for the risk to develop GDM.
In vitro fertilization outcomes in previously cured tuberculosis patients: a retrospective study.
Feng X, Cai H, Liu X … +2 more , Zhang L, Shi J
Arch Gynecol Obstet · 2026 Mar · PMID 41779204 · Full text
BACKGROUND: To investigate whether cured tuberculosis affect assisted reproductive outcomes in infertile women. METHODS: A retrospective cohort study was conducted to compare assisted reproductive outcomes between cured...
BACKGROUND: To investigate whether cured tuberculosis affect assisted reproductive outcomes in infertile women. METHODS: A retrospective cohort study was conducted to compare assisted reproductive outcomes between cured tuberculosis and non-tuberculosis patients. The primary outcomes were compared between fresh and frozen-thaw cycles in cured tuberculosis, as well as among different types of tuberculosis in fresh cycles. RESULTS: In IVF and total patients, the pregnancy (P > 0.05) and live birth rates (P > 0.05) did not differ between tuberculosis and control group. However, in ICSI protocol, the pregnancy (P = 0.027) and live birth rates (P = 0.027) in tuberculosis group were lower than those in controls. The pregnancy rate in fresh cycles for tuberculosis patients was lower than in frozen-thaw cycles in each protocol (P = 0.001). The live birth rate in fresh cycles was higher than in frozen-thaw cycles in IVF patients (P = 0.008) and total patients (P = 0.015), while the live birth rate in fresh cycles was lower in ICSI patients (P = 0.011). The pregnancy rate (P > 0.05) and live birth rate (P > 0.05) among cured patients diagnosed with pelvic tuberculosis demonstrated no significant difference compared to those with pulmonary tuberculosis or other types. CONCLUSIONS: Cured tuberculosis did not affect the primary assisted reproductive outcomes in infertile patients using IVF protocol. However, in ICSI protocol, tuberculosis had a negative impact on pregnancy outcomes in infertile women, even with treatment. The final pregnancy outcome of frozen-thaw cycle was worse than that of fresh cycle in IVF protocol but opposite in ICSI. If treated, there were no variations in pregnancy outcomes among different tuberculosis types.
Performance of next-generation AI chatbots in gynecological knowledge assessment: a comparative pilot study of ChatGPT-5, Gemini-3, DeepSeek-V3.2, and Claude-4.5-Opus.
Huan O, Wang Z
Arch Gynecol Obstet · 2026 Mar · PMID 41774170 · Full text
PURPOSE: As artificial intelligence (AI) models evolve into their next generations, their application in specialized medical fields requires rigorous validation. While large language models (LLMs) have shown promise in g...
PURPOSE: As artificial intelligence (AI) models evolve into their next generations, their application in specialized medical fields requires rigorous validation. While large language models (LLMs) have shown promise in general medicine, their reliability in complex gynecological clinical reasoning remains under-explored. This pilot study aimed to comparatively assess the knowledge retention, safety, and reasoning limitations of advanced AI chatbots in gynecology using a constrained zero-shot multiple-choice question (MCQ) format. METHODS: A total of 70 text-based MCQs covering seven core gynecological modules were adapted from "USMLE Step 1 Sample Test Questions". The questions were administered to four advanced AI models: ChatGPT-5, Gemini-3, DeepSeek-V3.2, and Claude-4.5-Opus. To simulate a rapid-retrieval clinical scenario, models were tested under "zero-shot" conditions with a constrained prompt prohibiting reasoning steps. We performed both quantitative statistical analysis (Kruskal-Wallis, Cochran's Q) and qualitative error analysis to identify specific failure modes. RESULTS: Contrary to expectations for advanced models, overall accuracy was unsatisfactory: Gemini-3 (32.86%), DeepSeek-V3.2 (30.00%), ChatGPT-5 (25.71%), and Claude-4.5-Opus (21.43%). Significant performance disparities were observed across modules. Notably, ChatGPT-5 scored 0.00% in Infertility, while DeepSeek-V3.2 reached 70.00% in Common Benign Conditions. Qualitative analysis revealed three critical failure patterns: (1) semantic association bias (confusing high-probability diseases with symptom-specific diagnoses), (2) spatial anatomy confusion, and (3) genetic logic reversal. No significant correlation was found between item difficulty and accuracy (p > 0.05). CONCLUSION: Under constrained non-reasoning prompts, even next-generation AI chatbots demonstrate unsatisfactory performance in gynecology. The qualitative analysis suggests that models often rely on probabilistic keyword matching rather than physiological simulation, leading to theoretically dangerous clinical errors (e.g., misdiagnosing adrenal enzymes). While potential exists, current reliability is insufficient for unsupervised use in gynecological education. These findings highlight the critical need for "chain-of-thought" prompting and human expert oversight.
Maternal-fetal attachment trajectories in IVF mothers during the first trimester: a prospective observational study.
Cheng X, Chen F, Huang H … +2 more , Zhang F, Xu X
Arch Gynecol Obstet · 2026 Mar · PMID 41772148 · Full text
OBJECTIVE: To identify trajectories of maternal-fetal attachment (MFA) in IVF mothers during the first trimester of pregnancy, and to explore categorical predictors of subgroups demonstrating MFA trajectories. METHODS: A...
OBJECTIVE: To identify trajectories of maternal-fetal attachment (MFA) in IVF mothers during the first trimester of pregnancy, and to explore categorical predictors of subgroups demonstrating MFA trajectories. METHODS: A prospective observational study was conducted on 495 IVF mothers. Self-report questionnaires assessing MFA, anxiety, depression, social support, and marital satisfaction were completed at three time points: 3-4 weeks (T1), 7-8 weeks (T2), and 12-14 weeks (T3) of gestation. Repeated measurement data were analyzed and growth trajectories identified. RESULTS: Three MFA trajectories were delineated in IVF mothers during the first trimester: low-attachment/slow-elevation group (30.9%), moderate-attachment/steady-elevation group (56.2%), and high-attachment/rapid-elevation group (12.9%). Secondary infertility (OR = 0.575, 95% CI: 0.368-0.901, p = 0.013) and higher marital satisfaction (OR = 0.941, 95% CI: 0.915-0.968, p < 0.001) were predictors for not being in the low-attachment/slow-elevation group. CONCLUSION: Among IVF mothers with ongoing pregnancies, a subset exhibited suboptimal development of MFA during the first trimester. Marital satisfaction and infertility type may help identify those at potential risk.
Planned mode of delivery and neonatal outcomes in pregnancies complicated by late-onset fetal growth restriction: a retrospective cohort study.
Rottenstreich M, Ashwal E, Yousef A … +3 more , DeFrance B, Barrett JFR, Sela HY
Arch Gynecol Obstet · 2026 Mar · PMID 41770369 · Full text
BACKGROUND: Fetal growth restriction (FGR) is a major contributor to perinatal morbidity and mortality. While guidelines address timing of delivery, the optimal mode-induction of labor (IOL) versus planned cesarean deliv...
BACKGROUND: Fetal growth restriction (FGR) is a major contributor to perinatal morbidity and mortality. While guidelines address timing of delivery, the optimal mode-induction of labor (IOL) versus planned cesarean delivery (CD)-remains uncertain. OBJECTIVE: To evaluate the association between planned mode of delivery and neonatal outcomes in pregnancies complicated by late onset FGR (LOFGR). STUDY DESIGN: We conducted a retrospective cohort study at a tertiary Canadian center (2017-2022). Singleton pregnancies with LOFGR (> 34 weeks' gestation), defined by Society for Maternal-Fetal Medicine (SMFM) criteria, were eligible if the last ultrasound was within 14 days of delivery. Exclusions included spontaneous labor, delivery < 34 weeks, and contraindications to labor. Planned mode of delivery (IOL vs CD) was the exposure. Outcomes were classified as severe (perinatal death, 5-min Apgar < 4, umbilical arterial pH < 7.05, base deficit ≥ 12 mmol/L, hypoxic-ischemic encephalopathy/therapeutic hypothermia, grade III-IV intraventricular hemorrhage, necrotizing enterocolitis, sepsis, or invasive ventilation > 24 h) or moderate (NICU stay > 72 h, Apgar 4-6, pH 7.05-7.10, non-invasive respiratory support > 6-12 h, transient tachypnea, or brief resuscitation). Multivariable logistic regression adjusted for confounders. A prespecified subgroup applied the ISUOG criteria. RESULTS: Of 12,270 deliveries, 1,143 (9.3%) met SMFM criteria for LOFGR; 869 were eligible (192 planned CD, 677 IOL). Severe outcomes and moderate outcomes were more frequent after CD (23.4% vs 16.7%; p = 0.03 and 42.2% vs 31.2%; p < 0.01, respectively). IOL was associated with lower adjusted risk of severe outcomes (aOR 0.35; 95% CI 0.19-0.67) and moderate outcomes (aOR 0.43; 95% CI 0.24-0.76). Results were consistent using ISUOG criteria (aOR 0.33; 95% CI 0.17-0.62 and aOR 0.44; 95% CI 0.25-0.79, respectively) About 20% of induced patients required intrapartum CD. CONCLUSIONS: IOL was associated with reduced severe and moderate neonatal morbidity compared with planned CD. IOL represents a safe alternative when intrapartum surveillance and timely operative delivery are available.
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