Archives Of Gynecology And Obstetrics[JOURNAL]
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200 papers
Oxidized cellulose polymer outperforms traditional hemostasis in preserving ovarian reserve during LESS cystectomy: a prospective comparative study.
Xu N, Li MX, Li M … +3 more , Gou YQ, Luo ZG, Li YH
Arch Gynecol Obstet · 2026 Feb · PMID 41689611 · Full text
OBJECTIVE: Preserving ovarian reserve function during single-port laparoscopic ovarian cystectomy is crucial for women of reproductive age. This study aimed to evaluate the hemostatic efficacy and impact on ovarian reser...
OBJECTIVE: Preserving ovarian reserve function during single-port laparoscopic ovarian cystectomy is crucial for women of reproductive age. This study aimed to evaluate the hemostatic efficacy and impact on ovarian reserve of three different hemostatic methods in LESS (laparoendoscopic single-site) ovarian cystectomy. METHODS: Patients with unilateral ovarian cysts were divided into three groups based on hemostatic methods: the oxidized cellulose polymer group, the suture group, and the bipolar coagulation group. All participants underwent standardized LESS ovarian cystectomy. Intraoperative hemostatic effects within 10 min, intraoperative blood loss, and postoperative hemoglobin reduction were observed. Blood samples were collected before surgery, 1 month and 6 months after surgery to measure anti-Müllerian hormone (AMH) levels via radioimmunoassay. Vaginal ultrasound was performed preoperatively and 6 months postoperatively to obtain ovarian stromal peak systolic velocity (PSV) and antral follicle count (AFC). RESULTS: All three hemostatic methods demonstrated equivalent hemostatic efficacy (P > 0.05). However, significant differences emerged in ovarian reserve outcomes, at 6-month evaluation, oxidized cellulose polymer demonstrated superior preservation: AMH decline was 5.9% (Δ-0.22 ng/mL) with a 15.4% advantage over bipolar coagulation (mean difference Δ-0.80 ng/mL; P < 0.001). Although there was no statistically significant difference in the decline of anti-Müllerian hormone (AMH) levels between the oxidized cellulose polymer group and the suture group (P = 0.749), the suture group still exhibited a greater reduction compared to the oxidized cellulose polymer group (Δ-0.27 ng/mL). However, in the endometriosis subgroup, the suture group demonstrated a significantly greater decline in AMH levels compared to the oxidized cellulose polymer group (P = 0.006). Oxidized cellulose polymer again demonstrated superior preservation over suturing in AFC (mean decline ratio 0.11, 95% CI 0.10-0.14) and PSV (mean decline ratio 0.051, 95% CI 0.043-0.062), particularly in endometriosis patients where these differences were statistically significant (P < 0.05). CONCLUSION: In LESS ovarian cystectomy, while bipolar coagulation, suturing, and oxidized cellulose polymer show equivalent hemostatic efficacy, the oxidized cellulose polymer demonstrates superior preservation of ovarian reserve function (AMH, AFC, and PSV parameters) with significantly less surgical trauma and greater technical simplicity. These findings strongly support the preferential use of oxidized cellulose polymer, particularly for fertility-preserving procedures in reproductive-age women, with added benefits for endometriosis patients who show heightened vulnerability to ovarian reserve compromise. CLINICAL TRIAL REGISTRATION: ChiCTR2500102270.
The assessment of association between endometrioma size and other endometriosis compartments according to #ENZIAN classification.
Piriyev E, Namazov A, Mahalov I … +6 more , Huseynova F, Liberty G, Gemer O, Schiermeier S, Römer T, Keckstein J
Arch Gynecol Obstet · 2026 Feb · PMID 41686339 · Full text
INTRODUCTION: Endometriomas are common in endometriosis and may coexist with deep pelvic disease. This study aimed to assess the association between endometrioma size and other endometriosis localizations using the #ENZI...
INTRODUCTION: Endometriomas are common in endometriosis and may coexist with deep pelvic disease. This study aimed to assess the association between endometrioma size and other endometriosis localizations using the #ENZIAN classification. STUDY DESIGN: This multicenter study included women who underwent laparoscopic surgery for endometriomas between 2021 and 2024, with available surgical reports defining the #ENZIAN classification. Endometriomas were categorized as O1/2 (< 7 cm) or O3 (≥ 7 cm). Other endometriosis localizations were compared between the study groups. RESULTS: A total of 269 women underwent surgery for endometriosis involving endometriomas. Of these, 42 had #ENZIAN O3 endometriomas, with a significantly higher rate of unilateral cysts compared to women with #ENZIAN O1/2 (92.8% vs. 68.2%, p = 0.0011). After excluding bilateral cases, 194 women with unilateral endometriomas were analyzed: 39 with #ENZIAN O3 and 155 with #ENZIAN O1/2. Women with O3 lesions were significantly younger (31.5 ± 5.9 vs. 34.5 ± 6.6 years; p = 0.011). The rate of adenomyosis (#ENZIAN F-A) was significantly lower in the O3 group (41% vs. 69%, p = 0.0012), as was rectal involvement (#ENZIAN C; 7.7% vs. 23.8%, p = 0.025). The prevalence of severe pelvic wall disease (T/B ≥ 2) did not differ significantly between groups. CONCLUSION: Smaller endometriomas (O1/2) are associated with more extensive pelvic disease, including higher rates of adenomyosis, rectal involvement, and pelvic adhesions, whereas larger endometriomas (O3) may represent a more localized disease phenotype. These findings support the use of the #ENZIAN classification for more accurate preoperative assessment and individualized surgical planning.
Fetal parietal bone fracture in late 3rd trimester secondary to traffic accident with improper seatbelt use: a case report.
Demir FN, Koyun M, Kayıkçı U
Arch Gynecol Obstet · 2026 Feb · PMID 41686311 · Full text
Approximately half of the women in developed countries drive motor vehicles and the consequences of road traffic-related injuries involving pregnant women can be severe. This case report describes a rare injury of a pari...
Approximately half of the women in developed countries drive motor vehicles and the consequences of road traffic-related injuries involving pregnant women can be severe. This case report describes a rare injury of a parietal bone fracture in a fetus resulting from improper seatbelt use during a motor vehicle accident. A 36-year-old woman at 35 weeks of gestation was involved in a traffic accident while seated in the front seat wearing a seatbelt, but in an improper way for pregnant women. Transabdominal ultrasonography revealed a displaced fracture of the fetus's right parietal bone with an overlying scalp hematoma. Despite initial conservative management, persistent fetal tachycardia and decelerations necessitated an emergency cesarean delivery resulting in live birth. This case underscores the importance of correct three-point seatbelt usage during pregnancy to prevent maternal and fetal injuries.
Retraction Note: APEX1/miR-24 axis: a promising therapeutic target in endometriosis.
Tan A, Ruan P, Sun P
Arch Gynecol Obstet · 2026 Feb · PMID 41686290 · Full text
Abstract loading — click title to view on PubMed.
Exploring the therapeutic potential of disulfiram in endometriosis: mechanisms targeting inflammation, oxidative stress, pyroptosis, and angiogenesis.
Wang L, Xing Y
Arch Gynecol Obstet · 2026 Feb · PMID 41677921 · Full text
PURPOSE: Endometriosis (EMS) is a prevalent, inflammatory gynecological disorder with limited effective treatments and high recurrence rates. Given the central roles of inflammation, oxidative stress, pyroptosis, and ang...
PURPOSE: Endometriosis (EMS) is a prevalent, inflammatory gynecological disorder with limited effective treatments and high recurrence rates. Given the central roles of inflammation, oxidative stress, pyroptosis, and angiogenesis in its pathogenesis, novel therapeutic strategies are urgently needed. This review aims to critically evaluate the potential of disulfiram (DSF), a repurposed antialcoholism drug, as a multifaceted therapeutic agent for EMS by analyzing its anti-inflammatory, antioxidant, anti-pyroptotic, and antiangiogenic properties. METHODS: A comprehensive literature review was conducted. Scientific databases (e.g., PubMed, Web of Science) were systematically searched for pre-clinical and clinical studies investigating the mechanisms of EMS pathogenesis and the pharmacological actions of DSF. The analysis focused on synthesizing evidence linking DSF's known biological effects to the key pathological drivers of EMS. RESULTS: The analysis demonstrates that DSF and its metabolites target multiple pathways implicated in EMS. Evidence confirms DSF's potent inhibitory effects on key inflammatory mediators and signaling pathways (e.g., NLRP3 inflammasome-mediated pyroptosis). Furthermore, DSF enhances cellular antioxidant defenses, reduces reactive oxygen species, and suppresses angiogenic factors, thereby potentially disrupting the establishment and survival of endometriotic lesions. CONCLUSION: Disulfiram presents a promising, mechanistically grounded candidate for the treatment of endometriosis. Its unique ability to simultaneously modulate inflammation, oxidative stress, pyroptosis, and angiogenesis aligns closely with the multifactorial pathology of EMS. This review provides a strong rationale for future pre-clinical and clinical investigations to formally evaluate the efficacy and safety of DSF repurposing for this challenging disease.
Clinical characteristics, prognosis, and fertility outcomes in patients with simple and complex endometrial hyperplasia: a comparative analysis.
Wei J, Wang H, Wang H … +3 more , Wang Y, Tian W, Zhang H
Arch Gynecol Obstet · 2026 Feb · PMID 41670809 · Full text
OBJECTIVE: To analyze the difference in general clinical data, clinical manifestations, hysteroscopic manifestations, prognosis and fertility between patients with complex endometrial hyperplasia (CH) and simple endometr...
OBJECTIVE: To analyze the difference in general clinical data, clinical manifestations, hysteroscopic manifestations, prognosis and fertility between patients with complex endometrial hyperplasia (CH) and simple endometrial hyperplasia (SH). MATERIAL AND METHODS: Collected the medical records of 616 premenopausal endometrial hyperplasia (EH) patients from January 2012 to October 2023, of which 419 SH patients and 197 CH patients were included in the study. All the patients were followed up at least 12 months, and asked about the follow-up treatment plan, review, pregnancy and reproductive outcome of the patients with reproductive needs. RESULTS: Obesity (P = 0.044), having diabetes or insulin resistance (P = 0.032) and polycystic ovary syndrome (PCOS) (P < 0.001) are risk factors for the occurrence of CH, while gravidity ≥ 1 (P = 0.045) is a protective factor for the occurrence of CH. Compared with the SH group, the reversal rate in the CH group was significantly lower (69.7% vs 83.6%, P < 0.001), while the rate of persistence, progression, recurrence and canceration were higher (P < 0.001). Compared with no treatment, oral progesterone (P < 0.001) and levonorgestrel-releasing intrauterine system (LNG-IUS) treatment (P < 0.001) could improve the prognosis of patients with EH. The live birth rate of the CH group was obviously lower than that of the SH group ( 42.3% VS 61.1%, P = 0.038). CH (OR = 2.68, 95%CI 1.12-6.39, P = 0.043) is an independent risk factor affecting the live birth rate of patients with EH. CONCLUSION: Obesity, diabetes, insulin resistance, PCOS and nulligravidity are risk factors for patients with EH, while gravidity ≥ 1 served as a protective factor, particularly against CH. The type of hyperplasia is associated with a low live birth rate. The prognosis of EH patients is usually poor, with a low reversal rate and a long reversal time. However, LNG-IUS can improve their prognosis.
Epistaxis during the third trimester of pregnancy is associated with blood transfusion a retrospective case-control study.
Sapir A, Friedrich L, Osovizky Y … +3 more , Heilig Y, Cohen O, Schneider S
Arch Gynecol Obstet · 2026 Feb · PMID 41670761 · Full text
BACKGROUND: Epistaxis is common during pregnancy due to physiological changes, yet its clinical significance regarding obstetric outcomes is poorly understood. This study investigated the associations between epistaxis d...
BACKGROUND: Epistaxis is common during pregnancy due to physiological changes, yet its clinical significance regarding obstetric outcomes is poorly understood. This study investigated the associations between epistaxis during pregnancy and maternal and neonatal outcomes. METHODS: We conducted a retrospective case-control study (2013-2022) at a single tertiary medical center. The study group included 104 pregnant women presenting with epistaxis, matched with 1924 controls based on age, ethnicity, and preexisting comorbidities. Multivariable logistic regression was used to identify independent predictors of adverse outcomes, including blood transfusion and preterm labor. RESULTS: Women with epistaxis experienced significantly higher rates of third-trimester vaginal bleeding (7.7% vs. 1.1%; p < 0.001), preterm labor (15.4% vs. 8.7%; p = 0.022), and blood transfusion requirements (4.8% vs. 1.6%; p = 0.014). In a multivariable model, third-trimester epistaxis emerged as an independent predictor for blood transfusion (OR 4.96, 95% CI 1.47- 14.38; p = 0.005), even after adjusting for delivery mode and initial hemoglobin levels. While univariate analysis associated epistaxis with preterm labor, this relationship did not remain significant in the multivariable model (p = 0.254). Most epistaxis episodes (81.7%) were mild and resolved spontaneously. CONCLUSION: Epistaxis during pregnancy, particularly in the third trimester, is independently associated with a nearly fivefold increase in the odds of requiring a blood transfusion. While typically considered benign, epistaxis may serve as a clinical marker for systemic vascular susceptibility. These findings suggest that pregnant women presenting with epistaxis may benefit from enhanced clinical surveillance and interdisciplinary coordination to manage potential peripartum hemorrhagic complications.
Inflammation at the crossroads of reproduction: SIRI as a prognostic signature of female infertility in hybrid regression-machine learning models.
Khaksar MA, Hosseinpour M, Bastani MN … +4 more , Mohammadpour Fard R, Zahedian M, Mahdizade AH, Bahreiny SS
Arch Gynecol Obstet · 2026 Feb · PMID 41670733 · Full text
BACKGROUND: Female infertility is a critical global health concern, with a rising prevalence and significant psychosocial consequences. This study aimed to investigate the association between Systemic Inflammatory Respon...
BACKGROUND: Female infertility is a critical global health concern, with a rising prevalence and significant psychosocial consequences. This study aimed to investigate the association between Systemic Inflammatory Response Index (SIRI) and female infertility. METHODS: This cross-sectional study enrolled 3059 reproductive-aged women (18-45 years) to examine the association between SIRI and female infertility using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2015 to 2020. Multivariable logistic regression generalized additive models (GAM), restricted cubic splines (RCS), and threshold effect analyses were leveraged. Machine learning approaches were also utilized to validate predictive performance and identify key features. RESULTS: Elevated SIRI was independently associated with increased odds of infertility. In the fully adjusted logistic model, each unit increase in SIRI corresponded to a 34% increase in infertility risk (OR 1.34, p = 0.001). Women in the highest SIRI quartile had more than double the odds of infertility compared to those in the lowest quartile (OR 2.08, p < 0.001), with a significant dose-response trend (p trend < 0.001). GAM and RCS models confirmed a monotonic and curvilinear association, respectively. Threshold analysis revealed a critical inflection point at SIRI = 1.66. Machine learning validation identified SIRI as one of the most influential predictors, with XGBoost achieving the highest (AUC = 0.866). CONCLUSION: These findings support the role of chronic systemic inflammation in female infertility and highlight SIRI as a valuable biomarker for risk prediction and clinical assessment.
Learning curves, safety, and experiences of a tertiary surgical center in the introduction of robotic-assisted surgery in gynecologic oncology.
Jung L, Taran FA, Huwer S … +4 more , Kurz B, Klar M, Favre-Inhofer A, Juhasz-Böss I
Arch Gynecol Obstet · 2026 Feb · PMID 41667699 · Full text
BACKGROUND: The dynamic development towards robotic-assisted surgery particularly affects operative gynecology. The analysis of operative data from robotic-assisted procedures since the first application at a surgical ce...
BACKGROUND: The dynamic development towards robotic-assisted surgery particularly affects operative gynecology. The analysis of operative data from robotic-assisted procedures since the first application at a surgical center provides valuable insights into the introduction phase and integration of the DaVinci system into routine clinical operations, as well as their impact on patient care. The aim of this work was to specifically examine the learning curve progression and to present the trend of the professionalization process in implementing the methodology in gynecologic oncology. MATERIALS AND METHODS: A retrospective data analysis was conducted of the first n = 107 patients who underwent surgery for a gynecological malignancy with the DaVinci surgical system at the University Medical Center Freiburg between 2020 and 2022. Classic operative parameters were evaluated, including preparation time, skin-to-skin time, console time, and the resulting learning curves of the surgeons and the operative team (including CUSUM analysis and linear regression models). Additionally, perioperative patient characteristics were recorded (e.g., blood loss, length of hospitalization, conversion rate). RESULTS: The average operative preparation time is 26.11 ± 8.13 min. The maximum value (CUSUM peak) is at approximately 20 performed procedures, indicating that the processes of operative preparation were mastered after this number of operations. The average skin-to-skin time is 172.84 ± 71.68 min (range 43-387 min), whereby after an initial reduction in skin-to-skin time within the first 30 cases, there was a slight increase in the further course with renewed reduction from approximately 65 procedures. The average console time for all tumor entities is 131.98 ± 63.74 min; for the most common operative indication (endometrial cancer, n = 61), it is 109.89 ± 52.04 min (range 48-221 min). In the surgeons' learning curves, the two surgeons with the most procedures show a CUSUM peak after 11 and 22 procedures, respectively. The average length of stay is 5.00 days (± 2.30). A total of two conversions occurred (conversion rate = 1.9%). DISCUSSION: Upon evaluation of the first n = 107 DaVinci operations, rapid learnability of robotic-assisted operations was demonstrated. The conversion rate was low at 1.9%. A positive effect on the learning curve of individual surgeons was evident after approximately 20 procedures. Both the preparation time and the skin-to-skin time could be rapidly reduced, so that integration into routine clinical operations was possible without problems.
Maternal anemia at admission for labor in twin pregnancies: an indicator of adverse maternal and neonatal outcome.
Peled T, Levitt Y, Tvito A … +2 more , Grisaru-Granovsky S, Rottenstreich M
Arch Gynecol Obstet · 2026 Feb · PMID 41661339 · Full text
PURPOSE: Maternal anemia during pregnancy is associated with adverse obstetrical outcomes. This study aimed to assess maternal and neonatal outcomes in women with anemia in twin pregnancies, compared to women with normal...
PURPOSE: Maternal anemia during pregnancy is associated with adverse obstetrical outcomes. This study aimed to assess maternal and neonatal outcomes in women with anemia in twin pregnancies, compared to women with normal hemoglobin levels. METHODS: A multicenter retrospective cohort study was conducted including women with twin pregnancies who delivered at 24-42 weeks between 2005 and 2021. Maternal and neonatal outcomes were compared between those who had diagnosis of maternal anemia upon admission for labor (hemoglobin < 11 g/dL), to those who have normal hemoglobin level. The primary outcome was composite adverse neonatal outcomes. Univariate analysis was followed by multivariate analysis to control potential confounders. RESULTS: During the study period, there were 5,530 twin deliveries; 5,004 women met the inclusion criteria. The maternal anemia prevalence upon admission was 16.8% (n = 840). After controlling for potential confounders, we found an independent association between maternal anemia in twin pregnancies and composite adverse neonatal outcomes for both twins-aOR 1.81 (1.55-2.12) for twin A and aOR 1.77 (1.51-2.06) for twin B. Anemia was also independently associated with higher risk for preterm delivery, cesarean delivery, maternal blood product transfusion and NICU admission for both twins. CONCLUSIONS: Maternal anemia in twin pregnancies is associated with an increased risk of adverse maternal and neonatal outcomes. Clinicians should be aware of this condition, consider appropriate interventions for correcting the anemia, and ensure close monitoring of both the mother and the neonates. Further research is warranted to evaluate the effectiveness of anemia correction strategies in reducing obstetric burden.
Polycystic ovary syndrome (PCOS) affects relative embryo morphokinetics observed by time-lapse imaging: an observational study.
Garçon VM, Dietrich JE, Strowitzki T … +1 more , Freis A
Arch Gynecol Obstet · 2026 Feb · PMID 41655163 · Full text
PURPOSE: To characterise the effect of polycystic ovary syndrome (PCOS) on embryo morphokinetics via time-lapse imaging, including absolute time points, relative time intervals, and ratios representing cleavage synchroni...
PURPOSE: To characterise the effect of polycystic ovary syndrome (PCOS) on embryo morphokinetics via time-lapse imaging, including absolute time points, relative time intervals, and ratios representing cleavage synchronicity. METHODS: This single-centre retrospective observational study examined patients aged 18-45 years undergoing in vitro fertilisation/intracytoplasmic sperm injection with time-lapse imaging (09/2016-12/2019; n = 1433 two-pronuclear oocytes). A group with PCOS (n = 48 embryos) was compared to a control group with uterine, tubal factor or idiopathic infertility (n = 400 embryos). Times from the two-cell stage to blastocyst expansion, eight intervals for embryonic cell cycle (ECC) duration and synchronicity and four cleavage synchronicity (CS) and DNA replication time ratios were analysed. RESULTS: PCOS patients were younger (P = 0.023) with higher anti-Müllerian hormone levels (P < 0.001) than controls. No statistically noticeable influence of PCOS on absolute times was observed. The intervals from the 3- to 4-cell (synchronicity of cell cycle 2, s2; P = 0.013), the 5- to 8-cell (synchronicity of cell cycle 3, s3; P = 0.032) and the 4- to 8-cell stage (ECC3; P = 0.043) were longer in the PCOS group. The relative CS ratio from the 2- to 8-cell stage (CS2-8) was lower (P = 0.003) and from the 2- to 4-cell stage (CS2-4) was higher (P = 0.001) in PCOS embryos. CONCLUSION: Whilst absolute times remained unaffected, relative morphokinetic intervals and ratios, potentially indicating poorer cleavage synchronicity, were altered in PCOS embryos. This is the first study examining the influence of PCOS on relative morphokinetic ratios.
Uterine biophysical profile after intrauterine instillation of autologous blood cell derivative (ABCD) for thin endometrium in frozen embryo transfer cycles.
Indrakanti P, Mundkur A, Poojari VG … +3 more , Adiga P, Tiwari S, Kumar P
Arch Gynecol Obstet · 2026 Feb · PMID 41652209 · Full text
PURPOSE: This study was conducted to investigate the changes in the uterine biophysical profile (UBP) before and after intrauterine administration of Autologous Blood Cell Derivatives (ABCD). METHODS: This prospective ob...
PURPOSE: This study was conducted to investigate the changes in the uterine biophysical profile (UBP) before and after intrauterine administration of Autologous Blood Cell Derivatives (ABCD). METHODS: This prospective observational study investigates endometrial receptivity in frozen embryo transfer (FET) cycles. It focuses on patients with thin endometrium (TEM), a basal serum FSH below 10 IU/L, and good-quality frozen embryos. The study utilizes the UBP to evaluate endometrial receptivity both before and after the ABCD procedure. RESULTS: The study involved 33 women with TEM undergoing FET cycles. ABCD was administered during the first, second, and third or later FET cycles in 21.21%, 45.45%, and 33.33% of patients, respectively. Following ABCD administration, significant improvements were observed in UBP scores (from 9.06 to 14.85), EMT (from 6.6 mm to 8.67 mm), blood flow to zone III (from 0.85 mm to 3.36 mm), and uterine artery pulsatility index (PI) (from 0.7 to 0.97). Odds ratio analysis showed an association between pregnancy and endometrial layering (OR = 2.12), though it was not statistically significant. Multivariate analysis revealed that the UBP score predicted pregnancy with 68% accuracy, while the ROC analysis yielded an accuracy of 54%. A UBP threshold score of 20 offered 100% specificity, making it a potentially reliable predictor of successful implantation. CONCLUSIONS: This study demonstrates that ABCD growth factors significantly enhance endometrial development in women with TEM, resulting in improved UBP scores, reduced EMT, lower uterine artery PI, and increased uterine blood flow. A UBP score cutoff of 20 demonstrated 95% sensitivity, highlighting its potential as a reliable prognostic tool in infertility treatment.
Validation of a machine-learning-based algorithm to predict preeclampsia-related adverse outcomes on a real-world dataset.
Hoyler A, Rieger O, Hackelöer M … +4 more , Neznansky M, Henrich W, Lorenz-Meyer L, Verlohren S
Arch Gynecol Obstet · 2026 Feb · PMID 41652088 · Full text
PURPOSE: Preeclampsia is a major obstetric disorder. Machine learning (ML) models incorporating angiogenic biomarkers show promise in predicting related adverse outcomes, but refinement is needed for clinical use. This s...
PURPOSE: Preeclampsia is a major obstetric disorder. Machine learning (ML) models incorporating angiogenic biomarkers show promise in predicting related adverse outcomes, but refinement is needed for clinical use. This study aimed to reduce features to a clinically meaningful set and to develop and validate predictive endpoints for preeclampsia-associated outcomes. METHODS: A model with a reduced feature set was derived from a training cohort of 1,634 patients (2, 412 visits) and then tested on a validation cohort of 402 patients (540 visits). Three machine learning models were developed to predict (1) adverse outcomes overall, (2) delivery within 14 days before 34 weeks of gestation, and (3) delivery within 7 days after 34 weeks, using 13 features versus 114 originally. RESULTS: Reduced-feature models demonstrated comparable accuracy to original models across all endpoints. Model 1 (any adverse outcome) achieved an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.92 (95% CI: 0.88-0.96) in training and 0.89 (95% CI: 0.84-0.93, p = 0.31) in the validation cohort, respectively. For delivery within 14 days, the AUROC was 0.92 (95% CI: 0.87-0.96) in training and 0.85 (95% CI: 0.78-0.92) in validation (p = 0.13). Delivery within 7 days showed AUROCs of 0.79 (95% CI: 0.70-0.87) and 0.80 (95% CI: 0.75-0.85) (p = 0.78). CONCLUSION: A machine learning model with a significantly reduced number of features can accurately predict clinically relevant preeclampsia outcomes. The identified endpoints (timing of delivery and adverse events) could support clinical decision-making and help reduce maternal and neonatal morbidity and mortality.
Ovarian stimulation toward oocyte cryopreservation for fertility preservation in a patient with Hirata syndrome: a clinical challenge in assisted reproduction.
Karkalemis K, Papadopoulou-Marketou N, Kalampokas E … +2 more , Simopoulou M, Kalampokas T
Arch Gynecol Obstet · 2026 Feb · PMID 41652049 · Full text
BACKGROUND: Insulin autoimmune syndrome (IAS), or Hirata disease, is a rare autoimmune disorder characterized by the presence of autoantibodies targeting insulin, leading to episodes of postprandial hypoglycemia. First i...
BACKGROUND: Insulin autoimmune syndrome (IAS), or Hirata disease, is a rare autoimmune disorder characterized by the presence of autoantibodies targeting insulin, leading to episodes of postprandial hypoglycemia. First identified in Japan, the condition was historically seen primarily in the Asian population, but with global recognition and improved diagnostic tools, its prevalence has expanded. While IAS is often self-limiting and resolves with dietary modifications and discontinuation of triggering medications, its management in the context of assisted reproductive technology (ART) remains understudied. CASE PRESENTATION: This case report discusses a 28-year-old female diagnosed with IAS who underwent oocyte cryopreservation following a fertility assessment revealing low serum AMH levels. Despite a history of severe hypoglycemia, which was managed with rituximab and resolved within a month, and the presence of elevated insulin and insulin autoantibodies, she successfully completed ovarian stimulation without experiencing hypoglycemic episodes. DISCUSSION: Close monitoring of glucose levels and insulin autoantibody concentrations was essential for successful oocyte retrieval. This case underscores the importance of careful monitoring and individualized care for patients with IAS undergoing ART as autoimmune flare-ups and hypoglycemia can still occur even when the disease is in remission. CONCLUSION: A multidisciplinary approach involving reproductive endocrinologists and fertility specialists is critical for safe management of such patients.
Multidisciplinary protocol and outcomes in placenta accreta spectrum: a 12 year cohort study.
Luder A, Castel E, Kleinmann N … +5 more , Mazaki-Tovi S, Lahav-Ezea H, Shvero A, Zilberman DE, Dotan ZA
Arch Gynecol Obstet · 2026 Feb · PMID 41652031 · Full text
BACKGROUND: Placenta accreta spectrum (PAS) is a high-risk obstetric condition associated with hemorrhage, urologic injury, and peripartum hysterectomy. Rising cesarean delivery rates continue to increase its prevalence....
BACKGROUND: Placenta accreta spectrum (PAS) is a high-risk obstetric condition associated with hemorrhage, urologic injury, and peripartum hysterectomy. Rising cesarean delivery rates continue to increase its prevalence. Variation in surgical management and limited multidisciplinary involvement may contribute to adverse maternal outcomes. OBJECTIVE: To evaluate whether the implementation of a multidisciplinary team (MDT) protocol for PAS was associated with improved perioperative outcomes. STUDY DESIGN: This retrospective cohort study included 417 women diagnosed with PAS from 2011 to 2022 at a tertiary center. In 2019, a structured MDT protocol was adopted, incorporating standardized imaging, preoperative conference, routine bilateral ureteral catheter (UC) placement, and on-site urologic support. Outcomes of MDT-managed patients (n = 108) were compared with pre-MDT patients (n = 309). Multivariable logistic regression and generalized linear models adjusted for maternal age, gravidity, prior cesarean delivery, placenta previa, PAS grade, surgical urgency, gestational age, and year of delivery. RESULTS: After adjustment, MDT care was associated with lower odds of urologic injury (aOR 0.34; 95% CI 0.12-0.82), surgical complications (aOR 0.39; 95% CI 0.18-0.78), transfusion (aOR 0.41; 95% CI 0.14-0.93), and hysterectomy (aOR 0.22; 95% CI 0.05-0.91). Adjusted estimated blood loss decreased by 260 mL (95% CI - 480 to - 70), and length of stay was reduced by 0.9 days (95% CI - 1.4 to - 0.3). Results remained consistent in sensitivity analyses limited to 2017-2022. CONCLUSION: Implementation of an MDT protocol was associated with reduced perioperative morbidity, supporting multidisciplinary management as a potentially safer strategy for high-risk PAS surgery.
Reply to matters arising: "Reassessing diagnostic accuracy claims in case-only study of T-shaped uterus".
Monaco G, Farsetti D, Exacoustos C
Arch Gynecol Obstet · 2026 Feb · PMID 41644845 · Full text
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Investigation of the association between maternal serum ferritin levels and preterm delivery: A systematic review and meta-analyses.
Ehsani A, Mehrabi MM, Bashar Awad T … +6 more , Ghasemi M, Eshraghi A, Asef Agah SA, Sajadi A, Ashtari S, Saedi N
Arch Gynecol Obstet · 2026 Feb · PMID 41639469 · Full text
BACKGROUND: Preterm delivery (PTD) has been a significant cause of neonatal morbidity and mortality. Maternal serum ferritin, a biomarker of both iron stores and systemic inflammation, has shown inconsistent associations...
BACKGROUND: Preterm delivery (PTD) has been a significant cause of neonatal morbidity and mortality. Maternal serum ferritin, a biomarker of both iron stores and systemic inflammation, has shown inconsistent associations with PTD risk in individual studies. OBJECTIVE: This systematic review and meta-analysis aimed to clarify the relationship between maternal serum ferritin levels and the risk of PTD. METHODS: Following the PRISMA guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar up to August 2025. Twenty-four observational studies with more than 10000 participants were included. Pooled standardized mean differences (SMDs) and odds ratios (ORs) were calculated using random-effects models. The ROBINS-1 tool was used to assess the quality of the studies and the risk of bias. RESULTS: Ferritin levels were significantly higher in pregnancies ending in PTD (random-effects SMD 0.82, 95% CI 0.28-1.36; I = 97.3%), with the strongest association observed in the second trimester (SMD 1.18, 95% CI 0.74-1.63). No independent predictive role for ferritin was shown (random-effects OR 1.05, 95% CI 0.97-1.13). High heterogeneity and evidence of publication bias were noted. Hemoglobin levels did not differ between groups. CONCLUSION: Elevated levels of maternal serum ferritin, especially during the second trimester, are linked to PTD. However, the adjusted OR estimates have not shown statistical significance. There is considerable variability among the studies and a risk of bias that warrants cautious interpretation. Additionally, the diagnostic thresholds reported differ greatly and lack sufficient validation for clinical application. It is essential to conduct standardized prospective studies before ferritin-based clinical decision-making can be endorsed.
The effect of umbilical cord coiling ındex measured in antenatal period on pregnancy results.
Cengiz M, Yilmaz E
Arch Gynecol Obstet · 2026 Feb · PMID 41639290 · Full text
PURPOSE: To evaluate the association between ultrasonographically measured umbilical coiling index (UCI) at 18-24 weeks of gestation and adverse perinatal outcomes in primigravid pregnancies. METHODS: This prospective st...
PURPOSE: To evaluate the association between ultrasonographically measured umbilical coiling index (UCI) at 18-24 weeks of gestation and adverse perinatal outcomes in primigravid pregnancies. METHODS: This prospective study included 461 primigravid women with singleton pregnancies. UCI was measured at 3 cord segments and classified as hypocoiled (< 0.20), normocoiled (0.20-0.40), or hypercoiled (> 0.40) using percentile distribution and ROC-derived thresholds. Maternal characteristics, delivery outcomes, fetal well-being, placental measurements, cord blood gas values, and neonatal outcomes were compared using Kruskal-Wallis, Mann-Whitney U, and chi-square tests (p < 0.05 was significant). RESULTS: Of the 461 patients, 72 (15.6%) were hypocoiled, 244 (52.9%) normocoiled, and 145 (31.5%) hypercoiled. No significant differences were found in maternal age, BMI, gestational age at delivery, hypertension, diabetes, or placental abruption. Birth weight was lowest in the hypocoiled group (p < 0.001). Umbilical artery pH was significantly lower in the hypercoiled group (p < 0.001). Both hypo and hypercoiled groups showed significantly reduced placental weight/thickness (p < 0.001) and higher rates of non-reassuring non-stress tests (34.7 and 28.3% vs. 9.0%, p < 0.001). Meconium-stained amniotic fluid (p = 0.003), oligohydramnios (p < 0.001), and intrauterine growth restriction (p < 0.001) were more common in abnormal coiling groups. Five-minute Apgar scores were significantly lower in both abnormal groups (p < 0.001). No association was found with fetal death (p = 0.575). CONCLUSION: Both decreased and excessive umbilical cord coiling in the second trimester are associated with impaired fetal growth and adverse perinatal outcomes. Routine second-trimester UCI assessment may help identify high-risk pregnancies.
Patient acceptance and implementation of micronutrient therapy in women with neurostress-related symptoms.
Loviat F, Pavicic E, Bitterlich N … +1 more , Stute P
Arch Gynecol Obstet · 2026 Feb · PMID 41636866 · Full text
PURPOSE: To evaluate the acceptance of micronutrient therapy in women with symptoms related to a pathological neurostress profile and to explore its association with patient-reported outcomes such as perceived efficacy,...
PURPOSE: To evaluate the acceptance of micronutrient therapy in women with symptoms related to a pathological neurostress profile and to explore its association with patient-reported outcomes such as perceived efficacy, side effects, compliance, and perceived lack of information. METHODS: This retrospective observational study included women aged ≥ 18 years who underwent neurostress testing followed by micronutrient therapy. The study was conducted at the Department of Obstetrics and Gynecology, University Hospital Bern. Patients were invited to complete the validated ACCEPT© questionnaire to assess their level of treatment acceptance. Descriptive statistics and non-parametric tests were applied, and correlations were analyzed using Spearman's rho. RESULTS: Eighty-one women participated. Overall treatment acceptance was high, with a median ACCEPT© score of 88.9 (Q1 = 66.6, Q3 = 100). Acceptance of drug-related constraints scored high (median = 100), whereas acceptance of treatment duration was lower (median = 66.6). Side effects were well tolerated (median = 100), and perceived efficacy was rated positively (median = 100). General acceptance correlated significantly with perceived efficacy (p < 0.001) and side effects (p < 0.001), but not with compliance (p = 0.084). A negative correlation was found with the perceived lack of information (p = 0.043). CONCLUSION: Micronutrient therapy in women with a pathological neurostress profile was highly accepted, particularly regarding treatment-related constraints and side effects. Acceptance was closely linked to perceived efficacy, highlighting the importance of patient-centered communication and expectation management.
Impact of chemotherapy dose capping on treatment intensity and survival in early breast cancer patients with high body surface area.
Englisch A, Eissler K, Dannehl D … +6 more , Englisch J, Hartkopf AD, Brucker SY, Grischke EM, Volmer LL, Engler T
Arch Gynecol Obstet · 2026 Feb · PMID 41636852 · Full text
PURPOSE: This study evaluates treatment intensity, tolerability, and survival outcomes in early breast cancer patients with high body surface area (BSA) receiving capped chemotherapy doses. METHODS: We retrospectively an...
PURPOSE: This study evaluates treatment intensity, tolerability, and survival outcomes in early breast cancer patients with high body surface area (BSA) receiving capped chemotherapy doses. METHODS: We retrospectively analyzed 730 patients with early breast cancer who received neoadjuvant or adjuvant chemotherapy with anthracycline/cyclophosphamide and taxane-based regimens at the University Hospital Tübingen between 2014 and 2021. Institutional policy capped dosing at BSA 2.0 m. To identify patients with clinically relevant dose reduction (≥ 5%), we classified those with BSA > 2.1 m as the high-BSA group. We assessed relative dose intensity (RDI), adverse events leading to treatment modifications, and survival outcomes using Kaplan-Meier analyses and Cox proportional hazards regression. RESULTS: Among 730 patients, 61 (8.4%) had BSA > 2.1 m. High-BSA patients received significantly lower median RDI (83.9% vs. 92.6%, p < 0.001). Consistent with reduced dose intensity, treatment tolerability was good: blood and lymphatic system disorders (8.2% vs. 24.5%, p = 0.006) and gastrointestinal disorders (0.0% vs. 11.1%, p = 0.002) occurred less frequently, and fewer patients required subsequent dose reductions (37.7% vs. 58.3%, p = 0.008). Despite this favorable tolerability profile, 5-year overall survival (85.5% vs. 94.3%, p = 0.015) and disease-free survival (74.3% vs. 91.0%, p = 0.008) were inferior in the high-BSA group. This association persisted in multivariate analysis (OS: HR 3.25; DFS: HR 2.17), though obesity-related effects could not be separated due to collinearity. CONCLUSIONS: In this cohort with consistent dose capping at BSA 2.0 m, patients with high BSA represent an at-risk population with reduced chemotherapy intensity, inferior survival, but good treatment tolerability. Lower rates of blood and lymphatic system disorders and gastrointestinal disorders and fewer dose reductions suggest these patients may have tolerated full weight-based doses. While the contributions of obesity-related prognostic factors and potential underdosing could not be separated, these findings support ASCO guideline recommendations against routine dose capping in curative settings.
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