International Journal Of Gynaecology And Obstetrics[JOURNAL]
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200 papers
Maternal serum thrombospondin-4 levels in placenta accreta spectrum: A case-control study.
Çanga K, Öztürk Ö, Bahadir İB … +3 more , Elüstü B, Özcan Ü, Yilmaz ZV
Int J Gynaecol Obstet · 2026 Jul · PMID 42402908 · Publisher ↗
OBJECTIVE: This study evaluates maternal serum thrombospondin-4 (TSP-4) levels in pregnancies complicated by placenta accreta spectrum (PAS) and examine their association with maternal and neonatal outcomes. METHODS: Thi...
OBJECTIVE: This study evaluates maternal serum thrombospondin-4 (TSP-4) levels in pregnancies complicated by placenta accreta spectrum (PAS) and examine their association with maternal and neonatal outcomes. METHODS: This prospective case-control study included 80 pregnancies, comprising 40 cases with PAS and 40 healthy controls. The study was conducted at Ankara Etlik City Hospital between June 2025 and March 2026. Maternal serum TSP-4 levels were measured by ELISA. Clinical, obstetric, maternal, and neonatal data were recorded. Univariable and multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed, including comparison of a clinical model with and without TSP-4. RESULTS: Maternal serum TSP-4 levels were significantly higher in the PAS group than in controls (9.88 [9.38-10.00] vs. 7.83 [6.01-9.30] ng/mL; P < 0.001). PAS was associated with prolonged hospitalization, increased transfusion requirement, earlier delivery, lower birth weight, lower Apgar scores, higher neonatal intensive care unit admission rates, and increased rates of adverse maternal and neonatal composite outcomes. Within the PAS cohort, TSP-4 levels were not associated with composite adverse maternal outcome, PAS grade, or major neonatal outcomes. In multivariable analysis, TSP-4 was the only variable independently associated with PAS (adjusted odds ratio 1.863, 95% confidnece interval [CI] 1.308-2.651; P = 0.001). ROC analysis demonstrated moderate discriminative ability (area under the curve [AUC] 0.796, 95% CI 0.697-0.895). At a cutoff value of >9.47 ng/mL, sensitivity and specificity were 72.5% and 82.5%, respectively, yielding a positive likelihood ratio of 4.14 and a negative likelihood ratio of 0.33. Adding TSP-4 to the clinical model increased the AUC from 0.660 to 0.816 (P = 0.002 for the difference). CONCLUSION: Maternal serum TSP-4 is elevated in PAS and, by adding discriminative value to clinical predictors, might be considered a complementary biomarker candidate for antenatal risk stratification, although these associations warrant confirmation in larger, prospective, multicenter cohorts. Its value appears greater for identifying disease presence than for reflecting disease severity.
Response: A comparison in maternal and neonatal outcomes between mild fundal pressure and vacuum extraction for shortening the second stage of labor-Reconsidering the use of the term "mild fundal pressure" in obstetric practice.
Dominsky O, Malka-Goldwasser N, Berkovitz-Shperling R … +4 more , Rosenberg-Friedman M, Baruch Y, Yogev Y, Lavie A
Int J Gynaecol Obstet · 2026 Jul · PMID 42402905 · Publisher ↗
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Comparing functionality, anxiety and depression during pregnancy and postpartum in women with hypertensive disorders: Findings from the WOICE assessment.
Lozano SP, Siqueira Guida JP, Charles CM … +4 more , Ortiz Rojas HJ, Gómez Muñoz C, Cecatti JG, Costa ML
Int J Gynaecol Obstet · 2026 Jul · PMID 42402898 · Publisher ↗
OBJECTIVE: To describe the use of the WOICE tool for assessing non-severe maternal morbidities among pregnant and postpartum women with hypertensive disorders. METHODS: Secondary analysis of a previously published cross-...
OBJECTIVE: To describe the use of the WOICE tool for assessing non-severe maternal morbidities among pregnant and postpartum women with hypertensive disorders. METHODS: Secondary analysis of a previously published cross-sectional study performed in Brazil, with the inclusion of women with hypertensive disorders (pre-eclampsia, chronic hypertension, and gestational hypertension), comparing them in the antenatal and postpartum periods. The WOICE tool was applied during 28 weeks of gestational age and in the 40th day after delivery. The study was conducted at a referral maternity hospital between November 2017 and December 2018. Descriptive and comparative analyses were performed using appropriate statistical tests. Prevalence ratio (PR) identified factors associated with functional impairment were assessed through multivariable analysis. RESULTS: Of 1046 women, 238 had hypertensive disorders and were included (99 pregnant, 139 postpartum). The mean age was 30 years old in both groups. Most participants had completed secondary education and were married. Among women in the postpartum period, there was a significant decrease in the frequency of employed women (P = 0.009). Functional impairment was reported in 40.4% versus 12.2% (P < 0.001); anxiety affected 31.3% versus 14.4% (P < 0.001); depressive symptoms were present in 13.1% versus 4.3% (P < 0.001), respectively, ante- and postpartum. Substance use was similar (13.1% vs. 14.4%). Risk of violence was reported by 7.1% of pregnant and 5.0% of postpartum women (P = 0.581). Having pre-existing conditions (PR 2.40, confidence interval [CI]: 1.28-4.51, P = 0.006) and anxiety (PR 2.75, CI: 1.31-5.77, P = 0.008) were associated with impaired functioning in prenatal care. Breastfeeding protected women from impaired functioning in the postpartum period (PR 0.12, CI: 0.02-0.69, P = 0.017), while having pre-existing conditions (PR 4.40, CI: 2.29-8.74, P < 0.001) increased the risk during the postpartum period. CONCLUSION: Anxiety, depression, and functional impairment were frequent among women with hypertensive disorders during pregnancy, occurring during antenatal and postpartum care. These findings highlight the need of routine maternal mental health screening and multidisciplinary care to identify and properly treat women affected by those conditions.
Response: A comparison in maternal and neonatal outcomes between mild fundal pressure and vacuum extraction for shortening the second stage of labor-Fundal pressure maneuvers are not created equal.
Dominsky O, Goldwasser NM, Berkovitz-Shperling R … +4 more , Rosenberg-Friedman M, Baruch Y, Yogev Y, Lavie A
Int J Gynaecol Obstet · 2026 Jul · PMID 42400333 · Publisher ↗
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Comparison of outpatient versus inpatient management after early stabilization in preterm prelabor rupture of membranes <34 weeks: Maternal safety, latency, and neonatal outcomes.
Ay O, Şahin F, Bahçeci P … +2 more , Taşkıran D, Gezginç K
Int J Gynaecol Obstet · 2026 Jul · PMID 42400201 · Publisher ↗
OBJECTIVE: This study compared outpatient/home follow-up after initial stabilization with inpatient management in singleton pregnancies with preterm prelabor rupture of membranes (PPROM) before 34 + 0 weeks of gestation,...
OBJECTIVE: This study compared outpatient/home follow-up after initial stabilization with inpatient management in singleton pregnancies with preterm prelabor rupture of membranes (PPROM) before 34 + 0 weeks of gestation, focusing on maternal safety, neonatal outcomes, latency, and healthcare utilization. MATERIALS AND METHODS: In this single-center retrospective cohort, singleton PPROM cases managed between January 2020 and December 2024 were evaluated. After stabilization, patients were classified as outpatient/home or inpatient. The primary outcome was neonatal intensive care unit (NICU) admission. Inverse probability of treatment weighting (IPTW) was used to reduce selection bias, and latency was assessed with landmark Kaplan-Meier analyses. RESULTS: A total of 239 cases were analyzed (inpatient, n = 173; outpatient/home, n = 66). NICU admission was lower in the outpatient/home group (unadjusted risk ratio [RR] 0.56; IPTW RR 0.59, P = 0.007). The outpatient/home group had higher gestational age at delivery (median 36 vs. 31 weeks), shorter NICU stay (IPTW median difference, -4 days), and greater birth weight (IPTW median difference, +980 g). Placental abruption was more frequent in the outpatient/home group (IPTW RR 2.48). Landmark analyses showed markedly longer additional latency in the outpatient/home group (after 48 h: 43 vs. 3 days; after 7 days: 38 vs. 5 days; log-rank P < 0.001). CONCLUSION: In carefully selected, initially stable PPROM cases before 34 weeks, outpatient/home management was associated with longer latency and lower NICU utilization. However, these findings should be interpreted cautiously because more stable patients might have been preferentially selected for outpatient follow-up. With careful selection and close surveillance, outpatient/home management might be a reasonable alternative to reduce inpatient resource use.
Flat glucose response curve during pregnancy and perinatal outcomes: A systematic review and meta-analysis.
Sangiovanni MC, Signore F, Angioli R … +2 more , Straface G, Vena F
Int J Gynaecol Obstet · 2026 Jul · PMID 42400187 · Publisher ↗
BACKGROUND: Gestational diabetes mellitus (GDM) is one of the most frequent metabolic disorders in pregnancy, affecting around 14% of pregnancies globally, and associated with increased risk of maternal and perinatal com...
BACKGROUND: Gestational diabetes mellitus (GDM) is one of the most frequent metabolic disorders in pregnancy, affecting around 14% of pregnancies globally, and associated with increased risk of maternal and perinatal complications. OBJECTIVE: This study evaluates the association between a flat glucose response curve (FC) during the oral glucose tolerance test (OGTT) in pregnancy and perinatal outcomes. SEARCH STRATEGY: This systematic review and meta-analysis adhered to the PRISMA guidelines. MEDLINE/PubMed, CINAHL, Cochrane Library, Embase, Ovid, Web of Science, and Google Scholar were searched from database inception to May 2, 2026. SELECTION CRITERIA: Eligible studies compared pregnant women with FC with those showing a standard OGTT curve. DATA COLLECTION AND ANALYSIS: The primary outcome was small for gestational age (SGA). Secondary outcomes were macrosomia, hypertensive disorders of pregnancy (HDP), primary caesarean delivery (PCD), vaginal delivery, Apgar score <7-8 at 5 min, neonatal intensive care unit (NICU) admission, and neonatal sex. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using fixed-effects models. Study quality was assessed using the NIH Quality Assessment Tool for observational cohort and cross-sectional studies. MAIN RESULTS: Five cohort studies involving 5150 women with FC and 41 898 controls were included. FC was associated with higher risk of SGA (OR 1.21; 95% CI 1.06-1.38; P = 0.005) and lower odds of macrosomia (OR 0.74; 95% CI 0.66-0.83; P < 0.00001), HDP (OR 0.66; 95% CI 0.55-0.80; P < 0.0001), and PCD (OR 0.85; 95% CI 0.77-0.93; P = 0.0005). FC was linked to increased vaginal delivery (OR 1.16; 95% CI 1.06-1.27; P = 0.001). No associations were found for Apgar <7-8 or NICU admission. Male sex was more frequent in the FC group (OR 1.14; 95% CI 1.04-1.24; P = 0.003). CONCLUSION: An FC may represent a distinct metabolic-obstetric phenotype associated with an increased risk of SGA, highlighting the potential prognostic value of OGTT curve morphology beyond conventional gestational diabetes thresholds.
Preserved large elastic arterial stiffness and impaired conduit artery endothelial function in patients with endometriosis receiving progestin therapy: A cross-sectional observational study.
Majhi S, Chandran DS, Patil A … +3 more , Vatsa R, Bharti J, Jaryal AK
Int J Gynaecol Obstet · 2026 Jul · PMID 42400182 · Publisher ↗
OBJECTIVE: To evaluate central arterial stiffness, endothelial function, and circulating vascular biomarkers in women with ovarian endometriosis and to explore their associations compared with age-matched controls. METHO...
OBJECTIVE: To evaluate central arterial stiffness, endothelial function, and circulating vascular biomarkers in women with ovarian endometriosis and to explore their associations compared with age-matched controls. METHODS: This cross-sectional observational study included women aged 18-40 years with Stage III-IV ovarian endometriosis (n = 20) and age-matched controls without endometriosis (n = 30). Of the 20 women with endometriosis, 18 were receiving Dienogest 2 mg/day at the time of assessment. Central arterial stiffness was assessed using carotid-femoral pulse wave velocity (cfPWV) and aortic Augmentation Index standardized to 75 bpm (AIx@75) using the SphygmoCor® XCEL system. Endothelial function was evaluated by brachial artery flow-mediated dilatation (FMD). Circulating biomarkers including high-sensitivity C-reactive protein (hsCRP), E-selectin, and Endothelin-1 were measured using ELISA. Group comparisons were performed using unpaired t-tests or Mann-Whitney U-tests, and correlations were assessed using Pearson or Spearman analyses. RESULTS: Arterial stiffness parameters did not differ significantly between groups. cfPWV was comparable between women with endometriosis and controls (median [interquartile range] 6.6 [6.0-7.0] vs 6.4 [6.1-6.9] m/s; P = 0.749), as was AIx@75 (24.68% ± 8.71% vs 26.7% ± 12.72%; P = 0.547). However, endothelial function was significantly impaired in women with endometriosis, with lower FMD compared with controls (10.80% ± 3.47% vs 15.26% ± 2.59%; P < 0.001). hsCRP levels were significantly higher in women with endometriosis compared with controls (0.0318 [0.0114-0.0631] vs 0.0105 [0.0062-0.0224] mg/L; P = 0.009), whereas Endothelin-1 levels were significantly lower (15.6 [6.4-32.4] vs 30.6 [18.8-53.6] pg/mL; P = 0.045). E-selectin levels did not differ significantly between groups (P = 0.218). No significant correlations were observed between arterial stiffness indices and molecular markers. CONCLUSION: Women with ovarian endometriosis, the majority of whom were receiving Dienogest therapy, demonstrated impaired endothelial function and elevated systemic inflammation despite preserved central arterial stiffness. These findings support the concept of endometriosis as a systemic inflammatory condition associated with early functional vascular impairment.
Development and validation of machine learning-based model for macrosomia and spontaneous preterm birth: A retrospective cohort study.
Chen J, Liu R, Zhou X … +4 more , Zeng D, She Q, Ouyang S, Liu L
Int J Gynaecol Obstet · 2026 Jul · PMID 42400159 · Publisher ↗
OBJECTIVES: This study aimed to develop and externally validate machine learning-based models for predicting macrosomia and spontaneous preterm birth (sPTB) using multidimensional clinical data. METHODS: This retrospecti...
OBJECTIVES: This study aimed to develop and externally validate machine learning-based models for predicting macrosomia and spontaneous preterm birth (sPTB) using multidimensional clinical data. METHODS: This retrospective cohort study included 14 238 pregnant women who received prenatal care between 2018 and 2023. Demographic characteristics, laboratory parameters, and delivery outcomes were integrated, with Least Absolute Shrinkage and Selection Operator regression used for feature selection. Predictive models were developed using logistic regression and machine learning algorithms (Light Gradient Boosting Machine, Adaptive Boosting, and gradient boosting decision tree), and performance was evaluated using the area under the curve (AUC), Brier score, decision curve analysis, and external validation results. RESULTS: Key predictors of macrosomia included pre-pregnancy body mass index, 1-h postprandial glucose, maternal education level, and comorbidities. The logistic regression model for macrosomia achieved an AUC of 0.742 (95% CI: 0.617-0.866) in external validation. For sPTB, significant predictors were comorbidities, aspartate aminotransferase, and uric acid, with the logistic regression model yielding an AUC of 0.706 (95% CI: 0.587-0.824) in external validation. Both models showed good calibration, with Brier scores of 0.182 (macrosomia) and 0.192 (sPTB). CONCLUSION: The predictive models effectively identify pregnancies at high risk of macrosomia and sPTB, facilitating early identification and targeted intervention. External validation highlights the need for prospective, multicenter studies in diverse populations to enhance generalizability.
Letter to the editor: Anovulatory bleeding and the spectrum of bleeding disorders: Understanding heavy menstrual bleeding in adolescents.
Munro MG, Critchley HOD
Int J Gynaecol Obstet · 2026 Jul · PMID 42396690 · Publisher ↗
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Response to Letter to the Editor - anovulatory bleeding and the spectrum of bleeding disorders: Understanding heavy menstrual bleeding in adolescents.
Özer E, Öden Akman A, Kurtipek FB … +6 more , Büyükyılmaz G, Bitkay A, Toksoy Adıgüzel K, Özbek NY, Boyraz M, Gürbüz F
Int J Gynaecol Obstet · 2026 Jul · PMID 42396677 · Publisher ↗
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Impact of Cell Saver technology on pro-hemostatic factors transfusion in placenta accreta spectrum interventions: A 10-year retrospective single-center study.
Levy I, Vachette M, Van Der Putten E … +5 more , Chouteau M, Goffinet F, Fischer C, Girault A, Athiel Y
Int J Gynaecol Obstet · 2026 Jul · PMID 42394398 · Publisher ↗
BACKGROUND: While Cell Saver technology effectively reduces red blood cell transfusion in the perioperative setting, its impact on the need for pro-hemostatic factors remains unclear. The use of Cell Saver could impact t...
BACKGROUND: While Cell Saver technology effectively reduces red blood cell transfusion in the perioperative setting, its impact on the need for pro-hemostatic factors remains unclear. The use of Cell Saver could impact the requirements of pro-hemostatic factors. OBJECTIVE: This study assesses whether the use of Cell Saver influences transfusion requirements for fresh frozen plasma, platelet concentrates, and fibrinogen in surgeries for placenta accreta spectrum (PAS) disorders. METHODS: This retrospective, single-center, before-and-after study was conducted in a tertiary maternity hospital. Women undergoing surgery for PAS (cesarean delivery with conservative treatment or hysterectomy) were included. Two periods were compared: before (2013-2017, Period A) and after Cell Saver implementation (2019-2023, Period B), with a 1-year washout (2018). The primary outcome was a composite criterion: transfusion of ≥ 3 units of FFP (fresh frozen plasma) and/or ≥ 1 unit of PC (platelet concentrates) and/or ≥ 4 g fibrinogen. Univariate and multivariable logistic regression analyses were conducted, with subgroup analyses in women undergoing hysterectomy and those with blood loss ≥ 2000 mL. RESULTS: Among 136 women (69 in Period A, 67 in Period B), Cell Saver was used in 86% of Period B cases (median volume: 769 mL). The primary outcome occurred in 42% of Period A versus 52.2% of Period B (P = 0.23). However, multivariable analysis showed lower odds of pro-hemostatic transfusion with Cell Saver use (adjusted odds ratio 0.21; 95% confidence interval 0.06-0.77). In patients with ≥ 2000 mL blood loss, the primary outcome was significantly less frequent in Period B (71.1% vs. 95.6%, P < 0.05). CONCLUSION: Cell Saver use during PAS surgery is independently associated with reduced pro-hemostatic transfusion, especially in cases with major bleeding, supporting its routine use.
Beyond coverage: A dual-standard cascade and latent class analysis of maternal healthcare continuity in Ghana-Identifying who gets left behind and why.
Nikoi EGA, Asante RKB, Yeboah E … +2 more , Nikoi ME, Toe I
Int J Gynaecol Obstet · 2026 Jul · PMID 42394368 · Publisher ↗
BACKGROUND: Ghana's maternal care cascade shows persistently low full completion. The legacy antenatal care (ANC) 4+ visit standard might inflate coverage estimates. METHODS: We analyzed data from 6965 women in the 2022...
BACKGROUND: Ghana's maternal care cascade shows persistently low full completion. The legacy antenatal care (ANC) 4+ visit standard might inflate coverage estimates. METHODS: We analyzed data from 6965 women in the 2022 Ghana Demographic and Health Survey. A dual-standard cascade (ANC 4+ vs. ANC 8+), skilled birth attendance, and postnatal care were constructed. Latent class analysis identified care-seeking typologies; multivariable logistic regression identified predictors of full cascade completion. RESULTS: Full cascade completion fell from 56.0% (ANC 4+) to 23.8% (ANC 8+). Four typologies were identified: Comprehensive Care Users (44.7%), Delivery-Focused Users (18.0%), ANC-Engaged/Delivery-Disengaged (9.1%), and Minimal Care Users (28.3%). ANC quality score was the strongest predictor (odds ratio [OR] = 2.20, P < 0.001), followed by health insurance (OR = 1.97) and secondary education (OR = 1.55). CONCLUSION: Applying the ANC 8+ standard reveals a larger coverage deficit than legacy metrics acknowledge. ANC quality is the dominant driver of care continuity and should be prioritized in Ghana's maternal health programming.
Influence of class III obesity on mode of delivery and perinatal complications in nulliparous women: A matched case-control study.
Gryson R, Bellamkonda S, Asandei D … +10 more , Dicker P, Malone C, Musa D, Habib SA, Floyd R, O'Malley E, Fullston E, Crimmins E, O'Mahony I, Breathnach FM
Int J Gynaecol Obstet · 2026 Jul · PMID 42394353 · Publisher ↗
OBJECTIVE: Obesity class III, defined as a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) exceeding 40, is associated with significant maternal and perinatal morbidity....
OBJECTIVE: Obesity class III, defined as a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) exceeding 40, is associated with significant maternal and perinatal morbidity. The primary objective of this study was to evaluate the independent effect of class III obesity on mode of delivery and perinatal outcome. METHODS: A matched case-control study was conducted, involving pairing a cohort of 69 nulliparous patients with a BMI ≥ 40 to two control groups of pregnancies (70 with maternal BMI 30-39 and 70 with BMI < 30). Subjects were matched for gestational diabetes mellitus (GDM) status and maternal age. Exclusion criteria were multiparity, multiple gestation, pregnancy loss < 24 weeks' gestation and pre-pregnancy diabetes. Patterns across the BMI groups were tested using the Cochrane-Armitage trend test and the Mann-Kendall trend test. A P value less than 0.05 was considered statistically significant. RESULTS: While the planned cesarean delivery (CD) rate was similar across BMI categories, class III obesity was independently associated with a statistically significant increase in the requirement for intrapartum CD (n = 32/60 [53%, excluding elective prelabor CD]) compared with BMI 30-39 (n = 24/61 [39%, excluding elective prelabor CD]) and BMI < 30 (n = 16/62 [26%]) (P = 0.006). This increase was observed both in spontaneous and induced labor. The decision to induce labor was significantly higher in the class III obesity group (n = 49/69 [82%]) compared with BMI 30-39 (n = 44/70 [79%]) and BMI < 30 (n = 30/70 [49%]) (P < 0.001). The most prevalent complication was cesarean wound infection requiring re-hospitalization, occurring in 20% of the class III group. CONCLUSION: Almost 60% of nulliparous pregnancies complicated by class III obesity require CD, the majority being intrapartum. Adjusting for the potential influence of maternal age and GDM status on perinatal decision making provides valuable insight into the independent effect of class III obesity on delivery outcome. When safely feasible, efforts should be directed toward awaiting spontaneous labor to optimize the prospect of achieving vaginal birth.
Contraceptive implant discontinuation at one year in adults and adolescents: Implications for adolescent reproductive health services.
Tarat C, Uaamnuichai S, Phutrakool P … +6 more , Rattawiwat R, Navyvichit J, Sarapat P, Taweepolcharoen C, Jaisamrarn U, Santibenchakul S
Int J Gynaecol Obstet · 2026 Jul · PMID 42394342 · Publisher ↗
OBJECTIVE: Contraceptive implants last for 3-5 years and are a highly effective and safe method of preventing unintended pregnancy. Adolescents face unique barriers that may predispose them to early discontinuation of co...
OBJECTIVE: Contraceptive implants last for 3-5 years and are a highly effective and safe method of preventing unintended pregnancy. Adolescents face unique barriers that may predispose them to early discontinuation of contraceptive implants, leading to a higher risk of unintended pregnancy. We compared early contraceptive implant discontinuation rates between adolescents (10-19 years) and adults (20-49 years) and evaluated sociodemographic and clinical factors associated with early contraceptive implant discontinuation. METHODS: This was a retrospective cohort study that followed 2014 participants who initiated etonogestrel and levonorgestrel contraceptive implants between 2016 and 2021 at King Chulalongkorn Memorial Hospital. Discontinuation of contraceptive implants at 12 months was determined by medical record review. Demographic characteristics and clinical factors were extracted from electronic medical records. A Cox proportional hazard model was used to assess factors associated with implant discontinuation. RESULTS: The overall rate of contraceptive implant discontinuation at 1 year after initiation was 3.83 per 100 person-years. The rates were significant at 2.84 and 4.16 per 100 person-years for adolescents and adults, respectively, with no statistically significant difference between the two groups, although adolescents trended toward a lower risk. The risk of discontinuation was significantly lower among sequential implant users (adjusted hazard ratio [HR] = 0.29, 95% confidence interval [CI]: 0.10-0.79, P = 0.016). No other demographic or clinical factors were found to be associated with discontinuation. Side effects, mainly abnormal uterine bleeding, were the most common cause of discontinuation. CONCLUSION: Contraceptive implant discontinuation within 1 year after initiation did not differ significantly between adolescents and adults. A trend toward a lower discontinuation rate was observed among adolescents.
Umbilical vein blood flow in macrosomic fetuses with and without pre-gestational diabetes: A cross-sectional study.
Rakha MH, Elshahat A, Ali TYM … +1 more , Al-Okda N
Int J Gynaecol Obstet · 2026 Jul · PMID 42388064 · Publisher ↗
OBJECTIVE: This study compares umbilical venous blood flow (Q) in macrosomic fetuses with and without pre-gestational diabetes (PGDM). METHODS: Seventy-nine women with PGDM and fetal macrosomia were enrolled in this comp...
OBJECTIVE: This study compares umbilical venous blood flow (Q) in macrosomic fetuses with and without pre-gestational diabetes (PGDM). METHODS: Seventy-nine women with PGDM and fetal macrosomia were enrolled in this comparative cross-sectional study (the PGDM group). A similar number of participants with fetal macrosomia and no diabetes constituted the control group. Fetal macrosomia was diagnosed antenatally based on increased ultrasound estimated fetal weight (EFW), symphysis-fundal height measurement, or both and was confirmed retrospectively based on a birthweight ≥4000 g. All participants underwent an ultrasound examination between 36 and 37 weeks' gestation for EFW and Doppler assessment of the umbilical vein (UV). RESULTS: The UV diameter was significantly higher in the PGDM group compared to the control group, while no statistically significant difference was found in the time-averaged maximum velocity (TAMXV). Both Q and Q corrected for EFW were significantly higher in the PGDM group compared to the control group. In addition to diabetes, increased neonatal birthweight and EFW were independently associated with a higher Q. Within the PGDM group, both UV diameter and Q were significantly higher in newborns with birthweights >4.5 kg in comparison to those ≤4.5 kg weight. CONCLUSION: Q measured between 36 and 37 weeks' gestation is increased enhanced in fetuses with macrosomia and PGDM compared to those with macrosomia and no diabetes. This increase is attributed to a larger UV diameter rather than an increase in the TAMXV. This study highlights the difference in fetal hemodynamics between fetal macrosomia attributed to maternal PGDM and macrosomia related to other risk factors such as pre-pregnancy obesity, increased gestational weight gain, or a previous macrosomic baby.
Readiness and affordability of utilizing human papillomavirus testing for cervical cancer screening among sexually active women in Gombe, Nigeria.
Hassan UM, Hayatu A, Farouk HU … +7 more , Mohammed A, Abdulshahid B, Mohammed I, Ishiyaku UM, Bojude AD, Manga MM, Steben M
Int J Gynaecol Obstet · 2026 Jul · PMID 42388037 · Publisher ↗
BACKGROUND: Cervical cancer remains a major cause of morbidity and mortality in Nigeria despite being preventable through timely screening and vaccination. While awareness of cervical cancer is increasing, uptake of huma...
BACKGROUND: Cervical cancer remains a major cause of morbidity and mortality in Nigeria despite being preventable through timely screening and vaccination. While awareness of cervical cancer is increasing, uptake of human papillomavirus (HPV) testing remains low due to structural and socioeconomic barriers. OBJECTIVES: This study assessed the readiness and affordability of HPV-based cervical cancer screening among sexually active women in Gombe State, Nigeria. METHODS: A cross-sectional study was conducted among 640 women attending gynecology and sexual health clinics across three levels of healthcare facilities. Data were collected from consenting participants, using a structured interviewer-administered questionnaire assessing socio-demographics, knowledge, attitudes, risk exposures, and willingness to pay for HPV testing. Descriptive statistics, Chi-square tests, and multivariable logistic regression were used for analysis. RESULTS: Overall, 91.6% of respondents expressed willingness to undergo HPV screening, yet actual uptake and HPV vaccination were extremely low (8.7% and 8.9%, respectively). While 82.6% identified HPV as a cause of cervical cancer, only 22.6% knew the eligible vaccination age. Self-sampling was preferred by 83.3% of respondents, and nearly all preferred female providers. None of the socio-demographic or risk factors significantly predicted willingness to screen (P > 0.05). Knowledge gaps, service unavailability, and affordability were major constraints. CONCLUSION: Despite high willingness, structural barriers and inadequate detailed knowledge hinder cervical cancer prevention in Gombe. Strengthening service availability, expanding self-sampling options, subsidizing HPV testing, and intensifying community education are essential to translate readiness into action and accelerate progress toward Health Organization cervical cancer elimination targets.
Prolonged interval between sibling embryo transfers impairs clinical pregnancy outcomes following assisted reproduction technology.
Yu Q, Wang M, Zhang C … +4 more , Mao R, Qi C, Jin L, Zhang B
Int J Gynaecol Obstet · 2026 Jul · PMID 42388015 · Publisher ↗
OBJECTIVE: This study investigates the impact of a prolonged time interval between sibling embryo transfers on clinical pregnancy outcomes, utilizing a model that controls for oocyte aging to isolate maternal time-depend...
OBJECTIVE: This study investigates the impact of a prolonged time interval between sibling embryo transfers on clinical pregnancy outcomes, utilizing a model that controls for oocyte aging to isolate maternal time-dependent factors. DESIGN: This retrospective, single-center, self-controlled cohort study evaluated patients who underwent at least two distinct embryo transfers utilizing sibling embryos derived from a single oocyte retrieval cycle between January 2013 and June 2024. The exposure group comprised subsequent transfers performed after an interval exceeding 36 months. Clinical outcomes, including implantation, biochemical pregnancy, clinical pregnancy, early miscarriage, and live birth rates, were compared. RESULTS: The final analysis included 2008 cycles from 654 couples (877 initial control cycles and 1131 subsequent exposure cycles). Following logistic regression analyses to adjust for potential confounders, the subsequent transfer group exhibited significantly decreased likelihood of biochemical pregnancy (adjusted odds ratio [OR] 0.60, 95% confidence interval [CI] 0.46-0.77, P < 0.001), clinical pregnancy (adjusted OR 0.49, 95% CI 0.38-0.63, P < 0.001) and live birth (adjusted OR 0.52, 95% CI 0.41-0.66, P < 0.001). To further minimize embryological bias, a highly restricted subgroup analysis was performed on single, good quality day 5 blastocyst transfers utilizing artificial endometrial preparation protocols (144 control vs. 163 exposure cycles). Within this subgroup, the subsequent transfers continued to demonstrate significantly inferior outcomes, with notable reductions in implantation, biochemical pregnancy, clinical pregnancy, and live birth rates (all P < 0.001). CONCLUSION: A prolonged interval (>36 months) between sibling embryo transfers independently and negatively impairs clinical pregnancy outcomes. For patients planning subsequent pregnancies using cryopreserved sibling embryos, it is clinically advisable to proceed with the transfer as early as medically appropriate to mitigate the time-dependent degradation of the reproductive environment.
Prediction of mode of delivery in nulliparous women by single measurement of angle of progression in active phase of first stage of labor.
Dasari P, Durai V, Garg S … +1 more , Vasudevan S
Int J Gynaecol Obstet · 2026 Jul · PMID 42383636 · Publisher ↗
BACKGROUND: Intrapartum Ultrasonography (USG) has recently evolved as an objective method to assess the progress of labor. Many parameters, such as angle of progression (AOP), head perineal distance (HPD), midline angle,...
BACKGROUND: Intrapartum Ultrasonography (USG) has recently evolved as an objective method to assess the progress of labor. Many parameters, such as angle of progression (AOP), head perineal distance (HPD), midline angle, and head direction, are assessed to predict vaginal delivery. These parameters are measured transperineally and based on clinical experience. This route is unpleasant to the patient, similar to digital vaginal examination. This study assesses whether a single measurement of AOP when measured abdominally can predict vaginal delivery. METHODS: A total of 110 nulliparous women were recruited after ethical clearance and informed consent had been attained. AOP was measured in the active phase of labor (4-6 cm) by abdominal technique, and HPD and cervical dilatation were also measured using the translabial technique. The receiver operating characteristics curve was plotted for the AOP of all women, and the cut-off value to predict vaginal delivery was determined. RESULTS: Vaginal delivery occurred in 72.7% of women, and the cesarean section rate was 27.3%. The cut-off value of AOP was 99.5° (area under the curve = 0.683; P = 0.002), which predicted vaginal birth. When the AOP was 90°, 50% delivered vaginally, and when it was >120°, all could deliver vaginally. Maximum vaginal deliveries occurred at an HPD of ≤4 cm. Cesarean birth was needed for 10.9% with non-progress of labor. CONCLUSION: The AOP as measured by abdominal technique in the active phase of the first stage of labor had moderate sensitivity in predicting vaginal delivery and, hence, it is a useful screening tool.
Maternal overweight and obesity during pregnancy and sex-dependent dysregulation of the materno-fetal stress axis.
Braun T, Hofmann M, Rancourt R … +11 more , Sommer J, Kühn A, Ehrlich L, Ziska T, Melchior K, Schellong K, Henrich W, Entringer S, Kennedy KM, Plagemann A, Sloboda DM
Int J Gynaecol Obstet · 2026 Jul · PMID 42383624 · Publisher ↗
OBJECTIVE: Maternal obesity and excess gestational weight gain (GWG) are linked to adverse perinatal outcomes, potentially via disruption of the maternal-fetal stress axis. Placental HSD11B2 protects the fetus from exces...
OBJECTIVE: Maternal obesity and excess gestational weight gain (GWG) are linked to adverse perinatal outcomes, potentially via disruption of the maternal-fetal stress axis. Placental HSD11B2 protects the fetus from excess glucocorticoids and may influence fetal programming during maternal metabolic stress. The present study assessed maternal overweight and GWG effects on stress axis and fetal development. METHODS: We conducted a prospective study of 175 singleton pregnancies at Charité University Berlin, recruited by pre-pregnancy body mass index (BMI: normal, overweight, obese). Maternal weight, hair and serum cortisol, neonatal anthropometrics, and placental HSD11B2 expression and methylation were analyzed during pregnancy, at delivery, and/or 6 months postpartum. Linear regression and correlation analyses were applied. RESULTS: Excessive gestational weight gain (GWG) was more common in obese women, who also showed higher postpartum weight retention. First-trimester hair cortisol and cortisone, reflecting chronic stress, were elevated in overweight and obese groups. While serum cortisol levels were similar, obese women showed a greater increase from the second to third trimester. Neonatal means did not differ consistently, yet macrosomia and small for gestational age rates were higher in offspring of obese mothers. Elevated maternal cortisol in late pregnancy and postpartum correlated with altered infant growth. Placental HSD11B2 was not GWG-dependent but varied by sex and BMI. Promoter methylation was linked to infant body composition and growth. CONCLUSION: Maternal overweight may relate to chronic hypothalamic-pituitary-adrenal (HPA) axis activation and altered placental HSD11B2, with sex-specific placental adaptations affecting fetal glucocorticoid exposure and offspring development. These findings support integrated perinatal strategies targeting nutrition and stress.
Associations of intrapartum fever and clinical chorioamnionitis with obstetric anal sphincter injuries in term vaginal deliveries.
Mikhail SM, Abu Shqara R, Ganem N … +4 more , Aiob A, Nakhleh Francis Y, Frank Wolf M, Lowenstein L
Int J Gynaecol Obstet · 2026 Jul · PMID 42383596 · Publisher ↗
OBJECTIVE: To evaluate the association between intrapartum fever, clinical chorioamnionitis, and the risk of obstetric anal sphincter injuries (OASIS) in term vaginal deliveries, stratified by fever severity. METHODS: Th...
OBJECTIVE: To evaluate the association between intrapartum fever, clinical chorioamnionitis, and the risk of obstetric anal sphincter injuries (OASIS) in term vaginal deliveries, stratified by fever severity. METHODS: This retrospective cohort study included all singleton, term (≥37 weeks), vertex vaginal deliveries at Galilee Medical Center between March 2020 and March 2025. The primary exposures were intrapartum fever-categorized as none, 38.0-38.9°C, and ≥ 39.0°C-and clinical chorioamnionitis, defined as maternal fever with at least one of the following: leukocytosis (>15 000/mm), fetal tachycardia (>160 bpm), or foul-smelling amniotic fluid. The primary outcome was OASIS (third- or fourth-degree perineal tears) diagnosed postpartum by obstetricians. Multivariable logistic regression was used to adjust for potential confounders, including nulliparity, body mass index (BMI), birth weight, gestational age, delivery mode, mediolateral episiotomy, and second-stage duration. RESULTS: Among 15 571 term vaginal deliveries, OASIS occurred in 93 (0.6%). The incidence increased with fever severity-83/15114 (0.6%) in afebrile women, 9/424 (2.1%) with moderate fever, and 1/21 (4.8%) with ≥39.0°C (P < 0.001). Clinical chorioamnionitis was also associated with OASIS (3.45% vs. 0.58%, P < 0.001). Independent risk factors for OASIS included nulliparity (adjusted odds ratio [aOR] 3.64, 95% confidence interval [CI]: 2.08-6.38), BMI <18.5 (aOR 24.90, 95% CI: 2.98-208.24), birth weight>4000 g (aOR 2.69, 95% CI: 1.40-5.18), intrapartum fever (aOR 2.57, 95% CI: 1.29-5.12), clinical chorioamnionitis (aOR 3.65, 95% CI: 1.27-10.47), and gestational age ≥ 41 weeks (aOR 1.91, 95% CI: 1.12-3.25). CONCLUSION: Intrapartum fever and clinical chorioamnionitis independently increase OASIS risk in term vaginal births, showing a clear dose-response relationship with fever severity.
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