International Journal Of Gynaecology And Obstetrics[JOURNAL]
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200 papers
Impact of junctional zone adenomyosis on reproductive outcomes after first single embryo transfer with donated oocytes: A retrospective single-center cohort study.
Etrusco A, Moliner Renau B, Agrifoglio V … +3 more , Maiorana A, Castillo Farfán JC, Bernabeu García A
Int J Gynaecol Obstet · 2026 Apr · PMID 41960937 · Publisher ↗
OBJECTIVE: To evaluate whether junctional zone (JZ) adenomyosis adversely affects assisted reproductive technologies (ART) outcomes in infertile women undergoing their first single embryo transfer (SET) using donor oocyt...
OBJECTIVE: To evaluate whether junctional zone (JZ) adenomyosis adversely affects assisted reproductive technologies (ART) outcomes in infertile women undergoing their first single embryo transfer (SET) using donor oocytes. METHODS: This retrospective single-center cohort study was conducted at Instituto Bernabeu (Alicante, Spain). A total of 240 infertile women undergoing their first SET with donor oocytes between December 2021 and June 2024 were included: 120 with isolated JZ adenomyosis diagnosed by two-dimensional (2D)-three-dimensional (3D) transvaginal ultrasound according to morphological uterus sonographic assessment (MUSA) criteria, matched to 120 controls without uterine abnormalities. Primary outcomes were live birth and miscarriage rates. Secondary outcomes included implantation rate and the relationship between adenomyosis severity and reproductive outcomes. Multivariable models were used to adjust for potential confounders. RESULTS: Women with JZ adenomyosis had significantly lower live birth rates than controls (34.16% vs 50.83%; P = 0.009) and higher miscarriage rates (32.93% vs 11.11%; P < 0.001), while implantation rates were comparable (68.33% vs 75.00%; P = 0.25). JZ adenomyosis independently predicted reduced live birth (odds ratio [OR] 0.43, 95% confidence interval [CI]: 0.24-0.76; P = 0.004) and increased miscarriage risk (OR 3.33, 95% CI: 1.42-7.82; P = 0.005). Increasing disease severity was associated with a higher risk of miscarriage. CONCLUSION: JZ adenomyosis is associated with significantly lower live birth rates and higher miscarriage rates after a first SET with donor oocytes, despite similar implantation rates. Comprehensive pre-ART ultrasound assessment of the JZ may improve counseling and support targeted strategies to optimize reproductive outcomes.
Polycystic ovarian syndrome and perinatal outcomes: A population-based pooled cross-sectional study.
Holek RA, Rossow C, Nechuta S
Int J Gynaecol Obstet · 2026 Apr · PMID 41960808 · Publisher ↗
OBJECTIVE: This study evaluates the associations of preconception polycystic ovarian syndrome (PCOS) and pregnancy conditions (gestational diabetes mellitus (GDM) and gestational hypertension) overall and by maternal obe...
OBJECTIVE: This study evaluates the associations of preconception polycystic ovarian syndrome (PCOS) and pregnancy conditions (gestational diabetes mellitus (GDM) and gestational hypertension) overall and by maternal obesity and plurality, and the associations of PCOS and birth outcomes overall and by GDM. METHODS: We conducted a pooled cross-sectional study using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016 to 2021 for population-based jurisdictions that included PCOS questions (N = 111 417). The PRAMS population-based random sample is weighted to give a representative sample of US women who gave birth in participating jurisdictions. The study exposure, outcomes, and covariates were measured using study questionnaires and birth certificate data. We used logistic regression to estimate confounder-adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Models accounted for sampling weights and were adjusted for maternal demographics and pregnancy characteristics. RESULTS: Approximately 6.5% (95% CI: 6.38-6.83) of women reported having preconception PCOS. Women with PCOS were more likely to develop GDM (aOR = 1.42; 95% CI = 1.27-1.58), to have gestational hypertension (aOR = 1.38; 95% CI = 1.25-1.52), to undergo cesarean delivery (aOR = 1.14; 95% CI = 1.05-1.24), to deliver a low birthweight infant (aOR = 1.32; 95%, CI = 1.20-1.45), and to have a preterm birth (aOR = 1.25; 95% CI = 1.12-1.39), compared to those without PCOS. Results were consistent across subgroups defined by maternal obesity, plurality, and GDM (as applicable). CONCLUSION: Findings fill a gap in research using recent population-based US representative data to emphasize the importance of early detection and tailored management strategies for women with PCOS to mitigate the risks of pregnancy complications and support the need for targeted interventions to improve maternal and neonatal outcomes.
Influence of maternal body mass index on the accuracy of clinical and sonographic fetal weight estimation.
Krencel A, Narkis B, Yedidia Moser R … +6 more , Bercovich O, Hendin N, Romano A, Hadar E, Gilboa Y, Houri O
Int J Gynaecol Obstet · 2026 Apr · PMID 41960805 · Publisher ↗
OBJECTIVE: Estimated fetal weight (EFW) is essential for managing pregnancy and delivery. Currently, two primary methods are used for EFW: Clinical and sonographic estimation. Both might be influenced by maternal habitus...
OBJECTIVE: Estimated fetal weight (EFW) is essential for managing pregnancy and delivery. Currently, two primary methods are used for EFW: Clinical and sonographic estimation. Both might be influenced by maternal habitus. Obesity has become a global epidemic; however, its effect on EFW and the accuracy of the two methods has yet to be determined. The aim of the present study was to describe the accuracy of clinical EFW (cEFW) and sonographic EFW (sEFW) as a function of maternal body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) by comparing them to actual birth weight. METHODS: This was a retrospective cohort study at a single tertiary center (2014-2020), including term (37-42 weeks) singleton deliveries with documented BMI, cEFW, and sEFW performed within 10 days of delivery, and known birth weight. At our institution, cEFW is routinely performed at admission by trained obstetricians as part of a standardized Leopold-based assessment. Participants were stratified into BMI groups: <25, 25-29.9, 30-34.9, and ≥35. The primary outcome was estimation accuracy across BMI strata, expressed as absolute error (in grams [g]) and as deviations greater than 10% and 20%. Secondary outcomes included diagnostic performance for large-for-gestational-age (LGA) neonates, assessed using receiver operating characteristic (ROC) curves and the area under the curve (AUC). Multivariable logistic regression identified factors associated with an error rate exceeding 20%. RESULTS: Among 19 397 deliveries, 2182 women qualified for analysis. Participants were distributed across BMI groups as follows: <25 (n = 408), 25-29.9 (n = 809), 30-34.9 (n = 634), and ≥35 (n = 331). Mean birth weight rose progressively with BMI, from 3045 ± 519 g in the lowest BMI group to 3557 ± 453 g in the ≥35 group (P < 0.01). Across BMI ≥25, cEFW showed larger absolute error than sEFW: BMI 25-29.9 (222 ± 184 vs. 202 ± 156 g), 30-34.9 (238 ± 187 vs. 204 ± 154 g), and ≥35 (254 ± 207 vs. 211 ± 161 g) (all P < 0.01). Rates of sEFW deviation >20% were low and stable across BMI (0.6%-1.7%; P = 0.42), whereas cEFW >20% increased with BMI (2.0%-6.0%; P < 0.01). In adjusted models, cEFW had higher odds of >20% error that escalated with BMI (adjusted odds ratio [aOR] 3.34, 5.87, 9.17 for BMI 25-29.9, 30-34.9, ≥35; all P < 0.01). In adjusted models, maternal BMI was not associated with >20% error in sEFW. For LGA detection, sEFW outperformed cEFW across strata, with the most significant gap at BMI ≥35 (AUC 0.873 vs. 0.791). CONCLUSION: Maternal obesity significantly reduces the accuracy of clinical EFW, whereas sonographic EFW maintains stable performance across BMI strata. Sonographic assessment should therefore be prioritized for fetal weight estimation in women with elevated BMI, particularly in the late third trimester, when weight-based delivery decisions are made.
Policy and advocacy considerations for the prevention and care of preterm birth.
Gudu W, Valencia CM, Ojeda LI … +2 more , Soma-Pillay P, FIGO Committee on Preterm Birth
Int J Gynaecol Obstet · 2026 Jun · PMID 41960790 · Full text
Preterm birth (PTB) is the leading cause of mortality in children aged under 5 years and a major contributor to lifelong morbidity, disproportionately affecting low- and middle-income countries. Despite its significant b...
Preterm birth (PTB) is the leading cause of mortality in children aged under 5 years and a major contributor to lifelong morbidity, disproportionately affecting low- and middle-income countries. Despite its significant burden, PTB remains underprioritized on global and national health agendas, with limited integration into monitoring frameworks, funding streams, and policy strategies. This paper, developed by the FIGO Committee on Preterm Birth, reviews current evidence and international experiences to highlight the urgency of elevating PTB as a maternal and newborn health priority. Effective, low-cost interventions-including quality antenatal care (ANC) and neonatal care, support for breastfeeding, infection management, and access to corticosteroids-could prevent up to three-quarters of PTB-related deaths, yet their implementation remains uneven. Moreover, addressing social determinants of health, such as poverty, gender-based violence, inadequate maternity leave, and poor access to health care, is essential to reducing inequities in outcomes. Policy innovations from Latin American countries demonstrate how national legislation and protocols can improve prevention and care. To achieve meaningful progress, PTB must be integrated into Sustainable Development Goal strategies and the Every Newborn Action Plan, supported by strong political will, multisectoral collaboration, and investment in research and innovation. Advocacy efforts should focus on developing national prevention programs, engaging community health workers (CHWs), standardizing care guidelines, and strengthening public-private and international partnerships. A comprehensive approach that integrates evidence-based interventions with policy reforms is crucial to reducing PTB incidence, improving survival, and ensuring equitable outcomes for mothers and newborns worldwide.
The impact of advanced maternal age on the risk of perineal and anal sphincter injuries in nulliparous women.
Dominsky O, Attali E, Maor M … +4 more , Gold R, Groutz A, Yogev Y, Baruch Y
Int J Gynaecol Obstet · 2026 Apr · PMID 41958424 · Publisher ↗
OBJECTIVE: The aim of the present study was to determine whether advanced maternal age is associated with increased risk of perineal injury and obstetric anal sphincter injury (OASI) among primiparous women. METHODS: Thi...
OBJECTIVE: The aim of the present study was to determine whether advanced maternal age is associated with increased risk of perineal injury and obstetric anal sphincter injury (OASI) among primiparous women. METHODS: This was a retrospective cohort study of primiparous women aged 20-50 years with singleton term pregnancies in cephalic presentation who delivered vaginally at a single tertiary center between 2012 and 2024. Women were stratified into three groups: 20-30 (reference), 30-40, and 40-50 years. The primary outcome was overall perineal injury, defined as spontaneous perineal laceration, labial tear, episiotomy, or OASI. The secondary outcome was OASI, analyzed separately. Multivariable logistic regression assessed the association between maternal age and each outcome. RESULTS: Among 45 021 primiparous women, 18 230 (40.5%) were aged 20-30 years, 25 520 (56.7%) aged 30-40 years, and 1271 (2.8%) aged 40-50 years. Overall perineal injury rates were similar across groups (86.0%, 85.0%, and 85.3%), and the only significant pairwise difference was between women aged 20-30 and 30-40 years (P = 0.008). OASI rates were consistently low (0.8%, 0.9%, and 0.7%; P = 0.589). In multivariable analysis, women aged 30-40 years had lower odds of overall perineal injury compared with the reference group (adjusted odds ratio [aOR] 0.89; 95% confidence interval [CI]: 0.84-0.95; P < 0.001), whereas women aged 40-50 years showed no significant difference (aOR 0.92; 95% CI: 0.76-1.11; P = 0.371). In the model for the secondary outcome, maternal age was not associated with OASI. CONCLUSION: Advanced maternal age is not an independent predictor of perineal injury or OASI. Clinical counseling should emphasize modifiable risk factors rather than maternal age.
Interstitial ectopic pregnancies managed by dual-site local injection and the characteristics of human chorionic gonadotropin elimination after treatment.
Peregrin-Alvarez I, Detti L, Woodard T … +2 more , Alexander M, Huang JC
Int J Gynaecol Obstet · 2026 Apr · PMID 41954016 · Publisher ↗
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Acupressure for postoperative pain after cesarean delivery: A meta-analysis.
Cuiyan L, Shen B, Xiao L
Int J Gynaecol Obstet · 2026 Apr · PMID 41952515 · Publisher ↗
BACKGROUND: Cesarean delivery is a major abdominal surgery with high global prevalence, and effective postoperative pain management is crucial for maternal recovery and well-being. Acupressure, a non-invasive Traditional...
BACKGROUND: Cesarean delivery is a major abdominal surgery with high global prevalence, and effective postoperative pain management is crucial for maternal recovery and well-being. Acupressure, a non-invasive Traditional Chinese Medicine technique, offers potential benefits but lacks comprehensive evidence for post-cesarean pain. OBJECTIVE: To evaluate the efficacy and safety of acupressure for pain relief after cesarean. SEARCH STRATEGY: Following PRISMA guidelines and MOOSE guidelines, nine randomized controlled trials (RCT; n = 712 participants) were identified from PubMed, EMBASE, and Cochrane Central (inception, August 2025). SELECTION CRITERIA: Studies compared acupressure with sham/standard care in postpartum women aged 18 years or older. Primary outcome was pain intensity at 0-2, 3-6, and 7-24 h postoperatively. DATA COLLECTION AND ANALYSIS: Meta-analysis used random-effects models (Stata 17.0), calculating mean differences (MD). MAIN RESULTS: Pooled results demonstrated significant pain reduction favoring acupressure across all time points: MD = -1.39 (95% confidence interval [CI] -1.96 to -0.83; I = 91.5%) at 0-2 h, MD = -0.99 (95% CI -1.53 to -0.45; I = 77.9%) at 3-6 h, and MD = -1.27 (95% CI -1.64 to -0.90; I = 13.6%) at 7-24 h. No serious adverse events were reported in the included studies; however, adverse-event reporting was limited, and minor transient events such as bruising or tenderness were described in three trials. CONCLUSION: Acupressure may reduce acute post-cesarean pain, particularly when LI4/SP6 acupoints are used, and may represent a promising non-pharmacologic adjunct within multimodal analgesia. However, the certainty of evidence was low, and the findings should be interpreted cautiously. Further high-quality, multicenter RCT with standardized protocols are needed to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: The review was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration no.: CRD420251230973).
Efficacy-oriented approach for medium-sized follicles: A perspective on stimulation, expectation, and triggering strategy in IVF cycles.
Aydin G, Ergin E, Arac M … +6 more , Bulbul M, Caliskan E, Hatirnaz S, Dahan M, Malvasi A, Tinelli A
Int J Gynaecol Obstet · 2026 Apr · PMID 41949741 · Publisher ↗
OBJECTIVE: To assess the therapeutic significance of routinely aspirating mid-sized follicles (14.0-16.9 mm) during oocyte pick-up (OPU) by looking at procedural efficiency and embryo usage in cycles with varied follicul...
OBJECTIVE: To assess the therapeutic significance of routinely aspirating mid-sized follicles (14.0-16.9 mm) during oocyte pick-up (OPU) by looking at procedural efficiency and embryo usage in cycles with varied follicular cohorts. METHODS: In vitro fertilization (IVF) cycles with follicles classified as large (≥17 mm) or mid-sized (14.0-16.9 mm) at the time of OPU were included in this prospective cohort. Each group's oocytes were extracted and treated independently while maintaining rigorous traceability. Analysis was performed on embryologic results, operative time factors, and embryo transfer utilization across successive transfer attempts. Pregnancy outcomes and the length of the operation were investigated. Laboratory results pertaining to trigger strategies were assessed descriptively. RESULTS: When measured per mature oocyte, oocytes from mid-sized follicles showed comparable fertilization and blastocyst development rates. However, only a small percentage of embryo transfers included embryos from mid-sized follicles, especially in the initial two transfer attempts. Large follicles had a longer total OPU duration, and cycles that resulted in miscarriage had significantly longer operative times among large-follicle-derived embryo transfers. For mid-sized follicles, there were no differences in the length of the procedure based on the pregnancy outcome. CONCLUSION: The contribution of mid-sized follicle-derived oocytes to embryo transfer selection seems to be restricted in everyday practice, despite their reassuring laboratory competence. Procedural efficiency is a potentially significant factor in customized IVF care, as evidenced by the correlation between longer operating times and worse clinical outcomes. In certain clinical situations, a focused stimulation and aspiration approach might be suitable without obviously jeopardizing cumulative results.
Effect of preoperative intravenous iron administration on transfusion outcomes in benign gynecologic surgery.
Olson SL, Hyndman A, Okocha O … +4 more , Tsai S, Chaudari A, Milad MP, Yang LC
Int J Gynaecol Obstet · 2026 Apr · PMID 41949589 · Publisher ↗
OBJECTIVE: Anemia is common in patients requiring gynecologic surgery and is associated with adverse surgical outcomes. The objective of this study was to evaluate the effect of preoperative intravenous (IV) iron adminis...
OBJECTIVE: Anemia is common in patients requiring gynecologic surgery and is associated with adverse surgical outcomes. The objective of this study was to evaluate the effect of preoperative intravenous (IV) iron administration on blood transfusion rates following hysterectomy and myomectomy and to share our experience establishing a standardized pre-procedure anemia evaluation (PPAE) pathway. METHODS: This was a retrospective cohort study at an academic tertiary care center including all patients who underwent benign hysterectomy or myomectomy between 2012 and 2021. The intervention reviewed was preoperative administration of IV iron and the implementation of a standardized PPAE pathway. RESULTS: A total of 2842 patients were included, with 15% (n = 413) receiving preoperative IV iron. Patients who received IV iron were more likely to be younger (median 42 vs 45 years, P < 0.0001), identify as Black (52% vs 18%, P < 0.0001), and have a higher body mass index (median 30.6 vs 28.6, P < 0.0001) compared to patients who did not receive IV iron. Multivariable modeling, controlling for blood loss, preoperative hemoglobin, surgical duration, CELL SALVAGE use, complications, myomectomy, and laparotomy, identified IV iron use as independently associated with a reduced likelihood of requiring a postoperative blood transfusion (adjusted odds ratio [aOR] = 0.4317, P = 0.0059). In patients with hemoglobin less than 10.0 g/dL at preoperative assessment, surgery scheduled after implementation of the PPAE program (aOR = 19.41, P < 0.0001) was independently associated with increased rates of IV iron use. CONCLUSION: Despite lower baseline hemoglobin values and greater surgical complexity, use of IV iron was independently associated with a reduced risk of blood transfusion. Among patients with moderate-to-severe preoperative anemia, IV iron use was more likely after implementation of a standardized PPAE referral pathway.
Interstitial pregnancy following ipsilateral salpingectomy: A case report.
Liu S, Lin X, Qin X … +1 more , Xie W
Int J Gynaecol Obstet · 2026 Apr · PMID 41949572 · Publisher ↗
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Predictors for intrapartum cesarean delivery after labor induction for suspected fetal growth restriction at term.
Anteby M, Reichman Y, Bar-Or A … +6 more , Herzlich J, Cohen S, Haratz KK, Lavie A, Hiersch L, Yogev Y
Int J Gynaecol Obstet · 2026 Apr · PMID 41949567 · Publisher ↗
OBJECTIVE: In term pregnancies with suspected fetal growth restriction (FGR) undergoing induction of labor (IOL), predictors for intrapartum cesarean delivery (CD) remain unclear. We aimed to determine predictors for int...
OBJECTIVE: In term pregnancies with suspected fetal growth restriction (FGR) undergoing induction of labor (IOL), predictors for intrapartum cesarean delivery (CD) remain unclear. We aimed to determine predictors for intrapartum CD in this population. METHODS: This study included a retrospective cohort of singleton pregnancies undergoing IOL at ≥37 weeks for suspected FGR, defined as estimated fetal weight (EFW) or abdominal circumference (AC) <10th percentile, at a tertiary medical center (2011-2019). Maternal characteristics, sonographic measurements, and Doppler parameters were compared between vaginal delivery and intrapartum CD. Multivariable logistic regression and CHAID (Chi-square Automatic Interaction Detector) decision tree analysis were performed. RESULTS: Of 428 inductions, 71 (16.6%) resulted in intrapartum CD, predominantly for non-reassuring fetal heart rate (88.7%). Mean maternal age was 31.3 ± 5.2 years, and 286 patients (66.8%) were nulliparous. Mean EFW was 2364.3 ± 252.7 g, corresponding to the 2.1st percentile. Overall, 273 fetuses (63.8%) were in the <3rd percentile. No differences in fetal biometry or Doppler flows were detected between groups, and neither parameter predicted intrapartum CD. The only independent predictors of intrapartum CD were nulliparity (adjusted odds ratio [aOR] 4.84, 95% confidence interval [CI] 2.26-10.37, P < 0.001) and maternal age (aOR 1.10 per year, 95% CI 1.04 to 1.16, P = 0.002). Decision tree analysis showed a low CD rate in parous patients (6.3%) versus 44.2% in nulliparous patients aged ≥35 years (P < 0.001). CONCLUSION: When considering induction of labor for suspected FGR at term, maternal age and parity, rather than fetal size or Doppler status, should guide counseling regarding cesarean risk.
Comparative effectiveness of curettage, uterine artery embolization, and gonadotropin-releasing hormone (GnRH) agonist therapy in the management of acquired uterine enhanced myometrial vascularity/arteriovenous malformation (EMV/AVM) and retained products of conception (RPOC): A retrospective cohort study.
Foroughi AA, Dehghani SS, Shiravani Z … +1 more , Mansoori M
Int J Gynaecol Obstet · 2026 Apr · PMID 41949559 · Publisher ↗
OBJECTIVE: To compare the effectiveness of curettage, uterine artery embolization (UAE), and gonadotropin-releasing hormone (GnRH) agonist therapy in the management of post-abortion acquired uterine enhanced myometrial v...
OBJECTIVE: To compare the effectiveness of curettage, uterine artery embolization (UAE), and gonadotropin-releasing hormone (GnRH) agonist therapy in the management of post-abortion acquired uterine enhanced myometrial vascularity/arteriovenous malformation (EMV/AVM) with retained products of conception (RPOC), focusing on short-term healing and reproductive outcomes. METHODS: This monocentric retrospective cohort study included 159 women with EMV/AVM associated with RPOC after abortion, treated at a tertiary referral center affiliated with Shiraz University of Medical Sciences between January 2022 and December 2025. Patients underwent curettage, UAE with polyvinyl alcohol (PVA) particles, or GnRH agonist therapy. Outcomes included EMV/AVM healing and RPOC resolution at 4 weeks, change in RPOC volume, subsequent pregnancy, and recurrent abortion. Analyses were performed in SPSS version 26.0 with a two-sided significance threshold of P less than 0.05, following STROBE guidelines. RESULTS: At 4 weeks, AVM healing occurred in 70.2% and RPOC resolution in 68.4% of patients. Curettage and UAE achieved significantly higher rates of EMV/AVM and RPOC healing than GnRH agonist therapy (P = 0.018 and P = 0.013, respectively). No significant between-group differences were observed for subsequent pregnancy (P = 0.933) or recurrent abortion (P = 0.065). CONCLUSION: Curettage and UAE provide superior short-term healing compared with GnRH agonist therapy, while reproductive outcomes appear comparable across modalities. Treatment selection should consider Doppler parameters, clinical stability, and fertility goals.
Application of geospatial analysis for mapping the distribution of severe maternal morbidities in eastern Ethiopia: The case of the Ethiopian obstetric surveillance system.
Alemu SM, Weitkamp G, Knight M … +6 more , Girma S, Yuya M, Stekelenburg J, van den Akker T, Biesma R, Tura AK
Int J Gynaecol Obstet · 2026 Apr · PMID 41944594 · Publisher ↗
INTRODUCTION: The disparity in maternal mortality and severe morbidity between high- and low-income countries is well established. Previously, we highlighted within-country disparities in Ethiopia using demographic and h...
INTRODUCTION: The disparity in maternal mortality and severe morbidity between high- and low-income countries is well established. Previously, we highlighted within-country disparities in Ethiopia using demographic and health survey data. This study used enhanced obstetric surveillance data to detect subnational hotspot areas and factors associated with disparities in severe maternal morbidity in eastern Ethiopia. METHODS: This study used data from the Ethiopian Obstetric Surveillance System (EthOSS) study, which collected data for all women who experienced severe maternal morbidity in 13 hospitals in eastern Ethiopia between April 2021 and March 2022. Women whose geographical location was not recorded were excluded. We used optimized hotspot analysis to identify areas with higher rates of severe maternal morbidity while controlling for population density and conducted linear and geographically weighted regression analyses to assess factors associated with the distribution. RESULTS: Of all 2043 women with severe maternal outcomes, 1775 (87%) women with severe maternal morbidity with complete geographical information were included for analysis. Less than half (47%) lived within the recommended 2-h travel time to the nearest emergency obstetric and newborn care (EmONC) facility, with significant geographic variation. Hotspot analysis identified clusters of high rates near urban centers such as Dire Dawa and Harari even after controlling for the population density, while lower rates were found in eastern Oromia. Geographically weighted regression analysis showed that proximity to health facilities, especially to a basic or comprehensive EmONC facility, was associated with higher maternal complication rates. CONCLUSION: This study highlights the value of leveraging geocoded surveillance data to conduct geospatial analyses to uncover spatial patterns. We found a higher rate of severe maternal morbidity in the larger cities, indicating that the urban population had better access to care during obstetric complications, while rural and remote areas with limited access might fail to come to hospitals when complications arise or die at home or lower-level facilities.
Association of novel intra-cesarean post-placental intrauterine device insertion techniques, and early ultrasound, with expulsion rates and strings visibility: A prospective exploratory study.
Kime KM, Bazzett-Matabele L, Hofmeyr GJ
Int J Gynaecol Obstet · 2026 Apr · PMID 41944588 · Publisher ↗
OBJECTIVE: To assess an innovative technique of intra-cesarean post-placental insertion of the Copper T380A IUD (CPPIUD), and explore the role of predischarge ultrasound with replacement of low-lying IUDs. METHODS: We co...
OBJECTIVE: To assess an innovative technique of intra-cesarean post-placental insertion of the Copper T380A IUD (CPPIUD), and explore the role of predischarge ultrasound with replacement of low-lying IUDs. METHODS: We conducted a prospective observational study at Princess Marina Hospital, Gaborone, Botswana, from May 31, 2023, to April 3, 2024. Sixty-seven participants were recruited following CPPIUD. We compared the standard FIGO technique with a novel method in which the insertion straw was left in place to stabilize the IUD and strings during uterine and abdominal closure, then retrieved transvaginally (see youtube video https://www.youtube.com/watch?v=ToWkp3z0_Vg). Technique selection was according to the attending surgeons' personal preference. IUD placement was assessed by predischarge transabdominal ultrasound, and participants were followed up at 6 weeks or later. The primary outcome was IUD retention. RESULTS: Overall IUD retention was 63/67 (94.0%). The straw-stabilized group showed a slightly but not statistically significantly higher retention rate (97.9% vs. 85.0%) and string visibility (34.0% vs. 15.0%). Predischarge ultrasound identified low-lying IUDs in 7/67 participants (10.4%) across both groups; these devices were replaced. One spontaneous expulsion and three removals on request occurred after discharge. CONCLUSION: The straw-stabilized method is at least equivalent to the standard approach. Early predischarge ultrasound may enhance retention.
Hypokalemic periodic paralysis associated with atypical CACNA1S in pregnancy: New challenge for a rare syndrome.
Dominoni M, Pano MR, Gardella B
Int J Gynaecol Obstet · 2026 Apr · PMID 41944566 · Publisher ↗
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Disparities in preterm birth: Impact of clinical, racial, and socioeconomic factors in US singleton pregnancies.
Staniczek J, Shah S, Sharifiheris Z … +3 more , Demirjian M, Kwan L, Afshar Y
Int J Gynaecol Obstet · 2026 Apr · PMID 41944520 · Publisher ↗
BACKGROUND: The incidence of preterm births in the USA continues to rise, increasing the risk of adverse health outcomes for both neonates and pregnant persons. OBJECTIVES: This study identifies and quantifies risk facto...
BACKGROUND: The incidence of preterm births in the USA continues to rise, increasing the risk of adverse health outcomes for both neonates and pregnant persons. OBJECTIVES: This study identifies and quantifies risk factors associated with preterm birth in singleton pregnancies. METHODS: We analyzed de-identified data on singleton pregnancies from the National Institute of Child Health and Human Development Consortium on Safe Labor, encompassing clinical and demographic information from electronic medical records. RESULTS: Among 223 385 pregnancies, 11.7% resulted in preterm birth. Black/non-Hispanic individuals were over-represented among preterm births compared with term births (33.6% vs. 22.1%, P < 0.0001). In univariate analyses, preeclampsia/eclampsia (31.6% vs. 10.9%, P < 0.0001) and fetal anomalies (26.5% vs. 10.6%, P < 0.0001) were strongly associated with preterm birth. In multivariable models, short cervix (adjusted odds ratio [aOR] 4.1) and prior preterm birth (aOR 3.7) emerged as the strongest predictors. Additional independent risk factors included third-trimester bleeding (aOR 2.3), drug use (aOR 1.5), smoking (aOR 1.4), alcohol use (aOR 1.3), and antenatal urinary tract infection (aOR 1.3). Public insurance was independently associated with preterm birth (aOR 1.2). Notably, Black/non-Hispanic individuals were more likely to rely on public insurance (57.6%), underscoring the contribution of structural socioeconomic disparities to observed racial differences in preterm birth. CONCLUSIONS: Preterm birth is strongly associated with the pregnant individual's comorbidities, socioeconomic disadvantage, and obstetric complications. Targeted interventions to address health disparities, enhance prenatal care, and reduce modifiable risk factors are essential to improving perinatal outcomes.
Association between hypoglycemia during glucose challenge and tolerance tests in pregnancy and adverse maternal and neonatal outcomes.
Peled T, Ben-Ami T, Helman S … +3 more , Lando MB, Grisaru-Granovsky S, Rottenstreich M
Int J Gynaecol Obstet · 2026 Apr · PMID 41937578 · Publisher ↗
OBJECTIVE: To evaluate the association between hypoglycemia (defined during pregnancy as blood glucose levels <60 mg/dL) during the glucose challenge test (GCT, 50 g) and the oral glucose tolerance test (OGTT, 100 g) in...
OBJECTIVE: To evaluate the association between hypoglycemia (defined during pregnancy as blood glucose levels <60 mg/dL) during the glucose challenge test (GCT, 50 g) and the oral glucose tolerance test (OGTT, 100 g) in pregnancy, and the risk of adverse maternal and neonatal outcomes. METHODS: A multicenter retrospective cohort study. The study population included women who experienced hypoglycemia (<60 mg/dL) during glucose challenge test or Oral Glucose Tolerance Test. Women with hypoglycemia on each test were compared with those with normal values on the respective test. Univariate analyses were followed by multivariable logistic regression. RESULTS: Overall, 2.2% (2921/145 978) of women had hypoglycemia during Glucose Challenge Test, and 16.4% (3441/30 264) had at least one hypoglycemic value on Oral Glucose Tolerance Test. In multivariable analysis, hypoglycemia during GCT was independently associated with reduced odds of delivering a large-for-gestational-age neonate (adjusted odds ratio [aOR] 0.53, 95% confidence interval [CI] 0.39-0.73) but increased odds of small-for-gestational-age (SGA) neonates (aOR 1.56, 95% CI 1.24-1.97). No independent association was found between hypoglycemia on either test or overall adverse neonatal outcome after adjustment. CONCLUSION: In this large multicenter retrospective cohort, hypoglycemia during the Glucose Challenge Test was independently associated with a higher risk of Small for Gestational Age but not with an increased risk of composite neonatal outcome. These findings may provide reassurance to clinicians and patients and help avoid unnecessary interventions.
The importance of gene polymorphism in familial inheritance of endometriosis.
Goksever Celik H, Eker C, Guzelbag B … +2 more , Bastu E, Gunel T
Int J Gynaecol Obstet · 2026 Apr · PMID 41934140 · Publisher ↗
OBJECTIVE: The study aimed to investigate familial transmission patterns in women with endometriosis by generating a customized single-nucleotide polymorphism (SNP) array. METHODS: Patients aged 18-45 who were diagnosed...
OBJECTIVE: The study aimed to investigate familial transmission patterns in women with endometriosis by generating a customized single-nucleotide polymorphism (SNP) array. METHODS: Patients aged 18-45 who were diagnosed histopathologically with endometriosis were included in the study. Daughters and mothers of these patients were also included, regardless of whether they were diagnosed with endometriosis or not. The control group consisted of female patients of similar ages who were not diagnosed with endometriosis. The first stage of this investigation was the determination of the genes associated with the SNPs through meta-analyses in the field of endometriosis in the literature. The second stage was the creation of a unique SNP array by determining the SNPs in the selected target genes. We specifically evaluated whether SNPs in the WNT4 gene at locus 1p36.12 (rs7521902), the GREB1 gene at locus 2p25.1 (rs13391619), and the FN1 gene at locus 2q35 (rs1250248) were associated with endometriosis risk in the Turkish population. RESULTS: The study included 91 participants, comprising 66 women diagnosed with endometriosis and 25 healthy controls. The analysis revealed statistically significant associations for the FN1 (rs1250248, G>A) and the GREB1 (rs13391619, T>C) variants among endometriosis patients and their mothers and daughters, indicating a possible familial genetic link. CONCLUSION: These findings strengthen the evidence for a hereditary component in endometriosis and suggest that SNP-based genetic profiling may support earlier identification of at-risk individuals, enabling more timely surveillance and clinical intervention.
Psychometric evaluation of the Mother-to-Infant Bonding Scale in a Flemish context in early post-partum mothers.
Vanharen Y, Verstraete M, Van Berendoncks A … +2 more , Mannaerts D, Goossens E
Int J Gynaecol Obstet · 2026 Apr · PMID 41931029 · Publisher ↗
INTRODUCTION: A strong mother-infant bond supports healthy development and leads to better long-term outcomes for both mothers and infants. Tools like the Mother-to-Infant Bonding Scale (MIBS) enable objective assessment...
INTRODUCTION: A strong mother-infant bond supports healthy development and leads to better long-term outcomes for both mothers and infants. Tools like the Mother-to-Infant Bonding Scale (MIBS) enable objective assessment of this bond. This study examined key psychometric properties of the Dutch MIBS in a Flemish population. METHODS: This study comprised two subsequent parts. First, face and content validity were assessed by an expert panel of healthcare providers (n = 17) and mothers (n = 6). Second, convergent and concurrent validity were assessed based on cross-sectional data collection. Internal consistency was evaluated using Cronbach's alpha. Exploratory factor analysis (EFA) was performed. Evidence based on relationships with demographic and clinical variables was examined to support the validity of the Dutch MIBS. RESULTS: Data were collected from 128 mothers who completed the MIBS and Postpartum Bonding Questionnaire (PBQ) on day 2 postpartum. Experts reached consensus on the face validity of the Dutch version of the MIBS in a Flemish context. Items showed adequate Item Content Validity Index (I-CVI) (≥0.79), except for the "resentful" and "aggressive" items. The scale achieved a Scale Content Validity Index/Average (SCVI/Ave) of 0.89, although internal consistency was moderate (α = 0.66). MIBS and PBQ scores correlated moderately (Kendall's Tau T = 0.27, P < 0.001). Fisher's exact test showed a significant difference in the proportion of mothers classified with disrupted bonding depending on the tool (P = 0.015). Combined feeding was associated with a higher rate of disrupted bonding (P = 0.007). CONCLUSION: This study found that the Flemish MIBS tool had acceptable content validity, except for "resentful" and "aggressive." Reliability was moderate and convergent validity with PBQ was limited, with substantial discordant classification of disrupted bonding. The superiority to the PBQ-tool could not be demonstrated.
Postpartum anemia and maternal wellbeing: A cohort analysis of the WOMAN-2 trial.
WOMAN‐2 Trial Collaborators
Int J Gynaecol Obstet · 2026 Apr · PMID 41930990 · Publisher ↗
OBJECTIVE: We examined the association between postpartum anemia and maternal wellbeing in women who gave birth with anemia. METHODS: We conducted a cohort analysis using secondary data from the WOMAN-2 trial. Between Au...
OBJECTIVE: We examined the association between postpartum anemia and maternal wellbeing in women who gave birth with anemia. METHODS: We conducted a cohort analysis using secondary data from the WOMAN-2 trial. Between August 2019 and September 2023, women with moderate or severe anemia who were giving birth vaginally were recruited from hospitals in Nigeria, Pakistan, Tanzania, and Zambia. Our exposure was postpartum anemia (hemoglobin concentration <70, 70-99, or ≥100 g/L: severe, mild/moderate, and no postpartum anemia, respectively). Our primary outcome was physical capacity (6-min walk test). Our secondary outcomes were patient-reported vigor, fatigue (general, physical, emotional, mental), overall fatigue, other anemia symptoms, breastfeeding difficulties, expected difficulties with usual activities, breathlessness, illness, and pain. Hemoglobin was measured at 24-h after birth or discharge and outcomes were measured at discharge or 42 days postpartum, whichever happened first. We assessed the association between postpartum anemia and maternal wellbeing with multivariable regression models. RESULTS: Among 15 068 participants, 11% had severe, 75% had mild/moderate, and 14% had no postpartum anemia. After adjusting for potential confounders, each 10 g/L increase in hemoglobin was associated with 2.99 (95% confidence interval [CI]: 2.12-3.86) more meters walked in 6 min. Compared to mild/moderate postpartum anemia, severe anemia was associated with expected difficulties doing usual activities (adjusted odds ratio [aOR] =1.48, 95% CI: 1.14-1.91) and other adverse wellbeing outcomes. No postpartum anemia was associated with less illness (aOR = 0.58, 95% CI: 0.35-0.96) and some adverse wellbeing outcomes. CONCLUSION: Low postpartum hemoglobin was associated with worse wellbeing of new mothers. Our results support recommendations to prevent and treat low postpartum hemoglobin.
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