OBJECTIVE: This study evaluate the indications, timing, and maternal outcomes of termination of pregnancy (TOP) after 20 weeks of gestation. METHODS: This single-center retrospective cohort study included all TOP cases p...OBJECTIVE: This study evaluate the indications, timing, and maternal outcomes of termination of pregnancy (TOP) after 20 weeks of gestation. METHODS: This single-center retrospective cohort study included all TOP cases performed after 20 weeks between January 2020 and December 2025 in a tertiary referral center. Clinical characteristics, indications, gestational age at diagnosis and termination, time interval between diagnosis and TOP, and delivery methods were analyzed. Cases were stratified into peri-viable (20-24 weeks) and post-viable (>24 weeks) groups. Univariable analyses were used to assess associations with delivery method and gestational age. RESULTS: A total of 116 TOP cases were included. The median gestational age at diagnosis and termination were 22 and 24 weeks, respectively, with a median interval of 11 days. The most common indications were central nervous system, cardiovascular, and genetic abnormalities. Post-viable cases accounted for 30.2% of the cohort and were associated with higher parity and a higher rate of hysterotomy (28.6% vs. 11.1%, P = 0.028). Vaginal delivery was the predominant method (83.6%). Hysterotomy was associated with advanced gestational age, higher birth weight, and prior cesarean section but did not increase transfusion or intensive care unit admission rates despite greater hemoglobin decline. CONCLUSION: Late TOP is a clinically complex but generally safe procedure with heterogeneous indications. While some cases might reflect delayed care, others are intrinsically late. Hysterotomy was not associated with increased major maternal morbidity in our cohort when clinically indicated.
OBJECTIVE: This study evaluates changes in bladder storage capacity and function following mid-urethral sling (MUS) surgery in women with urodynamic stress incontinence (USI). METHODS: In this retrospective cohort study,...OBJECTIVE: This study evaluates changes in bladder storage capacity and function following mid-urethral sling (MUS) surgery in women with urodynamic stress incontinence (USI). METHODS: In this retrospective cohort study, 685 women with USI underwent MUS using single-incision sling devices (Ophira, Solyx, or I-Stop Mini) between 2015 and 2024 at a tertiary urogynecology center. Preoperative and postoperative assessments included validated quality-of-life (QoL) questionnaires, 1-h pad test, and multichannel urodynamic studies. Subgroup analysis was performed in women with greater baseline leakage burden (pad test ≥5 g). The primary outcome was change in cystometric capacity (CC); secondary outcomes included urodynamic parameters, QoL, and continence outcomes. Objective cure was defined as a 1-h pad test <2 g with no leakage on urodynamics and subjective cure as Urogenital Distress Inventory-6 Question 3 ≤1. RESULTS: At 1 year, objective and subjective cure rates were 89.5% and 87.0%, respectively. Although overall CC increased modestly (369.6 ± 118.8 to 377.1 ± 121.3 mL; P = 0.097), a significant improvement was observed in women with greater baseline leakage (374.1 ± 118.2 to 391.8 ± 122.5 mL; P = 0.005). Mean 1-h pad test weight decreased markedly (25.1-2.7 g; P < 0.001). QoL scores improved significantly across both success and failure groups. De novo detrusor overactivity occurred in 3.9% of patients. CONCLUSION: Mid-urethral sling surgery achieved high continence rates and significant QoL improvement in women with USI. Although overall postoperative changes in cystometric capacity were modest and did not reach statistical significance, patients with greater baseline leakage (pad test ≥5 g) demonstrated significant improvements in bladder storage parameters. These findings suggest a possible association between successful continence restoration and improved bladder storage function in selected patients. Further prospective studies are warranted to confirm these observations and clarify underlying mechanisms.
This article examines systematic breaches of medical confidentiality in Argentina's reproductive healthcare system, where healthcare providers often report patients experiencing obstetric emergencies to law enforcement a...This article examines systematic breaches of medical confidentiality in Argentina's reproductive healthcare system, where healthcare providers often report patients experiencing obstetric emergencies to law enforcement agencies. Drawing on judicial records, interviews with healthcare professionals, and analysis of medical curricula, the study shows how structural weaknesses, regulatory ambiguities, and biases in medical education undermine professional confidentiality, turning hospitals into patients' entry points to the criminal justice system rather than spaces of care. Despite strong constitutional protections and Supreme Court rulings affirming patients' rights to confidentiality, significant gaps persist between legal standards and practice. Situating Argentina within broader Latin American patterns, the article argues that clearer institutional guidelines, improved professional training, and consistent judicial interpretation are needed to align medical practice with human rights standards and rebuild patient trust.
Int J Gynaecol Obstet
· 2026 Jun · PMID 42375023
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OBJECTIVE: Ovarian cancer is the deadliest gynecological cancer in the developed world. The absence of screening for early detection of ovarian cancer and the non-specific symptoms associated with the disease mean that t...OBJECTIVE: Ovarian cancer is the deadliest gynecological cancer in the developed world. The absence of screening for early detection of ovarian cancer and the non-specific symptoms associated with the disease mean that timely diagnosis is difficult. This study examined time to diagnosis (from first presentation to diagnosis) for epithelial ovarian cancer in Nova Scotia, Canada, and factors associated with a long time to diagnosis (> 75th percentile) and healthcare system use prior to diagnosis. METHODS: All Nova Scotians diagnosed with epithelial ovarian cancer between January 1, 2007, and December 31, 2016, were identified from the Nova Scotia Cancer Registry. Independent variables were obtained from linked clinical and administrative databases and census data. Time to diagnosis and healthcare system use were descriptively analyzed. Factors associated with time to diagnosis exceeding the 75th percentile were identified using modified Poisson regression models. RESULTS: A total of 652 individuals were included. The median time to diagnosis was 30 days. Factors associated with a long time to diagnosis included health zone, stage at diagnosis, year of first presentation, site of first presentation, and continuity of care. Sensitivity analyses examined factors associated with time to diagnosis exceeding 8 weeks and below the 25th percentile. The emergency department was the site of first presentation for 35.7% of individuals. The median number of physician visits between first presentation and diagnosis was four, and the median number of physician specialties seen in the same time interval was three, with the most common specialties seen being primary care, "other" specialties, and obstetrics/gynecology. CONCLUSION: Time to diagnosis for ovarian cancer can be long, specifically in some subgroups. Ways to streamline the diagnostic process must be identified.
Parekh V, Woodburn M, Leonard S
… +5 more, Bourke B, McMinn J, Brkic A, Byron A, Pomroy K
Int J Gynaecol Obstet
· 2026 Jun · PMID 42374999
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OBJECTIVE: Sexual violence affects 22% of Australian women, posing health and justice challenges. Systemic failures, fragmented data, and low conviction rates hinder effective responses. This study integrates Australian...OBJECTIVE: Sexual violence affects 22% of Australian women, posing health and justice challenges. Systemic failures, fragmented data, and low conviction rates hinder effective responses. This study integrates Australian Capital Territory (ACT) medical and policing datasets to examine victim characteristics and case progression from clinical presentation to legal outcomes. METHODS: This retrospective study analyzed 2179 deidentified cases of female sexual assault victims presenting to Forensic and Medical Sexual Assault Care (FAMSAC) between 2004 and 2022. De-identified patient variables and ACT Policing data were integrated and analyzed to examine victim characteristics and case progression from medical consultation to legal outcomes. RESULTS: Of 2179 females presenting for forensic and medical care, 41.8% reported to ACT Policing, 19.2% progressed to court and 10.4% of cases resulted in a conviction. Drug use (14.9%) was negatively associated with case progression, while alcohol use and pre-existing mental health conditions showed no significant effect. No victim, assailant, or medical factors were associated with conviction outcomes. Among cases withdrawn at the policing stage, anal penetration, forensic photography, and presentation outside business hours were associated with continuation to court. Overall, 54.3% of cases that proceeded to court resulted in conviction. CONCLUSION: Through collaborative practices, this study establishes a baseline for continuous system review from forensic medical presentation to court outcome. Legal outcomes were independent of victim characteristics, assault details, and medical findings, with attrition at every stage. Medical documentation alone could not predict conviction, though it may support the finders of fact. Further research is needed to assess whether medical evidence influences police action, court pleas, and convictions.
Dassen S, Chen X, Ciofolo-Veit C
… +6 more, Rouet L, Robert JL, Dieleman J, Van Sloun R, Monen L, Van Laar J
Int J Gynaecol Obstet
· 2026 Jun · PMID 42374995
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OBJECTIVE: Obstetric ultrasound is key for assessing fetal growth and detecting anomalies, with image quality critical for diagnostic accuracy. Maternal body mass index (BMI) and other factors can impair quality. Aberrat...OBJECTIVE: Obstetric ultrasound is key for assessing fetal growth and detecting anomalies, with image quality critical for diagnostic accuracy. Maternal body mass index (BMI) and other factors can impair quality. Aberration correction (AC) aims to reduce image quality degradation. This prospective observational study assessed the effect of AC on fetal ultrasound image quality and biometric measurements. METHODS: Routine ultrasound images of the fetal head, abdomen, and heart were analyzed. The image quality score (IQS) and biometric measurements, including the circumference of the head, abdomen, and heart, were compared before and after AC. Intraclass correlations (ICC) were used to describe intra- and inter-observer agreement of measurements. Secondary objective evaluated IQS subcomponents and outcomes stratified by BMI. RESULTS: The study included 186 images from 62 patients. IQS were significantly higher in AC-images (median 14) compared with no-AC images (median 13.5), with significance observed across both BMI groups and a more pronounced effect in the normal BMI group. Intra- and inter-observer agreement for cardiac circumference improved after AC (0.907 to 0.987 and 0.873 to 0.925). For other measurements, agreement was excellent (>0.9) regardless of AC or BMI. CONCLUSION: Aberration correction improved obstetric ultrasound by enhancing image quality and increasing the reliability of biometric measurements, particularly of smaller fetal structures. The results highlight the clinical potential of AC and lay the foundation for future research to assess its role in clinical practice.
Int J Gynaecol Obstet
· 2026 Jun · PMID 42370810
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BACKGROUND: Approximately one in four first-time mothers reach the second stage of labor but cannot have a spontaneous vaginal birth, necessitating an intervention such as forceps to facilitate birth. OBJECTIVE: This stu...BACKGROUND: Approximately one in four first-time mothers reach the second stage of labor but cannot have a spontaneous vaginal birth, necessitating an intervention such as forceps to facilitate birth. OBJECTIVE: This study synthesizes evidence comparing severe maternal morbidity (SMM) and neonatal morbidity or mortality (SNMM) following forceps and cesarean birth (CB) in the second stage of labor. METHOD: Four databases were searched from database inception to May 30, 2023. Original studies comparing SMM or SNMM among individuals with an attempted forceps birth versus second stage CB were included. Meta-analyses were conducted using the Mantel-Haenszel random-effects model and the risk ratio (RR) was used as an effect measure with 95% confidence intervals (CIs). RESULTS: After screening 945 articles, a total of 13 cohort studies encompassing 52 192 individuals were included. Four studies with 34 131 total individuals provided data on SMM. The incidence of SMM was 2.6% with attempted forceps versus 3.7% with second-stage CB (pooled RR of 0.83, 95% CI 0.64, 1.07). Six studies with a total of 36 135 individuals provided data on SNMM. The incidence of SNMM was 4.5% with forceps versus 2.1% with second stage CB (pooled RR of 1.34, 95% CI 0.90, 2.00). The evidence is very uncertain about the effect of attempted forceps on SMM and SNMM due to moderate or serious risk of bias, inconsistency, and heterogeneity. CONCLUSION: Risks of SMM and SNMM are unclear after forceps and second stage CB and the choice between operative interventions should depend on the clinical scenario. Our study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42023387112) on January 2, 2023.
Pergialiotis V, Fanaki M, Panagiotopoulos M
… +4 more, Lygizos V, Vlachos DE, Thomakos N, Haidopoulos D
Int J Gynaecol Obstet
· 2026 Jun · PMID 42370558
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BACKGROUND: Lymphovascular space involvement (LVSI) is a significant prognostic factor of survival outcomes in gynecologic oncology. Synthetic studies on vulvar cancer are lacking as well as clear consensus about the imp...BACKGROUND: Lymphovascular space involvement (LVSI) is a significant prognostic factor of survival outcomes in gynecologic oncology. Synthetic studies on vulvar cancer are lacking as well as clear consensus about the importance of LSVI in vulvar cancer. OBJECTIVES: This study systematically evaluates the evidence of the impact of LVSI on vulvar cancer survival outcomes and explore its potential association with inguinofemoral metastases whenever relevant data were available. METHOD: We searched the international literature using the Medline, Scopus, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar. Observational studies that compared survival outcomes among vulvar cancer patients that had positive pathology findings for LVSI and those without LVSI were included. RESULTS: Overall, 22 articles were retrieved and six were selected for inclusion. Significant differences were noted in the progression-free survinal (PFS) of patients with LVSI compared to that of patients without LVSI (hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.27, 6.14). Similarly, the overall survival (OS) of patients with LVSI was substantially lower compared to that of patients without LVSI (HR 1.66, 95% CI 1.18, 2.35). None of the studies reported differences in lymphatic metastases among patients with LVSI and those without LVSI in the primary tumor site. CONCLUSION: Despite the significant heterogeneity of included studies, current data suggest that vulvar cancer patients with LVSI of the primary tumor site have worse survival outcomes. It remains unclear how much this observation is influenced by other significant factors, including the stage of the disease and positive tumor margins.
Akinyemi O, Fasokun M, Thompson T
… +7 more, Ogunyankin F, Olomojobi O, Oluborode B, Hughes K, Michael M, Olomojobi O, Luo G
Int J Gynaecol Obstet
· 2026 Jun · PMID 42365432
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BACKGROUND: Intimate partner violence (IPV) is a major public health concern affecting one in three US women. Many survivors rely on emergency departments (EDs), particularly when socioeconomic disadvantage and mental he...BACKGROUND: Intimate partner violence (IPV) is a major public health concern affecting one in three US women. Many survivors rely on emergency departments (EDs), particularly when socioeconomic disadvantage and mental health vulnerabilities heighten risk. OBJECTIVE: This study identifies demographic, socioeconomic, and clinical factors associated with IPV-related ED visits among women aged 15-64 years in California. METHODS: We performed a cross-sectional analysis of the California State Emergency Department Database (SEDD-HCUP) records from 2018 to 2020. IPV was defined using validated ICD-10-CM codes capturing confirmed and suspected abuse. Covariates included age, race/ethnicity, insurance type, neighborhood socioeconomic status (Distressed Communities Index), and mental health and chronic conditions. Multivariable logistic regression was used to evaluate predictors of IPV-related ED visits. RESULTS: Among 1 387 772 ED visits, 5729 (0.41%) involved IPV. Women living in the most distressed communities had significantly greater odds of an IPV-related visit than those in prosperous areas (adjusted odds ratio [aOR] 1.74; 95% CI 1.52-2.00). Young women demonstrated the highest risk, with those aged 15-24 years having fourfold greater odds compared with women aged 55-64 years (aOR 4.07; 95% CI 3.56-4.65). Uninsured/self-pay women also had more than twice the odds of IPV-related visits relative to privately insured women (aOR 2.59; 95% CI 2.23-3.00). Several mental health conditions, including bipolar disorder, PTSD, and alcohol abuse, were independently associated with elevated IPV risk. CONCLUSION: IPV-related ED visits disproportionately affect young, uninsured women living in poor communities and those with mental health comorbidities. Enhancing ED-based screening, strengthening mental health integration, and expanding community-level prevention efforts are critical to reducing IPV burden.
Int J Gynaecol Obstet
· 2026 Jun · PMID 42365427
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OBJECTIVE: This study evaluates the effectiveness of a structured training program in improving prenatal ultrasound diagnostic accuracy for placenta accreta spectrum (PAS) and assesses trainees' ability to recognize indi...OBJECTIVE: This study evaluates the effectiveness of a structured training program in improving prenatal ultrasound diagnostic accuracy for placenta accreta spectrum (PAS) and assesses trainees' ability to recognize individual ultrasound markers of PAS. MATERIALS AND METHODS: This prospective educational study enrolled 16 third-year obstetrics and gynecology residents who participated in a standardized PAS ultrasound training program. The program comprised a pre-training assessment, a didactic lecture on PAS based on established ultrasound criteria, interactive case-scenario exercises, and a 2-month post-training assessment. Diagnostic performance before and after training was evaluated using paired analyses, including overall diagnostic accuracy, sensitivity, and specificity for PAS. Recognition of individual grayscale and color Doppler ultrasound markers was also evaluated. RESULTS: The training program significantly improved diagnostic performance. Overall diagnostic accuracy increased by 9.4% (from 65.6% to 75.0%). Diagnostic specificity improved significantly, by 17.5% (from 36.3% to 53.8%), while high sensitivity was maintained (95.0% vs. 96.3%). Improvements were also observed in the recognition of key PAS ultrasound markers. These findings are clinically significant, as increased specificity reduces false-positive diagnoses and may decrease unnecessary referrals and healthcare resource utilization. CONCLUSION: A structured ultrasound training program significantly improves prenatal diagnostic accuracy for PAS and enhances recognition of key ultrasound markers among trainees. These findings support the implementation of standardized PAS ultrasound training and suggest potential benefit for broader adoption to improve prenatal detection of PAS.
Roa L, James KE, Abdel-Rahim HF
… +13 more, Abonie M, Adu-Bonsaffoh K, Byamukama O, DeAndrade S, Francisco RPV, Lugobe HM, Ladfors L, Manotaya S, Ramos JA, Shahawy S, Srisupundit K, Svensson E, Boatin AA
Int J Gynaecol Obstet
· 2026 Jun · PMID 42358047
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OBJECTIVES: Obstetrics and gynecology (ObGyn) trainees will impact future practice patterns and their cesarean rates. The knowledge, attitudes, and practices (KAP) of ObGyn residents have not been extensively studied. We...OBJECTIVES: Obstetrics and gynecology (ObGyn) trainees will impact future practice patterns and their cesarean rates. The knowledge, attitudes, and practices (KAP) of ObGyn residents have not been extensively studied. We aimed to assess KAP towards mode of delivery and cesarean-sparing procedures among ObGyn trainees. METHODS: This is a multicountry study that was conducted in Brazil, Egypt, Ghana, Sweden, Thailand, Uganda, and the United States. A questionnaire was developed, piloted, translated, and adapted for ObGyn trainees in seven countries. The questionnaire was administered to assess knowledge regarding safety of cesarean and vaginal delivery (VD), attitudes towards mode of delivery, and perceived competency in performing cesarean-sparing procedures (forceps and vacuum-assisted VD, external cephalic version [ECV], and breech VD). The outcomes included the KAP of a group of global trainees, including number of procedures towards cesarean sections and cesarean-sparing procedures. RESULTS: Of 744 complete responses, most residents perceive VD as safer than cesarean delivery for the mother (67%) and baby (55%). More trainees in Sweden (92%) and the United States (73%) agree that patients with breech presentation should be offered an ECV, compared with Ghana (8%), Egypt (8%), and Uganda (10%), and only in Sweden do most trainees feel competent with ECV (62%). Trainees in Ghana (86%) and Uganda (78%) report perceived competency with singleton breech VD while few do in Sweden (7%), Thailand (5%), and the United States (2%). CONCLUSION: Most trainees agreed on the comparative risks of CD versus VD but there is marked variation in self-perceived competency around cesarean-sparing procedures, particularly ECV and breech delivery. These findings can provide useful insights into focus areas for ObGyn training.
Int J Gynaecol Obstet
· 2026 Jun · PMID 42347706
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The labor care guide (LCG) is a new tool for monitoring labor, introduced to replace the partograph, which had been used improperly and inconsistently across various contexts. Early research suggests that healthcare prac...The labor care guide (LCG) is a new tool for monitoring labor, introduced to replace the partograph, which had been used improperly and inconsistently across various contexts. Early research suggests that healthcare practitioners view the LCG as a tool that enhances the quality of care during labor and delivery. The aim of this study was to explore midwives' perceptions and experiences of using the LCG at two state hospitals in the Khomas region, Namibia. This study employed a qualitative transcendental (descriptive) phenomenology design. Purposive sampling and maximum variation sampling were applied. A total of 10 midwives' participated in the study. Data were collected through semi-structured in-depth interviews and analyzed using thematic analysis grounded in descriptive phenomenology. The study revealed the following four themes; midwives' experiences in transitioning from partographs to LCG in practice, midwives' perceptions of the LCG and adaptation into practice, challenges related to the implementation and use of LCG by midwives' and navigating from incompetence to an expert in using the LCG implication to practice. Despite some negative perceptions, midwives' found the LCG to be a valuable tool in managing labor. However, they recommended appropriate training and some context-based adjustments to enhance effective utilization.
Hochberg A, Hincapie M, Amikam U
… +3 more, Kugelman N, Buckett W, Reinblatt S
Int J Gynaecol Obstet
· 2026 Jun · PMID 42339562
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OBJECTIVE: To examine the effect of controlled ovarian stimulation (COS) protocol on follicular synchrony in a subsequent in vitro fertilization (IVF) cycle in patients whose previous cycle was canceled due to asynchrony...OBJECTIVE: To examine the effect of controlled ovarian stimulation (COS) protocol on follicular synchrony in a subsequent in vitro fertilization (IVF) cycle in patients whose previous cycle was canceled due to asynchrony. METHODS: A single-center retrospective-cohort study (January 2018-March 2024), including women undergoing IVF who had: (1) a COS cycle canceled without oocyte-pick-up (OPU) due to follicular asynchrony; and (2) a subsequent COS cycle with OPU performed. Patients were grouped as: Group 1-same protocol repeated; Group 2-protocol switched. Follicular asynchrony was defined as ≤50% of stimulated follicles ≥14 mm at cancellation. Women with ≤3 total stimulated follicles at cancellation were excluded. Follicular maturation rate in each cycle was the proportion of follicles ≥14 mm among all stimulated follicles at cancellation/trigger. Primary outcome was the difference in follicular maturation rate between the OPU and canceled cycles, representing synchrony improvement. Treatment outcomes were compared; analysis of variance (ANOVA) controlled for confounders. RESULTS: Overall, 95 patients met the inclusion criteria: 43 (45.26%) in Group 1, and 52 (54.74%) in Group 2. Group 1 versus Group 2 had higher parity and antral follicle count (AFC), and lower endometriosis prevalence and daily recombinant-luteinizing-hormone (rLH) dose in the OPU cycle (p < 0.05). Follicular maturation rate difference was significantly lower in Group 1 versus Group 2 (0.17 [0.05-0.28] vs. 0.3 [0.15-0.39], p = 0.03). Utilizing ANOVA adjusting for group, parity, endometriosis, daily rLH dose in the OPU cycle, and AFC, only group designation remained significantly associated with improved follicular maturation, with increased improvement in Group 2 (least squares mean 0.27 vs. 0.12, p = 0.01). CONCLUSION: Switching COS protocols after a cycle canceled for asynchrony was associated with improved follicular synchrony, suggesting consideration for protocol modification in a subsequent cycle.
Moreno-Verduzco ER, Duran JP, Monroy-Muñoz IE
… +4 more, Solis-Paredes JM, Espino-Y-Sosa S, Martinez-Portilla R, Torres-Torres J
Int J Gynaecol Obstet
· 2026 Jun · PMID 42339561
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OBJECTIVE: To evaluate the association between gender-based violence (GBV) assessed in early pregnancy and adverse perinatal outcomes using relative and absolute effect measures in an urban low- and middle-income setting...OBJECTIVE: To evaluate the association between gender-based violence (GBV) assessed in early pregnancy and adverse perinatal outcomes using relative and absolute effect measures in an urban low- and middle-income setting. METHODS: We conducted a prospective cohort study including 3890 singleton pregnancies recruited from two public healthcare institutions in Mexico City between October 2020 and April 2023. GBV was assessed at first-trimester enrollment using a standardized screening procedure and analyzed as any reported violence versus none. The primary outcome was a composite of low birth weight, fetal growth restriction, or perinatal mortality. Associations were estimated using Poisson regression with robust variance to obtain adjusted risk ratios and risk differences. Secondary analyses examined fetal growth restriction, stillbirth, and neonatal mortality. RESULTS: GBV was reported by 162 (4.16%) participants. After adjustment for sociodemographic factors, GBV was associated with higher risk of the composite adverse perinatal outcome (adjusted risk ratio [aRR] 1.23, 95% [confidence interval] CI: 1.06-1.44). The adjusted absolute risk difference was +0.099 (95% CI: 0.020-0.177), corresponding to approximately 99 additional adverse outcomes per 1000 births among women reporting GBV. GBV was not significantly associated with isolated fetal growth restriction but was associated with increased odds of stillbirth; no statistically significant association was observed with neonatal mortality. CONCLUSION: In this urban cohort, GBV reported at first-trimester screening was associated with a clinically meaningful increase in adverse perinatal outcomes, largely driven by stillbirth.
Juhantalo M, Hautakangas T, Palomäki O
… +1 more, Uotila J
Int J Gynaecol Obstet
· 2026 Jun · PMID 42338233
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OBJECTIVE: This study identifies clinically relevant thresholds for normal and excessive uterine activity (UA) in relation to umbilical artery (UmA) pH. METHODS: This blinded secondary analysis included 625 term singleto...OBJECTIVE: This study identifies clinically relevant thresholds for normal and excessive uterine activity (UA) in relation to umbilical artery (UmA) pH. METHODS: This blinded secondary analysis included 625 term singleton pregnancies from a randomized controlled trial (NCT02941393, ClinicalTrials.gov) cohort with intrauterine pressure (IUP) monitoring, cephalic presentation, and umbilical cord blood sampling at birth. Measures included IUP expressed as Montevideo units (MVUs), contraction frequency per 10 min, and uterine baseline tone. Associations between UA and UmA pH (≤7.15) or base excess (linear) were assessed using linear and logistic regression and Student's t-test. RESULTS: With an IUP cutoff >250 MVUs, the proportion of neonates with pH ≤7.15 increased from 16.8% to 25.6% (OR 1.68, 95% CI 1.10-2.59; P = 0.017). Among oxytocin-stimulated labors (n = 579), an IUP cutoff >200 MVUs was associated with an increase in pH ≤7.15 from 14.7% to 21.4% (OR 1.58, 95% CI 1.02-2.44; P = 0.038). Elevated baseline tone showed a similar association, with the incidence of pH ≤7.15 increasing from 16.6% to 23.6% at a threshold >20 mmHg (OR 1.59, 95% CI 1.06-2.39; P = 0.025). A significant downward shift in UmA pH distribution was observed at a contraction frequency >5/10 min (7.23 [0.09] vs. 7.22 [0.09]; P = 0.042), and among oxytocin-stimulated labors, this shift occurred already at >4/10 min (7.24 [0.08] vs. 7.23 [0.09]; P = 0.016). CONCLUSION: Suggested thresholds associated with neonatal acidemia are IUP ≤250 MVUs, contraction frequency ≤5/10 min, and baseline tone ≤20 mmHg. For oxytocin-stimulated labors, lower thresholds (IUP ≤200 MVUs and contraction frequency ≤4/10 min) appear safer.
de Oliveira LM, Dias NDM, Ferraz JM
… +1 more, da Silva Oliveira P
Int J Gynaecol Obstet
· 2026 Jun · PMID 42338226
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Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatological-gynecological condition. Conventional first-line treatment comprises topical corticosteroids; however, many patients remain refractory. Energy-based...Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatological-gynecological condition. Conventional first-line treatment comprises topical corticosteroids; however, many patients remain refractory. Energy-based devices, including radiofrequency (RF), have shown promising results in VLS, with symptomatic and functional improvement. Exosomes are vesicles containing bioactive molecules involved in tissue regeneration; their lyophilized form, stabilized for topical application, has been combined with energy-based therapies with satisfactory results in other dermatological conditions. To our knowledge, this is the first report of ablative RF combined with topical lyophilized exosomes for VLS. We present the case of a 38-year-old woman with biopsy-confirmed VLS refractory to standard treatment, who underwent ablative fractional RF combined with topical lyophilized exosomes derived from amniotic fluid stem cells. The patient showed improvement in pruritus, dyspareunia, and sexual function, and reported satisfaction with the combined therapy.