International Journal Of Gynaecology And Obstetrics[JOURNAL]
Sun
200 papers
The use of letrozole or mifepristone for pre-treatment of medical termination of pregnancy: A randomized, non-inferiority trial.
Teong ACA, Wong TTC, Soe NN … +8 more , Lau HCQ, Ang CYX, Loy SL, Ku CW, Chan JKY, Mohamed Siraj SH, Mathur M, Seet MJ
Int J Gynaecol Obstet · 2026 Jun · PMID 42300723 · Publisher ↗
OBJECTIVE: Mifepristone improves the effectiveness of medical termination of pregnancy (mTOP) but is expensive and restricted in some settings. Letrozole has been proposed as a potential alternative. This study aimed to...
OBJECTIVE: Mifepristone improves the effectiveness of medical termination of pregnancy (mTOP) but is expensive and restricted in some settings. Letrozole has been proposed as a potential alternative. This study aimed to evaluate whether letrozole is non-inferior to mifepristone as a pre-treatment for mTOP. METHODS: We conducted an assessor-blinded, randomized controlled non-inferiority trial comparing mifepristone versus letrozole pre-treatment for mTOP. Participants were randomized to one of two groups: the control group received oral mifepristone 200 mg on Day 1, while the intervention group received oral letrozole 10 mg daily from Day 1 to Day 3. On Day 3, both groups received per-vaginal misoprostol 800 mcg, followed by an additional 400 mcg after 4 h if there were no signs of abortion. Follow-up was conducted by Day 28 post-mTOP. The primary outcome was complete abortion, defined as a negative urine pregnancy test with no ongoing vaginal bleeding and no need for surgical evacuation by Day 28. Data was analyzed using SPSS Version 30.0. RESULTS: The intention-to-treat analysis included 135 participants, with a mean gestational age of 8.2 weeks. Complete abortion occurred in 72.1% (49/68) of the letrozole group compared with 85.1% (57/67) of the mifepristone group, with an absolute risk difference of -13.0% (95% CI -26.4 to +0.9). The lower bound of the 95% CI crossed the prespecified non-inferiority margin of -15%, so non-inferiority was not demonstrated. CONCLUSION: Letrozole could not be shown to be a non-inferior alternative to mifepristone as pre-treatment for mTOP. TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov (ID: NCT05341817) on April 5, 2022, and received ethics board approval from the SingHealth Centralized Institutional Review Board (CIRB 202110-00035).
The impact of the vaginal birth after cesarean as a new delivery mode on quality of life, sexual function, sleep quality and urinary incontinence during the postpartum period and comparison with the results of vaginal birth and cesarean delivery.
Bektaş B, Ulusoy CO, Uslu H … +4 more , Kuyucu M, Varli B, Namlı ME, Özcan P
Int J Gynaecol Obstet · 2026 Jun · PMID 42300709 · Publisher ↗
OBJECTIVE: In the present study, we aimed to evaluate the impact of vaginal birth after cesarean (VBAC) on quality of life, sexual function, sleep quality, and urinary incontinence and compare the results with those of v...
OBJECTIVE: In the present study, we aimed to evaluate the impact of vaginal birth after cesarean (VBAC) on quality of life, sexual function, sleep quality, and urinary incontinence and compare the results with those of vaginal birth (VB) and cesarean delivery (CD) via validated questionnaires. METHODS: A single-center retrospective cross-sectional observational study was conducted at the Bezmialem Vakıf University between 2017 and 2022. The participants were classified into three groups: VB (n = 49), CD (n = 54), and VBAC (n = 55). Postpartum maternal health outcomes were assessed via validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Female Sexual Function Index (FSFI), Postpartum Quality of Life (PP-QoL), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Statistical analyses were performed using SPSS version 29.0. RESULTS: There were no significant differences among the groups in terms of total PSQI scores or ICIQ-SF scores. However, the total FSFI and PP-QoL scores were significantly higher in the VBAC group (P < 0.001). Among the FSFI subdomains, only desire and pain scores remained significantly different after Bonferroni correction. CONCLUSION: Our findings suggest that while sleep quality and urinary incontinence symptoms did not significantly differ among the delivery groups, PP-QoL and FSFI scores were higher in the VBAC group than in the VB and CD groups.
Rapid maternal death surveillance and response during a hepatitis E virus outbreak in Madani, Al Jazera state, Sudan.
Alshaarany M, Black B, Burkhadt G … +5 more , Rijnberg N, Sharif AAZ, Daly M, Harigovind G, Almohammed A
Int J Gynaecol Obstet · 2026 Jun · PMID 42300684 · Publisher ↗
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Interprofessional collaboration is critical for woman-centred SRMNAH services.
Louwen F, Ugglas AA, Kihara AB … +6 more , Dunkley-Bent J, Sridhar A, Stringer K, Davis J, Drandic D, Koren V
Int J Gynaecol Obstet · 2026 Jun · PMID 42289822 · Publisher ↗
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Determinants of obstructed labor among pregnant women in Mogadishu, Somalia: A case-control study.
Abdi AA, Hassan YSA, Karikari JK … +4 more , Ali AS, Hussein SA, Gargaar NH, Hassan AS
Int J Gynaecol Obstet · 2026 Jun · PMID 42287096 · Publisher ↗
OBJECTIVE: Obstructed labor is a preventable cause of maternal and perinatal mortality, with a disproportionately high burden in low-resource settings. In Somalia, decades of conflict have fragmented the health system, c...
OBJECTIVE: Obstructed labor is a preventable cause of maternal and perinatal mortality, with a disproportionately high burden in low-resource settings. In Somalia, decades of conflict have fragmented the health system, contributing to one of the world's highest maternal mortality ratios. The aim of the present study was to identify the determinants of obstructed labor among women delivering at Banadir Hospital, Mogadishu, Somalia. METHODS: A hospital-based unmatched case-control study was conducted from June to August 2025. A total of 450 participants were enrolled. Data were collected using a structured questionnaire through participant interviews. Multivariable logistic regression analysis was performed to identify independent risk factors associated with obstructed labor. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULTS: Cephalopelvic disproportion was the primary cause of obstructed labor (63.3%). Significant independent risk factors included diabetes in pregnancy (aOR = 9.09, 95% CI: 2.73-30.29), being referred from another health facility (aOR = 7.00, 95% CI: 2.98-16.46), labor duration ≥12 h (aOR = 5.11, 95% CI: 2.71-9.63), and attending fewer than four antenatal care (ANC) visits (aOR = 3.71, 95% CI: 1.21-11.40). Other determinants included residing outside Mogadishu (aOR = 2.84, 95% CI: 1.16-6.93), maternal overweight body mass index (BMI) (aOR = 2.56, 95% CI: 1.36-4.82), neonatal birth weight ≥3.5 kg (aOR = 2.41, 95% CI: 1.37-4.24), and a previous history of obstructed labor (aOR = 2.06, 95% CI: 1.20-3.53). Primiparity was also a major risk factor, as multiparity demonstrated a 90% reduction in risk (aOR = 0.10, 95% CI: 0.05-0.23). CONCLUSION: Obstructed labor in Mogadishu is driven by a convergence of physiological vulnerabilities and systemic health system failures, characterized by the three delays in accessing and receiving care. To reduce the burden of this condition, interventions must focus on strengthening the continuum of care. Key priorities include improving early risk identification and diabetes screening during ANC, streamlining referral pathways from peripheral clinics, and ensuring the consistent use of partographs for intrapartum monitoring to prevent dangerously prolonged labor.
Intertwin birth weight discordance, mode of delivery, and fetal and neonatal outcomes in twin pregnancies.
Martínez-Zarco A, Sánchez-Romero J, Blanco-Carnero JE … +6 more , Crespo-Bañón P, Liandro RS, Pertegal-Ruiz M, Plasencia-Acevedo W, Nieto-Díaz A, de Paco-Matallana C
Int J Gynaecol Obstet · 2026 Jun · PMID 42287095 · Publisher ↗
OBJECTIVE: The aim of the present study was to evaluate the association between intertwin birth weight discordance and fetal and neonatal outcomes in twin pregnancies, and to assess its relationship with mode of delivery...
OBJECTIVE: The aim of the present study was to evaluate the association between intertwin birth weight discordance and fetal and neonatal outcomes in twin pregnancies, and to assess its relationship with mode of delivery. METHODS: This retrospective cohort study included twin pregnancies delivered at a tertiary referral center. Intertwin birth weight discordance was calculated as the percentage difference between the larger and smaller twin and categorized as 0%-15%, 15%-25%, and >25%. Fetal and neonatal outcomes were analyzed as predefined composite outcomes. Multivariable logistic regression models were used to assess associations, adjusting for gestational age at delivery, antenatal corticosteroid exposure, chorionicity, and mode of delivery. RESULTS: A total of 1408 twin pregnancies (2816 newborns) were included. In bivariate analyses, higher intertwin birth weight discordance was associated with increased rates of adverse fetal and neonatal outcomes. However, after adjustment, birth weight discordance was not significantly associated with the fetal composite outcome (discordance >25%: odds ratio [OR] 2.55; 95% confidence interval [CI]: 0.89-7.27), although the magnitude of the effect suggested a possible increased risk, nor the neonatal composite outcome (OR 1.53; 95% CI: 0.97-2.40). Gestational age at delivery was inversely associated with both fetal (OR 0.75 per week; 95% CI: 0.66-0.84) and neonatal composite outcomes (OR 0.54 per week; 95% CI: 0.45-0.65). Cesarean delivery (OR 2.26; 95% CI: 1.58-3.25) and antenatal corticosteroid exposure (OR 1.75; 95% CI: 0.99-3.08) were associated with increased odds of neonatal composite morbidity. CONCLUSION: Intertwin birth weight discordance was not independently associated with adverse fetal or neonatal outcomes after adjustment. Prematurity emerged as the main determinant of perinatal risk, supporting interpretation of birth weight discordance as a contextual marker rather than an independent determinant of delivery strategy or timing.
Postpartum kidney assessment after hypertensive disorders of pregnancy: A practical framework for obstetric care.
Corrêa LMA, Brandão LKV, Ferreira GD … +6 more , Fossati GW, Zanella J, Queiroz LRGM, Gonçalves MEC, Arruda SLP, Cunegatti NS
Int J Gynaecol Obstet · 2026 Jun · PMID 42287092 · Publisher ↗
Hypertensive disorders of pregnancy, particularly pre-eclampsia, are recognized not only as major obstetric complications but also as early indicators of future maternal cardiovascular and renal risk. Despite this, postp...
Hypertensive disorders of pregnancy, particularly pre-eclampsia, are recognized not only as major obstetric complications but also as early indicators of future maternal cardiovascular and renal risk. Despite this, postpartum care remains centered on blood pressure surveillance, whereas kidney assessment is not consistently incorporated into routine obstetric follow-up. This narrative review examines the renal implications of hypertensive disorders of pregnancy beyond delivery and translates guidance and observational evidence into a practical obstetric approach to postpartum kidney assessment. Available data indicate that a clinically meaningful subgroup of women have persistent renal abnormalities in the early postpartum period, most often as albuminuria or proteinuria rather than as overt reduction in estimated glomerular filtration rate. Reliance on blood pressure or serum creatinine alone may therefore fail to identify incomplete renal recovery, pregnancy-unmasked chronic kidney disease, or women requiring closer reassessment. We also emphasize pregnancy-associated acute kidney injury as a high-priority phenotype, operationalized by creatinine rise or oliguria using Kidney Disease: Improving Global Outcomes (KDIGO)-type criteria and interpreted against pregnancy-specific creatinine physiology. Patients meriting greater attention include those with severe or preterm disease, persistent hypertension, antenatal renal abnormalities, pregnancy-associated acute kidney injury, or relevant pre-existing comorbidity. We propose a feasible postpartum framework based on blood pressure measurement, serum creatinine with estimated glomerular filtration rate, and urinary assessment of albuminuria or proteinuria, with repeat testing or specialist evaluation guided by postpartum findings and clinical risk. Rather than creating a parallel nephrology pathway, this approach supports obstetric services in identifying women whose renal recovery may be incomplete.
Young bodies, aging ovaries: A systematic review and meta-synthesis of women's perspectives on spontaneous premature ovarian insufficiency.
Roman MP, Aggarwal S, Doumouchtsis SK
Int J Gynaecol Obstet · 2026 Jun · PMID 42281460 · Publisher ↗
OBJECTIVES: Spontaneous premature ovarian insufficiency (POI) is a condition characterized by the cessation of ovarian function before age 40, unrelated to medical interventions. It affects approximately 3.5% of women wo...
OBJECTIVES: Spontaneous premature ovarian insufficiency (POI) is a condition characterized by the cessation of ovarian function before age 40, unrelated to medical interventions. It affects approximately 3.5% of women worldwide and can result in significant emotional, physical, and social consequences. Despite clinical advancements in understanding POI, women's lived experiences remain underexplored, particularly the impact of early reproductive aging that conflicts with their chronological youth. This study aims to synthesize qualitative evidence on women's experiences of spontaneous POI, focusing on emotional, physical, social, and diagnostic challenges, as well as coping strategies. METHOD: A comprehensive search was conducted in MEDLINE, Embase, Scopus, Google Scholar, CINAHL, and PsycINFO from inception to January 2026, with studies screened independently by two reviewers using predefined criteria. Included studies employed qualitative methodologies, were peer-reviewed, and were published in English. Studies on iatrogenic POI or using mixed/quantitative methods were excluded. Participant characteristics were extracted using an adapted Cochrane data collection form. Two researchers independently performed line-by-line coding using Dedoose software, resolving discrepancies via team discussion. Themes were developed through inductive analysis. RESULTS: Thirteen studies involving 389 women revealed five key themes: (1) Emotional and psychological impact; (2) Physical and embodied experiences; (3) Social and relational challenges; (4) Diagnostic and treatment challenges; and (5) Coping and adaptation. CONCLUSION: Spontaneous POI profoundly affects women biopsychosocially, beyond reproductive loss. Clinical practice must shift toward woman-centered care, integrating emotional support, timely diagnosis, and culturally sensitive interventions.
Violence during pregnancy amplifies fear of childbirth: A nationwide cohort study in Finland.
Viheroksa R, Laine K, Gissler M … +3 more , Paavilainen E, Heinonen S, Räisänen S
Int J Gynaecol Obstet · 2026 Jun · PMID 42281453 · Publisher ↗
OBJECTIVE: This study examined the association between fear of childbirth (FOC) and exposure to violence during pregnancy, identified using diagnoses based on the International Classification of Diseases, 10th Revision....
OBJECTIVE: This study examined the association between fear of childbirth (FOC) and exposure to violence during pregnancy, identified using diagnoses based on the International Classification of Diseases, 10th Revision. METHODS: This population-based cohort study included 1 177 569 births in Finland between 2000 and 2020. Data from the Finnish Medical Birth Register and the Hospital Discharge Register were used to identify women diagnosed with FOC and exposure to violence. Logistic regression analyses were conducted to estimate crude and adjusted odds ratios (ORs) with confidence intervals (CIs), adjusting for major sociodemographic and clinical factors. RESULTS: Fear of childbirth was diagnosed in 23 246 women (2.0%), while 1 154 323 women (98.0%) had no diagnosis of FOC. Women with FOC had a higher prevalence of exposure to violence (0.9%) compared with women without FOC (0.3%). The association remained strong after adjustment for confounders (adjusted OR 3.07; 95% CI 2.66-3.54). A higher prevalence of FOC was observed among parous compared to nulliparous women, divorced women, students, and women experiencing long-term unemployment. CONCLUSION: Women with FOC were substantially more likely to have been exposed to violence. Recognizing FOC as a potential marker of underlying vulnerability might facilitate earlier identification, timely referral, and more responsive psychological and obstetric care.
Impact of anti-Müllerian hormone and antral follicle count discordance on elective fertility preservation outcomes.
Salhoov H, Yogev M, Azulay R … +7 more , Shinan E, Bentov Y, Godin M, Esh-Broder E, Hizkiyahu R, Adler Lazarovits C, Hershko Klement A
Int J Gynaecol Obstet · 2026 Jun · PMID 42281451 · Publisher ↗
OBJECTIVE: Anti-Müllerian hormone (AMH) and antral follicle count (AFC) are usually correlated, yet discordance might complicate counseling in elective fertility preservation (EFP). This study evaluated whether discordan...
OBJECTIVE: Anti-Müllerian hormone (AMH) and antral follicle count (AFC) are usually correlated, yet discordance might complicate counseling in elective fertility preservation (EFP). This study evaluated whether discordant ovarian reserve markers affect oocyte yield in healthy women undergoing EFP. METHODS: This retrospective cohort study included 230 healthy women aged 30-41 years undergoing their first EFP cycle at a university-affiliated tertiary fertility unit. Participants were categorized based on AMH (<1.1 or ≥1.1 ng/mL) and AFC (<7 or ≥7) thresholds. Analyses focused on concordant versus discordant AMH-AFC groups. The primary outcomes were the number of oocytes retrieved and vitrified. Multivariable linear regression assessed independent predictors of oocyte yield. RESULTS: The overall discordance rate was 30.43%. Women in Group 1 - Normal AFC (≥7) with low AMH (<1.1 ng/mL) (n = 67) had significantly fewer retrieved (mean 6.7 ± 4.5) and vitrified oocytes (mean 4.9 ± 3.4) than those in Group 4 - Normal AFC (≥7) with normal AMH (≥1.1 ng/mL) (n = 149; 14.6 ± 8.1 and 10.6 ± 6.8, respectively; P < 0.001), which represented the two largest study groups. AMH was the strongest independent predictor of oocyte yield. Discordance independently contributed additional explanatory value for the number of retrieved oocytes, with discordant patients predicted to achieve fewer oocytes than concordant-normal counterparts. The concordance status did not significantly affect the number of vitrified oocytes. CONCLUSION: AMH-AFC discordance (specifically low AMH in the presence of normal AFC) is an independent predictor of reduced oocyte yield in EFP but not of the number of vitrified oocytes. Joint interpretation of both markers might facilitate more accurate patient counseling and expectation management.
Maternal and clinical predictors of congenital toxoplasmosis: A prospective cohort study in Brazil.
D'Ambros D, Santos LHS, Dos Santos LS … +7 more , Ferreira M, Andrade C, Guttmann P, Frota AC, Abreu T, Machado E, Hofer CB
Int J Gynaecol Obstet · 2026 Jun · PMID 42281444 · Publisher ↗
OBJECTIVE: Congenital toxoplasmosis (CT) remains a major global health concern, with particularly high incidence in Latin America. Despite its relevance, prospective data from Brazilian cohorts are scarce. METHODS: We co...
OBJECTIVE: Congenital toxoplasmosis (CT) remains a major global health concern, with particularly high incidence in Latin America. Despite its relevance, prospective data from Brazilian cohorts are scarce. METHODS: We conducted a prospective cohort study at the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG/UFRJ), Rio de Janeiro, including 55 pregnant women with confirmed Toxoplasma gondii infection and their infants (January 2022-April 2025). Maternal sociodemographic, obstetric, behavioral, and clinical data were collected prospectively. Infants were classified as infected or exposed based on serological, molecular, radiologic, and clinical criteria. Regression analysis was used to compare the groups. RESULTS: Among 55 mother-infant pairs followed, 11 (20%) infants were diagnosed with CT. No significant associations were observed with maternal sociodemographic or environmental factors. However, mothers of infected infants had diagnosis later during gestation (24.3 vs. 16.4 weeks; P = 0.02), cohort entry later during gestation (31.2 vs. 24.3 weeks; P = 0.02), and more prenatal visits (7.7 vs. 4.9; P = 0.04 visits) (more prenatal visits likely reflecting increased monitoring after diagnosis). Adenomegaly (P = 0.04) and other systemic symptoms (P = 0.05) were more frequent among mothers of infected infants. Neonatal parameters did not differ significantly, but five infected infants presented neuroimaging abnormalities, five had ophthalmologic lesions, and six tested positive for IgM and/or PCR. CONCLUSION: Toxoplasmosis diagnosis later during gestation and symptomatic maternal infection were associated with CT. These findings highlight the need for systematic maternal screening, considering maternal clinical manifestations, timely referral, and close clinical monitoring to prevent vertical transmission and adverse neonatal outcomes.
Integration of two-dimensional microvascular flow imaging and ultrasound scoring for prediction of placenta accreta spectrum: A prospective study.
Reyhan Toptas G, Ocal FD, Altındıs Bal A … +4 more , Bozkurt Ozdal B, Karatas E, Karakus E, Sahin D
Int J Gynaecol Obstet · 2026 Jun · PMID 42281422 · Publisher ↗
OBJECTIVE: This study evaluates the diagnostic performance of two-dimensional (2D) microvascular flow imaging combined with standardized ultrasound markers for predicting placenta accreta spectrum disorders in pregnancie...
OBJECTIVE: This study evaluates the diagnostic performance of two-dimensional (2D) microvascular flow imaging combined with standardized ultrasound markers for predicting placenta accreta spectrum disorders in pregnancies complicated by placenta previa or low-lying placenta. METHODS: This prospective observational study included 61 women with placenta previa or low-lying placenta who underwent cesarean delivery between 32 and 38 weeks of gestation. All participants underwent standardized 2D microvascular flow imaging using the Samsung Hera W10 Elite system. The microvascular vascularization index was quantified as the percentage ratio of color-coded vascular pixels within a defined placental region of interest. Conventional Doppler indices and standardized ultrasound markers associated with placenta accreta spectrum were recorded. Placental invasion was confirmed histopathologically in 23 patients. Statistical analyses included Mann-Whitney U-testing, receiver operating characteristic (ROC) analysis, 95% confidence interval estimation, pairwise ROC comparison using the DeLong method, and exploratory internally validated machine-learning classification models. To avoid conceptual overlap and double counting, the total placenta accreta spectrum (PAS)score was excluded from the corrected machine-learning models. Intraobserver reproducibility of repeated MVI measurements was assessed using the intraclass correlation coefficient. RESULTS: The vascularization index was significantly higher in PAS cases than controls (47.65 ± 9.35 vs. 26.58 ± 8.93, P < 0.001). Conventional Doppler parameters did not differ significantly between groups. ROC analysis identified the vascularization index as the strongest single quantitative predictor of PAS, with an AUC of 0.985, sensitivity of 95.7%, and specificity of 97.4% at a cut-off value of 37.11. The corrected Placental Invasion Risk Score, calculated without the total PAS score, showed excellent diagnostic performance, with an AUC of 0.998. Exploratory machine-learning models excluding the total PAS score demonstrated improved discrimination after inclusion of the vascularization index, with logistic regression achieving an AUC of 0.990. Intraobserver reproducibility of repeated MVI measurements was excellent, with an intraclass correlation coefficient (ICC) of 0.977. For prediction of cesarean hysterectomy, the vascularization index also demonstrated excellent discriminatory performance at an optimal cut-off value of ≥53.51. CONCLUSION: The 2D MV-Flow vascularization index is a strong quantitative biomarker for predicting PAS in pregnancies complicated by placenta previa or low-lying placenta. When combined with individual ultrasound markers, but not redundantly with the total PAS score, it may improve antenatal risk stratification and preoperative planning. However, the exploratory machine-learning findings require external validation in larger multicenter cohorts.
The value of hysteroscopic microvascular and morphological subclassification in diagnosing endometrial malignant lesions: A single-center retrospective study.
Liao X, Liu Y, Cui Y … +1 more , Lei Y
Int J Gynaecol Obstet · 2026 Jun · PMID 42274105 · Publisher ↗
OBJECTIVE: This study develops and validates an integrated assessment system based on hysteroscopic features of microvascular morphology, lesion appearance, and extent, aiming to standardize the observational protocol an...
OBJECTIVE: This study develops and validates an integrated assessment system based on hysteroscopic features of microvascular morphology, lesion appearance, and extent, aiming to standardize the observational protocol and provide auxiliary judgment for diagnosing endometrial malignant lesions, especially for less experienced practitioners. METHODS: Data from 168 patients who underwent hysteroscopy with initial suspicion of endometrial malignant lesions at Hubei Maternal and Child Health Hospital from March 2020 to June 2021 were retrospectively analyzed. Hysteroscopic findings were systematically recorded according to lesion extent (localized/diffuse), microvascular classification (Type I-IV), morphological type (polypoid, nodular, papillary, ulcerative, hyperplastic), and the presence of necrosis or calcification. Biopsies were taken from suspicious areas for pathological examination. Using histopathology as the gold standard, the diagnostic performance of each indicator was evaluated. RESULTS: First, microvascular classification showed a significant correlation with lesion malignancy: Types I-II were most frequent in the hyperplasia without atypia group (68.6%), Type III was most frequent in the atypical hyperplasia group (54.9%), and Type IV was most frequent in the endometrial cancer group (48.4%). Second, among morphological types, the papillary pattern had the highest occurrence in the endometrial cancer group (58.1%) and, together with Type IV vessels, was significantly associated with malignant lesions (P < 0.001). Third, the proportion of postmenopausal patients in the endometrial cancer group was 64.5%, significantly higher than that in the benign group (P < 0.01). Fourth, a diagnostic model combining microvascular classification, lesion extent, and morphological type demonstrated excellent predictive value, with an AUC of 0.950 (95% CI: 0.912-0.989), a sensitivity of 87.1%, and a specificity of 84.7%. Finally, in this study, the under-diagnosis rate was 3.6%, and the over-diagnosis rate was 8.9%. CONCLUSION: The hysteroscopic microvascular and morphological classification system aids in distinguishing between benign and malignant endometrial lesions. Specifically, a papillary appearance and Type IV vessels are important indicators suggestive of malignancy. Combining multiple indicators improves diagnostic accuracy and can serve as an auxiliary tool for hysteroscopists, particularly for beginners.
Impact of ovarian preservation on survival for premenopausal women with early-stage endometrial carcinoma: A systematic review and meta-analysis.
Raffone A, Raimondo D, Neola D … +10 more , Maletta M, Doglioli M, Travaglino A, Ronsini C, Vastarella MG, Ferla S, Cosentino F, De Franciscis P, Seracchioli R, Cobellis L
Int J Gynaecol Obstet · 2026 Jun · PMID 42274100 · Publisher ↗
OBJECTIVE: Up to 14% of women with early-stage endometrial carcinoma (EEC) are diagnosed before menopause. Although ovarian preservation (OP) within surgical staging might avoid surgical menopause, its rate remains low i...
OBJECTIVE: Up to 14% of women with early-stage endometrial carcinoma (EEC) are diagnosed before menopause. Although ovarian preservation (OP) within surgical staging might avoid surgical menopause, its rate remains low in clinical practice, probably because the impact of OP on survival outcomes is unclear. This study evaluates the impact of OP on (i) survival outcomes, (ii) adverse events, and (iii) quality of life (QoL) in young women with EEC. METHOD: A systematic review and meta-analysis was performed searching seven electronic databases from their inception to 2022. The study included all randomized controlled trials (RCTs) and non-randomized comparative studies (NRS) comparing survival outcomes of women who underwent OP versus bilateral salpingo-oophorectomy (BSO). Primary outcome was the risk of death of any cause, while secondary outcomes were the risk of death due to endometrial carcinoma, the risk of recurrent disease, adverse events after ovarian surgery, and QoL. RESULTS: Twelve studies were included in the qualitative synthesis, while nine studies with a total of 115 528 women were suitable for the quantitative analysis. Compared to the BSO group, the OP group had a hazard ratio of 0.805 (95% confidence interval [CI]: 0.655-0.989) for death of any cause, 1.079 (95% CI: 0.395-2.953) for death due to endometrial carcinoma, and 1.332 (95% CI: 0.663-2.674) for recurrent disease. No pooled data were obtainable for adverse events after ovarian surgery and QoL. CONCLUSION: In young women with EEC, our study seems to support the OP at the time of surgical treatment as it appears to reduce the risk of death of any cause by approximately 20%, with no impact on the risk of death due to endometrial carcinoma and the risk of recurrent disease. However, given the risk of bias of the included studies, further well-designed studies are needed.
Regulatory role of the soluble TLR4 form in HMGB1-driven inflammation in PCOS: Integration of biochemical and molecular docking evidence.
Atheeb AK, Hussein SZ
Int J Gynaecol Obstet · 2026 Jun · PMID 42274095 · Publisher ↗
OBJECTIVE: Given the recognized role of chronic low-grade inflammation in polycystic ovary syndrome (PCOS), the aim of the present study was to investigate the role of the serum high-mobility group box 1 (HMGB1)-Toll-lik...
OBJECTIVE: Given the recognized role of chronic low-grade inflammation in polycystic ovary syndrome (PCOS), the aim of the present study was to investigate the role of the serum high-mobility group box 1 (HMGB1)-Toll-like receptor 4 (TLR4)-interferon beta (IFN-β) signaling axis and its association with immune-metabolic dysfunctions in women with PCOS. METHODS: This was a case-control study involving 90 Iraqi women aged 18-45 years, including 50 newly diagnosed PCOS patients and 40 healthy controls. Serum levels of HMGB1, soluble Toll-like receptor 4 (sTLR4), and INF-β were measured using enzyme-linked immunosorbent assay (ELISA). An automated analyzer was employed to assess the hormonal profile. Molecular docking simulations were performed using MOE software to evaluate the interaction of HMGB1 with both membrane-bond TLR4 and its soluble form. RESULTS: The PCOS group exhibited significant alterations in hormonal profiles compared to healthy controls. Serum levels of HMGB1, sTLR4, and INF-β were significantly elevated, consistent with a state of low-grade inflammation. Molecular docking analysis demonstrated favorable binding of HMGB1 to both TLR4 and sTLR4, with a slightly stronger affinity for sTLR4 (-7.20 kcal/mol; RMSD 2.13 Å) than TLR4 (-6.23 kcal/mol; RMSD 1.73 Å). CONCLUSION: The HMGB1-TLR4-INF-β signaling axis appears to contribute to low-grade inflammation in PCOS. The soluble form of TLR4 may act as a regulatory modulator that attenuates inflammatory signaling. The integration of biochemical and computational data findings provides novel insights into immune-metabolic dysregulation in PCOS and highlights potential therapeutic targets for modulating inflammation.
Appraisal of international, patient-facing resources on heavy menstrual bleeding.
Carere O, Clarfield L, Brennan L … +13 more , Critchley HOD, Desilets J, Diamond L, Hirota Y, Kumar K, Maheux-Lacroix S, Matteson KA, Monteiro I, Munro MG, Silverberg O, Uppal MT, Warshafsky C, Murji A
Int J Gynaecol Obstet · 2026 Jun · PMID 42274078 · Publisher ↗
This study aimed to systematically evaluate the quality of widely accessible, English language, patient-facing resources on heavy menstrual bleeding (HMB), identifying strengths, gaps, and opportunities for improvement....
This study aimed to systematically evaluate the quality of widely accessible, English language, patient-facing resources on heavy menstrual bleeding (HMB), identifying strengths, gaps, and opportunities for improvement. Resources were obtained from (1) a systematic Google Trends-informed Google search and (2) submissions from subject matter experts. Eligible resources were independently reviewed and scored using validated tools for credibility (QUEST), aesthetics (modified Abbott's scale), and readability. To evaluate clinical utility, resources were graded using a tool designed by international experts for comprehensiveness and accuracy across six domains. Inter-rater reliability was assessed with the intraclass correlation coefficient (ICC) and Cohen's kappa. Of 353 resources identified, 63 met the inclusion criteria. Mean QUEST score (maximum = 28) was 18.7 ± 5.1, with 4/63 (6%) resources meeting all credibility criteria. Mean aesthetics score (maximum = 7) was 5.3 ± 1.1, with only 15/63 (24%) resources with graphics. Most resources (40/63, 64%) were written at a grade 10-12 reading level. Mean comprehensiveness score (maximum = 6) was 4.6 ± 0.8, with gaps most often observed in advice on when to seek emergency care and information about iron deficiency. Mean accuracy score (maximum = 12) was 8.0 ± 2.3, with only 3/63 (13%) resources containing completely accurate content. There was moderate-to-substantial agreement across reviewers (ICC = 0.60-65 for aesthetics credibility; κ = 0.38-49 for accuracy comprehensiveness). In conclusion, most online resources accessed by patients are moderately credible, difficult to read, and underutilize figures. Content gaps exist mainly related to education on safety and iron deficiency. Very few resources are entirely accurate. We recommend targeted revisions to patient education resources to better inform and empower patients experiencing HMB.
Journey from domestic violence to self-reliance: A case report from a tertiary care crisis center.
Ahmed M, Fathima M
Int J Gynaecol Obstet · 2026 Jun · PMID 42267583 · Publisher ↗
Domestic violence and abuse (DVA) remains a major public health and human rights concern, with profound consequences for women's physical, psychological, and socioeconomic well-being. We report the case of a 32-year-old...
Domestic violence and abuse (DVA) remains a major public health and human rights concern, with profound consequences for women's physical, psychological, and socioeconomic well-being. We report the case of a 32-year-old married woman and mother of two who experienced prolonged domestic violence, including physical, emotional, and economic abuse, compounded by her husband's alcohol dependence. Economic abuse escalated when debt incurred through a self-help group loan, intended to support the family's livelihood, was transferred to the survivor, reinforcing financial dependency and coercive control. Following a severe episode of physical violence that resulted in her displacement from the marital home, she sought support through a hospital-based crisis center established within a tertiary care women's hospital. Through crisis intervention, structured counseling, legal guidance, child welfare support, and employment assistance, the survivor achieved financial independence, secured safe accommodation, and initiated steps toward legal separation. This case highlights the often-overlooked role of economic abuse and debt bondage as mechanisms of control within abusive relationships. It also demonstrates the value of integrated, hospital-based crisis services and intersectoral collaboration in supporting survivors of violence. Strengthening routine identification of DVA within healthcare settings, expanding access to crisis centers, and promoting women's economic empowerment may contribute to improved safety and long-term recovery for survivors.
Cervical tuberculosis mimicking carcinoma of the cervix in a patient with long-standing secondary amenorrhea.
Kaur S, Mohanta P, Joshi B … +1 more , Jain V
Int J Gynaecol Obstet · 2026 Jun · PMID 42267575 · Publisher ↗
BACKGROUND: Tuberculosis remains a significant cause of extrapulmonary disease in endemic regions. Genital tuberculosis most commonly affects the fallopian tubes and endometrium, while cervical involvement is rare. Prese...
BACKGROUND: Tuberculosis remains a significant cause of extrapulmonary disease in endemic regions. Genital tuberculosis most commonly affects the fallopian tubes and endometrium, while cervical involvement is rare. Presentation as a cervical mass is particularly uncommon and may closely mimic cervical cancer, leading to diagnostic challenges. CASE: We report a case of a woman in her 40s with a history of long-standing secondary amenorrhea for 12 years who presented with postcoital bleeding. Clinical examination revealed a cervical growth. Histopathological evaluation of the cervical biopsy demonstrated inflammation with granulomas, no evidence of malignancy was identified. The tissue was positive for ZN stain and MGIT. MANAGEMENT AND OUTCOME: The patient was initiated on standard anti-tubercular therapy for 6 months. Patient had resolution of symptoms and interval reduction in cervical lesion at 6 months follow-up. CONCLUSION: Cervical tuberculosis, though rare, should be considered in the differential diagnosis of suspected carcinoma cervix, particularly in patients from endemic areas.
Laparoscopic ultrasound eXAmination: Analysis of fellow surgeons learning curve in minimally invasive gynecologic procedures (LUXA study).
Giudice MT, Moro F, Ciancia M … +13 more , Russo C, Giannarelli D, Cappuccio S, Loverro M, Fedele C, D'Indinosante M, Rosati A, Perrone E, Ciccarone F, Mascilini F, Fagotti A, Fanfani F, Testa AC
Int J Gynaecol Obstet · 2026 Jun · PMID 42267555 · Publisher ↗
OBJECTIVE: Laparoscopic ultrasound (LUS), performed with an endoscopic ultrasound probe, has shown potential in addressing challenges related to haptic perception and lesion detection in minimally invasive surgery. The a...
OBJECTIVE: Laparoscopic ultrasound (LUS), performed with an endoscopic ultrasound probe, has shown potential in addressing challenges related to haptic perception and lesion detection in minimally invasive surgery. The aim of the present study was to evaluate the learning curve of gynecologic surgery fellows in achieving competency in LUS image acquisition during minimally invasive procedures. METHODS: This prospective single-center study included six gynecologic fellows with limited ultrasound experience who completed a one-day structured training program. Fellows performed laparoscopic ultrasound during elective surgeries for benign conditions and early-stage gynecologic cancers, assessing five anatomical sites. Competency was evaluated using learning curve cumulative summation (LC-CUSUM) analysis based on image quality and examination time. Learning curve time and quality score for each surgeon and anatomical site were measured. RESULTS: A total of 56 patients and examinations were analyzed. All fellows achieved competency within 2-5 procedures, with LC-CUSUM showing rapid and sustained skill acquisition. Ovarian imaging required fewer attempts than myometrial wall and iliac vessel imaging, with the right external iliac vessels being the most challenging. Patient characteristics did not differ among fellows. CONCLUSION: After targeted training, gynecologic surgery fellows can achieve proficiency in LUS within a short learning curve. These findings support the feasibility of integrating LUS training into gynecologic surgical education and highlight its potential to enhance surgical precision and to reduce surgical overall time.
INTERGROWTH 21st versus GROW fundal height charts and antenatal detection of small-for-gestational age: A multicenter cohort study.
Butler E, Ellson H, Taylor H … +2 more , Hugh O, Gardosi J
Int J Gynaecol Obstet · 2026 Jun · PMID 42261799 · Publisher ↗
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