International Journal Of Gynaecology And Obstetrics[JOURNAL]
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200 papers
From roadmaps to results: Seizing the moment for postpartum hemorrhage.
Evans C, Beyeza-Kashesya J, Moran AC
Int J Gynaecol Obstet · 2026 Jun · PMID 42260233 · Publisher ↗
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Moving beyond a legacy paradigm: A vision for equitable access to quality medicines in Africa.
Doi N, Orji BC, Ruffo M … +7 more , Mukumbayi P, Kibonge S, Muthamia MM, Tappis H, Biayi F, Kassim TY, Ndwiga A
Int J Gynaecol Obstet · 2026 Jun · PMID 42260231 · Full text
Ensuring the availability of quality medicines is fundamental to achieving health outcomes and safeguarding public health. However, in many low- and middle-income countries, especially across Africa, the current quality...
Ensuring the availability of quality medicines is fundamental to achieving health outcomes and safeguarding public health. However, in many low- and middle-income countries, especially across Africa, the current quality assurance paradigm-largely driven by historical donor preferences for WHO prequalification and stringent regulatory authority approval-can unintentionally limit access, equity, and sustainability. While these requirements have been effective in ensuring client safety, they can result in higher expenditures, reduced coverage, and deepening inequities. Moreover, such narrow focus risks undermining the authority of national regulatory authorities (NRAs), diminished economic development opportunities, erosion of trust in local health systems, and vulnerabilities to external shocks. This paper argues for a more inclusive approach to defining quality standards for procurement eligibility. It proposes qualifying for procurement products with marketing authorizations granted by NRAs that have achieved at least Maturity Level 3-a designation based on the WHO Global Benchmarking Tool that indicates a stable, well-functioning, integrated regulatory system; establishing financing mechanisms to minimize the budget impact of more costly quality medicines; promoting regulatory reliance through regional harmonization; and investing in system-wide regulatory strengthening. Such a model would not only enhance access to safe and effective medicines but also foster local regulatory capacity, support domestic pharmaceutical industries, reduce overdependence on donors and imported products, and promote self-reliance. By rethinking quality assurance strategies and aligning them with regional progress and aspirations, Africa can build more resilient, autonomous health systems and advance toward sustainable health equity.
The role of exchange hubs and learning between countries and regions in strengthening the implementation and expansion of essential products for postpartum hemorrhage.
Sy T, Diallo A, Traore Y … +6 more , Kourouma D, Traore O, Bolamba VL, Irinyenikan TA, Gooden R, Racine S
Int J Gynaecol Obstet · 2026 Jun · PMID 42260195 · Full text
Postpartum hemorrhage (PPH) affects about 6%-10% of women giving birth and is the leading cause of maternal mortality worldwide. Following its launch in the Democratic Republic of the Congo, Guinea, India, and Kenya in O...
Postpartum hemorrhage (PPH) affects about 6%-10% of women giving birth and is the leading cause of maternal mortality worldwide. Following its launch in the Democratic Republic of the Congo, Guinea, India, and Kenya in October 2022, and more recently in Nigeria and Zambia, the Unitaid-supported Accelerating Measurable Progress and Leveraging Investments for Postpartum Hemorrhage Impact (AMPLI-PPHI) project established regional and national exchange networks and learning hubs. These networks aim to propel dynamic learning and build on existing partnerships, through country and state level obstetrics and gynecology societies, under the umbrella of FIGO. As part of the AMPLI-PPHI project's exchange hub activities, professional associations in the target countries organized webinars, in-person meetings, and maintained regular communication through regional events, emails, and phone calls to share various aspects of the project with their colleagues in the platform. These hubs facilitated the transfer and application of learning from target countries to help propel PPH prevention, detection, and treatment across all exchange countries. In addition to these exchanges and as part of the hubs, target countries undertook advocacy training through cross-country learning sessions. This contributed to strengthened clinical leadership in women's health to raise their voices more effectively regarding the scale-up and expansion of access to life-saving medicines and essential health products for PPH. While this article focuses particularly on the work in Guinea, it also shares key lessons learned from all project target countries and their extended exchange hubs. The hubs have created an effective network of professional associations that can share evidence and clinical lessons, accelerating required processes and enabling effective wider adaptation and scale-up of essential and innovative PPH products.
Reducing inequities in access to postpartum hemorrhage prevention: Reframing advance distribution of misoprostol as a test case for health system responsiveness and adaptation.
Tappis H, Doi N, Bhola C … +2 more , Bamba Y, Lathrop E
Int J Gynaecol Obstet · 2026 Jun · PMID 42260066 · Full text
Advance distribution of misoprostol is an evidence-based strategy for preventing postpartum hemorrhage (PPH) at births without skilled health personnel present. Despite its lifesaving potential, initial momentum behind t...
Advance distribution of misoprostol is an evidence-based strategy for preventing postpartum hemorrhage (PPH) at births without skilled health personnel present. Despite its lifesaving potential, initial momentum behind this intervention has slowed over the last decade and has not been renewed since WHO released updated guidelines in 2020 or the global Roadmap to combat postpartum hemorrhage between 2023 and 2030 was launched in 2023. The present article argues for renewed consideration of advance distribution of misoprostol in comprehensive PPH prevention strategies and reframing of policy dialogues around the intervention to reflect current health system realities and public health imperatives. Drawing on experiences of the Accelerating Measurable Progress and Leveraging Investments for Postpartum Hemorrhage Impact (AMPLI-PPHI) project across six diverse health systems, we position advance distribution of misoprostol as a litmus test for health system responsiveness and call on health sector stakeholders to critically examine all available opportunities to optimize PPH prevention strategies and accelerate efforts to reduce inequities in preventable maternal mortality.
Igniting the spark in six countries to transform the trajectory of postpartum hemorrhage across the globe: An overview of the AMPLI-PPHI project.
Roman E
Int J Gynaecol Obstet · 2026 Jun · PMID 42260038 · Full text
Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, disproportionately affecting women in low- and middle-income countries. Despite updated WHO recommendations and the availability of n...
Postpartum hemorrhage (PPH) remains the leading cause of maternal mortality worldwide, disproportionately affecting women in low- and middle-income countries. Despite updated WHO recommendations and the availability of newer technologies-including heat-stable carbetocin, tranexamic acid as part of a clinical care bundle, misoprostol, and calibrated drapes-adoption and scale-up remain limited due to persistent supply and demand-side barriers. This article provides an overview of the Accelerating Measurable Progress and Leveraging Investments for Postpartum Hemorrhage Impact (AMPLI-PPHI) project. Led by Jhpiego, in partnership with PATH and FIGO, AMPLI-PPHI aims to reduce maternal mortality from PPH by catalyzing the adoption of effective drugs for PPH prevention and treatment as part of quality of intrapartum care, at all levels of the health system. Working in partnership with governments in project target countries (Democratic Republic of the Congo, Guinea, India, Kenya, Nigeria, and Zambia), AMPLI-PPHI helps to increase women's access to PPH prevention and management. AMPLI-PPHI introduces and integrates proven approaches and PPH commodities into routine maternal health systems, generates evidence, and supports countries in scaling up these practices. Globally, the project focuses on reducing supply-side barriers to help create the market for affordable and accessible PPH commodities. AMPLI-PPHI also fosters a regional exchange network-propelling shared learning and best practices-to light the spark for transformation in PPH care, thereby reducing maternal deaths from PPH-ensuring every woman, everywhere, has access to lifesaving care.
Role of professional associations in the drive for policy change and uptake of new WHO recommendations for the prevention and treatment of postpartum hemorrhage.
Wamae R, Jones D, Adamu AN … +2 more , Gooden R, Racine S
Int J Gynaecol Obstet · 2026 Jun · PMID 42260007 · Full text
The role of professional associations in the health ecosystem is crucial as they establish and uphold standards of professional practice, ethics, and continuing education, thereby safeguarding patient welfare and promoti...
The role of professional associations in the health ecosystem is crucial as they establish and uphold standards of professional practice, ethics, and continuing education, thereby safeguarding patient welfare and promoting accountability among practitioners. Their role is particularly important in combating postpartum hemorrhage (PPH), as outlined in the WHO PPH Roadmap's four strategic pillars: research, norms and standards, implementation, and advocacy. Professional societies, such as obstetrics/gynecology and midwifery associations and other collaborating cadres, such as anesthetists and pharmacists, can elevate PPH as a political and public health priority by raising awareness of its prevention and treatment. Advocating for access to quality uterotonics like heat-stable carbetocin is critical for effective PPH management, especially in countries that lack effective cold chain or have supply chains that cannot guarantee access to quality oxytocin. The Accelerating Measurable Progress and Leveraging Investments for Postpartum Hemorrhage Impact (AMPLI-PPHI) project, through the professional associations across six countries (Democratic Republic of the Congo, Guinea, India, Kenya, Nigeria, and Zambia), aimed to generate implementation evidence, create an enabling environment, and prepare national supply chains and markets for the adoption of three WHO newly recommended PPH drugs: heat-stable carbetocin, tranexamic acid, and misoprostol for advance distribution, in low- and middle-income countries. The Policy Change Cycle tool and SMART Advocacy approach were used during the project to influence government action on PPH management and commodity adoption. Progress was tracked and reviewed using the SMART Advocacy tool. Across six diverse countries, professional associations of obstetrics and gynecology successfully advocated for the institutionalization of WHO-recommended PPH interventions, by leveraging their trusted relationship with government, employing strategic advocacy frameworks, and navigating complex policy environments. Key enablers included the credibility of professional associations with Ministries of Health, strong collaboration among stakeholders, and alignment with government priorities. Barriers included insufficient government budget allocation to implement the PPH interventions nationwide, as well as professional associations' limited financial resources and insufficient capacity for effective advocacy. The AMPLI-PPHI experience demonstrates that national health professional associations, when supported with adequate financing and technical advocacy skills, can be powerful catalysts of health policy and practice. Formalizing and strengthening the role of professional associations in global and national health policy processes and advocacy is essential for accelerating progress toward achieving maternal health goals and building resilient, evidence-driven health systems.
From guesstimates to game changers: Introducing objective measurement of blood loss for timely postpartum hemorrhage detection in Nigeria, Zambia, and Kenya.
Njogu R, Tappis H, Orji BC … +7 more , Kapoma S, Adepoju VA, Ndhlovu M, Roman E, Muthamia MM, Lathrop E, Evans C
Int J Gynaecol Obstet · 2026 Jun · PMID 42260002 · Full text
Accurate, timely diagnosis of postpartum hemorrhage (PPH) is critical for effective management. However, in low-resource settings, reliance on visual estimation leads to missed diagnoses in up to 50% of cases, underscori...
Accurate, timely diagnosis of postpartum hemorrhage (PPH) is critical for effective management. However, in low-resource settings, reliance on visual estimation leads to missed diagnoses in up to 50% of cases, underscoring the need for more objective and reliable methods. Evidence suggests that the use of tools for objective measurement of blood loss, such as calibrated drapes, can improve early detection and prompt treatment of PPH. This article shares learning from the Accelerating Measurable Progress and Leveraging Investments for Postpartum Hemorrhage Impact (AMPLI-PPHI) project's experience introducing calibrated drapes for PPH detection in coordination with governments of Nigeria and Zambia and supporting county government-led rollout in Kenya. Early implementation revealed key lessons including the importance of engagement of ministries of health and key stakeholders in decision-making on the type of calibrated tool to use. Care must be taken to prepare healthcare providers, communities, government authorities, and other stakeholders about the potential increase in reported PPH cases due to more accurate measurement and diagnosis. Persistent challenges remain concerning safe waste disposal and ensuring monitoring of blood loss and vital signs, including documentation of checks every 15 min in the first hour, as recommended by 2025 WHO-FIGO-ICM guidelines. Additionally, context-specific considerations may be required for scale-up of objective measurement of postpartum blood loss, such as understanding the cultural dynamics related to blood measurement and afterbirth practices, and ensuring the workforce is sufficient in numbers and capacity to provide close monitoring and measurement of blood loss necessary for early PPH detection.
Age at first birth and risk of cardiovascular-kidney-metabolic syndrome in US women aged 40 years and older: A nationally representative cross-sectional study.
Jing Y, Lu C, Wang R … +1 more , Chen T
Int J Gynaecol Obstet · 2026 Jun · PMID 42257372 · Publisher ↗
OBJECTIVE: Age at first birth (AFB) is an important reproductive factor influencing long-term metabolic health. This study aimed to examine the associations between AFB and prevalence of cardiovascular-kidney-metabolic (...
OBJECTIVE: Age at first birth (AFB) is an important reproductive factor influencing long-term metabolic health. This study aimed to examine the associations between AFB and prevalence of cardiovascular-kidney-metabolic (CKM) syndrome among middle-aged and older US women. METHODS: US women aged ≥ 40 years at the time of the survey were analyzed using 1999-2018 National Health and Nutrition Examination Survey data. AFB was ascertained via self-report from a reproductive health questionnaire. CKM syndrome was defined using the 2023 American Heart Association criteria. Multivariate logistic regression models, restricted cubic spline analysis, and subgroup analysis were used for statistical analyses. RESULTS: Among 6840 women (mean age 63 years; mean AFB 22 years) included, restricted cubic spline curve showed a U-shaped association between AFB and CKM syndrome prevalence, with the nadir at AFB = 24 years. The odds ratios (95% confidence intervals) per 1-year increase in AFB were 0.878 (0.817-0.944) for participants with AFB < 24 years and 1.019 (0.949-1.095) for those with AFB > 24 years. Compared with the reference group (AFB 24-29 years), women with AFB < 18 years had 86.3% higher odds of CKM syndrome. Subgroup analysis revealed a stronger association between AFB and the odds of CKM syndrome among premenopausal women (p for interaction = 0.023). CONCLUSION: Early AFB < 24 years is associated with a higher likelihood of CKM syndrome in US women aged ≥ 40 years, especially among premenopausal women. Prospectively designed cohort studies are needed to establish AFB as an important factor for mid- to late-life CKM health.
Tumor budding as a predictive factor of lymph node metastases and survival in endometrial cancer patients: A systematic review and meta-analysis.
Fanaki M, Lygizos V, Nikolaos T … +3 more , Vlachos DE, Dimitrios H, Pergialiotis V
Int J Gynaecol Obstet · 2026 Jun · PMID 42257336 · Publisher ↗
BACKGROUND: Tumor budding (TB), defined as isolated single cells or small clusters at the invasive front, has emerged as an adverse prognostic marker in several solid tumors. Its prognostic value in endometrial carcinoma...
BACKGROUND: Tumor budding (TB), defined as isolated single cells or small clusters at the invasive front, has emerged as an adverse prognostic marker in several solid tumors. Its prognostic value in endometrial carcinoma (EC), however, remains uncertain. METHODS: We conducted a systematic review and meta-analysis (PROSPERO registration: CRD420251066731) of studies evaluating the association between TB and survival outcomes and lymph node positivity in EC. Comprehensive searches of CENTRAL, MEDLINE, PubMed, Scopus, and Google Scholar identified eligible observational studies. RESULTS: Ten studies comprising 1307 patients were included. TB was significantly associated with reduced progression-free survival (hazard ratio [HR] 2.44, 95% confidence interval [CI] 1.53-3.89) and overall survival (HR 1.89, 95% CI 1.21-2.96). Sensitivity analyses revealed attenuation of these associations after accounting for small-study effects, although trim-and-fill estimates remained statistically significant for progression-free survival. Evidence for an association between TB and lymph node metastasis was inconsistent and not robust after correction for potential bias. CONCLUSION: Tumor budding is associated with adverse survival outcomes in EC, highlighting its potential as a histopathological biomarker of aggressive disease. However, heterogeneity in assessment methods and limited integration with molecular classification constrain its current clinical applicability. Standardized evaluation and validation in large, molecularly stratified cohorts are essential to establish TB as an independent prognostic factor and to define its role in guiding adjuvant treatment decisions.
Mobility-enabling birth beds versus traditional gynecological tables: A quasi-experimental study of birth experiences and clinical outcomes.
Taştekin A, Durmuş Tekin Ö
Int J Gynaecol Obstet · 2026 Jun · PMID 42257330 · Publisher ↗
OBJECTIVE: This study compares birth experiences and clinical outcomes between women giving birth using mobility-enabling labor-birth-postpartum (LBP) beds and those using a traditional gynecological table (TGT). METHODS...
OBJECTIVE: This study compares birth experiences and clinical outcomes between women giving birth using mobility-enabling labor-birth-postpartum (LBP) beds and those using a traditional gynecological table (TGT). METHODS: This quasi-experimental study was conducted between June and October 2025 in a secondary-level maternity unit in Turkey. A total of 320 women who had vaginal births were sequentially assigned to either the LBP group (n = 160) or the TGT group (n = 160). Continuous variables were analyzed using Mann-Whitney U-tests, with Bonferroni correction applied for multiple comparisons, and categorical variables using χ-tests. RESULTS: Baseline characteristics were comparable between groups. Regarding the primary outcome, no significant difference in labor duration was observed between the groups (P = 0.254). After multiplicity adjustment, episiotomy (45.0% vs. 67.5%) and fundal compression (6.9% vs. 25.0%) were significantly less frequent in the LBP group (P < 0.001). Women using LBP beds reported lower pain scores and higher birth satisfaction (P < 0.001). There were no statistically significant differences between the groups in neonatal variables after adjusting the significance threshold (P > 0.0029). CONCLUSION: These results suggest that while mobility-enabling LBP beds do not shorten labor duration, they are associated with a substantial reduction in obstetric interventions from extremely high institutional levels and enhanced maternal birth experiences. By supporting maternal movement and positional flexibility, these beds may facilitate physiologic labor and represent a practical strategy for strengthening woman-centered intrapartum care. However, environmental modifications should be integrated with broader institutional policy shifts to fully align with global evidence-based standards and further reduce the need for routine interventions.
Carbon footprint of single-use surgical drapes in an Irish gynecology service.
Waters I, Nordrum OL, Burke C
Int J Gynaecol Obstet · 2026 Jun · PMID 42257322 · Publisher ↗
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Surgically confirmed severe endometriosis is associated with lower risk of steatotic liver disease: Evidence of estrogen-linked hepatic-reproductive crosstalk.
Park JH, Yang K, Yang H … +3 more , Bae SH, Kim MR, Lee J
Int J Gynaecol Obstet · 2026 Jun · PMID 42249739 · Publisher ↗
OBJECTIVE: The prevalence of steatotic liver disease (SLD) is increasing globally. Endometriosis, affecting up to 10% of women, is a major cause of infertility. While associations between endometriosis and metabolic synd...
OBJECTIVE: The prevalence of steatotic liver disease (SLD) is increasing globally. Endometriosis, affecting up to 10% of women, is a major cause of infertility. While associations between endometriosis and metabolic syndrome have been reported, its relationship with SLD remains unclear. Our study aimed to evaluate the association between endometriosis severity and SLD. METHODS: We retrospectively analyzed women who underwent surgery for endometriosis with documented revised American Society for Reproductive Medicine scores at a tertiary hospital (January 1, 2009, to February 28, 2025) and had undergone abdominal computed tomography (CT) within 6 months as part of the clinical evaluation for endometriosis. Hepatic steatosis was assessed on abdominal CT using the liver-to-spleen Hounsfield unit (LS) ratio with predefined cutoff values, where lower values indicate greater hepatic fat accumulation, and SLD and severe SLD were defined as LS <1.0 and <0.8, respectively. The hepatic steatosis index (HSI) was used for sensitivity analysis. RESULTS: Among 455 patients, 232 had severe endometriosis (SE, stage 4) and 223 had non-severe endometriosis (NSE). Baseline characteristics were similar between groups, except for higher estradiol levels in the SE group (P < 0.001). The prevalence of SLD was significantly lower in SE (48.3%) compared to NSE (62.3%) (P = 0.002), and severe SLD was less common in SE (8.2% vs 16.1%, P = 0.009). Patients with SLD exhibited lower estradiol levels than those without, suggesting a potential protective effect of estradiol on hepatic steatosis. Multivariate analysis confirmed that SE was independently associated with a reduced risk of SLD, irrespective of age, body mass index, and metabolic comorbidities. CONCLUSIONS: SE was associated with a lower prevalence of SLD, potentially mediated by higher estradiol levels.
Temperature and heat-load exposure effects on preterm births: Insights from a population-based study using distributed lag non-linear models.
Barzilay B, Abu-Kishk I, Bibi H … +2 more , Waisman D, Daniel S
Int J Gynaecol Obstet · 2026 Jun · PMID 42246627 · Publisher ↗
OBJECTIVE: Preterm birth presents a substantial health, psychological, and economic burden worldwide. Environmental factors, including temperature fluctuations, are known to influence the risk of preterm birth. This stud...
OBJECTIVE: Preterm birth presents a substantial health, psychological, and economic burden worldwide. Environmental factors, including temperature fluctuations, are known to influence the risk of preterm birth. This study aimed to investigate the association between high temperatures and heat load and preterm births. METHODS: Using a time-series analysis, we examined data from all births in five Israeli districts between 2010-2016. Meteorological indices were computed for each district. Distributed lag non-linear models (DLNM) incorporating Poisson regression were employed to investigate the associations between these meteorological indices and the daily number of preterm births across various time lags, assessing both short- and long-term associations, adjusting for seasonality, holidays and the general trend. RESULTS: During the study period, 1 216 040 newborns were delivered, of which 89 544 (7.36%) were preterm (<37 weeks) and 11 154 (0.91%) early preterm (<32 weeks). Significant non-linear associations were found between temperature, heat load, and daily preterm births. Acute exposure to a 1°C increase in mean daily temperature 14 days before delivery was associated with a higher risk of preterm birth (relative risk [RR] = 1.015; 95% confidence interval [CI]: 1.010-1.019). Similarly, acute exposure to a 1°C increase in maximal heat load 14 days before delivery was associated with elevated risk (RR = 1.018; 95% CI: 1.011-1.026). Cumulative effects over 14 days were substantial: a 1°C rise in mean daily temperature was linked to a 16% increase in risk (RR = 1.160; 95% CI: 1.145-1.176), while a 1°C increase in maximal heat load was associated with a 14% increase (RR = 1.139; 95% CI: 1.125-1.153). Similar associations were observed for heat load, and for early preterm and very low birth weight births; however, these subgroup analyses were based on fewer events and had wider CIs. CONCLUSION: High temperatures and heat load increase the risk of preterm birth over both short- and long-terms. In the context of global warming, these findings may warrant consideration of climate-related risks in maternal health planning and to develop preventive strategies against heat-related pregnancy complications.
From assumptions to outcomes: How unconscious bias shapes obstetric care.
Ruiloba Portilla FJ, Appiah-Kubi A, Deligeoroglou E … +18 more , Girmachew HE, Interlandi F, Karslı SE, Kartal DU, Libretti A, Mbarki C, Mukombwe OP, Muslim Z, Ng MY, Pacheco-Ruiz SI, Santiago Sanabria L, Sowemimo OO, Stephen AC, Ubom AEB, Ozpinar K, Zapata-Caballero CA, Topcu EG, Ramirez Negrin A
Int J Gynaecol Obstet · 2026 Jun · PMID 42246578 · Publisher ↗
Unconscious bias influences clinical judgment and communication across healthcare, but its effects in obstetric practice are particularly consequential due to time-sensitive decision making, high emotional vulnerability,...
Unconscious bias influences clinical judgment and communication across healthcare, but its effects in obstetric practice are particularly consequential due to time-sensitive decision making, high emotional vulnerability, and longstanding maternal health inequities. When bias-driven interactions escalate into coercion, non-consented procedures, or normalized mistreatment, they constitute forms of gender-based violence embedded within routine clinical care. This review synthesizes evidence on how unconscious bias shapes provider-patient communication, shared decision making, autonomy, and obstetric outcomes. A systematic review with narrative synthesis was conducted using PubMed Central and Google Scholar from inception to August 2025. English-language studies examining unconscious or implicit bias in obstetric communication or decision making were eligible. Dual screening, structured data extraction, and thematic synthesis were performed. A total of 89 studies met inclusion criteria, including qualitative, quantitative, mixed-methods, and conceptual designs. Across settings, unconscious bias manifested through: (1) Dismissal of symptoms and credibility discounting; (2) selective or incomplete information exchange; (3) stereotyping and moral judgment; (4) differential clinical discretion, surveillance, and escalation; and (5) normalized mistreatment and non-consented care. These mechanisms systematically undermined communication quality, restricted shared decision making, and reduced autonomy, particularly for Black, Indigenous, migrant, low-income, uninsured, adolescent, and disabled patients. Quantitative and vignette studies demonstrated measurable effects on clinical decisions, including biased cesarean recommendations, disparities in pain management, and delays in recognizing deterioration. These processes contributed to documented inequities in severe maternal morbidity, intervention rates, and maternal near-miss events. Notably, coercive consent practices, non-consented procedures, and normalized disrespect emerged as manifestations of gender-based violence within obstetric settings. Unconscious bias shapes obstetric interactions through interconnected communication and decision making pathways that constrain autonomy, reduce quality of care, and reinforce structural inequities. At its most severe, bias-driven care constitutes a form of gender-based violence that disproportionately affects racialised and socially marginalized women. Effective mitigation requires multi-level strategies combining communication-focused interventions, standardized protocols, interpreter support, reflective practice, and institutional accountability frameworks.
Association between the duration of the third stage of labor and postpartum hemorrhage.
Tuitemwong K, Pongsatha S, Kamlungkuea T … +2 more , Parapob N, Tongsong T
Int J Gynaecol Obstet · 2026 Jun · PMID 42240939 · Publisher ↗
OBJECTIVE: To determine the association between the duration of the third stage of labor and postpartum hemorrhage (PPH), and to identify an appropriate time threshold for performing manual removal of the placenta (MROP)...
OBJECTIVE: To determine the association between the duration of the third stage of labor and postpartum hemorrhage (PPH), and to identify an appropriate time threshold for performing manual removal of the placenta (MROP). METHODS: A retrospective cohort study was conducted in women who underwent vaginal delivery with an uncomplicated third stage of labor. Data were retrieved from a digital obstetric database, including consecutive records of singleton pregnancies delivered vaginally at ≥24 weeks of gestation. Cases with excessive bleeding or emergency placental removal before completion of the third stage were excluded. RESULTS: During a 13-year study period, 13 653 cases were eligible for analysis, comprising 13 509 cases managed expectantly and 54 undergoing MROP. The median duration of the third stage was 5 min, and <1% of cases exceeded 40 min. The duration of the third stage was an independent risk factor for increased blood loss (523 ± 376 vs. 239 ± 161 mL after and before 30 min, respectively; P < 0.001), higher PPH rates, and greater need for blood transfusion. When the third stage exceeded 30 min, MROP resulted in significantly greater median blood loss compared with expectant management (500 vs. 400 mL, P = 0.018) and a higher rate of PPH (62.96% vs. 38.58%, P < 0.001), whereas the duration of the third stage was significantly shortened (38 vs. 50 min, P < 0.001). CONCLUSION: Blood loss increased with prolonged third-stage duration, with a markedly higher risk of PPH after 30 min. In cases with an uncomplicated third stage, expectant management is preferable within the first 30 min. Beyond this point, either expectant management or MROP may be considered on an individualized basis, with appropriate preparedness for PPH.
Evaluation of ex-utero collection for umbilical cord blood banking: A randomized clinical trial comparing cord blood quality with the in-utero technique.
Ozbey N, Farssac E, García Martínez S … +5 more , Castillo N, Rodriguez-Melcon A, Querol S, Fernandez-Sojo J, Prats P
Int J Gynaecol Obstet · 2026 Jun · PMID 42240935 · Publisher ↗
BACKGROUND: Umbilical cord blood (UCB) can be collected in utero (before placental delivery) or ex utero (after placental delivery). While in utero collection is standard, ex utero collection is less intrusive during bir...
BACKGROUND: Umbilical cord blood (UCB) can be collected in utero (before placental delivery) or ex utero (after placental delivery). While in utero collection is standard, ex utero collection is less intrusive during birth and better tolerated by mothers. However, its efficiency remains unclear. OBJECTIVE(S): The primary objective was to demonstrate that ex utero umbilical cord blood (UCB) collection is non-inferior to in utero collection in terms of UCB unit weight, as a surrogate of collected volume. Secondary objectives were to confirm that progenitor cells obtained ex utero meet established quality criteria and that the method yields a lower rate of bacterial contamination. STUDY DESIGN: We conducted a prospective, unblinded, randomized clinical trial (from September 2023 to September 2024) at Hospital Universitari Dexeus and with the Concordia Cord Blood Program in Barcelona (Barcelona Cord Blood Bank) registered at ClinicalTrials.gov (Identifier: NCT05836974). Pregnant women were randomized 1:1 to ex utero or in utero collection. In the experimental arm, UCB was collected after placental delivery on a surgical table; in the control arm, collection occurred before placental delivery. In both arms, the cord was clamped 1 min after birth. A minimum UCB weight of 85 g was required. They were then distributed for further processing in: (i) research biobank/culture media (85-100 g); (ii) multicomponent use (>100 g with <1.5 × 10 nucleated cells); or (iii) transplantation (>100 g with >1.5 × 10 nucleated cells). Secondary endpoints included total nucleated cell (TNC) count, red blood cells count, hematocrit, platelets, and bacteriology, assessed only in units designated for clinical use. RESULTS: Of 133 patients screened, 129 were randomized. Following exclusions (10 in the in utero group and 18 in the ex utero group), a total of 53 in utero collections and 48 ex utero collections were analyzed. Baseline characteristics, including maternal age, gestational age, type of delivery, and newborn gender, were similar. The mean weight of the UCB was 107.19 ± 29.51 g ex utero and 110.81 ± 29.62 g in utero, resulting in a mean difference of -3.62 g (95% confidence interval [CI] -13.41; 6.16 g). The proportion of UCB units below 85 g was comparable between the groups. Both methods showed a similar distribution pattern. Bacteriology (number of samples tested were 35 in utero, 22 ex utero) yielded one positive culture in each group. Total nucleated cell counts, red blood cell counts, and hematocrit and platelet counts did not differ significantly between collection methods. CONCLUSION(S): Ex utero UCB collection is non-inferior to the standard in utero method in terms of UCB weight, cellular composition, and contamination rates. With standardized procedures, ex utero collection is a clinically viable alternative to facilitate umbilical cord blood donations. Date of registration: 19th April 2023. Date of initial participant enrollment: 1st September 2023. Clinical trial identification number: NCT05836974. URL of the registration site: ClinicalTrials.gov.
Value of echocardiography in the integrated management of fetuses with critical pulmonary stenosis or pulmonary atresia with intact ventricular septum.
Fu Y, Pang C, Shen J … +2 more , Yang L, Pan W
Int J Gynaecol Obstet · 2026 Jun · PMID 42234401 · Publisher ↗
OBJECTIVE: The aim of this study was to analyze the echocardiographic characteristics, intrauterine progression, postnatal outcomes, and follow-up results of fetuses diagnosed with critical pulmonary stenosis with an int...
OBJECTIVE: The aim of this study was to analyze the echocardiographic characteristics, intrauterine progression, postnatal outcomes, and follow-up results of fetuses diagnosed with critical pulmonary stenosis with an intact ventricular septum (CPS/IVS) and pulmonary atresia with an intact ventricular septum (PA/IVS) using echocardiography. METHODS: A retrospective cohort study was conducted on fetuses with isolated PA/IVS and CPS/IVS, collecting both morphological and hemodynamic echocardiographic data and following them postoperatively. RESULTS: A total of 48 cases were included in the study. On the initial ultrasound, eight cases were diagnosed with PA/IVS and 40 cases with CPS/IVS. The right ventricle/left ventricle long axis (RV/LV) ratio, right ventricle long axis (RV-L) z-score, and pulmonary artery/aorta (PA/AO) ratio for PA/IVS were significantly lower than those for CPS/IVS (RV/LV P < 0.001; RV-L P = 0.002; PA/AO P = 0.003). Severe tricuspid regurgitation (TR) was predominant in both PA/IVS and CPS/IVS, with six and 28 cases, respectively. A significant increase in RV-L, tricuspid valve (TV) annulus, and pulmonary valve (PV) was observed with gestational age and fetal growth. In an exploratory analysis, earlier gestational age at first ultrasound was associated with neonatal intervention (hypothesis-generating due to small sample size). Post-surgical follow-up showed improvements in RV/LV ratio, tricuspid valve/mitral valve (TV/MV) ratio, and PV z-score (P < 0.05), suggesting favorable short-term echocardiographic postoperative outcomes. CONCLUSION: In this cohort in which all infants achieved biventricular circulation, PA/IVS fetuses showed more compromised RV and PV annular development than CPS/IVS. Serial echocardiography demonstrated measurable growth of RV/TV/PV with gestation, while postnatal and post-intervention follow-up showed improved RV/LV ratio and PV z-scores. These findings support the descriptive value of echocardiography for longitudinal assessment and perioperative follow-up within an integrated management pathway.
Mortality trends in US women with concurrent sepsis and urinary tract infection.
Liu X, Xiong YJ, Meng X … +2 more , Lv T, Cai M
Int J Gynaecol Obstet · 2026 Jun · PMID 42227994 · Publisher ↗
OBJECTIVE: Urinary tract infections (UTIs) are common among women and are a recognized source of sepsis, particularly among older adults. However, long-term national mortality trends among females with concurrent UTI and...
OBJECTIVE: Urinary tract infections (UTIs) are common among women and are a recognized source of sepsis, particularly among older adults. However, long-term national mortality trends among females with concurrent UTI and sepsis remain inadequately characterized. METHODS: A retrospective population-based analysis was conducted using US mortality records from 1999 to 2023. Decedents were females aged ≥25 years with death certificates documenting both UTI (ICD-10: N39.0) and sepsis (A40-A41). Age-adjusted mortality rates (AAMRs) were computed using the 2000 US standard population. Joinpoint regression was applied to estimate annual percent change (APC) and average annual percent change (AAPC). Stratification included age, race, region, state, and urbanization level. RESULTS: A total of 275 514 deaths were identified. The UTI-sepsis AAMR rose from 6.07 per 100 000 in 1999 to 9.65 per 100 000 in 2023 (AAPC 2.26%, 95% confidence interval [CI]: 1.68-2.84). A significant increase was observed from 1999 to 2014, with a slower subsequent rise and a notable acceleration after 2019. The highest mortality burden was observed among women aged ≥85 years, while the steepest relative increases occurred in middle-aged groups. The South exhibited the highest regional mortality. Non-Hispanic Black women showed persistently elevated rates. Non-metropolitan areas experienced higher and more rapidly increasing mortality than metropolitan areas. CONCLUSION: Mortality among US females with concurrent UTI and sepsis has increased over two decades, accompanied by widening age, racial, and geographic disparities. These trends underscore the need for targeted interventions.
The utility of serum markers in the conservative management of placenta accreta spectrum (PAS) by leaving the placenta in situ in women with high-grade PAS.
Al Naimi A, Wiesmann C, Brueggmann D … +5 more , Hentrich AE, Deuster E, Hoock SC, Jennewein L, Louwen F
Int J Gynaecol Obstet · 2026 Jun · PMID 42223977 · Publisher ↗
OBJECTIVE: To investigate the association between serum markers and successful conservative management of patients with placenta accreta spectrum (PAS). METHODS: This was a retrospective case-control study where patients...
OBJECTIVE: To investigate the association between serum markers and successful conservative management of patients with placenta accreta spectrum (PAS). METHODS: This was a retrospective case-control study where patients with high-grade PAS between 2011 and 2025 undergoing conservative leaving the placenta in situ were included. The management followed the Frankfurt PAS Procedure where the placenta was left in situ after cesarean section (CS) followed by uterine artery embolization and two-step surgery. Regular laboratory investigations included the assessment of serum markers including beta human chorionic gonadotropin (β-hCG), serum placental growth factor (PlGF), progesterone, and pregnancy-associated plasma protein A (PAPP-A). Mixed effects models with random intercept were utilized to assess the association between the marker levels and uterine preservation over follow-up time. RESULTS: The study included 24 women, seven of which with successful uterine preservation had lower β-hCG, PlGF and progesterone with medians of 1469 (282.2, 5532), 117 (27.2, 258), and 24.5 (4.2, 66) compared to the 17 needing hysterectomy with medians of 9041 (3563, 16 824), 227.2 (129, 368), and 60 (47, 83), respectively, but no difference in PAPP-A levels. The mixed effects models showed a decline for β-hCG, PAPP-A, progesterone over time (P < 0.001), but not for PlGF. The rate of β-hCG drop was higher for patients with preserved uterus especially within the first two weeks of follow-up with a coefficient of 311 mIU/mL per day. CONCLUSION: β-hCG, PlGF and progesterone levels successively decrease after conservative PAS management, and there is a negative association between successful uterine retention and serum β-hCG levels. The optimal window for performing a two-step surgery might be 2-3 weeks post CS.
Rare vasculitis types and obstetric and neonatal outcomes - A population-based study.
Amikam U, Badeghiesh A, Baghlaf H … +2 more , Brown R, Dahan MH
Int J Gynaecol Obstet · 2026 Jun · PMID 42223974 · Publisher ↗
OBJECTIVE: Vasculitis is an infrequent pathology among reproductive-aged women. While data exists regarding pregnancy outcomes in the more common vasculitis subtypes, data is limited regarding these outcomes in rare vasc...
OBJECTIVE: Vasculitis is an infrequent pathology among reproductive-aged women. While data exists regarding pregnancy outcomes in the more common vasculitis subtypes, data is limited regarding these outcomes in rare vasculitis subtypes. We aimed to compare pregnancy and perinatal outcomes between women who suffered from rare types of vasculitis and those who did not. METHODS: This was a retrospective cohort study using the Healthcare Cost and Utilization Project- Nationwide Inpatient Sample (HCUP-NIS). All pregnant women who delivered or had a maternal death in the US (2004-2014) with an ICD-9 diagnosis of any of the following rare vasculitis subtypes: Polyarteritis nodosa, acute febrile mucocutaneous lymph node syndrome, hypersensitivity angiitis, Wegner's granulomatosis, giant cell arteritis, and Takayasu arteritis were included in the study. We divided the cohort into women with rare vasculitides (study group) and women without (control group). The obstetric and perinatal outcomes of the two groups were compared using multivariate logistic regression, adjusting for potential confounders. RESULTS: A total of 9 096 788 women met the inclusion criteria. Among them, 335 women (3.7/100000) had a diagnosis of rare vasculitis. Women with rare vasculitis, compared to those without, were more likely to be older; Caucasian; in the highest income quartile; be insured by private insurance; and have a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) ≥30, pregestational diabetes mellitus, thyroid disorders, and chronic hypertension (P < 0.05, all). Patients in the rare vasculitis group, compared to those without, had a higher rate of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI]: 1.4-2.56, P < 0.001); preterm delivery (aOR 1.76, 95% CI: 1.28-2.42, P < 0.001); and blood products transfusion (aOR 3.68, 95% CI: 2.14-6.34, P < 0.001); with higher rates of cesarean delivery (CD) (aOR 1.31, 95% CI: 1.05-1.64, P = 0.018); and a higher rate of congenital anomalies (aOR 4.1, 95% CI: 2.03-8.31, P < 0.001). Other perinatal outcomes, including placental abruption, hysterectomy, and venous thromboembolism, were comparable between the two groups. CONCLUSION: Women with rare vasculitis had a higher incidence of maternal complications, including hypertensive disorders of pregnancy, cesarean delivery and preterm delivery, as well as an increased risk of congenital anomalies.
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