International Journal Of Gynaecology And Obstetrics[JOURNAL]
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200 papers
A cross-sectional study of caesarean deliveries performed by medical doctors and associate clinicians in nine district and regional hospitals in Sierra Leone using the Robson Ten Group Classification System.
Westendorp J, Jalloh R, Sheriff S … +8 more , Wussow J, Stamland G, Bjorøy SA, Moses F, Rijken MJ, Hoffmann-Lonnee R, Bolkan HA, van Duinen AJ
Int J Gynaecol Obstet · 2026 May · PMID 42216876 · Publisher ↗
OBJECTIVE: Maternal and neonatal mortality remain high in Sierra Leone despite significant decline in the last decade. The aim of the present study was to evaluate obstetric care delivery using the Robson Ten Group Class...
OBJECTIVE: Maternal and neonatal mortality remain high in Sierra Leone despite significant decline in the last decade. The aim of the present study was to evaluate obstetric care delivery using the Robson Ten Group Classification System (TGCS), focusing on caesarean delivery (CD) and task-sharing. METHODS: This cross-sectional study analyzed maternity and surgical registry data from nine governmental hospitals, collected over 4 months in 2021 or 2022. Variables included mode and outcome of delivery, TGCS parameters, and provider cadre: associate clinician (AC) or medical doctor (MD). RESULTS: Of 5748 women included in the study, 3806 (66.2%) delivered vaginally, 156 (2.7%) by assisted vaginal delivery and 1786 (31.1%) by CD. The largest TGCS groups were low risk primipara (28.8%) and multipara (47.0%). In the low risk primipara group, 450/1656 (27.2%) underwent CD; in the low risk multipara group, 604/2702 (22.4%) underwent CD. MDs performed 876 (49.1%) of the total CDs and ACs 830 (46.5%). ACs performed more CDs with the indication of twin pregnancy, previous CD, or malpresentation, whereas MDs performed more with the indication of breech, uterine rupture, and fetal distress. CONCLUSION: Facility-based CD rates in Sierra Leone are high, particularly among low risk primi- and multipara-Robson groups, while assisted vaginal delivery rates remain low. Nearly half of all CDs are performed by ACs, highlighting the importance of task-sharing in this context. Further in-depth analysis is warranted to understand the factors influencing CD decision making and the collaborative processes between ACs and MDs to improve maternal and neonatal outcomes.
Comparative outcomes of abdominal wall endometriosis surgery: Specialized endometriosis surgeons versus general surgical teams.
Josephy D, Yagur Y, Weinberg M … +5 more , Ben-Zion M, Sharvit M, Klein Z, Daykan Y, Schonman R
Int J Gynaecol Obstet · 2026 May · PMID 42210872 · Publisher ↗
OBJECTIVE: To assess the preoperative diagnostic accuracy of abdominal wall endometriosis (AWE) by general surgical teams and specialized endometriosis centers in assessing abdominal wall masses using clinical evaluation...
OBJECTIVE: To assess the preoperative diagnostic accuracy of abdominal wall endometriosis (AWE) by general surgical teams and specialized endometriosis centers in assessing abdominal wall masses using clinical evaluation and imaging. METHODS: A retrospective cohort study included patients with a pathologic diagnosis of AWE who underwent surgical excision between 2007 and 2022. Patients treated by specialized endometriosis surgeons were compared with those treated by general surgery teams. Data collected included patient demographics, lesion size, preoperative symptoms, diagnostic modalities, and surgical outcomes. Statistical analysis was conducted using univariant and multivariable regression models to identify factors associated with misdiagnosis. Correlation between the size of lesion and the need for the use of mesh was also done. RESULTS: A total of 46 patients with AWE were included; 27 (58.7%) were treated by the specialized endometriosis center and 19 (41.3%) by general surgeons. Evaluation by a specialized endometriosis center demonstrated a significantly higher correct diagnosis rate compared to the general surgery group (96.3% vs 42.1%, P < 0.001), with no significant difference in complication rates. Regression model revealed that admission by general surgeons increased the likelihood of misdiagnosis by 28 times (28.01 95% confidence interval [CI]: 2.74-286.47, P = 0.005). Computed tomography (CT) and magnetic resonance imaging were used more frequently in the general surgery group 42.1% versus 3.7%, P = 0.001. Endometriosis ultrasound was used more frequently in the specialized endometriosis group (100% vs 0%, P < 0.001). Independent of the group the probability of mesh use increased markedly for lesions larger than 3 cm with near certainty for lesions larger than 5 cm. CONCLUSION: Evaluation by specialized endometriosis surgeons was associated with significantly higher diagnostic accuracy of AWE detection compared with evaluation by general surgical teams. Early referral to experienced endometriosis units may reduce misdiagnosis and improve surgical planning.
Screening and care for individuals experiencing human trafficking: A practical guide for gynecology and obstetrics providers.
Peeler M, Jensen CE
Int J Gynaecol Obstet · 2026 May · PMID 42210871 · Publisher ↗
Human trafficking is a global problem in which victims are exploited for profit through forced labor, sexual exploitation, or forced marriage. Most human trafficking victims worldwide are women or girls. Women's health p...
Human trafficking is a global problem in which victims are exploited for profit through forced labor, sexual exploitation, or forced marriage. Most human trafficking victims worldwide are women or girls. Women's health professionals, especially obstetrician-gynecologists, are uniquely positioned to identify and provide interventions for individuals who are trafficked when they present for routine gynecological care, pregnancy, sexual trauma, or sexually transmitted infection screening or treatment. Clinicians working in obstetrics and gynecology should have ready access to screening tools for human trafficking victims in the healthcare setting and have a high index of suspicion to recognize victims. Brief, trauma-informed screening should be incorporated into routine confidential visits, and clear referral pathways should be available for all patients. National laws protecting victims of human trafficking vary. Still, most nations are party to the United Nations Protocol on Human Trafficking, which provides special immigration support and legal protection for identified victims of human trafficking. Clinicians working in obstetrics and gynecology should familiarize themselves with their local laws to best support their patients, particularly mandatory reporting statutes.
A twisted tale of torsion of the uterus in a post-menopausal woman: Computed tomography findings of a rare entity.
Chandak S, Lalwani A, Kumar A
Int J Gynaecol Obstet · 2026 May · PMID 42210859 · Publisher ↗
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Risk factors for not proceeding to reconstructive surgery after female genital mutilation: A cohort study of 220 women in a specialized referral center.
Joinau-Zoulovits F, De Sacy MS, Renevier B … +1 more , Abramowicz S
Int J Gynaecol Obstet · 2026 May · PMID 42206774 · Publisher ↗
OBJECTIVE: This study identifies factors associated with not proceeding to clitoral reconstructive surgery among women with female genital mutilation (FGM) enrolled in a specialized surgical pathway. METHODS: A retrospec...
OBJECTIVE: This study identifies factors associated with not proceeding to clitoral reconstructive surgery among women with female genital mutilation (FGM) enrolled in a specialized surgical pathway. METHODS: A retrospective cohort study was conducted at a multidisciplinary referral center in Montreuil, France, between January 2021 and December 2023. The study included 220 women who expressed a wish for reconstructive surgery during their initial assessment. Factors associated with non-progression to surgery were identified using univariable and multivariable logistic regression, supplemented by Bayesian analysis. RESULTS: Of the 220 women, 35% did not proceed to surgery. In the multivariable model, lack of support within the care pathway (odds ratio [OR] 3.28, 95% confidence interval [CI] 1.46-7.55; P = 0.004) and financial vulnerability, specifically reliance on state welfare (OR 3.43, 95% CI 1.28-9.80; P = 0.017) or financial support from relatives/community (OR 6.18, 95% CI 1.40-28.9; P = 0.017), were independently associated with non-progression. Model discrimination was good (area under the curve 0.75). Bayesian analysis confirmed these findings (P[direction] >99%) and suggested that memory of the FGM event also played a role (OR 1.87, 95% credible interval 0.88-4.09; P[direction] 94.9%). CONCLUSION: Access to clitoral reconstruction is primarily determined by socioeconomic stability and social support rather than clinical factors alone. These findings highlight the need for multidisciplinary pathways that integrate social and psychological accompaniment to ensure equitable access to care for vulnerable women.
Efficacy and safety of laparoscopic nerve decompression for neuropathic sciatic pain due to endometriosis: A systematic review and meta-analysis.
Racca C, Franken J, Cahen M … +3 more , Cicchelero A, Mormont M, Cinotti R
Int J Gynaecol Obstet · 2026 May · PMID 42200541 · Publisher ↗
OBJECTIVE: Endometriosis is associated with neuropathic pain in approximately 40% of cases. Involvement of the sciatic nerve or sacral plexus represents one of the most frequently reported neuropathic pain presentations...
OBJECTIVE: Endometriosis is associated with neuropathic pain in approximately 40% of cases. Involvement of the sciatic nerve or sacral plexus represents one of the most frequently reported neuropathic pain presentations in endometriosis, for which no specific management guidelines currently exist. This study evaluate the efficacy and safety of laparoscopic decompression of the sciatic nerve or the sacral plexus for neuropathic sciatic pain caused by endometriosis. METHOD: A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines using PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov for studies published between 2000 and 2025. Eligible studies included interventional and observational studies reporting outcomes in women undergoing laparoscopic decompression for neuropathic pain located along the sciatic nerve distribution due to endometriosis involving the sciatic nerve and/or the sacral plexus. Data extraction was performed independently by two reviewers. W le, a random-effects meta-analysis was conducted. The primary outcome was the variation of sciatic pain intensity from baseline to postoperative follow-up, assessed at least 3 months after surgery using validated pain scales. Risk of bias was evaluated using the Joanna Briggs Institute critical appraisal checklists. RESULTS: The search identified 933 records, of which eight studies were included in the final analysis, comprising 744 individuals. Preoperative sciatica attributable to endometriosis was reported in 83.2% of cases (n = 619). Operative findings revealed sciatic nerve involvement in 52.3% of cases (n = 389) and sacral nerve root involvement in 45.0% (n = 335). In a minority of individuals, involvement of other pelvic nerves was also reported. Across five studies with extractable pain-intensity data (n = 520), the pooled mean reduction in sciatic pain was 6.47 points (95% confidence interval 5.55-7.43) on validated 10-point scales. Complete resolution of neuropathic symptoms in the lower limb was reported in a subset of individuals. Major complications occurred in 8% of cases and were mainly associated with concomitant pelvic procedures. CONCLUSION: Laparoscopic nerve decompression appears to be associated with a clinically significant reduction in neuropathic sciatic pain related to endometriosis, with a low incidence of major nerve-related complications. However, as the available evidence is predominantly observational and characterized by a low to moderate risk of bias, these findings should be interpreted with caution and highlight the need for further well-designed studies. PROSPERO REGISTRATION: The study protocol was prospectively registered in PROSPERO (CRD420251107880) on July 19, 2025.
Identification of disproportionate reporting signals for ectopic pregnancy in the FAERS database from 2004 to 2024: A real-world pharmacovigilance study.
Fu L, Xu J
Int J Gynaecol Obstet · 2026 May · PMID 42200533 · Publisher ↗
BACKGROUND: Ectopic pregnancy (EP) is a serious obstetric complication with a rising global incidence, partly related to the increasing use of hormonal therapies and assisted reproductive technologies. Although structura...
BACKGROUND: Ectopic pregnancy (EP) is a serious obstetric complication with a rising global incidence, partly related to the increasing use of hormonal therapies and assisted reproductive technologies. Although structural abnormalities and infectious factors have been extensively studied, the reporting patterns of EP involving specific drugs remain insufficiently characterized in large spontaneous reporting systems. Previous studies have been limited by small sample sizes and heterogeneous designs, and potential drug-related EP reporting signals have not been comprehensively evaluated. METHODS: This retrospective real-world pharmacovigilance study used data from the FDA Adverse Event Reporting System (FAERS), covering reports submitted from the first quarter of 2004 (2004Q1) to the fourth quarter of 2024 (2024Q4). After deduplication, drug names were standardized using RxNorm and adverse event terms were standardized using MedDRA version 27.1. Reports involving EP-related coded terms were extracted. Disproportionality analysis using the reporting odds ratio and 95% confidence intervals was performed to evaluate drug-event reporting associations. Subgroup analyses were conducted according to drug class, indication, body weight, and time to onset. Weibull distribution modeling was applied to explore report-based temporal patterns of frequently reported drugs. RESULTS: A total of 4924 EP reports were identified, predominantly among women of reproductive age, with 46.6% aged 24-35 years. Levonorgestrel, etonogestrel, and clomifene showed the strongest disproportionate reporting signals for EP. Sixteen drugs, including interferon beta-1a, mifepristone, and lamivudine, were identified as potential novel safety signals not described in product labeling. The distribution of signal-positive drugs varied across body weight strata, with montelukast and medroxyprogesterone showing notable reporting signals in higher-weight subgroups. Time-to-onset analysis identified both early failure and random failure reporting patterns, supporting the need for temporally tailored pharmacovigilance strategies. CONCLUSION: This study identified disproportionate reporting signals for EP in a large spontaneous reporting database. These findings should be interpreted as hypothesis-generating pharmacovigilance observations rather than evidence of incidence, causal effects, or clinically confirmed risk differences. The results might help prioritize drug-event pairs for further evaluation and warrant validation in well-designed epidemiologic and clinical studies.
Global and US standards for intrapartum surveillance of the pregnant and the fetal patient.
Grünebaum A, Dudenhausen J, Chervenak FA
Int J Gynaecol Obstet · 2026 May · PMID 42200530 · Publisher ↗
OBJECTIVE: Cardiotocography is a dual-signal physiologic modality monitoring the pregnant and fetal patient. The objective of the present study was to compare global guidelines with the recently updated US Clinical Pract...
OBJECTIVE: Cardiotocography is a dual-signal physiologic modality monitoring the pregnant and fetal patient. The objective of the present study was to compare global guidelines with the recently updated US Clinical Practice Guideline. METHODS: A comparative analysis was conducted across global guidelines and the US guideline, evaluating three domains: uterine physiology, fetal heart rate interpretation, and management models. Definitions, interpretive structures, and triggers for intervention were compared without attempting to reconcile divergent frameworks. RESULTS: Global guidelines (cardiotocography) define uterine activity across multiple physiologic parameters and integrate these with fetal heart rate to assess the maternal-fetal unit as a single physiologic system. In contrast, the US guideline (fetal monitoring) defines tachysystole but does not explicitly define additional uterine physiologic parameters, and intervention is recommended when tachysystole is associated with fetal heart rate abnormalities rather than as an independent physiologic trigger. Global frameworks interpret fetal heart rate patterns within uterine context, whereas the US guideline emphasizes pattern recognition with limited formal integration of uterine physiology. These differences result in a preventive model in global guidelines and a comparatively reactive model in the US guideline. CONCLUSION: Intrapartum surveillance functions most effectively when uterine activity and fetal heart rate are interpreted as components of a maternal-fetal physiologic system. The US guideline provides detailed fetal definitions but leaves most uterine physiologic elements unspecified. Reintegration of explicit uterine physiologic definitions may improve physiologic coherence and support earlier intervention.
Understanding barriers to cervical cancer screening in Botswana: Insights from a cross-sectional study.
Russell JC, Amin S, Kohler RE … +11 more , Kelly H, Morroni C, Mosepele M, Larson E, Mochoba L, Kula M, Makhema J, Botha MH, Shapiro R, Ramogola-Masire D, Luckett R
Int J Gynaecol Obstet · 2026 May · PMID 42187282 · Publisher ↗
OBJECTIVE: Cervical cancer is the leading cause of cancer deaths among women in Botswana, yet uptake of cervical screening remains suboptimal. Understanding knowledge and barriers to screening is essential to inform stra...
OBJECTIVE: Cervical cancer is the leading cause of cancer deaths among women in Botswana, yet uptake of cervical screening remains suboptimal. Understanding knowledge and barriers to screening is essential to inform strategies to achieve cervical cancer elimination. METHODS: We conducted high-risk human papillomavirus (hrHPV) testing and an accompanying cross-sectional survey at health clinics and in the community in South East District, Botswana (February 2022-July 2023). Eligible participants were women aged ≥25 years with an intact cervix and no prior diagnosis of cervical cancer. Interviewer-administered structured questionnaires assessed demographics, prior screening attendance, knowledge of cervical cancer, and perceived barriers to screening. Open-ended responses were thematically categorized. Logistic regression was used to examine factors associated with knowledge and screening barriers. RESULTS: Of 3000 women screened, 2994 (99.8%) had known HIV status and were included. Median age was 43 years (interquartile range [IQR] 36-51), and 1500 (50.1%) were women with HIV (WWH). Overall, 67.2% (2005/2994) reported prior cervical cancer screening, with substantially higher uptake among WWH than women without HIV (80.0% vs 54.5%, P < 0.001). Knowledge of cervical cancer etiology was limited, with only 27.1% (788/2905) correctly identifying hrHPV as the cause. Younger age, HIV-positive status, higher education, formal employment, and prior screening attendance were independently associated with better knowledge. Among women who had never been screened, the most commonly reported barriers were lack of prioritization (38.3%; 376/981), fear (17.0%; 167/981), lack of awareness (17.0%; 167/981) and service provision issues (12.0%). CONCLUSION: Despite relatively high screening uptake, important gaps in knowledge and persistent individual- and system-level barriers remain. Strengthening cervical screening delivery through HPV self-collection alongside targeted education, would address current barriers to cervical screening in Botswana.
Effectiveness of immersive virtual reality-based interventions for alleviating peri- and post-procedural pain and anxiety in gynecologic settings: A systematic review and meta-analysis of randomized controlled trials.
González-Lara C, Piñar-Lara M, Obrero-Gaitán E … +2 more , García-López H, Cortés-Pérez I
Int J Gynaecol Obstet · 2026 May · PMID 42183746 · Publisher ↗
BACKGROUND: Non-pharmacological and complementary therapeutic, notably immersive virtual reality-based interventions (IVR), could alleviate pain and anxiety associated with gynecologic procedures. OBJECTIVE: To evaluate...
BACKGROUND: Non-pharmacological and complementary therapeutic, notably immersive virtual reality-based interventions (IVR), could alleviate pain and anxiety associated with gynecologic procedures. OBJECTIVE: To evaluate the effectiveness of IVR in reducing peri- and post-procedural pain and anxiety in gynecologic procedures. Secondarily, to determine the safety of IVR. SEARCH STRATEGY: A systematic review with meta-analysis was conducted, after searching in PubMed/Medline, SCOPUS, Web of Science, CINAHL Complete and PEDro from database inception to September 2025 with no language or publication date restrictions set. SELECTION CRITERIA: Inclusion criteria were based on the PICOS framework: Population (patients undergoing gynecologic procedures), Intervention (IVR), Comparison (standard care or other therapeutic approaches), Outcomes (pain, anxiety and adverse events) and Study design (randomized controlled trials [RCTs]). DATA COLLECTION AND ANALYSIS: Pooled effects were calculated using Cohen's standardized mean difference (SMD) and its 95% confidence intervals (95% CI) in a random-effects model. Potential adverse events during IVR exposure were also compiled. MAIN RESULTS: A total of 25 randomized controlled trials (RCTs), comprising data from 2438 women (mean age 35.3 ± 12.6 years), were included. Intraprocedural outcomes indicated that IVR significantly decreased both pain (SMD = -0.46, 95% CI: -0.71 to -0.21, P < 0.001) and anxiety (SMD = -0.33, 95% CI: -0.63 to -0.03, P = 0.031). Post-procedurally, IVR yielded further reductions in pain (SMD = -0.81, 95% CI: -1.12 to -0.5, P < 0.001) and anxiety (SMD = -0.76, 95% CI: -1.22 to -0.3, P = 0.001). Reported adverse events were minor and infrequent. CONCLUSION: This meta-analysis suggests that IVR serves as a highly effective and safe non-pharmacological adjunct for mitigating peri- and post-procedural pain and anxiety in gynecologic settings. Translating these findings into clinical practice could substantially enhance patient care and overall experience. PROSPERO REGISTRATION: CRD420251000835.
An external validation study of a practical scoring system for identifying patients at risk of pelvic floor dysfunction following childbirth.
Arcieri M, Segatti M, Bordin F … +12 more , Armenise D, De Martino M, Isola M, Mattiussi C, Barbui E, Filippin S, Tius V, Delneri C, Dialti V, Restaino S, Driul L, Vizzielli G
Int J Gynaecol Obstet · 2026 May · PMID 42183740 · Publisher ↗
OBJECTIVE: To prospectively evaluate the perineal card, a risk-based scoring system, for identifying women at increased risk of postpartum urinary incontinence (UI). METHODS: This prospective observational study included...
OBJECTIVE: To prospectively evaluate the perineal card, a risk-based scoring system, for identifying women at increased risk of postpartum urinary incontinence (UI). METHODS: This prospective observational study included women without previous vaginal delivery who underwent vaginal birth at a tertiary referral center between June 2023 and October 2024. The perineal card was completed at hospital discharge to assess obstetric and perineal risk factors and classify patients into low-, intermediate-, and high-risk groups. Postpartum pelvic floor outcomes were assessed at follow-up using a standardized screening tool with validated questionnaires. Logistic regression identified factors independently associated with UI, and discriminative performance was evaluated by receiver operating characteristic analysis. RESULTS: Of 296 enrolled women, 265 were included in the final analysis. At follow-up, 18.3% reported UI. Women with UI had higher median perineal card scores than asymptomatic women. UI during pregnancy, pre-pregnancy body mass index (BMI), labor induction, and postpartum urinary retention lasting more than 24 h were independently associated with postpartum UI. The perineal card showed moderate discriminative ability, with an area under the curve of 0.65. CONCLUSION: Use of the perineal card at discharge may help identify women at increased risk of postpartum UI and support timely referral for pelvic floor rehabilitation.
Minimally invasive surgical approach to OHVIRA syndrome with vaginal fistula and pyocolpos: A fertility-preserving case report.
Leyva JMZ, Jalomo SAA, Arredondo NH … +1 more , Kway VB
Int J Gynaecol Obstet · 2026 May · PMID 42175773 · Publisher ↗
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Implementing Robson's classification to compare Cesarean section rates over time at a public tertiary care hospital in Pakistan: An eye-opener.
Bilqis H, Rehman S, Kahloon LE … +3 more , Noreen H, Farkhanda T, Aziz M
Int J Gynaecol Obstet · 2026 May · PMID 42175756 · Publisher ↗
OBJECTIVE: The aim of the present study was to assess changes in cesarean section (CS) rates over 3 years at a public tertiary care hospital using the Robson Ten Group Classification System (RTGCS). The specific objectiv...
OBJECTIVE: The aim of the present study was to assess changes in cesarean section (CS) rates over 3 years at a public tertiary care hospital using the Robson Ten Group Classification System (RTGCS). The specific objectives were to compare population distribution across Robson groups, evaluate overall, group-specific, absolute and relative CS rates and assess data quality and completeness. METHODS: This analytical cross-sectional study was conducted at a public tertiary care hospital in Rawalpindi, Pakistan and spanned over two phases. Phase 1: June 2019 to November 2019 and phase 2: August 2022 to January 2023. For analysis, RTGCS was applied. Robson's report tables (RRTs) of two phases were generated to calculate and compare CS rates. Statistical analysis included the calculation of P values (considering <0.05 as significant) by chi-square and Fisher exact tests, odds ratios (ORs), relative risks (RRs) and 95% confidence intervals (CIs), using established online tools. RESULTS: The total number of women included in study during phase 1 were 5437, and in phase 2 were 3762. Overall CS rate increased from 31.06% (phase 1) to 40.09% (phase 2) (P < 0.001). In both phases, Robson group 3 was the largest (33% and 25.2% in phases 1 and 2, respectively) and group 9 was the smallest (<1%). The highest absolute contribution towards CS rate was made by group 5, followed by groups 10 and 2 in both phases. Combined contribution of groups 5, 10, and 2 was 70.5% in phase 1 and 64.9% in phase 2. Group 9 had the highest group-specific CS rate in both phases (93.7% and 100%). In phase 1, it was followed by groups 5 (80.4%), 6 (78.2%) and 7 (72%), while in phase 2 by groups 6 (89.6%), 5 (85.2%), and 8 (72.2%). In CS rate, a statistically significant increase was noted in Robson groups 1, 3, 5, 6, 8, and 10, while a decline was observed in group 4 only. CONCLUSION: The overall CS rate significantly increased over time. This rise was mainly due to a shift in the obstetric population in high-risk groups; 6, 8, 9, 10, and group 5. Conversely, the reduced CS rates in groups 2 and 4 suggest improved induction practices. The data quality was satisfactory.
Distant metastasis in patients with cervical cancer: A systematic review and meta-analysis of incidence rates and common sites.
Yang Y, Yu M, Zeng M
Int J Gynaecol Obstet · 2026 May · PMID 42171512 · Publisher ↗
BACKGROUND: Cervical cancer (CC) is a major global health problem, and distant metastasis is a critical determinant of prognosis and survival. However, comprehensive data on the incidence and distribution of non-lymphati...
BACKGROUND: Cervical cancer (CC) is a major global health problem, and distant metastasis is a critical determinant of prognosis and survival. However, comprehensive data on the incidence and distribution of non-lymphatic distant organ metastases are limited. OBJECTIVES: This systematic review and meta-analysis aimed to quantify the incidence of non-lymphatic distant organ metastasis in patients with CC and to identify the most commonly reported organ sites. SEARCH STRATEGY: A systematic search was conducted across PubMed/Medline, Web of Science, Scopus, and Embase from inception to March 1, 2025. To supplement the database searches and minimize publication bias, we also searched Google Scholar to identify potentially relevant studies. Reference lists of included studies were screened for additional eligible articles. SELECTION CRITERIA: Observational studies reporting the incidence or distribution of non-lymphatic distant organ metastases (bone, brain, liver, and lung) in CC cohorts were included. Case reports, reviews, and studies restricted exclusively to patients with established stage IVB/M1 disease at presentation were excluded, to avoid overrepresenting patients with already documented metastatic disease. DATA COLLECTION AND ANALYSIS: Data were extracted using a standardized form. Pooled incidence rates per 100 patients with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I statistic. MAIN RESULTS: A total of 42 studies, comprising 238 387 patients, were included in the analysis. The pooled incidence rate of metastasis was 2.91 per 100 CC patients (95% CI: 2.84-2.97). Regional analysis showed that the Western Pacific region had the highest pooled incidence at 4.66 per 100 patients (95% CI: 4.52-4.79), followed by the European region at 2.50 per 100 patients (95% CI: 2.09-2.97) and the Americas at 1.68 per 100 patients (95% CI: 1.61-1.75). Among site-specific non-lymphatic distant organ metastases, bone was the most common, with a pooled incidence of 3.67 per 100 patients (95% CI: 2.37-5.06), followed by lung metastases (3.00 per 100 patients, 95% CI: 2.13-4.21), brain metastases (1.83 per 100 patients, 95% CI: 0.91-2.75), and liver metastases (1.70 per 100 patients, 95% CI: 0.45-2.95). CONCLUSION: Our findings indicate that the incidence of distant metastasis varies substantially by anatomic site, with bone and lung being the most common locations. However, due to large heterogeneity, these findings should be interpreted as descriptive trends rather than precise estimates. The predominance of bone and lung metastases emphasizes the need for enhanced clinical awareness regarding these organs and underscores the importance of standardized prospective studies to validate these patterns and guide surveillance strategies.
Paroxetine versus placebo for the management of vasomotor symptoms in surgical menopause: A pilot double-blind randomized clinical trial.
Álvarez Castro HG, Romero Huete AP, Bu Urbina RE … +2 more , Cambar-González AR, Gutierrez-Ramirez RA
Int J Gynaecol Obstet · 2026 May · PMID 42171505 · Publisher ↗
OBJECTIVE: To evaluate the efficacy and safety of low-dose paroxetine (20 mg/day) compared with placebo for managing vasomotor symptoms (VMS) in women with surgical menopause. METHODS: This was a pilot randomized, double...
OBJECTIVE: To evaluate the efficacy and safety of low-dose paroxetine (20 mg/day) compared with placebo for managing vasomotor symptoms (VMS) in women with surgical menopause. METHODS: This was a pilot randomized, double-blind, placebo-controlled trial conducted at the Instituto Hondureño de Seguridad Social (IHSS), Tegucigalpa, Honduras, from January 30 to July 31, 2025. Women aged <48 years, within 6 months of total hysterectomy with bilateral salpingo-oophorectomy, and experiencing moderate-to-severe VMS (≥ 7 episodes/week) were eligible. Participants were randomized 1:1 to receive paroxetine 20 mg/day or matching placebo (folic acid 5 mg) for 12 weeks. The primary outcome was change in total Menopause Rating Scale (MRS) score. Secondary outcomes included quality of life (SF-36) and adverse events. Analysis followed the per-protocol approach, with intention-to-treat sensitivity analysis. RESULTS: Of 150 women assessed, 90 were randomized. A total of 47 women in the paroxetine group and 43 in the placebo group completed follow-up and were analyzed. At 12 weeks, the paroxetine group showed greater reduction in total MRS score compared with placebo (mean 16.9 ± 7.7 vs. 22.6 ± 6.1; mean difference -5.7, 95% CI -8.6 to -2.8; P < 0.001). SF-36 scores also improved more with paroxetine (91.0 ± 6.4 vs. 86.9 ± 4.8; mean difference 4.1, 95% CI 1.7 to 6.5; P = 0.001). Adverse events (headache, fatigue, drowsiness) were more frequent with paroxetine but mild and transient; no serious events occurred. The dropout rate was 14.4% (13/90), and intention-to-treat analysis showed consistent findings with slightly attenuated effect sizes. CONCLUSION: In this pilot study, paroxetine 20 mg/day showed promise in reducing VMS and improving quality of life in Honduran women with surgical menopause, with acceptable tolerability. The high attrition rate underscores the need for larger trials to confirm these findings.
Clinical outcomes of placenta accreta spectrum in a Tunisian referral maternity unit: A retrospective review.
Amine HM, Khaoula S, Salim Z … +8 more , Bilel S, Takwa H, Feriel BA, Rim BA, Sofiane BM, Samia K, Monia M, Khaled N
Int J Gynaecol Obstet · 2026 May · PMID 42171476 · Publisher ↗
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Uterine intra-leiomyoma metastasis originating from primary breast cancer: A rare entity.
Bartholomew V, Lopez N, Schammel CMG … +2 more , Devane AM, Schammel DP
Int J Gynaecol Obstet · 2026 May · PMID 42165695 · Publisher ↗
Metastasis to the female genital tract from extragenital primaries is uncommon, with breast and gastrointestinal malignancies representing the predominant sources. Uterine involvement accounts for fewer than 10% of genit...
Metastasis to the female genital tract from extragenital primaries is uncommon, with breast and gastrointestinal malignancies representing the predominant sources. Uterine involvement accounts for fewer than 10% of genital tract metastases and most frequently occurs in the setting of disseminated disease with concomitant ovarian involvement. Invasive lobular carcinoma (ILC), despite comprising only 5%-20% of breast malignancies, accounts for over 80% of breast cancer metastases to the female genital tract, a predilection attributed to loss of E-cadherin expression-facilitating tumor cell detachment and hematogenous dissemination-and its diffuse infiltrative growth pattern. Metastasis to uterine leiomyomas is exceptionally rare, with approximately 30 cases reported to date. The underlying pathophysiologic mechanism is postulated to involve the hormonally enriched microenvironment of leiomyomas, wherein tissue concentrations of estrogen and progesterone receptors significantly exceed those of the surrounding myometrium, thereby conferring preferential tropism for circulating hormone receptor-positive breast carcinoma cells. Supporting this, 92.3% of reported cases were estrogen receptor positive. Concurrent lymphatic and hematogenous dissemination pathways are implicated based on patterns of organ involvement, with isolated uterine metastasis in the absence of ovarian disease favoring hematogenous spread. We report a case of metastatic invasive ductal/lobular carcinoma (ER+/PR+/HER2-) infiltrating a uterine leiomyoma, identified incidentally on histopathologic examination six years after primary treatment, in an asymptomatic African American woman undergoing hysterectomy for pelvic organ prolapse-representing, to our knowledge, the first such case reported in an African American patient. Immunohistochemical profiling confirmed breast origin and receptor concordance with the primary tumor.
Forensic photography in a sexual assault treatment unit: Insights from an Irish pilot evaluation.
Marsh C, Pucillo C, Richardson D … +3 more , Kane D, Maher N, Eogan M
Int J Gynaecol Obstet · 2026 May · PMID 42165606 · Publisher ↗
OBJECTIVE: Accurate and timely injury documentation is essential to post-sexual assault care. Irish Sexual Assault Treatment Units (SATUs) have generally relied on police photographers to photo-document these injuries, l...
OBJECTIVE: Accurate and timely injury documentation is essential to post-sexual assault care. Irish Sexual Assault Treatment Units (SATUs) have generally relied on police photographers to photo-document these injuries, leading to potential delays and additional patient distress. International models show that on-site forensic photography by trained forensic examiners improves efficiency and evidentiary quality. The aim of the present study was to evaluate the feasibility, acceptability and service impact of introducing forensic photography by forensic examiners within an Irish SATU. METHODS: An 11-month quality improvement pilot was undertaken at the Dublin SATU. A human-centered design approach incorporated staff surveys, forensic examiner reflections, observations and consultation with collaborating agencies. Eligible cases included patient's ≥14 years with visible (non-genital) injuries, examined by SATU forensic examiners who had completed additional training in forensic photography as part of the pilot and who provided informed consent for inclusion in research. RESULTS: Of 370 attending patients, 258 (69.7%) underwent a forensic examination. Among these, 69 (26.7%) were examined by pilot-trained staff and 23 (33.3%) consented to photography, representing 8.9% of the total cohort. Photography added a mean of 9 min to examination time. Examiner confidence improved substantially over the period of the pilot, and a secure chain-of-custody was established. Patient feedback indicated reduced anxiety when photography occurred within the SATU setting. A total of 103 patients with injuries in the non-pilot group received no photo-documentation due to unavailability of trained staff at the time of examination. CONCLUSION: The introduction of forensic photography within the Dublin SATU proved feasible, acceptable and legally robust. This pilot supports the integration of forensic photography as a trauma-informed component of sexual assault care and provides a foundation for national and international service development.
Type 2 diabetes and gynecologic cancers: Immunometabolic convergence and translational implications.
Cuello MA, Ibañez C
Int J Gynaecol Obstet · 2026 May · PMID 42153964 · Publisher ↗
Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic condition and an increasingly relevant host factor in cancer prevention, treatment, and survivorship. In gynecologic oncology, clinical observational data lin...
Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic condition and an increasingly relevant host factor in cancer prevention, treatment, and survivorship. In gynecologic oncology, clinical observational data link diabetes and broader metabolic dysfunction phenotypes to adverse outcomes in selected malignancies, including HPV-related disease and cervical cancer outcomes, and more consistently reported observational associations in endometrial cancer cohorts. Mechanistically, convergent signaling hubs-insulin/IGF biology, PI3K/AKT/mTOR, and inflammatory circuits such as IL-6/JAK/STAT3 and NF-κB-provide biological plausibility for diabetes-related effects on tumor growth, immune regulation, and treatment response. Persistent hyperglycemia can induce durable immune and epigenetic remodeling consistent with metabolic memory and trained immunity frameworks. Translational evidence is most developed for metformin, including randomized presurgical evaluation in uterine malignancy settings, while other antidiabetic drug classes (e.g., SGLT2 inhibitors and incretin-based biology) have emerging mechanistic and observational oncology-relevant signals that warrant biomarker-driven evaluation. We integrate a targeted narrative synthesis with exploratory transcriptomic and spatial analyses to generate testable hypotheses and propose pragmatic clinical implications and research priorities to support metabolic assessment within gynecologic cancer care pathways.
Evaluation of a novel fetal echocardiography training programme in two tertiary care obstetric Centres.
Cody F, Franklin O, Lynch C … +4 more , Molphy Z, Dicker P, Malone F, Breathnach FM
Int J Gynaecol Obstet · 2026 May · PMID 42153946 · Publisher ↗
OBJECTIVES: Improving and maintaining high detection rates for major congenital heart disease (CHD) is a priority for successful prenatal anatomy screening programmes. The primary objective of this study was to evaluate...
OBJECTIVES: Improving and maintaining high detection rates for major congenital heart disease (CHD) is a priority for successful prenatal anatomy screening programmes. The primary objective of this study was to evaluate the utility of on-site multidimensional targeted training in fetal cardiac screening. METHODS: A prospective study evaluating a targeted fetal echocardiography (FE) training programme in two obstetric tertiary care units was established. The programme was designed and approved by a dedicated fetal cardiology team. The one-day intervention involved supervised hands-on sonography and a prescribed educational programme for sonographers and doctors. The programme was completed by 23 trainees. Evaluation of the programme involved pre and post-training questionnaires and retrospective evaluation of cardiac images from 10 randomly-selected anatomy screening examinations performed by each trainee before and after training. Images were assessed for both technical quality and 6 priority elements of cardiac screening taught in the programme. The results were described with summary statistics and non-parametric tests. RESULTS: 1850 fetal cardiac images obtained before and after training by 21/23 trainees were assessed. Significant improvement was seen in the priority cardiac views obtained, for example from 24%(5/21) to 86%(18/21) for bifurcating pulmonary artery (P-value 0.001), from 33%(7/21) to 86%(17/21) for differential atrio-ventricular valve insertion (P-value 0.001), In addition, technical image quality improvements were observed following training as well as sonographer confidence. CONCLUSION: A targeted FE training programme can improve understanding of the priority elements required to exclude major CHD in prenatal screening, improve image quality, and sonographer confidence in cardiac screening.
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