Int J Gynaecol Obstet
· 2026 May · PMID 42141927
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OBJECTIVES: This study evaluates oral azithromycin's effectiveness in reducing intrapartum and puerperal infection rates in term pregnant women undergoing labor induction to guide antibiotic prophylaxis. METHODS: This si...OBJECTIVES: This study evaluates oral azithromycin's effectiveness in reducing intrapartum and puerperal infection rates in term pregnant women undergoing labor induction to guide antibiotic prophylaxis. METHODS: This single-center randomized controlled trial enrolled 472 women with term singleton pregnancies undergoing labor induction. The participants were randomly allocated to receive either 2 g of oral azithromycin (n = 236) or no treatment (n = 236). The primary outcome was the overall perinatal infection rate (which includes both intrapartum and/or puerperal infections). Secondary outcomes included maternal and neonatal complications, mode of delivery, and safety parameters. Results analysis adopted an intention-to-treat approach. RESULTS: The overall perinatal infection rate did not differ significantly between the azithromycin group (16.1%) and the control group (16.9%) (absolute risk difference [ARD] = -0.85%, relative risk [RR] = 0.950, 95% confidence interval 0.633-1.425; P = 0.804). Similarly, the incidence of neonatal infectious diseases showed no significant difference between the two groups (2.5% vs 5.1%, P = 0.149). Both groups had comparable outcomes in mode of delivery, maternal-neonatal complications (epidural analgesia, postpartum hemorrhage, and pre- and post-delivery antibiotic use), total labor duration, neonatal hypoglycemia, neonatal intensive care unit admission, and neonatal antibiotic administration. Maternal outcomes did not differ significantly between groups, although 3.4% (8/236) of women in the azithromycin group reported gastrointestinal symptoms during labor, with a total adverse event rate of 3.8% (9/236, including one case of dizziness). CONCLUSION: The use of an additional 2 g azithromycin provides no additional benefit in reducing the overall risk of maternal infection and perinatal infection in an already intensive antibiotic prophylactic and well-resourced setting. CLINICAL TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry, registration number ChiCTR2300077629, November 14, 2023 (https://www.chictr.org.cn/showprojEN.html).
Esteves AR, de Castro Pereira Bittar G, Lopes BM
… +1 more, Lima SMRR
Int J Gynaecol Obstet
· 2026 May · PMID 42141923
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OBJECTIVE: This study assessed the associations between gender identity (transmasculine vs transfeminine) and sexuality-related variables, including marital status, sexual partners, sex work, and age at first intercourse...OBJECTIVE: This study assessed the associations between gender identity (transmasculine vs transfeminine) and sexuality-related variables, including marital status, sexual partners, sex work, and age at first intercourse. METHODS: We conducted a cross-sectional retrospective study at a specialized transgender clinic in São Paulo, Brazil, analyzing medical records from March 2020 to August 2023. Data were routinely collected during clinical consultations through standardized questions for individualized care. Group assignment was based on self-identified gender identity documented in medical records. Chi-square and t-tests were applied (P < 0.05). RESULTS: We evaluated 74 individuals (trans men = 49, trans women = 25). Trans women were more frequently single (76% vs 44.9%, P = 0.014). Most reported one to five partners, but trans women more frequently reported no partners (16.7%) or >15 partners (11.1%) (P = 0.043). Sex work was more common among trans women (21.7% vs 6.3%, P = 0.049). No significant difference in age at first intercourse was observed (P = 0.298). CONCLUSION: Gender identity significantly influences relationship status, sexual behavior, and sex work engagement among transgender individuals. Trans women experienced greater sexual vulnerability, reflecting social exclusion and structural transphobia. These findings underscore the need for inclusive sexual health strategies and policies reducing structural inequalities.
Cuello MA, Ibañez C, Bustos M
… +19 more, Huete A, Gejman R, Brañes J, Orlandini E, Barriga MI, García K, Sáez N, Pertossi E, Úrzua M, Pérez V, Puga O, Saavedra M, Retamales J, Ramírez S, Walbaum B, Bennet JT, Canales JP, Lagos C, Misad C
Int J Gynaecol Obstet
· 2026 May · PMID 42138708
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Endometrial cancer incidence and mortality are rising globally, disproportionately affecting health systems facing diagnostic, therapeutic, and survivorship constraints. Rapid innovations-including the International Fede...Endometrial cancer incidence and mortality are rising globally, disproportionately affecting health systems facing diagnostic, therapeutic, and survivorship constraints. Rapid innovations-including the International Federation of Gynecology and Obstetrics (FIGO) 2023 staging, molecular classification, sentinel lymph node (SLN) mapping, evolving adjuvant strategies, immunotherapy, and digital tools-risk exacerbating inequities if implementation mismatches system readiness. This narrative review synthesizes key trials, international guidelines, and high-impact implementation studies published between 2010 and September 2025. We summarize contemporary evidence across staging, molecular pathology, imaging, surgery, radiotherapy, systemic therapy, survivorship, equity, and artificial intelligence (AI), translating this into a pragmatic, resource-stratified framework. A previously published principal-component-based structural-readiness clustering model encompassing 68 countries is applied-but not re-derived-to illustrate how health-system capacity shapes access to diagnostics, treatment, and innovation. Persistent gaps include limited availability of universal mismatch repair (MMR) and p53 immunohistochemistry, variable adoption of standardized SLN mapping, uneven radiotherapy access, restricted use of immunotherapy for mismatch-repair deficient (dMMR)/microsatellite instability high (MSI-H) tumors, and fragmented survivorship care. A minimum-core-optimal implementation ladder is proposed to guide diagnostic, surgical, radiotherapeutic, systemic-therapy, and survivorship priorities across varying resource levels. AI-supported quality assurance is discussed alongside essential requirements of local validation, bias mitigation, and robust governance. Rather than generating new empirical data, this review employs a cluster-informed, equity-oriented lens, applying previously validated system-level typologies to contextualize implementation gaps and support context-sensitive guideline adaptation.
Int J Gynaecol Obstet
· 2026 May · PMID 42112981
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BACKGROUND: Membranous dysmenorrhea, characterized by the expulsion of intact endometrial tissue rather than gradual dissolution during menstruation, occasionally presents as a decidual cast-a complete triangular mold of...BACKGROUND: Membranous dysmenorrhea, characterized by the expulsion of intact endometrial tissue rather than gradual dissolution during menstruation, occasionally presents as a decidual cast-a complete triangular mold of the uterine cavity. This poorly understood condition is likely underdiagnosed. OBJECTIVES: This study maps and describes the existing English literature on membranous dysmenorrhea and decidual cast expulsion, focusing on clinical presentation, etiology, and management. SEARCH STRATEGY: A scoping review was conducted according to Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed, EMBASE, Web of Science, and CINAHL were searched using the terms "membranous dysmenorrhea," or "membranacea dysmenorrhea," or "decidual cast," limited to English-language publications. The final search was performed in February 2026. Google Scholar and manual screening of references supplemented the search. SELECTION CRITERIA: English-language full text publications reporting on membranous dysmenorrhea or decidual cast expulsion were included, encompassing case reports, case series, and observational studies. DATA COLLECTION AND ANALYSIS: Data extracted included publication type, geographical origin, patient demographics, clinical features, and management approaches. Thematic analysis was performed to identify key patterns. MAIN RESULTS: One hundred and thirteen publications met inclusion criteria, including 86 case reports/series describing 121 individual cases, plus 42 additional cases from a single-author report. Patient ages ranged from 9 to 53 years. Most cases involved vaginal passage of tissue, with or without pain. Early reports noted spontaneous and recurrent episodes, while recent cases were often sporadic and involved hormonal treatments, particularly progestins. Additional associations were infection, ectopic pregnancy, pregnancy in uterus bicornis/didelphys, and postpartum hemorrhage. Proposed etiologies include hormonal influences (endogenous/exogenous progesterone), endometritis, or normal menstruation variants. Most cases resolved without intervention. Some required dilatation and evacuation of the uterine cavity. CONCLUSION: Membranous dysmenorrhea and decidual cast expulsion are benign phenomena that might cause diagnostic confusion and unnecessary interventions. Increased clinical awareness is essential for appropriate counseling and to distinguish this condition from early pregnancy loss. Hormonal contraceptives might act as both triggers and therapeutic agents. Further research beyond case reports is needed.
Magawa S, Nii M, Tamaishi Y
… +7 more, Okumura A, Takakura S, Maki S, Toriyabe K, Takayama E, Kondo E, Ikeda T
Int J Gynaecol Obstet
· 2026 May · PMID 42112952
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OBJECTIVE: Recurrent fetal heart rate (FHR) decelerations without acidosis are frequently observed during labor; however, the underlying autonomic mechanisms remain incompletely understood. This study explored fetal auto...OBJECTIVE: Recurrent fetal heart rate (FHR) decelerations without acidosis are frequently observed during labor; however, the underlying autonomic mechanisms remain incompletely understood. This study explored fetal autonomic responses to recurrent decelerations using FHR and FHR variability (FHRV) parameters. METHODS: This retrospective observational study included healthy women with singleton pregnancies, no pregnancy complications requiring treatment, and an umbilical artery pH >7.2 at delivery. Continuous FHR monitoring using fetal head electrodes was performed for ≥2 h before delivery (June-December 2021). FHRV was assessed using time-domain, frequency-domain, and nonlinear indices. RESULTS: Twenty-four patients were included. Baseline FHR did not differ between groups. In the recurrent deceleration group, root mean square of successive differences and high-frequency power were higher during the final 60 min before delivery. No differences were observed in standard deviation of normal-to-normal intervals or very-low-frequency power. Sample entropy was also higher, suggesting increased complexity of autonomic regulation. CONCLUSION: Fetuses with recurrent decelerations without acidosis demonstrated patterns consistent with increased vagal modulation, as inferred from FHRV indices. These findings may reflect an adaptive autonomic response; however, given the exploratory nature and small sample size, further studies are warranted.
Terada S, Morita A, Isumi A
… +4 more, Ugajin C, Khin YP, Shakagori S, Fujiwara T
Int J Gynaecol Obstet
· 2026 May · PMID 42112949
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OBJECTIVE: To evaluate the effectiveness of a motivation-based intervention for fathers to enhance empathy and egalitarian gender-role attitudes, aiming to prevent maternal postpartum depressive symptoms. METHODS: This w...OBJECTIVE: To evaluate the effectiveness of a motivation-based intervention for fathers to enhance empathy and egalitarian gender-role attitudes, aiming to prevent maternal postpartum depressive symptoms. METHODS: This was a single-blind, parallel-group randomized controlled trial conducted at a regional hospital in Japan. Eligible couples were recruited during the postpartum stay if the mother had a full-term birth and no psychiatric history. From October 2023 to November 2024, 262 fathers were enrolled and randomly assigned to the intervention or control group. The brief online intervention was delivered at 1 month postpartum. Follow-up assessments were conducted at 3 months (n = 221) and 6 months (n = 220). The primary outcome was maternal depressive symptoms (Japanese version of the Edinburgh Postnatal Depression Scale [EPDS]). Secondary outcomes included paternal gender-role attitudes, empathy, childcare and housework involvement, and paternal depressive symptoms. RESULTS: Sociodemographic variables were comparable between study arms. Maternal postpartum depression (EPDS ≥ 9) was 4.5% in the intervention group and 9.3% in the control groups (adjusted odds ratio [aOR] 0.45; 95% confidence interval [CI]: 0.14-1.50). With respect to paternal outcomes, the intervention arm significantly reduced traditional gender-role attitudes at 3 months (-1.74; 95% CI: -3.08 to -0.40) and 6 months (-1.52; 95% CI: -2.98 to -0.07), but no significant differences were observed in mother-rated paternal empathy or childcare and housework involvement. CONCLUSION: The intervention shifted paternal gender-role attitudes towards greater equality and flexibility, but did not produce measurable changes in paternal behavior or maternal depressive symptoms. Further studies are needed to confirm these findings. TRIAL REGISTRATION: The trial was registered with the UMIN Clinical Trials Registry (trial registration number: UMIN000051884. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000058421).
Root ER, Myers BA, Gaskins JT
… +4 more, Mukherjee A, Pierson RC, Miller EE, Kline J
Int J Gynaecol Obstet
· 2026 May · PMID 42112948
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OBJECTIVES: This study investigates the risk of cesarean delivery based on body mass index (BMI) in patients with class III obesity who undergo induction of labor. METHOD: This was a retrospective cohort study set in a u...OBJECTIVES: This study investigates the risk of cesarean delivery based on body mass index (BMI) in patients with class III obesity who undergo induction of labor. METHOD: This was a retrospective cohort study set in a university hospital. Study participants included patients presenting for delivery at term with class III obesity at the time of admission. A retrospective chart review was conducted of patients with a pre-delivery BMI ≥40 who delivered between May 2016 and December 2020 at a single institution. Patients were divided into the following BMI groups: 40-44.9, 45-49.99, 50-59.99, ≥60. Demographic and other clinical features were analyzed using analysis of variance and Fisher tests across BMI groups. Rates of labor induction and cesarean delivery (CD) were further analyzed by logistic regression. RESULTS: We identified 1010 patients with pre-pregnancy BMI ≥40 who delivered in the study period, of whom 497 met the study criteria. The median BMI in this population was 43.9 (interquartile range: 41.8-48.5, range 40.0-92.9). Twenty-seven percent of patients who underwent an induction of labor (IOL) delivered via CD compared to 12% for patients who presented in spontaneous labor. There were higher rates of induction seen in patients as BMI increased, but this effect was not seen in patients with BMI 60 or higher. The rate of CD was increased in patients who underwent IOL (P = 0.0332). This finding was only seen for those undergoing an elective IOL (P = 0.0088) but not a medically indicated IOL (P = 0.3588). CONCLUSION: Rates of induction of labor are higher in patients with higher BMI. In our cohort, those who underwent elective IOL were more likely to deliver via CD. Further study is needed to evaluate outcomes for patients with a BMI of 60 and greater, and more clarity is needed around recommendations for timing of elective induction of labor in patients with class III obesity.
Shi ZH, Guo Z, Dong XF
… +4 more, Zhang Y, Xu YD, Wu JL, Yang YY
Int J Gynaecol Obstet
· 2026 May · PMID 42104852
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OBJECTIVE: The aim of the current study was to assess the effects of psychological intervention combined with 1-day outpatient care on emotional well-being, glycemic control, and pregnancy outcomes in women diagnosed wit...OBJECTIVE: The aim of the current study was to assess the effects of psychological intervention combined with 1-day outpatient care on emotional well-being, glycemic control, and pregnancy outcomes in women diagnosed with gestational diabetes (GD). METHODS: Pregnant women who underwent a 75-g oral glucose tolerance test between 24 and 28 weeks of gestation from October 2022 to June 2024 and who were diagnosed with GD, received regular prenatal care, and who delivered at the study hospital were included. Women who voluntarily accepted the intervention were assigned to the intervention group, while those who did not were assigned to the control group. The intervention group received psychological intervention combined with 1-day outpatient care along with standard diagnosis and treatment, whereas the control group attended routine outpatient clinics. Measures of emotional well-being, glycemic control, and pregnancy outcomes were compared between the two groups. RESULTS: At study enrollment (24-28 weeks of gestation), no significant differences were observed between groups in Self-Rating Anxiety Scale (SAS) or Self-Rating Depression Scale (SDS) scores. However, SAS and SDS scores were significantly lower in the intervention group compared with the control group at 3 to 7 days postpartum. Similarly, no significant differences were noted in fasting plasma glucose (FPG), 2-h postprandial glucose (2hPG), or glycated hemoglobin (HbA) at enrollment. Prenatal 2hPG and HbA levels were significantly lower in the intervention group compared with the control group, as were prenatal FPG levels and the number of cases with abnormal urine glucose and urine ketones. The rate of spontaneous vaginal delivery was higher in the intervention group. Incidences of hypertensive disorders of pregnancy, premature rupture of membranes, polyhydramnios, preterm birth, fetal macrosomia, and neonatal hypoglycemia were lower in the intervention group than in the control group. CONCLUSIONS: Psychological intervention along with 1-day outpatient care was associated with reductions in negative emotions such as anxiety and depression, improvements in glycemic self-management, an increased rate of spontaneous delivery, reduced maternal and neonatal complications, and more favorable pregnancy outcomes in women with GD.
Eşkin Tanrıverdi MD, Cömert A, Kara ZG
… +2 more, Topçu HO, Açar Hİ
Int J Gynaecol Obstet
· 2026 May · PMID 42104845
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OBJECTIVE: To define and demonstrate a step-by-step surgical anatomical approach to pudendal nerve dissection using female cadavers, focusing on the identification of safe roadmap and key neurovascular structures to opti...OBJECTIVE: To define and demonstrate a step-by-step surgical anatomical approach to pudendal nerve dissection using female cadavers, focusing on the identification of safe roadmap and key neurovascular structures to optimize pelvic nerve surgery. METHODS: A descriptive anatomical study was conducted on 60 hemipelvises from 30 female cadavers. Dissections were performed in three stages comprising nine procedural steps to expose the pudendal nerve and related pelvic nerves. Key neurovascular landmarks were documented using video recordings. RESULTS: The dissection was organized into three stages: (1) exposure of the genitofemoral nerve and obturator fossa and its contents, (2) identification of the lumbosacral trunk and sciatic nerve, and greater sciatic notch (3) visualization of the pudendal nerve beneath the sacrospinous ligament. Variations in pudendal nerve branching and anatomical relationships with adjacent structures, including the sacrospinous ligament and ischial spine, were documented. This stepwise approach provided clear surgical landmarks to minimize the risk of nerve injury during pelvic surgery. CONCLUSION: This cadaveric study provides a detailed, practical roadmap for pudendal nerve dissection, enhancing anatomical understanding of pelvic neurovascular structures. The defined surgical approach in three stages, nine steps, and this comprehensive anatomical understanding can improve surgical precision and supports safer nerve-sparing techniques in complex pelvic surgery including gynecologic pelvic surgical procedures, surgeries for pudendal neuralgia, and deep infiltrating endometriosis.
Fatima L, Khan H, Bilal M
… +5 more, Rafique S, Siddique S, Kanwal M, Mahmood M, Irfan M
Int J Gynaecol Obstet
· 2026 May · PMID 42104844
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OBJECTIVES: Menstrual disorders adversely affect women's physical and psychological health. This study aimed to determine the prevalence of menstrual disorders and their association with sleep characteristics and mental...OBJECTIVES: Menstrual disorders adversely affect women's physical and psychological health. This study aimed to determine the prevalence of menstrual disorders and their association with sleep characteristics and mental health among young women in Pakistan. METHODS: A cross-sectional study was conducted from October 2024 to June 2025 among women aged 18-40 years. Data were collected using standardized tools, including the Pictorial Blood Assessment Chart, the Verbal Multidimensional Scoring System, the Sleep Timing Questionnaire, the Perceived Stress Scale-10, the Center for Epidemiologic Studies Depression Scale, and Generalized Anxiety Disorder-7. RESULTS: Initially, a total of 412 women were contacted, while 323 answered the questionnaire, and data from 217 complete questionnaires were analyzed. The prevalence of dysmenorrhea was 77.2%, while cycle-length disorders and bleeding disorders affected 19.0% and 20.4% of participants, respectively. Women with menstrual disorders showed significantly shorter sleep duration (449.4 ± 16.2 vs 505.2 ± 20.8 min; P = 0.040), greater sleep interruption (P = 0.001), and lower sleep efficiency (87.5% vs 93.2%; P = 0.003). The mean stress and depression scores were higher in women with menstrual disorders, with stress increasing by approximately 4.7 points and depression by 5.1 points. Each one-point rise in stress score increased the odds of menstrual disorders by 7.1%, and stress remained a significant independent predictor in the multivariate model. CONCLUSION: Menstrual disorders are highly prevalent among young Pakistani women and are strongly linked to elevated stress levels, poor sleep quality, and reduced sleep efficiency. Interventions addressing stress management, sleep hygiene, and menstrual awareness could improve both reproductive and mental health outcomes in this population.
Mocanu E, Tarlatzis B, Feldberg D
… +3 more, Diaz I, O'Brien C, Purandare N
Int J Gynaecol Obstet
· 2026 Jul · PMID 42104843
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The presence of uterine fibroids impacts fertility through multiple mechanisms. While subserosal fibroids have minimal impact, especially when of reduced size, the presence of intramural fibroids impacts both the likelih...The presence of uterine fibroids impacts fertility through multiple mechanisms. While subserosal fibroids have minimal impact, especially when of reduced size, the presence of intramural fibroids impacts both the likelihood of pregnancy and its outcomes. Submucosal fibroids significantly reduce the chance of pregnancy and increase pregnancy complications. While noninvasive techniques can treat fibroids and appear safe, surgical management of FIGO Type 0, 1, 2, and 3 fibroids remains the gold standard in women desiring pregnancy. Uterine artery embolization is not recommended. Where the ovaries are not visible due to the presence of large fibroids, assisted reproduction and transvaginal oocyte pick-up become a challenge and consideration for myomectomy should be given. A cesarean section should be performed for women where the uterine cavity has been opened at the time of myomectomy.
Int J Gynaecol Obstet
· 2026 May · PMID 42104841
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OBJECTIVE: This study assesses the changing patterns of domestic, sexual, and gender-based violence (DSGBV) among survivors managed at a dedicated referral center in North-East Nigeria over a 5-year period (2021-2025). M...OBJECTIVE: This study assesses the changing patterns of domestic, sexual, and gender-based violence (DSGBV) among survivors managed at a dedicated referral center in North-East Nigeria over a 5-year period (2021-2025). METHODS: A retrospective descriptive study was conducted at the Gender-Based Violence Unit of the Specialist Hospital Gombe. Records of all survivors of DSGBV managed between January 1, 2021, and December 31, 2025, were reviewed. Data on year of presentation, age, sex, type of violence, place of residence, and time of reporting were extracted. Descriptive statistics were used to summarize trends and distributions. Inferential analysis was performed using IBM SPSS version 26 (IBMCorporation, Armonk, NY, USA). This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS: A total of 675 survivors were recorded, with a progressive increase from 79 cases in 2021 to 171 in 2025. Adolescents aged 10-14 years consistently accounted for the highest proportion of cases (196/675; 29%). Females constituted 81.6% (551/675) of survivors. Sexual violence was the predominant form of abuse (556/675; 82.3%). Most survivors (601/675; 89.0%) resided in rural areas. Delayed reporting beyond 72 h was the most common pattern across all years. CONCLUSION: Reported cases of DSGBV increased progressively over 5 years, with children and adolescents bearing a disproportionate burden and sexual violence predominating. These findings highlight the need for strengthened routine screening, provider training, and equitable access to survivor-centered services, particularly for rural and adolescent populations in conflict-affected settings.
Aoki M, Obata S, Ogoyama M
… +16 more, Shimura K, Iwagoi Y, Kasahara M, Yoshida Y, Yamashita S, Sekizawa A, Hashii K, Nakata M, Murakoshi T, Katsuragi S, Tanaka H, Tanaka K, Sagara Y, Arakaki T, Hasegawa J, Working group of Maternal Mortality 2025 in the Japan Association of Obstetricians and Gynecologists
Int J Gynaecol Obstet
· 2026 May · PMID 42101038
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OBJECTIVE: To evaluate the effects of aortic occlusion (AO) on severe postpartum hemorrhage (PPH)-a leading cause of preventable maternal mortality-using a nationwide maternal death registry in Japan. METHODS: A nationwi...OBJECTIVE: To evaluate the effects of aortic occlusion (AO) on severe postpartum hemorrhage (PPH)-a leading cause of preventable maternal mortality-using a nationwide maternal death registry in Japan. METHODS: A nationwide retrospective observational study of hemorrhage-related maternal deaths was conducted in Japan between 2010 and 2024. Patients were classified into an AO group (resuscitative endovascular balloon occlusion of the aorta [REBOA] and/or resuscitative thoracotomy with aortic cross-clamping [RT-ACC]) and a non-AO group. The primary outcome was the achievement of definitive hemostatic procedures. Secondary outcomes included 24-h survival. RESULTS: Among 109 hemorrhage-related maternal deaths, 19 patients underwent AO (13 REBOA, six RT-ACC). Patients in the AO group were more frequently transferred to tertiary care centers than those in the non-AO group (84.2% (16/19) vs 43.3% (39/90), P < 0.01). Achievement of definitive hemostasis was significantly higher in the AO group (78.9% (15/19) vs 42.2% (38/90), P < 0.01), as were 24-h survival (42.1% (8/19) vs 15.6% (14/90), P = 0.02). Approximately 90% of AO procedures (17/19) were performed at tertiary centers, and only 16% (3/19) were initiated before cardiopulmonary arrest. CONCLUSION: AO, including REBOA and RT-ACC, was associated with higher rates of hemostasis and short-term survival among cases of maternal death due to severe PPH. Earlier application of AO before cardiopulmonary arrest may be critical to improving outcomes.
Anteby M, Wertheimer KO, Dominsky O
… +2 more, Hiersch L, Yogev Y
Int J Gynaecol Obstet
· 2026 May · PMID 42101016
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OBJECTIVE: To compare maternal and neonatal outcomes between women with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome with and without associated hypertension. METHODS: This was a retrospective co...OBJECTIVE: To compare maternal and neonatal outcomes between women with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome with and without associated hypertension. METHODS: This was a retrospective cohort study at a tertiary university-affiliated medical center including all singleton HELLP cases >24 weeks gestation (January 2011-March 2023). Cases were categorized as normotensive or hypertensive HELLP and compared for demographics, presentation, laboratory findings, and outcomes. RESULTS: Among 157 282 deliveries, 108 met the full criteria for HELLP syndrome: a total of 74 (68.5%) were hypertensive and 34 (31.5%) were normotensive. Normotensive HELLP cases were diagnosed at a significantly later gestational age (37.5 ± 3.0 vs 34.5 ± 4.4 weeks, P < 0.001). Proteinuria was less common in normotensive cases (58.8% vs 87.8%, P < 0.001). Laboratory parameters did not differ significantly between the groups. Neonates in the normotensive group had significantly higher mean birth weight (2574.6 ± 746.2 vs 1947 ± 816.6 g, P < 0.001), fewer neonatal intensive care admissions (29.4% vs 56.8%, P = 0.008), and lower rates of respiratory distress syndrome (2.9% vs 24.3%, P = 0.007). Maternal complications related to HELLP syndrome did not differ significantly between groups. CONCLUSION: Normotensive HELLP was diagnosed at a later gestational age and was associated with more favorable neonatal outcomes, yet comparable maternal outcomes. Despite the absence of hypertension, maternal complications were not reduced.
Etrusco A, Agrifoglio V, D'Amato A
… +9 more, Wyns C, Di Donna MC, Vitagliano A, Alviggi C, Conforti A, Laganà AS, Busnelli A, Levi Setti PE, Riemma G
Int J Gynaecol Obstet
· 2026 May · PMID 42087457
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BACKGROUND: Low serum progesterone levels around the time of frozen embryo transfer (FET) in artificially prepared cycles have been associated with reduced reproductive success. Rescue luteal phase support (LPS) has been...BACKGROUND: Low serum progesterone levels around the time of frozen embryo transfer (FET) in artificially prepared cycles have been associated with reduced reproductive success. Rescue luteal phase support (LPS) has been proposed as a strategy to optimize outcomes in these cases. OBJECTIVES: This study assesses the effectiveness of rescue LPS in improving reproductive outcomes among women with suboptimal serum progesterone levels prior to FET. METHOD: A comprehensive literature search was conducted to identify randomized and non-randomized (prospective or retrospective) studies evaluating the impact of additional progesterone administration in women with low serum levels around FET in artificial cycles. Twelve observational studies comprising more than 7500 participants were included. Eligible studies assessed clinical outcomes following supplemental progesterone via various routes in patients with below-threshold serum levels. A network meta-analysis was performed to compare the effectiveness of different rescue LPS protocols. Routes of progesterone administration included intramuscular, vaginal, oral, subcutaneous, and rectal. Primary outcomes included clinical pregnancy rate, live birth rate, ongoing pregnancy rate, pregnancy loss rate, and biochemical pregnancy rate. RESULTS: Rescue LPS in women with low serum progesterone was associated with improved reproductive outcomes, approaching that observed in women with adequate progesterone levels. Intramuscular and vaginal administration were frequently ranked highest, although no protocol demonstrated clear superiority. Significant heterogeneity existed across studies, particularly regarding progesterone cutoff values. CONCLUSION: Rescue luteal phase support appears to be a promising approach for managing low serum progesterone before FET. However, randomized controlled trials with standardized thresholds and protocols are needed to confirm these findings and guide clinical practice.