Nahshon C, Cohen N, Goldberg Y
… +5 more, Boms N, Lavie O, Damti A, Kedar R, Zilberlicht A
Int J Gynaecol Obstet
· 2026 May · PMID 42080640
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BACKGROUND: Effective pushing during the second stage of labor is critical for optimal birth outcomes, but many women-especially those under epidural analgesia-struggle with reduced pelvic sensation and pushing efficacy....BACKGROUND: Effective pushing during the second stage of labor is critical for optimal birth outcomes, but many women-especially those under epidural analgesia-struggle with reduced pelvic sensation and pushing efficacy. Transperineal ultrasound is widely used to assess labor progression, and visual biofeedback has shown promise in improving physical and psychological outcomes in other fields. However, its application during labor remains underexplored. OBJECTIVE: This study assesses the effect of sonographic visual biofeedback before and during labor on obstetric outcomes. METHOD: We performed an electronic search using MEDLINE with the OvidSP interface PUBMED, Embase, Web of Science, and Cochrane Library up to August 13, 2024. We included experimental and non-experimental studies, comprising randomized controlled and observational (case-control, cohort, and cross-sectional) studies assessing the effect of sonographic visual biofeedback on delivery outcomes. Four references comprising 457 patients were eventually included. Primary data collection was performed using standardized data extraction procedures, with disagreements being settled by discussion. Analysis was conducted using RevMan 5.4 (Cochrane Collaboration, Oxford, UK). RESULTS: Visual biofeedback is associated with a more pronounced change in angle of progression (AoP) measurements when comparing resting state to active pushing (mean difference [MD] 5.04 [95% confidence interval [CI] 1.42-8.66], P = 0.006, I = 63%), and the overall AoP while pushing was notably greater in the visual feedback group (MD 9.23 [95% CI 0.94-17.53], P = 0.03, I = 76%). There were no statistically significant differences in mode of delivery, duration of second stage of labor, rates of intact perineum, and incidence of second- and third-degree perineal tears. A significant reduction in episiotomies among patients who received visual feedback was observed (OR 0.42 [95%CI 0.24-0.76], P = 0.004, I = 0%). CONCLUSION: Visual feedback might influence maternal pushing behavior and enhance pushing efficacy, potentially reducing obstetrical interventions such as episiotomies. Additional prospective randomized studies are needed to definitively determine the effect of visual biofeedback on a wide range of obstetric outcomes. Such research could help refine the use of this technique and potentially improve the labor experience and outcomes for many women. The study protocol can be assessed at the PROSPERO International prospective register of systematic reviews (www.crd.york.ac.uk/PROSPERO, registration number CRD42024570484).
Poyet S, Degez M, Compaoré Y
… +3 more, Misbert E, Winer N, Dochez V
Int J Gynaecol Obstet
· 2026 May · PMID 42080631
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OBJECTIVE: Prophylactic oxytocin (5-10 IU) after vaginal birth is a grade A recommendation in France. During cesarean delivery, carbetocin is increasingly used as an alternative to oxytocin to reduce the risk and burden...OBJECTIVE: Prophylactic oxytocin (5-10 IU) after vaginal birth is a grade A recommendation in France. During cesarean delivery, carbetocin is increasingly used as an alternative to oxytocin to reduce the risk and burden of postpartum hemorrhage (PPH). Its role after vaginal birth remains uncertain, largely because of higher costs. This study assessed the cost-effectiveness of carbetocin for PPH prevention in vaginal deliveries. METHODS: We performed a retrospective single-center, observational before-after cohort study with a medico-economic component in a French tertiary maternity unit. All women who delivered vaginally between January 1 and March 31, 2024 (oxytocin period), and between November 1, 2024, and January 31, 2025 (carbetocin period), were included. These two periods corresponded to the institutional protocol change replacing oxytocin with carbetocin for prophylaxis of postpartum hemorrhage after vaginal delivery. RESULTS: A total of 1404 women were analyzed (702 per group). The overall PPH rate was similar between groups (9.0% vs. 7.8%). Severe PPH (≥1000 mL) occurred less frequently with carbetocin than with oxytocin (1.3% vs. 3.0%, P = 0.0244). Weighted mean costs per patient were €17.28 in the carbetocin group and €9.07 in the oxytocin group, with a mean difference of €8.11 (95% confidence interval [CI]: 0.31-15.48). The incremental cost-effectiveness ratio (ICER) was €511.87 per severe PPH avoided. CONCLUSION: Despite higher drug costs, prophylactic carbetocin significantly reduced severe PPH compared with oxytocin and showed favorable cost-effectiveness in vaginal deliveries. These findings support carbetocin as a valuable alternative for PPH prevention in this setting.
Chao WT, Liu CH, Yang ST
… +3 more, Lin CH, Wang LW, Wang PH
Int J Gynaecol Obstet
· 2026 May · PMID 42080626
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OBJECTIVE: To investigate the role of ST3 β-galactoside α-2,3-sialyltransferase 1 (ST3Gal1) and vascular endothelial growth factor receptor 2 (VEGF-R2) in endometrioid-type epithelial ovarian cancer (E-OC) because aberra...OBJECTIVE: To investigate the role of ST3 β-galactoside α-2,3-sialyltransferase 1 (ST3Gal1) and vascular endothelial growth factor receptor 2 (VEGF-R2) in endometrioid-type epithelial ovarian cancer (E-OC) because aberrant α2,3-sialylation mediated by ST3Gal1 and VEGF-R2-related angiogenesis is linked with tumor progression. METHODS: ST3Gal1 and VEGF-R2 expression levels were analyzed in E-OC tissues and cell lines. ST3Gal1 knockdown and ST3Gal1 inhibitor soyasaponin I (SsaI) treatment were performed to evaluate the effects of altered sialylation on the VEGF-R2 pathway, downstream Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling, and cell migration/invasion. Co-immunoprecipitation experiments were conducted to confirm the interaction between ST3Gal1 and VEGF-R2. The combination of SsaI and VEGF-R2 inhibitors was assessed using in vitro and in vivo studies. RESULTS: High ST3Gal1 expression was associated with advanced E-OC stage and poorer overall survival in a univariable analysis; however, it did not retain independent prognostic significance in a multivariable analysis. ST3Gal1 knockdown reduced VEGF-R2 expression and inhibited downstream JAK2/STAT3 signaling and suppressed tumor cell migration and invasion. SsaI treatment reduced VEGF-R2 signaling and impaired metastatic potential in vitro. The combined inhibition of ST3Gal1 and VEGF-R2 reduced tumor growth in vivo. CONCLUSIONS: Targeting ST3Gal1-mediated α2,3-sialylation disrupts VEGF-R2 signaling and suppresses metastatic behavior in E-OC models. Although clinical associations suggest a potential link with adverse outcomes, larger studies are required to clarify its independent prognostic significance. Combined inhibition of ST3Gal1 and VEGF-R2 reduced tumor growth in vivo; these findings support further investigations of ST3Gal1 as a potential therapeutic target in E-OC.
Y.A. Bassiouny, D.M.R. Dakhly, Y.A. Bayoumi, N.A. Salaheldin, H.A. Gouda, and A.A. Hassan, "Randomized Trial of Combined Cabergoline And Coasting in Preventing Ovarian Hyperstimulation Syndrome During In Vitro Fertilizat...Y.A. Bassiouny, D.M.R. Dakhly, Y.A. Bayoumi, N.A. Salaheldin, H.A. Gouda, and A.A. Hassan, "Randomized Trial of Combined Cabergoline And Coasting in Preventing Ovarian Hyperstimulation Syndrome During In Vitro Fertilization/intracytoplasmic Sperm Injection Cycles," International Journal of Gynecology & Obstetrics 140, no. 2 (2018): 217-222, https://doi.org/10.1002/ijgo.12360. This retraction has been issued for the above article, published online on 21 October 2017 in Wiley Online Library (wileyonlinelibrary.com), by agreement between the journal Editor-in-Chief, Michael Geary; and John Wiley & Sons Ltd. A third party expressed concerns about the randomization allocation process, noting that the reported methodology does not appear to reflect the standards of a randomized clinical trial. When asked for clarification, the authors provided their study data and explanation. However, the editorial team and publisher did not feel that the answers and data alleviated the concerns with the methodology. While the work may have been undertaken in good faith, it does not meet the minimum standards to constitute a randomized study. As a result, the data and conclusions are considered unreliable, and therefore the article must be retracted.
Razai MS, Nejadghaderi SA, Khaliqi S
… +2 more, Haress G, Cook RJ
Int J Gynaecol Obstet
· 2026 Jun · PMID 42063270
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This article synthesizes recent peer-reviewed studies and institutional reports on maternal mortality following the Taliban's return to power in Afghanistan in August 2021 and compares emerging patterns with the first Ta...This article synthesizes recent peer-reviewed studies and institutional reports on maternal mortality following the Taliban's return to power in Afghanistan in August 2021 and compares emerging patterns with the first Taliban period (1996-2001), when maternal mortality reached some of the highest levels recorded in conflict settings. Multiple data sources indicate worsening conditions after 2021, including sharp reductions in service utilization following funding interruptions, reported declines in access to antenatal and intrapartum care, and clinician-reported increases in delays and life-threatening obstetric complications. Modeling based on routine health data suggests that sustained reductions in coverage could result in thousands of additional maternal deaths annually. The acute difference between Afghanistan, especially since 2021, and many other fragile settings is that gender-based restrictions specifically target women's and girls' education, employment, and movement, directly affecting demand-side access and supply-side staffing capacity for maternal care, thus offending Afghanistan's obligations under the Convention on the Elimination of All forms of Discrimination against Women.
OBJECTIVE: To assess the role of fetal renal artery Doppler indices, specifically the pulsatility index (PI) and resistive index (RI), along with reduced fetal urine production rate (FUPR) in predicting fetal inflammator...OBJECTIVE: To assess the role of fetal renal artery Doppler indices, specifically the pulsatility index (PI) and resistive index (RI), along with reduced fetal urine production rate (FUPR) in predicting fetal inflammatory response syndrome (FIRS) in women with preterm prelabor rupture of membranes (PPROM). METHODS: A prospective, observational study was conducted in a tertiary care center of 160 singleton pregnancies between 28 and 36 weeks of gestation with PPROM. Fetal renal artery Doppler measurements (PI and RI) and FUPR estimation by measurement of bladder volume were performed weekly using ultrasound until delivery. At delivery, cord blood was collected for IL-6 quantification, and placental tissue was examined for histologic evidence of FIRS. FIRS was defined as IL-6 levels ≥11 pg/mL and/or histopathologic findings of funisitis/chorionic vasculitis. Statistical analyses including receiver operating characteristic (ROC) curves were performed, with P < 0.05 considered statistically significant. RESULTS: Of the 160 participants, 103 (64.4%) were diagnosed with FIRS. The mean IL-6 concentration was significantly higher in the FIRS group (210.40 ± 133.70 pg/mL vs. 7.44 ± 2.01 pg/mL, P < 0.001). Fetal renal Doppler indices were significantly elevated in the FIRS group (PI: 2.93 ± 0.08 vs. 2.41 ± 0.11, P < 0.001; RI: 0.96 ± 0.04 vs. 0.88 ± 0.03, P < 0.00). Reduced FUPR (<5th percentile for gestational age) was observed in 99% of FIRS cases. FUPR had significant inverse relationship with fetal renal Doppler indices. ROC analysis identified a PI ≥2.8 as the optimal cutoff for predicting FIRS, with 98.8% sensitivity and 100% specificity. CONCLUSION: Fetal renal artery Doppler indices offer a reliable, noninvasive method for early prediction of fetal inflammation, enabling timely interventions to improve maternal and neonatal outcomes.
OBJECTIVE: To develop and temporally validate a nationwide prediction model for cesarean delivery following induction or augmentation of labor in Japan. METHODS: We conducted a retrospective cohort study using the Japan...OBJECTIVE: To develop and temporally validate a nationwide prediction model for cesarean delivery following induction or augmentation of labor in Japan. METHODS: We conducted a retrospective cohort study using the Japan Society of Obstetrics and Gynecology Perinatal Database. Women with singleton pregnancies who underwent induction or augmentation of labor at ≥37 weeks of gestation between 2020 and 2022 were included. Cases from 2020 to 2021 (n = 113 572) formed the development cohort, and cases from 2022 (n = 59 045) served as the temporal validation cohort. Predictors were selected based on clinical relevance. Variable selection used least absolute shrinkage and selection operator logistic regression with the one standard error rule, followed by multivariable logistic regression. Model performance was assessed with the area under the receiver operating characteristic curve (AUROC) and calibration plots. RESULTS: A total of 172 617 women were included in the study. Thirteen predictors were selected: maternal age, height, pre-pregnancy body mass index (BMI), gestational BMI gain, multiparity, gestational age, assisted reproductive technology pregnancy, mechanical cervical ripening, pregestational diabetes mellitus, hypertensive disorders of pregnancy, epidural analgesia, birthweight, and neonatal sex. Discrimination was good in the development cohort (AUROC 0.757, 95% confidence interval [CI] 0.754-0.761) and temporal validation cohort (AUROC 0.767, 95% CI 0.762-0.772). Multiparity and epidural analgesia were associated with lower risk, whereas all other predictors increased cesarean risk (all P < 0.001). CONCLUSION: This nationwide prediction model demonstrated robust performance and might support individualized counseling, risk assessment, and perinatal care planning.
OBJECTIVE: To investigate the association between systemic inflammatory indices, including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflam...OBJECTIVE: To investigate the association between systemic inflammatory indices, including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), and vascular events during pregnancy, and to evaluate their association with maternal disease severity, particularly maternal intensive care unit (ICU) requirement. METHODS: This retrospective cohort study included pregnant and postpartum women with vascular events and gestational age-matched controls without vascular events. Inflammatory indices were calculated using first-trimester laboratory parameters and values obtained at the time of vascular event diagnosis. Group comparisons were performed using non-parametric tests, and receiver operating characteristic (ROC) curve analyses were conducted to assess the predictive performance of inflammatory indices for maternal ICU requirement. RESULTS: First-trimester inflammatory indices (SII-1, SIRI-1, and AISI-1) and delta (Δ) values did not differ significantly between groups. In contrast, inflammatory indices measured at the time of vascular event diagnosis (SII-2, SIRI-2, and AISI-2) were significantly higher in women who experienced vascular events. These indices were not associated with composite adverse perinatal outcomes (CAPO), neonatal intensive care unit (NICU) admission, or maternal sequelae. However, all three indices were significantly associated with maternal ICU requirement. Among them, SIRI-2 demonstrated the strongest discriminatory performance for predicting maternal ICU admission (area under the curve: 0.911). CONCLUSION: Systemic inflammatory indices measured at the time of vascular event diagnosis may be associated with maternal disease severity but not with adverse perinatal outcomes; however, further prospective studies are needed to confirm their clinical utility.
OBJECTIVE: Recent previous studies have revealed outcomes of higher risk of low birth weight, small for gestational age, and pre-eclampsia for vegan pregnant women compared to other diets. This review examined if patient...OBJECTIVE: Recent previous studies have revealed outcomes of higher risk of low birth weight, small for gestational age, and pre-eclampsia for vegan pregnant women compared to other diets. This review examined if patients with vegan diet in our tertiary hospital had similar outcomes. METHODS: A retrospective cohort study was conducted for 2022-2024 examining the factors of those who ate an unrestricted diet versus vegan diet (10 270 vs 68 women). Data included maternal demographics, clinical factors and pregnancy outcomes. Statistical analysis was performed using SPSS version 29. RESULTS: Vegans demonstrated a lower body mass index (BMI) than those with an unrestricted diet (P < 0.05). There was no difference in reported anemia in vegans versus those with unrestricted diets (17.6% vs 16.1%, P = 0.73) and no significant risk for requiring a blood transfusion either (2.9% vs 3.4%, P = 0.84), respectively. There was no statistically significant difference between the outcomes of those with a vegan versus unrestricted diet in median birth weight (3390 vs 3410 g, P = 0.77) or rate of premature delivery <37 weeks (7.4% vs 9.5%, P = 0.55). There was also no statistically significant difference for developing gestational diabetes (8.8% vs 9.9%, P = 0.77), or gestational hypertension (0% vs 3.5%, P = 0.12) for vegans versus unrestricted diets, respectively. CONCLUSION: The outcome in pregnancy for women with vegan and unrestricted diets was equivalent in our cohort. There is limited research on the consequences of vegan diets in pregnancy and further observational longitudinal studies are required for more robust data. Socioeconomic factors should be taken into consideration.
OBJECTIVE: Mild fundal pressure (MFP) and vacuum extraction (VE) are interventions used during the second stage of labor when clinical intervention is required. While VE is well established with standardized training and...OBJECTIVE: Mild fundal pressure (MFP) and vacuum extraction (VE) are interventions used during the second stage of labor when clinical intervention is required. While VE is well established with standardized training and predictable risks, MFP remains controversial with limited comparative data. This study aimed to compare maternal and neonatal outcomes of MFP versus VE in women requiring intervention during the second stage of labor. METHODS: This is a retrospective cohort study of women with singleton term pregnancies requiring intervention during the second stage of labor at a tertiary medical center (January 2022-June 2025). Both interventions were appropriate for the same indications; the choice was at physician discretion. The primary outcome was a composite maternal outcome comprising obstetric anal sphincter injury or postpartum hemorrhage. The secondary outcome was a composite neonatal outcome including Apgar score <7 at 5 min, umbilical cord pH <7.1, birth trauma, or neonatal intensive care unit admission. RESULTS: Of 2389 women, 641 (26.8%) underwent VE and 1748 (73.2%) received MFP. The composite maternal outcome occurred in 13.7% of VE versus 8.7% of MFP (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.45-0.79). The composite neonatal outcome occurred in 10.5% of VE versus 5.2% of MFP (OR 0.47, 95% CI 0.34-0.65), driven by higher birth trauma following VE (4.2% vs. 0.7%). After adjustment, MFP was associated with lower odds of composite maternal outcome (adjusted OR [aOR] 0.56, 95% CI 0.35-0.91) and composite neonatal outcome (aOR 0.57, 95% CI 0.32-0.99). CONCLUSION: Mild fundal pressure was associated with lower odds of composite maternal and neonatal adverse outcomes compared with VE.
OBJECTIVE: This study evaluates the biomechanical strength of the sacrospinous ligament (SSL) and the uterosacral ligament (USL) in managing apical prolapse. METHODS: This study was conducted during a surgical competency...OBJECTIVE: This study evaluates the biomechanical strength of the sacrospinous ligament (SSL) and the uterosacral ligament (USL) in managing apical prolapse. METHODS: This study was conducted during a surgical competency cadaveric workshop, focusing on evaluating the biomechanical strength of the SSL and the USL. Eight fresh-frozen cadavers were studied for various procedures for apical suspension. The AnchorSure System (SSLF-t) was used on the right SSL of six cadavers. The Miya hook ligature carrier (SSLF-m) and uterosacral ligament suspension (USLS) were used on the bilateral SSL and USL of the other two cadavers. The maximum load at failure was recorded by measuring the pullout strengths of these ligaments using a Newton meter. RESULTS: For SSLF-t, the highest mean load at failure was 52.5 ± 11.3 N (confidence interval [CI] 17.4-33.2), and the overall mean load at failure was 44.0 ± 15.9 N (CI 38.1-49.6; P < 0.001). For SSLF-m, the highest mean value was 69.7 ± 8.8 N, and the overall mean value was 69.2 ± 5.9 N (CI 59.8-78.2; P = 0.004). For USLS, the highest mean value was 81.9 ± 5.1 N, and the overall mean value was 81.4 ± 5.5 N (CI 72.6-90.1). CONCLUSION: Uterosacral ligament suspension demonstrated the highest biomechanical strength, followed by SSLF-m and SSLF-t, suggesting it might be more effective in managing pelvic organ prolapse. The degree of tissue engagement and mechanism of fixation do affect the overall strength and long-term stability. The choice of suture also contributed to the ultimate repair outcome.
OBJECTIVE: To compare the efficacy of the levonorgestrel-releasing intrauterine system combined with metformin versus oral progestin combined with metformin in fertility-preserving treatment for patients with atypical en...OBJECTIVE: To compare the efficacy of the levonorgestrel-releasing intrauterine system combined with metformin versus oral progestin combined with metformin in fertility-preserving treatment for patients with atypical endometrial hyperplasia and early endometrial cancer, and to analyze related factors affecting efficacy. METHODS: From January 2015 to December 2023, clinical data of patients with atypical endometrial hyperplasia or early endometrial cancer were retrospectively analyzed. Patients were divided into a study group and a control group based on treatment method. Complete remission rate, remission time, recurrence rate, pregnancy outcomes, and adverse reactions were compared between groups. Multivariate logistic regression was used to identify factors associated with complete remission, recurrence, and pregnancy. RESULTS: Post-treatment endometrial thickness decreased in both groups compared with pre-treatment levels, with a greater reduction in the study group than the control group. Compared with the control group, the study group demonstrated a higher complete remission rate at 3, 6, 9, and 12 months, shorter time to onset and time to complete remission, lower recurrence rate, higher pregnancy and live birth rates, and lower incidence of adverse reactions. Multivariate logistic regression analysis identified age 35 years or older, body mass index (BMI) of 28 or greater, polycystic ovary syndrome, and pathologic type of endometrial cancer as risk factors for complete remission. BMI of 28 or greater and pathologic type of endometrial cancer were risk factors for recurrence. Age 35 years or older and BMI 28 or greater were risk factors for pregnancy. BMI stratification analysis demonstrated that patients with lower BMI achieved better treatment outcomes. CONCLUSIONS: This retrospective study preliminarily suggests that the levonorgestrel-releasing intrauterine system combined with metformin shows a trend toward better treatment response in fertility-preserving treatment, manifested by higher complete remission rates, shorter time to remission, lower recurrence rates, and favorable pregnancy outcomes. In addition, obesity, age of 35 years or older, polycystic ovary syndrome, and pathologic type of endometrial cancer were identified as factors influencing treatment response.
OBJECTIVE: This study identifies quantitative ultrasound predictors for the failure of ultrasound-guided suction curettage (USG-SC) in cesarean scar pregnancy (CSP) and develops a risk stratification model integrating re...OBJECTIVE: This study identifies quantitative ultrasound predictors for the failure of ultrasound-guided suction curettage (USG-SC) in cesarean scar pregnancy (CSP) and develops a risk stratification model integrating residual myometrial thickness (RMT) and local vascularity (Adler grade). METHODS: This retrospective cohort study included 415 patients with CSP who underwent primary USG-SC. Baseline morphological categorization adhered to the international Delphi consensus. Procedural failure was defined as hemorrhage (≥500 mL), requirement for secondary interventions, or incomplete evacuation. Preoperative sonographic parameters, primarily RMT and Adler vascularity grading, were evaluated. Multivariate logistic regression and receiver operating characteristic analyses were used to ascertain independent predictors and evaluate model performance. RESULTS: The overall failure rate was 13.7% (57/415). Compared to the successful group, the failed group presented with a significantly thinner RMT (1.6 ± 0.7 mm vs. 3.4 ± 1.2 mm; P < 0.001) and a higher prevalence of Adler grade 3 vascularity (P < 0.001). Multivariate analysis confirmed RMT as a significant independent protective factor (adjusted odds ratio [OR] = 0.21, 95% CI: 0.12-0.38) and Adler grade 3 vascularity as a significant risk factor (adjusted OR = 4.52, 95% CI: 1.85-11.04). The optimal RMT cut-off for predicting failure was determined to be 2.2 mm (area under the curve [AUC] = 0.912). The incorporation of RMT and Doppler vascularity into a combined algorithm yielded the highest predictive performance (AUC = 0.945). CONCLUSION: Integrating RMT with Color Doppler vascularity establishes a robust quantitative framework for surgical triage in cesarean scar pregnancy. Specifically, an RMT ≥2.2 mm accompanied by low-to-moderate vascularity (Adler grades 0-2) reliably identifies optimal candidates for primary USG-SC. This combined approach minimizes hemorrhagic morbidities while safely averting unnecessary prophylactic interventions.
OBJECTIVE: To investigate alterations in brain pain-processing networks using resting-state functional magnetic resonance imaging (rs-fMRI) in women with endometriosis-associated chronic pelvic pain and to evaluate neuro...OBJECTIVE: To investigate alterations in brain pain-processing networks using resting-state functional magnetic resonance imaging (rs-fMRI) in women with endometriosis-associated chronic pelvic pain and to evaluate neurobiological evidence of central sensitization relevant to clinical management. METHODS: This retrospective study included 30 women aged 18-45 years: 10 with deep infiltrating endometriosis (DIE) and chronic pelvic pain, 10 with ovarian endometriomas without pain, and 10 healthy controls. rs-fMRI data were analyzed using the SPM12 and the CONN toolbox. Seed-to-voxel functional connectivity analyses focused on predefined pain-related brain regions. Between-group differences were assessed using two-sample t tests with family-wise error (FWE) correction. RESULTS: Compared with controls, women with DIE and chronic pelvic pain demonstrated significantly increased connectivity between the amygdala and the right frontal pole (FWE-corrected P = 0.012 and 0.044), left paracingulate gyrus (FWE-corrected P = 0.036), right frontal operculum cortex (FWE-corrected P = 0.040), and anterior cingulate gyrus (FWE-corrected P = 0.044). Increased con was also observed between the posterior cingulate gyrus and the precuneus cortex (FWE-corrected P = 0.002), whereas decreased connectivity was detected between the anterior cingulate gyrus and the posterior left middle temporal gyrus (FWE-corrected P = 0.002). No significant differences were found in patients with ovarian endometriomas without pain. CONCLUSION: Endometriosis-associated chronic pelvic pain is associated with altered connectivity within key pain modulation networks, supporting central sensitization. Persistent pelvic pain may therefore reflect maladaptive central pain processing in addition to peripheral pathology. Recognition of these neurofunctional alterations may improve understanding of treatment-resistant pain and support earlier multidisciplinary and individualized management strategies.