OBJECTIVES: The aim of this study was to present three adult cases of obstructed hemivagina, and ipsilateral renal anomaly (OHVIRA) syndrome diagnosed in different gynecological centers in Poland. The clinical presentati...OBJECTIVES: The aim of this study was to present three adult cases of obstructed hemivagina, and ipsilateral renal anomaly (OHVIRA) syndrome diagnosed in different gynecological centers in Poland. The clinical presentations, diagnostic imaging, surgical treatment, and outcomes were analyzed to highlight the diagnostic challenges and variability in clinical course. MATERIAL AND METHODS: This retrospective case series included three female patients aged 19,20 and 30 diagnosed in adulthood with OHVIRA syndrome. RESULTS: All three patients were diagnosed with uterus didelphys. Two had confirmed congenital right renal agenesis, while one had undergone nephrectomy in infancy. One patient presented with severe dysmenorrhea and purulent content in the right hemivagina, initially suspected to be hematocolpos. Another patient, with a history of adolescent hematocolpos, was diagnosed postpartum during assessment following cesarean section. The third case was identified incidentally during nephrological imaging. The patient had undergone the right nephrectomy in infancy. All patients underwent resection of the vaginal septum and drainage of hematocolpos. CONCLUSIONS: These cases show the variable clinical presentation of OHVIRA syndrome and emphasize the importance of a detailed history and imaging evaluation. Early diagnosis remains essential to prevent complications and provide treatment.
OBJECTIVES: Postpartum depression (PPD) profoundly affects maternal health and disrupts mother-infant bonding, with lasting effects on infant development. The causal roles of hormones that change most dramatically during...OBJECTIVES: Postpartum depression (PPD) profoundly affects maternal health and disrupts mother-infant bonding, with lasting effects on infant development. The causal roles of hormones that change most dramatically during the perinatal period, including estradiol, cortisol, and progesterone, in PPD pathogenesis remain unresolved. To address this, we conducted a two-sample Mendelian randomization (MR) study to assess bidirectional causal relationships between these hormones and PPD risk. MATERIAL AND METHODS: Genetic instruments were derived from genome-wide association studies: estradiol from UK Biobank (N = 163,985), cortisol (N = 3,366), and progesterone (N = 1,261) from German LIFE study, and PPD data from a meta-analysis of 18 European cohorts (17,339 cases/53,426 controls). We utilized seven methods to investigate the causal effects and conducted sensitivity analyses for robustness. RESULTS: MR analyses revealed that per one standard-deviation (SD) increase in genetically predicted estradiol levels was associated with a 20% higher risk of PPD (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.03-1.40, false discovery rate [FDR] p = 0.0250). Conversely, per one SD increase in genetically predicted cortisol levels was linked to a 19% lower risk of PPD (OR = 0.81, 95% CI = 0.67-0.96, FDR p = 0.0250). No significant causal association was found between genetically predicted progesterone levels and PPD risk. In reverse MR, PPD showed no causal effect on estradiol, cortisol, or progesterone levels. CONCLUSIONS: Our study clarifies the distinct causal roles of estradiol and cortisol in PPD risk and may inform future mechanistic studies and clinical strategies for PPD prevention and treatment.
OBJECTIVES: Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse maternal and fetal outcomes. Although the prevalence of GDM is high, the molecular mechanisms involved in GDM-rel...OBJECTIVES: Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse maternal and fetal outcomes. Although the prevalence of GDM is high, the molecular mechanisms involved in GDM-related placental dysfunction remain poorly understood. This study aimed to investigate the roles of Forkhead box O1 (FoxO1) and fibroblast growth factor 12 (FGF12; a non-FGF receptor) in regulating trophoblast survival under GDM conditions. MATERIAL AND METHODS: Placental tissue from women with GDM and matched non-GDM controls were collected to assess FGF12 expression. HTR8/SVneo trophoblast cells under high-glucose conditions were used to assess cellular functional assays, including proliferation, migration, and apoptosis, following FGF12 knockdown or overexpression. RESULTS: The level of FGF12 was significantly attenuated in placental tissues from GDM cases. Silencing FGF12 decreased trophoblast growth and migration, and increased apoptosis induced by high glucose, while FGF12 overexpression reversed these effects. Mechanistically, FoxO1 directly bound to the FGF12 promoter, downregulated its expression. In placental samples from GDM pregnancies, FoxO1 expression was negatively correlated with FGF12 levels. Furthermore, FoxO1 inhibited trophoblast proliferation and migration, while FGF12 overexpression partially rescued the inhibitory effects of FoxO1. CONCLUSIONS: These findings suggest that the FoxO1/FGF12 pathway may contribute to impaired trophoblast function in GDM. This study provides preliminary evidence for a regulatable molecular pathway involved in GDM-associated placental dysfunction; however, further validation in larger cohorts and physiologically relevant models is required before clinical applications can be applied.
OBJECTIVES: To compare the predictive performance of four risk of malignancy index (RMI) in patients with adnexal masses. MATERIAL AND METHODS: This retrospective study included 703 patients who underwent surgery for adn...OBJECTIVES: To compare the predictive performance of four risk of malignancy index (RMI) in patients with adnexal masses. MATERIAL AND METHODS: This retrospective study included 703 patients who underwent surgery for adnexal masses. Preoperative ultrasonographic findings, menopausal status, and serum CA-125 levels were used to calculate RMI-1, -2, -3, and -4. Histopathology served as the reference standard. Sensitivity, specificity, positive and negative predictive values, and overall accuracy were analyzed. RESULTS: Among 703 patients, 77.2% had benign lesions, 3.3% borderline tumors, and 19.5% malignant disease. RMI-1 demonstrated sensitivity 74.4%, specificity 91.3%, PPV 71.1%, NPV 92.4%; RMI-2 sensitivity 80.6%, specificity 86.2%, PPV 63.2%, NPV 93.8%; RMI-3 sensitivity 75.6%, specificity 90.1%, PPV 69.1%, NPV 92.6%; and RMI-4 sensitivity 78.8%, specificity 89.9%, PPV 69.9%, NPV 93.5%. ROC analysis showed areas under the curve of 0.900, 0.896, 0.893, and 0.893 for RMI-1 to RMI-4, respectively. RMI-1 had the highest specificity and overall accuracy, whereas RMI-2 achieved the highest sensitivity. Pairwise comparisons revealed statistically significant differences among RMIs. CONCLUSIONS: All four RMIs effectively differentiate benign from malignant adnexal masses. RMI-1 offers the highest overall accuracy and specificity, and RMI-2 the highest sensitivity. These indices provide valuable preoperative risk stratification to guide clinical management and referral to specialized care. Institutional resources should inform the choice of RMI.
OBJECTIVES: Endometriosis presents a multitude of challenges for individuals. Current treatment of the disease is based on pharmacotherapy that aims to relieve pain, improves future fertility, potentially slows disease p...OBJECTIVES: Endometriosis presents a multitude of challenges for individuals. Current treatment of the disease is based on pharmacotherapy that aims to relieve pain, improves future fertility, potentially slows disease progression and lessen the likelihood of recurrence. The present review outlines recent reports on the importance of Gonadotropin-Releasing Hormone antagonists/antagonists and a new prospective as a significant second- line treatment option. MATERIAL AND METHODS: A review of the literature from the last 5 years was conducted. The search included the following medical subject: "endometriosis", "GnRh agonists", "GnRh antagonists", "pharmacotherapy".The articles published in English were included. Publications without full text access and duplicates were rejected. RESULTS: Current researches no longer focuse exclusively on finding new GnRH agonists/antagonists, but rather on maximizing their usage, in favour of the latter ones . Multiple active substances are now being combined into one tablet, which makes it easier for patients to take their medication and improves their adherence to treatment recommendations. 24 months monotherapy of linzagolix did not indicate any clinically relevant impact on overall bone condition in comparison to placebo group. Relugolix combination therapy maintained bone mass density over two years while effectively alleviating pain symptoms. CONCLUSIONS: Despite being effective, all of treatments may have additional negative effects. The best approach to pharmacotherapy depends on the individual patient's needs and circumstances. Taking into consideretion potential effects, an appropriate dose or a combination of the above options should be performed. The treatment options of Relugolix and Linzagolix are both promising and well-tolerated. Further researches should focuse on long-term bone health monitoring strategies and its safety profile.
OBJECTIVES: To provide reference values for ovarian volume in healthy premenarchal girls for use in routine pelvic ultrasonography interpretation. MATERIAL AND METHODS: A retrospective analysis of 170 healthy girls aged...OBJECTIVES: To provide reference values for ovarian volume in healthy premenarchal girls for use in routine pelvic ultrasonography interpretation. MATERIAL AND METHODS: A retrospective analysis of 170 healthy girls aged 0 to 11 years who underwent pelvic ultrasound examinations between 2015 and 2022 at a private gynecology clinic. Ovarian volumes were measured using transabdominal ultrasonography and calculated by the prolate ellipsoid formula. Mean ovarian volumes were analyzed by age groups. RESULTS: The mean ovarian volume increased with age. A significant difference between right and left ovarian volume was not observed in most age groups. The data provides age-specific reference values that may aid in the clinical evaluation of ovarian development in premenarchal girls. CONCLUSIONS: Our study confirmed that significant variations in ovarian volume occur across various stages of growth and puberty, making the accurate determination of abnormal values essential for proper diagnosis.
OBJECTIVES: To evaluate the applicability of the INTERGROWTH‑21st prescriptive fetal growth standards for third‑trimester biometry and estimated fetal weight (EFW) assessment in a Polish population. MATERIAL AND METHODS:...OBJECTIVES: To evaluate the applicability of the INTERGROWTH‑21st prescriptive fetal growth standards for third‑trimester biometry and estimated fetal weight (EFW) assessment in a Polish population. MATERIAL AND METHODS: This retrospective single-center cohort study included 594 uncomplicated singleton pregnancies with reliable first‑trimester crown rump length dating and one routine third‑trimester ultrasound performed at a tertiary center in Poland (2014-2021). Standard biometry and EFW were obtained per international guidelines, and EFW was calculated using the INTERGROWTH‑21st formula. Z‑scores and centiles were derived from INTERGROWTH‑21st standards. EFW Z‑scores were grouped into < 3rd, 3rd ≤ 10th, 10th-90th, 90th-97th and > 97th centile categories; observed vs expected proportions (3%, 7%, 80%, 7%, 3%) were compared using the chi‑square test. RESULTS: Mean Z‑scores approximated zero for all parameters (HC 0.00 ± 1.01, AC 0.00 ± 1.02, FL 0.00 ± 1.08, BPD 0.00 ± 1.01, EFW 0.00 ± 0.93); 95% confidence intervals included zero, indicating minimal bias. For EFW, proportions were 1.0%, 4.7%, 85.2%, 6.2%, and 2.9%, respectively, significantly deviating from the theoretical distribution (χ² = 14.8, df = 4). CONCLUSIONS: Third trimester fetal size in low‑risk Polish pregnancies is well described by the INTERGROWTH‑21st standards regarding central tendencies. A slight underrepresentation of fetuses at the extremes suggests mild compression, warranting local audit and linking of centiles with perinatal outcomes to refine diagnostic thresholds.
OBJECTIVES: The study aimed to analyze maternal and neonatal outcomes of women with a history of three or four caesarean sections (CS) and to evaluate the feasibility and safety of vaginal birth after multiple caesarean...OBJECTIVES: The study aimed to analyze maternal and neonatal outcomes of women with a history of three or four caesarean sections (CS) and to evaluate the feasibility and safety of vaginal birth after multiple caesarean sections (VBAC ≥ 3) in Polish clinical practice. MATERIAL AND METHODS: A retrospective analysis was conducted on medical records of 186 women with three or four prior CS who delivered at St. Sophia Specialist Hospital in Warsaw between 2017 and 2024. Data on delivery mode, obstetric management, complications, and neonatal outcomes were assessed. Multivariate logistic regression was applied to identify factors associated with successful VBAC. RESULTS: Of the study group, 62 women attempted trial of labour after caesarean (TOLAC), resulting in 32 successful vaginal births (success rate 53.2%). 124 women chose Elective CS. Logistic regression showed that prior vaginal birth (OR = 20.34; p = 0.008) and the use of epidural anaesthesia (OR = 22.88; p = 0.006) significantly increased the likelihood of successful VBAC. Spontaneous onset of labour showed a positive but non-significant trend (OR = 2.52; p = 0.230). The model demonstrated a classification accuracy of 77.4% and a good overall fit (Nagelkerke R² = 0.456). Uterine rupture occurred in three cases (4.8%), while no maternal or neonatal deaths were reported. CONCLUSIONS: Vaginal birth after three or more CS may be a viable option for carefully selected women, provided it is offered in tertiary centers with immediate surgical readiness. Key predictors of success include prior vaginal birth and epidural anaesthesia. Further large-scale studies are needed to refine guidelines and inform clinical practice in this high-risk group.
OBJECTIVES: In the course of the study the differences regarding both C-reactive protein immune-expression and Lysophosphatidic Acid immune-expression between the stages and histologic grades of the vulvar cancer and the...OBJECTIVES: In the course of the study the differences regarding both C-reactive protein immune-expression and Lysophosphatidic Acid immune-expression between the stages and histologic grades of the vulvar cancer and the differences between the group of patients diagnosed with lichen sclerosus and the group of patients diagnosed with the vulvar cancer were assessed and verified. MATERIAL AND METHODS: Thirty patients with histopathological confirmed vulvar cancer and 32 women with histologically confirmed lichen sclerosus were enrolled into the study. The representative sections of tissues suspended in a 10% buffered formalin were examined regarding immunohistochemistry for C-reactive protein immune-expression and Lysophosphatidic Acid. RESULTS: There were no differences in intra-tumour nor peri-tumour depending on vulvar cancer stage defined following the International Federation of Gynecology and Obstetrics guidelines nor grading. The highest median C-reactive protein immune-expression was observed in intra-tumour and peri-tumour vulvar cancer specimens. Median peri-tumoral C-reactive protein immune-expression was significantly higher comparing to median C-reactive protein immune-expression in lichen sclerosus samples, but there were not significant differences in median C-reactive protein immune-expression between peri-tumour and intra-tumour samples nor between intra-tumour and lichen sclerosus specimens. CONCLUSIONS: In peri-tumour specimens C-reactive protein immune expression was significantly higher than in lichen sclerosus specimens. No statistically significant differences were found between intratumour and lichen sclerosus specimens. No statistically significant difference between each type of specimens acquired in the group of patients diagnosed with lichen sclerosus and the specimens acquired in the group of patients diagnosed with vulvar cancer regarding Lysophosphatidic Acid immune expression was detected.
OBJECTIVES: The aim of the study is to evaluate the safety and feasibility of using a nonabsorbable suture instead of synthetic mesh in laparoscopic pectopexy. MATERIAL AND METHODS: Women diagnosed with symptomatic Pelvi...OBJECTIVES: The aim of the study is to evaluate the safety and feasibility of using a nonabsorbable suture instead of synthetic mesh in laparoscopic pectopexy. MATERIAL AND METHODS: Women diagnosed with symptomatic Pelvic Organ Prolapse Quantification (POP-Q) stage III and IV vaginal vault prolapse were included in this study. A 30-mm needle armed with a 0 polypropylene monofilament suture was used instead of synthetic mesh. Preoperative outcomes, suture-related complications and recurrence were analyzed. Anatomical success was defined according to the POP-Q, patient quality of life was assessed using the Prolapse Quality of Life Questionnaire (P-QOL). RESULTS: A total of 26 women underwent LSP. The median age was 60 years. The median operating time was 61 minutes. The median estimated blood loss was 90 mL. There were no recorded intraoperative complications. The mean pain assessment 24 hours later with VAS score was 2 (range 0-10). The median length of hospital stay was 2 nights (range 1-3 nights). No patient developed recurrence or de novo prolapse in the median follow-up period of 6 months. Neither suture erosion, infection, nor suture sensation by the partner were detected. All variables of POP-Q points significantly improved after surgery (p < 0.05). Significant improvement was observed in each score of the P-QOL, (p = 0.003 for sleep/energy score, p < 0.0001 for all other scores). CONCLUSIONS: Polypropylene suture represents a reliable and feasible alternative to synthetic mesh in laparoscopic pectopexy for vault prolapse. Further multicentric, prospective studies with long-term follow-up are required to integrate this technique into standard practice.
Chimiczewski W, Robenek M, Borowkow-Bulek A
… +3 more, Paul M, Szuba A, Gabriel I
Ginekol Pol
· 2026 Jun · PMID 42261735
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OBJECTIVES: Lymphedema has emerged as a significant health challenge, often resulting in social isolation and the restriction of daily activities. Despite advancements in surgical techniques, it remains a notable consequ...OBJECTIVES: Lymphedema has emerged as a significant health challenge, often resulting in social isolation and the restriction of daily activities. Despite advancements in surgical techniques, it remains a notable consequence of oncologic treatment, particularly following gynecological procedures. However, there is a notable lack of reliable information regarding secondary lymphedema after gynecological oncologic treatment from Eastern European countries. MATERIAL AND METHODS: This retrospective study was conducted among women who underwent surgery between 2017 and 2022 for endometrial, vulvar, or cervical cancer at a tertiary cancer center. Inclusion criteria required a history of radical gynecological cancer surgery, a valid phone number in the medical records, ICD-10 diagnosis for lymphedema (I89.0, I89.8, I89.9) confirmed by hospital discharge note or ambulatory care discharge note. Trained research assistant collected data on the presence or absence of lymphedema and whether patients received targeted treatments such as manual lymph drainage, flat-knit compression therapy, or surgery. Phone calls were made three times, spaced one week apart. RESULTS: Data were collected from 157 patients with endometrial cancer (EC), 90 with vulvar cancer (VC), and 57 with cervical cancer (CC). Lymphedema was observed in 25% of EC patients, 33% of VC patients, and 31% of CC patients. Additionally, 45% of EC patients, 50% of VC patients, and 66% of CC patients received one of the previously mentioned treatment modalities for lymphedema. CONCLUSIONS: The absence of consistent guidelines and protocols for post-surgery prophylactic management of lymphedema as well as specialized centers for lymphedema treatment after gynecological surgery contributes to unfavorable outcomes within cancer survivors.
Drzycimska M, Bednarek-Jedrzejek M, Zahorowska A
… +4 more, Kwiatkowska E, Maksym K, Cymbaluk-Ploska A, Kwiatkowski S
Ginekol Pol
· 2026 Jun · PMID 42261734
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OBJECTIVE: Our goal was to summarize the previous management of pregnant women with LQTS, as well as to present the current guidelines in this area. DATA SOURCES: We conducted a systematic search in multiple databases, i...OBJECTIVE: Our goal was to summarize the previous management of pregnant women with LQTS, as well as to present the current guidelines in this area. DATA SOURCES: We conducted a systematic search in multiple databases, including PubMed, Scopus, and Medline/Embase between 1984 and 2022. STUDY SELECTION: Original articles were eligible if they included pregnant patients suffering from congenital long QT syndrome with the three most common types 1-3. DATA EXTRACTION AND SYNTHESIS: The subject-related articles were processed according to Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two authors independently screened studies, extracted data, and assessed methodological quality. A total of 15 publications were included in the final report. In the literature, 18 cases of long QT syndrome with the most common types in pregnant women were included, for a final total of 20 cases. CONCLUSIONS: Despite the advances in medicine there is a lack of studies that can determine unequivocally, the only right way to manage pregnant women suffering from long QT syndrome. The question remains - does cesarean section objectively reduce the risk of cardiovascular complications in such cases? There is a strong need for further research in this scientific field, especially to create opportunities to reduce the performance of unjustified cesarean sections and thus improve mother and neonatal outcomes. It is believed that the actual incidence of LQTS is significantly higher than current statistics report, therefore, it is so vital to standardize the management of this group of patients.
Dudek A, Urban A, Kacperczyk-Bartnik J
… +3 more, Dobrowolska-Redo A, Sienko J, Romejko-Wolniewicz E
Ginekol Pol
· 2026 Jun · PMID 42261733
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OBJECTIVES: This study aimed to evaluate Polish women's attitudes toward water birth, including perceived benefits, concerns, and the influence of demographic factors such as age, education, residence, and childbirth his...OBJECTIVES: This study aimed to evaluate Polish women's attitudes toward water birth, including perceived benefits, concerns, and the influence of demographic factors such as age, education, residence, and childbirth history. MATERIAL AND METHODS: A cross-sectional online survey was conducted using a structured questionnaire shared in 76 Facebook groups targeting women and families in Poland. Responses were collected from February 17 to July 27, 2025. The questionnaire included demographic questions, childbirth history, awareness of water birth, perceived pros and cons, sources of information, and willingness to consider this method. Statistical analysis included descriptive statistics and Pearson's chi-squared test. RESULTS: A total of 1,376 responses were analyzed. Awareness of water birth was high (98.2%), mainly acquired via the internet (83.6%). Benefits were known by 70.6% of respondents, particularly those aged 35-44 and those with higher education (p < 0.001). The most cited benefits were pain reduction (59.9%) and relaxation (51.6%). The most common concerns included complications (25.8%) and lack of familiarity (17.9%). Women with prior water birth experience were highly likely to choose it again (96.7%). Overall, 74.0% of all respondents would consider water birth, and 82.8% expressed a need for more accessible educational materials. CONCLUSIONS: Polish women are generally aware of and open to water birth, but many lack access or adequate knowledge. Misinformation and limited awareness of contraindications persist, especially among younger and less-educated women. Educational efforts should be enhanced, particularly online, to support informed childbirth choices.
Can S, Aktoz F, Tercan C
… +2 more, Vurgun E, Turgut A
Ginekol Pol
· 2026 Jun · PMID 42261732
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OBJECTIVES: Investigations into interleukins as predictors of vasomotor symptoms in the postmenopausal period have yielded mixed results. There is a growing interest in defining the complete cytokine profile during menop...OBJECTIVES: Investigations into interleukins as predictors of vasomotor symptoms in the postmenopausal period have yielded mixed results. There is a growing interest in defining the complete cytokine profile during menopause. This research aims to provide insights into the potential roles of IL-26 and IL-38 in relation to menopausal symptoms and the transition to postmenopausal status. MATERIAL AND METHODS: A total of 168 patients (56 in premenopausal women, 56 in postmenopausal women without vasomotor symptoms, and 56 in postmenopausal women with vasomotor symptoms) aged between 45 and 55 years were included. Serum levels of IL-26 and IL-38 were measured to assess differences in interleukin levels among the patient groups. RESULTS: The analysis revealed no significant differences in IL-26 and IL-38 levels between premenopausal and menopausal patients (p = 0.09 and p = 0.66, respectively). However, the median menopausal duration among individuals experiencing vasomotor symptoms was 24 months shorter compared to those without symptoms (p = 0.022). Although IL-26 levels did not vary significantly between groups, the group with vasomotor symptoms exhibited higher IL-38 levels compared to those without symptoms (p = 0.76 and p = 0.029, respectively). Furthermore, after adjusting for other variables, the odds of vasomotor symptom prevalence increased by 1% with every 1 ng/L increase in IL-38 levels and decreased by 1% with every additional month of menopausal time. CONCLUSIONS: In conclusion, this study shows that higher IL-38 levels were associated with the presence of vasomotor symptoms. These results suggest a potential involvement of IL-38 in the pathophysiology of menopausal symptoms.
Ginekol Pol
· 2026 Jun · PMID 42261731
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OBJECTIVES: To evaluate the limitations of fixed risk thresholds in first-trimester CST for T21, with a focus on age-related inflation of false-positive results, and to assess whether alternative threshold strategies can...OBJECTIVES: To evaluate the limitations of fixed risk thresholds in first-trimester CST for T21, with a focus on age-related inflation of false-positive results, and to assess whether alternative threshold strategies can mitigate this effect. MATERIAL AND METHODS: This retrospective study included 13,668 singleton pregnancies with first-trimester CST and confirmed prenatal or postnatal karyotype (13,540 euploid; 128 T21). Screening performance was evaluated using the standard 1:300 high-risk cut-off and two strategies targeting an approximately 5% FPR - a global threshold (5th percentile of euploid risk denominators, approximately 1:55) and an age-dependent threshold derived from age-specific 5th percentiles smoothed using locally estimated scatterplot smoothing. DR and FPR were calculated overall and stratified by maternal age (≤ 34, 35-39, and ≥ 40 years), with paired comparisons performed using McNemar's test. RESULTS: The standard 1:300 cut-off yielded an overall FPR of 16.1% (2,181/13,540), increasing from 9.7% in individuals aged ≤ 34 years to 38.5% in those aged ≥ 40 years. The global 5% FPR strategy substantially reduced false-positive classifications but decreased DR from 90.6% (116/128) to 79.7% (102/128) (p < 0.001). The age-dependent strategy-maintained a near-constant FPR across age groups (overall 5.4%), achieved a DR of 81.3% (104/128), and demonstrated higher diagnostic efficiency than the 1:300 threshold (diagnostic odds ratio 75.23; 95% confidence interval 48.15-117.55). CONCLUSIONS: Fixed risk thresholds in first-trimester CST lead to pronounced age-related inflation of false-positive results. Thresholds targeting an approximately 5% FPR - particularly age-dependent calibration - substantially reduce unnecessary screen-positive classifications with only moderate loss in detection. However, threshold adjustment alone does not address the fundamental limitation of binary classification based on a single posterior risk estimate. In contingent screening pathways where CST serves as triage before cell-free DNA or invasive testing, age-adapted thresholds offer a pragmatic approach to reducing avoidable escalation among pregnant individuals of advanced maternal age.