European journal of obstetrics, gynecology, and reproductive biology最新文献

Objective: Twin pregnancies have a substantial risk of preterm birth, but evidence on tocolytics is limited. We evaluated whether nifedipine or atosiban improves neonatal outcomes compared with placebo.

Design: Individual participant data network meta-analysis (IPD-NMA) of two international multicentre randomised controlled trials (APOSTEL 3 and 8).

Setting: The APOSTEL-3 compared nifedipine with atosiban, while the APOSTEL-8 compared atosiban with placebo.

Population: Women with twin pregnancies and threatened preterm birth between 30⁺⁰ and 33⁺⁶ weeks.

Methods: Analyses were performed at the infant level using generalised estimating equations to account for clustering within twin pairs.

Main outcome measures: Adverse neonatal outcome: composite of neonatal morbidity or mortality.

Results: A total of 179 women were included: 94 allocated to atosiban, 27 to nifedipine, and 58 to placebo. Prolongation beyond 48 h was not significantly increased with nifedipine (RR 0.96, 95% CI 0.68-1.36) or atosiban (RR 1.10, 95% CI 0.88-1.38). The composite adverse neonatal outcome occurred in 3.7% of neonates in the nifedipine group (2/54), 7.5% in the atosiban group (14/188), and 5.2% in the placebo group (6/116). Relative risks were 0.72 (95% CI 0.15-3.43) for nifedipine vs placebo, 1.44 (95% CI 0.57-3.64) for atosiban vs placebo, and 2.01 (95% CI 0.47-8.58) for atosiban vs nifedipine.

Conclusion: No clear benefit of nifedipine or atosiban over placebo on neonatal outcomes in twin pregnancies with threatened preterm birth between 30⁺⁰ and 33⁺⁶ weeks was found.

Objective: Current haplotype-based noninvasive prenatal diagnosis (NIPD) for recessive single-gene disorders (SGD) is limited by its dependence on proband-derived parental haplotyping or complex haplotyping procedures. To overcome this limitation, this study aims to develop a novel direct parental haplotyping approach, enabling proband-independent NIPD for recessive SGD (NIPD-SGD).

Methods: Seven couples at genetic risk of having a fetus with recessive SGD were recruited. Parental haplotypes were constructed using targeted single-tube long fragment read (stLFR) sequencing with a customized 490.6 kb probe. Relative haplotype dosage (RHDO) analysis was performed on maternal plasma samples with the same panel to determine fetal haplotypes. Invasive prenatal diagnosis served as the gold standard for confirming NIPD results.

Results: Targeted stLFR sequencing directly phased fourteen parental haplotypes in the target region. Among seven singleton pregnancies, NIPD correctly genotyped all seven fetuses, achieving 100% concordance with the gold standard (7/7). Notably, this method successfully identified four families with large copy number variations, highlighting its effectiveness in detecting complex genetic alterations.

Conclusions: Targeted stLFR sequencing is an effective method for direct haplotyping in NIPD-SGD, enabling proband-independent analysis. This approach allows for efficient haplotyping in a single tube, eliminating the need for expensive microfluidic devices. This significant advancement offers a promising solution for expanding the clinical utility of NIPD-SGD.

Objectives: To assess the natural history and safety of expectant management for sonographically benign endometrial polyps (EPs) in asymptomatic premenopausal and postmenopausal women, focusing on spontaneous regression, growth, abnormal uterine bleeding (AUB) onset, and malignancy risk.

Study design: Ambispective cohort study including 298 asymptomatic women (62 premenopausal, 236 postmenopausal) with sonographically benign EPs evaluated between January 2017 and January 2023. Ultrasound data were prospectively collected during routine care according to IETA standards (scheduled follow-up at 3 and 9 months, then annually), while case inclusion was ascertained retrospectively. Outcomes included complete spontaneous regression, lesion growth, AUB onset, hysteroscopic excision, and histopathology when available. Time-to-event analyses and parsimonious Cox proportional hazards models were applied.

Results: Median follow-up was 11 months (IQR 6-24). Complete spontaneous regression occurred in 24/298 women (8.05%; 95% CI 5.2%-11.9%), more frequently in premenopausal than postmenopausal women (14.5% vs. 6.4%; log-rank p = 0.058). AUB developed in 26/298 women (8.7%; 95% CI 5.7%-12.6%). Hysteroscopic excision was performed in 90/298 cases (30.2%; 95% CI 25.1%-35.7%), with histology available for 96 lesions (32.2%). One carcinoma was identified (1/96; 1.04%; overall 1/298 = 0.34%). Larger baseline mean diameter (per 5 mm; adjusted HR 1.22, 95% CI 1.06-1.41) and higher vascularity (score ≥ 3 vs. ≤ 2; HR 1.85, 95% CI 1.10-3.11) independently predicted earlier excision.

Conclusions: Expectant management of asymptomatic sonographically benign EPs appears safe with low observed malignancy among excised lesions. Structured ultrasound surveillance may reduce unnecessary surgery while enabling timely intervention.

Objectives: Breast cancer and unilateral mastectomy lead to profound emotional and social changes that influence how women view their bodies, relationships and sense of motherhood. With subsequent chemotherapy, these experiences often become more complex, shaping perceptions of femininity and self-worth. This study aimed to explore, in depth, the experiences of mothers who underwent chemotherapy with one breast (i.e. following unilateral mastectomy), emphasizing body image, social stigma and coping.

Methods: A descriptive phenomenological approach was adopted. The study was carried out between December 2024 and March 2025 in the oncology and outpatient chemotherapy units of a private hospital in Istanbul, Turkey, with 10 women who had undergone unilateral mastectomy and were receiving chemotherapy. Data were obtained through semi-structured, in-depth interviews lasting 45-60 min, and analysed using Colaizzi's (1978) seven-step method. The rigor of the study was supported by Lincoln and Guba's (1985) criteria of credibility, transferability, dependability and confirmability.

Results: Four main themes and eight subthemes were identified: (1) shock of diagnosis and emotional turmoil: fear, denial and the struggle to remain strong for their children; (2) reconstruction of motherhood and maternal identity: redefining motherhood and balancing treatment with maternal duties; (3) body image and femininity after unilateral mastectomy: feelings of incompleteness and efforts to conceal bodily change; and (4) social stigma and coping strategies: being judged or pitied, social withdrawal, and coping through faith and family support.

Conclusion: Mothers who underwent unilateral mastectomy followed by chemotherapy experienced emotional strain, altered self-perception, and social stigma, yet displayed notable resilience and adaptive coping.

Perinatal depression is a common and serious mental health condition affecting up to 20% of pregnant and postpartum individuals worldwide. It is characterized by persistent low mood, anhedonia, and functional impairment, with potential consequences for maternal well-being, obstetric outcomes, and infant development. Management is challenging for obstetricians, as treatment decisions must balance maternal mental health needs with fetal and neonatal safety, amid varying guideline recommendations and limited consensus on optimal screening and pharmacologic strategies. The American College of Obstetricians and Gynecologists, the National Institute for Health and Care Excellence, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Scottish Intercollegiate Guidelines Network, the Centre of Perinatal Excellence and the Canadian Network for Mood and Anxiety Treatment have all released guidelines to address the risks, diagnosis and management of perinatal depression. We performed a descriptive review of these guidelines along with a literature search to address conflicting recommendations and highlight new evidence. The variations in the guidelines reflect the heterogeneity of literature and the challenges of diagnosis and managing perinatal depression.

Background: Accurate fetal weight estimation is crucial in prenatal care to prevent complications related to low birth weight or macrosomia. Conventional methods such as the Hadlock formula, based on biometric parameters, may lack accuracy, especially at weight extremes. Mid-thigh soft tissue thickness (MTSTT) has emerged as a promising, reproducible parameter for improved fetal weight estimation. This study aimed to compare the accuracy of mid-thigh soft tissue thickness (MTSTT) and the Hadlock formula in fetal weight estimation during the third trimester of pregnancy.

Methods: A prospective cross-sectional study was conducted on 300 term singleton pregnancies at Hospital (2023-2025). Standard fetal biometric parameters were measured using ultrasound, and estimated fetal weight (EFW) was calculated via both Hadlock and MTSTT-based formulas. Actual birth weight was recorded post-delivery. Correlations, error analysis, and ROC curves were used to compare predictive accuracy.

Results: EFW using the MTSTT model showed a stronger correlation with Actual birth weight (r = 0.956, r² = 0.914) compared to the Hadlock method (r = 0.778, r² = 0.610). MTSTT-based estimation demonstrated higher accuracy, with 74 % of values within 5 % of Actual birth weight and an AUC of 0.992 for predicting macrosomia. Superior diagnostic performance was consistent across all birth weight categories.

Conclusion: MTSTT is a highly accurate and clinically feasible tool for fetal weight estimation. It outperforms the Hadlock formula, especially in extreme weight categories, and offers a reproducible alternative for routine obstetric practice.