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

{"title":"Correlation between ultrasonographic findings and histopathological and molecular characteristics in endometrial cancer: A multicenter study","authors":"Irene Colombi ,&nbsp;Giuseppe Vizzielli ,&nbsp;Eugenia Costantini ,&nbsp;Silvia Pisaneschi ,&nbsp;Federica Perelli ,&nbsp;Anna Biasoli ,&nbsp;Stefano Restaino ,&nbsp;Francesca Ciccarone ,&nbsp;Gabriele Centini ,&nbsp;Francesco Giuseppe Martire ,&nbsp;Martina Pacifici ,&nbsp;Alberto Mattei ,&nbsp;Errico Zupi ,&nbsp;Lucia Lazzeri","doi":"10.1016/j.ejogrb.2025.114900","DOIUrl":"10.1016/j.ejogrb.2025.114900","url":null,"abstract":"<div><h3>Background</h3><div>Accurate preoperative assessment of endometrial cancer is crucial for tailoring surgical and therapeutic management. Identifying correlations between ultrasonographic features and tumor histopathological and molecular profiles may help improve the accuracy of presurgical staging.</div></div><div><h3>Objectives</h3><div>This multicenter retrospective study aimed to evaluate the association between ultrasonographic features, histopathological characteristics and molecular profiles in endometrial cancer to improve preoperative assessment and risk stratification.</div></div><div><h3>Study design</h3><div>A total of 156 women from three Italian centers underwent standardized transvaginal or transrectal ultrasound following IETA criteria prior to hysterectomy. Ultrasonographic parameters, including endometrial thickness, echogenicity, junctional zone integrity, and vascularity assessed by Doppler, were analyzed. Postoperative histopathology and molecular classification (p53, MMR, POLE, NSMP) were performed. Statistical analyses evaluated correlations among ultrasound features, pathology, and molecular data.</div></div><div><h3>Results</h3><div>Endometrioid histotype was detected in 88.46 % of cases, mostly low-grade and early-stage. Cases in the early stage (i.e. lesions confined to the uterine corpus) accounted for 77.27 % of all cases. Ultrasound staging was consistent with the final staging in 65.5 % of cases, with errors primarily involving the overestimation of p53-abnormal tumors and the underestimation of MMRd tumors. Increased endometrial thickness was associated with a higher stage and grade (median 20 mm for stage III, p = 0.007). An irregular junctional zone was associated with high-grade tumors (p = 0.016). Complex and multifocal vascular patterns were significantly linked to advanced stages, high grade, and molecular aggressiveness, such as p53 mutations and MMR deficiency. Tumors with scattered vessels showed a higher risk of extensive lymphovascular space invasion.</div></div><div><h3>Conclusions</h3><div>Ultrasound features, particularly vascularity, junctional zone irregularity, and endometrial thickness, are significantly associated with tumor stage, grade, and molecular profiles. Incorporating detailed ultrasonographic assessment into preoperative evaluation can help identify high-risk endometrial cancers and guide personalized management strategies.</div><div>Larger prospective studies are needed to validate these findings.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114900"},"PeriodicalIF":1.9,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current management and research priorities for second trimester pregnancy loss: a survey of healthcare professionals in the UK and Ireland (PASTeL-3)","authors":"Andrea Woolner ,&nbsp;Laura Linehan ,&nbsp;Keelin O’Donoghue ,&nbsp;Rosinder Kaur ,&nbsp;Alexander E.P. Heazell","doi":"10.1016/j.ejogrb.2025.114899","DOIUrl":"10.1016/j.ejogrb.2025.114899","url":null,"abstract":"<div><h3>Background</h3><div>Second trimester pregnancy loss (STPL) is under-researched. There are no published national or international guidelines. Yet evidence suggests this may be a high risk group. We hypothesised that the management of STPL varied across the UK and Ireland and we asked healthcare professionals’ views on current care and future priorities for STPL.</div></div><div><h3>Methods</h3><div>A prospective cross-sectional survey was conducted as part of the PASTeL-3 project. An electronic online survey was live between 19th November 2024 and 7th March 2025. Professionals working in maternity services in the UK and Ireland were invited to participate the survey via social media and email.</div></div><div><h3>Findings</h3><div>The definition of STPL varied between hospitals, with lack of consensus on the lower and upper gestational age limits. Care location for assessment and management of STPL differed between hospitals. 43 % of women could self-refer for assessment in the second trimester. Dosages of misoprostol used for STPL varied between hospitals from 50-400 µg, and 63 % of respondents reported uncertainty over the optimal dosage of misoprostol for STPL. Elective surgical management for STPL was rarely offered. Pharmacological management of the third stage of labour after STPL was largely based on oxytocics, with a minority using Misoprostol alone (10 %). Although almost all units reported consultant follow-up, only 45 % of respondents reported routine follow up took place in a dedicated pregnancy loss clinic. Only 52 % of respondents reported that post-mortem examination was routinely offered after STPL. Respondents reported antenatal care after a STPL was provided in a specialist pregnancy loss clinic (31 %) or preterm birth clinic (43 %); 80.1 % reported they felt confident caring for women in a asubsequent pregnancy after STPL. Respondents highlighted concerns with care locations for women with STPL under 16–18 weeks’ gestation and contingency locations where bereavement suites were in use. Highlighted research priorities included: optimising medical management of STPL for women with a scarred uterus, medical methods to reduce the risk of retained placenta after STPL, the impact of STPL on next pregnancies and investigations after STPL.</div></div><div><h3>Interpretation</h3><div>There is confusion over the definitions, appropriate location for care, optimal therapeutic options and follow up needed following STPL. High quality research for STPL should be prioritised to develop evidence-based clinical guidance to reduce variation in care.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114899"},"PeriodicalIF":1.9,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between severity of obstetric perineal tears and risk of levator ani avulsion – a systematic review","authors":"Line Norring Holst ,&nbsp;Kathrine Perslev ,&nbsp;Niels Klarskov ,&nbsp;Hanna Jangö","doi":"10.1016/j.ejogrb.2025.114896","DOIUrl":"10.1016/j.ejogrb.2025.114896","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of this study was to investigate whether the incidence of levator ani avulsion (LAA) is associated with the degree of obstetric tear.</div></div><div><h3>Methods</h3><div>This systematic review was conducted in accordance with the PRISMA guidelines. A literature search was performed in PubMed, the Cochrane Library, and Embase. Articles were screened by two independent reviewers, and data were extracted on study characteristics, number of included women, degree of obstetric perineal tear, and the incidence of levator ani avulsion (LAA).</div></div><div><h3>Results</h3><div>A total of 13 studies were included, comprising 3,584 primiparous women. We found that the incidence of levator ani avulsion was 13 % (95 %CI: 10–17 %) in women without a perineal tear, 24% (95 %CI: 20–29 %) with a first-degree tear, 22 % (95 %CI: 18–25 %) with a spontaneous second-degree tear, 23 % (95 %CI: 17–29 %) with an episiotomy, and 35% (95 %CI: 30–40 %) with an obstetric anal sphincter injury (OASI). Additionally, some studies grouped women with no, first-, or second-degree tears together and here the incidence of LAA was 16% (95 %CI: 14–18 %).</div></div><div><h3>Conclusion</h3><div>LAA is common after vaginal delivery and is related to the degree of obstetric tear, ranging from 13 % in women without perineal tear to 35 % with OASI.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114896"},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diurnal variation in urine protein-to-creatinine ratio among pregnant women with and without hypertensive disorders: A retrospective clinical study","authors":"Cami Lehavi ,&nbsp;Amir Naeh ,&nbsp;Eiman Shalabna ,&nbsp;Rinat Gabbay-Benziv ,&nbsp;Esther Maor-Sagie","doi":"10.1016/j.ejogrb.2025.114893","DOIUrl":"10.1016/j.ejogrb.2025.114893","url":null,"abstract":"<div><h3>Objective</h3><div>Physiological proteinuria occurs in approximately 8 % of normal pregnancies due to increased glomerular filtration and altered tubular reabsorption. Hypertensive disorders complicate 3–8 % of pregnancies and are associated with adverse outcomes. Although 24-hour urine collection is the traditional standard for assessing proteinuria, it is cumbersome and time-consuming. The urine protein-to-creatinine ratio (Upcr) has largely replaced it owing to its convenience and strong correlation with 24-hour values. However, Upcr relies on random sampling and may be influenced by diurnal variation. This study aimed to assess and compare Upcr diurnal variability in normotensive versus hypertensive singleton pregnancies.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted of all Upcr tests performed between January 2021 and March 2024 at a single university-affiliated center. Tests were ordered following a positive urine dipstick during routine screening. Only the first test per pregnancy was included. Upcr values were compared by sampling time—day (07:00–22:59) versus night (23:00–06:59)—and by subsequent development of hypertensive disorders. Differences were analyzed using the Kruskal–Wallis test.</div></div><div><h3>Results</h3><div>Among 13,054 deliveries, 1,317 (10 %) underwent Upcr testing; 35.8 % developed hypertensive disorders. Most samples were collected during the day (1,121 vs. 196 at night). Hypertensive pregnancies exhibited higher Upcr levels regardless of sampling time. In this group, daytime Upcr values were significantly higher than nighttime values (0.75 vs. 0.39, <em>p</em> = 0.02), whereas no diurnal difference was observed in normotensive pregnancies.</div></div><div><h3>Conclusions</h3><div>Upcr demonstrates significant diurnal variation in hypertensive pregnancies. These findings support reevaluating current proteinuria thresholds and incorporating time-of-day considerations in Upcr interpretation.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114893"},"PeriodicalIF":1.9,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproductive factors, exogenous hormone use and risk of migraine among women: Results from UK Biobank","authors":"Nana Wang ,&nbsp;Yongli Yang ,&nbsp;Xiaocan Jia ,&nbsp;Yuping Wang ,&nbsp;Chaojun Yang ,&nbsp;Jingwen Fan ,&nbsp;Chenyu Zhao ,&nbsp;Yacong Bo ,&nbsp;Xuezhong Shi","doi":"10.1016/j.ejogrb.2025.114892","DOIUrl":"10.1016/j.ejogrb.2025.114892","url":null,"abstract":"<div><h3>Aims</h3><div>The association between female reproductive factors and migraine risk remains inconclusive. This study aimed to investigate the association between reproductive factors and migraine.</div></div><div><h3>Methods</h3><div>This study included 268,440 female participants enrolled in the UK Biobank from 2006 to 2010. Cox proportional hazard models and restricted cubic spline were used for association analyses.</div></div><div><h3>Results</h3><div>With a median of 13.67 years follow-up, a total of 4,394 cases of migraine were documented. The adjusted HR (95 % CI) for menarche &gt; 14 years was 1.16(1.04,1.28) compared with 12 to 14 years; 1.48(1.32,1.66) for menopause &lt; 45 years compared with 45 to 55 years; 1.32 (1.18,1.48) for reproductive life expectancy &lt; 33 years compared with 33 to 40 years; 1.60(1.43,1.79) for hysterectomy; 1.52(1.37,1.69) for oophorectomy; 1.31(1.19,1.45) for pregnant; 1.66(1.47,1.86) for first live birth &lt; 22 years compared with &gt; 27 years; 1.31(1.17,1.47) for last live birth &lt; 27 years compared with &gt; 33 years; 1.16(1.03,1.30), 1.16(1.06,1.27), and 1.17(1.05,1.29) for 1, 2, and 3 or more children compared with no children; 1.18(1.10,1.28) for miscarriages; 1.13(1.04,1.24) for abortions; 1.62(1.51,1.74) for using HRT. Age at menarche, age at first or last live birth, age started oral contraceptive pills, age started HRT, and HRT duration were nonlinearly associated with migraine risk (<em>P</em> &lt; 0.001).</div></div><div><h3>Discussion</h3><div>Female reproductive factors, including gynecologic surgery, early first birth, and using HRT, were associated with incident migraine. The findings emphasize the need to incorporate reproductive history into clinical profiles and provide an evidence base for personalized prevention strategies in women.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114892"},"PeriodicalIF":1.9,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual function after female genital cosmetic surgery: A systematic review and meta-analysis","authors":"Ebru Zulfikaroglu ,&nbsp;Didem Kurban","doi":"10.1016/j.ejogrb.2025.114894","DOIUrl":"10.1016/j.ejogrb.2025.114894","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate postoperative sexual function after female genital cosmetic surgery (FGCS)—predominantly labia minora reduction with or without clitoral hood reduction (CHR)—and to contextualize safety, satisfaction, and technique-related signals.</div></div><div><h3>Methods</h3><div>We systematically searched MEDLINE, Embase, Scopus, and Cochrane (2015–2025). Eligible designs included randomized or nonrandomized studies and case series (n ≥ 5) reporting validated sexual outcomes. Two reviewers independently screened and extracted data; risk of bias was assessed with Cochrane Risk of Bias 2, the Newcastle–Ottawa Scale, and the JBI checklist. Random-effects <em>meta</em>-analysis was performed, with prespecified subgroups by technique (trim/edge, wedge, composite) and follow-up.</div></div><div><h3>Results</h3><div>Eleven studies met inclusion; six used the Female Sexual Function Index (FSFI) and were pooled quantitatively. In primarily uncontrolled pre–post cohorts, pooled standardized mean change in sexual function corresponded to a moderate improvement (standardized mean difference 0.52; 95 % confidence interval 0.38–0.65)., although the certainty of evidence was low due to nonrandomized single-arm designs and serious risk of bias. Studies using other validated instruments (Female Genital Self-Image Scale, Sexual Function Questionnaire-28, Sexual Quality of Life–Female, BODY-Q) demonstrated convergent gains in genital self-image and sexual well-being. Reported complications were uncommon and mostly minor, with infrequent revisions during follow-up. No technique showed clear superiority. One prospective cohort with standardized sensory testing found no reduction in clitoral or labial sensitivity after labiaplasty with CHR.</div></div><div><h3>Conclusions</h3><div>Observational pre–post data suggest that FGCS is associated with moderate short-term improvements in sexual function and genital self-image, but these findings are based on small, uncontrolled studies that are vulnerable to regression to the mean, expectancy effects, and natural recovery. High-quality controlled trials are needed to confirm the magnitude and durability of benefit. Benefits appear consistent across commonly used techniques, but technique-specific differences remain uncertain. Counseling should integrate validated patient-reported measures and realistic timelines for recovery and sexual resumption. Further comparative studies with standardized reporting and ≥12-month follow-up are needed.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114894"},"PeriodicalIF":1.9,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emotional freedom techniques-based counseling with breathing exercises in in vitro fertilization: effects on psychological distress and well-being","authors":"Merve Coşkun ,&nbsp;Ergül Aslan","doi":"10.1016/j.ejogrb.2025.114891","DOIUrl":"10.1016/j.ejogrb.2025.114891","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate whether psychosocial care during in vitro fertilization (IVF) treatment affects the emotional capacity and well-being of women undergoing fertility treatment.</div></div><div><h3>Methods</h3><div>This randomized controlled, single-blind study was conducted between February 2020 and March 2021. A total of 112 women undergoing IVF were recruited based on predefined inclusion and exclusion criteria. After a 24.1 % loss to follow-up (n = 27), data from 85 participants (42 in the experimental group, 43 in the control group) were analyzed. The control group received routine care, while the intervention group attended a structured seven-session counseling program that included coping strategies such as Emotional Freedom Technique (EFT) and breathing exercises. Psychological outcomes were measured at three time points using Screening Tool on Distress in Fertility Treatment (SCREENIVF), Fertility Quality of Life Tool (FertiQol), COMPI Fertility Problem Stress Scales (COMPI-FPSS), and Subjective Units of Distress (SUD) scale. Group comparisons were analyzed with appropriate statistical methods.</div></div><div><h3>Results</h3><div>Baseline characteristics did not differ between groups (p &gt; 0.05). The experimental group had a higher positive hCG rate on day + 13 of IVF (42.9 % vs. 18.6 %, p = 0.015). Post-intervention, they showed greater reductions in anxiety (Cohen’s d = –0.72, 95 % CI [–1.15 to –0.28], p = 0.001) and helplessness (Cohen’s d = 1.26, 95 % CI [0.79–1.72], p &lt; 0.001), and increased acceptance (p &lt; 0.001), while depression decreased non-significantly (p = 0.167). Personal and social stress decreased (Cohen’s d = –0.99, 95 % CI [–1.43 to –0.54], p &lt; 0.001; social domain p = 0.003), but marital stress did not (p = 0.619). FertiQOL total and Treatment Environment scores improved (Cohen’s d = –1.89, 95 % CI [–2.39 to –1.39], p &lt; 0.001; Cohen’s d = –1.71, 95 % CI [–2.20 to –1.22], p &lt; 0.001), whereas Treatment Tolerance did not differ (p = 0.001). SUD scores decreased after sessions 2, 4, and 5 (r = –0.62 to –0.63, 95 % CI [–0.77 to –0.46], p &lt; 0.001). Effect sizes indicate medium to large clinical relevance. Participants at risk per SCREENIVF showed marked stress reduction and improved quality of life, with referrals to mental health services as needed.</div></div><div><h3>Conclusion</h3><div>Psychosocial care during IVF treatment appears to reduces psychological distress and enhances treatment-related well-being in women undergoing fertility procedures. These findings support the incorporation of psychosocial interventions into standard fertility care.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114891"},"PeriodicalIF":1.9,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training and assessment of competencies in hysteroscopy – A systematic review","authors":"Karen Høgh Abrahamsen ,&nbsp;Martine Siw Nielsen ,&nbsp;Nicolaj Bruun Brandt ,&nbsp;Anders Bo Nielsen ,&nbsp;Lars Konge ,&nbsp;Margit Dueholm ,&nbsp;Pernille Ravn","doi":"10.1016/j.ejogrb.2025.114890","DOIUrl":"10.1016/j.ejogrb.2025.114890","url":null,"abstract":"<div><h3>Objective</h3><div>Hysteroscopy is a core gynecological competence, acquired by training. Simulation training offers safe competence acquisition, but requires resource-efficient, clinically transferable approaches. Current hysteroscopic training curricula lack standardized assessment and validated pass-fail criteria. This review synthesizes evidence to inform optimized training and robust competency assessment.</div></div><div><h3>Methods</h3><div>Five databases were systematically searched on June 2nd 2025. Studies assessing hysteroscopy training and skills assessment were included without restrictions on population, study design, or publication year. Data extraction was performed using Covidence. Outcomes were evaluated with Kirkpatrick’s levels and quality assessment was evaluated with the Medical Education Research Study Quality Instrument (MERSQI).</div></div><div><h3>Results</h3><div>A total of 39 studies, 36 prospective cohort studies (92 %) and 3 RCTs (8 %), met the inclusion criteria. Studies used animal (13 %), inanimate (33 %), virtual reality (39 %), and combinations of models (15 %). Training approaches varied, with numbers-based training being most common (74 %). Outcomes were primarily evaluated with pre-post testing (41 %) and self-assessment (28 %). All studies reported improved performance, especially in novices, with either pre- and posttests or questionnaires. Study quality varied, with a mean MERSQI of 11.3 (range 5–16, of possible 5–18). Only one RCT showed clinical transferability.</div></div><div><h3>Conclusion</h3><div>Simulation-based training enhances hysteroscopic competencies. Despite methodological variability, evidence supports structured curricula combining theory, hands-on training, and pass-fail-based progression. A combination of virtual reality with tactile feedback seems optimal. Overall evidence failed to establish optimized training and robust competency assessment. Future research should include high-quality studies, patient-level outcomes, and updated validity frameworks to decide how to optimize training effectively.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114890"},"PeriodicalIF":1.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ferric carboxymaltose for third-trimester refractory anemia and perinatal outcomes: Retrospective cohort analysis","authors":"Şebnem Karagün ,&nbsp;Hamza Yıldız ,&nbsp;Yusuf Dal ,&nbsp;Sefanur Gamze Karaca ,&nbsp;Hatice Banu Atay ,&nbsp;Mürşide Çevikoğlu Kıllı ,&nbsp;Ayhan Coşkun","doi":"10.1016/j.ejogrb.2025.114887","DOIUrl":"10.1016/j.ejogrb.2025.114887","url":null,"abstract":"<div><h3>Background</h3><div>Iron deficiency anemia (IDA) in the third trimester is associated with adverse perinatal outcomes, but data on intravenous ferric carboxymaltose (FCM) effects beyond hematologic response remain limited.</div></div><div><h3>Methods</h3><div>This retrospective cohort study, conducted at Mersin University Hospital (January 2019 – March 2024), included 311 pregnant women diagnosed with IDA in the third trimester who were clinically recommended FCM therapy due to inadequate response to oral ferrous sulfate. Among these, 206 accepted FCM treatment (in addition to continued oral iron) while 105 declined and received oral iron alone. Women were compared as two groups: those who received oral iron alone versus those who received oral iron plus a single-dose FCM in the third trimester,. At four timepoints (baseline, post-FCM, delivery, and postpartum), hemoglobin (Hgb), hematocrit, MCV, and MCHC levels were evaluated. The primary outcome was maternal perinatal hemoglobin response, while the secondary outcome was the investigation of its correlation with key neonatal outcomes following FCM administration. Repeated measures ANOVA, two-way ANOVA, and correlation analyses were used.</div></div><div><h3>Results</h3><div>The FCM group showed significantly higher Hgb levels at baseline, delivery, and postpartum (all p &lt; 0.05). Birth weight (3164 ± 564 g vs. 2952 ± 691 g, p = 0.007), umblical cord blood pH (7.34 ± 0.04 vs. 7.28 ± 0.03, p &lt; 0.001), and Apgar scores were also improved in the FCM group. Neonatal intensive care unit (NICU) admission was significantly reduced (20.9 % vs. 31.4 %, p = 0.041), as was the incidence of fetal growth restriction (16.5 % vs. 38.1 %, p &lt; 0.001). In the FCM group, changes in Hgb from post-FCM to postpartum were positively correlated with 1-minute Apgar scores (r = 0.177, p = 0.011). Neonates requiring NICU admission showed an attenuated rise in Hgb across the same interval (p = 0.041), and women with adverse composite outcomes had greater Hgb fluctuation, particularly from delivery to postpartum (p = 0.020).</div></div><div><h3>Conclusion</h3><div>Third-trimester FCM therapy leads to superior hematologic correction and improved neonatal outcomes compared to oral iron alone. Hemoglobin recovery patterns after FCM may be predictive of neonatal adaptation and adverse outcomes, highlighting the broader perinatal significance of timely parenteral iron therapy in late pregnancy.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"317 ","pages":"Article 114887"},"PeriodicalIF":1.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of relugolix therapy for symptomatic uterine fibroids: a systematic review and meta-analysis","authors":"FNU Kalpina ,&nbsp;Dinesh Kumar ,&nbsp;Javeria Taj ,&nbsp;Manal Kaleem ,&nbsp;Tabia Shujaat ,&nbsp;Maimoona Qayyum ,&nbsp;Laiba Jabeen ,&nbsp;Ahmed Raza ,&nbsp;Muhammad Shaheer Bin Faheem","doi":"10.1016/j.ejogrb.2025.114889","DOIUrl":"10.1016/j.ejogrb.2025.114889","url":null,"abstract":"<div><h3>Introduction</h3><div>Uterine fibroids are the most common benign tumors in premenopausal women and often necessitate fertility-sparing treatments. Relugolix, an oral GnRh antagonist has emerged as a promising non-surgical option. This systematic review and meta-analysis evaluate the efficacy and safety of relugolix for symptomatic uterine fibroids.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, Cochrane CENTRAL, Scopus, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> through March 2025. Six studies (n = 511) were included in accordance with the PRISMA guidelines. Data were analysed using random-effects models in R (v4.5.0). Risk of Bias was assessed using ROB 2 tool. Continuous outcomes were reported as mean differences (MDs), dichotomous outcomes as odds ratios (ORs) or proportions, and heterogeneity using I² statistics, with sensitivity analyses for I² ≥ 50 %.</div></div><div><h3>Results</h3><div>Pooled analysis revealed a myoma volume reduction (MVR) of −30.18 %, with similar findings when compared to placebo (−28.50 %; p-value = 0.0070). Uterine volume decreased by −27.22 %. When compared with placebo, uterine volume significantly reduced by −30.31 (p-value = 0.0028). Amenorrhea was achieved by 63 % of patients, with relugolix-treated patients showing 31-fold higher odds versus controls (31.07 %; p-value &lt; 0.0001). Haemoglobin levels improved in 46.3 % patients, while relugolix-treated patients achieved significant pain relief compared to controls (OR 9.02; p = value &lt; 0.0001). Subgroup analyses showed that relugolix monotherapy produced greater reductions in myoma and uterine volumes than combination therapy, although both regimens were effective.</div><div>Treatment as generally well-tolerated, with hot flushes being the most common adverse event. A small proportion reported persistent menorrhagia without indicating treatment failure. Other adverse events, such as headache, were also reported, though discontinuation rates were comparable to controls.</div></div><div><h3>Conclusion</h3><div>Relugolix significantly reduces fibroid burden and symptoms with favourable safety profile. It offers a well-tolerated, fertility-preserving alternative to surgery. Further large-scale RCTs are needed to confirm these findings and optimize treatment protocols.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114889"},"PeriodicalIF":1.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}