Pub Date : 2026-02-01DOI: 10.1016/j.ejogrb.2026.114986
Ana R. Silva , Mariana Santos , Alexandra Coelho , Raquel Condeço , Filipa Alpendre , Paula Ambrósio , Patrícia Pinto , Maria José Bernardo , Dusan Djokovic
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.
目的：评估无症状绝经前和绝经后妇女超声检查良性子宫内膜息肉（EPs）的自然病史和安全性，重点关注自发消退、生长、子宫异常出血（AUB）发作和恶性肿瘤风险。研究设计：双前瞻性队列研究，纳入298名无症状妇女（62名绝经前妇女，236名绝经后妇女），在2017年1月至2023年1月期间对超声检查良性EPs进行评估。在常规护理期间，根据IETA标准前瞻性收集超声数据（计划随访3个月和9个月，然后每年一次），同时回顾性确定病例纳入。结果包括完全自发消退、病变生长、AUB发作、宫腔镜切除和组织病理学（如果有的话）。应用时间-事件分析和简洁的Cox比例风险模型。结果：中位随访11个月（IQR 6-24）。24/298名妇女发生完全自发回归（8.05%;95% CI 5.2%-11.9%），绝经前妇女比绝经后妇女更常见（14.5%比6.4%;log-rank p = 0.058）。26/298名女性发生AUB （8.7%; 95% CI 5.7%-12.6%）。90/298例（30.2%;95% CI 25.1%-35.7%）行宫腔镜切除，96例（32.2%）病变组织学资料可查。发现1例癌（1/96;1.04%；总1/298 = 0.34%）。较大的基线平均直径（每5毫米；调整后危险度1.22,95% CI 1.06-1.41）和较高的血管密度（评分≥3 vs≤2；危险度1.85,95% CI 1.10-3.11）独立预测较早切除。结论：对无症状的超声良性EPs的预期治疗是安全的，在切除的病变中观察到的恶性程度很低。结构化超声监测可以减少不必要的手术，同时实现及时干预。
{"title":"Expectant management as a primary approach for asymptomatic endometrial polyps: An ambispective cohort study","authors":"Ana R. Silva , Mariana Santos , Alexandra Coelho , Raquel Condeço , Filipa Alpendre , Paula Ambrósio , Patrícia Pinto , Maria José Bernardo , Dusan Djokovic","doi":"10.1016/j.ejogrb.2026.114986","DOIUrl":"10.1016/j.ejogrb.2026.114986","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Study design</h3><div>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.</div></div><div><h3>Results</h3><div>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% <em>vs</em>. 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 <em>vs</em>. ≤ 2; HR 1.85, 95% CI 1.10–3.11) independently predicted earlier excision.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114986"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117925","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}
Pub Date : 2026-01-31DOI: 10.1016/j.ejogrb.2026.114987
Jia Shan
<div><h3>Objective</h3><div>To evaluate the efficacy of pelvic floor muscle training (PFMT) combined with intravaginal Promestriene, a local steroid hormone precursor that is converted within vaginal tissues into active estrogens and androgens with minimal systemic absorption, in middle-aged and elderly women with pelvic floor dysfunction (PFD) and to explore its effects on muscle strength recovery, tissue improvement, and urinary control enhancement.</div></div><div><h3>Methods</h3><div>This single-center retrospective case analysis included 166 middle-aged and elderly female patients who received pelvic floor rehabilitation between January 2020 and December 2023. Based on previous treatment regimens, patients were divided into an intervention group (PFMT combined with Promestriene, n = 82) and a control group (PFMT alone, n = 84). The intervention period was 6–8 weeks, and all patients underwent follow-up assessments before the intervention, at the end of the intervention, and at 3 months post-intervention. Primary outcome measures included pelvic floor muscle strength (Oxford grading scale, electromyographic maximum voluntary contraction), muscle endurance, urinary control function (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] score, pad test weight), and vaginal tissue health (Vaginal Health Index [VHI] score, with higher values indicating better vaginal tissue health, pH, epithelial thickness, and tissue elasticity). Secondary outcomes included quality of life scores (Pelvic Floor Impact Questionnaire-Short Form 7 [PFIQ-7], Female Sexual Function Index [FSFI], Pittsburgh Sleep Quality Index [PSQI]), pelvic organ support (Pelvic Organ Prolapse Quantification [POP-Q] measurements), and adverse events. Propensity score matching was employed for sensitivity analysis to control for confounding factors.</div></div><div><h3>Results</h3><div>The intervention group demonstrated significantly greater improvements in pelvic floor muscle strength, muscle endurance, and electromyographic parameters compared to the control group (all P < 0.01). Regarding urinary control, the ICIQ-SF score decreased by an average of 5.4 points from baseline in the intervention group versus 3.7 points in the control group (P < 0.001), with a correspondingly greater reduction in pad test weight. Vaginal tissue health indicators showed that intravaginal Promestriene significantly improved mucosal color, lubrication, epithelial thickness, and tissue elasticity, with a greater overall improvement in VHI total score compared to the control group (P < 0.001). Quality of life across various domains also showed more pronounced enhancement, particularly in FSFI satisfaction and sleep quality. Improvements in pelvic support structures, such as POP-Q points Aa and Ba, were more marked in the intervention group. The clinical response rate (defined as a ≥ 4-point improvement in ICIQ-SF) was 68.3% in the intervention group, significantly higher t
{"title":"Efficacy of pelvic floor muscle training combined with promestriene in improving pelvic floor dysfunction in middle-aged and elderly women: a retrospective study","authors":"Jia Shan","doi":"10.1016/j.ejogrb.2026.114987","DOIUrl":"10.1016/j.ejogrb.2026.114987","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy of pelvic floor muscle training (PFMT) combined with intravaginal Promestriene, a local steroid hormone precursor that is converted within vaginal tissues into active estrogens and androgens with minimal systemic absorption, in middle-aged and elderly women with pelvic floor dysfunction (PFD) and to explore its effects on muscle strength recovery, tissue improvement, and urinary control enhancement.</div></div><div><h3>Methods</h3><div>This single-center retrospective case analysis included 166 middle-aged and elderly female patients who received pelvic floor rehabilitation between January 2020 and December 2023. Based on previous treatment regimens, patients were divided into an intervention group (PFMT combined with Promestriene, n = 82) and a control group (PFMT alone, n = 84). The intervention period was 6–8 weeks, and all patients underwent follow-up assessments before the intervention, at the end of the intervention, and at 3 months post-intervention. Primary outcome measures included pelvic floor muscle strength (Oxford grading scale, electromyographic maximum voluntary contraction), muscle endurance, urinary control function (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] score, pad test weight), and vaginal tissue health (Vaginal Health Index [VHI] score, with higher values indicating better vaginal tissue health, pH, epithelial thickness, and tissue elasticity). Secondary outcomes included quality of life scores (Pelvic Floor Impact Questionnaire-Short Form 7 [PFIQ-7], Female Sexual Function Index [FSFI], Pittsburgh Sleep Quality Index [PSQI]), pelvic organ support (Pelvic Organ Prolapse Quantification [POP-Q] measurements), and adverse events. Propensity score matching was employed for sensitivity analysis to control for confounding factors.</div></div><div><h3>Results</h3><div>The intervention group demonstrated significantly greater improvements in pelvic floor muscle strength, muscle endurance, and electromyographic parameters compared to the control group (all P < 0.01). Regarding urinary control, the ICIQ-SF score decreased by an average of 5.4 points from baseline in the intervention group versus 3.7 points in the control group (P < 0.001), with a correspondingly greater reduction in pad test weight. Vaginal tissue health indicators showed that intravaginal Promestriene significantly improved mucosal color, lubrication, epithelial thickness, and tissue elasticity, with a greater overall improvement in VHI total score compared to the control group (P < 0.001). Quality of life across various domains also showed more pronounced enhancement, particularly in FSFI satisfaction and sleep quality. Improvements in pelvic support structures, such as POP-Q points Aa and Ba, were more marked in the intervention group. The clinical response rate (defined as a ≥ 4-point improvement in ICIQ-SF) was 68.3% in the intervention group, significantly higher t","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114987"},"PeriodicalIF":1.9,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131574","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}
Pub Date : 2026-01-31DOI: 10.1016/j.ejogrb.2026.114984
Özden Tandoğan, Zehra Korkmaz
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.
{"title":"Navigating motherhood with one breast: a descriptive phenomenological study of body image, social stigma and resilience during active chemotherapy.","authors":"Özden Tandoğan, Zehra Korkmaz","doi":"10.1016/j.ejogrb.2026.114984","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2026.114984","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Mothers who underwent unilateral mastectomy followed by chemotherapy experienced emotional strain, altered self-perception, and social stigma, yet displayed notable resilience and adaptive coping.</p>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":" ","pages":"114984"},"PeriodicalIF":1.9,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131002","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":"Successful management of early-diagnosed cervical pregnancy with suction curettage alone: A case series","authors":"Tatsuya Arakaki, Ryu Matsuoka, Yuriko Yagi, Hiroko Takita, Yuka Yamashita, Mayumi Kaneko, Akihiko Sekizawa","doi":"10.1016/j.ejogrb.2026.114978","DOIUrl":"10.1016/j.ejogrb.2026.114978","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114978"},"PeriodicalIF":1.9,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146099745","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}
Pub Date : 2026-01-30DOI: 10.1016/j.ejogrb.2026.114977
James Bernard Hill , Isabella Sullivan , Katherine Lakey , Kimberly Evans , Edna Osei , Suneet P. Chauhan
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.
{"title":"Screening, diagnosing, and managing perinatal depression: Review of SIX national guidelines","authors":"James Bernard Hill , Isabella Sullivan , Katherine Lakey , Kimberly Evans , Edna Osei , Suneet P. Chauhan","doi":"10.1016/j.ejogrb.2026.114977","DOIUrl":"10.1016/j.ejogrb.2026.114977","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114977"},"PeriodicalIF":1.9,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131529","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}
Pub Date : 2026-01-29DOI: 10.1016/j.ejogrb.2026.114969
Mona Saad Salman , Ahmed Nagy Shaker , Mai Mosad Abdelghany Morsy , Heba Hassan Zeid , Mohamed Raslan , Sally Alaa El Dien Ibrahim El Attar , Ahmed Emad Abd El Tawwab
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.
{"title":"Comparative accuracy of mid-thigh soft tissue thickness and the hadlock formula in fetal weight estimation during the third trimester: A prospective cross-sectional study","authors":"Mona Saad Salman , Ahmed Nagy Shaker , Mai Mosad Abdelghany Morsy , Heba Hassan Zeid , Mohamed Raslan , Sally Alaa El Dien Ibrahim El Attar , Ahmed Emad Abd El Tawwab","doi":"10.1016/j.ejogrb.2026.114969","DOIUrl":"10.1016/j.ejogrb.2026.114969","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>EFW using the MTSTT model showed a stronger correlation with Actual birth weight (r = 0.956, r<sup>2</sup> = 0.914) compared to the Hadlock method (r = 0.778, r<sup>2</sup> = 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114969"},"PeriodicalIF":1.9,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146099763","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}
Pub Date : 2026-01-29DOI: 10.1016/j.ejogrb.2026.114980
Frank I. Jackson , Nathan A. Keller , Sarah Abelman , Luis A. Bracero , Matthew J. Blitz
Background
Delivery timing in pregnancies complicated by early-onset preeclampsia with severe features (sPEC) is individualized, aiming to prolong gestation for fetal benefit while minimizing maternal risk.
Objective
To determine whether expectant management (EM), compared to expedited delivery (ED), improves neonatal outcomes in pregnancies complicated by sPEC.
Study design
This retrospective cohort study evaluated pregnancies complicated by sPEC within a large New York health system from 2019 to 2023. Pregnancies requiring immediate delivery (<24 h after diagnosis or without betamethasone administration) were excluded. Patients were classified as ED if delivery occurred within 24–72 h after diagnosis, and EM if delivery occurred after 72 h. The primary outcome was severe neonatal morbidity (SNM), a composite of diagnoses and procedures indicative of life-threatening complications. Secondary outcomes included neonatal death, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), sepsis, and NICU discharge metrics. Outcomes were analyzed by gestational age at diagnosis: <28 weeks and 28–33 weeks.
Results
Of 225 pregnancies included, 36 (16.0%) were diagnosed with sPEC < 28 weeks and 189 (84.0%) between 28–33 weeks. Rates of SNM were similar between ED and EM at both gestational age groups (<28 weeks: 92.3% vs. 91.3%; 28–33 weeks: 82.6% vs. 78.3%). Neonatal death was more common in the < 28-week ED group (38.5% vs. 4.3%). Among pregnancies diagnosed at 28–33 weeks, NICU length of stay was shorter in the EM group (21.1 vs. 28.4 days, p = 0.03), while postmenstrual age at discharge was similar (35.4 vs. 35.3 weeks, p = 0.82).
Conclusions
For sPEC diagnosed between 28–33 weeks, EM did not significantly reduce SNM but was associated with shorter NICU stays. Among pregnancies diagnosed before 28 weeks, neonatal mortality was higher in the ED group, supporting EM when maternal condition permits.
{"title":"Early-onset preeclampsia: gestational age threshold of potential benefits","authors":"Frank I. Jackson , Nathan A. Keller , Sarah Abelman , Luis A. Bracero , Matthew J. Blitz","doi":"10.1016/j.ejogrb.2026.114980","DOIUrl":"10.1016/j.ejogrb.2026.114980","url":null,"abstract":"<div><h3>Background</h3><div>Delivery timing in pregnancies complicated by early-onset preeclampsia with severe features (sPEC) is individualized, aiming to prolong gestation for fetal benefit while minimizing maternal risk.</div></div><div><h3>Objective</h3><div>To determine whether expectant management (EM), compared to expedited delivery (ED), improves neonatal outcomes in pregnancies complicated by sPEC.</div></div><div><h3>Study design</h3><div>This retrospective cohort study evaluated pregnancies complicated by sPEC within a large New York health system from 2019 to 2023. Pregnancies requiring immediate delivery (<24 h after diagnosis or without betamethasone administration) were excluded. Patients were classified as ED if delivery occurred within 24–72 h after diagnosis, and EM if delivery occurred after 72 h. The primary outcome was severe neonatal morbidity (SNM), a composite of diagnoses and procedures indicative of life-threatening complications. Secondary outcomes included neonatal death, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), sepsis, and NICU discharge metrics. Outcomes were analyzed by gestational age at diagnosis: <28 weeks and 28–33 weeks.</div></div><div><h3>Results</h3><div>Of 225 pregnancies included, 36 (16.0%) were diagnosed with sPEC < 28 weeks and 189 (84.0%) between 28–33 weeks. Rates of SNM were similar between ED and EM at both gestational age groups (<28 weeks: 92.3% vs. 91.3%; 28–33 weeks: 82.6% vs. 78.3%). Neonatal death was more common in the < 28-week ED group (38.5% vs. 4.3%). Among pregnancies diagnosed at 28–33 weeks, NICU length of stay was shorter in the EM group (21.1 vs. 28.4 days, p = 0.03), while postmenstrual age at discharge was similar (35.4 vs. 35.3 weeks, p = 0.82).</div></div><div><h3>Conclusions</h3><div>For sPEC diagnosed between 28–33 weeks, EM did not significantly reduce SNM but was associated with shorter NICU stays. Among pregnancies diagnosed before 28 weeks, neonatal mortality was higher in the ED group, supporting EM when maternal condition permits.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114980"},"PeriodicalIF":1.9,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117911","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}
Pub Date : 2026-01-29DOI: 10.1016/j.ejogrb.2026.114981
O.P. Van Marle, J.P. Hoogendam, R.P. Zweemer, C.G. Gerestein
Objective
To describe a case series of patients with obturator nerve injury following pelvic lymphadenectomy (PLND) at the study centre, and provide a narrative review of the literature regarding the incidence, management and clinical course of obturator nerve injury after PLND.
Methods
A literature search was performed using PubMed and Google Scholar, applying the terms ‘obturator nerve injury’ and ‘lymph node dissection’, including relevant MeSH terms and synonyms. In addition, all patients with obturator nerve injury following robot-assisted laparoscopic PLND at the study centre between 1 January 2008 and 31 December 2023 were identified. Data regarding type of surgery, surgical repair technique, materials used, and postoperative course were collected. The primary outcome was recovery of motor and sensory function. Secondary outcomes included residual morbidity, the proportion of patients achieving full recovery within 1 year, and the need for additional surgical intervention.
Results
In total, 16 patients with obturator nerve injury following PLND were identified. In most cases, a primary end-to-end epineural anastomosis using 5–0 or 6–0 Prolene sutures was performed. In five patients, a primary anastomosis was not feasible, and nerve grafts or polyglycolic acid/collagen conduits were used. The majority of patients achieved full recovery within 3 months.
Conclusion
Obturator nerve injury is a rare complication of PLND. In most cases, primary end-to-end epineural repair can be performed to restore nerve continuity, and this is associated with a favourable clinical course. While most patients recover within 3 months, residual motor deficits may persist in a subset of cases. These findings should be interpreted as descriptive, as comparative evidence regarding surgical techniques and materials remains limited.
{"title":"Obturator nerve injury during robot-assisted laparoscopic pelvic lymphadenectomy: Literature review and case series","authors":"O.P. Van Marle, J.P. Hoogendam, R.P. Zweemer, C.G. Gerestein","doi":"10.1016/j.ejogrb.2026.114981","DOIUrl":"10.1016/j.ejogrb.2026.114981","url":null,"abstract":"<div><h3>Objective</h3><div>To describe a case series of patients with obturator nerve injury following pelvic lymphadenectomy (PLND) at the study centre, and provide a narrative review of the literature regarding the incidence, management and clinical course of obturator nerve injury after PLND.</div></div><div><h3>Methods</h3><div>A literature search was performed using PubMed and Google Scholar, applying the terms ‘obturator nerve injury’ and ‘lymph node dissection’, including relevant MeSH terms and synonyms. In addition, all patients with obturator nerve injury following robot-assisted laparoscopic PLND at the study centre between 1 January 2008 and 31 December 2023 were identified. Data regarding type of surgery, surgical repair technique, materials used, and postoperative course were collected. The primary outcome was recovery of motor and sensory function. Secondary outcomes included residual morbidity, the proportion of patients achieving full recovery within 1 year, and the need for additional surgical intervention.</div></div><div><h3>Results</h3><div>In total, 16 patients with obturator nerve injury following PLND were identified. In most cases, a primary end-to-end epineural anastomosis using 5–0 or 6–0 Prolene sutures was performed. In five patients, a primary anastomosis was not feasible, and nerve grafts or polyglycolic acid/collagen conduits were used. The majority of patients achieved full recovery within 3 months.</div></div><div><h3>Conclusion</h3><div>Obturator nerve injury is a rare complication of PLND. In most cases, primary end-to-end epineural repair can be performed to restore nerve continuity, and this is associated with a favourable clinical course. While most patients recover within 3 months, residual motor deficits may persist in a subset of cases. These findings should be interpreted as descriptive, as comparative evidence regarding surgical techniques and materials remains limited.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114981"},"PeriodicalIF":1.9,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146099782","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}
Pub Date : 2026-01-29DOI: 10.1016/j.ejogrb.2026.114982
Aenne Helps , Indra Lazaro Campillo , Paul Corcoran , Julie McGinley , Richard Greene , John Murphy , Peter McKenna
<div><div><strong>Background</strong>: Neonatal encephalopathy, often due to peripartum hypoxia–ischemia, remains a significant cause of neonatal morbidity and mortality. Therapeutic hypothermia is the established treatment for moderate and severe neonatal encephalopathy in Ireland since 2012 after publication of an international trial. Despite adherence to strict clinical criteria, the maternal and obstetric factors associated with infants requiring therapeutic hypothermia remain incompletely understood.</div><div><strong>Objectives</strong>: To describe maternal and infant characteristics among infants treated with therapeutic hypothermia in Ireland over five years, and to assess whether obstetric factors are associated with increased risk of neonatal encephalopathy.</div><div><strong>Study design</strong>: A population-based, retrospective cohort study of all infants (n = 357) who received therapeutic hypothermia in Ireland from 2016 to 2020 was conducted. Data were collected from 19 maternity units and compiled into a national register. The study compared antenatal and intrapartum characteristics between therapeutic hypothermia cases and the national birthing population. Risks per 1,000 births and their exact Poisson 95% confidence intervals and risk ratios (RR) and their 95% CI were the primary statistical measures reported.</div><div><strong>Results</strong>: The incidence of therapeutic hypothermia was 1.18 per 1,000 live births (357/301,442), with some evidence of increase over time (RR for 2020 vs 2016 = 1.36, CI: 0.98–1.90; p = 0.068). Infants born to nulliparous women had a more than twofold higher risk of receiving therapeutic hypothermia (1.79 vs 0.80 per 1,000; RR = 2.25, CI: 1.82–2.77; p < 0.001). Therapeutic hypothermia risk increased significantly with maternal obesity (RR = 1.65) and fetal growth restriction (RR = 2.74 for < 3rd centile; RR = 1.99 for 4th–10th centile). Emergency caesarean section was associated with the highest therapeutic hypothermia risk. Sentinel events such as shoulder dystocia (n = 42; 11.8%), placental abruption (n = 20; 5.6%), and uterine rupture (n = 12; 3.4%) were significantly associated with therapeutic hypothermia (shoulder dystocia RR = 17.48, CI: 12.67–24.12; p < 0.001). Overall, 14% (50/357) of infants died. Among those followed up with Bayley-III testing (n = 85), 21.2% had motor, 16.5% cognitive, and 28.2% language delays.</div><div><strong>Conclusion:</strong> Infants born to nulliparous women, those exposed to maternal obesity, fetal growth restriction and emergency caesarean section birth were at increased risk of requiring therapeutic hypothermia. Sentinel events, while strongly associated with therapeutic hypothermia, were infrequent, suggesting cumulative or dynamic perinatal factors play a critical role. These findings underscore the importance of enhanced intrapartum monitoring and structured clinical response systems to reduce avoidable neonatal encephalopathy cases in Ireland
{"title":"Neonatal encephalopathy requiring therapeutic hypothermia over 5 years in a national Irish birth cohort: Relevance of the obstetric data","authors":"Aenne Helps , Indra Lazaro Campillo , Paul Corcoran , Julie McGinley , Richard Greene , John Murphy , Peter McKenna","doi":"10.1016/j.ejogrb.2026.114982","DOIUrl":"10.1016/j.ejogrb.2026.114982","url":null,"abstract":"<div><div><strong>Background</strong>: Neonatal encephalopathy, often due to peripartum hypoxia–ischemia, remains a significant cause of neonatal morbidity and mortality. Therapeutic hypothermia is the established treatment for moderate and severe neonatal encephalopathy in Ireland since 2012 after publication of an international trial. Despite adherence to strict clinical criteria, the maternal and obstetric factors associated with infants requiring therapeutic hypothermia remain incompletely understood.</div><div><strong>Objectives</strong>: To describe maternal and infant characteristics among infants treated with therapeutic hypothermia in Ireland over five years, and to assess whether obstetric factors are associated with increased risk of neonatal encephalopathy.</div><div><strong>Study design</strong>: A population-based, retrospective cohort study of all infants (n = 357) who received therapeutic hypothermia in Ireland from 2016 to 2020 was conducted. Data were collected from 19 maternity units and compiled into a national register. The study compared antenatal and intrapartum characteristics between therapeutic hypothermia cases and the national birthing population. Risks per 1,000 births and their exact Poisson 95% confidence intervals and risk ratios (RR) and their 95% CI were the primary statistical measures reported.</div><div><strong>Results</strong>: The incidence of therapeutic hypothermia was 1.18 per 1,000 live births (357/301,442), with some evidence of increase over time (RR for 2020 vs 2016 = 1.36, CI: 0.98–1.90; p = 0.068). Infants born to nulliparous women had a more than twofold higher risk of receiving therapeutic hypothermia (1.79 vs 0.80 per 1,000; RR = 2.25, CI: 1.82–2.77; p < 0.001). Therapeutic hypothermia risk increased significantly with maternal obesity (RR = 1.65) and fetal growth restriction (RR = 2.74 for < 3rd centile; RR = 1.99 for 4th–10th centile). Emergency caesarean section was associated with the highest therapeutic hypothermia risk. Sentinel events such as shoulder dystocia (n = 42; 11.8%), placental abruption (n = 20; 5.6%), and uterine rupture (n = 12; 3.4%) were significantly associated with therapeutic hypothermia (shoulder dystocia RR = 17.48, CI: 12.67–24.12; p < 0.001). Overall, 14% (50/357) of infants died. Among those followed up with Bayley-III testing (n = 85), 21.2% had motor, 16.5% cognitive, and 28.2% language delays.</div><div><strong>Conclusion:</strong> Infants born to nulliparous women, those exposed to maternal obesity, fetal growth restriction and emergency caesarean section birth were at increased risk of requiring therapeutic hypothermia. Sentinel events, while strongly associated with therapeutic hypothermia, were infrequent, suggesting cumulative or dynamic perinatal factors play a critical role. These findings underscore the importance of enhanced intrapartum monitoring and structured clinical response systems to reduce avoidable neonatal encephalopathy cases in Ireland","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114982"},"PeriodicalIF":1.9,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104498","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}
Pub Date : 2026-01-27DOI: 10.1016/j.ejogrb.2026.114974
E. Raimond , C. Mimoun , I. Menouer , O. Graesslin , A. Fauconnier , C. Huchon
Introduction
Vulvar cancer surgery is associated with high rates of morbidity. Preventing or minimizing these morbidities is an important objective, as they impact on patients’ quality of life, and are highly deleterious in frail, aged patients, who represent the majority of those affected by this disease. This systematic literature review and meta-analysis assesses post-operative complications in vulvar cancer surgery, and attempts to identify the impact of frailty factors.
Method
A Pubmed search was conducted to identify studies reporting data on complications of vulvar cancer surgery in frail patients, from January 2000 to April 2022, following the recommendations of the PRISMA, and registered in PROSPERO (CRD 42024503036). The evaluation criteria were: age, frailty, and complications. Statistical heterogeneity of results was assessed by graphical representations of confidence intervals (CI) on forest plot and by a Chi2 heterogeneity test.
Result
Frailty related to age > 70 years increases the risk of inguinal disunion (OR = 1.89, 95%CI [1.12–3.20]). Frailty (due to age and obesity) does not increase the risk of lymphocele. Frailty factors, such as obesity, are risk factors for inguinal cellulitis (OR = 1.86, 95%CI [1.12–3.08]), and diabetes is a risk factor for inguinal infection.
Conclusion
This literature review and meta-analysis precludes drawing any significant clinical conclusion regarding the impact of frailty, in particular age-related frailty, on the occurrence of complications. This is due to different definitions of complications, a lack of precision in the data provided, the variety of surgical techniques performed, the absence of an age group or a frailty group.
{"title":"Systematic literature review and meta-analysis of postoperative complications of surgical management of vulvar cancer: what is the impact of frailty factors?","authors":"E. Raimond , C. Mimoun , I. Menouer , O. Graesslin , A. Fauconnier , C. Huchon","doi":"10.1016/j.ejogrb.2026.114974","DOIUrl":"10.1016/j.ejogrb.2026.114974","url":null,"abstract":"<div><h3>Introduction</h3><div>Vulvar cancer surgery is associated with high rates of morbidity. Preventing or minimizing these morbidities is an important objective, as they impact on patients’ quality of life, and are highly deleterious in frail, aged patients, who represent the majority of those affected by this disease. This systematic literature review and meta-analysis assesses post-operative complications in vulvar cancer surgery, and attempts to identify the impact of frailty factors.</div></div><div><h3>Method</h3><div>A Pubmed search was conducted to identify studies reporting data on complications of vulvar cancer surgery in frail patients, from January 2000 to April 2022, following the recommendations of the PRISMA, and registered in PROSPERO (CRD 42024503036). The evaluation criteria were: age, frailty, and complications. Statistical heterogeneity of results was assessed by graphical representations of confidence intervals (CI) on forest plot and by a Chi2 heterogeneity test.</div></div><div><h3>Result</h3><div>Frailty related to age > 70 years increases the risk of inguinal disunion (OR = 1.89, 95%CI [1.12–3.20]). Frailty (due to age and obesity) does not increase the risk of lymphocele. Frailty factors, such as obesity, are risk factors for inguinal cellulitis (OR = 1.86, 95%CI [1.12–3.08]), and diabetes is a risk factor for inguinal infection.</div></div><div><h3>Conclusion</h3><div>This literature review and meta-analysis precludes drawing any significant clinical conclusion regarding the impact of frailty, in particular age-related frailty, on the occurrence of complications. This is due to different definitions of complications, a lack of precision in the data provided, the variety of surgical techniques performed, the absence of an age group or a frailty group.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114974"},"PeriodicalIF":1.9,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076482","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}
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