{"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}
Pub Date : 2026-01-27DOI: 10.1016/j.ejogrb.2026.114976
Musa A. Muslimah , Halimat J. Akande , Hadijat O. Raji , Bola B. Olafimihan , Latifat T. Aremu , James I. Owolabi , Sadiya M. Gwadabe , Idris O. Quadri
Aim and objectives
To assess gestational age using the umbilical cord diameter (UCD) and cross-sectional area (CSA).
Methodology
This was a cross-sectional study among 300 women with no adverse medical history and uncomplicated pregnancies between the 14th and 40th completed weeks of pregnancy. The commonly used foetal parameters for gestational age (GA) estimation: Biparietal Diameter, Head and Abdominal Circumference and Femur Length were measured using standard protocols.
UCD and CSA were measured in a plane adjacent to cord insertion into the foetal abdomen within 1 cm. UCD was measured in long axis from outer-to-outer border of the umbilical cord using the electronic calipers. The cross-sectional area was obtained in transverse axis using the ellipse measurement and area was calculated automatically by the ultrasound machine in-built software. Measurements were taken twice for each parameter, and the average value was recorded for each participant to reduce intra-observer error.
Result
The mean UCD and CSA were 16.12 ± 4.28 mm and 2.08 ± 0.87 cm2 respectively. UCD and CSA were observed to increase steadily with GA up to the 33rd week of gestation, decline and then remain stable from the 38th and 39th week gestation respectively until the end of pregnancy. Significant correlations (p = 0.001) between umbilical cord diameter and cross-sectional area with estimated foetal weight (EFW), GA and other foetal parameters for GA estimation was observed.
A regression analysis model between UCD, CSA and GA showed 95% confidence interval (CI). GA by LMP (weeks) = 1.528 (UCD) + 2.646, 7.544 (CSA) + 11.540. GA by US (weeks) = 1.542 (UCD) + 2.653, 7.618 (CSA) + 11.619.
Conclusion
UCD and CSA measurement is a reliable method for prediction of GA and has a strong linear relationship with commonly used foetal parameters.
{"title":"Umbilical cord diameter and cross-sectional area in association with gestational age among women with uncomplicated pregnancies in north-central Nigeria: a cross-sectional study","authors":"Musa A. Muslimah , Halimat J. Akande , Hadijat O. Raji , Bola B. Olafimihan , Latifat T. Aremu , James I. Owolabi , Sadiya M. Gwadabe , Idris O. Quadri","doi":"10.1016/j.ejogrb.2026.114976","DOIUrl":"10.1016/j.ejogrb.2026.114976","url":null,"abstract":"<div><h3>Aim and objectives</h3><div>To assess gestational age using the umbilical cord diameter (UCD) and cross-sectional area (CSA).</div></div><div><h3>Methodology</h3><div>This was a cross-sectional study among 300 women with no adverse medical history and uncomplicated pregnancies between the 14th and 40th completed weeks of pregnancy. The commonly used foetal parameters for gestational age (GA) estimation: Biparietal Diameter, Head and Abdominal Circumference and Femur Length were measured using standard protocols.</div><div>UCD and CSA were measured in a plane adjacent to cord insertion into the foetal abdomen within 1 cm. UCD was measured in long axis from outer-to-outer border of the umbilical cord using the electronic calipers. The cross-sectional area was obtained in transverse axis using the ellipse measurement and area was calculated automatically by the ultrasound machine in-built software. Measurements were taken twice for each parameter, and the average value was recorded for each participant to reduce intra-observer error.</div></div><div><h3>Result</h3><div>The mean UCD and CSA were 16.12 ± 4.28 mm and 2.08 ± 0.87 cm<sup>2</sup> respectively. UCD and CSA were observed to increase steadily with GA up to the 33rd week of gestation, decline and then remain stable from the 38th and 39th week gestation respectively until the end of pregnancy. Significant correlations (p = 0.001) between umbilical cord diameter and cross-sectional area with estimated foetal weight (EFW), GA and other foetal parameters for GA estimation was observed.</div><div>A regression analysis model between UCD, CSA and GA showed 95% confidence interval (CI). GA by LMP (weeks) = 1.528 (UCD) + 2.646, 7.544 (CSA) + 11.540. GA by US (weeks) = 1.542 (UCD) + 2.653, 7.618 (CSA) + 11.619.</div></div><div><h3>Conclusion</h3><div>UCD and CSA measurement is a reliable method for prediction of GA and has a strong linear relationship with commonly used foetal parameters.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114976"},"PeriodicalIF":1.9,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076414","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 : 2026-01-26DOI: 10.1016/j.ejogrb.2026.114979
Julia M. Whelchel , Sofia Perez Otero , Ashley S. Roman , Sara G. Brubaker , Antonia F. Oladipo , Jason C. Fisher , Sandra S. Tomita
Background
Perinatal ovarian cysts may spontaneously resolve or cause ovarian torsion. Cyst size and appearance often guide surgical decision making. The natural history of these cysts and impact of perinatal interventions on ovarian outcomes remain unclear. We investigated the association of various clinical parameters with operative intervention and ovarian loss.
Methods
Infants with ovarian cysts meeting our definition of perinatal (diagnosed between 15 weeks gestational age and 1 year) from November 2006–January 2022 were identified. Cysts were characterized by size, morphology, laterality, and evolution. Outcome measures included resolution, ovarian loss, and operative intervention. Mann–Whitney U and Fisher exact tests were used. Optimal maximal size cutoffs were obtained using ROC curves.
Results
Sixty-two female patients with perinatal ovarian cysts were identified. Spontaneous resolution occurred in 35, prenatally and postnatally, with follow-up length averaging 186 days. Of 18 undergoing cystectomies, 9 revealed non-viable ovaries. Overall ovarian loss rate was 29%. Loss occurred more frequently with large, complex, and right-sided cysts (P < 0.05) but some complex cysts also resolved spontaneously. Operative intervention occurred more frequently with larger cysts (P=<0.001) and was associated with ovarian salvage when performed earlier (P = 0.008) on larger cysts (P = 0.02). Maximal cyst diameter > 4.05 cm predicted ovarian loss with 78% sensitivity, 64% specificity (AUC = 0.67,95%CI = 0.54–0.81, P = 0.04). Maximal cyst diameter > 4.55 cm predicted surgery with 83% sensitivity, 82% specificity (AUC = 0.86,95%CI = 0.77–0.96, P < 0.001).
Conclusions
29% of perinatal ovarian cysts resulted in ovarian loss. 56% resolved spontaneously (prenatal and postnatal resolution) including some complex cysts. Cysts that were postnatally complex and maximally > 4 cm had higher rates of ovarian loss and operative intervention. Earlier postnatal operative intervention was associated with ovarian preservation. Standardized imaging (such as the IOTA terminology) and management protocols are needed to better understand behavior and improve treatment of these cysts.
{"title":"Factors associated with ovarian loss and surgical intervention for perinatal ovarian cysts","authors":"Julia M. Whelchel , Sofia Perez Otero , Ashley S. Roman , Sara G. Brubaker , Antonia F. Oladipo , Jason C. Fisher , Sandra S. Tomita","doi":"10.1016/j.ejogrb.2026.114979","DOIUrl":"10.1016/j.ejogrb.2026.114979","url":null,"abstract":"<div><h3>Background</h3><div>Perinatal ovarian cysts may spontaneously resolve or cause ovarian torsion. Cyst size and appearance often guide surgical decision making. The natural history of these cysts and impact of perinatal interventions on ovarian outcomes remain unclear. We investigated the association of various clinical parameters with operative intervention and ovarian loss.</div></div><div><h3>Methods</h3><div>Infants with ovarian cysts meeting our definition of perinatal (diagnosed between 15 weeks gestational age and 1 year) from November 2006–January 2022 were identified. Cysts were characterized by size, morphology, laterality, and evolution. Outcome measures included resolution, ovarian loss, and operative intervention. Mann–Whitney U and Fisher exact tests were used. Optimal maximal size cutoffs were obtained using ROC curves.</div></div><div><h3>Results</h3><div>Sixty-two female patients with perinatal ovarian cysts were identified. Spontaneous resolution occurred in 35, prenatally and postnatally, with follow-up length averaging 186 days. Of 18 undergoing cystectomies, 9 revealed non-viable ovaries. Overall ovarian loss rate was 29%. Loss occurred more frequently with large, complex, and right-sided cysts (P < 0.05) but some complex cysts also resolved spontaneously. Operative intervention occurred more frequently with larger cysts (P=<0.001) and was associated with ovarian salvage when performed earlier (P = 0.008) on larger cysts (P = 0.02). Maximal cyst diameter > 4.05 cm predicted ovarian loss with 78% sensitivity, 64% specificity (AUC = 0.67,95%CI = 0.54–0.81, P = 0.04). Maximal cyst diameter > 4.55 cm predicted surgery with 83% sensitivity, 82% specificity (AUC = 0.86,95%CI = 0.77–0.96, P < 0.001).</div></div><div><h3>Conclusions</h3><div>29% of perinatal ovarian cysts resulted in ovarian loss. 56% resolved spontaneously (prenatal and postnatal resolution) including some complex cysts. Cysts that were postnatally complex and maximally > 4 cm had higher rates of ovarian loss and operative intervention. Earlier postnatal operative intervention was associated with ovarian preservation. Standardized imaging (such as the IOTA terminology) and management protocols are needed to better understand behavior and improve treatment of these cysts.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114979"},"PeriodicalIF":1.9,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156500","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 : 2026-01-26DOI: 10.1016/j.ejogrb.2026.114975
Qianshi Zheng, Yu Zou
Background
Incarceration of the gravid uterus (IGU) is a rare but serious obstetric condition that demands precise diagnosis for optimal management.
Objectives
To evaluate the value of MRI in the diagnosis and individualized management of IGU.
Methods
We retrospectively analyzed six patients with IGU admitted to the institution from November 2022 and September 2025. Clinical data like gravidity and parity, gestational weeks of diagnosis and delivery, clinical management and pregnancy outcomes. Imaging findings from MRI and ultrasound were compared, including assessment of cervical elongation, placental position, and complications. The correlation between MRI-measured parameters and pregnancy outcomes was explored.
Results
MRI clearly demonstrated typical signs of IGU, including uterine retroversion and anterior cervical displacement. No significant difference was found between MRI and ultrasound in measuring cervical elongation (9.6 ± 4.5 cm vs 7.6 ± 4.2 cm, p = 0.393). MRI additionally enabled assessment of cervical thinning (0.4 ± 0.1 cm) and identified one case of placenta previa missed by ultrasound. Based on MRI findings, four cases underwent successful manual reduction or knee-chest positioning. A preliminary correlation was observed between anterior lower uterine segment thickness and fetal birth weight (r = 1.000, p = 0.020), though this requires validation in larger studies.
Conclusions
MRI provides accurate diagnosis and objective assessment of IGU and its complications, serving as a crucial adjunct to ultrasound. Incorporating MRI into the standardized clinical management pathway offers essential evidence for developing individualized treatment strategies.
背景：妊娠子宫淤塞（IGU）是一种罕见但严重的产科疾病，需要精确诊断以获得最佳治疗。目的探讨MRI在IGU诊断和个体化治疗中的价值。方法回顾性分析2022年11月至2025年9月收治的6例IGU患者。临床数据，如妊娠和胎次、诊断和分娩的妊娠周数、临床管理和妊娠结局。比较MRI和超声的影像学表现，包括评估宫颈伸长、胎盘位置和并发症。探讨mri测量参数与妊娠结局的相关性。结果smri清晰显示IGU的典型征象，包括子宫后倾和宫颈前移位。MRI与超声测量宫颈伸长无显著差异（9.6±4.5 cm vs 7.6±4.2 cm, p = 0.393）。此外，MRI还能评估宫颈变薄（0.4±0.1 cm），并发现1例超声未发现的前置胎盘。根据MRI结果，4例患者成功进行了手动复位或膝胸定位。初步观察到子宫前下段厚度与胎儿出生体重之间存在相关性（r = 1.000, p = 0.020），但这需要在更大规模的研究中进行验证。结论smri对IGU及其并发症的诊断准确、客观，是超声的重要辅助手段。将MRI纳入标准化的临床管理途径，为制定个性化的治疗策略提供了必要的证据。
{"title":"MRI in the incarceration of the gravid uterus: From diagnosis to individualized management","authors":"Qianshi Zheng, Yu Zou","doi":"10.1016/j.ejogrb.2026.114975","DOIUrl":"10.1016/j.ejogrb.2026.114975","url":null,"abstract":"<div><h3>Background</h3><div>Incarceration of the gravid uterus (IGU) is a rare but serious obstetric condition that demands precise diagnosis for optimal management.</div></div><div><h3>Objectives</h3><div>To evaluate the value of MRI in the diagnosis and individualized management of IGU.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed six patients with IGU admitted to the institution from November 2022 and September 2025. Clinical data like gravidity and parity, gestational weeks of diagnosis and delivery, clinical management and pregnancy outcomes. Imaging findings from MRI and ultrasound were compared, including assessment of cervical elongation, placental position, and complications. The correlation between MRI-measured parameters and pregnancy outcomes was explored.</div></div><div><h3>Results</h3><div>MRI clearly demonstrated typical signs of IGU, including uterine retroversion and anterior cervical displacement. No significant difference was found between MRI and ultrasound in measuring cervical elongation (9.6 ± 4.5 cm vs 7.6 ± 4.2 cm, p = 0.393). MRI additionally enabled assessment of cervical thinning (0.4 ± 0.1 cm) and identified one case of placenta previa missed by ultrasound. Based on MRI findings, four cases underwent successful manual reduction or knee-chest positioning. A preliminary correlation was observed between anterior lower uterine segment thickness and fetal birth weight (r = 1.000, p = 0.020), though this requires validation in larger studies.</div></div><div><h3>Conclusions</h3><div>MRI provides accurate diagnosis and objective assessment of IGU and its complications, serving as a crucial adjunct to ultrasound. Incorporating MRI into the standardized clinical management pathway offers essential evidence for developing individualized treatment strategies.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114975"},"PeriodicalIF":1.9,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076485","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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