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

{"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":"2026-03-01","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}

{"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":"2026-03-01","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}

{"title":"MRI in the incarceration of the gravid uterus: From diagnosis to individualized management","authors":"Qianshi Zheng,&nbsp;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":"2026-03-01","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}

{"title":"Obturator nerve injury during robot-assisted laparoscopic pelvic lymphadenectomy: Literature review and case series","authors":"O.P. Van Marle,&nbsp;J.P. Hoogendam,&nbsp;R.P. Zweemer,&nbsp;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":"2026-03-01","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}

{"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 ,&nbsp;C. Mimoun ,&nbsp;I. Menouer ,&nbsp;O. Graesslin ,&nbsp;A. Fauconnier ,&nbsp;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 &gt; 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":"2026-03-01","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}

{"title":"Neonatal encephalopathy requiring therapeutic hypothermia over 5 years in a national Irish birth cohort: Relevance of the obstetric data","authors":"Aenne Helps ,&nbsp;Indra Lazaro Campillo ,&nbsp;Paul Corcoran ,&nbsp;Julie McGinley ,&nbsp;Richard Greene ,&nbsp;John Murphy ,&nbsp;Peter McKenna","doi":"10.1016/j.ejogrb.2026.114982","DOIUrl":"10.1016/j.ejogrb.2026.114982","url":null,"abstract":"&lt;div&gt;&lt;div&gt;&lt;strong&gt;Background&lt;/strong&gt;: 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.&lt;/div&gt;&lt;div&gt;&lt;strong&gt;Objectives&lt;/strong&gt;: 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.&lt;/div&gt;&lt;div&gt;&lt;strong&gt;Study design&lt;/strong&gt;: 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.&lt;/div&gt;&lt;div&gt;&lt;strong&gt;Results&lt;/strong&gt;: 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 &lt; 0.001). Therapeutic hypothermia risk increased significantly with maternal obesity (RR = 1.65) and fetal growth restriction (RR = 2.74 for &lt; 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 &lt; 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.&lt;/div&gt;&lt;div&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; 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":"2026-03-01","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}

{"title":"Expression of concern \"A randomized comparison of a single-incision needleless (Contasure-needleless®) mini-sling versus a mid-urethral sling (Contasure-KIM®): 60-month follow-up results\". [Eur. J. Obstet. Gynecol. Reprod. Biol. 307C (2025) 7-12].","authors":"Ozan Dogan, Pinar Kadirogullari, Erhan Huseyin Comert, Alper Basbug, Murat Yassa","doi":"10.1016/j.ejogrb.2026.114971","DOIUrl":"10.1016/j.ejogrb.2026.114971","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"114971"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776288","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":"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 ,&nbsp;Halimat J. Akande ,&nbsp;Hadijat O. Raji ,&nbsp;Bola B. Olafimihan ,&nbsp;Latifat T. Aremu ,&nbsp;James I. Owolabi ,&nbsp;Sadiya M. Gwadabe ,&nbsp;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 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.</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":"2026-03-01","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}

{"title":"Which body region’s fat accumulation increase the risk of stress urinary incontinence?","authors":"Ana Jéssica dos Santos Sousa ,&nbsp;Stela Márcia Mattiello ,&nbsp;Ana Paula Rodrigues Rocha ,&nbsp;Alessander Danna-Dos-Santos ,&nbsp;Patricia Driusso","doi":"10.1016/j.ejogrb.2026.114957","DOIUrl":"10.1016/j.ejogrb.2026.114957","url":null,"abstract":"<div><div>The objective of this cross-sectional study was to examine the association between fat mass distribution and stress urinary incontinence (SUI) symptoms, as well as the impact of SUI on daily activities. We assessed sociodemographic characteristics, urinary symptoms, and fat mass (total, android, gynoid, and visceral adipose tissue [VAT]). Descriptive statistics, independent t tests, and univariable and multivariable regression analyses were conducted. Women with SUI exhibited significantly higher total, android, gynoid, and VAT fat mass than women without urinary incontinence (p &lt; 0.05). Increases in total, android, gynoid, and VAT fat mass were associated with higher odds of SUI by 0.4%, 4.4%, 2.6%, and 31.4%, respectively. VAT fat mass was particularly influential, increasing the likelihood of SUI by 51% (odds ratio [OR] 1.51; 95% CI). Greater VAT accumulation was also associated with a 16.0% increase in discomfort related to urinary symptoms and a 9.3% increase in the impact on daily activities among women with SUI. In summary, higher adiposity in the android, gynoid, and especially VAT regions are associated with an increased likelihood of SUI and with greater symptom-related discomfort and functional impact.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114957"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076470","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":"An individual participant data network meta-analysis of the APOSTEL trials on the effect of tocolysis in threatened preterm birth between 30–33+6 weeks of gestation in twin pregnancies","authors":"L. van Gils ,&nbsp;L.I. van der Windt ,&nbsp;A.H. van Kaam ,&nbsp;C. Roos ,&nbsp;E. Pajkrt ,&nbsp;M.A. Oudijk","doi":"10.1016/j.ejogrb.2026.114989","DOIUrl":"10.1016/j.ejogrb.2026.114989","url":null,"abstract":"<div><h3>Objective</h3><div>Twin pregnancies have a substantial risk of preterm birth, but evidence on tocolytics is limited. We evaluated whether nifedipine or atosiban improves neonatal outcomes compared with placebo.</div></div><div><h3>Design</h3><div>Individual participant data network <em>meta</em>-analysis (IPD-NMA) of two international multicentre randomised controlled trials (APOSTEL 3 and 8).</div></div><div><h3>Setting</h3><div>The APOSTEL-3 compared nifedipine with atosiban, while the APOSTEL-8 compared atosiban with placebo.</div></div><div><h3>Population</h3><div>Women with twin pregnancies and threatened preterm birth between 30⁺⁰ and 33⁺⁶ weeks.</div></div><div><h3>Methods</h3><div>Analyses were performed at the infant level using generalised estimating equations to account for clustering within twin pairs.</div></div><div><h3>Main outcome measures</h3><div>Adverse neonatal outcome: composite of neonatal morbidity or mortality.</div></div><div><h3>Results</h3><div>A total of 179 women were included: 94 allocated to atosiban, 27 to nifedipine, and 58 to placebo. Prolongation beyond 48 h was not significantly increased with nifedipine (RR 0.96, 95% CI 0.68–1.36) or atosiban (RR 1.10, 95% CI 0.88–1.38). The composite adverse neonatal outcome occurred in 3.7% of neonates in the nifedipine group (2/54), 7.5% in the atosiban group (14/188), and 5.2% in the placebo group (6/116). Relative risks were 0.72 (95% CI 0.15–3.43) for nifedipine <em>vs</em> placebo, 1.44 (95% CI 0.57–3.64) for atosiban <em>vs</em> placebo, and 2.01 (95% CI 0.47–8.58) for atosiban <em>vs</em> nifedipine.</div></div><div><h3>Conclusion</h3><div>No clear benefit of nifedipine or atosiban over placebo on neonatal outcomes in twin pregnancies with threatened preterm birth between 30⁺⁰ and 33⁺⁶ weeks was found.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114989"},"PeriodicalIF":1.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131544","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}