Pub Date : 2026-01-09DOI: 10.1016/j.ejogrb.2026.114936
Seán Olann Whelan , Gráinne Kelleher , Sharon Campbell , Maeve Eogan , Frank Moriarty , Mohamed Elsammak , Richard John Drew
Objective
To assess the diagnostic performance of interleukin-6 (IL-6) versus in-use inflammatory markers (C-reactive protein [CRP], procalcitonin [PCT], neutrophil–lymphocyte ratio [NLR]) in maternal sepsis.
Methods
This was a retrospective cohort study in a single Dublin maternity hospital. All maternity patients (conception to 6-weeks post-partum) in whom IL-6 was measured to investigate suspected sepsis in an 11-month period were included. Cases were categorized twice into physiological (normal, systemic inflammatory response syndrome, sepsis, septic shock) and etiological (bacterial, viral or no infection) categories. Biomarker performance was assessed by area under the receiver operating characteristic curves (AUC) and measures of diagnostic accuracy at optimal cut-offs. Serial sampling evaluated biomarker kinetics.
Results
Seventy-two patients were included, 31.9 % had sepsis/septic shock, and 70.9 % had bacterial infection. Significant differences between categories were seen for both physiological and etiological axes for IL-6, for physiological categories alone for NLR, and for neither for PCT and CRP. IL-6 had an AUC of 0.78 for the primary physiological endpoint, significantly higher than CRP and PCT (p = 0.02), but not NLR (AUC 0.72, p = 0.47). The IL-6 AUC for the primary etiological endpoint was 0.94, higher than all other biomarkers (p < 0.001). IL-6 was highly sensitive (91.4 %) but poorly specific (55.1 %) for the physiological endpoint, while both were high in the diagnosis of bacterial infection (88.2 % and 90.5 %). On serial sampling, IL-6 fell rapidly between first and second sampling, while others initially rose further.
Conclusion
IL-6 exhibited significantly higher sensitivity compared to conventional sepsis biomarkers in detecting both bacterial infection and maternal sepsis.
{"title":"The utility of interleukin-6 compared to conventional sepsis biomarkers in pregnancy – A real-world cohort study","authors":"Seán Olann Whelan , Gráinne Kelleher , Sharon Campbell , Maeve Eogan , Frank Moriarty , Mohamed Elsammak , Richard John Drew","doi":"10.1016/j.ejogrb.2026.114936","DOIUrl":"10.1016/j.ejogrb.2026.114936","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the diagnostic performance of interleukin-6 (IL-6) versus in-use inflammatory markers (C-reactive protein [CRP], procalcitonin [PCT], neutrophil–lymphocyte ratio [NLR]) in maternal sepsis.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study in a single Dublin maternity hospital. All maternity patients (conception to 6-weeks post-partum) in whom IL-6 was measured to investigate suspected sepsis in an 11-month period were included. Cases were categorized twice into physiological (normal, systemic inflammatory response syndrome, sepsis, septic shock) and etiological (bacterial, viral or no infection) categories. Biomarker performance was assessed by area under the receiver operating characteristic curves (AUC) and measures of diagnostic accuracy at optimal cut-offs. Serial sampling evaluated biomarker kinetics.</div></div><div><h3>Results</h3><div>Seventy-two patients were included, 31.9 % had sepsis/septic shock, and 70.9 % had bacterial infection. Significant differences between categories were seen for both physiological and etiological axes for IL-6, for physiological categories alone for NLR, and for neither for PCT and CRP. IL-6 had an AUC of 0.78 for the primary physiological endpoint, significantly higher than CRP and PCT (p = 0.02), but not NLR (AUC 0.72, p = 0.47). The IL-6 AUC for the primary etiological endpoint was 0.94, higher than all other biomarkers (p < 0.001). IL-6 was highly sensitive (91.4 %) but poorly specific (55.1 %) for the physiological endpoint, while both were high in the diagnosis of bacterial infection (88.2 % and 90.5 %). On serial sampling, IL-6 fell rapidly between first and second sampling, while others initially rose further.</div></div><div><h3>Conclusion</h3><div>IL-6 exhibited significantly higher sensitivity compared to conventional sepsis biomarkers in detecting both bacterial infection and maternal sepsis.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114936"},"PeriodicalIF":1.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973396","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}
Joint Hypermobility Syndrome (JHS), also referred to as hypermobile Ehlers–Danlos Syndrome (hEDS), is increasingly recognised as a significant contributor to gynaecological, pelvic floor and lower urinary tract symptoms. This review aims to highlight the current evidence on the relationship between JHS and key urogynaecological conditions, with particular attention to recent developments in epidemiology, clinical presentation, and management.
Recent findings
Emerging research demonstrates a strong association between JHS and pelvic organ prolapse (POP), with meta-analytic data showing more than a twofold increased risk. Large cohort studies highlight substantial symptom burden, including high rates of stress and urgency incontinence, bladder pain, pelvic floor dysfunction and sexual difficulties. Recent work also reveals distinct challenges in perioperative care, such as dysautonomia-related anaesthetic risks, tissue fragility, impaired wound healing and higher rates of surgical complications in some series. Studies document higher prevalence of urinary incontinence, bladder diverticula, recurrent urinary infections and voiding dysfunction linked to increased bladder capacity and elevated residual volumes.
Summary
Women with JHS experience a wide and often severe spectrum of urogynaecological symptoms that significantly affect quality of life. Although management generally mirrors standard care pathways, the unique connective-tissue and systemic features of JHS necessitate tailored assessment and multidisciplinary involvement. Further high-quality research is required to develop specific management algorithms and clarify the role of conservative versus surgical treatments in this complex clinical population.
{"title":"Joint hypermobility syndrome for the urogynaecologist – A narrative review","authors":"Islam Abaza, Miriam Tadros, Bernadette Lemmon, Alka Bhide, Ruwan Fernando, Vik Khullar","doi":"10.1016/j.ejogrb.2026.114943","DOIUrl":"10.1016/j.ejogrb.2026.114943","url":null,"abstract":"<div><h3>Purpose of this review</h3><div>Joint Hypermobility Syndrome (JHS), also referred to as hypermobile Ehlers–Danlos Syndrome (hEDS), is increasingly recognised as a significant contributor to gynaecological, pelvic floor and lower urinary tract symptoms. This review aims to highlight the current evidence on the relationship between JHS and key urogynaecological conditions, with particular attention to recent developments in epidemiology, clinical presentation, and management.</div></div><div><h3>Recent findings</h3><div>Emerging research demonstrates a strong association between JHS and pelvic organ prolapse (POP), with meta-analytic data showing more than a twofold increased risk. Large cohort studies highlight substantial symptom burden, including high rates of stress and urgency incontinence, bladder pain, pelvic floor dysfunction and sexual difficulties. Recent work also reveals distinct challenges in perioperative care, such as dysautonomia-related anaesthetic risks, tissue fragility, impaired wound healing and higher rates of surgical complications in some series. Studies document higher prevalence of urinary incontinence, bladder diverticula, recurrent urinary infections and voiding dysfunction linked to increased bladder capacity and elevated residual volumes.</div></div><div><h3>Summary</h3><div>Women with JHS experience a wide and often severe spectrum of urogynaecological symptoms that significantly affect quality of life. Although management generally mirrors standard care pathways, the unique connective-tissue and systemic features of JHS necessitate tailored assessment and multidisciplinary involvement. Further high-quality research is required to develop specific management algorithms and clarify the role of conservative versus surgical treatments in this complex clinical population.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114943"},"PeriodicalIF":1.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922005","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 : 2026-01-06DOI: 10.1016/j.ejogrb.2026.114942
Dini Hidayat , Sri Dewi Rahmawati Syarief , Vyanda Sri Weningtyas , Faradiba Janiyustika
Background
Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric condition characterized by abnormal placental adherence to the myometrium. While hysterectomy remains the standard definitive management, conservative strategies such as wedge resection or delayed hysterectomy have been increasingly adopted to preserve fertility. The comparative impact of these approaches on women’s quality of life (QoL), particularly social and sexual functioning, has not been well investigated.
Method
A cross-sectional study included 185 women who underwent caesarean section (CS) for histopathologically confirmed PAS at Dr. Hasan Sadikin General Hospital, Bandung, West Java, from 2022 to 2024. A total of 161 met the inclusion criteria and were analyzed, while 24 were excluded. Sexual function and QoL were assessed using the Female Sexual Function Index (FSFI) and the 36-Item Short Form Health Survey (SF-36), respectively. Non-parametric analysis using the Mann–Whitney U test was applied for scale scores and categorical comparisons were analyzed using Chi-square or Fisher’s exact test, with p < 0.05 considered significant.
Result
Median FSFI scores for desire (3.0 [2.5–3.5] vs. 3.0 [2.0–4.0], p = 0.015), arousal (2.5 [2.0–3.5] vs. 3.0 [2.0–4.0], p = 0.048), and pain (2.4 [2.0–2.7] vs. 3.0 [2.0–4.0], p = 0.021) differed significantly between the hysterectomy and conservative groups, although median values for desire were similar. Other FSFI domains and total scores were not significantly different (p > 0.05). In the SF-36, a statistically significant difference was observed only in the social functioning domain, despite comparable median scores between groups.
Conclusion
Conservative management in PAS was associated with better preservation of specific aspects of sexual function, particularly pain and arousal.
背景：胎盘增生谱（PAS）是一种潜在危及生命的产科疾病，其特征是胎盘异常粘附于子宫肌层。虽然子宫切除术仍然是标准的最终治疗方法，但越来越多地采用楔形切除或延迟子宫切除术等保守策略来保持生育能力。这些方法对妇女生活质量（QoL）的相对影响，特别是社会和性功能，尚未得到很好的调查。方法横断面研究纳入了2022年至2024年在西爪哇万隆Dr. Hasan Sadikin总医院因组织病理学证实的PAS接受剖腹产（CS）的185名妇女。符合纳入标准的161例进行分析，排除24例。分别采用女性性功能指数（FSFI）和36项简短健康调查（SF-36）对性功能和生活质量进行评估。量表得分采用Mann-Whitney U检验进行非参数分析，分类比较采用卡方检验或Fisher精确检验，p <； 0.05为显著性。结果子宫切除术组与保守组的FSFI评分中位数分别为欲望（3.0 [2.5 - 3.5]vs. 3.0 [2.0-4.0], p = 0.015）、兴奋（2.5 [2.0-3.5]vs. 3.0 [2.0-4.0], p = 0.048）、疼痛（2.4 [2.0-2.7]vs. 3.0 [2.0-4.0], p = 0.021），但欲望中位数相似。其他FSFI域及总分差异无统计学意义（p > 0.05）。在SF-36中，尽管两组之间的中位数得分相当，但仅在社会功能领域观察到统计学上的显著差异。结论：PAS患者的保守治疗可以更好地保存性功能的某些方面，特别是疼痛和兴奋。
{"title":"Impact of placenta accreta spectrum on sexual and psychological health: a comparative analysis using FSFI and SF-36","authors":"Dini Hidayat , Sri Dewi Rahmawati Syarief , Vyanda Sri Weningtyas , Faradiba Janiyustika","doi":"10.1016/j.ejogrb.2026.114942","DOIUrl":"10.1016/j.ejogrb.2026.114942","url":null,"abstract":"<div><h3>Background</h3><div>Placenta accreta spectrum (PAS) is a potentially life-threatening obstetric condition characterized by abnormal placental adherence to the myometrium. While hysterectomy remains the standard definitive management, conservative strategies such as wedge resection or delayed hysterectomy have been increasingly adopted to preserve fertility. The comparative impact of these approaches on women’s quality of life (QoL), particularly social and sexual functioning, has not been well investigated.</div></div><div><h3>Method</h3><div>A cross-sectional study included 185 women who underwent caesarean section (CS) for histopathologically confirmed PAS at Dr. Hasan Sadikin General Hospital, Bandung, West Java, from 2022 to 2024. A total of 161 met the inclusion criteria and were analyzed, while 24 were excluded. Sexual function and QoL were assessed using the Female Sexual Function Index (FSFI) and the 36-Item Short Form Health Survey (SF-36), respectively. Non-parametric analysis using the Mann–Whitney <em>U</em> test was applied for scale scores and categorical comparisons were analyzed using Chi-square or Fisher’s exact test, with p < 0.05 considered significant.</div></div><div><h3>Result</h3><div>Median FSFI scores for desire (3.0 [2.5–3.5] vs. 3.0 [2.0–4.0], p = 0.015), arousal (2.5 [2.0–3.5] vs. 3.0 [2.0–4.0], p = 0.048), and pain (2.4 [2.0–2.7] vs. 3.0 [2.0–4.0], p = 0.021) differed significantly between the hysterectomy and conservative groups, although median values for desire were similar. Other FSFI domains and total scores were not significantly different (p > 0.05). In the SF-36, a statistically significant difference was observed only in the social functioning domain, despite comparable median scores between groups.</div></div><div><h3>Conclusion</h3><div>Conservative management in PAS was associated with better preservation of specific aspects of sexual function, particularly pain and arousal.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114942"},"PeriodicalIF":1.9,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973308","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 : 2026-01-05DOI: 10.1016/j.ejogrb.2026.114940
Anna Fichera , Chiara Pedretti , Nicola Fratelli , Adriana Valcamonico , Daniela Recupero , Andrea Coelli , Angelica Fiorini , Antonino D’Ippolito , Franco E. Odicino
Introduction
Epidural analgesia (EDA) is widely used for pain relief during labor. Concerns have been raised about its potential association with an increased risk of emergency delivery for presumed fetal compromise, particularly in fetuses with low birth weight. This study aimed to evaluate whether EDA increases the risk of emergency delivery for suspected fetal distress in small-for-gestational-age and fetal growth restricted fetuses.
Methods
Retrospective cohort study conducted on singleton pregnancies with prenatal diagnosis of small-for-gestational-age or fetal growth restricted fetuses, delivering at ≥ 36 + 0 weeks at a tertiary care center between January 2020 and January 2024. The primary exposure was EDA; the primary outcome was emergency cesarean section or vacuum-assisted delivery due to presumed fetal distress, based on cardiotocographic findings. The secondary outcome was the incidence of a composite neonatal outcome defined as the occurrence of at least one of umbilical artery pH < 7.00, base excess < –12 mEq/L, 5-minute Apgar score < 7, or NICU admission. The two groups (EDA vs. non-EDA) were compared using the chi-square test for categorical variables and the Mann–Whitney U test for continuous variables. Multivariate logistic regression was used to control for confounders.
Results
Among 310 eligible deliveries, 135 (43.5 %) received EDA. Emergency delivery for suspected fetal distress occurred in 16.5 % of cases. There were no significant differences in emergency delivery rates between the EDA and non-EDA groups (15.56 % vs 17.14 %; p = 0.759), nor within the small-for-gestational-age (13.4 % vs 13.9 %; p = 0.896) and the growth restricted fetuses (21.5 % vs 22.4 %; p = 0.874) subgroups. No significant difference in the composite adverse neonatal outcome was observed between the EDA and non-EDA groups (8.15 % vs 7.43 %; p = 0.814). Multivariate analysis confirmed no association between EDA and emergency delivery (p = 0.600), whereas nulliparity (p = 0.024) and U/C ratio > 0.8 (p = 0.004) emerged as independent risk factors. Composite neonatal outcomes were similar between groups.
Conclusions
In this cohort of well-characterized small-for-gestational-age and fetal growth restricted fetuses, EDA was not associated with an increased risk of emergency delivery for suspected fetal distress. Individualized patient assessment and tailored management of labor analgesia remain crucial to ensure maternal and fetal safety.
简介：硬膜外镇痛（EDA）被广泛应用于分娩过程中的疼痛缓解。已提出的关切是，它可能与假定胎儿受损的紧急分娩风险增加有关，特别是在出生体重低的胎儿中。本研究旨在评估EDA是否会增加小胎龄和胎儿生长受限胎儿疑似胎儿窘迫的紧急分娩风险。方法：对2020年1月至2024年1月在三级保健中心分娩≥36 + 0周且产前诊断为胎龄小或胎儿生长受限的单胎妊娠进行回顾性队列研究。主要暴露为EDA；主要结局是急诊剖宫产或真空辅助分娩，由于假定胎儿窘迫，根据心脏造影结果。次要结局是新生儿复合结局的发生率，定义为至少有一种脐动脉pH < 7.00，基础过量结果：在310例符合条件的分娩中，135例（43.5%）接受了EDA。16.5%的病例因怀疑胎儿窘迫而紧急分娩。EDA组和非EDA组的紧急分娩率无显著差异（15.56% vs 17.14%, p = 0.759），小胎龄组（13.4% vs 13.9%, p = 0.896）和生长受限胎儿组（21.5% vs 22.4%, p = 0.874）内也无显著差异。EDA组和非EDA组的新生儿综合不良结局无显著差异（8.15% vs 7.43%; p = 0.814）。多因素分析证实EDA和紧急分娩之间没有关联（p = 0.600），而未分娩（p = 0.024）和U/C比>.8 （p = 0.004）成为独立的危险因素。两组新生儿的综合结局相似。结论：在这个具有明显特征的胎龄小和胎儿生长受限胎儿队列中，EDA与疑似胎儿窘迫的紧急分娩风险增加无关。个体化患者评估和量身定制的管理分娩镇痛仍然是至关重要的，以确保产妇和胎儿的安全。
{"title":"Epidural analgesia in small for gestational age and growth restricted fetuses: Impact on emergency delivery for presumed fetal distress","authors":"Anna Fichera , Chiara Pedretti , Nicola Fratelli , Adriana Valcamonico , Daniela Recupero , Andrea Coelli , Angelica Fiorini , Antonino D’Ippolito , Franco E. Odicino","doi":"10.1016/j.ejogrb.2026.114940","DOIUrl":"10.1016/j.ejogrb.2026.114940","url":null,"abstract":"<div><h3>Introduction</h3><div>Epidural analgesia (EDA) is widely used for pain relief during labor. Concerns have been raised about its potential association with an increased risk of emergency delivery for presumed fetal compromise, particularly in fetuses with low birth weight. This study aimed to evaluate whether EDA increases the risk of emergency delivery for suspected fetal distress in small-for-gestational-age and fetal growth restricted fetuses.</div></div><div><h3>Methods</h3><div>Retrospective cohort study conducted on singleton pregnancies with prenatal diagnosis of small-for-gestational-age or fetal growth restricted fetuses, delivering at ≥ 36 + 0 weeks at a tertiary care center between January 2020 and January 2024. The primary exposure was EDA; the primary outcome was emergency cesarean section or vacuum-assisted delivery due to presumed fetal distress, based on cardiotocographic findings. The secondary outcome was the incidence of a composite neonatal outcome defined as the occurrence of at least one of umbilical artery pH < 7.00, base excess < –12 mEq/L, 5-minute Apgar score < 7, or NICU admission. The two groups (EDA vs. non-EDA) were compared using the chi-square test for categorical variables and the Mann–Whitney <em>U</em> test for continuous variables. Multivariate logistic regression was used to control for confounders.</div></div><div><h3>Results</h3><div>Among 310 eligible deliveries, 135 (43.5 %) received EDA. Emergency delivery for suspected fetal distress occurred in 16.5 % of cases. There were no significant differences in emergency delivery rates between the EDA and non-EDA groups (15.56 % vs 17.14 %; p = 0.759), nor within the small-for-gestational-age (13.4 % vs 13.9 %; p = 0.896) and the growth restricted fetuses (21.5 % vs 22.4 %; p = 0.874) subgroups. No significant difference in the composite adverse neonatal outcome was observed between the EDA and non-EDA groups (8.15 % vs 7.43 %; p = 0.814). Multivariate analysis confirmed no association between EDA and emergency delivery (p = 0.600), whereas nulliparity (p = 0.024) and U/C ratio > 0.8 (p = 0.004) emerged as independent risk factors. Composite neonatal outcomes were similar between groups.</div></div><div><h3>Conclusions</h3><div>In this cohort of well-characterized small-for-gestational-age and fetal growth restricted fetuses, EDA was not associated with an increased risk of emergency delivery for suspected fetal distress. Individualized patient assessment and tailored management of labor analgesia remain crucial to ensure maternal and fetal safety.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114940"},"PeriodicalIF":1.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917400","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 : 2026-01-05DOI: 10.1016/j.ejogrb.2026.114939
Giovanni Morganelli , Gabriella Maria Celora , Maria Chiara Bassi , Andrea Dall’Asta , Maurizio Di Serio , Vito Andrea Capozzi , Tullio Ghi , Stefania Fieni
Background
The potential preventive effect of mediolateral and lateral episiotomy on the risk of anal sphincter injury related to vacuum delivery in nullipara has been reported by different well-designed studies in the last years.
Objectives
The aim of this systematic review and meta-analysis is to summarize the available evidence on the protective effect of mediolateral or lateral episiotomy towards the occurrence of obstetric anal sphincter injury (OASI) in nulliparous women who were submitted to vacuum-assisted delivery.
Search strategy: PubMed, Embase, CINAHL, Cochrane Library and Scopus databases were retrospectively searched without any temporal restriction up to March 1st 2025.
Selection criteria: Randomized controlled trials, retrospective, prospective case-control or cohort studies investigating the incidence of perineal tears involving anal sphincter muscles and/or rectal mucosa after vacuum-assisted birth with and without mediolateral/lateral episiotomy in nulliparous women were included.
Data collection and analysis: Risk of bias assessment was conducted for each included study by applying ROB2 score for RCTs and ROBINS-I score for non-randomized studies. Data were extracted and analyzed with Review Manager 5.4.1, results were reported by means of pooled Odd-ratios (ORs) and presented as Forest plots.
Main results: 31 studies (3 RCTs and 28 non-randomized studies) were included. Cumulative sample size consisted in 608,359 nulliparous women who were submitted to vacuum-assisted delivery. Mediolateral/lateral episiotomy was found to halve the incidence of OASI (OR 0.56 [95 % CI 0.42–0.73]) with high between-study heterogeneity reported (I2 = 99 %). At sensitivity analysis, a significant reduction in OASI incidence in case of mediolateral/lateral episiotomy was confirmed (OR 0.58 [95 %CI 0.44–0.78]); this analysis was conducted on low/moderate risk of bias studies (1RCT e 5 non-randomized studies, 15,799 patients) and associated with low heterogeneity (I2 = 42 %).
Conclusions
This updated meta-analysis on the role of mediolateral/lateral episiotomy in nulliparous women submitted to vacuum assisted delivery confirms its protective role from OASI.
背景：在过去的几年里，不同的精心设计的研究已经报道了外阴中外侧切开术对肛门括约肌损伤风险的潜在预防作用。目的：本系统回顾和荟萃分析的目的是总结关于真空辅助分娩的未产妇女中外阴切开或外阴切开对产科肛门括约肌损伤（OASI）发生的保护作用的现有证据。检索策略：回顾性检索PubMed， Embase， CINAHL， Cochrane Library和Scopus数据库，无任何时间限制，截止到2025年3月1日。选择标准：包括随机对照试验、回顾性、前瞻性病例对照或队列研究，这些研究调查了无产妇女在有或没有外阴中外侧切开术的真空辅助分娩后涉及肛门括约肌和/或直肠粘膜的会阴撕裂的发生率。资料收集与分析：随机对照试验采用ROB2评分，非随机试验采用ROBINS-I评分，对每项纳入的研究进行偏倚风险评估。采用Review Manager 5.4.1软件对数据进行提取和分析，结果以混合奇比（or）报告，并以Forest样地表示。主要结果：纳入31项研究（3项rct和28项非随机研究）。累积样本量包括608359名接受真空辅助分娩的无产妇女。发现外阴内外侧切开术使OASI的发生率减少一半（OR 0.56 [95% CI 0.42-0.73]），研究间异质性较高（I2 = 99%）。在敏感性分析中，证实外阴中外侧切开术的OASI发生率显著降低（OR 0.58 [95% CI 0.44-0.78]）；本分析是在低/中等偏倚风险研究（1RCT和5个非随机研究，15799例患者）中进行的，并且与低异质性相关（I2 = 42%）。结论：这一最新的荟萃分析证实了真空辅助分娩的无产妇女中外阴中外侧切开术的保护作用。
{"title":"Role of mediolateral or lateral episiotomy in preventing obstetric anal sphincter injury (OASI) in nulliparous women undergoing vacuum-assisted delivery: A systematic review and meta-analysis","authors":"Giovanni Morganelli , Gabriella Maria Celora , Maria Chiara Bassi , Andrea Dall’Asta , Maurizio Di Serio , Vito Andrea Capozzi , Tullio Ghi , Stefania Fieni","doi":"10.1016/j.ejogrb.2026.114939","DOIUrl":"10.1016/j.ejogrb.2026.114939","url":null,"abstract":"<div><h3>Background</h3><div>The potential preventive effect of mediolateral and lateral episiotomy on the risk of anal sphincter injury related to vacuum delivery in nullipara has been reported by different well-designed studies in the last years.</div></div><div><h3>Objectives</h3><div>The aim of this systematic review and <em>meta</em>-analysis is to summarize the available evidence on the protective effect of mediolateral or lateral episiotomy towards the occurrence of obstetric anal sphincter injury (OASI) in nulliparous women who were submitted to vacuum-assisted delivery.</div><div><em>Search strategy:</em> PubMed, Embase, CINAHL, Cochrane Library and Scopus databases were retrospectively searched without any temporal restriction up to March 1st 2025.</div><div><em>Selection criteria:</em> Randomized controlled trials, retrospective, prospective case-control or cohort studies investigating the incidence of perineal tears involving anal sphincter muscles and/or rectal mucosa after vacuum-assisted birth with and without mediolateral/lateral episiotomy in nulliparous women were included.</div><div><em>Data collection and analysis:</em> Risk of bias assessment was conducted for each included study by applying ROB2 score for RCTs and ROBINS-I score for non-randomized studies. Data were extracted and analyzed with Review Manager 5.4.1, results were reported by means of pooled Odd-ratios (ORs) and presented as Forest plots.</div><div><em>Main results:</em> 31 studies (3 RCTs and 28 non-randomized studies) were included. Cumulative sample size consisted in 608,359 nulliparous women who were submitted to vacuum-assisted delivery. Mediolateral/lateral episiotomy was found to halve the incidence of OASI (OR 0.56 [95 % CI 0.42–0.73]) with high between-study heterogeneity reported (I<sup>2</sup> = 99 %). At sensitivity analysis, a significant reduction in OASI incidence in case of mediolateral/lateral episiotomy was confirmed (OR 0.58 [95 %CI 0.44–0.78]); this analysis was conducted on low/moderate risk of bias studies (1RCT e 5 non-randomized studies, 15,799 patients) and associated with low heterogeneity (I<sup>2</sup> = 42 %).</div></div><div><h3>Conclusions</h3><div>This updated meta-analysis on the role of mediolateral/lateral episiotomy in nulliparous women submitted to vacuum assisted delivery confirms its protective role from OASI.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114939"},"PeriodicalIF":1.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922007","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 : 2026-01-05DOI: 10.1016/j.ejogrb.2026.114941
Bixiu Du , Yaru Yang , Lang He , Ying Tang
Infertility constitutes a major global health concern, affecting approximately 17.5% of couples of reproductive age. Although advances in assisted reproductive technologies (ART) have expanded treatment options, success rates remain highly variable due to host-specific and biological determinants. This review synthesizes current evidence on the reproductive impact of the human microbiota and its translational relevance to ART outcomes. Vaginal microbial communities dominated by Lactobacillus, particularly L. crispatus, are associated with improved conception and implantation, whereas genital or intestinal dysbiosis correlates with infertility and suboptimal treatment responses. The microbiota modulates reproductive competence through intertwined immune, endocrine–metabolic, and mucosal barrier pathways that regulate inflammation, hormonal balance, and epithelial integrity. Emerging findings indicate that gut microbial alterations linked to polycystic ovary syndrome (PCOS) and endometriosis are accompanied by insulin resistance and chronic inflammation, impairing ovulation, endometrial receptivity, and embryo viability. Interventions such as probiotics and synbiotics yield heterogeneous efficacy; individualized antimicrobial strategies, metabolic modulation, and lifestyle optimization may offer complementary benefit, while microbiota reconstruction remains experimental. Methodological limitations, including contamination in low biomass samples, variations in sequencing workflows, and population heterogeneity, still hinder data comparability and mechanistic interpretation. Future research should prioritize adequately powered randomized controlled trials using standardized microbiome metrics and live birth as a primary endpoint. Integrating microbiome profiling into ART workflows may refine patient stratification and inform precision adjuvant therapies. However, clinical implementation requires stronger causal evidence, validated biomarkers, and harmonized methodological frameworks to translate microbiome discoveries into reproducible reproductive gains.
{"title":"Microbiota and infertility: a translational review of mechanisms and clinical applications in assisted reproduction","authors":"Bixiu Du , Yaru Yang , Lang He , Ying Tang","doi":"10.1016/j.ejogrb.2026.114941","DOIUrl":"10.1016/j.ejogrb.2026.114941","url":null,"abstract":"<div><div>Infertility constitutes a major global health concern, affecting approximately 17.5% of couples of reproductive age. Although advances in assisted reproductive technologies (ART) have expanded treatment options, success rates remain highly variable due to host-specific and biological determinants. This review synthesizes current evidence on the reproductive impact of the human microbiota and its translational relevance to ART outcomes. Vaginal microbial communities dominated by <em>Lactobacillus</em>, particularly <em>L. crispatus</em>, are associated with improved conception and implantation, whereas genital or intestinal dysbiosis correlates with infertility and suboptimal treatment responses. The microbiota modulates reproductive competence through intertwined immune, endocrine–metabolic, and mucosal barrier pathways that regulate inflammation, hormonal balance, and epithelial integrity. Emerging findings indicate that gut microbial alterations linked to polycystic ovary syndrome (PCOS) and endometriosis are accompanied by insulin resistance and chronic inflammation, impairing ovulation, endometrial receptivity, and embryo viability. Interventions such as probiotics and synbiotics yield heterogeneous efficacy; individualized antimicrobial strategies, metabolic modulation, and lifestyle optimization may offer complementary benefit, while microbiota reconstruction remains experimental. Methodological limitations, including contamination in low biomass samples, variations in sequencing workflows, and population heterogeneity, still hinder data comparability and mechanistic interpretation. Future research should prioritize adequately powered randomized controlled trials using standardized microbiome metrics and live birth as a primary endpoint. Integrating microbiome profiling into ART workflows may refine patient stratification and inform precision adjuvant therapies. However, clinical implementation requires stronger causal evidence, validated biomarkers, and harmonized methodological frameworks to translate microbiome discoveries into reproducible reproductive gains.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114941"},"PeriodicalIF":1.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922006","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 : 2026-01-04DOI: 10.1016/j.ejogrb.2025.114912
Jean-Marie Jouannic , Anaïs Dugas , Paul Maurice , Ferdinand Dhombres , Catherine Garel , Éléonore Blondiaux , Timothée de Saint Denis , Lucie Guilbaud
{"title":"Should we modify eligibility criteria for fetal surgery for open spinal dysraphism?","authors":"Jean-Marie Jouannic , Anaïs Dugas , Paul Maurice , Ferdinand Dhombres , Catherine Garel , Éléonore Blondiaux , Timothée de Saint Denis , Lucie Guilbaud","doi":"10.1016/j.ejogrb.2025.114912","DOIUrl":"10.1016/j.ejogrb.2025.114912","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114912"},"PeriodicalIF":1.9,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921950","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}
To evaluate the effect of a supplement blend (lactobacillus, vitamin C, cranberry and hibiscus) on the latency period after preterm premature rupture of membranes (PPROM).
Study design
A single-center, randomized (1:1), double-blind, placebo-controlled trial enrolled 84 patients with PPROM (24–34 weeks). Participants were assigned to daily oral supplements or an identical placebo. The primary outcome was the latency period from membrane rupture to delivery. Analysis was by intention-to-treat.
Result
The mean latency period was significantly longer in the intervention group compared to the placebo group (11.7 ± 7.2 days vs. 7.6 ± 4.8 days; mean difference 4.1 days, 95 % CI 1.4–6.8; p = 0.003). The standardized mean difference (Cohen’s d) was 0.67 (95 % CI 0.23–1.10), indicating a moderate-to-large effect size. Exploratory analysis suggested a more pronounced effect when treatment was initiated before 32 weeks and continued for over six days.
Conclusion
Supplementation with lactobacillus, vitamin C, cranberry and hibiscus significantly prolonged the latency period in PPROM, which may represent a low-cost adjunct to conservative management.
目的：评价乳杆菌、维生素C、蔓越莓和木槿混合补充剂对早产儿胎膜早破潜伏期的影响。研究设计：单中心、随机（1:1）、双盲、安慰剂对照试验，纳入84例PPROM患者（24-34周）。参与者被分配每日口服补充剂或相同的安慰剂。主要观察指标是从胎膜破裂到分娩的潜伏期。通过意向治疗进行分析。结果：干预组的平均潜伏期明显长于安慰剂组（11.7±7.2天比7.6±4.8天；平均差4.1天，95% CI 1.4-6.8; p = 0.003）。标准化平均差（Cohen’s d）为0.67 (95% CI 0.23-1.10)，表明存在中等到较大的效应量。探索性分析表明，当治疗在32周前开始并持续6天以上时，效果更明显。结论：补充乳酸菌、维生素C、蔓越莓和木槿可显著延长PPROM的潜伏期，这可能是一种低成本的保守治疗方法。
{"title":"Lactobacillus, vitamin C, cranberry and hibiscus versus placebo for prolonging the latency period of premature rupture of membranes: a double-blind randomized clinical trial","authors":"Iris Janeth Portillo Gonzales , Ramon Armando Lobo Oliva , Betsaida María Colindres Cruz , Lessy Yolanda Díaz Galeas , Ricardo Arturo Gutierrez-Ramirez","doi":"10.1016/j.ejogrb.2026.114938","DOIUrl":"10.1016/j.ejogrb.2026.114938","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effect of a supplement blend (<strong>lactobacillus, vitamin C, cranberry and hibiscus</strong>) on the latency period after preterm premature rupture of membranes (PPROM).</div></div><div><h3>Study design</h3><div>A single-center, randomized (1:1), double-blind, placebo-controlled trial enrolled 84 patients with PPROM (24–34 weeks). Participants were assigned to daily oral supplements or an identical placebo. The primary outcome was the latency period from membrane rupture to delivery. Analysis was by intention-to-treat.</div></div><div><h3>Result</h3><div>The mean latency period was significantly longer in the intervention group compared to the placebo group (11.7 ± 7.2 days vs. 7.6 ± 4.8 days; mean difference 4.1 days, 95 % CI 1.4–6.8; p = 0.003). The standardized mean difference (Cohen’s d) was 0.67 (95 % CI 0.23–1.10), indicating a moderate-to-large effect size. Exploratory analysis suggested a more pronounced effect when treatment was initiated before 32 weeks and continued for over six days.</div></div><div><h3>Conclusion</h3><div>Supplementation with lactobacillus, vitamin C, cranberry and hibiscus significantly prolonged the latency period in PPROM, which may represent a low-cost adjunct to conservative management.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114938"},"PeriodicalIF":1.9,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917417","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 : 2026-01-02DOI: 10.1016/j.ejogrb.2025.114927
Rahul Chatterjee , Marielle Nobbenhuis , Jenneke Kasius , Manou Kaur , Katherine Vroobel , Ayoma Attygalle , Thomas Edward James Ind
Objectives
To describe the implementation of robotic indocyanine green (ICG)–guided sentinel lymph node (SLN) mapping for nodal staging in early-stage cervical cancer and to report mapping outcomes, anatomical distribution of SLNs, and perioperative morbidity.
Methods
This single-centre cohort study included women with presumed early-stage cervical cancer who underwent robotic ICG-guided SLN mapping between 2015 and 2025. SLN mapping was performed with or without pelvic lymphadenectomy according to a side-specific algorithm. Institutional practice evolved over time from routine SLN mapping with lymphadenectomy to selective SLN-only staging. Outcomes included SLN detection rates, anatomical distribution of SLNs, nodal metastases, and postoperative morbidity.
Results
A total of 161 women underwent robotic SLN mapping. SLN detection was achieved in all patients, with bilateral mapping in 145 (90.1 %). Sixteen women (9.9 %) had nodal metastases; all metastatic disease was identified within sentinel lymph nodes. SLNs were most frequently located in the obturator and external iliac regions, with occasional upper pelvic and para-aortic drainage when lymphatic channels extended cranially. Lymphoedema occurred in 18 women (11.2 %) and was observed only in those who underwent pelvic lymphadenectomy.
Conclusions
This study describes long-term, real-world implementation of robotic ICG-guided SLN mapping in early-stage cervical cancer. The findings demonstrate consistent SLN detection, characteristic patterns of lymphatic drainage, and a lower observed incidence of lymphoedema when lymphadenectomy is avoided, supporting the role of SLN-guided nodal staging within contemporary, algorithm-based surgical practice.
{"title":"Robotic indocyanine green-guided sentinel lymph node mapping in early-stage cervical cancer: The fluorescent robotic indocyanine endoscopic node detection series (FRIENDS)","authors":"Rahul Chatterjee , Marielle Nobbenhuis , Jenneke Kasius , Manou Kaur , Katherine Vroobel , Ayoma Attygalle , Thomas Edward James Ind","doi":"10.1016/j.ejogrb.2025.114927","DOIUrl":"10.1016/j.ejogrb.2025.114927","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the implementation of robotic indocyanine green (ICG)–guided sentinel lymph node (SLN) mapping for nodal staging in early-stage cervical cancer and to report mapping outcomes, anatomical distribution of SLNs, and perioperative morbidity.</div></div><div><h3>Methods</h3><div>This single-centre cohort study included women with presumed early-stage cervical cancer who underwent robotic ICG-guided SLN mapping between 2015 and 2025. SLN mapping was performed with or without pelvic lymphadenectomy according to a side-specific algorithm. Institutional practice evolved over time from routine SLN mapping with lymphadenectomy to selective SLN-only staging. Outcomes included SLN detection rates, anatomical distribution of SLNs, nodal metastases, and postoperative morbidity.</div></div><div><h3>Results</h3><div>A total of 161 women underwent robotic SLN mapping. SLN detection was achieved in all patients, with bilateral mapping in 145 (90.1 %). Sixteen women (9.9 %) had nodal metastases; all metastatic disease was identified within sentinel lymph nodes. SLNs were most frequently located in the obturator and external iliac regions, with occasional upper pelvic and <em>para</em>-aortic drainage when lymphatic channels extended cranially. Lymphoedema occurred in 18 women (11.2 %) and was observed only in those who underwent pelvic lymphadenectomy.</div></div><div><h3>Conclusions</h3><div>This study describes long-term, real-world implementation of robotic ICG-guided SLN mapping in early-stage cervical cancer. The findings demonstrate consistent SLN detection, characteristic patterns of lymphatic drainage, and a lower observed incidence of lymphoedema when lymphadenectomy is avoided, supporting the role of SLN-guided nodal staging within contemporary, algorithm-based surgical practice.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114927"},"PeriodicalIF":1.9,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922009","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 : 2026-01-02DOI: 10.1016/j.ejogrb.2026.114935
Mai Vuong Hung , Pham Thi Hai Ha , Nguyen Khac Han Hoan , Nguyen Thanh Luan
Background
While maternal age is established as a dominant reproductive risk factor, the mechanistic distinction between age-dependent meiotic errors and age-independent mitotic errors remains uncharacterized. These divergent pathways have profound implications for patient counseling and treatment stratification but are rarely differentiated clinically.
Objectives
To establish distinct etiological pathways underlying chromosomal abnormalities by quantifying the differential age-sensitivity of whole-chromosome aneuploidies (meiotic origin) versus mosaic abnormalities (mitotic origin), determining whether developmental timing serves as an age-independent biomarker of genomic competence, and enabling practitioners to provide pathway-specific counseling and treatment recommendations.
Search strategy
PubMed, Embase, and ClinicalTrials.gov were searched for relevant studies.
Selection criteria
Retrospective cohort of 490 IVF patients (2,472 embryos) stratified by maternal age (≤35, 35–40, ≥40 years) with complete extended culture and next-generation sequencing (NGS)-based preimplantation genetic testing for aneuploidy.
Data collection and analysis
Age-stratified analysis of developmental kinetics and comprehensive chromosomal classification. Multivariate logistic regression identified independent predictors of aneuploidy, adjusting for maternal age and day-5 blastocyst count.
Main results
Whole-chromosome aneuploidies demonstrated striking age-sensitivity (14.0 % to 36.5 %, 2.6-fold increase, p < 0.001), reflecting progressive cohesin complex degradation, spindle checkpoint decline, and mitochondrial bioenergetic insufficiency. Mosaicism remained age-independent (∼41 %, p = 0.383), arising from post-meiotic mitotic errors. Day-5 blastocyst formation declined 30 % with age (p = 0.0154), yet day-6 formation remained age-independent (p = 0.106), indicating developmental delay rather than failure. Day-5 blastocyst count independently protected against aneuploidy (OR 0.965, 95 % CI: 0.944–0.987, p = 0.002), persisting after multivariate adjustment.
Conclusions
Mechanistic differentiation between age-dependent meiotic and age-independent mitotic chromosomal abnormalities reveals fundamentally distinct etiological pathways with profound implications for clinical decision-making. In particular, day-5 blastocyst achievement emerges as an independent biomarker of oocyte quality, enabling precise within-age-group risk stratification regardless of chronological age. These findings translate developmental kinetics into quantitative clinical algorithms that substantially improve reproductive counseling accuracy and patient-specific prognostication beyond traditional age-based approaches.
{"title":"Developmental kinetics distinguish meiotic from mitotic chromosomal defects: Day-5 blastocyst achievement as age-independent predictor of euploid embryo yield","authors":"Mai Vuong Hung , Pham Thi Hai Ha , Nguyen Khac Han Hoan , Nguyen Thanh Luan","doi":"10.1016/j.ejogrb.2026.114935","DOIUrl":"10.1016/j.ejogrb.2026.114935","url":null,"abstract":"<div><h3>Background</h3><div>While maternal age is established as a dominant reproductive risk factor, the mechanistic distinction between age-dependent meiotic errors and age-independent mitotic errors remains uncharacterized. These divergent pathways have profound implications for patient counseling and treatment stratification but are rarely differentiated clinically.</div></div><div><h3>Objectives</h3><div>To establish distinct etiological pathways underlying chromosomal abnormalities by quantifying the differential age-sensitivity of whole-chromosome aneuploidies (meiotic origin) versus mosaic abnormalities (mitotic origin), determining whether developmental timing serves as an age-independent biomarker of genomic competence, and enabling practitioners to provide pathway-specific counseling and treatment recommendations.</div></div><div><h3>Search strategy</h3><div>PubMed, Embase, and ClinicalTrials.gov were searched for relevant studies.</div></div><div><h3>Selection criteria</h3><div>Retrospective cohort of 490 IVF patients (2,472 embryos) stratified by maternal age (≤35, 35–40, ≥40 years) with complete extended culture and next-generation sequencing (NGS)-based preimplantation genetic testing for aneuploidy.</div></div><div><h3>Data collection and analysis</h3><div>Age-stratified analysis of developmental kinetics and comprehensive chromosomal classification. Multivariate logistic regression identified independent predictors of aneuploidy, adjusting for maternal age and day-5 blastocyst count.</div></div><div><h3>Main results</h3><div>Whole-chromosome aneuploidies demonstrated striking age-sensitivity (14.0 % to 36.5 %, 2.6-fold increase, p < 0.001), reflecting progressive cohesin complex degradation, spindle checkpoint decline, and mitochondrial bioenergetic insufficiency. Mosaicism remained age-independent (∼41 %, p = 0.383), arising from post-meiotic mitotic errors. Day-5 blastocyst formation declined 30 % with age (p = 0.0154), yet day-6 formation remained age-independent (p = 0.106), indicating developmental delay rather than failure. Day-5 blastocyst count independently protected against aneuploidy (OR 0.965, 95 % CI: 0.944–0.987, p = 0.002), persisting after multivariate adjustment.</div></div><div><h3>Conclusions</h3><div>Mechanistic differentiation between age-dependent meiotic and age-independent mitotic chromosomal abnormalities reveals fundamentally distinct etiological pathways with profound implications for clinical decision-making. In particular, day-5 blastocyst achievement emerges as an independent biomarker of oocyte quality, enabling precise within-age-group risk stratification regardless of chronological age. These findings translate developmental kinetics into quantitative clinical algorithms that substantially improve reproductive counseling accuracy and patient-specific prognostication beyond traditional age-based approaches.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114935"},"PeriodicalIF":1.9,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922008","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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