Pub Date : 2025-12-05DOI: 10.1016/j.ejogrb.2025.114819
Christina Pagkaki , Fenu Ediripolage , Kyriaki-Barbara Papalois , Abdullatif Elfituri , Jorge Haddad , Maria Patricia Roman , Elias Tsakos , Gabriele Falconi , Cornelia Betschart , Stergios K Doumouchtsis , CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women’s Health (i-chorus.org)
Background
Considerable variations exist in the selection and reporting of outcomes and outcome measures across randomized controlled trials (RCTs) evaluating surgical treatments for pelvic organ prolapse (POP). These variations hinder the ability to conduct comprehensive analyses and limit the comparability of results regarding safety and efficacy.
Objective
To create an inventory of selected and reported outcomes and outcome measures in published RCTs evaluating laparoscopic and robotic surgical treatments for POP and to assess their variations. Additionally, we aimed to investigate methodological parameters and quality of outcome reporting in these studies.
Methods
A comprehensive search was conducted across EMBASE, the Cochrane Central Register of Controlled Trials, and PubMed from inception to May 2025 to identify relevant RCTs. Data on study characteristics and reported outcomes were extracted and compiled. Outcomes were organized into overarching domains and sub-categorized into specific themes. We considered all RCTs on adult women in English language.
Results
Forty-five RCTs involving a total of 4566 female participants were included. Across these studies, 83 outcomes and 59 different outcome measures were identified. The most reported outcomes were duration of operation (65%), postoperative pain (45%), quality of life (45%), intraoperative blood loss (40%), and anatomical correction (40%). Twelve outcome domains were recognized, with “intraoperative technical aspects and observations” being the most comprehensive, containing 11 unique outcomes. Less frequently reported outcomes included financial cost (20%), sexual function (10%), and the cosmetic appearance of surgical wounds (5%). Outcome measures were grouped into six domains, with quality of life representing the most diverse, encompassing 24 different measures. The Pelvic Organ Prolapse Quantification (POP-Q) system emerged as the most consistently utilized outcome measure.
在评估盆腔器官脱垂（POP）手术治疗的随机对照试验（rct）中，结果和结果测量的选择和报告存在相当大的差异。这些差异阻碍了进行全面分析的能力，并限制了安全性和有效性结果的可比性。目的对已发表的评估腹腔镜和机器人手术治疗POP的随机对照试验中选择和报告的结果和结果测量进行盘点，并评估其差异。此外，我们旨在调查这些研究的方法学参数和结果报告的质量。方法综合检索EMBASE、Cochrane中央对照试验注册库（Central Register of Controlled Trials）和PubMed自成立至2025年5月的相关随机对照试验。提取并汇编了研究特征和报告结果的数据。结果被组织成总体领域，并细分为具体主题。我们考虑了所有英语成年女性的随机对照试验。结果纳入45项随机对照试验，共纳入4566名女性受试者。在这些研究中，确定了83个结果和59种不同的结果测量方法。报道最多的结果是手术时间（65%）、术后疼痛（45%）、生活质量（45%）、术中出血量（40%）和解剖矫正（40%）。确认了12个结果域，其中“术中技术方面和观察”最为全面，包含11个独特的结果。较少报道的结果包括经济成本（20%）、性功能（10%）和手术伤口的外观（5%）。结果测量分为六个领域，生活质量代表最多样化，包括24种不同的测量。盆腔器官脱垂量化（POP-Q）系统是最一致使用的结果测量方法。
{"title":"Reported outcomes and outcome measures in RCTs of laparoscopic and robotic interventions for pelvic organ prolapse in women: a systematic review","authors":"Christina Pagkaki , Fenu Ediripolage , Kyriaki-Barbara Papalois , Abdullatif Elfituri , Jorge Haddad , Maria Patricia Roman , Elias Tsakos , Gabriele Falconi , Cornelia Betschart , Stergios K Doumouchtsis , CHORUS: An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women’s Health (i-chorus.org)","doi":"10.1016/j.ejogrb.2025.114819","DOIUrl":"10.1016/j.ejogrb.2025.114819","url":null,"abstract":"<div><h3>Background</h3><div>Considerable variations exist in the selection and reporting of outcomes and outcome measures across randomized controlled trials (RCTs) evaluating surgical treatments for pelvic organ prolapse (POP). These variations hinder the ability to conduct comprehensive analyses and limit the comparability of results regarding safety and efficacy.</div></div><div><h3>Objective</h3><div>To create an inventory of selected and reported outcomes and outcome measures in published RCTs evaluating laparoscopic and robotic surgical treatments for POP and to assess their variations. Additionally, we aimed to investigate methodological parameters and quality of outcome reporting in these studies.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted across EMBASE, the Cochrane Central Register of Controlled Trials, and PubMed from inception to May 2025 to identify relevant RCTs. Data on study characteristics and reported outcomes were extracted and compiled. Outcomes were organized into overarching domains and sub-categorized into specific themes. We considered all RCTs on adult women in English language.</div></div><div><h3>Results</h3><div>Forty-five RCTs involving a total of 4566 female participants were included. Across these studies, 83 outcomes and 59 different outcome measures were identified. The most reported outcomes were duration of operation (65%), postoperative pain (45%), quality of life (45%), intraoperative blood loss (40%), and anatomical correction (40%). Twelve outcome domains were recognized, with “intraoperative technical aspects and observations” being the most comprehensive, containing 11 unique outcomes. Less frequently reported outcomes included financial cost (20%), sexual function (10%), and the cosmetic appearance of surgical wounds (5%). Outcome measures were grouped into six domains, with quality of life representing the most diverse, encompassing 24 different measures. The Pelvic Organ Prolapse Quantification (POP-Q) system emerged as the most consistently utilized outcome measure.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114819"},"PeriodicalIF":1.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788924","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 : 2025-12-04DOI: 10.1016/j.ejogrb.2025.114867
Bram Packet , Rik Van Severen , Laura Cattani , Adela Samesova , Florian Ramakers , Helena Williams , Jute Richter , Jan Deprest
Objectives
To study the association between the subpubic arch angle and area, the latter a novel estimator of maternal pelvic outlet dimensions, and postpartum anal incontinence.
Methods
Convenience sample from a prospective observational cohort study conducted in primiparous women who delivered vaginally at term. A transperineal ultrasound (TPUS) volume was acquired before the second stage for offline measurement of the subpubic arch angle, area, and levator ani hiatal area. Six to eight weeks postpartum, anal incontinence was self-reported using the St. Marks Incontinence Score (SMIS), and perineal and pelvic floor muscle structural changes were assessed by TPUS. Intra and inter-observer agreement on subpubic arch angle and area measurements was assessed. Anal incontinence and its potential predictors were studied in multivariable logistic regression. Last, a prediction model for postpartum anal incontinence was fitted based on antenatal predictors (age, BMI, anal incontinence at term). Individual sonographic variables were added to this baseline model to assess whether they influenced discriminatory accuracy by comparing the AUC.
Results
Data on 156 participants were available, of whom 73.7 % delivered spontaneously. Postpartum anal respective fecal incontinence was reported by 70.5 % and 7.7 %. The incidence of obstetric anal sphincter injury was 3.8 %. Inter- and intra-rater agreement was better for the subpubic area (ICC 0.95, 95 % CI 0.92–0.97 and ICC 0.97, 95 % CI 0.95–0.98) than the subpubic arch angle. Anal incontinence at term (aOR 3.77, 95 % CI1.46–9.73) and assisted vaginal birth (aOR 4.05, 95 %CI 1.27–12.92) were the strongest predictors of postpartum anal incontinence. Although less strong, the subpubic area was also an independent predictor (aOR 1.44, 95 %1.08–1.93). Addition of the subpubic area to the antenatal model did not improve discriminatory accuracy (AUC baseline model: 0.70, 95 % CI 0.61–0.80).
Conclusion
The subpubic area can be reliably measured on TPUS. Herein, it was an independent predictor of postpartum anal incontinence. Nonetheless, the addition of this variable to a model containing antenatal predictors only, did not improve discriminatory accuracy for postpartum anal incontinence, questioning its added value for individualized risk prediction.
Funding
Research Council Flanders (grant number 1S49923N).
目的：探讨耻骨下弓角与面积的关系，后者是一种新的估计产妇骨盆出口尺寸的指标。方法：从一项前瞻性观察队列研究中抽取方便样本，该研究对足月顺产的初产妇进行了研究。在第二阶段前获得经会阴超声（tpu）体积，用于离线测量耻骨下弓角度，面积和提肛孔面积。产后6 ~ 8周，采用St. Marks失禁评分（SMIS）自我报告肛门失禁，并通过TPUS评估会阴和盆底肌肉结构变化。评估了内部和内部观察者对耻骨下弓角度和面积测量的一致意见。采用多变量logistic回归研究肛门失禁及其潜在的预测因素。最后，基于产前预测因子（年龄、BMI、足月肛门失禁）拟合产后肛门失禁预测模型。将单个超声变量添加到该基线模型中，以通过比较AUC来评估它们是否影响区分准确性。结果：156名参与者的数据可用，其中73.7%的人自发分娩。产后肛门大便失禁分别为70.5%和7.7%。产科肛门括约肌损伤发生率为3.8%。与耻骨下弓角度相比，耻骨下区域（ICC 0.95, 95% CI 0.92-0.97, ICC 0.97, 95% CI 0.95-0.98）之间和内部的一致性更好。足月肛门失禁（aOR 3.77, 95% CI1.46-9.73）和辅助阴道分娩（aOR 4.05, 95% CI 1.27-12.92）是产后肛门失禁的最强预测因子。虽然不那么强，但阴下区域也是一个独立的预测因子（aOR为1.44,95%为1.08-1.93）。在产前模型中加入阴下区域并没有提高鉴别准确度（AUC基线模型：0.70,95% CI 0.61-0.80）。结论：tpu可以可靠地测量阴下面积。在这里，它是产后肛门失禁的独立预测因子。然而，将该变量添加到仅包含产前预测因子的模型中，并没有提高产后肛门失禁的歧视性准确性，质疑其对个性化风险预测的附加价值。资助：佛兰德斯研究委员会（资助号：1S49923N）。
{"title":"The sonographic subpubic area is a predictor of anal incontinence after a first vaginal delivery: A prospective cohort study","authors":"Bram Packet , Rik Van Severen , Laura Cattani , Adela Samesova , Florian Ramakers , Helena Williams , Jute Richter , Jan Deprest","doi":"10.1016/j.ejogrb.2025.114867","DOIUrl":"10.1016/j.ejogrb.2025.114867","url":null,"abstract":"<div><h3>Objectives</h3><div>To study the association between the subpubic arch angle and area, the latter a novel estimator of maternal pelvic outlet dimensions, and postpartum anal incontinence.</div></div><div><h3>Methods</h3><div>Convenience sample from a prospective observational cohort study conducted in primiparous women who delivered vaginally at term. A transperineal ultrasound (TPUS) volume was acquired before the second stage for <em>offline</em> measurement of the subpubic arch angle, area, and levator ani hiatal area. Six to eight weeks postpartum, anal incontinence was self-reported using the St. Marks Incontinence Score (SMIS), and perineal and pelvic floor muscle structural changes were assessed by TPUS. Intra and inter-observer agreement on subpubic arch angle and area measurements was assessed. Anal incontinence and its potential predictors were studied in multivariable logistic regression. Last, a prediction model for postpartum anal incontinence was fitted based on antenatal predictors (age, BMI, anal incontinence at term). Individual sonographic variables were added to this baseline model to assess whether they influenced discriminatory accuracy by comparing the AUC.</div></div><div><h3>Results</h3><div>Data on 156 participants were available, of whom 73.7 % delivered spontaneously. Postpartum anal respective fecal incontinence was reported by 70.5 % and 7.7 %. The incidence of obstetric anal sphincter injury was 3.8 %. Inter- and intra-rater agreement was better for the subpubic area (ICC 0.95, 95 % CI 0.92–0.97 and ICC 0.97, 95 % CI 0.95–0.98) than the subpubic arch angle. Anal incontinence at term (aOR 3.77, 95 % CI1.46–9.73) and assisted vaginal birth (aOR 4.05, 95 %CI 1.27–12.92) were the strongest predictors of <em>postpartum</em> anal incontinence. Although less strong, the subpubic area was also an independent predictor (aOR 1.44, 95 %1.08–1.93). Addition of the subpubic area to the antenatal model did not improve discriminatory accuracy (AUC baseline model: 0.70, 95 % CI 0.61–0.80).</div></div><div><h3>Conclusion</h3><div>The subpubic area can be reliably measured on TPUS. Herein, it was an independent predictor of postpartum anal incontinence. Nonetheless, the addition of this variable to a model containing <em>antenatal</em> predictors only, did not improve discriminatory accuracy for <em>postpartum</em> anal incontinence, questioning its added value for individualized risk prediction.</div></div><div><h3>Funding</h3><div>Research Council Flanders (grant number 1S49923N).</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114867"},"PeriodicalIF":1.9,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780057","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 : 2025-12-04DOI: 10.1016/j.ejogrb.2025.114877
Serena B. Gumusoglu, Brandon M. Schickling, Donna A. Santillan, Mark K. Santillan
Objectives
Pre-eclampsia is a common and dangerous hypertensive pregnancy complication, with recurrence in as many as 80% of subsequent pregnancies. However, it is often difficult to predict recurrence. Further complicating risk assessment and biomarker development, the genetic and environmental drivers of pre-eclampsia are varied and numerous. In this study, a longitudinal, repeated-measures design was used to control for many of these drivers, and to isolate factors that may be associated with pre-eclampsia in subsequent pregnancies.
Study design
In an exploratory cohort (n = 14) of individuals who had a pregnancy affected by pre-eclampsia and then had an immediate subsequent pregnancy without pre-eclampsia, late-gestation circulating metabolomics were evaluated utilizing a targeted (83 analytes) metabolomics profiling approach. Metabolites were extracted from maternal plasma samples collected from successive pregnancies.
Main outcome measures
Derivatized samples were analysed by gas chromatography–mass spectroscopy, and metabolites were identified and annotated in accordance with reference standards. All data were normalized ratiometrically and scaled uniformly.
Results
Exploratory comparisons of pre-eclamptic and non-pre-eclamptic pregnancies revealed significant differences in inositol, methyl citrate, gamma-aminobutyric acid (GABA) and cysteine levels. Metabolite set quantitative enrichment analysis showed that pyruvate metabolism was potentially enriched among metabolites changed by pre-eclamptic status.
Conclusions
These findings demonstrate that metabolomic changes within individuals may biomark subsequent risk for pre-eclampsia, and specific metabolites may prove to be successful targets for future studies of pre-eclamptic therapeutics.
{"title":"Metabolomics reveals pre-eclamptic-protective mechanisms within individuals","authors":"Serena B. Gumusoglu, Brandon M. Schickling, Donna A. Santillan, Mark K. Santillan","doi":"10.1016/j.ejogrb.2025.114877","DOIUrl":"10.1016/j.ejogrb.2025.114877","url":null,"abstract":"<div><h3>Objectives</h3><div>Pre-eclampsia is a common and dangerous hypertensive pregnancy complication, with recurrence in as many as 80% of subsequent pregnancies. However, it is often difficult to predict recurrence. Further complicating risk assessment and biomarker development, the genetic and environmental drivers of pre-eclampsia are varied and numerous. In this study, a longitudinal, repeated-measures design was used to control for many of these drivers, and to isolate factors that may be associated with pre-eclampsia in subsequent pregnancies.</div></div><div><h3>Study design</h3><div>In an exploratory cohort (<em>n</em> = 14) of individuals who had a pregnancy affected by pre-eclampsia and then had an immediate subsequent pregnancy without pre-eclampsia, late-gestation circulating metabolomics were evaluated utilizing a targeted (83 analytes) metabolomics profiling approach. Metabolites were extracted from maternal plasma samples collected from successive pregnancies.</div></div><div><h3>Main outcome measures</h3><div>Derivatized samples were analysed by gas chromatography–mass spectroscopy, and metabolites were identified and annotated in accordance with reference standards. All data were normalized ratiometrically and scaled uniformly.</div></div><div><h3>Results</h3><div>Exploratory comparisons of pre-eclamptic and non-pre-eclamptic pregnancies revealed significant differences in inositol, methyl citrate, gamma-aminobutyric acid (GABA) and cysteine levels. Metabolite set quantitative enrichment analysis showed that pyruvate metabolism was potentially enriched among metabolites changed by pre-eclamptic status.</div></div><div><h3>Conclusions</h3><div>These findings demonstrate that metabolomic changes within individuals may biomark subsequent risk for pre-eclampsia, and specific metabolites may prove to be successful targets for future studies of pre-eclamptic therapeutics.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"317 ","pages":"Article 114877"},"PeriodicalIF":1.9,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682305","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 : 2025-12-03DOI: 10.1016/j.ejogrb.2025.114863
Ana Clara Pimenta Servidoni , Clementin Castel , Giovanna Cristina de Castro Martin , Bruna Benigna Sales Armstrong , Wellgner Fernandes Oliveira Amador , Abdelrahman Yousif , Marina P. Andres , Mauricio S. Abrao , Hugh S. Taylor
{"title":"Diaphragmatic Endometriosis: Clinical Features and Surgical Outcomes—A Systematic Review and Meta-Analysis","authors":"Ana Clara Pimenta Servidoni , Clementin Castel , Giovanna Cristina de Castro Martin , Bruna Benigna Sales Armstrong , Wellgner Fernandes Oliveira Amador , Abdelrahman Yousif , Marina P. Andres , Mauricio S. Abrao , Hugh S. Taylor","doi":"10.1016/j.ejogrb.2025.114863","DOIUrl":"10.1016/j.ejogrb.2025.114863","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"317 ","pages":"Article 114863"},"PeriodicalIF":1.9,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733943","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 : 2025-12-02DOI: 10.1016/j.ejogrb.2025.114869
Charline Bradshaw , Alena Uus , Jordina Aviles Verdera , Mary Rutherford , Megan Hall , Anastasija Arechvo , Jana Hutter , Lisa Story
Congenital diaphragmatic hernia (CDH) is a complex fetal anomaly primarily associated with pulmonary hypoplasia and persistent pulmonary hypertension, but emerging evidence suggests that associated neurodevelopmental impairment may begin antenatally. This review examines current literature demonstrating alterations in fetal brain development in CDH, including regional reductions in brain volume, disrupted cortical architecture, and altered cerebral perfusion identified through fetal Magnetic Resonance Imaging (MRI) and Ultrasound-Doppler studies. Animal models further implicate hypoxia, impaired vascularisation, and neuroinflammation as contributing factors. These findings support a multifactorial pathogenesis involving hemodynamic and inflammatory mechanisms. Understanding antenatal brain changes in CDH may inform future prognostication and assist in optimising antenatal and postnatal management.
{"title":"Relationship between fetal brain development and congenital diaphragmatic hernia","authors":"Charline Bradshaw , Alena Uus , Jordina Aviles Verdera , Mary Rutherford , Megan Hall , Anastasija Arechvo , Jana Hutter , Lisa Story","doi":"10.1016/j.ejogrb.2025.114869","DOIUrl":"10.1016/j.ejogrb.2025.114869","url":null,"abstract":"<div><div>Congenital diaphragmatic hernia (CDH) is a complex fetal anomaly primarily associated with pulmonary hypoplasia and persistent pulmonary hypertension, but emerging evidence suggests that associated neurodevelopmental impairment may begin antenatally. This review examines current literature demonstrating alterations in fetal brain development in CDH, including regional reductions in brain volume, disrupted cortical architecture, and altered cerebral perfusion identified through fetal Magnetic Resonance Imaging (MRI) and Ultrasound-Doppler studies. Animal models further implicate hypoxia, impaired vascularisation, and neuroinflammation as contributing factors. These findings support a multifactorial pathogenesis involving hemodynamic and inflammatory mechanisms. Understanding antenatal brain changes in CDH may inform future prognostication and assist in optimising antenatal and postnatal management.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"317 ","pages":"Article 114869"},"PeriodicalIF":1.9,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682350","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 \"Which Anti-Incontinence Surgery Option is Better in Patients Undergoing Total Laparoscopic Hysterectomy? Burch Colposuspension or Transobturator Tape Procedure\". [Eur. J. Obstet. Gynecol. Reprod. Biol. 249 (2020) 59-63].","authors":"Kerem Doga Seckin, Pinar Kadirogullari, Huseyin Kiyak","doi":"10.1016/j.ejogrb.2025.114755","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2025.114755","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"315 ","pages":"114755"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534530","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}
<div><h3>Importance</h3><div>Apical pelvic organ prolapse (aPOP) significantly impacts quality of life, and its optimal surgical management remains debated. Minimally invasive vaginal approaches offer potential advantages over abdominal methods, particularly in terms of recovery, morbidity, and long-term function. However, comparative long-term data between non-mesh and mini-mesh solutions are limited.</div></div><div><h3>Objectives</h3><div>To compare long-term outcomes and patient satisfaction between two minimally invasive surgical techniques for aPOP repair: the non-mesh EnPlace® anchoring system and the Seratom MN2® mini-mesh implant.</div></div><div><h3>Study design</h3><div>A retrospective cohort study of 200 patients undergoing sacrospinous ligament fixation (SSLF) via either the EnPlace® (n = 100) or Seratom MN2® (n = 100) systems at a single center (2013–2022). Groups were matched by follow-up duration. Primary outcomes included anatomical success and patient satisfaction; secondary outcomes included operative details, complications, and postoperative recovery. Statistical analysis used Mann-Whitney U and chi-square tests.</div></div><div><h3>Results</h3><div>Both groups showed high long-term anatomical success (EnPlace®: 96.74 %; Seratom MN2®: 98.89 %). Patient satisfaction was significantly higher in the EnPlace® group at long-term follow-up (89.33 % vs. 74.67 %, p = 0.034). EnPlace® was associated with shorter operative time (23.4 vs. 29.9 min, p < 0.001), less blood loss (23.6 vs. 31.8 cL, p < 0.001), and reduced hospital stay (1.02 vs. 2.00 days, p < 0.001). Pain duration and severity were also significantly lower with EnPlace®.</div></div><div><h3>Conclusion</h3><div>Both systems demonstrated high efficacy and safety in apical prolapse repair. However, the EnPlace® system provided advantages in patient satisfaction, surgical efficiency, and postoperative recovery.</div></div><div><h3>Why this matters</h3><div>Sacrospinous ligament fixation (SSLF) is a common vaginal surgical technique for the treatment of apical pelvic organ prolapse (aPOP), including both uterine and vaginal vault descent. It offers a minimally invasive alternative to abdominal approaches, with reduced morbidity and faster recovery. Over time, various SSLF-based techniques have emerged, differing in the use of mesh, dissection depth, and anchoring mechanisms, aiming to improve safety and durability while preserving patient quality of life.</div><div>This study presents a long-term comparison between two contemporary SSLF approaches. The EnPlace® system uses a meshless, anchor-based method requiring minimal dissection, while the Seratom MN2® system utilizes a small, partially absorbable mini-mesh to reinforce the apical and anterior/posterior compartments. Both were designed to minimize surgical trauma and maximize anatomical support.</div><div>Following 200 women for up to ten years, our findings demonstrate that both techniques are effective and safe op
根尖盆腔器官脱垂（aPOP）显著影响患者的生活质量，其最佳手术治疗仍存在争议。微创阴道入路比腹部入路具有潜在的优势，特别是在恢复、发病率和长期功能方面。然而，非网格和微型网格解决方案之间的比较长期数据是有限的。目的比较无补片EnPlace®锚定系统和Seratom MN2®微型补片种植体两种微创aPOP修复技术的长期疗效和患者满意度。研究设计一项回顾性队列研究，在2013-2022年对200名接受骶棘韧带固定（SSLF）的患者进行单中心（n = 100）或Seratom MN2®（n = 100）系统的治疗。各组按随访时间进行匹配。主要结局包括解剖成功和患者满意度；次要结果包括手术细节、并发症和术后恢复情况。统计分析采用Mann-Whitney U检验和卡方检验。结果两组长期解剖成功率均较高（EnPlace®：96.74 %;Seratom MN2®：98.89 %）。长期随访中，EnPlace®组患者满意度显著高于对照组（89.33 % vs. 74.67 %,p = 0.034）。EnPlace®与缩短手术时间（23.4 vs 29.9 min, p <； 0.001）、减少失血量（23.6 vs 31.8 cL, p <； 0.001）和缩短住院时间（1.02 vs 2.00 days, p <； 0.001）相关。EnPlace®的疼痛持续时间和严重程度也显著降低。结论两种系统在根尖脱垂修复中均具有较高的疗效和安全性。然而，EnPlace®系统在患者满意度、手术效率和术后恢复方面具有优势。骶棘韧带固定（SSLF）是一种常见的阴道手术技术，用于治疗盆腔器官脱垂（aPOP），包括子宫和阴道穹窿下降。它提供了一种微创替代腹部入路，发病率低，恢复快。随着时间的推移，出现了各种基于sslf的技术，在使用网格、解剖深度和锚定机制方面有所不同，旨在提高安全性和耐久性，同时保持患者的生活质量。本研究提出了两种当代SSLF方法之间的长期比较。EnPlace®系统使用无网格、基于锚定的方法，需要最小的解剖，而Seratom MN2®系统使用小的、部分可吸收的微型网格来加强根尖和前后室。两者的设计都是为了尽量减少手术创伤和最大限度地提高解剖支持。在对200名女性长达10年的随访中，我们的研究结果表明，这两种技术都是aPOP修复的有效和安全的选择，每一种技术都取得了很高的长期解剖成功率。然而，统计学上观察到EnPlace®在患者满意度、手术时间和术后恢复方面有显著差异。这些结果为支持根尖脱垂手术的量身定制决策提供了有价值的证据，并强调了SSLF中技术选择的临床相关性。
{"title":"Long-term comparison of non-mesh anchoring vs mini mesh for apical suspension","authors":"Nati Bor , Jonatan Neuman , Réka Anikó Fábián-Kovács , Ido Givon , Ran Matot , Natav Hendin , Menahem Neuman , Haim Krissi","doi":"10.1016/j.ejogrb.2025.114865","DOIUrl":"10.1016/j.ejogrb.2025.114865","url":null,"abstract":"<div><h3>Importance</h3><div>Apical pelvic organ prolapse (aPOP) significantly impacts quality of life, and its optimal surgical management remains debated. Minimally invasive vaginal approaches offer potential advantages over abdominal methods, particularly in terms of recovery, morbidity, and long-term function. However, comparative long-term data between non-mesh and mini-mesh solutions are limited.</div></div><div><h3>Objectives</h3><div>To compare long-term outcomes and patient satisfaction between two minimally invasive surgical techniques for aPOP repair: the non-mesh EnPlace® anchoring system and the Seratom MN2® mini-mesh implant.</div></div><div><h3>Study design</h3><div>A retrospective cohort study of 200 patients undergoing sacrospinous ligament fixation (SSLF) via either the EnPlace® (n = 100) or Seratom MN2® (n = 100) systems at a single center (2013–2022). Groups were matched by follow-up duration. Primary outcomes included anatomical success and patient satisfaction; secondary outcomes included operative details, complications, and postoperative recovery. Statistical analysis used Mann-Whitney U and chi-square tests.</div></div><div><h3>Results</h3><div>Both groups showed high long-term anatomical success (EnPlace®: 96.74 %; Seratom MN2®: 98.89 %). Patient satisfaction was significantly higher in the EnPlace® group at long-term follow-up (89.33 % vs. 74.67 %, p = 0.034). EnPlace® was associated with shorter operative time (23.4 vs. 29.9 min, p < 0.001), less blood loss (23.6 vs. 31.8 cL, p < 0.001), and reduced hospital stay (1.02 vs. 2.00 days, p < 0.001). Pain duration and severity were also significantly lower with EnPlace®.</div></div><div><h3>Conclusion</h3><div>Both systems demonstrated high efficacy and safety in apical prolapse repair. However, the EnPlace® system provided advantages in patient satisfaction, surgical efficiency, and postoperative recovery.</div></div><div><h3>Why this matters</h3><div>Sacrospinous ligament fixation (SSLF) is a common vaginal surgical technique for the treatment of apical pelvic organ prolapse (aPOP), including both uterine and vaginal vault descent. It offers a minimally invasive alternative to abdominal approaches, with reduced morbidity and faster recovery. Over time, various SSLF-based techniques have emerged, differing in the use of mesh, dissection depth, and anchoring mechanisms, aiming to improve safety and durability while preserving patient quality of life.</div><div>This study presents a long-term comparison between two contemporary SSLF approaches. The EnPlace® system uses a meshless, anchor-based method requiring minimal dissection, while the Seratom MN2® system utilizes a small, partially absorbable mini-mesh to reinforce the apical and anterior/posterior compartments. Both were designed to minimize surgical trauma and maximize anatomical support.</div><div>Following 200 women for up to ten years, our findings demonstrate that both techniques are effective and safe op","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"317 ","pages":"Article 114865"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733935","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 compare survival and neurodevelopmental outcomes at 2 years’ corrected age for preterm twins (≤33+0 weeks) with the first twin in breech presentation, according to planned mode of delivery (planned vaginal delivery [PVD] vs planned caesarean delivery [PCD]). Secondary objectives were survival at discharge, survival without morbidity at discharge, neonatal outcomes, and maternal morbidity.
Methods
We conducted a retrospective cohort study of women with preterm breech first twins born after preterm labour (≤33+0 weeks) at Nantes University Hospital (2008–2019). A propensity score estimated each mother’s risk of caesarean. Outcomes (survival at discharge, survival at discharge without morbidity, and survival with normal neurodevelopment at 2 years) were adjusted for gestational age, sex, and propensity score. Sensitivity analyses included multiple imputation for missing data and exclusion of births < 26+0 weeks.
Results
Among 413 preterm twin deliveries, 61 women were included: 15 in the PVD group (30 newborns) and 46 in the PCD group (92 newborns). After adjustment for propensity score and gestational age, no significant differences were observed in survival at discharge (aOR 1.9, 95 % CI 0.28–12.7, P = 0.51) or survival without morbidity (aOR 0.3, 95 % CI 0.06–2.21, P = 0.27). Survival with normal neurodevelopment at 2 years trended lower with PVD (aOR 0.3, 95 % CI 0.07–1.22, P = 0.09). Maternal morbidity was higher in the PCD group.
Conclusion
Planned mode of delivery did not significantly influence survival in preterm breech-first twins, but confidence intervals were wide. A trend toward poorer neurodevelopment at 2 years was observed after planned vaginal delivery, whereas maternal morbidity was higher after planned caesarean delivery. These findings support individualized decision-making, balancing neonatal and maternal risks.
目的：根据计划分娩方式（计划阴道分娩[PVD]与计划剖宫产[PCD]），比较第一胎臀位早产双胞胎（≤33+0周）在2 岁矫正年龄时的生存和神经发育结局。次要目标是出院时的生存、出院时无发病率的生存、新生儿结局和产妇发病率。方法：对南特大学医院（2008-2019年）早产（≤33+0周）后出生的早产第一胎妇女进行回顾性队列研究。一个倾向评分估计了每位母亲剖腹产的风险。根据胎龄、性别和倾向评分对结果（出院时生存、出院时无发病生存和2 年神经发育正常生存）进行调整。敏感性分析包括对缺失数据的多重输入和排除出生 +0周。结果：在413例早产双胞胎中，包括61名妇女：PVD组15名（30名新生儿），PCD组46名（92名新生儿）。在调整倾向评分和胎龄后，两组的出院生存率（aOR为1.9,95 % CI 0.28-12.7, P = 0.51）和无发病生存率（aOR为0.3,95 % CI 0.06-2.21, P = 0.27）均无显著差异。2 年时神经发育正常的生存率随着PVD而降低（aOR为0.3,95 % CI为0.07-1.22,P = 0.09）。PCD组产妇发病率较高。结论：计划分娩方式对臀先双胞胎的生存率无显著影响，但置信区间较宽。计划阴道分娩后2 岁时神经发育较差，而计划剖宫产后产妇发病率较高。这些发现支持个性化决策，平衡新生儿和孕产妇风险。
{"title":"Twin pregnancy with the first twin in breech presentation: Survival and neurodevelopmental outcome of preterm infants at a corrected age of 2 years","authors":"Camille Dhonneur , Cyril Flamant , Jean-Christophe Rozé , Valérie Rouger , Norbert Winer , Vincent Dochez","doi":"10.1016/j.ejogrb.2025.114868","DOIUrl":"10.1016/j.ejogrb.2025.114868","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare survival and neurodevelopmental outcomes at 2 years’ corrected age for preterm twins (≤33<sup>+0</sup> weeks) with the first twin in breech presentation, according to planned mode of delivery (planned vaginal delivery [PVD] vs planned caesarean delivery [PCD]). Secondary objectives were survival at discharge, survival without morbidity at discharge, neonatal outcomes, and maternal morbidity.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of women with preterm breech first twins born after preterm labour (≤33<sup>+0</sup> weeks) at Nantes University Hospital (2008–2019). A propensity score estimated each mother’s risk of caesarean. Outcomes (survival at discharge, survival at discharge without morbidity, and survival with normal neurodevelopment at 2 years) were adjusted for gestational age, sex, and propensity score. Sensitivity analyses included multiple imputation for missing data and exclusion of births < 26<sup>+0</sup> weeks.</div></div><div><h3>Results</h3><div>Among 413 preterm twin deliveries, 61 women were included: 15 in the PVD group (30 newborns) and 46 in the PCD group (92 newborns). After adjustment for propensity score and gestational age, no significant differences were observed in survival at discharge (aOR 1.9, 95 % CI 0.28–12.7, P = 0.51) or survival without morbidity (aOR 0.3, 95 % CI 0.06–2.21, P = 0.27). Survival with normal neurodevelopment at 2 years trended lower with PVD (aOR 0.3, 95 % CI 0.07–1.22, P = 0.09). Maternal morbidity was higher in the PCD group.</div></div><div><h3>Conclusion</h3><div>Planned mode of delivery did not significantly influence survival in preterm breech-first twins, but confidence intervals were wide. A trend toward poorer neurodevelopment at 2 years was observed after planned vaginal delivery, whereas maternal morbidity was higher after planned caesarean delivery. These findings support individualized decision-making, balancing neonatal and maternal risks.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"317 ","pages":"Article 114868"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667714","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}
Sacrospinous fixation is the standard procedure for apical pelvic organ prolapse repair via the vaginal route. However, there may be a significant risk of per- and post-operative neurovascular damage due to the proximity of neurovascular structures, especially since the technique is performed by palpation without visual control. After developing a new innovative and minimally invasive technique that had been successfully tested on an anatomical model using a 1.9 mm fiber optic (NanoNeedle™, Arthrex, Germany) coupled with a specific suture capture device (I-Stitch™, AMI, Austria), we conducted a pilot clinical study.
Study design: Anterior and/or posterior sacrospinous fixation via the vaginal route was performed in 15 patients with apical prolapse. The objectives of the study were to demonstrate the feasibility of sacrospinous fixation under visual control and to evaluate the medium-term efficacy of the surgical technique at 12 months.
Results
Identification of the sciatic spine and sacrospinous ligament, as well as feasibility of sacrospinous fixation were always possible. No perioperative nor postoperative complications were observed. No postoperative pain was reported. Complete correction of the prolapse was observed at 12 months in 87 % of cases. Patient satisfaction was higher at 1, 6, and 12 months according to the various quality of life questionnaires used (PGI, SF-12, PFIQ-7, PFDI-20, PISQ-12).
Conclusions
This innovative minimally invasive new technology appears to be particularly relevant and could offer advantages in terms of safety and improved suture placement on the sacrospinous ligament under visual control.
{"title":"The vaginal minimally invasive sacrospinous fixation under visual guidance: A pilot study","authors":"Gautier Chene , Emanuele Cerruto , Stephanie Moret , Erdogan Nohuz","doi":"10.1016/j.ejogrb.2025.114866","DOIUrl":"10.1016/j.ejogrb.2025.114866","url":null,"abstract":"<div><h3>Objective</h3><div>Sacrospinous fixation is the standard procedure for apical pelvic organ prolapse repair via the vaginal route. However, there may be a significant risk of per- and post-operative neurovascular damage due to the proximity of neurovascular structures, especially since the technique is performed by palpation without visual control. After developing a new innovative and minimally invasive technique that had been successfully tested on an anatomical model using a 1.9 mm fiber optic (NanoNeedle™, Arthrex, Germany) coupled with a specific suture capture device (I-Stitch™, AMI, Austria), we conducted a pilot clinical study.</div><div>Study design: Anterior and/or posterior sacrospinous fixation via the vaginal route was performed in 15 patients with apical prolapse. The objectives of the study were to demonstrate the feasibility of sacrospinous fixation under visual control and to evaluate the medium-term efficacy of the surgical technique at 12 months.</div></div><div><h3>Results</h3><div>Identification of the sciatic spine and sacrospinous ligament, as well as feasibility of sacrospinous fixation were always possible. No perioperative nor postoperative complications were observed. No postoperative pain was reported. Complete correction of the prolapse was observed at 12 months in 87 % of cases. Patient satisfaction was higher at 1, 6, and 12 months according to the various quality of life questionnaires used (PGI, SF-12, PFIQ-7, PFDI-20, PISQ-12).</div></div><div><h3>Conclusions</h3><div>This innovative minimally invasive new technology appears to be particularly relevant and could offer advantages in terms of safety and improved suture placement on the sacrospinous ligament under visual control.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"317 ","pages":"Article 114866"},"PeriodicalIF":1.9,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676903","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 : 2025-11-29DOI: 10.1016/j.ejogrb.2025.114849
Hiroyuki Tokue, Azusa Tokue, Yoshito Tsushima
Objective
To investigate whether cervical venous plexus (CV) volume measured by MRI predicts massive intraoperative blood loss (IBL) in patients with placenta accreta spectrum (PAS) and placenta previa managed with prophylactic balloon occlusion of the internal iliac arteries, differentiating between anterior (APP) and posterior placenta previa (PPP).
Methods
Overall, 59 patients with PAS and placenta previa underwent a cesarean section with PBOIIA. CV volume was quantitatively measured using T2-weighted MRI. Associations between CV volume and IBL were analyzed and stratified according to placental location.
Results
Patients with PPP had significantly greater CV volumes than that of patients with APP (20.5 ± 10.8 vs 14.7 ± 10.7 cm3, p = 0.032). Operative time (172.2 ± 42.1 vs 122.7 ± 33.2 min, p = 0.023) and transfusion requirements (7.8 ± 4.1 vs 3.1 ± 2.2 units, p < 0.001) were higher in APP; however, total IBL did not differ significantly (3927.7 ± 2847.6 vs 2742.4 ± 1514.5 mL, p = 0.267). In PPP, smaller CV volume significantly correlated with increased IBL (Spearman’s ρ = −0.541, p = 0.002), predicting massive hemorrhage (IBL ≥ 2500 mL) with modest accuracy (area under the curve = 0.727; cutoff ≤ 21.0 cm3, sensitivity = 70.6 %, specificity = 78.6 %). No correlation was observed in APP cases (ρ = −0.098, p = 0.638).
Conclusion
In PAS with placenta previa managed by PBOIIA, a reduced CV volume on preoperative MRI predicted a higher intraoperative bleeding risk, particularly in PPP. In PPP, a smaller CV volume (≤21.0 cm3) was associated with massive intraoperative hemorrhage.
目的：探讨MRI测量颈静脉丛（CV）体积是否能预测增生性胎盘谱（PAS）和前置胎盘经髂内动脉预防性球囊闭塞治疗的患者术中大量失血量（IBL），并区分前前置胎盘（APP）和后前置胎盘（PPP）。方法：共有59例PAS合并前置胎盘患者行PBOIIA剖宫产术。使用t2加权MRI定量测量CV体积。根据胎盘位置对CV容积和IBL之间的关系进行分析和分层。结果：PPP患者CV容积显著高于APP患者（20.5±10.8 cm3 vs 14.7±10.7 cm3, p = 0.032）。手术时间（172.2±42.1 vs 122.7±33.2 min, p = 0.023）和输血需氧量（7.8±4.1 vs 3.1±2.2 units, p = 3，敏感性= 70.6%，特异性= 78.6%）。APP病例间无相关性（ρ = -0.098, p = 0.638）。结论：经PBOIIA治疗前置胎盘的PAS患者，术前MRI CV体积降低预示术中出血风险较高，尤其是PPP患者。在PPP中，CV体积较小（≤21.0 cm3）与术中大量出血相关。
{"title":"Predicting bleeding risk in placenta accreta spectrum with placenta previa managed by prophylactic balloon occlusion: Utility of cervical venous plexus volume on MRI","authors":"Hiroyuki Tokue, Azusa Tokue, Yoshito Tsushima","doi":"10.1016/j.ejogrb.2025.114849","DOIUrl":"10.1016/j.ejogrb.2025.114849","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate whether cervical venous plexus (CV) volume measured by MRI predicts massive intraoperative blood loss (IBL) in patients with placenta accreta spectrum (PAS) and placenta previa managed with prophylactic balloon occlusion of the internal iliac arteries, differentiating between anterior (APP) and posterior placenta previa (PPP).</div></div><div><h3>Methods</h3><div>Overall, 59 patients with PAS and placenta previa underwent a cesarean section with PBOIIA. CV volume was quantitatively measured using T2-weighted MRI. Associations between CV volume and IBL were analyzed and stratified according to placental location.</div></div><div><h3>Results</h3><div>Patients with PPP had significantly greater CV volumes than that of patients with APP (20.5 ± 10.8 vs 14.7 ± 10.7 cm3, p = 0.032). Operative time (172.2 ± 42.1 vs 122.7 ± 33.2 min, p = 0.023) and transfusion requirements (7.8 ± 4.1 vs 3.1 ± 2.2 units, p < 0.001) were higher in APP; however, total IBL did not differ significantly (3927.7 ± 2847.6 vs 2742.4 ± 1514.5 mL, p = 0.267). In PPP, smaller CV volume significantly correlated with increased IBL (Spearman’s ρ = −0.541, p = 0.002), predicting massive hemorrhage (IBL ≥ 2500 mL) with modest accuracy (area under the curve = 0.727; cutoff ≤ 21.0 cm<sup>3</sup>, sensitivity = 70.6 %, specificity = 78.6 %). No correlation was observed in APP cases (ρ = −0.098, p = 0.638).</div></div><div><h3>Conclusion</h3><div>In PAS with placenta previa managed by PBOIIA, a reduced CV volume on preoperative MRI predicted a higher intraoperative bleeding risk, particularly in PPP. In PPP, a smaller CV volume (≤21.0 cm<sup>3</sup>) was associated with massive intraoperative hemorrhage.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"317 ","pages":"Article 114849"},"PeriodicalIF":1.9,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676764","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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