Pub Date : 2025-12-29DOI: 10.1016/j.ejogrb.2025.114925
Barbara Gardella , Mattia Dominoni , Chiara Cassani , Martina Rita Pano , Cristina Angela Camnasio , Arsenio Spinillo
Objective
To evaluate the risk of major injuries associated with Veress, open (Hasson), direct and optical abdominal entry methods in laparoscopy.
Methods
Network meta-analysis was performed using penalized logistic regression. Pairwise meta-analysis was carried-out using Bayesian binomial-normal hierarchical models with weakly informative priors. Risk of bias was evaluated by ROB-2 method. NMA protocol was recorded in PROSPERO (n. CRD42024583526).
Results
Vascular lesions occurred in 14/2832 of Veress, 1/1661 of direct, 2/426 of optical and 0/2030 of open entry methods in 26 studies of 7250 laparoscopies. In NMA, direct and open entry methods were associated with a reduced risk of vascular lesions compared to Veress (OR = 0.17,95 %CI = 0.04–0.67 and OR = 0.09,95 %CI = 0.01–0.68,respectively). Overall, pooled rates of major injuries were 0.76/1000 (95 % CI = 0.06–2.05) in 29 studies of 7584 subjects. Major injuries were less common in direct as compared to either Veress (OR = 0.21,95 %CI = 0.08–0.56) or open method (OR = 0.23,95 %CI = 0.07–0.73). According to a ranking evaluation of absence of major complications, direct entry (SUCRA = 84.3 %) had the highest cumulative proportion of success, followed by optical entry (SUCRA = 68.5 %). Minor complications including extraperitoneal insufflation, multiple attempts, omental injury, trocar bleeding or infection or incisional hernia were studied in a network of 8984 subjects in 33 studies with a pooled prevalence of 30/1000 (95 %CI = 26.7–34.7). The risk of minor injuries was lower in direct (OR = 0.33,95 %CI = 0.23–0.46) as opposed to Veress entry. Direct entry was also the method with the lowest cumulative proportion of minor injuries (SUCRA = 97.75).
Conclusion
The open entrance method prevents vascular but not visceral injury. Overall, direct entry into the abdomen causes fewer severe and minor complications than Veress. In a hierarchy of procedures with fewer complications, direct entrance ranks first among the four most common methods of abdominal entry to establish pneumoperitoneum.
目的评价腹腔镜手术中采用Veress、开放式（Hasson）、直接入路和光学入路的重大损伤风险。方法采用惩罚逻辑回归进行网络meta分析。两两荟萃分析采用贝叶斯二项-正态层次模型，具有弱信息先验。采用rob2法评价偏倚风险。NMA协议记录在PROSPERO中（编号：CRD42024583526）。结果在7250例腹腔镜手术的26项研究中，Veress的血管病变发生率为14/2832，直接入路的发生率为1/1661，光学的发生率为2/426，开放入路的发生率为0/2030。在NMA中，与Veress相比，直接和开放式入路方法与血管病变风险降低相关（OR = 0.17, 95% CI = 0.04-0.67, OR = 0.09, 95% CI = 0.01-0.68）。总的来说，在29项研究的7584名受试者中，严重损伤的合并发生率为0.76/1000 （95% CI = 0.06-2.05）。与Veress法（OR = 0.21, 95% CI = 0.08-0.56）或开放式法（OR = 0.23, 95% CI = 0.07-0.73）相比，直接法的严重损伤发生率较低。根据无主要并发症的排序评价，直接入路（SUCRA = 84.3%）的累计成功率最高，其次是光学入路（SUCRA = 68.5%）。在33项研究的8984名受试者网络中研究了轻微并发症，包括腹膜外充气、多次尝试、网膜损伤、套管针出血或感染或切口疝，总患病率为30/1000 （95% CI = 26.7-34.7）。与Veress入路相比，直接入路的轻伤风险较低（OR = 0.33, 95% CI = 0.23-0.46）。直接入路也是轻伤累积比例最低的方法（SUCRA = 97.75）。结论开放入路法可防止血管损伤，但无脏器损伤。总的来说，直接进入腹部引起的严重和轻微的并发症比Veress少。在并发症较少的手术层次中，直接入路在四种最常见的腹部入路建立气腹的方法中排名第一。
{"title":"Does the abdominal entry method in laparoscopy really matter? A network meta-analysis of rare events in randomized trials","authors":"Barbara Gardella , Mattia Dominoni , Chiara Cassani , Martina Rita Pano , Cristina Angela Camnasio , Arsenio Spinillo","doi":"10.1016/j.ejogrb.2025.114925","DOIUrl":"10.1016/j.ejogrb.2025.114925","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the risk of major injuries associated with Veress, open (Hasson), direct and optical abdominal entry methods in laparoscopy.</div></div><div><h3>Methods</h3><div>Network <em>meta</em>-analysis was performed using penalized logistic regression. Pairwise <em>meta</em>-analysis was carried-out using Bayesian binomial-normal hierarchical models with weakly informative priors. Risk of bias was evaluated by ROB-2 method<strong>.</strong> NMA protocol was recorded in PROSPERO (n. CRD42024583526).</div></div><div><h3>Results</h3><div>Vascular lesions occurred in 14/2832 of Veress, 1/1661 of direct, 2/426 of optical and 0/2030 of open entry methods in 26 studies of 7250 laparoscopies. In NMA, direct and open entry methods were associated with a reduced risk of vascular lesions compared to Veress (OR = 0.17,95 %CI = 0.04–0.67 and OR = 0.09,95 %CI = 0.01–0.68,respectively). Overall, pooled rates of major injuries were 0.76/1000 (95 % CI = 0.06–2.05) in 29 studies of 7584 subjects. Major injuries were less common in direct as compared to either Veress (OR = 0.21,95 %CI = 0.08–0.56) or open method (OR = 0.23,95 %CI = 0.07–0.73). According to a ranking evaluation of absence of major complications, direct entry (SUCRA = 84.3 %) had the highest cumulative proportion of success, followed by optical entry (SUCRA = 68.5 %). Minor complications including extraperitoneal insufflation, multiple attempts, omental injury, trocar bleeding or infection or incisional hernia were studied in a network of 8984 subjects in 33 studies with a pooled prevalence of 30/1000 (95 %CI = 26.7–34.7). The risk of minor injuries was lower in direct (OR = 0.33,95 %CI = 0.23–0.46) as opposed to Veress entry. Direct entry was also the method with the lowest cumulative proportion of minor injuries (SUCRA = 97.75).</div></div><div><h3>Conclusion</h3><div>The open entrance method prevents vascular but not visceral injury. Overall, direct entry into the abdomen causes fewer severe and minor complications than Veress. In a hierarchy of procedures with fewer complications, direct entrance ranks first among the four most common methods of abdominal entry to establish pneumoperitoneum.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114925"},"PeriodicalIF":1.9,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881258","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 : 2025-12-25DOI: 10.1016/j.ejogrb.2025.114920
Pragnesh Parmar , Gunvanti Rathod
{"title":"Confirming age before MTP in minors: reconciling POCSO mandates with adolescent reproductive rights","authors":"Pragnesh Parmar , Gunvanti Rathod","doi":"10.1016/j.ejogrb.2025.114920","DOIUrl":"10.1016/j.ejogrb.2025.114920","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114920"},"PeriodicalIF":1.9,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838112","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 : 2025-12-25DOI: 10.1016/j.ejogrb.2025.114921
Sara Ebadi , Viktoria El Radaf , Tahir Mahmood , Charles Savona-Ventura , Mehreen Zaigham
<div><h3>Introduction</h3><div>Since the last two decades, there has been a dramatic rise in caesarean sections (CS) throughout the world. This increase has been seen even in Europe, where rates vary significantly from 17% in Northern Europe to 56% in the South. Although, CS can be a lifesaving intervention when medically necessary, non-essential CS are associated with short- and long-term complications for both the mother and newborn. To curb this rising trend, it is important to understand underlying causes behind regional disparities, including differences between public and private hospitals.</div></div><div><h3>Objective</h3><div>To investigate variations in CS rates between public and private hospitals across European regions and at a country level using the Robson Ten Group Classification.</div></div><div><h3>Methods</h3><div>A systemic review of studies published between 1st January 2000 and 12th March 2025 was conducted using MEDLINE/PubMed, CINAHL, EMBASE, Global Index Medicus, Web of Science and Cochrane library, analysing CS rates in 25 European countries. All studies reporting births in Europe, Robson group, written in English or Swedish were included. The developed protocol was prospectively registered in PROSPERO (Registration number 513579). Meta-analysis using absolute numbers and percentages was conducted to compare the birth rates at country and regional levels. To assess the risk of bias, two reviewers independently evaluated the quality of the studies included using a modified Newcastle–Ottawa Scale adapted for cohort studies.</div></div><div><h3>Results</h3><div>Of 1385 articles, 46 were eligible for inclusion in the final analysis. A total of 12 505<!--> <!-->939 births were analysed, with 8 543<!--> <!-->803 (68.3%) occurring in public hospitals and 3 962<!--> <!-->136 (31.7%) in private hospitals. Overall, Southern Europe illustrated the highest CS rate (54.9% of all births) as compared to Northern Europe (16.9%). There was a lack of reporting from private hospitals, with data only for Southern Europe, where CS rates were significantly higher in private (73.1%) as compared to public (40.9%) hospitals. The largest differences were seen for low-risk women Robson Group 1, 2, 3 and 4 (private vs public: 67.8 vs 28%, 67.6 vs 39.7, 26.9 vs 9.1% and 38 vs 18% respectively).</div></div><div><h3>Conclusion</h3><div>High CS rates were observed across Europe, with Southern Europe reporting the highest levels. Rates were consistently higher in private compared to public hospitals. In both settings, Group 5 (women with a previous CS) was the largest contributor to the overall CS rate. However, low-risk women in private hospitals (Groups 1 and 2) had twice the CS rates compared with public hospitals. These findings highlight that the excess CS burden in private hospitals is largely driven by unnecessary procedures in low-risk groups. There is an urgent need for interventions that promote evidence-based care and reduce unnecessary CS es
在过去的二十年里，全世界剖腹产的数量急剧上升。这种增长甚至出现在欧洲，其比率从北欧的17%到南欧的56%不等。虽然，在医学上必要时，CS可以是一种挽救生命的干预措施，但非必要的CS与母亲和新生儿的短期和长期并发症有关。为了遏制这一上升趋势，重要的是要了解地区差异背后的根本原因，包括公立医院和私立医院之间的差异。目的利用罗布森十组分类法调查欧洲地区和国家一级公立和私立医院CS率的差异。方法采用MEDLINE/PubMed、CINAHL、EMBASE、Global Index Medicus、Web of Science和Cochrane library对2000年1月1日至2025年3月12日发表的研究进行系统评价，分析欧洲25个国家的CS发生率。所有报告欧洲出生的研究，罗布森组，用英语或瑞典语撰写。开发的方案在PROSPERO中前瞻性注册（注册号513579）。采用绝对数字和百分比进行荟萃分析，比较国家和地区水平的出生率。为了评估偏倚风险，两位评论者独立评估了研究的质量，包括使用适用于队列研究的改良纽卡斯尔-渥太华量表。结果1385篇文献中，46篇符合纳入最终分析。共分析了12 505 939例分娩，其中8 543 803例（68.3%）发生在公立医院，3 962 136例（31.7%）发生在私立医院。总体而言，南欧的非传染性疾病发生率最高（占所有新生儿的54.9%），而北欧为16.9%。缺乏来自私立医院的报告，只有南欧的数据，那里私立医院的CS率（73.1%）明显高于公立医院（40.9%）。罗布森组1、2、3和4组的低风险女性差异最大（私人与公共：分别为67.8比28%、67.6比39.7、26.9比9.1%和38%比18%）。结论：整个欧洲都观察到高CS发生率，南欧报告的发生率最高。私立医院的比率一直高于公立医院。在这两种情况下，第5组（以前有过CS的女性）对总体CS率的贡献最大。然而，私立医院低风险妇女（1组和2组）的CS率是公立医院的两倍。这些发现强调，私立医院的CS负担过重主要是由低风险人群的不必要手术造成的。迫切需要采取干预措施，促进循证护理，减少不必要的CS，特别是在低风险妇女中。
{"title":"Caesarean section rates in public vs private hospitals in Europe: a systematic review and meta-analysis using the Robson ten group classification system","authors":"Sara Ebadi , Viktoria El Radaf , Tahir Mahmood , Charles Savona-Ventura , Mehreen Zaigham","doi":"10.1016/j.ejogrb.2025.114921","DOIUrl":"10.1016/j.ejogrb.2025.114921","url":null,"abstract":"<div><h3>Introduction</h3><div>Since the last two decades, there has been a dramatic rise in caesarean sections (CS) throughout the world. This increase has been seen even in Europe, where rates vary significantly from 17% in Northern Europe to 56% in the South. Although, CS can be a lifesaving intervention when medically necessary, non-essential CS are associated with short- and long-term complications for both the mother and newborn. To curb this rising trend, it is important to understand underlying causes behind regional disparities, including differences between public and private hospitals.</div></div><div><h3>Objective</h3><div>To investigate variations in CS rates between public and private hospitals across European regions and at a country level using the Robson Ten Group Classification.</div></div><div><h3>Methods</h3><div>A systemic review of studies published between 1st January 2000 and 12th March 2025 was conducted using MEDLINE/PubMed, CINAHL, EMBASE, Global Index Medicus, Web of Science and Cochrane library, analysing CS rates in 25 European countries. All studies reporting births in Europe, Robson group, written in English or Swedish were included. The developed protocol was prospectively registered in PROSPERO (Registration number 513579). Meta-analysis using absolute numbers and percentages was conducted to compare the birth rates at country and regional levels. To assess the risk of bias, two reviewers independently evaluated the quality of the studies included using a modified Newcastle–Ottawa Scale adapted for cohort studies.</div></div><div><h3>Results</h3><div>Of 1385 articles, 46 were eligible for inclusion in the final analysis. A total of 12 505<!--> <!-->939 births were analysed, with 8 543<!--> <!-->803 (68.3%) occurring in public hospitals and 3 962<!--> <!-->136 (31.7%) in private hospitals. Overall, Southern Europe illustrated the highest CS rate (54.9% of all births) as compared to Northern Europe (16.9%). There was a lack of reporting from private hospitals, with data only for Southern Europe, where CS rates were significantly higher in private (73.1%) as compared to public (40.9%) hospitals. The largest differences were seen for low-risk women Robson Group 1, 2, 3 and 4 (private vs public: 67.8 vs 28%, 67.6 vs 39.7, 26.9 vs 9.1% and 38 vs 18% respectively).</div></div><div><h3>Conclusion</h3><div>High CS rates were observed across Europe, with Southern Europe reporting the highest levels. Rates were consistently higher in private compared to public hospitals. In both settings, Group 5 (women with a previous CS) was the largest contributor to the overall CS rate. However, low-risk women in private hospitals (Groups 1 and 2) had twice the CS rates compared with public hospitals. These findings highlight that the excess CS burden in private hospitals is largely driven by unnecessary procedures in low-risk groups. There is an urgent need for interventions that promote evidence-based care and reduce unnecessary CS es","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114921"},"PeriodicalIF":1.9,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921949","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}
Pregnant women require different nutritional intake such as folic acid, iron and cholecalciferol, and specific vaccination to prevent fetal abnormalities and improve outcomes. This study aims to analyze usage trends for these recommended drugs over the last decade, and to identify maternal factors associated with their use.
Methods
The nationwide cross-sectional study is based on data from the French National Health Data System (SNDS) including pregnancies from 2012 to 2022. Folic acid, iron, cholecalciferol, and influenza vaccination use were analyzed according to the relevant periods based on WHO and French guidelines. Multivariable logistic regression assessed maternal characteristics associated with drug use.
Results
Analyzing 8,979,173 pregnancies, the study found that 46.0% of pregnancies used folic acid during the periconceptional period, rising from 33.8% in 2012 to 52.6% in 2022. Women with chronic disease and higher financial resources were more likely to use it. 64.1% used iron during pregnancy with exposure increasing with age. 35.5% used cholecalciferol, with higher socioeconomic status associated with increased use. Only 5.1% were vaccinated against influenza, with the rate increasing until 2020, before declining. Vaccination was positively associated with maternal age, the presence of a chronic disease, and higher financial resources.
Conclusion
This study revealed increasing trends of use in recommended drugs during pregnancy over the last decade in France, although overall prevalence remains not optimal, and concerning for influenza vaccination. The identified risk factors for non-use include young maternal age, low income, and deprived areas, emphasizing the need for targeted interventions to improve maternal health outcomes.
{"title":"Trends over years and maternal characteristics associated with use of recommended drugs during pregnancy: A cross-sectional study in France","authors":"Margaux Louchet , Mathis Collier , Jean-Marc Treluyer , Jeanne Sibiude , Laurent Chouchana","doi":"10.1016/j.ejogrb.2025.114903","DOIUrl":"10.1016/j.ejogrb.2025.114903","url":null,"abstract":"<div><h3>Aim</h3><div>Pregnant women require different nutritional intake such as folic acid, iron and cholecalciferol, and specific vaccination to prevent fetal abnormalities and improve outcomes. This study aims to analyze usage trends for these recommended drugs over the last decade, and to identify maternal factors associated with their use.</div></div><div><h3>Methods</h3><div>The nationwide cross-sectional study is based on data from the French National Health Data System (SNDS) including pregnancies from 2012 to 2022. Folic acid, iron, cholecalciferol, and influenza vaccination use were analyzed according to the relevant periods based on WHO and French guidelines. Multivariable logistic regression assessed maternal characteristics associated with drug use.</div></div><div><h3>Results</h3><div>Analyzing 8,979,173 pregnancies, the study found that 46.0% of pregnancies used folic acid during the periconceptional period, rising from 33.8% in 2012 to 52.6% in 2022. Women with chronic disease and higher financial resources were more likely to use it. 64.1% used iron during pregnancy with exposure increasing with age. 35.5% used cholecalciferol, with higher socioeconomic status associated with increased use. Only 5.1% were vaccinated against influenza, with the rate increasing until 2020, before declining. Vaccination was positively associated with maternal age, the presence of a chronic disease, and higher financial resources.</div></div><div><h3>Conclusion</h3><div>This study revealed increasing trends of use in recommended drugs during pregnancy over the last decade in France, although overall prevalence remains not optimal, and concerning for influenza vaccination. The identified risk factors for non-use include young maternal age, low income, and deprived areas, emphasizing the need for targeted interventions to improve maternal health outcomes.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114903"},"PeriodicalIF":1.9,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911023","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 determine the uterine cervix stiffness in patients presenting with threatened preterm labor (PTL) measured with an aspiration-based device (expressed as Cervical Stiffness Index − CSI) and to correlate CSI with pregnancy outcomes.
Study design
Single-center, prospective, observational pilot study of patients with singleton pregnancies presenting with threatened PTL between 240/7 and 336/7 weeks. Patients underwent a physical examination, ultrasound examination, transvaginal ultrasound cervical length (CL) measurement and cervical stiffness assessment using the Pregnolia System, an aspiration-based device measuring the vacuum required to displace the tissue into the device tip by a fixed distance, a proxy for stiffness (CSI, mbar). Higher CSI indicates stiffer tissue.
Results
Between April 2022 and August 2024, 100 patients with signs and symptoms of PTL were recruited. Thirty-five had a PTB, of which 7 delivered < 34 weeks, 5 within 14 days and 11 within 28 days from measurement. CSI and CL were significantly different between patients delivering at term and patients with a PTB. The Area under the Curve of CSI and CL for prediction of delivery ≤ 14 days from measurement were 0.979 (95 % CI, 0.952–1.000) and 0.744 (0.369–1.000), respectively; for delivery ≤ 28 days from measurement, 0.802 (0.612–0.993), and 0.764 (0.579–0.948), respectively; for PTB < 34 weeks, 0.873 (0.729–1.000) and 0.836 (0.563–1.000), respectively; and for PTB < 37 weeks 0.845 (0.763–0.926) and 0.779 (0.680–0.877), respectively.
Conclusions
In patients presenting with threatened PTL, a softer cervix as measured by CSI was associated with an increased risk of preterm birth. These findings suggest that CSI has potential as a predictor of PTB in symptomatic patients, but require confirmation in larger, independent cohorts.
{"title":"Cervical Stiffness Index as predictor of preterm birth in women with threatened preterm labor","authors":"Dario Colacurci , Gabriele Saccone , Alessandra Ammendola , Giorgia Buonomo , Chiara Murolo , Mariavittoria Locci","doi":"10.1016/j.ejogrb.2025.114910","DOIUrl":"10.1016/j.ejogrb.2025.114910","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the uterine cervix stiffness in patients presenting with threatened preterm labor (PTL) measured with an aspiration-based device (expressed as Cervical Stiffness Index − CSI) and to correlate CSI with pregnancy outcomes.</div></div><div><h3>Study design</h3><div>Single-center, prospective, observational pilot study of patients with singleton pregnancies presenting with threatened PTL between 24<sup>0/7</sup> and 33<sup>6/7</sup> weeks. Patients underwent a physical examination, ultrasound examination, transvaginal ultrasound cervical length (CL) measurement and cervical stiffness assessment using the Pregnolia System, an aspiration-based device measuring the vacuum required to displace the tissue into the device tip by a fixed distance, a proxy for stiffness (CSI, mbar). Higher CSI indicates stiffer tissue.</div></div><div><h3>Results</h3><div>Between April 2022 and August 2024, 100 patients with signs and symptoms of PTL were recruited. Thirty-five had a PTB, of which 7 delivered < 34 weeks, 5 within 14 days and 11 within 28 days from measurement. CSI and CL were significantly different between patients delivering at term and patients with a PTB. The Area under the Curve of CSI and CL for prediction of delivery ≤ 14 days from measurement were 0.979 (95 % CI, 0.952–1.000) and 0.744 (0.369–1.000), respectively; for delivery ≤ 28 days from measurement, 0.802 (0.612–0.993), and 0.764 (0.579–0.948), respectively; for PTB < 34 weeks, 0.873 (0.729–1.000) and 0.836 (0.563–1.000), respectively; and for PTB < 37 weeks 0.845 (0.763–0.926) and 0.779 (0.680–0.877), respectively.</div></div><div><h3>Conclusions</h3><div>In patients presenting with threatened PTL, a softer cervix as measured by CSI was associated with an increased risk of preterm birth. These findings suggest that CSI has potential as a predictor of PTB in symptomatic patients, but require confirmation in larger, independent cohorts.</div></div><div><h3>Clinical trial registration</h3><div>NCT05355649.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114910"},"PeriodicalIF":1.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838108","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}
Group B Streptococcus (GBS) infection remains a significant cause of neonatal morbidity and mortality worldwide. Universal screening using rectovaginal swabs and intrapartum antibiotic prophylaxis for GBS-positive women is a standard practice to prevent early-onset neonatal disease. Colonization rates vary internationally, and comprehensive data from Greece are limited. This study aimed to evaluate the incidence of GBS colonization and associated risk factors among pregnant women in Crete, Greece.
Methods
This retrospective study included all pregnant women and their newborns admitted to two major hospitals in Crete between January 1, 2015, and December 31, 2019. GBS colonization was assessed via vaginal cultures. Data on maternal age, nationality, area of residence, multiparity, comorbidities (e.g., diabetes, hypertension), number of prenatal visits, gestational age at screening, and mode of delivery were analyzed. Rates of antibiotic prophylaxis and incidence of neonatal GBS disease were also reviewed.
Results
Out of 7362 pregnant women reviewed, 4984 (67.7 %) underwent GBS screening. GBS colonization was found in 83 women (1.7 %). The highest colonization rate was among women aged 31–35 years (34.9 %). Screening before the 35th gestational week occurred in 45.8 % of cases, and comorbidities such as diabetes or hypertension were present in 9.6 %. Multiparity (≥2 births) was significantly associated with colonization (66.3 %), while other factors showed no significant association. All identified GBS-positive women received intrapartum antibiotic prophylaxis, and no cases of neonatal GBS disease were observed.
Conclusions
The GBS colonization rate in Crete is among the lowest globally reported. Universal screening combined with intrapartum antibiotic prophylaxis effectively prevented neonatal GBS disease. The establishment of clear national guidelines is crucial to ensure consistent screening practices and responsible antibiotic stewardship.
{"title":"Group B Streptococcus colonization in pregnant women and vertical transmission to neonates in Crete Greece: Incidence and risk factors","authors":"Kalliopi Vardaki , Emmanouil Galanakis , Despoina Gkentzi , Emmanouel Karavitakis , Sofia Maraki , Eleftheria Hatzidaki","doi":"10.1016/j.ejogrb.2025.114913","DOIUrl":"10.1016/j.ejogrb.2025.114913","url":null,"abstract":"<div><h3>Background</h3><div>Group B <em>Streptococcus</em> (GBS) infection remains a significant cause of neonatal morbidity and mortality worldwide. Universal screening using rectovaginal swabs and intrapartum antibiotic prophylaxis for GBS-positive women is a standard practice to prevent early-onset neonatal disease. Colonization rates vary internationally, and comprehensive data from Greece are limited. This study aimed to evaluate the incidence of GBS colonization and associated risk factors among pregnant women in Crete, Greece.</div></div><div><h3>Methods</h3><div>This retrospective study included all pregnant women and their newborns admitted to two major hospitals in Crete between January 1, 2015, and December 31, 2019. GBS colonization was assessed via vaginal cultures. Data on maternal age, nationality, area of residence, multiparity, comorbidities (e.g., diabetes, hypertension), number of prenatal visits, gestational age at screening, and mode of delivery were analyzed. Rates of antibiotic prophylaxis and incidence of neonatal GBS disease were also reviewed.</div></div><div><h3>Results</h3><div>Out of 7362 pregnant women reviewed, 4984 (67.7 %) underwent GBS screening. GBS colonization was found in 83 women (1.7 %). The highest colonization rate was among women aged 31–35 years (34.9 %). Screening before the 35th gestational week occurred in 45.8 % of cases, and comorbidities such as diabetes or hypertension were present in 9.6 %. Multiparity (≥2 births) was significantly associated with colonization (66.3 %), while other factors showed no significant association. All identified GBS-positive women received intrapartum antibiotic prophylaxis, and no cases of neonatal GBS disease were observed.</div></div><div><h3>Conclusions</h3><div>The GBS colonization rate in Crete is among the lowest globally reported. Universal screening combined with intrapartum antibiotic prophylaxis effectively prevented neonatal GBS disease. The establishment of clear national guidelines is crucial to ensure consistent screening practices and responsible antibiotic stewardship.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114913"},"PeriodicalIF":1.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145833432","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 : 2025-12-23DOI: 10.1016/j.ejogrb.2025.114911
Francy Waltilia Cruz Araújo , Danilo Santos de Sousa , Silvia Maria da Silva Sant’Ana Rodrigues , Thialla Andrade Carvalho , Paulo Ricardo Martins-Filho
{"title":"Pregnant women with Mpox in Brazil: findings from a nationwide surveillance database","authors":"Francy Waltilia Cruz Araújo , Danilo Santos de Sousa , Silvia Maria da Silva Sant’Ana Rodrigues , Thialla Andrade Carvalho , Paulo Ricardo Martins-Filho","doi":"10.1016/j.ejogrb.2025.114911","DOIUrl":"10.1016/j.ejogrb.2025.114911","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114911"},"PeriodicalIF":1.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877653","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 : 2025-12-22DOI: 10.1016/j.ejogrb.2025.114906
Anna Tsviban , Maurizio Serati , Tal Fligelman , Hadil Hassouna , Roni Tomashev , Anna Padoa
Background
Mid-urethral slings (MUS) are the first-line surgical treatment for stress urinary incontinence (SUI). Despite their efficacy, de-novo urgency (dUU) remains a common and distressing postoperative complication. This study aimed to assess the incidence of dUU following trans-obturator MUS using the Monarc® system, and to identify risk factors associated with its development.
Methods
This retrospective study included women who underwent Monarc® MUS between 2009 and 2017 at a tertiary medical center. Patients with less than 12 months of follow-up or pre-existing urinary urgency were excluded. Data on demographics, medical history, and concomitant procedures were extracted. The primary outcome was dUU, defined as a newly reported compelling urge to void at 12 months postoperatively. Univariate logistic regression was used to identify associated risk factors.
Results
Of 305 women, 63 met inclusion criteria. At 12 months, dUU occurred in 31.7 % of patients. Preoperative diabetes mellitus (30 % vs. 2.3 %, p = 0.003) and higher BMI (median 28.7 vs. 26.0 kg/m2, p = 0.002) were significantly associated with dUU. Age, parity, and concomitant pelvic floor surgeries were not significantly associated. The subjective cure rate for SUI was 93.7 %.
Conclusions
The incidence of dUU after trans-obturator MUS was higher than previously reported. Diabetes mellitus and elevated BMI emerged as significant risk factors. These findings support the inclusion of metabolic status in preoperative counselling and highlight the potential value of weight and glycemic management in improving postoperative outcomes for women undergoing SUI surgery.
背景：中尿道吊带术（MUS）是治疗压力性尿失禁（SUI）的一线手术方法。尽管它们有效，但新生急症（de-novo urgency, dUU）仍然是一种常见且令人痛苦的术后并发症。本研究旨在使用Monarc®系统评估经闭孔MUS后dUU的发生率，并确定其发展相关的危险因素。方法本回顾性研究纳入了2009年至2017年在三级医疗中心接受Monarc®MUS的女性。随访时间少于12个月或已存在尿急的患者被排除在外。提取了人口统计学、病史和伴随手术的数据。主要结果为dUU，定义为术后12个月新报道的强烈无效冲动。采用单因素logistic回归确定相关危险因素。结果305例女性中，63例符合纳入标准。12个月时，31.7%的患者发生dUU。术前糖尿病（30% vs. 2.3%, p = 0.003）和较高BMI（中位数28.7 vs. 26.0 kg/m2, p = 0.002）与dUU显著相关。年龄、胎次和伴随的盆底手术无显著相关。主观治愈率为93.7%。结论经闭孔微创手术后dUU的发生率高于既往报道。糖尿病和BMI升高是重要的危险因素。这些发现支持将代谢状态纳入术前咨询，并强调体重和血糖管理在改善SUI手术妇女术后预后方面的潜在价值。
{"title":"Diabetes mellitus and body weight as risk factors for de-novo urgency after trans-obturator mid-urethral sling","authors":"Anna Tsviban , Maurizio Serati , Tal Fligelman , Hadil Hassouna , Roni Tomashev , Anna Padoa","doi":"10.1016/j.ejogrb.2025.114906","DOIUrl":"10.1016/j.ejogrb.2025.114906","url":null,"abstract":"<div><h3>Background</h3><div>Mid-urethral slings (MUS) are the first-line surgical treatment for stress urinary incontinence (SUI). Despite their efficacy, de-novo urgency (dUU) remains a common and distressing postoperative complication. This study aimed to assess the incidence of dUU following trans-obturator MUS using the Monarc® system, and to identify risk factors associated with its development.</div></div><div><h3>Methods</h3><div>This retrospective study included women who underwent Monarc® MUS between 2009 and 2017 at a tertiary medical center. Patients with less than 12 months of follow-up or pre-existing urinary urgency were excluded. Data on demographics, medical history, and concomitant procedures were extracted. The primary outcome was dUU, defined as a newly reported compelling urge to void at 12 months postoperatively. Univariate logistic regression was used to identify associated risk factors.</div></div><div><h3>Results</h3><div>Of 305 women, 63 met inclusion criteria. At 12 months, dUU occurred in 31.7 % of patients. Preoperative diabetes mellitus (30 % vs. 2.3 %, p = 0.003) and higher BMI (median 28.7 vs. 26.0 kg/m<sup>2</sup>, p = 0.002) were significantly associated with dUU. Age, parity, and concomitant pelvic floor surgeries were not significantly associated. The subjective cure rate for SUI was 93.7 %.</div></div><div><h3>Conclusions</h3><div>The incidence of dUU after trans-obturator MUS was higher than previously reported. Diabetes mellitus and elevated BMI emerged as significant risk factors. These findings support the inclusion of metabolic status in preoperative counselling and highlight the potential value of weight and glycemic management in improving postoperative outcomes for women undergoing SUI surgery.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114906"},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838111","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 : 2025-12-22DOI: 10.1016/j.ejogrb.2025.114908
Marwa S. Abd Elhady , Niven R. Basyouni , Salam Bani Hani , Hala N. El Galada
Objective
Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions among women that can impact all aspects of quality of life. This study aims to compare active training (birth ball) and passive training (biofeedback) on pelvic floor muscle strength and urinary incontinence among post-hysterectomy women.
Methods
A Randomized Controlled Trial design was carried out that recruited a purposive sample of 40 women who were allocated randomly into two groups, 20 participants for each group. The intervention group received training in PFM by using biofeedback, while the control group demonstrated active PFM training using a birth ball. Data collected using a basic data structured interview schedule, the Protection, Amount, Frequency, Adjustment, Body Image (PRAFAB) questionnaire, and the Pelvic floor muscles strength test (Manometric Assisted Biofeedback-MBF).
Findings
Following 6 weeks and 3 months of interventions, there was a statistically significant difference in the two groups concerning pelvic floor muscle strength. Regarding the degree of urinary incontinence, a statistically significant difference was found between the two study groups after 6 weeks and 3 months following the intervention, with p-values of 0.048 and 0.024, respectively. In favor of the control group, where most participants (75 %) had mild urinary incontinence compared to only 50 % of the intervention group.
Conclusion
The study found that pelvic floor exercises improved strength and reduced incontinence, with active birth ball training yielding better outcomes and lower recurrence than passive biofeedback.
{"title":"Rehabilitation of pelvic floor muscle for women with urinary incontinence post hysterectomy: A randomized controlled trial","authors":"Marwa S. Abd Elhady , Niven R. Basyouni , Salam Bani Hani , Hala N. El Galada","doi":"10.1016/j.ejogrb.2025.114908","DOIUrl":"10.1016/j.ejogrb.2025.114908","url":null,"abstract":"<div><h3>Objective</h3><div>Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions among women that can impact all aspects of quality of life. This study aims to compare active training (birth ball) and passive training (biofeedback) on pelvic floor muscle strength and urinary incontinence among post-hysterectomy women.</div></div><div><h3>Methods</h3><div>A Randomized Controlled Trial design was carried out that recruited a purposive sample of 40 women who were allocated randomly into two groups, 20 participants for each group. The intervention group received training in PFM by using biofeedback, while the control group demonstrated active PFM training using a birth ball. Data collected using a basic data structured interview schedule, the Protection, Amount, Frequency, Adjustment, Body Image (PRAFAB) questionnaire, and the Pelvic floor muscles strength test (Manometric Assisted Biofeedback-MBF).</div></div><div><h3>Findings</h3><div>Following 6 weeks and 3 months of interventions, there was a statistically significant difference in the two groups concerning pelvic floor muscle strength. Regarding the degree of urinary incontinence, a statistically significant difference was found between the two study groups after 6 weeks and 3 months following the intervention, with p-values of 0.048 and 0.024, respectively. In favor of the control group, where most participants (75 %) had mild urinary incontinence compared to only 50 % of the intervention group.</div></div><div><h3>Conclusion</h3><div>The study found that pelvic floor exercises improved strength and reduced incontinence, with active birth ball training yielding better outcomes and lower recurrence than passive biofeedback.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114908"},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145826987","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 : 2025-12-22DOI: 10.1016/j.ejogrb.2025.114905
Sara Cortés-Amador , Amanda Vidal-Chaparro , David Hernández-Guillén , Fernando Domínguez-Navarro , Laura Fuentes-Aparicio
Purpose
Gender reassignment surgery is the surgical option for many transgender populations. However, there is little information about the gender reassignment process, especially the role that pelvic floor physiotherapy has in this process. The purpose of this study was to analyze the knowledge that the participants had about the gender reassignment process, about the experience of those who had gone through it, and about the knowledge they had about the role of pelvic floor physiotherapy in this process.
Methods
This was a cross-sectional study. A self-developed online survey b was developed consisting of 3 sociodemographic questions and 23 questions on participants’ knowledge and perception of pelvic floor physical therapy and the reassignment surgery process.
Results
Of the 35 participants aged 19–52 in the study, 22 identified as female, and 13 as male. Only 37.1 % were aware of the post-surgery role of pelvic floor physiotherapists. Additionally, 25.7 % considered consulting a physiotherapist, and 22.8 % had contemplated doing so. Just 11.4 % of those who had surgery sought pelvic floor physiotherapy. Common post-surgery issues included urethral stenosis, vaginal elasticity problems, and difficulty reaching orgasm, aligning with previous research. Notably, individuals receiving physiotherapy reported greater improvement in post-surgery sequelae.
Conclusion
Gender reassignment is a complex process that affects all aspects of the person and requires greater humanization of health professionals. Physiotherapy has shown significant barriers in terms of accessibility and knowledge of the benefits that physiotherapy can bring to this population. It is important to include in the curricula of different health professions the implications of a sex reassignment process to offer adequate support to the needs of the population.
{"title":"An overview of the transgender population’s knowledge of the role of physical therapy during the transitioning process: a cross-sectional survey study","authors":"Sara Cortés-Amador , Amanda Vidal-Chaparro , David Hernández-Guillén , Fernando Domínguez-Navarro , Laura Fuentes-Aparicio","doi":"10.1016/j.ejogrb.2025.114905","DOIUrl":"10.1016/j.ejogrb.2025.114905","url":null,"abstract":"<div><h3>Purpose</h3><div>Gender reassignment surgery is the surgical option for many transgender populations. However, there is little information about the gender reassignment process, especially the role that pelvic floor physiotherapy has in this process. The purpose of this study was to analyze the knowledge that the participants had about the gender reassignment process, about the experience of those who had gone through it, and about the knowledge they had about the role of pelvic floor physiotherapy in this process.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study. A self-developed online survey b was developed consisting of 3 sociodemographic questions and 23 questions on participants’ knowledge and perception of pelvic floor physical therapy and the reassignment surgery process.</div></div><div><h3>Results</h3><div>Of the 35 participants aged 19–52 in the study, 22 identified as female, and 13 as male. Only 37.1 % were aware of the post-surgery role of pelvic floor physiotherapists. Additionally, 25.7 % considered consulting a physiotherapist, and 22.8 % had contemplated doing so. Just 11.4 % of those who had surgery sought pelvic floor physiotherapy. Common post-surgery issues included urethral stenosis, vaginal elasticity problems, and difficulty reaching orgasm, aligning with previous research. Notably, individuals receiving physiotherapy reported greater improvement in post-surgery sequelae.</div></div><div><h3>Conclusion</h3><div>Gender reassignment is a complex process that affects all aspects of the person and requires greater humanization of health professionals. Physiotherapy has shown significant barriers in terms of accessibility and knowledge of the benefits that physiotherapy can bring to this population. It is important to include in the curricula of different health professions the implications of a sex reassignment process to offer adequate support to the needs of the population.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114905"},"PeriodicalIF":1.9,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827000","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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