Journal of gynecology obstetrics and human reproduction最新文献

{"title":"Nine-step standard operating procedure for uterine preservation in placenta accreta spectrum: 7-year experience in a Chinese tertiary hospital","authors":"Zhixia Wei ,&nbsp;Li Feng ,&nbsp;Xiaomin Yang ,&nbsp;Hailan Yang","doi":"10.1016/j.jogoh.2025.103032","DOIUrl":"10.1016/j.jogoh.2025.103032","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate risk factors for adverse outcomes in the placenta accreta spectrum (PAS) and assess the efficacy of a nine-step uterus-sparing cesarean section protocol compared with traditional approaches.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 137 women with PAS who underwent cesarean delivery between 2016 and 2022. Participants were stratified into nine-step surgery (<em>n</em> = 26) and conventional surgery (<em>n</em> = 111) groups. The allocation of patients in each group was based on surgeon experience and surgical team’s intraoperative judgment. The protocol integrates placental mapping, transient uterine ischemia, delayed vascular control, and multilayer reconstruction. Machine learning (SMOTE-enhanced Random Forest) was used to identify the predictors of hemorrhage and hysterectomy.</div></div><div><h3>Results</h3><div>The nine-step surgery group reduced the hysterectomy rate to 1.9 % vs. 9.0 % in the control group (<em>P</em> &lt; 0.001), with fewer severe complications (hemorrhagic shock: 3.8 % vs. 12.6 %; DIC: 1.9 % vs. 8.1 %). Multivariate logistic regression analysis confirmed that nine-step surgery was independently related to a lower probability of hysterectomy (<em>P</em> = 0.050) (odds ratio: 0.107, 95 %CI: 0.011, 0.998). Gravidity (Gini=3.809) and pathological placental adhesion (PPA) were key hemorrhage predictors. The hysterectomy prediction model achieved exceptional discrimination (AUC=0.993), driven by intraoperative blood loss (Gini=16.068) and PPA severity. Experienced teams preserved 83.3 % of the uterus, compared to 63.0 % in the less-experienced group (<em>P</em> = 0.008).</div></div><div><h3>Conclusion</h3><div>The nine-step uterine preservation protocol significantly reduced the hysterectomy rate in the PAS through dynamic risk stratification and staged hemostasis. Integrated machine learning models enhance precision management, enabling fertility preservation while minimizing the risk of severe complications.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"55 1","pages":"Article 103032"},"PeriodicalIF":1.6,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064930","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":"Bullying and burnout in French obstetrics and gynecology residency programs: a national cross-sectional study","authors":"Chloé Gaillard ,&nbsp;Camille Durand ,&nbsp;Marie Allegrini ,&nbsp;Estelle Le Pabic ,&nbsp;Estelle Michinov ,&nbsp;Ludivine Dion ,&nbsp;Vincent Lavoué ,&nbsp;Jean Levêque ,&nbsp;Linda Lassel ,&nbsp;Maela Le Lous ,&nbsp;Krystel Nyangoh Timoh","doi":"10.1016/j.jogoh.2025.103034","DOIUrl":"10.1016/j.jogoh.2025.103034","url":null,"abstract":"<div><h3>Introduction</h3><div>Prior research has demonstrated high burnout rates during medical residency, namely among obstetrics and gynecology (Ob-Gyn) specialists. Concurrently, reports of workplace bullying, particularly in surgical wards, have risen. However, no studies have evaluated these aspects among French Ob-Gyn residents. This study assessed the prevalence and impact of workplace bullying on Ob-Gyn residents, the relationship between bullying and burnout, and the risk and protective factors influencing burnout.</div></div><div><h3>Methods</h3><div>A national, observational, cross-sectional study was conducted involving 37 French Ob-Gyn residency programs during the 2021–2022 academic year. Data were collected via an anonymous online survey using instruments such as the Maslach Burnout Inventory, Negative Acts Questionnaire-Revised (NAQ-R), and Hospital Anxiety and Depression Scale. Sociodemographic data, working conditions, sources/locations of bullying, and incidence of suicidal ideation were also collected. Multivariable logistic regression was used to analyze associations.</div></div><div><h3>Results</h3><div>Of 625 respondents, 52.4% reported bullying as measured by the NAQ-R. Burnout was present in 18.4%, with notable rates of professional exhaustion (24.3%), depersonalization (34.9%), and diminished personal accomplishment (25.1%). A significative correlation between workplace bullying and burnout was found. Strong social support from superiors emerged as protective against burnout, whereas frequent exposure to bullying, excessive working hours, and high stress levels were identified as major risk factors.</div></div><div><h3>Conclusion</h3><div>Our study reveals that 52.5% of responding residents reported experiencing workplace bullying, and 18.4% met the criteria for burnout. While these findings are concerning and warrant attention, they reflect the experiences of residents who chose to participate in the survey, and may therefore overrepresent those most affected. Nevertheless, the significant association observed between bullying and burnout highlights the need for institutional strategies to better support residents' well-being and ensure a safe, respectful working environment in obstetrics and gynecology residency programs.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 9","pages":"Article 103034"},"PeriodicalIF":1.6,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069605","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":"Long hours, limited rest: a national snapshot of ObGyn resident work conditions in France and paths to reform","authors":"Charline Bertholdt ,&nbsp;Nadia Magroune ,&nbsp;Anne-Laure Fijean ,&nbsp;Mikaël Agopiantz ,&nbsp;Kévin Guillez ,&nbsp;Matthieu Dap ,&nbsp;Olivier Morel","doi":"10.1016/j.jogoh.2025.103033","DOIUrl":"10.1016/j.jogoh.2025.103033","url":null,"abstract":"<div><h3>Objectives</h3><div>The main aim was to describe the weekly working time of French ObGyn residents. As secondary objectives, we aimed to evaluate the respect of training time and day off for safety and finally, to describe proposed adjustments to respect maximal weekly working time.</div></div><div><h3>Methods</h3><div>This national descriptive survey was addressed among ObGyn residents in 2024. The primary outcome was the average weekly working time declared by all residents. For the secondary outcomes, we assessed the mean number of weekday and weekend on-call, the rate of applicability of day off after on-call, the rate of presence of training days and the description of modalities proposed regarding additional day off to respect working time.</div></div><div><h3>Results</h3><div>413 responses were obtained with 92.8 % of universities represented. The mean weekly working time was 63 h with a daily time range of 10.5 h. In total, 98.1 % of residents worked &gt;48 h by week. In 25 % of cases, residents assumed professional activity after on-call. 57.1 % of French universities offered adjustments to reduce weekly working time consisting of an additional day off for on-call during Friday, Saturday or Sunday.</div></div><div><h3>Conclusion</h3><div>The weekly working time is insufficiently controlled in French ObGyn residents but there are very promising suggestions for improvement.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 10","pages":"Article 103033"},"PeriodicalIF":1.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064962","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":"Comparison of obstetric outcomes between single and double embryo transfers among singleton live births from vitrified donor oocyte IVF cycles: a cohort study","authors":"Robert B. Hood ,&nbsp;Heather S. Hipp ,&nbsp;Zsolt P. Nagy ,&nbsp;Jessica B. Spencer ,&nbsp;Daniel B. Shapiro ,&nbsp;Audrey J. Gaskins","doi":"10.1016/j.jogoh.2025.103020","DOIUrl":"10.1016/j.jogoh.2025.103020","url":null,"abstract":"<div><h3>Research objective</h3><div>Among singleton live births resulting from donor oocyte cycles, do perinatal outcomes differ between single (SET) and double embryo transfers (DET)?</div></div><div><h3>Methods</h3><div>We utilized a retrospective cohort of 610 recipients who had a singleton livebirth following nonidentified vitrified donor oocyte IVF cycle from a fertility clinic in the southeast US, 2008–2016. Perinatal outcomes included gestational age and birth weight. Preterm birth was defined as &lt;37 weeks and low birth weight was defined as &lt;2500 grams. Cluster weighted generalized estimating equations were used to calculate effect estimates adjusted for year, embryo stage, prior donor transfers, recipient and donor age, recipient and donor body mass index, and infertility diagnosis.</div></div><div><h3>Results</h3><div>Among the 698 singleton live births, 482 (69 %) were the result of a SET while 216 (31 %) were the result of a DET. Women who had two embryos transferred, as compared with one, did not have a statistically significant difference in gestational age (adjusted mean difference [AMD]:0.23 weeks, 95 % confidence interval [CI]:0.63, 0.17) or birth weight (AMD:27.9 grams, 95 % CI:137.7, 81.9). Similar, non-significant results were observed when evaluating risk of preterm birth and low birthweight.</div></div><div><h3>Conclusion</h3><div>We did not observe an adverse impact of DET on gestational age or birthweight compared to SET in singleton live births from donor cycles. While reassuring, clinicians should continue to use SET in donor oocyte recipients to reduce the adverse impact of multiple pregnancy and all the associated adverse birth outcomes.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 9","pages":"Article 103020"},"PeriodicalIF":1.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015542","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":"Maternal glycaemic responses to antenatal glucocorticoids: a scoping review","authors":"Annabel S Jones ,&nbsp;I-Lynn Lee ,&nbsp;Devaang Kevat ,&nbsp;Joanne M Said ,&nbsp;Klea Atallah ,&nbsp;Tilda Fletcher ,&nbsp;Christopher J Yates","doi":"10.1016/j.jogoh.2025.103029","DOIUrl":"10.1016/j.jogoh.2025.103029","url":null,"abstract":"<div><h3>Background</h3><div>Antenatal glucocorticoids are associated with significant transient hyperglycaemia in women with diabetes, however, the glycaemic effects of antenatal glucocorticoids for women without diabetes and their neonates are unknown.</div></div><div><h3>Objectives</h3><div>To investigate the maternal glycaemic effects of antenatal glucocorticoids administered for fetal lung maturation in women without diabetes, as well as the association between maternal glycaemia and neonatal hypoglycaemia.</div></div><div><h3>Study design</h3><div>A systematic search was performed in May 2025 using the Ovid Medline and Embase data bases to identify relevant studies reporting glycaemic outcomes for women without diabetes receiving antenatal glucocorticoids. The key outcome of interest was maternal glycaemic patterns; secondary outcomes included the prevalence of neonatal hypoglycaemia as well as factors that may predict maternal hyperglycaemia.</div></div><div><h3>Results</h3><div>There were 14 studies that met the inclusion criteria, comprising 12 cohort studies and 2 randomised controlled trials. All studies unanimously reported maternal hyperglycaemia following the administration of either betamethasone or dexamethasone in women without diabetes, with a prevalence of 54-95 %. While three studies utilised insulin to manage maternal hyperglycaemia, dosages varied significantly, and the impact of treatment on maternal and neonatal outcomes remains unclear.</div></div><div><h3>Conclusions</h3><div>Maternal hyperglycaemia is highly prevalent following antenatal glucocorticoids in women without diabetes; however, it is currently unclear whether this is associated with adverse outcomes including neonatal hypoglycaemia. There is currently insufficient data to support monitoring or management of hyperglycaemia in patients without diabetes receiving antenatal glucocorticoids, however, given the extent and duration of hyperglycaemia documented, large multi-centre trials are required to inform clinical practice.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 10","pages":"Article 103029"},"PeriodicalIF":1.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040340","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":"Impact of serum progesterone level on the day of embryo transfer on live birth rate after single frozen-thawed blastocyst transfer in hormone replacement therapy cycles","authors":"Audrey Pérennec ,&nbsp;Thomas Goronflot ,&nbsp;Florence Leperlier ,&nbsp;Thomas Fréour ,&nbsp;Maxime Chaillot","doi":"10.1016/j.jogoh.2025.103024","DOIUrl":"10.1016/j.jogoh.2025.103024","url":null,"abstract":"<div><h3>Purpose</h3><div>As the number of frozen-thawed embryo tryansfer cycles with Hormonal Replacement Therapy increases, the issue of the optimal progesterone level to ensure maximal success rates becomes critical. In this study, we aimed to determine the respective relevance of the 3 recently reported progesterone thresholds using an original statistical method.</div></div><div><h3>Methods</h3><div>This single-center retrospective study was conducted in a University-based Hospital in France in all consecutive single frozen thawed blastocyst transfers (SFBT) performed with HRT protocol in 2021. Progesterone levels were measured on the morning of the transfer. Patients were divided into deciles based on their progesterone levels on the day of SFBT, and outcomes were calculated for each decile. Multivariate logistic regression models were constructed to measure the association of these thresholds with clinical pregnancy rate and live birth rate (LBR), adjusting for demographic and clinical factors.</div></div><div><h3>Results</h3><div>A total of 256 cycles were included in the analysis. Clinical pregnancy rate was 30.1%, and live birth rate (LBR) was 29.3%. An inverted U curve was observed for the Positive Predictive Value of a LB, as it increases up to a peak around 11 ng/ml (optimal interval 10.5-12 ng/ml), before decreasing for high serum progesterone levels (&gt;13 ng/ml).</div></div><div><h3>Conclusions</h3><div>Our study, aligned with recent literature, identified a positive relationship between progesterone levels on the day of SFBT in HRT and the positive predictive value of a live birth, the \"ideal window\" of progesterone on the day of FET being 10.5-12 ng/mL.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 9","pages":"Article 103024"},"PeriodicalIF":1.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015569","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":"Activity and access of surgical abortion in metropolitan France","authors":"Aubert Agostini ,&nbsp;Vanessa Pauly ,&nbsp;Veronica Orléans ,&nbsp;Fanny Romain ,&nbsp;Bach Tran ,&nbsp;Dong Keon Yon ,&nbsp;Masoud Rahmati ,&nbsp;Julie Berbis ,&nbsp;Pascal Auquier ,&nbsp;Laurent Boyer","doi":"10.1016/j.jogoh.2025.103023","DOIUrl":"10.1016/j.jogoh.2025.103023","url":null,"abstract":"<div><h3>Objective</h3><div>To report the territorial distribution and characteristics of healthcare centres performing surgical abortion in France, along with the accessibility of these centres.</div></div><div><h3>Material and Methods</h3><div>A nationwide population-based cohort study of all women hospitalized for surgical abortion was conducted from January 1 to December 31, 2022 in metropolitan France. Number, location, activity volume and use of local anaesthesia rate of surgical abortion centres were reported as distribution activity across metropolitan France. Correlation between socioeconomic status neighbourhood and surgical abortion centre was evaluated.</div></div><div><h3>Results</h3><div>There were 52,292 surgical abortion hospital stays among 51,507 women in 497 centres in 2022. Majority of them were performed in public sector (46,979/52,292 (89.8 %)). More than half of surgical abortion centres perform a maximum of 50 IVTP/year (277/497 (55.7 %)). There was an Inequality in the distribution of surgical abortion across centres with 49 (10 %) centres performing 50 % of surgical abortion. Only 10,141(19.4 %) surgical abortion were performed under local anaesthesia and more frequently in centres with high activity.</div><div>Women residing in the most deprived areas had longer average travel distances (mean: 21.82 ± 25.98 Km) and times (mean:19,87±19,2 min) to reach surgical abortion centre.</div></div><div><h3>Conclusion</h3><div>activity of surgical abortion is unequally distributer in metropolitan France. There are significant regional variations and unequal access depending on place of residence. Access to surgical abortion centre is more difficult for populations with low socioeconomic status. It is important that health system managers take into account this inequality, which concerns populations where abortion is more frequent.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 9","pages":"Article 103023"},"PeriodicalIF":1.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008244","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":"Retraction notice to “The value of ultrasound guidance during IUD insertion in women with RVF uterus: A randomized controlled trial” [J Gynecol Obstet Hum Reprod 50 (2025) 101875]","authors":"Ahmed M. Maged,&nbsp;Adel M. Nada,&nbsp;Hala Abdelwahab,&nbsp;Emad Salah,&nbsp;Mahmoud Soliman,&nbsp;Eman A. Hussein,&nbsp;Aimy Essam,&nbsp;Hala Nabil","doi":"10.1016/j.jogoh.2025.103016","DOIUrl":"10.1016/j.jogoh.2025.103016","url":null,"abstract":"","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 9","pages":"Article 103016"},"PeriodicalIF":1.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932957","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":"Retraction notice to “Comparison of the four malignancy risk indices in the discrimination of malignant ovarian masses: A cross-sectional study” [J Gynecol Obstet Hum Reprod 50 (2025) 101986]","authors":"Mustafa N. Ali,&nbsp;Dina Habib,&nbsp;Ahmed I. Hassanien,&nbsp;Ahmed M. Abbas","doi":"10.1016/j.jogoh.2025.103021","DOIUrl":"10.1016/j.jogoh.2025.103021","url":null,"abstract":"","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 9","pages":"Article 103021"},"PeriodicalIF":1.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932956","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":"Predictors for the efficacy of methotrexate and mifepristone treatment in ectopic pregnancy","authors":"Chaoying Feng","doi":"10.1016/j.jogoh.2025.103022","DOIUrl":"10.1016/j.jogoh.2025.103022","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the efficacy of methotrexate (MTX) alone versus MTX plus mifepristone for stable ectopic pregnancy, identify predictors of treatment success, and explore outcome-prediction models.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, two‑arm observational cohort of consecutive patients with stable ectopic pregnancy treated in routine care (MTX‑only <em>n</em> = 138; MTX+mifepristone <em>n</em> = 132). Treatment assignment was non‑randomized, reflecting clinician judgment and patient preference. Baseline characteristics and treatment details were recorded, and the primary outcome—resolution of the EP without surgery—was assessed. Predictive factors were analyzed via logistic regression with Hosmer–Lemeshow testing for calibration. We further evaluated advanced machine learning models to classify treatment success.</div></div><div><h3>Results</h3><div>Overall treatment success rates were 73.91% (MTX-only) and 78.79% (MTX plus mifepristone), with no statistically significant difference between groups (<em>p</em> = 0.38). Across the combined cohort, factors strongly predicting success included initial hCG &lt;1500 mIU/mL (adjusted OR 2.70, <em>p</em> = 0.01), absence of fetal cardiac activity (adjusted OR 2.10, <em>p</em> = 0.04), lower gestational age at diagnosis (adjusted OR 0.82 per week, <em>p</em> = 0.02), and <em>a</em> ≥ 15% hCG decline by Day 4 (adjusted OR 2.40, <em>p</em> = 0.02). By location, success rates were similar in tubal and non‑tubal strata. The treatment × location interaction was not significant (<em>p</em> = 0.85), and tubal‑only results were unchanged. The multivariable logistic regression predicting treatment success vs failure showed good discrimination (AUC 0.82) and adequate calibration (Hosmer–Lemeshow <em>p</em> = 0.45). In exploratory benchmarking of algorithms trained to predict success vs failure on the same predictors, gradient boosting yielded the highest apparent discrimination (accuracy 84%; AUC 0.88) in this dataset.</div></div><div><h3>Conclusions</h3><div>MTX plus mifepristone did not significantly outperform MTX alone in resolving stable ectopic pregnancy. Key predictors of successful medical management included lower baseline hCG levels, earlier gestational age, and substantial early hCG declines. Advanced machine learning approaches may improve predictive accuracy, supporting more individualized treatment selection for ectopic pregnancy.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"54 10","pages":"Article 103022"},"PeriodicalIF":1.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956768","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}