Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/OGX.0000000000001483
Laura Vilar Planella, Ignacio Rodriguez Garcia, Silvia Franco Camps, Pere N Barri-Soldevila, Silvia Cabrera Diaz
<p><p>A potential major complication of total endoscopic hysterectomy is vaginal cuff dehiscence (VCD), which is defined as partial or complete separation of the vaginal cuff edges after hysterectomy. Delayed diagnosis and treatment of VCD can lead to severe adverse outcomes such as bowel perforation, peritonitis, and sepsis; VCD incidence is higher for laparoscopic hysterectomy compared with abdominal or vaginal hysterectomy, and previous literature has estimated the risk of VCD at 0.64% to 4.93% for laparoscopic, 0.12% for abdominal, and 0.29% for vaginal methods. Vaginal cuff closure (VCC) can be performed with various methods, and preferences surrounding the performance of VCC vary based on provider and institution; VCC has been shown to decrease rates of VCD in laparoscopic hysterectomy. Vaginal cuff suture type can influence the duration of surgery and strength of sutures, which can both affect the risk of VCD. This study was designed to assess evidence surrounding barbed sutures compared with conventional sutures for VCC. This was a systematic review and meta-analysis, with databases searched including PubMed-MEDLINE and Embase between 2004 and 2024. The inclusion criteria for studies were peer-reviewed comparative studies focusing on the comparison of barbed to conventional sutures for VCC in patients undergoing total laparoscopic or robot-assisted hysterectomy. The exclusion criteria were abstract-only articles, editorials, commentaries, review articles without original data, single-arm studies, case studies, and case reports. The primary outcome of this study was VCD, with secondary outcomes of operative time, suture time, blood loss, total postoperative complications, surgical site infection, and development of granulation tissue. Publication bias was assessed with funnel plots and the Risk Of Bias in Nonrandomized Studies of Interventions for observational studies and the Risk of Bias 2 tool for randomized controlled trials. The final analysis included 24 studies, with 6 randomized controlled trials, 4 prospective cohort studies, 13 retrospective cohort studies, and 1 case-control study. VCD was investigated as a primary outcome in all the included studies. Among 1891 patients in 19 studies who had barbed sutures, VCD was observed in 13; out of 1746 patients across the same studies who had conventional sutures, 23 were diagnosed with VCD. This difference was not significant. No significant differences were detected in VCD incidence between laparoscopic and robotic approaches. For secondary outcomes, using barbed sutures resulted in a decreased operative time in both laparoscopic (8.58-min reduction) and robot-assisted hysterectomies (37.82-min reduction), although the results for laparoscopic surgery showed significant heterogeneity. Similarly, barbed sutures were found to significantly reduce suture time compared with conventional sutures for laparoscopic hysterectomy (a reduction of 4.90 min) but not for robot-assisted hysterectomie
{"title":"Optimizing Vaginal Cuff Closure: A Systematic Review and Meta-Analysis of Barbed Versus Conventional Sutures in Total Laparoscopic and Robot-Assisted Hysterectomies.","authors":"Laura Vilar Planella, Ignacio Rodriguez Garcia, Silvia Franco Camps, Pere N Barri-Soldevila, Silvia Cabrera Diaz","doi":"10.1097/OGX.0000000000001483","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001483","url":null,"abstract":"<p><p>A potential major complication of total endoscopic hysterectomy is vaginal cuff dehiscence (VCD), which is defined as partial or complete separation of the vaginal cuff edges after hysterectomy. Delayed diagnosis and treatment of VCD can lead to severe adverse outcomes such as bowel perforation, peritonitis, and sepsis; VCD incidence is higher for laparoscopic hysterectomy compared with abdominal or vaginal hysterectomy, and previous literature has estimated the risk of VCD at 0.64% to 4.93% for laparoscopic, 0.12% for abdominal, and 0.29% for vaginal methods. Vaginal cuff closure (VCC) can be performed with various methods, and preferences surrounding the performance of VCC vary based on provider and institution; VCC has been shown to decrease rates of VCD in laparoscopic hysterectomy. Vaginal cuff suture type can influence the duration of surgery and strength of sutures, which can both affect the risk of VCD. This study was designed to assess evidence surrounding barbed sutures compared with conventional sutures for VCC. This was a systematic review and meta-analysis, with databases searched including PubMed-MEDLINE and Embase between 2004 and 2024. The inclusion criteria for studies were peer-reviewed comparative studies focusing on the comparison of barbed to conventional sutures for VCC in patients undergoing total laparoscopic or robot-assisted hysterectomy. The exclusion criteria were abstract-only articles, editorials, commentaries, review articles without original data, single-arm studies, case studies, and case reports. The primary outcome of this study was VCD, with secondary outcomes of operative time, suture time, blood loss, total postoperative complications, surgical site infection, and development of granulation tissue. Publication bias was assessed with funnel plots and the Risk Of Bias in Nonrandomized Studies of Interventions for observational studies and the Risk of Bias 2 tool for randomized controlled trials. The final analysis included 24 studies, with 6 randomized controlled trials, 4 prospective cohort studies, 13 retrospective cohort studies, and 1 case-control study. VCD was investigated as a primary outcome in all the included studies. Among 1891 patients in 19 studies who had barbed sutures, VCD was observed in 13; out of 1746 patients across the same studies who had conventional sutures, 23 were diagnosed with VCD. This difference was not significant. No significant differences were detected in VCD incidence between laparoscopic and robotic approaches. For secondary outcomes, using barbed sutures resulted in a decreased operative time in both laparoscopic (8.58-min reduction) and robot-assisted hysterectomies (37.82-min reduction), although the results for laparoscopic surgery showed significant heterogeneity. Similarly, barbed sutures were found to significantly reduce suture time compared with conventional sutures for laparoscopic hysterectomy (a reduction of 4.90 min) but not for robot-assisted hysterectomie","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"16-18"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/01.ogx.0001179568.95475.5a
Ty Erickson, Edward Gheiler, Craig E Hanson, Rebecca McCrery, Mitesh Parekh, Mohamad Parva, Le Mai Tu
<p><p>The estimated prevalence of urinary incontinence (UI) in females varies widely, from 15% to 69%, and is additionally presumed to be underreported because of under-evaluation as well as stigma associated with it. Stress urinary incontinence (SUI) is reported to affect between 50% and 80% of cases of UI. Significant impacts on quality of life (QoL) in both personal and social aspects are common in SUI, and previous research has shown high rates of anxiety and depression. Current treatments for SUI include management of symptoms as well as surgical management, including midurethral sling (MUS) and single incision sling (SIS) procedures. This study was designed to compare the safety and effectiveness of the Altis SIS with other full-length slings for the treatment of SUI. An additional goal of this study was to compare QoL before and after surgery over the course of 36 months. This was a secondary analysis of data from the Altis 522 study, which was a prospective, multicenter, nonrandomized, noninferiority cohort study. The primary outcomes of the initial study were patient-reported success as measured by 24-hour pad weight reduction and serious adverse events at 6 months and through 36 months. QoL was measured at 6, 12, 18, 24, and 36 months. The inclusion and exclusion criteria have been previously reported. The final analysis included 355 patients recruited between January 2015 and May 2018. At 36-month follow-up, assessment was performed for 140 patients with the Altis SIS and 101 patients with full-length slings in the control group. The patients who received Altis SIS were older and more likely to be postmenopausal compared with controls. The control group had a higher body mass index, reported more current smoking, and had higher baseline urinary distress scores, as well as a larger proportion of individuals with mixed urinary incontinence. The Urogenital Distress Inventory (UDI-6) showed no significant differences between the Altis SIS and control groups at 36-month follow-up, with both groups showing significant improvement. The Incontinence Impact Questionnaire (IIQ-7) also showed no significant difference between groups at 36-month follow-up, with similarly improved scores in both groups. The same was true of the Patient Global Impression of Improvement (PGI-I) and the Surgical Satisfaction Questionnaire (SSQ-8). These results indicate that the Altis SIS performed very similarly to controls with full-length slings for treatment of SUI, even at long-term follow-up. Both groups demonstrated meaningful improvement in QoL, and each questionnaire showed improvement. This is consistent with previous literature assessing improvement in QoL over objective cure rate. There is some potential for patient satisfaction to be affected by adverse events, and this was the case in a small number of patients in this study. Future research should focus on ways to reduce the occurrence of adverse events as well as assessing the impact of SIS on other re
{"title":"Patient Satisfaction and QoL in SUI: Results With Single-incision or Full-length Slings.","authors":"Ty Erickson, Edward Gheiler, Craig E Hanson, Rebecca McCrery, Mitesh Parekh, Mohamad Parva, Le Mai Tu","doi":"10.1097/01.ogx.0001179568.95475.5a","DOIUrl":"10.1097/01.ogx.0001179568.95475.5a","url":null,"abstract":"<p><p>The estimated prevalence of urinary incontinence (UI) in females varies widely, from 15% to 69%, and is additionally presumed to be underreported because of under-evaluation as well as stigma associated with it. Stress urinary incontinence (SUI) is reported to affect between 50% and 80% of cases of UI. Significant impacts on quality of life (QoL) in both personal and social aspects are common in SUI, and previous research has shown high rates of anxiety and depression. Current treatments for SUI include management of symptoms as well as surgical management, including midurethral sling (MUS) and single incision sling (SIS) procedures. This study was designed to compare the safety and effectiveness of the Altis SIS with other full-length slings for the treatment of SUI. An additional goal of this study was to compare QoL before and after surgery over the course of 36 months. This was a secondary analysis of data from the Altis 522 study, which was a prospective, multicenter, nonrandomized, noninferiority cohort study. The primary outcomes of the initial study were patient-reported success as measured by 24-hour pad weight reduction and serious adverse events at 6 months and through 36 months. QoL was measured at 6, 12, 18, 24, and 36 months. The inclusion and exclusion criteria have been previously reported. The final analysis included 355 patients recruited between January 2015 and May 2018. At 36-month follow-up, assessment was performed for 140 patients with the Altis SIS and 101 patients with full-length slings in the control group. The patients who received Altis SIS were older and more likely to be postmenopausal compared with controls. The control group had a higher body mass index, reported more current smoking, and had higher baseline urinary distress scores, as well as a larger proportion of individuals with mixed urinary incontinence. The Urogenital Distress Inventory (UDI-6) showed no significant differences between the Altis SIS and control groups at 36-month follow-up, with both groups showing significant improvement. The Incontinence Impact Questionnaire (IIQ-7) also showed no significant difference between groups at 36-month follow-up, with similarly improved scores in both groups. The same was true of the Patient Global Impression of Improvement (PGI-I) and the Surgical Satisfaction Questionnaire (SSQ-8). These results indicate that the Altis SIS performed very similarly to controls with full-length slings for treatment of SUI, even at long-term follow-up. Both groups demonstrated meaningful improvement in QoL, and each questionnaire showed improvement. This is consistent with previous literature assessing improvement in QoL over objective cure rate. There is some potential for patient satisfaction to be affected by adverse events, and this was the case in a small number of patients in this study. Future research should focus on ways to reduce the occurrence of adverse events as well as assessing the impact of SIS on other re","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"21"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/OGX.0000000000001484
Noa S De Smit, Maria E de Lange, Martijn F Boomsma, Judith A F Huirnet, Wouter J K Hehenkamp
<p><p>Leiomyomas, or uterine fibroids, are benign tumors of the smooth muscle of the uterus with origins in the myometrium. Many women experience uterine fibroids, with an estimated prevalence ranging from 20% to 80%. Symptomatic fibroids can have a profound effect on quality of life and typically include symptoms such as heavy menstrual bleeding, pelvic pain, lower back pain, abdominal bloating, urinary symptoms, sexual dysfunction, fertility issues, and anxiety and depression resulting from physical symptoms. Treatment options have become more advanced in recent years, and this article is a review designed to assess evidence and raise awareness surrounding novel, minimally invasive or medicinal alternative treatments to hysterectomy or abdominal myomectomy. The goal of this article was to provide clinical guidance and contribute knowledge to personalized care and decision-making for patients while also identifying gaps in current literature. Current treatments for symptomatic fibroids included in this review are uterine artery embolization, magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU), laparoscopic radio-frequency ablation, transcervical radiofrequency ablation, ulipristal acetate intermittent treatment (four 12-week treatment regimens) and oral gonadotropin-releasing hormone receptor antagonists with add-back therapy. Uterine artery embolization includes blocking the blood supply to uterine fibroids and thus providing relief from symptoms as the fibroids shrink due to lack of blood flow. This is an inpatient hospital procedure done under local anesthesia with epidural or spinal anesthesia or intravenous pain medication postprocedure. Common side effects of this procedure include pain, nausea, groin hematoma, and fever, but most resolve within 24 to 72 hours. Studies comparing the effectiveness of uterine artery embolization and hysterectomy have shown that quality of life improvement is similar between the two, but hysterectomy is better in terms of controlling abnormal uterine bleeding. Comparisons to myomectomy have shown conflicting evidence in terms of quality of life improvement, with some showing myomectomy as superior and others showing uterine artery embolization as superior. There is little evidence surrounding fertility outcomes for uterine artery embolization, including pregnancy. MR-HIFU is a technique of thermal ablation that induces necrosis in uterine fibroids through a high-intensity ultrasound beam under MRI guidance. This is a noninvasive method with few side effects. Current treatments allow for 100% ablation of fibroids, and the procedure typically takes place over a 1-day admission to the hospital. There has been only 1 randomized controlled trial comparing MR-HIFU with a placebo, and an additional 3 have compared it to the standard of care. No study reported its effect on menstrual bleeding, but all reported improvement in quality of life at 12 weeks postintervention. Compared with placebo, howeve
{"title":"Current Treatment for Symptomatic Uterine Fibroids: Available Evidence and Therapeutic Dilemmas.","authors":"Noa S De Smit, Maria E de Lange, Martijn F Boomsma, Judith A F Huirnet, Wouter J K Hehenkamp","doi":"10.1097/OGX.0000000000001484","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001484","url":null,"abstract":"<p><p>Leiomyomas, or uterine fibroids, are benign tumors of the smooth muscle of the uterus with origins in the myometrium. Many women experience uterine fibroids, with an estimated prevalence ranging from 20% to 80%. Symptomatic fibroids can have a profound effect on quality of life and typically include symptoms such as heavy menstrual bleeding, pelvic pain, lower back pain, abdominal bloating, urinary symptoms, sexual dysfunction, fertility issues, and anxiety and depression resulting from physical symptoms. Treatment options have become more advanced in recent years, and this article is a review designed to assess evidence and raise awareness surrounding novel, minimally invasive or medicinal alternative treatments to hysterectomy or abdominal myomectomy. The goal of this article was to provide clinical guidance and contribute knowledge to personalized care and decision-making for patients while also identifying gaps in current literature. Current treatments for symptomatic fibroids included in this review are uterine artery embolization, magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU), laparoscopic radio-frequency ablation, transcervical radiofrequency ablation, ulipristal acetate intermittent treatment (four 12-week treatment regimens) and oral gonadotropin-releasing hormone receptor antagonists with add-back therapy. Uterine artery embolization includes blocking the blood supply to uterine fibroids and thus providing relief from symptoms as the fibroids shrink due to lack of blood flow. This is an inpatient hospital procedure done under local anesthesia with epidural or spinal anesthesia or intravenous pain medication postprocedure. Common side effects of this procedure include pain, nausea, groin hematoma, and fever, but most resolve within 24 to 72 hours. Studies comparing the effectiveness of uterine artery embolization and hysterectomy have shown that quality of life improvement is similar between the two, but hysterectomy is better in terms of controlling abnormal uterine bleeding. Comparisons to myomectomy have shown conflicting evidence in terms of quality of life improvement, with some showing myomectomy as superior and others showing uterine artery embolization as superior. There is little evidence surrounding fertility outcomes for uterine artery embolization, including pregnancy. MR-HIFU is a technique of thermal ablation that induces necrosis in uterine fibroids through a high-intensity ultrasound beam under MRI guidance. This is a noninvasive method with few side effects. Current treatments allow for 100% ablation of fibroids, and the procedure typically takes place over a 1-day admission to the hospital. There has been only 1 randomized controlled trial comparing MR-HIFU with a placebo, and an additional 3 have compared it to the standard of care. No study reported its effect on menstrual bleeding, but all reported improvement in quality of life at 12 weeks postintervention. Compared with placebo, howeve","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"15-16"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/01.ogx.0001179560.22096.dc
Giulia Bonanni, Maria C Lopez-Giron, Lisa Allen, Karin Fox, Robert M Silver, Sebastian R Hobson, Albaro J Nieto-Calvache, Sally Collins, Miroslaw Wielgos, Eric Jauniaux, Helena C Bartels, Loïc Sentilhes, John Kingdom, Frederic Chantraine, Joseph R Wax, Alison Cahill, Alfred Abuhamad, Diogo Ayres de-Campos, Kjersti Aagaard, Amir A Shamshirsaz, Scott A Shainker, Alireza A Shamshirsaz
<p><p>Placenta accreta spectrum (PAS) is an obstetrical complication in which the placenta abnormally invades the uterine wall, increasing the risk of hemorrhage, surgical morbidity, and maternal mortality. Management is often complex and multidisciplinary, particularly when invasion extends beyond the uterus. For this reason, standardized guidelines are essential to support early diagnosis and coordinated care across specialties. Significant variations in clinical practice guidelines (CPGs) remain, especially between countries with differing levels of income. This systematic review evaluates national and international CPGs published within the last decade to identify areas of agreement, disagreement, and insufficient evidence across all stages of PAS care. To identify CPGs related to PAS, a comprehensive search of professional society websites, PubMed, the GIN Library, and the ECRI Guidelines Trust was conducted. Two independent reviewers evaluated the sources to extract relevant clinical recommendations, which were then sent to a panel of 15 to 18 experts who had authored their own PAS guidelines. During 2 rounds of structured feedback, the panel could comment on, clarify, or revise their own guidelines before the committee would evaluate them for consensus and sufficiency of evidence. Each guideline was categorized as demonstrating high agreement, poor consensus, or high levels of insufficient evidence. The data were visualized by quantifying the level of agreement and sorting each guideline into categories of epidemiology, diagnosis, antenatal management, surgical management, and postnatal care. A total of 18 articles from 14 national or international societies were included. There was high agreement on epidemiologic risk factors, diagnostic principles, and key elements of antenatal management. A history of cesarean delivery consistently emerged as a major risk factor, especially in patients with concurrent placenta previa. All guidelines supported ultrasound as the primary diagnostic tool, with most recommending standardized descriptors to enhance accuracy. Targeted second-trimester imaging was widely endorsed, with some guidelines supporting first-trimester screening for high-risk patients. There was also strong consensus surrounding antenatal management and the need for specialized care, emphasizing referral to tertiary centers with multidisciplinary expertise, adequate surgical and transfusion resources, and planned delivery around 34 to 35 weeks. In contrast, surgical and peripartum recommendations showed substantial variability and limited evidence, including uncertainty regarding optimal incision type, use of balloon occlusion catheters, anesthesia approaches, and conservative management strategies. Only 1 guideline offered specific recommendations for low- and middle-income countries. These findings indicate that while some aspects of PAS management, such as diagnosis and antenatal care, have a broad consensus, other areas remain unde
{"title":"Guidelines on Placenta Accreta Spectrum Disorders: A Systematic Review.","authors":"Giulia Bonanni, Maria C Lopez-Giron, Lisa Allen, Karin Fox, Robert M Silver, Sebastian R Hobson, Albaro J Nieto-Calvache, Sally Collins, Miroslaw Wielgos, Eric Jauniaux, Helena C Bartels, Loïc Sentilhes, John Kingdom, Frederic Chantraine, Joseph R Wax, Alison Cahill, Alfred Abuhamad, Diogo Ayres de-Campos, Kjersti Aagaard, Amir A Shamshirsaz, Scott A Shainker, Alireza A Shamshirsaz","doi":"10.1097/01.ogx.0001179560.22096.dc","DOIUrl":"https://doi.org/10.1097/01.ogx.0001179560.22096.dc","url":null,"abstract":"<p><p>Placenta accreta spectrum (PAS) is an obstetrical complication in which the placenta abnormally invades the uterine wall, increasing the risk of hemorrhage, surgical morbidity, and maternal mortality. Management is often complex and multidisciplinary, particularly when invasion extends beyond the uterus. For this reason, standardized guidelines are essential to support early diagnosis and coordinated care across specialties. Significant variations in clinical practice guidelines (CPGs) remain, especially between countries with differing levels of income. This systematic review evaluates national and international CPGs published within the last decade to identify areas of agreement, disagreement, and insufficient evidence across all stages of PAS care. To identify CPGs related to PAS, a comprehensive search of professional society websites, PubMed, the GIN Library, and the ECRI Guidelines Trust was conducted. Two independent reviewers evaluated the sources to extract relevant clinical recommendations, which were then sent to a panel of 15 to 18 experts who had authored their own PAS guidelines. During 2 rounds of structured feedback, the panel could comment on, clarify, or revise their own guidelines before the committee would evaluate them for consensus and sufficiency of evidence. Each guideline was categorized as demonstrating high agreement, poor consensus, or high levels of insufficient evidence. The data were visualized by quantifying the level of agreement and sorting each guideline into categories of epidemiology, diagnosis, antenatal management, surgical management, and postnatal care. A total of 18 articles from 14 national or international societies were included. There was high agreement on epidemiologic risk factors, diagnostic principles, and key elements of antenatal management. A history of cesarean delivery consistently emerged as a major risk factor, especially in patients with concurrent placenta previa. All guidelines supported ultrasound as the primary diagnostic tool, with most recommending standardized descriptors to enhance accuracy. Targeted second-trimester imaging was widely endorsed, with some guidelines supporting first-trimester screening for high-risk patients. There was also strong consensus surrounding antenatal management and the need for specialized care, emphasizing referral to tertiary centers with multidisciplinary expertise, adequate surgical and transfusion resources, and planned delivery around 34 to 35 weeks. In contrast, surgical and peripartum recommendations showed substantial variability and limited evidence, including uncertainty regarding optimal incision type, use of balloon occlusion catheters, anesthesia approaches, and conservative management strategies. Only 1 guideline offered specific recommendations for low- and middle-income countries. These findings indicate that while some aspects of PAS management, such as diagnosis and antenatal care, have a broad consensus, other areas remain unde","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"10-12"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/01.ogx.0001179572.33885.08
Frédéric Amant, François Planchamp, Paul Berveiller, Elyce Cardonick, Anne De Middelaer, Robert Fruscio, Monica Fumagalli, Anna L V Johansson, Matteo Lambertini, Charlotte L LeJeune, Christianne Lok, W Glenn McCluggage, Philip Poortmans, Jacek Sienko, Cristel S Hjortshøj, Marta Swierczynska, Antonia Carla Testa, Indra A Van Assche, Kristel Van Calsteren, Vandecaveye Vincent, Carolien Versteeg, Flora Zagouri, Zapardiel, Michael J Halaska
<p><p>Gynecological cancer requiring management during pregnancy is rare, with an estimated incidence of 2 to 5 per 100,000 pregnancies in the first trimester. Balancing maternal and fetal health in these cases can be difficult, and management strategies differ from nonpregnancy cases. Management strategies are typically determined by maximizing benefit to the mother while minimizing harm to the fetus, considering the extent of the cancer, available treatment options for each type of cancer, and the gestational age of the fetus. This article is a guideline presenting the highest standard of evidence for the management of these cases, although the authors recognize that following these recommendations is not always possible in all areas of the world. These guidelines address imaging, pathology, surgery, medical oncology, obstetrics, radiation therapy, psychology, patient perspective, and pediatric follow-up for ovarian, cervical, and vulvar cancers during pregnancy. The guidelines in this article were developed using the European Society of Gynecological Oncology (ESGO) via the ESGO Guideline Committee. This consists of a multidisciplinary international development group that uses scientific evidence and expert consensus, as well as an external international review process. A systematic review was performed as part of the creation of these guidelines, including relevant studies published between January 2014 and June 2024. In cases where evidence was unclear, professional experience and expertise were used to fill the gap. General guidelines included discussing treatment with a multidisciplinary team, patient and partner counseling being a priority (including diagnostic and treatment plans, potential alternatives, risks and benefits, and side effects), workup and treatment being conducted at a specialized center, patients receiving care as close as possible to nonpregnant patients, taking into account individual modifications as necessary, prioritizing research with these cases, and registration of all cancer cases during pregnancy. The incidence of cancer during pregnancy is not decreasing, and thus, practitioners should be aware of these possible complications of pregnancy. Recommendations include investigating symptoms of cancer immediately and thoroughly, as well as preserving the pregnancy because pregnancy does not worsen the prognosis of gynecological cancers. Imaging guidelines include ultrasound examination for diagnosis, with the reassurance of its safety during pregnancy, magnetic resonance imaging (MRI) for inconclusive ultrasound examination, referral to an experienced radiologist, repeated ultrasound examination for management planning, using ultrasound to evaluate patient response to neoadjuvant chemotherapy, and avoiding the use of gadolinium-based contrast agents, using diffusion-weighted MRI instead. In addition, the use of a lead apron for shielding is not recommended. The recommendations surrounding pathology include recording
{"title":"ESGO/INCIP Guidelines for the Management of Patients With Gynecological Cancers During Pregnancy.","authors":"Frédéric Amant, François Planchamp, Paul Berveiller, Elyce Cardonick, Anne De Middelaer, Robert Fruscio, Monica Fumagalli, Anna L V Johansson, Matteo Lambertini, Charlotte L LeJeune, Christianne Lok, W Glenn McCluggage, Philip Poortmans, Jacek Sienko, Cristel S Hjortshøj, Marta Swierczynska, Antonia Carla Testa, Indra A Van Assche, Kristel Van Calsteren, Vandecaveye Vincent, Carolien Versteeg, Flora Zagouri, Zapardiel, Michael J Halaska","doi":"10.1097/01.ogx.0001179572.33885.08","DOIUrl":"10.1097/01.ogx.0001179572.33885.08","url":null,"abstract":"<p><p>Gynecological cancer requiring management during pregnancy is rare, with an estimated incidence of 2 to 5 per 100,000 pregnancies in the first trimester. Balancing maternal and fetal health in these cases can be difficult, and management strategies differ from nonpregnancy cases. Management strategies are typically determined by maximizing benefit to the mother while minimizing harm to the fetus, considering the extent of the cancer, available treatment options for each type of cancer, and the gestational age of the fetus. This article is a guideline presenting the highest standard of evidence for the management of these cases, although the authors recognize that following these recommendations is not always possible in all areas of the world. These guidelines address imaging, pathology, surgery, medical oncology, obstetrics, radiation therapy, psychology, patient perspective, and pediatric follow-up for ovarian, cervical, and vulvar cancers during pregnancy. The guidelines in this article were developed using the European Society of Gynecological Oncology (ESGO) via the ESGO Guideline Committee. This consists of a multidisciplinary international development group that uses scientific evidence and expert consensus, as well as an external international review process. A systematic review was performed as part of the creation of these guidelines, including relevant studies published between January 2014 and June 2024. In cases where evidence was unclear, professional experience and expertise were used to fill the gap. General guidelines included discussing treatment with a multidisciplinary team, patient and partner counseling being a priority (including diagnostic and treatment plans, potential alternatives, risks and benefits, and side effects), workup and treatment being conducted at a specialized center, patients receiving care as close as possible to nonpregnant patients, taking into account individual modifications as necessary, prioritizing research with these cases, and registration of all cancer cases during pregnancy. The incidence of cancer during pregnancy is not decreasing, and thus, practitioners should be aware of these possible complications of pregnancy. Recommendations include investigating symptoms of cancer immediately and thoroughly, as well as preserving the pregnancy because pregnancy does not worsen the prognosis of gynecological cancers. Imaging guidelines include ultrasound examination for diagnosis, with the reassurance of its safety during pregnancy, magnetic resonance imaging (MRI) for inconclusive ultrasound examination, referral to an experienced radiologist, repeated ultrasound examination for management planning, using ultrasound to evaluate patient response to neoadjuvant chemotherapy, and avoiding the use of gadolinium-based contrast agents, using diffusion-weighted MRI instead. In addition, the use of a lead apron for shielding is not recommended. The recommendations surrounding pathology include recording ","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"22-23"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/OGX.0000000000001486
Barbara Arbeithuber, Kate Anthony, Bonnie Higgins, Peter Oppelt, Omar Shebl, Irene Tiemann-Boege, Francesca Chiaromonte, Thomas Ebner, Kateryna D Makova
<p><p>Mitochondrial dysfunction can cause a multitude of systemic diseases, and thus, the origin of such dysfunction is of great interest to many clinicians and researchers. Part of mitochondrial dysfunction can be explained by mutations in mitochondrial DNA (mtDNA), which can be measured both in somatic and germline cells. As the average maternal age continues to increase, determining if mutations in mtDNA increase with age is an important aspect of reproductive health care. This study was designed to assess the frequency of de novo mutations in mtDNA in oocytes based on age, compared with the frequency of mutations in somatic cells. This study used high-quality, full-length mtDNA sequences for 22 individuals between the ages of 20 and 42, obtaining samples from blood, saliva, and oocytes. Duplex sequencing was used to identify variants in mtDNA; median mtDNA enrichment was 85.4%, 0.7%, and 4.0% and a median duplex consensus sequence (DCS) depth of 1440X, 78X, and 158X for oocytes, blood, and saliva, respectively. There were 3525 high-confidence variants identified across all samples. Across age groups and geographic regions, there were significantly fewer mutations in oocytes compared with blood and saliva. When predicting the probability of a mutation in mtDNA as a function of age, there were significant increases in mutation frequency in blood and saliva, but not in oocytes (P<0.001, P<0.001, P=0.688, respectively). Comparing different age groups, mutation frequency was higher in blood and saliva in older women compared with younger women, but there was no significant difference in oocyte mutation frequency. Within oocyte mtDNA, mutations were more frequent in the D-loop than in the "coding region" for each age group, consistent with previous literature. This remained true in several different analyses of regions of mtDNA, though no significant differences were found related to age. A total of 109 de novo mutations were located at confirmed disease-associated sites, with 32 variants in 29 positions. Lower proportions of disease-related mutations were present in oocytes compared with blood or saliva, suggesting preferential selection for oocytes against mutations. Hotspots for variants were identified in each type of cell, showing 58 sites overlapping between cell types; 40 of these were in the D-loop, 4 in rRNA, 4 in tRNA, and 10 in protein-coding regions. This supports the previous finding of high mutation frequency in the D-loop for oocytes. These results indicate that there is no increase in mutation frequency in oocytes as women age, though there was an increase in mutation frequency in both blood and saliva. This contrasts with previous literature in animal models that showed either continuous increases in mutation frequency with age or increases up to a certain age after which there was a plateau. The age group of this study was limited to 20-42, meaning that there could be an increase in mutation frequency that occurs either before or
{"title":"Allele Frequency Selection and No Age-Related Increase in Human Oocyte Mitochondrial Mutations.","authors":"Barbara Arbeithuber, Kate Anthony, Bonnie Higgins, Peter Oppelt, Omar Shebl, Irene Tiemann-Boege, Francesca Chiaromonte, Thomas Ebner, Kateryna D Makova","doi":"10.1097/OGX.0000000000001486","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001486","url":null,"abstract":"<p><p>Mitochondrial dysfunction can cause a multitude of systemic diseases, and thus, the origin of such dysfunction is of great interest to many clinicians and researchers. Part of mitochondrial dysfunction can be explained by mutations in mitochondrial DNA (mtDNA), which can be measured both in somatic and germline cells. As the average maternal age continues to increase, determining if mutations in mtDNA increase with age is an important aspect of reproductive health care. This study was designed to assess the frequency of de novo mutations in mtDNA in oocytes based on age, compared with the frequency of mutations in somatic cells. This study used high-quality, full-length mtDNA sequences for 22 individuals between the ages of 20 and 42, obtaining samples from blood, saliva, and oocytes. Duplex sequencing was used to identify variants in mtDNA; median mtDNA enrichment was 85.4%, 0.7%, and 4.0% and a median duplex consensus sequence (DCS) depth of 1440X, 78X, and 158X for oocytes, blood, and saliva, respectively. There were 3525 high-confidence variants identified across all samples. Across age groups and geographic regions, there were significantly fewer mutations in oocytes compared with blood and saliva. When predicting the probability of a mutation in mtDNA as a function of age, there were significant increases in mutation frequency in blood and saliva, but not in oocytes (P<0.001, P<0.001, P=0.688, respectively). Comparing different age groups, mutation frequency was higher in blood and saliva in older women compared with younger women, but there was no significant difference in oocyte mutation frequency. Within oocyte mtDNA, mutations were more frequent in the D-loop than in the \"coding region\" for each age group, consistent with previous literature. This remained true in several different analyses of regions of mtDNA, though no significant differences were found related to age. A total of 109 de novo mutations were located at confirmed disease-associated sites, with 32 variants in 29 positions. Lower proportions of disease-related mutations were present in oocytes compared with blood or saliva, suggesting preferential selection for oocytes against mutations. Hotspots for variants were identified in each type of cell, showing 58 sites overlapping between cell types; 40 of these were in the D-loop, 4 in rRNA, 4 in tRNA, and 10 in protein-coding regions. This supports the previous finding of high mutation frequency in the D-loop for oocytes. These results indicate that there is no increase in mutation frequency in oocytes as women age, though there was an increase in mutation frequency in both blood and saliva. This contrasts with previous literature in animal models that showed either continuous increases in mutation frequency with age or increases up to a certain age after which there was a plateau. The age group of this study was limited to 20-42, meaning that there could be an increase in mutation frequency that occurs either before or ","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"25-26"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/01.ogx.0001179544.68677.5c
Sailesh Kumar, William Tarnow-Mordi, Ben W Mol, Vicki Flenady, Helen G Liley, Nadia Badawi, Susan Walker, Jonathan Hyett, Anna Seidler, Emily Callander, John Simes, Rachel L O'Connell
<p><p>Uterine contractions during labor reduce placental perfusion, which limits fetal oxygenation. Intrapartum fetal hypoxia and acidemia occur when there is insufficient reperfusion time between contractions or when placental dysfunction restricts oxygen transfer. The risks of hypoxic-ischemic injury during labor include intrapartum stillbirth, neonatal death, and neonatal encephalopathy. Emergency cesarean or instrumental deliveries are often required when fetal acidemia is suspected, though these interventions carry increased maternal and neonatal risk. Despite widespread use of electronic fetal heart rate monitoring to detect fetal compromise, rates of cerebral palsy, perinatal mortality, and other neonatal well-being measures have not improved. This highlights the need for more effective strategies to prevent adverse perinatal outcomes related to hypoxic injury. Phosphodiesterase type 5 inhibitors may be used to improve uteroplacental perfusion and enhance vasoconstriction in uterine and spinal arteries. Sildenafil citrate, a PDE5 inhibitor, has been used for indications related to placental dysfunction, to treat maternal hypertension, or both. A previous phase II randomized clinical trial (RCT) found that oral sildenafil reduced operative birth for fetal distress by 51% compared with placebo, but was underpowered to assess perinatal outcomes. The aim of this study was to assess whether oral sildenafil citrate during labor improves perinatal outcomes related to intrapartum hypoxia.The iSEARCH trial was a placebo-controlled, double-blind RCT conducted at 14 Australian hospitals from September 2021 to June 2024. Included were adult women with singleton or dichorionic twin pregnancies attempting vaginal birth at term, either by spontaneous labor or induction of labor. Excluded were those with monochorionic twins, triplets, higher-order multifetal gestation, or severe hepatic or kidney impairment. Also excluded were those taking nitrate-containing medications or other PDE inhibitors. Study participants were randomized 1:1 to receive 50 mg sildenafil citrate or a placebo every 8 hours for a maximum of 3 doses. The primary outcome was a composite of 10 intrapartum or neonatal events, including intrapartum stillbirth, 28-day neonatal death, Apgar score <4 at 5 minutes, acidosis at birth, hypoxic ischemic encephalopathy, neonatal seizure, neonatal respiratory support, admission to the neonatal unit, persistent pulmonary hypertension of the newborn, or meconium aspiration syndrome. Secondary outcomes included the 10 individual primary outcomes and emergency cesarean delivery or instrumental vaginal birth for fetal distress.A total of 3257 women were included in the analysis, with 1626 in the sildenafil citrate group and 1631 receiving placebos. The primary composite outcome occurred in 5.1% of women in the intervention group and 5.2% in the placebo group [relative risk (RR), 1.02; 95% CI, 0.75-1.37]. No cases of infant death occurred. The sildenafil
{"title":"Intrapartum Sildenafil to Improve Perinatal Outcomes: A Randomized Clinical Trial.","authors":"Sailesh Kumar, William Tarnow-Mordi, Ben W Mol, Vicki Flenady, Helen G Liley, Nadia Badawi, Susan Walker, Jonathan Hyett, Anna Seidler, Emily Callander, John Simes, Rachel L O'Connell","doi":"10.1097/01.ogx.0001179544.68677.5c","DOIUrl":"10.1097/01.ogx.0001179544.68677.5c","url":null,"abstract":"<p><p>Uterine contractions during labor reduce placental perfusion, which limits fetal oxygenation. Intrapartum fetal hypoxia and acidemia occur when there is insufficient reperfusion time between contractions or when placental dysfunction restricts oxygen transfer. The risks of hypoxic-ischemic injury during labor include intrapartum stillbirth, neonatal death, and neonatal encephalopathy. Emergency cesarean or instrumental deliveries are often required when fetal acidemia is suspected, though these interventions carry increased maternal and neonatal risk. Despite widespread use of electronic fetal heart rate monitoring to detect fetal compromise, rates of cerebral palsy, perinatal mortality, and other neonatal well-being measures have not improved. This highlights the need for more effective strategies to prevent adverse perinatal outcomes related to hypoxic injury. Phosphodiesterase type 5 inhibitors may be used to improve uteroplacental perfusion and enhance vasoconstriction in uterine and spinal arteries. Sildenafil citrate, a PDE5 inhibitor, has been used for indications related to placental dysfunction, to treat maternal hypertension, or both. A previous phase II randomized clinical trial (RCT) found that oral sildenafil reduced operative birth for fetal distress by 51% compared with placebo, but was underpowered to assess perinatal outcomes. The aim of this study was to assess whether oral sildenafil citrate during labor improves perinatal outcomes related to intrapartum hypoxia.The iSEARCH trial was a placebo-controlled, double-blind RCT conducted at 14 Australian hospitals from September 2021 to June 2024. Included were adult women with singleton or dichorionic twin pregnancies attempting vaginal birth at term, either by spontaneous labor or induction of labor. Excluded were those with monochorionic twins, triplets, higher-order multifetal gestation, or severe hepatic or kidney impairment. Also excluded were those taking nitrate-containing medications or other PDE inhibitors. Study participants were randomized 1:1 to receive 50 mg sildenafil citrate or a placebo every 8 hours for a maximum of 3 doses. The primary outcome was a composite of 10 intrapartum or neonatal events, including intrapartum stillbirth, 28-day neonatal death, Apgar score <4 at 5 minutes, acidosis at birth, hypoxic ischemic encephalopathy, neonatal seizure, neonatal respiratory support, admission to the neonatal unit, persistent pulmonary hypertension of the newborn, or meconium aspiration syndrome. Secondary outcomes included the 10 individual primary outcomes and emergency cesarean delivery or instrumental vaginal birth for fetal distress.A total of 3257 women were included in the analysis, with 1626 in the sildenafil citrate group and 1631 receiving placebos. The primary composite outcome occurred in 5.1% of women in the intervention group and 5.2% in the placebo group [relative risk (RR), 1.02; 95% CI, 0.75-1.37]. No cases of infant death occurred. The sildenafil","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"4-5"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011468","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}
<p><p>The average increase in the incidence of cervical cancer in China has been estimated at 7.3% annually over the last 20 years. The most common cause of cervical cancer is human papillomavirus (HPV) infection, and thus screening for HPV is a cornerstone of cervical cancer detection and prevention. Standard treatment for individuals with HPV includes colposcopy and biopsy, if indicated, but the accuracy of colposcopy for diagnosis is dependent on the physician; a goal of advances in this field is to enhance the diagnostic accuracy of colposcopy to prevent misdiagnosis. A potential solution to this problem is the use of artificial intelligence (AI), which has been shown to enhance the accuracy, efficiency, and accessibility of cervical cancer screening in previous studies. Using AI in colposcopy could reduce challenges related to population differences, but previous AI algorithms have focused only on small training sets, which are limited in their application. This study was designed to assess the applicability of AI colposcopy in cervical cancer screening, comparing conventional, AI, and AI-assisted colposcopy in premenopausal and postmenopausal women. This was a cross-sectional, multicenter observational study of patients in China who were recruited for cervical cancer screening between March 2023 and May 2024. The inclusion criteria were an anatomically intact cervix, understanding of the screening procedure, and written informed consent. The final analysis included 825 patients, with 583 also undergoing a biopsy. Median age was 53, and a total of 451 patients were postmenopausal. Of 825 women screened, 675 were positive for some form of HPV. Of these, 299 tested positive for HPV 16 or 18, the types most highly correlated with cervical cancer. Conventional colposcopy identified 392 positive test results, and AI colposcopy identified 640 positive test results. The agreement between the 2 methods was 53%. The sensitivity of conventional colposcopy was 85.9% (95% CI: 77.1%-91.8%) and the specificity was 57.7% (95% CI: 54%-61.3%). Sensitivity and specificity of AI colposcopy were 96% (95% CI: 89.4%-98.7%) and 24.9% (95% CI: 21.9%-28.3%). AI-assisted colposcopy had a sensitivity of 100% (95% CI: 95.3%-100%) and a specificity of 15.8% (95% CI: 13.3%-18.7%). Results were similar in postmenopausal women, with AI and AI-assisted colposcopy having significantly greater sensitivity compared with conventional colposcopy (P=0.026, P<0.001, respectively). Sensitivity and specificity varied slightly depending on menopausal status, type of HPV, and visibility of the squamocolumnar junction, but results were similar across groups, showing an improved result for AI and AI-assisted procedures. These results indicate that AI colposcopy has advantages compared with conventional colposcopy, including increased sensitivity. AI-assisted colposcopy showed significantly improved diagnostic utility compared with conventional methods, especially in cases where diagnosi
{"title":"Effectiveness of Artificial Intelligence-Assisted Colposcopy in a Resource-Limited Population.","authors":"Yining Chang, Tingyuan Li, Qiang Zhou, Dianju Kang, Lingling Zhu, Jingjing Yang, Qiongxiu Kou, Huijuan He, Yulin Zhou, Qiong Liao, Jingchang Du, Xiaoping Yu, Yuqian Zhao","doi":"10.1097/01.ogx.0001179576.36055.f0","DOIUrl":"10.1097/01.ogx.0001179576.36055.f0","url":null,"abstract":"<p><p>The average increase in the incidence of cervical cancer in China has been estimated at 7.3% annually over the last 20 years. The most common cause of cervical cancer is human papillomavirus (HPV) infection, and thus screening for HPV is a cornerstone of cervical cancer detection and prevention. Standard treatment for individuals with HPV includes colposcopy and biopsy, if indicated, but the accuracy of colposcopy for diagnosis is dependent on the physician; a goal of advances in this field is to enhance the diagnostic accuracy of colposcopy to prevent misdiagnosis. A potential solution to this problem is the use of artificial intelligence (AI), which has been shown to enhance the accuracy, efficiency, and accessibility of cervical cancer screening in previous studies. Using AI in colposcopy could reduce challenges related to population differences, but previous AI algorithms have focused only on small training sets, which are limited in their application. This study was designed to assess the applicability of AI colposcopy in cervical cancer screening, comparing conventional, AI, and AI-assisted colposcopy in premenopausal and postmenopausal women. This was a cross-sectional, multicenter observational study of patients in China who were recruited for cervical cancer screening between March 2023 and May 2024. The inclusion criteria were an anatomically intact cervix, understanding of the screening procedure, and written informed consent. The final analysis included 825 patients, with 583 also undergoing a biopsy. Median age was 53, and a total of 451 patients were postmenopausal. Of 825 women screened, 675 were positive for some form of HPV. Of these, 299 tested positive for HPV 16 or 18, the types most highly correlated with cervical cancer. Conventional colposcopy identified 392 positive test results, and AI colposcopy identified 640 positive test results. The agreement between the 2 methods was 53%. The sensitivity of conventional colposcopy was 85.9% (95% CI: 77.1%-91.8%) and the specificity was 57.7% (95% CI: 54%-61.3%). Sensitivity and specificity of AI colposcopy were 96% (95% CI: 89.4%-98.7%) and 24.9% (95% CI: 21.9%-28.3%). AI-assisted colposcopy had a sensitivity of 100% (95% CI: 95.3%-100%) and a specificity of 15.8% (95% CI: 13.3%-18.7%). Results were similar in postmenopausal women, with AI and AI-assisted colposcopy having significantly greater sensitivity compared with conventional colposcopy (P=0.026, P<0.001, respectively). Sensitivity and specificity varied slightly depending on menopausal status, type of HPV, and visibility of the squamocolumnar junction, but results were similar across groups, showing an improved result for AI and AI-assisted procedures. These results indicate that AI colposcopy has advantages compared with conventional colposcopy, including increased sensitivity. AI-assisted colposcopy showed significantly improved diagnostic utility compared with conventional methods, especially in cases where diagnosi","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"24-25"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/01.ogx.0001179552.76476.7c
Maria P Velez, Natalie Dayan, Simone N Vigod, William Buckett, Sydney Flatt, Jonas Shellenberger, Joel G Ray
<p><p>The number of births achieved through a gestational carrier has been increasing. Yet few studies have looked at the mental health outcomes for gestational carriers. Pregnancy increases vulnerability to mental illness, and population-based data suggest that gestational carriers have higher rates of severe maternal morbidity than women in traditional pregnancies. Current guidelines emphasize selecting gestational carriers with stable family supports and requiring psychological evaluation before pregnancy, as up to half of women with prior severe mental illness relapse during pregnancy or postpartum. Risk factors for gestational carriers include emotional separation from the newborn, relationships with intended parents, and societal scrutiny. The aim of this study was to assess the risk of new-onset mental illness among gestational carriers compared with women who conceived unassisted and those who conceived using in vitro fertilization (IVF). This was a population-based study of births >20 weeks of gestation in women between 18 and 50 years of age from 2012 through 2021 in a universal health care system in Ontario, Canada. Excluded were women with a history of an infertility diagnosis or prior mental illness, and a medical condition that would preclude them from selecting a gestational carrier. The primary outcome was new-onset mental illness, such as a mood disorder, anxiety disorder, psychosis, substance use disorder, self-harm event, or other mental illness, based on ≥2 outpatient visits or ≥1emergency department visit or hospital admission. A total of 767,406 pregnancies were included in the analysis. Of these, 97.6% were conceived unassisted, 2.3% conceived by IVF, and 0.1% used a gestational carrier. Gestational carriers were more likely to be parous [91.2% vs. 57.9% (unassisted conception) and 34.1% (IVF)] and live in lower-income areas [23.4% vs. 21.9% (unassisted) and 12.1% (IVF)]. They also have a higher rate of obesity [36.1% vs. 17% (unassisted) and 17.1% (IVF)] and chronic hypertension [3.2% vs. 1.6% (unassisted) and 2.9% (IVF)]. After a median (IQR) follow-up of 4.5 (2.3 to 7.2) years, new-onset mental illness occurred in 236 gestational carriers compared with 195,022 women who conceived unassisted [6.9 vs. 5.2 per 100 person-years; incidence rate ratios (IRRs), 1.43; 95% CI, 1.26 to 1.63) and with 4704 women receiving IVF (6.9 vs. 5.0 per 100 person-years; adjusted IRR, 1.29; 95% CI, 1.13 to 1.47). The median (IQR) time from the estimated date of conception to a diagnosis of mental illness was 2.39 (1.11 to 4.19) years for gestational carriers versus 2.29 (1.02 to 4.34) years for those who conceived unassisted and 2.72 (1.11 to 4.82) years for those who used IVF. In conclusion, gestational carriers are more likely to be diagnosed with mental illness than women who conceive unassisted or use IVF. This study highlights the importance of enhanced mental health screening and support for gestational carriers.(Abstracted from: JAMA N
{"title":"New-Onset Mental Illness Among Gestational Carriers.","authors":"Maria P Velez, Natalie Dayan, Simone N Vigod, William Buckett, Sydney Flatt, Jonas Shellenberger, Joel G Ray","doi":"10.1097/01.ogx.0001179552.76476.7c","DOIUrl":"https://doi.org/10.1097/01.ogx.0001179552.76476.7c","url":null,"abstract":"<p><p>The number of births achieved through a gestational carrier has been increasing. Yet few studies have looked at the mental health outcomes for gestational carriers. Pregnancy increases vulnerability to mental illness, and population-based data suggest that gestational carriers have higher rates of severe maternal morbidity than women in traditional pregnancies. Current guidelines emphasize selecting gestational carriers with stable family supports and requiring psychological evaluation before pregnancy, as up to half of women with prior severe mental illness relapse during pregnancy or postpartum. Risk factors for gestational carriers include emotional separation from the newborn, relationships with intended parents, and societal scrutiny. The aim of this study was to assess the risk of new-onset mental illness among gestational carriers compared with women who conceived unassisted and those who conceived using in vitro fertilization (IVF). This was a population-based study of births >20 weeks of gestation in women between 18 and 50 years of age from 2012 through 2021 in a universal health care system in Ontario, Canada. Excluded were women with a history of an infertility diagnosis or prior mental illness, and a medical condition that would preclude them from selecting a gestational carrier. The primary outcome was new-onset mental illness, such as a mood disorder, anxiety disorder, psychosis, substance use disorder, self-harm event, or other mental illness, based on ≥2 outpatient visits or ≥1emergency department visit or hospital admission. A total of 767,406 pregnancies were included in the analysis. Of these, 97.6% were conceived unassisted, 2.3% conceived by IVF, and 0.1% used a gestational carrier. Gestational carriers were more likely to be parous [91.2% vs. 57.9% (unassisted conception) and 34.1% (IVF)] and live in lower-income areas [23.4% vs. 21.9% (unassisted) and 12.1% (IVF)]. They also have a higher rate of obesity [36.1% vs. 17% (unassisted) and 17.1% (IVF)] and chronic hypertension [3.2% vs. 1.6% (unassisted) and 2.9% (IVF)]. After a median (IQR) follow-up of 4.5 (2.3 to 7.2) years, new-onset mental illness occurred in 236 gestational carriers compared with 195,022 women who conceived unassisted [6.9 vs. 5.2 per 100 person-years; incidence rate ratios (IRRs), 1.43; 95% CI, 1.26 to 1.63) and with 4704 women receiving IVF (6.9 vs. 5.0 per 100 person-years; adjusted IRR, 1.29; 95% CI, 1.13 to 1.47). The median (IQR) time from the estimated date of conception to a diagnosis of mental illness was 2.39 (1.11 to 4.19) years for gestational carriers versus 2.29 (1.02 to 4.34) years for those who conceived unassisted and 2.72 (1.11 to 4.82) years for those who used IVF. In conclusion, gestational carriers are more likely to be diagnosed with mental illness than women who conceive unassisted or use IVF. This study highlights the importance of enhanced mental health screening and support for gestational carriers.(Abstracted from: JAMA N","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"7-8"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011483","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}
(Abstracted from Am J Obstet Gynecol 2025;233(3):152-161) One of the most commonly diagnosed female genital infections is vulvovaginal candidiasis (VVC), and data show that up to 75% of women have had VVC at least once. VVC is classified as uncomplicated or complicated; uncomplicated VVC occurs in approximately 90% of cases, and the first-line treatment for it is typically topical nystatin or topical or oral azole antifungal medications.
{"title":"Treatment of Uncomplicated Vulvovaginal Candidiasis: Topical or Oral Drugs? Single-Day or Multiple-Day Therapy? A Network Meta-analysis of Randomized Trials.","authors":"Barbara Gardella, Mattia Dominoni, Chiara Cassani, Marianna Francesca Pasquali, Arsenio Spinillo","doi":"10.1097/OGX.0000000000001470","DOIUrl":"10.1097/OGX.0000000000001470","url":null,"abstract":"<p><p>(Abstracted from Am J Obstet Gynecol 2025;233(3):152-161) One of the most commonly diagnosed female genital infections is vulvovaginal candidiasis (VVC), and data show that up to 75% of women have had VVC at least once. VVC is classified as uncomplicated or complicated; uncomplicated VVC occurs in approximately 90% of cases, and the first-line treatment for it is typically topical nystatin or topical or oral azole antifungal medications.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"80 12","pages":"755-756"},"PeriodicalIF":3.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145857551","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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