The absence of gestational age-specific reference intervals for serum N-acetyl-β-D-glucosaminidase (NAG) in pregnant women may lead to clinical misinterpretation. This study aimed to establish trimester-specific reference intervals for serum NAG in healthy pregnant women from Hainan, China, and to characterize its dynamic changes throughout gestation. In this cross-sectional study, 2416 healthy women with singleton pregnancies were stratified by gestational age into three groups: first trimester (1–12 +6 weeks; n = 1295), second trimester (13–27 +6 weeks; n = 670), and third trimester (28–40 weeks; n = 451). Serum NAG levels were measured, and trimester-specific reference intervals were established using the 2.5th to 97.5th percentiles. Serum NAG concentrations increased significantly with advancing gestation (P < 0.0001). The established reference intervals were 12.0–40.0 U/L for the first trimester, 16.0–63.2 U/L for the second trimester, and 29.3–107.0 U/L for the third trimester—all substantially higher than those of the non-pregnant control group (8.0–23.4 U/L). The median NAG level in the third trimester (56.2 U/L) represented a 143 % increase compared to the first trimester (22.5 U/L). This study provides the first gestational age-specific reference intervals for serum NAG in pregnant women in a tropical region of China. The findings confirm that physiological NAG levels increase progressively with gestational age. The use of non-pregnant reference intervals in clinical practice may lead to misclassification of renal function during pregnancy, underscoring the necessity of adopting trimester-specific reference standards in prenatal laboratory settings.
{"title":"Trimester-specific reference intervals for serum N-acetyl-β-D-glucosaminidase in healthy pregnant women in Hainan, China","authors":"Fen Zhou, Yichuan Wang, Ying Zheng, Desheng Wang, Meng Chang, Shichuan Wang","doi":"10.1016/j.eurox.2026.100444","DOIUrl":"10.1016/j.eurox.2026.100444","url":null,"abstract":"<div><div>The absence of gestational age-specific reference intervals for serum N-acetyl-β-<span>D</span>-glucosaminidase (NAG) in pregnant women may lead to clinical misinterpretation. This study aimed to establish trimester-specific reference intervals for serum NAG in healthy pregnant women from Hainan, China, and to characterize its dynamic changes throughout gestation. In this cross-sectional study, 2416 healthy women with singleton pregnancies were stratified by gestational age into three groups: first trimester (1–12 +6 weeks; <em>n</em> = 1295), second trimester (13–27 +6 weeks; <em>n</em> = 670), and third trimester (28–40 weeks; <em>n</em> = 451). Serum NAG levels were measured, and trimester-specific reference intervals were established using the 2.5th to 97.5th percentiles. Serum NAG concentrations increased significantly with advancing gestation (<em>P</em> < 0.0001). The established reference intervals were 12.0–40.0 U/L for the first trimester, 16.0–63.2 U/L for the second trimester, and 29.3–107.0 U/L for the third trimester—all substantially higher than those of the non-pregnant control group (8.0–23.4 U/L). The median NAG level in the third trimester (56.2 U/L) represented a 143 % increase compared to the first trimester (22.5 U/L). This study provides the first gestational age-specific reference intervals for serum NAG in pregnant women in a tropical region of China. The findings confirm that physiological NAG levels increase progressively with gestational age. The use of non-pregnant reference intervals in clinical practice may lead to misclassification of renal function during pregnancy, underscoring the necessity of adopting trimester-specific reference standards in prenatal laboratory settings.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"29 ","pages":"Article 100444"},"PeriodicalIF":1.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transvaginal radiofrequency ablation (TVRFA) is a minimally invasive, incisionless, outpatient procedure. This study evaluates the feasibility, outcomes, and complications of TVRFA in women with symptomatic uterine myomas (UMs).
Methods
This preliminary single-center, retrospective study included 79 women treated with TVRFA between December 2021 and April 2024 in Quito, Ecuador. Women with 1–4 UMs of any size or type were eligible. Preoperative and follow-up assessments included transvaginal ultrasound (TVUS) for both uterine and myoma volume. Outcomes (uterine and myoma volume + complications) were assessed at 45 days and 6 months. Complications were classified by Clavien–Dindo. Statistical analyses used paired tests for baseline vs. follow-up comparisons, with missing data excluded from each analysis.
Results
The median baseline uterine volume was 160.0 mL. At 6 months, this decreased to 91.0 mL (−43.1 %, p < 0.001). The median baseline myoma volume was 22.5 mL, which decreased to 7.7 mL at 45 days (−55.1 %) and 3.7 mL at 6 months (−81.5 %, p < 0.001). Follow-up was completed by 68/79 patients (86.1 %) at 45 days and 59/79 (74.7 %) at 6 months. Minor complications occurred in 12.7 %, most commonly skin burns at the electrode site. Two patients (2.5 %) experienced intestinal perforation requiring surgery.
Conclusion
TVRFA significantly reduced both uterine and myoma volumes, supporting its role as a minimally invasive alternative for fibroid management. However, the observed complication rate, particularly intestinal perforation, requires critical attention to operator training and procedural refinements. Prospective studies with standardized symptom measures are warranted.
{"title":"Transvaginal radiofrequency ablation for uterine myomas: A preliminary ecuadorian study","authors":"Hernan Sabay , Maritza Freire , Belen Tite , Eduardo Pilatuna , Paola Solis- Pazmino","doi":"10.1016/j.eurox.2025.100443","DOIUrl":"10.1016/j.eurox.2025.100443","url":null,"abstract":"<div><h3>Background</h3><div>Transvaginal radiofrequency ablation (TVRFA) is a minimally invasive, incisionless, outpatient procedure. This study evaluates the feasibility, outcomes, and complications of TVRFA in women with symptomatic uterine myomas (UMs).</div></div><div><h3>Methods</h3><div>This preliminary single-center, retrospective study included 79 women treated with TVRFA between December 2021 and April 2024 in Quito, Ecuador. Women with 1–4 UMs of any size or type were eligible. Preoperative and follow-up assessments included transvaginal ultrasound (TVUS) for both uterine and myoma volume. Outcomes (uterine and myoma volume + complications) were assessed at 45 days and 6 months. Complications were classified by Clavien–Dindo. Statistical analyses used paired tests for baseline vs. follow-up comparisons, with missing data excluded from each analysis.</div></div><div><h3>Results</h3><div>The median baseline uterine volume was 160.0 mL. At 6 months, this decreased to 91.0 mL (−43.1 %, p < 0.001). The median baseline myoma volume was 22.5 mL, which decreased to 7.7 mL at 45 days (−55.1 %) and 3.7 mL at 6 months (−81.5 %, p < 0.001). Follow-up was completed by 68/79 patients (86.1 %) at 45 days and 59/79 (74.7 %) at 6 months. Minor complications occurred in 12.7 %, most commonly skin burns at the electrode site. Two patients (2.5 %) experienced intestinal perforation requiring surgery.</div></div><div><h3>Conclusion</h3><div>TVRFA significantly reduced both uterine and myoma volumes, supporting its role as a minimally invasive alternative for fibroid management. However, the observed complication rate, particularly intestinal perforation, requires critical attention to operator training and procedural refinements. Prospective studies with standardized symptom measures are warranted.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"29 ","pages":"Article 100443"},"PeriodicalIF":1.7,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Total abdominal hysterectomy is associated with moderate to severe postoperative pain, often requiring multimodal analgesic strategies. This meta-analysis compares the efficacy of ultrasound-guided quadratus lumborum block (QLB) versus transversus abdominis plane (TAP) block for pain control in this setting.
Methods
A systematic search was conducted in January 2025 across PubMed, Scopus, and Web of Science, restricted to English-language publications. Study selection and data extraction followed standard protocols and PRISMA guidelines, with screening performed in two phases and study quality rigorously assessed. Outcomes were synthesized using random-effects meta-analysis, and risk of bias was evaluated.
Results
Eight randomized controlled trials (RCTs), encompassing 623 patients, met eligibility criteria and were included in the analysis. QLB was associated with significantly lower postoperative pain scores compared to TAP at 12 h (Hedges’ g = −4.48; 95 % CI: −8.04 to −0.92; p = 0.01) and 24 h (Hedges’ g = −4.16; 95 % CI: −7.56 to −0.77; p = 0.02). No significant differences were observed in duration of analgesia (Hedges’ g = 0.64; p = 0.65) or surgery time (Hedges’ g = 0.02; p = 0.86). Notable, persistent heterogeneity was present across most outcomes. Subgroup and sensitivity analyses did not identify determinants for this variation, and publication bias assessment by trim-and-fill indicated robust primary findings. However, the review was limited by restriction to selected databases, exclusion of gray literature, and inclusion of English-language studies only.
Conclusion
Ultrasound-guided QLB may provide superior analgesia to TAP block following total abdominal hysterectomy. Nonetheless, substantial between-study heterogeneity and database/language restrictions limit the generalizability of these findings. Future large-scale, high-quality trials—incorporating standardized endpoints, broader database searching, non-English studies, and gray literature—are warranted to further clarify the optimal regional analgesic approach post-TAH.
目的腹式全子宫切除术伴有中度至重度术后疼痛，通常需要多模式镇痛策略。本荟萃分析比较了超声引导下腰方肌阻滞（QLB）与腹横平面阻滞（TAP）在这种情况下控制疼痛的疗效。方法于2025年1月对PubMed、Scopus和Web of Science进行系统检索，仅限于英文出版物。研究选择和数据提取遵循标准方案和PRISMA指南，分两个阶段进行筛选，并严格评估研究质量。使用随机效应荟萃分析综合结果，并评估偏倚风险。结果8项随机对照试验（rct）， 623例患者符合入选标准，纳入分析。与TAP相比，QLB在12 h （Hedges ' g = - 4.48; 95 % CI: - 8.04至- 0.92;p = 0.01）和24 h （Hedges ' g = - 4.16; 95 % CI: - 7.56至- 0.77;p = 0.02）与术后疼痛评分显著降低相关。镇痛时间（Hedges ' g = 0.64; p = 0.65）和手术时间（Hedges ' g = 0.02; p = 0.86）差异无统计学意义。值得注意的是，在大多数结果中存在持续的异质性。亚组分析和敏感性分析没有确定这种差异的决定因素，通过修正和填充进行的发表偏倚评估显示了强有力的初步发现。然而，由于限于选定的数据库、排除灰色文献和仅纳入英语研究，本综述存在局限性。结论超声引导下QLB对腹式全子宫切除术后TAP阻滞有较好的镇痛效果。然而，大量的研究间异质性和数据库/语言限制限制了这些发现的普遍性。未来有必要进行大规模、高质量的试验，包括标准化的终点、更广泛的数据库搜索、非英语研究和灰色文献，以进一步阐明tah后最佳的局部镇痛方法。
{"title":"Ultrasound-guided quadratus lumboum block versus transversus abdominis plane block for post-operative analgesia in patients undergoing total abdominal hysterectomy: A systematic review and meta-analysis","authors":"Hossein Jalilzadeh , Amirali Farshid , Mahla Esmaeili , Yasaman Tamaddon , Sanam Faizabadi , Neda Hashemi , Kimia Mohammadi , Arash Saberian , Soroush Yousefi , Elahe Ahsan , Rasoul Hossein Zadeh , Reza Hossein Zadeh , Mahdyieh Naziri , Niloofar Deravi","doi":"10.1016/j.eurox.2025.100441","DOIUrl":"10.1016/j.eurox.2025.100441","url":null,"abstract":"<div><h3>Purpose</h3><div>Total abdominal hysterectomy is associated with moderate to severe postoperative pain, often requiring multimodal analgesic strategies. This meta-analysis compares the efficacy of ultrasound-guided quadratus lumborum block (QLB) versus transversus abdominis plane (TAP) block for pain control in this setting.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in January 2025 across PubMed, Scopus, and Web of Science, restricted to English-language publications. Study selection and data extraction followed standard protocols and PRISMA guidelines, with screening performed in two phases and study quality rigorously assessed. Outcomes were synthesized using random-effects meta-analysis, and risk of bias was evaluated.</div></div><div><h3>Results</h3><div>Eight randomized controlled trials (RCTs), encompassing 623 patients, met eligibility criteria and were included in the analysis. QLB was associated with significantly lower postoperative pain scores compared to TAP at 12 h (Hedges’ g = −4.48; 95 % CI: −8.04 to −0.92; p = 0.01) and 24 h (Hedges’ g = −4.16; 95 % CI: −7.56 to −0.77; p = 0.02). No significant differences were observed in duration of analgesia (Hedges’ g = 0.64; p = 0.65) or surgery time (Hedges’ g = 0.02; p = 0.86). Notable, persistent heterogeneity was present across most outcomes. Subgroup and sensitivity analyses did not identify determinants for this variation, and publication bias assessment by trim-and-fill indicated robust primary findings. However, the review was limited by restriction to selected databases, exclusion of gray literature, and inclusion of English-language studies only.</div></div><div><h3>Conclusion</h3><div>Ultrasound-guided QLB may provide superior analgesia to TAP block following total abdominal hysterectomy. Nonetheless, substantial between-study heterogeneity and database/language restrictions limit the generalizability of these findings. Future large-scale, high-quality trials—incorporating standardized endpoints, broader database searching, non-English studies, and gray literature—are warranted to further clarify the optimal regional analgesic approach post-TAH.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"29 ","pages":"Article 100441"},"PeriodicalIF":1.7,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-30DOI: 10.1016/j.eurox.2025.100442
A. Santalla-Hernández, M. Naveiro-Fuentes, N. Esquinas-Orellana, LM Benítez-Cejas, M. García-Rivera, J. Fernández-Parra
Objective
To evaluate the real-world effectiveness, safety, and tolerability of relugolix/estradiol/norethisterone acetate combination therapy (relugolix CT) for managing symptomatic uterine fibroids in routine gynaecological practice.
Methods
A retrospective, observational study was conducted at a tertiary hospital in Spain between June 2023 and January 2025. Adult women with symptomatic uterine fibroids treated with relugolix CT were included, either as a long-term treatment or preoperative management. Clinical outcomes were assessed at baseline, 6 months, and in a subset of patients, at 12 months. Primary endpoints included changes in total bleeding days, heavy menstrual bleeding (HMB) days, and UFS-QoL symptom severity scores (SSS), as well as treatment adherence and adverse events.
Results
Among the 142 women who initiated treatment, Relugolix CT significantly reduced total bleeding days (from 12 to 2.2), HMB days (from 7.1 to 0.4), and UFS-QoL SSS (from 27.9 to 15.1) at 6 months (p < 0.05). Amenorrhea was achieved in 52.7 % at 6 months and 66 % at 12 months. Better clinical outcomes were linked to continued treatment. Adverse events were reported in 34.5 % of patients, primarily abdominal pain and vasomotor symptoms. Bone densitometry at 12 months showed no osteoporosis and mild osteopenia in a few patients. Discontinuation was most commonly due to planned surgery or perceived lack of efficacy.
Conclusion
Relugolix CT demonstrates strong real-world effectiveness and tolerability for managing symptomatic uterine fibroids, with marked improvements in bleeding and quality of life, and a favourable safety profile.
{"title":"Results of relugolix/estradiol/norethisterone acetate combination therapy in real-world clinical practice: Effectiveness, tolerability, and factors influencing discontinuation","authors":"A. Santalla-Hernández, M. Naveiro-Fuentes, N. Esquinas-Orellana, LM Benítez-Cejas, M. García-Rivera, J. Fernández-Parra","doi":"10.1016/j.eurox.2025.100442","DOIUrl":"10.1016/j.eurox.2025.100442","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the real-world effectiveness, safety, and tolerability of relugolix/estradiol/norethisterone acetate combination therapy (relugolix CT) for managing symptomatic uterine fibroids in routine gynaecological practice.</div></div><div><h3>Methods</h3><div>A retrospective, observational study was conducted at a tertiary hospital in Spain between June 2023 and January 2025. Adult women with symptomatic uterine fibroids treated with relugolix CT were included, either as a long-term treatment or preoperative management. Clinical outcomes were assessed at baseline, 6 months, and in a subset of patients, at 12 months. Primary endpoints included changes in total bleeding days, heavy menstrual bleeding (HMB) days, and UFS-QoL symptom severity scores (SSS), as well as treatment adherence and adverse events.</div></div><div><h3>Results</h3><div>Among the 142 women who initiated treatment, Relugolix CT significantly reduced total bleeding days (from 12 to 2.2), HMB days (from 7.1 to 0.4), and UFS-QoL SSS (from 27.9 to 15.1) at 6 months (p < 0.05). Amenorrhea was achieved in 52.7 % at 6 months and 66 % at 12 months. Better clinical outcomes were linked to continued treatment. Adverse events were reported in 34.5 % of patients, primarily abdominal pain and vasomotor symptoms. Bone densitometry at 12 months showed no osteoporosis and mild osteopenia in a few patients. Discontinuation was most commonly due to planned surgery or perceived lack of efficacy.</div></div><div><h3>Conclusion</h3><div>Relugolix CT demonstrates strong real-world effectiveness and tolerability for managing symptomatic uterine fibroids, with marked improvements in bleeding and quality of life, and a favourable safety profile.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"29 ","pages":"Article 100442"},"PeriodicalIF":1.7,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1016/j.eurox.2025.100440
Jillian Chan , Julia Cunningham , Colin Cunningham , John Cunningham , Catherine Cunningham
Objectives
This study will address the effects of testosterone pellet therapy in menopausal women treated over a ten-year period.
Study design
A retrospective review of a single gynecologic practice was performed to evaluate patients treated with subcutaneous testosterone pellet therapy for androgen deficiency. Consent was obtained from all patients before pellet placement. Women completed a menopause rating scale (MRS) questionnaire prior to starting therapy and before the third pellet placement. Patients were treated every 3 months. Blood work was obtained prior to treatment, before the third pellet insertion and then yearly. Non-parametric analysis was performed using the Wilcoxon signed-rank test and the Bonferroni test was used to correct for comparisons across multiple domains. A p value of less than 0.05 was considered significant.
Main outcome measures
Scores on the MRS were calculated as medians and compared from the initial MRS to the subsequent MRS questionnaire. Patient’s age and peak testosterone levels were used to evaluate the effect of therapy on menopausal symptoms. Side effects from therapy were noted at follow-up visits.
Results
There were 78 patients who completed both MRS questionnaires. A comparison of results from the initial and subsequent MRS questionnaire showed that median scores were significantly reduced in all eleven categories of symptoms. Scores improved in all categories of patient age and peak testosterone levels. The most common side effects were acne and facial hair. These were treated with dose reduction and or spironolactone therapy.
Conclusions
The use of testosterone pellet therapy in women with androgen deficiency results in rapid and sustained relief of menopausal symptoms in all age groups and at all testosterone levels. Further studies are needed to optimize the use of testosterone in women with menopausal symptoms.
{"title":"The benefits of testosterone therapy for menopausal symptoms","authors":"Jillian Chan , Julia Cunningham , Colin Cunningham , John Cunningham , Catherine Cunningham","doi":"10.1016/j.eurox.2025.100440","DOIUrl":"10.1016/j.eurox.2025.100440","url":null,"abstract":"<div><h3>Objectives</h3><div>This study will address the effects of testosterone pellet therapy in menopausal women treated over a ten-year period.</div></div><div><h3>Study design</h3><div>A retrospective review of a single gynecologic practice was performed to evaluate patients treated with subcutaneous testosterone pellet therapy for androgen deficiency. Consent was obtained from all patients before pellet placement. Women completed a menopause rating scale (MRS) questionnaire prior to starting therapy and before the third pellet placement. Patients were treated every 3 months. Blood work was obtained prior to treatment, before the third pellet insertion and then yearly. Non-parametric analysis was performed using the Wilcoxon signed-rank test and the Bonferroni test was used to correct for comparisons across multiple domains. A p value of less than 0.05 was considered significant.</div></div><div><h3>Main outcome measures</h3><div>Scores on the MRS were calculated as medians and compared from the initial MRS to the subsequent MRS questionnaire. Patient’s age and peak testosterone levels were used to evaluate the effect of therapy on menopausal symptoms. Side effects from therapy were noted at follow-up visits.</div></div><div><h3>Results</h3><div>There were 78 patients who completed both MRS questionnaires. A comparison of results from the initial and subsequent MRS questionnaire showed that median scores were significantly reduced in all eleven categories of symptoms. Scores improved in all categories of patient age and peak testosterone levels. The most common side effects were acne and facial hair. These were treated with dose reduction and or spironolactone therapy.</div></div><div><h3>Conclusions</h3><div>The use of testosterone pellet therapy in women with androgen deficiency results in rapid and sustained relief of menopausal symptoms in all age groups and at all testosterone levels. Further studies are needed to optimize the use of testosterone in women with menopausal symptoms.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"29 ","pages":"Article 100440"},"PeriodicalIF":1.7,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.eurox.2025.100436
TRONCHE Perrine, BOUIT Camille, AHO Serge, DOUVIER Serge, KADHEL Philippe
Introduction
According to current guidelines, women with CIN 2/3 should undergo a conization procedure. However, for young patients with small lesions, it is possible to consider therapeutic abstention with close monitoring while awaiting potential spontaneous regression. The objectives of this study were to evaluate the regression rate of CIN 2/3 lesions over 24 months of follow-up in women under the age of 35 and to identify predictive factors for spontaneous healing.
Methods
This was a retrospective observational study based on data from patients diagnosed with CIN 2 or CIN 3 who underwent close monitoring every 6 months via colposcopy, for a maximum follow-up period of 24 months between May 2008 and May 2024. The primary endpoint was the rate of spontaneous regression of high-grade lesions.
Results
104 patients, with a mean age of 27.8 years, were included. Cervical intraepithelial neoplasia spontaneously regressed in 37 patients (35.6 %, 95 % CI: 26.4 % – 45.5 %) after a median follow-up of 25.22 months. In multivariate analysis, patients with a lesion limited to a single quadrant were more likely to experience spontaneous healing (OR = 2.98 [1.21–7.34], p = 0.017). No other presumed predictive factors were found to significantly influence spontaneous regression. 2 patients had an in-situ cancer at conization, performed after surveillance and no cases of invasive cancer were described.
Conclusion
The results of the study are consistent with the literature and support the possibility of 24-month surveillance of patients with a high-grade lesion, especially given the low risk of progression to more severe disease within two years.
{"title":"Spontaneous regression rate of high-grade cervical lesions in women under 35 at Dijon University Hospital: Incidence and predictive factors","authors":"TRONCHE Perrine, BOUIT Camille, AHO Serge, DOUVIER Serge, KADHEL Philippe","doi":"10.1016/j.eurox.2025.100436","DOIUrl":"10.1016/j.eurox.2025.100436","url":null,"abstract":"<div><h3>Introduction</h3><div>According to current guidelines, women with CIN 2/3 should undergo a conization procedure. However, for young patients with small lesions, it is possible to consider therapeutic abstention with close monitoring while awaiting potential spontaneous regression. The objectives of this study were to evaluate the regression rate of CIN 2/3 lesions over 24 months of follow-up in women under the age of 35 and to identify predictive factors for spontaneous healing.</div></div><div><h3>Methods</h3><div>This was a retrospective observational study based on data from patients diagnosed with CIN 2 or CIN 3 who underwent close monitoring every 6 months via colposcopy, for a maximum follow-up period of 24 months between May 2008 and May 2024. The primary endpoint was the rate of spontaneous regression of high-grade lesions.</div></div><div><h3>Results</h3><div>104 patients, with a mean age of 27.8 years, were included. Cervical intraepithelial neoplasia spontaneously regressed in 37 patients (35.6 %, <em>95 % CI: 26.4 % – 45.5 %</em>) after a median follow-up of 25.22 months. In multivariate analysis, patients with a lesion limited to a single quadrant were more likely to experience spontaneous healing (<em>OR = 2.98 [1.21–7.34], p = 0.017</em>). No other presumed predictive factors were found to significantly influence spontaneous regression. 2 patients had an in-situ cancer at conization, performed after surveillance and no cases of invasive cancer were described.</div></div><div><h3>Conclusion</h3><div>The results of the study are consistent with the literature and support the possibility of 24-month surveillance of patients with a high-grade lesion, especially given the low risk of progression to more severe disease within two years.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"28 ","pages":"Article 100436"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recurrent implantation failure (RIF) is a clinical phenomenon characterized by a lack of implantation after several embryo-transfers. The aim of this study was to evaluate missing pelvic pathologies in patients with RIF, following at least two embryo-transfers of good-quality blastocyst, using a dedicated transvaginal ultrasound (TVS) performed by experienced specialists.
Methods
This retrospective study included patients with RIF who were admitted to the Gynecological Ultrasound Unit of the University of Rome 'Tor Vergata' between 2020 and 2024 for a second-opinion ultrasound. Only patients with transfers of euploid blastocysts and/or blastocysts from oocytes donation were included. All patients underwent 2D, 3D and Power-Doppler transvaginal examination to evaluate all possible pelvic pathologies.
Results
The study included 152 patients who met the inclusion criteria. Pathological pelvic findings were identified in 45 of 152 women during the initial TVS scans performed at the IVF centres before ET, whereas expert TVS evaluation at our center after RIF diagnosed pelvic pathology in 129 of 152 cases (p < 0.0001). Significant differences were observed for all pathological ultrasound findings between the initial IVF center scan and the expert TVS, except for isthmocele. In particular, the lowest overall agreement (OA), Cohen’s Kappa (K) and positive percent agreement (PPA) was described regarding the diagnosis of adenomyosis, uterine malformations, hydrosalpinx and deep infiltrated endometriosis.
Conclusion
Our study revealed a significant discrepancy in the diagnosis of ultrasound-detectable pelvic pathologies between IVF centres and our expert gynecological ultrasound unit. This difference highlights the potential underdiagnosis of critical pelvic conditions when ultrasound is performed by not expert sonographers in IVF centres.
{"title":"Expert transvaginal ultrasound is determinant for diagnosing pelvic conditions after recurrent implantation failure in IVF","authors":"Aikaterini Selntigia , Consuelo Russo , Daniele Farsetti , Giulia Monaco , Elvira Nocita , Sara Valeriani , Federica Iacobini , Caterina Exacoustos","doi":"10.1016/j.eurox.2025.100438","DOIUrl":"10.1016/j.eurox.2025.100438","url":null,"abstract":"<div><h3>Objective</h3><div>Recurrent implantation failure (RIF) is a clinical phenomenon characterized by a lack of implantation after several embryo-transfers. The aim of this study was to evaluate missing pelvic pathologies in patients with RIF, following at least two embryo-transfers of good-quality blastocyst, using a dedicated transvaginal ultrasound (TVS) performed by experienced specialists.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with RIF who were admitted to the Gynecological Ultrasound Unit of the University of Rome 'Tor Vergata' between 2020 and 2024 for a second-opinion ultrasound. Only patients with transfers of euploid blastocysts and/or blastocysts from oocytes donation were included. All patients underwent 2D, 3D and Power-Doppler transvaginal examination to evaluate all possible pelvic pathologies.</div></div><div><h3>Results</h3><div>The study included 152 patients who met the inclusion criteria. Pathological pelvic findings were identified in 45 of 152 women during the initial TVS scans performed at the IVF centres before ET, whereas expert TVS evaluation at our center after RIF diagnosed pelvic pathology in 129 of 152 cases (p < 0.0001). Significant differences were observed for all pathological ultrasound findings between the initial IVF center scan and the expert TVS, except for isthmocele. In particular, the lowest overall agreement (OA), Cohen’s Kappa (K) and positive percent agreement (PPA) was described regarding the diagnosis of adenomyosis, uterine malformations, hydrosalpinx and deep infiltrated endometriosis.</div></div><div><h3>Conclusion</h3><div>Our study revealed a significant discrepancy in the diagnosis of ultrasound-detectable pelvic pathologies between IVF centres and our expert gynecological ultrasound unit. This difference highlights the potential underdiagnosis of critical pelvic conditions when ultrasound is performed by not expert sonographers in IVF centres.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"28 ","pages":"Article 100438"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aims to evaluate pregnancy rates using a novel classification system based on hysterosalpingography (HSG) findings, categorizing tubal patency as either patent or functionally deficient. Furthermore, the study assesses the predictive value of this scoring system for fertility outcomes.
Methods
A retrospective cohort study was conducted involving 4461 patients who underwent HSG at an academic radiology center between January 2020 and December 2022. HSG findings and subsequent pregnancy outcomes were systematically analyzed.
Results
Of the 2461 patients initially followed up, 301 were excluded due to incomplete data, resulting in a final cohort of 2160 patients. Within two years post-HSG, 970 patients (44.9 %) achieved natural pregnancy, 808 (83.2 %) of whom resulted in live births. In vitro fertilization (IVF) pregnancies accounted for 35.8 % (n = 775). Ectopic pregnancies occurred in 1.8 % of patients, with a higher incidence in those with unilateral tubal occlusion. Using the novel scoring system—where Score 0 indicates bilateral patency, Score 1 indicates unilateral functional deficiency, and Score 2 indicates bilateral functional deficiency—the Score 0 group exhibited the highest natural pregnancy rate (51.1 %), which was significantly higher than that of the Score 1 and Score 2 groups. Natural pregnancy rates were 20.8 % for unilateral hydrosalpinx and 36.7 % for unilateral occlusion. Only 5 % of patients with bilateral hydrosalpinx conceived naturally. Age was a significant factor; women under 35 years had a natural pregnancy rate of 46.8 %, compared to 10.2 % in those over 40 years.
Conclusion
Tubal patency status is significantly associated with pregnancy outcomes, and functional deficiencies appear to reduce fertility. The proposed HSG-based scoring system serves as a valuable predictive tool for pregnancy potential. Additionally, the presence of hydrosalpinx is associated with adverse pregnancy rates.
{"title":"Evaluation of pregnancy outcomes using a novel hysterosalpingography scoring system for tubal patency","authors":"Huijun Yang , Yali Xu , Saiming Cheng , Haixia Zhang , Jiejun Cheng , Feng Gao","doi":"10.1016/j.eurox.2025.100437","DOIUrl":"10.1016/j.eurox.2025.100437","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to evaluate pregnancy rates using a novel classification system based on hysterosalpingography (HSG) findings, categorizing tubal patency as either patent or functionally deficient. Furthermore, the study assesses the predictive value of this scoring system for fertility outcomes.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted involving 4461 patients who underwent HSG at an academic radiology center between January 2020 and December 2022. HSG findings and subsequent pregnancy outcomes were systematically analyzed.</div></div><div><h3>Results</h3><div>Of the 2461 patients initially followed up, 301 were excluded due to incomplete data, resulting in a final cohort of 2160 patients. Within two years post-HSG, 970 patients (44.9 %) achieved natural pregnancy, 808 (83.2 %) of whom resulted in live births. In vitro fertilization (IVF) pregnancies accounted for 35.8 % (n = 775). Ectopic pregnancies occurred in 1.8 % of patients, with a higher incidence in those with unilateral tubal occlusion. Using the novel scoring system—where Score 0 indicates bilateral patency, Score 1 indicates unilateral functional deficiency, and Score 2 indicates bilateral functional deficiency—the Score 0 group exhibited the highest natural pregnancy rate (51.1 %), which was significantly higher than that of the Score 1 and Score 2 groups. Natural pregnancy rates were 20.8 % for unilateral hydrosalpinx and 36.7 % for unilateral occlusion. Only 5 % of patients with bilateral hydrosalpinx conceived naturally. Age was a significant factor; women under 35 years had a natural pregnancy rate of 46.8 %, compared to 10.2 % in those over 40 years.</div></div><div><h3>Conclusion</h3><div>Tubal patency status is significantly associated with pregnancy outcomes, and functional deficiencies appear to reduce fertility. The proposed HSG-based scoring system serves as a valuable predictive tool for pregnancy potential. Additionally, the presence of hydrosalpinx is associated with adverse pregnancy rates.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"29 ","pages":"Article 100437"},"PeriodicalIF":1.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145665556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/j.eurox.2025.100434
Ning Su , Xiao Li , Dian Wang , Min Wang , Shuping Yan , Haifeng Qiu
Purpose
Neuroendocrine carcinoma of the cervix (NECC) is rare and aggressive. We analyzed a dual-center Chinese cohort to describe clinicopathologic features, outcomes, and treatment patterns, and to identify prognostic factors.
Methods
We retrospectively included patients with pathologically confirmed NECC treated from June 2012 to June 2021. Variables included age at diagnosis, symptoms, high-risk human papillomavirus (hrHPV), FIGO 2009/2018 stage, tumor histology, tumor diameter, depth of stromal invasion (DOI), lymphovascular space invasion (LVSI), lymph-node metastasis (LNM), and treatments. Follow-up followed NCCN guidance. Survival was assessed using Kaplan–Meier and Cox regression.
Results
We analyzed 175 patients. hrHPV was positive in 54.3 % (95/175); 84.0 % (147/175) presented with abnormal vaginal bleeding. By FIGO 2018, 39.4 % (69/175) had stage IIB–IVB disease. On univariable Cox regression analysis, younger age, higher FIGO stage (2009 and 2018), pure NECC histology, deeper DOI, larger tumor diameter, and positive LNM were associated with worse survival. In contrast, multivariable Cox regression analysis revealed that FIGO 2009 stage and DOI were independent predictors of both progression-free survival (PFS) and overall survival (OS); tumor histology was independently associated with OS. Survival did not differ between abdominal and laparoscopic radical hysterectomy. Among surgically treated patients, adjuvant radiotherapy did not improve PFS or OS across early-stage, locally advanced, or late-stage subgroups.
Conclusions
In this cohort, primary-tumor factors—especially DOI—and FIGO 2009 stage were independent prognostic factors, whereas surgical route and postoperative radiotherapy showed no survival benefit; these findings can inform staging considerations and treatment decisions for NECC.
{"title":"Neuroendocrine carcinoma of the cervix (NECC): A retrospective study of 175 Chinese patients","authors":"Ning Su , Xiao Li , Dian Wang , Min Wang , Shuping Yan , Haifeng Qiu","doi":"10.1016/j.eurox.2025.100434","DOIUrl":"10.1016/j.eurox.2025.100434","url":null,"abstract":"<div><h3>Purpose</h3><div>Neuroendocrine carcinoma of the cervix (NECC) is rare and aggressive. We analyzed a dual-center Chinese cohort to describe clinicopathologic features, outcomes, and treatment patterns, and to identify prognostic factors.</div></div><div><h3>Methods</h3><div>We retrospectively included patients with pathologically confirmed NECC treated from June 2012 to June 2021. Variables included age at diagnosis, symptoms, high-risk human papillomavirus (hrHPV), FIGO 2009/2018 stage, tumor histology, tumor diameter, depth of stromal invasion (DOI), lymphovascular space invasion (LVSI), lymph-node metastasis (LNM), and treatments. Follow-up followed NCCN guidance. Survival was assessed using Kaplan–Meier and Cox regression.</div></div><div><h3>Results</h3><div>We analyzed 175 patients. hrHPV was positive in 54.3 % (95/175); 84.0 % (147/175) presented with abnormal vaginal bleeding. By FIGO 2018, 39.4 % (69/175) had stage IIB–IVB disease. On univariable Cox regression analysis, younger age, higher FIGO stage (2009 and 2018), pure NECC histology, deeper DOI, larger tumor diameter, and positive LNM were associated with worse survival. In contrast, multivariable Cox regression analysis revealed that FIGO 2009 stage and DOI were independent predictors of both progression-free survival (PFS) and overall survival (OS); tumor histology was independently associated with OS. Survival did not differ between abdominal and laparoscopic radical hysterectomy. Among surgically treated patients, adjuvant radiotherapy did not improve PFS or OS across early-stage, locally advanced, or late-stage subgroups.</div></div><div><h3>Conclusions</h3><div>In this cohort, primary-tumor factors—especially DOI—and FIGO 2009 stage were independent prognostic factors, whereas surgical route and postoperative radiotherapy showed no survival benefit; these findings can inform staging considerations and treatment decisions for NECC.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"28 ","pages":"Article 100434"},"PeriodicalIF":1.7,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-30DOI: 10.1016/j.eurox.2025.100433
Muhammed A.M. Hammad, MacKinnly T. Knoerzer, Gamal M. Ghoniem
Objective
To compare the risk of opioid use, antimicrobial utilization, and postoperative complications, including paralytic ileus, between patients undergoing abdominal hysterectomy and sacrocolpopexy.
Methods
Using a global federated health research network, we performed a retrospective cohort analysis. After 1:1 propensity score matching for age, BMI, race, ethnicity, diabetes, and hypertension, 993 patients were included per group. Kaplan-Meier survival analysis assessed antimicrobial and opioid use, resistance, and opioid abuse or dependence.
Results
Mean follow-up was significantly longer in the sacrocolpopexy group (7.67 ± 4.66 years) than in the hysterectomy group (3.13 ± 4.23 years). Hysterectomy patients experienced a higher mean number of postoperative complications although these results were not statistically significant (p = 0.0688). Postoperative antimicrobial use was significantly higher in the hysterectomy group (25.9 %) than sacrocolpopexy (14.1 %) (HR 3.84, 95 % CI: 2.99–4.93; p < 0.0001). Opioid use was also more frequent in hysterectomy patients (44.4 % vs. 15.6 %; HR 5.68, 95 % CI: 4.69–6.88; p < 0.0001), with a higher incidence of abuse/dependence (6.04 % vs. 2.02 %; HR 6.91, 95 % CI: 4.07–11.73). No significant difference was observed in antimicrobial resistance (p = 0.4409). Paralytic ileus was rare and not significantly different between groups.
Conclusion
Hysterectomy was associated with greater risk of postoperative opioid use, opioid abuse/dependence, and antimicrobial use. These findings support individualized surgical planning and proactive postoperative management.
{"title":"Comparative analysis of postoperative outcomes following hysterectomy versus sacrocolpopexy: Insights from global federated health research network","authors":"Muhammed A.M. Hammad, MacKinnly T. Knoerzer, Gamal M. Ghoniem","doi":"10.1016/j.eurox.2025.100433","DOIUrl":"10.1016/j.eurox.2025.100433","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the risk of opioid use, antimicrobial utilization, and postoperative complications, including paralytic ileus, between patients undergoing abdominal hysterectomy and sacrocolpopexy.</div></div><div><h3>Methods</h3><div>Using a global federated health research network, we performed a retrospective cohort analysis. After 1:1 propensity score matching for age, BMI, race, ethnicity, diabetes, and hypertension, 993 patients were included per group. Kaplan-Meier survival analysis assessed antimicrobial and opioid use, resistance, and opioid abuse or dependence.</div></div><div><h3>Results</h3><div>Mean follow-up was significantly longer in the sacrocolpopexy group (7.67 ± 4.66 years) than in the hysterectomy group (3.13 ± 4.23 years). Hysterectomy patients experienced a higher mean number of postoperative complications although these results were not statistically significant (p = 0.0688). Postoperative antimicrobial use was significantly higher in the hysterectomy group (25.9 %) than sacrocolpopexy (14.1 %) (HR 3.84, 95 % CI: 2.99–4.93; p < 0.0001). Opioid use was also more frequent in hysterectomy patients (44.4 % vs. 15.6 %; HR 5.68, 95 % CI: 4.69–6.88; p < 0.0001), with a higher incidence of abuse/dependence (6.04 % vs. 2.02 %; HR 6.91, 95 % CI: 4.07–11.73). No significant difference was observed in antimicrobial resistance (p = 0.4409). Paralytic ileus was rare and not significantly different between groups.</div></div><div><h3>Conclusion</h3><div>Hysterectomy was associated with greater risk of postoperative opioid use, opioid abuse/dependence, and antimicrobial use. These findings support individualized surgical planning and proactive postoperative management.</div></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"28 ","pages":"Article 100433"},"PeriodicalIF":1.7,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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