Florian Recker, Ricarda Neubauer, Jana Adams, Sebastian Ludwig, Florin-Andrei Taran, Tanja Groten
As medical knowledge and technologies rapidly evolve, curricula have become increasingly dense, and designing effective OB-GYN education that prepares learners for diverse medical careers within limited timeframes is a global challenge. This review provides an international overview of contemporary medical education in obstetrics and gynecology (OB-GYN) across undergraduate, postgraduate, and continuing professional development levels. A narrative review of recent peer-reviewed literature, international guidelines, and global initiatives (2023–2025) was conducted, identifying key innovations, trends, and challenges in OB-GYN education worldwide, with a focus on curriculum reforms, competency-based education, simulation, telemedicine, AI applications, global standardization, and equity-oriented initiatives. Undergraduate OB-GYN curricula are increasingly standardized, integrating core competencies, early clinical exposure, and reproductive health. Postgraduate training adopts competency-based frameworks, enhanced by simulation, virtual reality, and tele-education, while continuing medical education has shifted toward flexible digital platforms and structured credentialing. Innovations, such as AI-driven learning tools, simulation drills, and telemedicine-based training, have improved skill acquisition, and global bodies, such as FIGO, RCOG, and ACOG, promote curriculum harmonization and equity. The COVID-19 pandemic accelerated digital adoption but revealed gaps in surgical training and support. Overall, OB-GYN education is in a transformative phase, marked by technology, standardization, and equity, yet significant disparities persist, especially in resource-limited settings. Continued global collaboration, investment in educational infrastructure, and adaptive curriculum development are essential to prepare OB-GYN professionals for evolving clinical demands and healthcare inequities in the postpandemic era.
{"title":"Medical education in obstetrics and gynecology: A global update from 2025","authors":"Florian Recker, Ricarda Neubauer, Jana Adams, Sebastian Ludwig, Florin-Andrei Taran, Tanja Groten","doi":"10.1111/aogs.70105","DOIUrl":"10.1111/aogs.70105","url":null,"abstract":"<p>As medical knowledge and technologies rapidly evolve, curricula have become increasingly dense, and designing effective OB-GYN education that prepares learners for diverse medical careers within limited timeframes is a global challenge. This review provides an international overview of contemporary medical education in obstetrics and gynecology (OB-GYN) across undergraduate, postgraduate, and continuing professional development levels. A narrative review of recent peer-reviewed literature, international guidelines, and global initiatives (2023–2025) was conducted, identifying key innovations, trends, and challenges in OB-GYN education worldwide, with a focus on curriculum reforms, competency-based education, simulation, telemedicine, AI applications, global standardization, and equity-oriented initiatives. Undergraduate OB-GYN curricula are increasingly standardized, integrating core competencies, early clinical exposure, and reproductive health. Postgraduate training adopts competency-based frameworks, enhanced by simulation, virtual reality, and tele-education, while continuing medical education has shifted toward flexible digital platforms and structured credentialing. Innovations, such as AI-driven learning tools, simulation drills, and telemedicine-based training, have improved skill acquisition, and global bodies, such as FIGO, RCOG, and ACOG, promote curriculum harmonization and equity. The COVID-19 pandemic accelerated digital adoption but revealed gaps in surgical training and support. Overall, OB-GYN education is in a transformative phase, marked by technology, standardization, and equity, yet significant disparities persist, especially in resource-limited settings. Continued global collaboration, investment in educational infrastructure, and adaptive curriculum development are essential to prepare OB-GYN professionals for evolving clinical demands and healthcare inequities in the postpandemic era.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"166-175"},"PeriodicalIF":3.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ane-Kersti Skaarup Knudsen, Tina Hovgaard Randrup, Ulrik Schiøler Kesmodel, Berit Bargum Booth, Line Winther Gustafson, Therese Koops Grønborg, Anne Hammer
Introduction
Adequate treatment of cervical precancer, defined as negative margins and a negative HPV test post-treatment, is essential for cervical cancer prevention, as inadequate excision of cervical precancer and a positive HPV test are associated with increased risk of recurrence. Here, we aimed to describe trends in the proportion of women receiving adequate treatment in Denmark.
Material and Methods
Nationwide historical cohort study including Danish women ≥18 years treated with large loop excision of the transformation zone (LLETZ) from 2013 to 2022. Using the Danish Pathology Register, we collected information on all LLETZ procedures performed due to cervical intraepithelial neoplasia grade 1 or worse (CIN1+). We calculated the proportion of negative margins and negative HPV tests post-treatment, overall and stratified by histology, age, calendar time, and residing region. Results were mainly reported descriptively.
Results
We included 41 128 women (median age: 35 years, interquartile range: 28–44). A total of 20 744 (50.4%) had negative margins, with the lowest proportion in women with CIN3 (47.2%) or adenocarcinoma in situ (38.3%). The proportion of negative margins declined with increasing age, from 54.1% in women aged 18–29 years to 43.6% in women aged ≥50 years. Overall, 62.4% had a negative HPV test, with no major differences observed across histology groups. The proportion of negative HPV tests ranged from 62.8% to 66.9% in women aged 18–49, whereas it was lower in women aged ≥50 years (48.4%).
Conclusions
Women aged ≥50 years were less likely to have negative margins and a negative HPV test post-treatment compared to women aged 18–49. These findings prompt a need to optimize treatment in this group of women to reduce the risk of cervical cancer.
{"title":"Negative margins and negative HPV tests after large loop excision of the transformation zone: A nationwide historical cohort study","authors":"Ane-Kersti Skaarup Knudsen, Tina Hovgaard Randrup, Ulrik Schiøler Kesmodel, Berit Bargum Booth, Line Winther Gustafson, Therese Koops Grønborg, Anne Hammer","doi":"10.1111/aogs.70107","DOIUrl":"10.1111/aogs.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Adequate treatment of cervical precancer, defined as negative margins and a negative HPV test post-treatment, is essential for cervical cancer prevention, as inadequate excision of cervical precancer and a positive HPV test are associated with increased risk of recurrence. Here, we aimed to describe trends in the proportion of women receiving adequate treatment in Denmark.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>Nationwide historical cohort study including Danish women ≥18 years treated with large loop excision of the transformation zone (LLETZ) from 2013 to 2022. Using the Danish Pathology Register, we collected information on all LLETZ procedures performed due to cervical intraepithelial neoplasia grade 1 or worse (CIN1+). We calculated the proportion of negative margins and negative HPV tests post-treatment, overall and stratified by histology, age, calendar time, and residing region. Results were mainly reported descriptively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 41 128 women (median age: 35 years, interquartile range: 28–44). A total of 20 744 (50.4%) had negative margins, with the lowest proportion in women with CIN3 (47.2%) or adenocarcinoma in situ (38.3%). The proportion of negative margins declined with increasing age, from 54.1% in women aged 18–29 years to 43.6% in women aged ≥50 years. Overall, 62.4% had a negative HPV test, with no major differences observed across histology groups. The proportion of negative HPV tests ranged from 62.8% to 66.9% in women aged 18–49, whereas it was lower in women aged ≥50 years (48.4%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Women aged ≥50 years were less likely to have negative margins and a negative HPV test post-treatment compared to women aged 18–49. These findings prompt a need to optimize treatment in this group of women to reduce the risk of cervical cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"186-194"},"PeriodicalIF":3.1,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jose Alberola-Rubio, Juan Miguel Mira-Tomas, Alba Diaz-Martinez, Pilar Alama Faubel, Sergio Caballero Sanz, Gemma Castillón Cortés, Maria de Arriba-Garcia, Joaquín Llácer, Javier Garcia-Casado
<div> <section> <h3> Introduction</h3> <p>The uterus exhibits dynamic peristaltic activity across the menstrual cycle, playing a critical role in reproductive processes such as sperm transport and embryo implantation. However, current imaging methods to assess this activity provide little information and are limited by subjectivity and lack of sensitivity. A recent pilot study has shown the potential of intracavitary electrohysterography (IC-EHG) to study peristalsis in the uterine fundus. This study aimed to generalize previous results, compare peristalsis in other uterine regions, and study more peristaltic features.</p> </section> <section> <h3> Material and Methods</h3> <p>This prospective multicenter cohort study included 40 healthy women with proven fertility. IC-EHG signals were recorded from different uterine sites for 30 min during three menstrual phases: mid-follicular (MF), early luteal (EL), and late luteal (LL) using a custom-designed multipolar catheter. Primary outcomes: contraction frequency (CT/min) and amplitude (μV); secondary outcomes: basal amplitude, contraction time percentage, contractility index and local organization index. Statistical comparisons between phases and regions were performed using Wilcoxon signed-rank tests.</p> </section> <section> <h3> Results</h3> <p>A total of 95 fundal and 90 lower-segment IC-EHG recordings were analyzed. Contraction frequency peaked during the EL phase (fundus: 3.91 CT/min; lower segment: 4.01 CT/min) and was lowest during MF (fundus: 3.28 CT/min, <i>p</i> = 0.042; lower segment: 3.65 CT/min, <i>p</i> = 0.024). Fundal contraction amplitude decreased progressively from MF (16.27 μV) to LL phase (10.56 μV, <i>p</i> < 0.001). Basal amplitude, contraction time percentage and contractility index were also lowest in the LL phase for both uterine regions. Except for frequency, fundus peristaltic activity features were smaller than those of the lower segment, significantly during the MF phase. Local coordination index revealed lower local cell organization in the fundus across all phases, with maximum coordination during EL in both regions (<i>p</i> < 0.01).</p> </section> <section> <h3> Conclusions</h3> <p>IC-EHG technique enables objective, reproducible, and quantitative assessment of multiple aspects of uterine peristalsis, revealing distinct regional and cycle-phase–dependent patterns. The decline in most contractile features during the LL phase supports the physiological uterine quiescence required for embryo implantation. The uterine fundus is more active during the MF phase. This s
子宫在整个月经周期中表现出动态蠕动活动，在精子运输和胚胎着床等生殖过程中起着关键作用。然而，目前评估这种活动的成像方法提供的信息很少，并且受主观性和缺乏敏感性的限制。最近的一项初步研究表明，腔内子宫电图（IC-EHG）研究子宫底蠕动的潜力。本研究旨在总结以往的研究结果，比较其他子宫区域的蠕动情况，并研究更多的蠕动特征。材料和方法：这项前瞻性多中心队列研究包括40名已证实生育能力的健康妇女。在卵泡中期（MF）、黄体早期（EL）和黄体晚期（LL）三个月经阶段，使用特制的多极导管记录不同子宫部位30分钟的IC-EHG信号。主要观察指标：收缩频率（CT/min）、收缩幅度（μV）；次要观察指标：基础振幅、收缩时间百分比、收缩性指数、局部组织指数。阶段和区域之间的统计比较采用Wilcoxon符号秩检验。结果：共分析95个基底节段和90个下节段的IC-EHG记录。收缩频率在EL期最高（眼底：3.91 CT/min，下段：4.01 CT/min），在MF期最低（眼底：3.28 CT/min, p = 0.042，下段：3.65 CT/min, p = 0.024）。结论：IC-EHG技术能够客观、可重复、定量地评估子宫蠕动的多个方面，显示出明显的区域和周期相依赖性模式。在LL期大多数收缩特征的下降支持胚胎着床所需的生理子宫静止。子宫底在MF期更为活跃。本研究为健康、生育条件提供了参考价值，并可为进一步调查因疾病或干预策略而引起的改变提供信息。
{"title":"Objective and comprehensive characterization of uterine peristaltic activity throughout the menstrual cycle by means of intracavitary electrohysterography, a cohort study","authors":"Jose Alberola-Rubio, Juan Miguel Mira-Tomas, Alba Diaz-Martinez, Pilar Alama Faubel, Sergio Caballero Sanz, Gemma Castillón Cortés, Maria de Arriba-Garcia, Joaquín Llácer, Javier Garcia-Casado","doi":"10.1111/aogs.70088","DOIUrl":"10.1111/aogs.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The uterus exhibits dynamic peristaltic activity across the menstrual cycle, playing a critical role in reproductive processes such as sperm transport and embryo implantation. However, current imaging methods to assess this activity provide little information and are limited by subjectivity and lack of sensitivity. A recent pilot study has shown the potential of intracavitary electrohysterography (IC-EHG) to study peristalsis in the uterine fundus. This study aimed to generalize previous results, compare peristalsis in other uterine regions, and study more peristaltic features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This prospective multicenter cohort study included 40 healthy women with proven fertility. IC-EHG signals were recorded from different uterine sites for 30 min during three menstrual phases: mid-follicular (MF), early luteal (EL), and late luteal (LL) using a custom-designed multipolar catheter. Primary outcomes: contraction frequency (CT/min) and amplitude (μV); secondary outcomes: basal amplitude, contraction time percentage, contractility index and local organization index. Statistical comparisons between phases and regions were performed using Wilcoxon signed-rank tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 95 fundal and 90 lower-segment IC-EHG recordings were analyzed. Contraction frequency peaked during the EL phase (fundus: 3.91 CT/min; lower segment: 4.01 CT/min) and was lowest during MF (fundus: 3.28 CT/min, <i>p</i> = 0.042; lower segment: 3.65 CT/min, <i>p</i> = 0.024). Fundal contraction amplitude decreased progressively from MF (16.27 μV) to LL phase (10.56 μV, <i>p</i> < 0.001). Basal amplitude, contraction time percentage and contractility index were also lowest in the LL phase for both uterine regions. Except for frequency, fundus peristaltic activity features were smaller than those of the lower segment, significantly during the MF phase. Local coordination index revealed lower local cell organization in the fundus across all phases, with maximum coordination during EL in both regions (<i>p</i> < 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>IC-EHG technique enables objective, reproducible, and quantitative assessment of multiple aspects of uterine peristalsis, revealing distinct regional and cycle-phase–dependent patterns. The decline in most contractile features during the LL phase supports the physiological uterine quiescence required for embryo implantation. The uterine fundus is more active during the MF phase. This s","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"156-165"},"PeriodicalIF":3.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145595671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olga Wihersaari, Päivi Karjalainen, Anna-Maija Tolppanen, Nina Mattsson, Jyrki Jalkanen, Kari Nieminen
Introduction: Further prolapse in the same or a different vaginal compartment is common, particularly following native tissue surgery. This study aims to report the rates of reoperations for prolapse and subjective recurrence after native tissue and mesh-augmented surgeries. Additionally, it seeks to describe the methods of repeat surgery for prolapse and to evaluate long-term mesh complications.
Material and methods: This is a follow-up study of the nationwide cohort (ClinicalTrials.gov [NCT02716506]) of pelvic organ prolapse surgeries performed in 2015 in Finland. Prolapse recurrence, reoperations and mesh complications were studied utilizing data from patient questionnaires and the national register. Reoperation rates, timing, methods of repeat surgery, and rates of subjective recurrence were compared among native tissue, transvaginal mesh and abdominal mesh surgeries. Predictive factors for reoperation were studied with logistic regression analysis. Mesh-related complications were evaluated after transvaginal and abdominal mesh repair.
Results: The mean follow-up of 3321 women was 7.4 years, during which 443 (13%) underwent reoperation for prolapse; 13.9% after native tissue, 10.1% after transvaginal mesh, and 12.1% after abdominal mesh repair (p = 0.09). Up to one third of women reported symptoms of vaginal bulging during follow-up, with significantly lower rates after transvaginal mesh surgery at 2- and 5-year follow-ups. The majority of reoperations for prolapse were single-site; anterior or apical repair was most common after native tissue and abdominal mesh surgery, while reoperations after transvaginal repair involved mainly posterior or apical compartments. Mesh was used in 40% of all reoperations. Prolapse surgery involving both posterior and apical compartments was the only factor associated with increased risk for reoperation (aOR 1.95 CI 1.30-2.92). Only 1.6% of women had a surgically treated mesh complication based on the register data, while the rates of patient-reported mesh exposures and mesh-related reoperations were 6.5% and 6.4%, with no significant difference between the two mesh groups.
Conclusions: The long-term risk of reoperation for prolapse was similar after native tissue and mesh-augmented surgery, while the site of reoperation differed based on the type of surgical treatment. Mesh complication rates were similar after transvaginal and abdominal mesh repair, and the majority of mesh exposures did not require surgical treatment.
简介：在同一或不同的阴道隔室进一步脱垂是常见的，特别是在原生组织手术后。本研究旨在报告脱垂的再手术率和自体组织和补片手术后的主观复发率。此外，它试图描述的方法重复手术脱垂和评估长期补片并发症。材料和方法：这是一项对2015年芬兰盆腔器官脱垂手术的全国队列（ClinicalTrials.gov [NCT02716506]）的随访研究。利用患者问卷和国家登记的数据研究脱垂复发、再手术和补片并发症。比较自然组织补片、经阴道补片和腹部补片手术的再手术率、时间、重复手术方法和主观复发率。采用logistic回归分析对再手术的预测因素进行分析。经阴道和腹部补片修复后评估补片相关并发症。结果：3321例女性平均随访7.4年，其中443例（13%）因脱垂再次手术；经阴道补片术后13.9%，经阴道补片术后10.1%，腹部补片术后12.1% （p = 0.09）。在随访期间，多达三分之一的妇女报告了阴道膨出的症状，在2年和5年的随访中，经阴道补网手术后的发生率显著降低。脱垂的再手术以单部位为主；前路或根尖修复在原生组织和腹部补片手术后最常见，而经阴道修复后的再手术主要涉及后路或根尖室。40%的再手术采用补片。后房室和根尖房室脱垂手术是增加再手术风险的唯一因素（aOR 1.95 CI 1.30-2.92）。根据登记数据，只有1.6%的女性有手术治疗的补片并发症，而患者报告的补片暴露率和补片相关再手术率分别为6.5%和6.4%，两组补片之间没有显著差异。结论：脱垂术后再手术的远期风险与原位组织和补片增强手术相似，但因手术方式不同，再手术部位不同。经阴道和腹部补片修复后补片并发症发生率相似，大多数补片暴露不需要手术治疗。
{"title":"Prolapse recurrence, methods of reoperation, and long-term mesh complications-A nationwide follow-up study.","authors":"Olga Wihersaari, Päivi Karjalainen, Anna-Maija Tolppanen, Nina Mattsson, Jyrki Jalkanen, Kari Nieminen","doi":"10.1111/aogs.70083","DOIUrl":"https://doi.org/10.1111/aogs.70083","url":null,"abstract":"<p><strong>Introduction: </strong>Further prolapse in the same or a different vaginal compartment is common, particularly following native tissue surgery. This study aims to report the rates of reoperations for prolapse and subjective recurrence after native tissue and mesh-augmented surgeries. Additionally, it seeks to describe the methods of repeat surgery for prolapse and to evaluate long-term mesh complications.</p><p><strong>Material and methods: </strong>This is a follow-up study of the nationwide cohort (ClinicalTrials.gov [NCT02716506]) of pelvic organ prolapse surgeries performed in 2015 in Finland. Prolapse recurrence, reoperations and mesh complications were studied utilizing data from patient questionnaires and the national register. Reoperation rates, timing, methods of repeat surgery, and rates of subjective recurrence were compared among native tissue, transvaginal mesh and abdominal mesh surgeries. Predictive factors for reoperation were studied with logistic regression analysis. Mesh-related complications were evaluated after transvaginal and abdominal mesh repair.</p><p><strong>Results: </strong>The mean follow-up of 3321 women was 7.4 years, during which 443 (13%) underwent reoperation for prolapse; 13.9% after native tissue, 10.1% after transvaginal mesh, and 12.1% after abdominal mesh repair (p = 0.09). Up to one third of women reported symptoms of vaginal bulging during follow-up, with significantly lower rates after transvaginal mesh surgery at 2- and 5-year follow-ups. The majority of reoperations for prolapse were single-site; anterior or apical repair was most common after native tissue and abdominal mesh surgery, while reoperations after transvaginal repair involved mainly posterior or apical compartments. Mesh was used in 40% of all reoperations. Prolapse surgery involving both posterior and apical compartments was the only factor associated with increased risk for reoperation (aOR 1.95 CI 1.30-2.92). Only 1.6% of women had a surgically treated mesh complication based on the register data, while the rates of patient-reported mesh exposures and mesh-related reoperations were 6.5% and 6.4%, with no significant difference between the two mesh groups.</p><p><strong>Conclusions: </strong>The long-term risk of reoperation for prolapse was similar after native tissue and mesh-augmented surgery, while the site of reoperation differed based on the type of surgical treatment. Mesh complication rates were similar after transvaginal and abdominal mesh repair, and the majority of mesh exposures did not require surgical treatment.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Embryo transfer at the blastocyst stage has become popular in assisted reproductive technology, but it is still a challenge for embryologists to select the embryos with the highest implantation potential. We aimed to investigate whether blastocyst development speed and blastocyst quality affect pregnancy and perinatal outcomes in single frozen–thawed blastocyst transfer (SFBT) cycles.
Material and Methods
We therefore conducted a meta-analysis to compare the pregnancy and perinatal outcomes after day 5 versus day 6 SFBT. Pregnancy and perinatal outcomes of SFBT included HCG positive rate, clinical pregnancy rate (CPR), live birth rate (LBR), miscarriage rate (MR), multiple pregnancy rate (MPR), ongoing pregnancy rate (OPR), ectopic pregnancy rate (EPR), mean birth weight, low birth weight (LBW) rate, rate of macrosomia, mean gestational age at birth, preterm birth rate, birth defects rate, and sex ratio (female/male).
Results
A total of 106 316 participants were included in this meta-analysis and were assigned to the D5 (n = 66 329) and D6 (n = 39 987) SFBT groups. Pooled analysis showed that the D5 SFBT group had a higher HCG positive rate (RR 1.24, 95% CI 1.14–1.34), CPR (RR 1.28, 95% CI 1.22–1.34), OPR (RR 1.36, 95% CI 1.21–1.53), LBR (RR 1.39, 95% CI 1.32–1.47), and a lower MR (RR 0.78, 95% CI 0.73–0.83) than the D6 SFBT group. No significant difference was observed between the D5 and D6 SFBT groups in other pregnancy and perinatal outcomes. Subgroup analysis comparing poor-quality D5 blastocysts with high-quality D6 blastocysts revealed no significant differences in most outcomes, except for a lower HCG positive rate (RR 0.92, 95% CI 0.87–0.97) and a higher rate of macrosomia (RR 2.13, 95% CI 1.05–4.31) in the poor-quality D5 group.
Conclusions
The findings suggested that transfer D5 blastocysts should be prioritized over D6 blastocysts in SFBT in clinical practice. Besides, poor-quality D5 blastocysts and D6 high-quality blastocysts exhibited comparable outcomes. Given the overall low quality of available evidence, the association between the pregnancy outcomes and blastocyst development speed requires further investigation.
在辅助生殖技术中，囊胚期胚胎移植已成为一种流行的方法，但如何选择着床潜力最大的胚胎仍然是胚胎学家面临的挑战。我们的目的是研究在单次冻融囊胚移植（SFBT）周期中，囊胚发育速度和囊胚质量是否影响妊娠和围产期结局。材料和方法：因此，我们进行了一项荟萃分析，比较SFBT第5天和第6天的妊娠和围产期结局。SFBT妊娠及围产期结局包括HCG阳性率、临床妊娠率（CPR）、活产率（LBR）、流产率（MR）、多胎妊娠率（MPR）、持续妊娠率（OPR）、异位妊娠率（EPR）、平均出生体重、低出生体重（LBW）率、巨大儿率、平均出生胎龄、早产率、出生缺陷率、性别比（男女）。结果：共有106 316名参与者被纳入本荟萃分析，并被分配到D5 （n = 66 329）和D6 (n = 39 987) SFBT组。合并分析显示，D5 SFBT组HCG阳性率（RR 1.24, 95% CI 1.14-1.34）、CPR （RR 1.28, 95% CI 1.22-1.34）、OPR （RR 1.36, 95% CI 1.21-1.53）、LBR （RR 1.39, 95% CI 1.32-1.47）高于D6 SFBT组，MR （RR 0.78, 95% CI 0.73-0.83）低于D6 SFBT组。D5和D6 SFBT组在其他妊娠和围产期结局方面无显著差异。比较质量差的D5囊胚与质量好的D6囊胚的亚组分析显示，除了质量差的D5囊胚HCG阳性率较低（RR 0.92, 95% CI 0.87-0.97）和巨大儿发生率较高（RR 2.13, 95% CI 1.05-4.31）外，大多数结果无显著差异。结论：在临床SFBT中，D5囊胚移植优先于D6囊胚移植。此外，质量差的D5囊胚和质量好的D6囊胚的结局相当。鉴于现有证据的总体质量较低，妊娠结局与囊胚发育速度之间的关系需要进一步调查。
{"title":"Pregnancy and perinatal outcomes after day 5 versus day 6 blastocyst-stage embryo transfer: A systematic review and meta-analysis","authors":"Wenhui Hou, Ziyi Wang, Tianrui Wen, Yuanlin Ma, Manman Lu, Xiuli Fan, Feifei Zhao","doi":"10.1111/aogs.70090","DOIUrl":"10.1111/aogs.70090","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Embryo transfer at the blastocyst stage has become popular in assisted reproductive technology, but it is still a challenge for embryologists to select the embryos with the highest implantation potential. We aimed to investigate whether blastocyst development speed and blastocyst quality affect pregnancy and perinatal outcomes in single frozen–thawed blastocyst transfer (SFBT) cycles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We therefore conducted a meta-analysis to compare the pregnancy and perinatal outcomes after day 5 versus day 6 SFBT. Pregnancy and perinatal outcomes of SFBT included HCG positive rate, clinical pregnancy rate (CPR), live birth rate (LBR), miscarriage rate (MR), multiple pregnancy rate (MPR), ongoing pregnancy rate (OPR), ectopic pregnancy rate (EPR), mean birth weight, low birth weight (LBW) rate, rate of macrosomia, mean gestational age at birth, preterm birth rate, birth defects rate, and sex ratio (female/male).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 106 316 participants were included in this meta-analysis and were assigned to the D5 (<i>n</i> = 66 329) and D6 (<i>n</i> = 39 987) SFBT groups. Pooled analysis showed that the D5 SFBT group had a higher HCG positive rate (RR 1.24, 95% CI 1.14–1.34), CPR (RR 1.28, 95% CI 1.22–1.34), OPR (RR 1.36, 95% CI 1.21–1.53), LBR (RR 1.39, 95% CI 1.32–1.47), and a lower MR (RR 0.78, 95% CI 0.73–0.83) than the D6 SFBT group. No significant difference was observed between the D5 and D6 SFBT groups in other pregnancy and perinatal outcomes. Subgroup analysis comparing poor-quality D5 blastocysts with high-quality D6 blastocysts revealed no significant differences in most outcomes, except for a lower HCG positive rate (RR 0.92, 95% CI 0.87–0.97) and a higher rate of macrosomia (RR 2.13, 95% CI 1.05–4.31) in the poor-quality D5 group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings suggested that transfer D5 blastocysts should be prioritized over D6 blastocysts in SFBT in clinical practice. Besides, poor-quality D5 blastocysts and D6 high-quality blastocysts exhibited comparable outcomes. Given the overall low quality of available evidence, the association between the pregnancy outcomes and blastocyst development speed requires further investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"50-69"},"PeriodicalIF":3.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pauline Lesur, Nassima Ramdane, Charles Garabedian
Introduction
The main objective was to study the occurrence of intraoperative complications after emergency caesarean section during labor according to the type of hysterotomy extension performed.
Material and Methods
This was a single-center comparative study of hysterotomy extension by transverse traction (January 2015 to April 2017) versus cephalocaudal traction (May 2021 to February 2022). All women who underwent an emergency caesarean section (orange or red code) during these two periods were included. The primary endpoint was a composite of the occurrence of unintended extension, uterine pedicle injury, postpartum hemorrhage >1 L, and the blood product transfusion.
Results
The study included 767 patients. At least one intraoperative complication occurred in 122 women (21.4%) in the transverse traction group and in 33 (16.8%) women in the cephalocaudal traction group (OR 0.74, 95% CI [0.48–1.13]; p = 0.16). The incidence of these complications did not differ between groups after weighting (adjusted OR 0.78, 95% CI [0.52–1.19]; adjusted p = 0.25). Individual analysis of each component of the composite endpoint also showed no differences between groups.
Conclusions
In this study of emergency caesarean sections, the type of hysterotomy extension did not significantly influence the rate or type of intraoperative complications.
前言：本研究的主要目的是研究急诊剖宫产术中剖宫产术中并发症的发生情况。材料和方法：这是一项单中心比较研究，横向牵引（2015年1月至2017年4月）与头尾牵引（2021年5月至2022年2月）的子宫切开延伸。所有在这两个时期接受紧急剖腹产手术的妇女（橙色或红色代码）都包括在内。主要终点是发生意外伸展、子宫蒂损伤、产后出血bbb1l和输血的复合终点。结果：共纳入767例患者。横向牵引组122例（21.4%）发生术中并发症，头尾牵引组33例（16.8%）发生术中并发症（OR 0.74, 95% CI [0.48-1.13]; p = 0.16）。这些并发症的发生率在加权后各组间无差异（校正OR 0.78, 95% CI[0.52-1.19]；校正p = 0.25）。综合终点各组成部分的个体分析也显示组间无差异。结论：本研究急诊剖宫产术中，剖宫产方式对术中并发症发生率及类型无显著影响。
{"title":"Does craniocaudal extension of the hysterotomy reduce intraoperative complications compared with transverse extension in the case of emergency caesarean section?","authors":"Pauline Lesur, Nassima Ramdane, Charles Garabedian","doi":"10.1111/aogs.70061","DOIUrl":"10.1111/aogs.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The main objective was to study the occurrence of intraoperative complications after emergency caesarean section during labor according to the type of hysterotomy extension performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This was a single-center comparative study of hysterotomy extension by transverse traction (January 2015 to April 2017) versus cephalocaudal traction (May 2021 to February 2022). All women who underwent an emergency caesarean section (orange or red code) during these two periods were included. The primary endpoint was a composite of the occurrence of unintended extension, uterine pedicle injury, postpartum hemorrhage >1 L, and the blood product transfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 767 patients. At least one intraoperative complication occurred in 122 women (21.4%) in the transverse traction group and in 33 (16.8%) women in the cephalocaudal traction group (OR 0.74, 95% CI [0.48–1.13]; <i>p</i> = 0.16). The incidence of these complications did not differ between groups after weighting (adjusted OR 0.78, 95% CI [0.52–1.19]; adjusted <i>p</i> = 0.25). Individual analysis of each component of the composite endpoint also showed no differences between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this study of emergency caesarean sections, the type of hysterotomy extension did not significantly influence the rate or type of intraoperative complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"87-93"},"PeriodicalIF":3.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145572788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sophia Braund, François Goffinet, Aude Girault, Aurélien Seco, Camille Le Ray, the ENP2021 study group
<div> <section> <h3> Introduction</h3> <p>Because induction of labor (IOL) is increasingly frequent in high-income countries, studying its impact on birth experience needs further attention. Our objective was to assess the association between IOL and birth experience, compared with spontaneous onset of labor (SOL), in routine practice using a national population-based survey.</p> </section> <section> <h3> Material and Methods</h3> <p>The French National Perinatal Survey (<i>Enquête Nationale Périnatale</i> (ENP)) is a nationwide study aimed at monitoring maternal and neonatal health in 2021. Women from mainland France, with live births, face-to-face interviews, and who participated at the 2-month follow-up were included. At 2 months, women answered the question ‘What kind of memories do you have about your childbirth?’ and were classified into two groups: ‘positive’ and ‘negative’ birth experiences. We used univariate and multivariable logistic regression to compare birth experiences between women with SOL and IOL. We performed three sensitivity analyses: (1) with the onset of labor as a three-class variable (SOL, IOL, cervical ripening), (2) according to the presence of a medical indication for IOL, and (3) among a subgroup of low-risk women. Finally, we identified potential mediators on the pathway between IOL and a negative birth experience (birth with complication or operative delivery, pain at delivery, labor duration) and used mediation modeling to estimate indirect and residual effects.</p> </section> <section> <h3> Results</h3> <p>Among the 6200 women included, 1777 (28.7%) had an IOL. Women with IOL reported negative birth experiences more often than women with SOL (16.4% vs. 8.8%, <i>p</i> < 0.001). In the case of cervical ripening, the rate of negative birth experience increased to 18.8% (<i>p</i> < 0.001). After adjustment, the association between IOL and negative birth experience remained significant (aOR = 1.78, 95% CI [1.47–2.16]). We found similar results according to medical indication for IOL and among women at low risk. We estimated that 26% (95% CI, 12%–41%) of the association between IOL and a negative birth experience was mediated by birth with complications or operative delivery.</p> </section> <section> <h3> Conclusions</h3> <p>Women with IOL had a significantly higher risk of negative birth experience, compared with those with SOL. Our findings underline the need for appropriate antenatal information for women about IOL, shared decision-making, and better follow-up for women at risk of negative birth experience.</p>
导言：由于人工引产（IOL）在高收入国家越来越频繁，研究其对分娩体验的影响需要进一步关注。我们的目的是通过一项基于全国人口的调查，在常规实践中评估IOL与分娩经历之间的关系，并与自然分娩（SOL）进行比较。材料和方法：法国全国围产期调查（Enquête Nationale pembroinatale (ENP)）是一项全国性研究，旨在2021年监测孕产妇和新生儿健康。来自法国大陆、活产、面对面访谈并参与2个月随访的妇女被纳入研究对象。在两个月大的时候，女性回答了“你对分娩有什么样的记忆？”，并被分为两组：“积极”和“消极”的分娩经历。我们使用单变量和多变量逻辑回归来比较人工晶状体和人工晶状体妇女的分娩经历。我们进行了三个敏感性分析：(1)将分娩的开始作为一个三类变量（SOL， IOL，宫颈成熟），(2)根据IOL的医学指征的存在，以及(3)在低风险妇女亚组中。最后，我们确定了人工晶状体与负面分娩经历（分娩并发症或手术分娩、分娩疼痛、分娩持续时间）之间通路的潜在中介，并使用中介模型来估计间接和残余影响。结果：6200例患者中，1777例（28.7%）行人工晶状体植入。结论：与单纯人工流产的女性相比，单纯人工流产的女性发生不良分娩经历的风险明显更高。我们的研究结果强调了对女性提供适当的有关人工流产的产前信息、共同决策以及对有不良分娩经历风险的女性进行更好的随访的必要性。
{"title":"Association between induction of labor and birth experience: A national population-based study","authors":"Sophia Braund, François Goffinet, Aude Girault, Aurélien Seco, Camille Le Ray, the ENP2021 study group","doi":"10.1111/aogs.70057","DOIUrl":"10.1111/aogs.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Because induction of labor (IOL) is increasingly frequent in high-income countries, studying its impact on birth experience needs further attention. Our objective was to assess the association between IOL and birth experience, compared with spontaneous onset of labor (SOL), in routine practice using a national population-based survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>The French National Perinatal Survey (<i>Enquête Nationale Périnatale</i> (ENP)) is a nationwide study aimed at monitoring maternal and neonatal health in 2021. Women from mainland France, with live births, face-to-face interviews, and who participated at the 2-month follow-up were included. At 2 months, women answered the question ‘What kind of memories do you have about your childbirth?’ and were classified into two groups: ‘positive’ and ‘negative’ birth experiences. We used univariate and multivariable logistic regression to compare birth experiences between women with SOL and IOL. We performed three sensitivity analyses: (1) with the onset of labor as a three-class variable (SOL, IOL, cervical ripening), (2) according to the presence of a medical indication for IOL, and (3) among a subgroup of low-risk women. Finally, we identified potential mediators on the pathway between IOL and a negative birth experience (birth with complication or operative delivery, pain at delivery, labor duration) and used mediation modeling to estimate indirect and residual effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 6200 women included, 1777 (28.7%) had an IOL. Women with IOL reported negative birth experiences more often than women with SOL (16.4% vs. 8.8%, <i>p</i> < 0.001). In the case of cervical ripening, the rate of negative birth experience increased to 18.8% (<i>p</i> < 0.001). After adjustment, the association between IOL and negative birth experience remained significant (aOR = 1.78, 95% CI [1.47–2.16]). We found similar results according to medical indication for IOL and among women at low risk. We estimated that 26% (95% CI, 12%–41%) of the association between IOL and a negative birth experience was mediated by birth with complications or operative delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Women with IOL had a significantly higher risk of negative birth experience, compared with those with SOL. Our findings underline the need for appropriate antenatal information for women about IOL, shared decision-making, and better follow-up for women at risk of negative birth experience.</p>\u0000 ","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"76-86"},"PeriodicalIF":3.1,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Severe birth asphyxia (BA) and the resulting hypoxic–ischemic encephalopathy (HIE) remain one of the main causes of neonatal brain injury and mortality in term infants globally.<span><sup>1</sup></span> Hypoxic–ischemic brain injury progresses gradually, providing windows of opportunity for the development of more effective therapeutic interventions.<span><sup>2, 3</sup></span> Translational experimental research on BA-HIE is essential for identifying novel treatments, ideally focusing on interventions applicable in low -and middle-income countries as well, where BA is most prevalent.<span><sup>1</sup></span> Therefore, experimental models of BA need to be well characterized to understand the systemic and cerebral physiological interactions leading to HIE.</p><p>The pathophysiology of HIE develops in phases.<span><sup>3</sup></span> Depending on its severity, the hypoxic–ischemic insult causes primary neuronal death by thoroughly studied cellular mechanisms. Birth and resuscitation are followed by the latent phase of up to 6–15 h that is characterized by recovery of oxidative energy metabolism, continued excitotoxicity, acute inflammation, and brain hypoperfusion. It provides an optimal window for therapeutic interventions, as the secondary mechanisms of injury are either already progressing or triggered during this phase. Seizures are one of the hallmarks of the secondary phase that lasts up to days and during which multiple pathogenic mechanisms progress. The tertiary phase extends from weeks to years and reveals the motor, cognitive, and behavioral consequences of the insult.</p><p>Despite extensive research into understanding the pathophysiological mechanisms of BA-HIE-induced brain injury and the search for novel neuroprotective interventions, the treatment methods currently in use remain inadequate. For term neonates, therapeutic hypothermia (TH) remains the only established intervention for moderate to severe HIE, available mainly in specialized centers.<span><sup>3</sup></span> Additionally, TH is not globally and equitably accessible, and even where available, term brain injury may result from multiple causes — including acute, subacute, or chronic hypoxia, infection, inflammation, genetic or metabolic disorders, intracranial hemorrhage, and stroke. Therefore, this complexity underscores the need for investigating new approaches to protect the fetal and neonatal brain at term.</p><p>Much of basic and translational research has been conducted using animal models. However, choosing an appropriate model poses several challenges, including species differences, alignment of neurodevelopmental stage with human neonates, and reliable induction of asphyxia insults that replicate intrapartum conditions.<span><sup>4</sup></span> No experimental model perfectly replicates human BA-HIE, which underscores the value of complementary animal models.</p><p>Rats and mice are altricial species with brain development corresponding to preterm and full-ter
{"title":"Fetal and neonatal brain protection at term—The role of translational experimental models","authors":"Juulia Lantto, Panu Kiviranta, Juha Voipio","doi":"10.1111/aogs.70098","DOIUrl":"10.1111/aogs.70098","url":null,"abstract":"<p>Severe birth asphyxia (BA) and the resulting hypoxic–ischemic encephalopathy (HIE) remain one of the main causes of neonatal brain injury and mortality in term infants globally.<span><sup>1</sup></span> Hypoxic–ischemic brain injury progresses gradually, providing windows of opportunity for the development of more effective therapeutic interventions.<span><sup>2, 3</sup></span> Translational experimental research on BA-HIE is essential for identifying novel treatments, ideally focusing on interventions applicable in low -and middle-income countries as well, where BA is most prevalent.<span><sup>1</sup></span> Therefore, experimental models of BA need to be well characterized to understand the systemic and cerebral physiological interactions leading to HIE.</p><p>The pathophysiology of HIE develops in phases.<span><sup>3</sup></span> Depending on its severity, the hypoxic–ischemic insult causes primary neuronal death by thoroughly studied cellular mechanisms. Birth and resuscitation are followed by the latent phase of up to 6–15 h that is characterized by recovery of oxidative energy metabolism, continued excitotoxicity, acute inflammation, and brain hypoperfusion. It provides an optimal window for therapeutic interventions, as the secondary mechanisms of injury are either already progressing or triggered during this phase. Seizures are one of the hallmarks of the secondary phase that lasts up to days and during which multiple pathogenic mechanisms progress. The tertiary phase extends from weeks to years and reveals the motor, cognitive, and behavioral consequences of the insult.</p><p>Despite extensive research into understanding the pathophysiological mechanisms of BA-HIE-induced brain injury and the search for novel neuroprotective interventions, the treatment methods currently in use remain inadequate. For term neonates, therapeutic hypothermia (TH) remains the only established intervention for moderate to severe HIE, available mainly in specialized centers.<span><sup>3</sup></span> Additionally, TH is not globally and equitably accessible, and even where available, term brain injury may result from multiple causes — including acute, subacute, or chronic hypoxia, infection, inflammation, genetic or metabolic disorders, intracranial hemorrhage, and stroke. Therefore, this complexity underscores the need for investigating new approaches to protect the fetal and neonatal brain at term.</p><p>Much of basic and translational research has been conducted using animal models. However, choosing an appropriate model poses several challenges, including species differences, alignment of neurodevelopmental stage with human neonates, and reliable induction of asphyxia insults that replicate intrapartum conditions.<span><sup>4</sup></span> No experimental model perfectly replicates human BA-HIE, which underscores the value of complementary animal models.</p><p>Rats and mice are altricial species with brain development corresponding to preterm and full-ter","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"4-6"},"PeriodicalIF":3.1,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cecile C. Hulshoff, Marc E. A. Spaanderman, Ralph R. Scholten, Joris van Drongelen
<div> <section> <h3> Introduction</h3> <p>An emergency (rescue, exam-indicated) cervical cerclage can be offered to pregnant women presenting with cervical dilatation and prolapsed fetal membranes in the second trimester of pregnancy due to suspected cervical insufficiency.</p> </section> <section> <h3> Material and Methods</h3> <p>This study aimed to evaluate the efficacy of emergency cerclage in preventing extreme preterm birth in singleton and twin pregnancies, and to identify predictors of unsuccessful outcomes. We conducted a 15-year observational cohort study at a tertiary care center in the Netherlands, including all women who underwent emergency cerclage. Analyses were conducted for the total population and stratified by pregnancy type, with direct comparisons between singleton and twin pregnancies. Outcomes included gestational age at delivery, offspring survival, and pregnancy prolongation. Kaplan–Meier analysis assessed pregnancy prolongation, with survival curves compared using the log-rank test. Multivariable logistic regression identified predictors of preterm birth <28 weeks, using backward stepwise selection. Results were reported as adjusted odds ratios with 95% confidence intervals, and model performance was evaluated using AUC.</p> </section> <section> <h3> Results</h3> <p>A total of 99 women were included: 64 singleton pregnancies and 35 twin pregnancies. We observed an overall survival of 77%, a median gestational age at delivery of 29.4 weeks, and pregnancy prolongation after cerclage placement of 53.0 days. For pregnancies that passed 24 weeks of gestation, overall survival was 92%. Outcomes were comparable between singleton and twin pregnancies. Key factors associated with reduced pregnancy prolongation were vaginal bleeding, prolapsed membranes beyond external os, cervical dilation ≥4.0 cm, elevated white blood cell count (≥13.600 mm<sup>3</sup>) and CRP levels (≥15.0 mg/L). Multivariable analysis revealed prolapsed membranes beyond external os and gestational age at cerclage placement to be the most important independent predictors for preterm birth <28 weeks.</p> </section> <section> <h3> Conclusions</h3> <p>Emergency cerclage is associated with high offspring survival in both singletons and twins. Clinical factors, among advanced cervical dilation and elevated infectious parameters prior to placement, significantly affect its efficacy, although prolapsed membranes and GA at cerclage placement emerged to be the most critical predictors for preterm birth <28 weeks. These findings provide valuable insights that can
{"title":"Predictive factors for emergency cervical cerclage efficacy in singleton and twin pregnancies: A retrospective cohort study","authors":"Cecile C. Hulshoff, Marc E. A. Spaanderman, Ralph R. Scholten, Joris van Drongelen","doi":"10.1111/aogs.70076","DOIUrl":"10.1111/aogs.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>An emergency (rescue, exam-indicated) cervical cerclage can be offered to pregnant women presenting with cervical dilatation and prolapsed fetal membranes in the second trimester of pregnancy due to suspected cervical insufficiency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>This study aimed to evaluate the efficacy of emergency cerclage in preventing extreme preterm birth in singleton and twin pregnancies, and to identify predictors of unsuccessful outcomes. We conducted a 15-year observational cohort study at a tertiary care center in the Netherlands, including all women who underwent emergency cerclage. Analyses were conducted for the total population and stratified by pregnancy type, with direct comparisons between singleton and twin pregnancies. Outcomes included gestational age at delivery, offspring survival, and pregnancy prolongation. Kaplan–Meier analysis assessed pregnancy prolongation, with survival curves compared using the log-rank test. Multivariable logistic regression identified predictors of preterm birth <28 weeks, using backward stepwise selection. Results were reported as adjusted odds ratios with 95% confidence intervals, and model performance was evaluated using AUC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 99 women were included: 64 singleton pregnancies and 35 twin pregnancies. We observed an overall survival of 77%, a median gestational age at delivery of 29.4 weeks, and pregnancy prolongation after cerclage placement of 53.0 days. For pregnancies that passed 24 weeks of gestation, overall survival was 92%. Outcomes were comparable between singleton and twin pregnancies. Key factors associated with reduced pregnancy prolongation were vaginal bleeding, prolapsed membranes beyond external os, cervical dilation ≥4.0 cm, elevated white blood cell count (≥13.600 mm<sup>3</sup>) and CRP levels (≥15.0 mg/L). Multivariable analysis revealed prolapsed membranes beyond external os and gestational age at cerclage placement to be the most important independent predictors for preterm birth <28 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Emergency cerclage is associated with high offspring survival in both singletons and twins. Clinical factors, among advanced cervical dilation and elevated infectious parameters prior to placement, significantly affect its efficacy, although prolapsed membranes and GA at cerclage placement emerged to be the most critical predictors for preterm birth <28 weeks. These findings provide valuable insights that can","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"105 1","pages":"105-116"},"PeriodicalIF":3.1,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12746203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Experiencing complications in early pregnancy is common. Miscarriage alone occurs in about 15%–20% of recognized pregnancies, amounting to 23 million annually worldwide<span><sup>1</sup></span> and represents in a biological sense, a natural event. However, while medically intending to convey frequency, doctors inappropriately call it “normal,” potentially minimizing the significant psychological impact it can have for the affected patient and their partner.<span><sup>2</sup></span> Incomplete miscarriages, with residual tissue causing bleeding, infection, or adhesions, often require repeated follow-up and treatment. Ectopic pregnancy, affecting 1%–2% of pregnancies, is another major early pregnancy complication that places a heavy burden on patients and healthcare systems through high resource use and costs. Further, it must be acknowledged that while deaths from early pregnancy complications are thankfully rare, they do still occur, with a disproportionate number occurring in the developing world.<span><sup>3</sup></span></p><p>Despite this considerable individual, societal, and economic burden, early pregnancy care remains underdeveloped, perhaps because it is perceived as straightforward, with the majority of care being provided by junior doctors. It stands at a crossroads, torn between the allure of advanced surgical techniques and the persistent reality of systemic underinvestment and insufficient training. This dissonance perpetuates uneven, sometimes substandard care, leaving patients vulnerable to both unnecessary interventions and basic oversights.</p><p>An old saying among gynecologists goes: “You see the heartbeat before the embryo.” While often true, it takes considerable skill to exclude a heartbeat with certainty and sometimes it is simply not possible, as the gestation could be too early. Yet, an “empty” gestational sac or an embryo without cardiac activity can be wrongly interpreted as a definite miscarriage rather than as a limitation of scanning skills, creating so-called “Lazarus” embryos: pregnancies initially declared lost but later found viable—with an unmeasured number tragically unintentionally terminated.<span><sup>4, 5</sup></span> To avoid such errors, diagnostic criteria for miscarriage had to be set extremely wide, building in a safety margin that prioritized preventing the most catastrophic mistake: terminating a viable pregnancy.<span><sup>4</sup></span> Worryingly, adherence to guidelines is variable.<span><sup>6</sup></span></p><p>A marker of ultrasound quality at a department is the rate of pregnancies of unknown location (PUL). PUL is defined as a positive pregnancy test without a detectable pregnancy on ultrasound. While very early pregnancies may not yet be visible, an expert operator can usually localize a pregnancy when serum hCG (s-hCG) levels exceed 1000 IU/L. A PUL rate of up to 20% is considered acceptable, with some expert centers reporting rates as low as 8%.<span><sup>7</sup></span> Yet, some cent
{"title":"The paradox of early pregnancy care: Overtreatment amid systemic neglect","authors":"Tina Tellum, Joel Naftalin","doi":"10.1111/aogs.70097","DOIUrl":"10.1111/aogs.70097","url":null,"abstract":"<p>Experiencing complications in early pregnancy is common. Miscarriage alone occurs in about 15%–20% of recognized pregnancies, amounting to 23 million annually worldwide<span><sup>1</sup></span> and represents in a biological sense, a natural event. However, while medically intending to convey frequency, doctors inappropriately call it “normal,” potentially minimizing the significant psychological impact it can have for the affected patient and their partner.<span><sup>2</sup></span> Incomplete miscarriages, with residual tissue causing bleeding, infection, or adhesions, often require repeated follow-up and treatment. Ectopic pregnancy, affecting 1%–2% of pregnancies, is another major early pregnancy complication that places a heavy burden on patients and healthcare systems through high resource use and costs. Further, it must be acknowledged that while deaths from early pregnancy complications are thankfully rare, they do still occur, with a disproportionate number occurring in the developing world.<span><sup>3</sup></span></p><p>Despite this considerable individual, societal, and economic burden, early pregnancy care remains underdeveloped, perhaps because it is perceived as straightforward, with the majority of care being provided by junior doctors. It stands at a crossroads, torn between the allure of advanced surgical techniques and the persistent reality of systemic underinvestment and insufficient training. This dissonance perpetuates uneven, sometimes substandard care, leaving patients vulnerable to both unnecessary interventions and basic oversights.</p><p>An old saying among gynecologists goes: “You see the heartbeat before the embryo.” While often true, it takes considerable skill to exclude a heartbeat with certainty and sometimes it is simply not possible, as the gestation could be too early. Yet, an “empty” gestational sac or an embryo without cardiac activity can be wrongly interpreted as a definite miscarriage rather than as a limitation of scanning skills, creating so-called “Lazarus” embryos: pregnancies initially declared lost but later found viable—with an unmeasured number tragically unintentionally terminated.<span><sup>4, 5</sup></span> To avoid such errors, diagnostic criteria for miscarriage had to be set extremely wide, building in a safety margin that prioritized preventing the most catastrophic mistake: terminating a viable pregnancy.<span><sup>4</sup></span> Worryingly, adherence to guidelines is variable.<span><sup>6</sup></span></p><p>A marker of ultrasound quality at a department is the rate of pregnancies of unknown location (PUL). PUL is defined as a positive pregnancy test without a detectable pregnancy on ultrasound. While very early pregnancies may not yet be visible, an expert operator can usually localize a pregnancy when serum hCG (s-hCG) levels exceed 1000 IU/L. A PUL rate of up to 20% is considered acceptable, with some expert centers reporting rates as low as 8%.<span><sup>7</sup></span> Yet, some cent","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 12","pages":"2206-2209"},"PeriodicalIF":3.1,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145538314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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