Archives of Gynecology and Obstetrics最新文献_第10页

Impact of gestational weight gain on perineal injury in overweight and obese primiparous women 妊娠期体重增加对超重和肥胖初产妇会阴损伤的影响。

IF 2.5 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Archives of Gynecology and Obstetrics

Pub Date : 2026-01-05 DOI: 10.1007/s00404-025-08291-1

Itamar Gilboa, Daniel Gabbai, Emmanuel Attali, Ronen Gold, Asnat Groutz, Yariv Yogev, Yoav Baruch

Objective

Overweight and obesity are associated with adverse pregnancy outcomes, yet higher body mass index (BMI) has paradoxically been linked to reduced risk of perineal lacerations, including obstetric anal sphincter injury (OASI). The role of gestational weight gain (GWG) in this context is not well established. The objective of this study was to evaluate the association between GWG and perineal injury among overweight and obese primiparous women.

Methods

A retrospective cohort study was conducted at a tertiary center between 2012–2023, including primiparous women with singleton, term (≥ 37 weeks), vertex vaginal deliveries and pre-pregnancy BMI ≥ 25.0 kg/m². Women were categorized by GWG based on Institute of Medicine guidelines: below (Group A), within (Group B), or above recommendations (Group C). Exclusion criteria included cesarean delivery, diabetes, multiple gestations, stillbirth, preterm birth, non-vertex presentation, and maternal age < 18 or > 45 years. Perineal injury was defined as any perineal laceration or episiotomy. Univariate and multivariable logistic regression analyses were performed.

Results

Among 5,082 deliveries, 13.1% were in Group A, 28.2% in Group B, and 58.7% in Group C. Episiotomy rates were higher in Group C versus Groups A/B (38.7% vs. 34.7%/34.5%; p = 0.011), while overall perineal injury (87.2%–88.5%, p = 0.652) and OASI rates (0.5–1.0%, p = 0.428) did not differ. In multivariate analysis, GWG was not associated with perineal injury. Independent risk factors included epidural analgesia (OR = 1.39, 95% CI 1.10–1.75), vacuum-assisted delivery (VAD) (OR = 2.83, 95% CI 2.07–3.86), higher birthweight (OR = 1.06 per 100 gr., 95% CI 1.03–1.08), and advanced gestational age (OR = 1.13, 95% CI 1.04–1.23).

Conclusion

GWG was not associated with perineal injury, whereas VAD, epidural analgesia, increased birthweight, and advanced gestational age were independent risk factors.

目的：超重和肥胖与不良妊娠结局有关，然而较高的身体质量指数（BMI）与会阴撕裂伤（包括产科肛门括约肌损伤（OASI））的风险降低有关。妊娠期体重增加（GWG）在这种情况下的作用尚未得到很好的确定。本研究的目的是评估超重和肥胖初产妇GWG与会阴损伤之间的关系。方法：2012-2023年在某三级中心进行回顾性队列研究，纳入单胎、足月（≥37周）、阴道顶点分娩、孕前BMI≥25.0 kg/m2的初产妇。根据医学研究所指南，GWG将女性分类为：以下（ A组），内（ B组）或以上（ C组）。排除标准包括剖宫产、糖尿病、多胎、死产、早产、非顶点表现和产妇年龄45岁。会阴损伤定义为会阴撕裂或会阴切开术。进行单变量和多变量logistic回归分析。结果：5082例产妇中， A组13.1%， B组28.2%， C组58.7%。 C组会阴切开率高于 A/B组（38.7%比34.7%/34.5%,p = 0.011），而总会阴损伤（87.2% ~ 88.5%,p = 0.652）和OASI发生率（0.5 ~ 1.0%,p = 0.428）无差异。在多变量分析中，GWG与会阴损伤无关。独立危险因素包括硬膜外镇痛（OR = 1.39, 95% CI 1.10-1.75）、真空辅助分娩（VAD）（OR = 2.83, 95% CI 2.07-3.86）、较高出生体重（OR = 1.06 / 100克，95% CI 1.03-1.08）和高龄胎龄（OR = 1.13, 95% CI 1.04-1.23）。结论：GWG与会阴损伤无关，而VAD、硬膜外镇痛、出生体重增加和胎龄提前是独立的危险因素。

{"title":"Impact of gestational weight gain on perineal injury in overweight and obese primiparous women","authors":"Itamar Gilboa, Daniel Gabbai, Emmanuel Attali, Ronen Gold, Asnat Groutz, Yariv Yogev, Yoav Baruch","doi":"10.1007/s00404-025-08291-1","DOIUrl":"10.1007/s00404-025-08291-1","url":null,"abstract":"<div><h3>Objective</h3><p>Overweight and obesity are associated with adverse pregnancy outcomes, yet higher body mass index (BMI) has paradoxically been linked to reduced risk of perineal lacerations, including obstetric anal sphincter injury (OASI). The role of gestational weight gain (GWG) in this context is not well established. The objective of this study was to evaluate the association between GWG and perineal injury among overweight and obese primiparous women.</p><h3>Methods</h3><p>A retrospective cohort study was conducted at a tertiary center between 2012–2023, including primiparous women with singleton, term (≥ 37 weeks), vertex vaginal deliveries and pre-pregnancy BMI ≥ 25.0 kg/m<sup>2</sup>. Women were categorized by GWG based on Institute of Medicine guidelines: below (Group A), within (Group B), or above recommendations (Group C). Exclusion criteria included cesarean delivery, diabetes, multiple gestations, stillbirth, preterm birth, non-vertex presentation, and maternal age < 18 or > 45 years. Perineal injury was defined as any perineal laceration or episiotomy. Univariate and multivariable logistic regression analyses were performed.</p><h3>Results</h3><p>Among 5,082 deliveries, 13.1% were in Group A, 28.2% in Group B, and 58.7% in Group C. Episiotomy rates were higher in Group C versus Groups A/B (38.7% vs. 34.7%/34.5%; <i>p</i> = 0.011), while overall perineal injury (87.2%–88.5%, <i>p</i> = 0.652) and OASI rates (0.5–1.0%, <i>p</i> = 0.428) did not differ. In multivariate analysis, GWG was not associated with perineal injury. Independent risk factors included epidural analgesia (OR = 1.39, 95% CI 1.10–1.75), vacuum-assisted delivery (VAD) (OR = 2.83, 95% CI 2.07–3.86), higher birthweight (OR = 1.06 per 100 gr., 95% CI 1.03–1.08), and advanced gestational age (OR = 1.13, 95% CI 1.04–1.23).</p><h3>Conclusion</h3><p>GWG was not associated with perineal injury, whereas VAD, epidural analgesia, increased birthweight, and advanced gestational age were independent risk factors.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12769598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Knowledge, attitude and practice toward obesity and polycystic ovary syndrome among women of childbearing age with overweight or obesity 超重或肥胖育龄妇女对肥胖和多囊卵巢综合征的知识、态度和行为。

IF 2.5 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Archives of Gynecology and Obstetrics

Pub Date : 2026-01-05 DOI: 10.1007/s00404-025-08278-y

Yibing Mu, Ying Zou, Chanchan Chen

Purpose

Knowledge, attitudes, and practices (KAP) studies are widely used public health research tools to assess what people know, how they feel, and how they behave toward health conditions, providing insights into awareness gaps and guiding targeted interventions. Overweight and obesity in women of childbearing age are linked to a higher risk of polycystic ovary syndrome (PCOS). This study aimed to investigate the KAP toward obesity and PCOS among women with overweight or obesity of childbearing age.

Methods

This cross-sectional study included women of childbearing age with overweight or obesity, defined as body mass index (BMI) ≥ 24.0 kg/m² or waist circumference ≥ 85 cm according to Chinese adult criteria, from November 2022 to April 2023. Structural equation modeling (SEM) assessed the relationships between knowledge, attitude, and practice.

Results

Among 740 valid questionnaires, 51.08% were aged 18–30 years. Knowledge, attitude, and practice scores were 13.55 ± 5.06, 27.27 ± 2.19, and 50.14 ± 6.49, respectively. Positive correlations were found between knowledge and attitude (r = 0.313, P < 0.001), knowledge and practice (r = 0.454, P < 0.001), and attitude and practice (r = 0.415, P < 0.001). SEM showed significant associations between knowledge and attitude (β = 0.13, P < 0.001), between knowledge and practice (β = 0.46, P < 0.001), and between attitude and practice (β = 0.90, P < 0.001).Knowledge was indirectly associated with practice through attitude (β = 0.12, P < 0.001).

Conclusion

Women of childbearing age with overweight or obesity demonstrated insufficient knowledge, neutral attitudes, and moderate practices concerning obesity and PCOS. Targeted educational interventions focusing on enhancing knowledge and fostering positive attitudes toward healthy lifestyles and PCOS management would be helpful to mitigate the risk and impact of PCOS in this population.

目的：知识、态度和实践（KAP）研究是广泛使用的公共卫生研究工具，用于评估人们对健康状况的了解、感受和行为，为认识差距提供见解并指导有针对性的干预措施。育龄妇女超重和肥胖与多囊卵巢综合征（PCOS）的风险较高有关。本研究旨在探讨育龄期超重或肥胖妇女的KAP对肥胖和多囊卵巢综合征的影响。方法：本横断面研究纳入了2022年11月至2023年4月期间体重指数(BMI)≥24.0 kg/m2或腰围≥85 cm的超重或肥胖育龄妇女，符合中国成人标准。结构方程模型（SEM）评估了知识、态度和实践之间的关系。结果：740份有效问卷中，年龄在18-30岁之间的占51.08%。知识、态度、实践得分分别为13.55±5.06分、27.27±2.19分、50.14±6.49分。结论：育龄超重或肥胖妇女对肥胖与多囊卵巢综合征的认知不足，态度中立，行为适度。有针对性的教育干预侧重于提高对健康生活方式和多囊卵巢综合征管理的认识和培养积极态度，将有助于减轻多囊卵巢综合征在这一人群中的风险和影响。

{"title":"Knowledge, attitude and practice toward obesity and polycystic ovary syndrome among women of childbearing age with overweight or obesity","authors":"Yibing Mu, Ying Zou, Chanchan Chen","doi":"10.1007/s00404-025-08278-y","DOIUrl":"10.1007/s00404-025-08278-y","url":null,"abstract":"<div><h3>Purpose</h3><p>Knowledge, attitudes, and practices (KAP) studies are widely used public health research tools to assess what people know, how they feel, and how they behave toward health conditions, providing insights into awareness gaps and guiding targeted interventions. Overweight and obesity in women of childbearing age are linked to a higher risk of polycystic ovary syndrome (PCOS). This study aimed to investigate the KAP toward obesity and PCOS among women with overweight or obesity of childbearing age.</p><h3>Methods</h3><p>This cross-sectional study included women of childbearing age with overweight or obesity, defined as body mass index (BMI) ≥ 24.0 kg/m<sup>2</sup> or waist circumference ≥ 85 cm according to Chinese adult criteria, from November 2022 to April 2023. Structural equation modeling (SEM) assessed the relationships between knowledge, attitude, and practice.</p><h3>Results</h3><p>Among 740 valid questionnaires, 51.08% were aged 18–30 years. Knowledge, attitude, and practice scores were 13.55 ± 5.06, 27.27 ± 2.19, and 50.14 ± 6.49, respectively. Positive correlations were found between knowledge and attitude (r = 0.313, P < 0.001), knowledge and practice (r = 0.454, P < 0.001), and attitude and practice (r = 0.415, P < 0.001). SEM showed significant associations between knowledge and attitude (β = 0.13, P < 0.001), between knowledge and practice (β = 0.46, P < 0.001), and between attitude and practice (β = 0.90, P < 0.001).Knowledge was indirectly associated with practice through attitude (β = 0.12, P < 0.001).</p><h3>Conclusion</h3><p>Women of childbearing age with overweight or obesity demonstrated insufficient knowledge, neutral attitudes, and moderate practices concerning obesity and PCOS. Targeted educational interventions focusing on enhancing knowledge and fostering positive attitudes toward healthy lifestyles and PCOS management would be helpful to mitigate the risk and impact of PCOS in this population.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12769952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of obstetric and surgical factors on isthmocele development: insights from a prospective cohort study 产科和外科因素对峡部发育的影响：来自前瞻性队列研究的见解。

IF 2.5 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Archives of Gynecology and Obstetrics

Pub Date : 2026-01-04 DOI: 10.1007/s00404-025-08297-9

Ashraf Moini, Niloofar Attari, Fatemeh Shakki Katouli, Rana Karimi

Background

Isthmocele is a defect at the site of the cesarean section scar and is increasingly being recognized as a common complication following cesarean delivery. It may cause abnormal uterine bleeding, pelvic pain, and fertility issues. This study aimed to identify risk factors associated with isthmocele formation after the first cesarean section.

Methods

This prospective cohort study included 262 women aged 14–50 years who underwent their primary cesarean section at Arash Women’s Hospital from 2021 to 2024. Previous cesarean deliveries, the history of myomectomy, repeated uterine curettage, and age outside the 14–50 years were exclusion criteria. Demographic, obstetric, surgical, and postoperative data were collected. A transvaginal ultrasound was used for the detection of an isthmocele. Univariate and multivariate logistic regression analyses were performed to identify associated factors with isthmocele formation.

Results

Isthmocele was detected in 19% (n = 50) of patients. Women with isthmocele had higher gestational age at delivery (39.2 ± 0.9 vs. 38.5 ± 1.7 weeks; p = 0.04), shorter delivery intervals (4.6 ± 1.3 vs. 5.2 ± 0.9 years; p = 0.01), more frequent retroverted uterus (28% vs. 11.3%; p = 0.003) and locking suture repair (20% vs. 7.1%; p = 0.005). In multivariable analysis, gestational age (OR = 1.71, 95% CI 1.19, 2.45) and retroverted uterus (OR = 2.82, 95% CI 1.25, 6.35) increased the odds of isthmocele, while longer inter-delivery intervals were protective (OR = 0.65, 95% CI 0.44, 0.97).

Conclusions

Isthmocele is a frequent complication after primary cesarean section. Modifiable factors, such as the timing of delivery, management of infection, inter-pregnancy interval, and surgical technique, should be considered in reducing the risk.

背景：峡部囊肿是一种发生在剖宫产瘢痕部位的缺损，越来越多地被认为是剖宫产后常见的并发症。它可能导致子宫异常出血、骨盆疼痛和生育问题。本研究旨在确定与第一次剖宫产术后峡部囊肿形成相关的危险因素。方法：这项前瞻性队列研究包括262名14-50岁的女性，她们于2021年至2024年在Arash妇女医院接受了初次剖宫产手术。既往剖宫产、子宫肌瘤切除术史、反复刮宫、年龄在14-50岁以上为排除标准。收集了人口统计学、产科、外科和术后数据。经阴道超声用于峡部膨出的检测。进行单因素和多因素logistic回归分析，以确定与地峡膨出形成相关的因素。结果：19% （n = 50）的患者检测到峡部膨出。峡部膨出患者分娩时胎龄较高（39.2±0.9周比38.5±1.7周，p = 0.04），分娩间隔较短（4.6±1.3年比5.2±0.9年，p = 0.01），子宫后移发生率较高（28%比11.3%,p = 0.003），锁缝线修复发生率较高（20%比7.1%,p = 0.005）。在多变量分析中，胎龄（OR = 1.71, 95% CI 1.19, 2.45）和子宫后移（OR = 2.82, 95% CI 1.25, 6.35）增加了峡部膨出的几率，而较长的分娩间隔则具有保护作用（OR = 0.65, 95% CI 0.44, 0.97）。结论：峡部膨出是剖宫产术后常见的并发症。可改变的因素，如分娩时间、感染处理、妊娠期间隔和手术技术，应考虑在降低风险。

{"title":"Impact of obstetric and surgical factors on isthmocele development: insights from a prospective cohort study","authors":"Ashraf Moini, Niloofar Attari, Fatemeh Shakki Katouli, Rana Karimi","doi":"10.1007/s00404-025-08297-9","DOIUrl":"10.1007/s00404-025-08297-9","url":null,"abstract":"<div><h3>Background</h3><p>Isthmocele is a defect at the site of the cesarean section scar and is increasingly being recognized as a common complication following cesarean delivery. It may cause abnormal uterine bleeding, pelvic pain, and fertility issues. This study aimed to identify risk factors associated with isthmocele formation after the first cesarean section.</p><h3>Methods</h3><p>This prospective cohort study included 262 women aged 14–50 years who underwent their primary cesarean section at Arash Women’s Hospital from 2021 to 2024. Previous cesarean deliveries, the history of myomectomy, repeated uterine curettage, and age outside the 14–50 years were exclusion criteria. Demographic, obstetric, surgical, and postoperative data were collected. A transvaginal ultrasound was used for the detection of an isthmocele. Univariate and multivariate logistic regression analyses were performed to identify associated factors with isthmocele formation.</p><h3>Results</h3><p>Isthmocele was detected in 19% (<i>n</i> = 50) of patients. Women with isthmocele had higher gestational age at delivery (39.2 ± 0.9 vs. 38.5 ± 1.7 weeks; <i>p</i> = 0.04), shorter delivery intervals (4.6 ± 1.3 vs. 5.2 ± 0.9 years; <i>p</i> = 0.01), more frequent retroverted uterus (28% vs. 11.3%; <i>p</i> = 0.003) and locking suture repair (20% vs. 7.1%; <i>p</i> = 0.005). In multivariable analysis, gestational age (OR = 1.71, 95% CI 1.19, 2.45) and retroverted uterus (OR = 2.82, 95% CI 1.25, 6.35) increased the odds of isthmocele, while longer inter-delivery intervals were protective (OR = 0.65, 95% CI 0.44, 0.97).</p><h3>Conclusions</h3><p>Isthmocele is a frequent complication after primary cesarean section. Modifiable factors, such as the timing of delivery, management of infection, inter-pregnancy interval, and surgical technique, should be considered in reducing the risk.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12764567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145896198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnosis of major cardiac defects through routine early pregnancy ultrasound examination 妊娠早期常规超声检查对重大心脏缺陷的诊断

IF 2.5 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Archives of Gynecology and Obstetrics

Pub Date : 2026-01-03 DOI: 10.1007/s00404-025-08284-0

Juixiang Ma, Yan He, Youming Lei, Mingying Yao, Wei Wei

Objective

Early detection of major cardiac defects is crucial for the management and prognosis of affected pregnancies. This study evaluated the effectiveness of routine first-trimester ultrasounds in detecting major cardiac defects in singleton pregnancies.

Methods

This retrospective study (2015–2023) at a tertiary center included 35,230 singleton pregnancies undergoing routine ultrasounds at 11–14, 20–24, 28–34, and 34–38 weeks. High-resolution equipment and standardized protocols were used to assess fetal nuchal translucency and cardiac structure.

Results

Among the 35,230 pregnancies studied, 270 cases (0.8%) of major heart defects were identified. Hypoplastic left heart syndrome (HLHS) was detected in 31 cases with a 90% detection rate, while ventricular septal defects (VSD) were the most common, found in 128 cases with a lower detection rate of 16%. Pregnancy outcomes varied significantly with gestational age: 55.9% of early detections (11–13 weeks) led to termination, while 63.9% of mid-term detections (18–22 weeks) resulted in live births. The first-trimester ultrasound scans demonstrated 100% sensitivity and Negative Predictive Value (NPV), with a specificity of 93.85% and a Positive Predictive Value (PPV) of 90.27%. The Kappa value of 0.917 indicated moderate agreement between early and later scans. Notably, early diagnosis (11–13 weeks) was associated with a higher rate of pregnancy terminations, while later diagnoses corresponded to higher live birth rates.

Conclusion

Routine first-trimester ultrasounds effectively detect major cardiac defects early. However, the high sensitivity but low specificity necessitates follow-up scans to confirm findings and reduce false positives, ultimately enhancing prenatal care.

目的早期发现重大心脏缺陷对影响妊娠的处理和预后至关重要。本研究评估常规孕早期超声检测单胎妊娠主要心脏缺陷的有效性。方法回顾性研究（2015-2023）在某三级中心对35230例11-14周、20-24周、28-34周和34-38周的单胎孕妇进行常规超声检查。采用高分辨率设备和标准化方案评估胎儿颈部透明度和心脏结构。结果在35,230例妊娠中，发现270例（0.8%）存在严重心脏缺陷。左心发育不全综合征（HLHS） 31例，检出率90%；最常见的是室间隔缺损（VSD）， 128例，检出率较低，为16%。妊娠结局随胎龄变化显著：55.9%的早期检测（11-13周）导致终止妊娠，而63.9%的中期检测（18-22周）导致活产。孕早期超声扫描的敏感性为100%，阴性预测值（NPV）为93.85%，阳性预测值（PPV）为90.27%。Kappa值为0.917，表明早期和后期扫描的一致性中等。值得注意的是，早期诊断（11-13周）与较高的终止妊娠率相关，而较晚的诊断与较高的活产率相关。结论妊娠早期常规超声检查能较早发现重大心脏缺陷。然而，高灵敏度但低特异性需要随访扫描以确认发现并减少假阳性，最终加强产前护理。

{"title":"Diagnosis of major cardiac defects through routine early pregnancy ultrasound examination","authors":"Juixiang Ma, Yan He, Youming Lei, Mingying Yao, Wei Wei","doi":"10.1007/s00404-025-08284-0","DOIUrl":"10.1007/s00404-025-08284-0","url":null,"abstract":"<div><h3>Objective</h3><p>Early detection of major cardiac defects is crucial for the management and prognosis of affected pregnancies. This study evaluated the effectiveness of routine first-trimester ultrasounds in detecting major cardiac defects in singleton pregnancies.</p><h3>Methods</h3><p>This retrospective study (2015–2023) at a tertiary center included 35,230 singleton pregnancies undergoing routine ultrasounds at 11–14, 20–24, 28–34, and 34–38 weeks. High-resolution equipment and standardized protocols were used to assess fetal nuchal translucency and cardiac structure.</p><h3>Results</h3><p>Among the 35,230 pregnancies studied, 270 cases (0.8%) of major heart defects were identified. Hypoplastic left heart syndrome (HLHS) was detected in 31 cases with a 90% detection rate, while ventricular septal defects (VSD) were the most common, found in 128 cases with a lower detection rate of 16%. Pregnancy outcomes varied significantly with gestational age: 55.9% of early detections (11–13 weeks) led to termination, while 63.9% of mid-term detections (18–22 weeks) resulted in live births. The first-trimester ultrasound scans demonstrated 100% sensitivity and Negative Predictive Value (NPV), with a specificity of 93.85% and a Positive Predictive Value (PPV) of 90.27%. The Kappa value of 0.917 indicated moderate agreement between early and later scans. Notably, early diagnosis (11–13 weeks) was associated with a higher rate of pregnancy terminations, while later diagnoses corresponded to higher live birth rates.</p><h3>Conclusion</h3><p>Routine first-trimester ultrasounds effectively detect major cardiac defects early. However, the high sensitivity but low specificity necessitates follow-up scans to confirm findings and reduce false positives, ultimately enhancing prenatal care.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08284-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical characteristics and outcome of fetuses with ventriculomegaly: a retrospective multicenter study 脑室肿大胎儿的临床特征和预后：一项回顾性多中心研究。

IF 2.5 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Archives of Gynecology and Obstetrics

Pub Date : 2026-01-03 DOI: 10.1007/s00404-025-08279-x

Ebru Alici Davutoglu, Bilge Çetinkaya Demir, Yasemin Doğan, Niyazi Cenk Sayın, Oya Demirci, Tuğba Saraç Sivrikoz, Ismail Yilmaz, Cihan İnan, Murad Gezer, Recep Has, Atıl Yuksel, Riza Madazli

Purpose

To evaluate the incidence of associated structural anomalies, chromosomal/genetic abnormalities, infections and outcomes of fetuses with ventriculomegaly (VM).

Methods

Retrospective multicenter cohort study of 627 pregnancies with fetal VM. VM was classified as mild, moderate, or severe and isolated or non‐isolated. Genetic, obstetric and outcome data were collected and compared according to VM categories.

Results

The incidences of associated structural anomalies were 21.9%, 53.1% and 63.9% in mild, moderate and severe VM, respectively (p = 0.032 mild vs. moderate-severe). The incidences of genetic abnormality and fetal infection of the total VM group were 16.1% and 0.8%, respectively, with no significant differences between the VM categories (p > 0.05). The incidences of pathogenic genetic variant in the mild, moderate and severe VM were 13.5% (5/37), 16.7% (3/18) and 38.1% (8/21), respectively (p = 0.032 mild vs. severe). Fetal MRI identified additional CNS anomalies in 5.6% of cases. The incidences of surviving babies with neurological morbidities were significantly higher in fetuses with non-isolated VM groups than in isolated VM groups (p < 0.001).

Conclusion

The prognosis of fetuses with VM mostly depends on the severity and the associated anomalies. In all types of fetal VMs additional genetic investigations are valuable.

目的：探讨脑室肥大（VM）胎儿的相关结构异常、染色体/遗传异常、感染及预后。方法：对627例胎儿VM妊娠进行回顾性多中心队列研究。VM分为轻度、中度、严重、隔离和非隔离。根据VM分类收集遗传、产科和结局数据并进行比较。结果：轻、中、重度VM伴发结构异常的发生率分别为21.9%、53.1%和63.9% （p = 0.032）。VM组遗传异常和胎儿感染发生率分别为16.1%和0.8%，VM组间差异无统计学意义（p < 0.05）。轻、中、重度VM致病性遗传变异发生率分别为13.5%（5/37）、16.7%（3/18）、38.1%(8/21)，差异有统计学意义（p = 0.032）。胎儿MRI在5.6%的病例中发现额外的中枢神经系统异常。结论：VM胎儿的预后主要取决于其严重程度和相关异常。在所有类型的胎儿vm中，额外的遗传调查是有价值的。

{"title":"Clinical characteristics and outcome of fetuses with ventriculomegaly: a retrospective multicenter study","authors":"Ebru Alici Davutoglu, Bilge Çetinkaya Demir, Yasemin Doğan, Niyazi Cenk Sayın, Oya Demirci, Tuğba Saraç Sivrikoz, Ismail Yilmaz, Cihan İnan, Murad Gezer, Recep Has, Atıl Yuksel, Riza Madazli","doi":"10.1007/s00404-025-08279-x","DOIUrl":"10.1007/s00404-025-08279-x","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the incidence of associated structural anomalies, chromosomal/genetic abnormalities, infections and outcomes of fetuses with ventriculomegaly (VM).</p><h3>Methods</h3><p>Retrospective multicenter cohort study of 627 pregnancies with fetal VM. VM was classified as mild, moderate, or severe and isolated or non‐isolated. Genetic, obstetric and outcome data were collected and compared according to VM categories.</p><h3>Results</h3><p>The incidences of associated structural anomalies were 21.9%, 53.1% and 63.9% in mild, moderate and severe VM, respectively (<i>p</i> = 0.032 mild vs. moderate-severe). The incidences of genetic abnormality and fetal infection of the total VM group were 16.1% and 0.8%, respectively, with no significant differences between the VM categories (<i>p</i> > 0.05). The incidences of pathogenic genetic variant in the mild, moderate and severe VM were 13.5% (5/37), 16.7% (3/18) and 38.1% (8/21), respectively (<i>p</i> = 0.032 mild vs. severe). Fetal MRI identified additional CNS anomalies in 5.6% of cases. The incidences of surviving babies with neurological morbidities were significantly higher in fetuses with non-isolated VM groups than in isolated VM groups (<i>p</i> < 0.001).</p><h3>Conclusion</h3><p>The prognosis of fetuses with VM mostly depends on the severity and the associated anomalies. In all types of fetal VMs additional genetic investigations are valuable.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12764503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145896159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Synergistic use of 1,5-AG and HbA1c for early prediction of gestational diabetes: capturing BMI-dependent glycemic phenotypes 协同使用1,5- ag和HbA1c早期预测妊娠糖尿病：捕获bmi依赖型血糖表型

IF 2.5 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Archives of Gynecology and Obstetrics

Pub Date : 2026-01-02 DOI: 10.1007/s00404-025-08281-3

Sho Tano, Tatsuo Inamura, Kazuya Fuma, Seiko Matsuo, Kenji Imai, Satoru Katsuki, Yasuyuki Kishigami, Hidenori Oguchi, Tomomi Kotani, Takafumi Ushida, Hiroaki Kajiyama

Purpose

Recognizing metabolic heterogeneity in gestational diabetes mellitus (GDM) and body mass index (BMI)-linked phenotypes, we evaluated whether combining hemoglobin A1c (HbA1c, reflecting fasting glycaemia) and 1,5-anhydroglucitol (1,5-AG, reflecting post-load glucose excursions) improves early prediction and whether performance differs by BMI.

Methods

In this multicenter retrospective study, pregnant women who had 1,5-AG and HbA1c measured before 20 weeks of gestation at two tertiary centers in Japan were included. Spearman’s correlation was used to assess associations between glycemic markers and glucose levels. Predictive performance for GDM was evaluated using ROC analysis, and stratified analyses were conducted by pre-pregnancy BMI.

Results

Among 191 participants, 45 (24.1%) developed GDM: 35.1 ± 4.9 years, pre-pregnancy BMI 22.9 ± 4.3 kg/m², and sampling at 14.3 [IQR 14.0–14.7] weeks. HbA1c correlated with fasting glucose (r = 0.35) while 1,5-AG correlated inversely with 2-h glucose (r = − 0.39). They themselves were not significantly correlated (r = − 0.13). As single predictors, performance depended on BMI: in ≥ 25.0 kg/m², HbA1c outperformed 1,5-AG (AUC 0.776 vs 0.618); in BMI < 25.0 kg/m², 1,5-AG outperformed HbA1c (AUC 0.704 vs 0.640). In both BMI strata, the dual-marker model was superior (AUC 0.833 and 0.803, respectively) and provided more balanced sensitivity, accuracy, and F1. Pre-pregnancy BMI correlated positively with fasting plasma glucose (r = 0.47) but not with 1-h or 2-h glucose (r = 0.20 and r = 0.16, respectively), supporting BMI-related metabolic variation.

Conclusion

Combining 1,5-AG and HbA1c enhances early prediction of GDM by capturing complementary glycemic abnormalities linked to BMI-specific metabolic phenotypes.

目的：认识到妊娠糖尿病（GDM）和体重指数（BMI）相关表型的代谢异质性，我们评估了结合血红蛋白A1c（反映空腹血糖）和1,5-无氢葡萄糖醇（1,5- ag，反映负荷后血糖偏差）是否能改善早期预测，以及BMI是否会导致表现差异。方法在这项多中心回顾性研究中，纳入了在日本两个三级中心妊娠20周前检测1,5- ag和HbA1c的孕妇。Spearman相关性用于评估血糖指标和葡萄糖水平之间的关系。采用ROC分析评估GDM的预测性能，并采用孕前BMI进行分层分析。结果191名参与者中，45名（24.1%）发生GDM: 35.1±4.9年，孕前BMI 22.9±4.3 kg/m2，取样时间为14.3周[IQR 14.0-14.7]。HbA1c与空腹血糖相关（r = 0.35），而1,5- ag与2小时血糖呈负相关（r = - 0.39）。两者本身无显著相关（r = - 0.13）。作为单一预测指标，表现取决于BMI:≥25.0 kg/m2时，HbA1c优于1,5- ag (AUC 0.776 vs 0.618)；在BMI≤25.0 kg/m2组，1,5- ag优于HbA1c （AUC 0.704 vs 0.640）。在两个BMI层中，双标记模型更优越（AUC分别为0.833和0.803），并且提供了更平衡的灵敏度、准确性和F1。孕前BMI与空腹血糖呈正相关（r = 0.47），但与1 h和2 h血糖无相关性（r分别为0.20和0.16），支持BMI相关代谢变异。结论：1,5- ag和HbA1c结合可通过捕获与bmi特异性代谢表型相关的互补血糖异常来增强对GDM的早期预测。

{"title":"Synergistic use of 1,5-AG and HbA1c for early prediction of gestational diabetes: capturing BMI-dependent glycemic phenotypes","authors":"Sho Tano, Tatsuo Inamura, Kazuya Fuma, Seiko Matsuo, Kenji Imai, Satoru Katsuki, Yasuyuki Kishigami, Hidenori Oguchi, Tomomi Kotani, Takafumi Ushida, Hiroaki Kajiyama","doi":"10.1007/s00404-025-08281-3","DOIUrl":"10.1007/s00404-025-08281-3","url":null,"abstract":"<div><h3>Purpose</h3><p>Recognizing metabolic heterogeneity in gestational diabetes mellitus (GDM) and body mass index (BMI)-linked phenotypes, we evaluated whether combining hemoglobin A1c (HbA1c, reflecting fasting glycaemia) and 1,5-anhydroglucitol (1,5-AG, reflecting post-load glucose excursions) improves early prediction and whether performance differs by BMI.</p><h3>Methods</h3><p>In this multicenter retrospective study, pregnant women who had 1,5-AG and HbA1c measured before 20 weeks of gestation at two tertiary centers in Japan were included. Spearman’s correlation was used to assess associations between glycemic markers and glucose levels. Predictive performance for GDM was evaluated using ROC analysis, and stratified analyses were conducted by pre-pregnancy BMI.</p><h3>Results</h3><p>Among 191 participants, 45 (24.1%) developed GDM: 35.1 ± 4.9 years, pre-pregnancy BMI 22.9 ± 4.3 kg/m<sup>2</sup>, and sampling at 14.3 [IQR 14.0–14.7] weeks. HbA1c correlated with fasting glucose (<i>r</i> = 0.35) while 1,5-AG correlated inversely with 2-h glucose (<i>r</i> = − 0.39). They themselves were not significantly correlated (<i>r</i> = − 0.13). As single predictors, performance depended on BMI: in ≥ 25.0 kg/m<sup>2</sup>, HbA1c outperformed 1,5-AG (AUC 0.776 vs 0.618); in BMI < 25.0 kg/m<sup>2</sup>, 1,5-AG outperformed HbA1c (AUC 0.704 vs 0.640). In both BMI strata, the dual-marker model was superior (AUC 0.833 and 0.803, respectively) and provided more balanced sensitivity, accuracy, and F1. Pre-pregnancy BMI correlated positively with fasting plasma glucose (<i>r</i> = 0.47) but not with 1-h or 2-h glucose (<i>r</i> = 0.20 and <i>r</i> = 0.16, respectively), supporting BMI-related metabolic variation.</p><h3>Conclusion</h3><p>Combining 1,5-AG and HbA1c enhances early prediction of GDM by capturing complementary glycemic abnormalities linked to BMI-specific metabolic phenotypes.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08281-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fertility treatment and risk of non-gynecological cancer: a systematic review 生育治疗和非妇科癌症的风险：系统综述

IF 2.5 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Archives of Gynecology and Obstetrics

Pub Date : 2026-01-02 DOI: 10.1007/s00404-025-08264-4

SoYoung Kim, Jin-A. Mo, Hyun-Jung Kim, Seung-Ah Choe

Purpose

Evidence on the relationship between fertility treatment and non-gynecologic cancers remains limited. This study synthesizes available research on the association between fertility treatments and the risk of non-gynecologic cancers in women with infertility.

Methods

We systematically searched MEDLINE, EMBASE, and the Cochrane Library for studies involving women with infertility who received fertility treatment, compared with untreated women or the general population. Primary outcomes included the incidence of thyroid, colorectal, gastric, and lung cancers. Subgroup analyses were conducted by type of ovarian stimulation drug, in vitro fertilization (IVF) status, parity, length of follow-up, and choice of reference group.

Results

Fifteen studies met the inclusion criteria. Fertility treatment was positively, though imprecisely, associated with thyroid cancer (relative risk [RR] = 1.22; 95% confidence interval [CI]: 0.95–1.57). No increased risk of colorectal cancer was observed among treated women. Clomiphene citrate use was associated with a higher risk of thyroid cancer (RR = 1.28; 95% CI: 1.07–1.54) and a lower risk of colorectal cancer (RR = 0.79; 95% CI: 0.65–0.96).

Conclusion

Fertility medications may increase the risk of thyroid cancer while potentially reducing the risk of colorectal cancer in women with infertility. Given the small number of studies and their heterogeneity, these findings should be interpreted cautiously. Further research is needed to clarify these associations.

目的关于生育治疗与非妇科癌症之间关系的证据仍然有限。本研究综合了有关不孕妇女生育治疗与非妇科癌症风险之间关系的现有研究。方法：我们系统地检索了MEDLINE、EMBASE和Cochrane图书馆中有关接受生育治疗的不孕症妇女的研究，并将其与未治疗的妇女或普通人群进行比较。主要结局包括甲状腺、结直肠癌、胃癌和肺癌的发生率。按促卵巢药物类型、体外受精（IVF）情况、胎次、随访时间、参照组选择进行亚组分析。结果15项研究符合纳入标准。生育治疗与甲状腺癌呈正相关，尽管不完全相关（相对危险度[RR] = 1.22； 95%可信区间[CI]: 0.95-1.57）。在接受治疗的妇女中未观察到结直肠癌风险增加。使用克罗米芬与甲状腺癌的高风险（RR = 1.28; 95% CI: 1.07-1.54）和结直肠癌的低风险（RR = 0.79; 95% CI: 0.65-0.96）相关。结论不孕妇女服用生育药物可能增加甲状腺癌的风险，同时可能降低结直肠癌的风险。考虑到研究数量少且具有异质性，这些发现应谨慎解读。需要进一步的研究来澄清这些关联。

{"title":"Fertility treatment and risk of non-gynecological cancer: a systematic review","authors":"SoYoung Kim, Jin-A. Mo, Hyun-Jung Kim, Seung-Ah Choe","doi":"10.1007/s00404-025-08264-4","DOIUrl":"10.1007/s00404-025-08264-4","url":null,"abstract":"<div><h3>Purpose</h3><p>Evidence on the relationship between fertility treatment and non-gynecologic cancers remains limited. This study synthesizes available research on the association between fertility treatments and the risk of non-gynecologic cancers in women with infertility.</p><h3>Methods</h3><p>We systematically searched MEDLINE, EMBASE, and the Cochrane Library for studies involving women with infertility who received fertility treatment, compared with untreated women or the general population. Primary outcomes included the incidence of thyroid, colorectal, gastric, and lung cancers. Subgroup analyses were conducted by type of ovarian stimulation drug, in vitro fertilization (IVF) status, parity, length of follow-up, and choice of reference group.</p><h3>Results</h3><p>Fifteen studies met the inclusion criteria. Fertility treatment was positively, though imprecisely, associated with thyroid cancer (relative risk [RR] = 1.22; 95% confidence interval [CI]: 0.95–1.57). No increased risk of colorectal cancer was observed among treated women. Clomiphene citrate use was associated with a higher risk of thyroid cancer (RR = 1.28; 95% CI: 1.07–1.54) and a lower risk of colorectal cancer (RR = 0.79; 95% CI: 0.65–0.96).</p><h3>Conclusion</h3><p>Fertility medications may increase the risk of thyroid cancer while potentially reducing the risk of colorectal cancer in women with infertility. Given the small number of studies and their heterogeneity, these findings should be interpreted cautiously. Further research is needed to clarify these associations.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08264-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145886887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The outcomes of pregnancy after metabolic and bariatric surgery: a literature review 代谢和减肥手术后妊娠的结局：文献综述

IF 2.5 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Archives of Gynecology and Obstetrics

Pub Date : 2025-12-31 DOI: 10.1007/s00404-025-08290-2

Parisa Keshtkaran, Atefe Hashemi, Mahsa Razeghi, Mina Moosaie, Shaghayegh Moradi Alamdarloo

Purpose

The main purpose of this review is to examine the outcomes of pregnancy following different metabolic and bariatric surgical procedures.

Methods

A comprehensive literature search was conducted in PubMed for studies published between 2014 and 2024, focusing on pregnancy outcomes after bariatric surgery. The review analyzed outcomes across different surgical procedures: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric banding (AGB), and biliopancreatic diversion with duodenal switch (BPD-DS).

Results

Metabolic and bariatric surgery demonstrates significant benefits in reducing obesity-related pregnancy complications, including decreased rates of gestational diabetes and hypertensive disorders. However, procedure-specific risks were identified: RYGB showed increased risks of internal herniation and nutritional deficiencies; SG demonstrated more stable glycemic profiles with lower rates of complications; AGB required ongoing adjustment during pregnancy; and BPD-DS presented the highest risk of nutritional deficiencies. Small-for-gestational-age births were more common after malabsorptive procedures compared to restrictive ones. The traditional recommendation of waiting 12–24 months before conception appears oversimplified, with evidence suggesting procedure-specific timing considerations may be more appropriate.

Conclusions

While all bariatric procedures improve pregnancy outcomes compared to untreated obesity, the choice of procedure for women of reproductive age should carefully consider the balance between metabolic benefits and potential risks to maternal and fetal health. Individualized, procedure-specific approaches to post-surgical care and pregnancy timing are recommended.

目的本综述的主要目的是研究不同的代谢和减肥手术后的妊娠结局。方法在PubMed上对2014年至2024年发表的研究进行全面的文献检索，重点是减肥手术后的妊娠结局。该综述分析了不同手术方式的结果：Roux-en-Y胃旁路术（RYGB）、袖式胃切除术（SG）、可调节胃束带术（AGB）和十二指肠开关胆胰分流术（BPD-DS）。结果：代谢和减肥手术在减少肥胖相关妊娠并发症方面有显著的益处，包括降低妊娠糖尿病和高血压疾病的发生率。然而，确定了特定手术的风险：RYGB显示出内部疝和营养缺乏的风险增加；SG表现出更稳定的血糖谱和更低的并发症发生率；怀孕期间AGB需要持续调整；BPD-DS患者出现营养缺乏的风险最高。与限制性手术相比，吸收不良手术后小胎龄分娩更为常见。等待12-24个月再受孕的传统建议似乎过于简单，有证据表明，特定程序的时机考虑可能更合适。结论：虽然与未治疗的肥胖相比，所有减肥手术都能改善妊娠结局，但育龄妇女在选择手术时应仔细考虑代谢益处与对母婴健康的潜在风险之间的平衡。个性化的，具体程序的方法，术后护理和妊娠时机的建议。

{"title":"The outcomes of pregnancy after metabolic and bariatric surgery: a literature review","authors":"Parisa Keshtkaran, Atefe Hashemi, Mahsa Razeghi, Mina Moosaie, Shaghayegh Moradi Alamdarloo","doi":"10.1007/s00404-025-08290-2","DOIUrl":"10.1007/s00404-025-08290-2","url":null,"abstract":"<div><h3>Purpose</h3><p>The main purpose of this review is to examine the outcomes of pregnancy following different metabolic and bariatric surgical procedures.</p><h3>Methods</h3><p>A comprehensive literature search was conducted in PubMed for studies published between 2014 and 2024, focusing on pregnancy outcomes after bariatric surgery. The review analyzed outcomes across different surgical procedures: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric banding (AGB), and biliopancreatic diversion with duodenal switch (BPD-DS).</p><h3>Results</h3><p>Metabolic and bariatric surgery demonstrates significant benefits in reducing obesity-related pregnancy complications, including decreased rates of gestational diabetes and hypertensive disorders. However, procedure-specific risks were identified: RYGB showed increased risks of internal herniation and nutritional deficiencies; SG demonstrated more stable glycemic profiles with lower rates of complications; AGB required ongoing adjustment during pregnancy; and BPD-DS presented the highest risk of nutritional deficiencies. Small-for-gestational-age births were more common after malabsorptive procedures compared to restrictive ones. The traditional recommendation of waiting 12–24 months before conception appears oversimplified, with evidence suggesting procedure-specific timing considerations may be more appropriate.</p><h3>Conclusions</h3><p>While all bariatric procedures improve pregnancy outcomes compared to untreated obesity, the choice of procedure for women of reproductive age should carefully consider the balance between metabolic benefits and potential risks to maternal and fetal health. Individualized, procedure-specific approaches to post-surgical care and pregnancy timing are recommended.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08290-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Antepartum prediction of shoulder dystocia using machine learning 应用机器学习预测产前肩难产

IF 2.5 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Archives of Gynecology and Obstetrics

Pub Date : 2025-12-31 DOI: 10.1007/s00404-025-08271-5

Lior Heresco, Noa Levy, Omer Todress, Hadar Gluska, Tal Biron-Shental, Omer Weitzner

Purpose

Shoulder dystocia (SD) is a serious delivery complication, often occurring without identifiable risk factors. Accurate risk assessment is essential for educated decisions regarding the mode of delivery. This study aimed to develop and validate a machine learning-based model for SD prediction.

Methods

We conducted a retrospective analysis of term singleton vaginal deliveries at a single academic hospital over 10 years. Exclusion criteria included cesarean deliveries and multiple gestations. Maternal and fetal characteristics were compared between SD and non-SD cases. Eleven features were selected for model development. Missing values in normally distributed variables were imputed using mean values. To address class imbalance, repeated random sampling of non-SD cases was performed. Data were split into training and test sets (70:30) and standardized. Multiple machine learning models—including logistic regression, decision tree, random forest, support vector machine, XGBoost, and CatBoost—were evaluated using cross-validation and area under the ROC curve (AUC).

Results

Among 51,628 deliveries, 94 (0.18%) involved SD. SD was associated with higher BMI, shorter stature, and increased diabetes rates (all p < 0.05). Mean birthweight was significantly higher in the SD group (3751 g vs 3287 g, p < 0.01). The CatBoost model achieved the highest performance (AUC = 0.83, 95% CI 0.77–0.89). Key predictive features were sonographic estimated fetal weight (EFW, 55.6% of the model’s decision-making weight), maternal BMI (20.1%), and clinical EFW (7.9%).

Conclusion

Our machine learning-based model predicted SD with an AUC of 0.83 and may support clinicians in delivery planning.

目的肩难产（SD）是一种严重的分娩并发症，通常没有可识别的危险因素。准确的风险评估对于有关交付方式的明智决策至关重要。本研究旨在开发和验证基于机器学习的SD预测模型。方法回顾性分析某学术医院10年来单胎阴道分娩足月病例。排除标准包括剖宫产和多胎妊娠。比较SD和非SD病例的母胎特征。11个特征被选择用于模型开发。正态分布变量的缺失值使用平均值进行估算。为了解决类别不平衡问题，对非sd病例进行了重复随机抽样。数据被分成训练集和测试集（70:30）并标准化。使用交叉验证和ROC曲线下面积（AUC）对多个机器学习模型（包括逻辑回归、决策树、随机森林、支持向量机、XGBoost和catboost）进行评估。结果51628例分娩中，94例（0.18%）发生SD。SD与较高的BMI、较矮的身材和糖尿病发病率增加相关（均p <； 0.05）。SD组的平均出生体重显著高于对照组（3751 g vs 3287 g, p < 0.01）。CatBoost模型获得了最高的性能（AUC = 0.83, 95% CI 0.77-0.89）。主要预测特征是超声估计胎儿体重（EFW，占模型决策权重的55.6%）、母体BMI（20.1%）和临床EFW（7.9%）。结论基于机器学习的模型预测SD的AUC为0.83，可为临床医生制定分娩计划提供支持。

{"title":"Antepartum prediction of shoulder dystocia using machine learning","authors":"Lior Heresco, Noa Levy, Omer Todress, Hadar Gluska, Tal Biron-Shental, Omer Weitzner","doi":"10.1007/s00404-025-08271-5","DOIUrl":"10.1007/s00404-025-08271-5","url":null,"abstract":"<div><h3>Purpose</h3><p>Shoulder dystocia (SD) is a serious delivery complication, often occurring without identifiable risk factors. Accurate risk assessment is essential for educated decisions regarding the mode of delivery. This study aimed to develop and validate a machine learning-based model for SD prediction.</p><h3>Methods</h3><p>We conducted a retrospective analysis of term singleton vaginal deliveries at a single academic hospital over 10 years. Exclusion criteria included cesarean deliveries and multiple gestations. Maternal and fetal characteristics were compared between SD and non-SD cases. Eleven features were selected for model development. Missing values in normally distributed variables were imputed using mean values. To address class imbalance, repeated random sampling of non-SD cases was performed. Data were split into training and test sets (70:30) and standardized. Multiple machine learning models—including logistic regression, decision tree, random forest, support vector machine, XGBoost, and CatBoost—were evaluated using cross-validation and area under the ROC curve (AUC).</p><h3>Results</h3><p>Among 51,628 deliveries, 94 (0.18%) involved SD. SD was associated with higher BMI, shorter stature, and increased diabetes rates (all <i>p</i> < 0.05). Mean birthweight was significantly higher in the SD group (3751 g vs 3287 g, <i>p</i> < 0.01). The CatBoost model achieved the highest performance (AUC = 0.83, 95% CI 0.77–0.89). Key predictive features were sonographic estimated fetal weight (EFW, 55.6% of the model’s decision-making weight), maternal BMI (20.1%), and clinical EFW (7.9%).</p><h3>Conclusion</h3><p>Our machine learning-based model predicted SD with an AUC of 0.83 and may support clinicians in delivery planning.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08271-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of clinical outcomes between use of estradiol transdermal gel and oral estradiol valerate in patients undergoing frozen–thaw embryo transfer: an observational study 冻融胚胎移植患者使用雌二醇透皮凝胶和口服戊酸雌二醇的临床效果比较：一项观察性研究

IF 2.5 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Archives of Gynecology and Obstetrics

Pub Date : 2025-12-30 DOI: 10.1007/s00404-025-08277-z

Danni Zhou, Xinglin Wang, Huali Deng, Xiu Luo, Dongyun Liu, Hong Ye

Objective

The purpose of this study was to compare oral estradiol valerate and estradiol transdermal gel for clinical pregnancy outcomes in patients undergoing frozen–thaw embryo transfer (FET).

Methods

This was a prospective study performed between March 1, 2017 and October 30, 2019. Totally 244 HR FET cycles were included, with 123 cycles using oral estrogen tablets (oral group) and 121 applying estradiol transdermal gel (gel group). The primary aim of this study was to compare implantation (IR), clinical pregnancy (CPR), miscarriage (MR) and live birth (LBR) rates between the two groups. The secondary aim was to assess liver function, specifically measuring alanine transaminase (ALT) and aspartate transaminase (AST) levels at 12 weeks of gestation.

Results

There were no significant differences in EPR, IR, and CPR between the two groups. Meanwhile, the gel group had a higher live birth rate (55.37% versus 51.20%, p = 0.302) and a lower miscarriage rate (5.79% versus 10.57%, p = 0.173) compared with the oral group, but statistical significance was not reached. The oral group had higher ALT (16.58 ± 6.13 versus 23.78 ± 7.17, p < 0.001) and AST (19.70 ± 3.58 versus 23.78 ± 7.17, p = 0.001) levels at 12 weeks of gestation.

Conclusion

Estradiol transdermal gel is a safe and feasible alternative for endometrial preparation in frozen embryo transfer cycles, yielding comparable ongoing pregnancy rates to the standard oral regimen.

目的比较口服戊酸雌二醇和雌二醇透皮凝胶对冻融胚胎移植（FET）患者妊娠结局的影响。方法这是一项前瞻性研究，于2017年3月1日至2019年10月30日进行。共纳入244个hrfet周期，其中口服雌激素片123个周期（口服组），雌二醇透皮凝胶121个周期（凝胶组）。本研究的主要目的是比较两组的着床率（IR）、临床妊娠率（CPR）、流产率（MR）和活产率（LBR）。第二个目的是评估肝功能，特别是在妊娠12周时测量丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）水平。结果两组患者EPR、IR、CPR均无显著差异。凝胶组活产率（55.37%比51.20%,p = 0.302）高于口服组，流产率（5.79%比10.57%,p = 0.173）低于口服组，但差异无统计学意义。口服组在妊娠12周ALT（16.58±6.13比23.78±7.17,p < 0.001）和AST（19.70±3.58比23.78±7.17,p = 0.001）水平较高。结论雌二醇透皮凝胶是冷冻胚胎移植周期子宫内膜制备的一种安全可行的替代方案，其持续妊娠率与标准口服方案相当。

{"title":"Comparison of clinical outcomes between use of estradiol transdermal gel and oral estradiol valerate in patients undergoing frozen–thaw embryo transfer: an observational study","authors":"Danni Zhou, Xinglin Wang, Huali Deng, Xiu Luo, Dongyun Liu, Hong Ye","doi":"10.1007/s00404-025-08277-z","DOIUrl":"10.1007/s00404-025-08277-z","url":null,"abstract":"<div><h3>Objective</h3><p>The purpose of this study was to compare oral estradiol valerate and estradiol transdermal gel for clinical pregnancy outcomes in patients undergoing frozen–thaw embryo transfer (FET).</p><h3>Methods</h3><p>This was a prospective study performed between March 1, 2017 and October 30, 2019. Totally 244 HR FET cycles were included, with 123 cycles using oral estrogen tablets (oral group) and 121 applying estradiol transdermal gel (gel group). The primary aim of this study was to compare implantation (IR), clinical pregnancy (CPR), miscarriage (MR) and live birth (LBR) rates between the two groups. The secondary aim was to assess liver function, specifically measuring alanine transaminase (ALT) and aspartate transaminase (AST) levels at 12 weeks of gestation.</p><h3>Results</h3><p>There were no significant differences in EPR, IR, and CPR between the two groups. Meanwhile, the gel group had a higher live birth rate (55.37% versus 51.20%, <i>p</i> = 0.302) and a lower miscarriage rate (5.79% versus 10.57%, <i>p</i> = 0.173) compared with the oral group, but statistical significance was not reached. The oral group had higher ALT (16.58 ± 6.13 versus 23.78 ± 7.17, <i>p</i> < 0.001) and AST (19.70 ± 3.58 versus 23.78 ± 7.17, <i>p</i> = 0.001) levels at 12 weeks of gestation.</p><h3>Conclusion</h3><p>Estradiol transdermal gel is a safe and feasible alternative for endometrial preparation in frozen embryo transfer cycles, yielding comparable ongoing pregnancy rates to the standard oral regimen.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08277-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145852627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0