European journal of obstetrics, gynecology, and reproductive biology最新文献

{"title":"Obstetric Pharmacoethics: An ethical framework for obstetric pharmacology.","authors":"Ahizechukwu C Eke","doi":"10.1016/j.ejogrb.2026.115407","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2026.115407","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"327 ","pages":"115407"},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound suspicion of fetal large for gestational age: A population-based cohort study using propensity score overlap weighting.","authors":"Samantha M Krueger, Giulia M Muraca","doi":"10.1016/j.ejogrb.2026.115410","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2026.115410","url":null,"abstract":"<p><strong>Objective: </strong>To compare maternal and neonatal outcomes among large-for-gestational-age neonates with and without prenatal ultrasound suspicion of large-for-gestational-age.</p><p><strong>Study design: </strong>We conducted a population-based retrospective cohort study of term large-for-gestational-age births in Ontario, Canada (2012-2021) using linked health administrative data. Outcomes included labour interventions, maternal complications, and neonatal outcomes. Propensity scores with overlap weights were applied in modified Poisson regression models.</p><p><strong>Results: </strong>Among 82,359 large-for-gestational-age births, 3,969 (4.8%) had prenatal ultrasound suspicion of large-for-gestational-age. After adjustment, suspected large-for-gestational-age had higher rates of induction (aIRR [adjusted incidence rate ratio] 1.48, 95% CI 1.44-1.52), planned cesarean (2.76, 2.54-3.00), unplanned cesarean (1.40, 1.33-1.48), postpartum hemorrhage (1.16, 1.06-1.27), shoulder dystocia (1.10, 1.02-1.19), and neonatal intensive care unit admission (1.33, 1.23-1.43). Operative vaginal delivery and obstetric trauma rates were lower among deliveries with suspected large-for-gestational-age (0.69, 0.61-0.79 and 0.83, 0.72-0.96 respectively). In sensitivity analyses 1) removing gestational hypertension variables from the propensity score and 2) including those without a documented complication of suspected-large-for-gestation-age but a late third trimester ultrasound to the exposed group, results were similar to the main analysis.</p><p><strong>Conclusion: </strong>Prenatal ultrasound suspicion of large-for-gestational-age is associated with altered management but does not reduce cesarean delivery or shoulder dystocia but is effective in reducing operative vaginal delivery and obstetric trauma in a cohort of confirmed large-for-gestational-age births. Sensitivity analyses accounting for potential mediating factors and misclassification bias further supported the above findings.</p>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"327 ","pages":"115410"},"PeriodicalIF":2.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted surgery implementation and trends in surgical approaches for benign hysterectomies: A 12-Year hospital level ecological analysis in a French tertiary hospital network.","authors":"Bérengère Tate, Sixtine de Mourgues, Clémentine Gonthier, Juan Pablo Estevez, Martin Koskas","doi":"10.1016/j.ejogrb.2026.115406","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2026.115406","url":null,"abstract":"<p><strong>Study objective: </strong>To assess the temporal associations between the implementation of robotic-assisted surgery (RAS) and changes in the hysterectomy surgical approach for benign disease, with a focus on open surgery (OS).</p><p><strong>Methods: </strong>Multicentre retrospective hospital-level ecological study using data from the French national medico-administrative database Programme de Médicalisation des Systèmes d'Information (PMSI). All patients who underwent hysterectomy for benign gynaecologic indications between January 1, 2012, and December 31, 2023. Fourteen university hospitals within the Assistance Publique-Hôpitaux de Paris (AP-HP) network were divided into two groups: a robotic hospital group which included seven centres where a RAS platform was implanted in 2019, and a non-robotic hospital group which included seven centres where the RAS platform was implemented. Hysterectomy was performed via OS, conventional laparoscopy vaginal, or RAS approaches.</p><p><strong>Results: </strong>A total of 17,170 benign hysterectomies were included (11,668 (68.0%) in the robotic hospital group and 5,502 (32.0%) in the non-robotic hospital group). Between 2012 and 2018, OS rates decreased similarly in both groups (-5.6%/year vs. -5.3%/year; p = 0.97). Between 2019 and 2023, trends diverged significantly (p < 0.01): OS continued to decline in the robotic hospital group (-5.9%/year) but remained stable in the non-robotic hospital group (+0.6%/year). In the robotic hospital group, RAS increased to 32% by 2023, partially substituting conventional laparoscopy.</p><p><strong>Conclusion: </strong>In this academic hospital network, RAS implementation was temporally associated with lower OS routes rates for benign hysterectomy, although robotic surgery widely replaced laparoscopy. In centres where robotic surgery was not performed, the laparotomy rate did not decrease.</p>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"327 ","pages":"115406"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with maternal choice of planned mode of delivery after cesarean.","authors":"Pauline Bessis, Cyrielle Prat, Jeanne Sibiude, Gilles Kayem, Anne Pinton, Yoann Athiel","doi":"10.1016/j.ejogrb.2026.115402","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2026.115402","url":null,"abstract":"<p><strong>Introduction: </strong>Among women with a single prior cesarean delivery, the planned mode of delivery is chosen by the woman following appropriate counseling on the risks and benefits of elective repeat cesarean delivery (ERCD) versus trial of labor after cesarean (TOLAC). This study aimed to identify factors associated with the choice of planned mode of delivery in this population.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included women with a single prior cesarean delivery and no subsequent delivery, who gave birth to a singleton in cephalic presentation at or beyond 37 weeks of gestation between January 2023 and December 2024. Women with any contraindication to TOLAC were excluded. Demographic and obstetrical characteristics were compared between women who chose ERCD and those who chose TOLAC, using univariate and multivariate analyses.</p><p><strong>Results: </strong>During the study period, 685 women with a single prior cesarean delivery gave birth at our institution. Of these, 465 met the inclusion criteria: 345 (74.2%) in the TOLAC group and 120 (25.8%) in the ERCD group. Overall, 46.5% of women in the TOLAC group had cesarean delivery. Women in the ERCD group were significantly older (median age 35 [IQR 32-38] vs. 34 [IQR 30-37] years, p = 0.008) and more frequently overweight (BMI ≥ 25 kg/m² before pregnancy: 46.7% vs. 33.3%, p = 0.01). The rate of assisted reproductive technology conception was higher in the ERCD group (15.8% vs. 6.7%, p = 0.01), as was the rate of suspected macrosomia (33.3% vs. 17.8%, p < 0.01). Women in the ERCD group suffered significantly less from social deprivation (3.5% vs. 11.1%, p = 0.02). On multivariate analysis, only mode of conception and suspected macrosomia remained independently associated with the choice of ERCD (respectively ORa 2.38 [1.10-5.12] and ORa 2.40 [1.41-4.08].</p><p><strong>Conclusion: </strong>One in four women with a single prior cesarean delivery opted for elective repeat cesarean delivery. Mode of conception and estimated fetal weight large for gestational age were independently associated with the maternal choice of ERCD.</p>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"326 ","pages":"115402"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A large ovarian fibroma mimicking a subserosal fibroid: radiologic-pathologic correlation and surgical confirmation.","authors":"Amarpreet Kaur, Harneet Marwah, Janmejay Pant","doi":"10.1016/j.ejogrb.2026.115404","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2026.115404","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"327 ","pages":"115404"},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal serum clusterin in established gestational diabetes mellitus: association with the need for insulin therapy in a prospective case-control study.","authors":"Ahmet Kurt, Can Ozan Ulusoy, Sadun Sucu, Dilara Sarikaya Kurt, Aziz Kından, Özgür Volkan Akbulut, Selinay Atakay, Sadullah Özkan, Kadriye Yakut Yücel, Murat Levent Dereli","doi":"10.1016/j.ejogrb.2026.115401","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2026.115401","url":null,"abstract":"<p><strong>Background: </strong>Clusterin is a multifunctional glycoprotein involved in lipid transport, complement regulation, and oxidative/inflammatory stress responses, pathways relevant to insulin resistance and metabolic stress in gestational diabetes mellitus (GDM). However, its role in established GDM remains insufficiently defined. This study aimed to compare maternal serum clusterin in established GDM and normoglycemic controls and explore associations with the need for insulin therapy and perinatal outcomes.</p><p><strong>Methods: </strong>This prospective single-center case-control study included 88 singleton pregnancies at 24-28 weeks' gestation (44 GDM, 44 controls). Fasting serum clusterin was measured by enzyme-linked immunosorbent assay after completion of GDM screening and, in women who subsequently required insulin, before insulin initiation.</p><p><strong>Results: </strong>Clusterin was lower in GDM than in controls (1.46 [0.76-2.81] vs 2.56 [1.31-3.98] ng/mL; p = 0.018). Within GDM, women who subsequently required insulin had lower clusterin than those managed with diet alone (1.14 [0.54-1.63] vs 2.26 [1.32-3.98] ng/mL; p = 0.005). In exploratory Firth penalized regression, higher clusterin remained inversely associated with the need for insulin therapy after adjustment for selected clinical and glycemic covariates (adjusted odds ratio per 1 ng/mL increase, 0.50; 95% CI 0.27-0.91; p = 0.024). Clusterin alone showed modest discrimination for GDM (AUC 0.646, 95% CI 0.537-0.745), whereas its discrimination for insulin therapy was higher but imprecise because of the small subgroup and wide confidence interval (AUC 0.748, 95% CI 0.595-0.867). Clusterin did not significantly discriminate the composite adverse perinatal outcome in either the overall cohort or the GDM subgroup.</p><p><strong>Conclusions: </strong>Maternal serum clusterin was reduced in established GDM and was associated with the subsequent need for insulin therapy, suggesting a possible link with metabolic severity. These exploratory findings are hypothesis-generating and require validation before use in treatment stratification.</p>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"326 ","pages":"115401"},"PeriodicalIF":2.3,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic high intensity focused ultrasound treatment of rectal endometriosis.","authors":"A Mazard, G Dubernard, P Collinet, T Dennis, B Chauveau, M Basso, J-P Estrade, G Legendre, B Merlot, S Warembourg, L Marcellin, P Capmas, E Faller, C-A Philip, H Roman, M Canis","doi":"10.1016/j.ejogrb.2026.115400","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2026.115400","url":null,"abstract":"<p><strong>Background: </strong>Rectal endometriosis is among the most symptomatic forms of the disease. When hormonal therapy fails, surgery is often required. High-intensity focused ultrasound (HIFU) is widely used in gynecology for the treatment of myomas and adenomyosis. Transrectal robotic HIFU has previously been used for the treatment of rectal endometriosis, and the clinical outcomes of this approach have been published. To our knowledge, this is the first publication of a dedicated video demonstrating this approach and detailing the technology, treatment planning and procedural steps.</p><p><strong>Technique: </strong>The HIFU probe is inserted into the rectum under sonographic guidance. The rectal nodule is visualized and delineated by the physician using the imaging transducer. The software then divides the nodule into several slices. For each slice, the physician outlines the area to be treated. Based on the defined surface, the software calculates the number and location of HIFU shots needed to cover the entire lesion. Once all treatment zones are defined, the probe automatically positions itself at the lower edge of the lesion. The therapeutic transducer then delivers the HIFU energy, and the robotic system sequentially treats all predefined slices under real-time monitoring. Average procedure duration is 35 min, with treatment performed as an outpatient procedure.</p><p><strong>Experience: </strong>Transrectal HIFU has undergone progressive clinical evaluation through prospective feasibility and multicentre safety studies, followed by comparative evaluation with conventional surgery. Published studies have reported a favorable safety profile, improvement in gynecological and digestive symptoms, and shorter hospitalization compared with surgery.</p><p><strong>Conclusion: </strong>Transrectal robotic HIFU for rectal endometriosis appears to be a promising, minimally invasive alternative to surgery, with short treatment duration, low morbidity and significant symptom improvement.</p><p><strong>Tweetable statement: </strong>Robotic transrectal high-intensity focused ultrasound offers a minimally invasive alternative to surgery for rectal endometriosis, with short procedure time, low morbidity and significant symptom improvement.</p>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"326 ","pages":"115400"},"PeriodicalIF":2.3,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical rehabilitation and sexual function in endometriosis: a systematic review and meta-analysis.","authors":"Andrea Sánchez-Martín, Patricia Palomo-López, María Del Valle Ramírez-Durán","doi":"10.1016/j.ejogrb.2026.115399","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2026.115399","url":null,"abstract":"<p><strong>Background: </strong>Endometriosis is a chronic gynecological disease associated with pelvic pain and dyspareunia that negatively affects sexual function. Physical rehabilitation programs have emerged as a non-pharmacological therapeutic alternative; however, evidence regarding their effectiveness remains limited.</p><p><strong>Objectives: </strong>To analyze the effectiveness of physical rehabilitation programs on sexual function in women with endometriosis, assessed using the Female Sexual Function Index (FSFI).</p><p><strong>Methods: </strong>A systematic review with meta-analysis was conducted following PRISMA guidelines. Searches were performed in PubMed, Web of Science, Scopus, and the Cochrane Library, including randomized controlled trials involving women with endometriosis undergoing physical rehabilitation interventions. Methodological quality was assessed using the CASPe checklist and the Jadad Scale. Standardized mean differences (SMD) with 95% confidence intervals (95% CI) were analyzed using a random-effects model.</p><p><strong>Results: </strong>Results showed a trend toward improved sexual function in the intervention group; however, no statistically significant differences were observed (SMD = 0.12; 95% CI: -0.39 to 0.63). Given the small number of studies and clinical variability between interventions, these findings should be interpreted cautiously.</p><p><strong>Conclusions: </strong>Physical rehabilitation programs may have a potential beneficial effect on sexual function in women with endometriosis; however, the available evidence remains limited and inconclusive, and the pooled estimate should be interpreted as exploratory. Further adequately powered randomized controlled trials with standardized rehabilitation protocols are needed.</p>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"327 ","pages":"115399"},"PeriodicalIF":2.3,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of primary dysmenorrhea on quality of life among adolescent girls and working women: A systematic review.","authors":"Sergio Sbeih, Hajra Farooq, Holly Sims, Leila Mieville, Ibelle Madera, Naomi Bennett, Irem Yasar, Emily Joseph, Tala Qasem, Rhieya Rahul, Adriana I Gutiérrez-Camacho, James Segars, Bhuchitra Singh","doi":"10.1016/j.ejogrb.2026.115395","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2026.115395","url":null,"abstract":"<p><p>Primary dysmenorrhea is one of the most prevalent gynecological conditions among women worldwide. Current quantitative literature on primary dysmenorrhea provides insight into the prevalence and severity of the condition; however, the reliance on standardized quality-of-life questionnaires has limited our understanding of women's lived experiences and its true impact on day-to-day experiences. The objective of this systematic review was to evaluate the qualitative impacts of primary dysmenorrhea on women's daily functioning, mental well-being, and social participation. Seven unique themes were identified across the fourteen included studies which reflected stressors associated with the physical, socioemotional, behavioral, educational, occupational, and financial impacts of primary dysmenorrhea. Limitations in functioning, mental health consequences, psychosocial effects, and impacts on interactions with others were some of the reported consequences. Women also reported facing interruptions in their everyday lives, poor performance in school and in the workplace, psychological discomfort, social isolation, embarrassment and shame, and the need for behavioral or environmental adjustments, among other effects on their quality of life. The review of these qualitative studies demonstrated that overall experiences with primary dysmenorrhea varied significantly by symptom severity and by the intersection of individual circumstances, life stage, and socioeconomic position. Therefore, inclusion of qualitative parameters in menstrual health evaluation could potentially aid in assessment and developing a personalized treatment plan. A combination of qualitative and standardized methods may offer a solution that leverages the strengths of both methodologies while acknowledging real-world clinical constraints.</p>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"326 ","pages":"115395"},"PeriodicalIF":2.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resective-reconstructive surgery versus hysterectomy for placenta accreta spectrum: a histopathologically stratified cohort study.","authors":"Firat Okmen, Huseyin Ekici, Ali Akdemir, Pinar Uc, Ertan Karaman, Teksin Cirpan","doi":"10.1016/j.ejogrb.2026.115398","DOIUrl":"https://doi.org/10.1016/j.ejogrb.2026.115398","url":null,"abstract":"<p><strong>Objective: </strong>To compare maternal surgical and postoperative outcomes between resective-reconstructive surgery and cesarean hysterectomy in histopathologically confirmed placenta accreta spectrum, analysing patients by the initially intended surgical strategy.</p><p><strong>Methods: </strong>We retrospectively reviewed 141 consecutive, histopathologically confirmed placenta accreta spectrum cases managed at a tertiary centre over approximately nine years (January 2017-January 2026). The primary analysis classified patients by the initially planned strategy (planned resective-reconstructive surgery, n = 84; planned hysterectomy, n = 57); six women converted to hysterectomy were analysed within the planned resective-reconstructive surgery group, and an as-treated analysis (resective-reconstructive surgery, n = 78; hysterectomy, n = 63) was pre-specified as secondary. The primary outcome was intraoperative bladder injury; estimates were adjusted for age, gravidity and depth of invasion and verified with Cochran-Mantel-Haenszel stratification.</p><p><strong>Results: </strong>Hysterectomy was associated with more frequent intraoperative bladder injury (24.6% versus 8.3%; adjusted odds ratio 3.16, 95% confidence interval 1.16-8.64) and with greater transfusion requirements, longer operative time and longer postoperative stay (all p < 0.05). The bladder-injury association was consistent across accreta, increta and percreta strata (common odds ratio 3.24, 95% confidence interval 1.20-8.74). The as-treated analysis showed the same associations with larger effect sizes.</p><p><strong>Conclusion: </strong>In histopathologically confirmed placenta accreta spectrum, resective-reconstructive surgery was associated with lower measured maternal morbidity than hysterectomy; the association persisted, though attenuated, under the initially intended strategy and across depth-of-invasion strata. Because treatment was not randomized, these associations cannot establish superiority, and management should be individualized through multidisciplinary evaluation at experienced centres.</p>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"326 ","pages":"115398"},"PeriodicalIF":2.3,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}