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

{"title":"Impact of previous caesarean section on outcomes of first and second trimester surgical abortion: A systematic review and meta-analysis","authors":"Natalie Drever ,&nbsp;Vinay Gangathimmaiah ,&nbsp;Zinat Mohammadpour ,&nbsp;Cecelia O’Brien ,&nbsp;Catriona Melville ,&nbsp;Kirsten Black ,&nbsp;Caroline de Costa","doi":"10.1016/j.ejogrb.2026.114948","DOIUrl":"10.1016/j.ejogrb.2026.114948","url":null,"abstract":"<div><h3>Background</h3><div>It is unclear whether previous caesarean section (CS) increases the risk of complications during surgical abortion.</div></div><div><h3>Aims</h3><div>To compare surgical abortion complication rates in women with a history of previous CS to those without previous CS.</div></div><div><h3>Materials and methods</h3><div>Four databases were systematically searched in July 2024. Primary studies in English reporting on surgical abortion complications in women with and without a history of previous CS were included. Overall complications and major complications were compared between women with and without previous CS using a random effects meta-analysis. Sub-analyses were performed in women with &gt; 1 previous CS, and incidence of emergency hysterectomy. Certainty of evidence was assessed using GRADE.</div></div><div><h3>Results</h3><div>Ten retrospective cohort studies with 3123 women with and 14,514 without a previous CS were included in the meta-analysis. The overall incidence of major complications from surgical abortion was 0.9 %. Previous CS was associated with an increase in overall complications (OR = 2.00, CI 1.32–3.04, p = 0.001) and major complications (OR = 2.82, CI 1.83–4.36, p &lt; 0.00001). Major complications included haemorrhage requiring transfusion, uterine perforation and unplanned laparoscopy/laparotomy, while minor complications included cervical laceration and the need for repeat evacuation. There were no cases of uterine rupture during pre-procedural cervical ripening. Hysterectomy was an exceptionally rare occurrence (0.05 %); low-quality evidence from seven studies showed an association between history of CS and need for emergency hysterectomy (OR = 8.73, CI = 1.83–41.61, p = 0.007). The quality of the evidence was judged to be very low to medium mainly due to risk of bias of the included studies.</div></div><div><h3>Conclusion</h3><div>While major surgical complications of surgical abortion are rare, women with a prior history of CS were more than twice as likely to experience a complication.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114948"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973291","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":"Diabetes mellitus and body weight as risk factors for de-novo urgency after trans-obturator mid-urethral sling","authors":"Anna Tsviban ,&nbsp;Maurizio Serati ,&nbsp;Tal Fligelman ,&nbsp;Hadil Hassouna ,&nbsp;Roni Tomashev ,&nbsp;Anna Padoa","doi":"10.1016/j.ejogrb.2025.114906","DOIUrl":"10.1016/j.ejogrb.2025.114906","url":null,"abstract":"<div><h3>Background</h3><div>Mid-urethral slings (MUS) are the first-line surgical treatment for stress urinary incontinence (SUI). Despite their efficacy, de-novo urgency (dUU) remains a common and distressing postoperative complication. This study aimed to assess the incidence of dUU following trans-obturator MUS using the Monarc® system, and to identify risk factors associated with its development.</div></div><div><h3>Methods</h3><div>This retrospective study included women who underwent Monarc® MUS between 2009 and 2017 at a tertiary medical center. Patients with less than 12 months of follow-up or pre-existing urinary urgency were excluded. Data on demographics, medical history, and concomitant procedures were extracted. The primary outcome was dUU, defined as a newly reported compelling urge to void at 12 months postoperatively. Univariate logistic regression was used to identify associated risk factors.</div></div><div><h3>Results</h3><div>Of 305 women, 63 met inclusion criteria. At 12 months, dUU occurred in 31.7 % of patients. Preoperative diabetes mellitus (30 % vs. 2.3 %, p = 0.003) and higher BMI (median 28.7 vs. 26.0 kg/m², p = 0.002) were significantly associated with dUU. Age, parity, and concomitant pelvic floor surgeries were not significantly associated. The subjective cure rate for SUI was 93.7 %.</div></div><div><h3>Conclusions</h3><div>The incidence of dUU after trans-obturator MUS was higher than previously reported. Diabetes mellitus and elevated BMI emerged as significant risk factors. These findings support the inclusion of metabolic status in preoperative counselling and highlight the potential value of weight and glycemic management in improving postoperative outcomes for women undergoing SUI surgery.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114906"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145838111","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":"Classification of patients with adenomyosis based on clusters of coexisting diseases: An illustration of clinical diversity","authors":"Xin Wang ,&nbsp;YuDan Fu ,&nbsp;RuoXi Zhao ,&nbsp;Yong Liu,&nbsp;RuiHua Zhao","doi":"10.1016/j.ejogrb.2026.114962","DOIUrl":"10.1016/j.ejogrb.2026.114962","url":null,"abstract":"<div><h3>Objective</h3><div>Adenomyosis (AM) is a complex disease with poorly understood pathogenesis and considerable clinical phenotypic heterogeneity. Cluster analysis of coexisting diseases may help identify distinct clinical subtypes of AM and explore the potential association between AM and its coexisting diseases.</div></div><div><h3>Methods</h3><div>In this study, data were extracted from a cross-sectional questionnaire. AM patients were clustered by Ward’s method according to the coexisting diseases. Cluster of patients with similar coexisting diseases pattern was captured and characterized. Subsequently, the clinical characteristics of these clusters were compared.</div></div><div><h3>Results</h3><div>Data from 2080 AM patients were collected. Sixteen types of coexisting diseases were included in the cluster analysis, resulting in six distinct clusters: cluster 1 (leiomyoma of the uterus); cluster 2 (endometrial lesions); cluster 3 (benign breast and thyroid masses); cluster 4 (pelvic inflammatory disease); cluster 5 (benign ovarian cyst); cluster 6 (low burden of comorbidity).</div></div><div><h3>Conclusion</h3><div>Identifying patient clusters with similar coexisting diseases pattern can improve our understanding of the multidimensional nature of AM, reveal the complex inter-disease relationship, aid in early screening for specific diseases in particular subgroups, support the identification of risk factors for AM prevention, and guide the development of tailored management strategies for different subgroups.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114962"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022845","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":"Clinical and biological characteristics of dengue in pregnant women in Reunion Island: A nested case-control analysis in the EPIDENGUE cohort study","authors":"Anne Cécilia Etoa Ndoko ,&nbsp;Phuong Lien Tran ,&nbsp;Marine Lafont ,&nbsp;Yves Marie Diarra ,&nbsp;Malik Boukerrou ,&nbsp;Antoine Bertolotti ,&nbsp;Patrick Gérardin","doi":"10.1016/j.ejogrb.2025.114932","DOIUrl":"10.1016/j.ejogrb.2025.114932","url":null,"abstract":"<div><h3>Introduction</h3><div>Dengue is globally the most widespread arboviral disease, especially in tropical and subtropical regions. The primary aim of this study was to compare clinical and biological characteristics of dengue in pregnant and non-pregnant women on Reunion Island.</div></div><div><h3>Methods</h3><div>In the EPIDENGUE retrospective cohort conducted in University Hospital Center (CHU) of Saint Pierre, Réunion Island, between January 1, 2019, and June 30, 2019, we matched pregnant women (“PWG”, cases) and non-pregnant women (“NPWG”, controls) infected with dengue on age and identified the characteristics associated with dengue in pregnant women using a conditional logistic regression model.</div></div><div><h3>Results</h3><div>Among 274 female patients (median age 28.3 years) that were matched, patients in the PWG were more likely to develop pruritus (OR 5.18 [95 %CI 1.34–20.08] p = 0.017), less likely to experience anorexia (OR 0.19 [95 %CI 0.06–0.59] (p = 0.004), fever (OR 0.15 [95 %CI 0.04–0.65], p = 0.012), or to have a hematocrit of 38 % or above (OR 0.05 [95 %CI 0.01–0.22] p &lt; 0.001) once controlled age, as compared to NPWG. We observed a non-significant trend towards a higher hematocrit level in women presenting warning signs (34.7 % <em>vs</em> 34.2 %, p = 0.084).</div></div><div><h3>Conclusion</h3><div>This nested case-control analysis highlights several clinical and-biological differences between pregnant and non-pregnant women with dengue, which are important to consider for avoiding the overdiagnosis of intrahepatic cholestasis of pregnancy and tailoring the monitoring of dengue in pregnant women. That implies screening for anorexia, fever and increase in hematocrit (prior to the decrease in platelet counts) as potential harbingers of progression to dengue with warning signs.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114932"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881265","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 effect of prophylactic antibiotics prior to catheter balloon insertion on clinical chorioamnionitis in GBS-colonized term pregnancies","authors":"Raneen Abu Shqara ,&nbsp;Sabaa Knaneh ,&nbsp;Roni Jeremias Laskar ,&nbsp;Lior Lowenstein ,&nbsp;Enav Yefet ,&nbsp;Maya Frank Wolf","doi":"10.1016/j.ejogrb.2025.114898","DOIUrl":"10.1016/j.ejogrb.2025.114898","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the risk of clinical chorioamnionitis at delivery among patients with Group B Streptococcus (GBS) colonization undergoing induction of labor (IOL) with catheter balloon insertion, according to two protocols.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of patients with term singleton pregnancies undergoing IOL for medical indications at two tertiary centers. At Galilee Medical Center, positive GBS colonization prompted intravenous ampicillin (2 g every 6 h) starting 30 min prior to catheter balloon insertion and continued until delivery (early antibiotic prophylaxis group). At Tzafon Medical Center, antibiotics were administered according to standard guidelines at the onset of active labor or rupture of membranes (routine intrapartum antibiotic prophylaxis (IAP) group). The primary outcome was clinical chorioamnionitis. Secondary outcomes included postpartum infectious morbidity, delivery mode, and neonatal outcomes.</div></div><div><h3>Results</h3><div>Of 144 patients, 75 received early prophylactic antibiotics and 69 received routine<!--> <!-->IAP<strong>.</strong> Baseline maternal and obstetric characteristics were comparable. For the early prophylactic antibiotics vs. the routine IAP group, prevalences were lower of clinical chorioamnionitis (0.0 % vs. 8.7 %, p = 0.002) and maternal fever (2.7 % vs. 15.9 %, p = 0.005). Statistically significant differences were not observed in postpartum infections, cesarean delivery rates (16.0 % vs. 26.1 %, p = 0.136), or neonatal outcomes. On multivariate analysis, routine IAP administration compared with early prophylactic antibiotics was independently associated with an increased risk of clinical chorioamnionitis (adjusted odds ratio 9.43, 95 % confidence interval 1.66–53.45, p = 0.01).</div></div><div><h3>Conclusion</h3><div>Prophylactic antibiotics administered prior to catheter balloon insertion in patients with GBS colonization were associated with a lower risk of clinical chorioamnionitis.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114898"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803580","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":"Association between severity of obstetric perineal tears and risk of levator ani avulsion – a systematic review","authors":"Line Norring Holst ,&nbsp;Kathrine Perslev ,&nbsp;Niels Klarskov ,&nbsp;Hanna Jangö","doi":"10.1016/j.ejogrb.2025.114896","DOIUrl":"10.1016/j.ejogrb.2025.114896","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of this study was to investigate whether the incidence of levator ani avulsion (LAA) is associated with the degree of obstetric tear.</div></div><div><h3>Methods</h3><div>This systematic review was conducted in accordance with the PRISMA guidelines. A literature search was performed in PubMed, the Cochrane Library, and Embase. Articles were screened by two independent reviewers, and data were extracted on study characteristics, number of included women, degree of obstetric perineal tear, and the incidence of levator ani avulsion (LAA).</div></div><div><h3>Results</h3><div>A total of 13 studies were included, comprising 3,584 primiparous women. We found that the incidence of levator ani avulsion was 13 % (95 %CI: 10–17 %) in women without a perineal tear, 24% (95 %CI: 20–29 %) with a first-degree tear, 22 % (95 %CI: 18–25 %) with a spontaneous second-degree tear, 23 % (95 %CI: 17–29 %) with an episiotomy, and 35% (95 %CI: 30–40 %) with an obstetric anal sphincter injury (OASI). Additionally, some studies grouped women with no, first-, or second-degree tears together and here the incidence of LAA was 16% (95 %CI: 14–18 %).</div></div><div><h3>Conclusion</h3><div>LAA is common after vaginal delivery and is related to the degree of obstetric tear, ranging from 13 % in women without perineal tear to 35 % with OASI.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114896"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780729","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":"Tubal patency testing in women with polycystic ovary syndrome − is it worth before ovarian induction: Cost-effectiveness analysis","authors":"Magdalena Piróg ,&nbsp;Bartosz Chrostowski ,&nbsp;Robert Jach","doi":"10.1016/j.ejogrb.2025.114888","DOIUrl":"10.1016/j.ejogrb.2025.114888","url":null,"abstract":"<div><h3>Background</h3><div>Polycystic ovarian syndrome (PCOS) is related to infertility due to anovulatory cycles. However, it is unknown whether women with PCOS are at higher risk of tubal factor of infertility.</div></div><div><h3>Objectives</h3><div>This study sought to investigate the diagnostic accuracy of hysterosalpingo-foam sonography (HyFoSy) in women with polycystic ovarian syndrome (PCOS) before initiation of ovarian induction (OI)?</div></div><div><h3>Study design:</h3><div>We studied 432 infertile women in two groups: 1) with PCOS (n = 216) and 2) without PCOS (n = 216) which served as the controls. Data analysis included basic clinical parameters, duration of infertility, history of previous abdominal surgeries, pelvic inflammatory disease (PID), ectopic pregnancy (EP) and smoking status. The primary outcome of this study was the evaluation of the tubal patency testing outcomes in women with PCOS and compare it to women without ovulatory disorders. Secondary outcome was a cost-effectiveness analysis focused on direct medical costs related to chosen therapeutic models: 1) primary 3 cycles of OI and 2) HyFoSy followed by 3 cycles of OI if at least one tube was patent.</div></div><div><h3>Results</h3><div>Women with PCOS had higher number of previous abdominal surgeries (+23.1 %) compared to the controls, with no differences in previously diagnosed either PID or EP and smoking. Bilateral tubal blockage was observed in 5 % of women with PCOS which was comparable to women without ovulatory disorders (4.2 %, p &gt; 0.05). Regarding risk factors for blockage, among PCOS women at least one risk factor such as previous abdominal surgery, history of PID, EP or smoking were observed in 81.8 % (n = 9) participants with bilateral blocked tubes, 63.2 % (n = 12) in unilateral blocked group and 23.1 % (n = 43) participants with both patent tubes. The mean total costs per women were lower in Model 1 compared to Model 2 ($61 vs. $364, respectively). Implementation of HyFoSy in women with PCOS without risk factors of tubal blockage is not worth the extra cost and prolong the time to pregnancy.</div></div><div><h3>Conclusion</h3><div>A treatment model starting with OI before HyFoSY is cost-effective compared to the model with HyFoSY performed before OI. Tubal factor is present in 5% of woman with PCOS which is comparable to infertile women without ovulatory disorders.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114888"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735919","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":"To the Editor: Tan RCA, Jie Ying KO, Ng QJ, Qi M, Lee JM, Bhutia K. vNOTES hysterectomy for patients with large uteri: Initial experience in the largest Tertiary Centre in Singapore. Eur J Obstet Gynecol Reprod Biol. 2025 Jun;310:113952. https://doi.org/10.1016/j.ejogrb.2025.113952. Epub 2025 Apr 4","authors":"Wai Yoong,&nbsp;Esther Skene,&nbsp;Martin Kawabata,&nbsp;Joachim Ho","doi":"10.1016/j.ejogrb.2026.114955","DOIUrl":"10.1016/j.ejogrb.2026.114955","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114955"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973293","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":"Assessment of AI-generated responses to common pregnancy questions: A blinded expert evaluation","authors":"Arif Onur Atay ,&nbsp;Feride Atay ,&nbsp;Oguzcan Corlu","doi":"10.1016/j.ejogrb.2026.114960","DOIUrl":"10.1016/j.ejogrb.2026.114960","url":null,"abstract":"<div><h3>Introduction</h3><div>We conducted a cross-sectional, blinded expert evaluation of AI-generated answers to 22 frequently asked pregnancy questions to characterize content quality and potential clinical utility.</div></div><div><h3>Methods</h3><div>Five obstetricians (not involved in rating) compiled the questions; ChatGPT produced responses using a minimal prompt with a fresh session per item. Forty board-certified OB/GYNs rated each answer on 5-point Likert scales for accuracy, comprehensiveness, safety, and understandability; two deliberately incorrect attention-check items were embedded and excluded.</div></div><div><h3>Results</h3><div>We obtained 879/880 expected rating blocks (&lt;0.1% missing). Domain means clustered tightly (accuracy 3.95 ± 0.20, safety 3.94 ± 0.16, understandability 3.94 ± 0.19, comprehensiveness 3.91 ± 0.17), with no overall domain difference (Friedman χ²(3) = 3.13, p = 0.372). Question-level means ranged 3.71–4.31, highest for routine daily-life topics (air travel, sexual activity, sleep position, exercise) and lowest for context-dependent items (e.g., (non-stress test) NST 3.71; heartburn 3.72; edema 3.79; vaginal bleeding 3.81). Pre-specified subgroups showed a small but significant difference (Kruskal–Wallis p = 0.033): daily life scored higher than follow-up/testing/procedures (adjusted p &lt; 0.05), whereas daily life vs symptoms and symptoms vs follow-up were not significant. In domain × subgroup analyses, only understandability differed (p = 0.020), with daily life &gt; symptoms (adjusted p = 0.043); safety’s global difference did not yield significant pairwise contrasts. Overall inter-rater reliability was moderate, supporting consistent expert evaluation while underscoring increased variability in symptom-based assessments.</div></div><div><h3>Conclusions</h3><div>Experts rated the AI-generated answers as moderate-to-high overall; however, inter-rater reliability was only moderate and varied markedly by question type (highest for daily life questions and very low for symptom-related questions) indicating heterogeneous clinician judgments and supporting cautious interpretation of these findings.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114960"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973295","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":"Delivery plan in cardio-obstetric management of pregnant patients with heart disease: an Italian Delphi study","authors":"Elena Zaccone ,&nbsp;Barbara Zaina ,&nbsp;Laura Angeli ,&nbsp;Gaia Spaziani ,&nbsp;Stefano Carugo ,&nbsp;Massimo Micaglio ,&nbsp;Giuseppe Sofi ,&nbsp;Fabio Parazzini ,&nbsp;Federico Mecacci ,&nbsp;Irene Cetin","doi":"10.1016/j.ejogrb.2026.114958","DOIUrl":"10.1016/j.ejogrb.2026.114958","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) is the leading indirect cause of maternal morbidity and mortality in high-income countries. Managing pregnant women with cardiac conditions requires multidisciplinary coordination and individualized planning. Early risk stratification, commonly performed using the modified World Health Organization (mWHO) classification, is essential to guide the management of pregnant women with heart disease. The Delivery Plan (DP) is proposed as a standardized tool to guide peripartum care in this population.</div></div><div><h3>Objective</h3><div>To evaluate expert consensus on the structure and implementation of a standardized DP for pregnant women with heart disease, using a modified Delphi methodology.</div></div><div><h3>Methods</h3><div>A two-round Delphi survey was conducted among 30 cardio-obstetric experts from five tertiary Italian centers. The first phase assessed current practices regarding cardiac follow-up and investigations in pregnancy. The second phase evaluated agreement on 21 proposed DP items across different mWHO risk classes and explored the role of non-cardiac risk factors.</div></div><div><h3>Results</h3><div>In phase one, consensus (≥70% agreement) was achieved for 78.4% of cardiac follow-up practices and 87.9% of diagnostic investigations. In phase two, all 21 DP items were endorsed for general inclusion. Stratification by mWHO risk class showed no consensus for mWHO I, partial agreement for mWHO II, and full consensus for mWHO II/III to IV. Strong agreement (median ≥ 9, IQR ≤ 2) was observed for most items in higher-risk classes. Additionally, obesity, hypertension, and preeclampsia were identified as relevant non-cardiac risk factors warranting structured planning.</div></div><div><h3>Conclusions</h3><div>The study supports the use of a structured, risk-adapted DP for pregnant women with cardiac disease. High consensus in moderate-to-severe risk groups confirms the DP’s utility in enhancing multidisciplinary coordination and may contribute to improved maternal–fetal outcomes, pending prospective validation.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114958"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973307","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}