Gynecologic and Obstetric Investigation最新文献

{"title":"SEMA3C Promotes the Progression of Endometriosis by Inducing Ferroptosis and Enhancing the Viability and Migration of Endometrial Stromal Cells.","authors":"Yan Li, Yi Zhang","doi":"10.1159/goi/aczag005","DOIUrl":"10.1159/goi/aczag005","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to examine SEMA3C expression in endometriosis (EMs) and its relationship with ferroptosis in human endometrial stromal cells (HESCs).</p><p><strong>Design: </strong>This experimental study used patient tissue samples and in vitro gain- and loss-of-function assays. Participants/Materials: The participants and materials involved endometrial tissues from 30 patients with EMs and 30 controls, including paired ectopic and eutopic tissues from 10 patients, and primary HESCs.</p><p><strong>Setting: </strong>This study was set in the Affiliated Women and Children's Hospital of Ningbo University and its associated laboratory facilities.</p><p><strong>Methods: </strong>SEMA3C expression was assessed by immunohistochemistry, Western blotting, and qRT-PCR in this study. Primary HESCs were subjected to SEMA3C overexpression or siRNA-mediated knockdown. Cell viability, migration, iron content, lipid peroxidation, antioxidant activity, inflammatory cytokines, and ferroptosis regulators were analyzed. Ferrostatin-1 was used for rescue experiments.</p><p><strong>Results: </strong>This experimental study showed that SEMA3C was upregulated in ectopic tissues versus controls (p < 0.001) and correlated with disease severity (stages III-IV vs. I-II, p < 0.01). Ectopic lesions showed higher SEMA3C mRNA than matched eutopic endometrium (p < 0.001). Ectopic tissues and SEMA3C-overexpressing HESCs showed increased ferroptosis-related oxidative and inflammatory changes. SEMA3C overexpression enhanced HESC viability and migration, increased ACSL4, and decreased Nrf2, GPX4, and SLC7A11 expression (p < 0.001). SEMA3C knockdown or Ferrostatin-1 attenuated these alterations and suppressed HESC viability and migration (p < 0.01).</p><p><strong>Limitations: </strong>The findings of this study are based on clinical tissues and in vitro HESC experiments, and in vivo validation and prospective confirmation are required.</p><p><strong>Conclusions: </strong>It was shown thatSEMA3C promotes HESC viability and migration through ferroptosis-related oxidative and inflammatory mechanisms, identifying the SEMA3C-ferroptosis axis as a potential pathogenic pathway in EMs.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1"},"PeriodicalIF":2.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873904","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":"Cecoappendiceal Endometriosis Presenting as a Cecal Traction Diverticulum: A Case Report.","authors":"Chang Hyeok Ahn, Heejeong Lee, Min Jeong Kim, Na Rae Kim","doi":"10.1159/goi/aczag004","DOIUrl":"10.1159/goi/aczag004","url":null,"abstract":"<p><strong>Objectives: </strong>Cecoappendiceal endometriosis is rare and frequently mimics colorectal neoplasia, making preoperative diagnosis challenging. We report the first documented case of a true cecal traction diverticulum caused directly by endometriosis-associated smooth muscle hypertrophy and subserosal fibrosis.</p><p><strong>Case presentation: </strong>A 42-year-old nulliparous woman presented with an incidentally discovered malignant-appearing polypoid cecal mass on colonoscopy. Abdominal CT demonstrated a 1.5-cm enhancing lesion at the proximal appendix. Laparoscopic wedge resection of the cecum and appendix was performed. Histology revealed deep endometriosis (>5 mm) with dramatic smooth muscle hypertrophy (muscularis propria 12 mm vs. normal ∼0.37 mm; >30-fold increase) in both the cecum and appendix. A true traction diverticulum - confirmed histologically to contain all three bowel wall layers - had formed as a direct mechanical consequence of progressive endometriosis-driven hypertrophy and fibrosis. Immunohistochemistry demonstrated estrogen-receptor-positive glands and CD10-positive stroma; beta-catenin negativity excluded mesenteric fibromatosis.</p><p><strong>Conclusion: </strong>This is the first documented case of endometriosis-induced cecal traction diverticulum, establishing a new mechanistic concept in intestinal endometriosis. Endometriosis-driven myoproliferation combined with subserosal fibrosis may generate sufficient mechanical traction to invert the cecal wall into a diverticular configuration. Endometriosis should be included in the differential diagnosis of cecal diverticular lesions in reproductive-aged women, and pelvic MRI should be considered for preoperative characterization before attributing such lesions to neoplasia or diverticulitis.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1"},"PeriodicalIF":2.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864795","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":"GnRH Agonist with Low-Dose hCG (Dual Trigger) versus GnRH Agonist Only Trigger in High Responders in GnRH Antagonist Cycle: A Systematic Review and Meta-Analysis.","authors":"Hanom Husni Syam, Hartanto Bayuaji, Dian Tjahyadi, Anita Rachmawati, Mulyanusa Amarullah Ritonga, Nicholas Adrianto","doi":"10.1159/goi/aczag007","DOIUrl":"10.1159/goi/aczag007","url":null,"abstract":"<p><strong>Introduction: </strong>Ovarian hyperstimulation syndrome (OHSS) remains a serious complication of assisted reproductive technology, particularly in high ovarian responders. Although a GnRHa-only trigger effectively minimizes the risk of OHSS, it has been associated with reduced oocyte yield and, in some reports, lower oocyte maturity, and may also compromise luteal function. Dual trigger, combining GnRHa with low-dose human chorionic gonadotropin (hCG), was developed to enhance reproductive outcomes; however, concerns persist that even low-dose hCG may reintroduce OHSS risk. This systematic review and meta-analysis aimed to compare the efficacy and safety of dual trigger versus GnRHa-only trigger in high ovarian responders.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, and Google Scholar from January 2000 to December 2025 identified studies comparing dual trigger (GnRHa plus low-dose hCG) with GnRHa-only trigger in high responders undergoing IVF/ICSI. Randomized and observational cohort studies reporting reproductive outcomes or moderate-to-severe OHSS were included. Risk ratios (RRs) were calculated for reproductive outcomes, and odds ratios (ORs) were calculated for OHSS using random-effects models. Risk of bias was assessed using ROBINS-I, and the certainty of the evidence was evaluated using the GRADE framework.</p><p><strong>Results: </strong>Five retrospective cohort studies were included. Dual trigger did not improve the number of oocytes retrieved, the mature oocyte rate, the fertilization rate, the embryo quality, the clinical pregnancy rate, the live birth rate, the cumulative live birth rate, or the miscarriage rate compared with the GnRHa-only trigger. In contrast, dual trigger was associated with increased risk of moderate-to-severe OHSS (OR 12.33; 95% CI 3.30-46.04), with consistently higher OHSS risk observed across hCG doses. Notably, no cases of OHSS were observed with the GnRHa-only trigger in either fresh or freeze-all cycles.</p><p><strong>Conclusion: </strong>In high ovarian responders, dual trigger with low-dose hCG does not confer a reproductive benefit over GnRHa-only trigger but is associated with a higher observed incidence of moderate-to-severe OHSS. Because the included studies were limited in number and heterogeneous in embryo-transfer strategy, ovarian stimulation protocols, and hCG dosing, these findings should be interpreted with caution and regarded as hypothesis-generating. In particular, as fresh transfer cycles modify OHSS risk and subgroup analysis was not feasible, the applicability of these results to contemporary universal freeze-all practice remains uncertain.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1"},"PeriodicalIF":2.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148827669","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":"Blood Count Ratios and Postpartum Depressive Symptoms: Findings from a Homogeneous Sample of First-Time Mothers.","authors":"Ahmet Bilgi, Osman Yıldırım, Rrezearta Cungu, Rabia Nur Sağlam, Şeyma Kılıç, Cetin Çelik, Mehmet Kulhan","doi":"10.1159/000552902","DOIUrl":"10.1159/000552902","url":null,"abstract":"<p><strong>Objectives: </strong>Postpartum depressive symptoms (PDSs) are a common psychiatric condition with multifactorial aetiology. Haematological inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) have been proposed as indicators of systemic inflammation in mood disorders. This study aimed to investigate the association between these markers and PDSs in a homogeneous sample of first-time mothers.</p><p><strong>Design: </strong>This was a cross-sectional observational study. Participants/Materials: Ninety-two primiparous women attending a routine 2-week postpartum follow-up were included. Inclusion criteria comprised age ≥18 years, singleton term pregnancy, and attendance at postpartum follow-up.</p><p><strong>Setting: </strong>The review was conducted in a Department of Obstetrics and Gynaecology, Selçuk University Faculty of Medicine, Türkiye.</p><p><strong>Methods: </strong>Depressive symptoms were assessed using the validated Turkish Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score of ≥12. Complete blood count parameters were analysed, and NLR, PLR, and MLR were calculated. Statistical analyses included independent samples t-tests, Mann-Whitney U tests, chi-square tests, and binary logistic regression analysis.</p><p><strong>Results: </strong>Maternal and neonatal characteristics were comparable between groups. NLR, PLR, and MLR values did not differ significantly between women with and without PDSs. Logistic regression analysis demonstrated that none of these markers were independent predictors of PDSs (all p > 0.05).</p><p><strong>Limitations: </strong>The cross-sectional design precludes causal inference. Inflammatory markers were assessed at a single postpartum time point, and psychosocial factors potentially associated with depressive symptoms were not systematically evaluated.</p><p><strong>Conclusions: </strong>In this study, NLR, PLR, and MLR were not associated with PDSs. These findings suggest that simple blood count-derived ratios may have limited utility as standalone indicators of PDSs.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-7"},"PeriodicalIF":2.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792371","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":"microRNA-145-3p/CTNND1/FGF18 Signaling Pathway Regulates Apoptosis and Extracellular Matrix Degradation in the Vaginal Wall Fibroblasts of Patients with Pelvic Organ Prolapse.","authors":"Chunyan Liang, Yun Jiang, Yiyang Jiang, Qiuhui Lin, Qingli Cao, Haishi Sun","doi":"10.1159/goi/aczag002","DOIUrl":"10.1159/goi/aczag002","url":null,"abstract":"<p><strong>Setting: </strong>This study was conducted at both the clinical and cellular levels, utilizing patient-derived vaginal wall tissues and cultured vaginal wall fibroblasts (VWFs).</p><p><strong>Participants: </strong>The study participants were patients diagnosed with pelvic organ prolapse (POP), from whom vaginal wall tissues and VWFs were obtained.</p><p><strong>Objectives: </strong>The primary objective of this study was to clarify the precise function and molecular mechanism of microRNA-145-3p in the pathogenesis of POP, focusing on its impact on apoptosis and extracellular matrix (ECM) degradation.</p><p><strong>Methods: </strong>Validation and analysis: microRNA-145-3p expression was validated using qRT-PCR. Functional effects on proliferation, apoptosis, migration, and invasion were assessed via CCK8, flow cytometry, and transwell assays. Pathway and protein assessment: Western blotting was employed to evaluate ECM-related proteins, and Wnt/β-catenin pathway-related and PI3K/AKT pathway-related proteins. Target identification: bioinformatics prediction, dual-luciferase reporter gene assays, and CHIP were utilized to confirm the targeting relationship between microRNA-145-3p and CTNND1.</p><p><strong>Design: </strong>This was an experimental study integrating clinical tissue analysis, in vitro cell culture models, and molecular biology techniques to establish a functional and mechanistic pathway.</p><p><strong>Results: </strong>microRNA-145-3p was significantly elevated in the VWFs of POP patients. This elevated expression correlated with heightened apoptosis and ECM degradation. CTNND1 was identified as a direct target of microRNA-145-3p. Targeting CTNND1 led to the suppression of the Wnt/β-catenin signaling pathway and a subsequent decrease in FGF18 expression.</p><p><strong>Conclusions: </strong>In POP, the molecular mechanism involves microRNA-145-3p targeting CTNND1, which suppresses the Wnt/β-catenin signaling pathway, alters FGF18 expression, and consequently enhances apoptosis and ECM metabolism in VWFs, contributing to tissue weakness.</p><p><strong>Limitations: </strong>The provided text does not explicitly state the limitations of this study. Potential limitations could include the sample size of the patient cohort, the need for further in vivo validation, and the exploration of additional downstream targets or interacting pathways.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1"},"PeriodicalIF":2.7,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792408","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 Systematic Analysis of PMS-Related Disease Burden in China and Globally between 1990 and 2021.","authors":"Xiaoyan Ma, Hui Ren","doi":"10.1159/000552441","DOIUrl":"https://doi.org/10.1159/000552441","url":null,"abstract":"<p><strong>Background: </strong>Premenstrual Syndrome (PMS) has become a prevalent public health issue among reproductive-age women. However, comprehensive analyses of the temporal trends in PMS disease burden in China remain limited.</p><p><strong>Objective: </strong>To investigate the trends in the disease burden of Premenstrual Syndrome (PMS) among reproductive-age women in China and globally from 1990 to 2021, and to predict the burden up to 2035.</p><p><strong>Design: </strong>Secondary analysis of data from the Global Burden of Disease (GBD) 2021 study. Participants/Materials: Women of reproductive age (15-49 years).</p><p><strong>Setting: </strong>China and global populations.</p><p><strong>Methods: </strong>We analyzed temporal trends in PMS burden using the number of cases, years lived with disability (YLDs), crude prevalence rate (CPR), crude YLDs rate (CYR), age-standardized prevalence rate (ASPR), and age-standardized YLDs rate (ASYR). Joinpoint regression was used to analyze temporal trends, and a Bayesian age-period-cohort model was used to predict disease burden from 2022 to 2035.</p><p><strong>Results: </strong>From 1990 to 2021, the ASPR and ASYR of PMS in China were both lower than the global levels. In 2021, the ASPR and ASYR of PMS in China were 43,631.94 per 100,000 and 370.48 per 100,000, respectively, representing decreases of 1.70% and 1.21% compared with 1990. Globally, the corresponding rates were 45,504.28 per 100,000 and 379.98 per 100,000, showing increases of 1.23% and 1.18% compared with 1990. Moreover, the global number of prevalent cases and YLDs rose substantially by 49.88% and 49.46%, respectively. In 2021, the peak numbers of prevalent cases and YLDs of PMS in both China and the world occurred in the 35-39-year age group, while the CPR and CYR peaked in the 40-44-year age group. Projection results indicated that the burden of PMS in China, as measured by ASPR and ASYR, would intensify from 2022 to 2035, with the rates expected to increase to 44,969.08 per 100,000 and 380.07 per 100,000, respectively. Globally, the ASPR was projected to rise to 45,786.66 per 100,000, whereas the ASYR was expected to decrease to 377.10 per 100,000.</p><p><strong>Conclusion: </strong>This study revealed that, in contrast to the upward trend in the global burden of PMS among women of reproductive age, the PMS burden in China exhibited a slight decline. However, the PMS burden in both China and the world is likely to face growth challenges over the next decade, highlighting the urgency of implementing targeted public health interventions.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-12"},"PeriodicalIF":2.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711874","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":"Elevated Exposure to Lead, Mercury, or Chromium in Relation to Polycystic Ovary Syndrome: A Meta Analysis.","authors":"Xiaodan Zhu, Xiaolin Chu, Yunzhi Zhao, Xiaomei Wu, Xinpei Zhang, Kai Yang, Chao Chen, Wenjuan Xu, Bozhen Fan, Meixia Liu","doi":"10.1159/000552606","DOIUrl":"https://doi.org/10.1159/000552606","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to systematically assess the association between exposure to endocrine-disrupting heavy metals (Pb, Hg, or Cr) and the risk of polycystic ovary syndrome (PCOS) through a meta-analysis of observational studies.</p><p><strong>Design: </strong>Meta analysis Materials, Setting, Methods: We thoroughly explored PubMed, Embase, and the Cochrane Library for studies released until April 2023, using MeSH terms and keywords related to heavy metals and PCOS. Inclusion criteria encompassed observational studies reporting blood or urinary concentrations of Pb, Hg, or Cr in PCOS cases versus healthy controls.</p><p><strong>Results: </strong>Seven Asian studies involving 897 reproductive-aged women were included. Whole-blood levels of Pb were significantly higher in PCOS (SMD=0.494, 95% CI: 0.227-0.761, p = 0.0003; I² = 99%), while serum or urinary levels showed no difference. Whole blood analysis provided more biologically relevant data for Pb exposure assessment due to its high binding affinity for hemoglobin. No statistically significant associations were observed for Hg exposure across biological matrices: serum (SMD = 2.047, 95% CI: -2.382 to 6.476, p = 0.365), whole blood (SMD = 0.831, 95% CI: -0.740 to 2.401, p = 0.300), or urine (SMD = 0.110, 95% CI: -0.253 to 0.473, p = 0.553). PCOS women had significant increased Cr across biological matrices (serum: SMD=0.287, 95%CI: 0.085-0.632, p <0.001; whole blood: SMD=0.506, 95% CI: 0.184-0.828, p =0.002) with minimal heterogeneity (I² = 0%).</p><p><strong>Conclusions: </strong>This meta-analysis identifies Pb and Cr exposure as a potential risk factor for PCOS in Asian populations. In contrast, Hg exhibited no statistically significant associations. These findings highlight the need for metal-specific prevention strategies in reproductive health.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-16"},"PeriodicalIF":2.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678580","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 Interaction between Embryo Developmental Stage and Endometrial Preparation Protocol on Live Birth Outcomes in Frozen-Thawed Embryo Transfer: A Retrospective Cohort Study.","authors":"Xiaofang Zhang, Tingting Cao, Yang Zhang, Hongshan Ge","doi":"10.1159/goi/aczag001","DOIUrl":"10.1159/goi/aczag001","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives were to evaluate the independent associations of embryo developmental stage and endometrial preparation protocol with live birth after frozen-thawed embryo transfer (FET) and secondarily to explore whether an interaction exists between these two factors.</p><p><strong>Design: </strong>A retrospective cohort study of 1,214 eligible first FET cycles (from an initial cohort of 1,634 cycles), stratified by embryo type (D3 high-quality cleavage-stage embryos vs. D5 non-top-quality blastocysts) and endometrial protocol (modified natural cycle [mNC] vs. artificial cycle [AC]).</p><p><strong>Participants/materials, setting, methods: </strong>All included patients were undergoing their first FET cycle. The primary exposure variables were embryo type and endometrial preparation protocol. The primary outcome was live birth per transfer cycle. A multivariable logistic regression model was employed to test for an interaction between embryo type and endometrial preparation protocol and to calculate adjusted odds ratios (aORs) after controlling for female age, anti-Müllerian hormone level, duration of infertility, and endometrial thickness. Exploratory subgroup analysis was performed based on age (<35 years vs. ≥35 years). Model performance was evaluated using the Hosmer-Lemeshow test and the area under the receiver operating characteristic curve.</p><p><strong>Results: </strong>No statistical evidence of an interaction was detected between embryo type and endometrial preparation protocol (adjusted p = 0.453). In the adjusted model, both factors were independent predictors of live birth rate. The live birth rate was significantly higher following the transfer of a D5 non-top-quality blastocyst compared to a D3 high-quality cleavage-stage embryo (aOR = 1.48, 95% CI: 1.14-1.93). The mNC protocol was associated with a significantly higher live birth rate than the AC protocol (aOR = 1.78, 95% CI: 1.28-2.49). In exploratory age-stratified analyses, the association between mNC and live birth reached statistical significance in patients aged <35 years (OR = 1.66, p < 0.001) but not in those aged ≥35 years (OR = 1.62, p = 0.194); however, the interaction term between age group and endometrial protocol was not significant (P for interaction = 0.312).</p><p><strong>Limitations: </strong>The retrospective design may introduce selection bias and confounding, and findings from a single center may not be fully generalizable.</p><p><strong>Conclusions: </strong>In this retrospective cohort, embryo developmental stage and endometrial preparation protocol were each associated with live birth outcomes, and no statistical evidence of an interaction was detected. These findings should be interpreted as associations rather than causal effects. Exploratory age-stratified findings are hypothesis-generating and require confirmation in prospective studies.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1"},"PeriodicalIF":2.7,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148602130","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":"Beyond Size: The Impact of Endometrial Polyp Location on Malignancy Risk.","authors":"Ismail Baglar, Fatih Sanlikan, Esra Keles, Ugur Kemal Ozturk, Damlanur Yucel, Ummugulsum Kuyucu, Ozge Nur Gulen, Arzum Ozer, Aslı Sasmaz, Murat Api","doi":"10.1159/000553547","DOIUrl":"10.1159/000553547","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to evaluate whether endometrial polyp localization is associated with premalignant/malignant histopathology and to compare clinical and morphological characteristics between benign and premalignant/malignant polyps.</p><p><strong>Design: </strong>This is a single-center retrospective observational study. Participants/Materials: A total of 580 women who underwent hysteroscopic polypectomy with subsequent histopathological evaluation were included.</p><p><strong>Setting: </strong>The study was conducted at a tertiary referral center between January 2010 and December 2024.</p><p><strong>Methods: </strong>Polyps were categorized according to hysteroscopic localization (fundal, anterior wall, posterior wall, cornual, lower uterine segment). Cases were grouped as benign versus premalignant/malignant based on histopathology. Demographic variables (age, menopausal status), clinical presentation (abnormal uterine bleeding), and morphological parameters (polyp size, endometrial thickness) were compared. A multivariate logistic regression model including age, menopausal status, abnormal uterine bleeding, polyp size, endometrial thickness, and polyp localization was used to identify independent predictors.</p><p><strong>Results: </strong>Most polyps were fundal (31.0%), anterior wall (24.3%), or posterior wall (21.0). Premalignant/malignant pathology was detected in 6.4% of cases and occurred more frequently in fundal and cornual localizations. Compared with the benign group, the premalignant/malignant group had a higher mean age (56.7 ± 8.1 vs. 48.9 ± 9.4 years) and a higher proportion of postmenopausal women (78.9 vs. 37.5%). Abnormal uterine bleeding was more common in premalignant/malignant cases (94.7 vs. 61.3%). Median polyp size was larger (18 mm [7-38] vs. 12 mm [4-34]) and mean endometrial thickness was greater (15.2 ± 5.1 mm vs. 10.1 ± 4.6 mm). In multivariate analysis, fundal (OR 2.18, 95% CI: 1.02-4.66) and cornual localization (OR 2.87, 95% CI: 1.21-6.79) remained independently associated with premalignant/malignant pathology.</p><p><strong>Limitations: </strong>This is a retrospective, single-center design; results depend on the completeness and accuracy of hysteroscopic records. Data regarding tamoxifen and hormone replacement therapy use were not available.</p><p><strong>Conclusions: </strong>Beyond established risk factors, fundal and cornual localization of endometrial polyps is independently associated with premalignant/malignant pathology. Localization may add clinical value to risk stratification during hysteroscopic assessment.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-7"},"PeriodicalIF":2.7,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470114","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":"Prediction Model and Novel Classification System for Complications after Minimally Invasive Hysterectomy.","authors":"Andrea Stuart, Karin Källen, Michael Conditt, Hanna Källen Murray, Jan Baekelandt","doi":"10.1159/000553532","DOIUrl":"10.1159/000553532","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The aim of the study was to develop and validate a novel model for predicting complications in minimally invasive hysterectomy and to define a standardized classification system, the Hysterectomy Complication Classes (HCCs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This is a retrospective cohort study using merged data from four national Swedish registries. Data were randomly split into development and validation datasets. Multivariable logistic regression was used to identify risk factors and construct the prediction model, which was evaluated using area under the receiver operating characteristic curve (ROC_AUC). Participants/Materials: There were a total of 60,424 benign hysterectomies recorded in the Swedish National Quality Register for Gynecological Surgery, the Swedish National Drug Registry, Statistics Sweden, and the Swedish National Patient Registry.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study setting comprised nationwide Swedish population-based registries covering benign hysterectomy procedures performed across Sweden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interventions: &lt;/strong&gt;The intervention consisted of minimally invasive hysterectomy performed using vaginal, laparoscopic, or robotic techniques, with uterus weight and surgical indication as key exposure variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Multivariable logistic regression models estimated odds ratios (ORs) for risk factors associated with a composite complication outcome. The final model was applied to the validation dataset, and predictive performance was assessed using the ROC_AUC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome measures: &lt;/strong&gt;The primary outcome was a composite complication measure including perioperative complications, blood loss &gt;300 mL, conversion to open surgery, postoperative complications, reoperation, or antibiotic prescription within 6 weeks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Key risk factors for complications were indication for hysterectomy, BMI, previous cesarean section, age, and uterus size, with a significant interaction between uterus size and surgical technique. The highest risk was observed in patients with uterus weight &gt;1 kg undergoing vaginal hysterectomy (VH) (adjusted OR 25.5, 95% CI 3.3-199.8). Predicted complication probabilities were used to define five HCCs, ranging from HCC 1 (0-20%) to HCC 5 (81-100%). Validation demonstrated strong predictive accuracy across risk strata.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The composite outcome includes heterogeneous complications of varying clinical significance. Registry-based data may be subject to misclassification or underreporting. External validation outside Sweden has not yet been performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This comprehensive predictive model and the proposed HCC classification system provide a structured approach to estimating complication risk in minimally invasive hysterectomy. By accounting for patient variability and surgical factors, the HCC system supports individualized preoperative ","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-14"},"PeriodicalIF":2.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}