Gynecologic and Obstetric Investigation最新文献

{"title":"Artificial Intelligence for Cervical Human Papillomavirus Infection and Lesion Screening: A Cross-Sectional Analysis of Its Application Potential and Patient Satisfaction.","authors":"Ping Zheng, Yan Yang, Sha Li, Jianxin Zhang, Fang Gu, Hua Li","doi":"10.1159/000553436","DOIUrl":"10.1159/000553436","url":null,"abstract":"<p><strong>Objective: </strong>This cross-sectional study aimed to explore the application potential of artificial intelligence (AI) in screening and diagnosing cervical human papillomavirus (HPV) infection and lesions, and to assess patient satisfaction with the current diagnostic and therapeutic process as well as their unmet needs.</p><p><strong>Design: </strong>This was a cross-sectional observational study. Participants/Materials: A total of 308 valid female participants who received cervical HPV and lesion screening were enrolled. Research material consisted of self-designed questionnaires (online and paper versions) covering demographic information, screening experience, cognition and acceptance of AI-assisted cervical screening, and open-ended feedback.</p><p><strong>Setting: </strong>Questionnaires were distributed via online Questionnaire Star platform and offline paper forms.</p><p><strong>Methods: </strong>An online cross-sectional survey was conducted via the Questionnaire Star platform, and 308 valid responses were collected. Descriptive statistics were used to summarize participants' demographic characteristics and questionnaire responses. Chi-square tests were performed to examine associations between demographic factors (e.g., age, residence) and key outcomes (e.g., AI acceptance, primary concerns). A two-tailed p value <0.05 was considered statistically significant. Qualitative content analysis was applied to synthesize and interpret responses to open-ended questions.</p><p><strong>Results: </strong>Most respondents were women aged 25-35 years (34.74%), with 84.74% residing in urban areas. Among all participants, 76.30% reported a history of HPV infection, and 91.56% had undergone ThinPrep cytologic test (TCT). The most distressing part of the screening process was anxiety during result waiting (41.23%), and 58.12% found medical terminology difficult to understand. Although 61.04% of respondents had no prior knowledge of AI-assisted diagnosis, 58.77% were willing to learn about its application in improving diagnostic efficiency. Younger respondents (≤35 years) showed significantly higher willingness to learn about AI than those aged >35 years (65.1% vs. 52.4%, χ2 = 6.24, p = 0.012). Additionally, 75.97% of respondents believed AI could shorten result waiting times, and 73.70% trusted the \"AI preliminary screening + physician confirmation\" model. The top concerns regarding AI application were technical reliability (70.78%) and data privacy (68.18%).</p><p><strong>Limitations: </strong>This study has several limitations, including convenience sampling of urban, HPV-prone women, lack of standardized AI knowledge assessment and demonstration, reliance on self-reported screening history, a cross-sectional design that precludes causal inference, and a modest sample size (n = 308) for subgroup analyses. However, these issues are common in exploratory research and provide a clear roadmap for future work: larger and more representative s","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-11"},"PeriodicalIF":2.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420720","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":"Vaginal Estrogen for Urinary Tract Infection Prevention: A Narrative Review of Evidence, Guidelines, and Regulatory Gaps.","authors":"Rola Ghasoub, William Mackay, Ashley Shepherd","doi":"10.1159/000553344","DOIUrl":"10.1159/000553344","url":null,"abstract":"<p><strong>Background: </strong>Recurrent urinary tract infections (rUTIs) are common in peri- and postmenopausal women and impose substantial symptom, quality of life, and antimicrobial stewardship burdens, with particularly high incidence and hospitalization costs documented in England and UK primary care populations. Vaginal estrogen, by restoring urogenital epithelium and the Lactobacillus-dominant microbiome, is recommended in several guidelines for preventing rUTI, including UK antimicrobial prescribing guidance for rUTIs and European Association of Urology recommendations. However, most formulations are licensed only for genitourinary syndrome of menopause, not for urinary tract infection (UTI) prophylaxis. This creates a mismatch between the growing clinical evidence base and the absence of a specific regulatory indication for rUTI prevention across major regulatory agencies, including the US Food and Drug Administration (FDA), the European Medicines Agency, and the UK Medicines and Healthcare products Regulatory Agency, which may contribute to underuse and clinician uncertainty.</p><p><strong>Objectives: </strong>The objective of this review is to summarize the evidence on vaginal estrogen for prevention of rUTIs in peri- and postmenopausal women, with a particular focus on its use alone and in combination with antibiotic therapy, and on the gap between clinical guideline recommendations and regulatory product labeling.</p><p><strong>Methods: </strong>We conducted a structured narrative review focusing on randomized controlled trials (RCTs) and clinical practice guidelines evaluating intravaginal estrogen for the prevention of rUTI in peri- and postmenopausal women. PubMed and Embase searches were performed using key terms for estrogen, UTI, and menopause, and were supplemented with targeted searches of major guidelines. Data were described in terms of study design, participant characteristics, estrogen formulations and dosing regimens, timing of initiation, comparators, outcome measures, and reported safety outcomes.</p><p><strong>Outcome: </strong>Evidence from five RCTs reported that low-dose vaginal estrogen, administered as creams, tablets, rings, or gels, reduced culture-confirmed rUTI episodes and improved vaginal health indices, with no head-to-head trials comparing estrogen formulations directly, precluding conclusions about the relative superiority of any single preparation, and a favorable local safety profile. One trial found estriol pessaries less effective than antibiotic prophylaxis for rUTI prevention, suggesting that estrogen alone may be insufficient in some women and that combined regimens warrant further investigation, although no trial has directly evaluated concurrent antibiotic and estrogen therapy. Initiation was predominantly prophylactic or post-antibiotic, and no identified trial evaluated co-initiation of vaginal estrogen with antibiotics at the onset of acute UTI, highlighting a persisting evidence gap regard","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.7,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360603","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}

{"title":"Auxiliary Data as Surrogates for Systematic Coronary Risk Evaluation Model Version 2 Risk Calculator Inputs: Design and Methodology of the Frauenherzen Study in Apparently Healthy Women Aged 40-69 Years.","authors":"Elena Pavicic, Miriam Strasser, Patric Wyss, Serena Lozza-Fiacco, Manuela Moraru, Danielle V Bower, Rowan Iskandar, Petra Stute","doi":"10.1159/000552881","DOIUrl":"10.1159/000552881","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to investigate whether data collected from wearable devices, such as heart rate, step count, and sleep-related parameters, can reduce uncertainty in cardiovascular disease (CVD) risk prediction among apparently healthy women aged 40-69 years when blood pressure and blood lipid values required for the SCORE2 risk calculator are unavailable. A secondary objective was to identify wearable-derived features that contribute most to reducing uncertainty in CVD risk prediction.</p><p><strong>Design: </strong>This was a monocentric, exploratory, cross-sectional observational study. Participants/Materials: Women aged 40-69 years with and without cardiovascular risk factors were invited to participate. Eligible participants were biologically female, fluent in German, owned a smartphone, and provided written informed consent. Women with diagnosed CVD, diabetes mellitus, chronic kidney disease, or familial hypercholesterolemia were excluded. The study uses clinical assessments, blood sampling, validated questionnaires, and 7-day continuous monitoring with a Garmin® Vivosmart 5 wearable device.</p><p><strong>Setting: </strong>The study was conducted at the Department of Obstetrics and Gynecology, University Hospital of Bern, Inselspital, Switzerland.</p><p><strong>Methods: </strong>Participants attended two study visits scheduled 7 to 10 days apart. At baseline, anthropometric measures, blood pressure, pulse, waist circumference, blood samples for lipid profile and HbA1c, and questionnaire data on medical history, nutrition, menopausal symptoms, psychosocial health, anxiety, depression, stress, sleep, and quality of life were collected. Participants wore a Garmin® wearable device for 7 days, generating data on heart rate, physical activity, sleep, and related digital biomarkers. Statistical analyses will explore probabilistic approaches to impute systematically missing SCORE2 input parameters, particularly blood pressure and blood lipids, using auxiliary variables such as age, BMI, and wearable-derived features. Model performance will be evaluated by comparing probabilistic CVD risk predictions with SCORE2 estimates based on complete clinical input data.</p><p><strong>Results: </strong>As this manuscript describes the study design and methodology, no outcome results are reported. The planned sample size is 250 participants, accounting for an estimated dropout rate of approximately 10%.</p><p><strong>Limitations: </strong>The exploratory design and monocentric setting may limit generalizability. The sample size may be limited for selecting predictors from high-dimensional wearable data, and identified surrogate features will require external validation. In addition, adherence to wearing the device and potential recording or transmission errors may affect the completeness and quality of wearable data.</p><p><strong>Conclusions: </strong>The Frauenherzen study provides a methodological framework for evaluat","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.7,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148328854","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}

{"title":"Comparison of Colpocleisis and Long-Term Pessary Therapy in the Management of Severe Pelvic Organ Prolapse: A Retrospective Observational Study.","authors":"Orsolya Oláh, Miklós Romics, Dóra Kéninger, Péter József Molnár, Júlia Ács, Attila Keszthelyi, Nándor Ács, Attila Majoros","doi":"10.1159/000553119","DOIUrl":"10.1159/000553119","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to compare the effectiveness, complications, and treatment preference parameters of long-term pessary therapy versus vaginal obliteration (colpocleisis) in elderly, sexually inactive female patients with severe pelvic organ prolapse (POP).</p><p><strong>Design: </strong>This study was a single-center, retrospective observational study. Participants/Materials: In our study, we included elderly, sexually inactive women treated for advanced POP between January 2015 and November 2023. Long-term pessary therapy was applied in 30 cases, while 46 patients underwent vaginal obliteration. The mean follow-up duration was 41.9 ± 31.9 vs. 61.9 ± 40.1 months, respectively.</p><p><strong>Setting: </strong>The study was performed at the department of urology of our university (n = 76).</p><p><strong>Methods: </strong>Data collection was carried out based on clinical patient documentation and telephone interviews. We used a standardized, non-validated questionnaire specifically designed for this study covering four domains: patient characteristics; POP-related symptoms; treatment effectiveness and complications; socioeconomic and health-related parameters, including treatment preferences. Pre- and post-treatment parameters and intergroup differences were statistically analyzed.</p><p><strong>Results: </strong>The mean age of the patients was 74 ± 5.6 years, and the mean BMI was 25.6 ± 4.4. Following both pessary therapy and surgery, high rates of symptom resolution were observed regarding vaginal foreign body sensation, discomfort, and/or palpable bulge (93.5% vs. 95.5%) and obstructive voiding difficulty (100% vs. 96.4%). The rate of patient satisfaction was high in both groups (90% vs. 97.8%, p = 0.15); however, symptom improvement was significantly greater following vaginal obliteration (VAS: 8.9 ± 1.1 vs. 7.7 ± 1.7, p < 0.001). Pessary therapy was discontinued in 23.3% of cases, and 20% later required surgical POP intervention. No reoperations due to recurrence were required following obliterative surgery. Adverse events occurred in 26.6% of pessary patients, and complications occurred in 17.3% of surgically treated patients. The most frequent reason for choosing pessary therapy was fear of surgery (76.6%), while the most common reason for choosing surgery was refusal of pessary therapy (58.5%).</p><p><strong>Limitations: </strong>The retrospective design and relatively small sample size limit the generalizability of the findings.</p><p><strong>Conclusions: </strong>In elderly, sexually inactive women requiring treatment for advanced POP, both vaginal obliteration and long-term pessary therapy provide excellent therapeutic alternatives. The two modalities demonstrate comparable outcomes, high effectiveness, and an acceptable rate of non-severe complications, making both options suitable for appropriately selected patients.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-8"},"PeriodicalIF":2.7,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317058","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}

{"title":"Comparative Study of Dehydroepiandrosterone versus Femarelle® on Menopausal Systemic and Genitourinary Syndrome.","authors":"Cheng-Yu Long, Chih-Cheng Huang, Chieh-Yu Chang, Zi-Xi Loo, Chien-Wei Feng, I-Chieh Sung, Kun-Ling Lin","doi":"10.1159/000552775","DOIUrl":"10.1159/000552775","url":null,"abstract":"<p><strong>Objectives: </strong>The aim was to evaluate the therapeutic effects of dehydroepiandrosterone (DHEA) and DT56a (Femarelle®) on systemic and genitourinary symptoms of menopause in postmenopausal women.</p><p><strong>Design: </strong>A comparative effectiveness research study of seventy postmenopausal women (mean age: 53 years), experiencing postmenopausal symptoms, was designed.</p><p><strong>Participants: </strong>Seventy patients were randomly assigned to receive either DHEA (60 mg/day) or Femarelle® (644 mg/day) for 3 months.</p><p><strong>Materials, setting, methods: </strong>Subjects were assessed for serum estradiol, luteinizing hormone, follicle-stimulating hormone, Greene Climacteric Scales Scores, female urinary symptoms, and female sexual function index (FSFI).</p><p><strong>Results: </strong>Both DHEA and Femarelle® demonstrated comparable efficacy in reducing total Greene Climacteric Scale scores. No significant differences in serum follicle-stimulating hormone and E2 levels were observed between the 2 groups. Within-group analyses showed that DHEA was associated with significant improvements in urinary symptoms (overactive bladder symptom score, urinary distress inventory-6, incontinence impact questionnaire-7, international consultation of incontinence questionnaire, and pelvic organ prolapse distress inventory) and sexual function measures (FSFI domains including desire, arousal, lubrication, orgasm, and satisfaction), whereas Femarelle® did not show significant changes over the 3-month period. Between-group comparisons of change scores suggested a trend toward greater improvement in the DHEA group; however, these findings should be interpreted with caution, given the exploratory design and limited sample size.</p><p><strong>Limitations: </strong>The absence of testosterone measurements limits the assessment of the androgenic effects of DHEA. Femarelle® has never been studied for sexual function; our findings are preliminary and require long-term validation.</p><p><strong>Conclusions: </strong>While both DHEA and Femarelle® were effective in improving climacteric symptoms, DHEA was associated with improvements in genitourinary symptoms in this cohort. However, given the exploratory design and absence of a placebo control, these findings should be interpreted as hypothesis-generating.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-10"},"PeriodicalIF":2.7,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294231","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 Role of Dietary Supplements in the Management of Endometriosis-Related Symptoms: Current Evidence Based on a Systematic Review of Randomized Controlled Trials.","authors":"Nagihan Kırcalı-Haznedar, Tuba Nur Yıldız-Kopuz","doi":"10.1159/000552625","DOIUrl":"10.1159/000552625","url":null,"abstract":"<p><strong>Introduction: </strong>Endometriosis is characterized by a persistent inflammatory process and is commonly shown to be associated with pelvic pain, dysmenorrhea, and a deterioration in overall quality of life. Due to limitations and side effects of current medical and surgical treatments, nutrition-based adjunctive strategies have gained attention. The purpose of this research was to critically examine the latest scientific evidence based on randomized controlled trials about dietary supplement treatment and the therapeutic management of endometriosis-related symptoms.</p><p><strong>Methods: </strong>The conduct of this systematic review adhered to PRISMA methodological principles, with prior registration of the protocol in PROSPERO (CRD42024624094). PubMed, Scopus, and Web of Science databases were comprehensively explored.</p><p><strong>Results: </strong>Eleven randomized controlled trials involving 739 participants were included. The mean intervention duration was 12.3 ± 6.03 weeks. Eight trials evaluated vitamin supplementation, and three assessed herbal or bioactive compounds. Combined vitamin C and E supplementation consistently demonstrated reductions in pain-related outcomes across five trials. In contrast, findings regarding vitamin D were inconsistent, with only one of three studies reporting significant improvement compared to placebo. Among herbal interventions, two of three trials reported significant reductions in pain-related symptoms.</p><p><strong>Conclusion: </strong>Overall methodological quality ranged from good to fair. However, the available literature restricts conclusions due to limited sample sizes and methodological differences. Larger, well-designed trials with standardized protocols and biomarker-guided approaches are needed.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-12"},"PeriodicalIF":2.7,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283680","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":"Rupture of the Uterine Artery Pseudoaneurysm Causing Late Postpartum Hemorrhage: Case Report and Literature Review.","authors":"Lore Hoefnagels, Arne Vanhie, Karin Leunen, Erika Werbrouck, Siu W Lam","doi":"10.1159/000553084","DOIUrl":"10.1159/000553084","url":null,"abstract":"<p><strong>Introduction: </strong>Postpartum hemorrhage (PPH) remains one of the leading causes of maternal mortality worldwide. A rare but potentially life-threatening cause of secondary PPH is uterine artery pseudoaneurysm (UAP). In this case report, we present two clinical cases of UAP and review the available literature summarizing clinical symptoms, diagnostic approaches, and treatment options.</p><p><strong>Case presentation: </strong>The first case involved a patient presenting with abdominal pain and syncope 6 days after vaginal delivery, subsequently diagnosed with a right-sided UAP and hemoperitoneum. The second patient presented with painless yet heavy vaginal bleeding and was also diagnosed with a right-sided UAP. Both patients were successfully managed with uterine artery embolization.</p><p><strong>Conclusions: </strong>UAP may present atypically, either with or without vaginal bleeding. Possible reported risk factors include cesarean delivery, uterine curettage, endometriosis, inflammation, cervical conization, myomectomy, and excision of cesarean scars. Transvaginal sonography is the first-line diagnostic tool due to its accessibility, while computed tomography (CT) or magnetic resonance imaging are helpful for confirmation and treatment planning. Endovascular embolization is the treatment of choice in hemodynamically stable patients due to its minimally invasive nature and favorable outcomes.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-11"},"PeriodicalIF":2.7,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277201","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}

{"title":"Can β-Human Chorionic Gonadotropin in Uterine Cavity Lavage Serve as a Differential Diagnostic Tool for Pregnancies of Unknown Location? Insights from a Prospective Study.","authors":"Reyyan Gökçen İşcan, Müşerref Banu Yılmaz, Önder Tosun, Eray Metin Güler","doi":"10.1159/000552695","DOIUrl":"10.1159/000552695","url":null,"abstract":"<p><strong>Objectives: </strong>This prospective study aimed to evaluate whether β-human chorionic gonadotropin (β-hCG) levels in uterine cavity lavage fluid can serve as a diagnostic tool to differentiate ectopic pregnancy from failed intrauterine pregnancy in patients with pregnancy of unknown location (PUL).</p><p><strong>Design: </strong>This prospective interventional study was conducted at a tertiary referral center, enrolling a total of 113 hemodynamically stable patients with PUL.</p><p><strong>Materials and methods: </strong>All enrolled patients underwent endometrial aspiration (EA), which was performed using a flexible Karman cannula to obtain tissue samples for histopathological examination. Based on histopathological results combined with clinical follow-up data, participants were subsequently categorized into two groups: those diagnosed with ectopic pregnancy and those with failed intrauterine pregnancy. Prior to performing EA, uterine lavage was performed to collect fluid samples from the endometrial cavity, and β-hCG levels were quantitatively measured in the lavage specimens. The primary outcome measure was the comparison of lavage β-hCG concentrations between the ectopic and failed intrauterine pregnancy groups, with the intent to establish a diagnostic cutoff value for clinical application. Secondary outcome measures included comparisons of serum β-hCG levels, endometrial thickness assessed via imaging, and clinical and demographic parameters between the groups.</p><p><strong>Results: </strong>After exclusion criteria and incomplete data removal, 103 patients were included in the final analysis, comprising 81 individuals diagnosed with ectopic pregnancy and 22 with failed intrauterine pregnancies. Statistical analysis showed that the mean age was significantly higher in the failed intrauterine pregnancy group versus the ectopic pregnancy group (p = 0.03), while other demographic and clinical variables did not differ significantly between the groups. β-hCG concentrations in uterine lavage fluid were lower in the ectopic group compared to the failed intrauterine pregnancy group. This difference was significant in absolute terms (mean ± SD: 122.78 ± 115.41 mIU/mL vs. 321.09 ± 495.19 mIU/mL, p = 0.008) and after normalization to total protein content in the lavage fluid (100.67 ± 208.19 mIU/mg vs. 294.32 ± 510.69 mIU/mg, p = 0.001). In contrast, serum β-hCG levels and endometrial thickness did not show statistically significant differences between the two groups.</p><p><strong>Conclusion: </strong>Lavage β-hCG appears promising as a tool for early PUL assessment by identifying the pregnancy location. This standardized methodology could expedite the diagnosis of high-risk pregnancies through a less invasive approach, thereby enhancing ectopic pregnancy management. Further research is needed to improve accuracy.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.7,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239258","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":"Interdisciplinary Implementation of the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome: Care Gaps and Knowledge Deficits in Key High-Burden Domains.","authors":"Annette Bachmann, Sandra Jordan, Thomas Karn, Daniela Chemogo-Gbellu, Bilal Alemi, Aynura Abbasova-Semiz, Sven Becker","doi":"10.1159/000552803","DOIUrl":"10.1159/000552803","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age and is associated with significant metabolic, reproductive, and psychological morbidity. Although international evidence-based guidelines exist, patient reports continue to indicate unmet needs, particularly in areas that most affect quality of life. The primary objective of this study was to assess PCOS-related knowledge, as well as general practitioners' (GPs) perceptions and interdisciplinary communication practices. A secondary objective was to examine whether identified knowledge gaps among GPs align with symptom domains reported by patients as most bothersome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This study employed a cross-sectional survey design targeting practicing GPs. Quantitative findings were descriptively analyzed and contextualized using published data from an independent, large-scale patient survey. Participants/Materials: A total of 918 GPs practicing in the federal state of Hesse, Germany, were invited to participate. The final analytical sample comprised 118 GPs who completed the survey. The GP questionnaire included demographic and professional characteristics as well as a 21-item knowledge assessment derived from the 2018 International PCOS Guideline. To contextualize GP findings, data from a published patient survey including 1,926 individuals with PCOS were used to identify patient-prioritized symptom domains.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study was conducted in primary care settings across Hesse, Germany.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The GP survey assessed awareness of PCOS prevalence, familiarity with guideline recommendations, perceived relevance of guidelines to daily practice, and interdisciplinary collaboration, particularly with gynecologists. Knowledge accuracy scores were calculated as the percentage of correct responses across the 21 items. Subgroup analyses explored associations between GP characteristics and knowledge levels. Published patient survey data were used to determine symptom burden and domains perceived as most distressing, allowing comparison with GP knowledge gaps.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 93.2% of GPs estimated PCOS prevalence in their practice below 5% and 69.5% considered the International PCOS Guideline irrelevant to routine practice. PCOS-related knowledge among participants showed a mean accuracy of 54.6% (95% CI: 50.4-58.8) across all domains, with the lowest scores in reproductive aspects (45.5%, 95% CI: 40.6-50.4) and hyperandrogenism (43.7%, 95% CI: 38.7-48.7). Notably, cosmetic manifestations of hyperandrogenism were identified by patients as among the most burdensome symptoms. Furthermore, 45.8% of GPs reported suboptimal communication with gynecologists, highlighting deficiencies in interdisciplinary care pathways.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Limitations include a low response rate with potential nonresponse bias, the","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-8"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143398","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}

{"title":"Late Cervical Shortening following Midtrimester Screening: Associations with Obstetric History and Risk of Preterm Birth.","authors":"Raneen Abu Shqara, Maisa Assy, Lior Lowenstein, Maya Frank Wolf","doi":"10.1159/000552724","DOIUrl":"10.1159/000552724","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The objective of this study was to evaluate the clinical significance of late-onset cervical shortening diagnosed between 24.0 and 34.0 weeks of gestation following normal midtrimester screening and to assess its association with spontaneous preterm birth (sPTB) and adverse neonatal outcomes. We also examined whether obstetric history modifies this risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This was a retrospective cohort study. Participants/Materials: A total of 500 singleton pregnancies with normal midtrimester cervical length (CL) who were subsequently diagnosed with cervical shortening (&lt;25 mm) between 24.0 and 34.0 weeks of gestation were included in the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study was conducted at a tertiary, university-affiliated medical center (Galilee Medical Center, Israel) between March 2020 and May 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with asymptomatic late cervical shortening were categorized into three groups: &lt;10 mm, 11-15 mm, and 16-25 mm. CL measurements were further stratified by gestational age at diagnosis (24.0-27.6, 28.0-31.6, and 32.0-34.0 weeks). The primary outcome was sPTB &lt;37 weeks. Secondary outcomes included sPTB &lt;34 and &lt;32 weeks and neonatal morbidity. Multivariable logistic regression was used to estimate adjusted odds ratios. Receiver operating characteristic (ROC) curve analysis was performed to determine gestational age-specific CL thresholds for predicting sPTB.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 500 patients were included: 24/500 (4.8%) with CL &lt;10 mm, 80/500 (16.0%) with CL 11-15 mm, and 396/500 (79.2%) with CL 16-25 mm. Baseline characteristics were comparable across groups. Rates of sPTB &lt;37 weeks were 18/24 (75.0%) in patients with CL &lt;10 mm, 42/80 (52.5%) in those with CL 11-15 mm, and 99/396 (25.0%) in those with CL 16-25 mm (p &lt; 0.001). Similarly, sPTB &lt;34 weeks occurred in 14/24 (58.3%), 20/80 (25.0%), and 33/396 (8.3%), and sPTB &lt;32 weeks in 11/24 (45.8%), 12/80 (15.0%), and 20/396 (5.1%) (all p &lt; 0.001). When stratified by CL groups, sPTB rates did not differ according to obstetric history among patients with CL &lt;10 mm and 11-15 mm. In contrast, among patients with CL 21-25 mm, sPTB occurred in 7/26 (26.9%) of those with a prior sPTB, 17/78 (21.8%) of nulliparas, and 10/78 (12.8%) of those with a prior term birth (p = 0.041). ROC analysis identified gestational age-specific thresholds for predicting sPTB &lt;37 weeks: 22 mm at 24.0-27.6 weeks (area under the curve [AUC] 0.69, p &lt; 0.001), 20 mm at 28.0-31.6 weeks (AUC 0.62, p = 0.002), and 18 mm at 32.0-34.0 weeks (AUC 0.72, p &lt; 0.001). Correspondingly, sPTB rates were higher below these cutoffs: 49.1% vs. 18.2% (p &lt; 0.001), 49.1% vs. 23.2% (p &lt; 0.001), and 43.9% vs. 18.8% (p &lt; 0.001), respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The retrospective design may introduce selection and information bias. Measurements were performed by multiple clinicians, potentially leading to interobserv","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-10"},"PeriodicalIF":2.7,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13363110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015186","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}