Gynecologic and Obstetric Investigation最新文献

{"title":"Comparative Study of the Flipping Technique and Conventional Vaginal Natural Orifice Transluminal Endoscopic Surgery Myomectomy.","authors":"Rihua Xu, Ayijiang Nuerlan, Hua Yao, Dan Tang, Yong Luo, Jing Zhou","doi":"10.1159/000552694","DOIUrl":"10.1159/000552694","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to evaluate the clinical application value of the flipping technique in vaginal natural orifice transluminal endoscopic surgery (vNOTES) for myomectomy in cases involving numerous, large, and difficult-to-expose uterine fibroids, particularly those located at the fundus.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of 42 patients without fertility requirements but desiring uterine preservation who underwent flipping technique vNOTES myomectomy (case group) and 46 patients who underwent conventional vNOTES myomectomy (control group) at two hospitals between January 2024 and May 2025. Preoperative, intraoperative, and postoperative clinical data were compared between the two groups.</p><p><strong>Results: </strong>All surgeries were successfully completed in both groups. Compared with the control group, the flipping technique group had greater uterine volumes, a greater number of fibroids removed intraoperatively, and the ability to remove fibroids at higher positions (e.g., fundus). However, the flipping technique group also experienced longer operative times, greater intraoperative blood loss, and a longer durations before postoperative urinary catheter removal. These differences were statistically significant (p < 0.05).</p><p><strong>Conclusion: </strong>The flipping technique in vNOTES offers advantages similar to conventional vNOTES, such as the absence of abdominal scarring and lower postoperative pain levels. Additionally, it offers the advantages of removing a greater number of fibroids and various types of fibroids, particularly those located at challenging positions such as the uterine fundus. This technique expands the indications for vNOTES myomectomy.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-11"},"PeriodicalIF":2.7,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13290129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005197","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":"Artificial versus Spontaneous Rupture of Membranes after Balloon Ripening: Implications for Maternal Infectious Outcomes.","authors":"Raneen Abu Shqara, Nadir Ganem, Ala Aiob, Lior Lowenstein, Maya Frank Wolf","doi":"10.1159/000552624","DOIUrl":"10.1159/000552624","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;p&gt;Objectives: The aim of this study was to compare maternal infectious morbidity following artificial versus spontaneous rupture of membranes (ROM) after cervical ripening with a balloon catheter and oxytocin augmentation. Although amniotomy is commonly performed to shorten labor, evidence regarding its infectious consequences after mechanical cervical ripening remains limited and inconsistent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A retrospective cohort study included 1,115 term singleton pregnancies induced with a transcervical balloon catheter followed by oxytocin between January 2020 and May 2024. Participants were categorized according to mode of ROM: artificial (amniotomy) or spontaneous. Participants/Materials: Eligible participants were patients with term (≥37 weeks) singleton pregnancies undergoing induction with a balloon catheter and oxytocin. Exclusion criteria included multiple gestations, pre-labor ROM, non-cephalic presentation, and major fetal anomalies. A total of 1,115 patients met the inclusion criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study was conducted at Galilee Medical Center, a tertiary referral hospital affiliated with the Azrieli Faculty of Medicine, Bar-Ilan University, Israel. Data were obtained from institutional medical records for deliveries between January 2020 and May 2024. Institutional Review Board approval was obtained, and informed consent was waived due to the retrospective design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Clinical, obstetric, microbiological, and neonatal data were extracted from electronic records. The primary outcome was clinical chorioamnionitis. Secondary outcomes included intrapartum fever, microbiological findings, mode of delivery, and neonatal complications. Continuous variables were analyzed using Student's t-test and categorical variables using χ2 or Fisher's exact test. Firth penalized logistic regression was performed to assess independent associations between ROM mode and outcomes, adjusting for potential confounders. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 1,115 patients, 725 (65%) underwent amniotomy and 390 (35%) experienced spontaneous ROM. Amniotomy was associated with higher rates of clinical chorioamnionitis (3.0% vs. 0.3%, p &lt; 0.001), intrapartum fever (7.4% vs. 1.5%, p &lt; 0.001), and positive chorioamniotic cultures (11.3% vs. 6.2%, p = 0.005), particularly Enterobacteriaceae. Despite a shorter ROM-to-delivery interval (6.4 vs. 12.2 h, p &lt; 0.001), amniotomy was associated with higher cesarean delivery rates (13.5% vs. 3.3%, p &lt; 0.001), including for non-reassuring fetal heart rate (9.2% vs. 1.5%, p &lt; 0.001). Neonatal outcomes did not differ between groups. In adjusted analyses, amniotomy remained independently associated with clinical chorioamnionitis (adjusted OR: 8.51; 95% CI: 2.17-78.46; p = 0.001), intrapartum fever (adjusted OR: 4.04; 95% CI: 1.84-10.46; p &lt; 0.001), and cesarean delivery (adjuste","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.7,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987129","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":"Endometriosis and Endometrial Polyps Co-Occurrence in Individuals Not Seeking Pregnancy: A Case-Control Study.","authors":"Veronica Bandini, Noemi Salmeri, Anna Preda, Beatrice Bracci, Elena Cosentino, Michele Vignali, Paolo Vercellini","doi":"10.1159/000552113","DOIUrl":"10.1159/000552113","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Endometriosis and endometrial polyps are both estrogen-dependent conditions, and an association between these two pathologies has been observed in infertile women. Our research question was: \"Is there an association between endometriosis and endometrial polyps also in a study population not selected for infertility?\" Therefore, we aimed to assess whether the prevalence of endometrial polyps is higher in patients with endometriosis not seeking pregnancy compared with a general gynecologic outpatient population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This is a case-control study including 438 women with endometriosis and 438 controls without endometriosis attending routine gynecologic visits, consecutively identified from the electronic health records of the Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants/materials, setting, methods: &lt;/strong&gt;Between November 2021 and July 2025, all participants underwent transvaginal ultrasound, with standardized pelvic/uterine assessment according to the IETA, IDEA, and MUSA criteria. Patients using hormonal therapy at the time of the examination or in the previous 2 months were excluded. The primary endpoint was the prevalence of endometrial polyps in the two study groups. Point estimates of proportions in each group and odds ratios were calculated with corresponding 95% confidence intervals. Multivariate logistic regression was used to calculate adjusted odds ratio.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean age was 32 (28-36) years in the 438 cases and 32 (26-36) years in the 438 controls (p = 0.13). Most participants were Caucasian, with a comparable distribution of ethnicities between the two study groups (89.3% and 87.2%; p = 0.23). Prior use of hormonal treatment was reported significantly more often by women with endometriosis (72% vs 48%; p &lt; 0.001). Endometrial polyps were detected in 7/438 women with endometriosis (1.6%) and in 11/438 without endometriosis (2.5%; OR 0.63, 95% CI 0.24-1.64, p = 0.35). When both current and past diagnoses of endometrial polyps were considered, prevalence rates were 3.4% in cases and 5% in controls (OR 0.67, 95% CI 0.34-1.31, p = 0.24). Similar findings were observed after adjusting for statistical and clinically relevant variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Considering the unexpectedly small number of endometrial polyps detected, a type II error cannot be excluded. Moreover, a 2-month hormonal therapy washout period among previous users might have been too short to fully rule out a potentially persistent protective effect of medications on the development of endometrial polyps. A possible misclassification bias cannot be excluded as polyps were diagnosed by ultrasound without direct visualization by hysteroscopy and histologic confirmation. No centralized image review was performed, introducing potential inter-operator variability. Finally, as no individual matching betwe","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-7"},"PeriodicalIF":2.7,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147987144","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":"Validation of Optimized Embryo Scoring Procedures: Single-Day versus 2-Day Assessment.","authors":"Annemie Mengels, Annouschka Laenen, Carl Spiessens, Sophie Debrock","doi":"10.1159/000551942","DOIUrl":"10.1159/000551942","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to determine whether single-day embryo selection (day 3 or day 5) achieves comparable sensitivity, specificity, and accuracy to 2-day selection (day 2 + day 3 or day 3 + day 5).</p><p><strong>Design: </strong>This was a retrospective cohort study conducted over a 15-year period (2008-2023).</p><p><strong>Setting: </strong>The review was conducted in a single assisted reproductive technology (ART) center.</p><p><strong>Participants: </strong>A total of 9,095 patients undergoing ART were included: 7,365 were managed under a day 3 policy (77,543 embryo assessments) and 1,730 patients under a day 5 policy (14,538 embryo assessments).</p><p><strong>Methods: </strong>All patients underwent routine ART procedures with morphological embryo scoring according to established criteria. Cleavage-stage selection based on a 2-day assessment (day 2 + day 3) was compared with a hypothetical selection of a single-day assessment (day 3). Blastocyst-stage selection based on a 2-day assessment (day 3 + day 5) was compared with a hypothetical selection of a single-day assessment (day 5). Sensitivity, specificity, and overall accuracy were calculated retrospectively for single-day versus 2-day evaluation.</p><p><strong>Results: </strong>Day 3 single-day assessment demonstrated sensitivity of 98.9%, specificity of 93.6%, and accuracy of 96.7%, comparable to day 2 + day 3 scoring. Day 5 single-day assessment yielded sensitivity of 99.5%, specificity of 89.7%, and accuracy of 93.4%, similar to day 3 + day 5 evaluation.</p><p><strong>Limitations: </strong>Limitations of this study include the retrospective design and the inherently subjective nature of embryo selection, in which prior assessments can bias subsequent evaluations. In addition, 2-day scoring reflected routine clinical practice, whereas single-day scoring represented a hypothetical approach based solely on embryo scores. This hypothetical single-day selection did not take the clinical context into account, as it was performed by a single embryologist based only on morphological scores, whereas actual clinical selection typically incorporates broader clinical considerations. Prospective randomized trials are therefore needed.</p><p><strong>Conclusion: </strong>Single-day embryo selection on day 3 or day 5 provides diagnostic accuracy (≥90%) comparable to 2-day protocols. Our data show that single-day assessments can be considered to cope with increased workload.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-7"},"PeriodicalIF":2.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837156","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":"Effects of Delivery with Epidural Anesthesia on Peripartum Serum Inflammatory Factors and Hemodynamics in Women with Gestational Hypertension.","authors":"Fei Chen, Wen-Kai Li, Li-Li Yin, Yun-Xia Chen, Rui-Qian Lai, Dong-Ya Zhang, Yan-Peng Hao","doi":"10.1159/000551804","DOIUrl":"10.1159/000551804","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to analyze the changes in serum inflammatory factors and hemodynamics in women with hypertensive disorder of pregnancy (HDCP) who undergo delivery with epidural anesthesia.</p><p><strong>Methods: </strong>A total of 100 HDCP pregnant women were admitted to our hospital from June 2021 to December 2023 and divided into a control group (conventional delivery, i.e., vaginal delivery without analgesia) and a painless group (delivery with epidural anesthesia, i.e., continuous epidural analgesia), with 50 cases in each group. The levels of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), as well as hemodynamic parameters including heart rate (HR), mean arterial pressure (MAP), and cardiac output (CO), were measured and compared between the two groups at the following time points: pre-analgesia (T1), full cervical dilation (T2), fetal delivery (T3), and 24-h postpartum (T4). Maternal and neonatal outcomes were also compared between the two groups.</p><p><strong>Results: </strong>The painless group had shorter first, second, and third stages of labor and colostrum time than the control group, and the 1-min APGAR score was higher than that of the control group (p < 0.05). The TNF-α and IL-6 levels in T2, T3, and T4 in the painless group were lower than those in the control group (p < 0.05). The TNF-α and IL-6 levels in T2, T3, and T4 in the painless group were lower than those in the control group (p < 0.05). The fluctuation range of MAP, HR, and CO levels in T2, T3, and T4 in the painless group was smaller than that in the control group (p < 0.05).</p><p><strong>Conclusion: </strong>Delivery with epidural anesthesia for HDCP mothers can reduce perinatal inflammatory factor levels and stabilize hemodynamic parameters.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-10"},"PeriodicalIF":2.7,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716645","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":"Obstetric Gel Use to Shorten Labor and Prevent Lower Genital Tract Trauma: A Randomized Controlled Trial.","authors":"Elie Hobeika, Ihab M Usta, Labib Ghulmiyyah, Ghina Ghazeeri, Hani Tamim, Anwar H Nassar","doi":"10.1159/000551868","DOIUrl":"10.1159/000551868","url":null,"abstract":"<p><strong>Objectives: </strong>Vaginal delivery is associated with numerous forms of lower genital tract trauma. Several practices were developed to decrease the duration of the second stage of labor and the likelihood of lower genital tract trauma. Applying obstetric gel is one practice that has been studied in literature, with insufficient and somewhat conflicting evidence. The aim of this study was to compare the duration of the first and second stages of labor, and the integrity of lower genital tract, with or without the application of obstetric gel.</p><p><strong>Design: </strong>A randomized controlled trial was conducted, where delivering women were randomly assigned, based on individual stratifications, to receive either standard care during labor and delivery (n = 82), or with the additional application of the obstetric gel (n = 78).</p><p><strong>Participants/materials, setting, methods: </strong>A specifically designed sterile obstetric gel (Natalis®) was applied in the intervention group starting with the first vaginal examination after admission, with a total of 20-30 mL administered per childbirth. Descriptive and inferential statistics were implemented to describe the sample and compare outcomes across the intervention and the control groups, which were further divided depending on their parity (nulliparous and multiparous). The primary outcome was the duration of the second stage of labor.</p><p><strong>Results: </strong>A total of 160 women were recruited. The obstetric gel did not significantly shorten the duration of the first and second stages of labor, among other labor outcomes. However, an underpowered subgroup analysis showed that nulliparas who had obstetric gel application have had a significantly shorter duration of the second stage of labor compared with the control group (69.5 ± 45.3 vs. 97.5 ± 54.3 min; p value = 0.041).</p><p><strong>Limitation: </strong>A major limitation in our clinical trial is the small sample size that didn't account for subgrouping of parity when estimating the study's power.</p><p><strong>Conclusions: </strong>The obstetric gel did not incur statistically significant effect on labor outcomes including the duration of the second stage of labor. While being underpowered, nulliparas in the intervention group had a shorter duration of the second stage of labor than the control group. The lack of certainty in our results calls for more research to tackle this problem with adequate power to conclude valid results and to further confirm our subgroup findings in order to consider utilizing this practice that aims at improving the delivery experience.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-8"},"PeriodicalIF":2.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698686","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":"Development of a Predictive Model for the Latency Period in Preterm Premature Rupture of Membranes before 32 Weeks' Gestation.","authors":"Junnan Ji, Qin Fang, Ting Zou, Fengli Yin, Tianyi Ye, Bin He, Yuyan Zhou, Haojing Ma, Guirong Tan, Zhangye Xu","doi":"10.1159/000551927","DOIUrl":"10.1159/000551927","url":null,"abstract":"<p><strong>Background: </strong>Only 13.7% of corticosteroid treatments occurred within the most effective treatment time window for preterm premature rupture of membranes (PPROM), mainly due to the lack of relevant predictive models. This study aimed to analyze the risk factors associated with the duration of the latency period in PPROM to develop a predictive model for the latency period in cases of PPROM before 32 weeks' gestation, thereby increasing the effective use rate of prenatal corticosteroids.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on pregnant women with PPROM before 32 weeks' gestation between 2018 and 2022 at the Second Affiliated Hospital of Wenzhou Medical University. The group was divided based on the latency period: duration of <5 days group (n = 192) and duration of ≥5 days group (n = 162). Five machine learning algorithms were utilized to predict the probability of a latency duration of treatment of ≥5 days. Model performance was evaluated using the area under the curve (AUC), predictive accuracy, sensitivity, and specificity.</p><p><strong>Results: </strong>Significant differences (p < 0.05) were observed between the two groups in terms of white blood cell count, gestational age at rupture, cervical dilation, uterine contractions, and color of vaginal discharge. The AUC values for the five predictive models ranged from 0.66 to 0.90. The Logistic Regression model was identified as the best predictive model for latency duration in PPROM patients.</p><p><strong>Conclusion: </strong>Elevated body temperature, cervical dilation, increased white blood cell count, and the color of vaginal discharge are risk factors for a longer latency period in PPROM before 32 weeks' gestation. The gestational age at the time of spontaneous membrane rupture is a protective factor for the latency period in PPROM.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.7,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672500","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":"From Transition to Reproduction: A Narrative Review of Evolving Evidence in Transgender Obstetrics and Gynecology.","authors":"Pietro Serra, Giuseppe Mascellino, Maria Teresa Bruno, Simone Garzon, Maria Francesca Guarneri, Giorgio Maria Baldini, Marco La Verde, Baydaa Alsannan, George Mpourazanis, Antonio Simone Laganà","doi":"10.1159/000551771","DOIUrl":"10.1159/000551771","url":null,"abstract":"<p><strong>Background: </strong>Transgender and gender-diverse (TGD) people assigned female at birth (AFAB) increasingly seek reproductive and gynecologic care, yet evidence and clinical pathways remain variable across health systems, including in Europe.</p><p><strong>Objectives: </strong>The objective of this study was to synthesize evidence on fertility, pregnancy, gynecologic care, and access to care in TGD populations and to highlight practical implications for gender-affirming clinical practice, with attention to European settings.</p><p><strong>Methods: </strong>A narrative review supported by a structured PubMed/MEDLINE search (January 1, 2014-May 31, 2025). Two reviewers screened 146 titles/abstracts; 58 full texts were assessed; and 31 publications were included. Nine primary studies reported quantitative pregnancy and/or assisted reproduction outcomes after prior testosterone exposure in AFAB TGD individuals.</p><p><strong>Outcome: </strong>Available data, largely small retrospective cohorts and case series, suggest that pregnancy and assisted reproduction are feasible after prior testosterone exposure, typically after temporary cessation. In studies with cisgender comparators, oocyte yield and embryology metrics appeared broadly comparable, but evidence remains heterogeneous and underpowered for robust safety conclusions. Survey-based studies indicate that more than half of pregnancies may be unintended. Barriers to fertility preservation (FP) and preventive gynecologic care include financial and structural constraints, limited provider training, and avoidance of pelvic examinations and cervical cancer screening.</p><p><strong>Conclusions and outlook: </strong>Reproductive counseling, FP, contraception, and organ-based screening should be integrated into gender-affirming pathways using trauma-informed, patient-centered communication. Prospective multicenter studies and standardized outcome reporting are needed to better define safety, effectiveness, and equity of care.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-10"},"PeriodicalIF":2.7,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653934","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":"Endometriosis, Anxiety, Allergic Rhinoconjunctivitis, and Asthma: A Population-Based Study.","authors":"Hormoz Nassiri Kigloo, Eva Suarthana, Tina C Montreuil, Togas Tulandi","doi":"10.1159/000551682","DOIUrl":"10.1159/000551682","url":null,"abstract":"<p><strong>Objectives: </strong>The objectives of the study were to evaluate the association between endometriosis, anxiety, allergic rhinoconjunctivitis, and asthma in hospitalized women and to determine the role of age.</p><p><strong>Design: </strong>A cross-sectional study using inpatient hospital discharge data from 2007 to 2014 was conducted. Participants/Materials: The study included 12,814,970 hospitalized women aged 18-49 years from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) in the USA. Diagnoses of asthma, allergic rhinoconjunctivitis, endometriosis, and anxiety were identified using ICD-9 codes.</p><p><strong>Setting: </strong>The study was conducted at US community hospitals in the HCUP NIS database between 2007 and 2014.</p><p><strong>Methods: </strong>Of the 12,814,970 patients hospitalized between 2007 and 2014, 1,042,015 (8.1%) had asthma, 50,867 (0.4%) had allergic rhinoconjunctivitis, 831,239 (6.5%) had anxiety without endometriosis, 85,990 (0.7%) had endometriosis without anxiety, and 8,880 (0.1%) had both anxiety and endometriosis. Multivariable logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between endometriosis, anxiety, and asthma, adjusting for age, race, insurance type, smoking, obesity, hypertension, diabetes, thyroid disease, dyslipidemia, atherosclerosis, and depression. Analyses were stratified by age groups (18-34 and 18-49 years).</p><p><strong>Results: </strong>Among hospitalized women aged 18-49 and 18-34 years, the coexistence of anxiety and endometriosis was associated with the highest odds of asthma and allergic rhinoconjunctivitis. For asthma, adjusted ORs were 2.07 (95% CI: 1.94-2.20) among patients aged 18-49 years and 2.57 (2.35-2.81) in patients aged 18-34 years. The ORs for allergic rhinoconjunctivitis were 2.78 (2.30-3.36) and 3.45 (2.55-4.66), respectively. Anxiety or endometriosis alone was also significantly associated with both conditions.</p><p><strong>Limitations: </strong>The study used administrative data lacking information on disease severity, outpatient diagnoses, and treatment details. As a cross-sectional study, it cannot establish causality or temporal relationships.</p><p><strong>Conclusions: </strong>Endometriosis and anxiety were independently associated with asthma and allergic rhinoconjunctivitis, with stronger associations in women under 35 years. The combination of both conditions was associated with the highest likelihood of asthma and allergic rhinoconjunctivitis, suggesting a potential synergistic effect. Given the nature of the study, future research is needed to explore the shared inflammatory mechanisms. Our findings support clinical awareness of related inflammatory and psychological comorbidities when managing asthma, allergic rhinoconjunctivitis, or endometriosis.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-10"},"PeriodicalIF":2.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608745","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":"Maternal Use of Fertility Treatments and the Risk for Celiac Disease in the Offspring.","authors":"Noa Haramati, Gil Gutvirtz, Gali Pariente, Tamar Wainstock, Eyal Sheiner","doi":"10.1159/000551751","DOIUrl":"10.1159/000551751","url":null,"abstract":"<p><strong>Background: </strong>Fertility treatments affect the maternal hormonal and immunological milieu, which also support the developing fetus. Given that celiac disease is an immune-mediated disorder, it has been hypothesized that fertility treatments may influence immune programming in utero and potentially increase the risk of immune-related conditions in the offspring, such as celiac disease.</p><p><strong>Objective: </strong>We sought to investigate whether offspring conceived following fertility treatments are at increased risk of developing celiac disease during childhood.</p><p><strong>Study design: </strong>A large population-based cohort study was conducted, including all singleton deliveries at a tertiary medical center between the years 1991 and 2021. The risk of developing celiac disease was compared between offspring (followed up to the age of 18) of women who conceived using fertility treatments - including ovulation induction and in vitro fertilization - and those born following natural conception. Data regarding celiac disease diagnoses were extracted from community-based clinics and hospitalization records of the offspring. Kaplan-Meier survival analysis was used to compare the cumulative incidence of celiac disease between the study groups. A Cox proportional hazards model was applied to control for potential confounders.</p><p><strong>Results: </strong>A total of 356,356 singleton deliveries were included in the study, of which 7,711 (2.2%) were conceived using fertility treatments. Offspring born following fertility treatments had a comparable rate of celiac disease to those born after natural conception (0.6% vs. 0.5%, p = 0.477). Kaplan-Meier survival analysis demonstrated similar cumulative incidence of celiac disease between the groups (log-rank test, p = 0.285). In a Cox proportional hazards model, adjusted for maternal age and gestational age, fertility treatments were not associated with an increased risk of celiac disease in the offspring (adjusted hazard ratio = 1.13, 95% confidence interval 0.84-1.52, p = 0.392).</p><p><strong>Limitations: </strong>Follow-up was limited to age 18, and cases diagnosed later in life could not be captured.</p><p><strong>Conclusion: </strong>In our large cohort with long-term follow up, fertility treatments were not associated with an increased risk of celiac disease in the offspring up to the age of 18.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-8"},"PeriodicalIF":2.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13262987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591806","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}