Gynecologic and Obstetric Investigation最新文献

{"title":"Neurosonographic Insights into Maternal Vitamin D Deficiency: Early Markers of Fetal Cortical Development.","authors":"Deniz Taşdemir, Murat Haksever","doi":"10.1159/000551073","DOIUrl":"10.1159/000551073","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the association between maternal vitamin D status and fetal cortical maturation using detailed neurosonographic assessment at 28-30 weeks of gestation.</p><p><strong>Methods: </strong>This prospective observational study included 422 singleton pregnancies evaluated between 28 and 30 gestational weeks. Maternal serum 25-hydroxyvitamin D [25(OH)D] was measured by chemiluminescence immunoassay and categorized as deficient (<20 ng/mL), insufficient (20-30 ng/mL), or sufficient (>30 ng/mL). Fetal neurosonography was performed with a GE Voluson E8 system to quantify sulcal depths (insula, Sylvian, parieto-occipital, calcarine, and cingulate fissures), corpus callosum thickness, cavum septum pellucidum length, operculization, and cortical maturation grades. Interobserver reliability, correlation, regression, and receiver operating characteristic (ROC) analyses were conducted.</p><p><strong>Results: </strong>Of 422 women, 280 (66.4%) were vitamin D deficient, 110 (26.1%) insufficient, and 32 (7.6%) sufficient. Deficient participants showed significantly lower mean insula, parieto-occipital, and calcarine fissure depths and thinner corpus callosum (p < 0.05). Operculization and cortical maturation grades were also reduced (p = 0.02 and p = 0.01, respectively). Maternal 25(OH)D levels positively correlated with calcarine fissure depth (r = 0.42, p < 0.001) and cortical maturation grade (r = 0.45, p < 0.001). After adjustment for gestational age, vitamin D deficiency independently predicted low cortical maturation (≤ grade 3) (adjusted OR 2.56, 95% CI: 1.34-4.89, p = 0.004). ROC analysis demonstrated good discriminatory ability (AUC = 0.74, p < 0.001), with an optimal vitamin D threshold of ≈ 21 ng/mL yielding 78% sensitivity and 65% specificity.</p><p><strong>Conclusion: </strong>Maternal vitamin D deficiency during the late second to early third trimester is associated with delayed fetal cortical sulcation and reduced operculization grades. Quantitative neurosonography can noninvasively identify early neurodevelopmental vulnerability related to suboptimal maternal vitamin D status, supporting the role of adequate vitamin D as a modifiable determinant of fetal brain development. Given the high prevalence of hypovitaminosis D observed in this cohort, assessment of maternal 25(OH)D levels may be justified in high-risk or high-prevalence populations. Based on commonly applied clinical thresholds, supplementation of approximately 600 IU/day for vitamin D-sufficient women, 1,000 IU/day for those with insufficiency, and 1,500-2,000 IU/day for deficient women may be considered.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"495-504"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213026","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":"Effect of SEMA3F on Proliferation, Migration, and Ferroptosis of Endometrial Stromal Cells in Patients with Endometriosis.","authors":"Yi Zheng, Yu Zhou, Caizhi Wang, Shuyu Liu","doi":"10.1159/000545947","DOIUrl":"10.1159/000545947","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to examine the impact of semaphorin 3F (SEMA3F) on the proliferation, migration and ferroptosis of endometrial stromal cells in patients with endometriosis (EMS).</p><p><strong>Methods: </strong>This study collected ectopic endometriotic tissues from 30 patients with EMS (EMS group) and eutopic endometrial tissues from 30 patients in the control group who underwent hysterectomy due to uterine fibroids. The ectopic endometriotic tissues were sourced from the cystic walls of ovarian endometriomas in women with EMS. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and Western blotting were adopted to evaluate SEMA3F expression of endometrial tissues. Endometrial stromal cells (ESCs) were isolated from ectopic endometriotic tissues and divided into the oe-NC group, oe-SEMA3F group, and a blank group (non-transfected). SEMA3F expression in cells was quantified by RT-qPCR and Western blotting. Cell proliferation was quantified with the Cell Counting Kit-8 (CCK-8) assay, and migration and invasion were analyzed via the Transwell method. Ferroptosis markers (Fe2+, malondialdehyde [MDA], glutathione [GSH]) and ferroptosis-related proteins (ACSL4, PTGS2) were evaluated with Western blotting, and inflammatory factors (IL-6, TNF-α) were measured using enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>Levels of both mRNA and protein in SEMA3F were lower in the ectopic endometriotic endometrial tissue of EMS patients compared to controls. Overexpression of SEMA3F in ESCs from patients with EMS reduced cellular activity, migration, and invasion. Additionally, Fe2+, MDA, and other ferroptosis markers were significantly reduced, while GSH levels increased. Ferroptosis-related protein expression (ACSL4, PTGS2) was suppressed, and inflammatory factor levels (IL-6, TNF-α) decreased.</p><p><strong>Conclusion: </strong>SEMA3F may regulate the development of EMS by affecting the proliferation, invasion, migration, as well as ferroptosis of ESCs from patients with EMS.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"76-85"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983421","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 Relation between the Inner Myometrium and the Junctional Zone.","authors":"Marwan Habiba, Ilary Ruscito, Paola Bianchi, Sun-Wei Guo, Giuseppe Benagiano","doi":"10.1159/000546463","DOIUrl":"10.1159/000546463","url":null,"abstract":"<p><strong>Background: </strong>The nature and functions of the innermost layer of the myometrium, which is located immediately below the endometrium, coined the \"junctional zone\" (JZ), continue to be the subject of debate. The role and significance of the JZ have attracted little attention beyond its relation to the diagnosis of adenomyosis.</p><p><strong>Objectives: </strong>This review was conducted to update our current understanding of the role of the JZ as a specific uterine region.</p><p><strong>Methods: </strong>This is a comprehensive review of literature that was published in PubMed and MEDLINE platforms till April 2025 and that addresses the uterine JZ, excluding articles concerned with uterine adenomyosis.</p><p><strong>Outcome: </strong>It is not possible to reconcile JZ appearance on imaging with embryological or functional correlates. There are clear histological and immunohistological differences between the inner and outer myometrium, but the change is gradual with no demarcation of the transition. Whether the JZ has a different origin remains controversial because of the lack of supportive embryological evidence. There is evidence that JZ appearance on MRI is hormonally dependent, but it is not always recognizable and is often indistinct before puberty and after menopause. JZ seems to increase in thickness in the secretory and menstrual phases.</p><p><strong>Conclusion: </strong>While increased thickness is often considered a sign of adenomyosis, considerable uncertainty remains. We have not been able to identify studies that related features of the JZ per se to clinical outcomes. This supports the need for caution when interpreting the relevance of the JZ.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"400-410"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145603812","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":"Oral Drospirenone/Estetrol as Rapid and Random Start Endometrial Preparation before Office Hysteroscopic Polypectomy: A Multicenter, Prospective, Randomized Controlled Trial.","authors":"Andrea Etrusco, Vittorio Agrifoglio, Vito Chiantera, Giuseppe Russo, Tullio Golia D Apos Augè, Marco Monti, Andrea Giannini, Gaetano Riemma, Giuseppe Scibilia, Basilio Pecorino, Antonio D'Amato, Antonio Simone Laganà","doi":"10.1159/000546077","DOIUrl":"10.1159/000546077","url":null,"abstract":"<p><strong>Objectives: </strong>Endometrial preparation provides significant surgical benefits prior to hysteroscopic procedures. However, there is still no consensus on the optimal presurgical protocol. Although there is evidence on rapid preparation, there are currently no studies on rapid endometrial preparation using combined oral contraceptives initiated at a \"random\" time in the menstrual cycle. The aim of the present trial was to evaluate the use of oral drospirenone/estetrol in random start rapid preparation of endometrium before office hysteroscopic polypectomy.</p><p><strong>Design: </strong>In this multicenter, prospective, randomized controlled trial, 80 women scheduled for polypectomy were randomly assigned to intervention (n = 40) or control (n = 40) groups.</p><p><strong>Participants/materials, setting, methods: </strong>The intervention group received oral drospirenone/estetrol (3 mg/14.2 mg/day) for 14 days, starting at any menstrual cycle point (random start). Controls underwent polypectomy on cycle days 8-11 without any prior pharmacological intervention.</p><p><strong>Results: </strong>Pre- and post-procedure, endometrial thickness was significantly lower in the drospirenone/estetrol group (p < 0.001), and patients showed more hypotrophic/atrophic endometrial patterns (p < 0.001). Operative time, distension medium usage, incomplete resections, and bleeding during polypectomy were significantly lower in the drospirenone/estetrol group (p < 0.001). Endometrial preparation quality, uterine cavity visualization, and procedure satisfaction were higher in the drospirenone/estetrol group (p < 0.001). Furthermore, patients in the drospirenone/estetrol group experienced less pain during (p < 0.001) and after the procedure (p < 0.001), requiring fewer analgesics (p < 0.001) and shorter post-procedure discharge time (p = 0.01) than controls.</p><p><strong>Limitations: </strong>Limited sample size; possible variability due to different hysteroscopists, caused by the multicenter nature of the study; hysteroscopists were unmasked to treatment allocation; absence of a cost-effectiveness analysis.</p><p><strong>Conclusions: </strong>Treatment with drospirenone/estetrol could provide rapid, satisfactory and low-cost endometrial preparation before office polypectomy, improving surgical performance and patient compliance.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"47-55"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13061394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985176","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":"Large Cervical Varices: A Key Risk Factor for Hemorrhage in Placenta Previa.","authors":"Akio Kamiya, Takahiro Yamada, Aya Yoshida, Shuhei Nishibata, Kaede Oku, Mamoru Morikawa, Hidetaka Okada","doi":"10.1159/000547269","DOIUrl":"10.1159/000547269","url":null,"abstract":"<p><p><p>Objectives: The primary objective of this study was to determine whether the volume of cervical varices, quantified by magnetic resonance imaging (MRI), predicts massive intraoperative blood loss in placenta previa. The secondary objective was to examine the relationship between cervical varices volume and placental location, sponge-like findings on transvaginal ultrasound (TVUS), and active lower uterine segment bleeding.</p><p><strong>Design: </strong>A retrospective cohort study was conducted.</p><p><strong>Participants/materials, setting, methods: </strong>This study included 98 individuals with singleton pregnancies and placenta previa who underwent prenatal MRI and cesarean section at a tertiary care center in Japan between April 2012 and March 2021. MRI was performed around 34 weeks of gestation as part of routine placenta accreta spectrum (PAS) screening. Cervical varices were defined as high-signal vascular structures located within the cervix and lower uterine segment on sagittal T2-weighted MRI. Their volume was manually calculated as an approximate cervical varices volume (aVCV). Receiver operating characteristic (ROC) analysis was used to determine the optimal aVCV cutoff for predicting massive blood loss (defined as ≥1,500 mL). Logistic regression was used to assess independent predictors of bleeding. A subgroup analysis was conducted among patients with posterior placenta previa without PAS.</p><p><strong>Results: </strong>Cervical varices were detected by MRI in 94.9% of cases. ROC analysis identified 36.0 cm3 as the optimal aVCV cutoff (AUC: 0.63), with a specificity of 86.2% and positive predictive value of 75.9%. Large cervical varices (aVCV >36.0 cm3) were significantly associated with massive bleeding (adjusted odds ratio: 9.44; 95% CI: 3.11-28.7). They also correlated with sponge-like findings on TVUS and posterior placental location but were smaller in cases with anterior placenta or PAS despite high bleeding volumes. Active bleeding from the lower uterine segment was more common in the large aVCV group and was associated with massive hemorrhage in non-PAS cases. In a subgroup of patients with posterior placenta previa without PAS (n = 43), predictive performance improved (AUC: 0.72; specificity: 95.8%; odds ratio: 9.53; 95% CI: 2.19-41.4).</p><p><strong>Conclusion: </strong>Large cervical varices are an independent predictor of massive blood loss in placenta previa, particularly in posterior previa without PAS. Recognition of cervical venous enlargement as a core hemorrhagic risk factor may improve preoperative preparedness and promote broader efforts to refine diagnostic approaches. </p>.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"233-240"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591140","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":"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><p><p>Objective: 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>.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"582-588"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","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":"Artificial Intelligence Applied to Ultrasound Diagnosis of Pelvic Gynecological Tumors: A Systematic Review and Meta-Analysis.","authors":"Axel Geysels, Giulia Garofalo, Stefan Timmerman, Lasai Barreñada, Bart De Moor, Dirk Timmerman, Wouter Froyman, Ben Van Calster","doi":"10.1159/000545850","DOIUrl":"10.1159/000545850","url":null,"abstract":"<p><p><p>Introduction: The objective of this study wasto perform a systematic review on artificial intelligence (AI) studies focused on identifying and differentiating pelvic gynecological tumors on ultrasound scans.</p><p><strong>Methods: </strong>Studies developing or validating AI models for diagnosing gynecological pelvic tumors on ultrasound scans were eligible for inclusion. We systematically searched PubMed, Embase, Web of Science, and Cochrane Central from their database inception until April 30, 2024. To assess the quality of the included studies, we adapted the QUADAS-2 risk of bias tool to address the unique challenges of AI in medical imaging. Using multilevel random-effects models, we performed a meta-analysis to generate summary estimates of the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. To provide a reference point of current diagnostic support tools for ultrasound examiners, we descriptively compared the pooled performance to that of the well-recognized ADNEX model on external validation. Subgroup analyses were performed to explore sources of heterogeneity.</p><p><strong>Results: </strong>From 9,151 records retrieved, 44 studies were eligible: 40 on ovarian, 3 on endometrial, and 1 on myometrial pathology. Overall, 95% were at high risk of bias - primarily due to inappropriate study inclusion criteria, the absence of a patient-level split of training and testing image sets, and no calibration assessment. For ovarian tumors, the summary AUC for AI models distinguishing benign from malignant tumors was 0.89 (95% CI: 0.85-0.92). In lower risk studies (at least three low-risk domains), the summary AUC dropped to 0.87 (95% CI: 0.83-0.90), with deep learning models outperforming radiomics-based machine learning approaches in this subset. Only five studies included an external validation, and six evaluated calibration performance. In a recent systematic review of external validation studies, the ADNEX model had a pooled AUC of 0.93 (95% CI: 0.91-0.94) in studies at low risk of bias. Studies on endometrial and myometrial pathologies were reported individually.</p><p><strong>Conclusion: </strong>Although AI models show promising discriminative performances for diagnosing gynecological tumors on ultrasound, most studies have methodological shortcomings that result in a high risk of bias. In addition, the ADNEX model appears to outperform most AI approaches for ovarian tumors. Future research should emphasize robust study designs - ideally large, multicenter, and prospective cohorts that mirror real-world populations - along with external validation, proper calibration, and standardized reporting. </p>.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"115-136"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019796","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":"Impact of the Systemic Inflammatory Indices on Birth Weight: A Prospective Observational Study.","authors":"Marco La Verde, Rossella Molitierno, Maria Maddalena Marrapodi, Mario Fordellone, Antonio Simone Laganà, Marica Palma, Antonella Petillo, Gaetano Riemma, Maria Giovanna Vastarella, Pasquale De Franciscis","doi":"10.1159/000545591","DOIUrl":"10.1159/000545591","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Several studies explored the role of maternal systemic inflammation indices during pregnancy. Different conditions, such as gestational hypertension, preeclampsia, and gestational diabetes, are associated with abnormal systemic inflammation indices. However, there is a lack of research on the impact of systemic inflammation indices on fetal growth in physiological pregnancies. The objective of this study was to explore the potential associations between birth weight, length, and head circumference with a group of systemic inflammatory indices, namely, platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR), the mean platelet volume-to-lymphocyte ratio (MPVLR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Full-term, physiological pregnancies admitted to a tertiary center from November 2019 until February 2021 were included in a prospective observational study. We excluded pregnancies affected by gestational or pregestational diabetes, chronic hypertension, gestational hypertension, pre-eclampsia/eclampsia, fetal growth restriction, preterm delivery or premature rupture of membranes, multiple pregnancies, and malformed fetuses. Sociodemographic characteristics, clinical data, and complete blood count were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Continuous variables were reported as either the means and standard deviation or median and interquartile ranges according to their distribution, as assessed by the Shapiro-Wilk normality test. Categorical variables were reported as percentages. To measure the linear association between continuous variables, the Pearson correlation test was used if variables had a normal distribution. Otherwise, Spearman's rank correlation test was calculated. To obtain an inflammatory latent score, a principal component analysis (PCA) was performed on NLR, PLR, MPVLR, MLR, SII, and SIRI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 264 pregnant women came to our observation before the delivery. After the exclusion criteria, 199 pregnant were included. The Spearman's rank correlation test showed a high correlation among the indices. Then, a PCA was performed to a composite indicator of inflammatory score. The first principal component was selected, with a proportion of explained variance equal to 73.11%. The contributions of variables suggested excluding from the score the MLR index. From the linear regression models, results denoted that the inflammatory score negatively affects the birth weight (β = -42.60, 95% CI -76.91, -8.28) and the head circumference (β = -0.14, 95% CI -0.24, -0.04); however, the effect of the score on the birth length is not statistically significant at 5% (β = -0.12, 95% CI -0.27, 0.02).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This research's main limitation is the lack of data about the indirect inflammatory markers during the first and ","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"36-46"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998140","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":"Effect of Gonadotropin Dose Reduction during Controlled Ovarian Hyperstimulation on Progesterone Levels and Embryo Outcomes in Women Undergoing IVF/ICSI-ET with GnRH-A Protocol.","authors":"Hongmei Xu, Jianwei Huo, Wujian Huang, Guoyong Chen, Lingyun He, Yun Liu","doi":"10.1159/000546691","DOIUrl":"10.1159/000546691","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates the impact of reduced gonadotropin doses during controlled ovarian hyperstimulation (COH) on progesterone levels in the late follicular phase of IVF/ICSI-ET.</p><p><strong>Design: </strong>This was a retrospective cohort study employing propensity score matching to balance groups. Participants/Materials: This study enrolled infertile patients undergoing IVF/ICSI-ET at the Reproductive Medicine Center of the 900th Hospital from January 2017 to July 2020.</p><p><strong>Setting: </strong>This study was carried out at the Reproductive Medicine Center, 900th Hospital of PLA Joint Logistic Support Force, formerly Fuzhou General Hospital.</p><p><strong>Methods: </strong>A total of 1,380 patients were enrolled; 670 received reduced gonadotropin doses (12.5-75 units/day from days 6 to 8), and 710 underwent routine treatment. The primary outcome measured was progesterone levels on trigger day.</p><p><strong>Results: </strong>Progesterone levels on trigger day were significantly lower in the gonadotropin dose reduction group (1.24 ± 0.51) compared to the control group (1.34 ± 0.53, p < 0.001). The proportion of patients with P ≥1.5 ng/mL was significantly lower in the gonadotropin dose reduction group compared to the control group (22.7% vs. 29.9%, p = 0.003). Multivariable logistic regression indicated that dose reduction decreased the risk of progesterone elevation (OR = 0.535, 95% CI: 0.404-0.709).</p><p><strong>Limitations: </strong>The study is limited by its retrospective design, which may introduce biases.</p><p><strong>Conclusions: </strong>Reducing gonadotropin doses during COH may lower elevated progesterone levels in the late follicular phase, potentially improving embryo outcomes in IVF/ICSI-ET.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"180-185"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484089","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 Number of Previous Cesarean Deliveries and Severity of Placenta Accreta Spectrum: A Referral Center Experience.","authors":"Neha Agarwal, Edgar A Hernandez-Andrade, Donatella Gerulewicz, Ramesha Papanna, Dejian Lai, Eleazar E Soto Torres, Sarah T Mehl, Elias Kassir, Farah H Amro, Baha M Sibai, Sean C Blackwell","doi":"10.1159/000547755","DOIUrl":"10.1159/000547755","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the frequency of severe stages of placenta accreta spectrum (PAS) in relation to the number of previous cesarean deliveries (PCDs).</p><p><strong>Design: </strong>We conducted a retrospective cohort study.</p><p><strong>Setting: </strong>The study was carried out at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.</p><p><strong>Participants: </strong>A total of 176 patients with histopathologically confirmed PAS were included in the study. The frequency of each stage of PAS severity was analyzed in relation to the number of PCDs Methods: Differences in the frequency of different stages of PAS severity among patients with varying numbers of PCDs were estimated. Adjusted logistic regression models were used to evaluate the association between the number of PCDs and PAS severity.</p><p><strong>Results: </strong>In our referral center, the frequency of placenta accreta was 18.1% (n = 32/176), placenta increta 55.6% (n = 98/176), and placenta percreta 26.1% (n = 46/176). There were 8 patients with no PCDs, 48 with 1 PCD, 62 with 2 PCDs, and 58 with ≥3 PCDs. The frequency of placenta increta was similar among all PCDs groups; however, the frequency of placenta percreta was significantly higher among women with ≥3 PCDs (25/58 [43.1%]) as compared to those with ≤2 PCDs (21/118 [17.7%], aOR, 3.49 [95% confidence interval, 1.73-7.05]; p = 0.005). Patients with no PCDs had a higher frequency of placenta accreta and a similar frequency of placenta increta to those with a history of PCDs.</p><p><strong>Limitations: </strong>The study was conducted at a single center with a high referral rate for severe forms of PAS, which may restrict the generalizability of the findings. Additionally, the classification of PAS relies heavily on histopathologic interpretation, which can introduce potential biases depending on provider experience and the criteria used.</p><p><strong>Conclusion: </strong>The frequency placenta increta was similar among women with the suspicion of PAS regardless of the number of PCDs. Women with ≥3 PCDs had a significantly higher frequency of placenta percreta.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"267-273"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816472","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}