International Journal of Gynecology & Obstetrics最新文献

{"title":"Chromosomal aberrations of reproductive dysfunction: An in-depth retrospective study of 1943 individuals with unexplained infertility.","authors":"Farzaneh Iravani, Khosro Namjoo, Fateme Montazeri, Mohammadreza Dehghani, Leila Zanbagh, Seyed Mehdi Kalantar","doi":"10.1002/ijgo.71462","DOIUrl":"https://doi.org/10.1002/ijgo.71462","url":null,"abstract":"<p><strong>Objective: </strong>Fertility refers to the ability to achieve a clinically successful pregnancy. Chromosomal aberrations constitute a fundamental etiological factor in reproductive dysfunction, with prevalence rates substantially elevated in infertile populations compared to general demographic baselines. This comprehensive retrospective investigation aimed to elucidate the cytogenetic signatures underlying infertility pathogenesis through systematic karyotypic analysis.</p><p><strong>Methods: </strong>This retrospective study evaluated individuals referred to the Yazd Reproductive Sciences Institute between April 2016 and March 2025 for reproductive health concerns. Among 7768 individuals assessed during the study period, 1943 had infertility and underwent cytogenetic evaluation. Peripheral blood lymphocytes were analyzed using standardized Giemsa (GTG)-banding karyotyping at a resolution of 400-550 bands per haploid genome. Chromosomal abnormalities were classified according to the International System for Human Cytogenomic Nomenclature (ISCN) 2020 guidelines, encompassing structural variants, numerical abnormalities, complex karyotypic alterations, and polymorphic heteromorphisms. The demographic characteristics of the patients were systematically evaluated and analyzed in correlation with their chromosomal abnormalities.</p><p><strong>Results: </strong>Among the 1943 individuals with infertility, chromosomal abnormalities were identified in 229 cases (12.0%), including numerical sex chromosome abnormalities (46.7%), chromosomal polymorphic variants (41.5%), structural abnormalities (9.2%), and complex karyotypes (2.6%). Males accounted for 83.8% of abnormal cases, with Klinefelter syndrome representing the most frequent abnormality.</p><p><strong>Conclusion: </strong>This study highlights that detecting chromosomal abnormalities in infertile couples is crucial for elucidating infertility etiology align with optimizing treatment and genetic counseling.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149286678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating large language models and expert knowledge to identify risk factors and predict mode of delivery with machine learning.","authors":"Farzaneh Rashidi, Saba Qanbarzadeh, Azam Orooji","doi":"10.1002/ijgo.71376","DOIUrl":"https://doi.org/10.1002/ijgo.71376","url":null,"abstract":"<p><strong>Background: </strong>Accurately predicting the mode of delivery is a significant challenge in obstetrics, with implications for maternal healthcare planning, resource allocation, and personalized patient counseling. While machine learning offers promising predictive capabilities, the selection of relevant clinical and socioeconomic risk factors from vast possibilities remains a critical and nontrivial step that directly affects model performance and clinical utility.</p><p><strong>Objectives: </strong>This study aimed to (1) predict the mode of delivery (vaginal vs. cesarean) using machine learning algorithms and (2) identify the key risk factors influencing delivery mode prediction.</p><p><strong>Methods: </strong>A retrospective study was conducted on eligible pregnant women who delivered at Bent-Al-Huda Hospital in Bojnourd, Iran. A hybrid feature identification approach was employed: large language models (LLMs) initially proposed 63 potential risk factors. Through iterative refinement involving domain experts and assessment of data availability and frequency, this list was consolidated to 35 final variables for modeling. Machine learning algorithms, including multilayer perceptron (MLP), decision tree, naïve Bayes, and support vector machine (SVM), were applied to build predictive models.</p><p><strong>Results: </strong>Among all models, SVM showed the best performance using all features, achieving an accuracy of 94.8% and an area under the curve (AUC) of 0.94. Decision tree analysis identified previous cesarean section history, insurance type, and fetal presentation as the three most important predictive factors. After excluding 40 women with prior cesarean delivery, SVM maintained robust performance with accuracy of 94.3% and an AUC of 0.92. Using antenatal features only, MLP achieved the highest accuracy before and after excluding women with previous cesarean section (92.9% and 92.2%), while SVM also showed the highest discriminative ability (accuracy 92.4%, AUC 0.90 and accuracy 91.3%, AUC 0.87, respectively).</p><p><strong>Conclusion: </strong>This study demonstrates that combining expert knowledge with LLMs enables effective risk factor identification and that careful feature selection allows the proposed model to predict delivery type with high accuracy.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149286765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical performance of sFlt-1/PlGF ratio triage in suspected pre-eclampsia: A prospective, observational multicenter diagnostic-triage study in South Africa (TsHEPPO study).","authors":"Ismail Bhorat, Priya Soma-Pillay, Lawrence Chauke, Mushi Matjila, Tshidi Sebitloane, Nitalia Naidoo, Manu Vatish","doi":"10.1002/ijgo.71428","DOIUrl":"https://doi.org/10.1002/ijgo.71428","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic and short-term predictive performance of the soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF ratio) in South African women with suspected pre-eclampsia (PE), comparing thresholds of ≥ 33 and ≥ 38 in a predominantly African population.</p><p><strong>Methods: </strong>This was a prospective, observational diagnostic-triage multicenter study across four tertiary hospitals in South Africa. A total of 555 women with suspected PE with complete outcome data were enrolled from four study sites. The sFlt-1/PlGF ratio (Elecsys, Roche Diagnostics) was measured at presentation and comprehensive clinical and delivery outcome data were collected. Diagnostic and short-term predictive performance for sFlt-1/PlGF thresholds (≥ 33 and ≥ 38) were assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristics (ROC) and associated area under the curve (AUC).</p><p><strong>Results: </strong>PE was diagnosed in 349/555 women (62.9%). The sFlt-1/PlGF ratio showed moderate discrimination for PE (area under the receiver operating characteristic curve [AUROC] 0.78, 95% confidence interval [CI]: 0.7-0.8) overall. Continuous-data ROC analysis in 418 women from Durban, Johannesburg and Pretoria yielded an AUROC of 0.8465 (95% CI: 0.8090-0.8841). In the all-site analysis, sensitivity, specificity, PPV, NPV and accuracy were 67.05%, 89.32%, 91.41%, 61.54% and 75.32% at ≥ 33, and 62.46%, 90.29%, 91.60%, 58.68% and 72.79% at ≥ 38, respectively. In short-term prediction, both thresholds showed high sensitivity (86.5%) for PE within 7 days while specificity/PPV were 77.3%/81.8% at ≥ 33 and 81.8%/84.9% at ≥ 38, with NPVs of 82.9% and 83.7%, respectively. By 28 days, NPVs declined to 62% and 64%.</p><p><strong>Conclusion: </strong>The sFlt-1/PlGF ratio is a clinically useful biomarker primarily as a rule-in triage tool for suspected PE in South Africa. The ratio showed high specificity and PPV in this predominantly African cohort. The exploratory ≥ 33 threshold increased sensitivity relative to ≥ 38, with a small reduction in specificity in the all-site estimates. The findings support its evaluation as an adjunct to clinical assessment in women with suspected PE. Both thresholds showed limited rule-out performance beyond short follow-up supporting the need for reassessment and repeat testing where clinically indicated. These findings support consideration of region-adapted thresholds and highlight the value of biomarker-guided triage in African settings.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149286801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An immune-inflammatory and thyroid function machine learning model for predicting adverse pregnancy outcomes: Development in a retrospective cohort and external validation in a prospective cohort.","authors":"Yumao Huang, Haihui Chen, Xiaolei Xie, Yu Jin, Jin Huang","doi":"10.1002/ijgo.71412","DOIUrl":"https://doi.org/10.1002/ijgo.71412","url":null,"abstract":"<p><strong>Objective: </strong>Maternal thyroid dysfunction is associated with adverse pregnancy outcomes, yet thyroid status alone stratifies individual risk poorly and the immune-inflammatory contribution is rarely incorporated into prospectively validated prediction tools. We aimed to develop and externally validate a model predicting a composite adverse pregnancy outcome from antenatal thyroid and cytokine markers.</p><p><strong>Methods: </strong>The model was developed in a retrospective cohort (n = 650; 131 events, 20.2%) and externally validated in an independent prospective cohort (n = 150; 26 events, 17.3%). Fifteen antenatal candidate predictors common to both cohorts were considered. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection; LASSO-logistic regression, random forest, extreme gradient boosting, and a support-vector machine were compared by repeated stratified cross-validation. Discrimination was quantified using the area under the receiver operating characteristic curve (AUC); calibration and clinical utility were also assessed, with internal-external cross-validation (IECV) as a sensitivity analysis.</p><p><strong>Results: </strong>LASSO retained three predictors: thyroid peroxidase antibody (TPOAb), interleukin-6 (IL-6), and interleukin-10 (IL-10). LASSO-logistic regression was selected (development cross-validated AUC 0.762, 95% confidence interval [CI] 0.692-0.846). On external validation, the model achieved an AUC of 0.750 (95% CI 0.647-0.848), exceeding a thyroid group-only reference model (AUC 0.625); the Brier score was 0.127, and the calibration slope was 1.77. Random 10-fold IECV gave a pooled AUC of 0.761 (95% CI 0.720-0.800). Higher IL-6 was associated with increased risk and higher IL-10 with decreased risk.</p><p><strong>Conclusion: </strong>A parsimonious three-marker model combining TPOAb, IL-6, and IL-10 showed moderate discrimination for adverse pregnancy outcomes and outperformed thyroid status alone. Calibration requires refinement, and validation in larger multicenter cohorts is warranted before clinical implementation.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-trimester sum-estimated fetal weight and gestational diabetes risk in twin pregnancies.","authors":"Naphtali Justman, Dana M Carny, Ron Beloosesky, Ido Solt, Nizar Khatib, Yuval Ginsberg, Yaniv Zipori","doi":"10.1002/ijgo.71440","DOIUrl":"https://doi.org/10.1002/ijgo.71440","url":null,"abstract":"<p><strong>Objective: </strong>Gestational diabetes mellitus (GDM) is more prevalent in twin pregnancies, yet screening strategies remain largely based on singleton data. In the present study, we aimed to evaluate whether the mid-trimester sum of estimated fetal weights (sum-EFW) at the anatomy scan is associated with subsequent GDM in twin pregnancies.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of twin pregnancies undergoing routine mid-trimester ultrasound (2010-2025) at a tertiary center. Sum-EFW was calculated as the combined estimated fetal weight of both fetuses. The primary outcome was GDM. Receiver operating characteristic (ROC) analysis assessed discriminative performance and multivariable logistic regression identified independent predictors.</p><p><strong>Results: </strong>Among 728 women, 70 (9.6%) developed GDM. Sum-EFW was higher in GDM pregnancies (1177 ± 187.9 vs. 1103 ± 178.8 g; P = 0.001). ROC analysis demonstrated modest discriminative ability (area under the curve [AUC] 0.62; 95% confidence interval [CI]: 0.55-0.69; P = 0.001). After adjustment for gestational age, discrimination was similar (AUC 0.586; 95% CI: 0.518-0.655; P = 0.013), with sensitivity 67.1%, specificity 47.6%, positive predictive value (PPV) 12.1%, and negative predictive value (NPV) 93.1% at the optimal threshold. A cutoff of 1130 g identified a higher-risk subgroup (14.3% vs. 6.3%; P = 0.001). In multivariable analysis, maternal age ≥ 30 years (adjusted odds ratio [aOR] 2.45; 95% CI: 1.10-5.45), body mass index (BMI) ≥30 (aOR 5.48; 95% CI: 2.33-12.85), and sum-EFW ≥1130 g (aOR 3.21; 95% CI: 1.41-7.34) were independently associated with GDM.</p><p><strong>Conclusion: </strong>In twin pregnancies, a higher mid-trimester sum-EFW is independently associated with subsequent GDM. These findings suggest that combined fetal growth may reflect early metabolic alterations in twin gestations. Discrimination remains modest, limiting use as a screening or risk-stratification tool.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric violence and associated factors among postpartum women in Turkey: A cross-sectional study.","authors":"Meserret Aslan, Hüsniye Dinç Kaya, Sevil Günaydın, Tülay Yılmaz","doi":"10.1002/ijgo.71432","DOIUrl":"https://doi.org/10.1002/ijgo.71432","url":null,"abstract":"<p><strong>Objective: </strong>The present study aimed to determine the level of reported obstetric violence among women who had given birth in Turkey and to identify the factors associated with reported obstetric violence.</p><p><strong>Methods: </strong>A cross-sectional, descriptive study was carried out between October 1 and December 30, 2024. The sample comprised 286 women aged 18 years or older, within their first postpartum year, who had given birth in Turkey. Data were collected using a Personal Information Form and the Obstetric Violence Scale (OVS) and were analyzed with SPSS.</p><p><strong>Results: </strong>In unadjusted analyses, higher OVS scores were associated with unplanned pregnancy, cesarean birth, postpartum complications, inadequate information, lack of consent, and several intervention-intensive childbirth practices (P < 0.05). In multivariable negative binomial regression, postpartum complications (aIRR = 1.42, 95% CI = 1.01-2.00), lack of information during labor (aIRR = 2.40, 95% CI = 1.43-4.03), prolonged fasting (aIRR = 1.60, 95% CI = 1.09-2.35), prolonged bed rest (aIRR = 3.07, 95% CI = 1.87-5.04), continuous non-stress test (NST) (aIRR = 1.56, 95% CI = 1.07-2.29), vacuum extraction (aIRR = 2.83, 95% CI = 1.18-6.80), and fundal pressure (aIRR = 2.29, 95% CI = 1.34-3.94) remained independently associated with higher total OVS scores.</p><p><strong>Conclusion: </strong>Reported obstetric violence was independently associated with several care-related factors, particularly lack of information during labor and selected intervention-intensive practices. These findings underscore the importance of respectful maternity care, effective communication, and careful evaluation of obstetric interventions.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal head station and head circumference at second-stage onset and likelihood of vaginal delivery in nulliparous women.","authors":"Itamar Gilboa, Keren-Or Wertheimer, Daniel Gabbai, Einat Tako, Anat Lavie, Yariv Yogev, Emmanuel Attali","doi":"10.1002/ijgo.71409","DOIUrl":"https://doi.org/10.1002/ijgo.71409","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to evaluate the combined association of fetal head station (FHS) at second-stage onset and fetal head circumference (HC) with the likelihood of spontaneous vaginal delivery (SVD) in nulliparous women.</p><p><strong>Methods: </strong>This retrospective cohort study included nulliparous women with singleton, vertex-presenting, term pregnancies (≥37 weeks) who reached the second stage of labor between 2013 and 2023 at a tertiary medical center. FHS was categorized as above, at, or below the ischial spines. HC, measured by ultrasound within 14 days before delivery, was dichotomized as <350 mm or ≥350 mm. Participants were classified into six FHS-HC groups. The primary outcome was SVD. Associations were assessed using multivariable logistic regression.</p><p><strong>Results: </strong>Among 4230 women, SVD rates ranged from 57.7% for FHS above the ischial spines with HC ≥350 mm to 88.7% for FHS below the ischial spines with HC ≥350 mm. Compared with the reference group (FHS below the ischial spines and HC <350 mm), the adjusted odds of SVD decreased with higher station: adjusted odds ratio (aOR) 0.73 (95% confidence interval [CI] 0.60-0.88) for station at the ischial spines and 0.59 (95% CI 0.44-0.80) for station above the ischial spines. Among women with HC ≥350 mm, those with FHS above the ischial spines had the lowest likelihood of SVD (aOR 0.35; 95% CI 0.14-0.82). Higher FHS and larger HC were associated with longer second-stage duration (P < 0.001).</p><p><strong>Conclusion: </strong>FHS at second-stage onset was more strongly associated with SVD than was HC. Combined FHS-HC assessment may help identify women at increased likelihood of operative delivery and support closer monitoring of labor progress.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Birth satisfaction and resilience in the association between prenatal anxiety and postpartum depressive symptoms: A mediational analysis.","authors":"Yanchi Wang, Wei Huang, Xujuan Xu, Jian Gu","doi":"10.1002/ijgo.71426","DOIUrl":"https://doi.org/10.1002/ijgo.71426","url":null,"abstract":"<p><strong>Objective: </strong>Postpartum depression (PPD) is a common mental health disorder among women after childbirth. This study aimed to examine whether birth satisfaction and resilience statistically mediated the association between prenatal anxiety and PPD.</p><p><strong>Methods: </strong>From February to August 2023, pregnant women in the third trimester were recruited using convenience sampling from three tertiary hospitals in Nantong, China. Prenatal anxiety was assessed using the anxiety subscale of the Depression Anxiety Stress Scale-21 (DASS-21), and resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) during pregnancy. Birth satisfaction and postpartum depressive symptoms were assessed using the Birth Satisfaction Scale-Revised Indicator (BSS-RI) and Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks postpartum. Parallel mediation analysis was performed using PROCESS macro with 5000 bootstrap samples, adjusting for maternal age and physical discomfort.</p><p><strong>Results: </strong>A total of 635 participants completed two rounds of questionnaire surveys. Birth satisfaction and resilience showed significant indirect associations between prenatal anxiety and PPD. The indirect association through birth satisfaction was 0.047 (95% confidence interval [CI]: 0.025-0.073), accounting for 17.34% of the total statistical association. Furthermore, the indirect association through resilience was 0.082 (95% CI: 0.054-0.116), accounting for 30.26% of the total statistical association.</p><p><strong>Conclusion: </strong>Prenatal anxiety was associated with postpartum depressive symptoms, with significant indirect associations through birth satisfaction and resilience. These findings highlight the potential relevance of psychological resources and childbirth experience in postpartum mental health and support further longitudinal and intervention research.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149266843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of pre-pregnancy underweight on the risk of perineal and anal sphincter injury in nulliparous women.","authors":"Daniel Gabbai, Omri Dominsky, Emmanuel Attali, Itamar Gilboa, Ronen Gold, Asnat Groutz, Yariv Yogev, Yoav Baruch","doi":"10.1002/ijgo.71399","DOIUrl":"https://doi.org/10.1002/ijgo.71399","url":null,"abstract":"<p><strong>Introduction: </strong>Perineal injury is a common complication of vaginal delivery with maternal consequences. Although the effects of obesity are established, the impact of underweight on perineal and obstetric anal sphincter injury (OASI), remains unclear.</p><p><strong>Objective: </strong>Our objective was to determine the association between pre-pregnancy underweight and the risk of non-severe perineal injury (NSPI) and OASI in nulliparous women.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a single, tertiary medical center including nulliparous women aged 18-45 years with singleton term vaginal deliveries (≥37 weeks) and pre-pregnancy body mass index (BMI) <25 kg/m² between 2012 and 2024. Women with diabetes were excluded. The cohort was divided into underweight (BMI <18.5 kg/m²) and normal BMI groups. The primary outcome was NSPI, and the secondary outcome was OASI. Multivariable logistic regression was performed to assess independent associations.</p><p><strong>Results: </strong>Overall, 32 112 women were included, 12.9% of whom were underweight. Underweight women had lower birthweights and lower rates of induction and occiput-posterior presentation (all P < 0.05). NSPI occurred slightly less frequently among underweight women than among women with normal BMI (81.5% vs 84.3%, P < 0.001), whereas OASI was more common (1.1% vs 0.8%, P = 0.033). In the fully adjusted model, underweight BMI was associated with slightly lower odds of NSPI (adjusted odds ratio [aOR] 0.905; 95% confidence interval [CI] 0.825-0.994) and higher odds of OASI (aOR 1.641; 95% CI 1.179-2.286). Additional factors associated with OASI in the fully adjusted model included higher birthweight per 100 g increment (aOR 1.132; 95% CI 1.096-1.169), occiput-posterior presentation (aOR 2.815; 95% CI 1.806-4.386), prolonged second stage (aOR 1.590; 95% CI 1.158-2.182), and vacuum-assisted delivery (aOR 2.304; 95% CI 1.666-3.187).</p><p><strong>Conclusion: </strong>Pre-pregnancy underweight was associated with slightly lower odds of NSPI but higher odds of OASI.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary incontinence burden and phenotype transitions after colpocleisis in older women with advanced pelvic organ prolapse.","authors":"Qi Wang, Xiaoxiang Jiang, Chaoqin Lin","doi":"10.1002/ijgo.71410","DOIUrl":"https://doi.org/10.1002/ijgo.71410","url":null,"abstract":"<p><strong>Objective: </strong>This study characterizes urinary incontinence (UI) burden and symptom-based UI phenotype transitions 1 year after colpocleisis in older women with advanced pelvic organ prolapse.</p><p><strong>Methods: </strong>This single-center retrospective cohort included women aged 60 years or older undergoing colpocleisis for advanced or recurrent pelvic organ prolapse between August 2019 and May 2025. Paired analyses included women with 1-year urinary follow-up. UI burden was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and symptom-based phenotypes were classified as stress UI (SUI), urgency UI (UUI), or mixed UI (MUI).</p><p><strong>Results: </strong>Of 505 women, 495 completed 1-year follow-up; 258 had preoperative UI. Any UI decreased from 52.1% to 39.8% (paired absolute risk difference -12.3 percentage points, 95% confidence interval [CI] -17.8 to -6.7; P < 0.001). The median ICIQ-SF total score declined from 4.0 (interquartile range [IQR] 0.0-7.0) to 0.0 (IQR 0.0-5.0), with a Hodges-Lehmann paired estimate of -0.5 (95% CI -1.5 to 0.0; P < 0.001). UUI and MUI decreased, whereas SUI increased modestly. Among 237 women without preoperative UI, 65 (27.4%) developed de novo UI, of which 55.4% was slight and none was very severe. Baseline UUI most often transitioned to no UI, whereas baseline MUI showed the broadest postoperative distribution.</p><p><strong>Conclusion: </strong>Colpocleisis was associated with reduced UI burden and distinct symptom-based phenotype transitions at 1 year. Descriptive transition patterns might inform preoperative counseling but should not be interpreted as an individual prediction tool.</p>","PeriodicalId":14164,"journal":{"name":"International Journal of Gynecology & Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}