Journal of gynecology obstetrics and human reproduction最新文献

{"title":"Carbetocin vs Oxytocin for prevention of Postpartum Hemorrhage in Women with Obesity undergoing Cesarean Delivery: A Systematic Review and Meta-Analysis.","authors":"Gabriela Francis, Kellen Rocha, Bruna Benigna Sales Armstrong, Hatem S Mohamed, Abdelrahman Yousif","doi":"10.1016/j.jogoh.2026.103208","DOIUrl":"https://doi.org/10.1016/j.jogoh.2026.103208","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness and safety of carbetocin versus oxytocin for the prevention of postpartum hemorrhage in women with obesity undergoing cesarean delivery.</p><p><strong>Study design: </strong>PubMed, CENTRAL, and Embase databases were searched from inception through July 2025, with no language restrictions. Randomized controlled trials were included. Outcomes assessed were mean blood loss, need for blood transfusion, use of additional uterotonics, hemodynamic parameters, and adverse events. Random-effects meta-analyses were performed in R software. Continuous outcomes were pooled as mean differences (MD), and binary outcomes as risk ratios (RR). Statistical heterogeneity was assessed using the I² statistic.</p><p><strong>Results: </strong>Three RCTs (n = 269 participants) were included. Carbetocin was associated with a greater reduction in blood loss than oxytocin (MD -230.11 ml; 95% CI -370.90 to -89.33; p=0.0014), and significantly fewer blood transfusions when compared to oxytocin (RR 0.14; 95% CI 0.03 to 0.63; p = 0.011); although these results lacked robustness in sensitivity analysis. However, in the pooled and sensitivity analyses, carbetocin demonstrated a significant and consistent reduction in the incidence of postpartum hemorrhage (RR 0.19; 95% CI 0.06 to 0.63; p = 0.006).</p><p><strong>Conclusions: </strong>Carbetocin was associated with significantly reduced incidence of postpartum hemorrhage compared with oxytocin in obese women undergoing cesarean delivery. These findings suggest potential benefit of carbetocin in this high-risk population; however, larger, high-quality trials are required to confirm these results.</p>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":" ","pages":"103208"},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856433","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":"Evaluation of an Office-Based Protocol for Pelvic Pain and Function in Female Patients with Chronic Pelvic Pain.","authors":"Allyson Shrikhande, Nairi Brown, Jasmine Ross, Jennifer Ezavin, Kimberlee Leishear, Rachelle Derosena, Gautam Shrikhande","doi":"10.1016/j.jogoh.2026.103206","DOIUrl":"https://doi.org/10.1016/j.jogoh.2026.103206","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic Pelvic Pain (CPP) is challenging to treat, with many patients living in pain for up to 15 years before finding suitable treatment. Patients frequently report sexual dysfunction, emergency room visits, opioid use, and impaired ability to work and perform everyday functions. Altogether, CPP is associated with reduced quality of life, presenting a need for additional treatment options.</p><p><strong>Materials and methods: </strong>We performed a retrospective cohort study in 1517 CPP patients who displayed trigger points, pelvic floor hypertonia, and tenderness of the levator ani sling. Patients also demonstrated tenderness along the pudendal nerve and posterior femoral cutaneous nerve at Alcock's canal and obturator canal bilaterally. These patients underwent a minimally invasive, office-based protocol involving six ultrasound-guided percutaneous pelvic peripheral nerve blocks and trigger point injections. Patients with data from an initial consult and a visit approximately three months following initiation of treatment were included. Patients with missing data were excluded.</p><p><strong>Results: </strong>Patients demonstrated a 48.8% reduction in pain and significant improvement across all functional domains (P < 0.001). The proportion of patients reporting emergency room visits and opioid use decreased by 88.5% and 44.8%, respectively (P < 0.001). Sexual function improved by 16.7% (P < 0.001). Patients reported a 45.4% increase in 0 workdays missed from pain and a 93.2% increase in 0 hours of impaired productivity (P < 0.001).</p><p><strong>Conclusion: </strong>This procedure is associated with significant improvements in pain and quality of life metrics. Further analysis of its long-term efficacy, especially compared to a control group, is suggested.</p>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":" ","pages":"103206"},"PeriodicalIF":1.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838755","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":"Clitoroplasty and urogenital sinus mobilization in females with congenital adrenal hyperplasia: A case report with focused literature discussion","authors":"Faruk Abike,&nbsp;Fatma Basak Tanoglu,&nbsp;Bashar Yacoub Abdelhafiz Sammour","doi":"10.1016/j.jogoh.2026.103134","DOIUrl":"10.1016/j.jogoh.2026.103134","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital adrenal hyperplasia (CAH) can result in masculinized genitalia due to excessive androgen production. This genital virilization often presents as clitoral hypertrophy, ranging from a significantly enlarged clitoris to a phallic-like clitoris in female patients.</div></div><div><h3>Case presentation</h3><div>A Syrian refugee girl presented at age 24 with complaints of abnormal genitalia. Gynecologic examination revealed clitoromegaly, absence of labia minora, and a single common orifice of the urethra and vagina, the size of a pinhead. Nerve-sparing clitoroplasty, total urogenital sinus mobilization, vaginoplasty, and creation of labia minora with perineoplasty were performed.</div></div><div><h3>Conclusions</h3><div>There are limited case reports on CAH, clitoroplasty, and urogenital sinus mobilization in adults. This case highlights the feasibility of one-stage feminizing genitoplasty in adulthood and provides unique educational value through detailed step-by-step surgical video documentation.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"55 5","pages":"Article 103134"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157337","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":"Successful live birth following robotic-assisted management of a cesarean scar pregnancy: a promising pathway","authors":"Antonella Iannaccone ,&nbsp;Paul Buderath ,&nbsp;Martin W. Britten ,&nbsp;Alberto Spina ,&nbsp;Katharina Krempel ,&nbsp;Zeynep Atas Elfrink ,&nbsp;Angela Köninger ,&nbsp;Rainer Kimmig ,&nbsp;Roland Csorba","doi":"10.1016/j.jogoh.2026.103131","DOIUrl":"10.1016/j.jogoh.2026.103131","url":null,"abstract":"<div><div>Cesarean scar pregnancy (CSP) is a variant of uterine ectopic pregnancy defined by full or partial implantation of the gestational sac in the scar of a previous cesarean section. The most usual recommendation is termination of pregnancy in the first trimester.</div><div>In this article, we present a case of live birth after detecting CSP in early pregnancy and robotic scar reinforcement surgery, effectively relocating the pregnancy into the cavum. At 25+3 gestational weeks, an emergency caesarean section was performed. A girl weighing 800 g was delivered with APGAR 7/7/9. The percrete area of the placenta was excised and the uterus could be preserved.</div><div>Prolongation of CSP and consecutive live birth is feasible and can be achieved. Using robotic surgical approach for both the scar reinforcement surgery as well as the surveillance of the pregnancy including caesarean section with management of placenta percreta require high expertise and specialized centres.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"55 5","pages":"Article 103131"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137416","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":"Misoprostol for Cervical Ripening Before Suction Curettage for Molar Pregnancy: Surgical Safety and Oncologic Outcomes.","authors":"Setareh Akhavan, Azam Sadat Moosavi, Shahrzad Sheikhhasani, Narges Zamani, Mina Sadat Mosavat","doi":"10.1016/j.jogoh.2026.103199","DOIUrl":"https://doi.org/10.1016/j.jogoh.2026.103199","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the operative safety, efficiency, and oncologic outcomes of a standardized misoprostol-assisted surgical evacuation protocol for molar pregnancies.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of 118 patients with histologically confirmed hydatidiform moles. All patients received 400 μg of vaginal misoprostol for cervical ripening 3-4 hours before undergoing ultrasound-guided suction curettage. The primary outcomes included operative metrics (need for mechanical dilation, blood loss, operative time) and the incidence of post-molar gestational trophoblastic neoplasia (GTN). Beta-human chorionic gonadotropin (β-hCG) normalization and reproductive outcomes were also analyzed.</p><p><strong>Results: </strong>The protocol demonstrated high operative efficiency. Cannula passage was achieved without mechanical dilators in 94.9% of patients, with a mean operative time of 15.2 minutes. No major complications (uterine perforation, cervical laceration, or trophoblastic embolism) occurred. Blood transfusion was required in 4.2% of cases. The overall post-molar GTN incidence was 13.6%, which is consistent with established literature; the rate for complete moles was 20.3%, with no cases following partial moles. Among patients desiring future pregnancy, the live birth rate was 81.5%.</p><p><strong>Conclusion: </strong>The use of misoprostol for cervical ripening before surgical evacuation of molar pregnancy is safe and effective. It facilitates a controlled procedure with favorable operative outcomes and does not appear to increase the risk of GTN.</p>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":" ","pages":"103199"},"PeriodicalIF":1.6,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816165","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":"Obesity in Obstetric Anesthesia: A Systematic Review.","authors":"I Pasca, L Soloniuk, C Baker, A Virdi, M Botros, C Ghobrial, A Sinha","doi":"10.1016/j.jogoh.2026.103179","DOIUrl":"https://doi.org/10.1016/j.jogoh.2026.103179","url":null,"abstract":"<p><p>Maternal obesity presents complex challenges for anesthetic management, with implications spanning neonatal, cardiovascular, airway, neuraxial, and procedural domains. This review synthesizes evidence on how elevated maternal body mass index (BMI) impacts perioperative evaluations, risks, complications, and outcomes, in addition to anesthetic modalities and efficacy in the pregnant population. Given the increasing global prevalence of maternal obesity, anesthesiologists must refine clinical practices, employing tailored, evidence-based strategies to mitigate risks and enhance patient outcomes. This review aims to provide anesthesiologists and obstetricians with key considerations and best practices for managing obstetric anesthesia patients with obesity. Clinical recommendations herein are based on current research and evaluated using Oxford Centre for Evidence-Based Medicine for level of evidence and class of recommendation.</p>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":" ","pages":"103179"},"PeriodicalIF":1.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645575","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":"Doppler ultrasound at 41 weeks: Pragmatic evidence, clinical relevance, and response to methodological considerations","authors":"Jeremy Boujenah,&nbsp;Bruno Carbonne","doi":"10.1016/j.jogoh.2026.103125","DOIUrl":"10.1016/j.jogoh.2026.103125","url":null,"abstract":"","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"55 4","pages":"Article 103125"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044047","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":"Prenatal alcohol exposure and sonographic abnormalities: Insights from a retrospective cohort","authors":"Margaux Sizaire ,&nbsp;Lucie Galvan ,&nbsp;Violaine Peyronnet ,&nbsp;Emilia Holmström ,&nbsp;Charles Egloff ,&nbsp;Victoire Pauphilet ,&nbsp;Oliver Picone ,&nbsp;Laurent Mandelbrot ,&nbsp;Imane Ben M’Barek","doi":"10.1016/j.jogoh.2026.103124","DOIUrl":"10.1016/j.jogoh.2026.103124","url":null,"abstract":"<div><h3>Context</h3><div>Foetal Alcohol Syndrome (FAS) is the most severe form of Foetal Alcohol Spectrum Disorders (FASD), caused by prenatal alcohol exposure, a major preventable cause of congenital disability. FASD lack specific prenatal ultrasound signs, making early diagnosis difficult.</div></div><div><h3>Objective</h3><div>To describe prenatal ultrasound findings in pregnancies with reported alcohol use and compare maternal and neonatal characteristics according to the presence of anomalies.</div></div><div><h3>Methods</h3><div>We conducted a retrospective multicentre study in three hospitals from September 2013 to April 2025. All women reporting alcohol use during pregnancy were included. Exposure was classified by quantity (moderate: ≤3 drinks/day or &lt;40 cl/day; excessive: &gt;3 drinks/day or &gt;40 cl/day) and frequency (occasional, often, chronic), based on maternal self-report. Ultrasound scans from all trimesters were reviewed for growth and morphological anomalies. Comparative analyses were performed between women with and without anomalies.</div></div><div><h3>Results</h3><div>Among 94 pregnancies, 30 (32%) showed ultrasound anomalies. Women with anomalies were older (33.9 vs. 31.7 years, p &lt;0.01), with no differences in BMI, parity, or co-exposures. Occasional alcohol use appeared not associated with anomalies, whereas increasing maternal age (aOR = 1.22; 95% CI [1.09-1.40]) was an independent risk factor. Most anomalies were detected in the second trimester, mainly foetal growth restriction (FGR) and microcephaly. Neonatal abnormalities occurred in 70% of the anomaly group versus 10.9% without anomalies (p &lt; 0.01). Seven neonates (11%) had undiagnosed FGR or microcephaly at birth.</div></div><div><h3>Conclusion</h3><div>Ultrasound anomalies were found in one-third of alcohol-exposed pregnancies, underscoring the risks of chronic alcohol use.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"55 4","pages":"Article 103124"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044073","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":"Determinents of spontaneous labor for prolonged pregnancy and effectiveness of membrane sweeping: An observational study","authors":"Vincent Marcoux ,&nbsp;Marie De Antonio ,&nbsp;Amélie Delabaere ,&nbsp;Marie Accoceberry ,&nbsp;Céline Houlle ,&nbsp;Pamela Bouchet ,&nbsp;Fanny Petillon ,&nbsp;Marion Rouzaire ,&nbsp;Denis Gallot","doi":"10.1016/j.jogoh.2026.103132","DOIUrl":"10.1016/j.jogoh.2026.103132","url":null,"abstract":"<div><h3>Background</h3><div>Prolonged pregnancy is associated with an increased risk of maternal, fetal and neonatal complications. Careful monitoring and systematic induction at 42 weeks of gestation are recommended in France.</div></div><div><h3>Objectives</h3><div>Our primary objective was to identify determinants for spontaneous labor during expectant management for prolonged pregnancy. Our secondary objective was to assess the efficacy of membrane sweeping in bringing on labor.</div></div><div><h3>Study design</h3><div>This observational, retrospective, monocentric study included all patients with a singleton pregnancy who had reached the term of 41 weeks of gestation to within one day. They underwent an expectant period up to 41 weeks and 6 days with fetal heart monitoring and ultrasound every two days. The cohort was divided into two groups according to the presence or absence of membrane sweeping. In the group that did not undergo membrane sweeping (Natural History cohort), we compared patients who entered spontaneous labor with those who required induction of labour.</div></div><div><h3>Results</h3><div>A total of 366 patients were included. For the 293 patients without membrane sweeping, spontaneous labor occurred in 51.1 % of cases. A higher Bishop score (<em>p</em> = 0.02) and a lower BMI (<em>p</em> = 0.08) were associated with spontaneous labor. Parity had no influence (<em>p</em> = 0.74). Effectiveness of membrane sweeping to promote spontaneous labor was highlighted after adjustment on parity, BMI and Bishop score (71.6 % vs 51.5 %, <em>p</em> = 0.021, SMD=0.422).</div></div><div><h3>Conclusion</h3><div>In prolonged pregnancy, the probability of going into spontaneous labor was only 50.9 %. Low BMI and high Bishop score were associated with spontaneous onset of labor in case of expectant management. Membrane sweeping was associated with spontaneous labor in our post-term population after adjustment on parity, BMI and Bishop score.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"55 4","pages":"Article 103132"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137377","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":"Chromosomal abnormalities diagnosed at the chromosomal microarray in pregnancies with isolated high risk of trisomy 21","authors":"Helyett Ollivier ,&nbsp;Valérie Malan ,&nbsp;Raphael Bartin ,&nbsp;Jean-Michel Dupont ,&nbsp;Julien Stirnemann ,&nbsp;Yves Ville ,&nbsp;Matthieu Dap","doi":"10.1016/j.jogoh.2026.103112","DOIUrl":"10.1016/j.jogoh.2026.103112","url":null,"abstract":"<div><h3>Introduction</h3><div>In most European countries, if the risk of trisomy 21 exceeds 1/50, Women are offered further investigation through an invasive test. Since the development of the non-invasive test based on circulating free DNA from the entire genome (cfDNA), the use of non-invasive tests in this high-risk population is now being debated. Our study aims to investigate a cohort of women at high risk of isolated trisomy 21 with no ultrasound abnormalities at the first trimester ultrasound scan or nuchal translucency greater than the 99th percentile who underwent invasive sampling with chromosomal microarray analysis (CMA).</div></div><div><h3>Material and methods</h3><div>This retrospective cohort included 159 women with isolated high-risk of Trisomy 21 (T21) screening who underwent invasive testing with CMA between 2017 and 2023. We described chromosomal abnormalities and explored associations with first-trimester markers and ultrasound findings.</div></div><div><h3>Results</h3><div>Chromosomal abnormalities were identified in 24% of cases (38/159), including twenty-seven trisomy 21, two trisomy 18, four true fetal mosaicisms (one trisomy 22, two trisomy 16, and one monosomy X), two cases of confined placental mosaicism (trisomy 22 and trisomy 13), and three copy number variants (two likely benign and one pathogenic). Low PAPP-A levels were significantly associated with chromosomal imbalance (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>In a population of women with a high risk of trisomy 21 but without nuchal translucency greater than the 99th percentile or ultrasound signs at the first trimester, the rate of chromosomal abnormalities is 24%. Although these abnormalities are heterogeneous, the majority are aneuploidy; with only large CNVs of 13.9 Mb having a poor neurodevelopmental prognosis.</div></div>","PeriodicalId":15871,"journal":{"name":"Journal of gynecology obstetrics and human reproduction","volume":"55 4","pages":"Article 103112"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989647","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}