Minerva obstetrics and gynecology最新文献

{"title":"Ultrasound signs of adenomyosis in pregnancy and counselling related to infertility and obstetric outcomes.","authors":"Emma Bertucci, Sofia Ceffa, Alessandra Danieli, Marialaura Diamanti, Filomena G Sileo, Anna L Tramontano, Carlo Alboni, Antonio La Marca","doi":"10.23736/S2724-606X.25.05857-9","DOIUrl":"10.23736/S2724-606X.25.05857-9","url":null,"abstract":"<p><p>Adenomyosis is the presence of endometrial glands and stroma within the myometrial wall of the uterus. This condition is related to a diffusely enlarged uterus with reactive hyperplasia and fibrosis of the surrounding myometrial smooth muscle cells. The symptomatology of adenomyosis is highly heterogeneous among patients and there are no pathognomonic symptoms specific to the condition. Clinically, although approximately 30% of patients remain asymptomatic, it can manifest as abnormal bleeding, pelvic pain, infertility and adverse obstetric outcome: miscarriage, preterm labor, uterine atony, other complications during labor. Diagnosis of adenomyosis relies on imaging techniques such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Precise ultrasound diagnosis enables the identification of symptomatic patients and allows for the implementation of appropriate treatments based on the severity of adenomyosis-related symptoms. Treatment options include pharmacological treatments usually with progestin or levonorgestrel-releasing intrauterine systems, hysteroscopic resection or ablation, conservative surgical methods and high-intensity focused ultrasound (HIFU). Diagnosis of adenomyosis during pregnancy can present challenges, as its symptoms may overlap with those of pregnancy, and it may be difficult to diagnose or differentiate from other conditions that affect the uterus during pregnancy. Additionally, imaging techniques commonly used to diagnose adenomyosis, such as transvaginal ultrasound and MRI, must be used cautiously due to the changes that occur in the uterus during pregnancy. Pregnancy leads to significant changes in the size and shape of the uterus, which can make the typical features of adenomyosis less apparent on imaging studies. Several studies suggest that adenomyosis may be linked to \"unexplained infertility\" and it is also conceived as a reproductive disorder, with reported prevalence rates of 38.2% in cases of recurrent pregnancy loss. Given the emerging evidence about the negative impact of adenomyosis on fertility and obstetric outcomes, accurate pre-conception and post-conception counseling is crucial. Treatment during pregnancy is generally conservative and they are based on symptoms control causing significant discomfort or interfere with pregnancy, management may include pain relief, such as acetaminophen or, in some cases, opioids (with caution) and careful monitoring throughout pregnancy. If adenomyosis is suspected during pregnancy, the condition is usually addressed post-delivery, and the approach to treatment depends on the severity of symptoms and any pregnancy complications that may arise. The aim of this review is to provide preconception and post-conception counselling for patients with adenomyosis, focusing on its impact on fertility and obstetric outcomes. It also aims to offer information on the symptoms and ultrasound diagnosis during pregnancy to ensure careful monitoring.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"375-387"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mature oocyte yield in patients with diminished ovarian reserve treated with luteal estradiol priming with or without GnRH antagonist.","authors":"Atoosa Ghofranian, Morgan Baird, Jensen Reckhow, Amalia Namath, Allison Eubanks, Anupama Rambhatla, Joseph A Lee, Phillip A Romanski, Alan B Copperman, Eric D Flisser, Kerry S Flannagan","doi":"10.23736/S2724-606X.26.05836-7","DOIUrl":"10.23736/S2724-606X.26.05836-7","url":null,"abstract":"<p><strong>Background: </strong>Luteal phase E2 priming is commonly used in patients with DOR to 30 synchronize follicular development before controlled ovarian hyperstimulation (COH). Some protocols 31 incorporate a GnRH antagonist during the luteal phase to further suppress endogenous gonadotropins, 32 though data on its added benefit are limited.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 1555 IVF cycles from 1212 patients with AMH <1 ng/mL undergoing COH for oocyte cryopreservation or IVF with PGT-A between 2012 and 2024 at an urban academic center. Patients received either luteal E2 priming alone (Group A, N.=280) or with a GnRH antagonist (Group B, N.=932). The primary outcome was the number of mature oocytes retrieved. Secondary outcomes included total oocytes, cycle cancellation, fertilization, blastocyst conversion, high-quality blastocysts, euploidy, implantation, clinical pregnancy, and live birth.</p><p><strong>Results: </strong>Baseline characteristics were similar between groups. No significant differences were observed in median total (6 [4-9] vs. 6 [4-9]) or mature oocytes retrieved (4 [3-6] vs. 5 [3-7]) between Group A and Group B. Fertilization rates, blastocyst development, quality, and euploidy outcomes were also comparable. Among 227 patients who underwent single euploid embryo transfer, implantation, clinical pregnancy, and live birth rates did not differ significantly between groups.</p><p><strong>Conclusions: </strong>The addition of a GnRH antagonist to luteal E2 priming did not improve oocyte yield or IVF outcomes in patients with DOR. Given similar efficacy and potential cost savings, luteal E2 priming alone may be a sufficient approach. Prospective trials are needed to validate these findings.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"323-330"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of low and late fertility on gestational diabetes mellitus and macrosomia.","authors":"Vincenzo Zanardo, Tiziana Battistin, Sara Sandri, Lorenzo Severino, Luca Brugnaro, Antonio Camporese, Daniele Romagnoli, Gianluca Straface","doi":"10.23736/S2724-606X.26.05845-8","DOIUrl":"10.23736/S2724-606X.26.05845-8","url":null,"abstract":"<p><strong>Background: </strong>Data on the occurrence of gestational diabetes mellitus (GDM) and related offspring macrosomia are limited in women with low and delayed fertility, both of which are increasingly common in high-income countries.</p><p><strong>Methods: </strong>We evaluated the occurrence of GDM among women who delivered in Abano Terme, Italy, between January 2020 and August 2023. Baseline and clinical characteristics of women with GDM (GDM group) and those with a normal oral glucose tolerance test (control group) were analyzed in relation to neonatal macrosomia (>4000 g).</p><p><strong>Results: </strong>Among 2600 women with low and late fertility included in the analysis, 231 (9.9%) were diagnosed with GDM. Women in the GDM group were older than control subjects (36.0 [31.5-39.0] vs. 33.0 [30.0-37.0] years; P<0.001), whereas parity did not differ between groups (2.00 [1.00-2.00] vs. 1.00 [1.00-2.00, P>0.5]). Pre-pregnancy BMI was significantly higher in the GDM group (63 [56-73] vs. 59 [54-66] kg, P<0.001), while height (164 [160-170] vs. 165 [160-170] cm, P<0.024] and gestational weight gain (GWG) (11 [8.5-14.0] vs. 13 [11.0-16.0] kg; P<0.001), P<0.001) were significantly lower. Neonatal birth weight (3400 [3080-3640] vs. 3360 [3100-3640] g; P>0.09) and the prevalence of macrosomia >4000 g (19 [8.2%] vs. 188 [8.1%]; P>0.9) did not differ between groups (P>0.09). In multivariate logistic regression analysis, the risk of GDM was significantly higher among women with low and late fertility or delayed fertility alone (odds ratios 2.3 and 1.9, respectively; P<0.001). Among maternal variables, only obesity at delivery (BMI ≥30 kg/m²) was independently associated with an increased risk of neonatal macrosomia (odds ratio 1.59; P=0.003).</p><p><strong>Conclusions: </strong>In women with low and late fertility, appropriate GWG may play a key role in mitigating the risk of neonatal macrosomia, even in the presence of GDM.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"331-337"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of robotic surgery in the treatment of advanced endometriosis: a systematic review and meta-analysis.","authors":"Emmanouil M Xydias, Elias Tsakos, Angelos Daniilidis, Georgios Grigoriadis, Georgios Gousis, Adrien Crestani, Benjamin Merlot, Horace Roman","doi":"10.23736/S2724-606X.25.05814-2","DOIUrl":"10.23736/S2724-606X.25.05814-2","url":null,"abstract":"<p><strong>Background: </strong>Advanced endometriosis (Stage III/IV) represents a particularly severe variant of endometriosis with more pronounced symptomatology and challenging surgical treatment. This review shall examine the role of robotic surgery, the latest breakthrough in surgical technology, in addressing this challenging condition.</p><p><strong>Methods: </strong>A systematic search of the literature in peer-reviewed databases was performed, focusing mainly on surgical outcomes. Meta-analysis was performed on comparative studies. Studies included in the meta-analysis were also subjected to risk of bias assessment and sensitivity analysis.</p><p><strong>Results: </strong>From the initial study pool, ultimately 36 studies were included, which indicated that robotic surgery was safe and feasible, with satisfactory surgical outcomes. Long-term quality of life and fertility outcomes were also positive, particularly for endometriosis-related pain, gastrointestinal symptoms and infertility, with 25-100% pregnancy rate after surgery. Comparative data versus laparoscopy, indicated no statistically significant differences between the two approaches with regard to blood loss, hospitalization or complications (including transfusion, conversion to open surgery, re-hospitalization and re-operation), although operative time was significantly longer for robotic surgery (WMD: 38.32, 95%CI: 24.14, 52.49, P<0.001). However, Robotic surgery was superior in addressing endometriosis-related pain and was less harmful on ovarian reserve according to two studies.</p><p><strong>Conclusions: </strong>Robotic surgery for advanced endometriosis is a safe and viable approach. While current data reveal no differences in surgical outcomes compared to laparoscopy, the lack of randomized studies precludes definitive conclusions. Future research should focus on patient randomization and on identifying subgroups that would most benefit from the application of this novel technology.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"348-365"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of six large language models for study identification in an obstetric systematic review.","authors":"Shmuel Somer, Maia Vardy, Jonathan Eisenberger, Moran Shapira, Shoshana Mehler, Myriam Safrai","doi":"10.23736/S2724-606X.25.05849-X","DOIUrl":"10.23736/S2724-606X.25.05849-X","url":null,"abstract":"<p><strong>Background: </strong>Identifying eligible studies is a foundational component of systematic reviews, requiring careful interpretation of complex inclusion and exclusion criteria. Given the rapid integration of large language models (LLMs) into evidence synthesis, their reliability in autonomously performing this task necessitates timely evaluation. This study intends to assess whether general-purpose LLMs can accurately perform the study identification phase of a published systematic review in obstetrics using only predefined eligibility criteria.</p><p><strong>Methods: </strong>Six publicly accessible LLMs were given a standardized prompt, without iterative refinement or human oversight, to identify eligible studies from a 2023 JAMA Network Open meta-analysis. Each model's output was compared with the 14 studies included in the reference review. Primary outcomes were precision, recall, F1 score, and hallucination severity.</p><p><strong>Results: </strong>Claude 3.7 achieved the highest accuracy, correctly identifying 5 of 14 reference studies (precision 71.4%, recall 35.7%, F1 score of 0.48). In comparison, all other models exhibited substantially lower performance with minimal variation in F1 scores (ranging between 0.08-0.12), indicating a poor balance of precision and recall. Precision was generally inversely related to the number of false positives, and LLMs that returned more total studies tended to produce more hallucinations.</p><p><strong>Conclusions: </strong>Current general-purpose LLMs are unreliable for autonomous study identification in clinically relevant systematic reviews and human oversight remains essential. The low F1 scores highlight major limitations in current LLMs' ability to accurately and comprehensively identify relevant studies. These findings underscore the need for fine-tuning and hybrid AI-human workflows before safe integration into evidence synthesis in obstetrics and gynecology.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"366-374"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian tissue cryopreservation in prepubertal girls: a systematic review of indications, outcomes, and clinical practice.","authors":"Loris Marin, Kutluk H Oktay","doi":"10.23736/S2724-606X.26.05865-3","DOIUrl":"10.23736/S2724-606X.26.05865-3","url":null,"abstract":"<p><strong>Background: </strong>Ovarian tissue cryopreservation (OTC) is the only fertility-preservation option available for prepubertal girls at risk of premature ovarian insufficiency (POI). While its use is well established in adults, the experience is more limited in children.</p><p><strong>Methods: </strong>This systematic review was conducted according to PRISMA 2020 guidelines (PROSPERO CRD420251158063). PubMed, Scopus, Embase, and Web of Science were searched through July 2025 for studies investigating OTC and subsequent ovarian tissue transplantation (OTT) in prepubertal girls (≤12 years). Forty-five studies met inclusion criteria, including case reports, case series, and cohort studies.</p><p><strong>Results: </strong>Endocrine recovery occurred in all documented OTT cases, with few reported pregnancies - both spontaneous and ART-assisted - and no reported disease relapses. Surgical approaches varied widely, particularly regarding ovarian tissue harvesting (biopsy vs. unilateral oophorectomy) and the use of energy devices. Of the GV oocytesobtained from harvested ovarian cortex, in-vitro maturation (IVM) rates ranged from 15% to 38% and appeared age-dependent; one study showed improved outcomes after gonadotropin priming. In Turner syndrome, follicular density showed high variability and frequent follicular abnormalities, and no OTTs were reported. Ethical analyses emphasized parental decision-making and highlighted the need to involve older children in assent discussions.</p><p><strong>Conclusions: </strong>Prepubertal OTC appears feasible and capable of restoring ovarian function after OTT, although current experience remains limited. Available data suggest reassuring oncologic safety, but further confirmation across malignancy types is required. OTC in prepubertal patients should therefore be confined to specialized programs, supported by multidisciplinary counseling and long-term follow-up.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"388-397"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147931051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of gestational weight gain with carotid intima-media thickness in correlation with pregnancy outcome and placental assessment: a prospective study.","authors":"Giulia Barda, David Hovel, Ann Dekalo, Margarita Mashavi, Jacob Bar, Letizia Schraiber, Mariana Shargorodsky, Amihai Rottenstreich","doi":"10.23736/S2724-606X.26.05817-3","DOIUrl":"10.23736/S2724-606X.26.05817-3","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to investigate the association of gestational weight gain with carotid artery intima-media thickness (IMT) during late pregnancy, and the association with metabolic parameters, pregnancy outcome and placental histological assessment.</p><p><strong>Methods: </strong>Pregnant patients admitted with signs of labor were prospectively recruited and categorized into two groups: Group 1 included women with excessive weight gain during pregnancy; Group 2 included women with gestational weight gain within recommended range. IMT of the carotid arteries was measured sonographically. Placental histopathology was assessed by an experienced pathologist.</p><p><strong>Results: </strong>The study group included 59 women, 32 in group 1 and 27 in group 2. Mean carotid artery IMT was thicker in group 1 compared with group 2 (0.7 vs. 0.6 mm, P=0.028). Metabolic parameters including blood glucose and insulin resistance, using the homeostasis model assessment-insulin resistance (HOMA-IR) were also significantly higher in women with excessive weight gain during pregnancy as compared with group 2 (P=0.026 and P=0.045, respectively). Gestational age at delivery was similar in the two groups, while birthweight and the rate of macrosomia were significantly higher in group 1 than in group 2 (P=0.033 and P=0.014, respectively). Placental lesions consistent with fetal thrombo-occlusive disease were more prevalent in group 1 than in group 2.</p><p><strong>Conclusions: </strong>Excessive weight gain during pregnancy is associated with increased IMT of the carotid arteries that correlate with abnormal metabolic parameters, adverse pregnancy outcome and abnormal placental findings.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"308-315"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of uterine cancer after supracervical hysterectomy.","authors":"Margot Le Neveu, Adrienne Simmons, Stephen Rhodes, Iryna Crescenze, David Sheyn","doi":"10.23736/S2724-606X.26.05828-8","DOIUrl":"10.23736/S2724-606X.26.05828-8","url":null,"abstract":"<p><strong>Background: </strong>Supracervical hysterectomy (SCH), commonly performed during sacrocolpopexy, involves removal of the uterine corpus, leaving the cervix in-situ. Significant anatomic variation exists in remnant tissue, which may develop into a uterine malignancy. No prior studies have sought to describe the future risk of developing de novo uterine cancer after SCH with benign pathology. This study aims to describe the incidence rate of uterine cancer following SCH performed for benign indication.</p><p><strong>Methods: </strong>Retrospective cohort study of patients who underwent SCH between June 2000 and December 2022 using the Premier Healthcare Database. Demographics and covariates were compared between patients who did and did not develop malignancy. Primary outcome was incidence rate of uterine cancer after benign SCH. Kaplan-Meier estimates were used to assess uterine cancer risk following SCH.</p><p><strong>Results: </strong>Among 25,126 benign SCHs, 92 patients (0.37%) were found to have incidental malignancy at the time of hysterectomy, and 35 (0.14%) patients subsequently developed de novo malignancy despite benign pathology at index surgery with an incidence rate of 0.44 per 1000 person-years (95% CI 0.31-0.61). Patients with uterine cancer were older (54.7 vs. 48.8 years, P<0.001) with lower rates of pelvic organ prolapse (17.3% vs. 35.7%, P<0.001) and higher rates of postmenopausal bleeding (19.7% vs. 3.0%, P<0.001), endometrial hyperplasia (11.2% vs. 1.2%, P<0.001), and cervical abnormalities (16.5% vs. 5.6%, P<0.001).</p><p><strong>Conclusions: </strong>Incidence of incidental and de novo uterine cancer after benign supracervical hysterectomy are low, occurring in 0.51% of patients, and can augment counseling regarding hysterectomy approach.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"316-322"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative predictors of blood transfusion during cesarean delivery in placenta accreta spectrum.","authors":"Sarah Dollinger, Lior Friedrich, Maya Ronen, Shay Sukenik, Gad Sabah, Yoav Peled, Haim Krissi","doi":"10.23736/S2724-606X.26.05906-3","DOIUrl":"10.23736/S2724-606X.26.05906-3","url":null,"abstract":"<p><strong>Background: </strong>Placenta accreta spectrum (PAS) carries substantial hemorrhagic morbidity during cesarean delivery (CD), yet clinically useful antenatal risk indicators of intraoperative hemodynamic instability remain limited. This study aimed to evaluate associations between routinely available preoperative clinical and sonographic factors and intraoperative blood transfusion.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of all patients with PAS who underwent CD at a tertiary medical center between 2000 and 2020. Patients were stratified by whether they received intraoperative blood product transfusion. Preoperative clinical characteristics and sonographic findings were analyzed. Multivariable logistic regression was used to evaluate associations between preoperative factors and blood transfusion, with a prespecified subgroup analysis restricted to grade-1 PAS.</p><p><strong>Results: </strong>Of 312 patients with PAS, 97 (40%) required intraoperative blood product transfusion. On multivariable analysis, antenatal diagnosis of placenta previa (odds ratio [OR] 4.99, 95% CI 2.55-9.92) and sonographic suspicion of PAS (OR 3.13, 95% CI 1.40-7.10) were independently associated with transfusion. In the subgroup of patients with grade-1 PAS, placenta previa remained the sole independent predictor of transfusion (OR 6.92, 95% CI 2.96-16.8). Intraoperative factors, including hysterectomy, longer operative duration, and use of general anesthesia, were more common among transfused patients and reflected surgical complexity rather than preoperative risk.</p><p><strong>Conclusions: </strong>Placenta previa and antenatal suspicion of PAS were the clinical features most strongly associated with intraoperative blood transfusion. These findings support pragmatic preoperative preparation and surgical planning in PAS management.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":"338-347"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of conventional insemination compared to intracytoplasmic sperm injection on fertilization and pregnancy outcomes among individuals utilizing cryopreserved donor sperm.","authors":"Joshua M Morris, Gabrielle Jenkins, Laura Zalles, Elizabeth Clain, Shelley Dolitsky, Jiarui Wang, Phillip A Romanski, Nicole Banks, Benjamin S Harris","doi":"10.23736/S2724-606X.26.05853-7","DOIUrl":"10.23736/S2724-606X.26.05853-7","url":null,"abstract":"<p><strong>Background: </strong>Intracytoplasmic sperm injection (ICSI) has not been shown to be superior to conventional insemination for non-male factor infertility indications in cycles using fresh sperm, however fertilization and reproductive outcomes have not been explored in the setting of cryopreserved sperm.</p><p><strong>Methods: </strong>This retrospective cohort study included 4413 patient couples between 2010 and 2021 that underwent autologous retrieval cycles utilizing cryopreserved donor sperm with linked subsequent fresh and frozen single blastocyst transfers at a large network of private practice fertility clinics in the United States. The primary exposure was insemination method; conventional insemination or ICSI. The primary outcome of interest was fertilization percentage. Secondary outcomes included percentages of blastulation, total fertilization failure, clinical pregnancy, and live birth. Adjusted associations were evaluated accounting for relevant confounders.</p><p><strong>Results: </strong>At first retrieval, patients in the conventional insemination group had a higher mean number of oocytes retrieved (14.29 [7.70] vs. 13.58 [8.84]) and number of fertilized oocytes (8.70 [5.27] vs. 7.89 [5.88]) compared to the ICSI group. Mean fertilization and blastulation percentages were also higher in those who utilized conventional insemination (61% and 45%) compared to those who utilized ICSI (56% and 34%). After multiple retrievals, adjusted associations examining fertilization method and outcomes showed conventional insemination was associated with a 12% (95% CI [0.05, 0.19]) higher mean blastulation percentage, increased likelihood of clinical pregnancy (RR 1.64; 95% CI [1.27, 2.12]), and higher live birth (RR=1.45; 95% CI [1.06, 2.00]) compared to ICSI.</p><p><strong>Conclusions: </strong>Use of conventional insemination in cycles involving cryopreserved donor sperm was associated with improved blastulation and increased likelihood of clinical pregnancy and live birth compared to ICSI. These findings suggest that routine ICSI use in this population may warrant reconsideration and that conventional insemination could remain an appropriate option in selected cases utilizing cryopreserved donor sperm.</p>","PeriodicalId":18572,"journal":{"name":"Minerva obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}