Archives of Gynecology and Obstetrics最新文献

{"title":"Clinical relevance and prognostic role of PDL-1 expression in cervical cancer patients","authors":"Antonio Arnò, Angelina Pernazza, Martina Leopizzi, Elena Benedettucci, Bruna Cerbelli, Lucia Manganaro, Giacomo Barchiesi, Federica Tomao, Giorgia Perniola, Violante Di Donato, Gabriella Gentile, Sofia Mancini, Francesca De Felice, Ludovico Muzii, Carlo Della Rocca, Innocenza Palaia","doi":"10.1007/s00404-026-08454-8","DOIUrl":"10.1007/s00404-026-08454-8","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08454-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147830080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical length following cerclage as a predictor of spontaneous preterm birth.","authors":"Maya Frank Wolf, Liron Kinog, Ruba Tuma, Lior Lowenstein, Marwan Odeh, Inshirah Sgayer","doi":"10.1007/s00404-026-08453-9","DOIUrl":"https://doi.org/10.1007/s00404-026-08453-9","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate the association between serial transvaginal cervical length measurements following McDonald cerclage and spontaneous preterm birth (PTB).</p><p><strong>Methods: </strong>This retrospective study included singleton pregnancies with cerclage performed during 2010-2024. Cerclage was placed prophylactically (n = 109) based on obstetric history, or emergently (n = 46) due to ultrasound findings. Cervical length was measured by transvaginal ultrasound before and after cerclage, and at 2-week intervals until 32 weeks.</p><p><strong>Results: </strong>For the prophylactic group, the median cervical length was shorter among those who delivered PTB < 37 weeks (n = 23) than term: at 21-22 + 6 weeks (2.5 vs. 3.9 cm, p = 0.042), 23-24 + 6 weeks (2.0 vs. 3.4 cm, p = 0.016), 25-26 + 6 weeks (3.0 vs. 3.8 cm, p = 0.042), and 31-32 + 6 weeks (2.4 vs. 3.4 cm, p = 0.015). In multivariable analysis adjusted for history of PTB, progesterone use, and gestational age at cerclage placement, shorter cervical length, at 23-24 + 6 weeks (adjusted odds ratio [aOR] 4.13, 95% confidence interval [CI] 1.23-13.89, p = 0.021) and at 25-26 + 6 weeks (aOR 3.39, 95% CI 1.08-10.64, p = 0.037), was independently associated with PTB < 37 weeks. Cervical length at 25-26 + 6 weeks was associated with PTB < 32 weeks (aOR 4.76, 95% CI 1.20-19.60, p = 0.027). For the emergency group, the median cervical length was shorter among those who delivered < 32 weeks than later, at 23-24 + 6 weeks (1.4 vs. 3.2 cm, p = 0.049) and 25-26 weeks (1.5 vs. 2.3 cm, p = 0.041).</p><p><strong>Conclusion: </strong>Serial cervical length monitoring after cerclage provides a clinically relevant prediction of spontaneous PTB.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833048","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":"Severe maternal morbidity in patients of advanced maternal age with and without metabolic syndrome","authors":"Carolyn Robb,&nbsp;Rebecca Strafella,&nbsp;Jay Ayar,&nbsp;Olivia Prizzi,&nbsp;Su Htwe,&nbsp;Sarah Weiss,&nbsp;Elizabeth Drugge,&nbsp;Vani Dandolu","doi":"10.1007/s00404-026-08449-5","DOIUrl":"10.1007/s00404-026-08449-5","url":null,"abstract":"<div><h3>Purpose</h3><p>To estimate the burden of metabolic syndrome (MetS) on severe maternal morbidity (SMM) in women of advanced maternal age (AMA), quantify age-related escalation in SMM risk, and evaluate sociodemographic influences.</p><h3>Methods</h3><p>We retrospectively conducted a cross-sectional, population-level analysis of the Nationwide Inpatient Sample (Q4 2015–2019), a discharge-level database, to identify delivery hospitalizations among patients aged ≥ 35 years. MetS was defined by ICD-10 codes indicating ≥ 3 of the following: hypertension, type 2 diabetes, obesity, hypertriglyceridemia, or low high-density lipoprotein cholesterol. The primary outcome was SMM as defined by the Centers for Disease Control and Prevention; a secondary outcome excluded blood transfusion. Multivariable logistic regression adjusted for race, income quartile, primary payer, hospital characteristics, and substance use. Weighted adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.</p><h3>Results</h3><p>Among 3.1 million delivery hospitalizations, 556,609 (17.8%) occurred in AMA patients; 12,188 (2.2%) experienced SMM and 6,528 (1.2%) experienced nontransfusion SMM. SMM was significantly higher among patients with MetS compared to  those without (7.37% vs 2.17%; nontransfusion SMM: 5.36% vs 1.16%). SMM rates increased with advancing age. After adjustment, MetS was associated with markedly increased odds of SMM (AOR 2.75, 95% CI 2.29–3.30) and nontransfusion SMM (AOR 3.59, 95% CI 2.90–4.44), both p &lt; 0.001.</p><h3>Conclusion</h3><p>MetS is associated with SMM risk among AMA patients, independent of sociodemographic factors, with risk increasing further at older maternal ages. This study quantifies the disproportionate burden of MetS in this high-risk population.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08449-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147829380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive role of Ki67 in pathological complete response (pCR) and invasive disease-free survival (IDFS) in HER2-positive breast cancer: a bi-centric retrospective cohort study of 244 cases","authors":"Laura Weydandt,&nbsp;Saida Agabejli,&nbsp;Massimiliano Lia,&nbsp;Pauline Wimberger,&nbsp;Bahriye Aktas,&nbsp;Theresa Link","doi":"10.1007/s00404-026-08401-7","DOIUrl":"10.1007/s00404-026-08401-7","url":null,"abstract":"<div><h3>Purpose</h3><p>The purpose of this study was to examine whether Ki67-scores have a predictive significance for pathological complete response (pCR) and invasive disease-free survival (IDFS) in HER2-positive breast cancer.</p><h3>Methods</h3><p>This retrospective, bi-centric cohort study focused on HER2-positive early breast cancer patients undergoing neoadjuvant chemotherapy from 2015 to 2023. Multivariable logistic regression was used to find independent association between various clinical parameters, including Ki67, and pCR. Ki67-values were categorized into three groups (low ≤ 15%, intermediate 15–35%, high &gt; 35%). Kaplan–Meier estimator calculated differences in IDFS.</p><h3>Results</h3><p>The study included 244 patients with known Ki67-expression. 147 patients (60.3%) achieved pCR. When categorized, 18 (7.4%) were Ki67 low, 114 (46.7%) Ki67 intermediate and 112 (45.9%) Ki67 high. No correlation between Ki67-score as continuous variable and pCR was observed (p = 0.25). HER2 immunohistochemistry (IHC) score 3 + significantly increased pCR compared to IHC score 2 + (63.2% vs. 45%, p = 0.031). Hormone receptor (HR)-positive tumors had a lower pCR rate (53.1% vs. 74.4%, p = 0.001) compared to HR-negative tumors.</p><p>5-year IDFS showed no difference between low Ki67 (88.9%; 95% CI 75.5–100%), intermediate Ki67 (82.0%; 95% CI 72.6–92.7%), and high Ki67 (80.9%, 95% CI 70.1–92.3%) subgroups (p = 0.7).</p><h3>Conclusion</h3><p>In HER2-positive breast cancer, the Ki67-score showed no association with either pCR or IDFS, thereby questioning its clinical utility. Conversely the HER2 IHC-score and HR-status were predictive indicators for achieving pCR. Clinical decisions in patients with early HER2-positive breast cancer should not be influenced by Ki67-scores, especially not by using cut-offs.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08401-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147796606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and adverse pregnancy outcomes associated with post-traumatic stress disorder: a population-based study of delivery hospitalisations","authors":"Dervla Quinn,&nbsp;Michael Donnelly,&nbsp;Joseph P. M. Kane,&nbsp;Lisa Kent,&nbsp;Ciaran O’Neill","doi":"10.1007/s00404-026-08448-6","DOIUrl":"10.1007/s00404-026-08448-6","url":null,"abstract":"<div><h3>Purpose</h3><p>This study examined the prevalence of post-traumatic stress disorder (PTSD) diagnoses among pregnant women who delivered in hospitals in the United States between 2016 and 2020, and explored associations with adverse pregnancy outcomes, hospital length of stay, and hospital costs.</p><h3>Methods</h3><p>This cross-sectional study utilised survey-weighted data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to estimate sample characteristics and prevalence trends. Logistic regression models were used to analyse associations between PTSD and adverse pregnancy outcomes. Length of hospital stay and hospital costs were examined using negative binomial and generalised linear models with log link and gamma distribution, respectively.</p><h3>Results</h3><p>PTSD prevalence increased from 236.3 to 545.8 per 100,000 delivery hospitalisations between 2016 and 2020 (p &lt; 0.001; average annual percentage change [AAPC] 23.0%). PTSD was associated with a higher prevalence of comorbidity, increased odds of preterm delivery (adjusted odds ratio [aOR] 1.13; 95% CI 1.08–1.18), and increased odds of fetal growth restriction (aOR 1.09; 95% CI 1.01–1.17, p = 0.03). Longer hospital stays and higher costs were also observed among women with PTSD.</p><h3>Conclusion</h3><p>These findings highlight a rising prevalence of PTSD among pregnant women who delivered in hospitals in the United States over the study period. PTSD was associated with higher prevalence of comorbidity, and increased length of stay and hospital cost. Further research is warranted to investigate the reasons behind the trend, and to clarify the temporal relationship between prenatal PTSD and adverse pregnancy outcomes.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08448-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does suture number matter in transvaginal cervical cerclage? A propensity score-weighted cohort study","authors":"Edis Kahraman,&nbsp;Nadiye Köroğlu,&nbsp;Turgut Aydın,&nbsp;Mehmet Aytaç Yüksel","doi":"10.1007/s00404-026-08444-w","DOIUrl":"10.1007/s00404-026-08444-w","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate whether the number of sutures used during transvaginal cervical cerclage influences obstetric and neonatal outcomes when surgical technique, suture material, and perioperative management are standardized.</p><h3>Methods</h3><p>This retrospective cohort study included 125 women who underwent transvaginal cervical cerclage using identical monofilament suture material. Cerclage was performed with either a single suture (<i>n</i> = 23) or a double suture (<i>n</i> = 102) in this non-randomized observational cohort. The primary outcome was term delivery (≥ 37 weeks’ gestation). Secondary outcomes included gestational age at delivery and selected neonatal outcomes. To address non-random allocation and baseline group imbalance, propensity scores were estimated using pre-treatment maternal, obstetric, and clinical severity variables. Stabilized inverse probability of treatment weighting (IPTW) with truncation was applied, and doubly robust outcome models were used to estimate adjusted associations. Neonatal outcomes were analyzed at the pregnancy level to account for clustering in twin gestations.</p><h3>Results</h3><p>Women receiving double-suture cerclage presented at earlier gestational ages and with greater markers of cervical severity at baseline; however, after IPTW and doubly robust adjustment accounting for these baseline differences, no statistically significant difference in term delivery was observed. Secondary obstetric outcomes, including gestational age at delivery, were also comparable between groups after adjustment. Pregnancy-level neonatal outcomes, including NICU admission and neonatal mortality, did not differ meaningfully by suture number. Sensitivity analysis restricted to singleton pregnancies and stratified by cerclage indication yielded consistent results.</p><h3>Conclusion</h3><p>After accounting for baseline cervical severity and clinical indication, single- and double-suture transvaginal cerclage was associated with comparable obstetric and neonatal outcomes under standardized surgical conditions. These findings suggest that cervical status at the time of cerclage placement, rather than the number of sutures applied, is the primary determinant of outcome.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08444-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving future care: the role of oncofertility education in medical curricula in Germany. Results of a nationwide survey of 346 medical students","authors":"Judith Altmann,&nbsp;Desislava Dimitrova,&nbsp;Elena Stark,&nbsp;Nadine Einsiedel,&nbsp;Lea Heistermann,&nbsp;Jalid Sehouli","doi":"10.1007/s00404-026-08425-z","DOIUrl":"10.1007/s00404-026-08425-z","url":null,"abstract":"<div><h3>Objective</h3><p>To study the existing knowledge, interests, and attitudes of medical students regarding fertility preservation measures.</p><h3>Design</h3><p>A multi-center nationwide survey was conducted among medical students across Germany. The survey consisted of 15 multiple-choice questions and six questions asking participants their level of agreement of a statement.</p><h3>Subjects</h3><p>346 medical students in Germany.</p><h3>Main outcome measures</h3><p>A multiple-choice questionnaire was used to evaluate the existing knowledge, interest and attitudes of medical students regarding fertility preservation measures.</p><h3>Results</h3><p>Regarding the assessment of ovarian reserve, Anti-Müllerian hormone testing was known by 38.8% of students, while only 15.9% were familiar with the antral follicle count method. The most widely recognized fertility preservation (FP) method was oocyte cryopreservation (91.0%), followed by ovarian tissue cryopreservation (45.1%), ovarian transposition surgery prior to pelvic radiation (38.2%), and the use of gonadotropin-releasing hormone analogs for ovarian protection during chemotherapy (28.6%). Regarding reproductive technologies, such as IVF, ICSI, or hormonal stimulation, 87.5% of students expressed a positive opinion. Oocyte donation was perceived positively by 77.6%. The acceptance for uterus transplantation was high among participants with 61.4%. The acceptance for surrogacy was lower with 53.2% of respondents. Social freezing was positively received by most respondents (72.7%). 80.0% of respondents expressed interest in expanding their knowledge of fertility and cancer, and 65.9% desired additional training.</p><h3>Conclusions</h3><p>To ensure high-quality fertility preservation counseling and the implementation of necessary FP measures for all cancer patients of childbearing age, it is crucial that future physicians are familiar with methods for assessing ovarian reserve and fertility preservation techniques. Strengthening oncofertility training in medical education will enhance future physicians’ ability to provide informed counseling and timely referrals, ultimately improving patient care and quality of life. This study highlights the urgent need to systematically integrate fertility preservation and oncofertility into the curriculum of medical schools in Germany.\u0000</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08425-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Induction of labor in women with prior cesarean section: outcomes in a selected low-risk population","authors":"Sven Kehl,&nbsp;Christel Weiss,&nbsp;Hanna Düster,&nbsp;Simon Bader,&nbsp;Florian Faschingbauer,&nbsp;Michael Schneider,&nbsp;Matthias W. Beckmann,&nbsp;Ulf Dammer,&nbsp;Jutta Pretscher","doi":"10.1007/s00404-026-08436-w","DOIUrl":"10.1007/s00404-026-08436-w","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate the impact of a previous cesarean section on maternal and perinatal outcomes in term pregnancies undergoing labor induction.</p><h3>Methods</h3><p>In this retrospective cohort study, women with singleton, low-risk term pregnancies and labor induction were compared according to the presence or absence of a previous cesarean delivery. The primary outcome was a composite of adverse maternal and perinatal events. Secondary outcomes included cesarean section rate, mode of vaginal delivery, and specific maternal or neonatal complications.</p><h3>Results</h3><p>The rate of composite adverse outcomes was comparable between groups (21.9% vs. 23.7%, <i>p</i> = 0.4826). However, placental abruption (1.3% vs. 0.3%, <i>p</i> = 0.0251), suspected triple I (1.9% vs. 0.4%, <i>p</i> = 0.0040), and shoulder dystocia (2.3% vs. 0.8%, <i>p</i> = 0.0265) occurred more frequently in women with a previous cesarean section. Abnormal cardiotocography (27.1% vs. 20.4%, <i>p</i> = 0.0058), operative vaginal delivery (17.8% vs. 11.9%, <i>p</i> = 0.0052), umbilical artery pH &lt; 7.10 (4.9% vs. 2.8%, <i>p</i> = 0.0381), and the need for fetal blood sampling (8.7% vs. 5.0%, <i>p</i> = 0.0055) were also more common in this group. There was no difference in neonatal unit transfer (10.0% vs. 11.5%, <i>p</i> = 0.4328) or low Apgar scores (&lt; 5 at 5 min: 0.3% vs. 0.4%, <i>p</i> = 1.0000). Cesarean section rates were similar (14.8% vs. 14.9%, <i>p</i> = 0.9692). In multivariable analysis, absence of prior vaginal delivery (OR = 3.460, <i>p</i> &lt; 0.0001), higher maternal BMI (OR = 1.038, <i>p</i> &lt; 0.0001), and older maternal age (OR = 1.033, <i>p</i> = 0.0002) were independently associated with adverse outcomes, whereas previous cesarean section was not.</p><h3>Conclusion</h3><p>Labor induction in women with a prior cesarean section was not associated with increased risk for composite adverse maternal or perinatal outcomes. Nonetheless, TOLAC should be conducted in settings with immediate access to obstetric and neonatal intervention.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08436-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Episiotomy and the risk of obstetric anal sphincter injury in nulliparous women with a prolonged second stage","authors":"Gal Bachar,&nbsp;Shahar Rosenthal,&nbsp;Nira Gridish,&nbsp;Naphtali Justman,&nbsp;Nizar Khatib,&nbsp;Ido Solt,&nbsp;Yaniv Zipori","doi":"10.1007/s00404-026-08451-x","DOIUrl":"10.1007/s00404-026-08451-x","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aimed to evaluate whether episiotomy reduces obstetric anal sphincter injuries (OASIS) rates in nulliparous women with a second stage of labor lasting ≥ 3 h.</p><h3>Methods</h3><p>This retrospective study focused on nulliparous women at ≥ 36 weeks of gestation with singleton pregnancies who experienced a second stage of labor lasting ≥ 3 h and ultimately achieved spontaneous, non-operative, vaginal delivery between 2014 and 2024. Participants were categorized into two groups based on their episiotomy status. The primary outcome was the occurrence of OASIS, namely third- and fourth-degree perineal lacerations.</p><h3>Results</h3><p>The study included 1164 (58.3%) women who underwent episiotomy and 831 (41.7%) who did not. Women in the episiotomy group were significantly younger (27.79 ± 4.31 vs. 28.47 ± 4.51 years, p &lt; 0.001), had a higher prevalence of hypertensive disorders (7.7% vs. 5.2%, p = 0.029), experienced a slightly longer second stage of labor (3.62 ± 0.4 vs. 3.53 ± 0.4 h, p &lt; 0.001), and delivered newborns with higher birthweight (3366 ± 390 vs. 3284 ± 376 g, p &lt; 0.001). The OASIS rates were comparable between the groups (1.9% vs. 2.2%, p = 0.82), consistent across all subtypes and in a subanalysis of women with a second stage of ≥ 4 h (2.9% vs. 2.5%, p = 0.59). In adjusted multivariable analysis, episiotomy was not associated with OASIS (adjusted OR 0.95, 95% CI 0.48–1.84).</p><h3>Conclusion</h3><p>In nulliparous women with spontaneous vaginal delivery and a prolonged second stage (≥ 3 h), episiotomy was not associated with a reduced risk of OASIS, even when the second stage exceeded 4 h. Our findings support existing guidelines that advocate against routine episiotomy in this population.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08451-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced fetal cardiac monitoring in gestational diabetes mellitus: HbA1c remains the relevant predictor of perinatal outcome under optimal metabolic control","authors":"Leonie H. Kömmel,&nbsp;Helena Ortlam,&nbsp;Rebekka S. Loewe,&nbsp;Christian Schürer,&nbsp;Yvonne Heimann,&nbsp;Alexander Schmidt,&nbsp;Florentine Fiedler,&nbsp;Friederike Weschenfelder,&nbsp;Ekkehard Schleußner,&nbsp;Tanja Groten,&nbsp;Janine Zöllkau","doi":"10.1007/s00404-026-08427-x","DOIUrl":"10.1007/s00404-026-08427-x","url":null,"abstract":"<div><h3>Purpose</h3><p>Perinatal complications can occur in gestational diabetes mellitus (GDM) despite adequate metabolic control and standard diagnostics. Metabolic alterations can cause structural and functional changes in the fetus, especially in the cardiovascular system, by affecting the autonomic nervous system and the cardiac conduction system. Advanced fetal cardiac monitoring may provide detailed insights into these processes and their impact on perinatal outcomes.</p><h3>Methods</h3><p>In this exploratory, prospective, single-center cohort study, 172 women with singleton pregnancies between 33 + 0 and 40 + 0 weeks were recruited (56 GDM, 116 controls). Non-invasive fetal ECG (fECG) and computerized cardiotocography (cCTG) assessed the fetal heart rate variability (HRV) and heart time intervals (HTI). Adverse perinatal outcomes (APO) were defined as a composite of the clinically relevant endpoints of operative delivery or emergency cesarean for fetal distress, NICU admission, umbilical cord pH &lt; 7.1, and/or 5-min APGAR &lt; 7. Predictive potential was evaluated using univariate and multivariate regression models.</p><h3>Results</h3><p>The median HbA1c in the GDM group was 5.32%, indicating overall good metabolic control. One hundred forty-five cCTGs and one hundred sixty-three fECGs provided data on HTI and fetal HRV parameters. HTI did not differ between GDM and controls. Although fetal HRV parameters differed, they did not add predictive value for APO. Only maternal metabolic status, as reflected by HbA1c, showed a measurable association with APO (OR 12.83, 95% CI 1.34–122.94).</p><h3>Conclusion</h3><p>In well-controlled GDM pregnancies, HRV and HTI derived from fECG and cCTG do not enhance risk prediction for APO. Maternal HbA1c remains predictive for the perinatal risk, underscoring the importance of strict metabolic control.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08427-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}