Archives of Gynecology and Obstetrics最新文献

{"title":"Influence of biopsychosocial factors on a functionally delayed ageing process.","authors":"Susanne Theis, Norman Bitterlich, Mirjam Moser, Michael von Wolff, Petra Stute","doi":"10.1007/s00404-024-07885-5","DOIUrl":"https://doi.org/10.1007/s00404-024-07885-5","url":null,"abstract":"<p><strong>Purpose: </strong>Increasing life expectancy and rising populations create new challenges for science, economy, politics, society and each individual. The bio-functional status (BFS) as a theoretical model incorporates the International Classification of Functioning (ICF) and the concept of active and healthy ageing (AHA). This study addresses the question of which the strengths and resources have the greatest positive impact on bio-functional age (BFA) and might be influencable.</p><p><strong>Methods: </strong>A monocenter, cross-sectional, observational, non-interventional trial was performed from 2012 to 2014 at Inselspital Bern to evaluate the BFS, a complex, generic, non-invasive, sex- and age-validated assessment tool. A standardized battery of assessments was performed on 464 females and 166 males, aged 18 to 65 years (n = 630). We aimed to statistically identify BFS items that might be influenceable to support healthy ageing and vitality.</p><p><strong>Results: </strong>341 participants of the original cohort were included. After carrying out regression analysis, 10 parameters (T = 8.992; p < 0.001) remained as possible variables that can be influenced (R² = 0.758). Of those identified parameters, one can be assigned to subcategory I of BFS (pulse performance index), two to II (tapping frequency part I and II), two to III (strategy building and verbal reaction time) and three to IV [sense of coherence, social potency, complaint questionnaire (BFB total)]. Age and sex, nevertheless, have an influence on the BFA and the BFA-Index.</p><p><strong>Conclusion: </strong>The most promising approach to support vitality, is to support low social stress, high social integration, a good sense of coherence and maintaining a good mental and cognitive status.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880811","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":"Surgical parameters affecting procedure duration of hysteroscopic fibroid resection: results of a retrospective longitudinal study.","authors":"Gaetano Riemma, Salvatore Giovanni Vitale, Márton György Lipták, Michał Ciebiera, Bence Zoltán Boldogh, Liliana Mereu, Kincső Sára Kovács, Péter Török","doi":"10.1007/s00404-024-07877-5","DOIUrl":"https://doi.org/10.1007/s00404-024-07877-5","url":null,"abstract":"<p><strong>Purpose: </strong>To identify and analyze the main surgical parameters affecting the operative time of hysteroscopic fibroid resection.</p><p><strong>Methods: </strong>This retrospective observational study included 65 cases of outpatient hysteroscopic fibroid resection performed between March 2021 and May 2023 in outpatient office setting. Patients aged 18-50 with various indications such as infertility, recurrent pregnancy loss, or abnormal uterine bleeding (AUB) were included. The operative time, fibroid size, FIGO classification, and fibroid localization were recorded and analyzed using ANOVA, Chi-square test, and linear regression models.</p><p><strong>Results: </strong>The average operative duration for all surgeries was 557.41 (± 449.52) s. A significant correlation between fibroid size and operative time was found in FIGO 0 (p = 0.0003) and FIGO 1 (p < 0.0001) subgroups, with weaker correlation in FIGO II (p = 0.039). FIGO I surgeries took significantly longer than FIGO 0 (p = 0.044), and fundal fibroids were associated with longer operative times compared to posterior fibroids (p = 0.0329).</p><p><strong>Conclusion: </strong>The size and FIGO classification of fibroids significantly influence operative time during hysteroscopic resection. Smaller and more accessible fibroids (FIGO 0 and 1) are resected faster than those embedded deeper in the uterine wall (FIGO 2). Detailed preoperative evaluation of fibroid characteristics can better predict operative time, aiding in patient preparation and optimized analgesia and perioperative planning as well as optimizing the use of operating theater. Further studies with larger sample sizes are recommended to validate these findings and explore additional influencing factors.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880928","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":"Lower extremity lymphedema in patients with gynecologic cancer: Validation of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) in German language and investigation of lymphedema real-world treatment.","authors":"Henrike Meyer, Andreas Hinz, Christiane Weisgerber, Adrian Pilny, Nadja Dornhöfer, Anja Mehnert-Theuerkauf, Bahriye Aktas, Benjamin Wolf","doi":"10.1007/s00404-024-07886-4","DOIUrl":"https://doi.org/10.1007/s00404-024-07886-4","url":null,"abstract":"<p><strong>Purpose: </strong>The Gynecologic Cancer Lymphedema Questionnaire (GCLQ) is an established patient-reported outcome measure for lower extremity lymphedema (LEL) in gynecologic oncology. We aimed to validate the GCLQ in German language (GCLQ-GER) for lymphedema detection in German-speaking patients and also investigated real-world patterns of lymphedema treatment.</p><p><strong>Methods: </strong>The GCLQ was translated from English into German in accordance with the standards of a professional translation process. Subsequently, the questionnaire was administered in a prospective observational study including 102 patients who had undergone lymph node dissection (LND) within gynecologic cancer surgery. Various test quality criteria were calculated for the GCLQ-GER. As gold standard of testing methods, patients were clinically evaluated for LEL, and limb volume measurements were taken. Further data for lymphedema treatment were collected in patients with lymphedema diagnosis.</p><p><strong>Results: </strong>Patients with LEL had increased GCLQ-GER total scores (mean 7.27) compared to patients without LEL (mean 1.81), p < 0.001. High diagnostic accuracy was indicated by the large area under the receiver operating characteristics curve (AUC) of 0.874 (95% CI 0.802-0.946). Based on sensitivity and specificity values ≥ 79.0%, the GCLQ total score ≥ 4 was determined as the optimal cut-off value to identify LEL. Excellent internal consistency was demonstrated by Cronbach's alpha of 0.876. The clinical examination revealed a LEL prevalence of 48.0% (n = 49), and 85.7% (n = 42) of these patients received treatment.</p><p><strong>Conclusion: </strong>The GCLQ-GER is a valid and feasible patient-reported outcome measure for lymphedema detection in German-speaking gynecologic cancer survivors. Its clinical introduction could improve secondary prevention of lymphedema and real-world treatment.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142880819","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":"Evaluating single-dose methotrexate alone versus methotrexate with letrozole for treating ectopic pregnancy: a comparative study.","authors":"Metin Ayğar, Mustafa Güven, Serhat Uygur, Özgür Arslan, Onur Karaaslan, Erbil Karaman","doi":"10.1007/s00404-024-07892-6","DOIUrl":"https://doi.org/10.1007/s00404-024-07892-6","url":null,"abstract":"<p><strong>Purpose: </strong>Ectopic pregnancy (EP) constitutes 1-2% of all pregnancies. Methotrexate (MTX) is commonly used in treating EP, but it has some limitations and potential side effects. Clinical studies have shown that letrozole, an aromatase inhibitor, may potentially be used in conjunction with MTX therapy. In our study, we explored the efficacy of adding letrozole to MTX in managing EP.</p><p><strong>Methods: </strong>Between June 2021 and September 2022, a total of 60 patients diagnosed with EP at the Faculty of Medicine, Yüzüncü Yıl University, were randomly divided into two groups. Group 1 received MTX alone, while Group 2 received a combination of MTX and letrozole. The primary outcome measure was the change in serum β-hCG levels. Secondary outcomes included the need for surgical intervention and the occurrence of side effects.</p><p><strong>Results: </strong>Both groups demonstrated similar success rates in treatment, and there was no significant difference between the MTX and MTX + letrozole groups regarding the need for surgical intervention. Although β-hCG levels declined more rapidly in the MTX + letrozole group, these decreases were not statistically significant. The combination of MTX and letrozole in the treatment of ectopic pregnancy has shown similar efficacy to single-dose MTX.</p><p><strong>Conclusion: </strong>Letrozole may offer a potential contribution to MTX therapy by providing a more pronounced reduction in β-hCG levels, but further research with larger sample sizes and longer follow-up periods is needed to confirm these findings.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875845","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":"Effect of pyridostigmine on growth hormone and IGF-1 levels and outcomes of controlled ovarian stimulation cycle in women with poor ovarian response.","authors":"Rana Karimi, Farnaz Hadavi, Mina Jafarabadi","doi":"10.1007/s00404-024-07895-3","DOIUrl":"https://doi.org/10.1007/s00404-024-07895-3","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the effect of Pyridostigmine on IGF-1 and GH levels and the outcomes of COS cycles in women with POR.</p><p><strong>Methods: </strong>A total of 110 eligible women were randomly allocated to Pyridostigmine (n: 55) and control (n: 55) groups. COS outcomes, including gonadotrophin doses, COS duration, cycle cancellation rate, number of retrieved oocytes, number of MII oocytes, and fertilization rate, were compared between the groups. Also, IGF-1 and GH levels were measured at three time points: baseline, on the 5th day of the cycle, and on the trigger day.</p><p><strong>Results: </strong>A total of 92 participants (Pyridostigmine: 44, Control: 48) were included in the final analysis. The Pyridostigmine group required significantly lower gonadotrophin doses (P < 0.0022) and had a shorter COS duration (P = 0.0019). No significant differences were observed in cycle cancellation rate, number of retrieved oocytes, number of MII oocytes, or fertilization rate. Pyridostigmine significantly accelerated GH levels over time compared to the Control group, with larger mean differences observed at each time point. The interaction between time and group indicated that the effect of the intervention on GH levels varied over the course of the COS cycle. Specifically, the intervention augmented the effect of COS agents on GH levels, as evidenced by the higher GH levels observed in the intervention group compared to the control group. For IGF-1 levels, time had a highly significant effect (P < 0.0001), but the interaction between Time and Group was not significant (P = 0.5067). Mean IGF-1 levels were higher in the Pyridostigmine group, though not statistically significant.</p><p><strong>Conclusion: </strong>Pyridostigmine improved COS efficiency by reducing gonadotrophin doses and COS duration. Further research is needed to explore its potential benefits in enhancing ovarian response in women with POR.</p><p><strong>Trial registry information: </strong>Iranian Registry of Clinical Trials (IRCT). Registration date: 2023-08-05, Registration number: IRCT20100518003950N8.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871177","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":"Operative and non-operative management of acute appendicitis during pregnancy: a population-based study.","authors":"Marco Ceresoli, Vera Rigamonti, Ilenia Famà, Marco Braga, Giovanni Corrao, Anna Locatelli, Anna Cantarutti","doi":"10.1007/s00404-024-07894-4","DOIUrl":"https://doi.org/10.1007/s00404-024-07894-4","url":null,"abstract":"<p><strong>Purpose: </strong>Acute appendicitis during pregnancy poses unique challenges due to altered anatomical and physiological dynamics and concern about foetal well-being. This study aimed to assess management strategies and outcomes of acute appendicitis during pregnancy, focusing on non-operative management versus surgical intervention.</p><p><strong>Methods: </strong>The study is based on the computerized healthcare utilization database of Lombardy.</p><p><strong>Results: </strong>In Lombardy, a total of 1,231,040 deliveries were identified. Acute appendicitis during pregnancy occurred in 0.03% of cases, with 74.49% of these cases classified as uncomplicated. Appendicitis during pregnancy was associated with worse maternal and perinatal outcomes. Among uncomplicated cases, 38.46% were treated with non-operative management. Perinatal outcomes did not significantly differ between non-operative management and surgery groups. Additionally, a declining trend in surgical treatment over the study period was observed (P = 0.0477), possibly indicating a shift towards conservative management.</p><p><strong>Conclusion: </strong>The findings suggest that non-operative management may be a viable option for selected pregnant patients with uncomplicated appendicitis, potentially avoiding surgical complications and allowing for faster recovery. Further research is warranted to validate these findings, explore evolving trends, and refine clinical guidelines for managing acute appendicitis during pregnancy.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862936","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 outcomes in women with vulvodynia and vaginismus: a systematic review.","authors":"Sophie Baril, Andréanne Marion, Haim A Abenhaim","doi":"10.1007/s00404-024-07871-x","DOIUrl":"https://doi.org/10.1007/s00404-024-07871-x","url":null,"abstract":"<p><strong>Purpose: </strong>Vulvodynia and vaginismus are pain disorders associated with adverse pregnancy outcomes. The few published studies addressing this topic were limited in terms of the different outcomes studied; hence, the purpose of our study was to perform the first systematic review examining maternal, neonatal and obstetric outcomes in patients with vulvodynia and/or vaginismus (VV).</p><p><strong>Methods: </strong>We conducted a systematic review searching PubMed, EMBASE, Cochrane Library and SCOPUS until November 2023 for observational studies reporting maternal and/or neonatal outcomes of VV in pregnancy. Data on maternal characteristics and obstetric outcomes were independently extracted from the included studies by two reviewers and then summarized between those with and without VV.</p><p><strong>Results: </strong>The search strategy yielded 1118 citations, of which 10 were included. A total of 2209 patients with a diagnosis of VV prior to pregnancy were identified over a 27-year study period. Compared with women without VV, women with VV were more likely to deliver by cesarean sect. (40.3 vs 29.8%, p < 0.001). Cesarean sections were more likely elective (41.0 vs 35.7%) and performed in response to maternal request (26.0 vs 9.5%) for women with VV. Of those who delivered vaginally, instrumental deliveries were more common among women with VV (16.7 vs 6.2%, p < 0.001), with more perineal injuries as well (43.0 vs 32.7% p < 0.001).</p><p><strong>Conclusion: </strong>Vaginismus/vulvodynia are high-risk conditions during pregnancy with increased rates of cesarean sections performed for elective reasons and upon maternal request. Offering support, education, and treatment for these conditions prior to pregnancy is important to reduce the rate of avoidable cesarean sections.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852250","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":"Epigenetics of oogenesis.","authors":"Neda Sindik, Nina Pereza, Sanja Dević Pavlić","doi":"10.1007/s00404-024-07882-8","DOIUrl":"https://doi.org/10.1007/s00404-024-07882-8","url":null,"abstract":"<p><p>Epigenetic changes include all modifications affecting the expression of genes without changing the nucleotide sequence of the genome. Most studied epigenetic changes include DNA methylation, histone alterations and non-coding RNAs. DNA methylation is an important epigenetic mark, protecting the genome during gametogenesis and early embryo development. Demethylation process is a genome-wide event, taking place in two distinct waves during gametogenesis. The first event helps restore naïve pluripotency of the zygote, while the second event aids in the loss of parental epigenetic memory and facilitates specification of gametes. Histone modifications were recognized in murine and human primordial germ cells where their subsets condense chromatin, protecting it from dynamic changes taking place during gamete maturation. Deacetylation of histones was recognized as an important prerequisite of chromosomal segregation during metaphase II. Germline-specific ncRNAs and piRNAs are important in inhibiting transposon activity during gametogenesis, protecting overall genome stability. All epigenetic changes are prone to disruption, especially by exogenous factors. In recent years, with the increase in infertility, the association between assisted reproductive technology (ART) and its effects on epigenome remodeling of gametes have gained importance. The aim of this review is to summarize the epigenetic modifications crucial for oocyte development, while highlighting their role in reproductive disorders and ART.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852278","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":"Association between obesity in women with multiple gestations and adverse obstetric outcomes: a study of an American population database with over 136,000 unique deliveries.","authors":"Naomi Suissa, Ahmad Badeghiesh, Haitham Baghlaf, Michael H Dahan","doi":"10.1007/s00404-024-07861-z","DOIUrl":"https://doi.org/10.1007/s00404-024-07861-z","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to compare obese and non-obese women with multiple pregnancies to determine the effects on pregnancy, delivery, and neonatal outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective population-based study utilizing data collected between 2004 and 2014 inclusively, from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A total of 137,303 multiple pregnancies were analyzed; 130,542 (95%) were non-obese, while 6761 (5%) were obese. An initial analysis was performed to identify the prevalence of obesity in women with multiple pregnancies. Subsequently, chi-square tests and binary logistic regression analyses were conducted to assess the association between obesity and multiple gestation in the context of obstetric complications.</p><p><strong>Results: </strong>There was a statistically significant increase in the prevalence of obesity for women with multiple gestations (p < 0.0001). The obese group was at higher risk of pregnancy-induced hypertension (adjusted odd's ratio [aOR] = 1.89, 95% confidence interval [CI] = 1.77-2.02), gestational hypertension (aOR = 1.84, CI = 1.65-2.05), preeclampsia (aOR = 1.68, CI = 1.55-1.81), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR = 1.86, CI = 1.58-2.20), gestational diabetes mellitus (aOR = 2.65, CI = 2.44-2.87), and placenta previa (aOR = 0.57, CI = 0.39-0.85). They were more likely to have preterm premature rupture of membranes (aOR = 1.19, CI = 1.06-1.34), chorioamnionitis (aOR = 1.24, CI = 1.03-1.51), caesarean deliveries (aOR = 1.28, CI = 1.18-1.38), wound complications (aOR = 1.65, CI = 1.31-2.08), and transfusions (aOR = 0.77, CI = 0.67-0.89). They were less likely to have small for gestational age neonates (aOR = 0.88, CI = 0.79-0.97), though more likely to have neonates with congenital anomalies (aOR = 1.56, CI = 1.16-2.10).</p><p><strong>Conclusion: </strong>Obesity and multiple gestations are independent risk factors for adverse obstetric outcomes. Combined, when analyzed in a large population, obesity in multiple gestation increases the risk of maternal, delivery, and neonatal complications.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845708","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 examination for identifying low-risk pregnancies suitable for expectant management beyond 40-41 gestational weeks: maternal and fetal outcomes.","authors":"Gulim Murzakanova, Sari Räisänen, Anne Flem Jacobsen, Branka M Yli, Tiril Tingleff, Katariina Laine","doi":"10.1007/s00404-024-07869-5","DOIUrl":"https://doi.org/10.1007/s00404-024-07869-5","url":null,"abstract":"<p><strong>Purpose: </strong>There is an ongoing discussion on whether the benefits of term elective labor induction outweigh its potential risks. This study evaluated the utility of a comprehensive clinical examination in identifying low-risk pregnancies suitable for expectant management beyond gestational age 40‒41 weeks and compared their outcomes with earlier labor induction by indication.</p><p><strong>Methods: </strong>Pregnant women (n = 722) with ≥ 40 + 0 gestational weeks referred to a tertiary hospital were included in this prospective cohort. The study population was divided into the primary induction group (induction before 42 + 0 gestational weeks) and the expectant management group (spontaneous labor onset or induction at 42 + 0 gestational weeks), by decision based on a primary consultation. The Chi-square test and logistic regression were applied. The outcome measures were composite adverse fetal outcome (admission to a neonatal intensive care unit, metabolic acidosis, or Apgar score < 7 at 5 min), treatment with intrapartum antibiotics, intrapartum maternal fever ≥ 38 °C, intrapartum cesarean section, and postpartum hemorrhage ≥ 1500 ml.</p><p><strong>Results: </strong>The main outcome measures did not differ significantly between the primary induction group (n = 258) and the expectant management group (n = 464): composite adverse fetal outcome (OR = 2.29, 95% CI = 0.92-5.68; p = 0.07), intrapartum cesarean section (OR = 1.00, 95% CI = 0.64-1.56; p = 1.00), postpartum hemorrhage ≥ 1500 ml (OR = 1.89, 95% CI = 0.92-3.90; p = 0.09), intrapartum maternal fever ≥ 38 °C (OR = 1.26, 95% CI = 0.83-1.93; p = 0.28), or treatment with intrapartum antibiotics (OR = 1.25, 95% CI = 0.77-2.02; p = 0.37).</p><p><strong>Conclusion: </strong>A comprehensive clinical examination at 40‒41 gestational weeks can identify pregnancies that might be managed expectantly until 42 gestational weeks obtaining similar outcomes to those induced earlier.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833793","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}