Archives of Gynecology and Obstetrics最新文献

{"title":"Life-threatening fetal goiter: diagnosis and outcomes in four consecutive cases with critical appraisal—why this diagnosis is not obviously trivial","authors":"Jann Lennard Scharf,&nbsp;Michael Gembicki,&nbsp;Amrei Welp,&nbsp;Guido Stichtenoth,&nbsp;Verena Sailer,&nbsp;Jan Weichert","doi":"10.1007/s00404-026-08543-8","DOIUrl":"10.1007/s00404-026-08543-8","url":null,"abstract":"<div><h3>Background</h3><p>The diagnosis of a fetal goiter constitutes a potentially life-threatening in utero condition for the fetus. Even with early diagnosis and close therapy with highly specialized interdisciplinary management, the prognosis remains poor. We discuss diagnostic and therapeutic challenges regarding the pre- and postnatal outcome based on four consecutive cases with a critical appraisal of latest heterogeneous recommendations in literature.</p><h3>Methods</h3><p>A retrospective review of four cases of fetal goiter is presented that were diagnosed at a tertiary university centre during targeted ultrasound (US) examination in second and third trimester. All cases underwent close and intensive pre- and postnatal diagnostics and treatment. A detailed workup of current diagnostic and therapeutic recommendations with identifying potential pitfalls was carried out.</p><h3>Case series</h3><p>In one case, the mother suffered from Graves’ disease with euthyroid blood parameters under medication. The other three gravidae largely had an uneventful medical history including euthyroid metabolism. In all cases, fetal hypothyroidism was suspected and in three of them, cordocentesis was performed and intraamniotic levothyroxine (LT4) was given. In none of the cases, sonographic signs of tracheoesophageal compression had been noticed. In all four cases, a planned cesarean section was performed between 32 and 39 weeks of gestation (weeks). Out of all four cases, only one fetus managed to survive: one fetus died antenatally at 35 weeks, one newborn died due to insufficient ventilation, and one due to fetal cardiac decompensation with bilateral hydrothorax with suspected ductal obstruction. The fetus who survived showed primary hypothyroidism. Two of the deceased fetuses underwent autopsy, one showed ectopic thyroid tissue in the trachea.</p><h3>Conclusion</h3><p>Prenatal diagnosis of congenital fetal goiter remains a serious condition in specialized centers. In practice, the following crucial considerations might impede proper application of the non-standardized recommendations suggested in available literature. In addition to the assessment of the underlying etiology, the evaluation of fetal cervical structures with determination of fetal tracheoesophageal patency and cardiac functional diagnostics requires adequate practical expertise. Interdisciplinary cooperation is mandatory when determining the time and mode of delivery and planning an <i>ex utero</i> intrapartum treatment (EXIT) strategy.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700717","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":"Accuracy of operative time prediction in endometriosis surgery: results of a prospective randomized multicenter pilot study","authors":"Marta Duvnjak,&nbsp;Andreas Mueller,&nbsp;Simon Binder,&nbsp;Philipp Guttenberg,&nbsp;Mai Thi Hornaus,&nbsp;Judith Helfenritter,&nbsp;Alexander Boosz,&nbsp;Evgeni Baev","doi":"10.1007/s00404-026-08545-6","DOIUrl":"10.1007/s00404-026-08545-6","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate whether preoperative clinical Enzian scoring and digital rectal examination improve accuracy of operative time prediction and surgical outcomes in women undergoing surgery for endometriosis.</p><h3>Design</h3><p>Prospective, randomized, multicenter pilot trial.</p><h3>Setting</h3><p>Three urban teaching hospitals certified as endometriosis centers.</p><h3>Patients</h3><p>A total of 107 women undergoing surgery for endometriosis.</p><h3>Interventions</h3><p>The participants were randomly assigned to three groups: Group 1 underwent clinical Enzian scoring combined with digital rectal examination (DRE); Group 2 underwent clinical Enzian scoring only; and Group 3 underwent digital rectal examination only. All patients received standard transvaginal ultrasound examinations.</p><h3>Main outcome measures</h3><p>The primary endpoint was defined as an absolute difference of ≤ 10 min between the estimated and the actual operative time. Secondary end points included conversion to laparotomy, abandonment of the operation, complete resection rate, need for secondary surgery, correspondence between the preoperative Enzian assessment and intraoperative findings, and postoperative pain (visual analog scale) and patient satisfaction.</p><h3>Results</h3><p>The primary endpoint was achieved in 9 patients (23.7%) in Group 1, 16 patients (47.1%) in Group 2, and 15 patients (42.9%) in Group 3. Exploratory comparison of the three groups did not demonstrate a statistically significant difference in the proportion of accurate operative time estimations. Secondary endpoints, including conversion rate, abandonment of the operation, complete resection rate, reoperation rate, and patient-reported outcomes, were also comparable across the groups.</p><h3>Conclusions</h3><p>The results demonstrate that neither diagnostic strategy provided a measurable advantage in predicting operative time or improvement of surgical outcome parameters.</p><h3>Study registration number</h3><p>DRKS00040760.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676990","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":"Editorial Expression of Concern: Obstetricians’ perspective towards cesarean section delivery based on professional level: experience from Egypt","authors":"Mohamed M. Shaaban,&nbsp;Waleed Ali Sayed Ahmed,&nbsp;Zeinab Khadr,&nbsp;Hesham F. El-Sayed","doi":"10.1007/s00404-026-08548-3","DOIUrl":"10.1007/s00404-026-08548-3","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677017","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":"Editorial Expression of Concern: Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate","authors":"Massimo Moscarini,&nbsp;Giusi Natalia Milazzo,&nbsp;Chiara Assorgi,&nbsp;Arianna Pacchiarotti,&nbsp;Donatella Caserta","doi":"10.1007/s00404-026-08549-2","DOIUrl":"10.1007/s00404-026-08549-2","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677012","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":"Diagnostic yield versus clinical utility in prenatal genomic testing for fetal CNS anomalies","authors":"Zahide Küçük","doi":"10.1007/s00404-026-08536-7","DOIUrl":"10.1007/s00404-026-08536-7","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668165","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":"Retraction Note: A randomized prospective comparison of the needleless mini‐sling “hammock” and “U‐shape” configurations for management of stress urinary incontinence: 60-month follow‐up results","authors":"Ozan Doğan,&nbsp;Alper Başbuğ,&nbsp;Ecem Eren,&nbsp;Murat Yassa","doi":"10.1007/s00404-026-08554-5","DOIUrl":"10.1007/s00404-026-08554-5","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668192","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":"Evolving paradigms in lymph node surgery in endometrial cancer: insights from the multicenter E-PEC trial","authors":"B. Eser,&nbsp;D. Papior,&nbsp;J. Salmanton-García,&nbsp;O. A. Cornely,&nbsp;B. Morgenstern,&nbsp;C. Herpel,&nbsp;J. C. Radosa,&nbsp;A. Almuheimid,&nbsp;B. Aktas,&nbsp;L. Weydandt,&nbsp;J. Wittenborn,&nbsp;P. Meyer-Wilmes,&nbsp;V. Friebe,&nbsp;C. Leidinger,&nbsp;P. Buderath,&nbsp;R. Kimmig,&nbsp;F. Thangarajah","doi":"10.1007/s00404-026-08514-z","DOIUrl":"10.1007/s00404-026-08514-z","url":null,"abstract":"<div><h3>Objective</h3><p>To describe temporal trends in lymph node staging for endometrial cancer in selected German academic centers between 2018 and 2022.</p><h3>Methods</h3><p>In this multicenter retrospective cohort study, patients who underwent primary surgical treatment for newly diagnosed endometrial cancer between 2018 and 2022 at six German university hospitals were included. Patients receiving primary systemic or chemoradiation therapy were excluded. Patient characteristics and treatment details were analyzed descriptively and stratified by year of surgery. This multicenter retrospective cohort study was conducted as part of the E-PEC project, an ethics-approved multicenter project assessing surgical management patterns in newly diagnosed endometrial cancer.</p><h3>Results</h3><p>A total of 644 patients met the inclusion criteria. Overall, 62.4% underwent lymph node surgery. Sentinel-based procedures were increasingly performed over time and accounted for 61.4% of all nodal staging procedures. In contrast, the rate of primary systematic lymphadenectomy significantly decreased from 30.3% in 2018 to 17.9% in 2022 (<i>p</i> &lt; 0.05).</p><h3>Conclusions</h3><p>We observed a temporal increase in less radical lymph node procedures in selected German academic centers during the study period. Sentinel-based techniques were increasingly used over time in parallel with evolving guideline recommendations.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08514-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148598193","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":"Reproductive and clinical outcomes after minimally invasive isthmocele repair: a comparison of robotic-assisted and laparoscopic approaches","authors":"Carolin Schröder,&nbsp;Laura Tascón Padrón,&nbsp;Anna K. Degenhardt,&nbsp;Dominique Koensgen,&nbsp;Lucia A. Otten,&nbsp;Alexander Mustea,&nbsp;Eva K. Egger","doi":"10.1007/s00404-026-08546-5","DOIUrl":"10.1007/s00404-026-08546-5","url":null,"abstract":"<div><h3>Purpose</h3><p>Caesarean scar defect (CSD), also known as an isthmocele or niche, is a common consequence of caesarean delivery, associated with chronic inflammation, abnormal uterine bleeding, pelvic pain, and infertility, though some patients remain asymptomatic. Minimally invasive isthmocele repair (MIIR) has emerged as a promising therapeutic option for symptomatic women and those seeking fertility, yet evidence guiding optimal surgical management remains limited. In particular, data on reproductive outcomes are scarce and largely based on small, heterogeneous case series. To our knowledge, there are no data from direct comparisons between robotic-assisted (RAIR) and conventional laparoscopic (LIR) isthmocele repairs.</p><h3>Methods</h3><p>This monocentric retrospective study included patients undergoing RAIR and LIR at the University Hospital Bonn between December 2019 and March 2026. The primary objective was to determine the live-birth rate after MIIR in women attempting conception. Secondary objectives included evaluating patient-reported outcomes, such as symptom relief, and objective outcomes, including changes in niche length, niche depth, and residual myometrial thickness, as well as obstetric outcomes in subsequent pregnancies, and comparisons between RAIR and LIR.</p><h3>Results</h3><p>Twenty-eight patients underwent CSD surgery, including 21 RAIR and 7 LIR procedures. Follow-up was available in 82% of patients (median 4 months). No intraoperative or postoperative complications occurred. Among women attempting conception (<i>n</i> = 8), the live-birth rate was 75% (6/8), with equal distribution between groups. In the RAIR group, a significant decrease in niche length and niche depth as well as a significant increase in myometrial thickness were observed between pre- and postoperative. In the LIR group, similar trends were noted that did not reach statistical significance. Between-group comparisons showed no significant differences in postoperative imaging outcomes. Symptom improvement was reported in the majority of patients, particularly regarding abnormal uterine bleeding and pelvic pain. Obstetric outcomes included one uterine scar dehiscence and one placenta accreta spectrum disorder (each 3.6%), both occurring after RAIR.</p><h3>Conclusion</h3><p>MIIR and especially RAIR represent a promising fertility-preserving and symptom-improving option for patients with CSD.</p><h3>Registration</h3><p>This study was registered in the German Clinical Trials Register (DRKS) under the number DRKS00038857 on April 15th 2026.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08546-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148598204","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":"Real-word evidence on the effectiveness of the Endo-App in reducing endometriosis-related complaints: a retrospective analysis","authors":"Meletios P. Nigdelis,&nbsp;Christine Anderl,&nbsp;Erich-Franz Solomayer,&nbsp;Martin Sillem","doi":"10.1007/s00404-026-08494-0","DOIUrl":"10.1007/s00404-026-08494-0","url":null,"abstract":"<div><h3>Purpose</h3><p>Randomized controlled clinical trials have shown that symptoms of chronic pain conditions, such as endometriosis, can be improved with the use of specialized health apps. In the current study, real-world evidence was collected from Endo-App users to determine whether there was a sustained and positive effect on endometriosis symptoms.</p><h3>Methods</h3><p>Users of the Endo-App were offered an optional, six-question anonymous survey through the platform upon first registration (T0), after 3 (T1), and 6 to 7 (T3) months of use. The survey questions were not standardized and aimed to assess the severity of endometriosis symptoms and overall quality of life. Data were analyzed using MatLab using a parametric paired t-test when pairs of data between T0–T1 and/or T0–T2 were available. Statistical significance was defined as <i>p</i> &lt; 0.05.</p><h3>Results</h3><p>A total of 143 users of the app completed at least part of the survey at 3 months and 55 users at 6 to 7 months. After 3 and 6 to 7 months of using the app average pain levels and days requiring medical assistance were significantly reduced compared to baseline values. In addition, the average reported number of sick days taken was significantly reduced at the 6-to-7-month timepoint compared to baseline.</p><h3>Conclusion</h3><p>This real-world study demonstrates that use of a specialized app for endometriosis, such as the Endo-App, documents and may lead to a significant and sustained improvement of some endometriosis symptoms.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08494-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590135","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":"Association between gestational age at planned repeat cesarean delivery and uterine scar dehiscence","authors":"Mete Bertizlioglu,&nbsp;Zekiye Soykan Sert,&nbsp;Görkem Aktaş","doi":"10.1007/s00404-026-08530-z","DOIUrl":"10.1007/s00404-026-08530-z","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the association between gestational age at planned repeat cesarean delivery and intraoperatively diagnosed uterine scar dehiscence (USD), and to assess gestational age–specific neonatal outcomes.</p><h3>Methods</h3><p>This retrospective cohort study included women with at least one previous cesarean delivery who underwent pre-labor planned repeat cesarean delivery between 38 + 3 and 39 + 3 weeks of gestation from 2019 to 2025. Gestational age was categorized as 38 + 3 to 38 + 4, 38 + 5 to 39 + 0, and 39 + 1 to 39 + 3 weeks. The primary outcome was intraoperatively diagnosed USD. Multivariable logistic regression was performed in the full cohort, and propensity score matching was used as a sensitivity analysis.</p><h3>Results</h3><p>Among 1,104 women, 184 had intraoperatively diagnosed USD. Delivery at 39 + 1 to 39 + 3 weeks was associated with higher odds of USD compared with 38 + 5 to 39 + 0 weeks (adjusted odds ratio [aOR]: 3.53; 95% confidence interval [CI]: 2.47–5.04; <i>p</i> &lt; 0.001), whereas delivery at 38 + 3 to 38 + 4 weeks was not (aOR: 0.92; 95% CI 0.58–1.45; <i>p</i> = 0.720). Neonatal outcomes were presented descriptively and were underpowered for multivariable adjustment. Previous cesarean delivery ≥ 2 (aOR: 5.20; 95% CI 3.47–7.79), interdelivery interval ≤ 2 years (aOR: 2.85; 95% CI 1.80–4.50), and antenatal suspected macrosomia (aOR: 2.24; 95% CI 1.34–3.73) were independently associated with USD. The matched sensitivity analysis showed consistent findings.</p><h3>Conclusions</h3><p>Delivery at 39 + 1 to 39 + 3 weeks was associated with higher odds of intraoperatively diagnosed USD than delivery at 38 + 5 to 39 + 0 weeks. Previous cesarean delivery ≥ 2, interdelivery interval ≤ 2 years, and antenatal suspected macrosomia were independently associated with USD.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08530-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103753","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}