Archives of Gynecology and Obstetrics最新文献

{"title":"Association between nausea and vomiting during pregnancy and adverse pregnancy outcomes: findings from the nuMoM2b study.","authors":"Ya-Ling Hsieh, Chia-Jung Chiang, Tsung Yu","doi":"10.1007/s00404-025-08176-3","DOIUrl":"10.1007/s00404-025-08176-3","url":null,"abstract":"<p><strong>Purpose: </strong>Nausea and vomiting of pregnancy (NVP), including its severe form hyperemesis gravidarum (HG), have been linked to various perinatal outcomes, though findings remain inconsistent. This study aimed to examine the association between NVP severity and adverse pregnancy outcomes and to evaluate whether gestational weight gain (GWG) mediates these relationships.</p><p><strong>Methods: </strong>We analyzed data from 8396 nulliparous women enrolled in the U.S. nuMoM2b cohort. NVP severity was measured using the Pregnancy-Unique Quantification of Emesis (PUQE) score across three prenatal visits and categorized as none, one, and ≥2 visits of medium-to-severe NVP. Perinatal outcomes included birth weight, gestational age, preterm delivery, small for gestational age (SGA), and low birth weight (LBW). GWG adequacy was assessed per Institute of Medicine guidelines. Multivariable regression models were used, adjusting for sociodemographic and clinical covariates.</p><p><strong>Results: </strong>Overall, 81.6% of women reported no visit with medium-to-severe NVP, 16.2% with one such visit, and 2.3% with two or three such visits. One visit with medium-to-severe NVP was associated with a modest reduction in birth weight (-41.4 g; 95% CI: -72.6, -10.2). Inadequate GWG-regardless of NVP status-was consistently associated with shorter gestation (-0.53 weeks), lower birth weight (-261.3 g), and increased risks of preterm birth, LBW, and SGA (ORs 1.66-2.75).</p><p><strong>Conclusion: </strong>NVP severity alone showed limited impact on short-term pregnancy outcomes. However, inadequate GWG emerged as a key modifiable risk factor. These findings underscore the importance of nutritional support and symptom management during pregnancy, particularly for women with moderate-to-severe NVP. Long-term outcomes warrant further investigation.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940297","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":"Fetal sex and the development of future type 2 diabetes: a 5-year cohort study.","authors":"Liron Livny, Mordechai Hallak, Amir Naeh, Yoel Toledano, Rinat Gabbay-Benziv, Esther Maor-Sagie","doi":"10.1007/s00404-025-08125-0","DOIUrl":"https://doi.org/10.1007/s00404-025-08125-0","url":null,"abstract":"<p><strong>Purpose: </strong>Gestational Diabetes Mellitus (GDM) increases the risk of developing Type 2 Diabetes Mellitus (T2DM) postpartum, with emerging evidence suggesting that fetal sex may influence pregnancy outcomes. Some studies suggest that individuals carrying male fetuses experience diminished insulin sensitivity and higher glucose levels during pregnancy. However, it remains unclear whether fetal sex affects the long-term risk of T2DM after pregnancy. This study aimed to investigate the impact of fetal sex on the risk of T2DM up to 5 years postpartum in individuals with GDM.</p><p><strong>Methods: </strong>This retrospective analysis included pregnant individuals diagnosed with GDM, with follow-up data from Meuhedet HMO's computerized pregnancy registry and the Israeli National Diabetes Registry. Inclusion criteria involved singleton pregnancies with GDM diagnosed via abnormal oral glucose tolerance tests (oGTT) or glucose challenge tests (GCT). Exclusion criteria were multifetal pregnancies or prior diabetes diagnosis. Maternal characteristics, obstetrics data, and T2DM incidence were compared by fetal sex using univariate and survival analyses, adjusted for confounders.</p><p><strong>Results: </strong>A total of 1637 individuals with GDM were included, with 808 carrying male fetuses and 829 carrying female fetuses. No significant differences were found in body mass index (BMI), glucose levels, or T2DM incidence between the two groups (6.2% for male vs. 7.1% for female fetuses, p = 0.48). Multivariate analysis identified maternal age and BMI as significant factors influencing the likelihood of developing T2DM.</p><p><strong>Conclusion: </strong>The risk of developing T2DM after GDM does not vary based on fetal sex.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940420","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":"Phenotypic heterogeneity in adenomyosis: internal and external subtypes.","authors":"Yan Liang, Minjiao Zhu, Feng Sun, Xiaoyi Liu, Jinglan Liu, Jian Zhang","doi":"10.1007/s00404-025-08166-5","DOIUrl":"https://doi.org/10.1007/s00404-025-08166-5","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate and compare the clinical characteristics and risk factors between intrinsic and extrinsic adenomyosis (AM), as well as the differences in their perioperative management and findings in the two subtypes.</p><p><strong>Methods: </strong>This observational study included women who were diagnosed with either intrinsic or extrinsic AM based on magnetic resonance imaging (MRI) and who underwent a hysterectomy with a subsequent pathological examination. Demographic characteristics, clinical features, treatment outcomes and associated factors were evaluated.</p><p><strong>Results: </strong>77 patients were classified in the intrinsic group and 54 in the extrinsic group. The results show that gravidity (P < 0.001), parity (P < 0.001), abortion (P < 0.001) and endometrial curettage (P = 0.017) were significantly higher in the intrinsic group, while the education level was lower in the intrinsic group (P = 0.012). Women in the extrinsic group had an earlier age of menarche (P = 0.026) and more commonly associated ovarian endometrioma (OMA) (P < 0.001) and deep infiltrating endometriosis (DIE) (P < 0.001). Dysmenorrhea was more severe in the extrinsic group (P = 0.009), whereas women in the intrinsic group had heavier menstrual blood loss (P < 0.001). Surgery time (P < 0.001), operative blood loss (P < 0.001), hospitalization cost (P < 0.001), and the intensity of postoperative medical treatment (P < 0.001) were significantly higher in the extrinsic group. Multivariate analysis showed that lower education level, higher gravidity and more endometrial curettage were significantly associated with intrinsic AM. OMA and DIE were more commonly associated to extrinsic AM.</p><p><strong>Conclusion: </strong>These results suggest that intrinsic and extrinsic AM exhibit specific clinical profiles, perioperative characteristics and associated risk factors.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940407","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":"Repeat cell-free DNA screening after initial false-positive results and term placental analysis for confined mosaicism: a prospective cohort study.","authors":"Yvette C Raymond, Shavi Fernando, Melody Menezes, Ben W Mol, Tristan Hardy, Kara Levin, Emma Brown, Andrew McLennan, Daniel Lorber Rolnik","doi":"10.1007/s00404-025-08162-9","DOIUrl":"https://doi.org/10.1007/s00404-025-08162-9","url":null,"abstract":"<p><strong>Purpose: </strong>False-positive prenatal cell-free DNA screening (cfDNA) results may arise from confined placental mosaicism (CPM). This cohort study examines the persistence of high-risk cfDNA in the third pregnancy trimester after exclusion of fetal involvement, and the concordance of these results with CPM in the postpartum placenta.</p><p><strong>Methods: </strong>Pregnant individuals receiving a false-positive primary cfDNA result were recruited from Monash Health and Monash Ultrasound for Women in Melbourne, Australia, between August 2023 and December 2024. Participants underwent genome-wide repeat cfDNA screening (r-cfDNA) after 30 + 0 weeks' gestation. Placental samples were collected and cytogenetically analysed postpartum.</p><p><strong>Results: </strong>This cohort included 21 individuals, of which 33.3% (7/21) screened high-risk on r-cfDNA. There was no significant association between r-cfDNA and CPM in the postpartum placenta (p = 0.397), as five (5/12, 41.7%) cases involving CPM were screened 'low-risk'. Fetal-fraction was significantly lower (5.0% [IQR = 4.6-8.0%] vs. 9.0% [IQR = 7.0-13.5%], p = 0.025), and maternal BMI (Kg/m2) higher (29.0 [IQR = 25.7-31.2] vs. 23.3 [IQR = 22.0-24.9], p = 0.006), in false-positive cases not attributable to CPM detected by r-cfDNA or postpartum. High-risk r-cfDNA results were associated with smaller babies (median birthweight percentile = 12.3 [IQR = 4.4-21.7] vs. 31.9 [IQR = 21.5-55.5], p = 0.009), though the majority of outcomes were favorable.</p><p><strong>Conclusion: </strong>High-risk r-cfDNA is not a sensitive predictor of CPM, though high mosaic ratios are associated with adverse obstetric outcomes. An alternative explanation for false-positive cfDNA besides CPM may be low fetal fraction, particularly in the context of high maternal BMI.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940417","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":"Reference ranges for peak systolic velocity ratio of ophthalmic artery Doppler from first to third trimester based on serial Doppler measurements.","authors":"Raden Aditya Kusuma, Irwan Taufiqur Rachman, Althaf Setyawan, Andri Welly, Adly Nanda Al Fattah, Detty Siti Nurdiati","doi":"10.1007/s00404-025-08148-7","DOIUrl":"https://doi.org/10.1007/s00404-025-08148-7","url":null,"abstract":"<p><strong>Background: </strong>Maternal ophthalmic artery Doppler assessment has been proposed as one of the predictors for preeclampsia at any given time. Changes in ophthalmic artery Doppler preceding the onset of PE have been reported in several studies. Some parameters of ophthalmic artery Doppler studies have been proposed, but peak systolic velocity ratio is the most reliable indicator in the prediction of preeclampsia. However, limited previous studies have investigated the reference value across pregnancy.</p><p><strong>Study design: </strong>This was a prospective longitudinal cohort study of low-risk singleton pregnancies without evidence of fetal anomaly, visiting antenatal care between February 2024 and December 2024 at Maternal and Children Harapan Kita hospital in Jakarta and Dr. Sardjito hospital in Yogyakarta, Indonesia. Women were recruited from 11 weeks until 40 weeks' gestation. They underwent serial ultrasound monitoring. Association of ophthalmic artery Doppler PSV was modeled with fractional polynomial regression. Equations for mean ± SD of the estimated curves were calculated, as well as GA-specific reference charts of centiles for ophthalmic artery PSV ratio from 11 + 0 weeks to 40 + 0 weeks.</p><p><strong>Result: </strong>We included 998 low-risk pregnancies and a total of 2439 ultrasound scans (median 3, range 2-4 per patient) were available for analysis. Goodness-of-fit assessment revealed that second-degree smoothing was the most accurate fractional polynomial for describing the course of ophthalmic artery PSV ratio curves. We observed a decrease in PSV ratio until 26 weeks and a substantial increase afterwards. The 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97th centiles according to GA for ophthalmic artery PSV ratio are provided, as well as equations to allow calculation of any value as a centile.</p><p><strong>Conclusion: </strong>Ophthalmic artery PSV ratio showed non-linear behavior in which it decreased from 11 weeks until the end of trimester 2, and it started to increase until the end of pregnancy.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940466","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":"Compatibility of family and clinical-scientific career for German gynecologists in different workplaces: a sub-analysis of the systematic trinational FARBEN survey.","authors":"Niklas Amann, Maggie Banys-Paluchowski, Claudia Becker, Philipp Foessleitner, Martin Göpfert, Rama Kiblawi, Nora Kiessling, Amanda Klee, Natalia Krawczyk, Laura Dussan Molinos, Gert Naumann, Achim Rody, Henning Schäffler, Lina Schiestl, Barbara Schmalfeldt, Solveig Simowitsch, Martin Weiss, Nikolas Tauber","doi":"10.1007/s00404-025-08087-3","DOIUrl":"https://doi.org/10.1007/s00404-025-08087-3","url":null,"abstract":"<p><strong>Introduction: </strong>The trinational survey project conducted by the young forums of the German, Austrian, and Swiss societies for gynecology and obstetrics aims to evaluate the preferences of prospective and practicing gynecologists regarding various working time models, training systems, career pathways, and the reconciliation of professional and family life.</p><p><strong>Materials and methods: </strong>Between October 2023 and May 2024, 1364 participants completed the FARBEN survey. The questionnaire comprised 62 items addressing aspects such as general workplace conditions, working time models, training priorities, team structures, and professional aspirations. Participation was voluntary and anonymous. The present analysis constitutes a national sub-analysis focusing on the preferences of German respondents, stratified by their current workplace setting (university hospitals, non-university hospitals, or outpatient care facilities).</p><p><strong>Results: </strong>Among the 1008 German respondents, 26.3% were employed in university hospitals, 55.4% in non-university hospitals, and 10.8% in outpatient care. Respondents working in university hospitals were significantly more likely to pursue an academic career (68.0% held a doctoral degree, and 7.5% held a habilitation-the highest academic qualification in German-speaking countries-or a professorship; 38.5% aspired to a habilitation, compared to 6.6% in non-university hospitals). Female respondents employed in university hospitals tended to have children at a later stage and returned to work earlier following parental leave. Institutional childcare was reported to be more accessible and flexible at university hospitals (20.4%) compared to non-university hospitals (9.6%) and outpatient care (8.4%). Furthermore, 34.1% of university hospital respondents indicated that their department head was female, in contrast to 19.2% in non-university hospitals (p < 0.001).</p><p><strong>Conclusions: </strong>Work-life balance and the compatibility of family life with a medical career are essential for most gynecologists in training, irrespective of their workplace setting. Respondents employed in academic institutions were more inclined to pursue scientific careers and reported greater flexibility and better childcare support. In light of the growing shortage of medical professionals, employment policies should prioritize these aspects. Initiatives such as the guideline \"Safe Surgery During Pregnancy\" can support the alignment of clinical training with family planning and help prevent career disadvantages related to parenthood.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940337","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":"The Charité protocol for surveillance, treatment and after-care management in women with Lynch syndrome.","authors":"Lukas Chinczewski, Radoslav Chekerov, Severin Daum, Claus-Eric Ott, Jalid Sehouli","doi":"10.1007/s00404-025-08112-5","DOIUrl":"https://doi.org/10.1007/s00404-025-08112-5","url":null,"abstract":"<p><strong>Background: </strong>Lynch syndrome (LS) is the most common inherited cancer syndrome, caused by germline mutations in mismatch repair (MMR) genes such as MLH1, MSH2, MSH6, and PMS2. While primarily associated with colorectal cancer, LS significantly impacts gynecological oncology, with increased risks for endometrial and ovarian cancers. Despite its clinical relevance, structured counseling and surveillance programs tailored to LS patients in gynecology are lacking.</p><p><strong>Objective and methods: </strong>This study presents the first structured gynecological outpatient consultation program for LS patients in Germany, established at Charité-Universitätsmedizin Berlin in August 2021. The aim was to develop an individualized, multidisciplinary framework for surveillance, therapy, and follow-up care, addressing the specific needs of different patient cohorts. Between August 2021 and December 2023, clinical data from 40 LS patients were collected and analyzed descriptively. From this experience, we furthermore concluded a guideline for the care of individuals with Lynch syndrome.</p><p><strong>Results: </strong>Among the 40 patients, 21 had been diagnosed with cancer (affected group), while 19 were cancer-free and undergoing routine surveillance (non-affected group). The distribution of MMR gene mutations was 40% MSH2, 25% MSH6, 25% PMS2, and 15% MLH1. In the non-affected group, the median age was 38 years, with a BMI of 21.4. Surveillance identified one urothelial carcinoma and one case of endometrial hyperplasia. In the affected group, the mean age was 55.2 years, and the BMI was 24.7. Twenty-three gynecological cancers were diagnosed, of which 52% were endometrial, 26% ovarian, and 18% breast cancers. 61.1% of tumors were MSI-positive, and 33.3% of patients received immunotherapy.</p><p><strong>Conclusion: </strong>A holistic, multidisciplinary approach is essential for the management of LS patients in gynecological oncology. The structured consultation model developed at Charité facilitates personalized surveillance, risk-adapted prevention, and evidence-based therapy strategies. Future studies and clinical trials should further investigate screening protocols, therapeutic interventions, and the role of LS patients in targeted treatment approaches. This guideline serves as a preliminary framework and will be continuously adapted as new research emerges.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940405","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":"Asymptomatic twin pregnancies with newly short cervix at 24-27^6/7 weeks' gestation based on dynamic series follow-up findings: is cervical cerclage necessary?","authors":"Han Xie, Xiang Jiang, Yirong Bao, Zhijuan Cao, Xiaoxian Qu, Shengyu Wu, Jiaqi Dong, Xiaoyuan Mao, Hao Ying","doi":"10.1007/s00404-025-08165-6","DOIUrl":"https://doi.org/10.1007/s00404-025-08165-6","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the safety and efficacy of cervical cerclage for asymptomatic twin pregnancies with a newly diagnosed short cervix between 24 and 27^6/7 weeks' gestation.</p><p><strong>Methods: </strong>Eighty-six pregnant women with asymptomatic twin pregnancies and a newly diagnosed short cervix at 24-27^6/7 gestational weeks were divided into two groups based on receipt of ultrasound-indicated cerclage (UIC). The primary outcome was gestational age at birth. Secondary outcomes included spontaneous preterm birth (sPTB) rates and neonatal outcomes.</p><p><strong>Results: </strong>Forty-seven participants received UIC and 39 comprised the control group. The UIC group demonstrated a significantly prolonged diagnosis-to-birth interval, higher gestational age at birth, improved ongoing pregnancy survival curve, and lower risk of sPTB at <36, 34, 32, 30, and 28 weeks compared to controls. Neonates in the UIC group had higher birth weights, lower risk of birth weight <1500 g, and reduced neonatal intensive care unit (NICU) admission rates.</p><p><strong>Conclusion: </strong>UIC performed at 24-27^6/7 weeks for asymptomatic twin pregnancies with a newly diagnosed short cervix can prolong gestation, reduce severe sPTB, and improve short-term perinatal outcomes.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940282","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":"Advancing gender equity in gynecology and obstetrics: perspectives from the German workforce.","authors":"Jasmin Neuhold, Frauke von Versen-Höynck","doi":"10.1007/s00404-025-08167-4","DOIUrl":"https://doi.org/10.1007/s00404-025-08167-4","url":null,"abstract":"<p><strong>Purpose: </strong>Despite the high proportion of women in medical education and clinical training, female physicians remain underrepresented in leadership and academic positions in Gynecology and Obstetrics in Germany. This study investigates structural and cultural factors contributing to this disparity and highlights trends in workforce composition and recognition in the field.</p><p><strong>Methods: </strong>We conducted a descriptive, cross-sectional analysis using publicly available data from the German Federal Statistical Office and the German Medical Association (2004-2024), as well as database from the German Society for Gynecology and Obstetrics (DGGG).</p><p><strong>Results: </strong>In 2023, women comprised 73% of gynecologists in Germany. Female representation declined with advancing career stage. In 2024, 82% of resident physicians at German university hospitals were women, while they held 26% of department head positions in Gynecology and Obstetrics. Female membership in the DGGG reached 75%, with 40% on the executive board. In 2022, 65% of major awards went to men, while women received most poster and lecture prizes (61%) at the biannual conference.</p><p><strong>Conclusions: </strong>While gender diversity in the clinical workforce has improved, systemic inequities persist in academic and leadership domains. Addressing these requires structural reforms, increased transparency in recruitment and promotion processes, and targeted programs supporting women's professional advancement. Enhanced visibility, mentorship, and inclusive institutional policies are essential to ensure gender-equitable development in the specialty.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940351","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":"Umbrella review and meta-analysis of the effect of delayed and immediate pushing in the second stage of labor on neonatal outcomes.","authors":"Paula Deusa-López, Ferran Cuenca-Martínez, Vanessa Sánchez-Martínez, Núria Sempere-Rubio","doi":"10.1007/s00404-025-08118-z","DOIUrl":"https://doi.org/10.1007/s00404-025-08118-z","url":null,"abstract":"<p><strong>Objective: </strong>To compare neonatal outcomes for immediate pushing and delayed pushing in the second stage of labor in women receiving epidural analgesia.</p><p><strong>Data sources: </strong>Systematic searches in PubMed, EMBASE, Scopus, and CINAHL without restrictions by language, date of publication, or methodological quality.</p><p><strong>Study selection: </strong>The inclusion criteria were based on methodological and clinical factors such as population (pregnant women with epidural analgesia), intervention and control (delayed versus immediate pushing), neonatal outcomes, and study design (systematic reviews).</p><p><strong>Data extraction: </strong>The outcome measures were Apgar scores at 1 and 5 min, neonatal intensive care unit admission, prevalence of low umbilical artery cord pH, and umbilical artery cord pH. The methodological quality was analyzed using the Assessing the Methodological Study Tool for Systematic Reviews (AMSTAR) and Risk Of Bias In Systematic Reviews (ROBIS) scales, and the strength of evidence was established according to the Guidelines Advisory Committee grading criteria. For the umbilical artery cord pH variable, standardized mean differences and 95% confidence intervals were calculated and pooled in a meta-analysis using the random-effects model.</p><p><strong>Data synthesis: </strong>Seven systematic reviews with meta-analysis were included. The results suggest no difference between groups for Apgar test scores at 5 min, nor in the rate of neonatal intensive care unit admissions. Mixed results were found for delayed pushing leading to improvements in Apgar test scores at 1 min. No statistically significant between-group differences in the umbilical artery cord pH were found. The total duration of the second stage in the delayed pushing group was not significantly correlated with the umbilical artery cord pH.</p><p><strong>Conclusions: </strong>Delayed pushing produces at least the same neonatal outcomes as immediate pushing in healthy pregnant women receiving epidural analgesia with a single fetus in vertex presentation with a limited quality of evidence. Review registered in the International Prospective Register of Systematic Reviews PROSPERO (CRD42023397616).</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940474","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}