Archives of Gynecology and Obstetrics最新文献

{"title":"Impact of epidural analgesia on outcomes of vaginal birth after cesarean delivery.","authors":"Tamar Eshkoli, Merav Jacobs, Alla Saban, Yael Baumfeld, Renana Ben Shushan-Amor, Zehava Yohay, Adi Y Weintraub","doi":"10.1007/s00404-025-07959-y","DOIUrl":"10.1007/s00404-025-07959-y","url":null,"abstract":"<p><strong>Primary objective: </strong>To assess the association between Epidural Analgesia (EA) during Vaginal Birth After Cesarean (VBAC) and delivery mode (spontaneous or instrumental vaginal delivery). Secondary objectives include maternal and neonatal outcomes.</p><p><strong>Methods: </strong>In this retrospective population-based cohort study, all women who underwent a VBAC with and without EA, between the years 1996-2016 at the Soroka University Medical Center (SUMC) were included. Women who delivered by cesarean section (elective and non-elective) and those who gave birth to a newborn with chromosomal abnormalities or major malformations, and multifetal gestations were excluded. Demographical, clinical, and obstetrical characteristics were recorded, and pregnancy complications and adverse perinatal outcomes were compared between the groups. The primary outcome was the type of delivery. Univariate analysis was followed by a multivariate analysis to control for confounders. A p value of < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>During the study period, 17,516 women who have had a previous CS met the inclusion criteria, of which 15% (n = 2652) used EA during labor, while the rest of the cohort 85% (n = 14,864) were non-EA users. Women in the EA group had higher rates of instrumental delivery and postpartum hemorrhage (PPH) as well as higher rates of oxytocin augmentation and a longer second stage of labor. The use of EA was found to be an independent risk factor for instrumental delivery after controlling for maternal age, ethnicity, parity, DM (diabetes mellitus), hypertensive disorders of pregnancy, oxytocin augmentation, prolonged second stage of labor, induction of labor, fertility treatments and oligohydramnios. However, no significant differences were observed regarding neonatal outcomes including perinatal mortality, birth weight, Apgar scores and shoulder dystocia rates.</p><p><strong>Conclusion: </strong>EA for women undergoing a VBAC was associated with higher rates of instrumental delivery and PPH, oxytocin augmentation and a longer second stage of labor compared with women without EA. However, neonatal outcomes did not differ between the groups.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":"131-137"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063472","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":"Hysteroscopic niche resection can effectively reduce the niche volume, increase residual myometrial thickness, and improve postmenstrual spotting symptoms.","authors":"Yang Wang, Wei Xia, Taotao Sun, Lirong Yan, Chuqing He, Judith A F Huirne, Jian Zhang","doi":"10.1007/s00404-025-07980-1","DOIUrl":"10.1007/s00404-025-07980-1","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the anatomical changes of the uterine niche in women before and after hysteroscopic niche resection (HNR) and to investigate the correlation between these changes and the improvement in postoperative spotting symptoms by thin-slice MRI.</p><p><strong>Methods: </strong>This prospective observational study enrolled women with symptomatic uterine niches between June 2019 and February 2024. All participants underwent thin-slice magnetic resonance imaging (MRI) before and after HNR. We assessed the effective rate of postoperative spotting at the 6-month follow-up (effective treatment was defined as a reduction of at least 50% in spotting days relative to baseline during the 6-month follow-up period) and the pre- and post-HNR anatomical indicators.</p><p><strong>Results: </strong>A total of 108 women were included in the study. Six months after HNR, 70.4% (76/108) of women experienced at least a 50% reduction in spotting days from baseline. Residual myometrial thickness (RMT) significantly increased by 1.9 ± 2.2 mm (p < 0.01). The volume of niche significantly decreased, with a median reduction rate of 38.5% (IQR 8.5-88.2%) (p < 0.01). Based on the ROC curve, a cut-off value of 50 mm² for volume was identified as an optimal threshold for subclassifying large niches and small niches, according to treatment efficacy. The reduction in niche volume was more pronounced in the small niche group compared to the large niche group, with median reduction rates of 51.9% (IQR 13.5-100.0%) and 12.4% (IQR -15.4-43.9%), respectively (p < 0.01). There is an interesting finding that most cases in the anatomical failure group (those with an enlarged niche) had a preoperative volume of ≥ 50 mm² (19.2%, p < 0.01). Furthermore, the effective treatment group exhibited a more significant increase in RMT and a greater reduction in niche volume after HNR compared to the ineffective group. Multivariate logistic regression analysis indicated that small niches [OR 16.85 (3.36-84.47), p < 0.01] and greater reductions in niche volume [OR 1.14 (1.07-1.21), p < 0.01] were associated with effective treatment.</p><p><strong>Conclusion: </strong>HNR is a promising approach for managing postmenstrual spotting, especially in treating small uterine niches (volume < 50 mm²). After HNR, RMT increases, and niche size decreases slightly.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":"207-218"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555725","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":"Impact of meconium-stained amniotic fluid thickness on maternal infectious morbidity: a comprehensive clinical and microbiological analysis.","authors":"Raneen Abu Shqara, Lior Lowenstein, Maya Frank Wolf","doi":"10.1007/s00404-024-07808-4","DOIUrl":"10.1007/s00404-024-07808-4","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to investigate the correlation between the thickness of meconium-stained amniotic fluid (MSAF) and maternal infectious morbidity.</p><p><strong>Methods: </strong>A retrospective study of 15,950 term singleton pregnancies at a tertiary hospital (2020-2024). Women were categorized into four groups based on the presence and thickness of MSAF: clear, light, intermediate, and thick. The co-primary outcomes were clinical chorioamnionitis and puerperal endometritis, defined as a composite maternal infectious morbidity. In women with intrapartum fever (IPF), chorioamniotic swabs were obtained and compared according MSAF thickness. Multivariate analysis identified predictors of a composite maternal infections and adverse neonatal outcomes.</p><p><strong>Results: </strong>Of the cohort, 13,745 had clear amniotic fluid, and 2,205 had MSAF (561 light, 1,426 intermediate, 218 thick). The incidence of maternal infections increased with MSAF thickness, with thick MSAF showing the highest rates of clinical chorioamnionitis (4.1%, p < 0.001) and endometritis (1.4%, p = 0.039). In IPF cases, thicker MSAF was associated with a higher prevalence of positive swab cultures, particularly of Enterobacteriaceae (61.9%). Group B Streptococcus (GBS) remained consistent across all MSAF groups. Multivariate analysis showed that MSAF levels were associated with increased maternal infectious morbidity (p < 0.001). Additional risk factors for maternal infections included nulliparity (p < 0.001), catheter balloon insertion (p = 0.004), prolonged ROM (p < 0.001), and cesarean delivery (p < 0.001). In contrast, only intermediate (p < 0.001) and thick MSAF (p < 0.001) correlated with adverse neonatal outcomes.</p><p><strong>Conclusion: </strong>Greater severity of MSAF is associated with increased maternal infectious morbidity, especially infections related to Enterobacteriaceae. Studies about preventive measures in cases of thick MSAF are warranted.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":"59-67"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602917","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":"Approach to abnormal uterine bleeding in presence of endometrial polyps with new hysteroscopic devices.","authors":"Francesco G Martire, Giorgia Schettini, Eugenia Costantini, Claudia d'Abate, Giuseppe Sorrenti, Gabriele Centini, Errico Zupi, Lucia Lazzeri","doi":"10.1007/s00404-025-08005-7","DOIUrl":"10.1007/s00404-025-08005-7","url":null,"abstract":"<p><strong>Purpose: </strong>To compare different endoscopic techniques, such as hysteroscopy with morcellator and traditional resectoscopy, and different surgical settings, such as operating room setting and outpatient setting, for patients with abnormal uterine bleeding (AUB) and suspected endometrial polyps.</p><p><strong>Metho: </strong>In this prospective study, 180 women diagnosed with endometrial polyps on ultrasound were enrolled. Patients were divided into three groups: 1) resectoscopy under anesthesia in an operating room setting; 2) morcellation with anesthesia in an operating room setting; and 3) outpatient morcellation without anesthesia. The main outcomes included procedure completion rates, operative time, patient satisfaction, and pain intensity using the Visual Analog Scale (VAS). Additionally, histological analysis was conducted for all cases.</p><p><strong>Results: </strong>Among the 180 patients, all procedures were completed in Groups 1 and 2, while Group 3 had a 96.7% completion rate. Procedure duration was the shortest in Group 3 (average 6.5 min), significantly less than in Group 1 (p value < 0.05; CI 95%). Pain was manageable in all groups, with VAS scores < 4 for most patients in the outpatient setting. Histology confirmed benign polyps in most cases, and malignant or premalignant conditions were around 3% of procedure.</p><p><strong>Conclusion: </strong>Outpatient \"see-and-treat\" hysteroscopy with morcellator, performed without anesthesia, proved feasible, safe, and cost-effective, with minimal discomfort and comparable diagnostic accuracy to traditional methods. This technique offers a practical approach for the management of AUB, enabling efficient treatment while reducing costs and resource usage, and may be considered as a preferred option in appropriate patients.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":"257-265"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742075","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":"Scar endometriosis, a form of abdominal wall endometriosis-a neglected obstetrical complication?","authors":"T M Gruber, K Lange, G S Ebeling, W Henrich, S Mechsner","doi":"10.1007/s00404-024-07834-2","DOIUrl":"10.1007/s00404-024-07834-2","url":null,"abstract":"<p><strong>Background: </strong>Scar endometriosis (EM) is defined by the presence of endometrial-like tissue outside the uterine cavity within the scar region after abdominal or pelvic surgery. It is a form of abdominal wall EM. This systematic review addresses the question of whether women after cesarean delivery (CD) are more frequently affected by scar EM than women after other pelvic surgical procedures. The primary aim is to analyze the distribution of previous operations in patients with scar EM. Secondarily, symptoms, diagnosis, and treatment are described.</p><p><strong>Methods: </strong>A systematic literature search in MEDLINE (Pubmed) was performed. Twelve studies were included.</p><p><strong>Results: </strong>The terminology of scar EM is unspecific and the descriptions are, therefore, of limited comparability among authors. In 64-96%, patients with scar EM had a history of CD, followed by laparoscopy, laparotomy, and episiotomy. The main symptoms were pain, often cyclical, and the presence of local swelling. For diagnosis ultrasound, CT scan and MR imaging were used. All patients had undergone surgical resection and the diagnosis was confirmed.</p><p><strong>Conclusion: </strong>Most often scar EM develops after CD. Diagnosis and treatment are often delayed. As an objective classifications system is missing, we propose a simple objective descriptive tool for abdominal wall EM.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738306","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":"Paracetamol versus ibuprofen for early postpartum pain control: a randomized controlled trial.","authors":"Shai Ram, Dotan Madar, Hila Shalev Ram, Goni Peleg, Yotam Lior, Ayelet Greenfeld, Gala Yakov, Yariv Yogev, Sharon Maslovitz","doi":"10.1007/s00404-024-07797-4","DOIUrl":"10.1007/s00404-024-07797-4","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the effectiveness of paracetamol and ibuprofen as non-opioid treatments for postpartum pain control after vaginal delivery.</p><p><strong>Materials and methods: </strong>This randomized controlled study at a university-affiliated medical center involved parturient who received blindly oral tablets of either 1000 mg of paracetamol or 400 mg of ibuprofen, post-vaginal birth. Pain levels were assessed using a numeric rating scale (NRS) at four time points: before treatment, and 1, 4, and 6 h post-treatment (T0, T1, T4, and T6, respectively). We also compared the need for additional analgesia, breastfeeding initiation, mobilization, and urination following the delivery between the groups. To ensure statistical power, the study was designed to detect differences of one point on the NRS with at least 37 women per group.</p><p><strong>Results: </strong>A total of 107 women participated, including paracetamol (n = 52) and ibuprofen (n = 55) groups. Demographics and perinatal outcomes were similar across groups. No significant differences were found in the interval between delivery and request for pain control (8 ± 6-10.5 and 11 ± 6-16 h for the paracetamol and the ibuprofen, respectively, P = .13). Pain levels on the NRS were similar for both groups at all intervals. There were also no group differences in the time to the initiation of breastfeeding, mobilization, urination, or the need for additional analgesia.</p><p><strong>Conclusion: </strong>Both, paracetamol and ibuprofen, can be considered equivalent and effective non-opioid alternatives for postpartum pain control. REGISTRY AT CLINICALTRIALS.GOV: (NCT04653506), https://register.</p><p><strong>Clinicaltrials: </strong>gov/prs/beta/studies/S000AFOR00000066/recordSummary .</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":"51-57"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581735","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":"PROM at term: when might be the best time to induce labour? A retrospective analysis.","authors":"Teresa Starrach, Lucia Ehmann, Hannah Volkmann, Andreas Flemmer, Anna Hester, Eileen Tremmel, Susanne Beyer, Linda Hertlein, Christoph Hübener, Roman Hornung, Thomas Kolben, Sven Mahner, Johanna Büchel","doi":"10.1007/s00404-025-07981-0","DOIUrl":"10.1007/s00404-025-07981-0","url":null,"abstract":"<p><strong>Purpose: </strong>PROM after 37 weeks of gestation occurs in approximately 10% of pregnancies. When spontaneous onset of labour does not follow, induction is recommended to decrease the risk of infection for both mother and child. However, there is no clear consensus on whether induction before 24 h after PROM results in fewer complications compared to induction after > 24 h.</p><p><strong>Material and methods: </strong>This retrospective observational study analysed the outcomes of 3174 women with PROM admitted to the delivery room of LMU Women's Hospital between 10/2015 and 09/2020. We evaluated whether timing of labour induction was associated with maternal or newborn postpartum infection rates.</p><p><strong>Results: </strong>Comparing women with spontaneous onset of labour to those who underwent induction, no significant differences were found in maternal CRP or leukocyte levels, fever, endometritis, or Group B streptococcus colonization. However, intrapartum antibiotic therapy was significantly higher in the induction group. When the induction group was subdivided based on the interval from PROM to induction, no significant differences were observed in maternal infection parameters, need for antibiotics, postpartum length of hospital stay, or endometritis. For newborn infections, a significant difference in CRP levels was found, with higher levels in the groups with \"induction < 12 h\" and \"> 24 h\".</p><p><strong>Conclusion: </strong>The presented data suggests that waiting for spontaneous contractions within the first 24 h after PROM was not associated with the risk of infection if no initial signs for infection are present. However, beyond 24 h, the risk of infection increased. These findings support current recommendations regarding the timing of induction after PROM.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":"247-255"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741889","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":"Comparison of complications and surgery outcomes in skin closure methods following cesarean sections.","authors":"Daniel Gabbai, Chen Jacoby, Itamar Gilboa, Sharon Maslovitz, Yariv Yogev, Emmanuel Attali","doi":"10.1007/s00404-024-07911-6","DOIUrl":"10.1007/s00404-024-07911-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the impact of absorbable subcutaneous staples for skin closure in cesarean delivery (CD) on maternal morbidity.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a single tertiary university-affiliated medical center between January 2011 and April 2022. In 2020, a new technique involving absorbable subcutaneous staples for skin closure in CD was introduced. We compared surgical outcomes among three groups: non-absorbable staples, absorbable subcutaneous staples, and absorbable subcutaneous sutures. Data were compared between the three groups and demographic, obstetric, and surgical characteristics were analyzed using univariate and multivariate analysis.</p><p><strong>Results: </strong>During the study period, 31,660 CDs were performed in our center. The data of 31,419 CDs were available for analysis. Absorbable subcutaneous staples were associated with a significantly shorter surgery time in comparison to non-absorbable staples and sutures (52 min vs 53 min vs 60 min, p < 0.001). No differences were found in rates of wound infections or any surgical site surgery in the 45 days following CD. In a multivariate analysis: the use of absorbable subcutaneous staples was associated with a significantly lower risk for prolonged hospitalization > 5 days (OR 0.6, p < 0.001) and re-admission within 45 days (OR 0.8, p = 0.04).</p><p><strong>Conclusion: </strong>The use of absorbable subcutaneous staples for skin closure during CD is associated with shorter surgery times and a lower risk of prolonged hospitalization and readmission within 45 days.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":"125-129"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036255","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":"Postpartum hemorrhage: risk factors for severe blood loss, surgical intervention and peripartum hysterectomy.","authors":"Emma Barth, Rüdiger Klapdor, Lars Brodowski, Peter Hillemanns, Constantin von Kaisenberg, Vivien Dütemeyer","doi":"10.1007/s00404-025-07969-w","DOIUrl":"10.1007/s00404-025-07969-w","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate risk factors in patients presenting with postpartum hemorrhage (PPH) associated with severe blood loss (BL), surgical intervention or peripartum hysterectomy.</p><p><strong>Methods: </strong>This retrospective cohort study included all patients who gave birth at the Hannover Medical School between January 2013 and August 2022 with PPH, defined as BL ≥ 500 ml after vaginal delivery and ≥ 1000 ml after cesarean section. The threshold for severe PPH was set at BL ≥ 1500 ml. Operative management included manual placental removal and/or aspiration/curettage, need for intrauterine balloon tamponade, uterine packing with a chitosan covered gauze or compression sutures. Hysterectomy as ultima ratio was observed separately.</p><p><strong>Results: </strong>In total 20.9% of 1038 patients with PPH developed severe BL. Several risk factors were identified such as nicotine abuse (aOR 3.45, 95% CI 1.57-7.59, p = 0.002), multiparity (aOR 2.12, 95% CI 1.10-4.10, p = 0.03), uterine malformation (aOR 5.09, 95% CI 1.22-21.16, p = 0.03), c-section (aOR 3.92, 95% CI 2.59-5.92, p < 0.001), placenta praevia (aOR 2.82, 95% CI 1.2-6.63, p = 0.02), abnormal placentation (aOR 9.76, 95% CI 4.22-22.56, p < 0.001) and inversion of the uterus (aOR 16.89, 95% CI 1.62-176.12, p = 0.02). More than one third of the women had a surgical intervention. Independent risk factors for an operative management of PPH were uterus malformation (aOR 5.04, 95% CI 1.22-20.91, p = 0.03), placenta praevia (aOR 2.84, 95% CI 1.23-6.53, p = 0.01), abnormal placentation (aOR 9.78, 95% CI 4.30-22.27, p < 0.001) and c-section (aOR 4.65, 95% CI 3.14-6.89, p < 0.001). Peripartum hysterectomy occurred in 1.9% of the cases and was in addition independently associated wih preeclampsia (aOR 7.50, 95% CI 1.29-43.81, p = 0.03) and amniotic infection syndrome (aOR 12.22, 95% CI 1.92-77.90, p = 0.01).</p><p><strong>Conclusion: </strong>PPH is a common complication in modern obstetrics and one in five patients with pathological bleeding after birth develops severe BL. There are specific risk factors associated with a BL ≥ 1500 ml, surgical intervention and peripartum hysterectomy in PPH that should be assessed by health professionals and taken into account in the management of this postpartum complication.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":"167-176"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397908","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":"Factors, pregnancy outcomes, and management associated with non-reportable results in prenatal cell-free DNA testing.","authors":"Hailing Yin, Jue Wang, Xin Wu, Mingzhu Miao, Ya Wang, Jiale Shi, Xi Wang, Xiang Ma","doi":"10.1007/s00404-025-07977-w","DOIUrl":"10.1007/s00404-025-07977-w","url":null,"abstract":"<p><strong>Purpose: </strong>To offer more effective strategies by classification of non-reportable results for physicians to manage those pregnancies.</p><p><strong>Methods: </strong>From July 2022 to May 2024, a total of 14,073 prenatal cell-free DNA (cfDNA) tests were performed by massively parallel sequencing (MPS) in our genetic laboratory and 52 cases received non-reportable results caused by different reasons. Chi-square analysis and logistic regression analysis were used to analyze the risk factors contributing to non-reportable results. The redraw test results and the pregnancy outcomes were collected and analyzed.</p><p><strong>Results: </strong>Overall, 52 (0.37%) of 14,073 pregnant women had non-reportable cfDNA testing results after the first draw. Multivariate logistic regression analysis revealed that pregnancies conceived by in vitro fertilization (IVF) (OR = 2.42, 95% CI 1.08-5.42, P = 0.03) and heparin use (OR = 7.04, 95% CI 2.40-20.62, P < 0.001) were independent factors for non-reportable cfDNA test results. In 52 cases with non-reportable results, 27 (51.92%) cases had borderline Z scores, 15 (28.85%) cases had a low fetal fraction (< 4.0%), 5 (9.62%) cases indicated multiple chromosomal aberrations (MCA, ≥ 4), and 5 (9.62%) cases had data fluctuation in sex chromosomes. All 52 (100%) cases chose to have a redraw test. The overall success rate of redraw test was 65.38%; however, cases with MCA mainly caused by cfDNA from uterine fibroids or maternal malignancies had relatively low success rate of redraw testing. Compared to pregnant women without risk factors, those with caution indications and with low fetal fraction (LFF) had a lower chance to obtain valid redraw testing results (100.00% vs 16.67%, P = 0.002). The abnormal conditions of perinatal women and infants were more frequent in the cases with non-reportable results after redraw tests (2.94% vs 14.71%, P = 0.027; 7.41% vs 14.81%, P = 0.038).</p><p><strong>Conclusion: </strong>Repeated testing was not suitable for all cases with non-reportable results. Invasive prenatal diagnosis should be recommended for cases with MCA, cases with caution indications and with low fetal fraction for the first non-reportable results, cases with consecutive non-reportable cfDNA results. More attention should be paid to the cases with non-reportable cfDNA results, especially to the cases with non-reportable redraw testing results.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":"197-205"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447853","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}