Archives of Gynecology and Obstetrics最新文献

{"title":"Robotic-assisted surgery in extremely obese patients: a multidisciplinary approach for a patient with a BMI of 101.7 kg/m².","authors":"Roland Csorba, Sàed Almasarweh, Zeynep Atas Elfrink, Paul Buderath, Rainer Kimmig, Martin W Britten","doi":"10.1007/s00404-025-08158-5","DOIUrl":"https://doi.org/10.1007/s00404-025-08158-5","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of obesity has risen significantly, affecting over 19% of the German population. Obesity is frequently associated with endometrial cancer, presenting considerable challenges in pre-, intra- and postoperative management. Challenges with intubation, patient positioning, respiratory and cardiac complications as well as wound dehiscence are commonly encountered in this patient population.</p><p><strong>Methods and results: </strong>For patients with uterine cancer, surgical intervention is essential for staging, symptom control, and potential cure. Minimally invasive approaches, particularly robotic-assisted surgery, have expanded the possibilities for treating morbidly obese patients. Robotic systems facilitate navigation around anatomical barriers and reduce surgeon fatigue. However, despite the technological advancements, morbidly obese patients often face increased perioperative risks and prolonged postoperative recovery. Laparoscopic procedures in steep Trendelenburg position for morbidly obese patients pose unique challenges, particularly in anesthesiological management. These challenges necessitate individualized ventilatory and hemodynamic support to ensure patient safety. This case highlights a multidisciplinary approach to managing a patient with extreme obesity (BMI 101.7 kg/m²) undergoing roboticassisted surgery for uterine cancer. It underscores the importance of comprehensive preoperative planning, intra-operative considerations, and post-operative care in minimizing complications and optimizing outcomes.</p><p><strong>Conclusion: </strong>Our case exemplifies our experience from similar cases and demonstrates that robotic-assisted surgery for endometrial cancer in obese patients can represent a safe and feasible option, characterized by a low complication rate, minimal blood loss, and a short hospital stay.</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":"144940394","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 the impact of labor induction on autism spectrum disorder risk.","authors":"Omri Zamstein, Tamar Wainstock, Eyal Sheiner","doi":"10.1007/s00404-025-08160-x","DOIUrl":"https://doi.org/10.1007/s00404-025-08160-x","url":null,"abstract":"<p><strong>Purpose: </strong>Significant effort has been made in recent years to identify environmental factors-particularly perinatal exposures-that contribute to the development of autism spectrum disorder (ASD), yet many proposed associations remain inconsistent and inconclusive. Given the common use of labor induction for both medical indications and maternal preference, we aimed to investigate its potential association with ASD development, while accounting for synergistic factors that may influence its onset.</p><p><strong>Methods: </strong>A population-based cohort study was conducted at a tertiary referral center, focusing on singleton births. The study aimed to compare the occurrence of ASD in children, considering both hospital and community-based diagnoses, in relation to whether labor was induced (using mechanical cervical ripening or prostaglandins, with or without oxytocin) or began spontaneously. A Kaplan-Meier survival curve was employed to assess the cumulative incidence of ASD, and a Cox proportional hazards model was used to account for confounding variables.</p><p><strong>Results: </strong>Among 115,081 births, 13,071 (11.4%) were labor induced, with the remainder beginning spontaneously. Pregnancy complications, such as gestational diabetes mellitus, preeclampsia or eclampsia, and non-reassuring fetal heart rate patterns, were significantly more common in the labor induction group (p<0.001 for all). During follow-up, 767 children were diagnosed with ASD: 1.0% in the labor induction group and 0.6% in the spontaneous labor onset group (p<0.001). The Kaplan-Meier analysis showed a significantly higher cumulative hazard for ASD diagnosis in the labor induction group (log-rank p-value <0.001). However, after adjusting for maternal and perinatal factors such as maternal age, cesarean delivery, ethnicity, and gestational conditions, no significant association was found between labor induction and ASD risk (adjusted HR = 1.21, 95% CI 0.99-1.47, p = 0.063).</p><p><strong>Conclusion: </strong>Labor induction was associated with a higher ASD incidence but not as an independent risk factor after adjusting for maternal and perinatal factors.</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":"144940479","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":"Chemotherapy in elderly patients with early breast cancer: a systematic review.","authors":"Miriam Fernández-Pacheco, Michael Gerken, Atanas Ignatov, Stephan Seitz, C Kowalski, Elisabeth C Sturm-Inwald, Maria Eleni Hatzipanagiotou, Olaf Ortmann","doi":"10.1007/s00404-025-08120-5","DOIUrl":"https://doi.org/10.1007/s00404-025-08120-5","url":null,"abstract":"<p><strong>Purpose: </strong>Breast cancer is the most common cancer affecting elderly patients. However, they may not receive optimal oncological care. Reasons might be comorbidities, limited compliance with clinical guidelines, and insufficient evidence for guideline recommendations. In the present review, the evidence for the clinical benefit of chemotherapy (CHT) in the population of elderly women with breast cancer was examined.</p><p><strong>Methods: </strong>A systematic review of relevant literature in English identifying studies published from January 2000 to April 2023 was conducted. The analysis included studies on the application of CHT, effects on survival, and toxicities. We searched PubMed databases for relevant publications. In total, 24 studies were included in the present review.</p><p><strong>Results: </strong>The benefit of CHT in elderly patients was inconsistent. Results of this review indicate evidence for the benefit of CHT in healthy elderly patients with high-risk breast cancer (BC) and specific subtypes such as triple-negative or HER2-positive BC. Data from studies on pathological complete response rates (pCR) or surgical downstaging rates after neoadjuvant chemotherapy (NACT) in different age groups are controversial.</p><p><strong>Conclusion: </strong>Results from studies on the effects of CHT in elderly patients are insufficient to draw differentiated conclusions due to heterogeneity of the definition for \"elderly\" patients, the application of different drugs and dosages. Patients with high-risk BC may benefit from CHT.</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":"144940334","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":"Design and implementation of a microlearning-based OSCE preparatory curriculum in obstetrics: a pilot study.","authors":"N Michlmayr, J Mitofsky, N Haverkamp, A Wittek, R Plöger, A Walter, B Strizek, F Recker","doi":"10.1007/s00404-025-08157-6","DOIUrl":"https://doi.org/10.1007/s00404-025-08157-6","url":null,"abstract":"<p><strong>Background: </strong>Bedside teaching in obstetrics is increasingly challenged by clinical workload, leading to inconsistent OSCE preparation for medical students. To address this, we developed and implemented a microlearning-based preparatory curriculum using the MiLeMed app.</p><p><strong>Methods: </strong>A microlearning-based OSCE preparatory curriculum was developed using Kern's six-step model. Goals and objectives were defined via a Delphi process involving educators and students. A dedicated app with a 20-day study plan was created, piloted by 13 students, and evaluated using an online questionnaire.</p><p><strong>Results: </strong>The Delphi process supported the use of microlearning with integrated quizzes and visuals. Pilot participants reported the app as helpful for understanding and exam preparation, and emphasized its usability and inclusive design in open-text feedback.</p><p><strong>Discussion: </strong>The pilot study suggests that a microlearning app is a feasible and well-received tool for OSCE preparation. However, limitations such as small sample size, self-selection bias, and technological disparities must be considered. Future studies, including a planned randomized controlled trial, are needed to evaluate effectiveness and generalizability.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940476","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":"Editorial Expression of Concern: Carbetocin versus syntometrine in the management of third stage of labor following vaginal delivery.","authors":"Alsaeed A Askar, Mohamed Taha Ismail, Amro Abo El-Ezz, Noha H Rabie","doi":"10.1007/s00404-025-08154-9","DOIUrl":"https://doi.org/10.1007/s00404-025-08154-9","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940437","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":"Correction: 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/s00404-025-08153-w","DOIUrl":"https://doi.org/10.1007/s00404-025-08153-w","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940391","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":"Does normal fetal brain imaging in monochorionic twins following co-twin fetal demise eliminate the risk of adverse neurodevelopmental outcome?","authors":"Daphna Amitai Komem, Tally Pinchas Cohen, Shir Nov, Tal Weissbach, Irina Rabinovich, Yael Furman, Hagai Avnet, Boaz Weisz, Yoav Yinon","doi":"10.1007/s00404-025-08149-6","DOIUrl":"https://doi.org/10.1007/s00404-025-08149-6","url":null,"abstract":"<p><strong>Objective: </strong>To assess the residual risk of long-term adverse neurodevelopmental outcomes in monochorionic twins following co-twin fetal demise and normal fetal brain imaging.</p><p><strong>Methods: </strong>All monochorionic twin pregnancies with co-twin fetal demise were included. Patients were identified through a search of inpatient medical records for co-twin fetal demise. Cases involving fetal demise following intrauterine procedures (e.g., laser ablation or termination of pregnancy following findings on fetal brain imaging) were excluded. Following co-twin demise, fetal brain imaging, including serial neurosonogram and fetal brain MRI, was performed on the surviving fetus. Neurodevelopmental outcomes were assessed postnatally using standardized age-appropriate developmental evaluation of personal-social, language, gross and fine motor skills, as well as hearing and vision screening. Additionally, parents completed a phone-based adaptive behavior questionnaire using the Vineland-II Adaptive Behavior Scales (VABS-II).</p><p><strong>Results: </strong>Nineteen patients met the inclusion criteria. Two patients underwent urgent cesarean delivery due to fetal distress following co-twin demise and did not undergo any imaging. Of the 17 patients who underwent fetal brain imaging, 2 had evidence of CNS injury, one of whom later presented with mild speech delay, and the other who achieved an adequate VABS-II score. Among the fetuses with normal brain imaging and available follow-up, 45.4% (5/11) had abnormal developmental evaluations including one global delay, one motor delay, one mild hypotonia, and two moderately low scores on VABS-II.</p><p><strong>Conclusion: </strong>Normal fetal CNS imaging following co-twin fetal demise in monochorionic twins does not guarantee normal neurodevelopmental outcome. This residual risk should be clearly discussed with parents during counseling to aid clinical decision- making.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940402","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":"A comparative evaluation of publicly available large language models in the assessment of CTG traces according to the FIGO criteria.","authors":"Iason Psilopatis, Cécile Monod, Valeria Filippi, Rebecca Tschudin, Olaf Lapaire, Julius Emons, Beatrice Mosimann, Tibor A Zwimpfer","doi":"10.1007/s00404-025-08145-w","DOIUrl":"https://doi.org/10.1007/s00404-025-08145-w","url":null,"abstract":"<p><strong>Background: </strong>Cardiotocography (CTG) remains a cornerstone in fetal monitoring, but its interpretation is subject to considerable inter- and intra-observer variability. Artificial intelligence (AI) tools, particularly large language models (LLMs), offer potential to improve diagnostic consistency and reduce clinician workload.</p><p><strong>Objectives: </strong>This study aims to evaluate and compare the accuracy of various LLMs in CTG interpretation based on Federation of Gynecology and Obstetrics (FIGO 2015) criteria.</p><p><strong>Study design: </strong>An analysis of sixty CTG traces previously classified by clinicians at the University Hospital Basel according to FIGO guidelines was conducted. In a two-run protocol, 30 normal CTG traces were initially presented as screenshots to Chat-GPT-4.0, Google Gemini, Bing Copilot, and DeepSeek. Subsequently, the LLMs that demonstrated adequate interpretation of normal CTGs were tasked to classify another 30 suspicious or pathological CTG traces. Each LLM was asked to classify each CTG trace as normal or abnormal.</p><p><strong>Results: </strong>DeepSeek was unable to interpret CTGs and was excluded. Google Gemini showed poor performance (6.7%) on normal CTGs. Chat-GPT-4.0 partially succeeded in correctly classifying the provided CTG traces as normal (46.7%) or abnormal (50%). Bing Copilot accurately interpreted normal CTGs (96.6%) but failed on abnormal ones (0%).</p><p><strong>Conclusions: </strong>LLMs show major limitations in the interpretation of CTG traces according to the FIGO criteria.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940325","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":"Common chromosomal aneuploidy testing using non-invasive trophoblast retrieval and isolation from the cervix (TRIC) in pregnant women.","authors":"Heeyeon Jang, Ji Eun Park, Hyunjin Kim, Minyeon Go, So Hyun Yang, Jong Chul Kim, Sujeong Eom, Hee Jin Park, Soo Hyun Kim, Sung Shin Shim, You Jung Han, Sung Han Shim, Dong Hyun Cha","doi":"10.1007/s00404-025-08156-7","DOIUrl":"https://doi.org/10.1007/s00404-025-08156-7","url":null,"abstract":"<p><strong>Purpose: </strong>Non-invasive prenatal diagnosis (NIPD) for aneuploidy has been developed to overcome the limitations of non-invasive prenatal testing (NIPT). NIPT, which analyzes cell-free fetal DNA (cffDNA) in the maternal blood, can only detect a few aneuploidies, such as trisomies 13, 18, and 21. Trophoblast retrieval and isolation from the cervix (TRIC) is an alternative method that separates trophoblasts from endocervical cells using a Papanicolaou smear for NIPD. Here, we report the application of fetal cells obtained from the uterine cervix using a non-invasive cervical cytobrush during the first trimester of pregnancy for diagnosing trisomies 13, 18, and 21, and sex chromosome anomalies.</p><p><strong>Methods: </strong>Trophoblast cells were isolated from the cervical fluid samples of nine pregnant women diagnosed with aneuploidy between the 5th and 20th weeks of gestation using magnetic nanoparticles with a human leukocyte antigen-G antibody.</p><p><strong>Results: </strong>Fluorescence in situ hybridization analysis of the isolated trophoblast cells identified aneuploidies in all nine samples, which was consistent with conventional prenatal genetic testing. The proportion of trisomic cells was between 14.35 and 23.8%, indicating that the isolated cells comprised some maternal cells.</p><p><strong>Conclusions: </strong>In summary, we successfully identified aneuploidies using TRIC, suggesting its potential as a non-invasive prenatal genetic testing method. However, the efficiency of recovering trophoblast cells from TRIC remains to be elucidated.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940315","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":"Single-versus double-layer uterine closure at the time of cesarean delivery and risk of uterine scar niche: a systematic review and meta-analysis of randomized trials","authors":"Mattia Dominoni,&nbsp;Marco Torella,&nbsp;Rossella Molitierno,&nbsp;Mario Fordellone,&nbsp;Gabriele Saccone,&nbsp;Dario Colacurci,&nbsp;Antonio Simone Laganà,&nbsp;Martina Rita Pano,&nbsp;Barbara Gardella,&nbsp;Marco La Verde","doi":"10.1007/s00404-025-08151-y","DOIUrl":"10.1007/s00404-025-08151-y","url":null,"abstract":"<div><h3>Objective</h3><p>This systematic review and meta-analysis compared single- versus double-layer uterine closure at the time of cesarean delivery.</p><h3>Data sources</h3><p>MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched from inception until May 2024.</p><h3>Study eligibility criteria</h3><p>We included only randomized controlled trials (RTSs) that compared single-layer versus double-layer uterine closure at the time of cesarean delivery.</p><h3>Study appraisal and synthesis methods</h3><p>Outcomes were analyzed using a random-effects model. Results are expressed as risk differences. The assessment of the risk of bias was performed by using the Risk of Bias 2 tool. The primary outcome was the incidence of scar defects (i.e., niche) at 6 months after delivery. The secondary outcomes were incidence of scar defects at 6 weeks and 3 months.</p><h3>Results</h3><p>A total of 18 studies were identified by the systematic review; 11 RCTs involving 6,058 participants were included in the meta-analysis. There is no statistical difference between single-layer and double-layer uterine closure of cesarean delivery incision regarding the incidence of uterine scar defect at six weeks. Single-layer closure showed a significantly lower incidence of niche after three months (RD = − 0.02 (− 0.06, 0.02); <i>I</i>² = 81%, <i>p</i> &lt; 0.01), and six months (RD = − 0.11, CI − 0.15, − 0.07, I² = 91%, <i>p</i> &lt; 0.01).</p><h3>Conclusions</h3><p>Single-layer uterine closure at the time of cesarean delivery resulted in a lower uterine scar defects after three and six months compared to double-layer uterine closure.</p><h3>Systematic review registration</h3><p>PROSPERO, Unique identifier: CRD42024552495.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"312 4","pages":"1095 - 1106"},"PeriodicalIF":2.5,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08151-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940459","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}