Archives of Gynecology and Obstetrics最新文献

{"title":"Spontaneous miscarriage and later lifestyle in predicting hazard of premature mortality: a cohort study in UK Biobank","authors":"Ying Hu,&nbsp;Rui Tang,&nbsp;Xiang Li,&nbsp;Xuan Wang,&nbsp;Hao Ma,&nbsp;Yoriko Heianza,&nbsp;Lu Qi,&nbsp;Zhaoxia Liang","doi":"10.1007/s00404-026-08471-7","DOIUrl":"10.1007/s00404-026-08471-7","url":null,"abstract":"<div><h3>Objective</h3><p>To prospectively assess the association of spontaneous miscarriage with the hazard of premature mortality and to examine the interaction between spontaneous miscarriage and lifestyle in relation to premature mortality.</p><h3>Methods</h3><p>A total of 231,148 participants from the UK Biobank were included. The unhealthy lifestyle was defined as an unhealthy diet, smoking, irregular physical activity, and an abnormal body mass index. Cox proportional hazards models were used to evaluate the associations.</p><h3>Results</h3><p>During a median follow-up time of 12.3 years, 11,672 premature mortalities were documented. Compared to women who did not have a spontaneous miscarriage, the multivariable-adjusted hazard ratios (aHRs) for all-cause premature mortality according to the number of spontaneous miscarriages were 0<b>.</b>98 (95% confidence interval [CI] 0<b>.</b>93–1<b>.</b>04) for one, 1<b>.</b>16 (1<b>.</b>06–1<b>.</b>27) for two, and 1<b>.</b>24 (1<b>.</b>10–1<b>.</b>39) for three or more, respectively (<i>P</i>-trend &lt; 0<b>.</b>001). In contrast, the ever-versus-never comparison (any miscarriage) was not significant after adjustment for lifestyle factors. We found a significant interaction on an additive scale between a greater number of spontaneous miscarriages and the unhealthy lifestyle score (<i>P</i> for additive interaction = 0<b>.</b>03) on the risk of premature mortality.</p><h3>Conclusions</h3><p>Our findings indicate that recurrent spontaneous miscarriage (≥ 2 events) serves as a risk marker for higher hazard of all-cause premature mortality, particularly death from cardiovascular disease, whereas a single miscarriage and the ever-versus-never comparison showed no significant association after full adjustment. A postnatal unhealthy lifestyle may partly account for the observed association, suggesting that lifestyle modification could be a focus for future preventive strategies in this high-risk population.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337694","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":"Evaluation of the concept of students learning practical gynecological and obstetric skills at a large German university hospital, using the example of the Homburg university women's clinic","authors":"Sebastian Findeklee,&nbsp;Mariz Kasoha,&nbsp;Gregor Leonhard Olmes,&nbsp;Klaus Diedrich,&nbsp;Mihai-Teodor Georgescu,&nbsp;Romina Marina Sima,&nbsp;Erich-Franz Solomayer,&nbsp;Bashar Haj Hamoud","doi":"10.1007/s00404-026-08473-5","DOIUrl":"10.1007/s00404-026-08473-5","url":null,"abstract":"<div><h3>Introduction</h3><p>The teaching and practical training of future doctors play an important role in the university curriculum.</p><h3>Material and methods</h3><p>At the Women’s Clinic of Saarland University Hospital in Homburg, we developed a five-day block placement concept that focused on learning practical gynecological and obstetric skills rather than simply imparting theoretical knowledge. The student`s satisfaction with the block placement was assessed using a non-standardized questionnaire with the two items “How do you rate your learning outcomes from the placement?” and “The placement increased my interest in gynecology and obstetrics”. The assessment was based on a scale of 1 to 6.</p><h3>Outcome</h3><p>A total of 205 out of 220 students (93.2%) from the winter semester 2022/2023 participated in the evaluation and completed the questionnaire. 198 students (96.6%) rated the satisfaction with their perceived learning from the block internship as very good (1) or good (2), and 201 students (98%) reported an increase in their interest in the subject area.</p><h3>Discussion</h3><p>An overwhelming majority of students rated the practical teaching concept as very good or good, which speaks to the success of this practical teaching format. Nevertheless, the study also has several limitations. For example, only one cohort of medical students was surveyed. Furthermore, when establishing a new teaching concept, there is a risk that participants in an evaluation will not respond objectively, but rather according to the criterion of social desirability. We suggest our practice-oriented block placement concept, which focuses on learning skills relevant to the future medical profession, as a possible curriculum for undergraduate teaching in gynecology and obstetrics, to inspire students for the field.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08473-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148343725","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":"Is a history of cesarean section a predictive factor for the failure of medical management in spontaneous abortion?","authors":"Ravit Pertez-Machluf,&nbsp;Maya Youran Kimhi,&nbsp;Rotem Yedidia Moser,&nbsp;Nissim Arbib,&nbsp;Yair Daykan,&nbsp;Omer Weitzner,&nbsp;Ron Schonman,&nbsp;Zvi Klein,&nbsp;Yael Yagur","doi":"10.1007/s00404-026-08504-1","DOIUrl":"10.1007/s00404-026-08504-1","url":null,"abstract":"<div><h3>Objectives</h3><p>This study aims to evaluate the risk factors for failure of medical treatment for first-trimester spontaneous abortion and the specific role of prior cesarean delivery (CD).</p><h3>Methods</h3><p>This retrospective cohort study analyzed data from patients who underwent medical management of first-trimester spontaneous abortion using mifepristone and misoprostol at a tertiary medical center between 2019 and 2022. Data collected included demographic, clinical, and sonographic parameters, with comparisons made between patients with successful and unsuccessful treatment outcomes. Univariable and multivariable logistic regression analyses were conducted.</p><h3>Results</h3><p>Among the 716 patients included in the study, treatment failure was observed in 29.5%. In multivariable analysis, prior CD was independently associated with an increased risk of treatment failure (aOR 1.97; 95%CI 1.25–3.12; <i>p</i> = 0.004). Additionally, advanced gestational age was also associated with an increased likelihood of failure (aOR 1.02 per day; 95%CI 1.00–1.03; <i>p </i>= 0.009). In subgroup analyses, patients with prior CD had higher failure rates compared with those without prior CD (43.2% vs 27.4%, <i>p</i> = 0.002). Among patients without prior CD, gestational age &gt; 70 days was associated with higher failure rates compared with ≤ 70 days (35.2% vs 24.3%, <i>p </i>= 0.006). In this subgroup (no prior CD and gestational age ≤ 70 days), the presence of bleeding during treatment was associated with lower failure rates (12.5% vs 25.6%, <i>p</i> = 0.001).</p><h3>Conclusion</h3><p>Prior cesarean delivery was independently associated with an increased risk of treatment failure following medical management of first-trimester spontaneous abortion. Advanced gestational age was also associated with increased failure rates. Further studies are needed to refine treatment protocols and explore approaches for patients with prior CD.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337629","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":"Subtype-specific analysis of factors associated with assisted reproductive technology indication and live birth in patients with adenomyosis: a retrospective study","authors":"Kota Tanaka,&nbsp;Yosuke Ono,&nbsp;Hajime Ota,&nbsp;Dai Miyashita,&nbsp;Tatsuya Yoshihara,&nbsp;So Owada,&nbsp;Satoko Sasatsu,&nbsp;Maki Ogi,&nbsp;Yasuhiko Okuda,&nbsp;Hideto Yamada,&nbsp;Shinichiro Wada,&nbsp;Osamu Yoshino","doi":"10.1007/s00404-026-08490-4","DOIUrl":"10.1007/s00404-026-08490-4","url":null,"abstract":"<div><h3>Purpose</h3><p>The magnetic resonance imaging (MRI)-based classification of adenomyosis subtypes helps predict reproductive and obstetric outcomes; however, background factors associated with use of assisted reproductive technology (ART) and live birth within each individual subtype remain unclear.</p><h3>Methods</h3><p>We conducted a multicenter retrospective study of 199 premenopausal women (32–49 years) who underwent pelvic MRI and laparoscopic surgery and had histopathologic confirmation of adenomyosis (January 2010–May 2023). Patients were classified as intrinsic (n = 58), extrinsic (n = 61), or indeterminate (n = 80) subtype. Within each subtype, multivariate logistic regression tested independent associations of age, ART history, gravidity, parity, lesion thickness, and intraoperative findings—including pelvic endometriosis—with ART use and live birth.</p><h3>Results</h3><p>The extrinsic subtype had a higher proportion with ART history than the intrinsic subtype (32.8% vs 8.6%; p = 0.008). Live birth rate was lower in the indeterminate than the intrinsic subtype (60.0% vs 86.2%; p = 0.0048). In the extrinsic subtype, greater lesion thickness independently predicted lower odds of live birth (adjusted OR = 0.94 per 1-mm increase; 95% CI, 0.88–0.99; p = 0.048). In the indeterminate subtype, older age was associated with ART use (adjusted OR = 1.155 per year; 95% CI, 1.002–1.351; p = 0.047), and ovarian endometrioma was linked to reduced live birth (adjusted OR = 0.172; 95% CI, 0.054–0.508; p = 0.001). In the intrinsic subtype, women with live birth were older than those without, but age was not an independent factor.</p><h3>Conclusion</h3><p>Adenomyosis lesion thickness and coexisting endometriosis are associated with ART indication and live birth outcomes in a subtype-specific manner and may support individualized counselling and management.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08490-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337643","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":"Global landscape of maternal hemorrhage mortality: a 40-year analysis based on GBD 2021 study","authors":"Lanfang Guo,&nbsp;Jun Hu,&nbsp;Shaokun Wang,&nbsp;Haiyan Wang,&nbsp;Lili Liu,&nbsp;You Wang","doi":"10.1007/s00404-026-08506-z","DOIUrl":"10.1007/s00404-026-08506-z","url":null,"abstract":"<div><h3>Background</h3><p>Maternal hemorrhage (MH) is the leading direct cause of global maternal mortality, accounting for over a quarter of all maternal deaths. While significant progress has been made, the decline in MH-related mortality varies widely across regions, reflecting disparities in healthcare access and quality. This study leverages the Global Burden of Disease (GBD) 2021 database to analyze MH mortality trends and inequalities.</p><h3>Methods</h3><p>We analyzed MH mortality data from 1982 to 2021 for women aged 15–49. We assessed trends using crude data and age-standardized mortality rates, calculating the estimated annual percentage change (EAPC). We also employed an age–period–cohort (APC) model to examine the effects of age, period, and birth cohort on mortality. Countries were grouped into five categories based on their sociodemographic index (SDI).</p><h3>Results</h3><p>Globally, the absolute number of MH deaths decreased by 63.13% between 1982 and 2021. High-middle SDI regions showed the greatest improvement with a 91.76% decrease, while low-SDI regions had the most modest progress at 21.57%. By 2021, Nigeria, India, and Pakistan had the highest absolute number of deaths, while Sierra Leone, Chad, and Niger had the highest age-standardized mortality rates. The APC analysis revealed a persistent disparity: successive generations in low-SDI regions still face substantially higher risks compared to their counterparts in high-SDI settings.</p><h3>Conclusion</h3><p>Our findings reveal significant global progress in reducing MH mortality, but also a growing health disparity, with the burden increasingly concentrated in low-SDI countries. This highlights the need for targeted policies that strengthen healthcare systems in vulnerable regions to achieve global equity in maternal health.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08506-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337659","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 three different hpv self-sampling tools – a subanalysis of the prospective, randomized hannover self-collection study","authors":"Stephanie Hempel,&nbsp;Sophia Groß,&nbsp;Lena Steinkasserer,&nbsp;Leonie Theis,&nbsp;Yvonne Ziert,&nbsp;Armin Koch,&nbsp;Peter Hillemanns,&nbsp;Matthias Jentschke","doi":"10.1007/s00404-026-08457-5","DOIUrl":"10.1007/s00404-026-08457-5","url":null,"abstract":"<div><h3>Objective</h3><p>Cervical cancer and its precursor lesions are treatable if detected early; however, screening participation for high-risk human papillomavirus infections (hr-HPV) remains low. In 2021, Germany recorded 4,544 new cervical cancer cases and 2,071 related deaths. The HaSCo study evaluates the feasibility of HPV self-testing to improve screening participation. This sub-study evaluates performance and acceptability of three self-testing tools.</p><h3>Methods</h3><p>This prospective, randomized sub-study examined Evalyn-Brush, FLOQSwabs, and first-void urine Colli-Pee among women aged 30—65 in Hannover, Germany. Addresses from the residents´ registration office were randomized into seven age groups and an 80/20 city–region distribution. A total of 19,995 women were assigned to opt-in (request a self-test) or opt-out (receive a test directly). Participation was requested from women without regular screening in the past two years.</p><h3>Results</h3><p>1,860 samples were returned (9.3%). Colli-Pee (10.4%) and FLOQSwabs (10.1%) had similar return rates, while Evalyn showed significantly lower rates (7.4%). Screening frequency didn´t significantly affect return rates (p = 0.1825), although FLOQSwabs showed higher return rates among underscreened women. Invalid sample rates were low, highest for FLOQSwabs (1.67%). A total of 145 samples tested positive for hr-HPV (7.9%). Evalyn collected highest DNA content (p &lt; 0.0001). Colli-Pee was most preferred, and 66.7% of participants favored self-testing.</p><h3>Conclusion</h3><p>HPV self-tests were highly accepted and effective for collecting sufficient DNA material. Direct provision of user-friendly self-tests may support screening participation, particularly among underscreened women. All three devices performed strongly and appear suitable for integration into cervical cancer screening programs.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08457-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315347","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":"Fertility-sparing strategy in a rare case of uterine adenosarcoma and consecutive spontaneous pregnancy and livebirth","authors":"E. Ziegler,&nbsp;J. Altmann,&nbsp;W. D. Schmitt,&nbsp;S. Mechnser,&nbsp;J. Sehouli,&nbsp;E. Roser","doi":"10.1007/s00404-026-08443-x","DOIUrl":"10.1007/s00404-026-08443-x","url":null,"abstract":"<div><h3>Introduction</h3><p>We present the rare case of a 29-year-old patient with uterine adenosarcoma who received fertility-sparing treatment, subsequently conceived spontaneously, and gave birth to a healthy infant.</p><h3>Case</h3><p>In August 2022, the nulliparous patient presented with acyclic uterine bleeding. Diagnostic hysteroscopy and targeted resection of a polyp located at the cervicouterine junction revealed uterine adenosarcoma without sarcomatous overgrowth (FIGO stage T1a). Imaging confirmed no residual tumor or metastasis. A fertility-sparing management strategy was chosen, avoiding hysterectomy but involving close oncological surveillance with quarterly MRI scans. During follow-up, a concurrent diagnosis of symptomatic endometriosis introduced therapeutic challenges. The patient spontaneously conceived in 2023 and delivered a healthy infant by cesarean section at term in 2024. Subsequent hysteroscopy and imaging in 2025 showed no evidence of recurrence, therefore fertility-preserving management was continued.</p><h3>Patient Perspective</h3><p>A short narrative of the patient’s perspective on her initial diagnosis, possible fertility loss, and the emotional turmoil of pregnancy after uterine adenosarcoma is presented.</p><h3>Discussion</h3><p>Treating young patients diagnosed with uterine adenosarcoma poses a challenge to the treating physician due to the lack of guidelines and evidence regarding fertility-preserving treatment of this rare tumor. This report adds to the limited literature on successful pregnancy after uterine adenosarcoma and discusses indications and limitations of fertility-sparing treatment.</p><h3>Conclusion</h3><p>Fertility preservation may be possible in selected early-stage uterine adenosarcoma cases without high-risk features such as sarcomatous overgrowth or myometrial invasion, with thorough counseling and strict follow-up. Further research is needed to develop standardized protocols and improve management in this context.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08443-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148300797","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":"Differential impacts of pregnancy-induced hypertension and chronic hypertension on maternal and foetal health outcomes: a systematic review of outcomes and risk factors","authors":"Joseph Amihere Ackah,&nbsp;Wisdom Senanu Mensah,&nbsp;Xiangyan Chen,&nbsp;Ellen Dyer,&nbsp;Uchendu Comrade Chukwanugo,&nbsp;Christian Ven Emery,&nbsp;Theophilus N. Akudjedu","doi":"10.1007/s00404-026-08503-2","DOIUrl":"10.1007/s00404-026-08503-2","url":null,"abstract":"<div><h3>Introduction</h3><p>Hypertensive disorders complicate approximately 5–10% of pregnancies globally, significantly impacting maternal and foetal health. To address the distinct impacts of chronic hypertension and pregnancy-induced hypertension (PIH) on foeto-maternal health, this review delineated their associated distinct risk factors and diagnostic markers, providing evidence-based insights to guide targeted, patient-centred management of hypertensive pregnancies.</p><h3>Methods</h3><p>A systematic search of Web of Science, PubMed, and SCOPUS was conducted using predefined criteria. Observational studies were rigorously screened and quality assessed. Data were extracted and narratively synthesised, with an emphasis on maternal and foetal outcomes, diagnostic modalities, and risk modifiers.</p><h3>Results</h3><p>The analysis confirmed that intrauterine foetal demise, intrauterine growth restriction, low birth weight, and neonatal as well as maternal mortality are major adverse outcomes of hypertensive pregnancies. The evidence demonstrates that whilst chronic hypertension and PIH confer considerable risk, PIH often results in more sudden and severe clinical deterioration, especially in the absence of vigilant prenatal monitoring and timely intervention. The findings underscored the value of targeted, patient-centred care: women with chronic hypertension benefit from early and sustained surveillance, whereas those with PIH require prompt escalation of monitoring following diagnosis, especially in the second trimester. Notably, comorbid systemic illnesses and advanced maternal age compound risks across hypertension categories, and diagnostic modalities, particularly ultrasound Doppler, are pivotal for early risk stratification and management.</p><h3>Conclusion</h3><p>Effective management of hypertensive pregnancies requires early identification and individualised monitoring, recognising that chronic hypertension and pregnancy-induced hypertension differ in onset and progression, but both pose significant risks to maternal and foetal health.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293286","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":"Pain and functional outcomes after surgical versus hormonal treatment in rectovaginal endometriosis: a retrospective cohort study","authors":"Franziska Werner,&nbsp;Renata Voltolini Velho,&nbsp;Sylvia Mechsner","doi":"10.1007/s00404-026-08495-z","DOIUrl":"10.1007/s00404-026-08495-z","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare changes in pain-related symptoms, bowel and bladder function, rectal bleeding, quality of life, and treatment satisfaction in women with rectovaginal endometriosis treated either surgically or with hormonal treatment alone in a tertiary referral centre.</p><h3>Methods</h3><p>This retrospective cohort study included women with rectovaginal endometriosis treated at a tertiary endometriosis centre with either surgical excision or hormonal treatment alone after informed consent. Standardised questionnaires assessed pain, functional symptoms, quality of life, and treatment satisfaction. Symptom changes were categorised as improvement, stability, or worsening. Between-group comparisons were performed using Mann–Whitney U tests and Pearson’s chi-square tests, with effect sizes reported (r or Cramér’s V). The analysis was exploratory.</p><h3>Results</h3><p>A total of 210 women were included (surgical <i>n</i> = 164; hormonal <i>n</i> = 46). Baseline pain intensity did not differ significantly between groups, although bowel dysfunction and rectal bleeding were more prevalent in the surgical cohort. Following treatment, approximately 80% of women in both groups reported improvement in pelvic pain and dysmenorrhoea. Improvements in dyspareunia, dyschezia, and functional outcomes were observed in substantial proportions. Between-group comparisons revealed no statistically significant differences in change categories across pain, functional symptoms, quality of life, or treatment satisfaction (all <i>p</i> ≥ 0.08), with consistently small effect sizes.</p><h3>Conclusion</h3><p>Both surgical and hormonal treatment were associated with substantial improvements in patient-reported outcomes in women with rectovaginal endometriosis. Direct comparison revealed no significant differences in outcome trajectories, supporting an individualised treatment approach.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08495-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293307","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":"Computerized CTG self-monitoring versus standard Doppler assessment in late-onset fetal growth restriction (cosmos): a pilot randomized controlled trial","authors":"Urszula Nowacka,&nbsp;Tadeusz Issat,&nbsp;Karolina Krajewska,&nbsp;Agnieszka Norwa,&nbsp;Natalia Mazanowska,&nbsp;Joanna Kowalczyk-Buss,&nbsp;Szymon Kozlowski,&nbsp;Marta Kuchcinska,&nbsp;Piotr Laudański,&nbsp;Artur Jakimiuk,&nbsp;Agata Majewska","doi":"10.1007/s00404-026-08493-1","DOIUrl":"10.1007/s00404-026-08493-1","url":null,"abstract":"<div><h3>Purpose</h3><p>Late-onset fetal growth restriction (FGR) presents clinical management challenges, often requiring frequent in-hospital fetal surveillance. Telemedicine-based computerized cardiotocography (cCTG) performed at home may offer a viable remote monitoring addition.</p><h3>Methods</h3><p>This single-center, open-label, a pilot randomized controlled pragmatic trial (COSMOS) was conducted in Warsaw, Poland, between 2022 and 2025. A total of 120 women with late-onset FGR, defined according to the Delphi criteria, were randomly assigned (1:1) to either a cCTG-based monitoring approach with protocol-mandated safety Doppler assessments or to standard hospital-based Doppler surveillance. The primary outcome was neonatal condition at birth (Apgar score at 5 min, umbilical artery pH). Secondary outcomes included emergency cesarean section for fetal compromise, maternal anxiety, measured using the Generalized Anxiety Disorder 7-item scale (GAD-7), number of antenatal visits, and a composite of adverse neonatal outcomes. The study protocol was registered at ClinicalTrials.gov (NCT05034861).</p><h3>Results</h3><p>There were no significant differences between groups in Apgar scores, umbilical cord arterial pH, or need for neonatal resuscitation. The rate of emergency cesarean delivery was lower in the cCTG-based group. Women in the cCTG-based group also reported significantly lower anxiety levels at delivery and required fewer antenatal visits, with no increase in adverse neonatal outcomes.</p><h3>Conclusions</h3><p>Home-based computerized CTG within a pragmatic real-world framework appears feasible in pregnancies complicated by late-onset FGR. These findings support the potential of this approach to reduce hospital-based monitoring, maternal anxiety and in-person visits; however, these results should be considered hypothesis-generating and not indicative of clinical effectiveness.</p><h3>Clinical trials registration</h3><p>Date 13.08.2021 NCT Number NCT05034861</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293347","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}