Archives of Gynecology and Obstetrics最新文献

{"title":"Comparative analysis of maternal and neonatal outcomes in cases of vaginal breech births versus cases of vaginal cephalic births: a retrospective cohort study","authors":"Hanna Kriegs,&nbsp;Joachim Graf,&nbsp;Harald Abele,&nbsp;Claudia Plappert","doi":"10.1007/s00404-025-08126-z","DOIUrl":"10.1007/s00404-025-08126-z","url":null,"abstract":"<div><h3>Purpose</h3><p>This study examines whether the perinatal mortality rates (up to 7 days postpartum) of successful vaginal breech birth (VBB) align with those of vaginal cephalic birth (VCB) under the current practice of risk stratification and promotion of VBB in Germany. This study excludes births that did not result in vaginal breech birth, i.e., cases where a vaginal birth was attempted but discontinued.</p><h3>Methods</h3><p>A retrospective cohort analysis of the 2021 German population dataset compared 1435 VBBs to 422,019 VCBs. Maternal and neonatal short-term outcomes were analyzed using Chi-squared and Mann–Whitney <i>U</i> tests.</p><h3>Results</h3><p><i>Main outcome:</i> No significant difference in perinatal mortality rates between VBB and VCB. <i>Other neonatal outcomes</i>: Mean arterial blood gas levels and mean APGAR levels were lower in the breech group. The need for resuscitation measures and transfers to the pediatric hospital were increased. <i>Maternal outcomes</i>: Births in the breech group received labor augmentation more frequently and had higher rates of episiotomies. They had lower rates of perineal tears and postpartum complications. The rates of hysterectomies and increased postpartum hemorrhage did not differ significantly.</p><h3>Conclusion</h3><p>With thorough risk stratification and interdisciplinary expert management, perinatal mortality rates (up to 7 days postpartum) of VBBs align with VCBs. However, higher neonatal intervention rates in VBB highlight the need to ensure adequate resources and preparedness for postnatal support.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"312 4","pages":"1237 - 1245"},"PeriodicalIF":2.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08126-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688728","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":"Combined transcervical radiofrequency ablation and hysteroscopic myomectomy: expanding treatment to diverse fibroid types","authors":"Elvin Piriyev,&nbsp;Angelika Dieter,&nbsp;Sven Schiermeier,&nbsp;Stefan Peter Renner,&nbsp;Thomas Römer","doi":"10.1007/s00404-025-08127-y","DOIUrl":"10.1007/s00404-025-08127-y","url":null,"abstract":"<div><h3>Introduction</h3><p>Uterine fibroids are highly prevalent and often symptomatic, leading to abnormal uterine bleeding (AUB) and impaired quality of life. While hysteroscopic myomectomy (HSC) is the gold-standard treatment for submucosal fibroids, it is limited in addressing deeper lesions. Transcervical radiofrequency ablation (TFA) offers a minimally invasive alternative for intramural and transmural fibroids. This study evaluated the safety and effectiveness of combining TFA with HSC in a single session compared to HSC alone.</p><h3>Study design</h3><p>We conducted a retrospective multicenter analysis of 127 women with symptomatic fibroids and AUB. Patients underwent either combined TFA + HSC (n = 75) or HSC alone (n = 52). Outcomes included intraoperative bleeding, complications, and symptom improvement.</p><h3>Results</h3><p>The combined group treated a broader range of fibroid types (FIGO 0–6) and larger fibroids (mean size 2.86 cm vs. 2.23 cm; p = 0.0013). Intraoperative bleeding was significantly lower in the combined group (0% vs. 9.6%; p = 0.0102), with no increase in total complication rates (8% vs. 15%; p = 0.2512). Among patients with follow-up data, 85.1% reported symptom improvement after combined treatment.</p><h3>Conclusion</h3><p>Combining TFA with hysteroscopic myomectomy is a safe and effective approach that expands the range of treatable fibroids, reduces intraoperative bleeding, and maintains high patient satisfaction. This integrated strategy offers advantages in tissue diagnosis, potential cost savings, and uterine preservation, making it a valuable addition to minimally invasive fibroid management.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"312 4","pages":"1247 - 1252"},"PeriodicalIF":2.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08127-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688727","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":"Endometriosis and infertility: pathophysiology, treatment strategies, and reproductive outcomes","authors":"Shai E. Elizur,&nbsp;Jollanar Mostafa,&nbsp;Elad Berkowitz,&nbsp;Raoul Orvieto","doi":"10.1007/s00404-025-08124-1","DOIUrl":"10.1007/s00404-025-08124-1","url":null,"abstract":"<div><p>Endometriosis is a chronic gynecological disorder characterized by ectopic endometrial-like tissue, leading to pain, dysmenorrhea, and infertility. This review explores classification systems, the mechanisms of endometriosis-related infertility, and the impact of endometriosis subtypes on fertility outcomes. Medical therapies, such as hormonal suppression, alleviate symptoms but are unsuitable for women who wish to conceive. Surgery may enhance natural conception rates in select cases but may have a negative impact on ovarian reserve. Assisted reproductive technologies, such as intrauterine insemination and in vitro fertilization, provide effective fertility treatments. However, endometriosis can negatively affect oocyte quality and implantation rates.</p><p>Given the complexity of endometriosis and its varying impact on fertility, a personalized, multidisciplinary approach is recommended. This review proposes an updated treatment algorithm that integrates clinical, imaging, and other infertility causes to optimize treatment outcomes. Future research is needed for refining classification systems and indications for fertility-preservation treatments, as well as improving assisted reproductive technology success rates.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"312 4","pages":"1037 - 1048"},"PeriodicalIF":2.5,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08124-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673811","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":"Non-invasive prediction of fetal growth restriction in pre-eclampsia: integrating peripheral blood endothelial progenitor cell count with uterine artery Doppler velocimetry","authors":"Yishan Li,&nbsp;Qiuyu Han,&nbsp;Feihu Zheng,&nbsp;Xiangfei Zhu","doi":"10.1007/s00404-025-08123-2","DOIUrl":"10.1007/s00404-025-08123-2","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the predictive value of peripheral blood endothelial progenitor cells (EPCs) combined with uterine artery resistance index (RI) and pulsatility index (PI) for fetal growth restriction (FGR) in patients with pre-eclampsia (PE).</p><h3>Methods</h3><p>A retrospective study was conducted on 265 PE patients. Based on pregnancy outcomes, they were categorized into FGR and N-FGR groups. EPCs and RI/PI were analyzed using flow cytometry and Doppler ultrasonography. The correlations of EPCs with RI/PI in PE complicated with FGR, predictive value of EPCs, RI, PI and their combination for FGR in PE, and factors influencing FGR occurrence in PE were analyzed by Pearson correlation, ROC, and multivariate logistic regression analyses.</p><h3>Results</h3><p>In this PE cohort, the prevalence of FGR was 33.58% (89/265). Compared to the N-FGR group, the FGR group exhibited significantly lower EPCs and higher RI/PI. The Early-FGR group showed reduced EPCs and elevated RI/PI than the Late-FGR group. EPC count significantly inversely correlated with RI/PI in PE-FGR patients. The combination of EPCs, RI, and PI demonstrated superior predictive accuracy for FGR in PE. PE classification (<i>OR</i> = 5.501), RI (<i>OR</i> = 1.422), and peripheral blood EPCs (<i>OR</i> = 0.044) independently correlated with FGR occurrence, and PLT (<i>OR</i> = 0.986) and PlGF (<i>OR</i> = 0.942) independently correlated with reduced EPCs in PE patients.</p><h3>Conclusion</h3><p>Reduced peripheral blood EPCs and elevated uterine artery RI/PI are closely associated with FGR progression in PE, and their combination presents high predictive value for PE-related FGR. EPCs and RI are independently correlated with PE-related FGR, indicating their potentials for clinical prevention, diagnosis, and treatment of PE-related FGR.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"312 4","pages":"1225 - 1235"},"PeriodicalIF":2.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08123-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666955","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":"The prognostic importance of features of myometrial invasion in endometrial endometrioid carcinoma","authors":"Maya Pasternak,&nbsp;Roy Kessous,&nbsp;Benzion Samueli,&nbsp;Jacob Dreiher,&nbsp;Mihai Meirovitz,&nbsp;Sharon Davidesko,&nbsp;Ruthy Shaco Levy","doi":"10.1007/s00404-025-08103-6","DOIUrl":"10.1007/s00404-025-08103-6","url":null,"abstract":"<div><h3>Purpose</h3><p>The depth of myometrial invasion (MI) is known to have a prognostic value in endometrial carcinoma (EC), and the FIGO 50% cutoff is widely accepted; however, recent studies have suggested other measurements such as the absolute depth of invasion and tumor-free distance (TFD) from the serosal surface to also be predictive. The aim of this study was to assess the association between the FIGO cutoff and other measures with overall survival and disease-free survival of patients.</p><h3>Methods</h3><p>This is a retrospective analysis of a cohort of 248 women diagnosed with stage I endometrioid endometrial carcinoma, treated at Soroka University Medical Center between 2006 and 2020. Clinical and pathological data were collected and analyzed. ROC analysis was used to define the best cutoffs in all three categories (MI, absolute depth and TDF). Survival analyses were then conducted using Kaplan–Meier curves, log-rank tests, and Cox proportional hazards regression.</p><h3>Results</h3><p>Absolute myometrial invasion (MI) to the depth of 1 cm significantly predicted overall survival (log-rank, <i>p</i> = 0.009) in univariate analysis; however, this significance was not maintained in multivariate analysis. Additionally, a 33% MI cutoff demonstrated potential for better outcome prediction as compared to the commonly used 50% MI threshold, though it did not reach statistical significance. Tumor-free distance (TFD) from the serosal surface was not significantly associated with outcome.</p><h3>Conclusions</h3><p>MI depth of more than 1 cm may serve as a meaningful prognostic indicator. Additionally, a cutoff of 33% MI probably has a better prognostic value than the current 50% cutoff.</p><p>These findings show a promising direction for future research, emphasizing the need for larger cohorts and multicenter studies to confirm our findings.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"312 4","pages":"1215 - 1224"},"PeriodicalIF":2.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08103-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641624","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":"Analysis of factors influencing ovarian reserve in patients with endometriosis","authors":"Huiyan Feng,&nbsp;Wenwei Li,&nbsp;Caini Zhan,&nbsp;Xiaomao Li,&nbsp;Qingjian Ye","doi":"10.1007/s00404-025-08114-3","DOIUrl":"10.1007/s00404-025-08114-3","url":null,"abstract":"<div><h3>Background</h3><p>To discover the related factors of ovarian reserve function and explore the relationship between AFC and AMH.</p><h3>Methods</h3><p>In this study, a retrospective analysis of endometriosis cases from January 2022 to December 2023 was performed with DIE ultrasound or surgical procedures. The association of AFC and AMH with age, single or bilateral cysts, healthy or affected side, cyst size, BMI, pregnancy history, recurrence, standard medication, comorbidities, four ultrasound sliding signs, presence or absence of deep nodules, and size of deep nodules were analyzed, and then multivariate analysis was performed.</p><h3>Result</h3><p>Correlation analysis results show significant factors influencing: Total AFC with age (<i>R</i> = −0.242, <i>P</i> &lt; 0.001), Unilateral/bilateral (<i>Z</i> = −4.095, <i>P</i> &lt; 0.001), the largest cyst diameter on the left side (R = −0.181, <i>P</i> = 0.004), the largest cyst diameter on the right side (<i>R</i> = −0.286, <i>P</i> &lt; 0.001), AMH (<i>R</i> = 0.543, <i>P</i> &lt; 0.001), recurrence (<i>R</i> = −2.007, <i>P</i> = 0.038), associated adenomyosis (<i>R</i> = −2.667, <i>P</i> = 0.007), posterior uterine wall sliding sign (<i>R</i> = −4.324, <i>P</i> &lt; 0.001), rectouterine pouch sliding sign (<i>R</i> = −2.098,<i>P</i> = 0.036), largest diameter of deep nodules (<i>Z</i> = −0.175, <i>P</i> = 0.023). AMH shared associations with age (<i>R</i> = −0.432, <i>P</i> &lt; 0.001), BMI (<i>Z</i> = −0.203, <i>P</i> &lt; 0.001), left AFC, right AFC, total AFC, gravidity (<i>R</i> = −0.795, <i>P</i> &lt; 0.001), recurrence (<i>R</i> = −2.203, <i>P</i> = 0.028), associated adenomyosis (<i>R</i> = −4.518, <i>P</i> &lt; 0.001), associated uterine fibroids (<i>R</i> = −3.504, <i>P</i> &lt; 0.001), posterior uterine wall sliding sign (<i>R</i> = −2.927, <i>P</i> = 0.003), and rectouterine pouch sliding sign (<i>R</i> = −1.995, <i>P</i> = 0.046). AFC on the healthy side was significantly higher than that on the affected side (<i>Z</i> = −9.786, <i>P</i> &lt; 0.001). The results of the multivariate analyses showed the following: Larger cyst diameters on the left side were associated with lower left AFC (OR = −0.547, <i>P</i> &lt; 0.001). Larger cyst diameters on the right side were associated with lower right AFC (OR = −0.601, <i>P</i> &lt; 0.001). Higher AMH levels were associated with higher left AFC (OR = 0.775, <i>P</i> &lt; 0.001), right AFC (OR = 0.778, <i>P</i> &lt; 0.001), and total AFC (OR = 0.667, <i>P</i> &lt; 0.001). AMH levels were influenced only by a history of recurrence (OR = 1.436, <i>P</i> = 0.047).</p><h3>Conclusion</h3><p>In OEM, compared to AMH, AFC may serve as a more suitable marker for assessing ovarian reserve.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"312 4","pages":"1205 - 1213"},"PeriodicalIF":2.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08114-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635985","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":"Prediction of spontaneous preterm birth in pregnant women using machine learning","authors":"Xiaoxue Yang,&nbsp;Xuewu Song,&nbsp;Kun Yang,&nbsp;Peng Gao,&nbsp;Shuai Wang,&nbsp;Simin Zhang,&nbsp;Rong Qiang,&nbsp;Zhibin Li,&nbsp;Xinru Gao","doi":"10.1007/s00404-025-08117-0","DOIUrl":"10.1007/s00404-025-08117-0","url":null,"abstract":"<div><h3>Purpose</h3><p>Spontaneous preterm birth (sPTB) is a significant global health concern, contributing to adverse outcomes for both pregnant women and newborns. Early identification of women with risk of sPTB is essential for mitigating these negative effects and improving maternal and neonatal health outcomes. The aim of this study is to explore the feasibility of using machine learning to predict sPTB risk and to analyze the contribution of variables.</p><h3>Methods</h3><p>All data were collected retrospectively. Prediction models were developed using eight different machine learning algorithms combined with six variable selection methods. The models’ predictive performance was evaluated using area under the receiver operating characteristic curve (AUROC), area under the precision recall curve (AUPRC), accuracy, sensitivity, F1-score, positive predictive value, and negative predictive value.</p><h3>Results</h3><p>A total of 1122 pregnant women, of whom 187 had preterm birth and 935 had term birth, were enrolled. The model by combining the categorical boosting algorithm and backward elimination had the best predictive performance with the highest AUROC (0.8762) and AUPRC (0.7061), and the Brier score was 0.12 on the test set. The top 5 variables for predicting sPTB risk in this study were free triiodothyronine, albumin/globulin, thyroglobulin antibody, total thyroxine, red cell volume distribution width.</p><h3>Conclusions</h3><p>The machine learning model may help identify pregnant women at high risk of sPTB, and individual risk factor analysis could provide reference for clinical decision. However, as some key variables are not part of routine laboratory tests during pregnancy worldwide, the model’s generalizability and clinical applicability require further study.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"312 4","pages":"1195 - 1204"},"PeriodicalIF":2.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08117-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616093","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":"Structural rearrangements affect blastocyst development","authors":"Yizi Wang,&nbsp;Yuanlin Ma,&nbsp;Yanling Tan,&nbsp;Jing Wang,&nbsp;Jiafu Pan,&nbsp;Junli Song,&nbsp;Yali Wang,&nbsp;Yanwen Xu","doi":"10.1007/s00404-025-08101-8","DOIUrl":"10.1007/s00404-025-08101-8","url":null,"abstract":"<div><h3>Purpose</h3><p>It is disputable whether chromosomal translocations lead to an inferior embryo development. The purpose of this study was to evaluate whether structural rearrangements (SR) affect blastocyst formation as compared to monogenic disorders in preimplantation genetic testing (PGT) cycles.</p><h3>Methods</h3><p>A total of 791 PGT-SR cycles and 757 PGT-M cycles from January 2021 to May 2023 were included.</p><h3>Results</h3><p>Lower blastocyst formation (graded 3BB or higher) rate was detected in the PGT-SR group compared with the control PGT-M group. In addition, lower proportion of day 5 blastocysts was found in the PGT-SR group compared with the control PGT-M group. Overall, a comparatively 12.7% lower proportion of eligible blastocysts in PGT-SR cycles. As expected, there were fewer balanced/normal blastocysts for transfer in the PGT-SR group (balanced/normal blastocysts rate, 32.3 vs. 59.9%, <i>P</i> = 0.02). The estimated curve by inverse model showed that yields of transferrable balanced/normal blastocyst per cycle came to a plateau stage followed with a rapid rise once the oocytes retrieved reached to the number of 20.4 in PGT-M cycle and 28.3 in PGT-SR cycle respectively.</p><h3>Conclusions</h3><p>Our results demonstrated that patients with SR had a high chance of obtaining lower blastocyst development and significantly fewer usable blastocysts available for transfer compared to PGT-M in their first ovarian stimulation cycle.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"312 4","pages":"1185 - 1194"},"PeriodicalIF":2.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08101-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616094","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 preservation in females requiring gonadotoxic therapy should be more than freezing measures before therapy - secondary fertility preservation and menopause care management after therapy should also be considered.","authors":"Michael von Wolff, Sara Imboden, Petra Stute","doi":"10.1007/s00404-025-08104-5","DOIUrl":"https://doi.org/10.1007/s00404-025-08104-5","url":null,"abstract":"<p><p>To date, fertility preservation has mainly been offered to patients prior to gonadotoxic treatment. Ovarian reserve is assessed by analysing blood levels of anti-müllerian hormone (AMH), and gonadal cells or tissue are cryopreserved if indicated and requested by the patient. If primary fertility preservation (Primary FertiProtekt) before gonadotoxic treatment was not performed or was ineffective, secondary fertility preservation should be considered approximately one year after treatment based on a more extensive ovarian reserve analysis including menstrual cycle pattern, antral follicle count, and serum levels of AMH, estradiol and follicle stimulating hormone. Ovarian reserve analysis is also required to consider endocrine treatment in (pre) menopausal patients. Both approaches require the fertility preservation treatment to be tailored to the ovarian reserve status, type of gonadotoxic therapy. For secondary fertility preservation (Secondary FertiProtekt), oocyte freezing may be considered if ovarian reserve is not too low. Monthly treatment cycles, natural cycle or minimal stimulation protocols and follicle aspiration without anesthesia should be preferred. Menopause care management (MenoProtekt) involves acute menopausal symptom relief and prevention of chronic non-communicable diseases. The management needs to be individualized based on type of disease (hormone-dependent or -independent).</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616092","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":"Earlier is not always better: Optimal time to initiate adjuvant chemotherapy after surgery for ovarian cancer","authors":"Philipp Meyer-Wilmes,&nbsp;Lieven Nils Kennes,&nbsp;Atanas Ignatov,&nbsp;Franziska Goetz,&nbsp;Julia Wittenborn,&nbsp;Elmar Stickeler,&nbsp;Svetlana Nikolayevna Tchaikovski","doi":"10.1007/s00404-025-08095-3","DOIUrl":"10.1007/s00404-025-08095-3","url":null,"abstract":"<div><h3>Objective</h3><p>Tumor resection followed by adjuvant chemotherapy constitutes the cornerstone of ovarian cancer (OC) treatment. This study aimed to evaluate the impact of the time to chemotherapy (TTC) after primary surgery on the survival outcomes of patients with OC.</p><h3>Methods</h3><p>Patients with OC at any stage who underwent primary surgery followed by adjuvant chemotherapy between 2000 and 2021 were included in the analysis. Data were obtained from the Cancer Registries of Aachen and nine hospitals in Saxony-Anhalt. Patients were stratified into three subgroups based on the timing of chemotherapy initiation: early (≤ 21 days), intermediate (22–35 days) and late (&gt; 35–180 days). The impact of TTC on progression-free survival (PFS) and overall survival (OS) was assessed using multivariate Cox proportional hazard models, both in complete case analysis and with multivariate imputation by chained equations to account for missing data.</p><h3>Results</h3><p>A total of 1699 patients with OC (mean age: 61.4 ± 12 years) started adjuvant chemotherapy 32.2 ± 24.6 days after surgery. For OS, the optimal TTC was identified at 26 days post-surgery. Compared with the intermediate group, both earlier and later initiation of chemotherapy were associated with worsened OS (Hazard Ratio (HR) = 1.34, 95%CI 1.23–1.60, p &lt; 0.05 and HR = 1.38 95%CI 1.14 –1.68; p &lt; 0.001, respectively).</p><h3>Conclusion</h3><p>The optimal timing for initiating adjuvant chemotherapy appears to be between 22 and 35 days after primary surgery for ovarian cancer. Remarkably, an earlier start of chemotherapy did not confer a survival advantage, possibly due to the need for adequate recovery after surgery.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"312 4","pages":"1163 - 1173"},"PeriodicalIF":2.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-08095-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607254","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}