Archives of Gynecology and Obstetrics最新文献

{"title":"Postnatal water immersion after perinatal death: a clinical study of appearance preservation and autopsy validity","authors":"Teresa Starrach,&nbsp;Jens H. L. Neumann,&nbsp;Lucia Ehmann,&nbsp;Laura Hahn,&nbsp;Esther Schouten,&nbsp;Sven Kehl,&nbsp;Sven Mahner,&nbsp;Uwe Hasbargen,&nbsp;Sarah Soliman,&nbsp;Christoph Hübener","doi":"10.1007/s00404-026-08472-6","DOIUrl":"10.1007/s00404-026-08472-6","url":null,"abstract":"<div><h3>Objective</h3><p>Perinatal loss is an emotionally devastating event for affected families. In some clinical settings, postnatal immersion of perinatally deceased infants in water is used to preserve the infant’s external appearance and facilitate parental farewell. The objective of this study was to evaluate possible effects of this practice on autopsy findings and diagnostic validity.</p><h3>Methods</h3><p>In this observational study, 28 infants after perinatal death with available autopsy data were analyzed. Fourteen infants were immersed in cold water after birth (water group) and fourteen infants were stored without water immersion (control group). Macroscopic appearance, degree of maceration, and microscopic findings in liver and lung tissue were assessed during autopsy. Descriptive analyses explored associations between maceration degree and the intervals between fetal death, birth, and autopsy.</p><h3>Results</h3><p>Infants immersed in water showed improved preservation of external appearance, including skin color, texture, and body posture. No macroscopic differences attributable to water immersion were observed during autopsy. No microscopic differences in the two investigated internal organs were observed between the water and control groups. Maceration grade assessed at autopsy showed no consistent increase with longer birth–autopsy intervals, whereas higher grades were more frequently observed with longer estimated intervals between fetal death and birth in both groups.</p><h3>Conclusion</h3><p>In this observational cohort, postnatal immersion in water after perinatal death was not associated with impaired autopsy findings. Maceration was primarily related to the intrauterine interval between fetal death and delivery rather than postnatal storage conditions. These findings suggest that the water method may offer a simple approach to support parental farewell while maintaining the diagnostic reliability of perinatal autopsy.</p><h3>Trial registration</h3><p>Clinical Trials Register (DRKS) (trial registration number DRKS00031373, URL https://www.drks.de), Registration Date: 27 February 2023.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08472-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148289","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":"A predictive model for spontaneous preterm birth and delivery within 7 days in women with threatened preterm labor: a prospective study integrating cervical length, quantitative PAMG-1, and clinical parameters","authors":"Jie Guo,&nbsp;Lingli Zhong,&nbsp;Xiaohong Xie,&nbsp;Huifang Xiong,&nbsp;Yuan Chen,&nbsp;Liangqin Wang,&nbsp;Xiaomin Lai,&nbsp;Li Zhang","doi":"10.1007/s00404-026-08477-1","DOIUrl":"10.1007/s00404-026-08477-1","url":null,"abstract":"<div><h3>Purpose</h3><p>To develop and internally validate predictive models for spontaneous preterm birth (sPTB) in women with threatened preterm labor (TPL).</p><h3>Methods</h3><p>This prospective observational study included 264 women with TPL between 24 + 0 and 36 + 0 weeks of gestation. Candidate predictors available at clinical assessment included demographic, obstetric, sonographic, inflammatory, and cervicovaginal biomarker variables. Least absolute shrinkage and selection operator (LASSO) regression with tenfold cross-validation and the one-standard-error criterion was used for variable selection. Model performance was evaluated using receiver operating characteristic analysis, calibration, bootstrap validation, and decision curve analysis.</p><h3>Results</h3><p>Eighty-four women (31.8%) experienced sPTB before 37 weeks, and 54 (20.5%) experienced sPTB within 7 days after sampling. Five predictors were retained in both final models: cervical length, quantitative PAMG-1 concentration, C-reactive protein, uterine contraction frequency, and mild vaginal bleeding or spotting. For sPTB before 37 weeks, the apparent AUC was 0.845 (95% CI 0.788–0.903), and the optimism-corrected AUC was 0.830. For 7-day sPTB, the apparent AUC was 0.939 (95% CI 0.900–0.978), and the optimism-corrected AUC was 0.929. The integrated models showed higher discrimination than cervical length alone, PAMG-1 alone, or cervical length plus PAMG-1.</p><h3>Conclusion</h3><p>Integrated models combining cervical length, quantitative PAMG-1, C-reactive protein, uterine contraction frequency, and mild vaginal bleeding or spotting showed promising performance for predicting sPTB in women with TPL. Given the modest sample size and internal validation only, these findings should be considered preliminary and require external validation before clinical implementation.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148358","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 incremental yield of CMA over karyotype in fetal ventriculomegaly: a systematic review and meta-analysis","authors":"Ioakeim Sapantzoglou,&nbsp;Zacharias Fasoulakis,&nbsp;Konstantinos Tasias,&nbsp;Angeliki Rouvali,&nbsp;Afroditi Pegkou,&nbsp;Marianna Theodora,&nbsp;Georgios Daskalakis,&nbsp;Panagiotis Antsaklis","doi":"10.1007/s00404-026-08470-8","DOIUrl":"10.1007/s00404-026-08470-8","url":null,"abstract":"<div><h3>Objective</h3><p>The main objective of our study was to conduct a systematic literature review and a meta-analysis to evaluate the incremental yield of chromosomal microarray analysis compared to karyotyping in cases of fetal ventriculomegaly.</p><h3>Methods</h3><p>Our review was designed according to the PRISMA guidelines. It included all observational studies that reported the results of CMA testing in fetuses diagnosed with ventriculomegaly (both isolated and non-isolated),in fetuses with isolated ventriculomegaly, in fetuses with non-isolated ventriculomegaly, and in fetuses with mild isolated ventriculomegaly.</p><h3>Results</h3><p>16 studies were included with a total of 2137 cases of affected fetuses that met the inclusion criteria for analysis. Combined data from these studies revealed an overall incremental yield of CMA over karyotyping of 7% (95% CI 4–10%) in cases with ventriculomegaly, 4% (95% CI 2–6%) in isolated cases, 10% (95% CI 6–16%) in non-isolated cases, and 2% (95% CI 1–4%) in mild isolated cases.</p><h3>Conclusions</h3><p>Our findings may be useful in clinical practice to guide management options and the counseling of the couples to individualize patient care and facilitate clinicians when they come across such a common clinical entity.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142601","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":"Diagnostic yield of chromosomal microarray analysis and exome sequencing in fetuses with central nervous system anomalies, with long-term follow-up: a single-center study over a 17-year period","authors":"Karla Feodorovici,&nbsp;Hannah Klinkhammer,&nbsp;Brigitte Strizek,&nbsp;Ulrich Gembruch,&nbsp;Annegret Geipel","doi":"10.1007/s00404-026-08481-5","DOIUrl":"10.1007/s00404-026-08481-5","url":null,"abstract":"<div><h3>Objective</h3><p>To assess the diagnostic yield of chromosomal microarray analysis (CMA) and exome sequencing (ES) in fetuses with central nervous system (CNS) anomalies across two study periods (January 2008 to June 2016 and July 2016 to December 2024), and to evaluate long-term outcomes.</p><h3>Methods</h3><p>This retrospective study included cases with fetal CNS anomalies undergoing invasive testing by G-banded karyotyping and, in selected cases, additional CMA and/or ES. Fetuses were classified into four groups: isolated CNS malformations, isolated CNS plus (additional minor abnormalities and dynamic findings), complex CNS anomalies, and multisystem malformations.</p><h3>Results</h3><p>Among 780 cases, causative findings were identified in 23.8% (25/105) by CMA and 39.0% (73/187) by ES. Use of CMA/ES increased in the second study period (16.3% vs. 59.7%), resulting in more pathogenic findings (26 vs. 72 cases), whereas diagnostic yield among tested cases decreased without significance. The highest ES yield was observed in multisystem CNS anomalies; isolated CNS plus cases showed higher yields than truly isolated CNS cases. In an exploratory subgroup analysis, isolated CNS plus cases with polyhydramnios had a higher CMA/ES yield than truly isolated cases. Among 91 live-born children with follow-up, 49.5% (45/91) had global developmental delay, which was more frequent with pathogenic findings (90.0%, 18/20; <i>p</i> = 0.002) and increasing anomaly complexity (11.1 to 81.8%; <i>p</i> &lt; 0.001).</p><h3>Conclusion</h3><p>Uptake of CMA and ES increased over time and resulted in more etiologic diagnoses. In tested cases, both methods provided meaningful diagnostic yield in fetuses with CNS anomalies and may contribute to prognostic assessment and prenatal counseling.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-026-08481-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148300","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 repeated cryopreservation on embryo development and chromosomal ploidy","authors":"Xi Qin,&nbsp;Li Fan,&nbsp;Yongmei Tang,&nbsp;Wugao Li,&nbsp;Zhetao Li,&nbsp;Yihua Yang","doi":"10.1007/s00404-026-08475-3","DOIUrl":"10.1007/s00404-026-08475-3","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;The potential adverse effects of repeated freezing and thawing processes on embryos remain controversial. This study aimed to investigate the impact of repeated embryo cryopreservation by comparing preimplantation genetic testing for aneuploidy (PGT-A) outcomes and clinical results of single vitrification and double-vitrification embryos.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;This study analyzed the data of 2,335 embryos from 309 patients who underwent PGT-A. Embryos were divided into two groups based on the total number of vitrification procedures: (1) the CV − group (single vitrification, &lt;i&gt;n&lt;/i&gt; = 1281), where fresh embryos were directly cultured to the blastocyst stage and vitrified once after trophectoderm biopsy, and (2) the CV + group (double vitrification, &lt;i&gt;n&lt;/i&gt; = 1054), where cleavage-stage embryos underwent an initial vitrification, were subsequently warmed and cultured to the blastocyst stage for biopsy, and then vitrified again.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.We confirm that the author list and their respective affiliations have been carefully verified and are correct. We have made minor editorial amendments to the English wording of the institutional names to ensure accuracy and consistency with official nomenclature.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The CV + group exhibited significantly lower blastocyst formation rate (39.6% vs. 46.6%, adjusted difference: − 6.7%, &lt;i&gt;P&lt;/i&gt; = 0.004), high-quality blastocyst formation rate (11.2% vs. 16.7%, adjusted difference: − 5.3%, &lt;i&gt;P&lt;/i&gt; = 0.001), and euploid rate per cleavage-stage embryo (7.8% vs. 10.6%, adjusted difference: − 2.6%, &lt;i&gt;P&lt;/i&gt; = 0.043) than the CV − group. In contrast, the euploid rate per biopsied blastocyst was not significantly different between groups (19.0% vs. 21.9%, &lt;i&gt;P&lt;/i&gt; = 0.175). Complementary embryo-level mixed-effects logistic regression likewise showed no statistically significant association between double vitrification and embryo euploidy outcomes (adjusted OR 0.72, 95% CI 0.49–1.07; &lt;i&gt;P&lt;/i&gt; = 0.101). Age-stratified analyses suggested that these detrimental laboratory effects appeared numerically greater in women aged ≥ 38 years, although formal interaction testing did not support statistically significant effect modification by age. No statistically significant differences were observed in live birth or neonatal outcomes following euploid blastocyst transfer; however, these exploratory comparisons were based on limited transfer numbers and, therefore, should be interpreted cautiously.&lt;/p&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Repeated vitrification-warming exposure was associated with reduced embryo developmental efficiency and a numerically lower euploid embryo yield per cleavage-stage embryo. No statistically significant differences were observed in reproductive outcomes after euploid blastocyst transfer; however, these analyses were exploratory and substantially underpowere","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142552","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 perinatal outcome of planned vaginal birth in multiple pregnancy influenced by using epidural analgesia: a systematic review","authors":"Ewout C. van der Wal,&nbsp;Johannes J. Duvekot,&nbsp;Ilse J. J Dons-Sinke,&nbsp;Robert J. Stolker,&nbsp;Sanne E. Hoeks,&nbsp;Caroline D. van der Marel","doi":"10.1007/s00404-026-08476-2","DOIUrl":"10.1007/s00404-026-08476-2","url":null,"abstract":"<div><h3>Purpose</h3><p>Epidural analgesia (EA) is considered safe and advantageous in twin deliveries, yet specific evidence to support this practice is scarce. This systematic review aims to identify the impact of EA on perinatal outcomes during planned vaginal twin deliveries.</p><h3>Methods</h3><p>A literature search was conducted to identify studies involving vaginal multiple delivery with EA. Newcastle–Ottawa scale quality assessments were performed, and baseline characteristics and perinatal outcomes were extracted.</p><h3>Results</h3><p>Seven retrospective cohort studies were included. Quality scores ranged from 5 to 8/8 stars. Baseline characteristics and reported outcome measures were heterogenous. When comparing EA to non-EA users, incidence of CS after vaginal trial of labor was similar in one study (13% vs 21%, OR 1.65 [0.70–3.90]), but lower in another study (7% vs 15%, OR 0.0435 [0.022–0.083]). A third study reported a beneficial effect of EA for the second twin only. Anesthesiologic strategies for emergency CS were not reported. Instrumental delivery was increased or similar for women in the EA group. Apgar scores for deliveries using EA were not reduced. Perinatal mortality for the second twin was similar.</p><h3>Conclusion</h3><p>EA in planned vaginal twin delivery seems to be associated with a reduced incidence of CS, a higher risk of assisted delivery, and an increased second-stage length. However, evidence of the associated consequences for mothers and neonates is limited. Given the limited number of eligible studies and reported outcomes, further research is needed to definitively assess the current practice of routine epidural administration for multiple deliveries, and to correctly inform women of its risks/benefits.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142622","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":"Beyond the middle cerebral artery: anterior and posterior cerebral artery doppler provide complementary prognostic ınformation in late-onset fetal growth restriction","authors":"Mustafa Raşit Özler,&nbsp;Erkan Sağlam,&nbsp;Ebubekir Sıddık Yılmaz,&nbsp;Bahadır Codal,&nbsp;Türkan Dikici Aktaş,&nbsp;Aziz Kından","doi":"10.1007/s00404-026-08478-0","DOIUrl":"10.1007/s00404-026-08478-0","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the association of anterior cerebral artery (ACA) and posterior cerebral artery (PCA) Doppler parameters with adverse perinatal outcomes in pregnancies complicated by late-onset fetal growth restriction (FGR), and assess their potential complementary prognostic role alongside conventional middle cerebral artery (MCA) Doppler assessment.</p><h3>Methods</h3><p>This prospective observational study included 130 pregnancies diagnosed with late-onset FGR between 32 and 37 weeks of gestation at a tertiary perinatology center. Doppler evaluation included umbilical artery (UA), uterine artery, MCA, ACA, and PCA. The cerebroplacental ratio (CPR) was calculated as MCA PI/UA PI. The primary outcome was composite adverse perinatal outcome defined as perinatal death, 5-min Apgar score &lt;7, umbilical artery pH &lt; 7.20, neonatal intensive care unit (NICU) admission, or need for mechanical ventilation. Predictive performance of Doppler parameters was assessed using receiver operating characteristic (ROC) analysis and multivariable logistic regression.</p><h3>Results</h3><p>Composite adverse perinatal outcomes occurred in 45 pregnancies (34.6%). Pregnancies with adverse outcomes had significantly higher UA PI and lower cerebral Doppler indices, including MCA PI (<i>p</i> = 0.004), ACA PI (<i>p</i> = 0.021), PCA PI (<i>p</i> = 0.036), and CPR (<i>p</i> = 0.002). CPR showed the highest discriminative performance (AUC = 0.85; 95%CI: 0.77–0.92), followed by MCA PI (AUC = 0.80), ACA PI (AUC = 0.74), and PCA PI (AUC = 0.70). In multivariable analysis, MCA PI, ACA PI, PCA PI, and estimated fetal weight percentile were independent predictors of adverse perinatal outcome.</p><h3>Conclusion</h3><p>In late-onset FGR, Doppler abnormalities in the anterior and posterior cerebral arteries were associated with adverse perinatal outcomes. Assessment of ACA and PCA Doppler parameters may provide complementary prognostic information regarding fetal cerebral hemodynamic adaptation alongside conventional MCA and CPR evaluation.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142560","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 human placenta development and anatomy","authors":"Dorcas Quaye,&nbsp;Peter Ofori Appiah,&nbsp;Dorotheah Obiri,&nbsp;John Ahenkorah,&nbsp;Kwame Adu-Bonsaffoh","doi":"10.1007/s00404-026-08382-7","DOIUrl":"10.1007/s00404-026-08382-7","url":null,"abstract":"<div><p>The human placenta is a specialized fetomaternal organ whose architecture evolves throughout pregnancy. Its development begins with implantation, followed by the differentiation of trophoblast lineages that establish the early villous structures and mediate subsequent exchange between the maternal and fetal circulations. By the end of the second trimester, coordinated remodeling of villous stroma, vasculature, and syncytium transforms the placenta into a highly specialized interface capable of meeting the growing demands of pregnancy. Despite extensive research in this area, most developmental accounts emphasize early morphogenesis, leaving the structural transitions of mid- and late gestation underexplored These later phases are critical for understanding how architectural specialization supports placental function and how deviations in these processes underpin pregnancy complications. This review synthesizes current understanding of placental morphogenesis and histomorphology across gestation. It integrates classical placental histology findings with recent advances in three-dimensional imaging, lineage tracing, and vascular modeling. By combining developmental and structural perspectives, this review offers an updated understanding of how the architecture of the placenta evolves to sustain pregnancy.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148040892","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":"Cervical ripening with mechanical method vs oral misoprostol in pregnancies with elevated BMI: a cohort study","authors":"Maria Castoldi,&nbsp;Florent Fuchs,&nbsp;Philippe Deruelle,&nbsp;Giulia Maria Scotti,&nbsp;Massimo Candiani,&nbsp;Paolo Ivo Cavoretto","doi":"10.1007/s00404-026-08458-4","DOIUrl":"10.1007/s00404-026-08458-4","url":null,"abstract":"<div><h3>Objective</h3><p>To compare labour duration and the effectiveness of cervical ripening by transcervical balloon versus oral misoprostol in women with elevated body mass index (BMI ≥ 25 kg/m²).</p><h3>Methods</h3><p>A retrospective single-centre cohort (2022–2024) at Montpellier University Hospital including singleton term pregnancies (37–42 weeks) with cephalic presentation, BMI &gt; 25 and Bishop score &lt; 6. Mechanical balloon versus oral misoprostol (25 µg/2 h or 50 µg/4 h) were compared by survival analysis assessing induction-to-delivery interval and by logistic regression assessing vaginal delivery rates, all adjusting for key covariates. Exclusion criteria: maternal age &lt; 18 years, scarred uterus, low-lying placenta.</p><h3>Results</h3><p>Among 7336 births, 2225 (30.3%) underwent labour induction, of which 247 met inclusion criteria. Vaginal delivery occurred in 180/247 (72.9%), of which 21/180(11.7%) were operative vaginal, caesareans were 67/247(27.1%), with no statistically significant difference observed; the study was not powered to assess equivalence of caesarean rates. Balloons achieved shorter induction-to-delivery (Mean 25.5 h; 95%CI 23.8–27.2 h vs. 35.3 h; 95%CI 33.0–37.6 h; <i>p &lt; </i>0.001), and induction-to-active-phase intervals vs. misoprostol (Mean 21.1 h; SD 12.8 h vs. 30.3 h; SD 17.7 h; <i>p &lt; </i>0.001), without difference in first active-stage and second-stage duration or among misoprostol regimens. Cox regression identified predictors of longer induction-to-delivery: nulliparity (HR:0.31; 95%CI 0.22–0.42), misoprostol (HR:0.46; 95%CI 0.33–0.66) vs intrauterine balloons, LGA (HR:0.63; 95%CI 0.43–0.92), higher BMI (HR:0.97; 95%CI 0.97–1.00), and excessive weight gain (HR:0.98; 95%CI 0.95–1.00). Treatment-by-parity and treatment-by-Bishop score interactions were not significant. A Fine and Gray competing-risks model showed that mechanical ripening vs. misoprostol provided shorter time intervals from induction to delivery (<i>p = </i>0.033) and to active phase (<i>p = </i>0.003). After one cycle of ripening, oxytocin infusion was associated with a higher rate of vaginal birth compared with repeated ripening (sHR 2.28, 95%CI 1.49–3.49). PPH or adverse neonatal outcomes were not different.</p><h3>Conclusions</h3><p>In a high-BMI population mechanical cervical ripening vs. oral misoprostol show similar effectiveness, with the first associated with a shorter duration of labour induction.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148025996","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":"Cumulative pregnancy and cumulative live birth rates and perinatal and obstetric outcomes in POSEIDON patients: insights from 19,371 IVF/ICSI cycles","authors":"Di Wu,&nbsp;Wanwan Luo,&nbsp;Hao Li,&nbsp;Yunyi Yang,&nbsp;Hengyu Yao,&nbsp;Yong Fang,&nbsp;Hongping Ba,&nbsp;Yongfeng Wang,&nbsp;Lei Jin,&nbsp;Shiqiao Hu","doi":"10.1007/s00404-026-08340-3","DOIUrl":"10.1007/s00404-026-08340-3","url":null,"abstract":"<div><h3>Purpose</h3><p>The objective of this study was to investigate the cumulative pregnancy, cumulative live birth, and perinatal and obstetric outcomes of individuals in the POSEIDON group, with the aim of enhancing the management of individuals receiving assisted reproductive technology (ART) who have characteristics associated with a poor prognosis.</p><h3>Methods</h3><p>In this study, 19,371 patients with infertility who underwent their first IVF/ICSI cycle at the Tongji Hospital from January 2016 to December 2021 were enrolled. The population was divided into 4 Poseidon subgroups (PG1-PG4) and a non-Poseidon (non-PG) group based on the POSEIDON criteria. The stratification is based on ovarian reserve and ovarian response to stimulation, with the goal of tailoring individualized stimulation strategies.</p><h3>Results</h3><p>The cumulative clinical pregnancy rate (CPR) gradually decreased from non-PG patients to PG 1–4 patients, with rates of 84.6%, 72.5%, 54.7%, 51.7%, and 30.7%, respectively. The cumulative live-birth rate (CLBR) was highest in non-PG patients, followed by PG1 patients, PG3 patients, PG2 patients, and PG4 patients, with rates of 81.0%, 67.0%, 45.3%, 45.2%, and 22.9%, respectively (p &lt; 0.001). Additionally, the PG patients did not differ from the non-PG patients in terms of perinatal and birth outcomes, except for a decrease in gestational age and birth weight and an increase in the rate of preterm births, gestational diabetes, and cesarean section.</p><h3>Conclusions</h3><p>Maternal age was the primary factor affecting pregnancy outcome. The younger subgroups (PG1, PG3) presented an acceptable CLBR (&gt; 50%) and were not associated with an increased risk of abnormal perinatal outcomes.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"313 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148026030","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}