Archives of Gynecology and Obstetrics

Bale, Claudia A.; Pearce, Janina V.; Deng, Xiaoyan; Bandyopadhyay, Dipankar; Yarden, Nophar; Sport, Catherine; Miller, Devin T.; Randall, Leslie M.; Fields, Emma; Sullivan, Stephanie A.

doi: 10.1007/s00404-026-08330-5pmid: 41609820

PurposeThis study sought to determine the relationship between cervical cancer recurrence and post-treatment change in standardized uptake value (SUV) of 18F-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) in the cervix and lymph nodes.MethodsThis retrospective cohort study included patients who received curative intent radiation therapy for biopsy-proven stage I–IVA locally advanced cervical cancer at a single tertiary referral center from 2009 to 2021. The exposure was percent change in SUV from pre- to post-treatment FDG-PET scans at the cervix and lymph nodes. The primary outcome was recurrence rate, and secondary outcomes were overall and progression-free survival. Firth’s penalized logistic regression and Cox proportional hazards models were used to assess associations.Results55 patients met eligibility criteria. Recurrence rate was 27% (15/55); of these, 33% had local recurrence (5/55) and 67% had distant recurrence (10/55). Median percent decrease of cervical SUV after treatment in those with and without recurrence was similar (71.4 vs 68.8, p = 0.89); this remained consistent when analyzing those with local recurrence only (70.5, p = 0.95). When the percent decrease in cervical SUV was examined in intervals (< 25%, 25–50%, 50–75%, > 75%), this was also not predictive of local (p = 0.91) or overall (p = 0.75) recurrence. Median percent decrease at the most avid and distant lymph node in those with and without recurrence was not significantly different (p > 0.05). Neither change in cervical nor lymph node SUV was associated with overall or progression-free survival.ConclusionChanges in SUV after treatment may not be a reliable stand-alone marker for predicting recurrence or survival in locally advanced cervical cancer after treatment with radiation therapy.

Manor, Itay; Gabbai, Daniel; Baruch, Yoav; Yogev, Yariv; Hiersch, Liran; Attali, Emmanuel

doi: 10.1007/s00404-026-08406-2pmid: 41886092

PurposeTwin pregnancies pose unique challenges during labor, particularly the risk of cesarean section for the second twin after vaginal delivery of the first—termed a combined vaginal–cesarean delivery. Although nonvertex presentation of the second twin is a recognized risk factor, predictors in vertex–vertex twin pregnancies remain unclear. The objective of this study was to identify maternal, pregnancy-related, intrapartum, and fetal risk factors associated with combined vaginal–cesarean delivery in twin pregnancies with vertex–vertex presentation.MethodsA retrospective single-center case–control study was conducted at Lis Maternity and Women’s Hospital, Tel Aviv Sourasky Medical Center, between 2012 and 2023. The study included women with twin pregnancies in vertex–vertex presentation who attempted vaginal delivery. The case group comprised women who underwent combined vaginal–cesarean delivery (vaginal birth of the first twin followed by cesarean of the second), while controls delivered both twins vaginally. Maternal, pregnancy-related, intrapartum, and fetal variables were analyzed using univariate and multivariable logistic regression models.ResultsAmong 503 twin deliveries meeting inclusion criteria, 22 (4.4%) resulted in combined vaginal–cesarean delivery. Maternal characteristics, labor features, and fetal parameters were similar between groups. Gestational diabetes mellitus was significantly more frequent among combined deliveries (31.8% vs. 10.8%; p = 0.009) and remained the only independent risk factor after adjustment (odds ratio 4.06; 95% CI 1.57–10.53; p = 0.004). No other associations were found between the delivery outcome and other factors, including maternal age, parity, previous cesarean delivery, preeclampsia, instrumental delivery of the first twin, gestational age at delivery, and intertwin birthweight discordance.ConclusionsIn vertex–vertex twin pregnancies, successful vaginal delivery is achieved in approximately 95% of cases. Gestational diabetes mellitus independently increases the likelihood of cesarean delivery for the second twin, suggesting a possible metabolic influence on labor dynamics. Optimal glycemic control and vigilant intrapartum management may help minimize cesarean conversions. Larger multicenter studies are warranted to validate these findings and explore the effect of diabetes severity and treatment type.

Alageel, Arwa A.

doi: 10.1007/s00404-026-08338-xpmid: 41760981

BackgroundPlatelet-rich plasma (PRP) is used as an adjunctive treatment in various medical fields, including orthopaedics, plastic surgery, dermatology, and wound healing. However, PRP application in reproductive medicine, particularly for fertility restoration, remains controversial, specifically for women with diminished ovarian reserve (DOR), premature ovarian insufficiency (POI), and pre-menopause. This systematic review aimed to comprehensively evaluate the existing literature on autologous PRP use for ovarian rejuvenation, with a focus on refining and standardising PRP protocols and identifying appropriate candidate populations.MethodsA comprehensive literature search was conducted on the autologous PRP use using Cochrane, Embase, PubMed, MEDLINE, NCBI, and Google Scholar databases. Studies on PRP application in reproductive medicine were identified and classified into two categories: DOR and POI. The PRP preparation protocol was assessed, and the results were compared. This narrative systematic review, carried out in compliance with PRISMA 2020 guidelines, combined results, although meta-analysis was not feasible due to significant variation in study design, PRP preparation, and outcome measures.ResultsSeveral studies reported restoration of menstruation following intraovarian PRP administration in women with POI. In women with DOR, studies reported changes in ovarian reserve markers, including increases in serum anti-Müllerian hormone (AMH) levels and reductions in follicle-stimulating hormone (FSH) levels; however, these changes were not consistently associated with higher antral follicle counts or oocyte yield. Instead, sseveral studies reported higher proportions of mature oocytes and pregnancy and live birth outcomes, particularly following repeated PRP treatment cycles in women with long-standing ovarian dysfunction.ConclusionsIntraovarian PRP may have a potential role in activating dormant follicles in a selected subset of women with poor ovarian response. However, the current evidence remains limited and heterogeneous, supporting its use only within structured clinical or research protocols until higher-quality, standardised studies are available.

Werner, Franziska; Velho, Renata Voltolini; Mechsner, Sylvia

doi: 10.1007/s00404-026-08495-zpmid: 42323744

PurposeTo 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.MethodsThis 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.ResultsA total of 210 women were included (surgical n = 164; hormonal n = 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 p ≥ 0.08), with consistently small effect sizes.ConclusionBoth 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.

Hamid, Amr M. Salaheldin Abdel; Madkour, Wael A. Ismail; Moawad, Ashraf; Elzaher, Mohamed Abd; Roberts, Mary P.

doi: 10.1007/s00404-026-08374-7pmid: 41784847

Bohne, Shara Maria; Wegwitz, Florian; Kruse-Wieczorek, Judith; Langer, Laura; Gallwas, Julia; Ströbel, Philipp; Hasanov, Mir Fuad

doi: 10.1007/s00404-026-08488-ypmid: 42307672

Purpose Parathyroid hormone-related peptide (PTHrP) is a peptide hormone that shares structural similarity with parathyroid hormone (PTH) and binds to the same receptor, leading to increased calcium levels. Humoral hypercalcemia of malignancy (HHM) is typically mediated by tumor-derived PTHrP and accounts for the majority of cases of malignancy-associated hypercalcemia, whereas it is rarely observed in benign conditions. The purpose of this study was to systematically review the literature to map and provide a structured and transparent overview of reported cases of HHM in malignant gynecologic tumors.MethodsA systematic literature search was conducted in PubMed/MEDLINE and Web of Science, complemented by manual reference screening and additional searches using Google Scholar, identifying relevant articles published between 1973 and 2025. Clinical and biochemical characteristics were extracted and analyzed descriptively.ResultsA total of 51 reported cases were identified, including 29 ovarian, 12 uterine, 5 vulvar, and 5 cervical tumors. Among the 29 cases in which serum PTHrP was measured, levels were elevated in 28 patients. In the remaining cases, suppressed PTH levels, exclusion of alternative causes, or indirect evidence from tissue immunohistochemistry (IHC) supported PTHrP involvement. Preoperative calcium levels ranged from 10.5 to 21.3 mg/dL. Following tumor resection, both PTHrP and calcium levels declined and normalized in most patients.ConclusionThese findings suggest that although rare, PTHrP-mediated hypercalcemia represents a clinically relevant paraneoplastic phenomenon in gynecologic malignancies. Prospective studies with standardized biochemical and tissue-based assessment are needed to clarify its epidemiology and clinical significance.

Tehraninejad, Ensieh Shahrokhe; Tanha, Fateme Davari; Ghajarzadeh, Mahsa; Zandieh, Zahra; Aziminekoo, Elham; Zanjani, Haleh Rahmanpour

doi: 10.1007/s00404-026-08397-0pmid: 41874716

Ioakeim, Sapantzoglou; Kontopoulou, Afroditi Maria; Christina, Karasmani; Zacharias, Fasoulakis; Chatziioannou, Maria Ioanna; Afroditi, Pegkou; Maria, Simou; Ioannis, Pafilis; Athina, Souka; Marianna, Theodora; Panagiotis, Antsaklis; Georgios, Daskalakis

doi: 10.1007/s00404-025-08299-7pmid: 41553376

PurposeWhile in singleton pregnancies the maternal serum biomarkers used in the first-trimester screening for aneuploidies, particularly PAPP-A, may be, also, used as predictors of adverse perinatal outcomes, there is a scarcity of data regarding the association of first-trimester biomarkers with unfavorable pregnancy outcomes in twin pregnancies. The main purpose of our study was to evaluate the association of low PAPP-A levels in twin pregnancies with the subsequent development of perinatal complications.Methods454 twin pregnancies were recruited over a period of 11 years, and their data were analyzed retrospectively. First trimester assessment at 11 + 0–13 + 6 weeks included examination of fetal anatomy and markers of aneuploidy and measurement of the maternal serum concentration of PAPP-A and free b-hCG. The outcomes under investigation were preterm rupture of the membranes, preterm delivery earlier than 32, 34, and 36 weeks, gestational diabetes, hypertensive disease of the pregnancy (including pregnancy induced hypertension and pre-eclampsia), intrauterine demise, birth weight difference of more than 25% among the fetuses and composite adverse pregnancy outcome (which included preterm rupture of the membranes, preterm delivery earlier than < 36 weeks, hypertensive disease of the pregnancy, and gestational diabetes).ResultsLow first-trimester PAPP-A levels were related with preterm birth, whereas high levels were associated with hypertensive disorders of pregnancy. When using specific cut-off points such as low PAPP-A MoM < 5th and < 10th centile or high PAPP-A MoM > 90th and 95th centile, these associations were not significant.ConclusionsLow first-trimester PAPP-A levels were related with preterm birth, whereas high levels were associated with hypertensive disorders of pregnancy. When specific cut-off points were investigated, these associations were not statistically significant.

Song, Shijing; Liang, Hua; Hou, Chenxiao; Zheng, Yucong; Xiong, Xiaowei; Xia, Taihui; Wang, Jingjing; Wu, Qingqing

doi: 10.1007/s00404-025-08275-1pmid: 41528526

PurposeIn our previous studies, differences in the upper airway inner diameter between fetuses with thoracic space occupying lesions and normal fetuses were found, but their clinical value has not been further validated. We designed a prospective case–control animal experiment to validate its prognostic value in congenital diaphragmatic hernia (CDH).MethodsUsing Nitrofen to create a fetal SD-rat model of CDH. Calculate the upper airway inner diameter and lung parameters of fetal rats on ultrasonic image and histology sections, and calculate the correlation between the upper airway and lung parameters. Design experiments to rule out the impact of major cardiac malformations on airway development, the correlation between the upper airway inner diameter and the area of CDH was also calculated.ResultsThere was no significant difference in lung and upper airway parameters between the control group and the group with unsuccessful CDH modeling. The upper airway and lung parameters of fetal rat with CDH were significantly smaller than those without CDH (p < 0.01). The correlation between upper airway inner diameter and lung volume is better than that with lung weight, especially the upper airway inner diameter measured on ultrasound images (p < 0.01, R = 0.76). In the CDH group, the airway lumen diameter was inversely correlated with the hernia area (p = 0.005, R = 0.507).ConclusionsThe upper airway inner diameter of fetal rat was correlated with lung volume, demonstrating the potential predictive value for fetal prognosis of congenital diaphragmatic hernia.

Graf, Joachim; Abele, Harald; Wallwiener, Markus; Kantelhardt, Eva J.; Brucker, Sara Y.; Simoes, Elisabeth

doi: 10.1007/s00404-026-08523-ypmid: 42455164

Key messageIn this study, half of all female patients with advanced and metastatic breast cancer reported experiencing financial difficulties. This highlights the need for gynecology and oncology specialists to also address patients’ socio-medical needs. Electronic patient-reported outcomes (ePRO) must be used to identify such areas of concern.AbstractPurposeThe aim was to investigate whether and to what extent female patients with advanced or metastatic breast cancer who are undergoing chemotherapy report financial difficulties due to their physical condition and/or the effects of medical treatment in relation to the German reference cohort.MethodsA secondary data analysis was performed using data collected prospectively as part of the ePROCOM study. A total of n = 168 female patients who had answered questions regarding financial implications of the EORTC QLQ-C30 questionnaire were included in the analysis. Unpaired t tests (Welch) and Chi-square tests as well as multiple regressions were conducted. A bilateral p value of < 0.05 was considered statistically significant in all analyses (alpha = 0.05).ResultsThe prevalence of financial distress was 50.0% (95%-CI 42.4%; 57.6%), defined as a response of at least 2 (“a little”) on a 4-point Likert scale. Between the reference cohort scored 4.8 and the breast cancer cohort scored 28.8, there was a significant difference of 24 ± 5.19 score points (p < 0.001; 95%-CI 18.81, 29.19) in financial burden. Overall, the regression model explained 27.7% of the total variance in financial burden through HRQoL, age, and civil status (R2 = 0.277).ConclusionWomen with advanced or metastatic breast cancer reported substantially higher financial burden than the female German reference population. Lower HRQoL, younger age, and living alone were associated with greater financial impact. These findings support routine assessment of financial distress in those patients and suggest that ePRO-based screening may help identify patients in need of early social-medical support.