Reproductive experts discuss applications on AI in gynecology

2025-06-23 - 2025-06

More than 70 renowned medical experts from home and abroad delved into discussions on gynecologic oncology, fetal medicine, reproductive endocrinology, perinatal health and the applications of artificial intelligence in obstetrics and gynecology at the Eighth Red House Forum and the Sixth Shanghai Public Hospital High-quality Development Forum held in Shanghai on Saturday.
The experts who shared the latest achievements and experiences in these fields included academicians from the Chinese Academy of Engineering and the Chinese Academy of Sciences, as well as leading experts from famous institutions worldwide, such as Johns Hopkins University School of Medicine and the Children's Hospital of Philadelphia in the United States, as well as the University of Toronto in Canada.
The Shanghai-based Obstetrics and Gynecology Hospital of Fudan University, host of the forum, announced the launch of an upgraded international exchange initiative at the event, signaling a new phase of international cooperation beginning this year.
As a participant in the projects of the World Health Organization, the Shanghai hospital has been collaborating widely with medical institutions globally. For instance, it cooperates with its counterparts in Canada, South Africa and India to establish health intervention programs spanning preconception, pregnancy, infancy, and early childhood stages, aiming to provide preventive solutions for global issues like childhood obesity and chronic diseases in adulthood. It also partners with a laboratory at the University of Cambridge in the United Kingdom to focus on HPV-related research, supporting cervical cancer prevention and control efforts.
"The hospital will continue to harness global expertise and benchmark against the highest global standards and the latest technological frontiers to strive to make itself not only a hub for clinical research in obstetrics and gynecology but also a window and platform for international academic exchanges in the field, injecting more vitality and hopes into the global women's health sector," said Jiang Hua, president of the Obstetrics and Gynecology Hospital of Fudan University.

Influence of Probiotics on Vaginal Flora and GBS in Pregnant Women

2025-06-22 - 2025-06

Researchers conducted a retrospective study published in the June 2025 issue of European Journal of Obstetrics and Gynecology and Reproductive Biology to evaluate the feasibility and effects of using probiotics in pregnancy, beginning in the third trimester, on rectovaginal colonization of group B streptococcus (GBS) in women at low obstetric risk.
They performed a study in 3 tertiary hospitals in northern Italy involving low-risk pregnant women. From 30 to 37 weeks of pregnancy, participants received either 2 capsules of probiotics or a placebo daily. The primary outcome, GBS colonization, was assessed using rectovaginal swabs. In a randomly selected subgroup, changes in the vaginal microbiome were evaluated with 16S Metagenomic Sequencing Library Preparation sequencing and analysis.
The results showed no significant difference in rectovaginal swab positivity (P = 0.24) and antibiotic use (P = 0.27) between the probiotics (n = 133) and placebo (n = 134) groups, 1 postpartum fever case (>38 °C) occurred in the placebo group. Labor, delivery, and neonatal outcomes were comparable in both groups. Vaginal microbiota analysis revealed no significant change in Lactobacillus spp. abundance, but Gardnerella spp. decreased significantly (3.6 ± 7.9 vs 5.5 ± 10.2; P = 0.03). The Lactobacillus spp. levels significantly decreased in women with partial rupture of membranes (46.9 ± 43.6 vs 77.7 ± 24.9; P = 0.02).
Investigators concluded that although clinical outcomes had remained unaffected, the administration of probiotics had led to favourable changes in vaginal microbiota.

Study backs Tandem automated insulin delivery in pregnant women with type 1 diabetes

2025-06-20 - 2025-06

A new study showed improved glucose control in pregnant women using Tandem Diabetes Care (Nasdaq:TNDM) insulin delivery technology.
The study showed that pregnant women with type 1 diabetes stayed in the target glucose range for pregnancy more with the Tandem t:slim X2 automated insulin delivery system with Control-IQ technology compared to standard insulin delivery with injections or open-loop, non-automated insulin pump therapy with continuous glucose monitoring (CGM). Tandem's technology is available for use in the U.S. but not approved for use in pregnancy.
Investigators plan to share findings from the study at the American Diabetes Association's 85th Scientific Sessions in Chicago.
According to an ADA news release, managing blood glucose before, during and after pregnancy proves crucial to minimizing diabetes risks. Researchers recently called for more studies of automated insulin delivery during pregnancy. This multicenter, open-label trial began in early pregnancy and continued for the remainder of the pregnancy.
Researchers evaluated the impact of a hybrid closed-loop (HCL) insulin therapy treatment regimen. This regimen featured the t:slim X2 using its Control-IQ algorithm to adjust insulin delivery based on real-time Dexcom G6 CGM readings. The study evaluated pregnant women with type 1 diabetes and early pregnancy A1C levels of 6.2%-10%.
A total of 91 women across 14 different sites in Canada and Australia were randomized to start therapy by 16 weeks gestation or continue their standard injections or open-loop pump use. Investigators recommended that participants use the lowest target range (sleep activity) throughout the day and night.
Results showed that participants using the Tandem technology spent a longer portion of the day (three hours on average) in the target range compared to the standard of care. Time spent in target range landed 12.5% lower in the standard of care group. For those using automation, they spent 11.5% less time above range. Investigators say this reflects a more stable management of glucose levels.
“Managing glucose levels during pregnancy with type 1 diabetes is of critical importance for optimal health in both mother and child,” said Dr. Lois Donovan, clinical professor at the University of Calgary AB Canada in the Cumming School of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, Department of Obstetrics and Gynecology and lead presenter of the study. “Our results reflect the importance of evolving automated insulin delivery to support those living with type 1 diabetes when they are pregnant or preparing for pregnancy.”

High rates of pain and heavy bleeding found in teens with endometriosis

2025-06-16 - 2025-06

A study of adolescents with pathology-confirmed endometriosis reveals common symptoms such as progressive dysmenorrhea and heavy bleeding.
Progressive dysmenorrhea, missed school or activities, and heavy menstrual bleeding are common in adolescent patients with pathology-proven endometriosis, with chosen treatment methods varying among this population
Determining characteristics of endometriosis
The study was conducted to establish demographic characteristics and preoperative medical management methods used among patients aged less than 22 years with endometriosis confirmed through pathology. These patients received diagnostic laparoscopy from 1 of 8 Midwestern US tertiary care hospitals.
Pathology records were assessed for demographics, medical history, clinical symptoms, and prior medical status. The final analysis included 305 patients aged a median of 15.6 years at first pediatric and adolescent gynecology (PAG) visit. Of these patients, 83.3% were White and 70.5% had commercial insurance.
Participants were aged a median of 12 years at menarche, and a family history of endometriosis was reported in 45.3%.2 This involved first-degree relatives in 68.1% of cases. Additionally, a high rate of nonsteroidal anti-inflammatory drug use was reported, at 80.1%. In comparison, only 5.9% reported opioid use.
Common symptoms among adolescents
Endometriosis was diagnosed in only 4.3% of patients before their first PAG visit. Progressive dysmenorrhea was reported in 76.7% of these patients, heavy menstrual bleeding in 50.8%, and missed school or activities because of dysmenorrhea in 55.1%.
Beyond PAG, variations were reported in the providers whom patients sought to receive care for their symptoms. This included primary care by 75.1%, gastroenterology by 18.7%, adult gynecology by 22.3%, and physical therapy by 13.4%. Before laparoscopy, 92.8% of patients attempted oral hormonal menstrual suppression.
Oral contraception was used for hormonal management by 62.3% of patients, medroxyprogesterone acetate injection by 15.7%, 5mg or less daily norethindrone by 14.8%, over 5mg daily norethindrone by 13.4%, hormonal intrauterine system by 13.1%, and contraceptive implant by 5.3%.
Comorbidities and limitations
The presence of at least 1 comorbidity was reported in 73.4% of patients. Of the comorbidities, the most common in the study population was psychiatric disorders. Investigators noted selection bias and inconsistencies in data documentation as limitations of the data. Additionally, the study did not include assessments of clinical outcomes after surgery.
Overall, the data highlighted a significant prevalence of progressive dysmenorrhea, missed school or activities, and heavy menstrual bleeding among patients with endometriosis. Variety was also reported in the providers whom patients sought care and in the method of care used.
“The findings underscore the need for early recognition, structured evaluation protocols, and consensus-based treatment algorithms in adolescent care,” wrote investigators.
Mental health concerns
Alongside these common symptoms, data has also indicated increased mental health risks among patients with endometriosis.3 This association was reported in a systematic literature review of articles from the PubMed and Cochrane databases.
The data highlighted anxiety rates ranging from 10% to 87.5% among women with endometriosis, which is a significant increase from the rate of 6% in the general population. Endometriosis was also linked to increased rates of depression, at 9.8% to 98.5% in endometriosis patients vs 6.6% to 9.3% in controls.
Symptomatic endometriosis patients also had an increased prevalence of depression vs asymptomatic patients. Overall, the data highlighted increased mental health burdens among endometriosis patients, further increased by pain.

Continuing Metformin in Early Pregnancy Linked to Lower Miscarriage Risk in PCOS: Meta-Analysis

2025-06-15 - 2025-06

UK: A recent systematic review and meta-analysis published in the American Journal of Obstetrics & Gynecology has suggested that women with polycystic ovary syndrome (PCOS) may benefit from continuing metformin therapy during the early stages of pregnancy. The study, led by Dr. James Cheshire from Birmingham Women's and Children's NHS Foundation Trust in the UK, found that maintaining metformin use through the first trimester may improve pregnancy outcomes, particularly by reducing miscarriage risk.
The research team analyzed data from 12 randomized controlled trials involving a total of 1,708 women with PCOS. All included trials assessed the use of metformin initiated before conception and continued until at least a confirmed pregnancy, comparing outcomes against either placebo or no treatment.
The analysis revealed the following findings:
Women who continued metformin through the first trimester had higher clinical pregnancy rates (OR 1.57).
In this group, there was a trend toward fewer miscarriages (OR 0.64).
A possible increase in live birth rates was also noted (OR 1.24), though not statistically conclusive.
Women who stopped metformin after a confirmed pregnancy also showed higher clinical pregnancy rates (OR 1.35).
However, this group had a potential increase in miscarriage risk (OR 1.46).
Indirect comparisons favored continued metformin use over stopping it at pregnancy confirmation.
Trends indicated a lower risk of miscarriage (OR 0.44) and better pregnancy outcomes when metformin was continued through the first trimester.
These findings challenge previous clinical guidance. The 2017 American Society for Reproductive Medicine (ASRM) guidelines stated there was insufficient evidence to support metformin use during pregnancy for miscarriage prevention. Similarly, current European Society for Human Reproduction and Embryology (ESHRE) guidelines recommend discontinuing metformin after conception during IVF or ICSI cycles.
Given these new insights, the authors suggest that international clinical recommendations may need to be reassessed. A large ongoing multicenter UK trial (LOCI trial) is expected to provide additional clarity. This trial examines metformin use in combination with ovulation induction agents, with treatment extended until 14 weeks of gestation.
The authors also emphasize the need for future research, particularly studies that explore the impact of metformin throughout the full course of pregnancy and its effects across different PCOS phenotypes. Tailoring treatment based on individual patient characteristics could optimize outcomes for women with PCOS planning pregnancy.
"Continuing metformin through the first trimester may help lower the risk of miscarriage and improve live birth rates in women with PCOS. Keeping the treatment going after a positive pregnancy test seems more beneficial than stopping it early. However, more high-quality studies are needed to confirm these findings," they concluded.

Postmortem ultrasound accurately estimates gestational age

2025-06-12 - 2025-06

Extrauterine ultrasound measurements of the cerebellum are feasible and accurate for evaluating postmortem gestational age (GA), according to a recent study published in the American Journal of Obstetrics & Gynecology
Need for innovative postmortem GA assessment
Although better quality care can be provided by identifying sources of perinatal death, low- and middle-income countries (LMICs) have reported slow reductions in perinatal mortality. Complete autopsies are traditionally utilized to determine the cause of death, but this method remains difficult to perform in LMICs.2
"Thus, there is an urgent need for innovative approaches allowing accurate evaluation of GA in a cost-effective and feasible manner," wrote investigators.1
Ultrasound as a tool for gestational age evaluation
Ultrasound may be utilized to measure the cerebellum as early as 10 to 11 weeks' gestation. Therefore, this method has been proposed as a tool to evaluate GA.
The observational cross-sectional study was conducted to determine the feasibility of extrauterine percutaneous transfontanelle ultrasound cerebellum measurements for estimating postmortem GA. This included fetal deaths, stillbirths, and neonatal deaths.
Deaths occurring from 15 to 21.9 weeks' gestation were considered fetal deaths, while those occurring from 22 weeks' gestation onward were considered stillbirths. Participants were patients with intrauterine fetal death from natural causes or legal abortion after 15 weeks' GA, neonatal death within 48 hours of birth, or regular ultrasound scan controls.
Validation and measurement methods
Extrauterine postmortem ultrasound cerebellar measurements were validated through comparisons with intrauterine ultrasound postmortem measurements and autopsy measurements of the cerebellum. Accuracy in assessing GA was also measured.
Routine pregnancy assessments included an intrauterine ultrasound scan, allowing potential fetal abnormalities to be identified. Crown-rump length was measured to estimate GA. Fetal death was confirmed through abdominal ultrasound in cases of suspected intrauterine fetal death.
Cerebellar measurements obtained during extrauterine postmortem cerebellar ultrasound included transcerebellar diameter (TCD), cranio-caudal length of the cerebellar vermis, and anteroposterior length of the cerebellar vermis. A trained pathologist or pathology technician performed all measurements.
Measurement accuracy
There were 137 cases included in the final analysis, 63% of whom were fetal deaths, 50.4% stillbirths, and 3.6% neonates. Median GAs among these populations were 20.5 weeks, 23 weeks, and 28.5 weeks, respectively. Neonates had a median life of 12 hours, and 84.7% of cases underwent a complete autopsy.
Approximately 76% of deaths were legal abortions, while approximately 24% were linked to natural causes. Median TCD values were 20.8 mm from intrauterine ultrasound and 23.7 mm from extrauterine ultrasound. When measuring by extrauterine ultrasound followed by direct examination of formalin-fixed cerebellums, medians were 25.1 mm and 25 mm, respectively.
Correlation between ultrasound and autopsy measurements
Extrauterine ultrasound TCD, intrauterine ultrasound TCD, and autopsy TCD were significantly correlated, with a correlation coefficient between 0.81 and 0.87. Average TCD values were lower from intrauterine ultrasound vs extrauterine ultrasound and autopsy, with mean bias values of 2.67 mm and 3.61 mm, respectively.
In comparison, similar TCD measurements were reported for extrauterine ultrasound and autopsy, with a mean bias value of 0.55 mm. All cases had successfully measured extrauterine postmortem TCD, and 98.5% had successfully measured cerebellar vermis height and length.
Both intrauterine ultrasound TCD and autopsy TCD displayed excellent GA prediction in univariate linear regression. A significant positive linear relationship was also noted between all 3 extrauterine postmortem cerebellar ultrasound measurements and GA. This highlighted the feasibility of estimating GA with postmortem extrauterine cerebellar ultrasound measurements.
"Future studies should validate our findings and feasibility in larger and more diverse cohorts, particularly those in LMICs," wrote the investigators.

Study finds childhood adversity linked to elevated risk of endometriosis

2025-06-11 - 2025-06

A nationwide study from Karolinska Institutet has found a significant association between adverse childhood experiences (ACEs) and the risk of being diagnosed with endometriosis later in life. Drawing on data from more than 1.3 million women in Sweden, the study suggests that early-life stressors, including exposure to violence, parental psychiatric illness, and family instability, may contribute to long-term gynecological health outcomes.1,2
The study, published in Human Reproduction, followed women born in Sweden between 1974 and 2001, excluding those adopted, diagnosed with endometriosis before age 15, or deceased. The final cohort included 1,316,946 women, among whom 24,311 had received a diagnosis of endometriosis by the end of follow-up in 2020.
Endometriosis is a chronic inflammatory condition affecting approximately 10% of women of reproductive age. It occurs when tissue similar to the lining of the uterus grows outside the uterus, often causing pain, inflammation, and infertility. While the causes remain unclear, this study aimed to explore whether early psychosocial stress contributes to disease risk.
The researchers assessed 11 types of ACEs using national registries. These included parental substance abuse, psychiatric disorders, intellectual disability, teenage parenthood, residential instability, parental separation, household financial support, child welfare intervention, and direct or parental exposure to interpersonal violence. The strongest association was found in women who had been exposed to violence during childhood. These individuals had more than twice the risk of developing endometriosis compared with women who had not experienced such exposure (adjusted hazard ratio [HR]: 1.93, 95% CI: 1.52-2.43).
"All factors examined, except death in the family, were linked to an increased risk of endometriosis," said Marika Rostvall, MD, the study's first author. "We also saw that the more adverse experiences in childhood, the higher the risk. Among those who had five or more factors, the risk increased to 60%."
The study found that even a single ACE increased the risk of endometriosis by 20% (adjusted HR: 1.16, 95% CI: 1.13-1.20). A clear dose-response relationship emerged, with risk rising progressively with the number of ACEs. Those with 5 or more had an adjusted HR of 1.57 (95% CI: 1.34-1.84) compared to those with no ACEs.
The researchers also conducted sensitivity analyses, including dysmenorrhea as an additional outcome, given that endometriosis is frequently underdiagnosed or misdiagnosed as menstrual pain. These secondary analyses supported the main findings.
Though the study is observational and cannot establish causality, the authors proposed several biological mechanisms. One possibility is that chronic stress from early-life adversity may dysregulate the immune system, impeding the body's ability to clear endometrial-like tissue from ectopic sites. Another theory is that early trauma increases pain sensitivity, making individuals more likely to report and seek care for endometriosis symptoms.
"The results suggest that early life experiences can affect the body's health much later in life and highlight the importance of looking at the whole person, not just the symptoms," Rostvall said. "The findings are also in line with previous research showing that difficulties in childhood have profound consequences for future health."
This study is the first of its kind to use register-based indicators of ACEs in a general population cohort, thereby reducing recall bias that affects self-reported studies. However, the authors note that the reliance on health care and social service records may underestimate exposure, particularly for types of abuse or neglect that go unreported.
The study was conducted in collaboration with the Centre for Epidemiology and Community Medicine (CES), Region Stockholm, and funded by Karolinska Institutet and Region Stockholm. According to the authors, these findings could inform future research into the biological pathways linking psychosocial stress and gynecologic disease and highlight the need for integrated, trauma-informed care.
"I hope that the findings can be used to improve both preventive measures and treatment in health care," Rostvall added.

Ultrasound scan of baby's heart to increase childbirth safety

2025-06-11 - 2025-06

An echocardiography of the baby's little heart soon after the onset of labour can predict the outcome of the birth and in particular whether the baby will adequately tolerate the contractions or will be more likely to go into distress, necessitating a caesarean section or an operative delivery.
This is suggested by a study published in the BJOG, British Journal of Obstetrics & Gynecology and coordinated by Professor Tullio Ghi, Professor of Obstetrics and Gynecology at the Catholic University of Sacred Heart, campus of Rome campus - and Chairman of the Obstetrics Unit at the Fondazione Policlinico A. Gemelli IRCCS in Rome. The study was carried out with the collaboration of other experts, including Professor Andrea Dall'Asta from the University of Parma and Professor Basky Thilaganathan from St George's University in London.
Preventing intrapartum hypoxic injury during childbirth is crucial for the future health of the baby. Professor Ghi explains: "In this work, at the onset of labour we studied and measured the changes in the shape of the baby's heart with ultrasound scanning. We noticed that, based on certain parameters, it is possible to predict which infants have a heart strong enough to tolerate maternal contractions, and which ones instead are at greater risk of developing hypoxic stress during labor and will therefore need a caesarean section or an instrumental vaginal birth to prevent possible complications." He continues: "The assessment of baby's heart morphology seems to work as a triage test, allowing to pick up since the very beginning of labor the small group of babies who are unfit for vaginal delivery because they are more susceptible to intrapartum hypoxia."
The study involved 208 pregnant women at the onset of labour. The majority of these women had a spontaneous uncomplicated birth while in 20 of these an operative delivery was necessary due to suspected foetal distress. In the latter group, the study of the fetal heart revealed different morphological parameters compared with the group that had an uncomplicated delivery.
The study suggests for the first time that identification of abnormalities of fetal cardiac function early in labor may impact the clinical management. In such circumstances the the decision to expedite birth through an operative delivery (e.g. caesarean section or use of vacuum extractor) with the aim of preventing intrapartum hypoxic injury might be considered.

Contemporary OB/GYN week in review: Postpartum psychosis, preeclampsia risk, and more

2025-06-06 - 2025-06

While conducting clinical rotations at St. Barnabas Hospital in the Bronx, Ivie Odiase, MD, now an obstetrics and gynecology resident at Mount Sinai West, identified a significant gap in the use of aspirin for preeclampsia prevention. "I started this project to see in our population, how many people [who] met criteria for aspirin prophylaxis by ACOG were actually receiving it," said Odiase. A retrospective analysis revealed that only 30% of eligible patients were prescribed aspirin.
The findings from this quality improvement project were presented at the 2025 ACOG Annual Clinical and Scientific Meeting.
In a recent interview with Contemporary OB/GYN, Veerle Bergink, MD, PhD, professor in the department of psychology at Icahn School of Medicine at Mount Sinai, discussed the implications of postpartum psychosis and highlighted findings from her research on familial risk and prevention strategies.
Postpartum psychosis is a rare but severe psychiatric emergency that typically arises within days to weeks after childbirth. It significantly impacts maternal quality of life and is a leading cause of maternal death in the first postpartum year, often because of suicide. Despite its severity, postpartum psychosis is highly treatable if identified early, with most women achieving full recovery within weeks when given appropriate psychiatric care, including lithium and antipsychotics.
Bergink emphasized the importance of early detection and proactive risk assessment during pregnancy. Her study found that women with a first-degree relative who experienced postpartum psychosis have a 10-fold increased relative risk. However, because the condition is rare, the absolute risk remains low at approximately 1.5%. The data offer reassurance to concerned family members while also underlining that postpartum psychosis has a heritable component, suggesting the need for continued genetic research.
In a recent interview with Contemporary OB/GYN, Sharon Erdrich, researcher from the School of Pharmacy at the University of Sydney, discussed the vital role clinicians can play in promoting better oral health among their patients and the broader implications of oral hygiene on systemic health. She emphasized that the mouth is often overlooked in general health assessments, despite being the entry point of the gastrointestinal system and a potential source of systemic disease.
Erdrich began by critiquing the current clinical practice where the mouth is typically only examined in response to specific complaints, such as a sore throat or a visible issue like a tongue lesion. She advocated for a more proactive approach where oral health assessments are integrated into routine clinical evaluations. This includes asking patients about the condition of their teeth and gums and how they perceive their oral health.
Susan Khalil, MD, assistant professor at the Icahn School of Medicine at Mount Sinai and program director for the minimally invasive gynecologic surgery fellowship at Mount Sinai Hospital, discussed research presented at the 2025 ACOG Annual Clinical and Scientific Meeting exploring the use of staged uterine artery embolization to improve feasibility and outcomes in uterine fibroid treatment
Khalil emphasized that large uterine fibroids can complicate hysterectomy procedures by reducing visibility and increasing the risk of morbidity. "Patient safety is going to come first, and sometimes large uterine fibroid size can also just limit visibility, can increase chances of having additional things that can add to morbidity," she said.
Severe maternal morbidity (SMM) patterns differ based on race and ethnicity among patients with a prior cesarean delivery, according to a recent study published in JAMA Network Open.
An unplanned repeat cesarean birth was reported in 15.3%, 11.5%, and 9.1% of Black, Hispanic, and White individuals, respectively. SMM rates among these populations were 1.5%, 0.9%, and 0.6%, respectively, highlighting a reduction among White patients.
When including 3-category birth mode and race and ethnicity as independent variables, an adjusted odds ratio (aOR) of 1.60 for SMM was reported among Black patients vs White patients. In those with planned and unplanned repeat cesarean delivery vs VBAC, the aORs were 1.57 and 3.05, respectively.

Urinary Tract Infections Before Surgery Elevate Readmission Odds in Hysterectomy Patients: Study Shows

2025-05-30 - 2025-05

USA: A recent large-scale retrospective study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology has shed light on the impact of preoperative urinary tract infections (UTIs) on surgical outcomes in women undergoing benign hysterectomy.
"Although UTIs did not significantly increase the overall rate of postoperative complications, the findings suggest a notably higher risk of readmission within 30 days following the procedure," the researchers reported.
Preoperative urinary tract infections have been linked to adverse surgical outcomes in specific patient groups. In this context, Laura Douglass, Section of Minimally Invasive Gynecologic Surgery, University of Chicago, Chicago, IL, USA, and colleagues aimed to evaluate the impact of a preoperative UTI on the likelihood of 30-day postoperative complications among women undergoing benign hysterectomy.
For this purpose, the researchers conducted a retrospective cohort study using data from the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program database. They identified surgeries based on CPT codes and categorized surgical indications using ICD-9 and ICD-10 codes. A preoperative urinary tract infection was defined as a symptomatic UTI in patients who had not yet started or were undergoing antibiotic treatment at the time of surgery.
The primary outcome measured was the occurrence of any postoperative complication within 30 days. To compare groups, statistical analyses such as the Chi-square and Fisher's exact tests were used for categorical variables, while the Mann-Whitney U test was applied for continuous variables.
Key Findings:
Patients with preoperative UTI were generally older and had higher rates of ASA physical status class 3 or 4.
The incidence of vaginal hysterectomy and surgical indications such as pain or prolapse was greater among those with UTI.
Operative time and reoperation rates were significantly higher in the UTI group.
Overall, 5.6% of all patients undergoing benign hysterectomy experienced a postoperative complication within 30 days.
Patients with a preoperative UTI had a higher 30-day complication rate (8.2%) compared to those without UTI (5.6%).
After adjusting for confounding factors, preoperative UTI was no longer independently associated with overall 30-day complications.
However, patients with UTI had nearly four times the odds of readmission within 30 days (adjusted OR 3.98).
The researchers concluded that although a preoperative urinary tract infection did not significantly impact the overall risk of postoperative complications, it was strongly linked to a nearly fourfold increase in 30-day readmission rates following benign hysterectomy. This highlights the importance of identifying and addressing UTIs before surgery as a potentially modifiable factor to improve surgical outcomes.

Cost Comparison Shows Intrauterine Balloon Tamponade as Practical First-Line Option for Postpartum Hemorrhage: Study

2025-05-29 - 2025-05

Netherlands: A recent study published in the International Journal of Gynecology & Obstetrics sheds light on the cost-effectiveness of two commonly used interventions for managing persistent postpartum hemorrhage (PPH)-intrauterine balloon tamponade and uterine artery embolization. While both approaches showed similar overall costs, the study highlights that balloon tamponade, being less invasive and easier to administer, may be a more practical and accessible first-line option, particularly in settings with limited resources.
The study analyzed the cost-effectiveness of two primary interventions for managing persistent postpartum hemorrhage (PPH): intrauterine balloon tamponade and uterine artery embolization. The findings suggest that while both strategies have similar financial implications, intrauterine balloon tamponade may offer practical advantages due to its less invasive approach.
Persistent PPH, defined as postpartum bleeding unresponsive to initial treatments, remains a significant cause of maternal morbidity. In the study, Lisanne R. Bonsen, Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands, and colleagues conducted a cost comparison between two clinical management strategies by retrospectively analyzing a matched cohort of women who underwent either intrauterine balloon tamponade (scenario 1) or uterine artery embolization (scenario 2).
The study involved a propensity score-matched sample of 100 women, with 50 patients in each group.
The key findings of the study were as follows:
In the balloon tamponade group, bleeding was successfully controlled in 29 women, accounting for 58% of the group.
The average cost per patient in this group was approximately 7060 Euros, with a standard deviation of 2846 Euros.
In the embolization group, 42 women (84%) experienced successful bleeding control.
The mean cost per patient in this group was 7122 Euros, with a standard deviation of 2918 Euros.
Both groups had the same rate of peripartum hysterectomy, with six women (12%) undergoing the procedure in each group.
The cost difference between the two approaches was minimal, with balloon tamponade being 62 Euros less expensive on average.
The negligible cost difference suggests that factors beyond economics should influence the choice of intervention.
Despite the slightly higher success rate of embolization, the researchers argue that intrauterine balloon tamponade is a favorable option. Its minimally invasive nature, ease of application, and potential for earlier use in the treatment pathway make it a practical first-line approach, especially in settings with limited access to interventional radiology services.
The study concludes that while both methods demonstrate near-equivalent costs and outcomes, intrauterine balloon tamponade should be considered a frontline strategy due to its safety profile and operational convenience. These findings could have significant implications for obstetric care protocols, particularly in resource-constrained environments.
"Overall, the research highlights the importance of integrating clinical effectiveness with cost considerations to optimize maternal health outcomes," the researchers wrote.

Women's Health Month: Multi-institutional study highlights role of robotic-assisted surgery in reshaping gynaecological care in India

2025-05-28 - 2025-05

As India observes Women's Health Month, a study conducted across five tertiary care hospitals by analysing the data of surgeries performed by using the da Vinci technology over a decade is shedding light on how robotic-assisted surgery (RAS) is steadily transforming gynaecological care across the country. The study documents a significant rise in the use of robotic surgery for both benign and malignant conditions and is significant for its implications on access, recovery, and surgical outcomes for women.
The multi-institutional study-'Trends in Gynecological Robotic Surgery in India: A Real-World Scenario'-analyzed data from ten years across five hospitals: Apollo Health City (Hyderabad), PGIMER (Chandigarh), Manipal Hospital (Bengaluru), Narayana Health (Bengaluru), and Tata Memorial Hospital (Mumbai). Notably, over 70% of robotic gynaecological procedures took place in the final five years, indicating a strong upward trajectory.
"Women's Health Month is a time to reflect on how surgical technology innovations like the da Vinci robotic technology are enhancing healthcare outcomes for women," said Dr. Rooma Sinha, Honorary Professor and Chief Gynaecologist at Apollo Health City, Hyderabad, one of the surgeons who oversaw the study. "Robotic-assisted surgery is increasingly being used to manage benign gynaecological conditions such as fibroids and endometriosis, offering enhanced precision and improved outcomes across a wide range of cases."
Many studies across the globe show reduced blood loss and faster recovery times for robotic-assisted surgery compared to other modalities. The patients in this study similarly experienced minimal blood loss and faster recovery times. Dr. Sinha, who is also the Founder-President of Association of Gynecological Robotic Surgeons, noted that "Even in cases involving large fibroids or endometriosis, we were able to keep blood loss low, recovery times short, and port-site pain/discomfort minimal. That matters a lot in a country like India, where patients often travel long distances for care and want to return home quickly."
Patient body mass index (BMI) was comparable across both groups, suggesting that RAS outcomes are consistent regardless of weight. Improvements were also noted in surgical workflow, including reductions in docking time as teams became more experienced.
"We have seen that with robotic procedures, women often spend less time in the hospital and experience fewer complications related to blood loss," said Dr. Vanita Jain, Head of Obstetrics and Gynaecology at PGIMER, Chandigarh, who was also part of the study. "It is not just about using new technology-it is about making recovery more manageable, especially for women who are balancing responsibilities at home and work."
The study found that fibroids were the most common benign indication for robotic surgery, followed by endometriosis, adenomyosis, vault prolapse, and ovarian cysts. These conditions often require careful dissection and suturing, particularly when fertility preservation is important.
"Myomectomy, or the removal of fibroids while preserving the uterus, especially calls for such precision," explained Dr. Subhas C Saha, Professor, Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, another key facilitator of the study. "Advanced robotic systems like the da Vinci platform offer us better visualisation and manoeuvrability, which can make a real difference in these challenging cases."
While more public and private insurers are beginning to include robotic-assisted surgery (RAS) in their coverage, the study highlights that there is still room to improve affordability and access. To optimise value and accessibility, surgeons are refining techniques-using fewer robotic arms and incorporating multifunctional instruments-to reduce costs while still delivering high-quality care and better patient outcomes.
"Given the clear benefits demonstrated in studies like this, there is a strong case for insurance payers to further expand coverage for robotic-assisted surgery. Broader, streamlined reimbursement support can help ensure more women across India have access to advanced surgical options," Dr. Saha added.

New Study Suggests Hormone Therapy May Improve Certain Heart Health Markers in Menopausal Women

2025-05-20 - 2025-05

There has been a lot of chatter in and out of the scientific community about the use of hormone therapy for women in menopause. Preliminary results released in 2003 from the Women's Health Initiative (WHI) clinical trial linked hormone therapy used to treat symptoms of menopause to a higher risk of developing serious health conditions, including heart disease and stroke. But research since then has found flaws in those findings.
Now, new research adds to the evidence challenging those initial findings on hormone therapy and heart health: It found that women in menopause who took oral hormone therapy showed improvements in certain biomarkers of cardiovascular health, including cholesterol.
Here's what the research found, plus why hormone therapy may help heart health in menopause.
What did the study find?
The study, which was published in the journal Obstetrics & Gynecology, analyzed data from the WHI, which is a long-term national study focused on menopausal women. The researchers analyzed biomarkers linked with cardiovascular health in nearly 2,700 women over a six-year period.
The women were broken into two groups: Those who took estrogen and those who took a combination of estrogen and progesterone. The women were between the ages of 50 and 79. They provided blood samples at the start and various other times during the study.
The researchers discovered that hormone therapy had a positive impact on certain cardiovascular biomarkers in the group that took estrogen, as well as those who took estrogen and progesterone. Specifically, levels of LDL ("bad" cholesterol) dropped by about 11%, while total cholesterol and insulin resistance (when your body's cells don't respond as well to the hormone insulin) also dropped.
Levels of HDL (or "good" cholesterol) increased by 13% in the estrogen-only group and 7% in the estrogen-progesterone group.
Levels of a cholesterol molecule called lipoprotein(a) dropped by 15% and 20% in the estrogen-only and the estrogen-plus-progesterone groups. This finding surprised researchers because the molecule is believed to be mostly influenced by genetics.
There was one noteworthy unfavorable outcome: Triglycerides and coagulation factors, which are proteins in the blood that help form blood clots, increased, which is a potential downside of hormone therapy. For this reason, if you have a history of blood clots, it's extra important to talk to your healthcare provider before taking hormone therapy.
Interestingly, the study found that, with the exception of triglycerides, hormone therapy had positive effects regardless of age, which contrasts to prior findings. "A lot of data suggests that the safest time to give hormone therapy is within 10 years of the menopause transition," Dr. Streicher says. Still, the study concludes that the results may be used to counsel younger menopausal women with bothersome symptoms, likely because broader research shows that it's safest to start hormone therapy closer to when menopause starts. (Note: hormone therapy isn't FDA approved to treat the risk of coronary artery disease or stroke.)
Why is hormone therapy in menopause controversial?
It traces back to the early 2000s when those preliminary results were published from the WHI that linked hormone therapy to a higher risk of developing serious health conditions like heart disease and stroke. The study was actually stopped as a result and many women have avoided hormone therapy to treat symptoms of menopause since.
But the preliminary conclusions were later debunked. Other researchers analyzed the data and discovered that the original study looked at women who were 65 and up who already had a greater risk of heart attack, stroke, blood clots, and more-and that had skewed the data.
The preliminary findings also didn't look at how old the women were when they started hormone therapy, which further muddled the results, explains Lauren Streicher, M.D., a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine.
In May 2024, a follow-up to the WHI study was released in JAMA with the conclusion that hormone therapy "is appropriate" for those with vasomotor symptoms (which could include hot flashes, for example) for interested women in early menopause without any contraindications.

Use of hair, cosmetic products linked to increased phthalate exposure in pregnancy

2025-05-19 - 2025-05

Frequent use of hair products and cosmetics during pregnancy may increase exposure to phthalates-endocrine-disrupting chemicals linked to adverse birth outcomes-according to findings presented at the 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting.1,2
The study analyzed data from 153 participants in the Atlanta African American Maternal-Child Cohort, focusing on a population that faces higher rates of adverse pregnancy outcomes, including preterm birth. Researchers assessed the relationship between personal care product (PCP) use and urinary phthalate levels early in pregnancy.
Phthalates, commonly found in PCPs such as cosmetics, hair relaxers, and moisturizers, are a known concern for reproductive health. While previous studies have explored phthalates in the general population, few have focused on whether PCP use contributes to phthalate levels of emerging concern, particularly during pregnancy.
Urine samples collected from participants between 8 and 14 weeks of gestation were tested for 12 individual phthalate metabolites. In addition, participants completed questionnaires about the frequency of their personal care product use. Researchers then applied linear regression models to evaluate associations between PCP use and urinary concentrations of several phthalate groups, including the sum of di(2-ethylhexyl) phthalate metabolites (SDEHP), di(isononyl) phthalate metabolites (SDINP), antiandrogenic phthalate metabolites (SAA), and specific individual metabolites such as monocarboxyisononyl phthalate (MCINP).
Results showed that individuals who reported more frequent PCP use had significantly higher urinary phthalate levels. Monthly hair product use was associated with a statistically significant increase in antiandrogenic phthalates (SAA), with a beta coefficient of 0.8 (95% CI, 0.02 to 1.57). Meanwhile, participants who reported weekly or daily use of hair relaxers had significantly lower concentrations of SDEHP (β = -0.16; 95% CI, -0.48 to -0.03), compared with those who did not use relaxers.
Cosmetic use was particularly associated with elevated levels of several phthalates. Users had significantly higher concentrations of SDEHP, SAA, and MCINP compared to non-users.
These findings underscore a potential modifiable exposure risk during early pregnancy. "Among African American pregnant persons, more frequent use of hair products and cosmetics was associated with a significant increase in urinary concentration of phthalates," the authors concluded.
Given the associations between phthalate exposure and adverse birth outcomes-including preterm birth-researchers emphasized the importance of patient counseling on safer product choices. Reducing the use of phthalate-containing personal care products could serve as a practical strategy to limit exposure during pregnancy.
The study adds to a growing body of evidence suggesting that product formulation and personal care routines can influence maternal health and prenatal environmental exposures.

Early Placement of Postpartum Hemorrhage control Devices improves Outcomes: Study

2025-05-18 - 2025-05

Researchers have found similar outcomes in terms of blood loss, transfusion rates, and device failure in a study comparing two postpartum hemorrhage-control devices; intrauterine balloon tamponade and vacuum-induced devices. However, earlier placement of either device significantly reduced the need for transfusion and the likelihood of device failure, highlighting the importance of timely intervention. The study was conducted by Shields L. and fellow researchers published in Obstetrics & Gynecology journal.
The research was conducted under a quality improvement initiative to improve postpartum hemorrhage management. Data were collected prospectively from August 2022 to February 2024, during 123,292 deliveries, of which 5,931 (4.8%) had postpartum hemorrhage. Hemorrhage-control devices were utilized in 666 cases (11.2%), intrauterine balloon tamponade being used in 300 cases and vacuum-induced devices in 366 cases. The key outcomes measured were quantitative blood loss following device placement, requirement for packed red blood cell (RBC) transfusion, transfusion of 3 or more RBC units, and failure of the device.
The research employed a standardized three-stage postpartum hemorrhage response protocol. Hemorrhage-control devices were used in stage 2 or 3 of the protocol. Quantitative blood loss was quantitated, and the proportions of blood transfusion, utilization of 3 or more RBC units, and device failure were compared.
Key Findings
The median quantitative blood loss during device placement was 194 mL (67-440 mL) for intrauterine balloon tamponade and 240 mL (113-528 mL) for vacuum-induced devices (P=0.40).
Packed RBC transfusion rates were 59.7% for balloon tamponade and 50.0% for vacuum devices (P=0.08).
3 or more RBC units transfusion was 27.0% of tamponade cases and 24.9% of vacuum device cases (P=0.53).
Failure rates for devices were 7.7% for tamponade and 8.5% for vacuum (P=0.70).
Preceding device insertion at blood loss of 1,000-1,499 mL decreased RBC transfusion rates (39.1% vs 70.3%, P<.001), requirement for 3 or more RBC units (13.7% vs 38.1%, P<.001), and device failure (3.4% vs 12.9%, P<0.001).
The study authors concluded that prior placement of hemorrhage-control devices during postpartum hemorrhage greatly reduces blood transfusion needs and device failure. Both intrauterine balloon tamponade and vacuum-induced devices worked, but timing is all about maximizing outcomes.

PICO sNPWT Significantly Reduces C-Section Complications, Lowers Cost, Study Finds

2025-05-14 - 2025-05

A single-use negative pressure wound therapy (sNPWT) device developed by Smith+Nephew significantly reduced postsurgical complications, including infections, wound separation, and seroma compared with another sNPWT system, according to a study.1
The retrospective cohort study, published in WOUNDS, also highlights meaningful cost savings and improved emotional and physical recovery outcomes for new mothers, particularly those at high risk.
"Postpartum is already a very vulnerable period for mothers, even without complications," said study coauthor, Tia Welsh, MD, chair of obstetrics and gynecology, Valley Medical Group, in a statement. "SSCs [surgical site complications] add physical pain, prolonged recoveries, emotional distress, and disrupt critical early bonding with newborns. These interruptions carry emotional and practical burdens, increasing the risks of postpartum depression, anxiety, and trauma-costs that can't be captured in dollars alone."
The study utilized patient data encompassing inpatient claims from a geographically diverse mix of US community and teaching hospitals between January 2017 and June 2022.2 Adult patients undergoing Cesarean (C-section) deliveries were identified using International Classification of Diseases, 10th Edition, Procedure Coding System codes and hospital billing charge descriptions for sNPWT devices set at either -80 mm Hg or -125 mm Hg. Patients treated with both devices and those with preexisting surgical site complications (SSCs), open wounds, multiple surgeries within 30 days, or inadequate follow-up were excluded.
Primary outcomes included incidence of SSCs at 30 and 90 days, as well as health care resource utilization metrics such as length of stay and cost.
The study revealed that Smith+Nephew's PICO sNPWT device was associated with significantly better clinical outcomes and lower health care costs for patients recovering from C-sections compared with another sNPWT device.1 Real-world data from over 10,000 patients who underwent C-section showed that use of PICO sNPWT led to statistically significant reductions in overall surgical site infections (SSIs) (P = .018), superficial SSIs (P = .017), wound dehiscence (P = .005), and seroma formation (P = .050).
Complementing these clinical findings, a patient survey highlighted the broader human impact of postsurgical complications. Mothers who experienced SSCs were 5-times more likely to describe their recovery as traumatic, over 50% reported depression, and they were 5.4 times more likely to struggle with breastfeeding. Furthermore, 66.3% said their complications negatively affected bonding with their newborn.
"We've long understood the benefits of NPWT in surgical recovery, but this is the first large-scale study to directly compare different pressure levels in a real-world setting," said the study's lead author Annmarie Vilkins, DO, director of obstetrics and gynecology, Henry Ford Health, in a statement. "We found that PICO sNPWT showed significantly improved outcomes through optimizing pressure, fluid management, and skin adhesion. Its unique design helped maintain a high moisture vapor transmission rate supporting an ideal healing environment for recovery, particularly critical for high-risk incisions like C-sections under skin folds, where moisture buildup can lead to infection."
In addition to clinical advantages, the study demonstrated that use of the PICO sNPWT device offered significant economic value. Compared with another sNPWT device, PICO was associated with a 3.8% reduction in mean index admission costs and an estimated cost savings of $728,220 per 1000 patients (P < .001). These savings are particularly meaningful given that SSIs alone contribute to more than $900 million in health care costs annually.

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