Journal of Clinical Gynecology & Obstetrics
Editor-in-Chief Jose Antonio Carugno, MD, FACOG, Professor, Department of Obstetrics & Gynecology, Miller School of Medicine, University of Miami, Miami, Florida, USA Read more Journal of Clinical Gynecology & Obstetrics | ISSN 1927-1271 print | ISSN 1927-128X online | Quarterly | Open Access | Aims and Scope Indexed and covered by: Scopus; Worldcat; Google; Google Scholar; JournalTOCs; PubMed: selected citations only (NIH supported articles). Journal archiving and digital preservation: Portico Article Publishing Charge (APC): Free publication
Does Office Hysteroscopy Add Value in Polycystic Ovary Syndrome Patients With Normal Transvaginal Ultrasound Findings?
Background: This cross-sectional study evaluated the utility of office hysteroscopy in infertile women with polycystic ovary syndrome (PCOS) and normal transvaginal ultrasonography (TVS), compared with unexplained infertility (UI). Methods: Between December 2021 and December 2024, 150 women were enrolled: 100 with PCOS and 50 with UI. All underwent clinical and hormonal assessment, office hysteroscopy, and endometrial sampling. Results: In the PCOS group, hysteroscopy identified a thin endometrium (4%), a tiny polyp (1%), and a sub-septate uterus (1%), while a thin endometrium was found in 8% of UI cases. Vascularity abnormalities and Darwish triad micropolyps were observed in both groups. Histopathology revealed chronic endometritis with micropolyps, disordered proliferative endometrium, and occasional hyperplasia, more frequently in PCOS. Conclusions: No significant clinical correlations were found. Routine hysteroscopy is not recommended in women with normal TVS but may be useful in selected long-standing infertility to detect subtle intrauterine pathology.
Copyright (c) 2026 Atef M.M. Darwish, Mohamed M. Fathalla, Ahmed N. Fetih, Nermin M. Elsaid, Dina Darwish, Ahmed A. Abden https://creativecommons.org/licenses/by-nc/4.0
A Case of Normal Uterus With Bicollis and Vaginal Septum: A Challenge to the Classical Theory of Mullerian Duct Fusion
Mullerian duct abnormalities (MDAs) are common, known to occur in 5% of women and can be categorized using a number of different classification systems, including those from the American Society for Reproductive Medicine (ASRM) or the European Society of Human Reproduction and Embryology (ESHRE). The most popular developmental theories assume that Mullerian duct fusion begins caudally then extends cranially. However, these theories cannot explain isolated cervical or vaginal MDA. Our case of a 20-year-old with isolated cervical duplication and longitudinal vaginal septum but normal uterus, diagnosed at the time of hysteroscopy, calls into question this hypothesis, instead supporting the theory of segmental or bidirectional fusion of the Mullerian ducts.
Copyright (c) 2026 Lewis Nancarrow, Beth Hankinson, Marwa Fakhreldin https://creativecommons.org/licenses/by-nc/4.0
Detection of AI Influence Within Women’s Health Literature
Background: The extent of large language models (LLM) being used to generate or edit medical literature without disclosure remains unknown. This study hypothesizes LLM influence and aims to quantify possible usage and disclosure rates in recent women’s health publications. Methods: Eighty women’s health journals were selected at random, and the first 20 publicly available abstracts from January through December 2025 were included from each journal. After selection for inclusion, a total of 1,600 abstracts were downloaded in addition to subspecialty categories, journal impact factor, and continent of corresponding authors. Abstract text was then individually inputted into GPTZero, an artificial intelligence (AI) detection software, to quantify percentages of sourced text that were human-generated, AI-generated, or AI-edited. Manuscripts with AI detected in their abstracts were then evaluated for disclosure of AI use. Source percentages were compared across subspecialties, impact factors, and continents, with significance defined as P < 0.05. Results: Of the 1,600 abstracts, 413 (25.8%) were flagged as containing AI influence. Additionally, 79 out of 413 (19.1%) abstracts were identified as entirely AI-generated and 21 out of 413 (5.1%) abstracts disclosed AI use. Abstracts in journals related to reproductive endocrinology and infertility were most often flagged for AI influence (35%, 77/220), whereas family planning-related abstracts showed the lowest proportion (6.7%, 4/60) (P < 0.05). A weak inverse association between impact factor and AI use was observed, but this relationship was not significant and explained only 4% of data variability for AI use (R2 = 0.04). No difference across continents and AI detection was found (P = 0.45). Conclusion: Findings suggest that AI may contribute to approximately one-quarter of published women’s health abstracts in 2025. This early signal underscores potential prevalence of LLM usage and low disclosure rates highlighting the need for clear guidelines and transparency regarding AI use in scholarly communication. Ongoing discussions are needed to outline responsible implementation to harness AI’s potential while maintaining the integrity of medical research.
Copyright (c) 2026 Hanna R. Perone, Anna Greenwood, Kaitlyn Zablock, Bernard Gonik https://creativecommons.org/licenses/by-nc/4.0
Incidence and Maternal Outcomes After Emergency Department Hysterotomy in the Setting of Trauma
Background: Trauma in the pregnant patient remains a challenge due the anatomic and physiologic changes that occur. In the setting of extremis, including cardiac arrest, a resuscitative hysterotomy (RH) may be performed to save the life of the mother and often the fetus. The incidence and maternal outcomes of RH in the setting of trauma remain poorly described. Methods: We analyzed data from the Trauma Quality Improvement Program (TQIP) data registry for any encounter that had documented female sex, diagnosis of pregnancy, and a procedure that involved removal of fetal contents from the uterus in the emergency department (ED). Results: From 2017 to 2023, there were a total of 8,014,737 total encounters, of which 142 RH procedures occurred in the ED and met inclusion for this analysis. The median maternal age was 27 years (interquartile range (IQR) 22–31, range 16–44). There were 86 (61%) that went straight from the ED to the operating room. The majority received at least one unit of blood products in the first 4 h. The median time from arrival to procedure start was 25 min (IQR 12–50) with the fastest being immediately upon arrival. There were 125 (88%) that had signs of life on arrival. For other resuscitation procedures, there were 48 (34%) that were intubated, one that had a resuscitative endovascular balloon placed, 25 (18%) that received cardiopulmonary resuscitation (CPR), and six (4%) that received a resuscitative thoracotomy. Among those with documented prehospital cardiac arrest, two (10%) survived to hospital discharge. Among those with documented ED CPR, one (4%) survived to hospital discharge. Among those with no signs of life on arrival, none survived to hospital discharge. Conclusions: RH was exceedingly rare and was associated with a high risk of maternal mortality.
Copyright (c) 2026 Elizabeth Blake Bogin, Michael D. April, Jonathan S. Hirshberg, Steven G. Schauer, Julie A. Rizzo https://creativecommons.org/licenses/by-nc/4.0
Rethinking Treatment Options in Lumbosacral Endometriosis: Positive Outcomes With Hormonal Therapy in Four Cases
Neural endometriosis can be a rare form of deep infiltrating endometriosis (DIE) involving the plexus lumbosacralis, often causing neuropathic pain and pelvic organ dysfunction. Traditionally, surgical excision has been the primary treatment approach; however, hormonal therapy is gaining preference due to its lower morbidity. This study aims to assess the effectiveness of hormonal therapy for this condition. This retrospective case series included four women treated at the Endometriosis Center Charite, all of whom had imaging- or histologically confirmed lumbosacral endometriosis. The patients received either hormonal therapy alone or a combination of hormonal therapy and surgery. Symptom progression was evaluated from clinical records and classified using a four-point symptom severity scale for pain, organ dysfunction, and mobility. Outcomes were illustrated using heat maps to compare symptom severity before and after treatment. Four patients with imaging- or histologically confirmed lumbosacral endometriosis were included in this case series. All four patients received hormonal therapy. Two of the patients were treated exclusively with uninterrupted hormonal treatment and did not undergo surgery; both experienced significant symptom relief and achieved full functional recovery. The other two patients required surgical intervention due to severe disease manifestations, which included motor deficits or organ obstruction. Although surgery resulted in pain reduction, their neurological recovery was incomplete, and they continued to experience persistent motor or sensory deficits. In both cases, ongoing postoperative hormonal therapy led to further improvement in their symptoms. The most favorable outcomes were observed in the two patients who received uninterrupted hormonal treatment without surgery, both of whom achieved full functional recovery. In this case series, hormonal therapy effectively alleviated symptoms of lumbosacral endometriosis, often with fewer complications than surgery. Surgical intervention may be required when nerve compression causes motor impairment or if hormonal therapy fails. Early and ongoing hormonal treatment seems to be a safe and effective approach for reducing pain and organ-related dysfunction while maintaining quality of life.
Copyright (c) 2026 Carlotta Isabella Zitzmann, Sylvia Mechsner https://creativecommons.org/licenses/by-nc/4.0
Advanced Electrosurgical Bipolar Vessel Sealing to Control Intraoperative Bleeding in Hysterectomy: A Rapid Review and Meta-Analysis
Background: Controlling intraoperative bleeding during hysterectomy is crucial and various methods exist to do this. Advanced electrosurgical bipolar vessel sealing (ABVS) may lead to improved outcomes compared to other hemostatic techniques. This rapid review aims to address the question “what is the clinical and cost effectiveness of ABVS compared with standard care for controlling intraoperative bleeding in hysterectomy?” Methods: Medline, Embase, CINAHL, KSR Evidence, Cochrane Library, and the International Network of Agencies for Health Technology Assessment (INAHTA) HTA database were searched up to February 2025. Forward citation searching of included studies was conducted in Scopus. Systematic reviews and randomized controlled trials (RCTs) comparing ABVS to standard care for controlling intraoperative bleeding during abdominal, laparoscopic, or vaginal hysterectomies were included. Outcomes extracted included blood loss, operative time, complications, length of hospital stay, patient-reported pain, blood transfusions, health-related quality of life, resource use, and economic outcomes. Meta-analyses were conducted for each type of hysterectomy and pooled effect sizes were analyzed. Studies were synthesized narratively if not included in meta-analyses. Results: One systematic review, one HTA, and 15 RCTs met the eligibility criteria. Meta-analyses found statistically significant differences in favor of ABVS over suturing for vaginal hysterectomy operative time and patient-reported pain the evening after surgery, abdominal hysterectomy blood loss and risk of requiring blood transfusion, and in favor of ABVS over conventional electrosurgical bipolar vessel sealing for total laparoscopic hysterectomy operative time. Two studies showed significantly lower blood loss with ABVS during subtotal laparoscopic hysterectomy. There were no statistically significant differences in other outcomes. A cost-consequence analysis from the UK perspective demonstrated high upfront costs associated with ABVS; however, potential cost savings were associated with reduced suture usage and lengths of hospital stay. Conclusions: Use of ABVS during hysterectomy may lead to some improved outcomes compared to suturing or other energy devices; however, many outcomes are similar between methods. A lack of economic evidence means economic consequences are uncertain. Use of ABVS should be based on the type of hysterectomy performed, complexity of individual patients, and surgeons’ familiarity with devices.
Copyright (c) 2025 Greg M. Hammond, Rebecca Boyce, Nathan Bromham, Ryan Miller, Elise Hasler, Miroslava Slavska https://creativecommons.org/licenses/by-nc/4.0
Multifocal Ovarian Leiomyosarcoma Presenting With Ambiguous Imaging and Rapid Progression: A Diagnostic Dilemma
Uterine sarcomas are rare, aggressive tumors with high recurrence rates and nonspecific presentations, making preoperative diagnosis difficult. Leiomyosarcoma with ovarian involvement is particularly uncommon and can mimic primary ovarian malignancy. A postmenopausal woman presented with progressive abdominal pain and unsteady gait. Examination revealed abdominal distension and tenderness. Imaging demonstrated a large heterogeneous pelvic mass with pelvic free fluid and bilateral inguinal lymphadenopathy, raising suspicion for ovarian malignancy. Laboratory testing revealed elevated cancer antigen 125 (CA-125). Imaging was inconclusive regarding the primary origin. The patient underwent exploratory laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, tumor debulking, and cholecystectomy. Histopathology confirmed multifocal high-grade leiomyosarcoma involving both ovaries, fallopian tube, mesosalpinx, and pelvic sidewall implant, with positive margins. No uterine histological involvement was noted. Surveillance imaging revealed rapid recurrence with peritoneal and nodal metastases. The patient commenced single-agent doxorubicin chemotherapy. This case highlights the diagnostic ambiguity, aggressive course, and need for early multidisciplinary management in leiomyosarcoma.
Copyright (c) 2026 Alexander Restum, Munna Hazime, Danielle Krause https://creativecommons.org/licenses/by-nc/4.0
Seasonal Variation in Maternal Vitamin D Levels on Neonatal Outcomes: A Systematic Review
Emerging evidence suggests that inadequate vitamin D levels in pregnant mothers can adversely affect fetal development, pregnancy outcomes, and maternal health. This systematic review analyzes current research to gain a better understanding of the association between seasonal variation in maternal vitamin D levels and differing, potentially adverse, fetal outcomes. A systematic search was conducted across four databases; combinations of keywords and/or MeSH guided the literature search, yielding 1,852 articles that were screened and included if the study focused on seasonal variation in maternal vitamin D levels with associated neonatal outcomes. Full text review was performed by four reviewers on 39 articles, yielding a finalized total of 11 articles. The results of this systematic review supported that, across a vast array of geographic locations, vitamin D levels in pregnant women were, on average, consistently highest during the summer and lowest in the winter. However, the relationships between maternal vitamin D status and select neonatal outcomes including small for gestational age (SGA), preterm birth, and low birth weight were inconsistent. These discrepancies most likely result from external factors including geographic latitude and resulting sun exposure, limited supplementation, cultural conventions, and maternal demographics. Additionally healthcare access and public health policies cannot be overlooked; thus, vitamin D deficiency amongst pregnant women, especially in areas with limited sun exposure, needs to be prioritized and addressed via clinician intervention and public health services and programs, and further research is needed to refine these protocols to reduce global vitamin D deficiency and its associated, potentially adverse, outcomes.
Copyright (c) 2026 Natalie Aguilar, Sara Ellias, Allison Rakowski, Morgan Schafer https://creativecommons.org/licenses/by-nc/4.0
Awareness Without Counseling: Missed Opportunities for Clinical Communication on Pre-Exposure Prophylaxis of Reproductive Age Females in the USA
Background: Pre-exposure prophylaxis (PrEP) has emerged as a highly effective strategy for human immunodeficiency virus (HIV) prevention, yet uptake remains disproportionately low among women and racially minoritized populations. This study aims to understand how PrEP counseling in clinical settings has changed over time and how it affected PrEP awareness in reproductive age females in the USA. Methods: Using the National Survey of Family Growth data set, this was a cross-sectional study of two survey cycles (2017–2019 (n = 6,141) and 2022–2023 (n = 5,586)). The primary outcome was awareness of PrEP, with secondary outcomes including reported provider counseling on PrEP, counseling and prescribing of contraception, and current use of contraception. Analyses were performed with Stata 18.5 (StataCorp, College Station, TX), and accounted for complex survey design. Results: Between 2017–2019 and 2022–2023, respondent reported awareness of PrEP increased from 31.8% to 36.6% (odds ratio (OR) = 1.24; 95% confidence interval (CI) = 1.04–1.47), while reported provider counseling rates remained unchanged (5.2% vs. 4.8%; OR = 0.91; 95% CI = 0.70–1.19). In 2022–2023, awareness among Hispanic women was significantly lower (24.9%) than among non-Hispanic white (42.0%) respondents (OR = 0.46; 95% CI = 0.36–0.58). Conclusions: This research demonstrates that public awareness of PrEP increased though provider counseling rates were unchanged. However, when accounting for language preference, Spanish-speaking women had less awareness than English speakers. This raises the concern that provider-patient interactions are ineffectively utilized, especially in non-English speakers, and highlights the need to optimize healthcare systems.
Copyright (c) 2026 Eric Ganz, Whitney Irie, Erica Hardy, Heidi Chang, Lawren Wellisch, Stephen Wagner, Benjamin Brown https://creativecommons.org/licenses/by-nc/4.0
The Relationship Between Branched-Chain Amino Acid Levels and Gestational Diabetes Mellitus in Low-Risk Pregnant Women
Background: Gestational diabetes mellitus (GDM) represents one of the most prevalent medical complications in pregnancy. The prevalence of GDM in society is increasing. The aim of GDM screening is to make an early diagnosis in order to prevent complications associated with GDM. The aim of our study was to investigate the effectiveness of branched-chain amino acid (BCAA) in the diagnosis of GDM by comparing the second-trimester serum BCAA concentrations between low-risk primigravid women with and without GDM. Methods: The study included a total of 110 primigravida evenly split between the GDM group (n = 55) and the control group (n = 55). The age, pre-pregnancy and test weights, body mass index, and demographic data of the participating pregnant women were recorded. Serum concentrations of BCAA in the fasting and postprandial states of the pregnant women were measured, and serum BCAA concentrations were compared between groups. Results: In our study, no significant differences were found between the two groups in terms of demographic data and anthropometric characteristics. Pregnant women diagnosed with GDM had significantly higher postprandial valine levels compared to the control group, with values of 168.5 ± 46.8 vs. 138.5 ± 35.9 (P = 0.001), fasting leucine levels of 82.9 ± 16.1 vs. 67.4 ± 18.7 (P < 0.001), postprandial leucine levels of 95.3 ± 34.2 vs. 57.7 ± 21.4 (P < 0.001), fasting isoleucine levels of 44.5 ± 9.7 vs. 37.7 ± 13.6 (P = 0.003), and postprandial isoleucine levels of 51.8 ± 19.2 vs. 34.6 ± 28.0 (P < 0.001). No significant difference was observed between the groups in terms of fasting valine (P = 0.990). Conclusion: According to the results of our study, fasting and postprandial BCAA levels were found to be higher in the primigravid women with GDM in the low-risk group at 24–28 weeks compared to the control group. These findings suggest that there may be an association between maternal serum BCAA levels and GDM between 24 and 28 weeks of gestation.
Copyright (c) 2026 Gizem Sayar, Elcin Islek Secen, Raziye Desdicioglu, Ceylan Bal, Gulsen Yilmaz https://creativecommons.org/licenses/by-nc/4.0
Association Between Post-Trigger Hormones and In Vitro Fertilization Cycle Outcomes
Background: Numerous studies have evaluated the association between estradiol and progesterone levels on the day of trigger administration and cycle outcomes; however, less is known about serum hormone levels following trigger and whether they are associated with cycle outcomes. This study was conducted to assess the association between serum steroid hormone parameters on the day after oocyte maturation trigger and ovarian stimulation cycle outcomes. Methods: This was a retrospective cohort study. All patients undergoing ovarian stimulation with the use of gonadotropins between September 2018 and September 2020 were assessed for inclusion. Chart review was performed to collect demographic information, cycle and trigger type, pre- and post-treatment serum hormone levels (estradiol, progesterone), and cycle outcomes. The primary outcomes were oocyte recovery rate, oocyte maturity rate, oocyte fertilization rate, and blastulation rate. Results: A total of 320 cycles were included in the study from 245 unique patients; 19% of cycles utilized a gonadotropin-releasing hormone (GnRH) agonist stimulation protocol and 81% utilized a GnRH antagonist stimulation protocol. Post-trigger progesterone level was associated with poor oocyte recovery, but not with oocyte maturity, fertilization, or blastulation rates. Post-trigger estradiol levels were not associated with oocyte recovery rate, oocyte maturity rate, fertilization rate, or blastulation rate. Conclusions: This is one of few studies evaluating the association between estradiol and progesterone levels on the day after trigger injection and oocyte stimulation cycle outcomes. Our findings suggest that the association between post-trigger progesterone levels and poor oocyte recovery rate may be small but meaningful.
Copyright (c) 2026 Olivia B. Chafitz, Anat Chemerinski, Swata Gade, Evelyn Minis, Patricia Greenberg, Peter G. McGovern, Sara S. Morelli https://creativecommons.org/licenses/by-nc/4.0
Spontaneous Hemoperitoneum in Advanced Maternal Age Pregnancy
Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but serious condition. Risk factors include endometriosis, in vitro fertilization (IVF), prior pelvic surgeries, and advanced maternal age (AMA). We report a 41-year-old female at 36 weeks’ gestation who presented with severe abdominal pain and non-reassuring fetal heart rate. Urgent cesarean delivery (CD) revealed hemoperitoneum. Clear amniotic fluid pointed to an extra-uterine source: bleeding from the posterior uterine serosa. While prompt surgical intervention in this case ensured maternal-fetal safety, the potential value of imaging to improve earlier recognition and diagnosis is discussed. This case underscores the need to consider SHiP in pregnancies lacking other known risk factors and presenting with unexplained abdominal symptoms.
Copyright (c) 2025 Elizabeth Stiles, Linda Zambrano Guevara, Andrew Rubenstein https://creativecommons.org/licenses/by-nc/4.0
Are Transobturator Slings as Durable as Retropubic Slings?
Background: Retropubic midurethral slings (RP-MUS) have demonstrated durable long-term outcomes, with 10-year studies confirming high continence and low complication rates. Transobturator midurethral slings (TO-MUS) have a potential advantage over RP-MUS in terms of a lower risk of bladder perforation and voiding dysfunction; however, data on long-term durability are limited, with few large, long-term cohort studies available. The aim of the study was to evaluate long-term subjective cure, reoperation, and complication rates after TO-MUS placement and to contextualize these outcomes relative to established retropubic (RP) durability data. Methods: This is a retrospective cohort study of 295 women who underwent TO-MUS surgery performed by a single high-volume surgeon between 2010 and 2014. Demographics, surgical details, and follow-up outcomes (subjective cure, reoperation, complications) were abstracted. Statistical analyses included Chi-square tests and logistic regression. Results: Nineteen percent of patients had ≥ 10 years of follow-up. Follow-up duration ranged from less than 1 month to 12.44 years, with a median of 3.0 years. At 10 years, 76.8% reported continued continence. The overall reoperation rate was 6.8%, including recurrent stress urinary incontinence (4.1%) and mesh-related complications (2.4%). Intraoperative bladder perforation occurred in 1.3% of cases, self-limited urinary retention in 9.2%, and postoperative urinary retention requiring reoperation in 0.3%; no significant bleeding events were observed. No independent predictors of recurrence or reoperation were identified. Conclusions: In this large single-surgeon cohort, TO-MUS demonstrated durable long-term continence rates and low reoperation rates, with outcomes comparable to published RP series. These findings support TO-MUS as a safe and effective alternative to RP-MUS.
Copyright (c) 2026 Mushka Kaye, Rachel Caskey, Margot Barker, Karyn S. Eilber https://creativecommons.org/licenses/by-nc/4.0
Acute Fatty Liver of Pregnancy or Atypical Presentation of Homolysis, Elevated Liver Enzymes, Low Platelets Syndrome: The Dilemma Continues
We report a case of a 28-year-old female in her first pregnancy at 31 + 1 weeks gestation who presented with upper abdominal pain and vomiting. Her pregnancy was complicated with gestational diabetes and she was newly started on metformin. On presentation, she complained of abdominal pain and vomiting. She was hypoglycemic, acidotic and bloods revealed hepatorenal failure and coagulopathy. A differential diagnosis of acute fatty liver of pregnancy (AFLP), atypical homolysis, elevated liver enzymes, low platelets (HELLP) or lactic acidosis from metformin was made. The patient was promptly delivered by cesarean section under general anesthetic. The post-delivery course was complicated with an intensive care unit (ICU) stay with worsening hepatorenal function, hypertension, and encephalopathy. A multidisciplinary approach was employed resulting in significant improvement by the 6-week follow-up, with blood parameters nearly normalized. Despite retrospective analysis, clinicians still face a diagnostic dilemma with varying opinions on the definitive diagnosis.
Copyright (c) 2025 Samah Ballal, Bidisha Ghosh https://creativecommons.org/licenses/by-nc/4.0
Impact of Severe Male Factor Infertility on In Vitro Fertilization-Intracytoplasmic Sperm Injection Outcomes: A Retrospective Cohort Study
Background: Severe male factor infertility presents challenges in assisted reproductive technology (ART). This study evaluated whether severe male factor infertility impacts clinical pregnancy outcomes following in vitro fertilization-intracytoplasmic sperm injection (IVF-ICSI) compared to non-male factor cases. Methods: In this retrospective cohort study at the Department of Reproductive Medicine and Surgery, SAT Hospital, Government Medical College, Thiruvananthapuram, couples undergoing IVF-ICSI between January 2017 and December 2020 were divided into severe male factor (group 1, n = 51) and non-male factor (group 2, n = 51) groups, matched for female age, body mass index, and ovarian reserve. Outcomes compared included clinical pregnancy rates (CPRs) based on sperm source (ejaculated vs. surgically retrieved) and male factor type (severe oligoasthenoteratozoospermia vs. azoospermia). Statistical analysis utilized univariate and multivariate logistic regression. Results: The overall CPR was 75.5%. Group 1 (severe male factor) achieved a CPR of 68.6%, while group 2 (non-male factor) achieved 82.4%, a difference that was not statistically significant (P = 0.107). Within group 1, no significant differences were found between outcomes using ejaculated versus surgically retrieved sperm (P = 0.393). Logistic regression showed lower odds of pregnancy with severe male factor infertility (odds ratio 0.469, 95% confidence interval: 0.185 - 1.190), but this was not statistically significant (P = 0.111). Conclusion: Severe male factor infertility, including cases requiring surgical sperm retrieval, does not significantly compromise CPRs in IVF-ICSI cycles when female factors and treatment protocols are optimized.
Copyright (c) 2025 Sholen Acharya, Sheila Balakrishnan, Reji Mohan, Deepak Rath https://creativecommons.org/licenses/by-nc/4.0
Reflections on the Challenges of Infertility-Based Randomized Controlled Trials
Successful randomized clinical trials (RCTs) are considered the gold standard in clinical research, but require sufficient recruitment, adequate sample size, appropriate participant selection, pre-defined outcomes, and transparent reporting of outcomes. Infertility-related RCTs harbor a unique set of logistical and ethical challenges, as highlighted by our multicenter RCT evaluating clinical differences in low-dose versus high-dose gonadotropin in poor responders undergoing assisted reproductive technology. This is a descriptive review and reflections of frequent difficulties faced by researchers while conducting RCTs and their implications, as well as potential solutions when conducting this type of research. While our RCT in poor responders undergoing in vitro fertilization (IVF) failed to demonstrate superior clinical outcomes with high-dose versus low-dose gonadotropins, the study was significantly underpowered. Despite this, our results help underscore universal difficulties in the recruitment, conduct, and publication of RCTs. We review our challenges and suggest available tools to aid in recruitment and enhance trial completion. Recruitment, conducting, and publishing an RCT have numerous challenges, particularly in an infertile population, which are not unique to our study. Addressing these barriers, despite the shortcomings, provides significant value to the scientific community.
Copyright (c) 2026 Peter Kovacs, Summer Crawford, Saira Kothari, Nigel Pereira, Jose Carugno, Steven R. Lindheim https://creativecommons.org/licenses/by-nc/4.0
Uterine Fibroid Embolization in Patient With Symptomatic Uterine Leiomyomas in Uterine Didelphys
Uterine didelphys is a rare congenital anomaly resulting from compete failure of Mullerian duct fusion, occurring in 0.5-5% of women. Its coexistence with uterine leiomyomas is extremely uncommon, with an estimated prevalence of 0.0026%. Surgical treatments such as hysterectomy or myomectomy are commonly used for uterine fibroid treatments. However, Uterine fibroid embolization (UFE) is a minimally invasive, fertility-sparing alternative that remains underutilized. We report a case of a 41-year-old Vietnamese woman who presented with abnormal uterine bleeding and pelvic pain and was found to have uterine didelphys with bilateral symptomatic fibroids. Magnetic resonance imaging (MRI) confirmed large fibroids in both uteri, with the largest measuring 14 × 11 × 1cm on the left side. Following consultation with the patient, and given her preference for a non-surgical option, she underwent successful UFE via selective embolization of both uterine arteries using Terumo (Terumo Company, Tokyo, Japan) Hydropearls 200 - 400 µm microspheres. Post-angiographic embolization of the uterine fibroids confirmed complete occlusion of the fibroid vascular supply, and a post-embolization MRI is scheduled for 3 months after the procedure. The patient tolerated the procedure well with no complications. This case highlights the effectiveness of UFE in a patient with the rare co-occurrence of uterine didelphys and symptomatic leiomyomas. UFE offers a safe, minimally invasive alternative to surgery even in complex cases, and should be more widely considered in eligible patients.
Copyright (c) 2025 Nicole T. Stambo, Glenn W. Stambo https://creativecommons.org/licenses/by-nc/4.0
A Randomized Controlled Trial Comparing Intracytoplasmic Sperm Injection and Conventional In Vitro Fertilization Outcomes in Patients With Advanced Maternal Age
Background: The most widely used fertilization treatment globally is intracytoplasmic sperm injection (ICSI), which is now indicated for a broader range of conditions. This study was designed to assess the outcomes of ICSI and conventional in vitro fertilization (c-IVF) specifically in advanced maternal age (AMA) patients. Methods: This randomized controlled study included 70 women aged 39 - 44 years with a body mass index (BMI) of 18 - 35 kg/m2 and partners with normal semen parameters. After informed consent, each patient’s ovaries were randomized before stimulation: oocytes from one ovary (n = 250) underwent ICSI, and those from the other (n = 250) underwent conventional IVF. Results: The average daily gonadotropin dose was 351.5 IU, with ovarian stimulation lasting about 9.7 days. Baseline follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were 9.1 and 4.9 IU/L, respectively. Semen parameters included a volume of 2.1 mL, concentration of 72.5 million/mL, 59.7% motility, and 5.2% normal morphology. An average of 7.1 oocytes were retrieved per patient. In the ICSI and c-IVF groups, 71.2% and 72.4% of oocytes formed zygotes, with similar cleavage and top-quality embryo rates. Embryo transfers occurred in 54.8% (ICSI) and 57.6% (c-IVF) of cases. No substantial disparities were detected between the groups concerning their clinical and ongoing pregnancy rates. Conclusions: In women aged 39 - 44 with normal sperm parameters, this study found no substantial variation in fertilization, embryo quality, or pregnancy rates between ICSI and c-IVF. Thus, ICSI offers no clear advantage over c-IVF in this population, suggesting that c-IVF remains a viable and effective option for patients with AMA.
Copyright (c) 2025 Yasser Abdelbaseer Hashim, Mohamed S. Salem https://creativecommons.org/licenses/by-nc/4.0
Microbiome Dysbiosis in Lichen Sclerosus: A Systematic Review
Background: Lichen sclerosus (LS) is a chronic, inflammatory skin condition primarily affecting the vulvar and perineal areas, often causing pain, pruritus, and scarring. While vulvar and vaginal microbiome composition is understood to contribute to genital health, their relationship with LS pathogenesis is unclear. Recent studies also suggest that gut microbiome imbalances may influence LS via systemic immune modulation. This systematic review aimed to characterize microbial alterations in the vulvar, vaginal, and gut microbiomes of LS patients and explore potential mechanisms linking dysbiosis to disease progression. Methods: A systematic search was conducted using five databases: EMBASE, Medline via Ovid, Web of Science, PubMed, and CINAHL. Eligible studies included female patients diagnosed with LS and assessed the primary outcome of vulvar and vaginal microbiome composition. Gut microbiome data were considered a secondary outcome of interest. Following an initial double-blind screening, eight full-text articles were reviewed in the secondary screening, and seven articles were ultimately included in this review. Results: Seven studies met the inclusion criteria. Across the vulvar, vaginal, and gut microbiomes, consistent patterns emerged, including reductions in protective taxa, such as Firmicutes and Lactobacillus, and increases in pro-inflammatory microbes, including Proteobacteria. Vulvar samples also showed higher abundances of Enterobacteriaceae, Peptoniphilus, and Campylobacter. Gut microbiome alterations included reduced short-chain fatty acid-producing bacteria, such as Firmicutes and Bacteroides, in addition to elevated Proteobacteria and Rikenellaceae. Alpha diversity findings were variable, and species-level changes were often inconsistent. Conclusions: Microbial dysbiosis of the vulvar, vaginal, and gut microbiomes may contribute to the development of LS through chronic inflammation, compromised epithelial barriers, and disrupted immune function. While some alterations in the microbiomes were identified, discrepancies between the results of these studies highlight the need for larger, standardized studies to better understand the relationship between the microbiome and LS pathophysiology.
Copyright (c) 2025 Sydney K. Risman, Una Milovanovic, Derek S. Weimer, Tanya Ramadoss, Michelle L. Demory https://creativecommons.org/licenses/by-nc/4.0
A Case of Mucous Membrane Pemphigoid Masquerading as Lichen Planus
Mucous membrane pemphigoid (MMP) is a rare, autoimmune blistering disease that affects mucosal surfaces and can mimic other inflammatory dermatoses such as erosive lichen planus (LP), lichen sclerosus, and pemphigus vulgaris. Diagnosis is challenging due to overlapping clinical and histopathological features, especially when hematoxylin and eosin (H&E) staining reveals nonspecific lichenoid changes. We report the case of a 79-year-old woman with a 2-year history of therapy-resistant vulvar erosions, pruritus, and pain. Initial physical exam performed by gynecology noted a focal erosion of the introitus. A vulvar biopsy showed lichenoid infiltrate with scattered eosinophils. She was initially treated with clobetasol 0.05% ointment and tacrolimus 0.1% ointment for presumed LP, without clinical improvement. The patient had also developed erosions of the oral and nasal cavities, in addition to conjunctival injection and symblepharon, prompting a biopsy of the left conjunctiva by her ophthalmologist. Direct immunofluorescence (DIF) of the conjunctiva showed linear deposits of IgG, IgA, and C3 at the basement membrane zone, consistent with MMP. Upon referral to our vulvar dermatology clinic, she was receiving rituximab infusions for her MMP and applying clobetasol 0.05% ointment to her nasal, oral, and genital ulcers. Despite improvement in the nasal and oral ulcers, vulvovaginal pruritus and pain persisted. Exam in our office was notable for well demarcated pink patches on the bilateral medial labia majora with erosions beginning in the introitus and extending into the vagina with surrounding white hyperkeratotic epithelium. Architectural changes were seen including labial agglutination, partial clitoral phimosis, and introital stenosis. Given vaginal and introital involvement, she was started on nightly hydrocortisone 25 mg vaginal suppositories and halobetasol 0.05% ointment to be applied to the labia and introitus. At follow-up, the patient reported significant improvement in pain with minimal pruritus and notable improvement of the erosions and erythema. This case uniquely contributes to the literature by highlighting the diagnostic challenges of vulvar MMP and emphasizing the importance of maintaining a high clinical suspicion for MMP when lichenoid features are present on H&E, especially in the setting of extra-genital mucosal erosions. Early recognition and diagnostic confirmation with DIF are paramount for ensuring timely treatment initiation and prevention of irreversible disease progression.
Copyright (c) 2025 Sierra R. Parkinson, Sabah Osmani, Sarah B. Corley https://creativecommons.org/licenses/by-nc/4.0
Racial and Ethnic Differences in Trial of Labor After Cesarean Attempts and Vaginal Birth After Cesarean Success Rates: A Retrospective Single-Health System Study
Background: Despite risks associated with repeat cesareans, only 14% of deliveries in the United States were vaginal births after cesareans (VBACs) in 2023. Current research demonstrates that women from minority groups are less likely to be offered a trial of labor after cesarean (TOLAC). The purpose of this study was to determine whether removal of race/ethnicity distinctions from the Maternal-Fetal Medicine Units (MFMU) Network’s VBAC calculator in 2021 resulted in a more equitable distribution of TOLAC and higher VBAC rates. Methods: Retrospective data of patients with a previous cesarean delivery were gathered from January 2017 to June 2024, which was then analyzed utilizing Chi-squared tests and logistic regression models. Results: Overall, 1,905 births were included, of which, 25.62% of patients identified as Hispanic and 12.65% identified as Black. Successful VBAC occurred in 516 (27.09%) births, and 1,389 deliveries were repeat cesareans (72.91%). Importantly, TOLAC rates increased after MFMU’s calculator changes. However, Black patients still had lower odds of VBAC compared to White patients after the calculator change. When evaluating reasons listed as to why patients had a failed TOLAC, it was more often attributed to maternal status for Black patients than White patients. Conclusions: Although changes in MFMU’s VBAC calculator are correlated with increased attempted TOLAC in both Black and Hispanic patients, racial disparities in rates of successful VBAC persist.
Copyright (c) 2025 Olivia Foley, Shannon Blee, Rebecca Hammond, Kallin Hermann, Claire Malhotra, Danielle B. Dilsaver, Megan Kalata https://creativecommons.org/licenses/by-nc/4.0
Spontaneous Adrenal Hemorrhage in Pregnancy
Spontaneous adrenal hemorrhage (SAH) is a rare condition that may lead to life-threatening adrenal insufficiency or adrenal crisis if not addressed appropriately. Abdominal pain during pregnancy has a broad differential diagnosis, which includes SAH. There are very few studies on the precipitating factors, management, and optimal mode of delivery. We present a 32-year-old multiparous woman who presented at 33 weeks of gestation with right-sided flank pain. The initial ultrasound of the abdomen was unremarkable. The diagnosis of SAH was made by magnetic resonance imaging (MRI) of the abdomen, and the patient management included analgesia, serial hemoglobin assessments, and clinical examination which resulted in uncomplicated vaginal delivery. She was followed up with endocrinology at 3 months with plan for repeat MRI of the abdomen. SAH, although rare, is an important consideration when evaluating abdominal and flank pain during pregnancy. It is a challenging diagnostic and therapeutic condition. The management options vary from conservative management to surgical intervention depending on the stability of the patient. A multidisciplinary team (MDT) approach is a very crucial aspect of diagnosis and management of this rare condition.
Copyright (c) 2025 Marvi Memon, Donald Wilson, Isioma Okolo, Amy Wang https://creativecommons.org/licenses/by-nc/4.0
Comparative Analysis of Intracervical Dinoprostone Gel and Vaginal Misoprostol for Labor Induction in a Primigravida at Term
Background: The study addresses critical aspects of contemporary obstetric practices regarding labor induction in primigravida at term, focusing on the effectiveness and safety of intravaginal misoprostol (25 µg every 6 h for a maximum of four doses) and dinoprostone gel (0.5 mg every 6 h for a maximum of three doses). Methods: It was a prospective interventional study. Inclusion criteria were: primigravida with an indication for labor induction, gestational age of 37 weeks or more, estimated fetal weight < 3.5 kg, Bishop score < 6 indicating an unfavorable cervix, singleton fetus, cephalic presentation, reactive fetal heart rate pattern, and patient consent. Exclusion criteria were: previous cesarean section uterine surgery, cephalo-pelvic disproportion, malpresentations, evidence of fetal distress pre-induction, grand multipara, fetal anomalies, intrauterine death, allergy to prostaglandins, major degree of placenta previa, and estimated fetal weight > 3.5 kg. Both the agents were compared in terms of: change in Bishop score (depending upon the doses of drugs and contractions), induction to active phase of labor, induction to delivery interval, total duration of labor, intrapartum complications (tachysystole, chorioamnionitis, rupture uterus), mode of delivery, fetal outcome at birth (fetal distress-hypoxia, bradycardia, meconium-stained liquor) Apgar score, postpartum complications like postpartum hemorrhage, and puerperal sepsis. Prospective interventional study was conducted among 200 primigravida women after meeting the strict inclusion and exclusion criteria of the hospital. Groups A and B were randomized with 100 patients each and maternal and fetal outcomes were studied. Partogram was used for monitoring and oxytocin was used as per necessity. Maternal and fetal outcomes were studied. Results: The average gestational age was 38.74 ± 1.03 weeks, with a range of 37 to 41 weeks. The mean pre-induction Bishop score was 4.39 ± 1.02, with scores ranging from 2 to 6. The average total duration of labor experienced by these participants was 13.94 ± 4.43 h. The predominant indication for labor induction was identified as intrahepatic cholestasis of pregnancy (IHCP), accounting for 35.5% of cases. Subsequently, postdatism was the second most prevalent reason at 22.5%, followed by pregnancy-induced hypertension (PIH) at 19.5%. It was noted that the majority of pregnant women, approximately 90%, required only one to two doses of inducing agents, either intravaginal misoprostol or dinoprostone gel. While both agents were effective in initiating labor, intravaginal misoprostol demonstrated superiority in expediting labor progression and reducing the duration of labor. Both the agents exhibited comparable rates of neonatal and maternal complications, highlighting their overall safety and efficacy in clinical practice. In terms of the need for oxytocin in both groups, there was a statistically significant difference demonstrating better efficacy of misoprostol than dinoprostone gel. Conclusions: While both intravaginal misoprostol and dinoprostone gel were successful in inducing labor, our results showed that intravaginal misoprostol was superior in several important areas.
Copyright (c) 2025 Geeta Jamwal, Minakshi Rana, Raghu Naina Sharma https://creativecommons.org/licenses/by-nc/4.0
Impact of Suspending Elective Inductions of Labor on Maternal and Fetal Outcomes
Background: In July 2021, an academic institution suspended elective inductions of labor (eIOL) after 39 weeks. Our objective was to determine how this policy impacted cesarean delivery rate and time on labor and delivery. Methods: A retrospective chart review was conducted of singleton, cephalic pregnancies delivering between 39 and 41 weeks, during the 6 months before and after the policy change. Results: From January 20, 2021, to January 29, 2022, there were 386 eligible deliveries, 50.3% before and 49.7% after the policy change. There was no statistical reduction in total inductions after the policy change restricting eIOL (67.5% vs. 62.0%, P = 0.287). Time on labor and delivery was similar (20.8 ± 13.0 vs. 20.6 ± 11.7 h, P = 0.800). Cesarean delivery rates were unchanged (14.4% vs. 15.1%, P = 0.887). Conclusions: Induction rates were not impacted by the policy. This suggests physicians found alternative non-elective reasons for induction. There were no significant differences in time spent on labor and delivery or cesarean delivery rate. The study was a convenience sample and not powered for definitive outcome differences.
Copyright (c) 2025 Taylor Scutari, Christopher Morosky, Jonathan P. Shepherd https://creativecommons.org/licenses/by-nc/4.0
Role of Vaginal Bromocriptine in Symptomatic Management of Adenomyosis
Background: Adenomyosis is a non-malignant uterine condition causing heavy bleeding, pelvic pain, and dysmenorrhea, greatly affecting women’s lives. Although its cause is unclear, prolactin may be involved. Treatments vary, with no standard approach. Recent studies suggest that vaginal bromocriptine, a prolactin blocker, may reduce symptoms and improve quality of life. This was a retrospective, single-center study that evaluated the effectiveness and the psychosocial impact of adenomyosis. Methods: We retrospectively reviewed reproductive-aged women with adenomyosis, heavy menstrual bleeding (HMB), and dysmenorrhea, all with pictorial blood loss assessment chart (PBLAC) scores > 100, treated with 5 mg vaginal bromocriptine daily. Exclusions included pregnancy, lactation, < 6 months postpartum, fibroids, endometriosis, or prior bromocriptine use. Data collected encompassed demographics, PBLAC scores, numeric pain rating scale (NPRS) for pain assessment, and perceived stress scale (PSS) evaluations from case notes. Results: Among 52 patients (median age 39, interquartile range (IQR) 36 - 45 years), no side effects were reported with vaginal bromocriptine. The PBLAC scores dropped significantly from 235 (220 - 320) at baseline to 232 (220 - 315) at 3 months (P = 0.806), with continued decline. The NPRS scores and stress levels improved notably by 6 months. Ultrasound at 6 months showed significant improvement in vascularity (P = 0.001), junctional zone (P = 0.045), and myometrial thickening (P = 0.014) in those with lesions. Conclusion: Vaginal bromocriptine was well tolerated, with significant reductions in pain, bleeding, stress, and sonographic changes in adenomyosis. These results suggest that it could be an effective alternative treatment.
Copyright (c) 2025 Mita Mandal, Subhankar Sarkar, Subrat Panda, Vineet Kumar Kamal https://creativecommons.org/licenses/by-nc/4.0
Relationship Between Characteristics and Risk Factors in Postoperative Surgical Wound Infections in Cesarean Section Patients
Background: Cesarean section rates have increased globally, with Indonesia showing a rise from 6.5% in 2016 to 16.5% in 2021. Although cesarean deliveries reduce certain risks, they also present the risk of surgical site infections (SSIs), a leading cause of postpartum infections. This study explores the relationship between patient characteristics and SSI following cesarean sections at Hasan Sadikin General Hospital, Bandung. Methods: This study used an analytical observational design with a retrospective case-control approach. Data were collected from the medical records of patients who underwent cesarean sections from January 2022 to January 2023. The sample consisted of 23 cases of patients with SSI and 46 controls. The analysis was performed using the Chi-square test and multivariate logistic regression. Results: Body mass index (BMI) and urinary tract infection (UTI) during pregnancy were found to be significant risk factors for SSI, with P-values of 0.019 and 0.001, respectively. UTI is the most significant risk factor with an adjusted odds ratio (aOR) of 6.48 (95% confidence interval (CI) 1.7 - 64.5). Overweight and obesity also showed a higher risk, with an aOR of 10.1 (95% CI 1.6 - 64) and 4.07 (95% CI 1.0 - 18.4), respectively. Other characteristics such as age, parity, history of anemia, diabetes mellitus, preeclampsia, premature rupture of membranes, previous cesarean section, and the type of cesarean incision were not significantly associated with SSI. Conclusion: Obesity and UTI during pregnancy are significant risk factors for SSI in post-cesarean section patients. Strict monitoring and preventive interventions for these conditions during pregnancy should be implemented to reduce SSI incidence and improve maternal and infant health after cesarean section.
Copyright (c) 2025 Ayrton Fajar, M. Alamsyah Aziz, Siti Salima, Nasheeha Wening Reza https://creativecommons.org/licenses/by-nc/4.0
Intrapartum Terbutaline Use and Cesarean Delivery for Labor Dystocia
Background: Terbutaline, a β2-adrenergic agonist used to inhibit uterine contractions, is often used to treat fetal heart rate abnormalities, but whether its use increases the risk of labor dystocia remains understudied. Therefore, we sought to assess the association between intrapartum terbutaline use and cesarean delivery (CD) for labor dystocia. Methods: We performed a secondary analysis of a single-center prospective cohort study of patients undergoing induction of labor (IOL) at an urban academic hospital from 2013 to 2015. Participants were singleton, full term with intact membranes, and Bishop score of ≤ 6 and dilation ≤ 2 cm undergoing IOL for any indication. Patients with prior CD were excluded. Patients who received terbutaline at any time during their IOL were compared to patients who did not receive terbutaline. The primary outcome was CD due to labor dystocia (defined as failed IOL, arrest of dilation, or arrest of descent). Results: Of 844 patients, 161 (19%) received terbutaline and 683 (81%) did not. Though the overall rate of CD was higher in the terbutaline group (51% exposed vs. 24% unexposed, P < 0.001), this was primarily driven by CD for fetal distress (26% exposed vs. 4% unexposed, P < 0.001). There was no difference in CD for labor dystocia (24.8% exposed vs. 19.5% unexposed, P = 0.13). Latent phase of labor was longer in the terbutaline group (11.8 h exposed vs. 10.4 h unexposed, P = 0.02), whereas the active phase and second stage of labor were similar between groups. Conclusion: Terbutaline use during labor was not associated with a statistically significant higher risk of CD due to labor dystocia among patients undergoing term IOL.
Copyright (c) 2025 Cecilia B. Leggett, Lisa Levine, Melissa Wong, Jennifer A. McCoy https://creativecommons.org/licenses/by-nc/4.0
Human Metapneumovirus as a Cause of Severe Respiratory Illness in the Second Trimester of Pregnancy: Two Cases
Despite being a fairly common cause of respiratory infection in adults, there have been few reported cases of human metapneumovirus (hMPV) in pregnancy. Other viruses, such as influenza, have been heavily reported on, and it is well established that these illnesses are detrimental to the pregnant population. However, we currently have limited data about hMPV’s effect. First, we discuss the case of a patient who presented to the emergency department in the second trimester with severe shortness of breath and was ultimately diagnosed with hMPV. Second, we discuss the case of a patient who presented as an intensive care unit transfer in the second trimester in severe respiratory distress with a positive test for hMPV at the outside facility. These cases highlight the fact that inpatient management might be needed to treat hMPV in pregnant patients, even for those without a significant prior respiratory medical history. Given the limited number of published cases of hMPV in the antepartum patient population, we hope to provide guidance for management of such cases and highlight the importance of prompt diagnosis in pregnant populations.
Copyright (c) 2025 Manvitha Manyam, Cameron Jackson, Amalia Brawley, Martha Cohen, Harold Katner, Padmashree C. Woodham https://creativecommons.org/licenses/by-nc/4.0
A Challenging Case of Malignant Struma Ovarii With Concurrent Papillary Thyroid Cancer
Struma ovarii is a rare type of ovarian tumor that is predominantly composed of thyroid tissue. The majority of these are benign, with malignant struma ovarii (MSO) comprising only 5-10% of all cases. A 41-year-old female with a history of ovarian cystectomy for bilateral dermoid cysts presented with gallstone pancreatitis. Computed tomography (CT) scan revealed adnexal masses, peritoneal nodules, and a thyroid nodule. Surgery, including total hysterectomy and salpingo-oophorectomy, showed MSO and differentiated follicular carcinoma. Subsequent thyroidectomy revealed multifocal papillary thyroid carcinoma. Postoperative radioactive iodine therapy was given, and the patient has recovered fully. MSO may present as an ovarian mass, and the mainstay treatment is surgical resection. The rarity of this condition requires a multidisciplinary approach for optimal management. MSO should be considered in the differential diagnosis of ovarian masses. Early and accurate diagnosis, followed by appropriate surgical and adjuvant therapies, can lead to favorable outcomes.
Copyright (c) 2025 Angelica Stephanie K. Munoz, Jeffrey Jen Hui Low https://creativecommons.org/licenses/by-nc/4.0
Socioeconomic, Demographic, and Provider Determinants of Staged Versus Concomitant Surgery for Pelvic Organ Prolapse and Stress Urinary Incontinence
Background: While concomitant surgery for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) may benefit patients, variability exists in practice. A better understanding of the decision-making process regarding the placement of mid-urethral slings (MUSs) in women undergoing POP surgery is crucial for achieving equitable surgical planning and patient counselling. This study assessed factors associated with staged vs. concomitant SUI surgery in patients undergoing POP surgery. Methods: This retrospective cohort study used 100% Medicare Standard Analytical Files from 2016 to 2020. The sample population consisted of female patients surgically treated for POP with staged (within 24 months) or concomitant mid-urethral sling (MUS). Data were merged with the Agency for Healthcare Research and Quality (AHRQ) Social Determinants of Health Database. Multivariable logistic regression was used to assess independent associations between patient, location, and surgeon characteristics and the likelihood of staged versus concomitant procedures. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results: Among 40,842 patients with POP surgery, 96.7% (39,440) had concomitant, while 3.4% (1,402) had staged MUS. Most were aged 65 - 74 years (67.2%), Caucasian (91.7%), from urban areas (91.9%), and had Charlson Comorbidity Index ≤ 3 (82.3%). A higher likelihood of staged surgery was seen in White vs. other racial groups (example OR: 1.50 vs. Black, 95% CI: 1.03 - 2.18); in the South vs. other regions (example OR: 1.55 vs. Northeast, 95% CI: 1.26 - 1.91); and for obstetrics/gynecology vs. urologic surgeons (OR: 1.19, 95% CI: 1.02 - 1.40). Patients in counties with lower per capita income (OR: 1.02, 95% CI: 1.01 - 1.03), lower proportions of foreign-born (OR: 1.01, 95% CI: 1.01 - 1.05), limited English-speaking (OR: 1.03, 95% CI: 1.01 - 1.05), or uninsured (< 64 years of age; OR: 1.02, 95% CI: 1.00 - 1.03) households had higher likelihood of receiving staged surgery. Conclusions: This study identified several demographic, socioeconomic, and surgeon-related factors associated with staged vs. concomitant MUS procedures among patients undergoing surgery for POP. The reasons for these differences are not fully understood and may reflect various underlying factors, including differences in communication, regional or specialty norms, patient choice, or other factors.
Copyright (c) 2025 Jaime B. Long, Krista Reagan, Ryoko Sato, Shunaha Kim-Fine, Kristen A. Gerjevic, Sarah Boyd, Olubiyi Aworunse, Cara L. Grimes https://creativecommons.org/licenses/by-nc/4.0