A recent Obstetrics & Gynaecology digest,
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Study Type: Population-based cohort study

Key Question: Does centre surgical volume affect severe postoperative complications following posterior deep infiltrating endometriosis surgery?

Key Findings:

• Centres performing ≥40 posterior deep infiltrating endometriosis surgeries annually had lower severe complication rates (3.6% vs 5.3% in low-volume centres)
• High-volume centres showed 17% reduced odds of severe complications (aOR 0.83, 95% CI 0.70-0.99, p=0.03)
• Overall severe complication rate was 4.3% across 15,364 procedures in France (2021-2023)

Clinical Relevance: This supports centralising complex endometriosis surgery to high-volume centres, aligning with RCOG guidance on subspecialist endometriosis services and informing NHS commissioning decisions for tertiary endometriosis centres.

Limitations: Administrative database coding may not capture all complications or accurately reflect surgical complexity variations between centres.

Study Type: Retrospective cohort study

Key Question: What is the long-term risk of developing overt hypothyroidism in women with subclinical hypothyroidism and/or thyroid peroxidase antibodies identified during pregnancy?

Key Findings:

• Over 25 years, 33.1% (238/718) of women with antenatal thyroid abnormalities developed overt hypothyroidism versus 10.2% (12/118) of normothyroid controls (p<0.001)
• Highest risk in women with both subclinical hypothyroidism and TPO antibodies: 52.9% (82/155) progressed to overt hypothyroidism
• Women with isolated subclinical hypothyroidism (25.0%) or isolated TPO antibodies (28.4%) had lower but still elevated risk compared to controls

Clinical Relevance: This supports implementing long-term thyroid surveillance protocols for women with antenatal thyroid abnormalities, as their risk of developing overt hypothyroidism is nearly three times higher than normal controls over decades.

Limitations: Single-centre study from a public health system may limit generalisability to broader UK NHS populations.

Study Type: Terminology consensus statement/guideline

Key Question: What is the updated 2026 ISSVD classification system for vulvar intraepithelial neoplasia and squamous intraepithelial lesions?

Key Findings:

• Classification now requires p16 and p53 immunohistochemistry to distinguish HPV-associated (HPVa) from HPV-independent (HPVi) disease
• HPVa disease uses two-tier system: VIN for cancer precursors versus LSIL/condyloma for transient manifestations
• HPVi disease introduces new category "vulvar aberrant maturation" (VAM) for lesions of uncertain neoplastic potential in lichen sclerosus, with HPVi VIN subcategorised by p53 status

Clinical Relevance: This updated classification provides UK gynaecologists with a standardised, evidence-based framework for vulvar pathology that should improve diagnostic accuracy, guide treatment decisions, and optimise surveillance strategies for cancer prevention.

Limitations: This represents consensus opinion rather than evidence from comparative studies validating the clinical utility of the new classification system.

Study Type: Retrospective cohort study

Key Question: Are maternal anti-HLA antibody levels associated with fetal growth restriction?

Key Findings:

• FGR occurred in 22.0% of women with high anti-HLA antibody levels (≥1000) versus 15.3% with lower levels
• High antibody levels independently associated with FGR (aOR 1.57, 95% CI 1.02-2.41)
• Antibody levels increased with parity and decreased with time since last pregnancy

Clinical Relevance: This provides potential mechanistic insight into unexplained FGR cases, suggesting alloimmune pathways may contribute to placental dysfunction in a subset of UK patients with otherwise idiopathic growth restriction.

Limitations: Retrospective design using blood donor cohort limits generalisability and prevents establishing causation.

Study Type: Prospective cohort study

Key Question: How do reproductive factors and lifestyle behaviours interact to influence cognitive decline risk in Chinese postmenopausal women?

Key Findings:

• Early menopause (<46 years: OR 2.55, 95% CI 1.07-6.06; 46-50 years: OR 2.32, 95% CI 1.11-4.83) and prolonged breastfeeding (>35 months: OR 2.15, 95% CI 1.02-4.51) independently increased cognitive decline risk
• Women with early menopause plus poor lifestyle factors (physical inactivity, insufficient vegetables, suboptimal sleep) had substantially higher cognitive decline risks (ORs 1.76-2.15)
• Significant additive interactions existed between early menopause and physical inactivity (attributable proportion 51%) and between prolonged breastfeeding and physical inactivity (attributable proportion 42%)

Clinical Relevance: This suggests UK clinicians should consider targeted lifestyle counselling for women with early menopause or extended breastfeeding history as part of cognitive health promotion strategies in postmenopausal care.

Limitations: Short follow-up period (1.8 years) may not capture longer-term cognitive changes, and findings from Chinese women may not be directly generalisable to UK populations.

Study Type: Retrospective disproportionality analysis using FDA adverse event surveillance data

Key Question: What hepatic adverse events are reported with fezolinetant in real-world postmarketing surveillance?

Key Findings:

• Among 1,282 fezolinetant reports, hepatic adverse events showed disproportionate reporting signals, predominantly transaminase elevations (ALT, AST) rather than clinically severe liver injury
• Median time-to-onset for hepatic events was 77 days (IQR: 30-149), with early failure pattern suggesting events occur relatively soon after treatment initiation
• Compared to other hepatotoxic drugs and hormone therapies, fezolinetant showed higher reporting signals for laboratory abnormalities but less consistent severe clinical hepatic outcomes

Clinical Relevance: UK clinicians prescribing fezolinetant for menopausal vasomotor symptoms should implement baseline liver function assessment and early monitoring protocols, given the signal for transaminase elevations in the first few months of treatment.

Limitations: Pharmacovigilance data cannot establish causality and may be subject to reporting bias and confounding factors.

Study Type: Cross-sectional analysis

Key Question: What are the trends and risk factors for methamphetamine and opioid co-use among pregnant individuals entering substance use disorder treatment in the United States?

Key Findings:

• Methamphetamine and opioid co-use among pregnant individuals more than doubled from 2.8% to 6.1% between 2011-2023, while opioid co-use with other substances declined
• Homelessness and rehabilitation admission were associated with higher risk of methamphetamine co-use
• Higher education and employment were protective factors against methamphetamine co-use

Clinical Relevance: This highlights an emerging polysubstance use pattern that UK obstetric teams should be aware of, as methamphetamine use may present different maternal and fetal risks compared to other substances, requiring tailored antenatal care approaches.

Limitations: US data may not be directly applicable to UK populations due to different healthcare systems, social contexts, and substance availability patterns.

Study Type: Retrospective cohort study

Key Question: What is the variation in postdischarge opioid prescribing patterns across hospitals for women having vaginal births with associated procedures (operative delivery or third/fourth-degree tears)?

Key Findings:

• Overall opioid prescription rate was low at 1.8%, but varied significantly by procedure: 11.6% for third/fourth-degree tears vs lower rates for operative deliveries
• Substantial inter-hospital variation existed, particularly for third/fourth-degree tears (0-66.7% prescription rate across hospitals) and operative births (25-135 oral morphine equivalents prescribed)
• Median prescription amount was 60 oral morphine equivalents overall, highest for operative births (75 OMEs)

Clinical Relevance: This highlights significant inconsistency in postpartum opioid prescribing practices across UK maternity units, suggesting need for standardised guidelines to ensure appropriate pain management while avoiding over-prescribing.

Limitations: Retrospective design cannot assess appropriateness of prescribing decisions or patient-reported pain outcomes.