Obstetrics & Gynecology

Single-gene NIPT panels show very high accuracy but remain screening tests

This systematic review and meta-analysis included 10 studies with 12,577 pregnancies undergoing NIPT panels for dominant single-gene disorders. Pooled positivity was low at 2.2%, but positive results were highly reliable with a PPV of 93.8%. Sensitivity reached 94.5% and specificity 99.7%, with an AUC of 0.98, indicating excellent discrimination. Positivity rates were highest in high-risk populations, but accuracy remained strong across risk strata. 1

PAS risk after myomectomy is elevated but similar across surgical approaches

This systematic review and meta-analysis synthesized 76 studies with 11,065 pregnancies after myomectomy with documented surgical route. Overall PAS prevalence after myomectomy was about 1–2%, higher than the 0.17% background rate in the general obstetric population. PAS prevalence numerically peaked after open myomectomy (2%) but did not differ significantly from laparoscopic, robotic, or hysteroscopic approaches. Postpartum hemorrhage, placenta previa, abruption, and uterine rupture showed similarly low prevalence across routes. 2

GLP-1RA plus progestin linked to large reductions in endometrial cancer and hysterectomy

This TriNetX cohort compared 18,414 women receiving GLP-1RA plus progestin with 426,406 on progestin alone for benign uterine disease or endometrial hyperplasia. GLP-1RA plus progestins was associated with substantially lower endometrial cancer risk than progestin monotherapy (HR 0.34, 95% CI 0.27–0.44). Risk reduction was consistent across progestin routes, baseline risk levels, BMI, and age strata. Combination therapy and triple therapy also reduced endometrial cancer compared with metformin-based regimens and lowered hysterectomy rates at 2 and 5 years. 3

Transdermal testosterone does not improve IVF pregnancy rates in diminished ovarian reserve

This triple-blind RCT randomized 288 women with diminished ovarian reserve to ~9 weeks of 5.5 mg transdermal testosterone or placebo before IVF. All patients underwent a standardized long GnRH-agonist protocol with high-dose hMG and fresh embryo transfer when available. Clinical pregnancy rates were nearly identical (15.7% testosterone vs 14.9% placebo; RR 1.05, 95% CI 0.61–1.81). A prespecified interim futility analysis prompted early termination, making a clinically meaningful benefit very unlikely. 4