Obstetrics & Gynecology

Intrauterine hCG Before Embryo Transfer Does Not Improve IVF Outcomes

This individual participant data meta-analysis included seven trustworthy RCTs with 2,244 IVF participants receiving intrauterine hCG vs placebo/no intervention before embryo transfer. Intrauterine hCG did not improve live birth (OR 0.99, 95% CI 0.83–1.19) or clinical pregnancy (OR 1.04, 95% CI 0.83–1.31). All IPD trials met predefined trustworthiness criteria, whereas non-IPD trials, which suggested benefit, failed these criteria and showed discordant results. These findings argue against routine intrauterine hCG as an IVF add-on and support de-implementation in standard embryo transfer protocols. 1

Prior Uterine Surgery Associated With Higher Preterm Birth and Stillbirth Risk

This population-linked study analyzed 520,050 first births in New South Wales from 2007–2019, with 14.7% having prior uterine surgery. Any prior uterine surgery was associated with increased preterm birth (adjusted OR 1.51, 95% CI 1.47–1.55) and stillbirth (adjusted OR 1.39, 95% CI 1.26–1.53). Associations strengthened with repeated procedures and were most pronounced at the earliest gestational ages. Authors highlight potential confounding by indication but recommend careful weighing of surgical indications and consideration of targeted antenatal surveillance when surgery is unavoidable. 2

Postmenopausal BSO at Benign Hysterectomy: Neutral on Major CVD, Signal for Metabolic Morbidity

This retrospective population-based cohort included 18,676 patients aged 50–60 undergoing benign hysterectomy in British Columbia; 46.3% also had bilateral salpingo-oophorectomy. There were no statistically significant differences in composite cardiovascular events or cardiovascular procedures between oophorectomy and ovarian-conserving groups. However, concurrent oophorectomy increased risk of being diagnosed with diabetes or hypertension and receiving cardiovascular medications (aHR 1.16, 95% CI 1.08–1.25; aHR 1.07, 95% CI 1.00–1.15). Findings suggest no clear penalty for overt CVD or fracture but a less favorable cardiometabolic profile, informing shared decisions about prophylactic oophorectomy in postmenopausal patients. 3

Routine 35–37 Week Ultrasound LGA Screening Increases Intervention Without Neonatal Gain

This retrospective cohort of 21,743 singleton pregnancies examined routine 35–37 week ultrasound screening for suspected LGA using estimated fetal weight ≥90th centile. Diagnostic performance for term LGA and macrosomia was poor, with sensitivities about 35% despite high specificity above 95%. Screen-positive pregnancies were less likely to attempt labor and more likely to undergo intrapartum cesarean, and had higher composite adverse maternal outcomes. Composite adverse neonatal outcomes were not improved, indicating a labelling effect driving intervention without neonatal benefit. 4