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We aimed at studying isolated Fallopian tube torsion (IFTT) in a relatively large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). This was a retrospective cohort study. We included women with surgically confirmed ovarian and/or Fallopian tube torsion between March 2011 and June 2020. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Oedematous and enlarged ovaries were less common in the IFTT group. In multivariate regression analysis, the following factors were independently associated with IFTT: (i) vaginal discharge [adjusted odds ratio (aOR) 95% CI 8.16, 1.98–33.55]; (ii) cervical motion tenderness (aOR 95% CI 2.71, 1.01–7.29); (iii) fertility treatments (aOR 95% CI 0.26, 0.70–0.77); (iv) previous abdominal surgery (aOR 95% CI 0.46, 0.22–0.96); (v) vomiting (aOR 95% CI 0.38, 0.19–0.76); and (vi) enlarged ovary (aOR 95% CI 0.34, 0.18–0.65). In conclusion, we have identified factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the association of the duration of the second stage with labor after cesarean (LAC) success and other outcomes among women with one prior cesarean delivery (CD) and no prior vaginal births. Methods: All women undergoing LAC that reached the second stage of labor from March 2011 to March 2020 were included in this retrospective cohort study. The primary outcome was the mode of delivery by second stage duration. The secondary outcomes included adverse maternal and neonatal outcomes. We allocated the study cohort into five groups of second stage duration. Further analysis compared <3 to ≥3 h of second stage based on prior studies. LAC success rates were compared. Composite maternal outcome was defined as the presence of uterine rupture/dehiscence, postpartum hemorrhage, or intrapartum/postpartum fever. Results: One thousand three hundred ninety seven deliveries were included. Vaginal birth after cesarean (VBAC) rates decreased as the second stage length time interval increased: 96.4% at <1 h, 94.9% at 1 to <2 h, 94.6% at 2 to <3 h, 92.1% at 3 to <4 h and 79.5% at ≥4 h (p < 0.001). Operative vaginal and CDs were significantly more likely as second stage duration time interval increased (p < 0.001). The composite maternal outcome was comparable among groups (p = 0.226). When comparing the outcomes of deliveries at <3 h versus ≥3 h, the composite maternal outcome and neonatal seizure rates were lower in the <3 h group (p = 0.041 and p = 0.047, respectively). Conclusion: Vaginal birth after cesarean rates decreased as second stage time interval length increased. Even with prolonged second stage, VBAC rates remained relatively high. Increased risk of composite adverse maternal outcomes and neonatal seizures were observed when the second stage lasted 3 h or more. [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis was conducted to assess the performance of ChatGPT, an artificial intelligence language model, in medical examinations. The study analyzed 19 articles that reported ChatGPT's performance in various medical fields, such as plastic surgery, anesthesia, and diabetes. The overall performance of ChatGPT ranged from 40% to 100%, with a mean performance of 61.1%. The study suggests that ChatGPT has the potential to be a useful educational tool in medical education, but caution should be exercised in its use for examination preparation. Future research is needed to explore the role of AI chatbots in medical education. [Extracted from the article]

Background: We evaluated the risk for cesarean delivery among term nulliparous women, categorized by maternal stature and recent sonographic estimated fetal weight (EFW). Methods: A retrospective study including singleton deliveries of nulliparous women between 2011 and 2020, with sonographic EFW within 1 week of delivery. We categorized maternal height into five groups: ≤150, 151‐155, 156‐160, 161‐165, and ≥166 cm. Fetal weight estimation was categorized into five groups as well: ≤2500 g, 2501‐2999, 3000‐3499, 3500‐3999, and ≥4000 g. Results: Overall, 13 107 deliveries were included. The cesarean delivery rate was inversely correlated with maternal height, ranging from 41.0% in group 1 to 13.1% in group 5. The vaginal delivery rate ranged from 33.3% in maternal height group 1 with EFW of ≥4000 g to 85% in maternal height group 5 with EFW of ≤2500 g. In weight categories above 2500 g, maternal height correlated significantly with vaginal delivery rate, except in weight category ≥4000 g in which vaginal delivery rate ranged around 30% in maternal height categories 1‐3 and increased significantly in groups 4‐5 to 50‐60%. In multivariable logistic regression analysis, EFW was independently associated with CD for EFW categories 3500‐3999 and ≥4000 g [aOR 95% CI 1.49 (1.08‐2.06) and 4.39 (2.97‐6.50), respectively]. Maternal height was negatively associated with CD [aOR 95% CI 0.67 (0.64‐0.70)] for each increase in maternal height group. Conclusions: Cesarean delivery rate was inversely correlated with maternal height, ranging from 41.0% among women ≤150 cm to 13.1% among women ≥166 cm. Maternal height and EFW of ≥3500 g are independently associated with CD rates among term nulliparous women. [ABSTRACT FROM AUTHOR]

The incidence of caesarean scar pregnancy (CSP) increases in recent years. Yet, the best mode of treatment and its effects on successive pregnancies is not well established. The aim of this study was to investigate the success rate of single-dose methotrexate (MTX) in the management of CSP, and the outcomes of subsequent pregnancies in a retrospective cohort study. All women who were treated for CSPs between the years 2011 and 2019 were included. Treatment included systemic MTX and ultrasound-guided needle aspiration (UGNA) in cases with active foetal heartbeat. Overall, 34 women were diagnosed with CSP, of whom 31 were treated with systemic MTX. Twelve patients (38.7%) needed additional curettage or hysteroscopy. The only identified risk factor for failure of MTX-based treatment was time interval between the previous caesarean delivery and CSP (22 vs 34 months, p = 0.04). Twelve women had a subsequent pregnancy. Five pregnancies ended in term delivery, three in preterm delivery, three in abortion and one woman had a recurrent CSP. The study conclusion is that a single dose MTX with UGNA in cases of active heartbeat is an effective mode of treatment in cases of CSP with good sequential pregnancy outcomes. Longer time interval from the previous caesarean delivery was identified as a risk factor for failure of conservative management. [ABSTRACT FROM AUTHOR]

Objective: To develop a comprehensive machine learning (ML) model predicting unplanned cesarean delivery (uCD) among singleton pregnancies based on features available at admission to labor. Methods: A retrospective cohort study from a tertiary medical center. Women with singleton vertex pregnancy of 34 weeks or more admitted for vaginal delivery between March 2011 and May 2019 were included. The cohort was divided into training (80%) and validation (20%) data sets. A separate cohort between June 2019 and April 2021 served as a test data set. Features selection was performed using a Random Forest ML algorithm. Results: The study population included 73 667 women, of which 4125 (6.33%) underwent uCD. The final model consisted of 13 features, based on prediction importance. The XGBoost model performed best with areas under the curve for the training, validation, and test data sets of 0.874, 0.839, and 0.840, respectively. The model showed a 65% positive predictive value for uCD among women in the 100th centile group, and a 99% or more negative predictive value in the less than 50th centile group. Positive and negative predictive values remained high among subgroups with high pretest probability of uCD. Conclusion: An ML model for the prediction of uCD provides clinically useful risk stratification that remains accurate across gestational weeks 34–42 and among clinical risk groups. The model may be clinically useful for physicians and women admitted for labor. Synopsis: A machine learning model predicts unplanned cesarean delivery and can inform women's individualized decision making. [ABSTRACT FROM AUTHOR]

No current screening methods for high‐grade ovarian cancer (HGOC) guarantee effective early detection for high‐risk women such as germline BRCA mutation carriers. Therefore, the standard‐of‐care remains risk‐reducing salpingo‐oophorectomy (RRSO) around age 40. Proximal liquid biopsy is a promising source of biomarkers, but sensitivity has not yet qualified for clinical implementation. We aimed to develop a proteomic assay based on proximal liquid biopsy, as a decision support tool for monitoring high‐risk population. Ninety Israeli BRCA1 or BRCA2 mutation carriers were included in the training set (17 HGOC patients and 73 asymptomatic women), (BEDOCA trial; ClinicalTrials.gov Identifier: NCT03150121). The proteome of the microvesicle fraction of the samples was profiled by mass spectrometry and a classifier was developed using logistic regression. An independent cohort of 98 BRCA mutation carriers was used for validation. Safety information was collected for all women who opted for uterine lavage in a clinic setting. We present a 7‐protein diagnostic signature, with AUC >0.97 and a negative predictive value (NPV) of 100% for detecting HGOC. The AUC of the biomarker in the independent validation set was >0.94 and the NPV >99%. The sampling procedure was clinically acceptable, with favorable pain scores and safety. We conclude that the acquisition of Müllerian tract proximal liquid biopsies in women at high‐risk for HGOC and the application of the BRCA‐specific diagnostic assay demonstrates high sensitivity, specificity, technical feasibility and safety. Similar classifier for an average‐risk population is warranted. [ABSTRACT FROM AUTHOR]