Through vaginal colonization, group B Streptococcus (GBS) causes severe outcomes including neonatal sepsis and meningitis. Although intrapartum antibiotic prophylaxis (IAP) has reduced neonatal disease rates, GBS can persist in the genitourinary tract even after antibiotic administration. To determine if IAP selects for genomic signatures that enhance GBS survival and persistence, we compared the isolates from individuals before (prenatal) and after (postpartum) IAP/childbirth. Among 34 of the paired strains from participants with persistent colonization, 31 (91.2%) clustered together in a core gene phylogeny, suggesting colonization with highly similar strains before and after IAP. A core-gene mutation analysis, however, identified mutations in 74% (n = 23) of these 31 postpartum genomes when each genome was compared to its respective prenatal genome from the same individuals. Several strains acquired mutations in the same genes, although two postpartum strains accounted for most of the mutations. These two strains were classified as mutators based on high mutation rates and mutations within DNA repair system genes. Changes in biofilm production were observed in a subset of postpartum strains, which is supported by the presence of point mutations in genes linked to survival and colonization. These findings suggest that exposures encountered during pregnancy and childbirth may select for mutations and phenotypes that promote adaptation and survival in vivo. Enhanced survival in the genitourinary tract can lead to persistent colonization, increasing the likelihood of invasive disease in subsequent pregnancies and in newborns (late-onset infections) following IAP cessation.IMPORTANCEGBS remains a major cause of neonatal sepsis, pneumonia, and meningitis despite the common use of IAP that aims to eradicate maternal colonization, the main risk factor for neonatal disease. Although IAP has reduced the incidence of early-onset neonatal infections, it has had no impact on late-onset infections in babies between 7 days and 3 months of age. Since colonization is intermittent and GBS has been shown to persist in the genitourinary tract despite antibiotic exposure, more research is needed to understand mechanisms of adaptation. By comparing the genomes of GBS strains recovered before (prenatal) and after (postpartum) IAP and childbirth, this study demonstrates how selective pressures shape GBS evolution, favoring traits that promote survival and persistence. Understanding adaptive traits is essential for improving diagnostics, refining prophylaxis strategies, and guiding the development of more effective prevention practices that can reduce the likelihood of GBS transmission to neonates.

Methotrexate is widely used to treat ectopic pregnancy (EP). Concerns about its teratogenicity have led to uncertainty regarding the optimal interval before attempting conception. Guidelines recommend a 3-month washout period, while the manufacturer advises 6 months. Evidence on the safety of early conception is limited. We aimed to evaluate whether conception within 1-3 months after methotrexate treatment for EP is as safe as conception after longer intervals. We conducted a retrospective cohort study of women treated with 30-150 mg methotrexate for ectopic pregnancy in Clalit Health Services hospitals (2010-2021). Subsequent pregnancies were categorized by time from treatment to conception. Outcomes included major congenital malformations, spontaneous abortion, preterm birth, and low birth weight. Adjusted odds ratios (aORs) were estimated using generalized estimating equations. The study included 711 cases: 38 conceived within 1-3 months, 111 within 3-6 months, and 562 after >6 months. Major congenital malformations were diagnosed in 70 infants, with no significant difference between groups. Although numerically higher rates of congenital malformations associated with methotrexate embryopathy, preterm birth, and low birth weight were observed in the 1-3 months group, these differences were not statistically significant. Adjusted ORs for congenital malformations were 0.87 (95% confidence interval [CI]: 0.245-3.14) for 1-3 months and 1.01 (95% CI: 0.48-2.13) for 3-6 months, compared to >6 months. Conception 1-3 and 3-6 months after methotrexate treatment for ectopic pregnancy does not appear to increase the risk of major fetal malformations, or other unfavorable obstetric outcomes. Prospective studies in larger cohorts are warranted.

To determine associations between gestational diabetes mellitus (GDM) and body mass index (BMI) change between consecutive pregnancies, and hospital length of stay (LOS) and hospital costs. Retrospective cohort study. Two maternity hospitals, New South Wales, Australia. Women with two most recent singleton births between September 2011 and April 2019. Multivariable generalised linear models assessed association between GDM status (none, first only, second only, or both pregnancies) and BMI change (loss: < -1 kg/m2; stable: -1 to < 1; small gain: 1 to < 2; medium gain: 2 to < 4; or large gain: ≥ 4) in relation to second-birth LOS and hospital birthing costs. Costs were calculated using DRG codes and valued in 2024 AUD. Hospital LOS and hospital costs for the second birth. Of 11 157 women, 5% had GDM only in the first pregnancy, 9% only in the second and 8% in both. For the second birth, women with GDM in both pregnancies stayed 0.91 days longer (3.71 vs. 2.79 days) and incurred AU$1960 higher costs (AU$14680 vs. AU$12720) than those without GDM in either pregnancy. Adjusted models indicated GDM in both pregnancies was associated with a 21% longer LOS (95% CI: 16%-26%, p < 0.001) and 9% higher costs (7%-11%, p < 0.001). Large BMI gain (≥ 4 kg/m2) was associated with a 9% longer LOS (4%-14%, p < 0.001). Women with both GDM (both pregnancies) and large BMI gain had a 23% longer LOS (12%-36%, p < 0.001) and 9% higher costs (4%-15%, p < 0.001). GDM and interpregnancy BMI gain were associated with increased hospital stay and higher birthing-related hospital costs for the second birth. These findings underscore the importance of preventive strategies and supportive public health policies to reduce the burden of GDM and high BMI gain. Approaches such as nutritional counselling, lifestyle modification and physical activity programs are likely to support women planning a subsequent pregnancy after their index birth (first pregnancy or first pregnancy with GDM diagnosis).

Managing pregnant patients in the coronary care unit and the intensive care unit has been a challenge for many clinicians, as they do not encounter those special populations on a routine basis. Peripartum cardiomyopathy (PPCM) is an uncommon but potentially life-threatening condition that occurs during the last month of pregnancy or within five months of delivery. It is associated with left ventricular systolic dysfunction, leading to reduced ejection fraction and heart failure. Although the exact etiology remains unclear, potential contributing factors can include factors such as myocarditis, abnormal immune responses, genetic predispositions, and hormonal imbalances. The future implications of PPCM are wide. Besides physical illness, mental illness can also limit functionality and impose health challenges. Additionally, subsequent pregnancies carry an increased risk of recurrence, especially if cardiac function remains poor. Ongoing research into the molecular and genetic underpinnings of PPCM may pave the way for different targeted therapies and strategies focusing on prevention. Increasing awareness, early detection, and advances in treatment can significantly reduce morbidity and mortality associated with PPCM. Multidisciplinary care is crucial in optimizing outcomes for women affected and their families. This mini review aims to help appraise healthcare providers and clinicians in addressing and managing this challenging condition.

Subsequent pregnancy in women with prior peripartum cardiomyopathy (PPCM) carries a risk of relapse and adverse maternal outcomes. This meta-analysis aimed to determine the recurrence of PPCM relapse and associated maternal and fetal outcomes during subsequent pregnancy, stratified by baseline (pre-subsequent pregnancy) left ventricular ejection fraction (LVEF). A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Nine databases were searched through June 2025 for cohort studies reporting subsequent pregnancy outcomes in women with prior PPCM, stratified as recovered (LVEF ≥50%) or non-recovered (LVEF <50%) groups. Outcomes included PPCM relapse, maternal mortality, LVEF during and after pregnancy, LV recovery, symptom worsening, and obstetric/neonatal events. Risk of bias was assessed with ROBINS-E, and random-effects models were used. Six cohort studies comprising 266 women were included (174 in recovered group and 92 in non-recovered group). Relapse occurred in both groups with no significant difference (rate ratio [RR] 0.77, 95% CI 0.50-1.19; I2=3%). Maternal mortality was significantly lower in the recovered group (1.7% vs 10.9%; RR 0.27, 95% CI 0.09-0.87; I2=0%). Recovered group had higher mean LVEF during subsequent pregnancy (mean difference [MD] 17.0; p<0.001), higher postpartum LVEF (MD 11.69; p=0.005; I2=84%), and greater likelihood of LV recovery (RR 2.07; p=0.005; I2=0%). No significant differences were observed in symptom worsening or obstetric/neonatal outcomes. Recovered LVEF prior to subsequent pregnancy is associated with improved maternal outcomes, yet relapse remains common. LVEF alone is insufficient for risk stratification, and individualized multidisciplinary care is essential for all women with prior PPCM.

Background: The integrity of the lower uterine segment scar following cesarean section (CS) is a critical determinant of safety in subsequent pregnancies. Sonographic measurement of the uterine scar niche and residual myometrial thickness provides a non-invasive means of stratifying risk for uterine rupture, scar dehiscence, and adverse perinatal outcomes. Despite a nationally elevated CS rate in Iraq, data from local populations remain scarce. Objective: To evaluate the relationship between lower uterine segment (LUS) scar thickness measured by transabdominal ultrasonography at 36–38 weeks of gestation and subsequent obstetric outcomes in women with a previous cesarean section attending Babylon Educational Hospital for Gynecology and Pediatrics, Iraq. Methods: A prospective cohort study was conducted between January 2023 and December 2024. A total of 215 pregnant women with one or more prior CS were enrolled and classified by LUS thickness: Group I (thin scar, &lt;2.5 mm), Group II (adequate scar, 2.5–3.5 mm), and Group III (thick scar, &gt;3.5 mm). Maternal and neonatal outcomes including mode of delivery, intraoperative uterine rupture or dehiscence, blood transfusion, neonatal Apgar scores, NICU admission, and birth weight were recorded and analyzed. Results: Of the 215 participants, 67 (31.2%) had a thin scar, 89 (41.4%) an adequate scar, and 59 (27.4%) a thick scar. Complete uterine rupture occurred exclusively in Group I (7.5%), and scar dehiscence was significantly more frequent in Group I (20.9%) compared with Groups II (2.2%) and III (0%) (p&lt;0.001). Emergency CS, blood transfusion, and neonatal NICU admission were all significantly higher in Group I. Logistic regression identified LUS thickness as an independent predictor of uterine dehiscence (OR 0.34 per mm increase; 95% CI 0.18–0.63; p=0.001). Conclusion: Lower uterine segment scar thickness measured at 36–38 weeks of gestation is a reliable sonographic predictor of uterine scar complications and adverse perinatal outcomes in Iraqi women. Routine third-trimester LUS assessment should be incorporated into antenatal care protocols for women with previous cesarean delivery.

To use a lived-experience account of stillbirth and subsequent pregnancy to examine how maternity care systems respond to trauma, reveal structural and relational failures in maternal health services and propose principles for more just, compassionate leadership in maternity care. Despite advances in clinical knowledge, maternal outcomes in the UK have plateaued, with widening inequities by ethnicity, deprivation and other intersecting forms of exclusion. Maternal trauma, including stillbirth and miscarriage, is frequently minimised, poorly recognised in policy and measurement frameworks and inadequately supported in routine care. Personal experience of stillbirth and subsequent pregnancy exposes how systems that appear evidence-based and guideline-driven can fail to provide continuity, psychological safety and trauma-informed support at women's most vulnerable moments. This reflective paper integrates first-person narrative of stillbirth, subsequent pregnancy and encounters with maternity and primary care services with professional insight from clinical and leadership roles. The reflection is informed by existing evidence on maternal outcomes, perinatal mental health, intersectionality and global trends in women's health and rights. The narrative is used as an analytic lens to explore how leadership, culture and structures in maternity care shape women's experiences and outcomes. The reflection identifies recurrent gaps: silencing of women's voices, inadequate bereavement and mental health support, fragmentation of care and limited recognition of trauma across the maternity pathway. It highlights structural injustice in maternal health, including inequities by race, poverty and migration status, and the marginalisation of outcomes such as stillbirth and early pregnancy loss in key indicators. It proposes leadership practices that are relational, trauma-informed and equity-focused, including embedding lived experience in governance, investing across the preconception-to-postpartum continuum and prioritising culturally safe, psychologically safe care. Leadership in maternity care must move beyond metrics and guidelines towards models grounded in humility, listening and justice. By centring lived experience, recognising trauma and addressing structural inequities, leaders can begin to rebuild trust, honour loss and reshape maternity systems to better serve women, babies, families and future generations.

Subsequent pregnancy following severe hypertensive disorders of pregnancy.

Laparoscopic cervical cerclage is an intervention for the prevention of preterm birth, for example, in women with a weak cervix due to prior cervical surgery or prior failed vaginal cerclage. Little is known about pregnancy outcomes when a cerclage is left insitu across consecutive pregnancies; this study aims to investigate neonatal outcomes following laparoscopic cervical cerclage placement in first and subsequent pregnancies and to compare pre- and postconception placement of the laparoscopic cervical cerclage on neonatal survival. We performed an observational study in women who had a laparoscopic cervical cerclage at Aarhus University Hospital, Denmark, between 2011 and 2021. Data on the timing of the procedure (pre- vs post-conception), surgical complications, obstetric, and neonatal outcomes were collected from electronic patient records and analyzed descriptively. The primary outcome was neonatal survival. Secondary outcomes were neonatal survival without major morbidity, preterm birth, and gestational age at birth. A total of 170 women had a laparoscopic cervical cerclage during the study period. Uterine wall perforation occurred in 10/170 procedures (6%), postoperative infection in 4/170 (2%), and 125/170 (74%) were discharged on the same day as the procedure. There were 145 women with at least one subsequent pregnancy and 229 registered pregnancies in total. In the 185 pregnancies that progressed beyond 20 weeks, 166/181 (92%) delivered ≥34 weeks of gestation. Neonatal survival was 183/186 (98%), and survival without major morbidity was 181/186 (97%). Neonatal outcomes were similar between women with a cerclage placed pre- or postconception. Fifty of 145 women (34%) with a cerclage left insitu had more than one pregnancy beyond 20 weeks of gestation. These repeated pregnancies showed consistently favorable outcomes, with neonatal survival rates of 100% in second pregnancies (44/44) and 100% in third pregnancies (4/4). Laparoscopic cervical cerclage supports favorable neonatal outcomes in first and subsequent pregnancies. Neonatal outcomes did not appear to differ based on whether the cerclage was placed pre- or postconception. Pregnancies in which the cerclage was left insitu demonstrated high neonatal survival rates and favorable obstetric outcomes in both second and third pregnancies.

Fetal growth restriction (FGR) is a frequent diagnosis with multiple etiologies (maternal, fetal, environmental) for which the placenta can be involved. A postnatal etiological work-up, such as placental pathology analysis, can help to identify the etiology of FGR and implement measures to prevent recurrence in a subsequent pregnancy. The aim of this study is to unravel and provide an update on the mapping of possible placental lesions in the context of hypotrophic birth (below the third percentile). This is a single-center retrospective observational cohort study, in a tertiary care maternity (Antoine Béclère Hospital, Clamart, France). Inclusion criteria were: singleton pregnancy, live-born neonate, delivery between January 2014 and December 2018, birthweight below the 3rd percentile according to Audipog curves. Data from placental anatomopathological analysis were collected and analyzed using Amsterdam criteria. Among 733 eligible pregnancies, 585 placentas (79.8%) underwent pathological examination. At least one lesion of maternal vascular malperfusion (MVM) was identified in 75.6% of cases. The most frequent findings were placental hypoplasia (64.6%), accelerated villous maturation (18.5%), and placental infarctions (12.5%). A progressive decrease in birth weight was observed with increasing numbers of MVM criteria. MVM lesions are highly prevalent in severe neonatal hypotrophy and correlate with disease severity. Placental pathological examination is a key component of the etiological work-up of FGR and may guide management and preventive strategies in subsequent pregnancies.

Feto-maternal hemorrhage: Guidelines of the French College of Obstetricians and Gynecologists. Expert consensus from a Delphi method

To examine the accuracy of prenatal counselling at a multidisciplinary fetal neurology clinic (FNC) that led to termination of pregnancy (TOP), to improve the quality of future consultations. This retrospective diagnostic cohort study compared the imaging (neurosonography and intrauterine magnetic resonance imaging) of fetuses evaluated at our FNC between 2009 and 2019, which underwent TOP because of brain anomalies, to the autopsy reports for concordance. The degrees of concordance were full, partial, and discordant. We identified 114 fetuses aborted because of brain anomalies, which underwent autopsy. All consultations were provided at the late stages of pregnancy, with 70% given in the third trimester and a mean gestational age of 29 weeks (range = 18-39, SD = 5). The imaging and autopsy results were fully or partially concordant in 96% of cases. Discordance was found in four fetuses, but termination was considered unjustified in only one. Microscopic evaluation of the fetal brain provided valuable information in 41% of fetuses and changed the diagnosis in 13%. We found excellent concordance between the imaging and autopsy findings. We suggest that an autopsy is crucial for learning and delivering correct consultations to patients and planning their subsequent pregnancies.

Stillbirth is the death, in utero, of a fetus from 20 weeks' gestation until immediately before birth. This may be spontaneous or can occur after termination for medical reasons (TFMR). The experience of stillbirth profoundly impacts subsequent pregnancies, with mothers frequently experiencing conflicted emotions, heightened anxiety, stress, symptoms of depression, fear, isolation, and a diminished sense of trust in a positive outcome. Supportive care options for individuals pregnant after a stillbirth or TFMR are needed to help meet their psychological and emotional needs. Individuals pregnant after a loss do not feel emotionally safe in their pregnancies; thus, the side effects and perception of safety in support interventions need to be explored. This article reports participants' experiences of safety, the harms, and adverse events in a study exploring massage as a support for individuals pregnant after a stillbirth. The study used questionnaires to collect side effect data and qualitative interviews to examine participants' experience of safety. The study found that 75% of participants experienced one or more side effects. Post-massage soreness (45.8%) was the most frequently reported side effect, followed by tiredness (43.1%). The main theme of the qualitative analysis was "safety: so much more than physical safety," reflecting the importance of safety to study participants and that safety was much more than avoiding physical harm. Participants needed the massage space to feel safe, both environmentally and psychologically, to facilitate their capacity to engage. Having trained massage therapists was important as this helped reassure participants that massage was a safe treatment for themselves and their baby.

This review aims to synthesize current evidence on maternal birth weight (MBW) as a determinant of reproductive health and pregnancy outcomes, examining biological mechanisms and potential intergenerational effects within the Developmental Origins of Health and Disease (DOHaD) framework. Evidence from large-scale cohort studies, systematic reviews, and experimental research examining the association between MBW and pregnancy-related outcomes, including hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm birth, offspring birth weight, and selected congenital malformations, is summarized. Findings are interpreted within a DOHaD framework, with attention to methodological heterogeneity, population differences, and potential confounding by shared familial socioeconomic and lifestyle factors. Recent large-scale cohort studies, including those conducted in Japan, further indicate that MBW is associated with pregnancy complications, offspring birth weight, and specific congenital malformations, suggesting potential intergenerational pathways involving genetic, epigenetic, and placental processes. Despite accumulating evidence, substantial heterogeneity persists across populations, and the underlying causal pathways remain incompletely understood. Interpretation is further complicated by family-level factors, such as socioeconomic disadvantage, nutritional patterns, and shared lifestyle behaviors, which may partially influence both MBW and subsequent pregnancy outcomes. Nevertheless, MBW is a simple and widely available metric that may enhance preconception risk assessment, improve risk stratification for pregnancy complications, and contribute to individualized perinatal care. Overall, current epidemiological evidence is consistent with biological mechanisms linking MBW to pregnancy and offspring outcomes. Research priorities are outlined to clarify causal pathways and inform DOHaD-based interventions.

Objective: To explore the potential pathogenic genes and variants of spontaneous abortion by exome sequencing (ES). Methods: From September to December 2024, 20 spontaneous abortion samples with no chromosomal abnormalities detected by chromosomal microarray analysis (CMA) in the Women's Hospital of Nanjing Medical University were selected for familial ES detection. According to the American College of Medical Genetics and Genomics (ACMG) guidelines (2015 edition), the pathogenicity of the sequencing results was interpreted, and the possible pathogenic or pathogenic gene variants were verified by Sanger sequencing. Results: Of the 20 patients with spontaneous abortion, 2 were found to have genetic variants that might be related to spontaneous abortion: KYNU gene c.766G>T(p.Gly256Ter) and c.235C>T(p.Gln79Ter) compound heterozygous variants, which were likely pathogenic (paternal) and pathogenic (maternal), respectively, and were associated with xanthurenic aciduria and vertebral-heart, kidney, limb deficiency syndrome type 2 (VCRL2). DNM1L gene c.185C>T(p.Pro62Leu), a likely pathogenic variant, was a de novo variant, which was associated with mitochondrial and peroxisome fission-deficient encephalopathy. Conclusions: ES technology could facilitate the genetic diagnosis of spontaneous abortion, and provide theoretical basis and guidance for subsequent genetic counseling and subsequent pregnancies.

Background: Placenta accreta spectrum (PAS) is a serious obstetric condition characterized by abnormal placental adherence to the uterus that can lead to major maternal morbidity. While hysterectomy has traditionally been the standard management, uterus-preserving approaches are increasingly used to preserve fertility. The risk of recurrent PAS in subsequent pregnancies and the overall fertility outcomes following conservative management remain unclear. Objective: We aimed to estimate the recurrence risk of PAS in subsequent pregnancies after conservative management and to assess fertility outcomes, including pregnancy and live-birth rates. Methods: This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive literature search was performed across multiple databases to identify studies reporting subsequent pregnancies after conservative PAS management. Data extraction and quality assessment were independently conducted. Pooled recurrence and pregnancy success rates were calculated using random-effects meta-analysis. Results: Eleven studies met the inclusion criteria, involving 2642 patients who underwent conservative PAS management. The pooled recurrence risk of PAS in subsequent pregnancies was 20.9% (95% CI: 12.2-29.6). Successful pregnancy rates following conservative treatment were 69.7% (95% CI: 49.9-89.5). Conclusions: While conservative PAS management poses a risk of recurrence, it remains a viable fertility-preserving option, with high subsequent pregnancy success rates. These findings support informed clinical decision-making, though further prospective studies are needed to optimize management strategies and patient outcomes.

Uterine compression sutures have proven to be a valuable and safe option in the control of Postpartum hemorrhage. To avoid complications related to uterine compression sutures (uterine necrosis, synechia, and pyometra), we assess the efficacy of removable uterine compression suture (RUCS) for primary postpartum hemorrhage (PPH) and evaluate its effectiveness. This retrospective preliminary study was conducted at a tertiary referral hospital between January 2020 and November 2024, including patients diagnosed with postpartum hemorrhage who required compression sutures. Demographic characteristics of the patients who underwent RUCS and postpartum clinical parameters were determined. Bleeding was successfully controlled in all 11 patients (100%). A mild, localized ecchymosis occurred at the unilateral suture exit site and resolved spontaneously. No intrauterine synechiae were detected in any of the 11 patients at 6-month hysteroscopic evaluation. Fertility outcomes were available for six women, five of whom achieved subsequent pregnancies. In this study, we present a novel removable compression suture that appears to be effective, simple, and rapid in application, with the potential to reduce serious complications; however, further evaluation is warranted.

Abstract Background: Triple-negative breast cancer (TNBC) in young women has traditionally been associated with poor prognosis. However, treatment outcomes are expected to improve with advances such as response-guided neoadjuvant chemotherapy, PARP inhibitors, and immune checkpoint inhibitors. For young women who have a desire for future pregnancies, whether pregnancy and childbirth are feasible after breast cancer treatment is a critical concern. Therefore, fertility preservation (FP) before cancer treatment and shared decision-making regarding post-treatment pregnancy are essential. Objective: To investigate treatment outcomes, temporal trends in FP, and pregnancy outcomes among young patients with TNBC. Methods: A retrospective analysis was conducted on 179 young patients under the age of 40 with stage I-III TNBC who underwent curative surgery at our institution between 2007 and 2022. We investigated treatment outcomes, FP rates, and subsequent pregnancy status. The primary endpoints were breast cancer recurrence, the development of secondary malignancies, and overall survival. Secondary endpoints were pregnancy and childbirth after breast cancer treatment. Results: The mean age at surgery was 34.4 years. Eighty-three patients (46.4%) had a history of childbirth. Among those tested, 41 patients (43.2%) carried pathogenic BRCA1/2 variants. The stage distribution was stage I in 42 patients (23.5%), stage II in 103 (57.5%), and stage III in 34 (18.0%). Chemotherapy was administered to 171 patients (95.5%), of whom 93 (52.0%) received neoadjuvant therapy. With a median follow-up of 5.8 years (range: 0.1-17.5), recurrence including contralateral breast cancer occurred in 14 patients (7.8%), secondary malignancies in 5 (2.8%)—of whom 3 had ovarian cancer—and 25 patients (14.0%) died. At the time of diagnosis, 61 patients (34.1%) had desire for future pregnancy. Among them, 26 (14.5%) underwent FP before chemotherapy, and 22 (12.3%) received LHRH analogs during chemotherapy for ovarian function protection. Comparing two time periods, 2007-2014 and 2015-2022, the 5-year overall survival significantly improved from 78.7% to 94.5% (p = 0.0088). FP implementation also increased over time, with the FP rate among those with desire for future pregnancies at the time of diagnosis rising from 12% to 58.3%. Seventeen patients conceived after treatment (6 spontaneously, 9 with assisted reproductive technology, 2 unknown), resulting in 23 pregnancies and 17 live births in 15 patients (8.4% of the total cohort, 24.6% of those who had desire for future pregnancies at the time of diagnosis). Among the patients who gave birth, one had been treated with immune checkpoint inhibitors. No serious perinatal complications were observed. All patients were disease-free at the time of attempting conception. No distant recurrence or breast cancer-related deaths occurred after childbirth. To date, none of the patients who treated with PARP inhibitor therapy became pregnant. Conclusion: Although numbers are limited, young patients with TNBC who attempted pregnancy after completing standard systemic therapy had favorable oncologic and perinatal outcomes. In this study, the treatment outcomes and FP implementation rate for young patients with TNBC improved over time. This real-world data may be useful in supporting shared decision-making for reproductive planning and treatment decisions for young patients with TNBC. Citation Format: M. Kasahara, A. Kataoka, A. Kanazawa, Y. Ito, Y. Kimura, N. Yoshida, U. Nakadaira, N. Uehiro, C. Takahata, Y. Ozaki, M. Nishimura, T. Takano, T. Kogawa, T. Sakai, T. Ueno. Longitudinal trends in prognosis and post-treatment pregnancy in young woman with triple-negative breast cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-10-24.

To identify factors associated with unsuccessful transabdominal cerclage (TAC) insertion, defined as delivery before 32 weeks, including maternal demographics, preterm birth risk factors, operative details (laparoscopic or open, pre-pregnancy or during pregnancy) and subsequent cervical length. Observational cohort study. A tertiary-level London hospital. Women who underwent TAC between 2011 and 2024 and consented to inclusion in the Preterm Clinical Network (PCN) Database. Data were collected from the PCN database and maternity records. Characteristics of women delivering before versus after 32 weeks were compared using student's t-test where data were continuous and chi-squared where data were categorical (SPSS version 29.0). Among 125 pregnancies following TAC, eight (6.4%) delivered before 32 weeks. Previous trachelectomy was strongly associated with preterm delivery (p < 0.0001). Mean cervical length differed significantly between groups: first trimester (19.3 mm vs. 33.8 mm, p < 0.001) and second trimester (18.8 mm vs. 31.9 mm, p < 0.001). Of 30 women with prior pregnancies using the same TAC, 80% (24/30) achieved at least one term birth and 13.3% (4/30) had two or more term deliveries. TAC is highly effective, with over 90% of women delivering beyond 32 weeks. Factors linked to unsuccessful TAC include prior trachelectomy and short cervical length in early pregnancy. Effectiveness persists across subsequent pregnancies, with many women achieving multiple term births using the same TAC.

To evaluate the effectiveness and safety of the intra-arterial infusion of methotrexate (MTX) followed by uterine arteries embolization (UAE) in women with cesarean scar pregnancy (CSP) in which serum β-HCG levels remained elevated and the gestational sac showed no significant reduction 2weeks after systemic administration of MTX. Twenty-one patients with CSP were enrolled in the study. Technical success, clinical success and complication rates were assessed. Technical success was defined as complete bilateral intra-arterial MTX infusion and successful UAE. Primary clinical outcomes included reduction of gestational sac size, absence of active vaginal re-bleeding, and normalization or steady decline of β-HCG values. Secondary clinical outcomes comprised pregnancy termination, gestational sac expulsion, and reduced or absent bleeding during suction curettage of the uterine cavity. Additionally, the need for uterine cavity revision, time to menstruation recovery, and outcome of subsequent pregnancies were evaluated. Technical success, primary clinical outcome, and pregnancy termination were achieved in all cases (100%). Spontaneous expulsion of the gestational sac occurred in five patients (23.9%), while the remaining patients underwent ultrasound-guided suction curettage of the uterine cavity. Two patients (9.5%) required additional hysteroscopy. No major complications were registered. Pain was effectively managed in all patients within 24h. Menstrual function resumed within 3months in all women. Among the 12 patients (91.6%) who wished to conceive again, 11 (91.6%) achieved a successful pregnancy. Intra-arterial MTX and UAE, following systemic MTX, appear to be a safe and effective treatment for CSP.