Background: While maternal obesity is a well-established risk factor for labor induction failure, the specific impact of regional fat distribution and its direct influence on prostaglandin dose–response profiles remain under-investigated. Relying solely on generalized anthropometric metrics like Body Mass Index (BMI) may obscure the true physiological variations in tissue bioavailability. Therefore, this study aimed to compare dinoprostone-induced labor outcomes between obese pregnant women and non-obese controls, and to evaluate whether ultrasonographically measured abdominal subcutaneous fat thickness (ASFT) can serve as a more precise, independent predictor of induction success and cumulative prostaglandin dose requirements. Methods: This prospective two-center observational study was conducted with 200 single-term pregnant women, comprising an obese study group (n = 100, BMI ≥ 30 kg/m²) and a symmetrical non-obese control group (n = 100, BMI 18.5–29.9 kg/m²). Maternal ASFT was measured via high-resolution ultrasonography at the infraumbilical midline prior to labor induction. All participants initially received a 10 mg dinoprostone vaginal insert governed by a standardized institutional induction protocol. Primary outcomes included successful labor induction (defined as achieving vaginal delivery within 24 h) and cumulative prostaglandin dose requirements. Secondary analyses involved comparative evaluation stratified by obesity classes (Class 1 vs. Class 2–3) and an exploratory ASFT threshold (<30 mm vs. ≥30 mm). Results: Obese women demonstrated significantly lower successful labor induction rates (defined as vaginal delivery within 24 h) compared to the non-obese control group (59.0% vs. 86.0%, p = 0.001). The cumulative dinoprostone dose required for cervical ripening was significantly higher in the obese cohort than in controls (16.8 ± 4.5 mg vs. 12.4 ± 2.2 mg, p < 0.001). Similarly, induction-to-delivery intervals were significantly prolonged in obese parturients (19.2 ± 6.1 vs. 14.6 ± 4.8 h, p < 0.001). Subgroup analysis within the obese cohort revealed that patients with ASFT ≥ 30 mm required higher prostaglandin doses (18.08 ± 3.40 mg vs. 14.14 ± 3.08 mg, p < 0.001) and exhibited lower vaginal delivery rates (45.7% vs. 70.4%, p = 0.012) than those with ASFT < 30 mm. Multivariate logistic regression analysis encompassing the entire study population (n = 200) confirmed that ASFT remained a strong independent predictor of induction failure (Adjusted OR: 1.14; 95% CI: 1.05–1.24, p = 0.002). Conversely, generalized obesity metrics via BMI did not maintain independent significance in the multivariate model (p = 0.420). Conclusions: Increased maternal ASFT is directly associated with blunted drug responsiveness, higher cumulative dinoprostone requirements, and a lower likelihood of successful labor induction. Compared with generalized metrics such as BMI, ultrasonographic measurement of ASFT provides a more precise and clinically relevant assessment of regional maternal adiposity. These findings suggest that incorporating pre-induction ASFT evaluation into routine obstetric practice could improve risk stratification and help clinicians design individualized, precision-based dosing strategies for obese parturients.

Background and Objectives: Vaginal natural orifice transluminal endoscopic surgery, vNOTES, has become an increasingly preferred minimally invasive option for benign hysterectomy. General anesthesia is still the routine choice, yet regional methods such as combined spinal epidural anesthesia may support a smoother postoperative course. Although the use of vNOTES is expanding, comparative information on anesthetic approaches remains limited, and its unique physiologic setting requires dedicated evaluation. To compare combined spinal epidural anesthesia with general anesthesia for benign vNOTES hysterectomy, focusing on postoperative nausea and vomiting, recovery quality, and intraoperative physiologic safety. Materials and Methods: This retrospective cohort study was conducted in a single center and identified women who underwent benign vNOTES hysterectomy between March 2024 and August 2025 from electronic medical records. Participants received either combined spinal epidural anesthesia or general anesthesia according to routine clinical practice. All patients were managed within an enhanced recovery pathway that incorporated standardized analgesia and prophylaxis for postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting during the first day after surgery. Secondary outcomes included time to discharge from the recovery unit, pain scores at set postoperative intervals, early functional recovery, patient satisfaction and physiologic parameters extracted from intraoperative monitoring records. Analyses were performed according to the anesthesia group documented in the medical files. Results: One hundred forty patients met inclusion criteria and were included in the analysis. Combined spinal epidural anesthesia was linked to a lower incidence of postoperative nausea and vomiting, a shorter stay in the post-anesthesia care unit, and reduced pain scores in the first 24 h (adjusted odds ratio 0.32, ninety five percent confidence interval 0.15 to 0.68). Early ambulation and oral intake were reached sooner in the combined spinal epidural group, with higher overall satisfaction also noted. Adherence to ERAS elements was similar between groups, with no meaningful differences in early feeding, mobilization, analgesia protocols or PONV prophylaxis. During the procedure, combined spinal epidural anesthesia produced more episodes of hypotension and bradycardia, while general anesthesia was linked to higher airway pressures and lower oxygen saturation. Complication rates within the first month were low in both groups. Conclusions: In this observational cohort study, combined spinal epidural anesthesia was associated with lower postoperative nausea, earlier recovery milestones and greater patient comfort compared with general anesthesia. Hemodynamic instability occurred more often with neuraxial anesthesia but was transient and manageable. While these findings point to potential recovery benefits for some patients, the observational nature of the study and the modest scale of the differences necessitate a cautious interpretation. They should be considered exploratory rather than definitive. The choice of anesthesia should therefore be individualized, weighing potential recovery benefits against the risk of transient hemodynamic effects. Larger and more diverse studies are needed to better define patient selection and clarify the overall risk benefit balance. These findings should be interpreted cautiously and viewed as hypothesis-generating rather than definitive evidence supporting one anesthetic strategy over another.

Objectives: The endometrium and cervix share a common Müllerian origin and may exhibit overlapping biological responses to oncogenic stimuli. However, the clinical significance of preoperative cervical cytology in patients with endometrial cancer remains unclear. This study aimed to investigate the association between preoperative cervical smear cytology and clinicopathologic characteristics, with particular emphasis on advanced FIGO stage (III–IV) as the primary outcome. Methods: This retrospective cohort study included 154 patients who underwent primary surgery for histologically confirmed endometrial cancer. Preoperative cervical smear cytology was classified according to the Bethesda System into four categories: normal, low-grade, high-grade, and malignant. For subgroup analyses, low-grade, high-grade, and malignant cytology results were combined and compared with normal cytology. FIGO stage was analyzed both as individual stages (IA–IV) and as early-stage (I–II) versus advanced-stage (III–IV) disease, where appropriate. Continuous variables were summarized as mean ± standard deviation or median (interquartile range), while categorical variables were expressed as n (%). Group comparisons were performed using the Pearson chi-square test or Fisher’s exact test, as appropriate, and a two-sided p value < 0.05 was considered statistically significant. Results: A total of 154 patients with endometrial cancer were included in the analysis. Preoperative cervical smear cytology was normal in 140 patients (90.9%), low-grade in 6 (3.9%), high-grade in 3 (1.9%), and malignant in 5 (3.2%). Comparison across cytology categories demonstrated a significant association between smear cytology and FIGO stage (p < 0.001), with high-grade and malignant cytology occurring more frequently in patients with advanced-stage disease. Vaginal cuff involvement was also significantly associated with smear cytology (p = 0.001), whereas no significant associations were observed for myometrial invasion, lymphovascular space invasion, cervical stromal involvement, tubo-ovarian involvement, omental involvement, or lymph node metastasis. Subgroup analysis comparing normal and abnormal cytology yielded similar findings, confirming significant associations with FIGO stage (p < 0.001) and vaginal cuff involvement (p = 0.002). In a multivariable model additionally including cervical cytology, LVSI and deep myometrial invasion were independent predictors of advanced stage (AUC = 0.888), whereas cytology was not statistically significant after adjustment (OR 4.51, p = 0.076) and showed poor standalone diagnostic performance (AUC = 0.564, sensitivity 19.4%, specificity 93.5%). All patients with vaginal cuff involvement had advanced-stage disease (Fisher’s exact p < 0.001). The cytology–FIGO stage association was not significant in postmenopausal (p = 0.065) or endometrioid-only (p = 1.00) subgroup analyses. Conclusions: Abnormal preoperative cervical smear cytology was significantly associated with advanced FIGO stage and vaginal cuff involvement in patients with endometrial cancer. These findings suggest that cervical cytological abnormalities may reflect overall disease extent rather than individual histopathological risk factors. Given the retrospective design and the limited number of patients with abnormal cytology, these findings should be interpreted cautiously and validated in larger prospective studies. However, cytology was not an independent predictor of advanced stage after multivariable adjustment and performed poorly as a standalone diagnostic marker, suggesting it should not be used alone to assess disease extent.

Objective: To compare non-epidural labor, standard epidural analgesia, and dural puncture epidural analgesia with respect to labor progression, obstetric outcomes, analgesia-related outcomes, and neonatal results. Methods: This single-center retrospective observational cohort study included 168 term singleton parturients: 58 without epidural analgesia, 56 with standard epidural analgesia, and 54 with dural puncture epidural analgesia. The primary outcome was the duration of the second stage of labor. Secondary outcomes included first-stage duration, mode of delivery, blood loss, transfusion, analgesia quality, maternal side effects, umbilical venous pH, biochemical acidosis, Apgar scores, neonatal intensive care unit admission, and neonatal resuscitation. Analyses included group comparisons, adjusted models, quantile regression, Firth penalized logistic regression, propensity-score inverse probability weighting, and a nulliparous sensitivity analysis. Results: Second-stage duration was comparable across groups (median 40.0, 45.0, and 48.5 min in the no-epidural, standard epidural, and dural puncture epidural groups, respectively; p = 0.118). Active pushing time was likewise comparable (8.0, 8.5, and 12.0 min, respectively; p = 0.292), and quantile regression, together with a nulliparous sensitivity analysis—in which the second stage was longest in the no-epidural group—did not indicate epidural-related labor prolongation. Compared with standard epidural analgesia, dural puncture epidural analgesia showed numerically lower pain scores and a numerically lower rescue bolus requirement (30/54 [55.6%] vs. 39/56 [69.6%]; p = 0.183), although neither difference reached statistical significance. Umbilical cord venous pH and biochemical acidosis (cord venous pH < 7.20) did not differ significantly among groups (p = 0.266 and p = 0.335, respectively). The only neonatal endpoint that differed between groups was a recorded fetal acidosis flag, which was more frequent in the epidural groups (0%, 7.1%, and 16.7%; p = 0.004) but was not corroborated by objective cord pH, Apgar scores, neonatal resuscitation, or a significant increase in neonatal intensive care unit admission (5.2%, 10.7%, and 16.7%; p = 0.145). Conclusions: Contemporary low-dose standard epidural and dural puncture epidural analgesia were not associated with clinically meaningful prolongation of labor, active pushing time, or major obstetric intervention. Dural puncture epidural analgesia showed a non-significant trend toward more favorable analgesic performance compared with standard epidural analgesia. Objective neonatal acid–base measures (cord venous pH and biochemical acidosis) did not differ significantly between groups; only a recorded fetal acidosis flag was more frequent in the epidural groups, without correlation to objective cord pH or to adverse clinical neonatal outcomes. These results support the obstetric and neonatal safety of contemporary low-dose epidural techniques; the isolated recorded acidosis signal warrants confirmation in prospective studies with standardized cord blood gas sampling.