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Until recently, trophoblast invasion during human placentation was characterized by and restricted to invasion into uterine connective tissues and the uterine spiral arteries. The latter was explained to connect the arteries to the intervillous space of the placenta and to guarantee the blood supply of the mother to the placenta. Today, this picture has dramatically changed. Invasion of endoglandular trophoblast into uterine glands, already starting at the time of implantation, enables histiotrophic nutrition of the embryo prior to perfusion of the placenta with maternal blood. This is followed by invasion of endovenous trophoblasts into uterine veins to guarantee the drainage of fluids from the placenta back into the maternal circulation throughout pregnancy. In addition, invasion of endolymphatic trophoblasts into the lymph vessels of the uterus has been described. Only then, invasion of endoarterial trophoblasts into spiral arteries takes place, enabling hemotrophic nutrition of the fetus starting with the second trimester of pregnancy. This new knowledge paves the way to identify changes that may occur in pathological pregnancies, from tubal pregnancies to recurrent spontaneous abortions.

To assess the risk of singleton intrauterine fetal death (IUFD) in women by the demographic setting of the online Fetal Medicine Foundation (FMF) Stillbirth Risk Calculator. Retrospective single-centre case-control study involving 144 women having suffered IUFD and 247 women after delivery of a live-born singleton. Nonparametric receiver operating characteristics (ROC) analyses were performed to predict the prognostic power of the FMF Stillbirth risk score and to generate a cut-off value to discriminate best between the event of IUFD versus live birth. Women in the IUFD cohort born a significantly higher overall risk with a median FMF risk score of 0.45% (IQR 0.23-0.99) compared to controls [0.23% (IQR 0.21-0.29); p<0.001]. Demographic factors contributing to an increased risk of IUFD in our cohort were maternal obesity (p = 0.002), smoking (p<0.001), chronic hypertension (p = 0.015), antiphospholipid syndrome (p = 0.017), type 2 diabetes (p<0.001), and insulin requirement (p<0.001). ROC analyses showed an area under the curve (AUC) of 0.72 (95% CI 0.67-0.78; p<0.001) for predicting overall IUFD and an AUC of 0.72 (95% CI 0.64-0.80; p<0.001), respectively, for predicting IUFD excluding congenital malformations. The FMF risk score at a cut-off of 0.34% (OR 6.22; 95% CI 3.91-9.89; p<0.001) yielded an 82% specificity and 58% sensitivity in predicting IUFD with a positive and negative predictive value of 0.94% and 99.84%, respectively. The FMF Stillbirth Risk Calculator based upon maternal demographic and obstetric characteristics only may help identify women at low risk of antepartum stillbirth.

Human extravillous trophoblast (EVT) invasion of the pregnant uterus constitutes a pivotal event for the establishment of the maternal-fetal interface. Compromised EVT function manifesting in inadequate arterial remodeling is associated with the severe pregnancy disorder early-onset preeclampsia (eoPE). Recent studies suggest that EVTs invade the entire uterine vasculature including arteries, veins and lymphatics in the first trimester of pregnancy. We therefore hypothesized that EVT-derived factors accumulate in the circulation of pregnant women early in gestation and may serve to predict eoPE. In contrast to published literature, we demonstrate that placenta-associated diamine oxidase (DAO) is not expressed by maternal decidual cells but solely by EVTs, especially when in close proximity to decidual vessels. Cultures of primary EVTs express and secret large amounts of bioactive DAO. ELISA measurements indicate a pregnancy-specific rise in maternal DAO plasma levels around gestational week (GW) 7 coinciding with vascular invasion of EVTs. Strikingly, DAO levels from eoPE cases were significantly lower (40%) compared to controls in the first trimester of pregnancy but revealed no difference at mid gestation. Furthermore, DAO-containing pregnancy plasma rapidly inactivates pathophysiologically relevant histamine levels. This study represents the first proof of concept suggesting EVT-specific signatures as diagnostic targets for the prediction of eoPE.

Background Congenital limb malformations are rare, and their perinatal outcomes are not well described. This study analyzed the perinatal outcomes of infants with congenital limb malformations. Methods All infants with congenital limb malformations who underwent prenatal assessment and delivery at our tertiary referral center from 2004 through 2017 were retrospectively identified. Neonatal outcome parameters were assessed, and the predictors of worse perinatal outcomes were determined. Results One hundred twenty-four cases of congenital limb malformations were identified, of which 104 (83.9%) were analyzed. The upper limb was affected in 15 patients (14.4%), the lower limb in 49 (47.1%), and both limbs in 40 (38.5%) patients. A fetal syndrome was identified in 66 patients (63.5%); clubfoot and longitudinal reduction defects were the most frequent malformations. In total, 38 patients (36.5%) underwent termination, seven (6.7%) had stillbirth, and 59 (56.7%) had live-born delivery. Rates of preterm delivery and transfer to the Neonatal Intensive Care Unit were 42.4 and 25.4%, respectively. Localization of the malformation was a determinant of perinatal outcome ( P  = .006) and preterm delivery ( P  = .046). Conclusions Congenital limb malformations frequently occur bilaterally and are associated with poor perinatal outcomes, including high rates of stillbirth and preterm delivery. Multidisciplinary care and referral to a perinatal center are warranted.

Background While substantial literature exists on the intersection of overweight/obesity (OWO) and pregnancy, much of it focuses on specific aspects, making it difficult to maintain an overview of clinically relevant factors for optimal care of OWO women throughout pregnancy. Objectives To provide a comprehensive synthesis of the existing literature, covering the full spectrum of clinically relevant information needed to manage OWO women from preconception to birth. Methods For this narrative review a literature search was conducted on PubMed in January 2025. Eligible studies included full-text English articles with data from human subjects, with no restrictions on publication date. Findings The impact of OWO on pregnancy is multifaceted, encompassing four interrelated themes: physiological consequences, emerging risks, challenges in prenatal care, and intervention strategies. OWO women exhibit differences in metabolic and inflammatory pathways compared to normal-weight women, reflected in altered laboratory tests. When managing gestational diabetes and preeclampsia, obesity-related characteristics must be considered. Clinicians need to be alert of obesity-mediated fetal complications, including overgrowth, malformations, stillbirth, and preterm birth, while navigating challenges in ultrasound measurements. Interventions during the preconception and prenatal periods provide key opportunities to optimize maternal weight and reduce the risk of long-term disease development. Conclusion The review’s insights enhance clinical practice and call on researchers and policymakers to prioritize strategies that offer early counseling for obese pregnant women. These initiatives aim to optimize outcomes for both mother and child and contribute to combating the global obesity crisis.

Introduction Gender disparities exist in the OBGYN discipline. This study investigates, for the first time, whether gender impacts on the confidence of practical and surgical skills among OBGYN residents, and of being prepared to work as a specialist. Methods The gynecological societies of Austria, Germany, and Switzerland established a web-based survey of 30 questions that was sent to all registered OBGYN members-in-training from August to September 2020. Data collection, controlling and analysis were performed by the Swiss Federal Institute of Technology in Zurich (ETH). Results A total of 422 participants took part in the survey, of which 375 (88.9%) were female, 46 (10.9%) were male, and one (0.2%) was divers. The diverse participant was excluded from further analyses. The gender distribution was comparable in all three countries. Multiple regression analyses showed that gender is an independent variable significantly impacting on the confidence levels in performing standard gynaecological ( p  = 0.03) and obstetric ( p  < 0.001) procedures. Similarly, the feeling of confidence in being prepared for working as a specialist in a clinic showed to be gender-dependent ( p  < 0.001), however, not the feeling of being prepared for working as specialist in an outpatient setting ( p  = 0.37). The “female factor” significantly decreases the confidence rating for surgical and practical skills and for working in a hospital. Covariates including year of training, country, workload, receiving regular feedback, and implemented simulation training were included in all analyses. Discussion Improvements of residency programs to promote female doctors to overcome factors reducing their confidence in their own OBGYN skills are highly warranted.

Drug-Facilitated Crimes (DFCs) involve criminal offenses where the victim's intoxicated state plays a central role. The substances used, often central nervous system depressants, are challenging to detect, leading to a high rate of undiagnosed cases. As a result, DFCs remain a form of violence that is weakly characterized. This cross-sectional study analyzed 1104 violence-related cases presented to the Children and Victim Protection Center (CAVPC) at a tertiary hospital. Of these, 12.2 % were suspected to be DFCs between 2014 and 2019, while 38.5 % were suspected to be DFCs between 2020 and 2023 (p < 0.001). This suggests a 544 % increase in the volume of DFC-related cases between the two time periods. Victims were predominantly female (86.4 %) and aged 20–30 years, though a concurrent rise in male victims, from 3.5 % in 2014–2019–15.1 % in 2020–2023 was also observed (p = 0.01). Perpetrators were primarily male (96.2 %), acted alone, and were known to the victim in 51.9 % of the cases. The crimes, which predominantly occurred in private settings between 2014 and 2019, increasingly took place in public spaces between 2020 and 2023 (p = 0.01), where alcohol was present, and peaked on weekends (especially Saturdays) and during late-night and early-morning hours. Most victims exhibited signs of amnesia (91.8 %) and physical injuries (58.4 %). Alarmingly, only 38.5 % of victims sought help within 12 h, significantly reducing the chances of detecting certain substances. Cannabinoids, cocaine, diphenhydramine, paracetamol and lidocaine were the most commonly identified substances in blood and urine. These findings highlight the urgent need for action, including implementing preventive measures, raising awareness, and reducing stigma – an approach that could help address the growing global public health concern of DFCs. [Display omitted] •DFC patient volume increased by 544 % from 2014 to 2023.•Most victims are female (86.4 %) and aged 20–30 years, though male victims rose from 3.5 % to 15.1 %.•Assaults increasingly took place in public spaces, with alcohol, late at night and early morning.•Amnesia and physical injuries should raise suspicion of drug-facilitated crimes.•Only 38.5 % of victims sought help within 12 h, limiting the opportunity for detection of certain substances.

Background There is frequent academic exchange between Switzerland, Germany and Austria, facilitated by the common language. Additionally, the postgraduate training curricula in obstetrics and gynecology show some similarities. We aimed to compare self-perceived level of ability, availability of simulation training and teaching and feedback culture among residents in obstetrics and gynecology in Switzerland, Germany, and Austria. The focus was on Switzerland to gain a better understanding of strengths and room for improvement. Methods With a cross-sectional design, a web-based survey with 30 questions was distributed to obstetrics and gynecology residents in the three countries in August and September 2020. The primary outcome was the self-perception of skills in between-country comparisons of mid-training trainees, i.e., omitting trainees in their first year as well as very advanced trainees and specialists. The secondary outcomes were reported teaching, simulation training and feedback culture. German and Austrian responses were calculated together and compared with the Swiss replies. Results A total of 422 participants took part in the survey, 27.5% ( n =  116) of whom were from Switzerland, corresponding to a questionnaire response rate of approximately 19%. 48% of Swiss trainees were in training years 2–5. 57% of Swiss participants felt confident in obstetric procedures and 69% in gynecological procedures, compared to 52% and 68% of non-Swiss participants ( p  = 0.005 and p  = 0.176, respectively). Swiss participants felt significantly more confident in performing gynecological than obstetric procedures ( p  = 0.015). A total of 63% of the Swiss participants had obstetric simulation training, and 28% had gynecological simulation training compared to 37% and 17% in Germany and Austria, respectively ( p  < 0.001 and p  = 0.007). 56% of Swiss participants reported “sufficient structured teaching”, 43% reported a “good teaching culture”, 47% of Swiss participants stated that they received regular feedback. Conclusions The majority of trainees in Switzerland feel confident in a range of procedures and interventions. Simulation training is relatively widespread, although in particular surgical simulation training should be expanded. Clinical teaching and feedback culture should be strengthened. “Teach the teacher” courses should be encouraged to promote a sustainable feedback culture.

Background: Congenital limb malformations are rare, and their perinatal outcomes are not well described. This study analyzed the perinatal outcomes of infants with congenital limb malformations. Methods: All infants with congenital limb malformations who underwent prenatal assessment and delivery at our tertiary referral center from 2004 through 2017 were retrospectively identified. Neonatal outcome parameters were assessed, and the predictors of worse perinatal outcomes were determined. Results: One hundred twenty-four cases of congenital limb malformations were identified, of which 104 (83.9%) were analyzed. The upper limb was affected in 15 patients (14.4%), the lower limb in 49 (47.1%), and both limbs in 40 (38.5%). A fetal syndrome was identified in 66 patients (63.5%); clubfoot and longitudinal reduction defects were the most frequent malformations. In total, 38 patients (36.5%) underwent termination, seven (6.7%) had stillbirth, and 59 (56.7%) had live-born delivery. Rates of preterm delivery and NICU transfer were 42.4% and 25.4%, respectively. Localization of the malformation was a determinant of the perinatal outcome (P = .006) and preterm delivery (P = .046). Conclusions: Congenital limb malformations frequently occur bilaterally and are associated with poor perinatal outcomes, including high rates of stillbirth and preterm delivery. Multidisciplinary care and referral to a perinatal center are warranted.