Obesity leads to menstrual irregularities and ovulation disorders and is a well-established risk factor for infertility. However, menstrual irregularities and ovulatory disorders are not affected in assisted reproductive technology (ART), which employs controlled ovarian stimulation. This study aimed to evaluate pregnancy outcomes in ART according to obesity level and to clarify the impact of obesity on fertility. We compared the cumulative clinical pregnancy, miscarriage, and cumulative live birth rate among 1,499 patients who underwent ART at our hospital between 2019 to 2023, excluding those with a body mass index(BMI) < 18.5 kg/m2. Participants were categorized into a normal weight group (BMI:18.5-24.9 kg/m2;Group C) and three obese groups: Group O1 (BMI: 25-29.9 kg/m2), Group O2 (BMI: 30-34.9 kg/m2), and Group O3 (BMI > 35 kg/m2). Statistical analyses were performed using Dunnett’s test and the chi-squaretest. The cumulative clinical pregnancy and live birth rates were 72.3% and 63.1% in Group C; 68.5% and 58.0% in Group O1; 63.8% and 57.4% in Group O2; and 61.5% and 53.8% in Group O3. Miscarriage rates were 19.8% in Group C; 21.0% in Group O1; 25.5% in Group O2; and 38.5% in Group O3, with no statistically significant differences among the groups. The total number of embryo transfers required to achieve pregnancy was significantly higher in the Group O3 (P=0.002). These findings suggest that cumulative clinical pregnancy and live birth rates do not significantly differ between obese patients and normal-weight patients undergoing ART. Delaying the start of treatment for weight loss purposes leads to a decline in fertility with age, so if pregnancy and childbirth are acceptable, it is necessary to actively consider the option of providing infertility treatment after considering the risks associated with pregnancy.〔Adv Obstet Gynecol, 78(1), 1-7, 2026(R8.2)〕

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閉経後の陰唇癒着症は低エストロゲン状態を背景にして，感染・炎症・外傷などが加わり発症するとされている．以前より，エストロゲン製剤の使用や癒着部位の剥離・切除などの外科的手術により治療が行われているが，再癒着することも多い．そのため，最近では形成外科で瘢痕拘縮の治療・予防目的に使用するZ形成術による治療も行われている．今回われわれは，尿線の乱れから陰唇癒着症の診断に至り，Z形成術および既報では陰唇癒着症に対して行われたことのない5―flap形成術を併用することにより再癒着防止を行った症例を経験したので報告する．症例は66歳．6カ月前からの尿線の乱れを主訴に近医泌尿器科を受診し，小陰唇の癒合を認めるため紹介となった．両側の小陰唇は癒合し中央やや肛門側が5 mmほど開口していた．癒着は強固であり，全身麻酔下に癒着剥離を実施し，両側小陰唇の接着防止にZ形成術，創部の拘縮瘢痕による再癒着防止目的に5-flap形成術を行い，術後はメチルイソプロピルアズレン軟膏塗布とエストロゲン腟錠を使用した．術後1年1カ月の経過で形成術を実施した部分には再癒着は認めず，本法は癒着防止のため有用な術式と考える．〔産婦の進歩78（1），8-13，2026（令和8年2月）〕

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卵巣腫瘍のautoamputationはまれな病態である．腹腔鏡手術を契機に確認されたautoampu-tationした卵巣成熟囊胞性奇形腫（mature cystic teratoma；MCT）の2症例を経験したので報告する．症例1は73歳，6妊2産．5 cm大の右卵巣MCTの疑いにて腹腔鏡手術を実施した．術中には膀胱子宮窩右側に5 cm大の腫瘍を認め，周囲組織と広範な癒着が存在していた．腫瘍は左卵管采と連続していたが卵巣固有靭帯および骨盤漏斗靭帯との解剖学的連続性は認められなかった．症例2は57歳，3妊2産．術前に6 cm大の右卵巣多房性MCTが疑われ，手術を実施した．術中にはダグラス窩に5 cm大の腫瘍を認め，左右いずれの卵巣固有靭帯および骨盤漏斗靭帯との連続性は認められなかった．左卵管は数珠状に捻転し欠失はなかった．萎縮した左卵巣および右付属器は正常解剖位置に存在していた．今回の2症例では，MCTは子宮および骨盤漏斗靱帯との解剖学的連続性を欠いており，卵管采との連続が認められた． 症例 2 では卵管の捻転を認めており， これらの所見はMCT における捻転，autoamputationおよびreimplantationを経て寄生性MCTが形成されるという仮説を支持する病態学的根拠となる可能性がある．寄生MCTは卵管采に連続していた所見ならびに膀胱子宮窩に存在した所見がまれと考えられるため，ここに報告する．〔産婦の進歩78（1），14-22，2026（令和8年2月）〕

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Ovarian mature teratoma is a benign tumor that predominantly occurs in young women. Malignant transformation is rare, accounting for approximately 1-2% of all cases, and sebaceous carcinoma arising within a mature teratoma is extremely uncommon. We report a rare case of sebaceous carcinoma arising in an ovarian mature teratoma, together with a review of the relevant literature. The patient was a 73-year-old nulligravid woman. Abdominal contrast-enhanced computed tomography revealed an 18-cm pelvic mass, and she was referred to our department with a suspected diagnosis of ovarian mature teratoma. Contrast-enhanced pelvic MRI showed no findings suggestive of malignancy; however, the SCC antigen level was elevated at 3.5 ng/mL. Therefore, intraoperative frozen section diagnosis was planned. A right abdominal salpingo-oophorectomy was performed, and frozen section analysis revealed findings suspicious for squamous cell carcinoma arising in the background of a mature teratoma. Consequently, total abdominal hysterectomy, left salpingo-oophorectomy, and partial omentectomy were added. Final histopathological examination revealed sebaceous differentiation in the area initially suspected to be squamous carcinoma. Based on the presence of frequent mitotic figures, necrosis, and nuclear atypia, the lesion was diagnosed as sebaceous carcinoma arising in an ovarian mature teratoma, classified as FIGO stage IA. No adjuvant therapy was administered, and the patient remains under observation without recurrence. Given the rarity of sebaceous carcinoma and the limited number of reported cases arising within ovarian mature teratomas, this case is presented with a review of the literature.〔Adv Obstet Gynecol, 78 (1), 23-29, 2026(R8.2)〕

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Right-sided congenital diaphragmatic hernia（CDH）accounts for approximately 13―17% of all CDH cases. However, clinical reports on its perinatal course remain limited in Japan. In this study, we retrospectively analyzed six cases of isolated right-sided CDH（iRCDH）without associated anomalies or chromosomal abnormalities, all of which were managed at our institution. All six cases were diagnosed prenatally and had liver herniation. Of these, three neonates survived to hospital discharge, while the other three died during the neonatal period. Consistent with previous studies, all three non-survivors had an observed-to-expected lung-to-head ratio（o/e LHR）of ≤45%. We also compared the lung-to-liver signal intensity ratio（LLSIR）in one survivor and one non-survivor. The survivor showed a ratio of 2.01, while the non-survivor showed 1.46, suggesting that lung maturation was poor in the non-surviving case. These findings indicate that, even in right-sided CDH, evaluating pulmonary hypoplasia is important, and parameters such as o/e LHR and MRI findings may be useful in predicting outcomes.〔Adv Obstet Gynecol, 78（1）, 30-37, 2026（R8.2）〕

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Immune-related adverse events associated with immune checkpoint inhibitors (ICIs) can presentwith a variety of symptoms. When interstitial pneumonia occurs during ICI therapy, immune-related pneumonia should be ruled out. We report a case of pneumocystis pneumonia (PCP) diagnosed during lenvatinib plus pembrolizumab (LP) therapy. The patient, 57 years old with multiple lung metastases, had undergone six cycles of adjuvant paclitaxel plus carboplatin (TC) chemotherapy for endometrial cancer. One year and six months after completing TC therapy, the disease progressed, prompting the initiation of LP therapy. After five cycles, the patient developed fever and hypoxemia, and computed tomography imaging revealed ground-glass opacities in bilateral lung fields. Laboratory test results showed elevated beta-D-glucan levels, and Pneumocystis jirovecii polymerase chain reaction assay of the bronchoalveolar lavage confirmed the diagnosis of PCP. The patient was treated with antifungal agents and steroids, after which LP therapy was resumed. One year later, the patient remained on LP therapy without recurrence of PCP. Pneumonia occurring during ICI treatment should be differentiated from drug-induced pneumonia, infectious etiologies, and other pulmonary conditions.〔Adv Obstet Gynecol, 78(1), 38-44, 2026(R8.2)〕

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Group A streptococcal toxic shock syndrome progresses rapidly to septic shock, diffuse intravascular coagulation, and multiorgan failure. The perinatal type is particularly fulminant and causes a high rate of fetal and maternal death. There are very few cases in which the mother survives when the fetus has already died upon arrival at the hospital. Herein, we present a case of streptococcal toxic shock syndrome with intrauterine fetal death. A 41-year-old female visited our hospital at 37 weeks of gestation with fever, abdominal pain, diarrhea, and decreased fetal movement. Intrauterine fetal death was confirmed, and the baby was delivered 2.5 hours after arrival at the hospital. Based on the disease course, fulminant group A streptococcal infection was suspected and high-dose antibiotics were initiated, followed by intensive treatment in cooperation with physicians. The patient was discharged without complications. When a pregnant female presents with fever, labor-like abdominal pain, or an abnormal fetal heart rate, it is important to be aware of the possibility of fulminant group A streptococcal infection and provide immediate therapeutic intervention in collaboration with other relevant departments, while considering the quick sepsis-related organ failure score.〔Adv Obstet Gynecol, 78（1）, 45-52, 2026（R8．2）〕

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Pelvic congestion syndrome (PCS) is a common cause of chronic pelvic pain. Typical symptoms include exacerbation of lower abdominal pain during standing or walking, and relief when in the supine position. We present the case of a 23-year-old nulliparous woman who complained of lower abdominal pain that had lasted for more than six months. The pain worsened with standing or walking and improved with lying down, consistent with the typical presentation of PCS. However, imaging studies did not reveal clear evidence of ovarian vein dilatation or pelvic varices. Medical management was ineffective. Based on the clinical presentation, a diagnosis of PCS was made, and ovarian vein embolization was performed. The pain was significantly relieved after the operation, and her quality of life markedly improved.Even in the absence of definitive imaging findings, PCS should be considered as a differential diagnosis when clinical symptoms are typical and timely therapeutic intervention should be considered to improve patient outcomes.〔Adv Obstet Gynecol, 78(1), 53-58, 2026(R8.2)〕

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We report a challenging case of tubo-ovarian abscess (TOA) that required prolonged antibiotic therapy because of recurrent infection from a residual abscess wall firmly adherent to the rectal wall. A 51-year-old woman (gravida 2, para 2) presented with a two-week history of fever. Contrast-enhanced computed tomography (CT) revealed an 11 cm fluid collection posterior to the uterus, raising suspicion of TOA. While awaiting surgery, repeat CT showed interval shrinkage of the collection, suggesting either spontaneous drainage through an occult gastrointestinal perforation or abscess rupture. Emergency laparoscopy identified a right TOA; the right adnexa were resected. However, the abscess wall was firmly adherent to the rectal wall, which prevented complete excision. As there was no macroscopic fistulous tract and the leak test was negative, bowel resection was not performed. Postoperatively, the patient improved with a week of fasting, pelvic drainage, and intravenous antibiotics and was discharged on postoperative day 32. The patient was readmitted on postoperative days 67 and 144 due to recurrent infection. Subsequent six-month outpatient management with oral antibiotics achieved clinical resolution. While bowel resection should be the primary consideration for TOA with suspected enteric fistula, when the fistulous site cannot be clearly identified, prolonged antibiotic therapy under strict systemic management may be considered as a conservative option.〔Avd Obstet Gynecol, 78(1), 59-67, 2026(R8.2)〕

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Uterine rupture is a rare but serious obstetric complication, with a recurrence rate of approximately 10%, posing significant risks to both mother and fetus. We report a case in which laparoscopic evaluation following surgical repair of pregnancy-related uterine rupture led to the identification of a uterine fistula, ultimately allowing for a successful pregnancy and delivery. A 37-year-old nulliparous woman with a history of uterine perforation due to the preparation for hysteroscopy was transferred at 31 weeks of gestation due to intrauterine fetal death and maternal shock caused by uterine rupture. A longitudinal rupture extending from the posterior wall to the uterine fundus was identified and surgically repaired. Five months after surgery, MRI evaluation of the posterior uterine wall was inconclusive. Laparoscopic examination revealed adhesions and a fistula at the same site, and re-repair was performed via laparotomy. Nine months later, pregnancy was achieved via assisted reproductive technology. She was admitted at 22 weeks for intensive monitoring and underwent an elective cesarean section at 30 weeks to prevent the re-rupture. Although placenta percreta necessitated a cesarean hysterectomy, a healthy infant was delivered. This case suggested the importance of laparoscopic evaluation when imaging is inconclusive in assessing uterine integrity after rupture.〔Adv Obstet Gynecol, 78 (1), 68-73, 2026(R8.2)〕

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Ebstein’s anomaly is a rare congenital heart disease caused by abnormal tricuspid valve formation, accounting for fewer than 1% of all congenital heart disease cases, with an estimated incidence of 1 in 20,000 live births. We encountered a case of fetal Ebstein’s anomaly recognized early following detection of increased nuchal translucency (NT) in early pregnancy. The patient was a 40-year-old primigravida. At 14 weeks of gestation, NT thickness was 3.6 mm. Considering the potential risk of congenital heart disease, serial fetal echocardiography was performed. At 22 weeks, mild tricuspid regurgitation was detected, which progressed to severe regurgitation and right heart enlargement by 33 weeks, prompting referral to our hospital. A detailed examination at 34 weeks revealed a Celermajer index of 0.78 (Grade II). A multidisciplinary team developed a delivery plan, and an elective cesarean section was performed at 37 weeks and 6 days of gestation. The newborn weighed 2,444 g, with Apgar scores of 9 and 9. The infant was intubated immediately after birth and managed with nitric oxide inhalation and inotropic support, showing a favorable course. At present, the child demonstrates normal growth and development at two years and two months of age.〔Adv Obstet Gynecol, 78(1), 74-79, 2026(R8.2)〕

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