Monthly obstetrics and gynecology bulletin — September 18, 2026

Monthly obstetrics and gynecology bulletin — September 18, 2026
Period covered: August 18 to September 18, 2026. Eleven verified items. A moderate-volume month: no new drug regulatory approvals or new phase 3 trials in gynecologic oncology; the strongest material is in contraception, ovarian cancer prevention and guidelines.

Obstetrics and maternal-fetal medicine

1. FDA grants breakthrough therapy designation to certolizumab pegol in antiphospholipid syndrome

[FDA regulatory] [USA / Belgium]
On September 9 the FDA granted Breakthrough Therapy Designation to certolizumab pegol (Cimzia, UCB) to prevent adverse placental outcomes in pregnant women with antiphospholipid syndrome and a positive lupus anticoagulant. It is based on IMPACT (NCT03152058), a phase 2, single-arm, open-label trial: certolizumab added to low-molecular-weight heparin and aspirin from week 8 to 28; in the efficacy population (n=45), 9 patients (20%; 95% CI 9.6–34.6) had the composite outcome (fetal death ≥10 weeks, preeclampsia with severe features, or placental insufficiency with delivery <34 weeks), lower than historical controls; median delivery at 36.5 weeks and neonatal survival 93%.
Why it matters: this is the first regulatory pathway specific to this population, but the data come from 45 patients with no concurrent control, and the designation is not an approval; the standard of care remains aspirin plus heparin. The biologic's cost puts it out of reach of the Dominican public system for now.
https://www.contemporaryobgyn.net/view/certolizumab-pegol-cimzia-fda-btd-antiphospholipid-syndrome-pregnancy

2. Real-time artificial intelligence improves ultrasound detection of fetal intracranial malformations

[Clinical trial] [China]
A multicenter randomized crossover trial (the same sonographers with and without assistance) at five Chinese tertiary hospitals, published in The Lancet Digital Health and covered by MedSci on September 16. The PAICS system raised sensitivity for ten intracranial malformations (agenesis of the corpus callosum, holoprosencephaly, ventriculomegaly, etc.) from 0.696 to 0.814 (p<0.0001) with no loss of specificity; the gain was greatest among operators with 3–5 years of experience (+0.075) and 6–7 years (+0.103).
Why it matters: this is one of the few randomized trials of AI in obstetric ultrasound; sample size and funding were not visible in the source, and the system is validated only in a Chinese population, but the benefit in less-experienced operators is exactly what a country with a shortage of fetal-medicine specialists would need. (Source in Chinese.)
https://www.medsci.cn/article/show_article.do?id=acb595112e8d

3. Aortic balloon occlusion (REBOA) versus tourniquet in conservative surgery for placenta accreta spectrum

[Publication] [Russia]
A single-center retrospective study from the Kulakov National Medical Research Center (Moscow), Akusherstvo i Ginekologiya 2026;8:83-92 (DOI 10.18565/aig.2026.106), reported on September 2: 32 planned cesareans for accreta spectrum in 2024-2025, REBOA (n=8) versus tourniquet compressive hemostasis (n=24). Median blood loss 725 mL [435–1,100] versus 2,225 mL [1,575–2,862] (p<0.001); surgical time 82.5 versus 151 min (p=0.035); hysterectomy 0/8 versus 6/24 (not significant); no balloon-related vascular complications. No funding declared.
Why it matters: this reinforces the trend favoring endovascular occlusion, but with only 8 patients in the intervention arm, no randomization and no prior registration; the authors themselves call it preliminary. It requires interventional radiology in the operating room, available in very few Dominican centers. (Source in Russian.)
https://aig-journal.ru/articles/sravnitelnaya-ocenka-effektivnosti-endovaskulyarnoi-ballonnoi-okkluzii-aorty-reboa-i-turniketnogo-gemostaza-pri-organosohranyaushih-operaciyah-u-pacie.html

4. One in four pregnancies with hyperglycemia: national study in Bangladesh

[Publication] [Bangladesh]
A cross-sectional study at 70 antenatal care centers across the country's 64 districts (The Lancet Regional Health – Southeast Asia, online September 10; DOI 10.1016/j.lansea.2026.100861). 6,631 pregnant women at 24–28 weeks with two-step screening (50 g GCT followed by 75 g OGTT, 2013 WHO criteria): gestational diabetes 19.4% and diabetes in pregnancy 8.1%; 24.4% in urban areas versus 12.6% in rural areas. Independent factors: age ≥25, urban residence, high BMI, family history and physical inactivity. No external funding.
Why it matters: this figure is much higher than previously estimated burden (13%), with a large sample and standard criteria, although without adjustment for clustering and with a prior GCT that may underestimate. For the Caribbean, with rising obesity prevalence, it argues for universal screening with the OGTT.
https://pmc.ncbi.nlm.nih.gov/articles/PMC13584127

5. ACOG publishes a new clinical practice guideline on obstetric cerclage

[Guideline] [USA]
ACOG published in September 2026 (Obstetrics & Gynecology; PubMed 42623688) a Clinical Practice Guideline dedicated to obstetric cerclage. We could not access the full text or the specific recommendations for this bulletin (restricted access), so they are not reproduced here.
Why it matters: this replaces prior guidance on cervical insufficiency and is worth reviewing directly before revising history-, ultrasound-, or exam-indicated cerclage protocols.
https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2026/09/obstetric-cerclage

Gynecologic oncology

6. ACOG reinforces opportunistic salpingectomy to prevent epithelial ovarian cancer

[Guideline] [USA]
A clinical practice update from the Committee on Clinical Consensus (Obstetrics & Gynecology, August 25). Four recommendations: routine bilateral salpingectomy at every hysterectomy; recommend it in any gynecologic surgery entering the peritoneal cavity when fertility is not desired; complete salpingectomy as the preferred tubal procedure for permanent contraception; and support other surgeons in offering it during non-gynecologic surgery. It cites a meta-analysis with OR 0.48 (95% CI 0.33–0.69) and the 2026 British Columbia cohort (40,527 salpingectomies; serous cancer HR 0.22, 95% CI 0.05–0.95), with 12–16 additional minutes and no increase in complications. New: it no longer discourages changing the surgical approach to complete the salpingectomy.
Why it matters: the evidence remains observational, but it is consistent and the cost is minimal; this is one of the most applicable preventive interventions in our operating rooms, including postcesarean sterilization.
https://www.contemporaryobgyn.net/view/acog-clinical-update-salpingectomy-hysterectomy-ovarian-cancer-prevention

7. Updated network meta-analysis of PARP inhibitors in first-line maintenance

[Meta-analysis] [China]
Frontiers in Oncology, September 18 (PROSPERO CRD420261382266): 7 phase 3 trials, 3,930 patients with advanced, platinum-responsive ovarian cancer, including for the first time FZOCUS-1 (fuzuloparib). PFS benefit versus placebo was greatest in BRCAm (olaparib HR 0.30; 95% CI 0.22–0.40) and HRD+ (niraparib HR 0.45; 0.36–0.57), significant in HRD+ non-BRCA, inconsistent in HRP; no active regimen outperformed another, and no additional benefit was shown from adding an antiangiogenic (PAOLA-1 was excluded from the primary network); more grade ≥3 adverse events with PARPi. No commercial conflicts declared.
Why it matters: this does not change practice, but it synthesizes the state of the art with the correct reading: BRCA/HRD testing remains the key to indicating these drugs, whose access in the Dominican Republic remains limited.
https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2026.1884407/full

Reproduction and gynecologic endocrinology

8. Intrauterine mepivacaine reduces pain during IUD placement in nulliparous women

[Clinical trial] [Sweden]
JAMA, September 17 (DOI 10.1001/jama.2026.14217), Karolinska Institutet / Danderyd Hospital. A placebo-controlled multicenter randomized trial, 370 nulliparous women receiving a reduced-diameter IUD: intrauterine instillation of 10 mL of mepivacaine 20 mg/mL versus saline. Primary outcome: pain during insertion; mepivacaine significantly reduced it and improved tolerability.
Why it matters: this is a cheap, needle-free intervention that is reproducible in any clinic; the release does not give the effect size or funding, so the article should be read before protocolizing it, but the signal is consistent with the same group's earlier trial.
https://www.eurekalert.org/news-releases/1144042

9. First Society of Family Planning guideline on deep or nonpalpable contraceptive implants

[Guideline] [USA]
A Committee Statement in Contraception (DOI 10.1016/j.contraception.2026.111567; released August 31, covered September 10). Standardized protocol: palpation; if either end cannot be palpated with certainty, imaging before any removal attempt (first-line ultrasound with a >10 MHz linear transducer; x-ray or MRI depending on radiopacity); no deep extraction attempt without localization and expert supervision; refer to experienced centers. Deep placement occurred in 8.8 per 1,000 insertions (95% CI 6.8–11.2); a quarter to half of referrals had prior failed attempts; U-technique with a modified clamp, success 98–100% suprafascial and 86–90% subfascial.
Why it matters: this is a consensus guideline, not a trial, but very timely with the etonogestrel implant now approved for 5 years; in our setting, the core message is do not "fish" blindly.
https://www.contemporaryobgyn.net/view/sfp-guidance-deep-nonpalpable-contraceptive-implant-removal-coe

10. Systematic review of endometriosis pharmacotherapy: dienogest and combined relugolix

[Publication] [Poland]
Journal of Clinical Medicine, September 17 (PROSPERO CRD420251183131), Medical University of Lublin: 44 studies from 926 records (2019–2025), a narrative synthesis without meta-analysis. It confirms dienogest as first line; combined relugolix therapy appears more effective and safer than elagolix or relugolix monotherapy (SPIRIT 1/2: dysmenorrhea responders 75% versus 29% with placebo); the evidence on immunotherapies is of very low certainty.
Why it matters: this brings no new data and the review's bar is modest; it serves as an updated map of options, with the caveat that oral GnRH antagonists still have limited access in the country.
https://www.mdpi.com/2077-0383/15/18/7238

Minimally invasive surgery and pelvic floor

11. Less pain after vNOTES hysterectomy than after conventional laparoscopy

[Publication] [Turkey]
Turkish Journal of Obstetrics and Gynecology, September 4 (DOI 10.4274/tjod.galenos.2026.45928), Sancaktepe Hospital, Istanbul: a retrospective cohort, 2021–2025, 192 benign hysterectomies (vNOTES 117, laparoscopy 75). Median VAS at 6 h 4 versus 6 and at 24 h 2 versus 3 (p=0.001); rescue analgesia 23.9% versus 60% (adjusted OR for laparoscopy 4.62; 95% CI 2.31–9.26); surgical time 86 versus 105 min and length of stay 1 versus 2 days. No funding.
Why it matters: the design is retrospective, single-center and without a sample-size calculation, but it is consistent with prior randomized evidence favoring the vaginal route; vNOTES is a low-instrumental-cost approach, attractive for Dominican centers with vaginal surgeons trained in it.
https://pmc.ncbi.nlm.nih.gov/articles/PMC13544008/

No verifiable items this month in: prolapse and incontinence (a 2026 Cochrane update on prolapse surgery with or without incontinence could not be verified), Japan, Korea, India, the Middle East and Latin America (nothing new this month cleared the quality filter; a Korean news item on triweekly cisplatin in cervical cancer and a Korean AI colposcopy approval turned out to be from March and April 2026).

Upcoming meetings and dates

XXV Latin American Congress of Obstetrics and Gynecology (FLASOG 2026): Lima, Peru, November 22–26, 2026 (precongress sessions on the 22nd). This is the year's regional meeting; it falls outside the six-week window, but is worth reserving. https://www.dmccongresos.com/xxvcongresolatinoamericanodeobstetriciayginecologia

Monthly obstetrics and gynecology bulletin — September 18, 2026

Eleven verified items from the past 30 days, spanning obstetrics, gynecologic oncology, reproduction and minimally invasive surgery.

Three worth your time:
• FDA breakthrough therapy designation for certolizumab pegol in antiphospholipid syndrome: a first regulatory pathway for this population, based on a small, single-arm phase 2 trial.
• ACOG update reinforcing opportunistic salpingectomy at hysterectomy and any peritoneal-entry gynecologic surgery to prevent ovarian cancer.
• Intrauterine mepivacaine (JAMA) significantly reduces pain during IUD placement in nulliparous women, a cheap and reproducible option.

Full bulletin: https://boletinesmedicos.com/en/ginecologia/2026-09-18.html

Monthly ob/gyn bulletin: FDA breakthrough therapy designation for certolizumab in antiphospholipid syndrome; ACOG reinforces opportunistic salpingectomy for ovarian cancer prevention; intrauterine mepivacaine cuts IUD-placement pain in JAMA trial. 11 verified items: https://boletinesmedicos.com/en/ginecologia/2026-09-18.html
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