Objective To describe temporal trends and causes of postpartum maternal mortality following livebirth in Israel during 1998–2017, including deaths up to one year postpartum. Study design National retrospective population-based study using de-identified Israeli Central Bureau of Statistics mortality records linked to 3,076,207 livebirths (1998–2017). Postpartum livebirth maternal mortality ratios (postpartum livebirth MMR) were calculated for early (0–42 days) and late (43–365 days) postpartum periods. Trend analyses used rolling five-year averages, Mann-Kendall trend test, and generalized Binomial models. Results A total of 449 women died within one year following live birth (132 early, 317 late). The overall rolling maternal mortality rate up to 1 year after livebirth declined significantly from 19.6 to 10.4 per 100,000 live births (rate-ratio 0.53; 95% CI 0.41–0.69). The MMR up to 42 days following livebirth declined significantly from 5.3 to 2.6 per 100,000 live births (rate-ratio 0.48; 95% CI 0.29–0.81). Maternal age >35 years increased mortality risk (OR 2.02; 95% CI 1.39–2.93 early). Trend analyses of non-obstetric cause-specific showed significant decline in cardiovascular mortality from 1.81 to 0.69 per 100,000 livebirth between 1998 and 2017, whereas cancer-related mortality exhibited no reduction over the same period. Conclusion This national Israeli study, applying the ICD-MM criteria for classifying causes of maternal death, shows a 50% decline in maternal mortality following livebirth. Improvements in cardiovascular care likely contributed to the reduction observed in non-obstetric postpartum deaths. Future research should enable access to more detailed information on deaths during pregnancy, abortion, as well as early and late maternal mortality to better target prevention efforts for sub-groups at increased risk.
Objective To describe, in a standardized 10-step approach, the surgical technique of uterus transplantation in a recipient using a graft retrieved from a deceased donor after brainstem death (DBD). Uterus transplantation has emerged as the only therapeutic option enabling women with absolute uterine factor infertility to achieve pregnancy and childbirth (1). Although the procedure has progressively evolved over the last decade, it remains one of the most technically demanding transplant procedures, requiring meticulous vascular dissection, complex pelvic reconstruction, and close multidisciplinary collaboration ([2], [3], [4], [5], [6], [7], [8], [9]). Standardization of the recipient procedure is essential to improve reproducibility, facilitate surgical training, and optimize perioperative outcomes. This educational video presents the recipient operation in 10 consecutive steps, from pelvic preparation and vascular exposure to graft implantation, vascular anastomoses, vaginal anastomose, fixation of the graft, and final assessment of graft perfusion. The video highlights key technical landmarks and surgical tips that may help reduce operative complexity and contribute to the dissemination of uterus transplantation programs. Design This video article shows all the technical details for uterine transplantation recipient surgery using uterus retrieval from brain-dead donor. Setting University, clinical trial. Intervention A uterus retrieved from a deceased donor after brainstem death (DBD) was prepared on the back table and transplanted into a recipient with absolute uterine factor infertility. The video demonstrates the recipient procedure using a standardized 10-step approach, including pelvic preparation, exposure of the iliac vessels, graft positioning, venous and arterial vascular anastomoses, restoration of blood flow, vaginal anastomosis, fixation of the uterus, and final assessment of graft perfusion and anatomical positioning. Main outcome measures Feasibility and reproducibility of a standardized 10-step recipient surgical technique, successful completion of vascular and vaginal anastomoses, restoration of uterine perfusion after reperfusion, and immediate intraoperative assessment of graft viability. Results This educational video illustrates each of the 10 key surgical steps of uterus transplantation in the recipient following deceased donor procurement. The standardized surgical workflow presented was successfully applied in three consecutive clinical uterus transplantations using grafts retrieved from deceased donors after brainstem death, demonstrating its reproducibility in a real-world transplant setting. Particular emphasis is placed on pelvic exposure, graft orientation, and technical pearls that facilitate complex arterial and venous anastomoses while preserving graft integrity. Immediate reperfusion resulted in homogeneous graft revascularization, with restoration of normal uterine color and satisfactory perfusion confirmed by intraoperative assessment. By providing a structured and reproducible surgical roadmap, this video aims to facilitate training, promote technical standardization, and support the dissemination of deceased donor uterus transplantation programs. Conclusion Recipient surgery remains one of the most technically demanding components of uterus transplantation. A standardized stepwise approach may improve reproducibility, facilitate training of multidisciplinary transplant teams, and contribute to the safe dissemination of uterus transplantation from deceased donors.
Background Available evidence on OdonAssist, a novel assisted vaginal birth device, is limited to precommercial studies, and its performance during routine implementation by newly adopting teams remains unknown. Objective To assess the success rate of OdonAssist during early routine implementation and explore factors associated with success. Study design This multicenter retrospective observational study included all consecutive OdonAssist attempts in two French maternity units between July 2025 and May 2026. Success was defined as vaginal birth with OdonAssist alone. Factors associated with success, maternal and neonatal outcomes, and operator- and patient-reported experience were assessed. Results Among 38 attempts by 8 obstetricians, 20 were successful (52.6%; 95% CI, 35.8–69.0). Success increased from 25.0% on each operator’s first attempt to 52.4% for attempts 2–5 and 77.8% for attempts ≥6 (p for trend = 0.030). Slippage accounted for 14 failures (77.8%). All unsuccessful attempts were completed vaginally using another instrument. Maternal morbidity and clinically pertinent neonatal outcomes did not differ between groups. Operators were satisfied or very satisfied in 57.9% of assessments, and 76.7% of women with available data rated their overall childbirth experience as good or very good. Conclusions During initial implementation, the OdonAssist success rate increased with operator-specific experience. The learning curve should therefore be considered both during clinical implementation of the device and when interpreting findings from future studies.
