Hypertensive disorders complicate approximately 5-10% of pregnancies globally, significantly impacting maternal and foetal health. To address the distinct impacts of chronic hypertension and pregnancy-induced hypertension (PIH) on foeto-maternal health, this review delineated their associated distinct risk factors and diagnostic markers, providing evidence-based insights to guide targeted, patient-centred management of hypertensive pregnancies. A systematic search of Web of Science, PubMed, and SCOPUS was conducted using predefined criteria. Observational studies were rigorously screened and quality assessed. Data were extracted and narratively synthesised, with an emphasis on maternal and foetal outcomes, diagnostic modalities, and risk modifiers. The analysis confirmed that intrauterine foetal demise, intrauterine growth restriction, low birth weight, and neonatal as well as maternal mortality are major adverse outcomes of hypertensive pregnancies. The evidence demonstrates that whilst chronic hypertension and PIH confer considerable risk, PIH often results in more sudden and severe clinical deterioration, especially in the absence of vigilant prenatal monitoring and timely intervention. The findings underscored the value of targeted, patient-centred care: women with chronic hypertension benefit from early and sustained surveillance, whereas those with PIH require prompt escalation of monitoring following diagnosis, especially in the second trimester. Notably, comorbid systemic illnesses and advanced maternal age compound risks across hypertension categories, and diagnostic modalities, particularly ultrasound Doppler, are pivotal for early risk stratification and management. Effective management of hypertensive pregnancies requires early identification and individualised monitoring, recognising that chronic hypertension and pregnancy-induced hypertension differ in onset and progression, but both pose significant risks to maternal and foetal health.
Endometriosis and interstitial cystitis/bladder pain syndrome (IC/BPS) frequently coexist; however, diagnostic delays and non-standardized criteria limit accurate identification of these conditions. To assess the feasibility, safety, and clinical characterization of coexisting endometriosis and IC/BPS using a standardized surgical evaluation approach. In this prospective single-center study, approximately 100 women with presumed endometriosis and bladder symptoms undergoing laparoscopy for staging and/or treatment will simultaneously undergo diagnostic cystoscopy for IC/BPS. Optical confirmation and phenotype characterization of IC/BPS will be assessed. In cases with cystoscopic signs of IC/BPS, a standardized therapeutic protocol will be initiated to address bladder-centric symptoms alongside endometriosis treatment. The study will evaluate whether systematic surgical assessment enables reliable detection of coexisting endometriosis and IC/BPS and facilitates the identification of bladder-centric and non-bladder-centric IC/BPS phenotypes. Early recognition of IC/BPS in women with endometriosis may reduce unnecessary interventions and inform individualized management strategies. The combination of standardized laparoscopy and cystoscopy may improve diagnostic precision in patients with suspected coexisting endometriosis and IC/BPS. The study is expected to provide insights that support phenotype-driven, multidisciplinary care and inform future research and the development of integrated diagnostic algorithms.
Ovarian clear cell carcinoma (OCCC) is frequently characterized by dysregulation of the PI3K/AKT/mTOR (PAM) pathway; however, the expression patterns and clinical significance of class I PI3K catalytic isoforms remain incompletely understood. This study aimed to comprehensively evaluate PI3K catalytic subunit expression, co-expression patterns, and their prognostic relevance in OCCC. A retrospective cohort of 100 patients with OCCC was analyzed. Immunohistochemistry was performed to assess the expression of p110α, p110β, p110δ, p110γ, and pAKT. PIK3CA exon 9 and exon 20 mutations were evaluated in available formalin-fixed paraffin-embedded tissues. Associations between PI3K isoforms, pAKT activation, clinicopathological characteristics, and survival outcomes were investigated. The expression positivity rates of the four class I PI3K catalytic subunits in OCCC were 86% for p110γ, 77% for p110α, 58% for p110δ, and 56% for p110β. p110α and p110β were positively associated with pAKT activation, whereas p110δ and p110γ showed no significant association. p110δ expression was significantly correlated with PI3KCA exon9 mutation. Frequent co-expression of multiple PI3K catalytic subunits was observed, with simultaneous expression of all four isoforms representing the predominant pattern and significantly correlating with pAKT positivity. In advanced-stage disease, p110β expression was significantly associated with poorer progression-free survival (PFS), while pAKT positivity correlated with worse overall survival (OS) and PFS. OCCC displays substantial heterogeneity in PI3K catalytic isoform expression and co-expression. p110α and p110β were associated with pAKT activation. In advanced-stage OCCC, high p110β expression was associated with poorer PFS, whereas pAKT activation was associated with both poorer PFS and OS, supporting further investigation of PI3K-targeted therapeutic strategies.
This meta-analysis evaluated the effects of complementary and alternative therapies on menopausal symptoms. Relevant randomized controlled trials published after 2020 were systematically searched in the ASSIA, CENTRAL, CINAHL, LILACS, PubMed, Embase, and WOS databases. A total of 24 studies were included, and analyses were conducted using RevMan and JASP software. Heterogeneity and publication bias were assessed using various statistical methods. Results Twenty-four randomized controlled trials were synthesized. Evidence from the included studies indicates that complementary and traditional interventions may contribute to improvements in menopausal symptoms; however, effect estimates varied substantially across studies. A random-effects meta-analysis identified an average effect estimate, but substantial heterogeneity (τ2 = 0.362) and a wide 95% prediction interval (-0.228 to 2.340) suggest considerable uncertainty in the magnitude and direction of effects across different settings. Meta-regression analyses showed that larger sample sizes were associated with smaller observed effects (β = -0.005, p = .014), indicating potential small-study effects. Intervention duration significantly influenced outcomes, whereas intervention type, dose, and formulation were not significant moderators. Subgroup analyses suggested beneficial trends for both herbal and non-herbal interventions, although prediction intervals remained wide, reinforcing the variability of findings. Improvements were most consistent for hot flashes, while evidence for overall symptom severity and quality of life was less consistent. Although no statistically significant publication bias was detected, this finding should be interpreted with caution given the limited number of studies and observed heterogeneity. Integrating evidence-based complementary and alternative approaches into clinical guidelines could enhance holistic women's healthcare.
The teaching and practical training of future doctors play an important role in the university curriculum. At the Women's Clinic of Saarland University Hospital in Homburg, we developed a five-day block placement concept that focused on learning practical gynecological and obstetric skills rather than simply imparting theoretical knowledge. The student`s satisfaction with the block placement was assessed using a non-standardized questionnaire with the two items "How do you rate your learning outcomes from the placement?" and "The placement increased my interest in gynecology and obstetrics". The assessment was based on a scale of 1 to 6. A total of 205 out of 220 students (93.2%) from the winter semester 2022/2023 participated in the evaluation and completed the questionnaire. 198 students (96.6%) rated the satisfaction with their perceived learning from the block internship as very good (1) or good (2), and 201 students (98%) reported an increase in their interest in the subject area. An overwhelming majority of students rated the practical teaching concept as very good or good, which speaks to the success of this practical teaching format. Nevertheless, the study also has several limitations. For example, only one cohort of medical students was surveyed. Furthermore, when establishing a new teaching concept, there is a risk that participants in an evaluation will not respond objectively, but rather according to the criterion of social desirability. We suggest our practice-oriented block placement concept, which focuses on learning skills relevant to the future medical profession, as a possible curriculum for undergraduate teaching in gynecology and obstetrics, to inspire students for the field.
The aim of this prospective cohort study was to evaluate the developmental potential of metaphase I (MI) oocytes that failed to mature following rescue in vitro maturation (IVM), and to investigate the roles of artificial oocyte activation (AOA) and meiotic spindle presence in fertilization and early embryo development. A total of 49 patients were included in the analysis. The study population was divided into 2 groups: an AOA group (28 patients, 42 MI oocytes) undergoing intracytoplasmic sperm injection (ICSI) followed by calcium ionophore-mediated activation, and a non-AOA control group (21 patients, 40 MI oocytes) undergoing ICSI without activation. Fertilization, embryo development, and clinical outcomes were compared between the groups. In addition, meiotic spindle presence was assessed using polarized light microscopy, and patients were categorized as spindle-positive or spindle-negative. Fertilization occurred in 23 of 42 MI oocytes (54.7%) in the AOA group, compared with 1 of 40 (2.5%) in the non-AOA group (p < 0.001). In the control group, fertilization was observed only in a spindle-positive patient, and the resulting embryo arrested before transfer. In contrast, embryos derived from AOA-treated oocytes were able to progress to the transfer stage. Among AOA-treated patients, fertilization rates were higher in the spindle-positive group than in the spindle-negative group (71.4% vs. 50.0%), although this difference did not reach statistical significance. A total of eight embryos reached the transfer stage, resulting in one biochemical pregnancy and one clinical pregnancy leading to a live birth. MI oocytes that fail to mature after rescue IVM appear to retain limited developmental potential. The use of artificial oocyte activation was associated with higher fertilization rates and enabled embryo development to progress to transferable stages in this cohort. The presence of a meiotic spindle may be associated with improved developmental competence and could represent a potential non-invasive marker; however, this observation requires further validation. Given the limited sample size and exploratory nature of the study, these findings should be interpreted with caution, and larger studies are needed to confirm their clinical relevance.
To evaluate whether preoperative clinical Enzian scoring and digital rectal examination improve accuracy of operative time prediction and surgical outcomes in women undergoing surgery for endometriosis. Prospective, randomized, multicenter pilot trial. Three urban teaching hospitals certified as endometriosis centers. A total of 107 women undergoing surgery for endometriosis. The participants were randomly assigned to three groups: Group 1 underwent clinical Enzian scoring combined with digital rectal examination (DRE); Group 2 underwent clinical Enzian scoring only; and Group 3 underwent digital rectal examination only. All patients received standard transvaginal ultrasound examinations. The primary endpoint was defined as an absolute difference of ≤ 10 min between the estimated and the actual operative time. Secondary end points included conversion to laparotomy, abandonment of the operation, complete resection rate, need for secondary surgery, correspondence between the preoperative Enzian assessment and intraoperative findings, and postoperative pain (visual analog scale) and patient satisfaction. The primary endpoint was achieved in 9 patients (23.7%) in Group 1, 16 patients (47.1%) in Group 2, and 15 patients (42.9%) in Group 3. Exploratory comparison of the three groups did not demonstrate a statistically significant difference in the proportion of accurate operative time estimations. Secondary endpoints, including conversion rate, abandonment of the operation, complete resection rate, reoperation rate, and patient-reported outcomes, were also comparable across the groups. The results demonstrate that neither diagnostic strategy provided a measurable advantage in predicting operative time or improvement of surgical outcome parameters. DRKS00040760.
Randomized controlled clinical trials have shown that symptoms of chronic pain conditions, such as endometriosis, can be improved with the use of specialized health apps. In the current study, real-world evidence was collected from Endo-App users to determine whether there was a sustained and positive effect on endometriosis symptoms. Users of the Endo-App were offered an optional, six-question anonymous survey through the platform upon first registration (T0), after 3 (T1), and 6 to 7 (T3) months of use. The survey questions were not standardized and aimed to assess the severity of endometriosis symptoms and overall quality of life. Data were analyzed using MatLab using a parametric paired t-test when pairs of data between T0-T1 and/or T0-T2 were available. Statistical significance was defined as p < 0.05. A total of 143 users of the app completed at least part of the survey at 3 months and 55 users at 6 to 7 months. After 3 and 6 to 7 months of using the app average pain levels and days requiring medical assistance were significantly reduced compared to baseline values. In addition, the average reported number of sick days taken was significantly reduced at the 6-to-7-month timepoint compared to baseline. This real-world study demonstrates that use of a specialized app for endometriosis, such as the Endo-App, documents and may lead to a significant and sustained improvement of some endometriosis symptoms.
Which patients with endometriosis suffer from diminished ovarian reserve as well as impaired embryo quality and therefore could benefit from medical freezing as part of fertility preservation strategies? This retrospective study analyzed 205 patients who underwent follicle puncture at our center in preparation for IVF/ICSI treatment. All patients with laparoscopically confirmed endometriosis were classified according to rASRM and #ENZIAN. In total, 183 follicle punctures and 168 embryos were evaluated. Anti-Müllerian hormone (AMH) levels, the antral follicle count (AFC), the number of retrieved oocytes as well as the rate of mature oocytes and the fertilization rate were compared among the different subtypes of endometriosis. Embryo quality was assessed by the KIDScore™ on days 3 and 5. The analyses revealed significant differences in the AFC among patients with peritoneal (mean AFC: 16.43), deep-infiltrating (11.84) and ovarian endometriosis (10.85) (p = 0.006). The largest difference was observed between superficial and ovarian endometriosis (p = 0.004). The number of retrieved oocytes also differed significantly among the subgroups (p = 0.012), with the strongest contrast between deep-infiltrating (11.18) and ovarian endometriosis (8.14). Although the AFC, AMH and number of retrieved oocytes were strongly correlated, AMH alone did not differ significantly between the subgroups. The rate of mature oocytes was the lowest in patients with deep-infiltrating endometriosis but did not reach statistical significance. Patients with endometriomas presented the lowest fertilization rates and KIDScore™ values; however, only the difference in KIDScore™ D5 reached statistical significance (FR: p = 0.077, D3: p = 0.659, D5: p = 0.005). Endometriosis subtypes differ in their impact on the ovarian reserve. Patients with ovarian endometriosis exhibit a diminished ovarian reserve, reflected by a lower AFC, a lower number of retrieved oocytes and lower number of mature oocytes. Additionally, a lower embryo quality was also observed. These findings could not be replicated in patients with superficial or deep-infiltrating endometriosis. Our study highlights the importance of identifying the specific form of endometriosis. Given that diminished ovarian reserve and recued embryo quality were observed at the time of reproductive therapy, we propose that early elective oocyte cryopreservation may help prevent these adverse outcomes, particularly in patients with ovarian endometriosis. However, additional factors and fertility preservation strategies should be taken into account when considering its indication and fertility preservation strategy in patients with deep-infiltrating or superficial endometriosis.
We present the rare case of a 29-year-old patient with uterine adenosarcoma who received fertility-sparing treatment, subsequently conceived spontaneously, and gave birth to a healthy infant. In August 2022, the nulliparous patient presented with acyclic uterine bleeding. Diagnostic hysteroscopy and targeted resection of a polyp located at the cervicouterine junction revealed uterine adenosarcoma without sarcomatous overgrowth (FIGO stage T1a). Imaging confirmed no residual tumor or metastasis. A fertility-sparing management strategy was chosen, avoiding hysterectomy but involving close oncological surveillance with quarterly MRI scans. During follow-up, a concurrent diagnosis of symptomatic endometriosis introduced therapeutic challenges. The patient spontaneously conceived in 2023 and delivered a healthy infant by cesarean section at term in 2024. Subsequent hysteroscopy and imaging in 2025 showed no evidence of recurrence, therefore fertility-preserving management was continued. A short narrative of the patient's perspective on her initial diagnosis, possible fertility loss, and the emotional turmoil of pregnancy after uterine adenosarcoma is presented. Treating young patients diagnosed with uterine adenosarcoma poses a challenge to the treating physician due to the lack of guidelines and evidence regarding fertility-preserving treatment of this rare tumor. This report adds to the limited literature on successful pregnancy after uterine adenosarcoma and discusses indications and limitations of fertility-sparing treatment. Fertility preservation may be possible in selected early-stage uterine adenosarcoma cases without high-risk features such as sarcomatous overgrowth or myometrial invasion, with thorough counseling and strict follow-up. Further research is needed to develop standardized protocols and improve management in this context.
Central adiposity increases during the menopausal transition, yet its hormonal signatures are not well defined. This study examined whether the waist-to-height ratio (WHtR) reflects coordinated variation in sex-steroid, thyroid, and metabolic pathways in midlife women, and evaluated the discriminative value of key endocrine markers for identifying elevated WHtR. We conducted a population-based cross-sectional analysis of 17,379 women aged 40-60 years who underwent standardized WHtR measurement and serum assessment of sex-steroid hormones (estradiol, testosterone, progesterone, FSH, LH), thyroid hormones (free T4, free T3, TSH), and metabolic markers (lipid profile, HbA1c). Associations were tested using univariate correlations and multivariable regressions adjusted for age and BMI. Age-adjusted WHtR percentiles were estimated using quantile regression. Hormonal-metabolic clustering was mapped using correlation matrices. Logistic regression and ROC analyses evaluated the performance of estradiol, free T4, and their combination for identifying WHtR ≥ 0.50. WHtR values were in the healthy range for 68.4% of women, while 29.3% exceeded the ≥ 0.50 threshold. WHtR showed weak negative correlations with estradiol (r = -0.024, P = 0.0019) and free T4 (r = -0.017, P = 0.026), with small effect sizes, and these markers remained independently associated with WHtR after adjusting for age and BMI. ROC analyses demonstrated moderate discrimination by FT4 (AUC 0.67), compared with estradiol (AUC 0.61), with improved accuracy when combined (AUC 0.76). Lower estradiol and FT4 levels were associated with higher central adiposity in midlife women. WHtR showed weak, but significant associations with both hormones, yet the small effect sizes and low explanatory power render it clinically unsuitable for individual-level assessment.
Caesarean scar defect (CSD), also known as an isthmocele or niche, is a common consequence of caesarean delivery, associated with chronic inflammation, abnormal uterine bleeding, pelvic pain, and infertility, though some patients remain asymptomatic. Minimally invasive isthmocele repair (MIIR) has emerged as a promising therapeutic option for symptomatic women and those seeking fertility, yet evidence guiding optimal surgical management remains limited. In particular, data on reproductive outcomes are scarce and largely based on small, heterogeneous case series. To our knowledge, there are no data from direct comparisons between robotic-assisted (RAIR) and conventional laparoscopic (LIR) isthmocele repairs. This monocentric retrospective study included patients undergoing RAIR and LIR at the University Hospital Bonn between December 2019 and March 2026. The primary objective was to determine the live-birth rate after MIIR in women attempting conception. Secondary objectives included evaluating patient-reported outcomes, such as symptom relief, and objective outcomes, including changes in niche length, niche depth, and residual myometrial thickness, as well as obstetric outcomes in subsequent pregnancies, and comparisons between RAIR and LIR. Twenty-eight patients underwent CSD surgery, including 21 RAIR and 7 LIR procedures. Follow-up was available in 82% of patients (median 4 months). No intraoperative or postoperative complications occurred. Among women attempting conception (n = 8), the live-birth rate was 75% (6/8), with equal distribution between groups. In the RAIR group, a significant decrease in niche length and niche depth as well as a significant increase in myometrial thickness were observed between pre- and postoperative. In the LIR group, similar trends were noted that did not reach statistical significance. Between-group comparisons showed no significant differences in postoperative imaging outcomes. Symptom improvement was reported in the majority of patients, particularly regarding abnormal uterine bleeding and pelvic pain. Obstetric outcomes included one uterine scar dehiscence and one placenta accreta spectrum disorder (each 3.6%), both occurring after RAIR. MIIR and especially RAIR represent a promising fertility-preserving and symptom-improving option for patients with CSD. This study was registered in the German Clinical Trials Register (DRKS) under the number DRKS00038857 on April 15th 2026.
Amniotic fluid sludge (AFS) is a sonographic finding associated with intra-amniotic infection and spontaneous preterm birth. The microbial composition of AFS remains poorly characterized. This systematic review and meta-analysis aimed to consolidate existing data on microbial prevalence in AFS and identify consistent microbial patterns. A systematic search of MEDLINE (PubMed), Dimensions, and OpenAlex was conducted from inception to February 11, 2026. Studies reporting the prevalence of microorganisms in AFS (minimum 10 cases) from pregnant women with AFS diagnosed via transvaginal ultrasound were included. Two reviewers independently performed screening, data extraction, and risk-of-bias assessment, with a third reviewer resolving discrepancies. Random-effects meta-analysis of proportions was used to pool overall and pathogen-specific prevalence. Four studies comprising 85 women met inclusion criteria. The pooled prevalence of any microorganism was 35% (95%CI 22-48%), with moderate heterogeneity (I2 = 36.8%). Ureaplasma spp. were the most frequently detected pathogens (pooled prevalence 17%, 95%CI 8-27%). Sensitivity analysis revealed that sampling technique was a source of heterogeneity in this dataset; excluding the single study using transvaginal amniocentesis reduced the pooled prevalence to 28% (95%CI 17-41%) and eliminated statistical heterogeneity (I2 = 0.0%). Transvaginally collected samples exhibited significantly greater microbial diversity (median 2 vs. 1 microorganism/sample, p = 0.005) and contained vaginal commensals, suggesting possible contamination. In transabdominal cohorts, the pooled prevalence of microorganisms (any) in amniotic fluid sludge was 28% (95%CI 17-41%), with Ureaplasma spp. emerging as the predominant pathogen when an infectious agent was identified. Transvaginal amniocentesis resulted in greater microbial diversity and detection of vaginal commensals, consistent with contamination. Our findings suggest that transabdominal sampling should be the preferred methodological approach for future studies of AFS microbiology.
Hormonal therapy and chemotherapy are common systemic therapy options in advanced and recurrent endometrial cancer. There is limited consensus on factors that affect therapy selection. This study aims to gain insight into those factors at the level of clinical decision-making and at the level of patient- and tumor-specific factors. We performed an international cross-sectional study among medical oncologists and gynecologists. The survey consisted of (1) statements about barriers and facilitators that affect the process of decision-making and (2) hypothetical vignette cases investigating three patients and tumor factors that were tested with three levels each. Results were analyzed with descriptive statistics and linear mixed-effects models. 167 physicians responded to the survey. The most important facilitating factors were: understanding the patient's personal context and the role of multidisciplinary tumor board discussions. The most important barrier was the lack of evidence for prediction of response to hormonal therapy and chemotherapy. The three patient and tumor factors included in the vignette cases were severity of symptoms, performance status, and progesterone-receptor (PR) expression in the tumor. PR expression and performance status were most discriminative, with high PR expression and poor performance status favoring hormonal therapy. The provision of personalized care in palliative treatment of endometrial cancer can be improved by multidisciplinary tumor board discussions with the personal context and preference of the patient in mind. The patient factors, severity of symptoms and WHO performance status, and the tumor factor, PR tumor expression, were most relevant for selecting hormonal therapy or chemotherapy.
Endometriosis, a prevalent gynecological condition, significantly impacts physical, psychological, and social well-being. This study explores the relationship between attachment styles, emotion regulation difficulties, and quality of life in women with endometriosis. Drawing on attachment theory, the study hypothesized that secure attachment would correlate with fewer emotion regulation difficulties and higher quality of life, while insecure attachment styles would correlate with greater difficulties and lower quality of life. The study included 354 Italian women diagnosed with endometriosis. Participants completed the Relationship Questionnaire to assess attachment styles, the Difficulties in Emotion Regulation Scale-Short Form to evaluate emotion regulation, and the WHOQOL-BREF to measure quality of life. Data analysis employed structural equation modeling to examine the direct and indirect effects of attachment styles on quality of life, mediated by emotion regulation difficulties. Results confirmed the hypotheses: secure attachment was associated with better emotion regulation and higher quality of life, whereas preoccupied and fearful attachment styles were linked to greater emotion regulation difficulties and lower quality of life. The dismissing attachment style did not show significant associations. The findings underscore the importance of addressing emotion regulation in therapeutic interventions for women with endometriosis.
Cervical cancer and its precursor lesions are treatable if detected early; however, screening participation for high-risk human papillomavirus infections (hr-HPV) remains low. In 2021, Germany recorded 4,544 new cervical cancer cases and 2,071 related deaths. The HaSCo study evaluates the feasibility of HPV self-testing to improve screening participation. This sub-study evaluates performance and acceptability of three self-testing tools. This prospective, randomized sub-study examined Evalyn-Brush, FLOQSwabs, and first-void urine Colli-Pee among women aged 30-65 in Hannover, Germany. Addresses from the residents´ registration office were randomized into seven age groups and an 80/20 city-region distribution. A total of 19,995 women were assigned to opt-in (request a self-test) or opt-out (receive a test directly). Participation was requested from women without regular screening in the past two years. 1,860 samples were returned (9.3%). Colli-Pee (10.4%) and FLOQSwabs (10.1%) had similar return rates, while Evalyn showed significantly lower rates (7.4%). Screening frequency didn´t significantly affect return rates (p = 0.1825), although FLOQSwabs showed higher return rates among underscreened women. Invalid sample rates were low, highest for FLOQSwabs (1.67%). A total of 145 samples tested positive for hr-HPV (7.9%). Evalyn collected highest DNA content (p < 0.0001). Colli-Pee was most preferred, and 66.7% of participants favored self-testing. HPV self-tests were highly accepted and effective for collecting sufficient DNA material. Direct provision of user-friendly self-tests may support screening participation, particularly among underscreened women. All three devices performed strongly and appear suitable for integration into cervical cancer screening programs.
The magnetic resonance imaging (MRI)-based classification of adenomyosis subtypes helps predict reproductive and obstetric outcomes; however, background factors associated with use of assisted reproductive technology (ART) and live birth within each individual subtype remain unclear. We conducted a multicenter retrospective study of 199 premenopausal women (32-49 years) who underwent pelvic MRI and laparoscopic surgery and had histopathologic confirmation of adenomyosis (January 2010-May 2023). Patients were classified as intrinsic (n = 58), extrinsic (n = 61), or indeterminate (n = 80) subtype. Within each subtype, multivariate logistic regression tested independent associations of age, ART history, gravidity, parity, lesion thickness, and intraoperative findings-including pelvic endometriosis-with ART use and live birth. The extrinsic subtype had a higher proportion with ART history than the intrinsic subtype (32.8% vs 8.6%; p = 0.008). Live birth rate was lower in the indeterminate than the intrinsic subtype (60.0% vs 86.2%; p = 0.0048). In the extrinsic subtype, greater lesion thickness independently predicted lower odds of live birth (adjusted OR = 0.94 per 1-mm increase; 95% CI, 0.88-0.99; p = 0.048). In the indeterminate subtype, older age was associated with ART use (adjusted OR = 1.155 per year; 95% CI, 1.002-1.351; p = 0.047), and ovarian endometrioma was linked to reduced live birth (adjusted OR = 0.172; 95% CI, 0.054-0.508; p = 0.001). In the intrinsic subtype, women with live birth were older than those without, but age was not an independent factor. Adenomyosis lesion thickness and coexisting endometriosis are associated with ART indication and live birth outcomes in a subtype-specific manner and may support individualized counselling and management.
In this study, half of all female patients with advanced and metastatic breast cancer reported experiencing financial difficulties. This highlights the need for gynecology and oncology specialists to also address patients' socio-medical needs. Electronic patient-reported outcomes (ePRO) must be used to identify such areas of concern. The aim was to investigate whether and to what extent female patients with advanced or metastatic breast cancer who are undergoing chemotherapy report financial difficulties due to their physical condition and/or the effects of medical treatment in relation to the German reference cohort. A secondary data analysis was performed using data collected prospectively as part of the ePROCOM study. A total of n = 168 female patients who had answered questions regarding financial implications of the EORTC QLQ-C30 questionnaire were included in the analysis. Unpaired t tests (Welch) and Chi-square tests as well as multiple regressions were conducted. A bilateral p value of < 0.05 was considered statistically significant in all analyses (alpha = 0.05). The prevalence of financial distress was 50.0% (95%-CI 42.4%; 57.6%), defined as a response of at least 2 ("a little") on a 4-point Likert scale. Between the reference cohort scored 4.8 and the breast cancer cohort scored 28.8, there was a significant difference of 24 ± 5.19 score points (p < 0.001; 95%-CI 18.81, 29.19) in financial burden. Overall, the regression model explained 27.7% of the total variance in financial burden through HRQoL, age, and civil status (R2 = 0.277). Women with advanced or metastatic breast cancer reported substantially higher financial burden than the female German reference population. Lower HRQoL, younger age, and living alone were associated with greater financial impact. These findings support routine assessment of financial distress in those patients and suggest that ePRO-based screening may help identify patients in need of early social-medical support.
Maternal psychological stress is associated with adverse obstetric and neonatal outcomes, including preterm birth and low birthweight. Warfare represents a significant source of acute and chronic stress, yet its impact on pregnancy outcomes remains unclear. This study aimed to evaluate the association between a 6-month period of continuous wartime exposure following October 7, 2023, during the "Iron Swords" conflict and preterm birth, neonatal outcomes, and obstetric management. This retrospective cohort study included all deliveries at ZIV Medical Center during the 6-month conflict period, compared with a pre-war cohort from 2021 until October 6, 2023. The primary outcome was preterm birth (< 37 weeks). Secondary outcomes included early preterm birth (< 34 weeks), labor induction, mode of delivery, maternal complications, and neonatal outcomes. Multivariate logistic regression was used to identify independent predictors of preterm birth. A total of 699 conflict-period deliveries were compared with 7821 pre-war deliveries. Preterm birth rates were similar (< 37 weeks: 6.6% vs. 5.5%; < 34 weeks: 2.1% vs. 1.5%). Labor induction was markedly lower during the conflict (oxytocin 23.7% vs. 38.7%; cervical ripening balloon 3.3% vs. 7.7%; prostaglandins 4.1% vs. 6.5%), accompanied by reduced postpartum hemorrhage (7.9% vs. 12%). Neonatal outcomes, including birthweight distribution, NICU admissions, and survival, were comparable or slightly improved. Prolonged wartime exposure was not associated with increased rates of preterm birth or adverse neonatal outcomes. Lower rates of obstetric intervention were observed during the conflict period and coincided with lower rates of maternal complications, although causality cannot be established.
To assess the overall safety and effectiveness of the etonogestrel implant radiopaque in real-world clinical settings in China. A multicenter, prospective, single-arm, observational study was conducted in women (aged ≥ 18 years) across 31 centers in China (March 2016-July 2021). The implant was prescribed as part of routine clinical practice. Primary outcomes included overall safety and topical (local) safety profile; secondary outcomes included participant and physician satisfaction and contraceptive effectiveness of the etonogestrel implant. Of 1,901 women using the etonogestrel implant, 45.4% completed the 3-year study. The mean (SD) age of the women was 32.1 (5.6) years and the mean (SD) implant exposure duration was 783.7 (388.7) days. Overall, 47.9% reported drug-related adverse events (AEs; excluding topical AEs), 1.1% reported serious AEs, and 10.4% reported topical AEs after insertion. Vaginal bleeding (15.6%) was the most frequent drug-related AE. At 36 months after insertion or upon removal, most women were satisfied (38.9%) or very satisfied (23.7%) with the implant. Among 96 physicians who completed questionnaires following the first insertion, 57.3% were very satisfied and 38.5% were satisfied. Most (98.9%) of the physicians reported satisfaction following their first removal procedure. Of them, 65.3% were very satisfied and 33.7% were satisfied. One (1.1%) physician was neither satisfied nor dissatisfied. One (0.05%) in-treatment pregnancy was reported. Safety findings from this study in China's real-world clinical setting were consistent with the clinical development program without unexpected safety signals. Observed contraceptive effectiveness was consistent with established evidence for the implant, with general satisfaction reported among Chinese women.