Women remain underrepresented in clinical drug development despite their unique biological characteristics and growing disease burden. In China, this disparity is particularly concerning given the rising incidence of gynecologic conditions such as uterine cancer. This study examined the profile and trends of obstetrics and gynecology (OBGYN) drug trials conducted at a large tertiary specialty hospital in China. A retrospective review of interventional drug trials registered between 2019 and 2023 was conducted using data from the Chinese Clinical Trial Registry (ChiCTR) and the hospital's Clinical Trial Management System. All eligible trials conducted at the Women's Hospital, School of Medicine, and Zhejiang University were included. Information on trial design, year of initiation, clinical specialty, drug category, and primary indication was extracted and analyzed descriptively. A total of 59 interventional drug trials were identified. The trial volume increased from 4 studies in 2019 to 11 in 2023, representing 176% growth. Most trials were domestic multicenter studies (68%), and 71% remained ongoing at the end of 2023. Gynecologic oncology accounted for the largest proportion of trials (44%), followed by gynecology (29%). Ovarian cancer was the leading oncologic indication, while endometriosis and assisted reproduction were the most common benign conditions studied. Antibody-drug conjugates, poly(ADP-ribose) polymerase (PARP) inhibitors, and programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors predominated in oncology trials, whereas hormonal and microbial therapies were more common in non-oncologic studies. OBGYN drug research in China has expanded substantially, with a strong focus on gynecologic cancers and chronic gynecologic conditions. However, maternal health-related drug development remains limited. Continued and systematic monitoring of ChiCTR data may help support more balanced and equitable research priorities across women's health.
The aim of this paper is to present the current status, challenges, and development directions of obstetrics and gynecology residency training in the Southern Great Plain region, in the context of the ongoing transformation of the Hungarian healthcare system. Obstetrics and gynecology represent one of the most complex fields of clinical medicine, where decision-making, ethical sensitivity, psychological resilience, and technical proficiency together define professional competence. Over the past decade, Hungarian postgraduate medical education has undergone significant reforms: the introduction of the healthcare service relationship, the elimination of informal gratuities, and the implementation of a competency-based educational framework have resulted in a more transparent and objective system. This paper draws attention to regional residency data, presenting trends in trainee distribution, the main structural elements of the program, and key areas of modernization - including digitalization, simulation-based training, the strengthening of research activity, and international mobility. The authors emphasize that high-quality residency training program requires structured competency assessment, modern infrastructure, the integration of international experience, and adequate mental support for trainees. The obstetrician-gynecologist of the future should not only be technically proficient but also reflective, empathetic, and responsible - a physician whose training is built on both professional excellence and the preservation of humanistic values and vocation. Orv Hetil. 2026; 167(29): 1159-1163. A jelen közlemény célja, hogy bemutassa a Dél-Alföld régió szülész-nőgyógyász rezidens képzésének aktuális helyzetét, kihívásait és fejlesztési irányait a hazai egészségügyi rendszer átalakulásának összefüggésében. A szülészet-nőgyógyászat szakképzése a klinikai orvoslás egyik legösszetettebb területe, ahol a döntéshozatal, az etikai érzékenység, a pszichés teherbírás és a technikai felkészültség egysége határozza meg a szakmai kompetenciát. Az elmúlt évtizedben a magyar szakorvosképzés jelentős reformokon ment keresztül: az egészségügyi szolgálati jogviszony, a hálapénz megszüntetése és a kompetenciaalapú oktatási struktúra bevezetése átláthatóbb, objektívebb rendszert eredményezett. A közlemény a Dél-Alföld régió rezidensképzésének adataira épül, bemutatva a rezidensek eloszlásának trendjeit, a képzési struktúra fő elemeit, valamint a modernizáció kulcsterületeit – a digitalizációt, a szimulációs oktatást, a tudományos tevékenység erősödését és a nemzetközi mobilitást. A szerzők kiemelik, hogy a minőségi szakorvosképzés alapfeltétele a strukturált kompetenciaértékelés, a korszerű infrastruktúra, a nemzetközi tapasztalatok beépítése és a rezidensek mentális támogatása. A jövő szülész-nőgyógyásza nem csupán technikailag felkészült, hanem gondolkodó, empatikus és felelősségteljes gyógyító, akinek képzése a szakmai kiválóság mellett az emberi hivatástudat megőrzésére is épül. Orv Hetil. 2026; 167(29): 1159–1163.
In Pakistan, one-third of under-5 deaths (58/1000 live births) are attributable to the high prevalence of stunting (40%), underweight (23%), and wasting (17.7%). Given the suboptimal prevalence of exclusive breastfeeding (EBF; 48%) and the alarmingly low consumption of a minimum acceptable diet (3.6%), mitigation of early-life nutritional risk provides a critical window of opportunity for intervention. Mobile health (mHealth) provides an innovative and low-cost option to improve infant and young child feeding practices (IYCFPs) among mothers. This study aims to assess the efficacy of a context-specific mHealth coaching app in promoting EBF and IYCFPs compared to face-to-face (F2F) counseling. This is a prospective, parallel-arm randomized controlled trial planned at a secondary care hospital in Karachi, Pakistan. The study will enroll 300 booked singleton pregnant women in the third trimester, who plan to stay in their respective areas for at least 1 year postdelivery, are registered for child immunization at the associated Family Health Center, own smartphones with internet access, are able to read Urdu, and provide consent. Participants in the intervention arm will receive the Pehli Ghiza mHealth app along with routine standard-of-care F2F counseling. The app will deliver context-specific educational content on breastfeeding and IYCFPs through short videos and messages sent 3 times per week, tailored to the stage of pregnancy and infant age. Participants in the control arm will receive only routine F2F counseling. The standard of care will be delivered at each follow-up visit, which is scheduled at birth, at 6, 10, and 14 weeks, and at 6, 9, and 12 months of the infant's age. Data will be collected at enrollment and at each follow-up visit using structured questionnaires. Primary outcomes are EBF and the introduction of age-appropriate complementary feeding. Secondary outcomes include early initiation of breastfeeding, continued breastfeeding at 1 year, minimum dietary diversity, meal frequency, minimum acceptable diet, and child health outcomes. Analysis will follow the intention-to-treat principle to detect a 20% absolute improvement in primary outcomes between the intervention and control groups over time and to evaluate between-group differences in feeding practices. Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit. The study was approved by the Ethics Review Committee of the Aga Khan University and the National Ethics Committee. Participant recruitment started on February 2, 2026. As of May 18, 2026, 241 participants have been recruited. Follow-ups and outcome assessments are expected to be completed by June 2027. If effective, the Pehli Ghiza intervention could support the integration of digital health tools into standard of care in Pakistan and similar low- and middle-income country settings.
Objective: To analyze the clinical characteristics of breast cancer susceptibility gene (BRCA) germline mutation carriers with ovarian cancer, collect family history information, screen for potential BRCA mutation carriers among family members, and provide preventive guidance for high-risk populations of ovarian cancer. Methods: A total of 77 patients with ovarian cancer (including fallopian tube cancer and primary peritoneal cancer, hereinafter collectively referred to as ovarian cancer) who were treated at the Department of Obstetrics and Gynecology, Chinese PLA General Hospital between 2015 and 2024 and confirmed to carry germline mutations in the BRCA1/2 genes through genetic testing were selected. According to the test results, they were divided into the BRCA1 mutation group (48 cases) and the BRCA2 mutation group (29 cases). The clinical baseline data, pathological characteristics, treatment efficacy, and survival outcomes were compared between the two groups. Family history information was collected, and BRCA genetic testing was performed on 81 relatives from 37 families. Family characteristics were analyzed in combination with family history and genetic testing results, and preventive guidance was provided to high-risk populations. Results: The age at onset of the 77 patients ranged from 19 to 78 years, with a median age of 55 years. The age at onset in the BRCA1 mutation group ranged from 19 to 74 years, with a median age of 52 years, which was earlier than the median age of 56 years in the BRCA2 mutation group. 43.8% (21/48) of BRCA1 carriers had a family history of hereditary breast and ovarian cancer syndrome (HBOC), which was 1.5 times higher than that in the BRCA2 group (17.2%, 5/29, P＜0.05). There were no statistically significant differences in fertility status, body mass index (BMI), personal history of breast cancer, and pre-treatment carbohydrate antigen 125 (CA125) levels between the two groups (P＞0.05). The median progression-free survival (PFS) for initial treatment was 21.8 months in BRCA1 mutation patients and 20.7 months in BRCA2 mutation patients. Among the 81 relatives, 47 BRCA gene mutation carriers were detected, of whom 63.8% (30/47) were from families without a family history of HBOC. Among 31 female mutation carriers, only 2 underwent risk-reducing salpingo-oophorectomy (RRSO). A survey of the general population showed that 78.5% of non-carrier women would accept prophylactic surgery, while the average surgical intention score among carriers was only 2.6 (on a 5-point scale), with 75.0% preferring to delay RRSO until after natural menopause. Conclusions: Chinese BRCA1/2 mutation carriers have significant concerns regarding iatrogenic menopause caused by RRSO, creating a decision-making dilemma for surgical prevention of ovarian cancer in high-risk populations. The age at onset of ovarian cancer in Chinese BRCA1/2 mutation carriers is relatively late compared with international data, and the optimal timing of surgery for Chinese women still requires further investigation. Developing a localized surgical timing prediction model may help advance ovarian cancer prevention and treatment efforts. 目的： 分析乳腺癌相关基因（BRCA）胚系突变卵巢癌患者的临床特征，并进行家系信息采集，筛查家系亲属中潜在的BRCA突变携带者，针对卵巢癌患病高危人群予以预防指导。 方法： 选取2015—2024年在解放军总医院妇产医学部接受治疗，并通过基因检测确认携带BRCA1/2基因胚系突变的77例卵巢癌（包含输卵管癌、盆腔腹膜癌，后文统称卵巢癌）患者，根据检测结果分为BRCA1突变组（48例）和BRCA2突变组（29例），比较两组患者的临床基线资料、病理特征、治疗效果及生存结局。采集患者家系信息，对来自37个家系的81位患者亲属进行BRCA基因检测，结合家族史情况和基因检测结果分析家系特征，对高危人群进行预防指导。 结果： 77例患者发病年龄波动于19～78岁，中位发病年龄55岁。BRCA1突变组发病年龄为19~74岁，中位发病年龄52岁，早于BRCA2突变组的56（37~78）岁（P＜0.05）。43.8%（21/48）的BRCA1携带者具有遗传性乳腺癌-卵巢癌综合征（HBOC）家族史，较BRCA2组高1.5倍（17.2%，5/29，P＜0.05）。两组患者的生育情况、体质指数、乳腺癌个人史及治疗前糖类抗原125水平比较，差异无统计学意义（P＞0.05）。BRCA1突变患者初始治疗的中位无进展生存时间（PFS）为21.8个月，BRCA2突变患者初始治疗的中位PFS为20.7个月。81位患者亲属中检测出47位BRCA基因突变携带者，其中63.8%（30/47）来自无HBOC家族史的家系。31位女性突变携带者中仅2位接受预防性双侧卵巢-输卵管切除术（RRSO）。健康人群调查显示，78.5%（128/163）非携带女性可接受预防性手术，而8位BRCA1/2突变携带者群体手术意向平均仅2.6分（5分制），6位（6/8）倾向延迟至自然绝经后施行RRSO。 结论： 中国BRCA1/2突变携带者对RRSO手术带来的医源性绝经顾虑较重，高危人群卵巢癌的手术预防存在决策困境。国内BRCA1/2 突变卵巢癌患者卵巢癌发病年龄较晚，适宜国内女性的手术时机仍需进一步探讨，开发本土化手术时机判定模型有助于推动卵巢癌防治工作。.
Bevacizumab (BEV) is pivotal for anti-angiogenic therapy in recurrent ovarian cancer (ROC), but its real-world bleeding risk profile and standardized management remain to be refined, demanding tailored pharmacovigilance data for clinical decision-making. This single-center retrospective study characterized BEV-related bleeding events, explored the association between vascular protection management and coagulation-fibrinolysis/inflammation markers and provided bleeding risk prevention guidance. This single-center retrospective study was conducted in Nanjing, China, from October 2024 to September 2025, with follow-up completed by December 2025. Data were extracted from electronic medical records, laboratory information systems, pharmacy records, infusion records, and nursing documentation. Bleeding was graded per CTCAE v5.0; vascular protection metrics and dynamic changes of biochemical markers (Hb, PLT, FIB, D-dimer, and CRP) were collected and analyzed. 22.5% had any-grade bleeding and 15.8% grade ≥2 bleeding, mostly mucocutaneous and clustered in early treatment. Compared to the non-bleeding group, the bleeding group exhibited higher concomitant drug use, a higher prevalence of hypertension, and lower vascular protection compliance (all P < 0.05). Additionally, this group experienced significant declines in Hb, PLT, and FIB, alongside elevated D-dimer and CRP levels (all P < 0.05). BEV-related bleeding has distinct features, associated with concomitant drugs, inadequate vascular protection and abnormal coagulation/inflammation markers. Integrating pharmacovigilance and multispecialty vascular protection strategies can effectively mitigate bleeding risk and reduce treatment disruptions.
Acute postprocedural pain remains a major barrier to uterine fibroid embolization (UFE). To assess whether intraarterial dexamethasone reduces postprocedural pain after UFE. This double-blind, placebo-controlled randomized clinical trial was conducted from July 2020 to December 2023, with follow-up through 3 months, at a single tertiary academic medical center. Participants were women, aged 20 to 50 years, undergoing UFE. Intraarterial dexamethasone (10 mg) or saline placebo administered during embolization. The primary outcome was postprocedural pain through 168 hours. Secondary outcomes included postembolization syndrome symptoms; fibroid-related symptoms and health-related quality of life, assessed using the UFE-Quality of Life questionnaire at baseline and at 1 and 3 months; and percentage reduction in uterine volumes on magnetic resonance imaging. Among 42 women randomized (mean [SD] age, 44.7 [4.7] years; 21 per group), 40 women were included in the final analysis (20 randomized to the dexamethasone group and 20 to the placebo group) after excluding 2 participants. In the dexamethasone group, 7 participants (35%) were African American, 6 (30%) were Hispanic, and 7 (35%) were White; in the placebo group, 9 (45%) were African American, 8 (40%) were Hispanic, and 3 (15%) were White. Intraarterial dexamethasone was associated with significantly lower mean (SD) pain scores immediately after the procedure (4.0 [3.3] vs 6.1 [3.1]; mean difference, -2.1 [95% CI, -4.14 to -0.06]; P = .04) and through 96 hours (2.4 [2.4] vs 4.5 [3.2]; mean difference, -2.1 [95% CI, -3.90 to -0.30]; P = .02) compared with placebo. The mean (SE) pain score over 168 hours was significantly lower in the dexamethasone group vs placebo (2.63 [2.28] vs 4.28 [2.27] visual analog scale units; mean difference, -1.64 [95% CI, -3.10 to -0.19]; P = .02). Among participants with paired magnetic resonance imaging follow-up, the mean (SD) uterine volume reduction from baseline to 3 months was 37.4% (17.7%) in the dexamethasone group vs 29.6% (20.2%) in the placebo group (P = .30), and the mean (SD) dominant fibroid volume reduction was 34.4% (22.8%) vs 38.6% (16.7%) (P = .60). No major complications occurred in either group. In this randomized clinical trial of 40 women undergoing UFE, intraarterial dexamethasone was associated with clinically meaningful reductions in postprocedural pain through 96 hours compared with placebo, without compromising treatment efficacy or increasing adverse events, which may offer a simple, low-cost strategy to reduce analgesic burden in individuals undergoing UFE. ClinicalTrials.gov Identifier: NCT04655144.
Preexposure prophylaxis (PrEP) is highly effective for HIV prevention, yet cisgender women remain underrepresented among PrEP users relative to their HIV burden in the United States. Obstetrics and gynecology (OB/GYN) settings-where many women receive routine sexual and reproductive health care-represent a promising but underutilized venue for PrEP delivery. Despite professional guidance endorsing PrEP discussion and prescribing in OB/GYN practice, implementation remains limited. We conducted a qualitative implementation study with two linked components in an academic OB/GYN clinic: semistructured interviews with 12 clinicians and clinical staff, and four multidisciplinary stakeholder workgroups focused on strategy refinement. Interview transcripts were analyzed using directed content analysis guided by the Consolidated Framework for Implementation Research (CFIR 2.0). Finalized determinants were brought to stakeholder workgroups, where participants reviewed interview findings and collaboratively identified and prioritized implementation strategies. Strategies were labeled using Expert Recommendations for Implementing Change (ERIC) terminology. Five implementation determinants were identified: preventive care misfit within problem-focused visit structures, limited cognitive integration of PrEP into routine gynecologic care, fragmented care continuity and unclear role ownership, administrative and access burden, and lack of patient activation infrastructure. Stakeholders concluded that implementation failure reflected a workflow placement problem rather than a motivation problem. Strategies requiring clinicians to absorb additional counseling or coordination tasks during already time-limited visits were viewed as unlikely to succeed. Stakeholders instead refined a clinic-facing strategy bundle centered on nurse-led PrEP navigation, supported by EHR-embedded referral prompts, standardized handoff workflows, brief provider education and protocol clarification, pharmacy and insurance coordination partnerships, and structured tracking and follow-up systems. PrEP underimplementation in this gynecologic setting appeared to be driven less by clinician willingness than by the absence of a reliable workflow location for counseling, coordination, and follow-up. A nurse-led navigation model supported by referral prompts and access coordination may offer a feasible approach to integrating PrEP into women's health care. Future work should test this strategy bundle in multi-site women's health settings and pair clinic-facing approaches with patient-facing activation strategies.
Striae gravidarum is common after pregnancy and may be accompanied by skin dryness, roughness, and visible textural irregularity that affect quality of life. This prospective, self-controlled clinical study evaluated whether a topical recombinant human collagen serum could improve the biophysical characteristics of postpartum striae gravidarum. Twenty postpartum women with bilateral abdominal striae applied the serum twice daily to one randomly assigned abdominal side for 4 weeks, while the contralateral side served as the within-participant control. Skin elasticity, firmness, striae area, and surface roughness were assessed at baseline, week 2, and week 4 using standardized non-invasive instruments and digital image analysis. Longitudinal modeling showed greater improvement on the treated side than on the control side, particularly for elasticity, visible striae area, and surface roughness. Multivariate analysis indicated that reductions in striae area and roughness occurred in a coordinated pattern, suggesting overall structural improvement of the affected skin. The serum was well tolerated, with only mild transient erythema in two participants. These findings indicate that recombinant human collagen serum is a promising non-invasive option for improving postpartum striae gravidarum-related dryness, roughness, and skin texture. Les vergetures gravidiques sont fréquentes après la grossesse et peuvent s’accompagner de sécheresse cutanée, de rugosité et d’irrégularités visibles de la texture de la peau, affectant ainsi la qualité de vie. Cette étude clinique prospective et auto-contrôlée a évalué si un sérum topique à base de collagène humain recombinant pouvait améliorer les caractéristiques biophysiques des vergetures gravidiques postpartum. Vingt femmes en période postpartum présentant des vergetures abdominales bilatérales ont appliqué le sérum deux fois par jour sur un côté abdominal attribué aléatoirement pendant 4 semaines, tandis que le côté controlatéral servait de contrôle intra-individuel. L’élasticité et la fermeté de la peau, la surface des vergetures et la rugosité cutanée ont été évaluées au départ, à la deuxième semaine et à la quatrième semaine à l’aide d’instruments standardisés non invasifs et d’une analyse numérique des images. Les modèles longitudinaux ont montré une amélioration plus importante du côté traité par rapport au côté témoin, en particulier pour l’élasticité, la surface visible des vergetures et la rugosité de surface. L’analyse multivariée a indiqué que les réductions de la surface des vergetures et de la rugosité se produisaient de manière coordonnée, suggérant une amélioration structurelle globale de la peau affectée. Le sérum a été bien toléré, avec seulement un érythème transitoire léger chez deux participantes. Ces résultats indiquent que le sérum de collagène humain recombinant constitue une option non invasive prometteuse pour améliorer la sécheresse, la rugosité et la texture cutanée associées aux vergetures gravidiques postpartum.
Vitamin D deficiency and insufficiency represent a widespread problem in the majority of Central Asian countries, attributable to the geographical location of the region, urbanization, and dietary patterns of the population. Given that vitamin D not only participates in the regulation of calcium and phosphate metabolism but also exerts pleiotropic effects on various organs and systems, its insufficiency and deficiency are associated with a broad spectrum of pathological conditions, ranging from asymptomatic manifestations to severe clinical symptoms, including the development of autoimmune diseases, metabolic disorders, cardiovascular, gynecological and reproductive, and rheumatological conditions. The development of national and interdisciplinary guidelines addressing the diagnosis, prevention of insufficiency, and correction of vitamin D deficiency in the countries of Central Asia represents an important step toward the establishment of effective preventive programs and treatment strategies, which may contribute to a reduction in the prevalence of diseases associated with vitamin D deficiency. The aim of the present work is to formulate a resolution capturing the conclusions and recommendations derived from an interdisciplinary expert discussion. An Expert Council meeting with the participation of specialists in endocrinology, obstetrics and gynecology, rheumatology, clinical pharmacology, and other medical disciplines from Central Asian and European countries was conducted in Almaty (Kazakhstan) on 18 June 2025. During this meeting, the pleiotropic action of vitamin D was extensively discussed basing on RCTs and observational studies. Following the Expert Council meeting, current international clinical guidelines, scientific research data, and relevant epidemiological evidence were reviewed, leading to the formulation of a resolution that reflects the agreed-upon recommendations for the prevention of vitamin D insufficiency and the correction of vitamin D deficiency across different age groups according to baseline vitamin D metabolite levels. The expert discussion emphasized the need for unified interdisciplinary approaches to the diagnosis, correction, and prevention of vitamin D deficiency in the countries of Central Asia. The proposed recommendations may serve as a foundation for the development of national clinical protocols and the implementation of effective preventive and therapeutic strategies in the countries of Central Asia.
Hysterectomy is a commonly performed gynecologic procedure; however, evidence regarding how different surgical techniques affect postoperative vaginal anatomy and sexual function remains inconsistent. This study aimed to evaluate postoperative vaginal length, female sexual function, male partner sexual function, and perioperative outcomes following total abdominal hysterectomy (TAH), total laparoscopic hysterectomy (TLH), and total vaginal hysterectomy (TVH) performed for benign gynecological indications. In this retrospective cohort study, 466 women who underwent total hysterectomy between January 2020 and June 2023 at a tertiary referral center were included. Patients were grouped according to surgical technique: TAH, TLH, or TVH. Vaginal length measurements, Female Sexual Function Index (FSFI) scores, perioperative laboratory values, blood transfusion requirement, and postoperative complications were analyzed. Male partner sexual function was assessed using the International Index of Erectile Function-5 (IIEF-5) in a subset of patients. Multivariable linear and logistic regression analyses were performed to identify factors associated with postoperative outcomes. Estimated intraoperative blood loss was not consistently available in the retrospective database and could not be included in the transfusion model. Of the 466 patients, 124 underwent TAH, 177 TLH, and 165 TVH. Preoperative vaginal length and FSFI scores were comparable across groups. Postoperative vaginal length differed significantly according to surgical technique, with the greatest reduction observed in the TLH group (p < 0.001). Postoperative female FSFI scores did not differ significantly among groups (p > 0.05). Among male partners with available data, IIEF-5 scores showed a statistically significant postoperative decline (mean ± SD: 14.87 ± 3.31 preoperatively vs. 14.10 ± 2.23 postoperatively; p < 0.001); however, this partner-related finding was exploratory. Blood transfusion was required in 12.0% of patients (95% CI, 9.4-15.3), and postoperative complications occurred in 8.2% (95% CI, 6.0-11.0). In multivariable analyses, lower preoperative hemoglobin levels were associated with a higher likelihood of blood transfusion. Longer operative time was associated with postoperative complications (OR per minute = 1.02; 95% CI, 1.01-1.03; p < 0.001), likely reflecting surgical complexity rather than a direct causal effect. Hysterectomy technique was associated with differences in postoperative vaginal length, but these anatomical differences did not translate into significant differences in early postoperative female sexual function. Lower preoperative hemoglobin was associated with blood transfusion requirement, although the lack of estimated intraoperative blood loss data limits interpretation of transfusion-related findings. Longer operative time was associated with postoperative complications and may reflect greater surgical complexity. The observed decline in male partner IIEF-5 scores should be interpreted cautiously as an exploratory finding, and future prospective studies incorporating both patient- and partner-reported outcomes with longer follow-up are warranted.
Bacterial vaginosis (BV) is a common vaginal dysbiosis associated with adverse pregnancy outcomes. However, the extent to which microbial indicators of dysbiosis covary with host oxidative stress and epithelial apoptotic responses during pregnancy remains unclear. In this analytical cross-sectional study, 220 pregnant women were screened at a referral gynecology clinic in Faisalabad, Pakistan; 168 met the eligibility criteria and had concordant modified Amsel and Nugent classifications (56 BV-positive, 112 BV-negative). Cervicovaginal secretions, vaginal swabs, and serum were analyzed for microbial, oxidative stress, and host-response markers. Epithelial-enriched cervicovaginal specimens passing predefined quality criteria (n = 142) were used for apoptosis-related gene expression and caspase-3/7 activity assays. Targeted microbial quantification focused on Lactobacillus and Acinetobacter spp. Associations between bacterial burden and host markers were evaluated using correlation and regression analyses with the Benjamini-Hochberg false-discovery-rate correction, where applicable. BV-positive participants exhibited a lower Lactobacillus spp. burden and a higher Acinetobacter spp., burden than BV-negative controls. They also showed higher cervicovaginal malondialdehyde and H2O2 concentrations and lower superoxide dismutase and catalase activities (all FDR-adjusted q < 10-13). Epithelial-enriched specimens from BV-positive participants demonstrated a higher BAX/BCL2 ratio, increased caspase-3/7 activity, increased expression of BAX, CASP9, CASP3, SOD2, and HMOX1, and reduced BCL2 expression. Higher Acinetobacter spp. burden covaried with greater local oxidative stress and increased epithelial apoptosis-associated signaling, although these associations were attenuated after adjustment for BV status. BV in pregnancy was associated with concurrent differences in cervicovaginal microbial indicators, oxidative stress, and epithelial apoptosis-related responses, supporting an integrated host-microbe response at the cervicovaginal interface. These findings provide a foundation for future longitudinal and mechanistic studies investigating host-microbe interactions in pregnancy-associated BV.
Objective: To investigate the quality of life (QoL) and its influencing factors in patients with early-stage endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) undergoing fertility-sparing treatment. Methods: A total of 134 patients with EC or AEH who received fertility-sparing treatment at Peking Union Medical College Hospital between August 2023 and December 2024 were enrolled. Patients were divided into two treatment groups: those receiving gonadotropin-releasing hormone agonist (GnRHa) combined with aromatase inhibitors, and those receiving high-dose oral progestins. During treatment, diagnostic curettage or hysteroscopy was performed every 3 months, and treatment was discontinued upon assessment of complete response (CR). According to treatment duration (time to achieve CR), patients were categorized into the 3-month group (n=79), 6-month group (n=40), and ≥9-month group (n=15). The Functional Assessment of Cancer Therapy-General (FACT-G) version 4 was used to quantitatively assess QoL during treatment; questionnaires were administered every 3 months, and all 134 patients completed the survey at baseline and at 3, 6, and 9 months of treatment. Multivariate linear regression analysis was used to analyzed the influencing factors of QoL. Results: Among the 134 patients, 61 (45.5%) had AEH and 73 (54.5%) had EC; 71 patients (53.0%) received GnRHa combined with aromatase inhibitors, and 63 (47.0%) received high-dose oral progestins. QoL assessment showed that FACT-G scores gradually increased from baseline in the 3-month and 6-month groups, indicating improvement in QoL as treatment progressed; whereas the median FACT-G scores in the ≥9-month group remained below 80 throughout treatment, indicating relatively lower QoL. However, there was no statistically significant difference in FACT-G scores at CR among the 3-month, 6-month, and ≥9-month groups (median scores: 82.0, 83.0, and 76.5, respectively; H=1.575, P=0.455). Univariate analysis showed no significant differences in FACT-G scores at CR among patients with different treatment regimens, body mass index (BMI), treatment duration, pathological type, marital status, treatment history, or reproductive history (all P＞0.05). Multivariate analysis showed that FACT-G scores at CR were positively correlated with baseline FACT-G scores (B=0.634, P＜0.001) and negatively correlated with BMI (B=-4.021, P=0.035). No correlation was observed between treatment regimen and QoL. Conclusions: In fertility-sparing treatment, BMI may be a key factor affecting QoL, while long-term treatment may lead to a decline in QoL. Clinical attention should be paid to weight management and psychosocial support. 目的： 探讨接受保留生育功能治疗的早期子宫内膜癌（EC）及不典型子宫内膜增生（AEH）患者的生活质量及其影响因素。 方法： 纳入2023年8月至2024年12月于北京协和医院接受保育治疗的EC及AEH患者134例。患者治疗方式分为促性腺激素释放激素激动剂（GnRHa）联合芳香化酶抑制剂、大剂量口服孕激素2种，治疗期间每3个月进行诊断性刮宫或宫腔镜检查，评估为完全缓解（CR）的停止治疗。按治疗持续时间（获得CR的时间）将患者分为3个月组（n=79）、6个月组（n=40）及≥9个月组（n=15）。采用肿瘤治疗功能评估系统通用模块（FACT-G）第4版对患者治疗过程中的生活质量状况进行量化评估，每3个月对患者开展1次问卷调查，134例患者均在治疗前及治疗3个月时、6个月时、9个月时参与调查。采用多因素线性回归模型分析患者生活质量的影响因素。 结果： 134例患者中，AEH 61例（45.5%），EC 73例（54.5%）；71例（53.0%）接受GnRHa联合芳香化酶抑制剂治疗，63例（47.0%）接受大剂量口服孕激素治疗。生活质量评估结果显示，3个月组和6个月组FACT-G评分较基线逐渐升高，提示生活质量随治疗推进有所改善；而≥9个月组在治疗过程中的中位FACT-G评分均在80分以下，相对更低。但3个月组、6个月组、≥9个月组患者CR时的FACT-G评分差异无统计学意义（中位FACT-G评分分别为82.0、83.0、76.5分；H=1.575，P=0.455）。单因素分析结果显示，不同治疗方式、体质指数（BMI）、治疗时间、病理类型、婚姻状况、治疗史及孕产史的患者，CR时FACT-G评分未见显著差异（均P＞0.05）。多因素分析结果显示，患者CR时FACT-G评分与基线FACT-G评分呈正相关（B=0.634，P＜0.001），与BMI呈负相关（B=-4.021，P=0.035）。未观察到不同治疗方式与患者生活质量的相关性。 结论： 在保育治疗中，BMI可能是影响患者生活质量的关键因素，但长期治疗可能导致生活质量下降，临床应重视体重管理与心理社会支持。.
Adenomyosis is commonly associated with dysmenorrhea and heavy menstrual bleeding. Although the levonorgestrel-releasing intrauterine system (Mirena, LNG-IUS) is recommended as a first-line conservative treatment, device displacement or expulsion remains a major limitation, especially in patients with enlarged uteri or deep uterine cavities. To evaluate the clinical efficacy and safety of the Indomethacin-GyneFix IUD (GyneFix IUD) combined with LNG-IUS in patients with adenomyosis and to assess whether uterine cavity depth influences device stability. In this single-center prospective randomized controlled trial, 270 patients with adenomyosis were randomly assigned in a 1:1:1 ratio to the GyneFix IUD + LNG-IUS group, the ring IUD + LNG-IUS group, or the LNG-IUS-alone group (90 patients each). The primary endpoint was the rate of device displacement/expulsion at 6 months. Secondary endpoints included changes in visual analogue scale (VAS) scores, pictorial blood loss assessment chart (PBAC) scores, uterine volume, hemoglobin (Hb), serum CA125, adverse events and patient acceptance. Subgroup analysis was performed according to uterine cavity depth (≤ 9cm vs. >9 cm). At 6 months, the displacement/expulsion rate was significantly lower in the GyneFix IUD + LNG-IUS group (2.22%) than in the ring IUD + LNG-IUS group (10.00%) and the LNG-IUS-alone group (18.89%) (χ2=13.468, P<0.001). All three groups showed significant improvement in dysmenorrhea, menstrual blood loss, Hb and CA125 compared with baseline, without significant between-group differences (all P>0.05). Adverse event rates were comparable among groups (all P>0.05). Patient willingness to choose the same treatment again (95.12%) and willingness to recommend it (90.24%) were significantly higher in the GyneFix IUD + LNG-IUS group. In patients with uterine cavity depth >9 cm, the stability advantage of this strategy was more pronounced. GyneFix IUD combined with LNG-IUS significantly reduces device displacement/expulsion in adenomyosis, particularly in patients with deeper uterine cavities, while maintaining comparable symptom relief and safety. It may represent a more stable and acceptable long-term conservative treatment option.
Pregnant women are at increased risk of severe coronavirus disease 2019 with potential adverse consequences for maternal and fetal health. Although remdesivir (RDV), molnupiravir and azvudine are RNA-dependent RNA polymerase (RdRp) inhibitors of SARS-CoV-2, their placental transport characteristics are unclear. This study aimed to compare the placental permeability and transport mechanisms of these antiviral drugs using placental cell models. A cost-effective LC-MS/MS method quantified these drugs and their metabolites. Drug accumulation in placental cell models was compared, and drug permeability was assessed using BeWo Transwell transport assay. Transporter inhibitors, siRNA knockdown and transporter-overexpression cell models were used to investigate the transmembrane transport mechanisms. RDV, GS-441524 and EIDD-1931 accumulated more in BeWo cells at 37°C than at 4°C, indicating carrier-mediated uptake. RDV and GS-441524 exhibited lower permeability, whereas EIDD-1931 and azvudine exhibited higher permeability in BeWo cells. RDV was a potential substrate of equilibrative nucleoside transporter (ENT) 1/2 and concentrative nucleoside transporter (CNT) 3; GS-441524 of ENT1/2, CNT2/3 and organic anion transporter (OAT) 4; and EIDD-1931 of ENT1/2 and OAT4. Breast cancer resistance protein (BCRP) was implicated in efflux of all four compounds in BeWo cells, whereas P-glycoprotein (P-gp) was involved in efflux of RDV and GS-441524. RDV and GS-441524 displayed low placental permeability in BeWo cells, whereas EIDD-1931 and azvudine displayed high permeability. Multiple ENTs, CNTs, OAT4, P-gp and BCRP might be involved in placental transport of RDV, GS-441524, EIDD-1931 and azvudine. These findings offer new insights into the placental transport of RdRp inhibitors during pregnancy.
Women with diabetes mellitus experience higher rates of urinary tract infections (UTIs) and recurrent UTIs, yet evidence-based guidance on risk factors and management in this population remains limited. Given that urogynecologists frequently evaluate women with recurrent UTI symptoms-many of whom also have diabetes-clarifying diabetes-specific risks is essential for guiding clinical decision making. This Clinical Consensus Statement reviews and summarizes existing evidence in a topic that is highly relevant to urogynecologists, who routinely manage women with recurrent UTI symptoms and diabetes mellitus. A team of 7 urogynecologists and pelvic reconstructive surgeons conducted a systematic review of literature from January 1995 to October 2024, analyzing 249 abstracts and 119 full-text articles, ultimately including 32 studies. Initially aiming to create clinical guidelines, insufficient evidence led to the development of a Clinical Consensus Statement, which was revised using the Delphi method. Consensus was reached on 7 of 11 statements in the first round, with the remaining 4 condensed into 2 final statements. Nine statements were developed and categorized into 3 areas: (1) epidemiology, (2) risk factors (glycemic control, glucose-lowering medications, and bacteriuria), and (3) prevention and treatment. UTI and recurrent UTI prevalence are higher in women with diabetes mellitus, but there is a significant lack of prospective studies, including randomized trials, on the risks and side effects of medications related to lower UTIs in this population. Future studies assessing the efficacy of UTI prevention and treatment strategies specifically in women with diabetes mellitus are urgently needed.
Pharmacologic cervical ripening is frequently used for labor induction, yet the comparative effectiveness, safety, and resource utilization of available agents remain uncertain. This review compared oral misoprostol with vaginal dinoprostone for labor induction in singleton pregnancies at ≥ 34 weeks' gestation. We conducted a systematic review and meta-analysis of randomized controlled trials, searching 11 databases to May 2025. Eligible studies compared oral misoprostol with vaginal dinoprostone in singleton pregnancies ≥ 34 weeks undergoing induction without contraindications to vaginal birth. Seven critical outcomes were assessed: cesarean birth, uterine hyperstimulation, 5-min Apgar score < 7, neonatal intensive care unit (NICU) admission, oxytocin augmentation, vaginal birth within 24 h, and induction-to-birth interval. Study selection and data extraction were performed in duplicate. Random-effects meta-analysis was applied, with risk of bias, certainty of evidence, and subgroup credibility assessed using Cochrane RoB 2.0, GRADE, and ICEMAN. Eleven trials including 3783 participants were analyzed. Oral misoprostol was associated with lower cesarean birth (RR 0.83, 95% CI 0.74-0.94) and reduced oxytocin augmentation (RR 0.89, 95% CI 0.82-0.97). Vaginal dinoprostone was associated with higher vaginal birth within 24 h (RR 0.91, 95% CI 0.86-0.96) and a shorter induction-to-birth interval. No significant differences were observed in uterine hyperstimulation, 5-min Apgar score < 7, or NICU admission. Oral misoprostol is associated with reduced cesarean birth and probably reduces the need for oxytocin augmentation, while vaginal dinoprostone is associated with higher rates of vaginal birth within 24 h and probably a shorter induction-to-birth interval. Maternal and neonatal safety outcomes appear comparable; these findings support consideration of oral misoprostol in selected populations and settings, while acknowledging underlying clinical and methodological heterogeneity.
Placental abruption accompanied by low neonatal Apgar scores represents a clinically important subgroup with a potential maternal hemorrhagic risk. Evidence remains limited regarding the factors associated with blood product transfusions in these patients. This study aimed to identify clinical and laboratory factors associated with transfusion in women with placental abruption and low neonatal Apgar scores and to develop an exploratory prediction model. This retrospective cohort study included women with confirmed placental abruption who delivered at the Fujian Maternity and Child Health Hospital between January 2013 and July 2023. Eligible patients had singleton pregnancies at ≥ 28 weeks of gestation and live-born neonates with 1-minute Apgar scores ≤ 7. Clinical characteristics, laboratory findings, neonatal outcomes, and blood product use were extracted from the electronic medical records. Candidate predictors were evaluated using univariate logistic regression, least absolute shrinkage and selection operator logistic regression, and multivariable logistic regression. A nomogram was developed from the final model and assessed using receiver operating characteristic curve analysis, calibration assessment, 1000 bootstrap resamples, Brier score, and decision curve analysis. Among the 140 women, 32 received blood product transfusions (22.9%). Preeclampsia, 1-minute Apgar score ≤ 3, fibrinogen level < 3.0g/L, and lower hemoglobin level were independently associated with transfusion. The nomogram showed good apparent discrimination, with an apparent area under the curve of 0.928 (95% confidence interval: 0.884-0.972). After bootstrap internal validation, the optimism-corrected area under the curve is 0.912. The bootstrap-corrected calibration slope was 0.869 and the Brier score was 0.086. Decision curve analysis suggests a potential net clinical benefit. Preeclampsia, 1-minute Apgar score ≤ 3, fibrinogen level < 3.0 g/L, and lower hemoglobin level were associated with blood product transfusion in women with placental abruption and low 1-minute neonatal Apgar scores. This exploratory nomogram may support early peripartum risk stratification and transfusion preparedness.
There are significant deficiencies in the general population's knowledge of pelvic floor disorders, including pelvic organ prolapse (POP). Educational videos can equip patients with a better understanding of POP. The objectives of this study were to assess whether a previsit POP educational video improves patient satisfaction with their management decision. Secondary outcomes were POP knowledge, patient perception of knowledge, decision conflict, physician perception of patient comprehension, and counseling ease. This was a physician-blinded, randomized trial. Thirty-seven participants with POP symptoms were assigned to watch a previsit video (video group, n=18) or no video (control group, n=19). Eligibility included age 18 years or older, initial POP evaluation, English-speaking, internet access, and no prior POP treatment, pregnancy, or cognitive disability. Participants completed a baseline, postvisit, and postmanagement survey, which included the Prolapse and Incontinence Knowledge-POP Questionnaire (PIKQ-POP), a self-assessment of POP knowledge, the Satisfaction with Decision Scale for Pelvic Floor Disorders (SDS-PFD), and decision conflict questions. The counseling physicians were surveyed on their perceptions of patient comprehension and counseling ease. After the initial visit, mean SDS-PFD scores were similar (4.89 vs. 4.78; P=0.44). However, the change in PIKQ-POP scores was greater in the video group (2.69 vs. 1.13; P=0.03). The change in self-perception of POP knowledge was also greater in the video group (1.72 vs. 1.05, P=0.02). There were no major differences in decision conflict, physician counseling ease, or perception of patient comprehension. POP video education as a supplemental resource to health care provider counseling did not improve patient decision satisfaction. It may improve POP knowledge from baseline though this study was not powered for this outcome.
Oocyte maturation requires substantial ATP, and the resulting oxidative stress may impair follicular development. Pyrroloquinoline quinone (PQQ), an antioxidant compound, protects mitochondria and promotes follicular development in animal models; however, its effects on human ovarian function remain unclear. This single-arm, open-label study prospectively evaluated the effects of oral PQQ supplementation on ovarian reserve and related clinical and biochemical outcomes. The primary outcome was serum anti-Müllerian hormone (AMH). Secondary outcomes included luteinizing hormone, follicle-stimulating hormone, estradiol, biological antioxidant potential, reactive oxygen metabolites-derived compounds (d-ROMs), and Menstrual Distress Questionnaire (MDQ) scores. Fifty healthy women aged 25-42 years with regular menstrual cycles and baseline serum AMH levels of 0.5 ≤ AMH < 3.0 ng/mL received 20 mg/day of PQQ for 90 ± 10 days. Blood samples were collected on menstrual cycle days 1-7 before and after supplementation. Exploratory subgroup analyses were performed using combined stratification by age and baseline AMH. Analyses were conducted in the per-protocol set (n = 35). AMH did not change significantly overall (1.561 ± 0.689 vs. 1.439 ± 0.772 ng/mL, p = 0.182). In younger participants with lower baseline AMH (n = 7), AMH showed a non-significant increase (1.121 ± 0.379 vs. 1.361 ± 0.604 ng/mL, p = 0.056), accompanied by a significant decrease in d-ROMs (351.3 ± 43.5 vs. 305.3 ± 34.3 U. CARR, p = 0.027). In contrast, older participants with lower baseline AMH (n = 13) showed a significant decrease in AMH (1.066 ± 0.296 vs. 0.852 ± 0.312 ng/mL, p = 0.033), while d-ROMs remained unchanged. Across the overall cohort, d-ROMs showed a non-significant reduction (334.2 ± 59.7 vs. 321.5 ± 63.9 U. CARR, p = 0.090). PQQ supplementation did not alter AMH levels in the overall cohort. Subgroup findings were inconsistent and should be interpreted cautiously given the small sample sizes and absence of a control group. These exploratory results do not permit conclusions regarding clinical efficacy. Larger, placebo-controlled trials with imaging-based and clinical reproductive endpoints are needed to determine whether PQQ has measurable effects on ovarian biology. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000056669, identifier UMIN000049793.
The impact of antenatal tocolytic therapy on postnatal patent ductus arteriosus (PDA) outcomes in preterm infants remains unclear. Previous studies have rarely evaluated clinically significant treatment-requiring PDA and treatment resistance as distinct but related outcomes. This study aimed to evaluate the association between antenatal tocolytic exposure and postnatal PDA outcomes in infants born at ≤32 weeks of gestation. In this single-center retrospective cohort study, preterm infants (≤32 weeks) admitted to a tertiary neonatal intensive care unit between January 2018 and August 2025 and undergoing echocardiographic evaluation were included. Infants were classified as exposed or unexposed to antenatal tocolytics and further categorized as receiving indomethacin-containing or indomethacin-free regimens. Primary outcomes were clinically significant treatment-requiring PDA supported by echocardiographic criteria and pharmacological treatment resistance. Multivariable logistic regression and propensity score-based inverse probability of treatment weighting (IPTW) analyses were performed. Among 236 infants, 53 (22.5%) were exposed to antenatal tocolytics. Clinically significant treatment-requiring PDA was identified in 87 infants (36.9%). Tocolytic exposure was independently associated with a lower likelihood of treatment-requiring PDA in the original adjusted model (aOR 0.377, 95% CI 0.17-0.85; p = 0.018) and in an expanded model including multiple gestation (aOR 0.368, 95% CI 0.15-0.87; p = 0.023). In contrast, among infants who developed treatment-requiring PDA, exposure was associated with treatment resistance (original model: aOR 21.802, 95% CI 2.72-175.02; p = 0.004; IPTW analysis: OR 8.794, 95% CI 1.46-52.96; p = 0.018). Among tocolytic-exposed infants, treatment-requiring PDA was more frequent after indomethacin-containing than indomethacin-free regimens (41.7% vs 13.8%, p = 0.022). Antenatal tocolytic exposure was associated with a lower overall likelihood of clinically significant treatment-requiring PDA, whereas treatment resistance among infants who developed treatment-requiring PDA was more frequent, particularly after indomethacin-containing regimens. These observational findings should be interpreted as hypothesis-generating because of potential residual confounding, practice-dependent outcome assessment, and small subgroup sizes.