搜索结果：European journal of obstetrics, gynecology, and reproductive biology

Assisted reproductive technology (ART) has expanded rapidly into a complex, highly regulated, and innovative field, with in vitro fertilisation (IVF) now accounting for millions of treatment cycles globally each year. Alongside these advances, numerous supplementary interventions, commonly referred to as "IVF add-ons," have been introduced into routine clinical practice with the aim of improving pregnancy or live birth rates, reducing miscarriage risk, or shortening time to conception. Despite their widespread adoption and substantial additional costs to patients, most IVF add-ons lack robust evidence of safety, efficacy, and cost-effectiveness. Regulatory and policy efforts to guide their use are constrained by significant methodological weaknesses in the existing evidence base, including heterogeneous definitions, suboptimal trial design, inconsistent outcome reporting, and limited translation of research findings into clinical practice. This article explores the principal methodological challenges that currently impede rigorous health technology assessment of IVF add-ons. These challenges include the absence of a clear, validated taxonomy to define and classify add-ons; lack of consensus on appropriate comparators and clinically meaningful outcomes; and failure to establish agreed thresholds for clinical utility and futility that incorporate economic considerations and patient perspectives. A major limitation arises from reliance on conventional parallel-group randomised controlled trials, which are often poorly suited to evaluating complex, multi-stage ART interventions in heterogeneous populations. We discuss the potential value of innovative trial designs-such as platform, basket, sequential multiple assignment randomised trials, hybrid pragmatic-explanatory approaches, and decentralised digital trials-to strengthen evidence generation. Collectively, these methods may enhance efficiency, improve interpretability, and better align research with real-world reproductive care.

Colpocleisis remains an effective yet often underutilised surgical option for advanced pelvic organ prolapse (POP), particularly in elderly women who no longer desire vaginal intercourse. Despite its long history, concerns persist regarding postoperative complications, urinary symptoms, and patient regret. This study aimed to evaluate the perioperative, long-term, and patient-reported outcomes of colpocleisis, and to identify predictors of persistent urinary incontinence. A retrospective single-centre cohort study was conducted including 66 women aged ≥60 years who underwent colpocleisis between January 2015 and January 2025. Perioperative data were obtained from a prospectively maintained database. Long-term follow-up was available for 40 patients, with a mean follow-up duration of 41.36 months. Outcomes included complications, prolapse recurrence, urinary symptoms, and patient satisfaction assessed using Patient Global Impression (PGI) questionnaires. Comparisons between partial and total colpocleisis were performed using risk ratios (RR), and univariate logistic regression was used to identify predictors of persistent urinary incontinence. The mean age was 78 years. Overall perioperative complication rate was 9.1% (95% CI 4.2-18.5%). At long-term follow-up, anatomical success was achieved in 92.5% (95% CI 80.1-97.4%), with no patients requiring repeat prolapse surgery (0%, 95% CI 0-4.5%). Persistent urinary incontinence occurred in 30% (95% CI 18.1-45.4%), while no cases of de novo incontinence were observed. High patient satisfaction was reported by 81.4% (95% CI 63.0-92.1%), with a low regret rate of 3.7% (95% CI 0.7-18.3%). There were no statistically significant differences in outcomes between partial and total colpocleisis. On univariate analysis, urodynamic stress incontinence (OR 7.5, 95% CI 1.57-35.7, p = 0.01) and BMI ≥ 30 (OR 5.0, 95% CI 1.13-22.2, p = 0.03) were significant predictors of persistent urinary incontinence. Colpocleisis is a safe and highly effective procedure for selected patients with advanced POP especially during the current emphasis on native tissues repairs for POP, offering durable anatomical outcomes, high satisfaction, and low regret rates. Preoperative urodynamic findings and obesity are important predictors of persistent urinary symptoms and should be considered during patient counselling and surgical planning.

To systematically evaluate evidence on intrapartum ultrasound markers, deflexion, spine position, asynclitism, and angle of progression (AoP), and their associations with spontaneous rotation and delivery outcomes in foetuses with occiput posterior (OP) position. A systematic search of Cochrane, Scopus, PubMed, and Ovid/MEDLINE was conducted using MeSH terms and keywords. Eligible studies included intrapartum ultrasound assessment of foetal position with at least one additional sonographic marker and reported outcomes related to rotation or mode of delivery. Data on study design, population characteristics, ultrasound methods, and outcomes were extracted. Of 543 records identified, 13 studies (predominantly prospective cohorts) published between 2010 and 2023 met inclusion criteria and were critically appraised. Foetal head deflexion and posterior spine position were most consistently associated with persistence of OP and higher operative delivery rates. Evidence for asynclitism and AoP was limited and inconsistent. Small sample sizes, heterogeneous study populations, variable ultrasound timing, and inconsistent reporting limited comparability across studies. Intrapartum ultrasound markers, particularly deflexion and spine position, are associated with persistent OP, but current evidence is constrained by methodological heterogeneity and underpowered cohorts. Standardised definitions and larger, well-designed studies are required before these markers can be integrated into routine clinical assessment.

Endometriosis is a substantial public health challenge, affecting nearly 10% of women of reproductive age. Given the therapeutic benefits of elagolix over conventional therapies, along with the growing body of clinical evidence, a comprehensive evaluation of its role in managing endometriosis is warranted. An expert panel meeting was convened to deliberate on the clinical positioning of elagolix in the management of endometriosis-associated pain and to develop a comprehensive guideline on using elagolix in endometriosis. A literature search was conducted using the PubMed and Google Scholar databases to evaluate the efficacy and safety of elagolix in endometriosis-associated pain. In pivotal clinical trials, elagolix demonstrated a significant reduction in dysmenorrhoea and non-menstrual pelvic pain among women with endometriosis. Beyond pain relief, elagolix was associated with marked improvements in dyspareunia, fatigue and health-related quality of life. The safety profile of elagolix was favourable, with the most commonly reported adverse events being hot flushes, headache and nausea. When compared with current therapies, elagolix showed comparable efficacy with fewer hypo-oestrogenic side effects, such as bone mineral density loss, breakthrough bleeding and mood disturbances. Elagolix provides dose-dependent oestrogen suppression and significant pain relief in all types of endometriosis pain, including dyspareunia. Elagolix also provides notable improvements in quality of life with a more favourable safety profile compared to conventional therapies. These attributes position elagolix as an emerging first-line treatment option for the management of endometriosis-associated pain.

Endometriosis and adenomyosis are both characterised by ectopic endometrial-like tissue growing outside the endometrium of the uterus, however, they are ultimately distinct diseases with different pathophysiological mechanisms. Endometriosis and adenomyosis both have negative impacts on fertility and pregnancy outcomes. Women often have both conditions simultaneously, however, the reproductive burden of comorbid endometriosis and adenomyosis remains relatively unknown. This systematic review aims to investigate the effects of comorbid endometriosis and adenomyosis on fertility and pregnancy outcomes as compared to neither disease, or both in isolation. A systematic review was performed in line with PRISMA guidelines using PubMed and EMBASE search engines for papers published between 2000-2024, which evaluated fertility and/or pregnancy outcomes in adult females with endometriosis and/or adenomyosis. Risk of bias was also evaluated. The captured literature reported clinical pregnancy rates (6 studies) and live birth rates (4 studies) were significantly reduced by comorbid endometriosis and adenomyosis. However, inconsistent results were demonstrated for the impact of comorbidity on various pregnancy outcomes, including ectopic pregnancy, miscarriage, pre-eclampsia, placenta praevia, preterm birth and small for gestational age. Women with endometriosis and adenomyosis combined, may be at a higher risk of poor fertility, low pregnancy rates and possible obstetric complications, which may be due to the cumulative effects of both conditions.

The aim of the current study was to compare the effectiveness of the functional electrical stimulation (FES) and transobturator tape (TOT) methods in the management of pure stress urinary incontinence (SUI). This clinical study was performed on 58 pure SUI patients. FES and TOT groups were compared in terms of intensity of complaints and changes in quality of life before and after the therapy. The ICIQ-SF and EORTC QLQ-30 questionnaires were applied via interview method. The objective cure rate was evaluated by cough and pad tests. ICIQ-SF scores before and after the treatment and EORTC QLQ-30 scores before the treatment were similar in FES and TOT groups. After treatment, functional and symptomatic outcomes were similar in FES and TOT groups (p = 0.05 and p = 0.115), while general health status outcomes were better in FES group (p = 0.007). There was no significant difference between two groups regarding the objective cure rate. Our results have shown that FES and TOT are similar in their effect on the alleviation of urine leakage. However, FES seems to be superior to TOT for improvement of quality of life. Further studies are needed to compare the efficacy of these two treatment modalities.

To evaluate the impact of centralisation of acute obstetric care (AOC) on perinatal outcomes, care patterns, and obstetric interventions in three Dutch regions, while accounting for temporal trends. This retrospective cohort study used data from the Perined registry covering three regions that had closure of 24/7 obstetric units in 2018. Data were analysed for 1.5&#xa0;years before and 1&#xa0;year after centralisation. Perinatal outcomes included neonatal mortality, Apgar scores, prematurity, and postpartum haemorrhage. Care patterns and obstetric interventions comprised level of care, place of birth, mode of birth and induction of labour. Multivariable logistic regression analyses were performed, adjusting for ethnicity and time trends. We evaluated potential effect modification by time trends. The effects of centralisation varied across regions. Region 1 showed an increased odds of an Apgar score <7 at 5&#xa0;min (aOR 2.11, 95% CI 1.02-4.36) after centralisation. In Region 2 lower rates of neonatal mortality were observed based on unadjusted analyses restricted by a small sample size. After centralisation several care patterns changed: Region 1 had higher rates of midwife-led care, Region 2 showed increases in obstetrician-led care and unplanned caesarean sections, while Region 3 demonstrated higher rates of obstetrician-led care at labour onset alongside fewer birth centre deliveries. Centralisation of AOC did not have consistent effects on perinatal outcomes, care patterns and obstetric interventions across Dutch regions. The heterogeneous findings suggest that local context and organisational responses substantially influence centralisation outcomes.

To study the effect of intrauterine instillation of Hyaluronan enriched media on reproductive outcomes of intrauterine insemination treatment. 100 couples with unexplained infertility were approached and were randomly allocated to the intervention and control arm with 1:1 allocation over 2&#xa0;years of duration. The study participants received controlled ovarian stimulation and intrauterine insemination. Additionally, the intervention group, received intrauterine administration of Hyaluronan enriched media. The intervention group and control group was compared for clinical pregnancy, live birth and miscarriages using the SPSS statistical package (version 23.0). The study observed a trend of improved cumulative biochemical pregnancy rates (33.3% Vs 15.5%, RR 2.14, 95% CI 0.96-4.75, p&#xa0;=&#xa0;0.061) and clinical pregnancy rates (31.1% Vs 15.5%, RR 2.00, 95% CI 0.89-4.48, p&#xa0;=&#xa0;0.093) in the intervention group, which however did not reach statistical significance. The cumulative live birth occurrence was statistically significantly better in the intervention arm (28.9% vs 11.1%). RR 2.60, 95% CI 1.01-6.89, p&#xa0;=&#xa0;0.047) of the trial. Similar miscarriage rates were observed in both arms of the trial (4.4% Vs 4.4%, RR 1.0, 95% CI 0.15-6.79, p&#xa0;=&#xa0;1.00). The intrauterine insemination instillation of hyaluronan enriched media was well tolerated by participants in the intervention arm. The study suggests a potential benefit of use of hyaluronan enriched media as a novel minimally invasive add-on intervention to facilitate the enhancement of success rates of IUI treatment.

To analyze the disease spectrum, treatment patterns, and maternal and fetal outcomes of pregnancy-associated malignancy, and to explore factors associated with obstetric intervention, particularly iatrogenic preterm birth. This single-center retrospective cohort study included pregnant women diagnosed with histologically confirmed malignancy from January 2013 to December 2021. Clinical, pathological, obstetric, neonatal, and follow-up data were extracted from electronic medical records. Maternal survival was assessed using the Kaplan-Meier method. Factors associated with iatrogenic preterm birth among women who continued pregnancy were explored using univariate analyses and multivariate logistic regression. Because of the limited sample size and multiple comparisons, inferential findings were interpreted cautiously and primarily as exploratory. Fifty-three patients met the inclusion criteria. Nine terminated pregnancies in the first trimester because of disease severity, and four were lost to follow-up, leaving 40 pregnancies for obstetric and neonatal outcome analyses. The most common malignancies were hematologic cancers (30.19%, 16/53) and breast cancer (24.53%, 13/53). The median gestational age at diagnosis was 20&#xa0;weeks. Among women who continued pregnancy, 19 (47.5%) received antitumor therapy during pregnancy. Compared with controls (n&#xa0;=&#xa0;50), the malignancy cohort had higher rates of preterm birth (62.5% vs. 8.0%), low birth weight (45.0% vs. 6.0%), and cesarean delivery (60.0% vs. 32.0%) (all P&#xa0;<&#xa0;0.001). Nineteen patients died during follow-up (35.8%, 19/53). In multivariate analysis for iatrogenic preterm birth, advanced tumor stage was associated with higher odds (OR&#xa0;=&#xa0;5.82, 95% CI 1.21-27.98, P&#xa0;=&#xa0;0.028). Other variables showed wide confidence intervals and were interpreted with caution. Pregnancy-associated malignancy is associated with increased obstetric intervention and adverse neonatal outcomes, largely driven by prematurity. Tumor stage and the timing of diagnosis appear closely related to delivery decisions. Individualized multidisciplinary management is essential to balance maternal treatment needs with fetal maturity and neonatal safety.

Endometriosis, a chronic inflammatory disease, has been associated with adverse pregnancy and perinatal outcomes, which in turn have been linked to long-term neurological morbidity in the offspring. This study aimed to determine whether maternal endometriosis is associated with long-term neurological morbidity in the offspring, independent of these perinatal complications. We conducted a retrospective, population-based cohort study comparing offspring of mothers with a documented diagnosis of endometriosis to those without endometriosis. Offspring long-term neurological morbidity data was obtained using inpatient and outpatient records. Kaplan-Meier survival analysis was used to compare the cumulative incidence of neurological morbidity, and a Cox regression model was applied to adjust for potential confounders. A total of 232,476 singleton deliveries were included; of them, 224 deliveries were of mothers with a documented diagnosis of endometriosis. The overall neurological morbidity (26.8% vs. 17.4%) as well as the cumulative incidence (log rank, p&#xa0;<&#xa0;0.001) was higher in children born to mothers with endometriosis. In a Cox regression model adjusted for maternal age, gestational age at birth, use of fertility treatments, cesarean delivery, ethnicity, hypertensive disorders and diabetes mellitus, maternal endometriosis remained independently associated with long-term neurological morbidity of the offspring (adjusted HR&#xa0;=&#xa0;1.34, 95% CI 1.04-1.73, p&#xa0;=&#xa0;0.023). Maternal endometriosis was associated with an increased risk of long-term neurological morbidity in offspring. These findings should be interpreted cautiously given the retrospective design and the small number of exposed pregnancies and diagnosis-specific events, and further research is warranted.

Oral contraceptives are a popular choice of contraception globally. The objective was to assess whether oral contraceptive use is associated with diagnosis, treatment, and symptoms of depression in healthy women. Databases (MEDLINE, EMBASE, and PsycINFO databases via OvidSP for relevant studies, from database inception to 01 July 2025) were searched for prospective and observational studies comparing users of any currently prescribed oral contraceptives to non-users. Binary outcomes were summarised via relative risks (RR) with 95% confidence intervals (95% CI). Continuous outcomes were evaluated via standardised mean differences (SMD) along with 95% CI. Main outcomes and measures included incident depression diagnosis, antidepressant initiation, and depressive symptom scores measured with externally validated depression scales. Out of 438 screened references, 14 (2,425,648 participants) were included in the analysis. Of the five studies (1,607,461 participants) that examined depression diagnoses, oral contraceptives were associated with a 31% increased relative risk of being diagnosed with depression compared to non-users (RR: 1.31; 95% CI: 1.07 to 1.61, I2&#xa0;=&#xa0;94.18%, moderate certainty, high heterogeneity). Three studies (2,150,352 participants) with incidence of antidepressant use showed oral contraceptive users were 25% more likely to take antidepressants than non-users (RR: 1.25; 95% CI: 1.20 to 1.30 I2&#xa0;=&#xa0;75.4%, moderate certainty). Eight studies (2,525 participants) measuring depressive symptom scores found oral contraceptive users had statistically significantly higher, but clinically small, differences in depressive symptom scores than non-users (SMD: 0.12, 95% CI: 0.05 to 0.20). Subgroup analyses of depressive symptom scores showed no evidence of group differences by study design, follow-up length or progestogen content. Evidence from this meta-analysis suggests oral contraceptive use is associated with increased risks of depression diagnoses, antidepressant initiation, and higher depressive symptom scores. The findings, which reflect the association between hormonal oral contraceptives and depression in women without pre-existing psychological or gynaecological conditions, suggest that adverse effects on mood should be closely monitored by contraception prescribers.

Prenatal anomaly scanning is a core component of obstetric care, yet remains highly operator-dependent. Variability in training contributes to inconsistent detection rates of fetal anomalies. Structured, multimodal educational strategies have been proposed to improve competence across undergraduate and postgraduate learners. This review synthesizes evidence on teaching methods, simulation modalities, digital learning tools, and assessment frameworks for anomaly scan education. A comprehensive narrative review of the literature without language or time restrictions was performed, integrating data on traditional teaching, simulation-based training, e-learning, artificial intelligence (AI) tools, and competence assessment methodologies. Evidence from undergraduate, residency, and fellowship training contexts was evaluated, with attention to skill acquisition, transfer to clinical practice, and programmatic implementation. Traditional apprenticeship, didactic instruction, peer learning, and case-based teaching provide foundational knowledge but insufficient psychomotor skill acquisition when used alone. Simulation-based training-high-fidelity mannequins, VR/AR systems, and hybrid phantoms-significantly accelerates learners' ability to obtain standard fetal views and diagnose anomalies, with documented transfer to real-patient performance. Digital tools, including e-learning modules, app-based simulators, and emerging AI-driven feedback systems, further support standardized and scalable training. Assessment strategies such as OSCEs, OSAUS global rating scales, logbooks, and image-quality benchmarks enable structured and objective evaluation, although no universal standard yet exists. Blended learning approaches that combine cognitive, psychomotor, and reflective modalities offer the most reliable educational outcomes. Simulation and AI-supported systems may mitigate resource limitations and enhance training consistency. Remaining challenges include cost, faculty development, and curriculum standardization.

Caesarean section (CS) rates have increased worldwide, raising concerns about maternal and child health and healthcare costs. Although vaginal birth after caesarean (VBAC) is considered a safe alternative, its use remains limited and variable. We aimed to identify sociodemographic, clinical, and organizational factors associated with VBAC utilization in Tuscany, Italy, and to assess the impact of VBAC on perinatal outcomes. We conducted a retrospective population-based study using administrative healthcare data (2021-2024), including women with one previous CS who delivered at term (n&#xa0;=&#xa0;6,737). Single-level and multi-level logistic regression models were used to investigate independent determinants of VBAC utilization and its association with perinatal outcomes. Missing data were handled using multiple imputation. Overall, 27% of women underwent VBAC. Older maternal age, unemployment, Italian nationality, assisted reproductive technologies, diabetes, private care pathways, and indicators of more intensive prenatal surveillance were associated with lower odds of VBAC, whereas antenatal class attendance and early initiation of prenatal care were associated with higher odds. VBAC rates increased from 2021 to 2022 to 2023-2024. The multi-level model showed that 25.4% of the variance in VBAC utilization was attributable to differences between hospitals. VBAC was associated with improved perinatal outcomes (higher Apgar scores; increased breastfeeding and skin-to-skin contact; lower neonatal ventilation) and reduced length of stay and hospitalization costs. VBAC utilization in Tuscany remains below recommended levels. Hospital-level differences explain a substantial proportion of the observed variation, supporting the need to standardize VBAC practices at the regional level.

To investigate the key research hotspots and trends related to exosomes in premature ovarian insufficiency (POI) using bibliometric visualization analysis, and to provide a data-driven framework for future scientific and clinical development. Using the Web of Science Core Collection database, 103 documents were analysed with CiteSpace and VOSviewer to evaluate the research status and development trajectories from 2016 to July 2025. The study revealed a consistent increase in publication output, with China at the forefront, followed by the USA. Research publications have predominantly focused on mesenchymal-stem-cell-derived exosomes, exploring their various sources and mechanisms, such as inhibition of cell apoptosis, activation of signalling pathways, delivery of non-coding RNAs to regulate gene expression, and improving ovarian function in preclinical models. Keyword burst analysis highlighted terms related to specific experimental models, pathological conditions, and clinical applications. Although exosome-based therapy shows promise for restoring ovarian function in preclinical POI models, bibliometric data underscore critical translational bottlenecks. Furthermore, there is rising interest in exosomes as biomarkers for early POI diagnosis. Future research should prioritize the elucidation of molecular mechanisms, establishment of standardized protocols for exosome production and delivery, and acceleration of clinical translation.

The aim of our study is to investigate the percentage of ovarian cancer (OC) patients with concomitant endometriosis and its distribution across histological subtypes, and to assess whether the presence of endometriosis influences overall survival (OS) and disease-free survival (DFS) in patients with clear cell and endometrioid OC. We conducted a retrospective observational study using patient's medical records of two reference hospitals in Spain, including OC patients, with and without endometriosis. We analysed the frequency of the association between cancer and endometriosis, the differences in OS and DFS survival between patients with and without endometriosis and the influence of age, tumour size, histological subtype and grade. Among the 257 patients included, 39 (15.2%) had concomitant endometriosis. This correlation was particularly strong in endometrioid (EC) and clear cell carcinoma (CCC) patients; 61.0% of whom have concomitant endometriosis. Survival analysis demonstrated that, in EC and clear CCC, endometriosis-associated patients had longer OS (HR&#xa0;=&#xa0;0.1773 [IC95% 0.03053-1.019]) and DFS (HR&#xa0;=&#xa0;0.02 [IC95% 0.0009266-0.5100]) than OC patients without endometriosis. The difference was statistically significant for OS (p&#xa0;=&#xa0;0.0174) but not for DFS (p&#xa0;=&#xa0;0.0525). Univariate analysis shows that age, BMI or cyst size did not significantly affect disease outcomes. Endometriosis has a clear association with EC and CCC. Its presence improves OS in Ovarian Cancer patients. Further studies are needed to confirm the improvement in outcomes and to determine the nature of the putative protection.

Swedish national guidelines recommend computed tomography (CT) of the thorax and abdomen at diagnosis of endometrial cancer (EC), whereas European guidelines suggest CT primarily for patients at risk of advanced disease. As metastatic disease is uncommon in EC and incidental findings are frequent, we evaluated the diagnostic yield of routine CT regarding treatment planning and the prevalence and clinical impact of incidental findings. This retrospective study included 195 women with endometrial cancer who underwent CT scan at diagnosis. Women with symptoms of disseminated disease at diagnosis were excluded. Data were obtained from medical records. Descriptive statistics were applied to estimate the frequency of suspected metastatic according to histology and incidental findings and their impact on management. Suspected metastatic disease was identified in 11 patients (5.6%), leading to altered management in eight (4.1%), all with high-risk histology. Among 129 patients (66.2%) with low-grade endometrioid carcinoma, two (1.6%) had suspected metastases, none resulting in treatment changes. Of 57 patients (29%) with high-risk histology, nine (15.8%) had suspected metastases. Incidental findings occurred in 43 patients (22.1%), prompting 62 additional investigations. Pulmonary nodules were most common (10.7%). Two primary lung cancers were diagnosed. Twenty-five CT scans were required to alter management in one patient. Routine CT at EC diagnosis detects more incidental findings than metastatic disease. Clinical benefit appears confined to high-risk histologies, while its value in low-grade disease is limited.

Over the last decade, remote technological initiatives for obstetric antenatal care have rapidly developed. However, variation in outcome reporting can preclude effective data synthesis. A remedy for this is to develop of a core outcome set (COS). However, prior to this, it is necessary to examine the heterogeneity of outcome reporting. MEDLINE, Embase, Cochrane Database of Clinical Trials (CENTRAL), Web of Science, and PubMed databases from January 2015 to November 2025. Randomised controlled trials (RCTs), RCT protocols or pilot RCTs which assessed any outcome for any type of remote monitoring device during the obstetric antenatal period were included. Study characteristics, outcomes definitions and timings were extracted and descriptively analysed. Of the 4904 papers screen, 40 studies were included (24 full RCTs, 10 protocols and six pilot RCTs) The most common remote monitoring devices used, either in isolation or in combination, were blood pressure (n&#xa0;=&#xa0;17, 42.5%) and blood glucose (n&#xa0;=&#xa0;16, 40.0%). In total, 1004 verbatim outcomes were noted, categorised into 361 unique outcomes, across 72 domains. Outcome definition was heterogenous, with glycaemic monitoring demonstrating the largest variation, with 29 different definitions. Longer-term outcomes were infrequently reported, with fewer than 6% of all outcomes evaluating more than 3&#xa0;months postpartum. Maternal remote monitoring devices were most commonly assessed, with 29 studies solely evaluating these devices. No single outcome was reported in all studies. This review demonstrates a lack of consistent outcome reporting for trials examining remote antenatal monitoring devices. Consequently, the development of a COS is recommended.

To examine the association between age at menarche and polycystic ovary syndrome (PCOS) diagnosis among US women aged 20-49&#xa0;years. Our retrospective cross-sectional analysis used data from the 2022-2023 National Survey of Family Growth. The primary outcome was self-reported PCOS diagnosis, and the primary exposure was self-reported age at menarche, categorized in the primary analysis as early (<12&#xa0;years), normal (12-13&#xa0;years), or late (>13&#xa0;years). Multivariable logistic regression modeled the association between age at menarche and PCOS. All analyses adjusted for the survey's complex sampling design. Our sample had 4,254 respondents, with a weighted PCOS prevalence of 9%. Weighted prevalence estimates of early and late menarche were 25% and 24% respectively. On multivariable analysis, there was no significant association between early (adjusted odds ratio [aOR]: 1.18; 95% confidence interval [CI]: 0.85, 1.62; p&#xa0;=&#xa0;0.312) or late (aOR: 1.19; 95% CI: 0.85, 1.68; p&#xa0;=&#xa0;0.307) age at menarche and odds of PCOS diagnosis, compared to normal age at menarche. On post hoc analysis using an optimal dichotomized age cutoff, age at menarche &#x2265;16&#xa0;years was associated with increased odds of PCOS, compared to <16&#xa0;years. Our analysis found no significant association between a conventional classification of age at menarche and PCOS in a survey of US women aged 20-49&#xa0;years, although delayed menarche at age >16&#xa0;years was associated with PCOS prevalence. The null findings in the primary analysis may be attributed to challenges in accurately diagnosing PCOS or environmental factors affecting PCOS incidence in the US.

Mitochondrial dysfunction has been demonstrated with a role in pathologically driving various obstetric and gynecological (OB/GYN) diseases, but molecular mediators associating mitochondrial dysfunction with discrete pathologies have not been determined yet. CHCHD2, a bi-organellar protein called MNRR1 as well, integrates mitochondrial stress sensing with nuclear adaptive responses; nonetheless, its effect on reproductive disorder remains substantially paradoxical, which creates an important translational roadblock. Such ambiguity may not be arbitrary, instead, it may be associated with the unavailability of a uniform conceptual model in this field. In the present work, a new pathogenic framework called the 'Driver vs. Response' dichotomy was proposed and substantiated for resolving the above-mentioned paradox. According to our findings, the role of CHCHD2 conformed to the stark, context-dependent dichotomy: with its dysregulation manifested as the failed compensatory response associated with excess apoptosis in high-stress inflammatory states (such as preterm birth, preeclampsia). In comparison, under pro-survival pathological conditions (like ovarian cancer, endometriosis), its increased expression was the primary pathogenic driver, which suppressed apoptosis and conferred metabolic flexibility. The proposed framework identified CHCHD2 as the context-dependent mediator, which resolved an essential intellectual gap and exposed an important therapeutic dichotomy. Notably, the resolution of this challenge (protein inhibition within cancer is toxic and protein activation within preeclampsia is oncogenic) is an essential translational priority.