Recurrent urinary tract infections (rUTIs) are common in peri- and postmenopausal women and impose substantial symptom, quality of life, and antimicrobial stewardship burdens, with particularly high incidence and hospitalization costs documented in England and UK primary care populations. Vaginal estrogen, by restoring urogenital epithelium and the lactobacillus-dominant microbiome, is recommended in several guidelines for preventing rUTI; including UK antimicrobial prescribing guidance for rUTIs and European Association of Urology recommendations. However, most formulations are licensed only for genitourinary syndrome of menopause, not for UTI prophylaxis. This creates a mismatch between the growing clinical evidence base and the absence of a specific regulatory indication for rUTI prevention across major regulatory agencies, including the U.S. Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the UK Medicines and Healthcare products Regulatory Agency (MHRA), which may contribute to underuse and clinician uncertainty. To review and summarize the evidence on vaginal estrogen for prevention of recurrent urinary tract infections in peri- and postmenopausal women, with a particular focus on its use alone and in combination with antibiotic therapy, and on the gap between clinical guideline recommendations and regulatory product labelling. We conducted a structured narrative review focusing on randomized controlled trials and clinical practice guidelines that evaluate intravaginal estrogen for the prevention of rUTI in peri- and postmenopausal women. PubMed and Embase searches were performed using key terms for estrogen, urinary tract infection, and menopause, and were supplemented with targeted searches of major guidelines. Data were described in terms of study design, participant characteristics, estrogen formulations and dosing regimens, timing of initiation, comparators, outcome measures, and reported safety outcomes. Evidence from five RCTs reported that low-dose vaginal estrogen, administered as creams, tablets, rings, or gels, reduced culture-confirmed rUTI episodes and improved vaginal health indices, with no clear superiority of any single formulation and a favorable local safety profile. One trial found estriol pessaries less effective than nitrofurantoin prophylaxis, indicating that estrogen may complement rather than fully replace antibiotics in some women. Initiation was predominantly prophylactic or post-antibiotic, and no identified trial evaluated co-initiation of vaginal estrogen with antibiotics at the onset of acute UTI, highlighting a persisting evidence gap regarding optimal timing of therapy. Vaginal estrogen is an evidence-based yet underutilized strategy for rUTI prevention in peri- and postmenopausal women, supported by RCT data and guideline recommendations, but not recognized in current FDA-approved indications for vaginal estrogen products. Closing this evidence licensing gap will require regulatory reconsideration informed by existing trial data, alongside new pragmatic studies to refine timing, dosing, and formulation choices, to evaluate co-administration with antibiotics, and to explore women's knowledge, preferences, and adherence to support patient-centered implementation in routine care.
The objective of this study was to evaluate the clinical significance of late-onset cervical shortening diagnosed between 24.0 and 34.0 weeks of gestation following normal midtrimester screening and to assess its association with spontaneous preterm birth (sPTB) and adverse neonatal outcomes. We also examined whether obstetric history modifies this risk. This was a retrospective cohort study. Participants/Materials: A total of 500 singleton pregnancies with normal midtrimester cervical length (CL) who were subsequently diagnosed with cervical shortening (<25 mm) between 24.0 and 34.0 weeks of gestation were included in the study. This study was conducted at a tertiary, university-affiliated medical center (Galilee Medical Center, Israel) between March 2020 and May 2025. Patients with asymptomatic late cervical shortening were categorized into three groups: <10 mm, 11-15 mm, and 16-25 mm. CL measurements were further stratified by gestational age at diagnosis (24.0-27.6, 28.0-31.6, and 32.0-34.0 weeks). The primary outcome was sPTB <37 weeks. Secondary outcomes included sPTB <34 and <32 weeks and neonatal morbidity. Multivariable logistic regression was used to estimate adjusted odds ratios. Receiver operating characteristic (ROC) curve analysis was performed to determine gestational age-specific CL thresholds for predicting sPTB. A total of 500 patients were included: 24/500 (4.8%) with CL <10 mm, 80/500 (16.0%) with CL 11-15 mm, and 396/500 (79.2%) with CL 16-25 mm. Baseline characteristics were comparable across groups. Rates of sPTB <37 weeks were 18/24 (75.0%) in patients with CL <10 mm, 42/80 (52.5%) in those with CL 11-15 mm, and 99/396 (25.0%) in those with CL 16-25 mm (p < 0.001). Similarly, sPTB <34 weeks occurred in 14/24 (58.3%), 20/80 (25.0%), and 33/396 (8.3%), and sPTB <32 weeks in 11/24 (45.8%), 12/80 (15.0%), and 20/396 (5.1%) (all p < 0.001). When stratified by CL groups, sPTB rates did not differ according to obstetric history among patients with CL <10 mm and 11-15 mm. In contrast, among patients with CL 21-25 mm, sPTB occurred in 7/26 (26.9%) of those with a prior sPTB, 17/78 (21.8%) of nulliparas, and 10/78 (12.8%) of those with a prior term birth (p = 0.041). ROC analysis identified gestational age-specific thresholds for predicting sPTB <37 weeks: 22 mm at 24.0-27.6 weeks (area under the curve [AUC] 0.69, p < 0.001), 20 mm at 28.0-31.6 weeks (AUC 0.62, p = 0.002), and 18 mm at 32.0-34.0 weeks (AUC 0.72, p < 0.001). Correspondingly, sPTB rates were higher below these cutoffs: 49.1% vs. 18.2% (p < 0.001), 49.1% vs. 23.2% (p < 0.001), and 43.9% vs. 18.8% (p < 0.001), respectively. The retrospective design may introduce selection and information bias. Measurements were performed by multiple clinicians, potentially leading to interobserver variability. Residual confounding cannot be excluded. Late-onset cervical shortening after normal midtrimester screening is strongly associated with sPTB and adverse neonatal outcomes. The degree of shortening and obstetric history significantly influence risk, particularly in patients with moderate late shortening. Gestational age-specific CL thresholds may enhance late pregnancy risk stratification and support individualized surveillance and management strategies.
Transgender and gender-diverse (TGD) people assigned female at birth (AFAB) increasingly seek reproductive and gynecologic care, yet evidence and clinical pathways remain variable across health systems, including in Europe. The objective of this study was to synthesize evidence on fertility, pregnancy, gynecologic care, and access to care in TGD populations and to highlight practical implications for gender-affirming clinical practice, with attention to European settings. A narrative review supported by a structured PubMed/MEDLINE search (January 1, 2014-May 31, 2025). Two reviewers screened 146 titles/abstracts; 58 full texts were assessed; and 31 publications were included. Nine primary studies reported quantitative pregnancy and/or assisted reproduction outcomes after prior testosterone exposure in AFAB TGD individuals. Available data, largely small retrospective cohorts and case series, suggest that pregnancy and assisted reproduction are feasible after prior testosterone exposure, typically after temporary cessation. In studies with cisgender comparators, oocyte yield and embryology metrics appeared broadly comparable, but evidence remains heterogeneous and underpowered for robust safety conclusions. Survey-based studies indicate that more than half of pregnancies may be unintended. Barriers to fertility preservation (FP) and preventive gynecologic care include financial and structural constraints, limited provider training, and avoidance of pelvic examinations and cervical cancer screening. Reproductive counseling, FP, contraception, and organ-based screening should be integrated into gender-affirming pathways using trauma-informed, patient-centered communication. Prospective multicenter studies and standardized outcome reporting are needed to better define safety, effectiveness, and equity of care.
The aim of this study was to explore the application of enhanced recovery after surgery (ERAS) in patients undergoing gynaecological surgery. This investigation included an analysis of the postoperative recovery curve and the factors that influenced the number of postoperative recovery days. This study also aimed to further investigate the impact of various factors on health economics. A retrospective cohort study was conducted in the Fourth Ward of the General Gynaecology Centre of the Peking Union Medical College Hospital. A total of 1000 patients who had undergone elective benign gynaecological surgery between July 2021 and December 2022 were included. Demographic, perioperative and other relevant data were collected, and a visual analogue scale (VAS) survey was conducted using the European Five-Dimensional Health Scale (EQ-5D). The factors that influenced the number of postoperative recovery days were analysed using a multivariate linear regression analysis. Additionally, patients who had undergone laparoscopic myomectomy, laparoscopic ovarian cystectomy, laparoscopic total hysterectomy, abdominal myomectomy and abdominal total hysterectomy were grouped based on whether their ERAS implementation rate was ≥70%. Our goal was to evaluate the health economic value of the diagnosis-related group (DRG) payments from multiple perspectives and provide actionable recommendations for health insurance bureaus, hospitals and patients from a multi-dimensional perspective. ERAS completion rates for measures such as avoiding preoperative sedation and early postoperative ambulation exceeded 95%, whereas rates for chewing gum and intraoperative temperature monitoring were <5%. The follow-up EQ-5D questionnaire VAS scores were as follows: a preoperative score of 79.48±13.75, score on the day of surgery of 74.18±15.43, score on the first postoperative day of 76.43±14.25, and score on the second postoperative day of 79.84±13.12. Patients returned to a healthy state with a median recovery time of 3 (range, 0-8) days. The postoperative recovery curve was then drawn based on the VAS scores. Additionally, a multivariate linear regression analysis revealed that the prevention of postoperative nausea and vomiting, correction of preoperative anaemia and malnutrition, ERAS completion rate and VAS score on the second postoperative day significantly influenced the number of postoperative recovery days (p<0.05). Patients with ERAS compliance rates of <70% incurred an average hospital cost increase of 8% compared with those with a compliance rate of ≥70%. Specifically, patients who underwent laparoscopic myomectomy and laparoscopic total hysterectomy experienced more significant and more obvious increases in hospitalisation costs of approximately 15% (p<0.001) and 8% (p=0.031), respectively.An analysis of the relationship between hospital costs and different ERAS measures, insurance types and disease types showed that seven measures could reduce hospital costs without negatively affecting the patient recovery speed, and five measures could slightly increase hospital costs. In addition, hospitalisation cost differences based on various insurance types and disease categories were statistically significant (p<0.05). The postoperative recovery speed was accelerated, the recovery time was shortened and the patient's quality of life was enhanced during gynaecological surgery due to the implementation of ERAS practices. Increasing the ERAS completion rate can significantly reduce patient average hospitalisation costs. Additionally, variations in medical insurance, disease categories and specific ERAS measures influenced these costs. Therefore, hospitals that are unable to fully implement all ERAS measures must prioritise those that promote recovery. In addition, hospitals should adopt flexible strategies to minimise costs, thereby achieving mutual benefits for patients and hospitals. These findings establish a foundation for the implementation of a simplified ERAS version. It has been observed through the perspective of DRG implementation in China that payment standards exceed the average hospitalisation costs associated with specific surgical procedures. This result suggests that DRG implementation can benefit both patients and hospitals. These study results will serve as a valuable reference for decision-making by health insurance bureaus, hospitals and patients.
Vaginal delivery is associated with numerous forms of lower genital tract trauma. Several practices were developed to decrease the duration of the second stage of labor and the likelihood of lower genital tract trauma. Applying obstetric gel is one practice that has been studied in literature, with insufficient and somewhat conflicting evidence. The aim of this study was to compare the duration of the first and second stages of labor, and the integrity of lower genital tract, with or without the application of obstetric gel. A randomized controlled trial was conducted, where delivering women were randomly assigned, based on individual stratifications, to receive either standard care during labor and delivery (n = 82), or with the additional application of the obstetric gel (n = 78). A specifically designed sterile obstetric gel (Natalis®) was applied in the intervention group starting with the first vaginal examination after admission, with a total of 20-30 mL administered per childbirth. Descriptive and inferential statistics were implemented to describe the sample and compare outcomes across the intervention and the control groups, which were further divided depending on their parity (nulliparous and multiparous). The primary outcome was the duration of the second stage of labor. A total of 160 women were recruited. The obstetric gel did not significantly shorten the duration of the first and second stages of labor, among other labor outcomes. However, an underpowered subgroup analysis showed that nulliparas who had obstetric gel application have had a significantly shorter duration of the second stage of labor compared with the control group (69.5 ± 45.3 vs. 97.5 ± 54.3 min; p value = 0.041). A major limitation in our clinical trial is the small sample size that didn't account for subgrouping of parity when estimating the study's power. The obstetric gel did not incur statistically significant effect on labor outcomes including the duration of the second stage of labor. While being underpowered, nulliparas in the intervention group had a shorter duration of the second stage of labor than the control group. The lack of certainty in our results calls for more research to tackle this problem with adequate power to conclude valid results and to further confirm our subgroup findings in order to consider utilizing this practice that aims at improving the delivery experience.
Areas without adequate access for obstetric health care known as maternal health care deserts (MHCD) make up a large part of the United States and significantly impact access to care. Increasing attention has been drawn to stationing of active duty service members (ADSM) and their families in these areas with little to no obstetric health care. This study aims to assess the association between U.S. military base location and ADSM obstetric outcomes. This is an observational, retrospective cohort study using de-identified data sourced from the Medical Assessment and Readiness System. The Medical Assessment and Readiness System protocol was approved by the Naval Medical Center Portsmouth Institutional Review Board. Using this repository, researchers identified all pregnant ADSMs between 2011 and 2021 with and without preventable pregnancy outcomes (PPO). Demographic, military, and health factor data were compared using t-test and chi-squared test. A survival analysis was used to assess the effects of social and community factors associated with maternal health care deserts on PPO risk. Between 2011 and 2021, 545,851 female ADSM began military service and had 141,360 incident pregnancies. There were 21,544 pregnancies that resulted in PPO, or 152.4 PPO per 1,000 pregnancies. Factors associated with increased PPO risk include younger age, higher body mass index, Asian/Pacific Islander race, lower rank, non-Air Force service, non-married status, income level, proximity to obstetric care and increasing Social Deprivation Index. PPO risk increased when both the obstetric clinic and the patient residence were in an area with increased Social Deprivation index (adjusted hazard ratio = 5.07; 95% CI, 4.86-5.28). Risk of PPO increased with increasing distance between the obstetric clinic and patient residence. This study demonstrates that the risk of adverse pregnancy outcomes was higher among those living or being treated in high socioeconomic deprivation areas as well as those living further away from their treating clinic. Further studies should be undertaken to investigate the effects of obstetric healthcare deserts on obstetric outcomes in female servicemembers.
The objectives of the study were to evaluate the association between endometriosis, anxiety, allergic rhinoconjunctivitis, and asthma in hospitalized women and to determine the role of age. A cross-sectional study using inpatient hospital discharge data from 2007 to 2014 was conducted. Participants/Materials: The study included 12,814,970 hospitalized women aged 18-49 years from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) in the USA. Diagnoses of asthma, allergic rhinoconjunctivitis, endometriosis, and anxiety were identified using ICD-9 codes. The study was conducted at US community hospitals in the HCUP NIS database between 2007 and 2014. Of the 12,814,970 patients hospitalized between 2007 and 2014, 1,042,015 (8.1%) had asthma, 50,867 (0.4%) had allergic rhinoconjunctivitis, 831,239 (6.5%) had anxiety without endometriosis, 85,990 (0.7%) had endometriosis without anxiety, and 8,880 (0.1%) had both anxiety and endometriosis. Multivariable logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between endometriosis, anxiety, and asthma, adjusting for age, race, insurance type, smoking, obesity, hypertension, diabetes, thyroid disease, dyslipidemia, atherosclerosis, and depression. Analyses were stratified by age groups (18-34 and 18-49 years). Among hospitalized women aged 18-49 and 18-34 years, the coexistence of anxiety and endometriosis was associated with the highest odds of asthma and allergic rhinoconjunctivitis. For asthma, adjusted ORs were 2.07 (95% CI: 1.94-2.20) among patients aged 18-49 years and 2.57 (2.35-2.81) in patients aged 18-34 years. The ORs for allergic rhinoconjunctivitis were 2.78 (2.30-3.36) and 3.45 (2.55-4.66), respectively. Anxiety or endometriosis alone was also significantly associated with both conditions. The study used administrative data lacking information on disease severity, outpatient diagnoses, and treatment details. As a cross-sectional study, it cannot establish causality or temporal relationships. Endometriosis and anxiety were independently associated with asthma and allergic rhinoconjunctivitis, with stronger associations in women under 35 years. The combination of both conditions was associated with the highest likelihood of asthma and allergic rhinoconjunctivitis, suggesting a potential synergistic effect. Given the nature of the study, future research is needed to explore the shared inflammatory mechanisms. Our findings support clinical awareness of related inflammatory and psychological comorbidities when managing asthma, allergic rhinoconjunctivitis, or endometriosis.
Endometriosis and endometrial polyps are both estrogen-dependent conditions, and an association between these two pathologies has been observed in infertile women. Our research question was: "Is there an association between endometriosis and endometrial polyps also in a study population not selected for infertility?" Therefore, we aimed to assess whether the prevalence of endometrial polyps is higher in patients with endometriosis not seeking pregnancy compared with a general gynecologic outpatient population. This is a case-control study including 438 women with endometriosis and 438 controls without endometriosis attending routine gynecologic visits, consecutively identified from the electronic health records of the Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Between November 2021 and July 2025, all participants underwent transvaginal ultrasound, with standardized pelvic/uterine assessment according to the IETA, IDEA, and MUSA criteria. Patients using hormonal therapy at the time of the examination or in the previous 2 months were excluded. The primary endpoint was the prevalence of endometrial polyps in the two study groups. Point estimates of proportions in each group and odds ratios were calculated with corresponding 95% confidence intervals. Multivariate logistic regression was used to calculate adjusted odds ratio. The mean age was 32 (28-36) years in the 438 cases and 32 (26-36) years in the 438 controls (p = 0.13). Most participants were Caucasian, with a comparable distribution of ethnicities between the two study groups (89.3% and 87.2%; p = 0.23). Prior use of hormonal treatment was reported significantly more often by women with endometriosis (72% vs 48%; p < 0.001). Endometrial polyps were detected in 7/438 women with endometriosis (1.6%) and in 11/438 without endometriosis (2.5%; OR 0.63, 95% CI 0.24-1.64, p = 0.35). When both current and past diagnoses of endometrial polyps were considered, prevalence rates were 3.4% in cases and 5% in controls (OR 0.67, 95% CI 0.34-1.31, p = 0.24). Similar findings were observed after adjusting for statistical and clinically relevant variables. Considering the unexpectedly small number of endometrial polyps detected, a type II error cannot be excluded. Moreover, a 2-month hormonal therapy washout period among previous users might have been too short to fully rule out a potentially persistent protective effect of medications on the development of endometrial polyps. A possible misclassification bias cannot be excluded as polyps were diagnosed by ultrasound without direct visualization by hysteroscopy and histologic confirmation. No centralized image review was performed, introducing potential inter-operator variability. Finally, as no individual matching between cases and controls was performed, residual confounding cannot be completely excluded despite statistical adjustment. In women not seeking pregnancy, endometriosis was not associated with a higher prevalence of endometrial polyps compared with a general gynecologic population undergoing routine gynecologic visits. These findings suggest that the co-occurrence of endometriosis and endometrial polyps observed in infertile populations may reflect independent correlations of the two pathologies with a common determinant condition (infertility) rather than a true biological relationship between them.
Vitamin D deficiency during pregnancy has been linked to adverse maternal-fetal outcomes. However, it remains unclear whether standard supplementation mitigates risks equally in patients with differing baseline 25-hydroxyvitamin D [25(OH)D3] levels. The objective of this study was to determine whether differences exist in obstetric outcomes and pregnancy-related disorders among patients with different levels of 25(OH)D3 in the first trimester who receive standard supplementation. This retrospective comparative cohort study involves pregnant women aged 16-50 years who received prenatal care at a semiprivate hospital in Northeastern México between January 2022 and December 2024. Participants were grouped based on first-trimester serum 25(OH)D3 levels (≥30 ng/mL vs. <30 ng/mL), all receiving standard 25(OH)D3 supplementation (4,000 IU/day). For comparisons between groups, we performed independent samples t-tests or Mann-Whitney U tests for quantitative variables and chi-square tests for qualitative variables. A multivariate logistic regression analysis was conducted to identify predictors of adverse obstetric outcomes. A total of 303 women (mean [standard deviation] age 29.3 [5.4] years) were analyzed, divided almost equally between first-trimester 25(OH)D3 deficient group (n = 151) and the sufficient group (n = 152), with similar baseline characteristics. Although insufficient 25(OH)D3 women reached sufficiency during the second and third trimesters, sufficient women maintained significantly higher serum 25(OH)D3 levels throughout pregnancy (p < 0.001) and had lower rates of preeclampsia (1.3% vs. 10.6%, p < 0.001), gestational diabetes (8.6% vs. 24.5%, p < 0.001), preterm labor (0% vs. 5.3%, p = 0.003), urinary tract infections (4.6% vs. 14.6%, p = 0.003), and bacterial vaginosis (3.9% vs. 13.2%, p = 0.004). Logistic regression confirmed first-trimester 25(OH)D3 sufficiency as independently protective against adverse outcomes (OR = 0.21, 95% CI: 0.10-0.43, p < 0.001). First-trimester 25(OH)D3 sufficiency was associated with reduced risk of obstetric complications, compared with women with insufficiency, even when the last achieved sufficiency in the second and third trimester. These findings highlight the importance of early screening and support the need for personalized supplementation strategies before conception to optimize maternal-fetal outcomes.
The objectives of this study were to identify factors associated with intrapartum fever (IPF) and clinical chorioamnionitis in patients with term prelabor rupture of membranes (PROM) lasting <18 h and to evaluate microbiological findings in chorioamniotic swab cultures from patients with IPF. This was a retrospective study. Participants/Materials: A total of 6,828 patients with term PROM were included and categorized into: PROM <12 h (n = 5,745) and PROM 12-18 h (n = 1,083). Exclusion criteria included multiple gestations, fetal anomalies, and incomplete medical records. The retrospective study was conducted at Galilee Medical Center, a tertiary care hospital, between March 2020 and May 2024. The primary outcome was clinical chorioamnionitis, diagnosed by intrapartum fever (IPF) ≥38°C and ≥2 clinical signs. Secondary outcomes included maternal (delivery mode, IPF, postpartum complications) and neonatal (Apgar scores, neonatal intensive care unit (NICU) admission, early onset sepsis) outcomes. Chorioamniotic swabs were obtained from patients with IPF for microbiological analysis. Statistical analysis included chi-square or Fisher's exact tests, Mann-Whitney U tests, relative risks (RRs) with 95% confidence intervals (CIs), and multivariate logistic regression to identify independent predictors of clinical chorioamnionitis and IPF. PROM 12-18 h was associated with higher rates of clinical chorioamnionitis (3.9% vs. 2.3%, p = 0.002; RR 1.73, 95% CI: 1.23-2.45) and IPF (4.8% vs. 2.3%, p < 0.001; RR 2.13, 95% CI: 1.34-3.31) compared with PROM <12 h. The risk of clinical chorioamnionitis increased progressively with PROM duration, reaching a maximal elevation between 16 and 18 h (adjusted RR 5.23, 95% CI: 2.80-9.76, compared with PROM ≤4 h). Vaginal delivery was less frequent (76.9% vs. 83.4%, p < 0.001), whereas cesarean (16.2% vs. 11.4%, p < 0.001) and vacuum-assisted delivery rates (6.9% vs. 5.2%, p = 0.029) were higher with PROM 12-18 h. Postpartum antibiotic administration was more common (4.1% vs. 1.7%, p < 0.001), and postpartum hospitalization was longer (2.4 vs. 2.1 days, p = 0.003), respectively. Neonates born after PROM 12-18 h had higher rates of NICU admission (4.9% vs. 3.1%, p = 0.003), sepsis workups (4.6% vs. 3.0%, p = 0.007), and NICU antibiotic treatment (2.9% vs. 1.6%, p = 0.003). Multivariate analysis identified parity as protective against chorioamnionitis (OR 0.38, 95% CI: 0.21-0.69, p = 0.002) and IPF (OR 0.52, 95% CI: 0.31-0.89, p = 0.017). Epidural analgesia increased the odds of IPF (OR 2.20, 95% CI: 1.61-3.90, p = 0.048), while meconium-stained amniotic fluid was associated with higher odds of chorioamnionitis (OR 2.86, 95% CI: 1.45-5.63, p = 0.002). Positive chorioamniotic swab cultures were more frequent in PROM 12-18 h than PROM <12 h (59.6% vs. 35.7%, p < 0.001; RR 1.71, 95% CI: 1.42-1.91), with higher Enterobacteriaceae detection (26.9% vs. 12.6%, p = 0.014). Among group B streptococcus (GBS)-colonized patients, Enterobacteriaceae detection was higher than in GBS-negative patients (32.3% vs. 14.3%, p < 0.001), while GBS detection rates were comparable. The retrospective design and lack of long-term maternal and neonatal follow-up limit causal inference. PROM lasting 12-18 h was associated with higher rates of maternal and neonatal infections compared with PROM <12 h. These findings suggest that infection risk rises earlier than the conventional 18 h threshold, raising important considerations regarding the timing and choice of intrapartum antibiotic prophylaxis. Further prospective studies are warranted to validate these findings and to determine optimal antibiotic protocols.
<p>Objectives: Early-onset Group B Streptococcus (GBS) infection is a major cause of neonatal morbidity and mortality, which can be prevented through intrapartum antibiotic prophylaxis (IAP). First-line β-lactams (penicillin or ampicillin) are preferred, whereas clindamycin is reserved for patients with a confirmed high-risk penicillin allergy and documented susceptibility. Increasing clindamycin resistance and concerns about intra-amniotic efficacy highlight the need to evaluate maternal outcomes. This study examined maternal infectious morbidity, neonatal outcomes, and microbiological findings in GBS-positive term patients receiving ampicillin versus clindamycin IAP. This retrospective cohort study was conducted between March 2021 and March 2024 at a tertiary university-affiliated hospital. Participants/Materials: Singleton term pregnancies (≥37 weeks) with a documented positive GBS vaginal-rectal culture obtained within 5 weeks before delivery were included. Patients received either ampicillin (n = 1,833) according to the institutional protocol or clindamycin (n = 78) if they reported a severe β-lactam allergy. No intrapartum clindamycin susceptibility testing was performed. The study was conducted at a tertiary university-affiliated hospital between March 2021 and March 2024. The co-primary outcomes were clinical chorioamnionitis and admission to the neonatal intensive care unit (NICU). Secondary maternal outcomes included intrapartum fever, postpartum fever, postpartum antibiotic administration use, and cesarean delivery. Secondary neonatal outcomes included a 5-min Apgar score of <7, umbilical cord pH at <7.1, respiratory distress, and ventilatory support. Chorioamniotic swabs were obtained after delivery. Data were analyzed using chi-square or Fisher's exact tests for categorical variables, t tests or Mann-Whitney U tests for continuous variables, and multivariable logistic regression to identify independent predictors. Baseline maternal and obstetric characteristics were similar. Compared with ampicillin, clindamycin was associated with significantly higher rates of intrapartum fever (23.1% vs. 2.3%, p < 0.001), clinical chorioamnionitis (9.0% vs. 0.5%, p < 0.001), postpartum fever (5.1% vs. 1.0%, p = 0.001), and postpartum antibiotic use (7.6% vs. 0.8%, p < 0.001). Cesarean delivery rates did not differ significantly (19.2% vs. 11.6%, p = 0.084). NICU admission and other neonatal outcomes were comparable. Compared with ampicillin, clindamycin IAP was identified as a strong independent predictor of clinical chorioamnionitis (adjusted odds ratio [aOR] 20.1, 95% confidence interval [CI] 6.6-61.4, p < 0.001), together with prolonged rupture of membranes >18 h (aOR 4.9, 95% CI 1.6-15.7, p = 0.006) and cervical ripening by catheter balloon (aOR 4.1, 95% CI 1.2-13.6, p = 0.023). Postpartum, GBS-positive chorioamniotic cultures were significantly more frequent among patients who received clindamycin compared with those who received ampicillin (28.2% vs. 10.5%; p < 0.001). This retrospective, single-center study may be subject to bias and has limited generalizability. The small clindamycin group reduced the power for rare outcomes. Penicillin allergy was self-reported without confirmatory testing, and clindamycin susceptibility was not assessed intrapartum. Among GBS-positive term patients, intrapartum clindamycin prophylaxis was associated with markedly higher maternal infectious morbidity and increased GBS detection in chorioamniotic cultures compared with ampicillin, without significant differences in neonatal outcomes. These findings raise concerns about the intra-amniotic effectiveness of clindamycin and support minimizing its use whenever possible. Further prospective studies are warranted to confirm these findings and to evaluate alternative prophylactic regimens for patients with penicillin allergy. </p>.
Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder affecting up to 10% of women of reproductive age, commonly associated with visceral obesity, insulin resistance, and chronic low-grade inflammation. Sodium butyrate, a microbial-derived short-chain fatty acid, has been proposed as a therapeutic agent due to its anti-inflammatory and metabolic regulatory properties. However, its efficacy under hyperandrogenic and pro-inflammatory conditions remains uncertain. Experimental study using prepubertal female BALB/c mice (n = 40) allocated into five groups: control (CT), high-fat diet (HFD), DHEA (HFD + dehydroepiandrosterone), BUT (HFD + sodium butyrate), and DHEA+BUT (HFD + DHEA + sodium butyrate). Hyperandrogenism was induced by subcutaneous DHEA implants, and obesity by a high-fat diet (60% kcal from fat). Sodium butyrate (100 mg/kg/day) was administered by oral gavage during the last 40 days of the 90-day protocol. This five-group design allowed the evaluation of butyrate effects in obesity alone (BUT) and in the combined obese-hyperandrogenic state (DHEA + BUT). Body weight, glucose tolerance, adipose depot weights, gene expression (IL-6, TNF-α, UCP1), serum adipokines. Butyrate-treated groups, particularly DHEA + BUT, exhibited greater body weight gain and adipose tissue expansion than controls (p < 0.01). Glucose tolerance tests revealed impaired glycemic control in all HFD-fed groups, with the BUT group showing the highest peaks (p < 0.05). IL-6 and TNF-α expression were upregulated in visceral adipose tissue of butyrate-treated animals, while adiponectin levels were reduced in DHEA + BUT. The modest number of animals per group reduced statistical power, reflecting constraints in breeding and availability of age-matched BALB/c mice. Their relatively small adipose depots limited tissue yield for molecular and histological assays. Daily oral gavage, required for precise dosing, was technically challenging and led to the loss of one DHEA+BUT animal. In this model of preestablished obesity and hyperandrogenism, sodium butyrate supplementation was not metabolically protective. Instead, it exacerbated adipose inflammation, altered adipokine profiles, and impaired glucose regulation. These findings underscore the context-dependent nature of butyrate's effects and suggest caution in extrapolating its benefits to hyperandrogenic or obesity-associated PCOS phenotypes.
<p>Introduction: Lymphocele is one of the complications after lymphadenectomy for female pelvic malignancies. In recent years, some studies indicated that the use of biomedical materials during surgery for gynecological malignancies may help to reduce the occurrence of lymphatic cysts, but results were inconsistent. The aim of the study was to evaluate the correlation between the use of biomedical materials intraoperatively and formation of lymphocele after lymph node dissection in patients with gynecological malignancies. We conducted a systematic search of 4 electronic databases (PubMed, Web of science, EMBASE, Cochrane Library) for articles published before April 14, 2025. We included randomized controlled clinical trials (RCTs) on the results of lymphatic cysts after the application of biomedical materials for gynecological malignant patients undergoing lymph node dissection. Statistical analyses were conducted using the RevMan 5.3 software. Ten randomized controlled studies were finally included in the present study. A total of 879 patients (from 10 studies) with gynecological cancer who underwent pelvic lymph node dissection and/or para-aortic lymph node dissection were included in the meta-analysis. Pelvic lymphoceles were diagnosed in 249 (28.3%) patients. The symptomatic lymphocele incidence proportion was 6.4% (47/731). The lymphocele incidence of biomedical material group was significant lower compared with control group (432 vs. 447 cases, OR 0.68, 95% CI: 0.50-0.93, p = 0.02, data derived from 10 studies), while symptomatic lymphocele incidence was not significantly different between the two groups (358 vs. 373 cases, OR 0.66, 95% CI: 0.39-1.10, p = 0.11, data derived from 9 studies). In the subgroup analysis, the incidence difference of lymphoceles between the biomedical material group and control group showed significant association with extension of nodes dissection (p = 0.02) and diagnosis time after surgery (p = 0.02). The present meta-analysis supports that the use of biomedical materials is effective in reducing the incidence of lymphocele after lymphadenectomy due to gynecologic cancer, and subgroup analysis found the reduction was more significant in the group without para-aortic lymph node dissection, and in the short term after surgery. Further well-designed clinical studies are required to confirm our conclusions. </p>.
The aim of the study was to analyze the changes in serum inflammatory factors and hemodynamics in women with hypertensive disorder of pregnancy (HDCP) who undergo delivery with epidural anesthesia. A total of 100 HDCP pregnant women were admitted to our hospital from June 2021 to December 2023 and divided into a control group (conventional delivery, i.e., vaginal delivery without analgesia) and a painless group (delivery with epidural anesthesia, i.e., continuous epidural analgesia), with 50 cases in each group. The levels of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), as well as hemodynamic parameters including heart rate (HR), mean arterial pressure (MAP), and cardiac output (CO), were measured and compared between the two groups at the following time points: pre-analgesia (T1), full cervical dilation (T2), fetal delivery (T3), and 24-h postpartum (T4). Maternal and neonatal outcomes were also compared between the two groups. The painless group had shorter first, second, and third stages of labor and colostrum time than the control group, and the 1-min APGAR score was higher than that of the control group (p < 0.05). The TNF-α and IL-6 levels in T2, T3, and T4 in the painless group were lower than those in the control group (p < 0.05). The TNF-α and IL-6 levels in T2, T3, and T4 in the painless group were lower than those in the control group (p < 0.05). The fluctuation range of MAP, HR, and CO levels in T2, T3, and T4 in the painless group was smaller than that in the control group (p < 0.05). Delivery with epidural anesthesia for HDCP mothers can reduce perinatal inflammatory factor levels and stabilize hemodynamic parameters.
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age and is associated with significant metabolic, reproductive, and psychological morbidity. Although international evidence-based guidelines exist, patient reports continue to indicate unmet needs, particularly in areas that most affect quality of life. The primary objective of this study was to assess PCOS-related knowledge, as well as general practitioners' (GPs) perceptions and interdisciplinary communication practices. A secondary objective was to examine whether identified knowledge gaps among GPs align with symptom domains reported by patients as most bothersome. This study employed a cross-sectional survey design targeting practicing GPs. Quantitative findings were descriptively analyzed and contextualized using published data from an independent, large-scale patient survey. Participants/Materials: A total of 918 GPs practicing in the federal state of Hesse, Germany, were invited to participate. The final analytical sample comprised 118 GPs who completed the survey. The GP questionnaire included demographic and professional characteristics as well as a 21-item knowledge assessment derived from the 2018 International PCOS Guideline. To contextualize GP findings, data from a published patient survey including 1,926 individuals with PCOS were used to identify patient-prioritized symptom domains. The study was conducted in primary care settings across Hesse, Germany. The GP survey assessed awareness of PCOS prevalence, familiarity with guideline recommendations, perceived relevance of guidelines to daily practice, and interdisciplinary collaboration, particularly with gynecologists. Knowledge accuracy scores were calculated as the percentage of correct responses across the 21 items. Subgroup analyses explored associations between GP characteristics and knowledge levels. Published patient survey data were used to determine symptom burden and domains perceived as most distressing, allowing comparison with GP knowledge gaps. A total of 93.2% of GPs estimated PCOS prevalence in their practice below 5% and 69.5% considered the International PCOS Guideline irrelevant to routine practice. PCOS-related knowledge among participants showed a mean accuracy of 54.6% (95% CI: 50.4-58.8) across all domains, with the lowest scores in reproductive aspects (45.5%, 95% CI: 40.6-50.4) and hyperandrogenism (43.7%, 95% CI: 38.7-48.7). Notably, cosmetic manifestations of hyperandrogenism were identified by patients as among the most burdensome symptoms. Furthermore, 45.8% of GPs reported suboptimal communication with gynecologists, highlighting deficiencies in interdisciplinary care pathways. Limitations include a low response rate with potential nonresponse bias, the newly developed questionnaire without formal psychometric validation, and reliance on self-reported data. In addition, variation in patient populations across practices and the lack of linkage between physician responses and patient outcomes may limit generalizability. PCOS-related knowledge gaps among GPs are most pronounced in clinical domains that patients perceive as most distressing, highlighting a critical mismatch between care provision and patient needs. These findings underscore the necessity for targeted educational interventions, improved dissemination and implementation of PCOS guidelines in primary care, and strengthened interdisciplinary collaboration to enhance patient-centered PCOS management.
Objective The aim of the study was to compare the effectiveness, complications, and treatment preference parameters of long-term pessary therapy versus vaginal obliteration (colpocleisis) in elderly, sexually inactive female patients with severe POP. Design Single-center, retrospective observational study. Participants/Materials In our study we included elderly, sexually inactive women treated for advanced POP between January 2015 and November 2023. Long-term pessary therapy was applied in 30 cases, while 46 patients underwent vaginal obliteration. The mean follow-up duration was 41.9 ± 31.9 vs. 61.9 ± 40.1 months, respectively. Setting The study was performed at the Department of Urology of our University (n = 76). Methods Data collection was carried out based on clinical patient documentation and telephone interviews. We used a standardized, non-validated questionnaire specifically designed for this study covering four domains: patient characteristics; POP-related symptoms; treatment effectiveness and complications; socioeconomic and health-related parameters, treatment preferences. Pre- and post-treatment parameters and intergroup differences were statistically analyzed. Results The mean age of the patients was 74 ± 5.6 years, and the mean BMI was 25.6 ± 4.4. Following both pessary therapy and surgery, high rates of symptom resolution were observed regarding vaginal foreign body sensation, discomfort and/or palpable bulge (93.5% vs. 95.5%) and obstructive voiding difficulty (100% vs. 96.4%). The rate of patient satisfaction was high in both groups (90% vs. 97.8%, p = 0.15); however, symptom improvement was significantly greater following vaginal obliteration (VAS: 8.9 ± 1.1 vs. 7.7 ± 1.7, p < 0.001). Pessary therapy was discontinued in 23.3% of cases, and 20% later required surgical POP intervention. No reoperations due to recurrence were required following obliterative surgery. Adverse events occurred in 26.6% of pessary patients and complications in 17.3% of surgically treated patients. The most frequent reason for choosing pessary therapy was fear of surgery (76.6%), while the most common reason for choosing surgery was refusal of pessary therapy (58.5%). Limitations The retrospective design and relatively small sample size limit the generalizability of the findings. Conclusions In elderly, sexually inactive women requiring treatment for advanced POP, both vaginal obliteration and long-term pessary therapy provide excellent therapeutic alternatives. The two modalities demonstrate comparable outcomes, high effectiveness, and an acceptable rate of non-severe complications, making both options suitable for appropriately selected patients.
The aims of this study were to investigate influence of placental position and type on occurrence of placenta accreta spectrum (PAS) and to analyze their correlation with adverse perinatal outcomes. This retrospective study included 270 pregnant women who delivered at the Affiliated Hospital of Guangdong Medical University and Huizhou Central People's Hospital between January 2021 and December 2023. Placental position, type, and related imaging features were assessed using magnetic resonance imaging (MRI) and compared with PAS and perinatal outcomes. Logistic regression was used to analyze the associations between placental position, type, and PAS, as well as adverse outcomes. There were significant differences between the PAS group and the non-PAS group in terms of pregnancy history, cesarean section history, delivery history, history of placenta previa, antepartum hemorrhage, and intraoperative blood loss. Lateral wall/fundus placenta location (OR = 4.984, 95% CI: 1.376-18.050, p = 0.014) and complete placenta previa (OR = 3.160, 95% CI: 1.321-7.558, p = 0.010) were significantly associated with the occurrence of PAS. Placental location and the type of placenta previa were significantly associated with the occurrence of PAS and adverse perinatal outcomes. In future clinical management, particular attention should be paid to placental location and type, especially in cases of lateral wall/fundus placenta and severe placenta previa. Individualized monitoring and intervention strategies should be implemented to improve both PAS-related and overall perinatal outcomes.
This cross-sectional study aimed to explore the application potential of artificial intelligence (AI) in screening and diagnosing cervical human papillomavirus (HPV) infection and lesions, and to assess patient satisfaction with the current diagnostic and therapeutic process as well as their unmet needs. An online cross-sectional survey was conducted via the Questionnaire Star platform, and 308 valid responses were collected. Descriptive statistics were used to summarize participants' demographic characteristics and questionnaire responses. Chi-square tests were performed to examine associations between demographic factors (e.g., age, residence) and key outcomes (e.g., AI acceptance, primary concerns). A two-tailed P-value < 0.05 was considered statistically significant. Qualitative content analysis was applied to synthesize and interpret responses to open-ended questions. Most respondents were women aged 25-35 years (34.74%), with 84.74% residing in urban areas. Among all participants, 76.30% reported a history of HPV infection, and 91.56% had undergone ThinPrep cytologic test (TCT). The most distressing part of the screening process was anxiety during result waiting (41.23%), and 58.12% found medical terminology difficult to understand. Although 61.04% of respondents had no prior knowledge of AI-assisted diagnosis, 58.77% were willing to learn about its application in improving diagnostic efficiency. Younger respondents (≤35 years) showed significantly higher willingness to learn about AI than those aged >35 years (65.1% vs. 52.4%, χ²=6.24, P=0.012). Additionally, 75.97% of respondents believed AI could shorten result waiting times, and 73.70% trusted the "AI preliminary screening + physician confirmation" model. The top concerns regarding AI application were technical reliability (70.78%) and data privacy (68.18%). Patients with cervical lesions have strong demands for diagnostic efficiency, psychological support, and information transparency. AI technology holds great potential in enhancing screening efficiency and assisting diagnosis; however, key challenges remain, including ensuring data privacy, improving technical reliability, and strengthening patient trust.
This prospective cohort study aimed to identify key factors influencing the success rate of external cephalic version (ECV) and to evaluate its impact on the mode of delivery and maternal-neonatal outcomes. A prospective cohort study was conducted. Participants/Materials: The study enrolled 62 pregnant women with singleton breech presentations at or beyond 37 weeks of gestation who consented to undergo ECV. A convenience sample of 12 women with cephalic presentations was also enrolled as a control group for outcome comparison. The study was conducted at the Department of Obstetrics and Child Health Hospital, Jinniu District Maternal and Child Health Hospital, Chengdu, China. Participants were divided into ECV success (n = 51) and failure (n = 11) groups based on procedural outcome. Baseline characteristics were compared, and predictors of ECV success were analyzed using univariable logistic regression. Maternal and neonatal outcomes were compared between the success group and the control group. Five independent predictors of ECV success were identified: lower maternal body mass index (BMI) at delivery (odds ratio [OR] = 0.816, 95% confidence interval [CI]: 0.662-0.991; p = 0.042), prior spontaneous vaginal delivery (OR = 8.250, 95% CI: 1.879-58.080; p = 0.012), non-posterior placental location (OR = 0.171, 95% CI: 0.034-0.678; p = 0.017), higher amniotic fluid index (OR = 1.442, 95% CI: 1.053-2.185; p = 0.048), and fewer ECV attempts (OR = 0.174, 95% CI: 0.059-0.375; p = 0.001). The ECV success group had a significantly higher vaginal delivery rate (81% vs. 0%; p = 0.012) and a lower cesarean delivery rate (19% vs. 100%) compared to the failure group. Neonates in the success group exhibited higher birth weights (3,266.4 ± 352.54 g vs. 3,063.2 ± 202.93 g; p = 0.017). Outcomes in the success group were comparable to the cephalic-presentation control group, except for a higher rate of labor induction (33.3% vs. 0%, p = 0.050). The main limitations of this study include its modest sample size, single-center design, and the lack of long-term follow-up data on maternal and neonatal outcomes post-ECV. ECV is an effective intervention for reducing cesarean delivery rates in breech presentations. Success is associated with lower maternal BMI, a history of vaginal delivery, favorable placental location, adequate amniotic fluid, and fewer procedural attempts. These findings support the integration of patient-specific factors into clinical protocols to optimize ECV success and improve perinatal outcomes.
Objectives To develop and validate a novel model for predicting complications in minimally invasive hysterectomy and to define a standardized classification system, the Hysterectomy Complication Classes (HCC). Design A retrospective cohort study using merged data from four national Swedish registries. Data were randomly split into development and validation datasets. Multivariable logistic regression was used to identify risk factors and construct the prediction model, which was evaluated using ROC_AUC. Participants / Materials A total of 60,424 benign hysterectomies recorded in the Swedish National Quality Register for Gynecological Surgery, the Swedish National Drug Registry, Statistics Sweden, and the Swedish National Patient Registry. Setting Nationwide Swedish population based registries covering benign hysterectomy procedures performed across Sweden. Interventions Minimally invasive hysterectomy performed using vaginal, laparoscopic, or robotic techniques, with uterus weight and surgical indication as key exposure variables. Methods Multivariable logistic regression models estimated odds ratios (ORs) for risk factors associated with a composite complication outcome. The final model was applied to the validation dataset, and predictive performance was assessed using the Area Under the Receiver Operating Characteristic Curve (ROC_AUC). Outcome Measures The primary outcome was a composite complication measure including perioperative complications, blood loss >300 mL, conversion to open surgery, postoperative complications, reoperation, or antibiotic prescription within 6 weeks. Results Key risk factors for complications were indication for hysterectomy, BMI, previous cesarean section, age, and uterus size, with a significant interaction between uterus size and surgical technique. The highest risk was observed in patients with uterus weight >1 kg undergoing vaginal hysterectomy (adjusted OR 25.5, 95% CI 3.3-199.8). Predicted complication probabilities were used to define five Hysterectomy Complication Classes (HCC), ranging from HCC 1 (0-20%) to HCC 5 (81-100%). Validation demonstrated strong predictive accuracy across risk strata. Limitations The composite outcome includes heterogeneous complications of varying clinical significance. Registry based data may be subject to misclassification or underreporting. External validation outside Sweden has not yet been performed. Conclusions This comprehensive predictive model and the proposed HCC classification system provide a structured approach to estimating complication risk in minimally invasive hysterectomy. By accounting for patient variability and surgical factors, the HCC system supports individualized preoperative counseling and enhances comparability between surgical techniques.