Delays in decision-to-delivery interval (DDI) during emergency caesarean section (CS) may increase the risk of adverse maternal and neonatal outcomes. Evidence on health-system and provider-related factors influencing DDI in low-resource settings remains limited. We examined whether surgeon cadre, operating theatre location, and the presence of intern healthcare professionals were associated with prolonged DDI in a tertiary hospital in Northern Uganda. We conducted a historical cohort study at St. Mary's Hospital Lacor, a tertiary hospital in Northern Uganda, involving women who underwent emergency CS (6 September 2022 to 1 June 2024). Logistic regression was used to examine the association between prolonged DDI (≥60 minutes) and surgeon cadre, operating theatre location, and intern presence, adjusting for confounders. Effect modification by emergency CS indication was assessed. Of the 760 participants enrolled (median DDI was 51 minutes [IQR: 36-67]), 36.0% had prolonged DDI. Emergency CS performed by junior doctors had twice the odds of prolonged DDI compared to fully-licensed doctors (adjusted odds ratio [aOR]: 2.07; 95% CI: 1.38-3.10). Theatre location and presence of interns showed no association with prolonged DDI (aOR: 0.89; 95% CI: 0.61-1.28) and (aOR: 0.71; 95% CI: 0.50-1.02), respectively. There was no statistically significant evidence that these associations differed by the CS indication. Emergency CS performed by junior doctors was associated with increased odds of prolonged DDI compared with procedures performed by fully-licensed doctors. These findings highlight the importance of strengthening supervision, mentorship and emergency obstetric training for junior doctors in resource-limited settings. Operating theatre location and the presence of intern healthcare professionals were not significantly associated with prolonged DDI. Emergency caesarean section (CS) is performed when a pregnant woman or her baby needs urgent delivery to prevent serious complications or death. Delays between the decision to perform the surgery and the actual delivery may increase the risk of poor outcomes for both the mother and baby, especially in low-resource settings. However, little is known about the hospital and healthcare worker factors that may contribute to these delays in Northern Uganda.We conducted a study at St. Mary’s Hospital Lacor, a tertiary hospital in Northern Uganda, involving 760 women who underwent emergency caesarean between September 2022 and June 2024. We examined whether the experience level of the surgeon, the location of the operating theatre, and the presence of intern healthcare professionals were associated with delays in delivery.We found that about one in every three women experienced delays of more than one hour between the decision for surgery and delivery. Emergency CSs performed by junior doctors were more likely to experience delays compared with those performed by fully licensed doctors. In contrast, the location of the operating theatre and the presence of intern healthcare professionals were not associated with delays.These findings suggest that improving supervision, mentorship and emergency obstetric training for junior doctors may help reduce delays in emergency CS delivery. Strengthening surgical training and emergency obstetric care systems may contribute to better maternal and newborn outcomes in resource-limited settings such as Northern Uganda.
According to the World Health Organisation, antenatal care should ensure continuity, respect and evidence-based education. Fear of childbirth (FOC), affecting 20-40% of women globally, contributes to prolonged labour, higher caesarean rates and negative birth experiences. In Türkiye, where midwifery-led support remains limited, this study examined how pregnant women's health literacy influences empowerment and FOC within antenatal care and evaluated the effectiveness of the midwifery-led continuity-of-care (MLCC) model. A quasi-experimental study with a comparative group design was conducted online between April 2024 and April 2025 using digital maternal communities and antenatal platforms in Türkiye. The intervention consisted of four structured online sessions based on the MLCC model, focusing on pregnancy adaptation, labour preparation, birth preferences and postpartum care. A total of 81 pregnant women participated, with 40 in the intervention group receiving MLCC-based antenatal education and 41 in the control group receiving standard care. Participants self-selected into groups, and data were collected online using validated scales: MHELIP, PRES and W-DEQ (Version A). All analyses were performed using SPSS 25.0 software. Independent samples t-tests and Pearson's correlations were used for analysis, and multiple regression was performed to identify predictors of empowerment and FOC. All statistical values were verified and reported as mean ± SD with exact p values. Pregnant women in the intervention group had significantly higher health literacy and empowerment scores and significantly lower FOC scores than those in the control group (p <.05). Health literacy was positively correlated with empowerment (r = .748) and negatively correlated with FOC (r = -.710). The intervention reduced fear and increased empowerment, likely through improved knowledge, self-efficacy and perceived control during pregnancy. The MLCC model enhanced health literacy and empowerment while reducing FOC. Structured education models integrated into antenatal care can support women's autonomy and psychological preparedness for birth. This study explored how pregnant women’s ability to understand and use health information, known as health literacy, affects their confidence and feelings of control (empowerment), as well as their fear of childbirth (FOC). It also examined whether being cared for by the same midwife or a small team of midwives throughout pregnancy, using a model called midwifery-led continuity of care, could help reduce these fears and improve women’s experiences.A total of 81 pregnant women from different parts of Türkiye took part in the study. One group received regular hospital-based care, while the other group joined an online midwifery education programme that included weekly sessions about pregnancy, childbirth and the postpartum period.Women who received midwife-led care had higher health literacy, felt more empowered and reported less FOC compared to those who received only standard care. The findings also showed that the more informed and confident women felt, the less likely they were to experience anxiety or fear about giving birth.These results highlight the importance of continuously educating and supporting women throughout pregnancy, not only in hospitals but also through accessible online programmes. Enhancing women’s understanding of health information and ensuring consistent, compassionate care from midwives can help them feel more prepared, in control, and positive about the birth process, thereby contributing to better maternal and newborn health outcomes.
This study aimed to estimate the global trend of age-standardised incidence rates (ASIR) and age-standardised disability-adjusted life years (AS-DALYs) of pelvic organ prolapse from 1990 to 2021, and analyse the separate effects of age, period and birth cohort. Data of pelvic organ prolapse's ASIR and AS-DALYs were obtained from the Global Burden of Disease (GBD) 2021. The regions were classified by the socio-demographic index (SDI). An age-period-cohort (APC) model was employed to analyse the effect of every age, period and birth cohort on pelvic organ prolapse's ASIR. In 2021, the global ASIR and AS-DALY were 317.51 (95% UI, 267.67-378.25) and 8.68 (95% UI, 4.26-16.38) per 100,000 population, respectively. The rates decreased globally and in five SDI regions from 1990 to 2021. APC analysis demonstrated that ASIR significantly increased with advancing age, exhibiting a bi-peak curve, with one peak appearing around 50 years and the other around 70 years. Over the past 32 years, the global ASIR and AS-DALY of pelvic organ prolapse have continued to decrease significantly, while in low SDI regions, the rates remain high. These findings highlight the need for targeted pelvic organ prolapse prevention programs and proper investment in pelvic floor care in low SDI regions. Pelvic organ prolapse is a considerable global health issue that requires improvement, leaving a significant burden on women’s health and the economy. This study estimated the global trend of age-standardised incidence rates and age-standardised disability-adjusted life years of pelvic organ prolapse from 1990 to 2021 based on GBD 2021 data. It analysed the separate age, period and birth cohort effects. Over the past 32 years, the number of incident cases has increased. The results indicate that the age-standardised incidence rates and age-standardised disability-adjusted life years of pelvic organ prolapse have continued to decrease significantly. Moreover, in regions with low socio-demographic index, the age-standardised incidence rates and age-standardised disability-adjusted life years remain high. According to age-period-cohort analysis, the age-standardised incidence rates and age-standardised disability-adjusted life years significantly increased with advancing age, exhibiting a bi-peak curve, with one peak occurring around 50 years and the other around 70 years. Therefore, there is an urgent need to develop more cost-effective and targeted strategies to reduce the incidence of pelvic organ prolapse.
Clinical guidelines recommend hereditary cancer risk assessment (HCRA) to identify candidates for genetic counselling and testing based on personal and family history. Incorporating genetic testing into HCRA improves risk stratification and management. We previously showed that process improvements increase genetic testing completion rates. This study describes outcomes of routine genetic testing in a community obstetrics and gynaecology (OB/GYN) setting. A prospective, single-arm quality improvement initiative was conducted at five U.S. OB/GYN practices (July 2021-November 2022). A guideline-based online screening tool and virtual patient education were implemented. Genetic testing used a 48-gene hereditary pan-cancer panel (MyRisk®). The remaining lifetime breast cancer risk was estimated using Tyrer-Cuzick 7.0.2 alone or a combined risk score (CRS). Of 1,285 patients meeting guideline criteria, 439 (34.2%) completed testing. Among 367 (88.0%) without a clinically significant mutation and with valid risk estimates, 233 (63.5%) had lifetime breast cancer risk <20% and 66 (18.0%) had risk ≥20% by both Tyrer-Cuzick and CRS. Discordance between Tyrer-Cuzick and CRS occurred in 68 (18.5%) patients: 49 (13.4%) were <20% by CRS but ≥20% by Tyrer-Cuzick; 19 (5.2%) were ≥20% by CRS but <20% by Tyrer-Cuzick. Overall, 134 (36.5%) had lifetime risk ≥20% by either model. Fifteen pathogenic variants were identified in 14 (3.2%) patients, including CHEK2 (n = 4), HOXB13, MITF, PALB2 (n = 2 each), and BRCA2, PMS2, MSH6, RAD51C, BRIP1 (n = 1 each). Most patients undergoing genetic testing did not carry an inherited mutation; however, over one-third of those without a mutation had lifetime breast cancer risk ≥20% based on Tyrer-Cuzick and/or CRS. These findings underscore the importance of routine HCRA and individualised management based on comprehensive risk assessment. This study examined whether adding genetic testing and improved cancer risk assessment tools in community obstetrics and gynaecology practices can better identify women at higher risk for cancer. Guidelines recommend using personal and family medical history to identify patients who may benefit from genetic counselling and testing. Researchers introduced an online screening tool, virtual education, and a multigene hereditary cancer test with comprehensive breast cancer risk assessment at five obstetrics and gynaecology clinics. They then examined how well these tools identified high‑risk patients compared with standard risk assessment methods. More than 5,000 patients were screened, and 1,285 met national guidelines for genetic testing. Of those, 439 completed testing. Only 3.2% of tested patients had a harmful genetic mutation. However, among patients without a mutation, more than one‑third (36.5%) still had a lifetime breast cancer risk of 20% or higher. These patients were considered at elevated risk based on results calculated by the Tyrer‑Cuzick breast cancer risk model, and/or a combined risk score that uses personal clinical factors, family history and polygenic risk factors. Women in this group may benefit from earlier and more frequent screening, including mammograms starting at age 30, supplemental breast imaging, and cancer prevention strategies.The study also found that the combined risk score and Tyrer‑Cuzick model did not always produce the same results. About 18.5% of patients had different risk classifications depending on the method used. These findings suggest that combining family history and genetic testing can help identify women who need more personalised screening and care.
Inadequate childbirth readiness can adversely affect the birthing experience of pregnant women and may even influence their willingness to have further children. This study aimed to explore the determinants of childbirth readiness and the network relationships among these factors, thereby providing evidence to improve childbirth readiness. This cross-sectional study surveyed 350 pregnant women attending Wuxi Maternity and Child Health Care Hospital. Latent profile analysis (LPA) was first performed using the four domains of the Childbirth Readiness Scale to identify subgroups of childbirth readiness, and potential associated factors were then screened using univariate analysis and multinomial logistic regression. A Bayesian network model was employed to construct the structural relationships of factors influencing childbirth readiness. Childbirth readiness was categorised into three levels: poor (26%), good (30.9%), and complete (43.1%). Univariate analysis revealed significant differences across the three categories in relation to age, parity, pregnancy complications, antenatal exercise, planned pregnancy, self-efficacy, eHealth literacy, fear of childbirth, and family support (p < 0.2). Multinomial logistic regression indicated that parity, self-efficacy, and eHealth literacy were important predictors of childbirth readiness. The Bayesian model identified self-efficacy, fear of childbirth, eHealth literacy, and parity as the nodes most closely associated with childbirth readiness, while planned pregnancy, antenatal exercise, family support, and age were linked indirectly through other nodes. Previous studies on childbirth readiness have mainly relied on regression models, which are unable to elucidate the intrinsic interconnections among influencing factors. By constructing a Bayesian model, this study demonstrated that women with high self-efficacy, no fear of childbirth, high eHealth literacy, and multiparity had the highest probability of achieving complete childbirth readiness (83.3%). Insufficient readiness for childbirth may not only exert a negative influence on the birthing experience of women, but may also diminish their willingness to conceive again. This study investigated 350 pregnant women in Wuxi, Jiangsu Province, China, and employed a Bayesian network model to construct the structural relationships among the factors influencing childbirth readiness. The aim was to identify the determinants of childbirth readiness and their interrelated pathways, thereby providing empirical evidence to support the improvement of childbirth readiness. The Bayesian model revealed that self-efficacy, fear of childbirth, electronic health literacy, and parity were the most strongly associated nodes with childbirth readiness, whereas planned pregnancy, antenatal exercise, family support, and maternal age were indirectly associated through other nodes. Specifically, women with previous childbirth experience, high levels of confidence in their own abilities, proficient use of online health information, and minimal fear of childbirth exhibited the highest levels of childbirth readiness. These findings indicate that health care professionals should pay particular attention to three groups: primiparas, women with low self-confidence, and women who encounter difficulties in accessing reliable health information. By providing antenatal education, developing personalised exercise programmes, offering digital health support, and encouraging family involvement, it is possible to enhance maternal readiness for childbirth and foster a more positive birthing experience.
Climacteric symptoms affect a large and growing proportion of women worldwide. Furthermore, women are increasingly participating in the workforce. Many women do not use treatment for their symptoms; however, little is known about how untreated women experience climacteric symptoms. This study examined the occurrence and severity of climacteric symptoms among full-time working women before treatment and compared their experiences across two different work environments. A cross-sectional study was conducted in a group of Finnish women aged 52-66 years who had never used any treatment for their climacteric symptoms and were employed full-time. The data were obtained from two population-based postal surveys. Statistical techniques were used to analyse the data. The most common symptoms among all participants (n = 338) were hot flushes (80%), sweats (72%), and sleeping problems (72%). The most severe symptoms were hot flushes, sweats, and loss of sexual desire; 12% of participants experienced each of these as severe. Regarding symptom categories, vasomotor symptoms and loss of sexual desire were the most common and the most severe. Participants in either low-strain or high-strain jobs (n = 164) most often experienced five (15%) or 10 (13%) different symptoms out of 12 presented in the study questionnaire. Participants in high-strain jobs (n = 79) experienced a higher number of symptoms (p = 0.019) and more often urinary incontinence (p = 0.008) and depressive symptoms (p = 0.043) than those in low-strain jobs (n = 85). Furthermore, they experienced more severe sweats (p = 0.038). Hot flushes, sweats, sleeping problems, and loss of sexual desire were both common and severe among full-time working untreated women. In addition, symptoms were more troublesome among women in high-strain than low-strain jobs. Therefore, healthcare professionals should pay special attention to the above symptoms and to women in high-strain jobs. Menopausal symptoms affect millions of women worldwide, and this number continues to grow as the population ages. At the same time, more women than ever before are in employment. While many women do not use medical treatment for their symptoms, we know little about their specific experiences. In this study, we looked at how menopausal symptoms affect Finnish women aged 52–66 who work full-time and had never used any treatment. We also wanted to see if the type of work environment made a difference. The women took part in a large national survey where they were asked about 12 common symptoms. They rated how often they experienced these symptoms and how severe they felt. We then analysed their answers to find patterns. The results showed that many women suffered from bothersome symptoms, most commonly hot flushes, night sweats, sleeping problems, and a lower sex drive. We also found that women in high-stress or demanding jobs experienced more symptoms than those in less demanding roles. In conclusion, our study suggests that healthcare professionals should pay closer attention to these common symptoms. It is also vital to provide better support for women working in high-pressure environments to help them manage this stage of life.
To compare the short-term (three-month) anatomical alterations and subjective outcomes of transobturator tape (TOT), tension-free vaginal tape (TVT), and Burch colposuspension using transperineal ultrasound (TPUS). This prospective observational study, reported in accordance with TREND guidelines, included 80 women with stress urinary incontinence (SUI) (TOT: n = 30; TVT: n = 30; Burch: n = 20) assigned based on institutional protocols. Pre- and postoperative assessments included TPUS (alpha/beta angles, bladder neck descent) and validated questionnaires (UDI-6, IIQ-7). Multivariate regression models were utilised to adjust for baseline age, BMI, and parity. All procedures resulted in significant intra-group anatomical and symptomatic improvements (p < 0.05). In adjusted analyses, the TVT procedure was associated with a significantly greater reduction in the alpha angle (p = 0.046). Furthermore, TVT showed a statistically significant association with greater UDI-6 score improvement compared with the Burch procedure (Adjusted OR: 0.04; 95% CI: 0.003-0.71; p = 0.032). Non-responder analysis confirmed that attrition bias was minimal (p > 0.05). TOT, TVT, and Burch procedures are all effective in providing significant short-term restoration of anatomy and symptoms. While TVT demonstrated more pronounced anatomical and subjective gains in adjusted models, clinical satisfaction remains high across all techniques. Findings should be interpreted with caution due to the observational design and short follow-up. Stress urinary incontinence (SUI) is the unintentional leakage of urine during physical activities such as coughing, sneezing, or exercise. It is a common condition that significantly affects a woman’s quality of life. While several surgical treatments exist—including the TOT and TVT “tape” procedures and the Burch colposuspension—there is limited information comparing how each method changes the internal anatomy and how these changes relate to patient satisfaction.We followed 80 women undergoing one of these three surgical treatments. To look at the internal changes without causing discomfort, we used a non-invasive method called transperineal ultrasound (TPUS). This involves placing an ultrasound probe on the outside of the body rather than internally. We measured the position and angles of the bladder and urethra both before the surgery and three months after.Our results showed that all three surgical procedures are highly effective. Every group experienced significant improvements in their symptoms and overall quality of life. While the TVT procedure was slightly more effective at restoring the anatomical angle of the bladder neck, this did not mean those patients were “happier” than others; women in all three groups reported similar, high levels of satisfaction. We also found that differences in the number of previous births did not appear to explain the differences in surgical outcomes.This study suggests that surgeons have three reliable options to offer patients, as TOT, TVT, and Burch procedures all provide excellent short-term results. It also highlights that transperineal ultrasound is a safe, painless, and effective tool for doctors to monitor surgical success and ensure the treatment is working as intended.
Artificial intelligence (AI) holds considerable promise for strengthening sexual, reproductive and maternal health (SRMH) by enhancing diagnosis, optimising service delivery and expanding access to information. In Latin America and the Caribbean (LAC), however, the scope, focus and maturity of AI applications in SRMH remain poorly described. To identify, map and analyse existing applications of AI in SRMH priority services in LAC, characterising thematic areas, target populations, and types of AI tools, whilst highlighting gaps and future research needs. We conducted a scoping review guided by the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Searches were performed in PubMed, SciELO, Cochrane and LILACS up to August 2023, complemented by targeted Google searches and snowballing. We included records reporting AI applications in SRMH services in LAC and extracted data on setting, population, SRMH domain, AI techniques and implementation stage. A total of 1,518 records were identified, of which 143 met the inclusion criteria. Most were published between 2020 and 2023 and originated from Mexico, Colombia, Peru, Brazil and Argentina. Over half were peer-reviewed articles, with additional theses and web-based reports. Applications concentrated on prenatal, childbirth and postnatal care (36%) and reproductive organ cancers (31%), with far fewer initiatives addressing sexual health, contraception, gender-based violence, sexual satisfaction or counselling. Machine learning methods predominated (52%), followed by deep learning (41%). Almost half of initiatives (48%) were exploratory projects, 17% implemented tools without outcome data and 35% reported performance in real-world contexts. AI applications in SRMH in LAC are expanding but remain thematically narrow, population-selective and predominantly exploratory, highlighting the need for more diverse, rigorously evaluated and equity-oriented tools. This review explores how artificial intelligence (AI) is being used to improve health care access and information about sexual, maternal, and reproductive health in Latin America and the Caribbean. These include access to contraception, care during pregnancy and childbirth, prevention and treatment of sexually transmitted infections, among others.We reviewed 143 publications and found that most AI tools focus on pregnancy care and cancer detection. Far fewer initiatives focus on sexual health or contraception. Many tools are still in early development and have not yet been tested in real health care settings. Others have been implemented but lack reports about their efficiency and/or effectiveness.This study highlights the need to expand the use of AI to a broader range of health services and populations. AI has the potential to reduce inequalities and improve access to care, but only if it is designed in a responsible way.
The occiput posterior (OP) foetal position is a global obstetric challenge associated with increased maternal and neonatal complications. Manual rotation and specific maternal positioning (hands-and-knees, lateral position) are potential interventions for managing persistent OP position during labour; however, their comparative effectiveness remains uncertain. This systematic review and network meta-analysis aimed to evaluate the efficacy of these interventions versus standard care. A systematic search of multiple databases was conducted from inception to January 3, 2025 following PRISMA-NMA guidelines. An updated literature search using the same criteria was performed on July 5, 2026 during the final stage of peer review, which yielded no additional studies for inclusion. Randomised controlled trials comparing manual rotation, hands-and-knees position, or lateral position to standard care or each other were included. The primary outcome was spontaneous vaginal delivery. Secondary outcomes included caesarean delivery, severe perineal lacerations, and low Apgar score. Bayesian and frequentist network meta-analysis was performed using MetaInsight software. Fifteen randomised trials involving 2,934 participants were analysed. No intervention demonstrated statistically significant benefits for any primary or secondary outcome. For spontaneous vaginal delivery, the lateral position showed the highest point estimate (OR: 1.97, 95% CrI 0.83 to 4.88), though all credible intervals were wide and crossed the null value. The evidence was characterised by substantial imprecision and methodological limitations, resulting in low to very low certainty for all comparisons. Current evidence does not support the routine use of manual rotation or specific maternal positions for managing persistent OP position. The substantial uncertainty and methodological limitations preclude definitive recommendations. Future high-quality trials with larger sample sizes and standardised protocols are essential. When a baby is positioned with its head facing the mother’s back during labour, delivery can become more difficult. This position increases the chance of needing a caesarean section or other assisted delivery. Healthcare providers sometimes try to turn the baby’s head by hand, or ask the mother to lie on her side or kneel on her hands and knees. These methods are commonly used, but it is not clear whether they actually help.We reviewed 15 trials involving 2,934 women to see if these techniques increase normal vaginal delivery and reduce complications such as caesarean section, severe vaginal tears, or low health scores in babies after birth. Our findings showed that none of these methods made a clear difference. The evidence was not strong enough to say that manual rotation, lying on the side, or hands-and-knees positions are better than standard care. Many studies were small and used different methods, which made it difficult to draw firm conclusions. Because of this uncertainty, we cannot recommend these methods as routine practice. Women should discuss their options with their healthcare provider and make decisions based on their own situation. More research with larger groups and consistent methods is needed.
Recurrent missed miscarriage (RMM) is heterogenous and emotionally burdensome. Low-molecular-weight heparin (LMWH) plus low-dose aspirin improves live-birth rates in women with obstetric antiphospholipid syndrome (APS), but the value of the use of LMWH in APS-negative RMM with and without confirmed coagulation disorders remains controversial, and optimal dosing frequency is uncertain. We performed a narrative synthesis of randomised controlled trials (notably ALIFE and ALIFE2), Cochrane systematic reviews, pharmacokinetic studies, and national/international guidelines (RCOG, ESHRE). Emphasis was placed on live-birth outcomes, trial design limitations (including inclusion of chromosomally abnormal losses), pharmacokinetics relevant to once-daily (OD) versus twice-daily (BD) regimens, and safety/tolerability data. Robust evidence supports LMWH plus low-dose aspirin in improving live-birth rates in women with APS. In APS-negative populations, randomised controlled trials and meta-analyses show no reproducible live-birth benefit; interpretation is limited by clinical heterogeneity, underpowering and failure to exclude chromosomally abnormal losses, which account for up to half of early miscarriages. Notably, these trials almost exclusively used once-daily LMWH. Pharmacokinetic data indicate that twice-daily dosing yields more stable anti-Xa levels than once-daily dosing; however, this is a pharmacokinetic rationale only, and no adequately powered trial has tested whether it improves clinical outcomes. Routine LMWH for APS-negative RMM is not supported outside clinical trials. Key knowledge gaps include the effect of pre-randomisation genetic stratification (euploid-only cohorts), directly comparing OD vs BD LMWH regimens, and incorporation of patient-centred and health-economic outcomes. Well-designed, adequately powered trials with genetic and phenotypic enrichment and embedded pharmacokinetic sub-studies are required to resolve clinical equipoise. Miscarriage is common, and some women sadly experience it again and again. This is very distressing, and doctors cannot always explain why it happens.One possible cause is a problem with blood clotting, which may affect how the placenta (the organ that nourishes the baby) develops. Because of this, blood-thinning treatments have been tried to help prevent miscarriage. One such treatment is a daily injection of a blood thinner, often given together with a low dose of aspirin.This review looked at how well these blood-thinning injections work. The evidence shows that they clearly help one specific group: women who have a known immune condition that makes the blood more likely to clot. For these women, treatment improves the chance of a successful pregnancy. For women who do not have this condition, however, research so far has not shown that the injections improve the chances of having a baby. Many studies are hard to interpret because they included miscarriages caused by genetic differences in the pregnancy, which no treatment can prevent.There is also debate about how often the injection should be given each day. Giving it twice a day keeps the medicine at a steadier level in the body, but no good-quality study has shown that this leads to more babies being born. In summary, these injections should not be used routinely for women without the immune clotting condition, except within research studies. Future research needs to choose patients more carefully and to consider their experience and wellbeing.
Gushen Antai recipe (GSAT), known herbal medicine, has long been used in China to treat early pregnancy loss. Several randomised controlled trials have demonstrated its efficacy in improving clinical pregnancy rates. This study aimed to elucidate the mechanism of GSAT in patients undergoing in vitro fertilisation-embryo transfer (IVF-ET). Patients undergoing IVF-ET were recruited on day 14 after embryo transfer. Participants either received GSAT alongside hormonal medication for 2 weeks (intervention group) or received hormonal treatment (control group). Plasma metabolites and inflammatory factors was analysed by gas chromatography-mass spectrometry and enzyme-linked immunosorbent assay, respectively. Faecal microbiota was assessed by 16S rRNA sequencing. GSAT was found to contain 56.44% flavonoids, primarily come from Scutellariae Radix, including baicalin, baicalein, wogonoside, wogonin, oroxylin A and Chrysin 6-C-glucoside 8-C-arabinoside. At the end of the fourth week after embryo transfer, plasma levels of interleukin (IL)-2 and tumour necrosis factor-α were significantly lower in the intervention group than in the control group, whereas the anti-inflammatory cytokine IL-10 were markedly higher (687.3 vs. 448.5 pg/mL, p < 0.01). Moreover, the plasma IL-10 levels and proportion of four kinds of fatty acids (lauric acid, myristic acid, palmitic acid, linoleic acid) in plasma correlated with each other. These fatty acids were not directly detected in GSAT and may originate from biosynthesis by gut microbiota. The alteration of plasma cytokine levels (IL-10, TNF-α and IL-2) associated with GSAT intervention was linked to specific fatty acids produced by characteristic intestinal microbiota. These results provide insights into the mechanism underlying the role of the GSAT in improving clinical pregnancy rates. During pregnancy, the developing baby can sometimes be mistakenly identified as a foreign substance by the mother’s immune system, which may lead to rejection and miscarriage. To prevent this, the mother’s body naturally sends special peacekeeping cells to the womb and releases calming signals, like a substance called anti-inflammatory cytokines. Women who have experienced multiple miscarriages often have fewer of these peacekeeping cells and lower levels of these calming signals. Therefore, helping the body bring more of these cells to the womb and increasing calming signals are considered important ways to help prevent pregnancy loss. A herbal medicine known as Gushen Antai recipe appears to work in this manner. It has been used in China for a long time, and several clinical studies have shown that it can improve the chances of a successful pregnancy. However, exactly how it works has not been fully understood. This study found that when women took this herbal medicine for 2 weeks after embryo transfer, their blood showed higher levels of the calming cytokines and lower levels of inflammatory substances. This balancing effect is believed to be one of the ways Gushen Antai recipe helps support a healthy pregnancy.
Urinary tract infections (UTIs) during pregnancy can cause serious maternal and foetal complications if not properly managed. However, many pregnant women have limited knowledge and inadequate preventive behaviours. This study aimed to evaluate the effect of a Health Belief Model-based educational intervention on UTI preventive behaviours among pregnant women in Khormoj, Bushehr province, Iran. This quasi-experimental study was conducted in 2024-2025 among 93 pregnant women with confirmed UTI in Khormoj, Iran. Participants were selected through cluster sampling and assigned to intervention (n = 45) and control (n = 48) groups. Data were collected using demographic characteristics, a 30-item knowledge questionnaire, a validated HBM-based questionnaire, and a 26-item preventive behaviour scale. The intervention group received five 30-minute HBM-based educational sessions, and outcomes were assessed before and three months after the intervention. Data were analysed using SPSS-27 with t-tests, chi-square, and Fisher's exact test (p < 0.05). After the intervention, significant improvements were observed in all Health Belief Model constructs-including perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self‑efficacy-in the intervention group compared with the control group (p < 0.05). Preventive behaviours related to urinary tract infections also significantly increased among pregnant women in the intervention group compared with the control group (p = 0.001). The HBM‑based educational intervention effectively improved preventive behaviours related to urinary tract infections among pregnant women. Considering that barriers to UTI prevention may originate from individual factors and limited facilities, further large‑scale studies are recommended to explore women's beliefs and barriers regarding UTIs. Urinary tract infections (UTIs) are common during pregnancy. If they are not prevented or treated early, they can cause serious health problems for both the mother and the baby. This study looked at whether a targeted health education programme could help pregnant women learn and practise better habits to prevent these infections. The study took place between 2024 and 2025 in Khormoj, Iran, and involved 93 pregnant women who had a UTI. Half of the women took part in five short, face-to-face training sessions, while the other half received only their standard pregnancy care. The researchers compared the two groups using questionnaires before the study and three months after the training. Before the training, both groups had similar levels of knowledge and habits. However, three months after the education programme, the women who attended the sessions showed a major improvement. They had more knowledge about UTIs, understood the risks better, felt more confident in preventing the infection, and were practising much healthier daily habits compared to the women who received standard care. Simple, face-to-face health education during pregnancy can successfully help women protect themselves from urinary tract infections. Adding this kind of training to regular prenatal check-ups could improve health outcomes for both mothers and their babies.
Endometriosis (EMs) is a chronic gynaecological condition characterised by the ectopic growth of endometrial tissue; however, its molecular mechanisms remain insufficiently understood. Ferroptosis, an iron-dependent form of regulated cell death, has been suggested as a potential contributor to its pathogenesis. This study aimed to identify differentially expressed ferroptosis-related genes (DE-FRGs) in EMs through bioinformatics analysis and to explore their underlying molecular mechanisms. The gene expression datasets GSE7305 and GSE25628 were obtained from the GEO database. Ferroptosis-related genes (FRGs) were extracted from the FerrDb database. DE-FRGs were identified by intersecting differentially expressed genes (DEGs) with FRGs across the two datasets. Protein-protein interaction (PPI) networks were constructed using STRING and Cytoscape software, while core genes were identified through the cytoHubba plugin. Functional enrichment analysis was performed via the KEGG pathway. A total of 11 DE-FRGs were identified, all of which demonstrated consistently upregulated expression in EMs tissues across both datasets. Four core genes - GATA6, KLF2, BGN and AEBP1 - were selected for further analysis owing to their significant enrichment. KEGG analysis indicated that these genes were particularly enriched in the 'taurine and hypo-taurine metabolism' and 'muscle cell cytoskeleton' pathways. This study identified GATA6, KLF2, BGN, and AEBP1 as potential core genes associated with ferroptosis in EMs, highlighting their roles in metabolic and cytoskeletal pathways. These findings provide a novel perspective on the pathogenesis of EMs and suggest new therapeutic targets that warrant further experimental validation. Endometriosis is a prevalent condition characterised by the growth of tissue resembling the endometrium outside the uterus, resulting in pain and infertility. This study employed computational techniques to analyse genetic data and identified four pivotal genes that may affect a cell death process referred to as ‘ferroptosis’ in endometriosis. These genes are associated with metabolic and cellular structural alterations. Elucidating the functions of these genes will facilitate the development of novel therapeutic approaches for treating endometriosis in the future.
Observational studies have established a strong epidemiological connection between obesity and an increased risk of pre-eclampsia (PE). However, the genetic mechanisms underlying this comorbidity remain largely unexplored. In this study, we conducted a comprehensive cross-trait analysis to elucidate the shared genetic architecture between various adiposity-related traits and PE. Using the genome-wide association study (GWAS) statistics, we first evaluated the overall genetic overlap between adiposity-related traits and PE through multiple approaches, including linkage disequilibrium score regression (LDSC), high-definition likelihood inference (HDL), genetic covariance analysis, and pleiotropy and annotation methods. Causal relationships were then evaluated through bi-directional Generalised Summary-data-based Mendelian Randomisation (GSMR). Candidate pleiotropic loci were identified using a robust suite of analytical tools, including cross-phenotype association analysis, Multi-Trait Analysis of GWAS (MTAG), pleiotropic analysis under a composite null hypothesis, a pleiotropy-informed conditional false discovery rate (pleioFDR) framework, and Functional Mapping and Annotation (FUMA). Bayesian colocalisation (COLOC) was subsequently applied to these loci to pinpoint independent, significant causal single nucleotide polymorphisms (SNPs). To identify and validate shared genes, we performed tissue enrichment analysis, using Multi-marker Analysis of Genomic Annotation, and integrated SPrediXcan with COLOC. Finally, gene functional enrichment was characterised via Gene Ontology (GO) and Kyoto Encyclopaedia of Genes and Genomes (KEGG) enrichment analyses. We identified significant positive genetic correlations and robust causal associations between adiposity-related traits and PE-related diseases. Our analyses revealed 35 independent significant causal SNPs, 32 enriched tissues, and 7 shared high-confidence genes supported by COLOC analysis. Collectively, our study indicates a genetic correlation and common risk genes, linking adiposity-related traits to PE-related diseases. These findings offer novel insights into the biological mechanisms underlying this comorbidity, highlighting promising targets for future mechanistic studies and stratified preventative strategies. Preeclampsia is a serious pregnancy condition characterised by high blood pressure, which can lead to severe health problems for both the mother and baby. Women with higher body weight or specific patterns of body fat distribution are at a greater risk of developing this condition, but the underlying biological reasons remain largely unclear. In this study, we analysed large-scale genetic data from hundreds of thousands of individuals to explore the connection between obesity-related traits and PE. We examined whether these traits and the disease share common biological factors and whether excess body weight directly contributes to the development of the condition. Our findings reveal that body weight and body fat distribution are closely linked to PE at a genetic level, sharing common biological pathways. We successfully identified several key genetic signals and specific genes that help explain how this connection works at a cellular level. These results improve our understanding of why body composition affects PE risk, providing valuable insights that could guide future prevention and treatment strategies.
Agouti signalling protein (ASIP) is an adipokine regulating appetite and energy balance. This study aimed to investigate the association of first-trimester serum ASIP and triglyceride-glucose (TyG) index with the development of gestational diabetes mellitus (GDM). This prospective study enrolled 231 singleton pregnant women (GDM, n = 42; non-GDM, n = 189). Serum ASIP, the TyG index, and routine metabolic parameters were measured during the first (8-12 gestational weeks) and second (24-28 gestational weeks) trimesters. GDM was diagnosed at 24-28 weeks via a standard 75-g oral glucose tolerance test. Both serum ASIP levels and TyG index were significantly elevated in the GDM group compared to the non-GDM group during both trimesters (all P < 0.001). First-trimester ASIP and TyG index correlated positively with second-trimester fasting plasma glucose, 2-hour postprandial glucose, and homeostatic model assessment of insulin resistance, and inversely with quantitative insulin sensitivity check index and Bennett insulin sensitivity index (all P < 0.01). After adjustment, both ASIP and TyG index in the first trimester remained independent risk factors for GDM (ASIP: adjusted odds ratio [a OR] = 1.031, 95% confidence interval [CI] 1.015-1.047, P = 0.019; TyG: a OR = 5.445, 95% CI 1.936-15.319, P < 0.001), with consistent associations across age and body mass index subgroups (interaction P > 0.05). The combination of ASIP and TyG index in the first trimester yielded an AUC of 0.788 for GDM prediction, with a sensitivity of 76.2%, specificity of 68.8%, positive predictive value of 35.2%, and negative predictive value of 92.9%. Its predictive performance improved in the second trimester, achieving an AUC of 0.894, with corresponding values of 92.9%, 72.0%, 42.4%, and 97.9%, respectively. Elevated first-trimester serum ASIP and TyG index are associated with an increased risk of GDM, and correlate with increased insulin resistance and dysglycaemia during pregnancy. We wanted to know if a simple blood test in early pregnancy could help tell if a woman might later develop gestational diabetes.We followed 231 pregnant women. At their first check-up (around 8–12 weeks), we measured two things in their blood: a protein called agouti signalling protein (ASIP) and a score called the triglyceride-glucose (TyG) index, which combines blood sugar and fat levels together. Later, between 24–28 weeks, they took the standard test for diabetes.We found that women who were later diagnosed with diabetes already had higher levels of both ASIP and TyG index in early pregnancy. This link stayed strong even after considering other factors like the mother’s age and weight. Importantly, using both measurements together was better at identifying high-risk women than using either one alone.So, checking for these two things early in pregnancy might help doctors spot women who are more likely to develop gestational diabetes.
Polycystic Ovary Syndrome (PCOS) imposes substantial metabolic and reproductive burdens. Exercise has emerged as a crucial lifestyle intervention, and corresponding scientific interest has expanded. This study provides a comprehensive bibliometric analysis of global research on the intersecting PCOS and exercise. Relevant publications (2005-2025) were collected from the Web of Science Core Collection (WoSCC). CiteSpace, VOSviewer, and bibliometrix were applied to map publication trends, international collaboration patterns, and evolving research hotspots. A total of 1,146 publications were identified, demonstrating sustained growth. The United States and Australia dominated productivity, collaborating primarily with India, the United Kingdom (UK), and Switzerland. Key research hotspots included metabolic syndrome, endothelial function, cardiovascular disease, and increasing emphasis on exercise-based interventions. Monash University and the University of Adelaide played central roles in institutional networks. Emerging themes, including oxidative stress and anxiety, have emerged in the broader PCOS literature and are closely linked to exercise-related biological pathways. Exercise is an increasingly prominent research focus in PCOS management. This analysis outlines the field's structural and thematic evolution and identifies opportunities for advancing scientific understanding. Strengthened international and multidisciplinary collaboration remains essential. PCOS is a common hormonal condition that impacts women’s health, leading to issues with fertility, metabolism, and overall quality of life. Exercise has become an important non-pharmacological intervention for managing PCOS, especially in women who are overweight. To gain a clearer understanding of global research on this topic, we analysed studies published from 2005 to 2025. We identified 1,146 papers, with the majority originating from the United States and Australia, and strong collaborations with countries such as India, the UK, and Switzerland. Prominent institutions included Monash University and the University of Adelaide. Research frequently focuses on how exercise impacts metabolism, cardiovascular health, and psychological well-being. More recently, emerging topics such as oxidative stress and anxiety have garnered increased attention. Our findings suggest exercise is increasingly acknowledged as a key therapeutic approach for PCOS, but stronger international collaboration is essential to advance both research and clinical care.
Malaria and schistosomiasis are major public health challenges in sub-Saharan Africa (SSA), with overlapping geographical distributions leading to high rates of coinfection among children. Plasmodium falciparum (P. falciparum) causes most severe malaria cases, while Schistosoma haematobium (S. haematobium) and Schistosoma mansoni (S. mansoni) are the predominant schistosome species. Coinfections result from shared environmental factors, but interactions between these parasites remain unclear due to inconsistent study findings. This systematic review and meta-analysis aim to provide pooled prevalence estimates of P. falciparum-Schistosoma coinfection in children aged 0-17 years in SSA. This systematic review and meta-analysis followed the PRISMA guidelines. We searched PubMed, the Cochrane Library, Web of Science, EBSCOhost, Google Scholar, ProQuest, and publisher platforms (Wiley Online Library, SpringerLink) and screened the reference lists for observational studies reporting coinfection with P. falciparum and S. haematobium and/or S. mansoni among children in SSA. Data from 21 eligible studies were extracted using Microsoft Excel and analysed using Stata version 17. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Proportions were stabilized using the Freeman-Tukey double arcsine transformation, and pooled prevalence estimates with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using I2, and publication bias was evaluated using funnel plots, Egger's test, and Begg's test. Twenty-one studies were included in this analysis. The aggregated prevalence of P. falciparum-S. haematobium coinfection was 10.0% (95% CI 6.0-14.0%), with substantial heterogeneity (I2 = 98.0%, p < 0.001). The highest prevalence was recorded in West Africa (13.0%, 95% CI 6.0-22.0%), followed by Central Africa (9.0%, 95% CI 7.0-10.0%) and East Africa (3.0%, 95% CI 0.0-11.0%); however, the regional differences were not significant (p = 0.150). No significant temporal variation was detected (p = 0.185), with prevalence estimates of 22.0% (2011-2015), 5.0% (2016-2020), and 7.0% (2021-2025). The diagnostic methods yielded significantly different estimates (p < 0.001), ranging from 13.0% (PCR + microscopy) and 11.0% (microscopy) to 3.0% (RDT + microscopy) and 1.0% (PCR + PCR). The pooled prevalence of P. falciparum-S. mansoni coinfection was 13.0% (95% CI 6.0-24.0%), with very high heterogeneity (I2 = 99.28%, p < 0.001). Significant regional variation was identified (p < 0.001), with East Africa exhibiting the highest prevalence (25.0%, 95% CI 13.0-39.0%) compared to Central Africa (3.0%, 95% CI 2.0-5.0%) and West Africa (2.0%, 95% CI 1.0-3.0%). Temporal patterns did not show significant differences (p = 0.683), with prevalence estimates of 13.0% (2010-2014), 18.0% (2015-2019), and 14.0% (2020-2025). Diagnostic approaches also varied significantly (p < 0.001), with prevalence ranging from 12.0% (microscopy + microscopy) to 6.0% (PCR + PCR) and 2.0% (PCR + microscopy). Coinfections of P. falciparum and Schistosoma species remain a major health challenge in SSA, particularly affecting children owing to systemic healthcare gaps, poverty, and inadequate water and sanitation. Geographic and temporal patterns reflect persistent transmission hotspots, with diagnostic limitations underestimating the true prevalence. Effective control requires integrated public health strategies prioritizing children, combining medical treatment, improved sanitation, and affordable, sensitive diagnostics to stop transmission.
Diastasis recti abdominis (DRA) is characterised by a separation of the rectus abdominis muscles, which is common in the postpartum period. This randomised controlled trial investigated the effects of a physiotherapy protocol combining abdominal exercises and physical agents-namely electromagnetic shock waves, transfer of energy capacitive and resistive (TECAR) therapy, and neuromuscular electrical stimulation-on reducing the inter-rectus distance in women with DRA six months after childbirth. Sixty women diagnosed with DRA were randomised into three groups: kinesiotherapy (Group A); electromagnetic shock waves, TECAR therapy, and neuromuscular electrostimulation (Group B); and a combination of both (Group C). The inter-rectus distance (IRD) of participants was assessed before and after treatment, with re-evaluation conducted sixty days after the initial assessment, using ultrasound and abdominal perimeter measurements. group C showed a 0.80 cm reduction in supraumbilical IRD when compared with Group B. In the infraumbilical region, Group C had a 0.74 cm reduction compared to Group A and 0.85 cm compared to Group B. Regarding abdominal perimeter, Groups B and C showed greater reductions in the infraumbilical circumference than Group A, with mean differences of approximately 10 cm. No significant differences were observed in the supraumbilical and umbilical regions. the combination of kinesiotherapy and physical agents is more effective in reducing inter-rectus distance and abdominal circumference than either approach alone in postpartum women with diastasis recti abdominis. After pregnancy, many women develop a condition where the belly muscles separate more than usual. This can lead to weakness, discomfort, and changes in appearance. In our study, we tested physiotherapy treatments in 60 women who were six months postpartum. One group did guided abdominal exercises, another received treatments with special devices that act on the muscles and tissues, and a third group received both. We measured the muscle gap and waist size before and after treatment. The women who did the combined program showed the greatest improvements, suggesting that combining approaches may be more effective than using either one alone.
The gamma-glutamyl transferase (GGT) to high-density lipoprotein (HDL) ratio (GGT/HDL) has recently emerged as a potential biomarker for metabolic and liver diseases. This study aimed to investigate the association between GGT/HDL ratio and endometriosis using a population-based dataset from the National Health and Nutrition Examination Survey (NHANES). Data from NHANES 1999 to 2006 were used to assess the relationship between the GGT/HDL ratio and endometriosis. The diagnosis of endometriosis was based on self-reported data from the Reproductive Health Questionnaire. The GGT/HDL ratio was calculated and Ln-transformed for analysis. Multivariable logistic regression and sensitivity analysis were used to estimate the odds ratio (OR) for endometriosis in relation to the GGT/HDL ratio. A total of 3815 individuals were included, with 307 diagnosed with endometriosis. The Ln-transformed GGT/HDL ratio was positively associated with the endometriosis. Each unit increase in the Ln-GGT/HDL ratio was associated with a 22% higher likelihood of endometriosis (OR = 1.220, 95% CI: 1.003-1.483, p = 0.046). Sensitivity analyses including the use of original GGT/HDL value, the further adjustments of covariates, the exclusion of those with CVD and liver diseases confirmed the robustness of this association. This study found a significant positive association between the GGT/HDL ratio and endometriosis. Higher GGT/HDL levels may serve as a potential biomarker for identifying women at risk of endometriosis. This study investigated the relationship between the gamma-glutamyl transferase (GGT) to high-density lipoprotein (HDL) ratio (GGT/HDL) and endometriosis, using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006. GGT/HDL were from laboratory tests and endometriosis diagnosis was based on self-reported information from the Reproductive Health Questionnaire.The study included 3815 individuals, of whom 307 were diagnosed with endometriosis. The results showed that a higher GGT/HDL ratio was associated with a higher risk of endometriosis. Specifically, for each unit increase in the Ln-GGT/HDL ratio, the likelihood of having endometriosis increased by 22%. This association remained robust even after conducting sensitivity analyses.The findings suggested that the GGT/HDL ratio could be a useful biomarker for identifying women at risk of developing endometriosis.
Triage of human papillomavirus (HPV)-positive women with atypical squamous cells of undetermined significance (ASC-US) remains a longstanding clinical challenge in cervical cancer screening, as conventional strategies often lead to excessive colposcopy referrals. We conducted a diagnostic cohort study of 195 HPV-positive women who underwent ASC-US cytology. Multigene DNA methylation analysis was performed on residual cervical exfoliated cells, using histology from colposcopy-directed biopsy and/or endocervical sampling as the reference standard to minimise colposcopy referrals. Our results showed that methylation levels of PAX1, EPB41L3, and FAM19A4 increased progressively from ≤ CIN1 to CIN2, CIN3, and cervical cancer, with significant decreases in ΔCt values from ≤ CIN1 to CIN3 for all three genes (p < 0.05). For detection of CIN2+, the assay achieved a sensitivity of 85.19%, specificity of 96.43%, positive predictive value (PPV) of 79.31%, negative predictive value (NPV) of 97.59%, and an area under the receiver operating characteristic curve (AUC) of 0.91, thereby avoiding colposcopy referrals in 96.43% (162/168). For CIN3+, the assay demonstrated sensitivity, specificity, PPV, NPV, and AUC values of 94.44%, 93.22%, 58.62%, 99.4%, and 0.94, respectively. Stratified analyses showed high and comparable sensitivity (81.82% vs. 87.50%), specificity (96.92% vs. 96.12%), and AUC (0.89 vs. 0.92) in women with HPV16/18 compared with those with non-16/18 high-risk HPV. Optimal diagnostic accuracy was observed in women aged ≥30 years, with sensitivities ranging from 85.70% to 100%, specificities from 94.44% to 100%, and AUC values ranging from 0.93 to 0.97. In contrast, the performance was suboptimal in women aged <30 years (sensitivity, 33.33%; AUC, 0.64). The host multigene DNA methylation assay demonstrates high specificity and good sensitivity for triaging HPV-positive ASC-US women, with the potential to reduce colposcopy referrals while maintaining robust detection of high-grade lesions, particularly in those aged ≥30 years. In cervical cancer screening, management of human papillomavirus-positive individuals with atypical squamous cells of undetermined significance presents a clinical challenge, as the routine approach of direct referral for colposcopy often results in many patients undergoing unnecessary invasive procedures. In this study, we applied a combined multigene DNA methylation assay in this population, using histology as the gold standard. The results demonstrated that the assay accurately stratifies high- and low-risk groups, enables more than 96% of low-risk individuals to avoid colposcopy, and shows optimal performance in women aged ≥30 years. Overall, this assay is an effective tool for achieving precise triage, as it not only optimises cervical cancer screening pathways but also substantially reduces medical burden and psychological anxiety.