Adenomyosis is the presence of endometrial glands and stroma within the myometrial wall of the uterus. This condition is related to a diffusely enlarged uterus with reactive hyperplasia and fibrosis of the surrounding myometrial smooth muscle cells. The symptomatology of adenomyosis is highly heterogeneous among patients and there are no pathognomonic symptoms specific to the condition. Clinically, although approximately 30% of patients remain asymptomatic, it can manifest as abnormal bleeding, pelvic pain, infertility and adverse obstetric outcome: miscarriage, preterm labor, uterine atony, other complications during labor. Diagnosis of adenomyosis relies on imaging techniques such as transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). Precise ultrasound diagnosis enables the identification of symptomatic patients and allows for the implementation of appropriate treatments based on the severity of adenomyosis-related symptoms. Treatment options include pharmacological treatments usually with progestin or levonorgestrel-releasing intrauterine systems, hysteroscopic resection or ablation, conservative surgical methods and high-intensity focused ultrasound (HIFU). Diagnosis of adenomyosis during pregnancy can present challenges, as its symptoms may overlap with those of pregnancy, and it may be difficult to diagnose or differentiate from other conditions that affect the uterus during pregnancy. Additionally, imaging techniques commonly used to diagnose adenomyosis, such as transvaginal ultrasound and MRI, must be used cautiously due to the changes that occur in the uterus during pregnancy. Pregnancy leads to significant changes in the size and shape of the uterus, which can make the typical features of adenomyosis less apparent on imaging studies. Several studies suggest that adenomyosis may be linked to "unexplained infertility" and it is also conceived as a reproductive disorder, with reported prevalence rates of 38.2% in cases of recurrent pregnancy loss. Given the emerging evidence about the negative impact of adenomyosis on fertility and obstetric outcomes, accurate pre-conception and post-conception counseling is crucial. Treatment during pregnancy is generally conservative and they are based on symptoms control causing significant discomfort or interfere with pregnancy, management may include pain relief, such as acetaminophen or, in some cases, opioids (with caution) and careful monitoring throughout pregnancy. If adenomyosis is suspected during pregnancy, the condition is usually addressed post-delivery, and the approach to treatment depends on the severity of symptoms and any pregnancy complications that may arise. The aim of this review is to provide preconception and post-conception counselling for patients with adenomyosis, focusing on its impact on fertility and obstetric outcomes. It also aims to offer information on the symptoms and ultrasound diagnosis during pregnancy to ensure careful monitoring.
Patient education materials (PEMS) are not always available in a patients' written language. Google Translate, using artificial intelligence (AI), provides a cost-effective, widely available translation option. We evaluated understandability and actionability of Google AI translations of International Urogynecological Association (IUGA)'s midurethral sling (MUS) leaflet with the Patient Education Materials Assessment Tool (PEMAT). We also evaluated translation equivalence using the comparability of language (CL) and similarity of interpretability (SI) assessments. We hypothesized no differences between back-translated and original version's PEMAT scores, CL, or SI and that PEMAT back-translated version scores would be non-inferior to original versions. IUGA's MUS leaflet was translated into Mandarin Chinese and Swahili, then back-translated into English using Google Translate. Participants scored original and back-translated versions using the PEMAT (0-100, better scores are higher) and CL and SI (1-7 scale, lower scores better). Participants were randomized whether they evaluated the original or back-translated version first to decrease bias. No significant differences were found on understandability or actionability between the original English and back-translated Mandarin Chinese or Swahili versions. However, neither met the pre-specified non-inferiority margin of 5-points on the PEMAT. CL (mean: 4.4±0.9) and SI (mean: 4±1.2) scores for both indicated moderate comparability and similarity. Original and back-translated versions of Mandarin Chinese or Swahili MUS IUGA leaflets did not score differently on the PEMAT although we did not meet the non-inferiority margin. CL and SI support Google translate as a moderately useful tool in providing IUGA leaflets in languages not commonly available.
Labor progression is traditionally considered linear; however, recent evidence highlights natural variations, including pauses or plateaus in contraction intensity or cervical dilation. Recognizing these variations is crucial, as a lack of clear distinction between physiological and pathological plateaus often leads to unnecessary interventions with potential short- and long-term consequences. This scoping review aims to map and summarize the characteristics, differences and management strategies of physiological and pathological labor plateaus in low-risk women. This scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and its extension for scoping reviews (PRISMA-ScR). Eligibility criteria included studies on physiological term pregnancies detailing labor plateau characteristics or management strategies. We searched five databases (MEDLINE, CINAHL, Embase, Scopus, CENTRAL), relevant gray literature, and reference lists of included studies, without restrictions on time, geography, or setting. Two reviewers independently screened abstracts and full-text articles for inclusion. Data were synthesized narratively and summarized in tables. We included 35 studies. Definitions of labor plateaus varied widely. Factors contributing to labor plateaus were categorized into modifiable and non-modifiable factors. Management strategies ranged from non-invasive approaches such as emotional support and hydration to invasive interventions like amniotomy and oxytocin administration. Current literature does not clearly distinguish between physiological and pathological labor plateaus. Standardized definitions and management protocols are needed to improve clinical outcomes. Recognizing the potential for physiological progression during plateaus may help balance timely interventions with the benefits of supporting natural labor processes.
Persistent inequities in unintended pregnancy among adolescents across the globe combined with their increased use of technology warrants an increased understanding of technology-based pregnancy prevention interventions designed specifically for this population. The objective of this systematic review was to identify "standalone" (i.e., able to be implemented without facilitation by people) technology-based interventions designed to support pregnancy prevention among adolescents and young adults. We included peer-reviewed articles available on the PubMed database that were published between 2010-2025 if they evaluated a standalone technology-based adolescent pregnancy prevention intervention. Articles went through a title and abstract review and subsequently a full-text review. Intervention characteristics and reported impacts were extracted and summarized from included articles. From 247 articles identified, 16 articles representing 13 interventions were included. Among the interventions, three were text message-based, four were web-based, and six were smartphone applications. Most of the interventions were developed in the USA for female adolescents and young adults. Five interventions used randomized control trials and demonstrated improvements in behaviors that can reduce the risk of unintended pregnancies. Several technology-based interventions have been shown to improve adolescent pregnancy prevention behaviors; however, more attention to intervention implementation efforts, mechanisms of action that lead to behavior change, and the impact youth engagement has on the development and implementation has on outcomes is needed. In addition, greater investments and attention to pregnancy prevention efforts that target youth from different cultural backgrounds, countries and contexts are also needed to reach those who have less access to information and care. Future research and practice should also address how engaging males, gender-expansive and sexual minorities in pregnancy prevention efforts can contribute to improved outcomes. There is also a need to standardize behavioral measures to facilitate meta-analysis.
We evaluated the common histopathological characteristics of preeclampsia (PE) and fetal growth restriction (FGR), and demonstrated the major differences of the three groups of 1/PE with FGR, 2/PE without FGR and 3/FGR without PE. Placental slides were studied retrospectively. Predominantly FGR- and PE-associated lesions were identified. Gestational age at the time of delivery (GATD) and diagnosis-to-delivery time (DTDT) were also examined. Decidual arteriopathies, maternal hypertension and obesity were more common in PE, and villous capillarization was significantly lower in FGR. We found that only villous infarction and chorangiosis had a connection with GATD. Villous infarction and chorangiosis were associated with DTDT >80 days, while placental changes leading to decreased villous capillarization was associated with DTDT <30 days. Despite several common histopathological characteristics, placental histopathological profile of PE with FGR, PE without FGR and FGR without PE have remarkable differences, indicating histological background of their distinguished prognosis. Inadequate vascular development and decidual vasculopathies are characteristic in PE, while the undercapillarization of placental villous tree and villitis of unknown etiology leading to placental damage are characteristic of FGR. The dynamic equilibrium of different entities determines global placental function, and manifestation of FGR and/or PE.
Endometriosis is an inflammatory disorder characterized by ectopic endometrial-like tissue, affecting approximately 10% of women. It significantly impairs quality of life through symptoms such as dysmenorrhea, pelvic pain, and infertility. Conventional treatments often inadequately manage the complex pain associated with the disease. Complementary, alternative, and integrative medicine (CAIM) approaches are proposed as supplementary strategies addressing broader symptomatology. This scoping review employed a comprehensive search of PubMed and PsycINFO databases from inception through April 25th, 2025. Studies assessing CAIM treatments on endometriosis-associated pain or quality of life were included. Screening and data extraction were performed independently by multiple reviewers, following PRISMA-ScR guidelines. A total of 107 studies across diverse CAIM domains were analyzed, including acupuncture, Chinese and natural medicine, nutritional supplements, physical therapy, dietary interventions, relaxation techniques, psychotherapy, and combined therapies. Acupuncture, Chinese and natural medicine, and nutritional supplements had the most substantial evidence base, featuring randomized controlled trials and meta-analyses indicating significant pain relief and quality of life improvements. However, significant heterogeneity in study designs, diagnosis confirmation methods, intervention specifics, and outcome measures limited direct comparability and generalizability. CAIM therapies demonstrate potential as adjunctive treatments for endometriosis-associated pain and quality of life enhancement. Future research should examine additive benefits of CAIM therapies combined with conventional treatments, supporting integrative care addressing endometriosis-related pain, sensitization, mental health, inflammation, and myofascial dysfunction.
Female fertility is influenced by a complex interplay of lifestyle factors. They may include weight, diet, supplementation, physical activity, sleep and substance use. Understanding these factors, in combination with a thorough understanding of strategies to support effective behavior change is essential to develop effective lifestyle interventions for women who wish to enhance their fertility. This review aimed to summarize the evidence on female fertility and lifestyle, and to discuss intervention considerations which may affect implementation of the evidence. Electronic databases (PubMed, Google Scholar) were searched to identify relevant peer-reviewed studies and evidence-based guidelines. The following lifestyle factors are associated with improved female fertility: maintaining a healthy weight, following a healthy dietary pattern (e.g. Mediterranean diet) with appropriate supplementation, participating in regular physical activity, attaining 7-8.5 hours of high-quality nocturnal sleep and avoiding or limiting substance use (caffeine, alcohol and smoking). Considering the factors affecting lifestyle management in both consumers (e.g. emotional eating and financial barriers) and health professionals (e.g. time constraints and concerns about patient expectations of care) is essential to optimize success of lifestyle interventions to improve fertility. Lifestyle management has an important role in improving reproductive health and overall health for women who wish to conceive. A patient-centered approach which incorporates behavioral science, individual preferences, and healthcare delivery considerations is essential. There is a need for further research to inform optimal intervention components and behavior change strategies for this population.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women, which is associated with a significantly higher risk of developing cardiometabolic abnormalities. The present review is aimed to understand the different mechanism related to the cardiometabolic alteration of women with PCOS. A literature search was made on terms encompassing PCOS, hyperandrogenism, obesity, lipid metabolism, insulin resistance, inflammation, oxidative stress, gut microbiota, cardiovascular event, and mortality. Hyperandrogenism is the key signature of women with PCOS. Androgens by reducing the intracellular signal of insulin, induce an insulin resistance that is compensated by hyperinsulinemia. Hyperinsulinemia and insulin resistance are the key determinants of the metabolic syndrome and therefore of the cardiovascular risk. Obesity, oxidative stress and chronic inflammation further increase insulin resistance and represent adjunctive pejorative risk factors. Modification of gut microbiota is common in women with PCOS, and it is consequent to hyperandrogenism and obesity. Gut dysbiosis contributes to induce metabolic alterations. In women with PCOS the cardiovascular risk depends upon syndrome manifestation. The risk is maximal in hyperandrogenic obese anovulatory women, milder in hyperandrogenic non obese women, and is not increased in non-hyperandrogenic PCOS women. Among PCOS women, phenotypes characterized by hyperandrogenism, anovulation and obesity are at high risk of cardiometabolic alterations. In general, a careful investigation on the presence of cardiovascular risk factors, and the use of appropriate remedies to reduce them, is useful in all PCOS women with hyperandrogenism, and in particular in those with associated anovulation and obesity.
Clinical characteristics of polycystic ovary syndrome (PCOS) (menstrual irregularities, obesity, anovulation, etc.), occur together with a series of conditions at skin level like seborrhea, acne, hirsutism, and androgenetic alopecia. Estroprogestins (EPs) are recognized as the most powerful therapy to treat hyperandrogenism and/or hyperandrogenemia and regularize menstrual cycle. This review includes the most relevant publications about the effects of EPs in PCOS women published between 1995 and 2025. According to the available data, EPs composed by an anti-androgenic progestin appear the most suitable to reduce the hyperandrogenic manifestations of PCOS. More specifically, cyproterone acetate (CPA), drospirenone (DRSP) and dienogest (DNG) associated with 20-30 μg of ethinylestradiol (EE) seem to be the most effective compounds for the management of androgen excess. As the benefit risk/ratio of the association EE/CPA is less favorable, the use of EPs with other antiandrogenic progestins could be more appropriate to treat PCOS patients, also from a metabolic point of view. In conclusion, an aware choice of the most adequate and tolerable EP formulation according to the pharmacological profile and individual characteristics of PCOS patient is essential to opportunely customize the treatment of androgen excess.
Ovarian tissue cryopreservation (OTC) is the only fertility-preservation option available for prepubertal girls at risk of premature ovarian insufficiency (POI). While its use is well established in adults, the experience is more limited in children. This systematic review was conducted according to PRISMA 2020 guidelines (PROSPERO CRD420251158063). PubMed, Scopus, Embase, and Web of Science were searched through July 2025 for studies investigating OTC and subsequent ovarian tissue transplantation (OTT) in prepubertal girls (≤12 years). Forty-five studies met inclusion criteria, including case reports, case series, and cohort studies. Endocrine recovery occurred in all documented OTT cases, with few reported pregnancies - both spontaneous and ART-assisted - and no reported disease relapses. Surgical approaches varied widely, particularly regarding ovarian tissue harvesting (biopsy vs. unilateral oophorectomy) and the use of energy devices. Of the GV oocytesobtained from harvested ovarian cortex, in-vitro maturation (IVM) rates ranged from 15% to 38% and appeared age-dependent; one study showed improved outcomes after gonadotropin priming. In Turner syndrome, follicular density showed high variability and frequent follicular abnormalities, and no OTTs were reported. Ethical analyses emphasized parental decision-making and highlighted the need to involve older children in assent discussions. Prepubertal OTC appears feasible and capable of restoring ovarian function after OTT, although current experience remains limited. Available data suggest reassuring oncologic safety, but further confirmation across malignancy types is required. OTC in prepubertal patients should therefore be confined to specialized programs, supported by multidisciplinary counseling and long-term follow-up.
Polycystic ovary syndrome (PCOS) is an endocrine/metabolic condition. Hyperandrogenism and insulin-resistance with compensatory hyperinsulinemia are important features of PCOS. The aim of this paper is to review the rationale of antiandrogens and insulin-sensitizers use in PCOS management. We include in our research the most relevant scientific literature about the impact of antiandrogens and insulin sensitizers in PCOS between 1976 and 2025. According to the most recent recommendations, antiandrogens can be a possible therapeutic option to reduce the impact of hyperandrogenism and treat hirsutism in PCOS patients after a period of 6 months of estroprogestins and/or cosmetic therapy without adequate results. Insulin-sensitizers can decrease the levels of insulin in subjects affected by hyperinsulinemia, improving metabolic and hormonal alterations observed in PCOS patients. Antiandrogens and insulin sensitizers represent fundamental pharmacological therapies for PCOS management.
Adenomyosis is a chronic reproductive condition that impairs fertility and is characterized by endometrial tissue invading the myometrium. Despite advances in MRI and 3D ultrasound for diagnosis, there is still no consensus on optimal fertility management. The choice between uterus-sparing surgery and direct IVF, including the ideal timing for each approach, remains a subject of ongoing debate. This narrative review analyzed relevant studies retrieved from PubMed, Scopus, and Web of Science, focusing on uterine morphology, hormonal and surgical therapeutic responses, and IVF/ICSI outcomes in women with adenomyosis. Infertility in adenomyosis is associated with JZ remodeling, inflammation, hypercontractility, and impaired endometrial receptivity. Poor prognostic markers include JZ thickness ≥8.5 mm, uterine volume 90-130 mL, and MUSA direct features. These features are linked to lower live birth rates (aRR=0.62; 95% CI 0.43-0.88; P=0.007) and higher miscarriage risk (aRR=2.88; 95% CI 1.49-5.57; P=0.002), with larger uterine volume (>130 cm3) and thicker JZ significantly correlating with pregnancy failure and reduced cumulative live birth in Kaplan-Meier analyses. Assessment of JZ morphology, uterine volume, and MUSA features is crucial for individualized treatment planning in women with adenomyosis and infertility. Based on observational data, a pragmatic approach may include: 1) medical therapy with GnRH agonists for 3-6 cycles for uterine volumes 100-200 mL and JZmax 8.5-16 mm, followed by IVF; 2) consideration of uterus-sparing surgery for volumes >200 mL and JZmax >16 mm in highly selected patients, then IVF with an ultra-long protocol; and 3) direct IVF for volumes <100 mL and JZmax <8.5 mm, preferably using an ultra-long protocol with a freeze-all and HRT-FET strategy. These proposals are intended as a clinically oriented framework derived from current observational evidence rather than as formal guideline recommendations.
Plastics are a grave, growing, and under-recognised danger to human and planetary health. Plastics cause disease and death from infancy to old age and are responsible for health-related economic losses exceeding US$1·5 trillion annually. These impacts fall disproportionately upon low-income and at-risk populations. The principal driver of this crisis is accelerating growth in plastic production-from 2 megatonnes (Mt) in 1950, to 475 Mt in 2022 that is projected to be 1200 Mt by 2060. Plastic pollution has also worsened, and 8000 Mt of plastic waste now pollute the planet. Less than 10% of plastic is recycled. Yet, continued worsening of plastics' harms is not inevitable. Similar to air pollution and lead, plastics' harms can be mitigated cost-effectively by evidence-based, transparently tracked, effectively implemented, and adequately financed laws and policies. To address plastics' harms globally, UN member states unanimously resolved in 2022 to develop a comprehensive, legally binding instrument on plastic pollution, namely the Global Plastics Treaty covering the full lifecycle of plastic. Coincident with the expected finalisation of this treaty, we are launching an independent, indicator-based global monitoring system: the Lancet Countdown on health and plastics. This Countdown will identify, track, and regularly report on a suite of geographically and temporally representative indicators that monitor progress toward reducing plastic exposures and mitigating plastics' harms to human and planetary health.
Advanced endometriosis (Stage III/IV) represents a particularly severe variant of endometriosis with more pronounced symptomatology and challenging surgical treatment. This review shall examine the role of robotic surgery, the latest breakthrough in surgical technology, in addressing this challenging condition. A systematic search of the literature in peer-reviewed databases was performed, focusing mainly on surgical outcomes. Meta-analysis was performed on comparative studies. Studies included in the meta-analysis were also subjected to risk of bias assessment and sensitivity analysis. From the initial study pool, ultimately 36 studies were included, which indicated that robotic surgery was safe and feasible, with satisfactory surgical outcomes. Long-term quality of life and fertility outcomes were also positive, particularly for endometriosis-related pain, gastrointestinal symptoms and infertility, with 25-100% pregnancy rate after surgery. Comparative data versus laparoscopy, indicated no statistically significant differences between the two approaches with regard to blood loss, hospitalization or complications (including transfusion, conversion to open surgery, re-hospitalization and re-operation), although operative time was significantly longer for robotic surgery (WMD: 38.32, 95%CI: 24.14, 52.49, P<0.001). However, Robotic surgery was superior in addressing endometriosis-related pain and was less harmful on ovarian reserve according to two studies. Robotic surgery for advanced endometriosis is a safe and viable approach. While current data reveal no differences in surgical outcomes compared to laparoscopy, the lack of randomized studies precludes definitive conclusions. Future research should focus on patient randomization and on identifying subgroups that would most benefit from the application of this novel technology.
Endometriosis is a frequent chronic estrogen-dependent condition that can significantly impair fertility and reduce the quality of life in affected individuals. Women with endometriosis face a 30-50% risk of infertility. Multifactorial factors such as peritoneal inflammation, altered ovarian reserve, impaired tubal function and modified endometrial receptivity have been proposed to contribute to infertility. Endometriosis has been highlighted as a condition that may require a fertility preservation to safeguard reproductive potential. This review aims to provide a comprehensive update on fertility preservation for women with endometriosis. A comprehensive literature search was conducted using PubMed, focusing on peer-reviewed studies. Key words included "endometriosis," "fertility preservation," "oocytes," and "cryopreservation." Studies in English and French that delve into FP techniques, success factors, and risks were included. Several fertility preservation techniques are available, but oocyte cryopreservation following ovarian stimulation is the most common and effective option for women affected by endometriosis. Success rates depend on factors such as age and prior surgical history. Surgery for ovarian endometriomas may reduce ovarian reserve, underscoring the importance of considering fertility preservation before surgery. All of ovarian stimulation protocols can be used and may not increase the risk of disease progression or recurrence however the use of an antagonist protocol with GnRH agonist triggering could be particularly beneficial in this context, as it may help reduce pain and minimize the risk of ovarian hyperstimulation syndrome. The number of cryopreserved oocytes is directly correlated with pregnancy success. Multiple stimulation cycles can be performed to obtain a sufficient number of oocytes, increasing the chances of achieving a successful live birth in case of reuse. FP should be routinely discussed with women with endometriosis, particularly those who may undergo surgery, however, its implementation is not systematic and should be considered on a case-by-case basis. Further research is essential to tailor FP strategies for women with endometriosis optimizing both clinical outcomes and cost-effectiveness.
Data on the occurrence of gestational diabetes mellitus (GDM) and related offspring macrosomia are limited in women with low and delayed fertility, both of which are increasingly common in high-income countries. We evaluated the occurrence of GDM among women who delivered in Abano Terme, Italy, between January 2020 and August 2023. Baseline and clinical characteristics of women with GDM (GDM group) and those with a normal oral glucose tolerance test (control group) were analyzed in relation to neonatal macrosomia (>4000 g). Among 2600 women with low and late fertility included in the analysis, 231 (9.9%) were diagnosed with GDM. Women in the GDM group were older than control subjects (36.0 [31.5-39.0] vs. 33.0 [30.0-37.0] years; P<0.001), whereas parity did not differ between groups (2.00 [1.00-2.00] vs. 1.00 [1.00-2.00, P>0.5]). Pre-pregnancy BMI was significantly higher in the GDM group (63 [56-73] vs. 59 [54-66] kg, P<0.001), while height (164 [160-170] vs. 165 [160-170] cm, P<0.024] and gestational weight gain (GWG) (11 [8.5-14.0] vs. 13 [11.0-16.0] kg; P<0.001), P<0.001) were significantly lower. Neonatal birth weight (3400 [3080-3640] vs. 3360 [3100-3640] g; P>0.09) and the prevalence of macrosomia >4000 g (19 [8.2%] vs. 188 [8.1%]; P>0.9) did not differ between groups (P>0.09). In multivariate logistic regression analysis, the risk of GDM was significantly higher among women with low and late fertility or delayed fertility alone (odds ratios 2.3 and 1.9, respectively; P<0.001). Among maternal variables, only obesity at delivery (BMI ≥30 kg/m2) was independently associated with an increased risk of neonatal macrosomia (odds ratio 1.59; P=0.003). In women with low and late fertility, appropriate GWG may play a key role in mitigating the risk of neonatal macrosomia, even in the presence of GDM.
Congenital anomalies of the kidney and urinary tract (CAKUT) represent 15-20% of prenatally diagnosed congenital anomalies, often presenting unilaterally. This study aimed to describe sonographic features of fetuses with unilateral renal anomalies and evaluate their postnatal outcomes. Additionally, we assessed whether specific prenatal ultrasound findings predicted postnatal complications. This was a retrospective, observational study including singleton pregnancies referred to our center from 2008 to 2023 for unilateral renal anomalies identified in second or third trimester ultrasounds. Sequential prenatal ultrasound evaluations were conducted to monitor disease progression and associated anomalies. Postnatal outcomes were retrieved from delivery records and pediatric follow-ups. Statistical analyses included Chi-square tests, t-tests, and ROC curve analysis to assess the predictive value of the antero-posterior diameter (DAP) of the renal pelvis for postnatal complications. A total of 226 cases were included: 116 (51.3%) pyelectases, 51 (22.6%) hydroureteronephroses, 48 (21.2%) multicystic kidneys, and 11 (4.9%) renal dysplasias. Diagnosis occurred at an average gestational age of 25 weeks, with 19.3% showing progression during pregnancy and 23% having associated anomalies detected during ultrasound examinations. Of 135 children with follow-up data, 47.4% required surgery, 1.5% developed hypertension, and 1.5% developed chronic kidney disease (CKD). Associated anomalies significantly correlated with unfavorable outcomes, such as need for intervention (P=0.001), risk of developing postnatal recurrent urinary infections (P=0.025), vesicoureteral reflux (P=0.001) and CKD (P=0.010). Progression during pregnancy correlated with vesicoureteral reflux (P=0.002) and development of anomalies in the contralateral kidney (P=0.012). DAP measurement did not reliably predict postnatal complications (AUC=0.590, P=0.191). Unilateral renal anomalies are often associated with other congenital anomalies, influencing postnatal outcomes. DAP measurement was not a significant predictor of postnatal complications. Comprehensive prenatal ultrasound assessments are critical for guiding parental counseling, pregnancy management, and postnatal care.
Endometrial carcinoma (EC) is the most common gynecologic malignancy in the USA, with surgical staging as the cornerstone of treatment. Although most patients are diagnosed at an early stage, adjuvant therapies, including external beam radiation therapy (EBRT), vaginal brachytherapy (VBT), and systemic treatments, are employed in select cases to reduce recurrence risk. This review highlights data from randomized controlled trials assessing the efficacy of adjuvant radiotherapy in early-stage EC. For low-risk EC, studies suggest that postoperative brachytherapy has minimal impact on locoregional recurrence and is not recommended without significant uterine risk factors. In intermediate-risk EC, trials such as GOG 99 and PORTEC-1 demonstrated reduced recurrence with pelvic RT, particularly in high-intermediate risk subsets, though overall survival benefits were not observed. For high-intermediate risk EC, PORTEC-2 showed that VBT effectively controls vaginal recurrence with less morbidity compared to EBRT, recommending VBT as the preferred modality. Medium-risk cases benefit similarly from VBT alone, as shown in Swedish trials. In high-risk EC, RCTs such as GOG 249 and PORTEC-3 examined the addition of chemotherapy to radiotherapy, finding comparable recurrence and survival outcomes between VBT with chemotherapy and EBRT, though acute toxicity was higher with combined therapy. Across these trials, the degree of lymphovascular space invasion (LVSI), patient age, tumor grade, and histology were key prognostic factors influencing treatment recommendations. Despite advancements in molecular classification and modern radiotherapy techniques, most data derive from earlier studies, emphasizing the need for updated research to refine treatment paradigms.
Vaginal birth after two cesarean deliveries (VBAC2) is increasingly recognized as a reasonable and, in selected cases, preferable option. Current evidence suggests that successful and safe VBAC2 can be achieved, particularly among carefully selected candidates, including grand multiparous women. However, the factors that reliably predict success and reduce maternal and neonatal risk in this population remain insufficiently defined. This retrospective observational study included 541 women with a history of two previous cesarean deliveries who attempted vaginal birth between 2005 and 2022 at a single tertiary teaching hospital. Machine learning models were applied to predict the safety and success of VBAC2 using maternal demographic and clinical characteristics. The primary outcome was successful VBAC2 without uterine rupture. Secondary outcomes included low Apgar score, admission to the Neonatal Intensive Care Unit (NICU), and the need for postpartum blood transfusion. A total of 541 women attempted a trial of labor, and 78.9% achieved a successful VBAC. Uterine rupture occurred in 2.0%. The XGBoost Classifier performed best with a sensitivity of 83%. The most important factors associated with successful VBAC were the time interval since the last cesarean delivery, followed by the number of previous vaginal births and cervical dilatation at admission. Grand multiparous women had significantly higher VBAC2 success rates, while uterine rupture rates remained low. Machine learning models can help predict the likelihood of safe vaginal delivery after two cesarean deliveries, thereby supporting informed decision-making regarding the preferred mode of delivery in this unique population. Predictive modeling in this study showed that grand multiparous women had high VBAC2 success rates (78.9%) with a low risk of uterine rupture (2%); key predictors included prior vaginal birth and cervical dilatation.
The aim of this study was to investigate the association of gestational weight gain with carotid artery intima-media thickness (IMT) during late pregnancy, and the association with metabolic parameters, pregnancy outcome and placental histological assessment. Pregnant patients admitted with signs of labor were prospectively recruited and categorized into two groups: Group 1 included women with excessive weight gain during pregnancy; Group 2 included women with gestational weight gain within recommended range. IMT of the carotid arteries was measured sonographically. Placental histopathology was assessed by an experienced pathologist. The study group included 59 women, 32 in group 1 and 27 in group 2. Mean carotid artery IMT was thicker in group 1 compared with group 2 (0.7 vs. 0.6 mm, P=0.028). Metabolic parameters including blood glucose and insulin resistance, using the homeostasis model assessment-insulin resistance (HOMA-IR) were also significantly higher in women with excessive weight gain during pregnancy as compared with group 2 (P=0.026 and P=0.045, respectively). Gestational age at delivery was similar in the two groups, while birthweight and the rate of macrosomia were significantly higher in group 1 than in group 2 (P=0.033 and P=0.014, respectively). Placental lesions consistent with fetal thrombo-occlusive disease were more prevalent in group 1 than in group 2. Excessive weight gain during pregnancy is associated with increased IMT of the carotid arteries that correlate with abnormal metabolic parameters, adverse pregnancy outcome and abnormal placental findings.