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The traditional World Health Organization (WHO) partograph has been used globally for decades as a standard tool for intrapartum labor monitoring. However, accumulating evidence has challenged its underlying assumptions, particularly the use of rigid cervical dilatation thresholds, and highlighted the need for a more individualized and woman-centered approach to childbirth care. In response, the WHO introduced the Labor Care Guide (LCG) in 2020, aligned with the 2018 WHO recommendations on intrapartum care for a positive childbirth experience. This narrative review aims to examine the scientific rationale, global implementation experience, and policy implications of the WHO LCG, with a particular focus on its relevance and application in the Republic of Moldova. A narrative review of peer-reviewed literature, WHO normative documents, International Federation of Gynecology and Obstetrics position statements, and international implementation studies was conducted. National policy documents and clinical guidelines from the Republic of Moldova were analyzed to contextualize local adoption. International evidence demonstrates that the WHO LCG supports individualized labor monitoring, reduces unnecessary obstetric interventions, and promotes respectful, woman-centered care without compromising maternal or neonatal safety. In 2025, the Republic of Moldova approved a new national guideline on intrapartum care, aligned with WHO principles and the conceptual framework of the LCG. This policy shift reflects a strategic effort to improve the quality of intrapartum care and address ongoing challenges in maternal health outcomes. The transition from the classical WHO partograph to the principles underpinning the WHO LCG represents a significant evolution in intrapartum care. The Republic of Moldova's experience illustrates how countries with a long tradition of structured labor monitoring can adopt WHO-aligned, woman-centered approaches through national policy reform. Ongoing evaluation of implementation, including assessment of healthcare providers' preparedness and perceptions, will be essential to ensure sustainable integration and to maximize potential benefits for maternal and neonatal health.

Although the South-South Cooperation has been recognized as a vital component of the sustainable development goals, there are too few articles that document the benefits of such a collaboration with most of them focused on research and none of them focused on describing capacity building among health professionals nor on health system strengthening through South-South Cooperation. This article covers the importance of healthcare professionals' educational and capacity building exchange programs in the global South.

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We aimed to synthesize current evidence on the clinicopathological features, diagnostic strategies, treatment modalities, and outcomes of gastric-type adenocarcinoma (GAS) of the cervix, a rare and aggressive HPV-independent subtype of cervical adenocarcinoma. A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered on PROSPERO. Comprehensive searches of PubMed, Scopus, ScienceDirect, and Springer were performed and supplemented by manual searches. Eligible studies were English-language case reports or case series describing histologically confirmed GAS, minimal deviation adenocarcinoma, or adenoma malignum. Data were extracted on clinicopathology, diagnostic modalities, treatments, and outcomes. Quality was appraised using the Joanna Briggs Institute checklists. Fifty-nine studies were included, comprising 51 case reports and 8 case series, with a total of 150 patients. The mean age at diagnosis was 52.8 years, most commonly between 41 and 60 years. Vaginal bleeding and discharge were the leading initial symptoms, although over one-third lacked symptom data. Most cases were diagnosed at FIGO stage I-III, while 16% presented with stage IV disease. Radical hysterectomy was the predominant surgical approach, and concomitant chemoradiotherapy was the most frequent non-surgical treatment. IHC consistently demonstrated MUC6 and CK7 positivity, with frequent abnormal p53 and variable p16 expression. Recurrence occurred in 28.7% of patients, predominantly at distant sites, and 5-year survival was only 26.7%. GAS is a rare, distinct, and highly aggressive cervical adenocarcinoma with poor long-term outcomes and limited responsiveness to standard therapy. Improved diagnostic strategies and tailored treatment protocols are urgently needed.

Malnutrition affects approximately 462 million pregnant women globally. Despite initiatives like the productive safety net program (PSNP) in Ethiopia, evidence comparing maternal undernutrition between PSNP beneficiary and nonbeneficiary households remains limited. This study aimed to compare undernutrition and its associated factors among pregnant women in West Belessa District, Central Gondar Zone. A community-based comparative cross-sectional study was conducted from April 1 to April 30, 2025, among 617 randomly selected pregnant women. Data were collected through face-to-face interviews, and nutritional status was assessed using mid-upper arm circumference (MUAC). Data entry was done using EpiData 3.1 and analyzed with STATA 14. Bivariate and multivariate logistic regression analyses identified factors associated with undernutrition, with significance set at P<.05. Model fitness was assessed using the Hosmer-Lemeshow test. The overall prevalence of undernutrition was 44.4% (95% CI: 40.5-48.5). Factors significantly associated with undernutrition included poor nutritional knowledge (AOR=5.73, 95% CI: 3.9-8.4), no prenatal dietary advice (AOR=1.89, 95% CI: 1.27-2.83), poorest wealth index (AOR=3.24, 95% CI: 1.75-6.0), and no habit of eating snacks (AOR=1.47, 95% CI: 1.04-2.16). Undernutrition among pregnant women in West Belessa District remains high. Improving nutritional knowledge, promoting dietary counseling during antenatal care, and addressing socioeconomic disparities are essential to reduce maternal undernutrition.

Tetanus toxoid (TT) immunization is a critical public health intervention for reducing maternal and neonatal mortality. Despite global recommendations, TT coverage remains low in several low- and middle-income countries, including Somaliland. This study aims to assess the prevalence and determinants of TT immunization among pregnant women in Somaliland using the 2020 Somaliland Demographic Health Survey. A cross-sectional analytic study was conducted using the 2020 Somaliland Demographic Health Survey. Data from 2584 women aged 15 to 49 years. STATA 17 was used for analysis. Descriptive statistics were used to examine immunization coverage. The chi-square test was used to identify bivariate associations between TT uptake and explanatory variables. Given the nature of the count outcome and high proportion of zeros, a zero-inflated negative binomial regression model was applied. The result was interpreted using incidence rate ratios with 95% confidence intervals. The model with the lowest Akaike Information Criterion and Bayesian Information Criterion values and the highest log likelihood was selected as the best fit. Only 14.24% of pregnant women received at least two TT doses, while 73.03% received none. Antenatal care (ANC) attendance (IRR=3.93; 95% CI: 3.32-4.66), wealth index, maternal employment (IRR=0.41; 95% CI: 0.23-0.75 for unemployed), institutional delivery, and distance to health facility (IRR=1.17; 95% CI: 1.02-1.34) were significantly associated with TT uptake. Regional disparities and media exposure were associated with a slightly lower rate of TT uptake. TT immunization among pregnant women in Somaliland is alarmingly low and shaped by both socio-demographic and reproductive health factors. Targeted interventions should focus on expanding ANC coverage, reducing geographic and economic barriers, empowering women, enhancing awareness through media, and improving physical access to healthcare facilities. These findings are aligned with Sustainable Development Goal 3 in Somaliland.

Female genital mutilation/cutting (FGM-C) affects more than 230 million women and girls worldwide and carries increased risk of adverse obstetrical outcomes, including obstetrical anal sphincter injury (OASIS). With growing global migration, obstetrical care providers may increasingly encounter individuals affected by FGM-C in historically low-prevalence settings such as the United States. Therefore, it is essential to understand the association between FGM-C and adverse obstetrical outcomes in settings such as the United States to inform evidence-based practice. To estimate the association between FGM-C and OASIS, among inpatient, singleton, vaginal deliveries among people delivering in-hospital in the United States. The secondary objectives were to estimate the association between FGM-C and postpartum hemorrhage and prolonged second stage of labor in this population and the role of episiotomy in mitigating risk of OASIS in this population. We conducted a population-based, retrospective cohort study of pregnant individuals delivering singleton fetuses in the United States using the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) database (2016-2019, inclusive). Exposure and outcome variables were derived using International Classification of Diseases-10 disease and procedure codes. Weighted multivariate logistic regression models were used to estimate the odds ratio (OR) for the association between FGM-C and OASIS and secondary outcomes. During the study period, 2020,780 delivery-related discharges were captured, representing an estimated 10,168,193 singleton vaginal deliveries nationwide using the complex survey design of the NIS. A total of 795 (0.03%) individuals were diagnosed with FGM-C and 39,668 with OASIS (1.4%) during the study period. After adjusting for potential confounders, vaginal deliveries affected by FGM-C had 3.02 times the odds of sustaining OASIS (95% CI: 2.23-4.07), 1.99 times the odds of experiencing postpartum hemorrhage (95% CI: 1.45-2.73), and 2.33 times the odds of a prolonged second stage of labor (95% CI: 1.23-4.39) compared to unaffected individuals. Performance of episiotomy attenuated the risk of OASIS (aOR 1.12, 95% CI: 0.59-2.11). Singleton vaginal deliveries complicated by FGM-C have significantly increased odds of experiencing adverse obstetric outcomes, including OASIS, postpartum hemorrhage, and prolonged second stage of labor. Episiotomy may be protective against OASIS in this population.

Hypertensive disorders of pregnancy (HDP) constitute a group of conditions characterized by elevation of blood pressure detected for the first time after 20 weeks of gestation, with a global prevalence estimated at nearly 10% of all pregnant women. To evaluate the clinical evolution and perinatal outcomes of pregnant women identified with a first elevation of blood pressure after 20 weeks of gestation, from the diagnostic confirmation of the type of HDP, until the termination of pregnancy under conservative management in the hospital. Observational analytical cohort study in pregnant women attended at the Social Security Fund hospital of Panama, from July 1, 2023, to December 31, 2024. Pregnant women &#x2265;20 weeks of gestation were included, identified for presenting a first elevation of blood pressure (140/90 mmHg), who were subsequently confirmed with an HDP diagnosis through a second elevated blood pressure measurement found in a minimum of 4 hours or a maximum of 7 days. During the 18 months of the study, 191 pregnant women were admitted to confirm or rule out HDP. It was confirmed that 20 (10.4%) had white coat hypertension, in 11 (5.8%), chronic hypertension without superimposed preeclampsia was diagnosed, confirming pregnancy-associated hypertensive disorder in 160 (83.8%). 51.2% with a diagnosis of HDP without severity criteria under conservative management developed severity criteria. The pregnancy prolongation time with conservative management was 3 weeks. The average gestational age at the time of termination was 35 weeks, and 30% of the newborns were admitted to the intensive care unit. There were 8 (5%) perinatal deaths: one in utero and 7 neonatal deaths associated with prematurity. This study shows that one in 10 patients with an initial elevation in blood pressure ultimately has a diagnosis of white-coat hypertension, and that nearly half of pregnant women identified with a first elevation in blood pressure after 20 weeks of gestation develop severe features during conservative inpatient management. HDP are dynamic and evolving entities that may progress unpredictably, leading to high rates of prematurity and maternal and perinatal complications.

Postpartum hemorrhage (PPH) is the leading global cause of maternal morbidity and mortality. Tranexamic acid (TXA), an antifibrinolytic agent that has been shown to reduce hemorrhage-related mortality in trauma, is used off-label for the prevention and treatment of PPH, typically in conjunction with uterotonic agents. If TXA is effective in the prevention and management of PPH, this inexpensive medication could improve PPH care and reduce PPH-related morbidity and mortality. The majority of evidence on TXA use for PPH prevention and treatment comes from studies conducted in low- and middle-income countries (LMICs) and may be of less relevance to the U.S. or other high-income contexts. To review recent, high-quality evidence on the use of tranexamic acid (TXA) for the prevention and treatment of postpartum hemorrhage (PPH) in high-income countries (HICs). We searched databases including PubMed, CINAHL, EMBASE, Web of Science, and SCOPUS for recent evidence on the use of TXA for prevention or treatment of PPH. Searches were limited to English-language records of human subjects published between January 2019 and February 2025. Supplementary searches of the grey literature, including Advanced Google Scholar and ClinicalTrials.gov, were also conducted. We used explicit inclusion and exclusion criteria determined a priori following the PECOTS framework. Publication types were restricted to completed randomized controlled trials (RCTs) meeting minimum sample size criteria in their reporting. We also included recent large seminal trials that included HICs in their study population even if they were published prior to January 2019. We identified thirteen recent RCTs conducted in HICs; 3 of these met sample size requirements, and all focused on the use of TXA for PPH prevention. No large RCTs focused exclusively on the use of TXA for PPH treatment in HICs. Studies included a mix of cesarean (2 RCTs) and vaginal (1 RCT) deliveries.Only 2 new, large trials (both on PPH prevention in cesarean deliveries) were published within the last five years. These 2 studies conflicted on whether TXA prevents PPH: the larger RCT (conducted in the U.S.) showed no reduction in PPH (&#x2265;1,000 mL or greater blood loss), and the smaller RCT (TRAAP2 trial, conducted in France) showed that TXA reduced the incidence of PPH overall, and reduced estimated blood loss but not gravimetrically estimated blood loss. However, neither study found TXA effective for preventing clinical outcomes associated with PPH, including the rate of blood transfusions, use of surgical interventions, or ICU admissions. The third RCT (TRAAP trial, conducted in France) was published in 2018 and found that TXA was not effective at preventing PPH, including the rate of blood transfusions and the use of surgical interventions, after vaginal deliveries. Recent, high-quality RCT evidence on the use of TXA in PPH care in high-income countries has shown limited, if any, effectiveness of TXA for PPH prevention in vaginal or cesarean deliveries.

Intravascular leiomyomatosis (IVL) and benign metastasizing leiomyoma (BML) are uncommon variants of uterine smooth muscle tumors that can demonstrate extrauterine spread despite their benign histological appearance. Both lesions are known to be estrogen-dependent, yet their coexistence with gynecologic malignancies-particularly endometrial carcinoma-is exceedingly rare. We present a 51-year-old postmenopausal woman who was admitted with progressive abdominal distension and ecchymotic skin changes over the abdominal wall. Radiologic evaluation revealed a large retroperitoneal mass with multiple solid pelvic lesions. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and resection of a para-aortic mass. Histopathological examination identified 3 concurrent entities: intravascular leiomyomatosis confined to the uterus, benign metastasizing leiomyoma involving para-aortic lymph nodes, and an incidental FIGO stage IA1 endometrioid adenocarcinoma confined to an endometrial polyp. Immunohistochemistry confirmed smooth muscle differentiation (Desmin, h-caldesmon), retained FH expression, low proliferative index (Ki-67 &#x2248; 2%-3%), and wild-type p53 pattern. Postoperative recovery was uneventful, and adjuvant hormonal suppression with letrozole was initiated. The patient remains disease-free during 6 months of follow-up. This case represents an exceptionally rare triple coexistence of IVL, BML, and early-stage endometrial carcinoma. Recognition of such unique associations broadens the understanding of estrogen-dependent uterine neoplasms and emphasizes the need for thorough histopathological and immunohistochemical evaluation. A multidisciplinary approach with long-term hormonal surveillance is recommended to detect recurrence or additional hormone-responsive lesions.

Cervical cancer poses a major health risk in low- and middle-income countries (LMICs), with high morbidity and mortality among women. It is largely preventable through screening and early treatment, but underused programs lead to a heavy burden. The goal is to identify key factors influencing screening, reveal inequities, and improve policies in resource-limited areas. Using recent Demographic and Health Surveys (DHS) data from 19 LMICs, this study estimated lifetime cervical cancer screening among women aged 15 to 49 years. Missing data were removed, and class balancing was performed with synthetic minority oversampling technique. GridSearch optimized hyperparameters before dividing data into training and validation sets. Multiple machine learning algorithms predicted lifetime screening, including decision trees, random forests, gradient boosting, extra trees, XGBoost, LightGBM, and catBoost classifiers. Model performance was evaluated using accuracy, recall, precision, F1 score, and receiver operating characteristics area under the curve. The analysis of 261,371 women aged 15 to 49 from the DHS found that random forest achieved 80% accuracy, 87% precision, 80% recall, and an 80% F1 score, while extra trees achieved 79%, 87%, 79%, and 83%. Key predictors included household size, wealth, women's age, and education. Ensemble methods such as random forests and extra trees demonstrated strong generalization, making them useful for targeted interventions. Ensemble algorithms such as random forests and extra trees predict lifetime cervical cancer screening with &#x223c;80% accuracy in LMICS. The study emphasizes targeted awareness, education, and age-sensitive screening. Findings will be tested in other populations to support clinical decision systems.

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Vestibulodynia is the most common subtype of vulvodynia and is characterized by persitent, contact-evoked pain localized to the vulvar vestibule. Increasing evidence supports a neuropathic pain mechanism in vestibulodynia, including vestibular hyperinnervation, neuroinflammation, and overexpression of the transient receptor potential vanilloid 1 receptor. Despite this, there are no standardized treatment protocols, and available therapies often provide incomplete relief or are limited by systemic side effects. Targeted topical therapies may offer advantages by acting directly on peripheral pain generators. Resiniferatoxin, a highly potent transient receptor potential vanilloid 1 receptor agonist, induces long-lasting desensitization of nociceptive fibers and may represent a novel therapeutic option for vestibulodynia. To evaluate the clinical efficacy, tolerability, and neurophysiological effects of topical resiniferatoxin cream applied to the vulvar vestibule in women with vestibulodynia. This was a prospective, observational pilot study. Premenopausal women aged &#x2265;18 years with a diagnosis of vestibulodynia lasting at least 3 months were enrolled. Participants applied topical resiniferatoxin 10 mcg/mL cream to the vulvar vestibule once daily for 4 weeks using a standardized dosing dispenser. Outcomes included patient-reported pain intensity (visual analog scale for pain and dyspareunia), vestibular cotton swab test scores, levator ani muscle tone, and vestibular current perception thresholds at 2000, 250, and 5 Hz. Baseline and 1-month follow-up values were compared using the Wilcoxon signed-rank test and McNemar test, as appropriate. Twenty-four women were enrolled (median age 31 years; median vestibulodynia duration 66 months). Most participants reported a transient, tolerable burning sensation after resiniferatoxin application; 5 women (20.8%) discontinued treatment due to local discomfort. Among participants with complete follow-up, significant improvements were observed at 1 month in provoked vulvar pain and dyspareunia, with median Visual Analog Scale reductions of 2.0 (P=.01) and 2.5 (P=.01) points, respectively. Vestibular cotton swab test scores also improved. current perception thresholds values increased significantly at 250 Hz and 5 Hz, indicating reduced sensitivity of A&#x3b4; and C fibers, while no significant change was observed at 2000 Hz. A reduction in levator ani hypertonicity was observed but did not reach statistical significance. Topical resiniferatoxin was associated with meaningful reductions in vulvar pain and dyspareunia and with objective improvements in vestibular nerve fiber sensitivity in women with vestibulodynia. These findings support the role of transient receptor potential vanilloid 1 receptor-mediated peripheral mechanisms in vestibulodynia and suggest that resiniferatoxin may be a promising targeted therapy. Larger, placebo-controlled trials with longer follow-up are warranted to confirm these preliminary results.

Pregnancy-Induced hypertension (PIH) remains a major contributor to maternal and fetal illness and death. Enhancing knowledge and implementing preventive measures for PIH among pregnant women is crucial for achieving positive health outcomes. This study explored the level of knowledge and the associated factors among pregnant women in Africa. A comprehensive literature search was conducted on June, 2025, using international electronic databases including PubMed, Google Scholar, Hinari, Medline, and Open Google to assess the pooled awareness of pregnancy-induced hypertension and its associated factors among pregnant women. Two authors independently screened and extracted relevant data from the eligible studies. The collected data were compiled in Excel and subsequently analyzed using STATA version 11. Heterogeneity among the studies was assessed using the I&#xb2; statistic, while potential small study effects were evaluated through graphical methods and Egger's test, with a significance threshold set at 5%. Subgroup and sensitivity analyses were also performed. A total of eight studies met the inclusion criteria and were incorporated into the systematic review and meta-analysis. The meta-analysis revealed significant associations between PIH knowledge and several factors: educational status (AOR&#x202f;=&#x202f;4.88, 95% CI: 1.73-13.79), history of previous births (OR&#x202f;=&#x202f;2.04, 95% CI: 1.30-3.19), and employment status (OR&#x202f;=&#x202f;2.85, 95% CI: 1.26-6.44). However, due to the limited number of studies addressing each specific variable, the evidence was insufficient to establish conclusive links between PIH knowledge and other factors such as primi gravida status, socioeconomic status, maternal age, sources of information, marital status, maternal nutrition, antenatal care attendance, place of residence, and other related variables. Awareness of PIH is typically lower among women with a personal or family history of the condition, first-time mothers (primiparous women), and those with limited educational attainment, compared to their respective counterparts. To address this gap, increased investment in women's health is essential, with healthcare providers giving particular attention to those at higher risk due to limited PIH knowledge. Moreover, targeted interventions should aim to improve educational opportunities for women and raise awareness about the risk factors associated with PIH.

Hypertension in the young is defined as the occurrence of elevated blood pressure in patients aged <40 years. It is unusual for hypertension to be present before the second decade of life and more so in a pair of siblings. This study aimed to report a case of a sibling pair (18- and 16-year-olds), reared as females, who presented with primary amenorrhea and resistant hypertension. The initial presentation was hypertension. The siblings were treated with escalating doses of antihypertensive agents, including calcium channel blockers, beta-blockers, and diuretics, with suboptimal control. Primary amenorrhea led to an endocrine referral, and detailed evaluation revealed obesity, acne, atypical external genitalia, and palpable gonads. The hormonal panel showed low cortisol, elevated adrenocorticotropic hormones, and progesterone, along with hypokalemia, raising the possibility of a rare congenital adrenal hyperplasia due to 17-alpha-hydroxylase deficiency. The siblings had a 46 XY karyotype, and CYP17A1 gene sequencing revealed a homozygous deletion of c.157_159TTC of the phenylalanine codon (thymine-thymine-cytosine) at amino acid position 54 (p.Phe54del) in exon 1, confirming our diagnosis. The siblings were treated with glucocorticoids and spironolactone, which remarkably improved the blood pressure, coupled with the gradual withdrawal of all antihypertensive agents. Psychological evaluation established a preference for the female gender. The siblings underwent bilateral gonadectomy with vaginoplasty, along with estrogen replacement therapy. Hypertension in the young suggests a secondary etiology, including renovascular and endocrine conditions. Our report highlights the CYP17A1 gene mutation, a rare form of monogenic hypertension presenting in phenotypical females with a male genotype.

Glycogen storage disease type I (GSDI) is caused by biallelic pathogenic variants in the gene encoding the glucose-6-phosphatase complex. Deficiency of this enzyme in the liver, kidneys, and intestines leads to glycogen accumulation in these organs and, consequently, to inadequate glucose production due to impaired glycogenolysis and gluconeogenesis. The condition is rare, and only a limited number of cases have been reported in pregnant women with favorable maternal and perinatal outcomes. This is partly because GSDI has been associated with significant morbidity, including maternal metabolic disturbances, renal and/or hepatic disease, preeclampsia, and fetal growth restriction, among other complications. We present the case of a 23-year-old woman with a diagnosis of GSDI who was evaluated at 19 weeks of pregnancy and managed according to a multidisciplinary protocol, resulting in a favorable perinatal outcome. This case highlights the need for clinical management protocols with specific strategies during the preconception period, pregnancy, delivery, and postpartum, aimed at preventing complications and improving maternal and perinatal outcomes.

Virtual Reality (VR) is increasingly used in medicine for pain and anxiety management. It has been frequently studied in the field of Gynecology and Obstetrics and found effective during labour. However, its application during (outpatient) gynecological procedures as pain and anxiety management remains underexplored. This systematic review with meta-analysis aimed to study the effect of VR on pain, anxiety and patient experiences when provided during (outpatient) gynecological procedures. A systematic review was performed, by systematically searching PubMed, Embase, APA PsycInfo and Web of Science (Core Collection) from inception to March 20th 2024. Articles on the effect of VR on pain (VAS or NRS) and anxiety (all measurement tools) during (outpatient) gynecological procedures were included. Study designs had to be randomized controlled trials (RCTs) or cohort studies. Data were collected independently by two reviewers. A meta-analysis was performed to calculate mean differences (MD) with 95% Confidence Intervals (95%CI), Sensitivity analyses and a subgroup analysis were performed. Thirteen RCTs, published between 2015 and 2024, reporting on VR during (outpatient) gynecological procedures for benign conditions were included. Virtual Reality significantly improved overall pain scores (MD -0.95 (95%CI -1.44 to -0.47); n=12, I2=77%; scale 0-10), preprocedural anxiety (MD -3.33 (95%CI -5.84 to -0.82); n=5, I2=5%; scale 0-100) and postprocedural anxiety (MD-15.83 (95%CI -29.39 to -2.17); n=6, I2=93%; scale0-100). The meta-analysis suggests that VR could positively influence overall pain and procedural anxiety. Not all studies reported on all outcome measures which might have introduced reporting bias and lead to an overestimation of the effect of VR. Future studies should further study the correlation between pain and anxiety and the effect of VR on this. However, VR provides an alternative to pain medication, without the risks associated with pharmaceuticals, making it an attractive option.

To assess the magnitude, associated factors, and immediate outcomes of nonreassuring fetal heart rate status (NRFHRS) among laboring mothers in Ethiopia. Systematic review and meta-analysis. Data were extracted from published articles identified by searching using major bibliographic databases such as PubMed/Medline, Cochrane Library, Virtual Health Library (VHL) Regional Portal, HINARI (research4life), and Google Scholar. The meta-analysis included all observational studies on NRFHRS among laboring mothers in Ethiopia published in English between 2010 and 2024. Unpublished studies were also considered, and studies without abstracts or full texts were excluded. Using PRISMA standards, we systematically reviewed and meta-analyzed articles from PubMed, Cochrane Library, and Google Scholar. Q and I2 tests were used to assess heterogeneity across studies. To evaluate the national magnitude and effect size of the linked covariates, a weighted inverse variance random effects model was used. Funnel plots and Egger regression tests were used to examine publication bias. Sensitivity analysis was also performed to determine the impact of the studies. The analysis included 10 studies with 5949 participants used in the analysis. The pooled magnitude of nonreassuring fetal heart rate (NRFHR) in Ethiopia was 23.29% (14.89, 31.69) augmentation of labor (AOR=3.8; 95% CI: 2.51-5.10; I2=0.00%; P=.98), being primiparas (AOR=2.33; 95% CI: 1.84-2.84; I2=92.66%; P=.00), meconium stained amniotic fluid (AOR=5.97; 95% CI: 3.01-8.93; I2=83.31%; P=.00), mothers who are not referred (AOR=2.65; 95% CI: 3.01-8.93; I2=98.21%; P=.00), and no antenatal follow up (AOR=4.08; 95% CI: 2.79-5.37; I2=97.46%; P=.00) respectively were significantly associated with nonreassuring fetal heart rate in Ethiopia. The magnitude of the NRFHR in Ethiopia remains high, worsened by factors such as labor augmentation, primiparity, meconium-stained amniotic fluid, and lack of antenatal care follow-up, which are associated with adverse outcomes. These include heightened risks of neonatal intensive care unit admission, low Appearance, Pulse, Grimace, Activity, and Respiration scores, perinatal death, and a greater likelihood of needing caesarean section. The critical need for vigilant monitoring and timely intervention is evident to enhance the health of maternal and neonatal outcomes in such cases.

To determine whether higher-dose aspirin (150-162 mg/d) reduces preeclampsia risk compared with lower-dose aspirin (75-81 mg/d) in pregnant women at elevated risk, using pooled evidence from all available head-to-head randomized controlled trials. PubMed/MEDLINE, Cochrane CENTRAL, Embase, Scopus, and ClinicalTrials.gov were searched from inception through April 27, 2026. Parallel-group randomized controlled trials comparing at least two aspirin dose arms (head-to-head dose comparison) in pregnant women at elevated risk for preeclampsia, with a binary preeclampsia outcome reported. Aspirin-vs-placebo trials were excluded. Log odds ratios were pooled using restricted maximum likelihood (REML) estimation with the Hartung-Knapp-Sidik-Jonkman (HKSJ) correction. Risk of bias was assessed using the Cochrane RoB 2 tool; evidence certainty was graded using GRADE. Egger's test, Duval-Tweedie trim-and-fill, and univariate meta-regression (geography, dose ratio, gestational age at initiation) were performed. Six randomized controlled trials enrolling 1099 participants across five countries were included. REML+HKSJ pooled OR 1.93 (95% CI 0.84-4.42, P=.096; I&#xb2;=64.9%), representing approximately 48% lower odds of preeclampsia with higher-dose aspirin, a clinically substantial effect size that did not reach conventional statistical significance, primarily due to limited sample size (N=1099) and substantial between-study heterogeneity. Egger's test was significant (P=.010); trim-and-fill estimated three missing studies (adjusted OR 1.92, 95% CI 1.47-2.50). No significant dose advantage was seen in North American trials (OR 1.25, 95% CI 0.67-2.34). A safety signal for placental abruption was identified with higher-dose aspirin in one large trial (8 vs 0 events). GRADE certainty: Very Low. Applying conservative statistical methods (REML+HKSJ), higher-dose aspirin (150-162 mg/d) was associated with approximately 48% lower odds of preeclampsia vs lower-dose aspirin (75-81 mg/d; OR 1.93), a clinically meaningful effect that did not reach conventional statistical significance (95% CI 0.84-4.42, P=.096) due to limited sample size and heterogeneity. Clinical significance and statistical significance must be considered independently; the magnitude of this effect warrants serious attention in guideline discussions. A placental abruption safety signal warrants further investigation. Larger, harmonized head-to-head trials with preterm preeclampsia as the primary endpoint are needed.