Diagnostic accuracy of plasma microRNA as a potential biomarker for detection of endometriosis

Endometriosis is a complex condition with a wide range of clinical manifestations, presenting significant challenges, particularly for young women. Its diverse and often perplexing presentations pose difficulties within the medical community. Laparoscopy remains the gold-standard diagnostic tool for endometriosis. However, alternative diagnostic methods are valuable for monitoring disease progression, assessing the likelihood of recurrence, reducing the need for surgical procedures, and facilitating timely decisions regarding fertility concerns. Recent research highlights the potential of microRNAs (miRNAs) as an alternative diagnostic test for endometriosis. A case-control study was conducted at the infertility unit of Arash Women's Hospital, involving 50 female participants, 25 with endometriosis and 25 without it. Plasma samples were collected and analyzed for the expression levels of 16 miRNAs using quantitative reverse transcription polymerase chain reaction (qRT-PCR). Diagnostic accuracy measures were evaluated to establish a reliable and comparable diagnostic framework. Compared to the control group, downregulation of 11 miRNAs and upregulation of 5 miRNAs were observed in the case group. Regarding expression patterns, evidence from this study indicates that half of the evaluated miRNAs fall into the high-agreement category with similar studies. Sensitivity (SN) of the evaluated miRNAs ranged from 64.0% to 88.0%, while specificity (SP) ranged from 56.0% to 88.0%. The area under the curve (AUC) was reported between 0.619 (miR-135a) and 0.846 (miR-340). These findings suggest that the evaluated miRNAs demonstrate moderate to acceptable diagnostic accuracy for endometriosis.

The role of maternal age, markers of ultrasound, sFlt-1 and CA125 serum levels in the prediction of miscarriage: Study acronym: MIS-CARE (markers of ultrasound, immunologic and serum factors in the comprehensive analysis of the risks for early pregnancy loss)

OBJECTIVE

To evaluate the effectiveness of combining sociodemographic factors, circulating endothelial growth factor-1 (sFlt-1), cancer antigen 125 (CA125), placental growth factor (PLGF), along with ultrasound measurements of crown-rump length (CRL), and fetal heart rate (FHR) in assessing the risk of spontaneous abortion, and to develop a predictive model for miscarriage risk.

METHODS

Between 2020 and 2023, we conducted a prospective observational study involving 235 pregnancies. Participants were divided into 2 groups - viable pregnancies and miscarriage before the 14th week of gestation. We recruited all patients at 6.0 to 6.6 weeks of gestation. At that point, demographic data was collected, and the first measurements of CRL and FHR were performed. Blood samples were taken for sFlt-1, PLGF, and CA125 analysis. Consequent visits were appointed every 2 weeks, which included a US scan and repeated blood serum tests. The outcome variable was early pregnancy loss, defined by the occurrence of spontaneous abortion (SA) before 14 weeks of gestation.

RESULTS

Our study has shown that in cases with first-trimester pregnancy loss, the FHR and sFlt-1 were consistently decreased, while MA and CA125 were increased. We observed that a combination of MA, FHR, CRL, CA125, and sFlt-1 can reliably identify singleton pregnancies at risk of spontaneous abortion before 14 weeks of gestation. Each additional variable substantially improved the prediction characteristics, suggesting a good stepwise discriminatory performance of the overall model. The combination of all variables achieved a DR of 73,53 %, and more importantly - clinically feasible Positive Predictive Value (PPV) of 75,81 %, and high Negative Predictive Value (NPV = 94,75 %) levels.

CONCLUSION

Combining maternal age, FHR, CA125, and sFlt-1 can reliably identify singleton pregnancies at risk of spontaneous abortion before the 14th week of gestation. To our best knowledge, this is the first SA prediction model combining CA125 and sFlt-1 serum markers with well-established US modalities and demographic characteristics. External validation would be required before adopting the proposed prediction model in clinical practice.

Advances in Imaging for Placenta Accreta Spectrum Disorder

Placenta accreta spectrum (PAS) is a disorder secondary to abnormal development of placental trophoblasts, resulting in invasion of the maternal uterine tissue beneath the placenta. The incidence of PAS continues to rise as a result of several factors, with the most common being the increasing number of cesarean deliveries. The diagnosis of PAS carries significant increased risk of maternal morbidity and mortality from maternal hemorrhage, surgical complications, and need for critical care services. Accurate prenatal diagnosis is critical to ensure optimized resources and surgical planning before delivery. Advances in ultrasonography, magnetic resonance imaging, and computed tomography, which have improved antenatal diagnosis, are described in this article.

Imaging Modalities for the Diagnosis of Placenta Accreta Spectrum

Placenta accreta spectrum (PAS) is the result of the invasion of the placental trophoblasts into the myometrium. The rate of PAS continues to increase due to the increased number of cesarean sections. Other risk factors include increasing maternal age, multiparity, uterine surgeries, and placenta previa. Due to the high risk of maternal morbidity and mortality, prenatal diagnosis is essential to ensure proper resources and surgical planning before delivery. Ultrasound is considered the gold standard for diagnosis of PAS. Ultrasound findings include placental lacuna, loss of placental clear space, lower uterine segment thickness, and increased vascularity between the placenta and bladder.

Ultrasound versus magnetic resonance imaging features in diagnosing placenta accreta: A systematic review and meta-analysis

OBJECTIVE

The purpose of this study is to conduct a complete analysis of the accuracy of ultrasound and MRI in detecting placenta accreta spectrum (PAS) disorders, as well as to investigate the accuracy of independent imaging findings in these diseases.

METHODS

Pubmed, Web of Science, Embase, The Cochrane Library, and Google Scholar databases were searched from their establishment to January 1, 2025. Included were all studies that used both ultrasonography and MRI to diagnose pregnant women with PAS disorder. The ability of ultrasonography, MRI, and their independent features to diagnose PAS was evaluated using pooled sensitivity, specificity, diagnostic odds ratio (DOR), and receiver operating curves (ROC). Heterogeneity was calculated using Cochran Q and I2 statistics, and the sources of heterogeneity were investigated using meta-regression and subgroup analysis.

RESULTS

Following a series of rigorous assessments, the meta-analysis comprised 1989 pregnant women from 30 studies. The sensitivity and specificity of ultrasonography for the diagnosis of PAS were 0.87 (95 % CI, 0.82-0.90) and 0.83 (95 % CI, 0.77-0.88), respectively, whereas the sensitivity and specificity of MRI for the same diagnostic were 0.87 (95 % CI, 0.82-0.90) and 0.84 (95 % CI, 0.80-0.88). Intraplacental lacunae has the best diagnostic accuracy of ultrasound, while placental bulge has the highest diagnostic accuracy of MRI, with their area under the curve (AUC) of the ROC being 0.76 (95 % CI, 0.72-0.79) and 0.89 (95 % CI, 0.85-0.91), respectively.

CONCLUSION

The diagnostic accuracy of ultrasound and MRI for PAS was similar. However, radiographic findings should not be utilized to make an independent diagnosis of PAS disorders.

Impact of body weight on IVF: pathophysiology, outcomes, and clinical considerations

PURPOSE OF REVIEW

This study aimed to examine if excess body weight impacts the outcomes of IVF treatment cycles.

RECENT FINDINGS

While data on the effect and/or association of excess weight on IVF outcomes continue to produce mixed results, recent studies stratifying analyses by age are yielding clarity on a detrimental potential of obesity on IVF outcomes. Specifically, IVF outcomes in the third decade of life are susceptible to adverse implications of excess weight, as reflected in lower clinical pregnancy and live birth rates. Plausible pathogenic mechanisms underlying the detrimental impact of excess weight on IVF outcomes include inflammation, DNA repair, insulin resistance, and the targets of such mechanisms that include the spectrum of players critical to reproductive success, including the oocyte, sperm, embryo, and uterine receptivity.

SUMMARY

The detrimental implications of excess weight on IVF outcomes are more pronounced by age, and inflammatory processes seem to be particularly relevant to the interplay of weight excess, adiposity, and IVF cycle outcomes.

Evaluating the Effects of Sports Bra Design, Body Composition, Metabolic Markers, and Sex Hormones on Kinetic Measures of Postural Control in Full-Busted Women During Physical Activity

Due to inadequate commercial availability of sports bras designed with adequate breast support for full-busted women (cup size D and above), breast discomfort can be a significant barrier to exercise. In this study, postural characteristics during dynamic physical activities were evaluated for 20 full-busted women in 3 different sports bra conditions, 2 of which were bras designed specifically for full-busted women. Participants performed quiet standing, walking, jumping jacks, high knees, and running tasks on a force plate treadmill in each condition to collect postural measures associated with center of pressure (COP). COP measures were also evaluated with respect to body composition, metabolic health markers, and sex hormone profiles. COP measures were larger in high knees and jumping tasks with respect to quiet standing. Across running speeds, conventional bras were associated with the largest COP metrics. Analysis of covariance analysis indicated increased anthropometry measures such as mass and body fat percentage resulted in decreased COP area and favored mediolateral orientation. Luteinizing hormone, estradiol, progesterone, testosterone, and sex hormone-binding globulin were all found to impact statistical models, indicating the importance of incorporating a comprehensive hormone panel when considering the impact subject-level variations have on motor function.

The role of mitochondrial DNA copy number in spent culture medium in predicting outcomes of single blastocyst transfer

PURPOSE

To evaluate the value of mtDNA copy number measurement in spent culture medium of blastocysts for predicting the chance of implantation following single blastocyst transfer (SBT).

METHODS

Copy numbers of mtDNA and genomic DNA (gDNA) were determined using multiplex PCR and NGS and modeled to predict implantation following SBT using a generalized linear model (GLM), generalized additive model (GAM), and extreme gradient boosting (XGBoost). The predictive power of the models was demonstrated and compared with the area under the receiver operating characteristic curve (AUC-ROC).

RESULTS

Neither the mtDNA copy number nor the mtDNA/gDNA provided meaningful discriminatory power for prediction in GLM and GAM models. However, higher gDNA quartiles were associated with a negative correlation with pregnancy (OR 0.92, 95% CI 0.85, 1) and an interaction with mtDNA, suggesting that gDNA should not be used to normalize mtDNA copy number. An XGBoost model, which considered both mtDNA and gDNA values, demonstrated an AUC of 0.837 (95% CI 0.800, 0.874).

CONCLUSIONS

The mtDNA copy number in spent medium alone may not be a reliable predictor of pregnancy, and dividing mtDNA by gDNA could distort the outcome. Alternatively, a model that makes full use of the interaction of the values may improve the prediction power.

Platelet-Rich Plasma (PRP) in Reproductive Medicine: A Critical Review of PRP Therapy in Low-Reserve and Premature Ovarian Insufficiency

Background: Intraovarian platelet-rich plasma (PRP) has emerged as a novel intervention at the intersection of reproductive medicine and regenerative biology. As women with diminished ovarian reserve (DOR), poor response to stimulation, or premature ovarian insufficiency (POI) seek fertility solutions, PRP provides a scientifically plausible-yet exploratory-strategy to restore or augment ovarian function. The proposed pathways include the stimulation of local stem cells, tissue remodeling, neoangiogenesis, and the potential reawakening of dormant follicles. Methods: This narrative review critically synthesizes the existing literature on intraovarian PRP therapy. It draws from published case series, pilot studies, and preclinical data to evaluate the biological rationale, clinical outcomes, and current limitations of PRP use in women with DOR and POI. Results: Early clinical findings, albeit limited to modest case series and pilot investigations, reveal promising outcomes such as improved ovarian reserve markers, menstrual restoration, and infrequent spontaneous pregnancies in women who had previously been unresponsive to treatment. However, the variability in preparation techniques, patient selection criteria, and outcome measures limits the generalizability of these results. Conclusions: While intraovarian PRP presents an exciting frontier in reproductive medicine, the absence of defined protocols, controlled trials, and long-term safety data underscores its experimental nature. Future research should focus on standardizing methodologies, conducting randomized controlled trials, and elucidating the molecular mechanisms underlying observed clinical effects to establish PRP's role in managing poor ovarian response and POI.

Saliva-based Hormone Diagnostics: advances, applications, and future perspectives

INTRODUCTION

Saliva has emerged as an important biological fluid for diagnostics, particularly hormone analysis. Its noninvasive collection and accessibility make it a compelling alternative to traditional blood-based diagnostics, enabling detection of biomarkers reflecting physiological and pathological conditions.

AREAS COVERED

This review examines hormones measurable in saliva, including cortisol, testosterone, progesterone, estradiol, dehydroepiandrosterone (DHEA), and others. It highlights methods such as Enzyme-Linked Immunosorbent Assay (ELISA), Radioimmunoassay, and Liquid Chromatography coupled with Tandem Mass Spectrometry (LC-MS/MS) for hormonal analysis, focusing on their sensitivity and challenges. The discussion addresses the advantages and limitations of saliva as a diagnostic medium, including practicality and susceptibility to external influences. Clinical applications are explored, including stress monitoring, hormonal dysfunction diagnosis, and applications in personalized medicine.

EXPERT OPINION

Salivary diagnostics holds significant potential in clinical and research contexts, particularly for hormone analysis. Despite challenges such as hormonal variability and technical limitations, advances are steadily overcoming these barriers. The noninvasive and accessible nature of saliva collection positions it as a promising medium for diagnostic innovation. Continued research, coupled with standardization of techniques, will be critical to fully harnessing saliva-based diagnostics for advancing personalized medicine, influencing the detection, diagnosis, and prognosis of certain conditions.

Fetal Aortic Isthmus Doppler Evaluation in Pre-Eclampsia Patients

PURPOSE

This study aimed to evaluate the role of fetal aortic isthmus (AoI) Doppler parameters in predicting adverse perinatal outcomes in pre-eclampsia patients.

METHODS

This prospective study included 60 pre-eclampsia patients (divided into early-onset [EOPE] and late-onset [LOPE] groups) and 74 controls from Ankara Etlik City Hospital. Doppler parameters-such as aortic isthmus flow index (IFI), systolic/diastolic ratio (S/D), pulsatility index (PI), and resistive index (RI)-were collected, and their associations with adverse perinatal outcomes were analyzed using ROC analysis.

RESULTS

In the EOPE group, gestational age, birth weight, and APGAR scores were significantly lower compared to the LOPE and control groups (p < 0.001). The EOPE group also showed significantly higher rates of NICU (neonatal intensive care unit) admission, preterm birth, respiratory distress syndrome, and need for mechanical ventilation (p < 0.001). The cut-off values for IFI (> 1.13) and AoI S/D (> 7.42) were found to be significant predictors of adverse perinatal outcomes.

CONCLUSION

AoI Doppler parameters may aid in predicting adverse neonatal outcomes in pre-eclampsia patients. The values of IFI, S/D, PI, and RI show potential as useful tools in clinical management, especially in monitoring high-risk pregnancies.

Research hotspots and trends in unexplained recurrent spontaneous abortion (URSA) from 2014 to 2024: a bibliometric analysis

Introduction

Recurrent spontaneous abortion (RSA) represents a significant challenge in obstetrics and reproductive medicine. Causative factors in 40%-50% of RSA couples remain unknown, a condition termed unexplained recurrent spontaneous abortion (URSA). This study employed bibliometric analysis to elucidate global research trends and identify key areas of interest in URSA.

Methods

We utilized the Web of Science Core Collection (WoSCC), including Science Citation Index Expanded (SCI-EXPANDED) and Social Sciences Citation Index (SSCI), as our data source. Our search encompassed all publications on URSA published between 1 January 2014 and 30 October 2024. Following rigorous removal of duplicates, we retained 586 relevant publications, including 532 original articles and 54 reviews. We conducted bibliometric analysis using CiteSpace, VOSviewer and Microsoft Excel.

Results

Analysis of annual publications and their citations demonstrated significant growth over the last 10 years. China, the United States and Iran emerged as the most productive countries in the field. Author distribution indicated the absence of a cohesive core author group, suggesting a dispersed research community. The top five cited publications included one prospective observational study, one randomized controlled trial, two reviews, and one immunohistochemistry study, focusing on the etiology, interventions, and therapies of URSA. Keyword cluster analysis identified six categories, with the top three keywords being "expression," "polymorphisms," and "regulatory T-cells."

Conclusion

This bibliometric analysis reveals three key research domains over the last decade in URSA: immunological mechanism and therapies, genetic mechanism, and anticoagulation therapies. While these areas have advanced our understanding, limitations persist in etiological heterogeneity and therapeutic inconsistencies. Future studies should prioritize rigorous multicenter trials with phenotypic stratification, and multi-omics approaches for mechanistic insights. Enhanced global collaboration and interdisciplinary integration are essential to transition from empirical management to evidence-based precision medicine in URSA.

Efficacy and safety of intravenous administration of dexamethasone on post-cesarean delivery pain: a systematic review and meta-analysis of current literature

BACKGROUND

Surgical tissue trauma induced by cesarean delivery serves as a pivotal stimulus for initiating the activation of nociceptors, leading to severe postoperative pain. Dexamethasone seems to mitigate pain-elicited inflammatory response and potentially serve as an analgesic adjunct in the post-cesarean period. This systematic review and meta-analysis aimed to assess the administration of intravenous dexamethasone for post-cesarean pain management.

METHODS

An electronic database search involving PubMed, Scopus, CENTRAL, and the Public Library of Science was conducted to identify all randomized controlled trials (RCTs) pertinent to the analgesic efficacy of intravenous dexamethasone compared with placebo for cesarean delivery. The risk of bias and certainty of evidence in eligible trials were assessed using the ROB2 tool and the GRADE approach, respectively.

RESULTS

Seventeen RCTs were included in the qualitative analysis, and 15 in the quantitative analysis. Intravenous dexamethasone was associated with prolonged time to first request for rescue analgesia (mean difference [MD] 3.33 hours, 95% CI 1.67 to 4.99; I2 = 92.7%), lower opioid analgesic consumption (MD, -3.23 mg; 95% CI, -4.04 to -2.41; I2 = 67.5%) within 24 hours and improved pain scores up to 24 hours postoperatively compared with placebo, however prediction intervals failed to confirm these favorable effects. The risk of postoperative nausea and vomiting was reduced with intravenous dexamethasone, but not that of pruritus.

CONCLUSIONS

Intravenous perioperative dexamethasone seems to be a promising adjunct to established analgesic modalities in cesarean delivery, with prolonged time to first request for rescue analgesia, reduced analgesic consumption, and reduced pain scores at rest up to 24 hours postoperatively. However, the substantial heterogeneity and low certainty of available evidence preclude any definite conclusions from being drawn.

Efficacy and safety of acupuncture as an adjuvant therapy for osteoporosis: a systematic review and meta-analysis of randomized controlled trials

Objective

To systematically evaluate the efficacy and safety of acupuncture as an adjuvant therapy for osteoporosis (OP) through a comprehensive synthesis of recent randomized controlled trial (RCT) evidence.

Methods

A systematic literature search was conducted across PubMed, Web of Science, CNKI, and Wanfang databases (2014 - 2024) to identify RCTs investigating acupuncture combined with conventional therapy for OP. Study quality was appraised using the Cochrane Risk of Bias tool, and meta-analyses were performed using RevMan 5.4 and Stata 15.0, with subgroup analyses stratified by intervention type, population characteristics, and treatment duration.

Results

28 RCTs (n=2,758) were included. Meta-analysis revealed acupuncture significantly enhanced bone mineral density (BMD) versus controls: total (SMD = 0.47, p = 0.03), femoral neck (MD = 0.05, p = 0.01), lumbar spine (SMD = 0.40, p < 0.001), Ward's triangle (MD = 0.07, p = 0.02), and hip (SMD = 0.55, p < 0.001), with particularly marked improvements in the postmenopausal osteoporosis subgroup. Acupuncture demonstrated significant improvements in treatment efficacy, biochemical markers, pain scores, and symptom assessments, while reducing adverse events. Warm needle moxibustion outperformed controls in femoral neck (MD = 0.07, p = 0.002) and hip BMD (SMD = 0.87, p < 0.001), while electroacupuncture significantly elevated serum calcium (MD = 0.18, p = 0.02). Short-term interventions (≤ 3 months) demonstrated optimal efficacy.

Conclusion

Acupuncture demonstrates efficacy and safety as an OP adjuvant therapy. Current evidence is limited by regional bias and methodological heterogeneity. Multicenter, large-sample RCTs are needed to standardize protocols and validate long-term therapeutic efficacy.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024499354.

The Impact of Maternal Obesity on the Duration of Labor Stages in Dinoprostone-Induced Vaginal Delivery

Objective: Dinoprostone vaginal inserts are widely used as one of the primary pharmacological methods for labor induction. In this study, we aimed to investigate whether BMI affects the duration of the different phases of labor in pregnant women undergoing vaginal delivery induced with slow-release dinoprostone. Methods: A prospective study was conducted on pregnant women at a tertiary maternity hospital between August 2021 and February 2023. Patients were categorized into three groups according to BMI: normal-weight, overweight, and obese. The duration of total labor and each phase of induced labor was recorded. Multivariate analysis was used to determine the association between maternal obesity and the duration of each phase of the labor process. Results: The final analysis included 205 women who received slow-release dinoprostone for labor induction. The mean maternal age was significantly lower in the normal-weight group (p < 0.01). The obese group showed a higher need for oxytocin augmentation and had a higher median infant birth weight compared to the normal and overweight groups. After adjusting for confounders, multivariate linear regression analysis showed that the duration of the latent phase of labor did not differ between the groups. However, the duration of the active phase of labor and total induced labor were significantly longer in the obese group. Conclusions: An increased BMI in pregnant women is associated with a longer active phase and overall labor duration during dinoprostone-induced delivery.

The value of subcutaneous tissue closure and drain in obese women undergo elective caesarean section: a randomized controlled trial

OBJECTIVE

to compare the efficacy and safety of subcutaneous suture reapproximation alone versus suture plus subcutaneous drain or non-closure for the prevention of wound complications in obese women undergoing elective cesarean delivery (CD).

METHODS

This randomized controlled open label trial was conducted on 352 obese women candidates for elective CD. Participants were randomized into 4 groups: group I (n = 89) were allocated for interrupted closure of subcutaneous tissue with insertion of subrectus drain, group II (n = 88) were allocated for interrupted closure of subcutaneous tissue, group III (n = 88) were allocated for insertion of subrectus drain, group IV (n = 87) were allocated for non-closure of subcutaneous tissue without insertion of subrectus drain The primary outcome parameter was the development of wound complications including seroma, infection and dehiscence. Secondary outcome included postoperative pain assessed by VAS, postoperative fever, time of hospital stay and duration of surgery.

RESULTS

There were significant differences between the 4 groups regarding the mean duration of surgery (48.67 ± 2.84, 46.56 ± 4.80, 45.95 ± 4.29, and 41.59 ± 5.08 in combined, sutures only, drain only and none groups, respectively, P < 0.001). Assessment of outcome parameters revealed significant differences between the 4 groups regarding postoperative pain (2.93 ± 1.95, 3.62 ± 2.26, 3.83 ± 2.16, and 3.99 ± 2.032, P = 0.006), postoperative fever (3/68 (3.5%),5/86 (5.8%),3/68 (3.5%),, and 12/86 (14%), P = 0.017) wound infection (4/68 (4.7%),7/86 (8.1%),4/68 (4.7%),, and 13/86 (15.1%), P = 0.035) and wound dehiscence (4/68 (4.7%),6/86 (7%),8/68 (9.3%),, and 16/86 (18.6%), P = 0.011) and highly statistical significant differences regarding wound seroma (4/68 (4.7%),13/86 (15.1%),6/68 (7%),, and 21/86 (24.4%), P < 0.001) and redressing(10/68 (11.6%),17/86 (19.8%),19/68 (22.1%), and 32/86 (37.2%), P < 0.001) 08 in combined, sutures only, drain only and none groups, respectively.

CONCLUSION

The additional use of a subcutaneous drain along with a standard subcutaneous suture reapproximation technique is effective for the prevention of wound complications named seroma, redressing, dehiscence and infection in obese women undergoing CD.

TRIAL REGISTRATION

NCT04177381 Date of registration: 21/11/2019.

Comparative analysis of hCG and dual-trigger protocols in IVF for advanced maternal age women: a single‑center retrospective cohort study based on propensity score matching

PURPOSE

This study aimed to compare the efficacy of human chorionic gonadotropin (hCG) and dual-trigger (gonadotropin-releasing hormone agonist [GnRH-a] and hCG) protocols in terms of cumulative live birth rate (CLBR) and other pregnancy outcomes among advanced-age women.

METHODS

We enrolled 801 women aged ≥ 35 years who were experiencing infertility and beginning their first in vitro fertilization cycle at a tertiary academic medical institution between August 2015 and June 2023. Among these, 115 and 686 women used the dual-trigger and hCG methods. Propensity score matching was employed to account for confounding variables. The main outcomes evaluated were CLBR and time to live birth (TTLB).

RESULTS

The CLBR did not differ significantly between the hCG and dual-trigger groups (29.86% vs. 26.09%, P = 0.44), whereas the TTLBs of both groups were similar (9.60 vs. 10.14 months, P = 0.72). CLBR results were similar for both groups, according to a Kaplan-Meier analysis (hazard ratio [HR] = 0.95; 95% confidence interval [CI] 0.63-1.43; P = 0.82). After a multiple Cox proportional hazards model was established, the CLBR of the hCG group remained comparable with that of the dual-trigger group (HR = 0.83; 95% CI 0.53-4.11; P = 0.39). The subgroup analysis also showed similar findings.

CONCLUSION

Considering the higher fertilization rate and shorter TTLB, the dual-trigger protocol may be more suitable than the hCG trigger protocol.

Accuracy of ultrasound in prediction of abnormal placental adherence: a systematic review and meta-analysis

Background

The accuracy of ultrasound in detecting invasive placentation, such as placenta accreta spectrum (PAS), remains a topic of debate. Accurate prenatal diagnosis is crucial to improve maternal outcomes, especially in women with high-risk factors..

Objective

This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of ultrasonography in predicting invasive placentation among at-risk pregnant women.

Study Design

A comprehensive search of multiple databases (MEDLINE, EMBASE, Cochrane Library, etc.) was conducted to identify studies assessing the diagnostic accuracy of ultrasound in detecting PAS. A total of 24 studies, including 1,509 high-risk pregnancies, met the inclusion criteria. Data on sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were extracted and analyzed.

Results

The meta-analysis demonstrated that ultrasound has a high diagnostic performance, with a pooled sensitivity of 91.73% (95% CI: 88.3-94.7%) and specificity of 97.95% (95% CI: 97.4-98.6%). The DOR was 99.6 (95% CI: 49.9-200.1). Among ultrasound modalities, color Doppler showed the highest predictive accuracy with a sensitivity of 91.75% (95% CI: 86.3-95.6%) and specificity of 87.69% (95% CI: 85.7-91.5%).

Conclusion

Ultrasound, especially with the use of color Doppler, is highly effective in the prenatal diagnosis of PAS disorders in high-risk pregnancies. Early detection through ultrasound allows for better clinical management, reducing maternal morbidity by enabling planned interventions.

Is it justified to offer intrauterine infusion of autologous PRP in women with repeated implantation failure?

In recent years, an increased interest in the efficacy of intrauterine infusion of autologous platelet-rich plasma (PRP) in women with repeated implantation failure (RIF) has resulted in the publication of 13 randomized controlled trials (RCTs) and 11 meta-analyses. Although these meta-analyses support an increase in pregnancy rates after intrauterine infusion of autologous PRP, the low quality of the available original clinical studies along with concerns regarding their trustworthiness seriously questions their internal validity and does not allow for definitive conclusions to be drawn. In addition, the variability in the definition of RIF used in the individual studies limits their external validity, renders the pooling of the results problematic, and, overall, complicates the extrapolation of the results published. The variability in the definition of RIF has been recently addressed by the ESHRE, which published an evidence-based definition of RIF to facilitate the evaluation of interventions in these patients. Taking into consideration this definition, which identifies a real clinical problem, evaluation of intrauterine infusion of PRP in the published literature has not so far been performed explicitly in patients with RIF. The potential of intrauterine infusion of autologous PRP to improve outcomes for women with RIF remains an important area of research in ART. However, the current evidence is insufficient to inform clinical practice, highlighting the need for well-designed studies to provide clearer guidance.

An explainable ultrasound-based machine learning model for predicting reproductive outcomes after frozen embryo transfer

RESEARCH QUESTION

Can an optimal machine learning model be developed to predict reproductive outcomes following frozen embryo transfer (FET)?

DESIGN

This prospective study included 787 infertile females who underwent FET. The participants were split into a training cohort (n = 550) and a test cohort (n = 237) at a ratio of seven to three. Radiomics features were extracted from ultrasound images of the endometrium and junctional zone. A radiomics model was developed to generate the radiomics score (rad score). Logistic regression was applied to process the clinical data and create a clinical model. A fusion machine learning model was developed by integrating the rad score with independent clinical data using the XGboost algorithm. The performance of the models was compared using the area under the receiver operating characteristic curve (AUC). The SHapley Additive exPlanations (SHAP) method was used to interpret and visualize the contributions of features to the outcomes of FET.

RESULTS

The fusion model demonstrated superior performance, as indicated by an AUC of 0.861 (95% CI 0.829-0.890), in the training cohort, surpassing both the clinical model (AUC 0.680, 95% CI 0.635-0.722; P < 0.001) and the radiomics model (AUC 0.814, 95% CI 0.777-0.848; P < 0.001). The SHAP summary plot reveals the impacts of each feature on the predictive model, and the rad score was found to be the main feature. SHAP force plots provided explanations at the individual level.

CONCLUSION

An explainable machine learning model was established utilizing clinical data and ultrasound images to forecast the outcomes of FET. By utilizing the SHAP method, clinicians may better comprehend the contributors to the outcomes of FET in individual patients, and make better decisions before FET.

Interventions for recurrent embryo implantation failure: An umbrella review

BACKGROUND

Recurrent implantation failure (RIF) has a multifactorial etiology. An umbrella review was undertaken to evaluate the multiple proposed interventions.

OBJECTIVES

To summarize and assess the strength of evidence of interventions for RIF from published systematic reviews (SR) of randomized clinical trials (RCTs).

SEARCH STRATEGY

After prospective registration (PROSPERO CRD42023414255), a systematic search was conducted in the Cochrane Library, Scopus and Medline from inception until March 2024.

SELECTION CRITERIA

SRs of RCTs, with or without meta-analyses (MA), were included if they reported clinical pregnancy rates (CPR) or live birth rates (LBR).

DATA COLLECTION AND ANALYSIS

The methodological quality of the included SRs was appraised independently in duplicate using the AMSTAR 2 tool. For each intervention, the MAs of RCTs with statistically significant improvements were counted as a percentage of the total assessing the strength of evidence using the GRADE system.

MAIN RESULTS

A total of 47 SRs were included: 32 reviews covered immunomodulatory interventions, 10 (68 RCTs) covered uterine and endometrial interventions, one covered antibiotics, and four (69 RCTs) addressed mixed approaches, including laboratory interventions. AMSTAR 2 appraised 41 (88%) SRs as critically low or low, and 6 (12%) as moderate or high in quality. The SRs often had a level of overlap of RCTs (median 33.3%), inconsistent definitions of RIF, and varied comparisons for the interventions. Considering the significant meta-analytic evidence of high-moderate GRADE strength: Granulocyte colony-stimulating factor (G-CSF) showed improvement in CPR in 9/13 (69.2%) MAs and LBR in 1/7 (14%); intralipid infusion showed improvement in CPR in 4/6 (57.14%) MAs and LBR in 3/4 (75%); peripheral blood mononuclear cells (PBMC) showed improvement in CPR in 4/8 (50%) MAs and LBR 3/5 (60%); platelet-rich plasma (PRP) intervention showed improvement in CPR in 6/10 (60%) MAs and LBR in 1/5 (20%); human chorionic gonadotropins showed improvement in CPR in 3/3 (100%) MAs; growth hormone showed improvement in CPR in 1/1 (100%) MA; low molecular weight heparin showed improvement in CPR in 1/1 (100%) MAs and LBR in 1/2 (50%); hysteroscopy showed improvement in CPR in 1/2 (50%) MAs; and, intentional endometrial injury showed improvement in CPR in 3/4 (75%) MAs and LBR in 2/3 (66.66%).

CONCLUSIONS

Evidence syntheses of RCTs evaluating interventions for RIF suggest a consistent direction, with high to moderate strength, indicating that immunomodulatory treatments, including G-CSF, PBMC, PRP, intralipid infusion, and intentional endometrial injury are likely to be effective. However, this conclusion should be interpreted with caution due to the generally low methodological quality of the included studies and the clinical heterogeneity observed in most SRs.

Diagnostic accuracy of a specialized pro forma in assessing morbidly adherent placenta in correlation to intra-operative findings

OBJECTIVES

To assess the clinical value of ultrasound criteria for the "Morbidly Adherent Placenta" (MAP) and the diagnostic accuracy of a customized "pro forma" in predicting MAP, its extent, and its relationship to intra-operative results.

METHODS

Twenty-one pregnant women with a high possibility of placenta accreta were included in the study. Gray scale transabdominal and transvaginal ultrasound with color Doppler were done to confirm the MAP diagnosis and evaluate the signs of placental invasion. The ultrasound findings were compared with the operative details to predict placental invasion (focal or diffuse) and vascularity of the lower uterine segment to assess the clinical significance of the customized "pro forma."

RESULTS

There was a good accuracy of ultrasound signs to detect the vascularity of the lower uterine segment with a sensitivity of 94.12%, specificity of 25%, positive predictive value (PPV) of 84.21%, negative predictive value (NPV) of 50%, and accuracy of 80.95%; however, it was insignificant (p = 0.352). Additionally, we found a good accuracy of ultrasound signs to detect the degree of placental invasion (focal or diffuse), with a sensitivity of 71.43%, specificity of 100%, PPV of 100%, NPV of 63.64%, and accuracy of 80.95%, which was significant (p = 0.004).

CONCLUSION

This customized "pro forma" has satisfactory accuracy in predicting MAP cases with anterior placenta previa or anterior low-lying placenta.

A Comprehensive Review of the Effects of Hyoscine Butylbromide in Childhood

Background/Objectives: Hyoscine butylbromide (HBB) is a spasmolytic drug classified as indispensable by the World Health Organization. While mostly used in adults, it is also approved for use in adolescents and children aged 6 years and older. We have comprehensively reviewed the efficacy and safety of HBB in approved and off-label childhood indications. Results: Childhood studies covered an age range starting as early as 2 days. A randomized controlled trial (RCT) found a similar efficacy compared to paracetamol in the approved indication of abdominal cramps and pain. Among off-label uses, several studies demonstrate efficacy in general anesthesia and various diagnostic procedures, but the largest body of evidence relates to use in childbirth/labor, including 17 RCTs. While these largely focused on efficacy outcomes on the mother, fetal safety outcomes were reported in 12 of these studies, mostly as effects on the APGAR score and/or heart rate. The overall evidence supports safety in infants and children including those younger than the approved use age of 6 years and older. Conclusions: While only limited pediatric efficacy data from RCTs are available in the approved indications, data from thousands of patients in RCTs, case series, and non-randomized trials do not raise concerns on the safety and tolerability of HBB in childhood. Additional dedicated childhood studies, particularly RCTs, on efficacy are recommended.

Carbetocin versus oxytocin in prevention of postpartum hemorrhage after cesarean delivery in high-risk women. A systematic review and meta-analysis

OBJECTIVES

To assess the value of carbetocin in prevention of postpartum hemorrhage (PPH) after Cesarean delivery (CD).

SEARCH STRATEGY

Screening of PubMed, Web Of Science, Scopus, register clinical trials registry and Google scholar from inception to December 2023. The keywords used included postpartum hemorrhage, intraoperative blood loss, postoperative blood loss, Cesarean delivery and their MeSH terms.

SELECTION CRITERIA

All RCTs that compared carbetocin to oxytocin in women undergoing CD with risk factor for PPH. Fourteen studies including 3068 participants. Thirteen were written in English and one in Polish.

DATA COLLECTION AND ANALYSIS

The extracted data included location of the trial, number of centers involved in recruitment, the number of participants and their characteristics, details of the study groups and dose time and route of intervention and its comparator, primary and secondary outcome parameters and trial registration number and timing in relation to patients recruitment. The evaluated outcomes parameters included intraoperative and 1st 24 h post-operative blood loss, PPH, the hemoglobin changes after the procedure, the need for any additional uterotonic agents, surgical interventions or blood transfusion and drugs side effects.

MAIN RESULTS

Blood loss during the 1st 24 h after CD was evaluated in 11 studies with 2497 participants and revealed a mean difference (MD) of -111.07 with 95% CI of [-189.34 and -32.80 (P = 0.005, I2 97%). The hemoglobin changes after the operation was evaluated in 8 studies with 1646 participants and revealed a MD of -0.46 with 95% CI of -0.14 and -0.79 (P = 0.03, I2 96%). The incidence of PPH > 500 ml was reported in 8 studies with 1787 participants and revealed an Odd Ratio (OR) of 0.52 with 95%CI of [0.36, 0.77] (P < 0.001, I2 0%). The need for additional uterotonic agents was evaluated in 12 studies with 2663 participants and revealed an OR of 0.17 with 95% CI of 0.07 and 0.37 (P < 0.001, I2 88%). The need for blood transfusion was evaluated in 10 studies with 2439 participants and revealed an OR of 0.27 with 95% CI of 0.12 and 0.57 (P < 0.001, I2 20%). The need for additional interventions was evaluated in 3 studies with 1311 participants and revealed an OR of 0.67 with 95% CI of 0.28 and 1.60 (P = 0.37, I2 59%).

CONCLUSION

Carbetocin decreased the blood loss during the 1st 24 h after CD, post-operative hemoglobin drop, PPH the need for additional uterotonic agents and blood transfusion when compared to oxytocin.

Predicting placenta accreta spectrum and high postpartum hemorrhage risk using radiomics from T2-weighted MRI

BACKGROUND

Antenatal diagnosis of placenta accreta spectrum (PAS) is of critical importance, considering that women have much better outcomes when delivery occurs at a level III or IV maternal care facility before labor initiation or bleeding, thus avoiding placental disruption. Herein, we aimed to investigate the performance of magnetic resonance imaging (MRI) in antenatal prediction of PAS and postpartum hemorrhage (PPH).

METHODS

This retrospective study included 433 women with singleton pregnancies (PAS group, n = 208; non-PAS group, n = 225; PPH-positive (PPH (+)) group, n = 80; PPH-negative (PPH (-)) group, n = 353), who were randomly divided into a training set and a test set in a 7:3 ratio. Radiomic features were extracted from T2WI (T2-weighted imaging). Features strongly correlated with PAS and PPH (p < 0.05) were selected using Pearson correlation, followed by LASSO regression for dimensionality reduction. Subsequently, radiomics models were constructed for PAS and PPH risk prediction, respectively. Regression analyses were conducted using radiomics score (R-score) and clinical factors to identify independent clinical risk factors for PAS and PPH, leading to the development of corresponding clinical models. Next, clinical-radiomics models were built by combining R-score and clinical risk factors. The predictive performance of the models was evaluated using nomograms, calibration curves, and decision curves.

RESULTS

The clinical-radiomics models and radiomics models for predicting PAS and PPH risk both outperformed their clinical models in the training and testing sets. For PAS, the AUC (Area Under the Receiver Operating Characteristic Curve) of the clinical-radiomics model, radiomics model, and clinical model in the training set are 0.918, 0.908, and 0.755, respectively, and in the testing set, the AUCs are 0.885, 0.866, and 0.771, respectively. For PPH, the AUCs of the clinical-radiomics model, radiomics model, and clinical model in the training set are 0.918, 0.884, and 0.723, respectively, and in the testing set, the AUCs are 0.905, 0.860, and 0.688, respectively. The DeLong test p-values between the clinical-radiomics models and radiomics models for predicting PAS and PPH are both less than 0.05. Additionally, in the testing set, the clinical-radiomics models perform best in predicting PAS and PPH risk, with accuracies of 82.31% and 84.61%, respectively.

CONCLUSION

This novel clinical-radiomics model has a robust performance in predicting PAS antepartum and predicting massive PPH in pregnancies.

Prediction of clinical pregnancy after frozen embryo transfer based on ultrasound radiomics: an analysis based on the optimal periendometrial zone

BACKGROUND

To investigate the optimal periendometrial zone (PEZ) in ultrasound (US) images and assess the performance of ultrasound radiomics in predicting the outcome of frozen embryo transfer (FET).

METHODS

This prospective study had 422 female participants (training set: n = 358, external validation set: n = 64). We delineated the region of interest (ROI) of the endometrium (EN) from ultrasound images of the median sagittal surface of the uteri of patients. We determined the ROIs of PEZ on US images by automatically expanding 2.0, 4.0, 6.0, and 8.0 mm radii surrounding the EN. We determined the radiomics characteristics based on the ROIs of the endometrium and PEZ, then compared the different sizes of PEZ to determine the optimal PEZ. We constructed models of the EN and optimal PEZ using six machine learning algorithms. We developed a combined model using the radiomics characteristics of EN and the optimal PEZ. We evaluated the performance of the three models using the area under the curve (AUC).

RESULTS

The optimal PEZ was 4.0 mm with a maximum AUC of 0.715 (95% confidence interval (CI): 0.581 - 0.833) in the external validation set. The combined radiomics model (endometrium and PEZ4.0 mm) yielded the best predictive performance with AUC = 0.853 (95% CI: 0.811 - 0.890) for the training set and AUC = 0.809 (95% CI: 0.696 - 0.909) for the external validation set.

CONCLUSIONS

PEZ4.0 mm could be the optimal area for predicting clinical pregnancy after FET. An US-based radiomics model that combines EN and PEZ4.0 mm demonstrated strong potential in helping clinicians predict FET outcomes more accurately, thereby supporting informed decision-making before treatment.

Comparative efficacy of intrauterine infusion treatments for recurrent implantation failure: a network meta-analysis of randomized controlled trials

OBJECTIVE

Recurrent implantation failure (RIF) is a significant challenge in assisted reproductive technology (ART), affecting many women undergoing in vitro fertilization (IVF). This study aims to compare the efficacy of various intrauterine infusion treatments, including granulocyte colony-stimulating factor (G-CSF), platelet-rich plasma (PRP), human chorionic gonadotropin (HCG), and peripheral blood mononuclear cells (PBMCs), in improving clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR) in women with RIF.

METHODS

A comprehensive search was conducted in multiple databases, including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Web of Science, and China National Knowledge Internet (CNKI), to identify randomized controlled trials (RCTs) evaluating the efficacy of intrauterine infusion treatments for RIF. Data extraction and quality assessment were performed independently by two reviewers. Network meta-analysis was conducted using a random-effects model to compare the outcomes of different treatments.

RESULTS

A total of 25 RCTs involving 3035 patients were included in the network meta-analysis. The treatments involved G-CSF, PRP, HCG, PBMCs, placebo, and blank control. The results of the network meta-analysis for CPR and LBR were statistically significant among treatments, but there was no statistical significance in MR. The surface under cumulative ranking curve (SUCRA) ranking of CPR and LBR showed that intrauterine infusion treatments of G-CSF, PRP, HCG, and PBMCs were much better than placebo and blank. The SUCRA values of CPR were ranked probabilistically from high to low as follows: PRP (84.5%) > PBMCs (76.5%) > G-CSF (65.7%) > HCG (52.5%) > placebo (20.8%) > blank (0.1%). The SUCRA values of LBR were ranked probabilistically from high to low as follows: PRP (81.4%) > PBMCs (64.6%) > G-CSF (58.0%) > HCG (48.7%) > placebo (42.4%) > blank (4.9%).

CONCLUSION

All these findings confirmed that intrauterine infusions of PRP and PBMCs significantly improve pregnancy outcomes in women with RIF. PRP emerged as the most effective treatment. However, to establish the most effective approach for managing patients with RIF, future research should prioritize direct and robust comparisons between PRP and other therapeutic strategies, ensuring a comprehensive evaluation of their relative efficacy.

Implementing a bundle for evidence-based cesarean delivery may not be as beneficial as expected: a multicenter, pre- and post-study

BACKGROUND

Standardization of procedures improves outcomes. Though systematic reviews have summarized the evidence-based steps of cesarean delivery, their bundled implementation has not been investigated.

OBJECTIVE

In this preimplementation and postimplementation trial, we sought to ascertain if bundled evidence-based steps of cesarean delivery, compared with the surgeon's preference, improve outcomes.

STUDY DESIGN

A Standards for Reporting Implementation Studies compliant, multicenter preimplementation and postimplementation trial at 4 teaching hospitals was conducted. The preimplementation period consisted of cesarean delivery done on the basis of the physicians' preferences for 3 months; educational intervention (eg, didactics, badge cards, posters, video) occurred in the fourth month. Cesarean deliveries in the postimplementation period employed the bundled evidence-based steps. A preplanned 10% randomized audit of both groups assessed adherence and uptake of evidence-based steps. The primary outcome was composite maternal morbidity, which included estimated blood loss ≥1000 mL, blood transfusion, endometritis, postpartum fever, wound complications, sepsis, thrombosis, intensive care unit admission, hysterectomy, or death. The secondary outcome was composite neonatal morbidity, and some of its components were a 5-min Apgar score <7, positive pressure oxygen use, hypoglycemia, or sepsis. A priori Bayesian sample size calculation indicated 700 cesarean deliveries in each group were needed to demonstrate a 20% relative reduction (from 15% to 12%) of composite maternal morbidity with 75% certainty. Bayesian logistic regression with neutral priors was used to calculate the likelihood of net improvement in adjusted relative risk with 95% credible intervals.

RESULTS

A total of 1425 consecutive cesarean deliveries (721 in preimplementation and 704 in postimplementation group) were examined. Audited data indicated that the baseline evidence-based steps utilization rate during the preimplementation period was 79%; after the implementation of bundled evidence-based steps of cesarean delivery, the audited adherence was 89%-an uptake of 10.0% of the evidence-based steps. In 4 aspects, the maternal characteristics differed significantly in the preimplementation and postimplementation periods: race/ethnicity, hypertensive disorder, and the relative contribution of the 4 centers to the cohorts and the gestational age at delivery, but the indications for cesarean delivery and whether its duration was less or greater than 60 minutes did not. The rates of composite maternal morbidity in the preimplementation and postimplementation groups were 26% and 22%, respectively (adjusted relative risk, 0.88 [95% credible intervals, 0.73-1.04]), with a 94 % Bayesian probability of a reduction in composite maternal morbidity. The composite maternal morbidity occurred in 37% of the preimplementation and 41% of the postimplementation group (adjusted relative risk, 1.12 [95% credible intervals, 0.98-1.39]), with a 95% Bayesian probability of worsening in composite maternal morbidity. When composite maternal morbidity was segregated by preterm (<37 weeks) and term (≥37 weeks) cesarean delivery, the improvement in maternal outcomes persisted; when composite maternal morbidity was segregated by gestational age subgroups, the potential for worsening neonatal outcomes persisted as well.

CONCLUSION

Standardization of the evidence-based bundled steps of cesarean delivery resulted in a modest reduction of the composite maternal outcome; however, a paradoxical increase in neonatal composite morbidity was noted. Although individual evidence-based steps may be of value while awaiting additional intervention trials, a formal bundling of such steps is currently not recommended.

The Role of Oxytocin versus Carbetocin in Prevention of Postpartum Hemorrhage in Cesarean Section: A Randomized Control Trial

BACKGROUND

Preventing postpartum haemorrhage (PPH) is a significant concern because of its effect on maternal morbidity and mortality. PPH is leading cause of maternal death in developing countries and also globally.

AIM

Evaluation of safety and efficacy of carbetocin versus oxytocin for PPH prevention in caesarean deliveries.

METHODS

Double blind randomised controlled trial carried for one year. 42 pregnant patients included in study, who underwent caesarean section and fulfilled inclusion criteria. Patients divided into two groups A and B with 21 in each group, with the help of computer generated random number, group A recieved 100 microgram of carbetocin through intravenous route and 1 ml of normal saline given intramuscularly as placebo, group B received 10 IU oxytocin through intramuscular route and 1 ml of normal saline is given intravascular.

RESULT

Mean age was 25.19 years±3.86 years and 24.76 years±3.93 in group A and group B respectively. Mean blood loss significantly reduced in carbetocin compared to oxytocin with significant p value 0.006, haemoglobin deficit was less in group A as we compare with group B having p value 0.052 whereas incidence of PPH in group A was 4.76 % and group B was 19.05% and had p value of 0.343, not significant. Effect of both medication on blood loss varies significantly across different BMI categories.

CONCLUSION

Observation shows equal efficacy and safety of both carbetocin and oxytocin in prevention of postpartum haemorrhage in caesarean section but carbetocin is considered as uterotonics of crucial importance due to heat stability in poor resource settings, therefore use of carbetocin could be better in comparison to oxytocin in PPH prevention.

A systematic review and meta-analysis of randomized controlled studies comparing follicular flushing versus aspiration during oocyte retrieval in IVF cycles

OBJECTIVES

To assess the value of follicular flushing during ovum pick up compared to follicular aspiration in IVF cycles.

SEARCH STRATEGY

Screening of PubMed, Web Of Science, Cochrane, Scopus, and clinical trials registry from inception to October 2024. The search key words included follicular flushing, follicle aspiration, ovum pick up, oocyte retrieval, IVF, and their MeSH terms.

SELECTION CRITERIA

This review included all RCTs that evaluated the use of follicular flushing during ovum pick-up. Seventeen studies including 2218 participants (1124 were subjected to follicular flushing and 1094 subjected to follicular aspiration) were included.

DATA COLLECTION AND ANALYSIS

The extracted data included the settings of the study, the number and characteristics of participants, intervention details including the number of flushes, and the suction pressure used, outcome parameters including number of retrieved oocytes, the oocyte/ follicle ratio, the number of MII oocytes, the time of the procedure, the fertilization, implantation, clinical pregnancy, chemical pregnancy, ongoing pregnancy, live birth, miscarriage and cancellation rates, and risk of bias assessment.

MAIN RESULTS

The number of retrieved and MII oocytes were evaluated in 14 and 11 studies with 1920 and 1588 participants and revealed a mean difference (MD) of 0.03 and 0.16 with [-0.50, 0.57] and [-0.29, 0.61] 95% CI (P value =0.9 and 0.48, I2 = 87% and 90%), respectively. The fertilization and implantation rates were evaluated in 4 and 7 studies with 3331 and 1605 participants and revealed an Odd Ratio (OR) of 1.48 and 0.91 with [0.98, 2.24] and [0.55, 1.51] 95% CI (P value =0.06 and 0.72, I2 = 82% and 61%), respectively. The clinical pregnancy rate was evaluated in 11 studies with 1542 participants and revealed an Odd Ratio (OR) of 1.23 with [0.86, 1.74] 95% CI (P value =0.26, I2 = 42%). The ongoing pregnancy /livebirth rate was evaluated in 11 studies with 1266 participants and revealed an Odd Ratio (OR) of 1.07 with [0.80, 1.43] 95% CI (P value =0.65, I2 = 0%). The time of the procedure was evaluated in 8 studies with 985 participants and revealed a mean difference (MD) of 178.58 with [98.23, 258.93] 95% CI (P value <0.001, I2 = 97%). The cycle cancellation rate was evaluated in 5 studies with 856 participants and revealed an Odd Ratio (OR) of 0.66 with [0.45, 0.98] 95% CI (P value =0.04, I2 = 0%).

CONCLUSION

Follicular flushing during oocyte retrieval did not improve the number of retrieved oocytes, the oocyte retrieved over the aspirated follicles ration, the number of MII oocytes, the fertilization rate, implantation rate, clinical pregnancy, chemical pregnancy, ongoing pregnancy/livebirth, and miscarriage rates and associated with significant prolongation of the procedure. Cycle cancellation was significantly improved with follicular flushing in women with poor ovarian response.

TRIAL REGISTRATION

Registration number CRD42024600698 date of registration 23/10/2024.

Predicting Risk for Patent Ductus Arteriosus in the Neonate: A Machine Learning Analysis

Background and Objectives: Patent ductus arteriosus (PDA) is common in newborns, being associated with high morbidity and mortality. While maternal and neonatal conditions are known contributors, few studies use advanced machine learning (ML) as predictive factors. This study assessed how maternal pathologies, medications, and neonatal factors affect the risk of PDA using traditional statistics and ML algorithms: Random Forest (RF) and XGBoost (XGB). Materials and Methods: A retrospective 3-year cohort study of 201 NICU neonates assessed maternal and neonatal factors. Logistic regression (LR) and chi-square analyses identified significant predictors, while ML models enhanced predictive accuracy and pinpointed key PDA factors. Results: LR identified prolonged rupture of membranes (>18 h) as the most significant predictor (OR: 13.03, p < 0.001). The ML models identified gestational age, maternal anemia, prenatal care level, birth weight, prolonged rupture of membranes, medication usage, diabetes, pregnancy-induced hypertension, SARS-CoV-2 infection, and cervical cerclage as key predictors. The RF model had 76.3% accuracy, moderate sensitivity (47.4%), and high specificity (90%). XGB performed better with 81.4% accuracy, an AUC of 0.872, sensitivity of 92.5%, and specificity of 57.9%. Conclusions: This study shows that maternal and neonatal factors significantly influence the risk of PDA. ML, particularly XGBoost, enhances predictive abilities, guiding targeted interventions and improving neonatal outcomes.

Prehospital Trauma Compendium: Management of Injured Pregnant Patients- A Position Statement and Resource Document of NAEMSP

The assessment and management of critically injured pregnant trauma patients represents a high-risk, low-frequency event. One in every 12 pregnant patients experience physical trauma during their pregnancy, but only 0.1% experience major trauma with an injury severity score (ISS) greater than fifteen. It is crucial that emergency medical services (EMS) clinicians understand the anatomic and pathophysiologic changes that impact morbidity and mortality for pregnant trauma patients so they can effectively provide life-saving interventions and resuscitation for this patient population.

Carbetocin Is More Effective in Stabilizing Hemodynamic Parameters Compared to Oxytocin During Cesarean Section

Background/Objectives: First-line uterotonics include carbetocin and oxytocin, which act on the oxytocin receptor with varying potencies. Methods: In 70 pregnant Caucasian women who delivered by cesarean section, the effects of oxytocin and carbetocin on heart rate and blood pressure were compared. The pregnant women were divided into two groups: the OXY group, which received intravenous oxytocin 5 IU on an even day of the month, and the CARBE group, which received intravenous carbetocin 100 µg on an odd day of the month. Blood pressure and heart rate were measured noninvasively every 3 min from the beginning of cesarean section until the lower uterine incision, and then at 1, 2, and 3 min after the fetus and placenta were removed and the uterotonic drugs were discontinued. Subsequent measurements were taken at 3 min intervals until the end of the cesarean procedure. Results: After the administration of uterotonic drugs, a significant decrease in systolic blood pressure was observed only in the group receiving oxytocin at the first (p < 0.0001) and second minute after drug administration (p < 0.0001). Diastolic arterial pressure was significantly different in the study groups at the sixth minute after oxytocin and carbetocin administration (p = 0.004). Mean arterial pressure values were significantly different in the two study groups at the first and sixth minute after drug administration (p = 0.006; p = 0.014). With regard to heart rate, significant differences between the groups were found at 6 min after uterotonic drug administration (p = 0.019). Conclusions: Blood pressure and heart rate variability are significantly higher after oxytocin than after carbetocin administration in women delivering by cesarean section.

Platelet-Rich Plasma and Electrochemical Biosensors: A Novel Approach to Ovarian Function Evaluation and Diagnostics

Preserving ovarian function is important to women's reproductive health. It is necessary for fertility and maintaining the overall hormonal balance. Platelet-rich plasma (PRP) is an autologous plasma containing a predominately platelet concentrate prepared from fresh blood. It has been observed that PRP injections into the ovary can renew the functional cells of the cortical layer of the ovary follicles and reactivate the production of sex hormones. It may improve a woman's fertility in the case of premature ovarian failure, the condition after chemotherapy treatment, or during the climacteric period. The main markers to evaluate the procedure's success are elevated anti-Müllerin hormone and enlarged count level of atrial follicles in ovaries. The aim of this review is to identify the ovarian PRP procedure success markers and point out the electrochemical sensor techniques. Literature was selected depending on including and excluding criteria; studies were sorted by topics in two blocks: PRP biomarkers and electrochemistry. As PRP acts as a regenerative care, electrochemical biosensors can provide accurate, real-time data to evaluate the biological response to PRP therapy. The biosensors' ability to monitor hormonal levels and follicle development serves as objective markers of the effectiveness of PRP in restoring ovarian function. Together, these approaches enable a more precise evaluation of ovarian health and fertility outcomes after PRP intervention.

The effect of oxytocin, sublingual, and intrauterine misoprostol on blood loss in cesarean delivery: A randomized clinical trial

Background

The efficacy of different uterotonic agents is yet to be determined.

Methods

This was a randomized clinical trial on 240 pregnant mothers with a history of cesarean section in three groups: A: sublingual misoprostol and oxytocin, B: intrauterine misoprostol and oxytocin, and C: a higher dose of oxytocin alone. The intrapartum blood loss and the estimated blood loss within 24 h after surgery were compared between the groups.

Results

The baseline characteristics showed no significant differences among the groups. The volume of blood loss during surgery and within 24 h postpartum did not differ significantly among the groups (A: 230.72 ± 97.30, B: 245.60 ± 88.50, C: 229.02 ± 109.78, p = 0.115, and A: 2023.84 ± 480.08, B: 2045.26 ± 598.99, C: 2025.61 ± 538.93, p = 0.819, respectively).

Conclusion

Intrauterine misoprostol plus oxytocin, sublingual misoprostol plus oxytocin and a higher dose of oxytocin did not show any significant difference in the amount of blood loss during surgery and within 24 h post-operation.

Therapeutic management in women with a diminished ovarian reserve: a systematic review and meta-analysis of randomized controlled trials

IMPORTANCE

The clinical management of women with diminished ovarian reserve (DOR) is a challenge in the field of medically assisted reproduction. Several therapeutic strategies have been proposed, but with mixed results, mainly because the definition of DOR used was inconsistent among trials.

OBJECTIVE

To investigate adjuvant treatments and protocols involving only women with DOR according to POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) criteria.

DATA SOURCES

We conducted a systematic search using the MEDLINE (PubMed), EMBASE, and ISI Web of Knowledge databases to identify relevant studies published up to June 2024.The review protocol was registered at http://www.crd.york.ac.uk/PROSPERO/ (registration number: CRD42022346117).

STUDY SELECTION AND SYNTHESIS

After duplication removal, the titles and abstracts of 4,806 articles were scrutinized, and 124 full-text articles were assessed for eligibility. In total, 38 randomized controlled trials were included in the qualitative/quantitative analysis. The following interventions were evaluated: dehydroepiandrosterone (n = 1,336); testosterone (n = 418); high- vs. low-dose gonadotropin (n = 957); delayed-start protocol with gonadotropin hormone-releasing hormone antagonist (n = 398); letrozole (n = 612); clomiphene citrate (1,113); growth hormone (311); luteal phase stimulation (n = 57); dual triggering (n = 139); dual stimulation (168); luteinizing hormone (979); oestradiol pretreatment (n = 552); and corifollitropin alfa (n = 561).

MAIN OUTCOMES

The primary outcome was live birth rate or ongoing pregnancy if data on live birth were unavailable. Secondary outcomes were number of oocytes retrieved, number of metaphase II oocytes, clinical pregnancy rate and miscarriage rate.

RESULTS

Testosterone supplementation is associated with higher live birth rates compared with nonsupplemented women among all interventions evaluated (odds ratio: 2.19, 95% confidence interval [CI]: 1.11-4.32, four studies, 368 patients). Testosterone (weighted mean difference [WMD] 0.88, 95% CI: 0.03-1.72; 4 studies, n = 368 patients), dehydroepiandrosterone (WMD 0.60, 95% CI: 0.07-1.13; 4 studies, n = 418 patients), and delayed started protocol (WMD 1.32, 95% CI: 0.74 to 1.89; 3 studies, n = 398 patients) significantly improved the total number of eggs collected. Lower number of oocytes retrieved is achieved in women undergoing low dose gonadotropin regimen vs high dose (WMD: -1.57, 95% CI: -2.12 to -1.17; 2 studies, n = 905 patients), The other interventions did not produce significant improvements.

CONCLUSION AND RELEVANCE

Specific interventions such as testosterone seem to correlate with a better live birth rate in women with DOR; these findings should be further explored in randomized trials.

Machine learning applications in placenta accreta spectrum disorders

This review examines the emerging applications of machine learning (ML) and radiomics in the diagnosis and prediction of placenta accreta spectrum (PAS) disorders, addressing a significant challenge in obstetric care. It highlights recent advancements in ML algorithms and radiomic techniques that utilize medical imaging modalities like magnetic resonance imaging (MRI) and ultrasound for effective classification and risk stratification of PAS. The review discusses the efficacy of various deep learning models, such as nnU-Net and DenseNet-PAS, which have demonstrated superior performance over traditional diagnostic methods through high AUC scores. Furthermore, it underscores the importance of integrating quantitative imaging features with clinical data to enhance diagnostic accuracy and optimize surgical planning. The potential of ML to predict surgical morbidity by analyzing demographic and obstetric factors is also explored. Emphasizing the need for standardized methodologies to ensure consistent feature extraction and model performance, this review advocates for the integration of radiomics and ML into clinical workflows, aiming to improve patient outcomes and foster a multidisciplinary approach in high-risk pregnancies. Future research should focus on larger datasets and validation of biomarkers to refine predictive models in obstetric care.

Pharmacological and non-pharmacological interventions for pain control in outpatient hysteroscopy: A systematic review

BACKGROUND

Outpatient hysteroscopy (OPH) is an important diagnostic and therapeutic intervention in gynaecology. However, the most common reason for failure is pain. Currently, there is no consensus regarding analgesia for OPH amongst the literature.

OBJECTIVE

The aim of this systematic review was to assess the efficacy of pharmacological and non-pharmacological interventions for pain control during OPH.

STUDY DESIGN AND METHODS

Randomised controlled trials (RCT) from January 2017 to February 2024 assessing efficacy of pharmacological and non-pharmacological methods for analgesia in OPH were included. MEDLINE, Embase and CENTRAL databases were used to search papers for inclusion. Two independent reviewers selected eligible studies for systematic review. The primary outcome was pain assessed via a subjective pain screening tool. Secondary outcomes included adverse events.

RESULTS

16 RCTs were included with the majority being 'low risk' of bias. Tramadol, vaginal misoprostol and cervical lidocaine flushing significantly reduced pain. Hyoscine-N-butyl Bromide (HBB) with diclofenac and lidocaine in distension media produced conflicting results. Oral misoprostol and diclofenac alone failed to show significant differences in pain scores. Regarding non-pharmacological interventions, vocal distraction, transcutaneous electrical nerve stimulation and video-based multimedia information all significantly reduced pain. The effect of warmed distension media and virtual reality for pain control is unclear. Only one study found the treatment group (HBB and diclofenac) was associated with significantly higher adverse events.

CONCLUSION

This study highlights potential use of both pharmacological and non-pharmacological methods as safe and effective forms of analgesia for OPH. We hope the results of this systematic review will help improve clinical practice and assist with developing future pain management protocols for OPH while also highlighting areas of interest for future research.

Advanced strategies for single embryo selection in assisted human reproduction: A review of clinical practice and research methods

Among the primary objectives of contemporary assisted reproductive technology research are achieving the births of healthy singletons and improving overall fertility outcomes. Substantial advances have been made in refining the selection of single embryos for transfer, with the aim of maximizing the likelihood of successful implantation. The principal criterion for this selection is embryo morphology. Morphological evaluation systems are based on traditional parameters, including cell count and fragmentation, pronuclear morphology, cleavage rate, blastocyst formation, and various sequential embryonic assessments. To reduce the incidence of multiple pregnancies and to identify the single embryo with the highest potential for growth, invasive techniques such as preimplantation genetic screening are employed in in vitro fertilization clinics. However, new approaches have been suggested for clinical application that do not harm the embryo and that provide consistent, accurate results. Noninvasive technologies, such as time-lapse imaging and omics, leverage morphokinetic parameters and the byproducts of embryo metabolism, respectively, to identify noninvasive prognostic markers for competent single embryo selection. While these technologies have garnered considerable interest in the research community, they are not incorporated into routine clinical practice and still have substantial room for improvement. Currently, the most promising strategies involve integrating multiple methodologies, which together are anticipated to increase the likelihood of successful pregnancy.

The role of platelet-rich plasma in biomedicine: A comprehensive overview

Biomedicine has seen significant advancements in the 21st century, with platelet-rich plasma (PRP) playing a crucial role in clinical practice. This blood derivative, enriched with platelet components, has shown great potential for promoting tissue repair and regeneration. Its wide range of applications and the presence of anti-inflammatory and growth-promoting factors make it a valuable tool in the field of biomedicine. The exploration of PRP in clinical settings has been gaining momentum. Despite its cost-effectiveness, safety, and therapeutic efficacy, the widespread clinical adoption of PRP has been hindered by the absence of consistent preparation standards and standardized treatment protocols. This article provides a comprehensive analysis of the clinical uses, physiological roles, molecular mechanisms, and preparation techniques of PRP in biomedicine. The aim is to offer a thorough understanding of the potential applications and benefits of PRP in medical practice.

Transcriptomic landscape of cumulus cells from patients <38 years old with a history of poor ovarian response (POR) treated with platelet-rich plasma (PRP)

Intraovarian injection of autologous platelet-rich plasma (PRP) has recently been investigated as a potential treatment for patients with diminished ovarian reserve. In the current study, differential gene expression in cumulus cells obtained from patients treated with PRP was compared to controls. RNA sequencing libraries were constructed from the cumulus cells, and differential expression analysis was performed with a false discovery rate threshold of p-value ≤0.05 and Log2 fold change ≥0.584. RNA sequencing of cumulus cells revealed significant differences in gene expression when comparing those treated with PRP and resulted in a live birth (n = 5) to controls with live birth (n = 5), or to controls with failed implantation (n = 5). Similarly, when all samples treated with PRP (those that resulted in live birth or arrested embryos (n = 10)) were compared to all samples from controls (those that resulted in live birth, no pregnancy, or arrested embryos (n = 13)), gene expression was significantly different. Several pathways were consistently affected by PRP treatment through multiple comparisons, including carbohydrate metabolism, cell death and survival, cell growth and proliferation, and cell-to-cell signaling, all of which have been implicated in human causes of infertility.

Efficacy and safety of HYYK formula for residual follicle revival in premature ovarian insufficiency: a multicenter, randomized, double-blind, placebo-controlled trial protocol

BACKGROUND

Premature ovarian insufficiency (POI), a condition impacting women under 40, is rising globally, posing significant risks to fertility, bone health, and cardiovascular function. Conventional hormone replacement therapy (HRT) alleviates symptoms but fails to restore ovarian function. Our prior studies have demonstrated that the Huyang Yangkun (HYYK) formula effectively supports menstrual cycle frequency and alleviates menopause-related symptoms in POI patients. This study aims to evaluate the efficacy and safety of the HYYK formula, a traditional Chinese medicine (TCM) approach, in enhancing residual follicle activity in POI patients.

METHODS

This multicenter, randomized, double-blind, placebo-controlled trial will enroll 102 women with POI, who will be randomly assigned to receive either the HYYK formula or a placebo for 24 weeks. Primary outcomes will be assessed through Hoogland and Skouby scores (indicative of residual follicle activity) and menstrual cycle regularity. Secondary outcomes include hormone levels (AMH, FSH, LH, E2), ovarian volume, antral follicle count, and clinical symptom scales, such as the Greene Scale and the Female Sexual Function Index. Safety assessments will involve routine physical exams and adverse event monitoring.

DISCUSSION

This is the first multicenter, randomized, double-blind, placebo-controlled study to investigate the efficacy of TCM in stimulating residual follicle recovery in POI patients. The trial rigorously investigates the potential of the HYYK formula as a therapeutic alternative for POI, aiming to deliver high-quality evidence that supports the use of TCM in POI management. This study will concentrate on stimulating residual follicle development in POI patients, offering a viable approach to delaying ovarian decline and generating compelling clinical evidence.

TRIAL REGISTRATION

Chinese Clinical Trials.gov ChiCTR2100049604 Registered on August 6, 2021 ( http://www.chictr.org.cn ).

Acupoint stimulation for postpartum breastfeeding insufficiency: a systematic review and meta-analysis

BACKGROUND

Insufficient lactation, known as hypogalactia, is an important reason for weaning. To date, no effective methods have been established to increase lactation volume. With the advantages of low cost and convenience, acupoint stimulation-defined as any stimulation applied at acupoints-is a promising option.

OBJECTIVES

The aim of this systematic review was to evaluate the effectiveness of acupoint stimulation for postpartum breastfeeding insufficiency.

METHODS

A systematic search of seven databases (PubMed, MEDLINE, Embase, Cochrane, CNKI, Airiti Library, ClinicalTrials.gov) was performed from their inception dates to September 30, 2023. Randomized trials were included. The inclusion criteria of the intervention included acupuncture, acupressure (including tuina and massage), electroacupuncture, laser stimulation, catgut embedding, and auriculotherapy. The primary outcomes were the amount of lactation and the level of prolactin. Secondary outcomes were colostrum time and adverse effects. The risks of bias were assessed using RoB 2.0.

RESULTS

Twenty-four studies involving 3214 participants were included. When compared to the control group, the experimental group exhibited improved volume of milk production (MD = 81.30; 95% CI = 58.94-103.67) and higher prolactin levels (MD = 41.90, 95% CI = 28.57-55.22). Colostrum time was shorter in the control group ([MD = - 7.26; 95% CI = - 10.69 to - 3.83] for continuous data; [RR = 1.70; 95% CI = 1.38-2.08] for dichotomous data). Adverse effects were reported in only one trial, which included three cases of fear of acupuncture and one case of hypotension.

CONCLUSIONS

Acupoint stimulation may have beneficial effects on postpartum breastfeeding insufficiency. However, the results should be interpreted with caution because of the presence of risks of bias and heterogeneity among studies.

Perimenopausal combined hormonal contraception: focus on sexual function

Age alone should not be an absolute contraindication for any contraceptive methods. However, medical eligibility criteria for combined hormonal contraception (CHC) use must be taken into consideration when choosing an appropriate contraceptive method. Women should be counseled on the benefits and risks of CHC while in their 40s. If there are no contraindications, women may use CHC for contraception up until the age of 50 years. Loss of libido is a common symptom during the late 40s. While women associate this with hormone levels, libido is multifactorial and is influenced by family and work stress, tiredness, self-image, medications and the physical changes in their partner. During this stage, women might experience urogenital issues such as vaginal dryness, dyspareunia and bladder problems, which can further affect the woman's sexual function. Before attributing the cause of sexual dysfunction to CHC use, a complete gynecologic examination and a full biopsychosocial assessment of the woman and her partner should be conducted to define other potential causes. When CHC-related female sexual dysfunction is suspected, using an oral CHC with a higher estrogen dose, a vaginal contraceptive ring or a transdermal contraceptive patch, or switching to a progesterone-only pill or non-hormonal method, might be suggested.

Meta-analysis: the prophylactic use of tranexamic acid to reduce blood loss during caesarean delivery

INTRODUCTION

The 2022 national guideline on The Prevention and Management of Primary Postpartum Haemorrhage (PPH) recommended consideration of prophylactic tranexamic acid (TXA) for women who are at high PPH risk undergoing caesarean section (CS). This meta-analysis reviews the basis for this recommendation.

METHOD

PubMed, OVID Medline, EMBASE, Science Citation Index, Scopus, CENTRAL, and ClinicalTrials.gov were searched (from inception to January 2024) for randomised controlled trials comparing prophylactic intravenous TXA with placebo or no treatment in women undergoing CS who received a uterotonic. Our main outcome was PPH > 1L. Secondary outcomes included estimated mean blood loss, blood transfusion, drop in haemoglobin, the need for additional uterotonics, or surgical intervention. Adverse effects of TXA were also assessed.

RESULTS

Sixty-one studies including 25,098 women were identified, and 12,446 received prophylactic TXA. Patients who received prophylactic TXA had significantly reduced likelihood of PPH > 1L (RR, 0.47; 95% CI, 0.38 to 0.59), reduced estimated mean blood loss (MD 185.86 ml, 95% CI 159.14-212.59), and reduced drop in Hb (MD 0.84g/dl, 95% CI 0.72, 0.95). There was a significant reduction in need for additional uterotonics (RR 0.47, 95% CI 0.39-0.57) or surgical intervention (RR 0.54, 95% CI 0.30-0.95).

CONCLUSION

The reduced risk of PPH > 1L was greatest in patients at higher risk of bleeding. The greatest risk reduction was seen in smaller studies and in studies undertaken in developing economies. Prophylactic TXA administration is effective at reducing the incidence of PPH > 1L at CS. The clinical benefit of universal prophylaxis is questionable; women who are high risk of PPH are more likely to derive benefit.

Anemia during pregnancy and adverse maternal outcomes in Georgia-A birth registry-based cohort study

BACKGROUND

Anemia in pregnancy is an important public health challenge; however, it has not been thoroughly studied in Georgia. We assessed the prevalence of anemia during pregnancy across Georgia and the association between anemia in the third trimester of pregnancy and adverse maternal outcomes.

METHODS

We used data from the Georgian Birth Registry and included pregnant women who delivered between January 1, 2019, and August 31, 2022 (n = 158,668). The prevalence of anemia (hemoglobin (Hb) < 110 g/L) at any time during pregnancy was calculated per region. Pregnant women were classified into anemia severity groups based on their lowest measured Hb values, taking into account the thresholds for each trimester of pregnancy as defined by the WHO recommendations for anemia classification. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated for the associations between anemia status and post-delivery intensive care unit (ICU) admission and preterm delivery.

RESULTS

The prevalence of anemia occurring at least once during pregnancy was 33.1%, with large regional differences in anemia prevalence (19.2%-32.8%). Of 105,811 pregnant women with Hb measurements in the third trimester, 71.0% had no anemia; 20.9%, mild anemia; and 8.1%, moderate or severe anemia. The odds of post-delivery ICU admission did not increase linearly with decreasing Hb value (P for trend .13), and the relationship was inverse for preterm delivery (P for trend .01).

CONCLUSIONS

A considerable proportion of pregnant women in Georgia have anemia during pregnancy, and the prevalence and quality of reporting differ across regions. Anemia occurring in the third trimester did not substantially increase the odds of maternal ICU admission or preterm delivery. To progress toward sustainable development goals and alleviate the public health burden of anemia, it is essential to not only identify and manage anemia during pregnancy but also address underlying factors with a multifaceted response.

Advances in human umbilical cord mesenchymal stem cells-derived extracellular vesicles and biomaterial assemblies for endometrial injury treatment

Endometrial injury caused by repeated uterine procedures, infections, inflammation, or uterine artery dysfunction can deplete endometrial stem/progenitor cells and impair regeneration, thereby diminishing endometrial receptivity and evidently lowering the live birth, clinical pregnancy, and embryo implantation rates. Currently, safe and effective clinical treatment methods or gene-targeted therapies are unavailable, especially for severe endometrial injury. Umbilical cord mesenchymal stem cells and their extracellular vesicles are characterized by their simple collection, rapid proliferation, low immunogenicity, and tumorigenicity, along with their involvement in regulating angiogenesis, immune response, cell apoptosis and proliferation, inflammatory response, and fibrosis, Therefore, these cells and vesicles hold broad potential for application in endometrial repair. This article reviewed recent research on human umbilical cord mesenchymal stem cells as well as their extracellular vesicles in repairing endometrial injury.

Au nanoparticle-modified hollow carbon spheres as an advanced electrochemical sensing platform for effective detection of homocysteine in human serum

It is widely known that homocysteine (Hcy) is associated with the pathogenesis of many clinical diseases, and its quantitative detection can help early treatment of related diseases. The selection of materials with excellent properties is important for the construction of electrochemical sensing platforms and quantitative detection of Hcy. In this study, two nanocomposites, Au nanoparticles/hollow carbon spheres (AuNPs@HCS) and Au nanoparticles/solid carbon spheres (AuNPs@SCS), were prepared first. Then their morphology, structure and electrochemical behavior were investigated. And the comparison found that the HCSs have a large electroactive surface area and outstanding conductivity. Thanks to the catalytic properties of AuNPs and the synergistic effect of HCSs, AuNPs@HCS/GCE showed excellent electrochemical sensing performance for a wide range of Hcy concentrations with a detection limit down to 4.44 nM (S/N = 3). Moreover, the electrochemical mechanism of Hcy on Au@HCS/GCE is discussed in detail. Finally, in the actual serum sample assay, the sensor is used to detect Hcy directly and the recovery rate is satisfactory. This work may provide a valid method for the quantitative determination of Hcy in the future.