Reprod. Med., Volume 6, Issue 2 (June 2025) – 3 articles

Background/Objectives: This study examines index pregnancies with histopathological diagnosis of placenta accreta, based on findings of basal plate myometrial fibers (BPMFs) without intervening decidua, and the risk of hemorrhagic morbidity and/or clinically adherent placenta in the subsequent pregnancy. Outcomes were compared between index pregnancies with incidental asymptomatic BPMF findings and those with symptoms based on hemorrhagic and placental factors. Methods: A retrospective cohort study was conducted at a large, integrated healthcare system from 2008 to 2019. All patients with an index finding of BPMF without intervening decidua and subsequent delivery of a live singleton were identified. Index pregnancies with BPMF were categorized as asymptomatic or symptomatic by the absence or presence of hemorrhagic morbidity and/or clinically adherent placenta. Rates of hemorrhagic morbidity and clinically adherent placenta in the subsequent pregnancy were compared among asymptomatic and symptomatic BPMF index pregnancies in bivariate analyses and multivariate models controlling for potential confounders. Results: A total of 140 patients were found to have BPMF and a subsequent delivery of a live singleton. Subsequent hemorrhagic morbidity/adherent placenta occurred in 28% of cases, with a lower incidence in asymptomatic patients (8% vs. 39%, p < 0.0001). Symptomatic BPMF was associated with increased odds of hemorrhagic morbidity/adherent placenta (aOR 10.2, 95% CI 2.7–38.4). Among 71 patients with subsequent placental pathology, 32% had recurrent BPMF, which correlated with higher morbidity compared to those without recurrence or those without placental pathology (61% vs. 40% vs. 9%, p < 0.0001). Conclusions: Incidentally identified BPMF was associated with a lower rate of subsequent hemorrhagic morbidity and/or adherent placenta compared to symptomatic BPMF. Symptomatic BPMF is highly associated with hemorrhagic morbidity and/or adherent placenta in the next pregnancy compared with incidentally identified BPMF, particularly if it is recurrent. These data can inform counseling and management of pregnant individuals with BPMF planning subsequent pregnancies. Full article

Pelvic floor fistulas are abnormal communications between the lower urinary tract and/or anorectum and the female genital tract. Classification systems for female pelvic floor fistulas have existed for over 150 years. At present, there is no consensus on a classification system. Traditionally, classification systems were used for obstetric fistulas. Earlier classification systems were descriptive (small/large/simple/complex) to communicate clinical findings. More recently, classification systems, in particular the Goh and Waaldijk systems, have been tested to predict the outcome of surgical closure and the risk of post-fistula closure urinary incontinence. Conclusions: Features of the fistula may predict outcomes following fistula surgery but other patient features and surgical experience and skill also play a role in the results. Full article

Background/Objective: Preterm births disproportionately affect low- and middle-income countries (LMICs), where evidence-based interventions to improve birth outcomes are lacking. The objective of this study was to systematically review, collate, and synthesize data on low-dose aspirin’s (LDA) effect on the incidence of preterm births in women from LMICs. Materials and Methods: This review included nine randomized controlled trials (RCTs) spanning thirteen LMICs, with 22,545 participants. The intervention group comprised 11,275 participants and the control group comprised 11,270 participants. The relative risk ratios and pooled intervention effects were calculated using Review Manager software, RevMan v5.4.1, with a random effects model. Low-dose aspirin’s effects on five outcomes were analyzed: preterm birth, perinatal mortality, low birth weight, antepartum hemorrhage, and post-partum hemorrhage. The quality of the studies was assessed by the Cochrane risk-of-bias tool and overall quality of evidence, using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Two independent authors participated in screening, data extraction, and quality assessment of the included studies. Results: Low-dose aspirin therapy significantly lowered the risks of preterm births (RR 0.91, 95% CI 0.84–0.98, p = 0.02) and perinatal mortality (RR 0.83, 95% CI 0.73–0.94, p < 0.01) in at-risk pregnant women from LMICs. Its effects on low birthweight and ante- and post-partum hemorrhages were less conclusive. Conclusions: Targeted LDA therapy should be considered to reduce preterm births in at-risk pregnant women from LMICs. Full article