Reprod. Med., Volume 6, Issue 2 (June 2025) – 5 articles

Cervical cancer is a significant global health challenge, ranking as the fourth most common malignancy in women worldwide (age-standardized incidence: 13.3/100,000). In the UK, prevalence is markedly lower (7.6/100,000) compared to global averages, attributable to successful HPV vaccination and screening programs. post-treatment follow-up is critical for monitoring recurrence, managing complications, and addressing survivors’ psychosocial needs. However, follow-up care lacks standardization, especially for advanced-stage cervical cancer. This narrative review critically assesses existing guidelines, practices, and innovative approaches to follow-up care post-cervical cancer treatment, identifying inconsistencies and offering recommendations for standardization. This review synthesizes recommendations from 12 guidelines (NCCN, ASTRO, ESGO, BSCCP, BGCS, and ESMO) to evaluate follow-up strategies for cervical cancer survivors. Emerging evidence supports risk-stratified approaches combining Patient-Initiated Follow-Up (PIFU) for low-risk patients with intensive imaging (PET/CT/MRI) for advanced stages. Psychosocial interventions, particularly for sexual health and return-to-work challenges, remain underutilized despite ESGO recommendations. Follow-up recommendations vary significantly, focusing on clinical examination and symptom-based imaging. Patient-Initiated Follow-Up (PIFU) is a growing trend, though concerns persist regarding its appropriateness for high-risk groups. Most recurrences are symptomatic, supporting less-intensive protocols for low-risk patients. Imaging methods like FDG PET/CT provide prognostic insights but are not universally adopted. Psychosocial and psychosexual care needs remain under addressed. Standardized, evidence-based follow-up protocols are essential to address disparities in survivorship care. Holistic strategies incorporating psychosocial support and tailored plans will ensure comprehensive care. This is the first review to integrate NCCN imaging standards with ESGO psychosocial care in a risk-stratified model. Future research should refine PIFU models and imaging strategies to balance resource use with quality care. Critical clinical implications emerge: (1) Risk-stratified follow-up reduces unnecessary imaging by 31% (95% CI 24–38%) in low-risk patients while maintaining 98% 5-year survival; (2) mandatory psycho-oncology referrals (per ESGO guidelines) lower depression rates by 58% (OR 0.59); (3) PET/CT should be reserved for stage IIB+ patients with symptoms, saving EUR 2300 per avoided scan. These evidence-based thresholds enable personalized survivorship care. Full article

Background/Objectives: Barbed sutures have been recognised to offer numerous advantages compared to traditional sutures in minimally invasive procedures including holding tension. However, they are also associated with increased reports of small bowel obstructions (SBOs) in laparoscopic procedures. We are the first to conduct a review on the incidence of SBOs secondary to the use of barbed sutures in robotic surgery. Our aim is to raise awareness about this rare complication and promote early recognition and timely intervention, leading to a reduction in the incidence of severe complications and thereby improving patient outcomes. Methods: A systematic review of the literature was performed by searching the Ovoid Medline, PubMed and Cochrane Databases. After applying our exclusion criteria of articles unavailable in English, seven articles remained. We examined the literature and calculated the median and mean ranges for surgical procedures, time to presentation, symptoms of presentation, type of complications involving the bowel, the type of barbed suture and the additional length of hospital stay. Results: Our systematic review revealed eight cases of bowel obstruction secondary to the use of a barbed suture during robotic surgery. Robotic sacrocolpopexy had the highest complication rate: the median time to presentation was 14 days with vomiting being the most common presenting symptom. Most cases were resolved with a diagnostic laparoscopy and truncation of the barbed suture, and length of re-admission was a median of 4 days. Discussion: The introduction of new devices always carries advantages as well as unfortunate complications. Minimisation of complications through learnt surgical techniques including shortening thread tails and prompt recognition of the complication on re-presentation are key to optimising future patient care. Conclusions: Further prospective trials in this field will be useful to assess the appropriate use of the barbed suture as well as research dedicated to exploring alternate adhesive sutures. Full article

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