Reprod. Med., Volume 6, Issue 4 (December 2025) – 6 articles

Background: The human fetal adrenal gland is a unique endocrine organ with distinct morphology and functional dynamics, which is significantly different from the postnatal adrenal. Its rapid growth and vital steroidogenic role during gestation have positioned it as a key regulator of fetal development and pregnancy maintenance. Objectives: To provide a comprehensive overview of the morphogenesis, function, regulatory mechanisms, and clinical implications of the human fetal adrenal gland, highlighting recent advances in understanding its development and its role in prenatal and postnatal health outcomes. Methods: A systematic review was conducted, including original research articles focused on human fetuses or validated animal models, examining the genetic, molecular, and hormonal mechanisms underlying adrenal development and function. Studies were excluded if they were editorials, case reports, focused on adult adrenal physiology, had small sample sizes, or were non-English publications. Study quality was evaluated using PRISMA guidelines. Results: The fetal adrenal gland develops from both mesodermal and ectodermal origins, forming three primary zones: fetal, transitional, and definitive. Each zone has distinct functions and developmental pathways. The fetal zone, which predominates, is responsible for producing dehydroepiandrosterone sulfate, DHEA-S, which is crucial for placental estrogen synthesis. The adrenal gland undergoes rapid growth and functional maturation, regulated by ACTH, placental CRH, IGF, and the renin–angiotensin system. Disruption of adrenal function is associated with conditions such as preterm birth, adrenal hypoplasia, congenital adrenal hyperplasia, and intrauterine growth restriction. Emerging evidence suggests that fetal adrenal hormones may influence long-term health through fetal programming mechanisms. Conclusions: The fetal adrenal gland plays a critical and multifaceted role in fetal and placental development. This gland influences placental development via steroid precursors (DHEA-S → estrogen synthesis), while also being regulated by placental factors such as the corticotropin-releasing hormone. Understanding its complex structure–function relationships and regulatory networks is essential for predicting and managing prenatal and postnatal pathologies. Future research should focus on elucidating molecular mechanisms, improving diagnostic tools, and exploring long-term outcomes of altered fetal adrenal function. Full article

Telemedicine has emerged as a promising tool in obstetric and reproductive healthcare, offering new possibilities for patient-centered care delivery. This literature review explores its impact across key areas, including abortion, assisted reproduction, childbirth, contraception, gestational diabetes, mental health, opioid and smoking cessation, and perinatal care during the COVID-19 pandemic. A structured narrative approach was applied, with studies identified through PubMed and Scopus databases for screening, with selection based on predefined inclusion and exclusion criteria, and synthesized narratively with attention to clinical outcomes, access, satisfaction, and barriers to implementation. Perspectives on the acceptance of telemedicine among healthcare providers, technological advancements enhancing reproductive outcomes, and telemedicine’s pivotal role in maintaining continuity of care during crises, such as the COVID-19 pandemic, are examined. The review also addresses challenges and barriers, including technological proficiency and patient acceptance, while emphasizing telemedicine’s potential to improve accessibility, patient satisfaction, and healthcare outcomes across diverse reproductive health services. Full article

Background/Objectives: Classified as a hypertensive disorder of pregnancy, preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The abnormal trophoblast invasion that leads to a failed transformation of the uterine spiral arteries during placentation remains the most probable cause for preeclampsia. It is known that adiponectin acts on the placenta, playing a regulatory role in placentation processes. Therefore, the aim of this systematic review is to compile scientific evidence to evaluate the role of adiponectin as a biomarker for preeclampsia. Methods: The protocol for this systematic review was registered on the PROSPERO database (ID CRD42024542403) and follows the PRISMA 2020 guidelines. Overall, twenty-nine studies were selected from the PubMed and Scopus databases, including case–control, prospective and retrospective cohort, cross-sectional, and bidirectional Mendelian randomization studies. Results: From the articles analyzed, nine studies indicated an increase in adiponectin levels in preeclampsia, eleven reported a decrease, eight detected no significant changes, and in two studies, it was not possible to determine the glycoprotein levels. Analysis of the evidence quality revealed that moderate and low evidence levels predominate, with stronger evidence for decreased adiponectin levels. Conclusions: Promoting the advancement of scientific research is crucial, particularly exploring the association between adiponectin and other biomarkers. This approach could facilitate the development of screening and diagnostic methods, enabling the implementation of specific preventive and therapeutic strategies. Full article

Primary care providers are increasingly tasked with providing basic gynecologic care, including contraceptive therapy, to their patients. In the United States, oral contraceptive pills are the most frequently prescribed form of contraception; thus, it is critical that primary care providers are well versed in addressing common patient questions. Well-documented concerns relating to oral contraception initiation include changes in weight, mood, cancer risk, libido, acne, and infertility. Herein, we provide a clinical case example of a patient with these common concerns, review the related evidence, and suggest appropriate counseling with the goal of helping primary care clinicians provide the highest level of evidence-based oral contraceptive care. Full article

Background: Cornual pregnancy (CP) is a rare but life-threatening form of ectopic pregnancy. Severe complications include uterine rupture and massive hemorrhage, often requiring complex surgical management despite prompt intervention. We report a case of a ruptured left CP at 12 weeks, occurring three months after ipsilateral salpingectomy for a tubal pregnancy. Case Presentation: A 27-year-old woman, gravida 2, with a history of left salpingectomy, presented at 12 weeks of amenorrhea with severe pelvic pain and irregular uterine bleeding. Clinical examination, serum β-hCG testing, and transvaginal ultrasound confirmed hemoperitoneum due to rupture of a cornual pregnancy. Emergency laparoscopy was performed, with drainage of massive hemoperitoneum, excision of the ectopic gestation, and uterine wall repair. Uterine integrity was preserved, and the patient was discharged without complications. Discussion: Cornual ectopic pregnancy remains diagnostically and surgically challenging, with high risk of catastrophic hemorrhage. Transvaginal ultrasonography, supported by 3D ultrasound or MRI in equivocal cases, facilitates early diagnosis. Laparoscopy is increasingly recognized as the gold standard, offering reduced morbidity, faster recovery, and preservation of fertility compared with laparotomy, though it requires advanced surgical expertise. Long-term follow-up is essential due to the risk of uterine rupture in subsequent pregnancies, and elective cesarean delivery is often advised. Conclusion: This case demonstrates that minimally invasive laparoscopic management of ruptured CP with massive hemoperitoneum is feasible and safe when performed by experienced surgeons, but further studies are needed to optimize standardized protocols and assess reproductive outcomes. Full article

Pregnancy in women with type 1 diabetes mellitus (T1DM) is associated with a high risk of maternal and perinatal complications, and achieving optimal glycaemic control remains a clinical challenge. This article presents a narrative review of the evidence on advanced hybrid closed loop (AHCL) insulin delivery systems in pregnancy, with a focus on maternal glycaemic outcomes, neonatal outcomes, and psychosocial aspects. The relevant literature was identified through a structured search of PubMed, Scopus, and Web of Science (2010–2025), supplemented by guideline documents and reference screening. Eligible studies included randomised controlled trials, observational studies, and qualitative investigations. Data were synthesised thematically. Findings from key trials, including CONCEPTT, AiDAPT, and CRISTAL, demonstrate that AHCL systems improve time in range, lower mean glucose, and reduce hyperglycaemia without increasing hypoglycaemia. Some evidence also suggests improved neonatal outcomes, though statistical significance varies. Qualitative studies highlight reduced anxiety, improved sleep, and enhanced quality of life for women using AHCL during pregnancy. In conclusion, AHCL systems show strong promise in optimising maternal glycaemic control and potentially improving perinatal outcomes. However, larger, unbiased studies and real-world evaluations are needed to confirm their benefits and support broader clinical implementation. Full article