Biomedicines

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9 pages, 397 KB

Open AccessArticle

Using Shear Wave Elastography to Predict Medical Treatment Response in Tubo-Ovarian Abscess

by Serav Koç, Şule Gül Aydın, Hasan Can Toyganözü, Emel Lüftüoğlu, Ali Can Koç, Cenk Parlatan, Cevdet Adıgüzel and Emre Destegül

Biomedicines 2026, 14(8), 1671; https://doi.org/10.3390/biomedicines14081671 - 24 Jul 2026

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Abstract

Background: This study aimed to evaluate the clinical utility of shear wave elastography (SWE) in assessing abscess wall stiffness and its potential contribution to predicting the need for surgical intervention in patients with tubo-ovarian abscess (TOA). Materials and methods: This prospective [...] Read more.

Background: This study aimed to evaluate the clinical utility of shear wave elastography (SWE) in assessing abscess wall stiffness and its potential contribution to predicting the need for surgical intervention in patients with tubo-ovarian abscess (TOA). Materials and methods: This prospective cross-sectional study included 34 women diagnosed with TOA who underwent SWE evaluation upon admission. Demographic characteristics, laboratory parameters, abscess size, abscess wall elasticity, and abscess content elasticity were recorded. These patients were categorized as either medically managed or surgically treated. Group comparisons, receiver operating characteristic (ROC) curve analysis, and multivariable binary logistic regression were performed to identify independent predictors of surgical intervention. Results: There were no significant differences between the operated and non-operated groups regarding age, body mass index, and laboratory parameters (p > 0.05). The median length of hospital stay was significantly longer in the operated group (15 vs. 12 days, p = 0.017). Abscess diameter was significantly larger in the operated group (6.75 ± 1.17 cm vs. 4.65 ± 1.20 cm; p = 0.001). Likewise, the median abscess wall SWE value was significantly higher in the operated group (3.12 vs. 1.47 kPa; p = 0.027). The optimal cut-off value for abscess wall SWE was 2.04 kPa (AUC: 0.721, 95% CI: 0.551–0.892, sensitivity: 64.7%, specificity: 70.6%). Abscess size demonstrated a higher predictive performance (AUC: 0.905, 95% CI: 0.796–1.000). However, in the multivariable logistic regression analysis, only abscess size remained an independent predictor of surgical intervention (OR: 4.14, 95% CI: 1.50–11.39, p = 0.006), whereas abscess wall SWE and baseline C-reactive protein were not independently associated with treatment failure. Conclusions: Increased abscess wall stiffness measured by SWE was associated with the need for surgical intervention in patients with TOA. Although SWE was not an independent predictor after adjustment for abscess size and baseline C-reactive protein, it may serve as a complementary imaging biomarker when interpreted together with established clinical, laboratory, and conventional ultrasonographic findings. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics and Therapeutics in Obsterics and Gynaecology (2nd Edition))

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12 pages, 608 KB

Open AccessArticle

Screening of a Novel Synonymous DNAH5 Variant in Histopathologically Confirmed Adenomyosis Cases from Turkiye

by Berivan Guzelbag, Sevcan Aydin, Nimet Eser Ma, Nura Fitnat Topbas Selcuki, Engin Oral and Feyza Nur Tuncer

Biomedicines 2026, 14(7), 1435; https://doi.org/10.3390/biomedicines14071435 - 24 Jun 2026

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Abstract

Background/Objectives: Adenomyosis is a common estrogen-dependent gynecological condition with a largely undefined genetic architecture. Ciliary dysfunction has been implicated in its pathogenesis, positioning genes governing ciliary structure and motility as biologically plausible candidates for investigation. The DNAH5 gene encodes a critical component of [...] Read more.

Background/Objectives: Adenomyosis is a common estrogen-dependent gynecological condition with a largely undefined genetic architecture. Ciliary dysfunction has been implicated in its pathogenesis, positioning genes governing ciliary structure and motility as biologically plausible candidates for investigation. The DNAH5 gene encodes a critical component of the outer dynein arms within the ciliary axoneme, and pathogenic variants are among the most common causes of primary ciliary dyskinesia. This study aimed to systematically determine the frequency of a novel synonymous DNAH5 variant, NM_001369.3:c.9258C>T, p.(Leu3086=), in a large, histopathologically confirmed sporadic adenomyosis cohort from Turkiye, and to evaluate its occurrence relative to population-level reference data. Methods: A total of 121 women with histopathologically confirmed adenomyosis following hysterectomy were enrolled. Sanger sequencing was performed under stringent quality control conditions, including primer specificity verification by NCBI BLAST and UCSC In Silico PCR. Variant frequency was compared against gnomAD v4.0 and an in-house Turkish exome database (NGS Cloud; ~30,000 sequences) using Fisher’s exact test. In silico splice site analysis was performed using SpliceAI, and variant classification followed ACMG/AMP guidelines. Results: The variant was detected in 63 of 121 patients (52.1%; 95% CI: 43.1–61.0%), exclusively in the heterozygous state; no homozygous carriers were identified. The variant was absent from both gnomAD v4.0 across all populations and the NGS Cloud Turkish exome database (MAF: 0.0000), yielding a frequency difference (p < 2.2 × 10⁻¹⁶). SpliceAI analysis predicted no significant splice site impact (all delta scores < 0.1). The variant was classified as a variant of uncertain significance (VUS; BP7, PM2_supporting). Conclusions: This study identifies a difference in the frequency of a novel synonymous DNAH5 variant between a histopathologically confirmed adenomyosis cohort from Turkiye and population-level reference datasets, in which the variant was absent. Given the unphenotyped nature of the reference dataset, these findings are hypothesis-generating and do not establish a causal genetic association. Replication in independent cohorts and functional studies are warranted to elucidate the biological significance of this variant in adenomyosis susceptibility. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics and Therapeutics in Obsterics and Gynaecology (2nd Edition))

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12 pages, 246 KB

Open AccessArticle

Maternal Response to Therapeutic Plasma Exchange in Early Gestation: A Case Series of Thrombotic Microangiopathies and Neurological Disorders

by Onur Karaaslan, Gürcan Türkyılmaz, Latif Hacıoğlu, Çağrı Ateş, Ersin Onat, Erbil Karaman, Hanım Güler Şahin and Ali Doğan

Biomedicines 2026, 14(6), 1403; https://doi.org/10.3390/biomedicines14061403 - 22 Jun 2026

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Abstract

Background/Objectives: Therapeutic plasma exchange (TPE) is an extracorporeal treatment used in thrombotic microangiopathies (TMAs) and various autoimmune and neurological disorders. However, data regarding its use during early pregnancy remain limited. This study aimed to evaluate maternal laboratory response and perinatal outcomes in pregnant [...] Read more.

Background/Objectives: Therapeutic plasma exchange (TPE) is an extracorporeal treatment used in thrombotic microangiopathies (TMAs) and various autoimmune and neurological disorders. However, data regarding its use during early pregnancy remain limited. This study aimed to evaluate maternal laboratory response and perinatal outcomes in pregnant women who underwent TPE before 26 weeks of gestation. Methods: This retrospective case series included 10 pregnant women diagnosed before 26 weeks of gestation who underwent TPE between 2010 and 2023. Clinical and laboratory parameters before and after TPE were compared. Results: Indications for TPE included HELLP syndrome (n = 4), thrombotic thrombocytopenic purpura (n = 3), presumed atypical haemolytic uremic syndrome (n = 1), neuromyelitis optica (n = 1), and Guillain–Barré syndrome (n = 1). The mean gestational age at diagnosis was 22.1 ± 3.1 weeks, and the mean gestational age at delivery was 27.1 ± 6.9 weeks. Five fetuses (50%) died and five (50%) survived to discharge. In patients with TMAs, TPE was associated with significant decreases in LDH, INR, APTT, ALT, AST, and total bilirubin levels, along with a significant increase in platelet count and ADAMTS13 activity (p < 0.01). No maternal complications occurred in neurological cases, all of which resulted in term deliveries with healthy neonates. Conclusions: In this uncontrolled case series, TPE was associated with rapid maternal clinical and laboratory improvement in selected pregnant women with TMAs, although a causal effect cannot be established from these data. However, perinatal outcomes were primarily determined by gestational age at delivery: all fetal losses occurred before 26 weeks, whereas all infants survived when delivery occurred after 26 weeks. Larger studies are needed to confirm these findings. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics and Therapeutics in Obsterics and Gynaecology (2nd Edition))

17 pages, 3122 KB

Open AccessArticle

The Relationship of Vaginal Symptoms and Cervical Inflammation Severity with Cytological Abnormalities and HPV Positivity: A Prospective Observational Study

by Alihan Tigli, Rulin Deniz, Toros Taskin, Guzide Ece Akinci, Sultan Deniz Altindag, Nazli Sener, Yasemin Ercan Degirmenci, Sefer Ustebay, Muhammet Bora Uzuner, Erdem Gurkan, Oguzhan Karakoc and Yakup Baykus

Biomedicines 2026, 14(6), 1384; https://doi.org/10.3390/biomedicines14061384 - 19 Jun 2026

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Abstract

Background/Objectives: This study aimed to evaluate the association between the clinical parameters of vaginal infection—specifically the presence, type, number of concurrent symptoms, and recurrence frequency—and cervical cytology findings, including inflammation severity, Candida, bacterial vaginosis, cellular abnormalities, and Human Papillomavirus (HPV) positivity. Methods [...] Read more.

Background/Objectives: This study aimed to evaluate the association between the clinical parameters of vaginal infection—specifically the presence, type, number of concurrent symptoms, and recurrence frequency—and cervical cytology findings, including inflammation severity, Candida, bacterial vaginosis, cellular abnormalities, and Human Papillomavirus (HPV) positivity. Methods: This prospective, cross-sectional, observational study included 458 women attending our gynecology outpatient clinic for Pap smear screening. Vaginal symptoms were documented through face-to-face interviews using a structured data collection form. Cervical samples were evaluated via liquid-based cytology by a single, experienced cytopathologist, who was blinded to the clinical data; cellular abnormalities, the degree of inflammation and cytomorphological findings indicative of infection were reported. HPV analysis was performed on the 218 women for whom results were available. Chi-square and trend chi-square tests were used in the statistical analysis. Results: No significant association was found between the clinical parameters of vaginal symptoms—specifically presence, concurrency, and recurrence frequency—and cytological abnormalities, HPV positivity and bacterial vaginosis (p > 0.05). In contrast, the prevalence of moderate-to-severe inflammation was significantly higher in women with vaginal discharge and a greater symptom burden (p < 0.05). Pruritus, dysuria, and vaginal burning were significantly associated with Candida positivity (p < 0.05). However, no significant association was found between the severity of cervical inflammation and abnormal cytology or HPV positivity (p > 0.05). In multivariable logistic regression analyses, neither symptom burden nor cervical inflammation severity was independently associated with abnormal cytology or HPV positivity. Conclusions: Our findings indicate that vaginal symptoms and the severity of cervical inflammation may not serve as definitive or independent discriminatory markers for cellular abnormalities or HPV positivity in this context. Nevertheless, specific symptom patterns may assist clinicians in evaluating localized infectious processes. Consequently, while standard cytological and molecular protocols remain essential for oncogenic screening, evaluating the overall symptom burden provides clinicians with a valuable framework for identifying benign dysbiotic and inflammatory processes. These findings remained consistent after adjustment for major clinical confounders. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics and Therapeutics in Obsterics and Gynaecology (2nd Edition))

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15 pages, 957 KB

Open AccessArticle

Risk-Based Triage Using Cytology and HPV Genotyping to Reduce Unnecessary Colposcopy: A Real-World Cross-Sectional Study

by Sait Erbey, Mehmet Alican Sapmaz, Murat Polat, Ömer Osman Eroğlu and Çağanay Soysal

Biomedicines 2026, 14(6), 1224; https://doi.org/10.3390/biomedicines14061224 - 28 May 2026

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Abstract

Background and Objectives: Despite the widespread adoption of HPV-based cervical cancer screening, the optimal triage strategy for women with low-grade cytological abnormalities and non-16/18 high-risk HPV (hrHPV) types remains debated. This study evaluated the impact of ASCCP risk-based triage strategies on colposcopy referral [...] Read more.

Background and Objectives: Despite the widespread adoption of HPV-based cervical cancer screening, the optimal triage strategy for women with low-grade cytological abnormalities and non-16/18 high-risk HPV (hrHPV) types remains debated. This study evaluated the impact of ASCCP risk-based triage strategies on colposcopy referral and biopsy outcomes in a large tertiary care center. Methods: This retrospective cross-sectional study included 2748 sexually active women aged 30–65 years who underwent colposcopy at Ankara Etlik City Hospital (January 2023–June 2025). Of these, 1932 met ASCCP criteria for cervical biopsy. Cytology results, HPV genotypes (16, 18, and other hrHPV types), and histopathological findings were analyzed. CIN3+ (CIN3, adenocarcinoma in situ, or invasive carcinoma) was the primary outcome. Multivariable logistic regression identified independent predictors, with model fit assessed by Nagelkerke R² and the Hosmer–Lemeshow test. Results: The mean age was 42.8 ± 8.1 years. The overall CIN3+ prevalence was 15.9% (308/1932). HSIL cytology was the strongest independent predictor of CIN3+ (adjusted OR 22.41, 95% CI: 11.28–44.52). HPV16/18 combined with HSIL or ASC-H cytology conferred the highest risk (adjusted OR 17.88–21.67). Women with ASC-US or LSIL cytology and non-16/18 hrHPV types had CIN3+ rates below 10%. Irregular screening history was also an independent predictor (adjusted OR 1.38). A risk-based triage approach suggested a potential reduction of approximately 29.7% in colposcopy utilization. However, this estimate applies exclusively to the biopsied subgroup and does not account for potentially undetected lesions in the 816 non-biopsied women enrolled in surveillance follow-up. Conclusions: HSIL cytology and HPV16/18 positivity represent the highest-risk profile for CIN3+ and should remain primary indications for colposcopy. Conversely, women with ASC-US or LSIL cytology and non-16/18 hrHPV types may be candidates for surveillance-based co-testing rather than immediate colposcopy, potentially enabling a resource-efficient reduction in unnecessary procedures within the biopsied cohort studied. Prospective validation in broader colposcopy-referred populations is needed before generalizing these findings to primary screening settings. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics and Therapeutics in Obsterics and Gynaecology (2nd Edition))

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13 pages, 2175 KB

Open AccessArticle

sMICA/sMICB and Immune Checkpoint in Endometriosis: Toward a Minimally Invasive Diagnostic Model Based on Machine Learning

by Anastasia Belevich, Maria Yarmolinskaya, Ilya Smirnov, Anastasia Stolbovaya, Olga Shashkova, Marina Samoylovich, Sergey Selkov, Polina Grebenkina, Elizaveta Tyshchuk and Dmitry Sokolov

Biomedicines 2026, 14(3), 647; https://doi.org/10.3390/biomedicines14030647 - 12 Mar 2026

Cited by 2 | Viewed by 788

Abstract

Background: Endometriosis is a complex condition that impairs women’s quality of life and reproductive potential. Its diagnosis remains significant challenge for clinicians. The aim of the study was to investigate cancer-like immune evasion mechanisms in endometriosis and to develop a novel diagnostic model [...] Read more.

Background: Endometriosis is a complex condition that impairs women’s quality of life and reproductive potential. Its diagnosis remains significant challenge for clinicians. The aim of the study was to investigate cancer-like immune evasion mechanisms in endometriosis and to develop a novel diagnostic model using machine learning. Methods: In this study, we measured the levels of soluble forms of the following immune markers in blood serum and peritoneal fluid (PF): sMICA, sMICB, sEng, sCD25, s4-1BB, sB7.2, sCTLA-4, sPD-L1, sPD-1, sTIM-3, sLAG-3, and sGal-9. Results: sMICB levels in PF differed across endometriosis stages and were higher in patients with endometriosis-associated adhesions. sMICA levels in PF were elevated in women with endometriosis-associated infertility. The disease severity was inversely correlated with serum sB7.2 levels and positively correlated with serum sTIM-3 levels. A logistic regression model achieved an accuracy = 0.79, AUC = 0.94, and F1-score = 0.88, whereas XGBoost performed better with accuracy = 0.94, AUC = 0.95, and F1-score = 0.96. The key predictive features in both models were sMICB serum level and patients’ pain score. Conclusions: Our results demonstrate the potential role of sMICA and sMICB shedding in endometriosis and present a novel, minimally invasive diagnostic approach. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics and Therapeutics in Obsterics and Gynaecology (2nd Edition))

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15 pages, 6292 KB

Open AccessArticle

Differential Scanning Calorimetry, a Novel Method to Detect Uterine Ischemia-Reperfusion Injury During Autotransplantation in Experimental Sheep Model

by Gabor Fazekas, Balint Farkas and Denes Lorinczy

Biomedicines 2025, 13(10), 2388; https://doi.org/10.3390/biomedicines13102388 - 29 Sep 2025

Cited by 1 | Viewed by 1014

Abstract

Background/Objectives: A novel treatment of absolute uterine factor infertility is uterus transplantation. In preparation for human surgery, autotransplantation was performed in a sheep model to assess ischemia-reperfusion injury of the uterine wall. Methods: Seven multiparous ewes underwent live-donor uterus autotransplantation; in [...] Read more.

Background/Objectives: A novel treatment of absolute uterine factor infertility is uterus transplantation. In preparation for human surgery, autotransplantation was performed in a sheep model to assess ischemia-reperfusion injury of the uterine wall. Methods: Seven multiparous ewes underwent live-donor uterus autotransplantation; in six, the procedure was completed successfully. Tissue blocks of complete uterine wall, endometrium, and myometrium were obtained at four predefined time points: native (baseline), after 1 h of cold ischemia, after 30 min of warm ischemia, and after 30 min of reperfusion. Samples were analyzed by differential scanning calorimetry and routine hematoxylin–eosin histology. Results: Histology demonstrated preserved epithelial, glandular, and stromal structures, with only minimal, reversible changes that increased with the ischemic duration. Differential scanning calorimetry confirmed alterations in thermal stability: in the uterine wall and myometrium, the calorimetric enthalpy decreased from baseline (3.40 ± 0.53 J/g) to reperfusion (2.62 ± 0.22 J/g), indicating structural loosening; in contrast, the endometrium calorimetric enthalpy slightly increased, suggesting greater flexibility and less susceptibility to ischemia-reperfusion injury. Conclusions: In this preliminary study, differential scanning calorimetry proved to be an effective and sensitive method for detecting early structural alterations in the uterine wall that could negatively impact post-transplant function. Cold and warm ischemia did not cause irreversible damage within a two-hour time frame, supporting the feasibility of short-term preservation in uterus transplantation. The myometrium demonstrated more significant vulnerability than the endometrium, which highlights the necessity of protective strategies to preserve smooth muscle integrity during transplantation. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics and Therapeutics in Obsterics and Gynaecology (2nd Edition))

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Review

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23 pages, 2055 KB

Open AccessReview

From Endometriosis to Lipedema: Toward a Neuroimmune Framework for Pain Amplification in Hormone-Sensitive Disorders

by Diogo Pinto da Costa Viana, Thiago Bracks Oliveira, Adriana Luckow Invitti and Eduardo Schor

Biomedicines 2026, 14(7), 1510; https://doi.org/10.3390/biomedicines14071510 - 3 Jul 2026

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Abstract

Background: Endometriosis and lipedema are chronic female-predominant disorders characterized by persistent pain that is frequently disproportionate to anatomical lesion burden. Although traditionally interpreted within distinct lesion-centered frameworks, both conditions exhibit striking clinical and epidemiological parallels, including hormonally modulated symptom dynamics, overlap with [...] Read more.

Background: Endometriosis and lipedema are chronic female-predominant disorders characterized by persistent pain that is frequently disproportionate to anatomical lesion burden. Although traditionally interpreted within distinct lesion-centered frameworks, both conditions exhibit striking clinical and epidemiological parallels, including hormonally modulated symptom dynamics, overlap with central pain syndromes, weak correlation between structural disease severity and pain intensity, and symptom clustering during reproductive transitions such as puberty, pregnancy, and menopause. Methods: This study aims to synthesize clinical, molecular, neuroimmune, and endocrine evidence on the interrelationship between endometriosis and lipedema, and to propose a hypothesis-generating neuroimmune framework linking both conditions. This integrative narrative review conducted a non-systematic literature search in PubMed/MEDLINE, Scopus, and Web of Science, focusing on mechanisms related to chronic pain, mast cell biology, TRPV1 signaling, CGRP-mediated neurogenic inflammation, intracrine steroidogenesis, and peripheral and central sensitization. Results: The review identifies convergent biological characteristics between the two diseases, including mast cell activation, macrophage polarization, endothelial dysfunction, fibrosis, angiogenesis, intracrine estrogen metabolism, and persistent inflammatory signaling. In endometriosis, direct evidence demonstrates increased sensory innervation, nerve growth factor expression, TRPV1 sensitization, CGRP-positive fibers, and mast cell-nerve interactions. In lipedema, convergent upstream mechanisms, including mast cell infiltration, elevated histamine levels, adipose tissue inflammation, and local estrogen activation, support the plausibility of a functionally analogous neuroimmune organization, despite incomplete direct neural characterization. In this context, the mast cell-TRPV1-CGRP axis is proposed as a biologically plausible framework, directly supported in endometriosis and currently hypothetical in lipedema, connecting peripheral sensitization, neurogenic inflammation, hormonal chronodependence, and central nociceptive amplification. The model further conceptualizes pain crises as transient events of instability within a sensitized neuroimmune network and proposes mechanistic phenotypes that integrate gastrointestinal, inflammatory, central, and hormonal triggers. Conclusion: Endometriosis and lipedema may represent topographically distinct manifestations of a shared neuroimmune process operating within hormone-sensitive tissues. Although the evidentiary basis remains asymmetric, with stronger mechanistic support in endometriosis than in lipedema, this framework provides a biologically plausible and experimentally testable model integrating endocrine, immune, neural, and vascular contributors to chronic pain amplification. This perspective supports coordinated translational investigation across reproductive biology, endocrinology, and pain medicine and may contribute to future mechanism-based stratification and therapeutic development. This work is hypothesis-generating and is not intended to establish causality or to provide clinical recommendations; all proposed mechanistic and therapeutic inferences require prospective experimental validation. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics and Therapeutics in Obsterics and Gynaecology (2nd Edition))

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21 pages, 912 KB

Open AccessReview

After the Shock: Impact of Ectopic Pregnancy on Subsequent Fertility and Parenthood

by Efthalia Moustakli, Ekaterini Domali, Anastasios Potiris, Angeliki Gerede, Ismini Anagnostaki, Athanasios Zikopoulos, Charalampos Theofanakis, Nikolaos Kathopoulis, Konstantinos Louis, Peter Drakakis and Sofoklis Stavros

Biomedicines 2025, 13(9), 2205; https://doi.org/10.3390/biomedicines13092205 - 9 Sep 2025

Cited by 2 | Viewed by 6137

Abstract

The potentially fatal condition known as ectopic pregnancy (EP) occurs when an embryo implants outside of the uterus, usually in the fallopian tube. It accounts for approximately 1–2% of all pregnancies and remains a leading cause of maternal morbidity in the first trimester. [...] Read more.

The potentially fatal condition known as ectopic pregnancy (EP) occurs when an embryo implants outside of the uterus, usually in the fallopian tube. It accounts for approximately 1–2% of all pregnancies and remains a leading cause of maternal morbidity in the first trimester. EP is an important area of focus in reproductive health that extends beyond its immediate clinical care. The purpose of this study is to investigate the effects of EP on the physical, reproductive, and psychological aspects of eventual fertility and parental outcomes. The findings from qualitative interviews, case–control studies, and cohort studies that have been published in peer-reviewed journals over the past 20 years were compiled into a narrative literature review. Included were studies looking at patient experiences after EP, psychosocial impacts, and reproductive results. According to research, women who have had EP in the past may have a slightly lower chance of becoming pregnant in the future, particularly following a salpingectomy. Assisted reproductive technology may potentially mitigate some of these risks. The parenting journey is often complicated by psychological consequences. Access to fertility services and counseling was found to have a significant impact on post-EP reproductive outcomes. The need for thorough follow-up care that addresses both physical and mental wellness is highlighted by the fact that EP can have long-lasting impacts on fertility and the parenting path. To optimize patient well-being and reproductive results, post-EP treatment must include early fertility counseling and psychological support. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics and Therapeutics in Obsterics and Gynaecology (2nd Edition))

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Other

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11 pages, 418 KB

Open AccessSystematic Review

The sFlt-1/PlGF Index as an Auxiliary Tool in the Prediction of Adverse Perinatal Outcomes in Late-Onset Fetal Growth Restriction: A Systematic Review

by Martyna Drzycimska, Magdalena Bednarek-Jędrzejek, Ewa Kwiatkowska and Sebastian Kwiatkowski

Biomedicines 2026, 14(6), 1321; https://doi.org/10.3390/biomedicines14061321 - 10 Jun 2026

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Abstract

Background/Objectives: This study evaluates the prognostic utility of placental insufficiency biomarkers in late-onset fetal growth restriction occurring after 32 weeks of gestation. These markers were assessed both independently and in conjunction with ultrasound and Doppler indices to predict adverse perinatal outcomes. Given the [...] Read more.

Background/Objectives: This study evaluates the prognostic utility of placental insufficiency biomarkers in late-onset fetal growth restriction occurring after 32 weeks of gestation. These markers were assessed both independently and in conjunction with ultrasound and Doppler indices to predict adverse perinatal outcomes. Given the clinical integration of maternal angiogenic factor assessment, it is imperative to determine whether these markers—specifically the sFlt-1/PlGF ratio—can effectively mitigate fetal and neonatal morbidity and mortality. Methods: This review is registered with PROSPERO and encompasses the literature from the last decade. The present analysis incorporated prospective observational cohort studies. Four comprehensive databases were queried, resulting in the evaluation of fifty-one relevant records. Thirty-six full-text articles were assessed for eligibility, resulting in the inclusion of six relevant manuscripts. The total sample size was 14.499 patients. Detection rates for growth restricted fetuses demonstrated significant variability, ranging from 15% to 88.5%. Conclusions: The clinical utility of angiogenic biomarkers for the prediction of fetal growth restriction remains unresolved; moreover, the empirical evidence synthesized within this review exhibits a significant degree of heterogeneity. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics and Therapeutics in Obsterics and Gynaecology (2nd Edition))

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