Reproductive Medicine

Background: Preeclampsia (PE) and gestational diabetes mellitus (GDM) are complex pregnancy disorders characterized by hypertension, proteinuria, increased blood glucose levels, and metabolic dysfunction. Methods: We investigated lymphocyte proliferation, immune function, key antioxidants, and metabolic and mitochondrial enzyme activities in women with PE and PE with GDM compared to normotensive pregnant (NP) controls. Lymphocyte proliferation was assessed following phytohemagglutinin (PHA) stimulation at varying concentrations (0.5, 2.5, and 5 µg/mL). Activities of key antioxidant enzymes, metabolic enzymes, and mitochondrial enzymes were measured. Other stress markers, including nitric oxide (NO) production and lipid peroxidation (TBARS), along with acetylcholine esterase (AChE) activity, and proinflammatory cytokine assays (IL-6 and TNF-α) were also evaluated from the PHA-induced lymphocytes. Results: Lymphocyte proliferation in response to PHA was significantly increased in PE and PE with GDM groups compared to NP, although low-dose PHA (0.5 and 2.5 µg/mL) moderately enhanced proliferation in NP. IL-6 and TNF-α levels were notably elevated in both disease groups. Antioxidant activities of SOD, GST, GPx and AChE, Citrate synthase, Cytochrome c oxidase, and NO production were significantly reduced in PE and PE with GDM, while hexokinase activity involved in glycolysis was elevated in both groups. Further, TBARS levels were elevated in the disease groups, particularly in PE with GDM. Conclusions: The findings arise from a clinical cross-sectional study and highlight significant immune alterations, oxidative stress, and mitochondrial impairment in PE and PE with GDM. The observed elevation in proinflammatory cytokines further underscore the role of immune activation in the pathogenesis of these complications, emphasizing the integrated immunometabolic shifts identified in this study, as potential molecular indicators for early intervention. Full article

Background/Objectives: Non-receptive endometrium is associated with recurrent implantation failure, which leads to a decrease in the frequency of pregnancy during IVF; therefore, new treatment methods such as the use of Platelet-Rich Plasma (PRP) are gaining popularity in the treatment of infertility in women with repeated unsuccessful IVF attempts. Methods: A total of 38 women were included in this study, with the main complaint being the inability to conceive or maintain pregnancy. Medical examination, laboratory tests, ultrasound of the pelvic organs and hysteroscopy were performed. After that, whole blood was taken to prepare an autologous PRP; then, the PRP was inserted into the uterine using an intrauterine catheter in the first phase of the menstrual cycle (1–7 procedures). The primary outcome of this study was an increase in endometrial thickness and improvement of the receptive endometrial layer. The secondary outcome was pregnancy rate. This was a single-center prospective interventional clinical study. Results: Statistical analysis of changes in endometrial thickness after PRP therapy showed that endometrial thickness indicators after treatment significantly exceeded the values before the intervention. This may be evidence of the effectiveness of PRP therapy for thin endometrium. When analyzing pregnancy status, it was noted that after receiving PRP, more than half (56% of cases) became pregnant and the majority of them successfully gave birth. Conclusions: Based on the results of our study, we can conclude that intrauterine injection of PRP may be a new therapeutic approach in the treatment of thin endometrium and associated infertility. The use of PRP demonstrated effectiveness in increasing the thickness of the endometrium, regardless of pregnancy, while the secondary indicator was the frequency of successful pregnancies among the participants. Full article

Background/Objectives: Cervical insufficiency remains a leading cause of second-trimester pregnancy loss and early preterm birth. Although single-level cerclage techniques such as McDonald or Shirodkar are widely accepted, the potential advantages of double or modified double-level cerclage remain controversial. Methods: This systematic review was conducted in accordance with PRISMA guidelines. Comprehensive searches of PubMed, Embase, Web of Science, and the Cochrane Library (to September 2025) were supplemented by Google Scholar and conference proceedings. Eligible studies included randomized controlled trials, comparative cohort studies, and case series directly comparing double versus single transvaginal cerclage. A total of twenty-six sources were included, spanning randomized trials, comparative cohort studies, published protocols, case series, systematic reviews, conference abstracts, and early technical or historical reports. The primary outcome was preterm birth before 34 weeks; secondary outcomes were GA at delivery, latency, neonatal morbidity and mortality, and maternal complications. Results: Across prophylactic (history- or ultrasound-indicated) settings, double sutures produced outcomes comparable to single-level cerclage without consistent superiority. In contrast, in emergency or exam-indicated cases with advanced cervical dilation or bulging membranes, double or double-level cerclage significantly prolonged latency and reduced very preterm birth (<32–34 weeks). Double-level reinforced techniques (including monofilament-based and modified Wurm-type approaches) showed improved mechanical support and lower neonatal intensive-care admission. Case series further demonstrated successful rescue procedures beyond 24 weeks, indicating expanded surgical feasibility in selected patients. Conclusions: While double cerclage yields similar results to single cerclage in prophylactic use, it appears advantageous in high-risk or emergency scenarios. Comparative analyses suggest that combined mechanical and infection-controlled approaches may improve cervical competence and prolong gestation in selected patients. Ongoing multicenter randomized trials are needed to establish its definitive role in modern obstetric practice. Full article

Background: The management of symptomatic uterine fibroids in women of reproductive age remains a clinical challenge, with uterine preservation being a primary objective in order to safeguard fertility. To date, no clear consensus has been established in the literature regarding the optimal treatment strategy, as therapeutic choices largely depend on individual patient characteristics. In selected cases, the use of preoperative measures aimed at minimizing the risk of major intraoperative hemorrhage has been associated with an increased likelihood of adopting a more conservative surgical approach. Case presentation: We report the case of a young patient treated at our institution who presented large uterine fibroids and underwent Preoperative Uterine Artery Embolization (PUAE) before planned open myomectomy with positive outcomes. In our case, this approach provided excellent intraoperative hemostatic control, minimizing blood loss. At post-discharge follow-up, the patient showed marked symptom relief and improved quality of life. Long-term follow-up will assess sustained treatment efficacy. Conclusions: PUAE should be considered a valuable therapeutic option in patients with symptomatic uterine fibroids at high risk of surgical bleeding. When integrated into a multidisciplinary treatment plan, PUAE may enhance surgical safety, support fertility preservation, and broaden the range of conservative options available for women with complex fibroid disease. Full article

Background/Objectives: Serum progesterone (P) levels on the day of frozen–thawed embryo transfer (FET) appear to influence treatment success. Some studies suggest that low P levels may negatively affect pregnancy outcomes, whereas others report a detrimental impact of elevated p values. Although a threshold of 10 ng/mL is frequently cited as indicative of adequate luteal support, the optimal P cut-off on the FET day remains unclear. This study aims to identify a predictive serum p value above which pregnancy rates do not decline in artificial FET cycles. Methods: A retrospective cohort study comprising 236 women who underwent FET between November 2021 and July 2023 was conducted at the Center of Assisted Medical Procreation of Centro Materno-Infantil do Norte. Serum P levels were measured on the day of FET. Three analytical approaches were used in assessing the association between P levels and FET outcomes: (1) fixed threshold of 10 ng/mL; (2) stratification into quartiles (Q1 < 7.30; Q2: 7.30–10.26; Q3: 10.27–13.42; Q4 > 13.42 ng/mL); (3) optimal P cut-off derived from ROC analysis (9.34 ng/mL). Continuous variables were compared using T-test or One-Way ANOVA. Categorical variables were analyzed using Chi-square test or Fisher’s exact test. Associations between P levels and pregnancy outcomes were further examined using logistic regression. Results: Using the P threshold of 10 ng/mL, women with p < 10 ng/mL showed significantly lower positive β-hCG rates (p = 0.020), implantation rates (p = 0.002), and clinical pregnancy rates (CPRs) (p = 0.019). Quartile-based comparisons revealed no significant differences. Regarding the ROC-derived cut-off, women with p ≥ 9.34 ng/mL had significantly higher positive β-hCG rates (38.5% vs. 52.8%, p = 0.012), implantation rates (30.0% vs. 45.5%, p = 0.002), CPR (36.3% vs. 50.0%, p = 0.016), ongoing pregnancy rates (24.4% vs. 37.6%, p = 0.013), and live birth rates (24.4% vs. 37.6%, p = 0.013). p ≥ 9.34 ng/mL remained an independent predictor of improved pregnancy outcomes in multivariate analysis. Conclusions: Serum P levels ≥ 9.34 ng/mL on the day of FET were associated with significantly higher pregnancy success, supporting the relevance of center-specific P thresholds and suggesting potential benefit in individualized luteal phase support strategies. Full article

We carried out a comprehensive literature search for publications on the range of vascular events that have been linked to adenomyosis. This covered vascular diseases, blood coagulation disorders, thrombosis, hypercoagulation, stroke (embolic, ischemic, thrombotic, hemorrhagic), cerebrovascular episodes, cerebral infarction, cerebral hemorrhage) and renal disease. This review covers 63 articles. Nineteen articles reported clinical manifestations of intravascular thrombosis in women with adenomyosis. Eleven publications were identified that reported on cerebral involvement and adenomyosis, including cases of ischemic stroke or infarction. Dysregulation primarily seems to occur via local factors leading to altered angiogenesis. Five case reports were identified that reported on various vascular complications attributed to the presence of adenomyosis. The search also identified reports of cerebral complications in women with adenomyosis. Through a secondary search, we identified publications dealing with a possible connection between cardiac complications and renal pathology, which the authors attributed to adenomyosis. Vascular involvement in adenomyosis is documented in rare cases by the presence of endometrial tissue in myometrial vessels both in menstrual and non-menstrual uteri. Women with adenomyosis have a higher platelet count, a shorter thrombin and prothrombin time and an activated partial thromboplastin time. These findings has been applied to attempts to identify therapies for adenomyosis based on targeting the vasculature, but the existence of a link between the two conditions is under question for several reasons: only case reports (or very small series) have been published; all published cases come from one region of the world (the Far East); the published literature does not contain objective proof of a causal relationship between the two pathologies, except for the elevation of some markers. In summary, it is not possible to conclude that the presence of adenomyosis has a pathogenetic role in causing vascular events, first and foremost because available evidence consists mostly of case reports. Full article

Objectives: Female fertility is increasingly threatened by environmental pollutants such as fine particulate matter (PM_2.5 and NO₂), endocrine-disrupting chemicals (BPA, phthalates, PFAS, and PCBs), and microplastics. These exposures are associated with impaired ovarian reserve, reduced implantation rates, and lower assisted reproductive technology (ART) success. Given the rising prevalence of obesity and weight-loss interventions, particularly bariatric surgery, understanding the combined influence of metabolic and environmental factors on reproductive outcomes is of critical importance. This review aimed to synthesize recent evidence on how these exposures interact to affect female fertility. Methods: A narrative review was conducted of studies published between 2019 and 2025 using PubMed, Google Scholar, Web of Science, and Wiley Online Library. The PubMed Boolean search string was “female fertility”, “ovarian function”, “IVF” and “pollution”, “endocrine disruptors”, “air pollutants”, and “microplastics”. Searches were limited to English language publications, with the last search performed on 30 March 2025. Human, animal, and in vitro data were screened separately. Human evidence was prioritized, and confounding factors (age, BMI, and smoking) were considered during interpretation. Results: Environmental pollutants were consistently associated with diminished ovarian reserve, poor oocyte quality, and reduced live birth rates in ART. PFAS exposure correlated with lower fecundability, while PM_2.5 and NO₂ were linked to decreased AMH and AFC levels. Mechanistic animal and in vitro studies support these findings through pathways involving oxidative stress, endocrine disruption, and epigenetic alterations. Rapid metabolic changes, particularly post-bariatric surgery, may transiently increase circulating lipophilic toxicants and reduce antioxidant defenses, amplifying reproductive vulnerability. Conclusions: Environmental exposures, especially PM_2.5, NO₂, PFAS, and microplastics, adversely influence ovarian and embryonic competence. Rapid metabolic transitions may further modulate this susceptibility through pollutant mobilization and micronutrient imbalances. Future interdisciplinary prospective studies integrating exposure monitoring, metabolic profiling, and reproductive endpoints are essential to guide clinical recommendations and precision fertility counseling. Full article

Background and Clinical Significance: This article presents a clinical case of persistent umbilical vein of the extrahepatic type in a fetus. The features, diagnosis, and prognosis of this rare vascular anomaly, as well as the applied pregnancy monitoring tactics, are reviewed. Case Presentation: A 34-year-old woman was referred to a tertiary-level hospital at 25th weeks’ gestation for evaluation of a suspected fetal heart defect. Persistent right umbilical vein of the extrahepatic type, cardiomegaly with predominant atrial enlargement, a primum atrial septal defect, and hydropericardium were diagnosed. At 33 + 5 weeks of gestation, signs of decompensation emerged, including progressive cardiomegaly, hydropericardium, and newly developed ascites, leading to the decision to induce labor. Imaging was performed using a Voluson E8 ultrasound system (GE Healthcare, Zipf, Austria). Despite all efforts, the severity of the condition ultimately proved fatal in this clinical case. Conclusions: Patients carrying fetuses suspected or diagnosed with PRUV should receive coordinated management by a multidisciplinary team of specialists. Delivery should be planned in a tertiary-level hospital. Full article

Background/Objectives: There is a paucity of research studying point-of-care ultrasound in the pregnant population, despite the rising incidence of maternal medical complications and, in particular, preeclampsia. This study sought to compare the inferior vena cava collapsibility index (IVC-CI) between patients with preeclampsia with severe features (PECS) and gestational age-matched controls and to assess whether pulse pressure (PP) correlates with IVC-CI in PECS. Methods: This was a prospective pilot study of patients recruited at an inpatient hospital and an outpatient office. The case group included admitted patients with a diagnosis of PECS considered to be stable for prolonged antepartum expectant management. One patient per gestational age week from 23 to 34 weeks with PECS was compared to a gestational age-matched patient without any form of preeclampsia and/or gestational hypertension. Patients on magnesium sulfate, those with multiple gestation, large-for-gestational age fetus, fetal growth restriction, polyhydramnios, oligohydramnios, and/or an anomalous fetus were excluded. Results: IVC-CI was significantly lower in the PECS group compared with controls (mean 20.1% vs. 48.3%, 95% CI = −0.40–−0.16, p < 0.001). There was an inverse relationship between IVC-CI and pulse pressure in patients with PECS. For each additional 1 mmHg in pulse pressure, the odds of having IVC-CI greater than 50% decreased by 13%. Conclusions: Patients with preeclampsia exhibit detectable changes in inferior vena cava diameter that can be assessed with bedside ultrasound and correlated with maternal PP. Future research should focus on validating these findings and exploring the clinical significance of these measurements. Full article

Background: Infertility is a multifactorial condition that causes significant emotional distress and financial burden for couples. Despite advances in assisted reproductive technologies (ARTs), many patients experience recurrent implantation failure (RIF) or pregnancy loss. Intralipid, an intravenous lipid emulsion, has been proposed as an adjunctive therapy due to its immune-modulatory effects, particularly in reducing elevated natural killer (NK) cell activity, which may be associated with poor reproductive outcomes. This study evaluated the effect of intralipid infusion on pregnancy rates and miscarriage rates in women with recurrent implantation failure undergoing in vitro fertilization (IVF). Materials and Methods: This was a retrospective study of women who had suffered from recurrent implantation failure and underwent IVF between September 2023 and September 2024. A comparative group undergoing IVF but who did not have recurrent implantation failure matched for age was selected. Outcomes of clinical pregnancy, miscarriage and livebirth rates were compared in both groups. Results: A total of 113 women undergoing IVF were identified and 51 received intralipid. Intralipid was initiated at varying stages of the IVF process, a day before embryo transfer (ET) (18 or 35.3%), on the day of ET (20 or 39.2%) and after ET (13 or 25.5%). The clinical pregnancy rate was 44.2% in the treatment group compared to 29% in the comparator group (p < 0.05) while the miscarriage rates were 13.7% versus 11.3% (p > 0.05). Elevated NK cells were present in 65.4% of the patients who received intralipid, but the correlation between NK cell levels and pregnancy outcomes was weak (Spearman ρ = 0.032). No adverse effects were reported in any of the women. Conclusions: Intralipid infusion increased the successful pregnancy rates in women who had recurrent implantation failure during IVF. The successful pregnancy rate was significantly higher than that in those undergoing ART who had not suffered from RIF. These findings support several studies on the potential benefit and safety of intralipids in women undergoing ART, but the numbers remain small and more prospective studies are needed to confirm these findings Full article

Background/Objective: Dyspareunia negatively affects women’s lives. Up to 35% suffer from postpartum dyspareunia. Many factors may influence the occurrence of postpartum dyspareunia, but little is known about them. This study aimed to look at the frequency of dyspareunia one year postpartum in a cohort of primiparae. Which perinatal factors influence the frequency of postpartum dyspareunia? Methods: A total of 3264 primiparae were included in this observational cohort study. Perinatal factors were documented, and a specially designed questionnaire was sent to them one year postpartum. The primary outcome was the frequency of dyspareunia one year postpartum. The secondary outcomes included potential influencing factors such as birthing method (spontaneous bed delivery, spontaneous delivery other than bed, water delivery, and vacuum-assisted delivery); perineal injuries (first- and second-degree perineal tears, obstetric anal sphincter injuries (OASIs), and episiotomies); and the use of oxytocin. Results: Postpartum dyspareunia was observed in 15% of the 3264 primiparae. In multivariate analysis, there were influences found in the perineal injury group, especially for first- and second-degree perineal tears and OASIs. In the oxytocin group, a trend toward a higher rate of postpartum dyspareunia was observed. No influence of the different birthing methods was found. Conclusions: Postpartum dyspareunia, affecting 15% of women one year after vaginal delivery, is associated with perineal injuries, particularly minor perineal tears and OASIs. This highlights the importance of good preparation of the perineum and pelvic floor before delivery, efficient perineal protection during labor, and the use of a precise repair technique for all perineal injuries. Full article

Introduction: Maternal thrombophilia is associated with numerous obstetric complications, often occurring without overt clinical manifestations during pregnancy. Histological evaluation of the placenta can provide valuable insights into the etiology of these complications. Objective: To compare the placental histopathological profile in pregnancies with thrombophilia versus physiological pregnancies and to develop a synthetic score capable of retrospectively indicating thrombophilic risk. Materials and Methods: A retrospective observational study was conducted on two groups (n = 80 thrombophilia, n = 31 control). Macroscopic and histopathological placental parameters were analyzed. A histological score (range 0–5 points) was constructed based on the presence of villous stasis, stromal fibrosis, infarction, acute atherosis, and intervillous thrombosis. Results: The mean histological score was significantly higher in the thrombophilia group (2.20 ± 1.4) compared to the control group (1.18 ± 1.1; p = 0.0011). A score ≥ 3 was present in 39.1% of thrombophilic cases versus 13.6% in controls. Regression analysis showed that only placental diameter was significantly correlated with the histological score (p = 0.0379). Conclusions: The proposed histological score may serve as a simple and effective tool for the indirect identification of potential thrombophilic risk in complicated pregnancies. Its validation in future studies could support its implementation in routine obstetric and histopathological practice. Full article

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

Background/Objectives: Outpatient operative hysteroscopy is a cornerstone in the management of intrauterine pathologies within reproductive medicine. However, procedural pain and anxiety remain key barriers leading to failed procedures and referrals for surgery under general anesthesia. This study aimed to assess whether a comfort-enhanced procedural environment could reduce perceived pain and increase procedural success rates. Methods: Analysis of 970 consecutive patients who underwent outpatient operative hysteroscopy at the Hysteroscopy Unit of “Degli Infermi” Hospital (Biella, Italy): 470 in 2023 under standard conditions, 500 in 2024 with an enhanced setting. Surgical technique, analgesic/sedation policies and operators were unchanged. The primary outcome was referral to the OR for completion of the procedure. Secondary outcomes included patient-reported pain assessed by Visual Analog Scale (VAS) in a consecutive subsample. Differences between years were evaluated with appropriate parametric/non-parametric tests. Results: Implementation of the enhanced environment was associated with a lower OR referral rate in 2023 versus 2024. Post hoc power for this comparison was approximately 60%. Mean VAS scores also decreased in 2024, with post hoc power >99%. No adverse events were recorded. Conclusions: Environmental and interpersonal modifications were associated with meaningful decline in reported pain and OR referrals. Prospective studies incorporating systematic case-mix and validated anxiety measures are warranted to confirm these results. Full article