Reproductive Medicine

Chromosomal defects are a significant cause of perinatal death and childhood disability, occurring in 3.6–6.0 per 1000 births in unscreened populations. Common chromosomal defects include trisomy 21, 18, and 13, triploidy, and sex chromosome abnormalities. Screening for these defects began in the mid-1960s with the advent of amniocentesis, and various methods have since been developed to improve screening performance. Initial screening was based solely on maternal and gestational age, a method incorporated later into all subsequent screening methods giving an a priori background risk. This a priori background risk, which is further refined by maternal serum biochemistry, results of ultrasound examinations, and most recently, results of non-invasive prenatal testing by cell-free DNA in maternal blood. This paper will describe methods of screening for all chromosomal defects and their performance. Unlike most reviews, this paper covers not only screening tests for Down syndrome, but also screening methods for the other most common and less common chromosomal defects. Full article

Chronic endometritis (CE) is a persistent, often asymptomatic inflammatory condition of the endometrium, increasingly recognized as a potential contributor to infertility and recurrent implantation failure. Despite its clinical significance, CE remains underdiagnosed due to a lack of standardized diagnostic criteria and its subtle clinical presentation. Objective: This review aims to synthesize the current evidence on the pathophysiology, diagnosis, and treatment of CE, highlighting its impact on reproductive outcomes and the effectiveness of therapeutic interventions. A comprehensive literature review was conducted, analyzing 85 peer-reviewed studies published in the last decade, of which 65 were deemed relevant and retained for further analysis. These studies were selected based on their relevance to the pathophysiology, diagnostic methodologies, and treatment outcomes for CE, focusing on their implications for fertility and assisted reproductive technologies (ARTs). The findings suggest that CE is associated with impaired endometrial receptivity, increased inflammatory markers, and reduced implantation and pregnancy rates with ARTs. Histopathological assessment using CD138 immunostaining remains the gold standard for diagnosis, while hysteroscopy and molecular microbiological techniques provide complementary diagnostic value. Antibiotic treatment has been shown to significantly improve implantation rates and pregnancy outcomes, particularly in women with recurrent implantation failure. Emerging therapies, including probiotics and regenerative medicine approaches, are being explored as potential adjuncts to the conventional treatment. Early and accurate diagnosis of CE is essential for optimizing reproductive outcomes. Standardized diagnostic protocols and individualized treatment strategies are crucial for improving implantation success and pregnancy rates in affected women. Future research should focus on refining the diagnostic methods and exploring novel therapeutic options to enhance endometrial health and fertility outcomes. Full article

Background/Objectives: In the past 50 years, human reproductive capacity has steadily declined with elusive and idiopathic origins. Amongst theorized causes, oxidative stress has been proposed to directly contribute to male infertility. The glutathione (GSH) and glutathione disulfide (GSSG) molecular couple reflect cellular redox environments and are thus reflective of oxidative stress in most cells. Shifting GSH/GSSG redox states to abnormal, more oxidizing conditions can disrupt normal cellular activities. This study explores the correlation between the GSH/GSSG redox system and factors involved in male infertility, including sperm quality, specifically sperm motility and total count. Methods: Semen samples from 98 patients underwent high-performance liquid chromatography (HPLC) for GSH/GSSG analysis. A protein assay determined the protein concentration for normalization, and GSH/GSSG redox potentials (E_h) were calculated using the Nernst equation. Results: A significant inverse correlation between GSH/GSSG E_h and sperm count was identified (p = 0.0046 and R² = 0.071). Analysis also found that cellular GSH concentrations (p < 0.001 and R² = 0.11) and total GSH (GSH + (GSSG × 2); p = 0.0039 and R² = 0.074) were significantly and positively correlated with total sperm count, whereas GSSG concentrations were not. The correlation between redox potential and motility was not significantly different (p = 0.11 and R² = 0.02). Conclusions: This study shows that total sperm count decreases with increasing redox potential, indicating that more oxidized systems, such as the GSH/GSSG system, are associated with lower sperm counts in ejaculated sperm samples. These findings support a potential link between oxidative stress and sperm parameters. As understanding of the relationship between GSH/GSSG E_h and sperm quality improves, this may inform future potential therapies and approaches aimed at supporting male reproductive health. Full article

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

Background/Objective: Actinomyces is a genus of anaerobic gram-positive bacteria. It forms part of human body microbiota commonly in the oral cavity and genital tract. During pregnancy, the organism may cause the rare chorioamnionitis, where the maternal genital tract or other sites such as the oral cavity will be the likely source of the pathogen. This condition may increase the risk of foetal morbidity and mortality, and preterm birth. Methods: The placenta of a 33-year-female, primigravida, who presented with preterm labour and eventual delivery of baby at 20 weeks gestation was sent for histopathological examination. Her antenatal and clinical history were reviewed, to identify possible aetiology for her preterm birth. Results: She is noted to have presented with sudden per-vaginal creamy coloured discharge with no associated odour and no irritation. The discharge became blood staining associated with labour pain, this followed by premature spontaneous rupture of membrane and pre-mature labour. Laboratory tests revealed leucocytosis, neutrophilia, monocytosis, high CRP and elevated derived fibrinogen. The patient was delivered of a live male baby weighing 0.35 kg, who died shortly after birth. Placenta microscopic examination revealed patchy severe acute chorioamnionitis and prominent clusters of Gram-positive filamentous bacteria with histopathologic features of Actinomyces spp. The mother before discharged was treated with oral antibiotic. Conclusions: The intrauterine Actinomyces spp. infection is associated with preterm birth and neonatal mortality, early diagnosis during ante-natal could perhaps prevent preterm birth and reduce the associated neonatal mortality. Full article

Background/Objectives: Evans’ syndrome (ES) is a rare autoimmune disorder characterized by the simultaneous or sequential onset of immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA). Given its rarity, available data concerning the clinical course and optimal management in pregnancy are limited. Methods: We present the case of a 32-year-old woman who experienced ES during her first pregnancy. She had been previously diagnosed with childhood-onset SLE at the age of 14 but had been in treatment-free remission since the age of 24. The treatment of both AIHA and ITP included intravenous immunoglobulins, cyclosporine-A, high dosage oral corticosteroids, and, in the second trimester, rituximab. The delivery was planned at 34 + 6 weeks of gestation (GW); no immunological alterations or infectious complications were detected in the newborn. The post-delivery period was uncomplicated, and the mother was discharged with a normal blood count. A narrative review of available ES cases during pregnancy is also presented. Results: A total of 16 patients with ES in pregnancy were reported, including the one we described. None of them developed major bleedings during gestation, while a case of abruptio placentae with delayed postpartum hemorrhage occurred. ITP was difficult to treat in 4/16 women after delivery; 4/16 patients also developed gestational hypertensive disorders. Perinatal outcomes include 13/17 healthy newborns and 4/17 stillbirths (2 of them were twins), of which 1 was due to fetal AIHA. Gestational age at birth was before 37 GW in 8/17. In 15/16 women, ES resolved after delivery. Conclusions: The occurrence of ES during pregnancy has been rarely reported; it constitutes a clinical challenge due to the need for multiple treatments, including conventional immunosuppressants and/or biologic drugs as steroid-sparing agents. After delivery, ES appeared to be less resistant to treatment than it was during pregnancy. Full article

Background and Clinical Significance: Anti-Leucine-rich glioma inactivated-1 (anti-LGI1) encephalitis is a rare, autoimmune disorder often presenting with limbic encephalitis. The reported incidence of anti-LGI1 is 0.83/million/year, with elderly males accounting for the overwhelming majority of cases. While anti-LGI1 encephalitis is a well-known cause of autoimmune encephalitis in men over 50, our literature review found no published cases in pregnant women. The purpose of this study is to describe a rare presentation of this pathology in an unexpected population. Case Presentation: A 21-year-old gravida 2, para 1001 woman at 20 weeks’ gestation presented with worsening seizure-like activity for the past four months, frequent falls, loss of consciousness, and concern for trauma to the abdomen. Her neurologic workup one month prior revealed a 72 h electroencephalography (EEG) with epileptic seizures of the left frontotemporal region, but a normal magnetic resonance image (MRI) of her head. A repeat MRI during this hospitalization showed bilateral limbic and basal ganglia T2 hyperintensities. She was treated with increasing doses of antiepileptic drugs without improvement and was transferred to a neurology intensive care unit, where she was diagnosed with anti-LGI1 encephalitis. She was initially treated with oral corticosteroids with inadequate response, then with intravenous immunoglobulin therapy (IVIG). Her seizure activity persisted throughout her pregnancy, requiring multiple admissions for IVIG, but she eventually delivered a healthy baby and continues to receive long-term care for her new diagnosis. Conclusions: This case illustrates classic findings of anti-LGI1 encephalitis in a non-classic patient population. Knowledge that such a case exists may serve to broaden the differential diagnoses when physicians are presented with a similar pregnant patient and expand the reported patient population in this rare disease. Full article

Background and Clinical Significance: Borderline ovarian tumors (BOTs) are a rare diagnosis, especially in the adolescent population. This can make initial management and surveillance strategies difficult, given the limited guidelines and experience in this young age group. Case Presentation: We present two cases of recurrent serous BOTs diagnosed in adolescent patients. Both patients were initially treated with fertility-sparing surgery and followed with transabdominal pelvic ultrasounds. Secondary surgical debulking of recurrent disease with uterine preservation was successful in both patients with a long-term disease-free status. Conclusions: Although rare, BOTs can occur in adolescent patients and should be on the differential for ovarian masses in this age group. Fertility-sparing surgical techniques, reproductive endocrinology consultation, surveillance strategies, and hormone replacement therapy should all be taken into consideration when treating adolescent patients with BOTs. Full article

Background: Diagnoses for right lower quadrant pain in women must include both gynecologic and non-gynecologic causes. In this differential, ovarian torsion and appendicitis are both serious etiologies that can require swift surgical intervention. Ovarian torsion is the least common of the two, accounting for 2.7% of emergency surgery cases according to a 10-year review, while the lifetime risk of appendectomy for females is 23.1%. As many as 2–3% of patients undergoing surgery for acute appendicitis are instead found to have ovarian torsion. However, there are currently only rare case reports of these two conditions co-presenting in the same patient simultaneously, with little discussion on how to be better prepared before entering the operating room. Objective: The purpose of this study is to describe this rare co-presentation to better inform providers of this potential complication and to improve future patient care outcomes. Method: A case report of a patient seen at Tripler Army Medical Center, Honolulu, Hawaii, was assessed. Conclusions: This case shows the rare possibility of dual acute etiologies of abdominal pain warranting urgent surgical management. This case also highlights the need for a multidisciplinary approach in the pre-procedural evaluation of possible competing etiologies of acute abdominal pain that warrant surgical management. Additionally, this case brings up interesting ethical questions regarding informed consent, autonomy, and the obligation of intraoperatively consulted surgeons to provide definitive and indicated surgical care in the absence of prior discussion of possible pathology. Full article

Background/Objectives: In the postpartum period, approximately 12% of patients seek care in the emergency department (ED), with a higher representation of Black patients. Hypertension is a common reason for ED visits during this period, often leading to dangerously delayed diagnosis and treatment. Objective: This study aims to assess the time to diagnosis and treatment of hypertensive disorders in the postpartum period in the ED, focusing on potential disparities in care, to identify areas for quality improvement. Design: Retrospective cohort study. Setting: A multi-centered large medical institution in the metro Detroit area. Methods: Postpartum patients (day 2 through day 28) presenting to the ED from November 2015 to December 2022. Exposures: none. Main Outcome Measures: Primary analysis assessed the time elapsed between severe-range blood pressure readings (greater than/equal to 160 systolic and/or 110 diastolic) and the administration of antihypertensives. Secondary analyses assessed the presence of essential laboratory workups such as complete blood counts, complete metabolic panels, and urine protein and creatinine. Results: Among the 430 women who presented to the ED during the postpartum period with hypertension, 372 (86.5%) exhibited severe-range blood pressure (greater than/equal to 160 systolic and/or 110 diastolic). Patients presented on average on postpartum day 6. Of the patients with severe hypertension, only 72% received a complete blood count, 66% underwent evaluation of creatinine and liver profile, and 4% had a urine protein and creatinine test ordered. The average time from severe-range blood pressure reading to antihypertensive administration was 189 min for Black patients and 370 min for White patients. There were no statistically significant differences in the time of the first blood pressure reading, laboratory evaluation, or treatment of severe-range blood pressure between racial groups. Conclusions: This study identifies the most significant area for improvement in the timely administration of antihypertensive medication following severe-range blood pressure readings. Additional areas for improvement were observed in ordering essential laboratory tests to assess the severity of preeclampsia. The institution demonstrated delayed yet equitable care for White and Black patients, contrary to the existing literature indicating potential racial disparities. A targeted quality improvement plan has been implemented to improve the identified areas of concern to adhere to the ACOG’s treatment recommendations for hypertensive disorders of pregnancy. The impact on patient care will be reassessed at the 1-year mark. Full article

Background/Objectives: Previous literature has described that non-white pregnant patients are at increased risk of severe morbidity from obstetric hemorrhage (OBH). Here, we investigate whether such disparities are secondary to delay in the administration of postpartum oxytocin for non-white patients compared to white patients. Methods: This is a retrospective cohort study of all deliveries from 2018 to 2019, comparing (1) Hispanic white or non-white race (HW/NWR) pregnant people and (2) non-Hispanic white (NHW) pregnant people. Our primary outcome was the time from delivery to the first dose of postpartum oxytocin, and our secondary outcome was the frequency of other hemorrhage interventions. Results: Out of 3832 patients with self-identified race and ethnicity recorded in their patient record, 644 patients identified as NHW, and 3188 patients identified as HW/NWR. We found no difference in time to first dose of postpartum oxytocin (p = 0.51), and there was also no difference in the frequency of other hemorrhage-related interventions. Conclusions: Our study found no delay in the administration of postpartum oxytocin for non-white patients. Full article

Background: The COVID-19 pandemic highlighted the global challenge of inadequate data on SARS-CoV-2’s effects on pregnant women and their infants. In response, Slovakia, along with other countries, launched a nationwide study to assess the incidence, characteristics, and outcomes of SARS-CoV-2 infection during pregnancy. Methods: We conducted a national observational descriptive study of SARS-CoV-2 positive cases among pregnant women from the pandemic’s onset to its conclusion. In collaboration with the Public Health Office of the Slovak Republic, we identified 1184 pregnant women who tested positive for SARS-CoV-2 and contacted them for participation. Results: Among the 240 participating SARS-CoV-2-positive pregnant women, 13 required hospitalizations, with an increased need for intensive care and respiratory support. However, the absolute risk of poor outcomes remained low. Higher maternal age and infection during the third trimester emerged as key risk factors for hospitalization. A symptomatic course was dominant, with fatigue (70%), headache (58%), and fever (56%) as the leading symptoms. While maternal and neonatal outcomes were generally favourable, a slight increase in caesarean sections and preterm births suggests an indirect impact on maternity care. Vaccination during pregnancy correlated with reduced symptoms and no hospitalizations. Elevated CRP levels were common among infected women, while ultrasound findings remained normal. Conclusions: This study offers a multi-dimensional view of pregnancy during the pandemic, capturing both the mother’s personal concerns and the objective insights from prenatal and labour care settings. The findings suggest that most pregnant women with SARS-CoV-2 experience mild to moderate illness, offering reassurance to clinicians about generally favourable maternal and neonatal outcomes while underscoring the need for vigilance in rare severe cases. Full article

Introduction: A Skene’s gland cyst is a rare gynecological disorder, and the cause of an adult onset is largely unknown. However, periurethral and perineal cystic lesions are common, causing often indistinguishable symptoms. Therefore, accurate diagnosis is crucial because it can significantly alter clinical management. Methods: A 27-year-old woman was gravida 2 para 1 with the onset of a unique, progressively large vulvar mass that began at approximately 6 weeks of gestation. At 22 weeks of gestation, the mass became more symptomatic and measured approximately 9 cm × 7 cm × 6 cm in size, with some areas of excoriation on the lateral surface. Results: The patient had a pelvic MRI without contrast, and it showed that the mass was most likely a giant Skene’s gland cyst. At 24 weeks, the mass was surgically removed under spinal anesthesia and followed by vulvar reconstruction. Histopathology showed a benign cyst lined by transitional and squamous epithelium cells, which was consistent with a benign Skene’s gland cyst. She recovered fully, continued with the pregnancy and delivered vaginally at 39 weeks and 3 days without complications. Conclusions: A case of excoriating giant Skene’s gland cyst in pregnancy that caused significant discomfort to the patient. To this day, there has been no reported literature of a Skene’s gland cyst this large, especially during pregnancy. Hence, Skene’s gland cysts should be part of the differential diagnosis of a large vulvar mass of this magnitude during pregnancy. Full article

Background/Objectives: Adverse pregnancy outcomes correlate with blood glucose levels in women with type 1 diabetes (T1DM). There is a gap between the glycaemic targets and the blood glucose control achieved in pregnancy. This study aimed to investigate the impact of an intensive weekly service on glycaemic control compared with our previous care model in pregnancies affected by T1DM. Materials and Methods: This is a retrospective cross-sectional pre/post study comparing measures of glycaemic control in women with T1DM in each trimester of pregnancy in the 12 months before and the 8 months after the commencement of an intensive weekly insulin stabilisation service (ISS). Results: This study utilised data from Dexcom continuous glucose monitoring (CGM) reports to analyse pregnancy-specific glycaemic data (incorporating time in the range of 3.5–7.8 mmol/L). In total, 16 women provided data for 35 trimesters pre-ISS and 17 women provided data for 38 trimesters post-ISS. There was an improvement in pregnancy-specific time in range in trimester 3 following the commencement of the intensive weekly insulin stabilisation service (pre-ISS mean: 49.6%, post-ISS mean: 61.4%, p = 0.042). Similar results were seen when women using hybrid closed-loop technology were excluded, although statistical significance was not reached. It was not possible to assess the effect of the intervention during the first trimester. There were no statistically significant changes in glycaemia in trimester 2. Conclusions: In a small group of pregnant women with T1DM, a clinically significant improvement in pregnancy-specific time in range occurred in trimester 3, but not in trimester 1 or 2, following the introduction of intensive weekly clinical support. Full article

Acute fatty liver of pregnancy (AFLP), although rare, is a potentially fatal obstetrical disorder. It is characterized by acute liver failure of varying degrees with associated coagulopathy that occurs often in the third trimester of pregnancy. The following review discusses the history, etiopathogenesis, and subsequent clinical and laboratory findings that are associated with this disorder. It additionally attempts to aid in differentiating AFLP from other common obstetrical and non-obstetrical diseases with special emphasis on its differentiation from hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. This review also discusses recommendations for delivery and postpartum care with focus on return to baseline and additional life-saving measures that may need to be pursued in the most difficult and refractory cases. Finally, it addresses maternal and perinatal outcomes associated with the disorder and the effect that this disorder can have on future pregnancies. Full article