Search Results (2,385)

Aim: Premenstrual Syndrome (PMS) substantially impairs quality of life, while standard pharmacologic treatments are often limited by adverse effects or contraindications. This systematic review and meta-analysis evaluated the efficacy of vitamin D supplementation compared to passive control (placebo or standard care) for PMS symptom relief. Methods: PubMed, Web of Science, Scopus, Google Scholar, and CENTRAL were searched for randomized controlled trials (RCTs) up to January 2026. The primary outcome was change in total PMS severity scores. Secondary outcomes included depression, anxiety, physical symptoms, craving, and water retention. Standardized mean differences (SMDs) with 95% confidence intervals (CI) were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic. Results: Five RCTs including 436 participants were reviewed. The overall risk of bias was rated as “some concerns” in four RCTs and “low risk” in one trial. Vitamin D significantly reduced total PMS severity (SMD: −0.78, 95% CI: −1.30, −0.26, I² = 58.22%) as well as physical symptoms (SMD: −1.00, 95% CI: −1.99, −0.01, I² = 90.53%) and depression (SMD: −0.78, 95% CI: −1.53, −0.02, I² = 84.56%). No significant effects were observed for anxiety, craving, or water retention. Vitamin D was well tolerated with no reported adverse events. Conclusions: Vitamin D supplementation may reduce overall PMS severity, particularly physical and depressive symptoms. However, results show substantial heterogeneity across outcomes, and the certainty of evidence remains “very low”, underscoring the need for further high-quality, well-powered RCTs. Full article

Background: Uterine fibroids are among the most common benign tumors affecting women of reproductive age and may substantially impair health-related quality of life (HRQL). Although anxiety and stress are frequently reported by affected women, their contribution to HRQL remains unclear. This study aimed to evaluate the relationships between symptom severity, anxiety, stress, and HRQL in women with uterine fibroids. Methods: A cross-sectional study was conducted among 107 women hospitalized for uterine fibroid treatment. Symptom severity and HRQL were assessed using the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire. Anxiety and information needs were evaluated using the Amsterdam Preoperative Anxiety and Information Scale (APAIS), while subjective anxiety and stress levels were measured with the Visual Analog Scale (VAS). Associations between variables were analyzed using non-parametric tests, Spearman’s correlations, and multiple regression analysis. Results: Clinically significant anxiety was observed in 41.1% of participants. The mean HRQL score was 57.4 ± 22.3 points. In multivariate analysis, symptom severity was the only independent predictor of HRQL (β = −0.67, p < 0.001), explaining approximately 45% of its variance. Anxiety, stress, and sociodemographic factors were not independently associated with overall HRQL. However, higher levels of anxiety and stress were significantly associated with poorer sexual functioning. Women living in rural areas and those with higher body weight reported poorer outcomes in selected quality-of-life domains. Conclusions: Symptom severity is the primary determinant of HRQL in women with uterine fibroids. Although anxiety and stress do not independently predict overall quality of life, they may adversely affect sexual functioning. These findings support a comprehensive management approach that combines symptom-oriented treatment with psychological and educational support. Full article

Background/Objectives: Shift work is a form of circadian dysregulation, which has been associated with adverse reproductive health outcomes. However, the association between circadian dysregulation and ovarian reserve remains uncertain. The present study examines whether shift work is associated with lower AMH levels in women seeking fertility treatment. Methods: This retrospective cohort study includes female patients aged 20–39 years presenting between February 2023 and June 2024. Patients were excluded if they had only one ovary, a current cancer diagnosis, or past chemotherapy use. Demographic and medical data were obtained from the electronic medical record. AMH levels were compared between daytime workers and shift workers. Results: A total of 1135 patients met inclusion criteria. The median age was 35 years (IQR 32–37). Of these, 89% (n = 1014) reported daytime work, and 11% (n = 121) reported shift work, comprising 102 working rotating shifts, seven working night shifts, and 12 working evening shifts. Daytime-only workers had a median AMH of 17.20 pmol/L (9.1–30.0). Combined shift workers had a median AMH of 17.10 pmol/L (8.1–31.0). There was no statistically significant difference in AMH levels between daytime workers and shift workers (p = 0.935). Although not significant, the odds of having low AMH levels (<7 pmol/L) were 25% higher among shift workers compared to daytime workers (OR 1.246, p = 0.345). Conclusions: In this cohort, AMH levels did not significantly differ between daytime and shift workers, offering reassurance to individuals required to engage in shift work. Future research should include larger cohorts and incorporate more comprehensive measures of circadian disruption. Full article

Background: Assisted reproductive technology (ART) is increasingly utilized worldwide, and approximately 30% of ART pregnancies result in twin gestations. Chorionicity strongly influences perinatal risk, yet its specific impact on ART-conceived twins has not been systematically clarified. Objective: To compare obstetrical and neonatal outcomes in assisted ART-conceived monochorionic (MC) versus dichorionic (DC) twin pregnancies and evaluate the impact of chorionicity on maternal and perinatal outcomes. Methods: This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42024600292). PubMed, Scopus, and Web of Science were searched through October 2024 for studies comparing obstetrical and neonatal outcomes in ART-conceived monochorionic and dichorionic twin pregnancies. Eligible studies were qualitatively synthesized. Results: Thirty-five studies comprising 15,648 ART-conceived twin pregnancies were included, including 371 monochorionic and 15,277 dichorionic pregnancies. MC pregnancies consistently demonstrated less favorable perinatal outcomes compared with DC pregnancies, including an earlier gestational age at delivery, increased prematurity, lower birth weight, and higher rates of perinatal mortality. By contrast, maternal complications, such as hypertensive disorders, gestational diabetes mellitus, PROM, and cesarean delivery, varied considerably across the studies without a consistent association with chorionicity. The baseline maternal characteristics were generally comparable between the groups. Conclusion: Monochorionicity in ART-conceived twin pregnancies is associated with increased adverse neonatal and perinatal outcomes, particularly prematurity and perinatal mortality, while maternal outcomes appear less clearly influenced by chorionicity. Standardized prospective studies are needed to further clarify the chorionicity-specific risks in ART twin pregnancies. Full article

Background/Objectives: Embryo implantation is a highly regulated, multistep process requiring precise synchronization between a developmentally competent blastocyst and a receptive endometrium. Despite advances in reproductive medicine, implantation failure remains a major limiting factor in assisted reproductive technology (ART), particularly in cases of recurrent implantation failure (RIF). This review aims to summarize current knowledge on the molecular, cellular, and immunological mechanisms governing embryo–endometrial interaction and to evaluate contemporary strategies for optimizing implantation outcomes. Methods: This narrative review synthesizes the current literature on embryo implantation, including studies addressing uterine receptivity, etiological factors contributing to implantation failure, and emerging diagnostic and therapeutic approaches. The review integrates findings from molecular biology, clinical ART practices, and bioengineering-based models. Key areas include transcriptomic tools such as endometrial receptivity analysis, time-lapse imaging, artificial-intelligence-based embryo selection, and advanced in vitro models (e.g., microfluidic “womb-on-a-chip” systems and three-dimensional embryo–endometrial platforms). The literature was identified through major biomedical databases, following a structured but non-systematic approach. Results: Implantation success is dependent on a complex interplay of hormonal regulation, gene expression, immune modulation, and embryo quality. Disruption of uterine receptivity during the window of implantation is a critical contributor to infertility and RIF. Multiple factors—including genetic abnormalities, maternal age, lifestyle influences, immunological imbalance, uterine pathology, and chronic endometrial conditions—are implicated in implantation failure. Emerging technologies, such as AI-assisted embryo selection, transcriptomic profiling, and advanced in vitro implantation models, provide enhanced insight into implantation dynamics and offer potential for improved clinical outcomes. Conclusions: Advances in understanding embryo implantation and the development of innovative diagnostic and therapeutic technologies hold significant promise for improving reproductive success. However, further research, validation, and standardization are required before these approaches can be fully integrated into routine clinical practice. A more personalized and mechanism-based approach to implantation may ultimately enhance ART outcomes and reduce the burden of infertility. Full article

Background/Objectives: Sentinel lymph node (SLN) biopsy is a minimally invasive alternative to systematic lymphadenectomy for endometrial cancer staging. However, optimization of SLN identification during robot-assisted surgery remains an important clinical issue. This prospective exploratory study evaluated the feasibility and mapping characteristics of dual-tracer SLN mapping combining radioisotope (RI) and indocyanine green (ICG) in robot-assisted surgery for clinical stage IA endometrial cancer. Methods: Ten patients with clinical stage IA endometrioid carcinoma (grade 1 or 2) who underwent robot-assisted surgery at our institution between June 2025 and March 2026 were prospectively enrolled. Technetium-99m phytate was injected cervically the day before surgery, followed by SPECT-CT imaging. ICG was administered intraoperatively. SLNs were identified using both RI mapping and near-infrared fluorescence imaging. All patients subsequently underwent pelvic lymphadenectomy. SLN detection rates, concordance between tracers, intraoperative findings, and perioperative outcomes were evaluated. Results: The SLN detection rate with the dual-tracer method was 100% (10/10). RI mapping alone achieved bilateral detection in 30% (3/10), whereas ICG fluorescence imaging identified SLNs in all patients (100%). All RI-positive SLNs were also identified by ICG fluorescence imaging. In several cases, multiple fluorescent lymph nodes were observed, and gamma-probe assessment aided intraoperative SLN selection. No lymph node metastases were identified. One Clavien–Dindo grade IIIa complication (pelvic hematoma requiring intervention) occurred. No adverse events related to ICG were observed. Conclusions: Dual-tracer SLN mapping using RI and ICG was feasible in robot-assisted surgery for clinical stage IA endometrial cancer. ICG fluorescence imaging provided sensitive lymphatic visualization, whereas RI mapping offered complementary information for intraoperative SLN identification in selected cases. Further prospective studies with larger cohorts are required to clarify the clinical utility of the dual-tracer approach. Full article

Background/Objectives: This study assessed whether endometriosis is associated with an increased risk of placenta accreta spectrum (PAS) disorders and investigated if assisted reproductive technology (ART) further increases the risk in patients with endometriosis. Methods: This retrospective study used multi-institutional data from the TriNetX database to identify patients who experienced delivery on or before 31 December 2024, with a prior diagnosis of endometriosis and ART therapy, as coded by CPT and ICD-10 codes. The primary outcomes included up to 7-day perinatal results, such as PAS (accreta, increta, percreta), and maternal complications, including peripartum hysterectomy, transfusion, postpartum hemorrhage (PPH), ICU admission, and sepsis. Risk ratios, 95% confidence intervals, and p-values were calculated for endometriosis versus no endometriosis and endometriosis patients with ART versus without ART. Results: Out of 3,487,612 patients identified, 24,341 had a prior diagnosis of endometriosis prior to propensity score matching. Propensity score matching was used to control for age, demographic variables, previous procedures, and comorbidities. Compared to controls, endometriosis was linked to a higher risk of PAS disorders (RR 1.74), including accreta (RR 2.22), increta (RR 2.50), and percreta (RR 1.59). Additional complications included peripartum hysterectomy (RR 1.72), transfusion (RR 1.26), PPH (RR 1.35), ICU admission (RR 1.43), and sepsis (RR 1.56). Patients conceived via ART faced greater risks of PAS disorders (RR 2.00), accreta (RR 2.14), hysterectomy (RR 1.63), transfusion (RR 2.10), and PPH (RR 1.66). Conclusions: This study shows a positive link between endometriosis and the risk of PAS disorders and maternal complications, and the use of ART in patients with endometriosis further increases this risk, emphasizing the importance of comprehensive counseling and a multidisciplinary approach to delivery planning for this high-risk group. Full article

Background/Objectives: The soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio is an established biomarker in the diagnosis of preeclampsia; however, its significance outside overt hypertensive disorders of pregnancy remains unclear. Emerging evidence suggests that angiogenic imbalance may reflect subclinical placental dysfunction even in otherwise low-risk pregnancies. To investigate associations between the sFlt-1/PlGF ratio and maternal and neonatal outcomes in a low-risk term obstetric population, beyond established diagnostic cut-offs. Methods: This prospective cohort study included 87 women with singleton term pregnancies. Serum sFlt-1 and PlGF concentrations were measured at hospital admission before delivery, and the sFlt-1/PlGF ratio was calculated. The primary outcome was estimated blood loss at delivery. Secondary maternal outcomes included postpartum hemoglobin decline, uterine atony, and fibrinogen concentration. Neonatal outcomes included birthweight, umbilical artery pH, and bilirubin concentration. Multivariable regression models were used to evaluate associations between the ln-transformed sFlt-1/PlGF ratio and outcomes after adjustment for prespecified maternal and obstetric covariates. Results: Each doubling of the sFlt-1/PlGF ratio was associated with greater estimated peripartum blood loss (+78.0 mL, 95% CI 42.1–113.9; p < 0.001), a larger postpartum hemoglobin decline (+0.078 g/dL, 95% CI 0.008–0.148; p = 0.030), lower fibrinogen concentration (−20.7 mg/dL, 95% CI −30.5 to −10.9; p < 0.001), and lower neonatal birthweight (−64.6 g, 95% CI −102.0 to −27.2; p = 0.001). No significant associations were observed for uterine atony, premature rupture of membranes, or umbilical artery pulsatility index above the 75th centile. Conclusions: In low-risk term pregnancies, higher sFlt-1/PlGF ratios were associated with greater estimated peripartum blood loss, lower fibrinogen concentrations, and lower neonatal birthweight. These findings support the hypothesis that variation in angiogenic balance may reflect subclinical placental dysfunction even in apparently uncomplicated pregnancies. Further prospective studies are needed to validate these exploratory observations and determine their clinical relevance. Full article

Background: Hereditary fibrinogen disorders comprise a rare and heterogeneous group of conditions characterized by highly variable clinical phenotypes, ranging from entirely asymptomatic to severe hemorrhage or paradoxical thrombosis. Within this spectrum, hereditary hypofibrinogenemia (HH) poses a significant obstetrical challenge due to the lack of evidence-based management guidelines during pregnancy. Methods: A scoping review of the literature was conducted to identify reported cases of pregnancies with HH reaching the third trimester. PubMed, Scopus, and Cochrane Library were searched through April 2026 for eligible studies reporting maternal and neonatal outcomes, fibrinogen replacement therapy during pregnancy, and peri- and postpartum management. A complementary LeapSpace search was also performed. Data were extracted using a structured form and owing to the heterogeneity and descriptive nature of the available evidence, results were synthesized narratively. Results: Out of 202 unique records identified, a total of 13 studies, comprising 33 pregnancies, were included. All evidence arose from case reports and small case series, with substantial variability in patient characteristics and clinical management. Successful outcomes are associated with early diagnosis, careful assessment of medical and obstetrical history, and close multidisciplinary surveillance. Maintaining fibrinogen levels above 50–100 mg/dL during pregnancy and ≥150 mg/dL peripartum appeared beneficial. The use of global coagulation assessment tools such as rotational thromboelastometry (ROTEM^®), particularly the FIBTEM^® assay, may support individualized management beyond fibrinogen levels alone; however, up to date it has been incorporated in the management of a single pregnancy. Conclusions: Management of pregnancy in women with HH should be individualized and multidisciplinary, with tailored fibrinogen supplementation strategies to optimize maternal and neonatal outcomes. Small sample sizes and the heterogeneity of the reported results limit the certainty of these findings, requiring further research to establish subtype-specific recommendations and to define additional coagulation parameters that may improve perinatal care. Full article

Background: Adolescent pregnancy is associated with increased maternal and neonatal morbidity, particularly in the context of inadequate prenatal care. Understanding the distribution of maternal and obstetrical complications in this population is important for improving clinical management and pregnancy outcomes. Methods: This retrospective observational study included primiparous adolescent patients (≤18 years) and focused on the assessment of maternal and obstetrical complications. The analysis compared the frequency of these complications between adolescents with adequate prenatal care and those without adequate prenatal follow-up, aiming to identify the most common complications and their distribution according to antenatal care status. Results: Significant differences were identified between groups. Maternal infections were more frequent among patients without adequate prenatal care (24.1% vs. 9.3%, p = 0.039). Hemorrhage was significantly more frequent among patients with adequate prenatal care (59.3% vs. 35.2%, p = 0.012). Among obstetrical complications, cephalopelvic disproportion showed a significant association with prenatal care status (p = 0.034), occurring more frequently in patients without antenatal follow-up. Hypertensive disorders, including gestational hypertension and preeclampsia, were identified only among patients without adequate prenatal care; however, no statistically significant association was observed (p = 0.118). Placenta previa (p = 0.057) and placental abruption (p = 0.495) were also observed only among patients without adequate prenatal care. Conclusions: Primiparous adolescent patients without adequate prenatal care showed a higher frequency of maternal and obstetrical complications, particularly infections and delivery-related disorders. Prenatal monitoring was associated with earlier identification and management of maternal and obstetrical risk factors. These findings highlight the importance of improving access to antenatal care among adolescent populations. Full article

Background/Objectives: Despite well-documented chemical and physical hazards in healthcare settings, existing reviews of occupational reproductive risks have largely focused on single-agent risk estimation and have rarely translated occupational hygiene evidence into clinical decision-making frameworks for reproductive counseling and surveillance. This narrative review synthesizes evidence across multiple occupational exposure categories—antineoplastic agents, high-level disinfectants (HLDs), sterilants, and work-organization factors—and proposes an integrated, clinically operational framework for preconception counseling, pregnancy-sensitive risk stratification, exposure-control verification, and reproductive health surveillance among women healthcare workers. Methods: A structured narrative literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and Embase from database inception through January 2025 and updated in March 2026. The review was guided by a Population–Exposure–Comparison–Outcome (PECO) framework and structured using Search–Appraisal–Synthesis–Analysis (SALSA) principles and the Scale for the Assessment of Narrative Review Articles (SANRA). Evidence quality was summarized using a modified hierarchy-of-evidence classification provided as a reader aid. This narrative review employed structured transparency tools but does not claim the methodological status of a systematic review. Quantitative meta-analytic pooling was not performed owing to substantial heterogeneity across study designs, exposure assessment methods, and outcome definitions; findings were synthesized narratively by exposure category. Results: The strongest and most consistent evidence was identified for occupational exposure to antineoplastic agents, which has been associated with spontaneous abortion, stillbirth, congenital abnormalities, impaired fecundability, and selected cancer-related concerns. HLDs and sterilants represent exposure categories warranting precautionary attention, with some evidence suggesting possible adverse effects on fecundability and early pregnancy maintenance; however, findings are considerably more heterogeneous, context-dependent, and reliant on self-reported exposure assessment than those for antineoplastic agents. Broader workplace factors, including shift work, prolonged working hours, physical workload, and mixed exposures, may further contribute to reproductive risk. The synthesis supports task-specific occupational history taking, exposure-control verification, and pregnancy-sensitive risk stratification. Conclusions: This review provides a multi-exposure, clinically operational framework that bridges occupational hygiene evidence with reproductive healthcare delivery, offering practical decision-support tools for clinicians managing women healthcare workers during preconception, pregnancy, and lactation. The framework includes structured occupational history-taking questions, a clinical decision pathway with evidence-tier classification, and a prevention matrix linking exposure sources to workplace controls and clinical actions. Integrating task-specific occupational history taking into routine reproductive care may improve detection of preventable workplace risks and support timely accommodation, while clinicians should calibrate recommendation strength to the underlying evidence quality for each exposure category. Full article

Background/Objectives: This cohort study aims to evaluate the association between antenatal blood pressure levels and postpartum cardiovascular outcomes in women with preeclampsia and/or fetal growth restriction (FGR). The objective of the study was to test the hypothesis that blood pressure levels during pregnancy are associated with cardiovascular health after delivery. Methods: The study was conducted at a tertiary hospital in Germany and involved women who developed preeclampsia and/or FGR during their pregnancies between 2021 and 2024. Participants were invited for cardiovascular follow-up consultations at 6 weeks and 6 months postpartum. VICORDER measurements were used for cardiovascular function assessment. Results were compared between the group with persisting hypertension and normotensive women at each study visit to assess the long-term progression of hypertensive disorders in relation to antenatal blood pressure levels. Statistical analysis employed Mann–Whitney U tests and adjusted odds ratios (aORs). Results: Of the 103 women who attended postpartum cardiovascular consultations during the study period, a substantial proportion still had elevated blood pressure at 6 weeks (51.49%) and 6 months (42.86%) after delivery. Women with persistent hypertension had higher systolic and diastolic blood pressure throughout pregnancy (p < 0.001), used antihypertensive medication more frequently (p < 0.001) and showed significantly increased arterial stiffness up to 6 weeks postpartum compared with normotensive women (7.4 m/s vs. 6.7 m/s, p < 0.001). In adjusted analyses, higher blood pressure levels during pregnancy were significant predictors of persistent postpartum hypertension (p < 0.05). Except for systolic blood pressure in the 3rd trimester at the 6-week follow-up, every 10 mmHg increase in blood pressure during pregnancy was associated with higher odds of postpartum hypertension, with aORs ranging from 1.82 to 3.42 at 6 weeks and from 2.18 to 5.51 at 6 months postpartum (depending on the trimester). Conclusions: Maintaining healthy blood pressure levels during pregnancy may reduce the long-term cardiovascular risk for mothers. These findings underscore the importance of early detection and consistent management of hypertension in expectant mothers with hypertensive pregnancy disorders. Further research is required to identify optimal blood pressure management strategies during pregnancy that could improve immediate and long-term maternal health outcomes. Full article

Background/Objective: Postpartum hemorrhage is a leading cause of maternal morbidity and mortality, particularly among high-risk women undergoing cesarean section. This systematic review and meta-analysis evaluated the efficacy and safety of prophylactic tranexamic acid in high-risk cesarean sections. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Risk of bias was assessed using RoB 2.0 and certainty of evidence was evaluated with GRADE. Random-effects meta-analyses, subgroup analyses and sensitivity analyses were performed. PROSPERO: CRD420251087054. Results: Nine randomized controlled trials involving 1776 participants were included. Tranexamic acid reduced total blood loss (MD −300.78; 95% CI −459.78 to −157.77), with greater efficacy when administered 15–20 min before incision (SMD −0.61; 95% CI −0.82 to −0.39). It also reduced intraoperative blood loss (MD −256.71 mL; 95% CI −375.04 to −138.39), blood loss >1000 mL (RR 0.24; 95% CI 0.14 to 0.41), additional uterotonics (RR 0.37; 95% CI 0.24 to 0.58), blood transfusions (RR 0.30; 95% CI 0.22 to 0.40), and complementary surgical interventions (RR 0.35; 95% CI 0.16 to 0.78). Conclusions: Prophylactic tranexamic acid may reduce blood loss in high-risk cesarean deliveries, particularly when administered 15–20 min before skin incision. It may decrease total and intraoperative blood loss and blood loss exceeding 1000 mL. It also likely reduces the postoperative decline in hemoglobin, the need for additional uterotonics, blood transfusions, and complementary surgical interventions; however, its effect on hematocrit remains uncertain. Full article