Search Results (2,696)

Background: A short cervix in the second trimester significantly increases preterm birth risk, yet no reliable first-trimester prediction method exists. Current guidelines lack consensus on which women should undergo transvaginal ultrasound (TVUS) screening for cost-effective prevention. Therefore, it is vital to establish a highly accurate and economical method for use in the early stages of pregnancy to predict short cervix in mid-pregnancy. Methods: A total of 1480 pregnant women with singleton pregnancies and at least one risk factor for spontaneous preterm birth (<37 weeks) were recruited from January 2020 to December 2020 at the Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine. Cervical length was assessed at 20–24 weeks of gestation, with a short cervix defined as <25 mm. Feature selection employed tree models, regularization, and recursive feature elimination (RFE). Seven machine learning models (logistic regression, linear discriminant analysis, k-nearest neighbors, support vector machine, decision tree, random forest, XGBoost) were trained to predict mid-trimester short cervix. The XGBoost model—an ensemble method leveraging sequential decision trees—was analyzed using Shapley Additive Explanation (SHAP) values to assess feature importance, revealing consistent associations between clinical predictors and outcomes that align with known clinical patterns. Results: Among 1480 participants, 376 (25.4%) developed mid-trimester short cervix. The XGBoost-based prediction model demonstrated high predictive performance in the training set (Recall = 0.838, F1 score = 0.848), test set (Recall = 0.850, F1 score = 0.910), and an independent dataset collected in January 2025 (Recall = 0.708, F1 score = 0.791), with SHAP analysis revealing pre-pregnancy BMI as the strongest predictor, followed by second-trimester pregnancy loss history, peripheral blood leukocyte count (WBC), and positive vaginal microbiological culture results (≥10⁵ CFU/mL, measured between 11⁺⁰ and 13⁺⁶ weeks). Conclusions: The XGBoost model accurately predicts mid-trimester short cervix using first-trimester clinical data, providing a 6-week window for targeted interventions before the 20–24-week gestational assessment. This early prediction could help guide timely preventive measures, potentially reducing the risk of spontaneous preterm birth (sPTB). Full article

Letrozole, a third-generation aromatase inhibitor initially developed for breast cancer, has become the preferred first-line agent for ovulation induction (OI), particularly in women with polycystic ovary syndrome (PCOS). This narrative review critically evaluates the efficacy, safety, and clinical applications of letrozole across diverse infertility contexts. Compared to clomiphene citrate, letrozole is associated with higher ovulation and live birth rates, a lower risk of multiple gestation, and a more favorable endometrial environment. Its pharmacokinetics—marked by transient estrogen suppression and a short half-life—limit embryonic exposure, supporting its favorable safety profile. Emerging data from large, randomized trials and meta-analyses demonstrate no increase in congenital anomalies, miscarriage, or adverse perinatal outcomes in letrozole-conceived pregnancies. Moreover, maternal side effects are generally mild, and the risk of ovarian hyperstimulation syndrome is low. Letrozole has also shown utility in mild stimulation protocols, fertility preservation for estrogen-sensitive malignancies, and clomiphene-resistant PCOS. Key clinical strategies—such as early-cycle initiation, lowest effective dosing, and individualized monitoring—optimize therapeutic outcomes while minimizing potential risks. While long-term offspring data remain limited and mechanistic concerns persist, current evidence robustly supports letrozole as a safe and effective option for OI, balancing reproductive success with maternal–fetal safety across a range of infertility indications. Full article

Transvaginal ultrasound-guided follicle aspiration remains the gold standard for oocyte retrieval in assisted reproductive technology (ART). This procedure employs either a single-lumen aspiration needle (SLN) or double-lumen aspiration needle (DLN), both of which are effective modalities for oocyte retrieval. The primary objective of this review is to systematically compare the impact and clinical outcomes associated with the use of SLN versus DLN in women undergoing ART. A systematic literature search was conducted across two databases, PubMed and Google Scholar, encompassing publications from their inception until May 2025, and articles published in English. A total of five studies were included in the final analysis. The oocyte yield and the number of MII oocyte did not differ significantly between the groups. Procedural duration was markedly shorter in the SLN group compared to the DLN group. No significant differences were observed in procedure-related complications across groups. Two randomized controlled trials reported comparable fertilization rates and numbers of high-quality embryos between the two needle types. Additionally, clinical pregnancy rates, ongoing pregnancy rates, and live birth rates were similar between the SLN and DLN groups. In conclusion, the utilization ofan SLN for oocyte retrieval demonstrates comparable efficacy to that of a DLN. Full article

Background and Objectives: Human papillomavirus (HPV) is the most prevalent sexually transmitted infection worldwide and, beyond its oncogenic potential, may impair reproductive health in both sexes. This review examines HPV’s effects on male and female fertility, obstetric outcomes, vertical transmission, and fertility-sparing management in oncology. Materials and Methods: A systematic search of PubMed, Embase, and Scopus was conducted using terms related to HPV and reproduction. Additional search terms included those related to therapeutic vaccines, antivirals, and genotype prevalence. English-language human studies reporting clinical reproductive outcomes were included. Thirty-seven studies met the inclusion criteria. Two reviewers independently screened and assessed study quality using a simplified GRADE framework. Results: In men, seminal HPV infection correlates with reduced progressive motility (SMD ≈ −0.85), abnormal morphology, and increased DNA fragmentation. In women, high-risk HPV doubles the odds of infertility (OR ≈ 2.3) and is associated with endometrial involvement. High first-trimester viral load predicts vertical transmission (aOR 6.4), which is also increased by vaginal delivery (RR 1.8) and is linked to PROM (OR 1.8) and preterm birth (OR 1.8). Modeling suggests that nine-valent vaccination plus 5-year HPV-based screening could reduce CIN2+ by up to 80% and excisional treatments by >75%. Fertility-sparing surgery in early cervical cancer yields a <4% recurrence and up to 68% live birth rates. Conclusions: This review uniquely synthesizes reproductive and oncologic impacts of HPV and emphasizes risk stratification, multidisciplinary prevention, and fertility preservation. Integration of HPV DNA quantification, personalized care, and vaccine-based strategies offers a path toward optimized outcomes in both sexes. Full article

Background/Objectives: Fat-soluble 25-hydroxyvitamin D (25-OHD) may be endogenously synthesized or obtained from dietary sources. Notably, it is crucial in calcium homeostasis, gene regulation, and immune system modulation, being even more relevant during prenatal stages, as the embryo utilizes vitamin D obtained from maternal plasma. Moreover, 25-OHD has been recently demonstrated to affect hematological parameters. We aimed to determine the correlation between maternal plasma 25-OHD levels, other blood parameters, and fetal anthropometric outcomes. Methods: Pregnant women attending an obstetrics and gynecology clinic during their gestation period were recruited, and data during follow-ups until the birth of their child were collected (IRB Approval Code: 07-XD-096). Data from 103 pregnant women were analyzed. Results: Compared to participants with normal levels, pregnant women with inadequate plasma 25-OHD levels exhibited a higher red blood cell count (4.3 ± 0.51 vs. 4.1 ± 0.42; p = 0.012) and lower mean corpuscular volume (86.4 ± 8.47 vs. 90.4 ± 6.74; p = 0.003), mean corpuscular hemoglobin (28.1 ± 3.34 vs. 29.6 ± 2.70; p = 0.008), plasma folate (12.6 ± 5.91 vs. 15.6 ± 5.86; p = 0.006), and vitamin B12 (289 ± 174 vs. 352 ± 147; p = 0.001) levels. Fish consumption frequency was positively associated with plasma 25-OHD levels. Conclusions: 25-OHD deficiency was correlated with alterations in hematological markers, plasma folate, and vitamin B12 levels. Given the high prevalence of 25-OHD deficiency in women of fertile age, government policies and healthcare professionals should emphasize vitamin D consumption adequacy in fertile women and expectant mothers. Full article

Background: Adverse early childhood developmental outcomes across physical, cognitive, language, communication, and socioemotional domains are major global health concerns. This systematic review aimed to synthesise perinatal and childhood risk factors using a socioecological model. Methods: We searched six databases for cohort, case–control, and cross-sectional studies published between January 2000 and January 2024. Studies reporting risk factors for adverse developmental outcomes were included. Findings were organised across individual, interpersonal, community, and societal levels using a socioecological model. The protocol was registered in PROSPERO (CRD42023447352). Results: A total of 175 studies were included. Individual-level risk factors, including preterm birth, low birth weight, male sex, chronic illness, undernutrition, and excessive screen use, were associated with adverse developmental outcomes, while exclusive breastfeeding, reading books, and storytelling were protective factors. Interpersonal risks included maternal age, education, mental health, and pregnancy complications. Community and societal risks include environmental pollution, access to education, conflict, and healthcare access. Conclusions: Improving early childhood developmental outcomes may require intervention at multiple levels. Future studies may need to focus on the influence of culturally and linguistically diverse backgrounds and environmental exposures on early childhood developmental outcomes. Full article

Background: Embryo selection in in vitro fertilization (IVF) aims to prioritize embryos with the highest reproductive potential. While preimplantation genetic testing for aneuploidy (PGT-A) remains the gold standard for identifying euploid embryos, it is invasive and not universally applicable. Deep learning (DL)-based models, such as the intelligent data analysis (iDA) score, have emerged as non-invasive alternatives for embryo assessment. This review critically evaluates the relationship between iDAScore (versions 1.0 and 2.0), embryo euploidy, and clinical outcomes, including live birth and miscarriage rates. Methods: A narrative review was performed using PubMed and Google Scholar, covering studies published from January 2020 to May 2025. The search included terms such as “iDAScore,” “deep learning,” “euploidy,” and “live birth.” Only English-language full-text studies assessing the predictive performance of iDAScore relative to chromosomal status or reproductive outcomes were included. Results: Six retrospective studies met the inclusion criteria. All reported a statistically significant association between higher iDAScore values and embryo euploidy. AUC values for euploidy prediction ranged from 0.60 to 0.68. In several studies, iDAScore was also positively associated with live birth rates and negatively with miscarriage rates. However, the predictive accuracy was moderate when restricted to euploid embryo cohorts, indicating that iDAScore may be more effective in broader populations where chromosomal status is unknown. Conclusions: iDAScore represents a promising adjunct to traditional embryo assessment. Although it cannot replace PGT-A, it may aid in embryo prioritization when genetic testing is not feasible. Larger prospective studies are warranted to further validate its clinical utility. Full article

Background/Objectives: Cystic hygroma is a congenital lymphatic malformation often identified during early pregnancy and frequently associated with chromosomal abnormalities and adverse outcomes. We aimed to appraise the genetic and clinical characteristics of fetuses diagnosed with cystic hygroma in the first/early second trimester, assess the resolution patterns in chromosomally normal cases, and provide insights into prognosis—based on data collected over a 30-year period. Methods: A retrospective cohort study was conducted on 405 consecutive fetuses diagnosed with nuchal cystic hygroma between 8.0 and 14.0 weeks of gestation from 1993 to 2023 at two tertiary care centers. Diagnoses were established using high-resolution transabdominal and transvaginal 3D/4D ultrasonography. All cases underwent prenatal cytogenetic analysis, including karyotyping. Fetuses with a normal karyotype were observed through serial ultrasounds through the remainder of the pregnancy to verify the eventual resolution of hygromas. Both descriptive and inferential statistical methods were used, with p < 0.05 as a cut-off (two-tailed). Results: Of the 405 fetuses, 210 (51.9%) had chromosomal abnormalities, most commonly trisomy 21, while 195 (48.1%) had a normal karyotype. A significantly higher frequency of trisomy 21 was observed compared to other identified chromosomal abnormalities (p < 0.001). In the chromosomally normal group, 85 (43.6%) showed spontaneous resolution of the hygroma within four weeks, and these pregnancies resulted in phenotypically normal live births. Septated hygromas were significantly more frequent in the abnormal karyotype group (71.4%). Conclusions: The finding and diagnosis of cystic hygroma in first trimester and early second-trimester pregnancy represent a strong predictor of chromosomal aneuploidy and warrant comprehensive prenatal genetic testing and close follow-up. However, in the absence of genetic abnormalities and additional malformations, spontaneous resolution is common, and neonatal outcomes are generally favorable. Health systems should provide equitable access to genetic testing and fetal imaging to support accurate diagnosis and informed decisions. Full article

Aim: We aimed to investigate the incidence, treatment patterns, and associated risk factors of type 1 retinopathy of prematurity (ROP) in the only tertiary-level Neonatal Intensive Care Unit (NICU) in Cyprus. Methods: This retrospective study included all infants screened for ROP between January and December 2023. Data were collected from standardized NICU discharge summaries and included gestational age (GA), birth weight (BW), multiple birth, systemic infection, blood transfusion, oxygen therapy, surgical interventions, and ROP outcomes. Infants were categorized into non-ROP, non-type 1 ROP, and type 1 ROP groups. Statistical analysis was performed to identify differences in risk factor distribution. Results: Among 183 infants, 33 (18.0%) developed ROP, with 11 (6.0%) requiring treatment for type 1 ROP. All infants with type 1 ROP were born at ≤28 weeks GA and weighed <1501 g. Type 1 ROP was significantly associated with lower GA, lower BW, systemic infection, surgery, and prolonged oxygen support (p < 0.05). Six infants were treated with laser and three with intravitreal bevacizumab. No recurrence was observed in the anti-VEGF group during 18 months of follow-up. Two infants with aggressive ROP died before treatment. Conclusions: Type 1 ROP in Cyprus occurred exclusively in extremely preterm infants, associated with the cumulative effect of multiple risk factors. Laser remained the primary treatment, while anti-VEGF was used selectively with favorable outcomes. This study emphasizes the importance of tailoring ROP screening and treatment strategies based on individual neonatal risk profiles, supporting a personalized approach to neonatal ophthalmic care. Full article

The present article is an opinion piece mainly based on selected articles in the field of sarcopenia, with possible relevance for pregnancy. Sarcopenia has gained increasing interest in recent years, since it has emerged that sarcopenia may determine significant health consequences, with related substantial health care expenditure. In particular, some studies suggested that sarcopenia may cause increased risk for several diseases, such as type 2 diabetes, obesity, and major cardiovascular events. On the other hand, some studies have reported that the association between sarcopenia and these diseases may be bidirectional. In particular, this holds for type 2 diabetes, because sarcopenia and type 2 diabetes share many etiological and pathogenetic factors, such as insulin resistance, oxidative stress, low-grade chronic inflammation, and adiposity. It is also worth noting that some studies have shown a non-negligible sarcopenia prevalence even in people below 40 years of age, and therefore of reproductive age. Taken together, the above considerations support the hypothesis that sarcopenia may be present in women with gestational diabetes (GDM), which shares common traits with type 2 diabetes. Notably, we hypothesize that sarcopenia may exacerbate GDM-related complications and may influence maternal–fetal outcomes, such as preterm birth or cesarean delivery. Additionally, since pregnancy often presents with insulin resistance independently of any comorbidity, it is plausible that sarcopenia may be present during pregnancy even in cases of normal glycemia. However, there is a lack of data about sarcopenia prevalence in pregnancy and its potential impact on outcomes. Therefore, future studies addressing these aspects are advisable. Full article

Background/Objectives: Early pain exposure in newborns is linked to negative short- and long-term outcomes. Preterm infants often require endotracheal intubation for mechanical ventilation or brief laryngoscopy for surfactant administration via Less Invasive Surfactant Administration (LISA) or Intubation–Surfactant–Extubation (INSURE). While premedication before intubation is well-studied, data regarding premedication for LISA/INSURE are limited. We aimed to explore premedication practices for intubation and LISA/INSURE procedures across Neonatal Intensive Care Units (NICUs) in Israel. Methods: An anonymous online questionnaire comprising 27 questions about premedication practices was distributed to neonatal caregivers in Israel. The questions addressed the use of premedication before intubation or LISA/INSURE, the existence of written protocols, pharmacological agents employed, and caregiver satisfaction with the medications used. Results: Questionnaires were collected between January and July 2023, yielding 69 responses from 20 NICUs. Almost all respondents (95.7%) routinely use premedication before intubation, but only 65.7% use it for LISA/INSURE. For non-emergency intubations, extremely low-birth-weight (ELBW) infants received premedication less often than the general neonatal population (75.4% vs. 95.7%, respectively). Most caregivers (91.2%) did not report increased procedure failure associated with premedication during LISA/INSURE. The vast majority of Israeli caregivers do not include muscle relaxants in their premedication regimen for intubation. Dual therapy regimens yielded higher satisfaction rates than monotherapy. Higher complication rates, particularly respiratory depression, were observed with Fentanyl, especially when used as monotherapy. Conclusions: Significant variations exist in premedication practices among caregivers across Israeli NICUs. Premedication is commonly administered for intubation but is considerably less frequent for LISA/INSURE, despite these procedures also being painful. ELBW infants received less premedication. Notably, muscle relaxants are infrequently used for premedication by Israeli NICU caregivers. Full article

Background and Objectives: As maternal mortality has become increasingly rare in developed countries, it is no longer a reliable metric for evaluating obstetric care quality. To address this limitation, the World Health Organization (WHO) introduced the concept of maternal near miss (MNM)—a term adapted from aviation—to standardize the identification and analysis of severe maternal complications. In addition to MNM, various indices are used to assess both access to and the quality of healthcare services. Materials and Methods: This retrospective study evaluated all pregnant women who presented at Başakşehir Çam and Sakura City Hospital, including postpartum referrals, between May 2020 and May 2023. Given the ongoing COVID-19 pandemic during the study period, data from COVID-19-positive patients were reported separately. All definitions and classifications were based on the standardized WHO MNM criteria. Results: A total of 45,458 births occurred at our institution during the study period. Among the COVID-19-excluded cohort, we identified 223 life-threatening conditions (LTCs), 206 MNM cases, and 17 maternal deaths. The resulting mortality index was 7.62%. The most frequent primary diagnoses included placental invasion anomalies, severe preeclampsia, and uterine atony. The most common interventions among LTC cases were ICU admission, prolonged hospitalization, hysterectomy, and massive transfusion. Conclusions: Although the rates of LTCs, MNM, and maternal mortality (MM) are gradually declining, they remain essential metrics for assessing healthcare quality. This study reveals that, while tertiary centers may report higher-than-global-average indices, there remains a significant gap between current outcomes and ideal targets. Enhancing diagnostic training, optimizing intervention strategies, and implementing robust clinical algorithms are critical steps toward reducing severe maternal morbidity and mortality. Full article

HIV mother-to-child transmission (MTCT) continues to pose a significant public health challenge, especially in regions with limited resources, although the worldwide distribution of antiretroviral therapy (ART) has drastically lowered the risk of vertical transmission to even below 1% in some regions. There are still uncertainties regarding the safety of some ART regimens during pregnancy and their longer-term effects on infants who are perinatally exposed to HIV but remain uninfected. This review explores current evidence regarding the interplay between maternal HIV infection, ART during pregnancy, and both maternal and pediatric outcomes. Particular attention is given to the risk/benefit ratio surrounding different drug classes, with integrase inhibitors seeming promising choices in MTCT due to their rapid viral suppression and favorable safety profiles. Meanwhile, regimens containing protease inhibitors or nucleoside reverse transcriptase inhibitors have been linked to some adverse outcomes such as low birth weight, growth restriction, and potential mitochondrial or metabolic disturbances. Although ART remains central in preventing MTCT, a deeper understanding of its effects on fetal development and postnatal health is needed, and it should be thoroughly monitored through future research and longitudinal surveillance. Full article

Background/Objectives: Newborn heart rate is an integral part of resuscitation algorithms, but the impact of ECG monitoring on resuscitative interventions and clinical outcomes has been identified as a knowledge gap. The objective was to evaluate the impact of routine use of dry-electrode ECG in all newborns immediately after birth on time to start positive pressure ventilation (PPV) when indicated. Methods: We conducted a randomized clinical trial from June 2019 to November 2021 at Stavanger University Hospital, Norway. Dry-electrode ECG sensors were applied immediately after birth to all newborns ≥ 34 weeks’ gestation. Randomization determined whether the heart rate display was visible or masked. Time of birth was registered in an observation app. Time to start ventilation was calculated from video recordings. Results: In total, 7343 newborns ≥ 34 weeks’ gestation were enrolled, 4284 in the intervention and 3059 in the control group, and 3.7% and 3.8% received ventilation, respectively. In 171/275 (62%) of the newborns the exact time of birth and a video of the resuscitation were available, for 98 in the intervention and 73 in the control group. Ventilation was provided within 60 s to 44/98 (45%) in the intervention and 24/73 (33%) in the control group, p = 0.12. Time from birth to start of PPV was a median of 66 (44, 102) s in the intervention and 84 (49, 148) s in the control group, p = 0.058. Resuscitated newborns were apneic (74%) or breathing ineffectively (26%) at the start of PPV, and only 36% had a heart rate < 100 beats per minute. Conclusions: The use of dry-electrode ECG heart rate monitoring did not change the proportion of newborns that received ventilation within 60 s after birth, but early termination due to employee protests to video recordings rendered the trial inadequately powered to detect a difference. Breathing status was likely a more important determinant of starting ventilation than bradycardia. Full article

Background/Objectives: Depression and anxiety in children pose a significant public health concern, with long-term implications for well-being. Over 10% of children and adolescents are affected by emotional disorders such as depression and anxiety. African American youth face disproportionate exposure to mental health risk factors, including poverty, adverse childhood events, community violence, and racial discrimination, which elevate their vulnerability to these disorders. A particularly at-risk subgroup includes African American children in kinship care arrangements (e.g., grandparents raising grandchildren), who may face additional factors such as family disruption and separation from birth parents. Methods: This mixed-methods sequential study examined how caregiver stress and birth mother–child relationship quality relate to depression and anxiety symptoms in African American children in kinship care. Phase I included survey data from 58 caregivers of children aged 5 to 12; Phase II involved interviews with 16 of these caregivers. Results: Results indicated that lower caregiver stress was associated with reduced child depression and anxiety symptoms. Furthermore, findings suggest that a high quality of the birth mother–child relationship serves as a promotive factor, particularly for depressive symptoms. Qualitative findings highlighted two themes: (1) the weight of kinship care, marked by factors such as ongoing grief and financial strain; and (2) birth parent relationships, defined by a mix of connection, conflict, and loss that affects children’s mental health. Conclusions: These findings underscore the need for greater understanding of the strengths and resources within kinship families that support positive mental health outcomes and highlight the importance of targeted interventions to reduce caregiver stress and foster supportive parent–child relationships. Full article