Search Results (594)

Objective: Influenza and pertussis vaccines are recommended during pregnancy; however, uptake remains insufficient in many European countries, increasing the risk of preventable infections. Recent recommendations for maternal respiratory syncytial virus vaccination have been endorsed by scientific societies. This study evaluated maternal vaccination coverage, knowledge, attitudes, and factors influencing vaccine uptake among Lithuanian women. Methods: A retrospective cross-sectional online survey was conducted between 4 and 14 November 2025 in Lithuania among women aged 18–55 years with at least one previous pregnancy. The questionnaire contained 29 questions on sociodemographic characteristics, obstetric history, vaccination history, attitudes, and informational sources influencing decisions. Internal reliability was confirmed (Cronbach’s α = 0.83). Descriptive statistics were used to summarize the data. Associations between categorical variables were assessed using the Chi-square test or exact tests (Fisher’s exact or Fisher–Freeman–Halton). Binary and multivariable logistic regression analyses were performed to evaluate factors associated with self-reported vaccination uptake and the relationship between influenza and pertussis vaccination. Odds ratios with 95% confidence intervals were calculated. Statistical significance was set at p < 0.05. Results: A total of 241 women participated. Self-reported vaccination coverage during pregnancy was 28.7% for influenza, 43.8% for tetanus–diphtheria–pertussis, and 4.2% for respiratory syncytial virus. Physician’s recommendation was the strongest predictor: women advised to vaccinate were 17.0 times more likely to receive influenza, 16.5 times more likely to receive pertussis, while RSV vaccination occurred almost exclusively among women who reported receiving a physician’s recommendation. Higher uptake was associated with younger maternal age and university education. Reasons for declining vaccination were avoidance of medical interventions and concerns about safety or side effects. Conclusions: Maternal vaccination coverage in Lithuania remains low despite public funding and national recommendations. Strengthening provider communication, improving information strategies, and integrating vaccination counseling into routine antenatal care may increase uptake and enhance maternal and neonatal protection. Full article

Background: Preeclampsia is a heterogeneous multisystem disorder characterized by endothelial dysfunction and angiogenic imbalance. While the sFlt-1/PlGF ratio is widely used for diagnostic purposes, its role in defining biological phenotypes of preeclampsia remains insufficiently explored. This study aimed to investigate whether angiogenic imbalance is associated with distinct multisystem phenotypes of preeclampsia and with perinatal outcomes. Methods: We conducted a retrospective cohort study including 320 pregnant women, of whom 68 were diagnosed with preeclampsia. Multisystem phenotypes were defined using laboratory markers reflecting renal, hepatic, and hematologic involvement. The sFlt-1/PlGF ratio was compared across phenotypes. Associations with gestational age at delivery, birth weight, Apgar score, and neonatal intensive care unit (NICU) admission were evaluated. Receiver operating characteristic (ROC) analysis assessed the discriminatory performance of the sFlt-1/PlGF ratio for identifying the renal-dominant phenotype. Results: The mean sFlt-1/PlGF ratio was higher in preeclampsia compared to normotensive pregnancies (58.5 ± 20.3 vs. 34.6 ± 15.9). Within preeclampsia, the renal-dominant phenotype showed the highest ratio (66.0 ± 22.5), followed by hepatic (55.9 ± 18.2) and hematologic phenotypes (52.0 ± 16.8). The renal phenotype was associated with earlier delivery (34.6 weeks), lower birth weight (2196 g), higher NICU admission (10.7%), and lower Apgar scores. The sFlt-1/PlGF ratio demonstrated moderate discrimination for the renal phenotype (AUC = 0.69). Conclusions: Angiogenic imbalance varies across multisystem phenotypes of preeclampsia and is associated with meaningful perinatal differences. The sFlt-1/PlGF ratio may contribute to phenotype-based risk stratification, supporting a move toward precision obstetrics. Prospective studies are needed to validate phenotype-oriented classification models. Full article

Background and Objectives: Placental vascular lesions are significant histopathological findings that indicate disruptions in uteroplacental and fetoplacental circulations and are associated with adverse pregnancy outcomes such as preeclampsia, intrauterine growth restriction (IUGR), and perinatal morbidity. This study aimed to re-examine the frequency and distribution of placental vascular lesions in placentas submitted for histopathological analysis at our center, based on criteria established by the Amsterdam Placental Workshop Group Consensus Statement. Materials and Methods: In this retrospective study, placental samples examined in the Department of Pathology at Akdeniz University Faculty of Medicine from 2016 to 2019 were analyzed. A total of 571 cases with at least one placental vascular lesion identified on histopathology were included. Hematoxylin–eosin-stained sections from all cases were re-evaluated, and maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), and other placental vascular pathologies were assessed according to the Amsterdam consensus criteria. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25 (IBM Corp., Armonk, NY, USA). Categorical variables were compared using the chi-square or Fisher’s exact test, while continuous variables were analyzed with the Mann–Whitney U test. Results: MVM and FVM were considered the primary outcomes of the study. MVM was identified in 95.1% of cases, whereas FVM was present in 1.9%. Among individual lesions, chorangiosis (97.2%) and villous/perivillous fibrinoid deposition (88.3%) were the most frequent findings, followed by mucinous cystic degeneration of the umbilical cord (61.5%) and dystrophic calcification (58.1%). Retroplacental hematoma was observed in 38.4% of cases. Although no significant association was found between MVM and placental weight or size, umbilical cord length was significantly shorter in MVM-positive cases (p = 0.032). In contrast, FVM showed significant associations with chorangiosis (p = 0.035) and placentomegaly (p = 0.003). The high frequency of chorangiosis may reflect a compensatory angiogenic response to chronic intrauterine hypoxia, potentially mediated by vascular growth factors, with variable effectiveness depending on the severity of the underlying condition. Conclusions: These findings suggest that placental vascular lesions are not only markers of obstetric complications but also serve as morphological indicators of fetoplacental adaptive responses. Full article

Background: Pelvic fractures in young patients are typically associated with high-energy trauma and long-term functional impairment. Young women may experience additional gender-specific sequelae following surgical treatment. This study aimed to evaluate functional outcomes and quality of life in young women following pelvic ring injuries. Methods: A retrospective cohort study was conducted including female patients of childbearing age (16–45 years) who sustained pelvic ring injuries and underwent surgical treatment at a single Level 1 trauma centre between 2009 and 2019. Validated PROMs were used to assess quality of life (EQ-5D, EQ-5D-VAS), and functional outcomes (Majeed Pelvic Score), along with a self-designed questionnaire to collect obstetric-related data. Radiographic measurements were performed to assess fracture reduction. PROM results were analysed descriptively and correlations between outcome scores were assessed using Pearson correlation. Results: A total of 32 patients completed all questionnaires and were included in the analysis. The mean EQ-5D index score was 0.61 (SD 0.31), the mean EQ-5D-VAS score was 68 (SD 24), and the mean Majeed Pelvic Score was 77 (SD 21). Most patients achieved good or excellent functional outcomes according to the Majeed score. Strong correlations were observed between PROM scores. Obstetric follow-up data were available for 21 patients; among these patients, 53% reported fear of pregnancy following the injury. Conclusions: Young women treated surgically for pelvic ring injuries demonstrated generally good pelvic-specific functional outcomes but lower quality-of-life scores compared with population norms. Obstetric concerns were commonly reported. Larger prospective studies are required to better understand long-term outcomes in this patient population. Full article

Background/Objectives: The diagnosis of endometriosis (EM) remains challenging due to the lack of a perfect diagnostic standard and the poor concordance between clinical symptoms and lesion severity. Although laparoscopy is widely used in clinical practice, it is invasive and associated with a non-negligible false-negative rate, while serum CA125 has limited diagnostic accuracy. In our previous studies, circulating endometrial cells (CECs) were identified in the peripheral blood of patients with EM, suggesting their potential as a non-invasive biomarker. Building on this finding, the present study aimed to systematically evaluate the clinical value of CECs in the diagnosis and stratified diagnosis of EM in the absence of a perfect diagnostic reference standard. Methods: Female patients treated at the Department of Obstetrics and Gynecology, Peking University People’s Hospital, between June 2022 and June 2024 were enrolled. Participants were clinically classified according to laparoscopic evaluation into an EM group and a non-EM group. However, laparoscopy was not treated as a definitive diagnostic gold standard in the statistical analysis. Instead, given the absence of a perfect reference standard, nonparametric latent class analysis was applied to jointly estimate disease status and the diagnostic performance of CECs, CA125, and laparoscopy. Patients with EM were further stratified according to dysmenorrhea severity (mild, moderate, and severe), lesion activity status (active or dormant), and menstrual cycle phase. Peripheral blood samples were collected from all participants, and CECs were detected using subtraction enrichment combined with immunofluorescence and fluorescence in situ hybridization (SE-iFISH). Serum CA125 levels were measured concurrently. Results: A total of 302 participants were included. The primary analysis focused on 133 surgically confirmed EM patients and 146 non-EM controls. After adjustment for an imperfect diagnostic reference standard, CECs demonstrated superior diagnostic performance compared with serum CA125 in the overall cohort, with higher sensitivity (0.58 vs. 0.37) and specificity (0.81 vs. 0.75). Under laparoscopic assessment in patients with severe dysmenorrhea (VAS ≥ 7), where the sensitivity and specificity were 0.759 and 1.00, respectively, CECs demonstrated superior diagnostic performance compared with serum CA125, with higher sensitivity (0.694 vs. 0.355) and specificity (0.946 vs. 0.429). Similarly, in patients with active EM, where laparoscopy showed a sensitivity of 0.79 and a specificity of 1.00, CECs again demonstrated superior diagnostic performance compared with CA125 (sensitivity 0.73 vs. 0.35; specificity 0.96 vs. 0.31), showing high concordance with laparoscopic diagnosis. When stratified by menstrual cycle phase, CECs maintained superior diagnostic performance over CA125 during both the proliferative and menstrual phases, with higher sensitivity (0.84 vs. 0.44) and specificity (0.83 vs. 0.65). Conclusions: Circulating endometrial cells (CECs) demonstrate high diagnostic accuracy for EM, significantly outperforming serum CA125, and show high concordance with laparoscopic diagnosis across clinically relevant stratified conditions in the absence of a perfect diagnostic gold standard. Full article

Background: Emergency obstetric situations require rapid clinical decision-making, technical competence, and emotional preparedness to ensure safe and compassionate care for both mother and newborn. However, nursing students often have limited opportunities to experience such high-risk, low-frequency events during clinical placements. Simulation-based education has emerged as an effective strategy to prepare future nurses for caring in emergency contexts, allowing them to develop both technical and non-technical skills in a safe learning environment. This study aimed to evaluate the effects of a high-fidelity obstetric emergency simulation program on nursing students’ knowledge, perceived safety, and learning experience. Methods: A mixed-methods design was employed, combining a quasi-experimental pretest–posttest assessment without a control group and qualitative analysis of open-ended reflections. Eighty-two third-year nursing students participated in two simulation sessions addressing obstetric emergencies such as breech birth, shoulder dystocia, out-of-hospital delivery, eclampsia, postpartum hemorrhage, and maternal cardiac arrest. Data were collected using validated instruments measuring knowledge, perceived safety, and satisfaction and self-confidence in learning, and were analyzed using Wilcoxon signed-rank tests and thematic analysis. Results: Significant improvements were observed in specific knowledge areas related to complex obstetric maneuvers and in their perceived safety when managing emergency situations (p < 0.001, r > 0.40). Participants reported high levels of satisfaction and confidence in learning. Qualitative findings highlighted increased emotional preparedness, improved clinical reasoning, and recognition of the importance of teamwork and reflective debriefing in emergency care contexts. Conclusions: High-fidelity simulation appears to be an effective educational strategy for preparing nursing students to provide safe and confident care in obstetric emergencies. Integrating simulation into nursing curricula can strengthen both technical competence and the emotional readiness required for caring in urgent and high-pressure clinical situations. Full article

Background: Access to reliable medicines information is essential to support safe medicine use during pregnancy and breastfeeding, where concerns regarding fetal and neonatal safety complicate clinical decision-making. Analgesics are widely used during these periods, yet uncertainty regarding safety persists due to evolving evidence, regulatory changes, and inconsistent information sources. Obstetric medicines information services play a critical role in addressing these information needs. This study aimed to evaluate patterns of analgesic-related enquiries to a pharmacist-led specialist obstetric medicines information service over a 20-year period. Methods: A retrospective observational study was conducted using enquiry data from the King Edward Memorial Hospital Obstetric Medicines Information Service (KEMH OMIS), Western Australia. All enquiries recorded between 1 January 2001 and 31 December 2020 were extracted from the Microsoft Access^® database. Records with incomplete data were excluded. Data were standardised, coded, and analysed using Microsoft Excel^® and SPSS^® Version 25. Descriptive statistics were used to summarise enquiry characteristics, caller type, the timing of exposure, and analgesic medicines involved. Trends over time were analysed. Results: A total of 48,458 enquiries were analysed, of which 4,978 (10.3%) related to analgesics, making this the third most common medicine class. Most enquiries related to breastfeeding (62.1%), followed by pregnancy (32.7%). The public accounted for 60.9% of calls, while health professionals contributed 39.1%. The highest frequency of breastfeeding enquiries occurred within the first four weeks postpartum, and pregnancy enquiries were most common in the second trimester. Paracetamol was the most frequently enquired analgesic (24.5%), followed by codeine (19.8%), ibuprofen (14.4%), diclofenac (7.2%), and tramadol (9.3%). Analgesic-related enquiries declined significantly over time (p < 0.001), particularly codeine-related enquiries following regulatory safety warnings. Conclusions: Analgesics represent a substantial proportion of medicines information enquiries in pregnancy and breastfeeding, reflecting widespread use and ongoing safety concerns. Pharmacist-led medicines information services play a critical role in supporting safe analgesic use. Full article

Background/Objectives: Breastfeeding initiation after cesarean section is frequently delayed due to postoperative routines and early mother–infant separation. Enhanced Recovery After Surgery (ERAS) protocols have been introduced in obstetrics to improve maternal recovery and may facilitate practices aligned with a family-centered model of care. The aim of this study was to evaluate the association between ERAS implementation and breastfeeding outcomes, including early feeding patterns and effective breastfeeding at discharge. Methods: An analytical longitudinal study was conducted including women undergoing scheduled cesarean section between January 2025 and November 2025 at Quirón Salud Málaga Hospital (Spain). A total of 131 women were enrolled in this study. Two groups were compared: an exposed group that received an ERAS protocol (n = 65) for scheduled cesarean section and a control group (n = 66) managed with conventional in-hospital care. An intrasubject analysis was conducted, and associations were assessed using odds ratios (ORs) with 95% confidence intervals (CIs). Multivariable logistic regression was performed to identify factors independently associated with effective breastfeeding. Results: The ERAS group showed a stable feeding pattern over time, with a high persistence of exclusive breastfeeding (Stuart–Maxwell χ²(2) = 1.14; p = 0.565). In multivariable analysis, ERAS implementation remained an independent factor (adjusted OR 3.79; 95% CI 1.50–9.55; p = 0.005), together with early skin-to-skin (adjusted OR 2.68; 95% CI 1.13–6.36; p = 0.026), as was breastfeeding support (adjusted OR 2.72; 95% CI 1.02–7.22; p = 0.045). LATCH scores were also higher in the ERAS group (p = 0.0005; r = 0.34). Conclusions: Women managed under ERAS presented a higher prevalence of exclusive breastfeeding at hospital discharge and better breastfeeding performance. ERAS implementation was associated with improved breastfeeding outcomes, possibly through clinical conditions that facilitate early contact and structured breastfeeding support. Full article

Background: Water birth has gained increasing attention as an alternative childbirth method intended to promote maternal comfort and physiological labor while potentially reducing obstetric interventions. However, evidence regarding its maternal and neonatal safety compared with conventional delivery approaches remains heterogeneous. This study aimed to evaluate maternal and neonatal outcomes associated with water birth compared with conventional spontaneous vaginal delivery in a secondary obstetric center. By focusing on vaginal births, the study evaluates the specific impact of water immersion on perineal integrity and neonatal transition. Methods: We conducted a retrospective cohort study including 3747 deliveries recorded at a tertiary maternity unit over a five-year period. Among these, 692 births occurred in water (water birth group) and 561 were conventional vaginal deliveries (land birth group), both managed under a standardized institutional protocol. Maternal characteristics, obstetric outcomes, and neonatal parameters were extracted from medical records and compared between the two cohorts. Primary outcomes included rates of episiotomy, perineal trauma and neonatal indicators such as Apgar score. Statistical analyses were performed to assess differences between groups using appropriate comparative tests. Results: Water birth was associated with a significantly lower rate of episiotomy compared with land birth (5.06% vs. 13.72%, OR 0.33, 95% CI 0.22–0.50, p < 0.001). Neonatal outcomes, including Apgar scores and NICU admissions, did not differ significantly between the two cohorts. Conclusions: In this retrospective cohort, water birth among selected low-risk pregnancies was associated with reduced obstetric intervention, particularly episiotomy, without evidence of adverse neonatal outcomes. These findings suggest that water birth may represent a safe and feasible option in carefully selected low-risk pregnancies when strict clinical protocols are applied. Full article

Background/Objective: RNA modifications, including N⁶-methyladenosine (m⁶A), 5-methylcytosine (m⁵C), 7-methylguanosine (m⁷G), N¹-methyladenosine (m¹A), pseudouridine (Ψ), N⁴-acetylcytidine (ac⁴C), 5-methoxycarbonylmethyl-2-thiouridine (mcm⁵s²U) and adenosine-to-inosine (A-to-I) editing, constitute a critical layer of post-transcriptional regulation that influences RNA stability, splicing, translation and degradation. This review aims to systematically summarise the current understanding of the molecular mechanisms and regulatory networks of RNA modifications in the female reproductive physiology and to evaluate their pathological implications in obstetric and gynaecologic disorders. Methods: We conducted a comprehensive literature review, synthesising findings from high-throughput sequencing studies, functional experiments and clinical investigations. The review integrates evidence across multiple RNA modification types, their regulatory enzymes (writers, erasers and readers) and their roles in physiological processes (germ cell development, oocyte maturation, embryogenesis and endometrial function) and pathological conditions (gynaecologic cancers, preeclampsia, endometriosis, polycystic ovary syndrome and premature ovarian insufficiency). Results: RNA modifications function as dynamic and reversible regulators that orchestrate key reproductive events, including primordial germ cell differentiation, oocyte meiosis, the maternal-to-zygotic transition, the establishment of uterine receptivity, and placental development. These modifications operate through coordinated writer–eraser–reader networks that fine tune transcripts’ stability, translation efficiency and RNA decay. The dysregulation of these epitranscriptomic networks is strongly implicated in the pathogenesis of gynaecologic malignancies (cervical, ovarian, endometrial cancers and choriocarcinoma), pregnancy-related disorders (preeclampsia, gestational diabetes mellitus and recurrent miscarriage), reproductive endocrine disorders (polycystic ovary syndrome and premature ovarian insufficiency) and benign gynaecological conditions (endometriosis and adenomyosis). Emerging evidence also reveals complex crosstalk among RNA modifications, such as cooperative interactions between m⁶A and m⁵C in translation regulation and antagonistic relationships between m⁶A and A-to-I editing. Conclusions: RNA modifications represent an essential and multifaceted regulatory layer in female reproduction, with broad implications for disease pathogenesis. Their unique reversibility and context-dependent functions offer promising opportunities for the development of diagnostic biomarkers and targeted therapeutic interventions. Future researchers should prioritise integrated multi-omics approaches, enhanced human-relevant models and clinical translation to fully realise the potential of epitranscriptomic medicine in reproductive health. Full article

Objective: To identify clinical and neuroimaging predictors of atypical Posterior Reversible Encephalopathy Syndrome (PRES) in eclampsia and evaluate the role of multi-regional cerebral involvement (neuroimaging burden). Methods: This retrospective cohort study included 266 patients with eclampsia and radiologically confirmed PRES (2018–2025). Patients were classified as typical (n = 234, 88.0%) or atypical (n = 32, 12.0%). A two-stage multivariable logistic regression was performed to identify independent predictors, sequentially incorporating clinical and neuroimaging variables. Results: Peak systolic blood pressure was significantly higher in atypical vs. typical groups (191.6 ± 20.4 vs. 172.4 ± 18.5 mmHg, p < 0.001). Furthermore, atypical cases exhibited a significantly higher systemic inflammatory burden, characterized by markedly elevated Systemic Immune-Inflammation Index (SII) and CRP levels (p < 0.001). Atypical cases exhibited a markedly greater neuroimaging burden, with a higher mean number of involved brain regions (4.4 ± 1.2 vs. 2.1 ± 0.6, p < 0.001). In Model 1 (clinical variables only), systolic blood pressure was a strong predictor of atypicality (OR: 1.24 per 10 mmHg increase, 95% CI: 1.12–1.38, p < 0.001). After incorporating neuroimaging features in Model 2, the total number of involved brain regions emerged as the strongest independent predictor (OR: 2.08, 95% CI: 1.52–2.85, p < 0.001), while the independent effect of blood pressure was attenuated. Conclusions: Atypical PRES in eclampsia reflects extensive, high-burden cerebral vasogenic edema rather than a distinct radiological subtype. While hypertension initiates the process, the total regional burden determines the atypical signature. This burden-focused perspective improves risk stratification and diagnostic vigilance in high-risk obstetrics. Full article

Background: Early pregnancy loss, defined as the spontaneous loss of a pregnancy before 20 weeks of gestation or when the fetus weighs less than 500 g, remains a common obstetric complication, affecting up to 15% of clinically recognized pregnancies. Chromosomal abnormalities, particularly aneuploidies such as trisomies and monosomy X, account for 50–60% of first-trimester losses, with incidence increasing alongside maternal age. Additional risk factors include maternal medical conditions, uterine anomalies, infections, and modifiable lifestyle factors. Pregnancies conceived through assisted reproductive technologies also carry a slightly higher risk of miscarriage, often influenced by maternal age and embryo quality. Methods: Two pathologists, blinded to each other’s assessments, analyzed abortive material from patients who experienced spontaneous first-trimester abortion between January 2012 and January 2025 at Agostino Gemelli Hospital, Rome, Italy. Inclusion criteria were defined independently of patient demographics. No restrictions were applied regarding maternal age. With respect to gestational age, only first-trimester miscarriages (≤12 weeks of gestation) were considered. In cases of discordance, the case was reviewed and re-evaluated to reach a final diagnosis. Results: The findings of this study are presented as a proposed histopathological classification and diagnostic framework for first-trimester miscarriages. Specifically, a total of 1168 cases were categorized into eight distinct groups of miscarriage etiology based exclusively on the histomorphological features of chorionic villi and maternal decidua. Conclusions: Histopathological examination of products of conception is essential for confirming intrauterine pregnancy, identifying underlying maternal or fetal causes, and guiding future reproductive management, particularly in recurrent pregnancy loss. This study evaluates histopathological features of first-trimester losses, classifies findings by etiology, and proposes a practical diagnostic guide to support clinical decision-making and improve outcomes in subsequent pregnancies. Full article

Background: Pregnancy in women with systemic lupus erythematosus (SLE) carries an increased risk of maternal and obstetric complications. Current risk assessment often relies on disease activity measured at a single time point and may not reflect dynamic changes during pregnancy. The clinical value of longitudinal disease activity trajectories remains insufficiently defined. Methods: We conducted a retrospective cohort study of 245 pregnancies in women with SLE managed at a tertiary referral center. Disease activity was assessed longitudinally and classified into three trajectories: persistent low activity, early flare with subsequent control, and uncontrolled disease activity during pregnancy. The primary outcome was a composite of clinically actionable maternal or obstetric complications prompting medical intervention. Multivariable logistic regression was performed to evaluate associations between disease activity trajectories and the primary outcome. Results: Clinically actionable pregnancy complications occurred in 41 out of 245 pregnancies (16.7%). The incidence differed significantly across disease activity trajectories, occurring in 3.9% of pregnancies with persistent low activity, 11.6% with early flare followed by control, and 63.8% with uncontrolled disease activity during pregnancy (p < 0.001). After adjustment for relevant covariates, uncontrolled disease activity remained strongly associated with the primary outcome (adjusted odds ratio 13.45, 95% confidence interval 4.01–45.08), whereas early flare with subsequent control was not associated with increased risk. Conclusions: Disease activity trajectories during pregnancy are strongly associated with clinically actionable pregnancy complications in women with SLE. Uncontrolled disease activity confers a markedly increased risk, while early disease flare followed by effective control does not. Trajectory-based assessment may improve risk stratification and support more individualized management during SLE pregnancies. Full article

Nearly 2 million stillbirths occur globally each year. These outcomes are often driven by disparities in healthcare access, especially in low- and middle-income countries, where limited resources and shortages of trained medical personnel further increase preventable risks. Addressing these challenges requires not only strengthening healthcare systems but also enhancing intervention strategies. In this context, the development of decision-support systems becomes essential to dynamically identify at-risk pregnancies and improve fetal outcomes. Therefore, we propose AI-FRS (Artificial Intelligence–Fetal Risk Prediction System), a decision support tool for fetal risk prediction, designed to classify fetal conditions as healthy or at risk, using clinical data from Mexican obstetric patients. AI-FRS is built upon seven distinct machine learning models, systematically evaluated through 127 first-order ensemble combinations using hard voting. To further enhance predictive performance, we assessed 32,752 second-order ensembles, constructed by combining top-performing first-order ensembles across recall, precision, and F1-score metrics. The final selected model, called BSOEM, achieved a robust F1-score of 0.812, providing a more balanced and robust decision-making framework than individual models or simple ensembles. Additionally, we conducted an interpretability analysis to identify the clinical variables with the greatest contribution to model predictions, strengthening the system’s transparency and potential clinical trust. AI-FRS features a user-friendly interface specifically designed to facilitate adoption by healthcare professionals. This provides a fast and clinically applicable AI tool for intrapartum and peripartum risk detection in obstetrics, supporting clinical decision-making and improving fetal health outcomes. Full article

Toxoplasma gondii establishes latent infection in a substantial proportion of the global population, yet the long-term health consequences of this infection remain incompletely characterized. We conducted a retrospective observational matched cohort study using longitudinal electronic health record data from a nationwide integrated healthcare provider, including members aged 18–45 years who underwent routine Toxoplasma serologic screening, typically performed in obstetric evaluation, excluding patients with clinical toxoplasmosis, immunosuppression, or HIV. Seropositive individuals were matched 1:1 without replacement to seronegative controls to align demographic, temporal, and socioeconomic variables. Time-to-event associations with predefined medical conditions were evaluated using Cox proportional hazards models with false discovery rate correction. The final cohort included 19,443 seropositive individuals and 19,443 matched controls (96.7% female), with a tight baseline balance of demographic and temporal characteristics. During follow-up, seropositivity was associated with increased risks of tobacco dependence (aHR 1.65), alcohol dependence (2.32), suicide attempt (1.82), motor vehicle accidents (1.22), and work accidents (1.27), as well as multiple infectious conditions, including hepatitis B (1.55), hepatitis C (2.15), and syphilis (2.43), with an overall trend toward increased all-cause mortality (1.32, 95% CI [1.00–1.74]). These findings suggest that asymptomatic Toxoplasma infection in young adults is associated with increased long-term behavioral and medical comorbidity. Full article