Search Results (1,312)

Background/Objectives: Emerging evidence suggests that multiple micronutrient supplements (MMS) provide additional benefits for maternal and neonatal health compared with iron and folic acid (IFA) supplements. To achieve effective coverage, acceptability, and adherence—and to inform a nationwide rollout of MMS—it is essential to understand the context-specific factors that shape implementation. This study evaluated the pilot implementation of MMS in Rwanda to identify key enablers, areas for improvement, and challenges related to antenatal care (ANC) attendance and MMS use. Methods: Data were collected through a survey of 3257 women who attended ANC services, seven focus group discussions with 35 ANC attendees, and key informant interviews with 20 ANC nurses and 21 community health workers. Results: Pregnant women reported high ANC attendance (74%) and MMS consumption (79%), largely driven by strong motivation and awareness of MMS benefits. Strategies to remember daily intake and to manage side effects supported adherence, as did reminders, motivation, and information from family members and healthcare providers. Limited patient-centered counselling, financial constraints, barriers to accessing ANC services, and product stock-outs were key areas for strengthening service delivery in Rwanda. Conclusions: Sustaining high ANC attendance and MMS adherence as the program transitions from the pilot phase to national scale-up is essential. Improving counseling quality and strengthening supply chains may reinforce ANC services and support sustained MMS adherence, with benefits for maternal and child health. Full article

Oropouche virus (OROV) has emerged as a significant arboviral pathogen in South America, responsible for recurrent outbreaks of febrile illness. In the Loreto region of Peru, more than 600 cases were reported in 2024, markedly exceeding expected incidence rates. We conducted a retrospective observational study using clinical–epidemiological records of all RT-qPCR-confirmed cases of Oropouche fever from the Regional Health Directorate of Loreto between October 2024 and March 2025. A total of 100 confirmed cases were identified. The most frequent symptoms were fever (88%), headache (78%), and myalgia (72%). No atypical or neurological presentations were reported. No severe cases or deaths occurred. Eight patients required hospitalization, mainly due to severe abdominal pain, persistent vomiting, arthralgia, and pregnancy. Six pregnant women were identified; three experienced pregnancy complications, though no fetal malformations or miscarriages were observed. This outbreak represents a new OROV epidemic in the region, with fewer cases than in 2024 and predominantly mild clinical courses. Although outcomes were generally favorable, the occurrence of complications in pregnant women underscores the importance of continued molecular surveillance and targeted public health interventions. Full article

Background/Objectives: Preeclampsia is a leading cause of maternal and perinatal morbidity worldwide, yet its underlying mechanisms remain unclear. Polyunsaturated fatty acids, particularly docosahexaenoic acid (DHA), are essential for placental development and vascular function, but evidence on their role in preeclampsia is inconsistent. This study aimed to compare serum DHA levels between women with preeclampsia and normotensive pregnant women and to examine their association with disease severity and maternal and perinatal outcomes. Methods: A total of 145 pregnant women aged 18–40 years were enrolled, including 47 with newly diagnosed preeclampsia (PE) and 98 normotensive controls. PE was defined according to the ACOG 2019 criteria. Serum DHA levels were measured using ELISA in fasting blood samples collected at the first visit. Results: Maternal serum DHA levels did not differ significantly between preeclampsia and control groups (p = 0.571); they were similar across control, mild PE, and severe PE groups. DHA showed a negative correlation with neutrophil-to-lymphocyte ratio (r = −0.305) and maternal hospitalization duration (r = −0.334). Independent predictors of PE included nulliparity (OR: 4.43), advanced age (OR: 1.14), elevated BMI (OR: 1.29), and low albumin (OR: 0.77). After adjusting for age and BMI, DHA was an independent negative predictor of IUGR (OR: 0.65). Conclusions: DHA levels: Placental and/or fetal DHA metabolism may be impaired in patients with preeclampsia. Although DHA was not associated with the development of PE, it was a negative predictor of IUGR. DHA reduces the length of maternal hospital stay through its anti-inflammatory effect. Full article

Background: The aim of this study was to evaluate the diagnostic and prognostic performance of albumin-based inflammatory–nutritional indices in hyperemesis gravidarum (HG) and to determine their associations with disease severity and risk of re-hospitalization. Methods: This retrospective case–control study included 246 women with HG and 246 gestational-age-matched healthy pregnant controls at 6–16 weeks of gestation. Disease severity was classified as mild, moderate, or severe using the Pregnancy-Unique Quantification of Emesis (24 h scale) (PUQE-24) score. A comprehensive panel of albumin-based inflammatory indices—including C-reactive protein-to-albumin ratio (CAR), fibrinogen-to-albumin ratio (FAR), neutrophil-to-albumin ratio (NAR), leukocyte-to-albumin ratio (LAR), neutrophil percentage-to-albumin ratio (NPAR), monocyte-to-albumin ratio (MAR), hemoglobin–albumin–lymphocyte–platelet (HALP) score, modified HALP (m-HALP) score, prognostic nutritional index (PNI) score, systemic immune-inflammation index-to-albumin (SII/Alb), and systemic inflammatory response index-to-albumin (SIRI/Alb)—was calculated from routine complete blood count and serum biochemistry results obtained at diagnosis. Receiver operating characteristic analysis, along with univariate and multivariate logistic regression models, was performed to evaluate diagnostic performance and identify predictors of severe HG and re-hospitalization. Results: Albumin-based indices exhibited severity-associated alterations, with an overall trend toward worsening immuno-nutritional status across increasing HG severity. Among these, m-HALP score demonstrated the strongest inverse correlations with PUQE-24 score, ketonuria grade, length of hospital stay, and re-hospitalization risk (r = −0.74 to −0.52; all p < 0.001) and achieved the highest discriminative accuracy for both severe HG (AUC 0.864, 95% CI 0.836–0.892, p < 0.001) and re-hospitalization (AUC 0.722, 95% CI 0.675–0.766, p < 0.001). In multivariable analysis, higher HALP, m-HALP, and PNI were independently associated with a lower likelihood of severe HG. For re-hospitalization, higher m-HALP and HALP were independently associated with a lower risk, whereas higher NPAR, higher ketonuria grade, and higher PUQE-24 score were independently associated with an increased risk of re-hospitalization. Conclusions: Albumin-based indices, particularly m-HALP, demonstrated robust diagnostic and prognostic performance in HG compared with conventional biomarkers. These readily available, cost-neutral composite biomarkers enable objective severity stratification and accurate identification of patients at elevated risk of recurrent hospitalization, offering immediate potential to guide personalized, evidence-based clinical management. Full article

Background: Primary fallopian tube carcinoma (PFTC) is a rare gynecologic malignancy, and data describing its biopsychosocial characteristics remain limited. Understanding the biological, psychological, and social features of affected women may support patient-centered care and inform future research. Methods: This retrospective, single-center, descriptive pilot study included 20 patients with histopathologically confirmed PFTC treated in 2024–2025. Demographic, reproductive, clinical, preventive, and record-documented psychosocial variables were extracted from medical records. Categorical variables were analyzed using chi-square tests (or Fisher’s exact test where appropriate), and effect sizes were summarized using Cramér’s V. Proportions were reported with 95% confidence intervals using the Wilson method. Results: Half of the women were aged ≥70 years (50.0%; 95% confidence interval (CI): 29.9–70.1) and 65.0% had never been pregnant. Normal body mass index (BMI) predominated (65.0%). International Federation of Gynecology and Obstetrics (FIGO) stage was available for 12/20 patients; among those with documented staging, 58.3% were FIGO stage III. Preventive behaviors documented in medical records suggested suboptimal screening patterns: cervical cytology was classified as occasional in 75.0% of patients. Psycho-oncological support was documented in 45.0% of patients, and sleep problems were documented in 25.0%. An age-group difference in documented psycho-oncological support was observed (χ² = 14.007; p = 0.007; Cramér’s V = 0.751); however, given the very small sample size and the distribution of observations across age categories, this finding should be interpreted as hypothesis-generating rather than confirmatory evidence. No association was observed between place of residence and FIGO stage in the subset with available staging data. Conclusions: In this small retrospective, single-center cohort, patients with PFTC were predominantly older and frequently nulligravid, while normal BMI was common. Record-documented psychosocial needs (including psycho-oncological support and sleep problems) were observed in a subset of patients and underscore the importance of systematic psychosocial assessment using validated tools in future studies and clinical pathways. Findings are preliminary and hypothesis-generating and support the need for larger prospective multicenter studies integrating comprehensive clinical and standardized psychosocial data in PFTC populations. Full article

Despite the many benefits for both the mother and fetus of physical activity during pregnancy, only 12.7–37.8% of pregnant persons in the United States achieve the recommended 150 min of moderate-intensity physical activity per week. While many variables influence physical activity participation during pregnancy, social support has been associated with physical activity participation in various populations. Originally used in the study of criminology, the social support theory has been applied in recent evidence as a method of promoting physical activity and other healthy behaviors. Recent literature suggests that social support and co-participation are interpersonal facilitators of participation in physical activity. Therefore, we propose an integrated model through a combination of social support and co-participation in physical activity to increase physical activity during pregnancy: the SsCo-PAP Model. The practical advantage of this combination is that both social support and co-participation emphasize social connectedness to facilitate physical activity. We recommend that the model be utilized by clinicians to educate, encourage, and support their patients to be physically active during their pregnancy. Future research should analyze the feasibility and effectiveness of using the SsCo-PAP Model in clinical practice. Full article

Mpox is an emerging zoonotic infection caused by the Monkeypox virus, an Orthopoxvirus with increasing global relevance following the 2022 multinational outbreak. Historically endemic to Central and West Africa, the disease has evolved from sporadic zoonotic transmission to sustained human-to-human spread, particularly through close physical and intimate contact. Clinical manifestations typically include fever, lymphadenopathy, and progressive mucocutaneous lesions, although severity varies according to viral clade, immune status, and comorbidities. The 2022 outbreak, predominantly associated with the Clade IIb variant, was characterized by milder disease, localized lesions, and reduced mortality compared with the more virulent Clade I variant. Despite this, severe outcomes remain possible, particularly in vulnerable groups such as children, pregnant individuals, immunocompromised patients, and persons with extensive dermatological disorders. Diagnosis relies primarily on polymerase chain reaction testing from lesion-derived samples, with genomic sequencing serving as a complementary tool for epidemiological surveillance. Management is largely supportive, though antivirals such as tecovirimat may be considered in severe cases or in high-risk populations. Data regarding therapeutic safety in pregnancy are limited; however, tecovirimat appears to have the most favorable profile, whereas cidofovir and brincidofovir remain contraindicated. Prevention strategies include targeted vaccination with the non-replicating Modified Vaccinia Ankara–Bavarian Nordic vaccine, used for both pre- and post-exposure prophylaxis, particularly in individuals at elevated risk. Given the evolving epidemiological profile, the potential for vertical transmission, and the risk of adverse perinatal outcomes, Mpox infection during pregnancy poses unique clinical challenges. This review synthesizes current evidence on virology, clinical presentation, diagnosis, prevention, and management, with an emphasis on obstetric considerations and public health implications. Full article

Background: Iron-deficient anemia (IDA) in pregnant women is a significant health issue globally. Oral iron supplementation is the primary treatment for IDA during pregnancy. For women who do not respond to or cannot tolerate oral iron treatment, intravenous (IV) iron preparations may offer a viable therapeutic option in the third trimester of pregnancy. Ferric carboxymaltose (FCM; Ferinject^®) is an IV iron preparation that allows rapid administration of high single doses of iron with a favorable safety profile. This study evaluated the potential impact of FCM therapy on fetal well-being by recording cardiotocography (CTG) before, during, and after iron infusions. Materials and Methods: We examined 105 women with IDA in the third trimester of pregnancy. During the initial evaluation, each patient was assessed for complete blood count, iron metabolism, B12, folates, hemoglobinopathies, CRP, kidney and liver function, and glucose levels. Each subject received intravenous ferric carboxymaltose (FCM), 500 mg. The study focused on the maternal and fetal safety of FCM infusion. The primary endpoint for maternal safety was the observation of adverse effects of iron infusion. For fetal safety, the primary endpoint was the assessment of CTG. Results: We considered 105 women, comprising 101 singleton and 4 twin pregnancies. The median hemoglobin (Hb) at initial observation was 95 g/L and 117 g/L post-therapy. Regarding maternal safety, side effects were observed during or after FCM infusion in four subjects; three cases involved local symptoms, while one case included nausea and skin rash. Concerning fetal safety, 100% of the cardiotocography records were deemed “normal” using the Dawes–Redman criteria. Conclusions: In conclusion, FCM proved effective in treating anemia in this clinically complex population of pregnant women in the third trimester and appeared safe in this cohort, though larger prospective studies are warranted. Full article

Spontaneous hemoperitoneum in pregnancy is rare, and rupture of a superficial uterine fundal vein in an unscarred uterus is exceptionally uncommon. A 37-year-old woman at 27 + 0 weeks presented with left upper quadrant abdominal pain, and imaging revealed a localized hematoma adjacent to the left uterine fundus without active bleeding. During conservative management, she developed sudden severe pain with fetal heart rate decelerations at 27 + 6 weeks, prompting emergency cesarean delivery. Intraoperative findings showed approximately 2400 mL of hemoperitoneum caused by rupture of a superficial fundal vein, with the uterus otherwise intact, and bleeding was controlled with a fibrin sealant patch. Maternal recovery and neonatal outcome were favorable. This case underscores that rupture of superficial uterine veins should be considered in pregnant patients presenting with unexplained hemoperitoneum during pregnancy. Full article

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy, and its prevalence continues to rise worldwide. Dietary management is the cornerstone of therapy, yet adherence may impose a substantial everyday burden. This study aimed to assess perceived burden and practical challenges related to following a diabetic diet in women with GDM. Methods: A cross-sectional anonymous online questionnaire study was conducted among 109 women with a current or past diagnosis of GDM within the previous five years. The survey addressed self-reported difficulties in maintaining normal blood glucose levels, adherence to a diabetic diet, perceived increases in grocery expenses, time required for meal preparation, dietary preferences, and family attitudes toward the diet. Associations between categorical variables were analyzed using contingency tables and the contingency coefficient. Results: Women with insulin-treated GDM (GDM2) reported more difficulties maintaining normal blood glucose levels than women treated with diet and physical activity alone (GDM1) (p = 0.014). Educational level was associated with perceived financial burden (p = 0.013) and meal preparation time (p = 0.003). These patterns likely reflect both differences in economic resources and the extent of dietary changes undertaken, rather than uniform differences in nutritional awareness. Pregnancy status was associated with dietary preferences, as non-pregnant respondents more often reported liking diabetic-diet meals than pregnant respondents (p = 0.037). Overall, 53.2% of respondents reported that a diabetic diet made daily functioning more difficult, mainly due to increased time and financial demands. Conclusions: Dietary management of GDM is associated with a meaningful perceived burden, especially among women requiring insulin therapy and those facing financial and time constraints. Understanding these subjective challenges may support more individualized dietary counseling and patient-centered care. Full article

Background: Mucormycosis, an invasive fungal infection with high morbidity and mortality rates, requires prompt surgical and antifungal therapies; however, the role of antifungal susceptibility testing (AFST) in clinical management of mucormycosis remains underexplored. We aimed to describe the experience of using AFST in the clinical management of mucormycosis. Methods: We conducted a retrospective study from 1 October 2017 to 8 February 2023. We included non-pregnant patients aged ≥ 18 years old with a positive culture for Mucorales and with proven or probable mucormycosis. We collected clinical and microbiological data using a chart review. Results: Over the study period, a total of 119 patients were included, with 36 (30%) undergoing AFST. Of all patients, the median age was 54 years, with 80 (67%) being White and not Hispanic and 73 (61%) being male. Fifty-three (45%) patients had DM, 27 (23%) had hematological malignancy, 15 (13%) had SOT, and 23 (19%) had COVID-19. Half of the cases met the criteria of proven invasive mucormycosis, with pulmonary involvement being the most common presentation (46, 39%), followed by rhino-cerebral-orbital involvement (35, 29%). The majority of Mucorales isolates were Rhizopus species (79, 66%). Among the 36 who underwent AFST, posaconazole minimal inhibitory concentrations (MICs) were lower than isavuconazole (range 0.03 to 2 µg/mL versus 0.1 to 16 µg/mL, respectively). AFST resulted in a change in antifungal therapy from isavuconazole to posaconazole in 3/36 (8%) cases. There was no statistically significant difference in the mortality between the patients whose isolates received AFST versus those who did not have AFST performed. Conclusions: AFST led to a change in antifungal therapy in a minority of mucormycosis cases. Further studies to understand the epidemiological range of antifungal MICs and the effect of AFST-informed antifungal therapy are needed. Full article

Background: The use of continuous glucose monitoring (CGM) offers several benefits. Compared to point-of-care (POC) capillary glucose tests, user acceptability is greater, and time in the target glucose range is improved. If these advantages can be transferred from outpatient to in-patient settings, CGM could assist clinicians in making timely, proactive treatment decisions. Scope of the review: This scoping review focuses on clinical studies of CGM use in hospital settings among non-pregnant adults, with a particular focus on studies from 2023 to 2025. It examines the latest evidence and guidelines and sets out the clinical and analytical considerations involved in implementing in-patient CGM. Main findings: In-hospital CGM facilitates hypoglycemia detection, especially asymptomatic and nocturnal episodes. Data on the impact of CGM use on clinical outcomes are scarce, and most studies focus on the reliability of CGM technology rather than clinical outcomes. Several factors affect CGM accuracy in hospitals, such as medications, fluid management, and hemodynamic disturbances. Despite between-device and settings-related variability, CGM devices generally show reasonable accuracy, with Mean Absolute Relative Differences (MARDs) ranging from 10% to 23%. In-hospital CGM has also improved workflows and reduced personnel exposure in infectious disease settings. Key implementation challenges: The MARD thresholds for safe in-hospital CGM use without confirmatory POC testing and evidence-based protocols for CGM application in ICU and non-ICU settings are not yet established. Despite challenges related to implementation, including personnel training, integrating diabetes technology with electronic health records, and costs, the benefits of improved monitoring and in-patient safety make CGM use worthwhile to pursue. Full article

Background/Objectives: In low-resource settings, diagnostic delays and limited specialist access worsen health inequalities, making hypertensive disorders of pregnancy (HDPs) defined by new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of gestation, with or without proteinuria, a major cause of maternal morbidity and mortality. This study evaluated the diagnostic effectiveness of a rural-applicable clinical model for detecting HDPs in a real-world population from Hospital General San Felipe (Tegucigalpa, Honduras). Methods: A cross-sectional diagnostic accuracy study was conducted on 147 consecutive pregnant women in February 2025. Clinical documentation from the initial appointment defined HDP. We modeled HDP risk using penalized logistic regression and common factors such maternal age, gestational age, blood pressure, BMI, primary symptoms, semi-quantitative proteinuria, and medical history. Median imputation was utilized for missing numbers and stratified five-fold cross-validation assessed performance. We assessed AUROC, AUPRC, Brier score, calibration, and operational utility at a data-driven threshold. Results: Of patients, 27.9% (41/147) had HDP. The model had an AUROC of 0.614, AUPRC of 0.461 (cross-validation averages), and Brier score of 0.253. The threshold with the highest F1-score (0.474) had a sensitivity of 0.561, specificity of 0.679, positive predictive value of 0.404, and negative predictive value of 0.800. HDP had higher meaning systolic/diastolic/mean arterial pressure (130.7/82.9/98.9 vs. 120.5/76.1/90.9 mmHg) and ordinal proteinuria (0.59 vs. 0.36 units). Conclusions: The model had moderate but clinically meaningful discriminative performance using low-cost, commonly obtained variables, excellent calibration, and a good negative predictive value for first exclusion. These findings suggest modification of predictors, a larger sample size, and clinical usefulness assessment using decision curves and process outcomes, including quick referral and prophylaxis. This approach aligns with contemporary developments in the 2023–2025 European Society of Cardiology (ESC) and 2024 American Heart Association (AHA) guidelines, which emphasize earlier identification and risk-stratified management of hypertensive disorders during pregnancy as a cornerstone of women’s cardiovascular health. Full article

Background/Objectives: Chronic kidney disease is more prevalent among women, and there are significant disparities in the management of female patients. Our study aimed to assess the clinical experience and educational needs of physicians in the treatment of reproductive and sex and gender-related health problems in patients with CKD. Methods: The three-part survey was distributed among nephrologists and other internal medicine specialists in Poland, both online and in paper form. Results: A total of 116 physicians participated in the survey, including 81 nephrologists. Most respondents (64.7%) were female and practiced in multispecialty hospitals (72.4%). While 97.4% managed patients with CKD, only 37.9% reported caring for pregnant women. Experience in sex-specific and pregnancy-related issues was limited—56.9% reported low or minimal experience in managing CKD during pregnancy. Residency training lacked coverage of crucial topics, with 66.2% reporting limited teaching on sex-related CKD progression. Over 90% supported integrating reproductive planning and interdisciplinary care into nephrology, favoring guidelines, conferences, and webinars for education. Conclusions: Our study has highlighted a critical discrepancy between the importance of sex-specific and reproductive health considerations in the management of CKD and the current level of clinical experience among Polish doctors. Full article

Background/Objectives: Large Language Models (LLMs), including ChatGPT-4 and Gemini, are increasingly incorporated into clinical care; however, their reliability within maternal–fetal medicine (MFM), a high-risk field in which diagnostic and management errors may affect both the pregnant patient and the fetus, remains uncertain. Evaluating the alignment of AI-generated case management recommendations with those of MFM specialists, emphasizing accuracy, agreement, and clinical relevancy. Study Design and Setting: Cross-sectional study with blinded online evaluation (November–December 2024); evaluators were blinded to responder identity (AI vs. human), and case order and response labels were randomized for each evaluator using a computer-generated sequence to reduce order and identification bias. Methods: Twenty hypothetical MFM cases were constructed, allowing standardized presentation of complex scenarios without patient-identifiable data and enabling consistent comparison of AI-generated and human specialist recommendations. Responses were generated by ChatGPT-4, Gemini, and three MFM specialists, then assessed by 22 blinded board-certified MFM evaluators using a 10-point Likert scale. Agreement was measured with Spearman’s rho (ρ) and Cohen’s (κ); accuracy differences were measured with Wilcoxon signed-rank tests. Results: ChatGPT-4 exhibited moderate alignment (mean 6.6 ± 2.95; ρ = 0.408; κ = 0.232, p < 0.001), performing well in routine, guideline-driven scenarios (e.g., term oligohydramnios, well-controlled gestational hypertension, GDMA1). Gemini scored 7.0 ± 2.64, demonstrating effectively no consistent inter-rater agreement (κ = −0.024, p = 0.352), indicating that although mean scores were slightly higher, evaluators varied widely in how they judged individual Gemini responses. No significant difference was found between ChatGPT-4 and clinicians in median accuracy scores (Wilcoxon p = 0.18), while Gemini showed significantly lower accuracy (p < 0.01). Model performance varied primarily by case complexity: agreement was higher in straightforward, guideline-based scenarios and more variable in complex cases, whereas no consistent pattern was observed by gestational age or specific clinical domain across the 20 cases. Conclusions: AI shows promise in routine MFM decision-making but remains constrained in complex cases, where models sometimes under-prioritize maternal–fetal risk trade-offs or incompletely address alternative management pathways, warranting cautious integration into clinical practice. Generalizability is limited by the small number of simulated cases and the use of hypothetical vignettes rather than real-world clinical encounters. Full article