Abstract Objective Our objective was to determine the association between gestational weight gain (GWG) and the risk of perineal injury in nulliparous women with normal pre‐pregnancy body mass index (BMI). Methods We conducted a retrospective cohort study (January 2012–January 2024) at a single tertiary center including nulliparous women with normal pre‐pregnancy BMI (18.5–24.9 kg/m 2 ) who delivered a singleton, live, term infant (≥37 weeks) vaginally, excluding pregestational or gestational diabetes. Participants were stratified by GWG per American College of Obstetricians and Gynecologists guidelines (recommended 11.5–16 kg) into below‐, within‐, and above‐recommended GWG groups. The primary outcome was perineal injury (1st–4th degree). Multivariable logistic regression assessed the independent association between GWG and perineal trauma. Results Of 26 828 women, a total of 9019 (33.6%) had below‐, 11 527 (43.0%) within‐, and 6282 (23.4%) above‐recommended GWG. Overall perineal injury was more common with above‐recommended GWG (86.4% vs. 84.9% vs. 84.2%, P = 0.001), whereas obstetric anal sphincter injury (OASI) rates were comparable (0.9% vs. 0.7% vs. 0.7%, P = 0.506). The above‐recommended group had higher rates of induction and epidural analgesia, longer second‐stage duration, and higher birthweight (all P < 0.001). After adjustment, GWG category was not independently associated with overall perineal injury (above‐recommended: odds ratio [OR] 1.021; 95% confidence interval [CI] 0.930–1.120, P = 0.665) or OASI (above‐recommended: OR 1.065; 95% CI 0.743–1.526, P = 0.733). Independent risk factors for perineal injury included vacuum extraction (OR 3.288), epidural analgesia (OR 1.489), occiput‐posterior position (OR 1.450), induction (OR 1.285), and higher birthweight (OR 1.957 per kg). Conclusion Among nulliparous women with normal pre‐pregnancy BMI, GWG, whether below, within, or above American College of Obstetricians and Gynecologists recommendations, did not independently affect the risk of perineal tears or OASI. Intrapartum and fetal factors remain the primary determinants of perineal injury.
Abstract Advances in cancer treatment have improved survival rates for many patients with pelvic malignancies, highlighting the importance of long‐term reproductive outcomes and overall quality of life. Pelvic radiotherapy, chemotherapy, and multimodal treatment can cause substantial and permanent injury to ovarian reserve, uterine function, or both. Oncofertility can be clinically complex because reproductive risks and available options vary according to patient age, pubertal status, cancer type, treatment urgency, planned radiotherapy field, chemotherapy regimen and dosage, baseline ovarian reserve, desire for future pregnancy, and expertise. The present review summarizes established and emerging fertility preservation options for patients undergoing treatment for pelvic malignancies. Cryopreservation focused options, including embryo, oocyte, and ovarian tissue cryopreservation, can preserve gametes, embryos, or ovarian tissue before gonadotoxic therapy but do not protect the uterus from radiation related injury. Surgical approaches, including ovarian transposition, uterine ventrofixation, and uterine transposition, are aimed at reducing radiation exposure to reproductive organs, although their effectiveness depends on surgical technique, radiation planning, and use of systemic therapy. Uterine transplantation may provide a restorative option for selected patients with irreversible uterine factor infertility but remains highly specialized and resource intensive. Because each option differs in timing, evidence base, risks, costs, resource requirements, and applicability across patient groups, fertility preservation should be discussed early and incorporated into multidisciplinary cancer care. Continued research is needed to better define reproductive outcomes, pregnancy safety, complications, and comparative effectiveness of emerging approaches. image
Abstract Objective This study evaluates the association between cervical length measured at first diagnosis of a short cervix and delivery within 14 days among symptomatic and asymptomatic singleton pregnancies at 24 0/7 –33 6/7 weeks of gestation. Methods A retrospective cohort study was conducted comprising singleton pregnancies diagnosed with a short cervix (≤ 25 mm) at 24 0/7 –33 6/7 weeks, including both symptomatic and asymptomatic women. The primary outcome was spontaneous delivery within 14 days with delivery within 7 days as a secondary outcome. The optimal cervical length (CL) threshold was identified using Youden's index and internally validated. Predictors for delivery within 14 days were analyzed using multivariable logistic regression. Results Among 1027 pregnancies, 94 (9.2%) delivered within 14 days and 53 (5.2%) within 7 days. CL was significantly associated with gestational age at delivery ( P < 0.001). A CL of ≤ 14 mm was the optimal threshold for both outcomes (14 days: area under the receiver operating characteristic curve [AUC] 0.59, 95% confidence interval [CI] 0.52–0.65, sensitivity 38.3%, specificity 79.0%, positive predictive value 15.5%, negative predictive value 92.7%; 7 days: AUC 0.65, 95% CI 0.57–0.73). Delivery within 14 days occurred in 15.5% of women with CL ≤ 14 mm versus 7.3% of those with longer cervices, and CL ≤ 14 mm remained independently associated with the outcome after adjustment (adjusted odds ratio 2.62; 95% CI 1.59–4.27; P < 0.001). Conclusion In singleton pregnancies with a newly diagnosed short cervix at 24 0/7 –33 6/7 weeks, a CL of ≤ 14 mm is independently associated with delivery within 14 days, although discrimination is modest. The threshold might have greater value when combined with symptoms, gestational age, and other clinical factors.
Abstract Objective Recent observational studies have identified an association between the anxious/worrier trait and endometriosis. However, the causal nature of this relationship remains unclear. Methods Summary statistics from genome‐wide association studies were used to identify independent genetic variants associated with the anxious/worrier trait, which served as instrumental variables in a two‐sample Mendelian randomization (MR) study. Causal estimates for the effect of emotional factors on endometriosis risk were obtained using inverse variance weighting, MR–Egger regression, and weighted median methods. Reverse MR analysis was then used to assess the impact of endometriosis on emotional indicators. Sensitivity analyses included the MR–Egger intercept test, leave‐one‐out analysis, and Cochran's Q test, which were used to detect potential pleiotropy and heterogeneity. Results The inverse variance weighted analysis indicated that the anxious/worrier trait significantly elevated the risk of developing endometriosis (odds ratio 3.84; 95% confidence interval 1.42–10.41, P = 0.008). The results of the reverse MR analysis did not indicate a significant causal effect of endometriosis on emotional indicators ( P > 0.05). Conclusion This study provides genetic evidence for a causal relationship between emotional factors (anxious/worrier trait) and endometriosis. However, the specific biological pathways involved warrant further investigation.
Abstract Objective Our objective was to investigate the association between elevated urine protein‐to‐creatinine ratio (UPCR) and resistant hypertension during postpartum hospitalization in patients with severe preeclampsia at a tertiary care center in Colombia. Methods This retrospective cohort study was conducted in Medellín, Colombia. Patients aged >18 years diagnosed with severe preeclampsia who underwent UPCR assessment were included. Associations between elevated UPCR (≥0.3) and resistant hypertension during postpartum hospitalization were evaluated using robust Poisson regression models. Results A total of 261 patients were included in the study. Bivariate analysis showed that resistant hypertension in the postpartum period was more frequent in the UPCR ≥0.3 group than in the UPCR <0.3 group (43.2% vs. 12.7%; risk ratio 3.69; 95% confidence interval 1.92–7.07). After adjustment for maternal age, body mass index, and gestational age at diagnosis, elevated UPCR remained independently associated with resistant hypertension (adjusted risk ratio 4.87; 95% confidence interval 1.86–12.76). Earlier gestational age at diagnosis was also independently associated with resistant hypertension. Conclusion The UPCR is independently associated with the development of resistant hypertension during postpartum hospitalization in patients with severe preeclampsia.
