With the rising burden of gynecologic cancers, survivors face complex long-term challenges, making digital health and telehealth interventions increasingly relevant for supportive survivorship care. A systematic review was conducted, using data sourced from Web of Science, PubMed, Cochrane Library, CNKI, Ovid MEDLINE, Wiley Online library journals, and Scopus from 2010 to December 31, 2024. Following PRISMA guidelines, empirical intervention studies delivered through digital health or telehealth modalities and focused on improving survivorship-related outcomes in gynecologic cancer survivors were included. As a result, a total of 17 studies were analyzed in this systematic review. Results indicate that digital health and telehealth interventions significantly enhance quality of life, alleviate psychological distress, and promote patient satisfaction and self-care capabilities among gynecologic cancer survivors. This systematic review suggests that digital health and telehealth interventions are promising approaches to supportive survivorship care for gynecologic cancer survivors, while highlighting the need for more rigorous study designs, clearer intervention reporting, and stronger evidence on long-term effectiveness.
Observational research plays an important role in gynecologic oncology. Purposes of such studies include, but are not limited to, examining disease etiology, quantifying disease burden, identifying risk or protective factors, and evaluating the effectiveness and safety of pharmacotherapies and non-pharmaceutical interventions. Building on fundamental principles of observational study design, this article systematically introduces the basic concepts, key design considerations, and main strengths and limitations of three classic study designs: cross-sectional, case-control, and cohort studies in gynecologic oncology, supported by customized, practical examples. Based on the target trial emulation framework, we further elaborate on approaches to addressing common methodological challenges, such as immortal time bias, selection bias, and time-dependent confounding. Finally, we provide concise guidelines for the selection of study design for different research questions, with illustrative examples. This article aims to equip researchers in gynecologic oncology with the most readily useful and up-to-date set of epidemiological tools, thereby promoting broader and more appropriate use of real-world data to generate scientific and clinical evidence in gynecologic oncology.
Hypertensive disorders of pregnancy contribute significantly to maternal and perinatal mortality and morbidity. Twin pregnancies which already carry an increased risk to mothers and fetuses, are affected in more significant numbers, earlier gestations and more severely by preeclampsia.This narrative review assesses the current state of research on maternal haemodynamics in twin pregnancy and the specific changes in those affected by preeclampsia. We assessed current literature focusing on maternal haemodynamics, angiogenic markers and screening models in twin versus singleton pregnancies. Relevant literature was identified through a search of electronic databases using keywords such as “twin pregnancy”, “preeclampsia” and “maternal haemodynamics”. Studies were included based on their relevance to cardiovascular adaptation and clinical outcomes in twin pregnancy. We highlight the unique challenges of diagnosing and managing preeclampsia in twin pregnancies compared to singleton pregnancies.
Three-dimensional (3D) ultrasound has emerged as a valuable non-invasive imaging modality in gynecologic oncology, particularly in the evaluation of endometrial and cervical cancers. This technique offers enhanced spatial visualization of pelvic anatomy compared to conventional two-dimensional ultrasound, improving diagnostic accuracy and preoperative staging. In endometrial cancer, 3D ultrasound provides detailed assessment of endometrial thickness, volume, and vascular patterns through power Doppler angiography, aiding in the detection of malignancy. Furthermore, it allows for accurate measurement of myometrial invasion depth, which is a critical factor in staging and treatment planning. In cervical cancer, 3D ultrasound facilitates delineation of tumor margins, stromal infiltration, and parametrial involvement, contributing to more precise local staging. The integration of multiplanar reconstruction and volume contrast imaging improves the sensitivity and specificity of lesion characterization. Several studies have demonstrated that 3D ultrasound approaches the diagnostic performance of magnetic resonance imaging (MRI) for local staging, while being more accessible, cost-effective, and tolerable for patients. Despite these advantages, limitations include operator dependency and reduced image quality in certain patient populations. Nevertheless, ongoing advances in ultrasound technology and standardized protocols are enhancing its clinical utility. In this narrative review we summarize current evidence regarding the role of three-dimensional ultrasound in the diagnosis and staging of endometrial and cervical cancer.
Uterine transplantation (UTx) offers the only treatment for those with uterine factor infertility to carry their own pregnancy. Cytomegalovirus infection is significant in UTx, given its implications for both transplant and pregnancy. There is little evidence and no management guidance on cytomegalovirus in periconception and pregnancy in transplant recipients and no consensus or guidelines on managing cytomegalovirus in UTx. This review highlights the pertinent issues surrounding cytomegalovirus infection following transplantation and congenital cytomegalovirus infection. It summarises the published cases of periconceptional/antenatal cytomegalovirus infection in transplant recipients, outlines the UK UTx team's experience and draws on expert opinion to propose a management strategy for the prevention of congenial cytomegalovirus infection following UTx, which is also applicable to other transplants. The highest risk group for infection are cytomegalovirus IgG negative recipients receiving IgG positive organs (D+/R-). 11 cases of periconceptional/antenatal cytomegalovirus infection have been described, including one UTx case. This team proposes six months of prophylaxis for D+/R-transplant recipients post-transplant. Maternal cytomegalovirus DNA viral load should be checked shortly prior to embryo transfer (ET) in all patients. Prophylaxis (valaciclovir or cytomegalovirus-hyperimmune globulin) around ET and may be considered in D+/R-recipients who have not contracted cytomegalovirus. Frequent monitoring for infection is required in pregnancy. Valaciclovir or cytomegalovirus-hyperimmune globulin should be used to treat infection prior to 20 weeks' gestation due to teratogenicity risk associated with valganciclovir. Valganciclovir may be considered in severe infection and after 20 weeks’. A worldwide registry on cytomegalovirus infection in pregnancy would be useful for future research.
OBJECTIVES:To evaluate the maternal and perinatal outcomes of twin pregnancies undergoing induction of labor (IOL). METHODS:MEDLINE, EMBASE, CINAHL, Cochrane database and the Scopus databases were searched electronically up to May 2024 (PROSPERO CRD42024520118). All studies regarding maternal or neonatal outcomes of induction of labor in twins were included. Language was restricted to English. Four different analyses were performed: IOL was compared to spontaneous onset of labor, elective Caesarean delivery, IOL in singletons and at last different methods of IOL in twin pregnancies were compared. Maternal and neonatal outcomes were analysed. Random-effect head-to-head meta-analyses were used to analyze the data. Quality assessment was performed using ROBINS-I for non-randomised and RoB2 for randomised studies. RESULTS:The comparison of IOL and spontaneous onset of labor (8 studies) showed that the incidence of unplanned Caesarean delivery (CD) was similar between the two groups (pooled OR 0.94, 95% CI 0.36-2.45; p = 0.89). Neonatal deaths were significantly lower in the IOL group compared to the spontaneous onset of labor group (pooled OR 0.22, 95% CI 0.10-0.51, p = 0.0003 for Twin 1 and 0.29, 95% CI 0.14-0.60, p = 0.008 for Twin 2). On the other hand, the comparison of IOL with planned CD (7 studies) demonstrated that the rate of composite adverse maternal outcome was significantly higher in women undergoing IOL compared to women who had planned CD (pooled OR 2.48, 95% CI 1.16-5.31; p = 0.02). However, no significant differences were observed among these two groups regarding neonatal complications (p > 0.05). The comparison of IOL outcomes in twin and singleton pregnancies (3 studies) showed no significant difference in the rate of unplanned CD (pooled OR 1.42, 95% CI 0.89-2.28; p = 0.14). At last, the comparison of different methods of IOL (5 studies) showed similar rates of Caesarean deliveries were observed in the different groups (pooled OR 1.01, 95% CI 0.56-1.85; p = 0.97). The risk of bias assessment showed overall low risk of bias for observational studies (ROBINS-I) and some concerns for the randomized studies (RoB2). According to the GRADE system, the quality of evidence was overall low to moderate. CONCLUSIONS:IOL may be considered a safe option in twin pregnancies as it is significantly associated with a lower risk of neonatal mortality and does not seem to increase the risk of unplanned CD when compared to the spontaneous onset of labor. However, IOL is associated with higher maternal morbidity when compared to elective Caesarean delivery. Larger studies are needed to further evaluate predictive factors of unplanned CD after IOL among these pregnancies.
A growing proportion of women work during pregnancy and return to employment within the first postpartum year. Their working conditions may shape maternal mental health, yet the evidence is uneven. We reviewed how occupational exposures relate to the full range of maternal psychological outcomes, from distress to wellbeing, across pregnancy and the return to work. Ten studies met the criteria. All addressed psychosocial exposures, only two also physical and ergonomic demands, and none chemical or biological hazards. Adverse psychosocial conditions, including job strain, pregnancy discrimination, and poor job quality, predicted higher depression and anxiety in both periods, with perceived stress as a pathway. Protective resources, such as schedule flexibility and social support, helped only under specific conditions. The mental health impact of non-psychosocial exposures is therefore a structural gap, relevant to antenatal care and occupational medicine.
Sample size calculation and biostatistical analysis are fundamental to rigorous clinical research, yet many clinician-researchers struggle with appropriate methods. This chapter provides practical, principle-based guidance for non-statisticians on sample size determination and analysis planning. Clearly specified study objectives are the essential foundation. For sample size determination, key considerations include: distinguishing confirmatory from exploratory studies (formal calculation versus sample size rationale); developing a sound analysis plan; selecting appropriate tools; using conservative estimates; defining clinically meaningful effect sizes; accounting for multiplicity; addressing reduced power with co-primary outcomes; and considering approaches for artificial intelligence and machine learning studies. Core principles of biostatistical analysis include: familiarization with statistical software, now facilitated by generative AI; appropriate regression applications; proper handling of missing data; controlling false-positive errors; and distinguishing statistical from clinical significance. These principles apply across common study designs, with clear objectives remaining foundational throughout.
Non-immune fetal anemia is a major cause of perinatal morbidity and mortality, affecting 3-5 per 10,000 pregnancies. It results from a range of conditions, including genetic hemoglobinopathies, congenital infections, fetomaternal hemorrhage, and twin-related complications. Advances in ultrasound-based screening, particularly middle cerebral artery peak systolic velocity measurement, have improved early detection, with a sensitivity exceeding 90% for detecting moderate to severe anemia in high-risk population. Intrauterine transfusion remains the primary treatment, with survival rates exceeding 90% in non-hydropic fetuses, though outcomes worsen when hydrops is present. Despite improvements, challenges remain in the early detection of mild anemia, development of curative therapies for genetic disorders, and antiviral treatments for congenital infections. Emerging approaches, including gene therapy, maternal antiviral therapy, and non-invasive prenatal testing, hold promise for improving outcomes. Future research should focus on optimizing fetal interventions, refining prenatal screening, and expanding access to novel therapies.
Fetal growth restriction (FGR) is associated with significant perinatal morbidity and mortality, yet its identification remains challenging due to the limited sensitivity of conventional biometric assessment and the lack of a reliable tool for assessing placental function. Placental function depends on uteroplacental perfusion which, in turn reflects maternal cardiovascular adaptation to pregnancy. In this context, umbilical venous flow (UVF) has emerged as a quantitative parameter reflecting fetal blood supply and a potential surrogate marker of placental function. This narrative review aims to provide an overview of UVF and maternal hemodynamics, and to explore their interaction within the framework of the cardiac-fetal-placental unit. The current literature indicates that UVF is reduced in pregnancies complicated by FGR, and it correlates significantly with maternal cardiac output (CO) and systemic vascular resistance (SVR). A hypodynamic maternal profile (high SVR, low CO) is consistently associated with reduced UVF and impaired placental perfusion, regardless of fetal biometry. The integration of maternal cardiovascular assessment and UVF evaluation provides a functional perspective on placental insufficiency and may improve the identification of pregnancies at risk. Furthermore, this approach offers a potential framework for understanding the effects of maternal hemodynamic interventions on fetal growth.
Objective Fetal growth restriction is associated with increased perinatal mortality and morbidity. We aimed to evaluate whether the combined assessment of birthweight centile (BWc) and cerebroplacental ratio expressed as multiples of the median (CPR MoM) during the late third trimester can identify distinct risk profiles for intrapartum fetal compromise (IFC) in late-onset fetal growth disorders and to propose a risk-based classification to guide birth management. Methods This retrospective observational study included 1530 singleton pregnancies with births between 34 and 41 weeks’ gestation. All fetuses underwent antenatal ultrasound with fetal biometry and Doppler assessment of the umbilical artery pulsatility index (PI), middle cerebral artery PI, and the CPR was calculated. IFC was defined as either abnormal intrapartum cardiotocography requiring cesarean section, a fetal scalp pH < 7.20, or a neonatal pH < 7.10. Fetuses were classified into six groups according to the combination of BWc and CPR MoM. Results IFC occurred in 7.25% of pregnancies. Lower BWc and abnormal CPR MoM were associated with increased IFC risk, including fetuses with BWc ≥10th centile. Fetuses with BWc <3rd centile and abnormal CPR MoM had the highest IFC risk (24.44%), while those with BWc ≥10th centile and abnormal CPR MoM also showed substantial risk (15.96%). Two groups, BWc <3rd centile with normal CPR MoM and BWc 3rd-9th centile with abnormal CPR MoM, had intermediate IFC risks, while those fetuses with BWc 3rd-9th centile and normal CPR MoM (small-for-gestational-age) presented risks comparable to fetuses with normal BWc and CPR MoM. Conclusions Late-onset fetal growth disorders represent a spectrum of placental dysfunction rather than a homogeneous pathology. Integration of BWc and CPR MoM identifies distinct risk phenotypes with different probabilities of IFC, supporting a risk-based approach to surveillance and birth management near term.
This review synthesises and appraises the research evidence for psychosocial interventions to support women who are pregnant following previous reproductive loss. A scoping review methodology was used to search for relevant peer-reviewed articles published (2000 - December 2025) using six databases: CINAHL, Medline, Web of Science, PsycINFO, SocIndex, and ProQuest. Included studies were assessed for quality using the Mixed Methods Appraisal Tool (MMAT). Sixteen papers met the eligibility criteria for inclusion. Findings were summarised under five themes: 1) the focus of psychosocial interventions; 2) the types of psychosocial interventions; 3) the timing of interventions and evaluations; 4) the measurement of intervention outcomes and 5) the outcomes and effectiveness of psychosocial interventions. Variability in study quality limited the generalisability of the findings. Psychosocial interventions aimed to reduce loss impacts and improve pregnancy outcomes. Research focused on controlled trials; evidence quality remains unclear. Further research is needed to broaden understanding of perinatal experiences.
Hemolytic Disease of the Fetus and Newborn (HDFN) is complication caused by maternal alloantibodies crossing the placenta and leading to the destruction of fetal red blood cells. While RhD is the most common antigen causing HDFN, Kell alloimmunization is the most severe. The assessment of HDFN risk begins with identifying the fetal antigen status. The HDFN Delphi consensus supports the use of cell-free fetal DNA (cffDNA) to determine fetal antigen status for RhD, Kell, and Rhc as a noninvasive alternative to amniocentesis. Ultrasound monitoring, including middle cerebral artery (MCA) Doppler assessments, should be initiated when antibody titers reach ≥16 for non-Kell antibodies. MCA Doppler can be started at 16 weeks' gestational age (GA) and should continue weekly until delivery. Antenatal management of HDFN involves both medical therapy with IVIg and intrauterine transfusions (IUT). Maternal IVIg can be initiated at 10-14 weeks GA for patients with a history of early intrauterine transfusion (IUT) or prior fetal/neonatal loss due to HDFN. IUT can be initiated at 16-18 weeks GA, with intraperitoneal IUT preferred before 20 weeks GA and intravascular IUT preferred after 20 weeks GA, and should be discontinued by 35 weeks GA. The timing of subsequent transfusions may be guided by hemoglobin drop calculation rates, MCA-PSV Doppler and ultrasound evaluations. Delivery is recommended at 37-38 weeks GA for those not requiring IUT and 2-3 weeks after the final IUT for those who did require IUT.
Common treatments for depression and anxiety include antidepressant medications and psychotherapy. However, concerns regarding medication side effects during breastfeeding and limitations of psychotherapy highlight the need for alternative approaches. This systematic review and meta-analysis aimed to rigorously evaluate the effects of yoga on anxiety, depression, and stress during pregnancy and the postpartum period by synthesizing evidence from existing studies. To enhance clinical relevance, outcomes were pooled based on validated perinatal mental health scales such as EPDS, STAI-S, CES-D, STAI, PSS, SCL-25, SRQ-20, HADS, HRSA, HARS, HDRS, SAS, SDS, PSRS and BDI-II, enabling clinicians to interpret findings using established screening tools. Interventional studies were identified through systematic searches in multiple databases, and data were analyzed using RevMan version 5.3. The risk of bias was assessed using the ROB1 tool for randomized controlled trials (RCTs) and the ROBINS-I tool for quasi-experimental studies. The quality of the included studies was evaluated using the GRADE approach. A total of 35 studies (23 RCTs and 12 quasi-experimental) were included. Meta-analysis showed that yoga may be associated with reductions in scores of prenatal depressions (SMD = -0.98), anxiety (SMD = -1.15), and stress symptoms (SMD = -0.88), particularly in women without prior depressive or anxiety symptoms (P < 0.00001). No statistically significant effects were found among women with existing symptoms. Yoga may be a feasible, safe, and acceptable intervention for reducing postpartum depression, anxiety, and stress in healthy pregnant women. However, methodological limitations, low to very low certainty of evidence and the small number of RCTs, particularly regarding postpartum outcomes, underscore the need for further research. PROSPERO REGISTRATION CODE: CRD42024618001.
The prediction of major obstetric syndromes has driven advancements in non-invasive prenatal assessment. Among these, Doppler ultrasound has notably improved the detection of obstetric pathologies. By evaluating uteroplacental circulation, Doppler studies can identify both physiological and pathophysiological changes throughout pregnancy, providing crucial insights into placental insufficiency. This condition affects up to 15% of pregnancies and contributes to preeclampsia, fetal growth restriction, and preterm delivery, leading causes of preventable perinatal morbidity and mortality. Uterine artery Doppler, ideally performed in the first trimester, should be incorporated into a competing risks algorithm to identify pregnant women at high risk for preeclampsia, enabling early prevention with acetylsalicylic acid, ideally before 16 weeks. The assessment should be performed transabdominally, using standardized techniques and the mean pulsatility index, and should be conducted by trained and audited professionals.
Precocious puberty, defined as the onset of secondary sexual characteristics at 2.5 SD below the mean age of onset of puberty (8 years in girls and 9 years in boys) is a complex clinical condition that has considerable physiological and psychological consequences on children and their parents. There are two types - central (gonadotrophin-dependent) and peripheral (gonadotrophin independent). Among the causes of central precocious puberty are various genetic mutations, syndromes and central nervous system disorders that prematurely activate the hypothalamic pituitary gonadal axis leading to the secretion of sex steroids that induced pubertal changes. Peripheral precocious puberty is commonly secondary to isolated sources of sex steroids such as tumours, exogenous steroids or as part of the McCune Albright syndrome. Long-term consequences of precocious puberty especially the central type include short stature and psychological problems. Children presenting with features of precocious puberty (PP) must be thoroughly assessed starting with a detailed history, physical examination and initiation of appropriate investigations followed by categorisation of the PP. A multidisciplinary team (consisting of a paediatrician an adolescent gynaecologist, a paediatric endocrinologist, a geneticist and a clinical psychologist) is essential for management. Treatment should aim at arresting or reversing the pubertal changes, counselling and support both for the children and their families and, addressing the implications for genetic causes for the family (if any). Untreated, precocious puberty may have considerable negative psychological and medical impact on the child.
Dysmenorrhoea or painful menstruation is a common and challenging gynaecological condition affecting women of reproductive age, with a prevalence of between 45% and 93% worldwide. Despite its significant impact on quality of life, dysmenorrhoea has often been normalised as an integral part of the menstrual cycle. Recent advances in next-generation sequencing technology have opened new opportunities for exploring the microbial landscape of the female genital tract, providing new insights into the role of the microbiota in both healthy individuals and those with dysmenorrhoea. A growing body of research is addressing the complex interplay between dysmenorrhoea and the microbiome of the female genital tract. This systematic review aims to present an updated synthesis of current knowledge on this relationship. A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus databases. Twelve articles were identified between 2018 and 2023, comprising a total of 397 cases of dysmenorrhoea that met the inclusion criteria. This review provides a detailed discussion of the microbiome findings of selected studies and offers the users the flexibility to choose the most appropriate indices. Therefore, this review would offer insights that hold promise for the development of targeted interventions aimed at modulation of the microbiome to alleviate symptoms, paving the way for a deeper understanding of women's reproductive health.
Dysmenorrhea is among the most common gynecological complaints in adolescents. Its diagnosis depends on the exclusion of other underlying pathologies, with the patient's history playing a crucial role. Initial therapy with over-the-counter medications can be initiated solely based on the patient's history. However, factors such as adolescents not seeking care, reliance on family advice, or incomplete evaluations by healthcare providers may contribute to misdiagnosis, leading to delays in both appropriate diagnosis and management. This article presents a narrative review of primary dysmenorrhea in adolescents, addressing its risk factors, pathophysiology, potential underlying conditions, diagnostic approaches, and treatment options. A step-by-step treatment algorithm for primary dysmenorrhea is also proposed, emphasizing that cases unresponsive to initial therapy should prompt reevaluation for secondary causes, such as endometriosis. This review urges healthcare professionals and others working with adolescents to increase awareness of primary dysmenorrhea and its management.
