ABSTRACT Background Despite various initiatives to promote family planning and the availability of various contraceptive methods, many women of reproductive age do not utilise these services effectively, and the gap between need and access has translated to a high unintended pregnancy rate in Osun State. Therefore, this study aimed to determine the effect of reproductive health education intervention on family planning uptake among market women of reproductive age in Osun State. Methods A quasi‐experimental study design was used. Ninety‐nine (99) respondents were estimated for each intervention and control group using the formula for comparing two independent proportions: n = (2( Z α + Z β ) 2 p (1 − p ))/( p o − p 1 ) 2 , with α = 0.05, power = 80% and an anticipated difference of 27.1% between groups based on previous studies. The study population comprised market women of reproductive age (15–49 years) residing in Osun State, selected using multi‐stage sampling techniques. The study was conducted in three phases: pre‐intervention, intervention and post‐intervention. At pre‐intervention, baseline data were collected from both control and intervention groups using pre‐tested interviewer‐administered questionnaires. At the intervention phase, interactive sexual health education, community awareness campaigns and short message service (SMS) were used to provide information on family planning services in the intervention group. At post‐intervention, data were collected from both groups using the same questionnaire. Cleaned datasets were exported to SPSS version 25 for analysis. Descriptive statistics were computed for all variables. McNemar's test was used to compare pre‐ and post‐intervention proportions within each group, and chi‐square tests were used for between‐group comparisons. The level of significance was set at p < 0.05. Results In the intervention group, uptake of family planning services (current contraceptive use) increased significantly from 30.3% at baseline to 59.6% at post‐intervention (McNemar's test, p < 0.001). In the control group, uptake increased from 38.5% to 48.5%, but this change was not statistically significant (McNemar's test, p = 0.153). The between‐group difference in post‐intervention uptake was statistically significant ( χ 2 = 8.127, df = 1, p = 0.043). Conclusions This study found that reproductive health education significantly enhanced the uptake of family planning services among market women. This highlights the importance of reproductive health education in improving knowledge about and uptake of family planning services. We recommend that policymakers and health practitioners prioritise such educational interventions to enhance family planning services and improve reproductive health outcomes in similar settings.
ABSTRACT Objectives Osteoporosis is a common and debilitating condition that disproportionately affects older adults, particularly women, leading to increased fracture risk and reduced quality of life. While traditional risk factors such as age, hormonal changes, and lifestyle factors are well established, the impacts of diabetes and obesity on osteoporosis remain unclear. This study aimed to investigate associations between diabetes, obesity, and osteoporosis diagnosis in Caucasian women aged 65 years and older. Materials and Methods Data on osteoporosis diagnosis, diabetes diagnosis, and Body Mass Index (BMI) were obtained from the Study of Osteoporotic Fractures (SOF) online database, and statistical analyses were performed using IBM SPSS software. Results No significant association was found between diabetes and osteoporosis diagnoses at visit 1 ( p = 0.966); however, a statistically significant association emerged at visit 8 ( p < 0.001). A weak negative association was observed between the two conditions at visit 8 ( r = –0.068, p < 0.001), and participants with diabetes had approximately 41% lower odds of osteoporosis compared with those without diabetes. Higher BMI was associated with a lower prevalence of osteoporosis, while being underweight was associated with a higher prevalence. Significant differences in osteoporosis prevalence were observed between underweight individuals and those with severe obesity at the initial visit, and between healthy‐weight individuals and overweight or obese individuals at the later visit. Conclusions Diabetes was not consistently associated with osteoporosis diagnosis across study visits. The results suggest that being overweight and obese is protective against osteoporosis in women.
ABSTRACT Background In pelvic organ prolapse (POP), a common condition requiring surgical intervention, physiotherapy interventions including pelvic floor muscle training (PFMT) may improve recovery. Objectives The objective of this umbrella review was to provide a comprehensive synthesis of existing systematic reviews (SRs) of randomised controlled trials (RCTs) evaluating the effect of physiotherapy interventions following POP surgery compared to no physiotherapy intervention on POP symptoms, quality of life (QOL) and pelvic floor muscles (PFM) strength. Search Strategy A literature search was conducted in PubMed, Google Scholar, and the CRD database from inception to 1st January 2025, using search terms capturing SRs on pelvic organ prolapse, surgery, physiotherapy, and pelvic floor muscle training. Selection Criteria SRs of RCTs assessing physiotherapy interventions after POP surgery compared to a control group without physiotherapy were included. Data Collection and Analysis Corrected Covered Area (CCA) analysis addressed the degree of RCT overlap among the included systematic reviews. Methodological quality was assessed using AMSTAR 2 and ROBIS tools, and evidence was graded. Main Results A total of 8 SRs were included, with 11 unique RCTs. CCA was 28%, indicating a very high degree of overlap. AMSTAR‐2 assessment showed that all SRs were low or critically low, and ROBIS assessment showed that 3 out of 8 reviews had a low risk of bias. The graded evidence was mixed with variable methodological quality and heterogeneity. The effect of physiotherapy intervention (PFMT) on POP symptoms, QOL and PFM strength was mostly uncertain but one meta‐analysis with heterogeneity showed a statistically significant effect on QOL (p = 0.03). Conclusion This umbrella review identified mixed‐grade evidence with a proportion of results in favour of PFMT on the outcomes POP symptoms, QOL and PFM strength. New high‐quality RCTs are needed to establish the role of PFMT.
ABSTRACT Objective To evaluate the incidence, clinical presentation, management, and maternal and neonatal outcomes of uterine rupture over a 15‐year period in a UK district general hospital, and to assess local practice against the Royal College of Obstetricians and Gynaecologists (RCOG) Green‐top Guideline No. 45. Design Retrospective case series. Setting Single UK district general hospital. Population Women with confirmed uterine rupture between January 2010 and June 2025. Only women who were booked and received antenatal care at our hospital were included; unbooked cases were excluded. Methods This clinical audit was approved by the hospital Audit and Quality Committee; individual consent was waived as data were anonymized and retrospectively collected. Cases were identified from maternity databases, incident reporting systems, and electronic medical records. Maternal, obstetric, labour, operative, and neonatal data were extracted using a standardized proforma and reviewed against national guidance. Main Outcome Measures Incidence of uterine rupture; maternal morbidity including haemorrhage, transfusion, hysterectomy, and intensive care admission; neonatal outcomes. Results Thirty‐two cases were identified, with 17 (53%) complete and 15 (47%) partial ruptures. Most women were multiparous (97%) with a scarred uterus (88%), commonly after one previous caesarean section. Four cases (13%) occurred in unscarred uteri, often associated with induction or oxytocin augmentation. Diagnosis was delayed in 72%. Major maternal morbidity included transfusion (41%), hysterectomy (9%), and intensive care admission (13%), with no maternal deaths. Neonatal outcomes were generally favourable, though one stillbirth and two intrauterine deaths occurred. Conclusion Uterine rupture is rare but serious, with significant maternal morbidity. Vigilance, cautious use of uterotonics, and prompt senior involvement are essential to optimise maternal and neonatal outcomes.
ABSTRACT Introduction Maternal near‐miss is a major public health problem, particularly in underdeveloped countries like Ethiopia. However, little is known about how determinants influence maternal near‐miss through mediators in the Ethiopian context. Objectives To identify determinants and their direct and indirect effects on maternal near‐miss among pregnant women in Bahir Dar City, Northwest Ethiopia. Methods A nested case‐control study was conducted among women in Bahir Dar City, Northwest Ethiopia, from 1 May 2023 through 6 March 2024. The study included 165 cases and 658 controls. Data were collected using structured checklists and interview questionnaires. Binary logistic regression was used to identify determinants, and the Karlson–Holm–Breen approach was used for mediation analysis in Stata 17.0. Results Determinants of maternal near‐miss included rural residence (AOR = 2.14, 95% CI: 1.27–3.61), third party decision (AOR = 4.73, 95% CI: 2.30–9.73), genital mutilation (AOR = 3.32, 95% CI: 1.79–6.13), caesarean history (AOR = 4.85, 95% CI: 2.43–9.67), late antenatal care booking (AOR = 2.10, 95% CI: 1.28–3.44), undernutrition (AOR = 3.51, 95% CI: 1.74–7.07), anaemia (AOR = 4.31, 95% CI: 2.55–7.28), hypertension (AOR = 4.43, 95% CI: 2.56–7.69), first delay (AOR = 4.29, 95% CI: 2.99–6.34) and distance (AOR = 6.25, 95% CI: 4.28–9.12). In mediation analysis, 19.1% of the effect of residence was mediated by distance, 7.5% of the effect of distance was mediated by a third‐party decision, 17.4% of decision‐making power was mediated by first delay, 8.4% of antenatal booking time was mediated by first delay, and 34.5% of genital mutilation was mediated by prior caesarean section. Conclusion Easily identifiable factors determined maternal near‐miss. Some factors had direct and indirect effects via mediators, while others had only direct effects. Early identification of these factors during antenatal visits is crucial for prevention.
ABSTRACT Objective To describe the successful use of vaginal natural orifice transluminal endoscopic surgery (vNOTES) for hysterectomy with bilateral salpingo‐oophorectomy in a patient with a large symptomatic fibroid uterus. Methods A 51‐year‐old nulligravida presented with chronic heavy menstrual bleeding and pelvic discomfort. Imaging demonstrated multiple uterine fibroids, including a large anterior intramural fibroid causing marked distortion of the endometrial cavity. After counselling regarding treatment options, including ovarian preservation versus removal and the implications of surgical menopause, the patient elected to undergo vNOTES hysterectomy with bilateral salpingo‐oophorectomy because of its minimally invasive, scarless approach and expected reduction in postoperative pain. Results The procedure was completed successfully without intraoperative or postoperative complications. Despite the large uterine size, complete removal of the uterus and adnexa was achieved, with a total specimen weight of 1800 g. Operative time was 160 min, and estimated blood loss was 220 mL. The patient was discharged within 24 h, remained pain‐free postoperatively, and was started on oral estrogen therapy. Conclusion This case demonstrates that vNOTES hysterectomy with bilateral salpingo‐oophorectomy can be a feasible and safe approach for selected patients with large benign uterine pathology. Even in the setting of a markedly enlarged fibroid uterus, the technique may offer effective surgical management, rapid recovery, minimal postoperative pain and improved cosmetic outcomes.
ABSTRACT Objectives There is growing evidence for the paternal origins of health and disease. This review aimed to systematically search the literature examining relationships between paternal exposures during early life, peri/conception or pregnancy, and offspring body composition and musculoskeletal health at birth. Data Sources A systematic search was conducted in MEDLINE, Embase, CINAHL, and the Cochrane Library for studies published in English up to October 2024, using relevant subject headings and free‐text terms. Study Eligibility Criteria Observational and experimental studies that assessed paternal exposures during early life, peri/conception, or pregnancy, and their association with offspring body composition and musculoskeletal health at birth, were included. Study Appraisal and Synthesis Methods Data were extracted, and the studies were descriptively summarised based on the outcome assessed. This study was registered with PROSPERO (CRD42022340146) and the PROSPERO registration date was 27 July 2022. Results The search identified 7351 papers, which narrowed down to 5202 after duplicates were removed. Of these, 202 studies reported offspring outcomes at birth. Some paternal exposures, like anthropometrics, were associated with offspring birthweight and birth length. However, many paternal exposures had limited supporting evidence. Conclusions Certain paternal exposures are associated with offspring body composition and musculoskeletal health at birth. Further high‐quality studies are needed to explore additional paternal exposure associations.
ABSTRACT Objective Interstitial cystitis/bladder pain syndrome (IC/BPS) is linked to bladder and/or pelvic pain, pressure, and discomfort with urinary frequency. Despite guidelines, there is a need for better treatment options. This study analyzed patient demographics, clinical characteristics, and treatment patterns for medications and procedures in interstitial cystitis/bladder pain syndrome. Methods This retrospective study examined real‐world claims from the Merative™ Marketscan® Commercial and Medicare Supplemental Databases (Set B) between January 1, 2016, and September 30, 2023. Treatment patterns for the interstitial cystitis/bladder pain syndrome cohort were analyzed by examining the most frequent American Urological Association (AUA) IC/BPS guideline‐recommended medications prescribed during pre‐ and post‐index periods (index date=date of first diagnosis of interstitial cystitis/bladder pain syndrome) during the identification period (December 31, 2016–September 30, 2022). Results The IC/BPS cohort was predominantly female (92.2%), with 49.8% of the population aged 40–59 years. Post‐index increases in the prescriptions of amitriptyline (pre‐index; n = 1316 vs post‐index; n = 2268), hydroxyzine (pre‐index; n = 1299 vs post‐index; n = 2096), cimetidine (pre‐index; n = 33 vs post‐index; n = 68), and pentosan polysulfate sodium (pre‐index; n = 796 vs post‐index; n = 1968) indicated alignment with AUA guidelines. While AUA guidelines recommend medication, utilization of pain agents, amitriptyline, cimetidine, hydroxyzine, and pentosan polysulfate sodium decreased from month 1 to month 2 post‐index and then remained steady. The most frequent procedure, both pre‐ and post‐index, was urinalysis/culture. Conclusion The management of IC/BPS is challenging due to its heterogeneity and lack of universally effective treatments. This study highlights the complexity of treatment patterns and evolving medication use over time.
ABSTRACT Background Labour pain is among the most intense forms of human pain. Although pharmacologic methods such as opioids are widely used, maternal satisfaction with childbirth is shaped by more than pain relief alone. Psychoprophylactic antenatal education, which emphasises preparation, coping, and non‐pharmacological strategies, may influence women's overall childbirth experience. However, its combined effect with standard analgesia in African settings remains underexplored. This trial evaluated the impact of a structured Psychoprophylactic Antenatal Education Module alongside pethidine analgesia on labour pain perception and childbirth experience. Methods A parallel‐group randomised controlled trial was conducted at Lagos State University Teaching Hospital, Nigeria. One hundred and eighty eligible pregnant women (aged ≥ 18 years, singleton, cephalic presentation, 35–38 weeks gestation) were allocated to either an intervention group (PAEM + pethidine, n = 90) or a control group (routine antenatal education + pethidine, n = 90). The PAEM consisted of two sessions on childbirth preparation, relaxation, breathing, coping strategies, and a labour ward tour. The primary outcome was labour pain perception measured by a Visual Analogue Scale (VAS) and an 8‐point Likert scale. Secondary outcomes included duration of active labour, mode of delivery, and maternal childbirth experience (rated on a 6‐point Likert scale where 0=extremely fantastic and 5=not at all fantastic). Analysis was by intention‐to‐treat with pre‐specified subgroup analyses by age and delivery mode. This trial was prospectively registered with the Pan African Clinical Trial Registry with Trial number PACTR202411534456230. Results One hundred and sixty‐four women (83 intervention, 81 control) were analysed. There was no significant difference in median pain scores between groups (VAS: median 8 [IQR 3–9] vs. 6 [IQR 2–8], p = 0.316; Likert: median 5 [IQR 2–6] vs. 4 [IQR 1–6], p = 0.325). For childbirth experience (where lower scores indicate better experience), the control group reported significantly more favourable outcomes overall (median 1 [IQR 0–2] vs. 1 [IQR 1–2], p = 0.011). Notably, this significant difference disappeared when caesarean section cases were excluded (p = 0.145). The effect of the intervention on pain differed significantly between women who delivered vaginally versus by caesarean section (p = 0.041). Among women who underwent caesarean section, the intervention group reported significantly less favourable childbirth experiences (p = 0.007). Subgroup analysis revealed that women aged 31–35 years in the intervention group had significantly worse childbirth experience (p = 0.0007), while women aged > 35 years showed improved pain scores (p = 0.049). Obstetric and neonatal outcomes were similar between groups. Conclusion Psychoprophylactic antenatal education did not reduce labour pain intensity in our target population of women delivering vaginally and showed no significant effects on obstetric outcomes. The differential effects observed by delivery mode suggest that the intervention may have raised expectations for natural birth that, when unmet due to caesarean section, resulted in psychological distress and less favourable appraisal of the childbirth experience.
ABSTRACT Objective To assess whether the hemoglobin–albumin–lymphocyte–platelet (HALP) score distinguishes fetal growth restriction (FGR) from small for gestational age (SGA) and its association with composite adverse perinatal outcome (CAPO). Method This retrospective study included 444 singleton pregnancies (214 FGR; 230 SGA) at a tertiary center (2021–2023). FGR was defined as early‐onset (< 32 weeks) or late‐onset (≥ 32 weeks) by Delphi/ISUOG criteria. HALP was calculated at diagnosis as [hemoglobin × albumin × lymphocytes ÷ platelets]. CAPO comprised ≥ 1 of neonatal intensive care admission, Apgar < 7 at 5 min, cord pH < 7.2, or perinatal death. Group comparisons and ROC analyses were performed. Results FGR cases had lower HALP (31.5 vs. 40.0, p < 0.001) and higher CAPO (15% vs. 7%, p = 0.04) than SGA. They delivered earlier, with lower birthweight, cord pH, and more NICU admissions. HALP moderately differentiated FGR from SGA (AUC 0.667; cutoff < 26.8: 44% sensitivity, 81% specificity) but did not predict CAPO (AUC 0.542, p = 0.334). A biological gradient was observed (EO‐FGR < LO‐FGR < SGA; all p < 0.001). Conclusions HALP is decreased in FGR, especially in early‐onset cases, and somewhat differentiates FGR from constitutionally small SGA. While it does not predict short‐term morbidity, it could be a simple addition to Doppler assessments when evaluating suspected growth restriction.
ABSTRACT Background Immature ovarian teratomas are rare malignant germ cell tumours, particularly in children under 2 years old. Ovarian torsion may further obscure diagnosis by altering adnexal anatomy and radiological interpretation. Case Presentation A 20‐month‐old girl presented with persistent vomiting, abdominal distension, and poor oral intake. Imaging suggested a left‐sided mesenteric teratoma. However, exploratory laparotomy revealed a torsed right ovarian mass displaced across the midline. Right salpingo‐oophorectomy was performed. Histopathological examination confirmed a Grade 3 immature teratoma with prominent immature neuroepithelial elements. No metastasis was identified, and the tumour was staged as FIGO Stage IA. Discussion Ovarian torsion in paediatric patients may lead to atypical presentations and mislocalization of adnexal masses. This case underscores the importance of correlating imaging with intraoperative findings. Despite high‐grade histology, early‐stage disease with complete resection is associated with favourable outcomes, though close surveillance is required. Conclusion This case highlights a rare presentation of high‐grade immature teratoma in a toddler, emphasizing diagnostic challenges and the importance of timely surgical and pathological management.
ABSTRACT Objective Type 2 endometrial cancer (EC) histology has been associated with endometrial stripe thickness (EST) < 4 mm, and anatomic factors like obesity, fibroids, and endometrial polyps have been found to impact sonographic interpretation of EST. We aim to evaluate the recommended 4 mm EST threshold for endometrial biopsy in patients with postmenopausal bleeding, with rising incidence of type 2 EC and high prevalence of obesity and uterine structural factors. Methods This retrospective cohort study identified patients with EC at an academic center (October 2015 to December 2017), abstracting demographic data, EST measurement, presence of fibroids or endometrial polyps, EC histology, grade, and stage at diagnosis. χ2 tests and logistic regression were performed comparing EST ≤ 4 and > 4 mm groups. Results 445 patients were included after application of the inclusion/exclusion criteria. Type 1 EC accounted for 83.9% and type 2 for 16.1%. About 8% had EST ≤ 4 mm. Type 2 histology was associated with a higher proportion of EST ≤ 4 mm than type 1 (15.7% vs 6.8%, p = 0.029). Lower BMI was associated with increased odds of EST ≤ 4 mm; OR 5.42 for BMI < 25 versus BMI ≥ 40 kg/m2 (95% CI 1.29‐22.90, p = 0.021). There was no association of fibroids or polyps with EST. Conclusions Type 2 EC and lower BMI were associated with EST ≤ 4 mm. The 4 mm EST threshold does not consider cancer histology or factors that impact sonographic interpretation; this threshold should be re‐evaluated, as the current guidelines may put some patients at risk of delayed diagnosis.
ABSTRACT Background Polygynous marriages are a common cultural practice in northern Nigeria, deeply rooted in religious and traditional norms. However, these unions often pose unique challenges for women, particularly in managing sexual health, navigating power dynamics and fostering effective communication among women in polygynous marital unions. Objectives This study aims to explore the lived experiences of women in northern Nigeria who are in polygynous marital unions, in relation to their sexual health and rights. Materials and Methods Using a qualitative research design, data were collected through semi‐structured interviews with 24 purposively selected women from Hausa Muslim communities in Sokoto State. Thematic analysis identified key themes, with interviews conducted in Hausa for participant comfort and later translated into English for analysis. Participants, aged 26–48 years, described complex negotiations around sexual health, with the uwar gida (senior wife) often playing a central role in decision‐making. Results The 24 participants described complex sexual health negotiations in polygynous unions, influenced by co‐wife dynamics. The uwar gida played a central role in decision‐making. Jealousy and lack of cooperation among co‐wives hindered collective health efforts, leading to recurring infections and unresolved health issues. However, some women reported successful collaboration and mutual support, often facilitated by senior wives or their husbands. Education and improved healthcare access emerged as critical strategies for addressing these challenges and fostering healthier relationships and better health outcomes in polygynous marital unions. Conclusion The findings of this study provide valuable insights for policymakers, healthcare providers and community leaders seeking to support women in polygynous marital settings. By addressing structural and interpersonal barriers, this study contributes to creating healthier and more equitable family environments.
ABSTRACT Background Maternal mortality remains a major global public health concern, with the highest burden in low‐ and middle‐income countries. Despite global progress, preventable causes such as hemorrhage and hypertensive disorders continue to contribute significantly to maternal deaths. Bhutan, a resource‐constrained and mountainous country, historically faced substantial challenges in ensuring equitable access to maternal healthcare. Objectives This study reviewed the trends in maternal mortality in Bhutan from 1985 to 2024 and described the key health system interventions and milestones that contributed to the country's achievement of Sustainable Development Goal 3 (SDG‐3). Methods This was a narrative national review based on secondary data from government reports, national health bulletins, and international databases. Trends in maternal mortality ratio (MMR), causes of maternal death, and health system developments were analyzed over time. Results Bhutan's maternal mortality ratio declined dramatically from 969 per 100 000 live births in 1985 to 53 per 100 000 live births in 2024, achieving the SDG‐3 target (< 70 per 100 000 live births). This reduction was supported by expansion of healthcare infrastructure, increased skilled birth attendance (> 98%), high antenatal care coverage (98.5%), and implementation of key programs such as the Safe Motherhood Initiative, Emergency Obstetric and Newborn Care (EmONC), and Maternal and Perinatal Death Surveillance and Response (MPDSR). Over time, the leading causes of maternal death shifted from direct obstetric causes, particularly postpartum hemorrhage, to indirect medical conditions. Bhutan has entered Stage III of the obstetric transition, characterized by low maternal mortality and improved health system performance. Conclusion Bhutan has made remarkable progress in reducing maternal mortality and successfully achieved SDG‐3 ahead of schedule. Continued efforts should focus on improving the quality of care at health facilities, addressing indirect causes of maternal death, strengthening workforce retention, and expanding preconception care services to sustain and further advance maternal health outcomes.
ABSTRACT Introduction The main aim is to describe fetal growth trajectories in pregnancies conceived by assisted reproductive technology (ART) from gestational week 12 until birth. The secondary aims are to compare ultrasound dating and transfer date estimations of gestational age and to describe birthweight. Materials The study population consists of 114 pregnant women following blastocyst transfer at St. Olavs hospital, Trondheim University Hospital, Norway, during the inclusion period from February 2022 to January 2024. Methods Ultrasound scans were performed 70, 112, 154, and 224 days after embryo transfer (ET) (gestational week 12 + 5, 18 + 5, 24 + 5 and 34 + 5). Crown‐rump length obtained at the first scan and biparietal diameter (BPD) from the second scan were used to calculate gestational age according to three different growth curves. We evaluated fetal growth across four timepoints with a linear mixed‐effects model. Data regarding pregnancy, birth, and neonatal outcomes were obtained from patient records. Results The within‐pregnancy correlation of BPD, mean abdominal diameter and femur length between the four examinations was relatively small (intraclass correlation 0.36, 0.31 and 0.33), indicating that intra‐pregnancy variation in fetal growth exceeds inter‐pregnancy variation. Ultrasound measurements suggested a gestational age 2 days older than ET‐based estimates. The growth difference between the study group and the normal population increased during pregnancy, reaching a difference in median birthweight of 120 g. Conclusion Fetuses conceived through ART show altered growth dynamics, with higher gestational age estimates based on ultrasound measurements compared to dating from ET. We found a higher median birthweight for pregnancies following ART compared with reference data from the general population.
ABSTRACT Objective The interplaying relationship between anemia and adverse pregnancy outcomes is concerning to both short‐ and long‐term maternal and child health. Despite strong biological plausibility, a causal link has not been established for all outcomes. On the contrary, there are statements which state that higher maternal hemoglobin (Hb) concentration increases risk for adverse perinatal outcomes. Both low and high Hb concentrations should be identified as at‐risk groups and optimal level of Hb that would yield the best outcome should be included in guidelines for clinical practice. However, it is also not clear which trimester Hb should be taken as the standard for assessment. During pregnancy, fetal growth occurs in various phases and most of the micronutrient related issues occur in the third trimester. Hence, the aim of the study is to find the correlation of maternal Hb level during the third trimester on neonatal birth weight. Methods A hospital‐based cross‐sectional study was conducted at Gynecology and Obstetrics Department, Bharatpur Hospital, Chitwan, Nepal, after ethical approval. Pregnant ladies in their third trimester admitted to maternity ward of Bharatpur Hospital in the view of delivery from both Emergency Department (ED) and Out‐Patient Department (OPD), who met the inclusion criteria, were included in the study. Informed written consent was taken from all the participants. Routine panel of investigations as per hospital protocol were sent on admission which invariably included hemoglobin concentration. Estimated hematocrit (Hct) level was calculated from maternal Hb using a factor of 3. Birth weight of the newborn was measured using digital infant weighing scale and noted immediately after birth, if possible, otherwise within 24 h. Karl Pearson's correlation coefficient was calculated between estimated Hct and neonatal birth weight. Results A total of 97 patients were included in the study. Our study showed that maternal hematological status in pregnancy affects neonatal birth weight. There was lower mean Birth weight of the neonates were lower than the mean in both high and low Hct group participants. A weak positive correlation between maternal Hct in third trimester and neonatal birth weight with p‐value of 0.974 was analyzed. Pregnant individuals having higher mean Hct had assisted vaginal delivery/instrumental delivery. The study showed that there was a higher proportion of neonates with low Apgar scores in participants with high Hct ( ≥ 40%). Conclusion While our study observed a weak positive trend between maternal hematocrit and neonatal birth weight, this correlation was not statistically significant (r = 0.003, p = 0.974), and thus no definitive association can be concluded. Pregnant individuals with high hematocrit appeared to have a higher proportion of assisted vaginal deliveries and neonates with lower birthweight and Apgar scores; however, these observations were not statistically significant and should be considered exploratory. Thus, this study suggests that further research with larger or multicenter sample is needed to clarify potential relationships.
ABSTRACT Background IgG levels in preterm infants play a crucial role in response to infection and inflammation. Infectious disease burden in the low‐income countries, such as Yemen, exacerbates the problem. The preterm infant's IgG sources are either maternal or fetal immune system. The aim of this study was to determine the IgG level in preterm Yemeni infants and to investigate the relative contribution of both maternal and infant factors to IgG elevation. Subjects and Methods This cross‐sectional study was conducted on 107 preterm newborn babies (< 37 weeks of gestation) in the Ibb governorate, Yemen. The babies' and maternal data were collected in the full questionnaire. Approximately 4 mL of blood sample was collected and analyzed for complete blood count and immunoglobulin G level determination. Results Most preterm newborns were male (69.2%). The mean IgG level in preterm infants was 1160.7 ± 350.8 mg/dL. Twenty‐one preterm babies had IgG levels above normal (1661.5 ± 213.9 mg/dL). A higher IgG level was associated with babies' problems: fetal stage problems (OR = 3.9, 95% CI = 1.18–12.87, p = 0.047), home birth (OR = 5.70 at 95% CI = 1.92–16.90, p = 0.002), and postnatal infections (OR = 3.03, 95% CI = 1.13–8.13, p = 0.044). However, a statistically significant association of IgG levels was with maternal pregnancy problems (hypertension, bleeding, and infections) with an odds ratio of 0.196, 95% CI = 0.43–0.90, p = 0.044. The preterm baby's IgG was positively correlated with age (r = 0.375, p < 0.0001), weight (r = 0.743, p < 0.0001), and days of hospitalization (r = 0.305, p = 0.002). Conclusion In Yemeni preterm neonates, IgG is generally elevated due to infections. This elevation is primarily driven by infant‐specific factors rather than maternal factors. Further studies are needed to explore these factors profoundly with a large sample size.
ABSTRACT Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with reproductive, metabolic and psychological complications. Despite its prevalence, clinical management remains largely reactive and symptom driven, reflecting limited capacity to predict individual disease trajectories or treatment responses. Existing risk stratification and machine learning approaches have improved phenotyping and outcome prediction but are generally static, population based and unable to capture the complex longitudinal interactions that characterise PCOS. Main Body Digital twin technology, defined as a continuously updating, patient specific computational model, offers a potential framework for personalised disease management. This article discusses the development of a clinically grounded digital twin concept for PCOS that integrates endocrine, metabolic, behavioural and longitudinal outcome data to support clinician guided decision making. Potential applications are explored across lifestyle intervention, pharmacotherapy, fertility management and long term metabolic risk prediction. Key translational challenges, including data integration, model validation, ethical considerations, patient privacy and clinical implementation, are also discussed. Conclusions PCOS represents a compelling and underexplored area for digital twin development. By enabling dynamic modelling of individual disease trajectories and treatment responses, digital twins may support a transition from reactive symptom management towards anticipatory, personalised care. Further interdisciplinary research and clinical validation are required to realise the potential of this approach and facilitate its integration into routine PCOS management.
ABSTRACT Objective This article reviews the burgeoning applications of artificial intelligence (AI) in obstetrics, evaluating its diagnostic, predictive, and educational value, and addresses implementation challenges and needs for enhanced AI literacy in perinatal medicine. Methods We conducted a comprehensive synthesis of current literature on AI methodologies—ranging from symbolic approaches to deep learning—and their translation into obstetric contexts. Key domains examined include perinatal ultrasonography, foetal monitoring, risk stratification, patient education, clinician decision support, and emerging frameworks for AI adoption. Results AI technologies have advanced perinatal ultrasonography through automated foetal biometric measurements, standard plane detection, gestational age prediction, and anomaly screening; neurosonography and foetal echocardiography benefited from high accuracy even when performed by non‐experts. In foetal monitoring, AI‐enhanced cardiotocography and nonlinear heart rate analysis demonstrated classification accuracy exceeding 96%. Predictive models for adverse outcomes—such as preterm birth, preeclampsia, haemorrhage, and postpartum depression—show AUCs ranging from moderate to excellent (up to 0.99). Generative AI simplifies informed consent, improving readability and comprehension. Obstetricians value AI for clinical decision support, administrative relief, remote assistance, and care delivery in low‐resource settings. Despite this promise, clinical validation is limited, generalisability remains uncertain, and issues of transparency, bias, and regulatory integration persist. Frameworks like OPTICA offer structured pathways for responsible deployment. Conclusions AI holds transformative potential across obstetrics—from improving diagnostic precision and risk prediction to enhancing patient engagement and clinical workflows. To harness these benefits responsibly, clinical validation, ethical oversight, and AI‐focused training—including prompt engineering—must become integral to perinatal education and practice.
