Background and Aims:Achieving adequate intraoperative hemostasis is critical in gynecological surgeries to reduce perioperative morbidity. Surgi-oxidized regenerated cellulose (ORC) is a biodegradable hemostatic agent that controls mild to moderate bleeding. This study aimed to generate preliminary observational data on the efficacy and safety of Surgi-ORC across a range of gynecological procedures. Methods:This prospective, multicentre, single-arm observational study was conducted at two centres in India. A total of 28 women undergoing gynecological surgeries, including hysterectomy, myomectomy, sacrohysteropexy, cystectomy with oophorectomy, laparotomy, and recanalization, received Surgi-ORC intraoperatively for bleeding control. Time to hemostasis (TTH), the association between product variants and TTH, the association of TTH across surgery types, short-term safety outcomes, and surgeon-reported usability were assessed. Follow-ups were conducted on postoperative Days 2, 28, and 60. Subgroup analyses were considered exploratory due to the limited sample size. Results:Hemostasis was achieved in all cases, with a mean TTH of 1.3 min (SD = 0.43). Descriptive evaluation showed broadly similar TTH values across surgery types and product variants; however, small and imbalanced subgroup sizes limited definitive conclusions. On Day 2, X-ray imaging showed no radiographic abnormalities attributable to retained material and was confirmed based on clinical judgment of the radiologist and operating surgeon. No device-related adverse events, complications, or short-term safety concerns were identified during the study period. Most surgeons rated handling characteristics as "Good" across all evaluated parameters, indicating favorable usability. Conclusion:This observational pilot study suggests that Surgi-ORC is effective in achieving hemostasis and demonstrates no short-term safety concerns during the 60-day follow-up along with satisfactory usability characteristics in gynecological procedures. However, given the exploratory nature of analysis, single-arm design, and small sample size, these findings should be interpreted cautiously, and larger comparative studies are required to further validate its clinical utility.
Background and Aims:Magnesium is an essential micronutrient involved in numerous biochemical and physiological processes during pregnancy. The aim of this study was to evaluate serum magnesium level dynamics during physiological and complicated pregnancies and to assess the effectiveness of magnesium deficiency correction. Methods:A retrospective-prospective observational cohort study was conducted between 2020 and 2025, including 233 pregnant women. Serum magnesium levels were measured in the first and third trimesters. Participants were divided into physiological (n = 110) and complicated pregnancy (n = 123) groups. Magnesium status was classified as deficiency (< 0.72 mmol/L), insufficiency (0.72-0.80 mmol/L), and normal (> 0.80 mmol/L). Oral magnesium lactate with pyridoxine was administered in cases of deficiency. Statistical analysis was performed using SPSS software with a significance level of p < 0.05 (two-sided). Effect size was assessed using Cohen's d. Results:In physiological pregnancies, no statistically significant changes in serum magnesium levels were observed between trimesters (p > 0.05). In complicated pregnancies, a downward trend in magnesium levels was observed, reaching statistical significance in one subgroup (p = 0.043; d = 0.41). Patients with baseline deficiency or insufficiency did not achieve normalization despite therapy. Differences between treated and untreated groups were limited and inconsistent. Conclusion:Serum magnesium levels remain stable during physiological pregnancy but tend to decrease in complicated pregnancies. Standard oral magnesium supplementation demonstrates limited effectiveness in restoring normal serum levels, highlighting the need for further research and individualized therapeutic strategies.
Objectives:We aimed to determine the clinical outcomes, incidence, associated factors, and a predictive model for intensive care unit (ICU) admission among patients with postpartum hemorrhage (PPH) following cesarean delivery. Study Design:Secondary analysis of a retrospective cohort of parturients with PPH following cesarean delivery between January 1, 2016, and December 31, 2020. Methods:Patients with an estimated blood loss < 1000 mL or incomplete data were excluded. Perioperative, obstetric, and anesthetic variables were evaluated. Multivariable logistic regression identified factors associated with ICU admission. Results are reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results:Of 649 eligible patients, 44 (6.78%; 95% CI, 5.09-8.98) were admitted to the ICU. Estimated blood loss > 2200 mL (aOR 16.51; 95% CI, 7.28-37.45; p < 0.001) strongly predicted ICU admission. Other independent predictors were general anesthesia (aOR, 4.12; 95% CI, 1.76-9.65; p = 0.001) and gestational age < 36.2 weeks (aOR, 2.28; 95% CI, 1.11-4.67; p = 0.024). Emergency cesarean delivery was also predictive (aOR, 2.25; 95% CI, 1.02-4.92; p = 0.043). Among ICU admissions, 37/44 (84.1%) required mechanical ventilation. The median ICU length of stay was 1 day (IQR, 1-2). ICU patients had higher rates of blood transfusion, hysterectomy, and reoperation than non-ICU patients (all p < 0.001). An exploratory prediction model incorporating these variables demonstrated good discrimination (AUC 0.891; 95% CI 0.835-0.946). Conclusions:ICU admission was associated with more severe maternal illness and adverse perioperative outcomes. Factors associated with ICU admission included severe blood loss, general anesthesia, earlier gestational age, and emergency cesarean delivery. Recognition of these characteristics may facilitate timely escalation of monitoring and multidisciplinary management when severe PPH occurs. Trial Registration: ClinicalTrials.gov identifier: NCT04833556.
Childbirth is a crucial event in a woman’s life, and the quality of care provided during this time can have a great impact on the mother’s well-being. Unfortunately, disrespectful and abusive treatment during childbirth remains a concern in many healthcare settings, affecting women’s childbirth experiences and satisfaction with maternity care. This qualitative study employed a descriptive phenomenological approach to explore the lived experiences of mothers regarding respectful maternity care (RMC) during childbirth at a secondary-level quasi-government hospital in Kumasi, Ashanti region, Ghana. Individual, face-to-face interviews guided by a semistructured interview guide were conducted in English among 12 purposively sampled mothers who were seeking antenatal and postnatal services at the hospital. Interviews were transcribed verbatim and analyzed using inductive thematic analysis, aided by the NVivo software version 20.0. The study revealed that women perceived RMC as the absence of verbal abuse; consideration of women’s choices in delivery of care; showing concern for mother’s well-being; and availability of knowledgeable healthcare providers. The study also revealed a range of experiences during childbirth. These included positive aspects such as friendly care and attention to mothers’ needs, as well as negative experiences, including mistreatment, lack of informed consent, and delay in receiving care. These experiences significantly influenced mothers’ overall satisfaction. It emphasizes the need for healthcare providers to receive training and sensitization on respectful communication and informed consent. Additionally, hospital management should work toward establishing feedback mechanisms to ensure the voices of women about the care they receive are heard.
Objectives:To assess the knowledge and attitudes toward human papillomavirus (HPV) and HPV vaccination among healthcare professionals and medical students and to identify demographic and professional factors associated with variations in HPV knowledge. Methods:This cross-sectional study included 903 participants comprising medical doctors, medical students, nurses, and other allied healthcare personnel. HPV knowledge was measured using the validated 33-item Human Papillomavirus Knowledge Scale (HPV-KS), which evaluates four domains: general HPV knowledge, HPV screening tests, HPV vaccination, and the national HPV vaccination program. Demographic, educational, occupational, and geographical variables were also collected. Total and domain-specific scores were compared across gender, professional groups, and educational levels. Results:The mean total HPV knowledge score was 19.23 out of 33, indicating moderate overall knowledge. Correct response rates were high for core factual items (e.g., HPV as the leading cause of cervical cancer), yet several misconceptions persisted, including misunderstandings about HIV/AIDS causation and HPV transmission dynamics. Male participants demonstrated significantly higher total knowledge (p = 0.008) and greater HPV screening test knowledge (p = 0.003) than females. Professional category did not yield significant differences in total scores although medical doctors and medical students showed slightly higher vaccination-related knowledge. Participants who were not physicians or medical students had higher screening and vaccination knowledge, whereas physicians and medical students scored higher on vaccination program knowledge. Conclusions:HPV knowledge among healthcare professionals and medical students was moderate, with persistent misconceptions across several domains. Gender-based differences and unexpected patterns among physicians and medical students suggest that existing curricula may not adequately address HPV and HPV vaccination. Strengthening formal education, integrating evidence-based HPV modules into health sciences training, and providing structured professional development are essential to enhancing HPV awareness, supporting vaccination advocacy, and improving preventive health practices.
Background and Aims:The optimal timing of cesarean delivery in women with placenta previa (PP) remains controversial because earlier delivery may reduce maternal risks, whereas later delivery may improve neonatal outcomes. This study aimed to evaluate whether delaying planned cesarean section (CS) until 38 gestational weeks was associated with improved neonatal outcomes without increasing maternal risks in women with PP who remain clinically stable. Methods:This historical control study included women with singleton pregnancies complicated by PP who underwent CS at a single tertiary center between 2015 and 2024. Planned CS was scheduled at 38+0 to 38+6 gestational weeks between 2022 and 2024 and at 36+0 to 37+6 gestational weeks between 2015 and 2022. Women who underwent emergency CS or developed obstetric complications, including antepartum hemorrhage or threatened preterm labor, were excluded from the primary analysis. Women who underwent planned CS at the scheduled gestational weeks were assigned to Group A (38-week group) and Group B (36-37-week group). Maternal and neonatal outcomes were compared between the groups. Results:Of the 204 eligible women, 29 were included in Group A and 81 in Group B. Maternal outcomes, including blood loss, operation time, and rates of severe complications, were comparable between the groups. In contrast, neonatal outcomes were improved in Group A, with higher birthweight and lower rates of neonatal hospitalization and hypoglycemia. Most obstetric complications occurred before 36 gestational weeks in both periods. Conclusion:Delaying planned CS until 38 gestational weeks in clinically stable women with PP was associated with improved neonatal outcomes without an apparent increase in maternal risks or emergency CS. These findings support further investigation of the optimal timing of delivery in women with PP.
Background and Aims:Preimplantation genetic testing for aneuploidy (PGT-A) is widely used to select euploid embryos in patients at higher risk of transmitting genetic abnormalities during assisted reproductive technology (ART). Advances in PGT-A have resulted in the increased detection of embryo chromosomal mosaicism. This review aims to update clinicians and researchers on the implications of mosaicism in ART and emerging clinical outcomes from the use of mosaic embryo transfer cycles. Methods:A critical narrative review of the current literature was conducted, focusing on clinical outcomes of mosaic embryo transfers, the reliability of mosaicism detection in blastocyst trophectoderm biopsy, and controversies surrounding mosaicism thresholds and their clinical significance in ART. Literature was identified through searches of PubMed and relevant databases focusing on studies related to PGT-A and embryo mosaicism. As this is a narrative review, no statistical analysis was performed. We conducted a critical narrative review of articles published between January 2015 and May 2026 identified through searches of PubMed, Embase, and the Cochrane Library using terms related to PGT-A, mosaicism, and IVF outcomes, including original studies, society guidelines, and position statements. Results:Recent findings demonstrate that mosaicism detected in blastocyst trophectoderm does not always reflect the chromosomal constitution of subsequent embryonic-fetal development. Mosaic embryo transfers can result in healthy clinical outcomes, avoid embryo wastage, and potentially reduce the number of ART cycles. However, such transfers result in reduced implantation rates and higher miscarriage rates, notably with embryos exhibiting complex and high-level mosaicism. Genetic testing is more reliable with high-level mosaicism, and defining a high-level threshold presents one strategy to prioritize mosaic embryos for transfer. Conclusion:Future research should determine the clinical factors that may influence mosaicism and whether a threshold of mosaicism can improve clinical outcomes. Understanding the benefits versus potential risks of mosaicism will provide important information for patients, counselors, and clinicians in the selection and management of mosaic embryos in ART.
Interactions between maternal killer-cell immunoglobulin-like receptors (KIR) and fetal human leukocyte antigen-C (HLA-C) play a key role in implantation and placentation, yet their clinical relevance remains controversial, partly due to heterogeneous phenotyping of reproductive failure. We conducted a retrospective observational study of 73 biologically comparable clinically referred couples undergoing reproductive immunology assessment. Couples involving donor gametes, surrogacy, or multiple male partners were excluded. Clinical phenotypes were classified as isolated recurrent implantation failure (RIF-only), isolated recurrent pregnancy loss/adverse pregnancy outcome (RPL/APO-only), combined RIF + RPL/APO, or no reproductive failure. Maternal KIR phenotype (AA vs. Bx) was determined by flow cytometry and genetically confirmed. Maternal and paternal HLA-C genotypes were classified as C1C1, C1C2, or C2C2. Associations were assessed using univariable, age-adjusted, and multivariable logistic regression models. Maternal KIR-AA was present in 53.4% of women and was more frequent in the RIF-only group than in the RPL/APO-only group (56.8% vs. 35.3%). In age-adjusted analysis, KIR-AA was associated with increased odds of RIF (OR 2.35; p=0.054), but not with RPL/APO. Maternal HLA-C genotype showed an exploratory signal consistent with implantation outcomes: C1C2 (OR 0.28; p=0.031) and C2C2 (OR 0.10; p=0.002) were protective against RIF compared to C1C1. In multivariable models, maternal C2C2 remained independently protective (aOR 0.08; p=0.0048). Paternal HLA-C genotype showed no independent associations. In conclusion, immunogenetic effects in reproductive failure are phenotype-specific and predominantly influence implantation rather than postimplantation pregnancy loss.
Background and aims Debate regarding the value of HIV screening in English colposcopy services is ongoing. With no national guidance provided by the NHSCSP, few colposcopy services offer HIV testing. Sheffield colposcopy introduced standardised HIV testing in January 2023. We assessed prevalence rates and acceptability to HIV testing in our referred population with moderate or worse dyskaryosis, CIN2 or worse. Methods A retrospective service evaluation with interval analysis was conducted on 1st January to 31st December 2023 at the Jessop Wing Colposcopy Service, Sheffield, UK. All patients with moderate dyskaryosis or worse on referral cytology, CIN2 or worse on biopsy, were offered an HIV test. Results Of 367 eligible patients, six (1.6%) were known HIV positive. HIV prevalence rates in patients referred with moderate or worse cytology (16.34 per 1000) (95% confidence interval 6-35), and CIN2 or worse (12.46 per 1000) (95% confidence interval 3-28) were high in comparison with overall prevalence rates for Sheffield (2.14 per 1000). HIV testing was offered to 296 (82%) patients and accepted by 246 (83%). All HIV test results were reported as not detected. Sixty-five (18%) were not offered a test. Consultant colposcopists (p < 0.0001) were less likely to offer an HIV test as compared to colposcopy nurses. Conclusion Acceptance of HIV testing in patients attending colposcopy is high, but willingness to offer the test varies at both local and national levels. Whilst there were no new HIV diagnoses in our sampled cohort, knowledge of HIV status is a key prognostic indicator and crucial for determining ongoing management. National societies must join forces and provide national guidance for the colposcopy community regarding HIV testing in colposcopy services. Audit registration number: STH 12112.
Objective:To identify independent prognostic factors for endometrioid endometrial carcinoma based on a 10-year follow-up Chinese cohort study. Methods:This retrospective study included 142 patients diagnosed with endometrioid endometrial carcinoma from 2009 to 2013. Clinical, pathological, and immunohistochemical data were analyzed. Patients were categorized into three outcome groups: no recurrence, recurrence with ongoing survival, and death group. Kaplan-Meier survival analysis and univariate and multivariate Cox proportional hazards regression analysis were conducted to assess disease-free survival (DFS) and overall survival (OS). Results:Advanced FIGO stage and tumor size ≥ 4 cm were independent predictors of poorer OS. Grade 3 histology also independently correlated with reduced survival. For DFS, tumor size ≥ 3 cm and advanced stage were significant risk factors. Progesterone receptor (PR) positivity and lack of lymphovascular space invasion (LVSI) were significantly associated with better prognosis in univariate analysis but were not retained in multivariate models. Conclusions:Tumor size and FIGO stage are key prognostic factors for recurrence and mortality in endometrioid endometrial carcinoma. Grade 3 histology further worsens the prognosis. Traditional pathological markers continue to be critical for individualized risk assessment and treatment planning.
Background and AimsPersonalized medicine utilizing comprehensive cancer genomic profiling (CGP) for gynecologic cancers is still in its early stages and faces numerous challenges. In this study, we aimed to elucidate the current status of CGP for gynecologic cancers at our institution.MethodsWe prospectively analyzed 44 cases of gynecologic cancers that underwent CGP (FoundationOne CDx or Liquid CDx) from March 2020 to July 2022, evaluating the CGP results and clinical outcomes.ResultsForty-one cases underwent FoundationOne CDx and four underwent FoundationOne Liquid CDx testing. The distribution of cancer types consisted of 10 cases of cervical cancer, 21 cases of ovarian cancer, 7 cases of endometrial cancer, and 6 cases of sarcomas. Actionable genomic alterations were identified in 42 cases (95.5%), with 16 cases (36.4%) presenting clinically for genotype-matched therapy (GMT). However, GMT was administered in only three cases (6.8%). Among the cases without GMT, four experienced a deterioration in overall physical condition and two had complications as the reason for nonimplementation. Consideration of presumed germline pathogenic variants occurred in 10 cases (22.2%), with confirmatory testing conducted in two. In survival analysis using the Cox proportional hazards model, the presence of PIK3CA mutations was identified as being potentially associated with adverse prognosis (hazard ratio: 2.73, 95% confidence interval: 1.15-6.49, and p = 0.023).ConclusionTo enhance the prognosis of gynecologic cases, earlier CGP testing to expand the opportunities for GMT and the proactive introduction of PIK3CA-related clinical trials might be crucial.
Objectives:To investigate the effectiveness of a physiotherapy protocol in preventing and managing pain in women in the immediate postpartum period after cesarean section. Methods:A randomized, parallel, open-label clinical trial, whose data collection took place between October and December 2024, in the rooming-in wards of a Brazilian teaching hospital. The study included 40 women in the immediate postpartum period after cesarean section, randomized into an intervention and a control group (standard care). Participants were asked about the presence of pain when performing movements. If pain was present, they were asked to identify its location, and a Visual Numerical Pain Scale was used to measure the pain score. Participants allocated to the intervention group received the physiotherapy intervention protocol, which consisted of postural guidelines. After 24 h, participants in both groups were asked again about the presence of pain in the listed activities. The chi-square and Fisher's exact tests were applied to categorical variables and the t-test for independent samples for pain scores, and the effect size was calculated to determine the magnitude of the associations. A significance level of 5% was adopted for all analyses. Results:Pain complaints were reported in all movements assessed. Pain was felt most frequently in the abdominal region (generalized) and the surgical scar (localized). The intervention had an effect on the movements of coughing, sitting on the toilet, and walking. The physiotherapy protocol effectively reduced pain scores during walking (p = 0.009). Additionally, postpartum women in the intervention group reported greater satisfaction with pain management. Conclusion:The physiotherapy intervention protocol effectively reduced pain scores during walking, with effects on coughing and sitting on the toilet, and increased satisfaction with pain management. Trial Registration: Brazilian Registry of Clinical Trials (ReBEC): UTN: U1111-1308-5716.
Background:Estimated fetal weight (EFW) is a key determinant of obstetrical decision-making and an independent risk factor of high perinatal morbidity and mortality. However, routine ultrasound during pregnancy test is not universally available in the Malaysia primary care settings. Objective:To compare the accuracy of ultrasonographic EFW to the actual birth weight (ABW). Study DesignThis was a prospective cohort study involving women with singleton pregnancies, at term (37-38 + 6 weeks) and age ≥ 18 years. The accuracy of EFW was evaluated by calculating the percentage error (PE). PE of < 10% was regarded as "accurate." Results:A total of 153 participants were recruited. The majority of the participants were Malay (77.8%), followed by Indian (12.4%), Chinese (4.6%), and others. There was no significant association between ethnicity and ultrasound accuracy. The mean maternal weight at booking was 64.10 kg, while the mean body mass index (BMI) was 26.09 kg/m2. The mean EFW was 2992.72 ± 338 g, while the mean ABW was 2960 ± 400 g. For ultrasound accuracy, the mean PE was 8.11%, with 68.63% of accurate EFW. Maternal weight, parity, and gestational diabetes were significantly associated with the accuracy of ultrasound EFW. The mean number of days from ultrasound to birth was 2.64 days. Performing an EFW within 24 h prior to delivery yielded optimal accuracy of EFW. There was a significant association between experiences of examiners with ultrasound accuracy. Conclusion:The accuracy of EFW in our study was comparable to similar studies done in other countries. There was a strong positive correlation between ultrasound EFW using the Hadlock-4 weight estimation model with ABW in our population. The accuracy of EFW within 24 h prior to delivery warranted a calculated decision on the induction of labor. Adequate training of examiners was crucial. Routine ultrasound EFW services should be made available and accessible in all healthcare settings in Malaysia.
Introduction:Maternal neutrophils (N), lymphocyte, platelets (PLTs), neutrophil-lymphocyte ratio (NLR), and platelets-lymphocyte ratio (PLR) have been used to predict preterm birth. We studied changes in these markers in preterm labor (PTL) and whether they can serve as single or combined predictive indicators. Material and Methods:Patients in premature labor participated in a retrospective case-control study. CBC, Hb, HCT, lymphocytes, N, PLTs, NLR, and PLR were measured and compared between total preterm cases (20 0/7-36 6/7 weeks) and normal pregnancies. Subgroups of early preterm labor (EPL) (20 0/7-33 6/7 weeks) and late preterm labor (LPL) (34 0/7-36 6/7 weeks) were also compared with gestational-age-matched controls. ROC curves were utilized to estimate the cutoff, specificity, sensitivity, and area under the curve (AUC) for every marker. According to cutoff levels of each marker, a score system was created (0-4). Combined Score Index and Systemic Immune-Inflammatory Index (SII) were calculated for total, early, and late preterm groups. Results:A total of 1000 patients with PTL were included. No significant difference was found in lymphocytes between groups. N, PLTs, NLR, and PLR were significantly higher in total PTL vs. controls. In EPL, N, PLTs, NLR, and PLR were significantly elevated (p ≤ 0.0001, 0.0001, 0.0002, and 0.0009). Similarly, LPL showed significant differences (p ≤ 0.0003, 0.01, 0.0008, and 0.05). These markers were also significantly higher in EPL vs. LPL (p ≤ 0.0001, 0.05, 0.0001, and 0.05). AUC values in early preterm for N, PLTs, NLR, and PLR were 0.640, 0.626, 0.627, and 0.593, respectively, and in late preterm, 0.611, 0.568, 0.610, and 0.581-indicating a weak predictive value. A high score index (3-4) was more frequent in total (57%), early (31.7%), and late (50.27%) preterm compared with controls (38.5%, 15.56%, and 31.86%). AUC of Combined Score Index was 0.604, 0.630, and 0.611 and for SII, 0.660, 0.684, and 0.622 in total, early, and late preterm, respectively, showing statistically significant but weak predictive values. Conclusion:Significant changes in N, PLTs, NLR, and PLR (both as individual and combined markers) are observed in PTL groups, but their predictive value for prematurity remains limited.
Background:Gestational trophoblastic diseases (GTDs) are rare trophoblastic disorders that contribute substantially to maternal morbidity. However, the epidemiology and clinical characteristics of GTD-related evidence from Ethiopia remain limited and scattered. Consequently, the national burden, histopathological distribution, and clinical presentation of GTD in Ethiopia are not well defined. In response to this gap in the literature, this systematic review and meta-analysis sought to quantify the pooled prevalence of GTD and to synthesize available evidence on its histopathological and clinical profiles in Ethiopia. Methods:PubMed, Scopus, Embase, the Cochrane Library, CINAHL, and Google Scholar were systematically searched, supplemented by manual searches of local journals and institutional repositories. The study protocol was registered and implemented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. All studies reporting the prevalence of GTD in Ethiopia up to December 5, 2025, were eligible for inclusion. To stabilize variances when pooling proportions, a random-effects meta-analysis was performed by using the Freeman-Tukey double arcsine transformation. Publication bias and heterogeneity across studies were evaluated. Results:Seven studies met the inclusion criteria, out of a total of 436 records collected and evaluated, comprising 121,248 women who had delivered. The pooled prevalence of GTD in Ethiopia was 0.8% (95% CI: 0.2%-1.3%). Hydatidiform mole was the most common histopathological subtype, with complete and partial moles accounting for 47.1% and 20.7% of cases, respectively. Vaginal bleeding was the most frequently reported clinical presentation (88.4%), followed by a uterus larger than gestational age (34.8%). Conclusions:This systematic review and meta-analysis demonstrated that the prevalence of GTD in Ethiopia is slightly higher than estimates reported from other regions. Hydatidiform mole was the predominant histopathological subtype, and vaginal bleeding was the most common clinical presentation. These results highlight the necessity of enhancing early detection and diagnostic capacity, particularly at the primary healthcare level.
Objective:To assess whether simulation-based education improves learning outcomes in obstetric emergency management among healthcare students compared with traditional teaching methods. Data Sources:PubMed, Embase, Global Index Medicus, and Web of Science were searched from database inception to September 2025 using controlled vocabulary and free-text terms related to healthcare students and obstetric emergencies. Only randomized controlled trials published in English were included. Methods of Study Selection:Randomized controlled trials comparing simulation-based training with nonsimulation educational methods among healthcare students were eligible. Two reviewers independently screened titles, abstracts, and full texts using Rayyan software, with disagreements resolved by a third reviewer. Nine studies met the inclusion criteria. Tabulation Integration and Results:Data were extracted independently using a standardized form, and risk of bias was assessed with the Cochrane RoB 2 tool. Standardized mean differences were pooled using a random-effects model with restricted maximum likelihood estimation. Seven studies (n = 333) were included in the meta-analysis. Simulation-based training significantly improved post-test knowledge compared with conventional methods (SMD 0.84; 95% CI 0.36-1.32; prediction interval -0.36 to 2.05; I 2 = 75.1%), corresponding to an estimated increase of 8.4 points on the Knowledge Assessment Form (95% CI 3.6-13.2). Additional trials reported improvements in teamwork and critical thinking. Conclusion:Simulation-based education was associated with greater knowledge gains than traditional teaching methods in obstetric emergency training among healthcare students. However, substantial heterogeneity and a prediction interval that crosses the null suggest that its effectiveness may vary across contexts. Further research should evaluate long-term retention and clinical outcomes.
Introduction:Human papillomavirus (HPV) vaccines prevent types of HPV responsible for most cervical cancers. While Guillain-Barré syndrome (GBS) has rarely reported postvaccination, a causal relationship remains unestablished. This study evaluates the association between the nonavalent HPV vaccine (9-valent) and GBS using the Vaccine Adverse Event Reporting System (VAERS). Methods:We analyzed VAERS data from January 1, 2016, to July 26, 2024, focusing on domestic reports for individuals aged 6-29 years. GBS cases were identified using the MedDRA preferred term code 10018767. Disproportionality was assessed via a 2 × 2 contingency table to calculate the proportional reporting ratio (PRR) and Yates' chi-squared (χ 2) test. A signal was defined as PRR ≥ 2, χ 2 ≥ 4, and n ≥ 3. Results:A total of 11 serious GBS cases were reported following HPV 9-valent vaccination out of 14,367 total adverse events for the vaccine. Comparison with all other vaccines (1757 GBS cases) yielded a PRR of 0.79 (95% CI: 0.44-1.44) and a Yates' χ 2 of 0.384 (p = 0.535). Of the HPV 9-valent-associated GBS cases, 64% occurred in females and 57% in the 6-17 age group. Most cases occurred 10-30 days postvaccination; no deaths were reported. Conclusions:The findings indicate an absence of a disproportionality signal in VAERS, suggesting that GBS is not reported more frequently after HPV 9-valent than other vaccines. However, this study is limited by a small number of cases and the inherent constraints of passive surveillance; thus, these results reflect reporting patterns and cannot establish causality or absolute incidence.
Background and Aims:Preeclampsia is a major cause of maternal and fetal morbidity worldwide. Advanced maternal age is considered an important risk factor for adverse pregnancy outcomes. This study aimed to compare hematological, coagulation, and renal laboratory parameters between preeclamptic women aged < 35 years and ≥ 35 years in order to determine the impact of advanced maternal age on disease severity. Methods:A cross-sectional study was conducted at Osh Interregional Clinical Hospital, Kyrgyzstan. 67 Pregnant women were included and categorized into severe preeclampsia (n = 48), moderate preeclampsia (n = 12), and normotensive controls (n = 7). Participants were divided into two age groups: under 35 years and ≥ 35 years. Hematological parameters (hemoglobin, RBC count, and platelets), coagulation markers (prothrombin time, INR, and fibrinogen levels), and renal function tests (serum creatinine and urinary protein levels) were analyzed. Results:Women with severe preeclampsia showed significantly lower hemoglobin levels (< 35 years: 112.15 g/L, > 35 years: 123 g/L, p < 0.05) and platelet counts. Prolonged PT (13.59 s in < 35 years vs. 12.73 s in > 35 years, p < 0.05) and reduced INR values (0.93 in > 35 years vs. 0.96 in < 35 years, p < 0.005) indicated hypercoagulability. Fibrinogen levels were elevated in severe preeclampsia (4.9 g/L in < 35 years vs. 4.5 g/L in > 35 years, p < 0.05). Renal dysfunction was evident with increased serum creatinine levels and significant proteinuria (p < 0.05). Conclusions:Advanced maternal age significantly influences hematological and coagulation abnormalities in preeclampsia, contributing to a hypercoagulable state and renal impairment. Regular laboratory monitoring, early screening, and individualized management strategies are crucial to mitigating adverse maternal and fetal outcomes. Clinical Significance:This study highlights the critical role of laboratory markers in detecting and managing preeclampsia, particularly in older pregnant women who are at higher risk of severe complications. The findings emphasize the necessity of early intervention strategies, such as frequent monitoring of coagulation and renal function, to reduce maternal morbidity and mortality. Understanding the hematological and biochemical variations associated with advanced maternal age in preeclampsia allows clinicians to implement personalized treatment plans aimed at improving both maternal and neonatal outcomes. These results also support the inclusion of laboratory marker analysis in routine prenatal care, enhancing the prediction and prevention of severe preeclampsia-related complications.
Objective:The objective was to compare the performance of three postpartum hemorrhage risk screening tools with a known patient data set. Design:This is a retrospective secondary data analysis of a parent study whose aim was to develop a novel biomarker for detecting elevated blood loss with childbirth. Setting:A single tertiary care hospital in the United States. Participants:Inclusion criteria for the parent study were ≥ 37 weeks, ≥ 18 years, and pregnancy with one live fetus (no multiples). Eligible participants were identified upon admission to the labor unit and enrolled after informed consent was obtained. Methods/Main Outcome Measures:Statistical analyses were computed using Stata SE, v18. Bivariate associations between binary outcomes and continuous measures were calculated using independent t-tests. Bivariate associations between binary outcomes and categorical measures were calculated using chi-square tests. Results:Recruitment occurred June through September 2021 and included n = 525 participants. When using the American College of Obstetricians and Gynecologists' threshold of ≥ 1000 mL, 13.3% (n = 70) of parturients experienced a hemorrhage. When using the World Health Organization's definition of postpartum hemorrhage of ≥ 500 mL, the prevalence of hemorrhage was 36.8% (n = 193). Sensitivity was highest in identifying hemorrhage with the Association of Women's Health, Obstetric and Neonatal Nurses' tool. When high- and medium-risk scores were considered, the tool had 86% (95% CI: 83.0%-89.0%) accuracy in identifying cases of hemorrhage. This tool also had the highest negative predictive value (78.7%, CI 75.2%-82.2%). Conclusions:The tool with the highest sensitivity and negative predictive values identified 21% of cases as "low risk" that went on to experience blood loss ≥ 500 mL, thus underscoring the need for better predictive models.
Objectives:This study evaluated whether an online mindfulness-based stress reduction (MBSR) program could reduce psychological distress and improve pregnancy rates in women undergoing in vitro fertilization (IVF). Methodology:A total of 133 infertile women were randomized to an online MBSR intervention or a control group. The intervention included twice-weekly mindfulness sessions over 3 months. Primary outcomes were anxiety and depression, and the ultrasound-confirmed intrauterine pregnancy rate was a secondary outcome. Results:The intervention group showed significant reductions in anxiety and a significant borderline decrease in depression compared to controls. Participation in MBSR was also associated with a higher rate of ultrasound-confirmed intrauterine pregnancy. Online MBSR may effectively reduce psychological distress in women undergoing IVF, with potential benefits for pregnancy outcomes. Conclusion:This study suggests that online MBSR may serve as an effective complementary approach for alleviating emotional distress and potentially enhancing pregnancy outcomes in women undergoing IVF. Online MBSR programs appear to be a valuable tool for supporting women in managing infertility-related psychological challenges. Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20241002063238N1.
