AIM:To clarify the clinical characteristics, diagnostic course, and presumed etiologies of severe cerebral palsy associated with perinatal cerebral infarction, and to compare cases in which cerebral infarction was diagnosed during and after the neonatal period. METHODS:This retrospective registry-based study used data from the Japan Obstetric Compensation System for Cerebral Palsy between 2009 and 2022. Severe cerebral palsy cases associated with cerebral infarction were identified. The clinical characteristics and diagnostic courses of cerebral infarction were evaluated and compared between neonatally diagnosed cases and post-neonatally diagnosed cases. RESULTS:Of the 85 cases of cerebral infarction analyzed, neonatally diagnosed cases accounted for 40 (47.1%) and post-neonatally diagnosed cases for 44 (51.8%); 1 case was diagnosed prenatally. Neonatal diagnosis was more frequently triggered by seizures, apnea, respiratory distress, or neuroimaging during NICU hospitalization, whereas most post-neonatal diagnoses followed recognition of motor impairment. Neonatally diagnosed cases more frequently exhibited a non-reassuring fetal status, lower umbilical artery pH, lower Apgar scores, and neonatal asphyxia. However, no significant differences were observed in median age at the recognition of motor impairment (7 months in both groups) or severe brain injury findings between neonatally and post-neonatally diagnosed cases. Potential contributing conditions were identified in 15.3% of cases. CONCLUSIONS:Similar timing of motor impairment recognition and frequency of severe brain injury findings between the two groups may suggest that differences in cerebral infarction diagnostic timing may primarily reflect different clinical triggers for neuroimaging. The etiology and timing of infarction onset remained unclear in many cases.
AIM:To evaluate menstrual recovery, reproductive outcomes, and survival following fertility-sparing surgery and platinum-based chemotherapy in women with malignant ovarian germ cell tumors (MOGCTs). METHODS:We retrospectively reviewed women aged 15-40 years with MOGCT treated at a university hospital (2001-2012). All underwent fertility-sparing surgery and platinum-based chemotherapy. Menstrual and reproductive outcomes were assessed through structured interviews and compared with age-matched controls. Survival outcomes were analyzed by Kaplan-Meier method. RESULTS:Among 1934 ovarian cancer cases, 209 (10.8%) were MOGCT; 44 patients met inclusion criteria and were matched to 44 controls. Median age was 21 years; dysgerminoma was the most common histology (40.9%), and 70.4% had Stage I disease. All received bleomycin, etoposide, and cisplatin (median 4 cycles). After a median follow-up of 55 months, 97.7% resumed menstruation. Compared with baseline and controls, cycles were shorter (4 vs. 5 days, p = 0.026), lighter (2 vs. 3 pads/day, p = 0.004-0.047), and longer in interval (29.2 vs. 26.4 days, p < 0.001). Of 17 patients attempting conception, 9 achieved 10 pregnancies, with a pregnancy rate of 52.9% and live-birth rate of 90.9%, without congenital anomalies. Only one recurrence occurred, with 10-year progression-free and overall survival of 95.3% and 97.9%, respectively. CONCLUSIONS:Fertility-sparing surgery followed by platinum-based chemotherapy was associated with excellent long-term survival, high rates of menstrual recovery, and favorable reproductive outcomes in young women with MOGCT. These findings support current international recommendations for fertility-preserving treatment in selected patients and provide long-term evidence from a Southeast Asian cohort.
Leptomeningeal metastasis (LM) is a rare complication of cervical cancer associated with a poor prognosis. We report a 61-year-old woman with stage IVB cervical squamous cell carcinoma who developed acute headache and diplopia during systemic chemotherapy. Brain magnetic resonance imaging suggested LM, which was confirmed by cerebrospinal fluid (CSF) cytology. An Ommaya reservoir was inserted, and intrathecal methotrexate therapy was initiated. The patient showed rapid neurological improvement, normalization of CSF opening pressure, and sustained clearance of malignant cells on serial CSF cytology. Although systemic disease subsequently progressed, LM-related neurological symptoms remained well controlled. The patient survived for 8 months after LM diagnosis. This case highlights the importance of considering LM in cervical cancer patients with new neurological symptoms and suggests that intrathecal chemotherapy via an Ommaya reservoir may provide effective neurological control and symptomatic relief.
Atypical superimposed preeclampsia (sPE) developing before 20 weeks of gestation is extremely rare, and its pathophysiology remains unclear. We herein report three women with underlying chronic hypertension or IgA nephropathy who developed severe hypertension, worsening proteinuria, and fetal growth restriction or fetal death before 20 weeks of gestation. All cases showed markedly elevated soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratios (617-1357), and placental pathology demonstrated maternal vascular malperfusion. Maternal clinical manifestations promptly improved after the termination of pregnancy. All three women subsequently achieved successful pregnancies with appropriate management. These results suggest that atypical sPE shares the angiogenic imbalance and placental pathology characteristic of conventional preeclampsia. Although limited by the small number of cases, these results provide additional insights into the pathophysiology of atypical sPE and suggest a role for angiogenic biomarkers in evaluating placental dysfunction.
BACKGROUND:High-risk HPV screening achieves high sensitivity but low specificity, resulting in excessive colposcopy referrals. DNA methylation biomarkers could refine risk stratification across the cervical cancer care continuum. OBJECTIVE:To evaluate the diagnostic performance and clinical implementation of DNA methylation testing in HPV-positive triage and post-treatment surveillance. METHODS:Narrative review of prospective cohorts and randomized trials (2013-2024) evaluating methylation markers in cervical cancer screening and monitoring. RESULTS:The FAM19A4/miR124-2 panel demonstrated sensitivity/specificity of 0.83/0.90 for CIN3+ in HPV-positive women, reducing colposcopy referrals by 45% while maintaining < 3% missed CIN3+. In post-treatment surveillance, plasma cell-free DNA (cfDNA) methylation may enable earlier recurrence detection than imaging (sensitivity 0.81, specificity 0.93, based on limited prospective data). A proposed three-step conceptual framework integrating methylation testing across screening, postoperative assessment, and recurrence monitoring is presented as a hypothesis-generating model requiring prospective validation. CONCLUSIONS:DNA methylation testing shows promise for clinical implementation in HPV triage and post-treatment surveillance. Evidence remains fragmented across separate studies. Standardization of thresholds and cost reduction are priorities for guideline inclusion.
AIM:To map and characterize the available evidence on podcasts addressing topics related to women's health. METHODS:This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) guidelines. A comprehensive search was carried out in 12 databases in November 2025. Quantitative and qualitative studies addressing podcasts related to women's health were included, with no restrictions on publication date or language. The review protocol was registered on the Open Science Framework (https://osf.io/7p9yr/overview). The results are reported in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR). RESULTS:A total of 37 studies were included, primarily targeting health professionals and students (n = 15). Thematic analysis showed that gynecology was the most frequent category (48.6%), with subthemes focusing on the climacteric (n = 6), breast cancer (n = 4), and fertility (n = 3). Breastfeeding and healthy lifestyle shared second place (18.9% each), emphasizing lactation challenges and physical activity/nutrition, respectively. Obstetrics (13.5%) addressed labor and postpartum recovery, while motherhood (8.1%) explored maternal guilt. Finally, miscellaneous themes (16.2%) covered mental health, chronic diseases, and maternal mortality. CONCLUSION:Podcasts have emerged as a versatile and strategic tool for health education and self-care promotion throughout the female life cycle. While widely used for professional training and patient empowerment, there is a critical need for rigorous content curation and evidence-based production to mitigate the risks of misinformation. Future research should focus on validating these digital tools and evaluating their long-term impact on clinical outcomes and health literacy.
AIM:Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder, and the independent effect of exercise as a fundamental intervention for it remains to be clarified. Therefore, this study aimed to examine the effect of exercise intervention alone on improving reproductive endocrine and metabolic profiles in individuals with PCOS. METHODS:A systematic search of multiple databases was conducted for randomized controlled trials (RCTs) published until July 2025. Data from eligible RCTs were collected, and quality evaluation with meta-analysis was performed. RESULTS:This investigation encompassed 22 RCTs involving 1044 women with PCOS. The meta-analysis indicated that exercise significantly reduced total testosterone (TT), free testosterone, fasting insulin, and homeostatic model assessment of insulin resistance (HOMA-IR), while increasing high-density lipoprotein levels. Subgroup analyses showed that moderate-to-low intensity exercise specifically increased sex hormone-binding globulin. Exercise duration ≥ 150 min per week yielded more pronounced reductions in TT. Concerning population characteristics, Asian cohorts exhibited particularly prominent improvements in reducing body mass index, TT, low-density lipoprotein, fasting insulin, and HOMA-IR. South American and European populations showed significant benefits in lowering TT and fasting insulin, respectively. Moreover, non-obese women with PCOS experienced greater reductions in TT compared to their obese counterparts. CONCLUSIONS:Exercise intervention alone significantly ameliorates body composition, hyperandrogenism, and certain glucose and lipid metabolic disturbances in individuals with PCOS. The benefits are modulated by exercise parameters (intensity, weekly duration) and baseline patient characteristics (geographical distribution, obesity status), highlighting the importance of individualized interventions in clinical practice.
AIM:Increasingly, point-of-care testing has been adopted to rapidly assess fibrinogen levels for managing severe postpartum hemorrhage; however, evidence regarding its impact on clinical outcomes is limited. We evaluated whether implementing a transfusion strategy guided by point-of-care testing was associated with changes in blood loss and transfusion outcomes in patients with severe postpartum hemorrhage. METHODS:We conducted a retrospective single-center interrupted time series analysis at a tertiary perinatal referral center in Japan. Consecutive patients with severe postpartum hemorrhage (blood loss, ≥ 1000 mL) requiring emergency transfer between April 2014 and March 2019 were included. A dry hematology-based point-of-care testing system combined with a standardized transfusion protocol was introduced in March 2016. The primary outcome was total blood loss. Secondary outcomes included transfusion volumes and in-hospital maternal mortality. Segmented regression models were used to estimate changes in level and trend before and after implementation. RESULTS:Among 142 patients included (52 before and 90 after intervention implementation), baseline severity indicators were higher in the pre-intervention period. Implementation of the point-of-care testing-guided transfusion strategy was not associated with significant changes in total blood loss or volumes of red blood cells or fresh frozen plasma transfused. Similar findings were observed for in-hospital outcomes. Results were consistent across the adjusted and sensitivity analyses. CONCLUSIONS:Implementing a point-of-care testing-guided transfusion strategy was not associated with significant improvements in blood loss or transfusion outcomes among patients with severe postpartum hemorrhage at our tertiary referral center. These findings should be interpreted within the context of this institutional setting and do not exclude the possibility that point-of-care testing may provide clinical benefit in other patient populations or healthcare settings. Further studies are needed to identify the clinical settings in which point-of-care testing-guided transfusion strategies are most effective.
OBJECTIVE:The Psychological Expectation Scale for Patients with Middle- and Late-Stage Cervical Cancer (PES-PMLSCC) was developed to assess the psychological expectations of patients with middle and late cervical cancer, and its reliability, validity, and acceptability were tested. METHOD:Employing classical test theory methodology, a cohort of 148 cervical cancer patients classified as FIGO Stage III or IV (or equivalent TNM staging) was enrolled in this study. The PES-PMLSCC scale was developed. The initial iteration of the PES-PMLSCC was refined through item analysis. To assess the structural validity of the final scale, exploratory factor analysis (EFA) was conducted, followed by preliminary internal validation using confirmatory factor analysis (CFA) and structural equation modeling (SEM). The criterion-related validity (CRV) of the final PES-PMLSCC version was evaluated by calculating the Pearson correlation coefficient between the PES-PMLSCC and the QLQ-C30. RESULTS:The PES-PMLSCC scale comprises 14 items distributed across four subscales: physiological needs (three items), safety needs (four items), social needs (two items), and self-actualization (five items). Preliminary evidence of reliability, as indicated by a Cronbach's alpha of 0.819, a Spearman-Brown coefficient of 0.912, and a test-retest reliability coefficient of 0.928. The preliminary internal validation of the validity showed that χ2/df = 1.39, GFI = 0.93, CFI = 0.98, NFI = 0.93, IFI = 0.98, TLI = 0.97, RMSEA = 0.05, and the I-CVIs exceeded 0.80. CONCLUSIONS:The findings indicate that the PES-PMLSCC is applicable for assessing the level of psychological expectations among patients with middle- and late-stage cervical cancer in China, particularly in the southwestern region.
BACKGROUND:Wired electronic fetal monitoring (EFM) restricts maternal mobility during labor and may negatively affect pain coping, comfort, birth satisfaction. Although both wired and wireless systems are available, wired EFM remains the standard method in many countries, including Türkiye. This randomized controlled trial evaluated the effects of wireless EFM on maternal comfort, labor pain, birth satisfaction. MATERIALS AND METHODS:The final sample comprised 88 women, with 44 participants in the experimental group and 44 in the control group. Data were collected using the personal information form, childbirth comfort questionnaire (CCQ), visual analog scale (VAS), and birth satisfaction scale-revised (BSS-R). Women in the experimental group were monitored using wireless EFM, whereas those in the control group received conventional wired EFM. The VAS and CCQ were administered during the active phase of labor (8-10 cm cervical dilatation), and the BSS-R was completed 1 h postpartum. RESULTS:Labor duration was shorter, reactive EFM findings were more frequent in the experimental group. Mean CCQ and BSS-R scores were higher, whereas mean VAS scores were lower in the experimental group. Significant between-group differences were observed for VAS and BSS-R scores, whereas the difference in CCQ scores was not statistically significant. CONCLUSION:Women monitored with wireless EFM experienced lower perceived labor pain and higher birth satisfaction than those receiving conventional wired EFM. Wireless EFM was also associated with shorter labor duration and a higher rate of reactive EFM findings. These findings suggest that wireless EFM may improve women's childbirth experience while maintaining effective fetal monitoring.
AIM:This study aimed to clarify the clinical significance of perinatal changes in fibroblast growth factor 21 and their association with postpartum metabolic outcomes in women with gestational diabetes mellitus. METHODS:This single-center retrospective observational study used prospectively collected residual serum samples to investigate longitudinal changes in serum fibroblast growth factor 21 concentrations at approximately 26 (T1) and 36 (T2) weeks of gestation and within 7 days postpartum (T3) in 45 women with gestational diabetes mellitus and 30 controls. Associations between fibroblast growth factor 21 concentrations and postpartum metabolic outcomes were evaluated in the gestational diabetes mellitus group. RESULTS:Serum fibroblast growth factor 21 concentrations increased significantly from T1 to T2 and remained elevated at T3, irrespective of gestational diabetes mellitus status, as assessed using the Friedman test with post hoc comparisons. In women with gestational diabetes mellitus, fibroblast growth factor 21 showed predictive performance for postpartum insulin resistance, as assessed using the homeostasis model assessment of insulin resistance. Receiver operating characteristic analysis showed the highest area under the curve for predicting postpartum insulin resistance at T1 (area under the curve, 0.871; bootstrap 95% confidence interval, 0.732-0.973). Fibroblast growth factor 21 concentrations appeared to decline during the early postpartum period, as indicated by significantly lower T3/T1 ratios in samples from postpartum Days 5-7 compared with those from Days 1-4. CONCLUSIONS:These findings suggest that perinatal fibroblast growth factor 21 dynamics may reflect physiological changes in insulin sensitivity and that fibroblast growth factor 21 concentrations measured during pregnancy may serve as a complementary indicator for postpartum metabolic risk stratification in women with gestational diabetes mellitus. Further validation is needed before clinical application.
AIM:To investigate the determinants of fetal growth abnormalities such as large for gestational age (LGA) and small for gestational age (SGA) in singleton pregnancies complicated by maternal psychiatric disorders, particularly focusing on the impact of psychotropic medication exposure and maternal background factors on infants. METHODS:A retrospective single-center cohort study was conducted involving 400 singleton pregnancies complicated by maternal psychiatric disorders, with deliveries occurring between 2019 and 2023. Data regarding maternal characteristics, psychiatric diagnoses, psychotropic medication use including polypharmacy and metabolically high-risk psychotropic medications, and obstetric outcomes were extracted from medical records. Infants were classified as LGA or SGA according to gestational age-specific birth weight standards. Multivariable logistic regression analyses were performed to identify independent factors associated with LGA and SGA. RESULTS:Of the 400 pregnancies, 40 infants were classified as LGA and 40 as SGA. Psychotropic medication use, including polypharmacy and metabolically high-risk psychotropic medications, was not independently associated with either LGA or SGA. For LGA, only high prepregnancy BMI was identified as an independent risk factor. For SGA, hypertensive disorders of pregnancy, maternal alcohol consumption, and lower prepregnancy BMI were independently associated with increased risk. CONCLUSIONS:In pregnancies complicated by psychiatric disorders, fetal growth abnormalities were primarily associated with maternal background factors. No statistically significant association was identified between psychotropic medication use and LGA or SGA fetuses in our study cohort. These findings highlight the potential importance of preconception care focused on optimizing metabolic health and lifestyle factors to improve fetal growth outcomes.
Uterine arteriovenous fistula (UAVF) associated with adenomyosis during pregnancy is a rare, life-threatening condition. This report describes a 36-year-old woman with adenomyosis who conceived through in vitro fertilization-embryo transfer and experienced recurrent vaginal bleeding in early pregnancy, followed by spontaneous miscarriage at 14 weeks. One month post-miscarriage, she developed a delayed massive hemorrhage. Color Doppler ultrasound revealed mosaic blood flow signals and high-velocity low-resistance spectra (resistance index 0.52) within the myometrium, confirming acquired UAVF. Emergency uterine artery embolization achieved successful hemostasis while preserving bilateral uterine artery trunks. Menstruation resumed 3 months postoperatively. This case raises the hypothesis of a possible association between adenomyosis and pregnancy-related UAVF. In patients with adenomyosis who are pregnant, recurrent early bleeding that is unresponsive to conservative therapy should raise suspicion for underlying vascular abnormalities, and color Doppler ultrasound evaluation may be warranted. Delayed explosive post-miscarriage hemorrhage refractory to uterotonics is characteristic. UAE is the preferred fertility-sparing treatment, with individualized embolization strategies and long-term follow-up essential.
BACKGROUND:Polycystic ovary syndrome (PCOS) is a complex endocrine and metabolic disorder that affects 5%-10% of women of reproductive age. Supplements with potential anti-inflammatory properties, such as Nigella sativa oil, have been proposed as adjunctive therapies that may improve selected metabolic and inflammatory features of PCOS. OBJECTIVE:This study investigated the effect of N. sativa oil on serum levels of IL-6 and insulin in patients with polycystic ovary syndrome. METHOD:This study was a randomized, double-blind, placebo-controlled clinical trial conducted on 60 PCOS patients. Patients received either N. sativa oil supplementation (1000 mg daily) or placebo for 12 weeks. Intermenstrual interval, menstrual duration, fasting blood glucose, insulin, insulin resistance, and serum IL-6 levels were measured. RESULTS:Sixty women with PCOS were randomized equally to the intervention and placebo groups. After baseline adjustment, serum IL-6 (adjusted mean difference -4.21; 95% CI -6.34 to -2.08; p < 0.001) and fasting blood glucose (adjusted mean difference -8.16 mg/dL; 95% CI -12.73 to -3.58; p < 0.001) were significantly lower in the N. sativa group than in the placebo group. No significant between-group differences were observed for fasting insulin, HOMA-IR, QUICKI, luteinizing hormone, or total testosterone. The intermenstrual interval was significantly shorter in the intervention group, whereas menstrual duration and other clinical manifestations showed no significant between-group differences. CONCLUSION:Twelve weeks of N. sativa oil supplementation were associated with significant improvements in inflammatory status and fasting blood glucose compared with placebo after baseline adjustment. However, no significant between-group effects were observed for insulin resistance indices or hormonal outcomes. These findings support the potential adjunctive role of N. sativa oil in PCOS while highlighting the need for larger adequately powered clinical trials.
AIM:Conservative management with the placenta left in situ has emerged as an alternative approach for placenta accreta spectrum (PAS). Methotrexate (MTX) is sometimes used to facilitate placental resorption; however, its clinical benefit remains uncertain. METHODS:We conducted a retrospective cohort study at two tertiary centers including patients with PAS managed conservatively with the placenta left in situ after cesarean delivery between April 2011 and March 2026. Patients were divided into MTX and non-MTX groups. The primary outcome was a composite adverse outcome, defined as cytopenia, bloodstream infection (BSI), late postpartum hypofibrinogenemia (LPH), therapeutic uterine artery embolization (UAE), or delayed hysterectomy. Secondary outcomes included suspected intrauterine infection and time to serum human chorionic gonadotropin (hCG) normalization. RESULTS:Seventeen patients were included (MTX, n = 8; non-MTX, n = 9). The composite adverse outcome occurred in 50.0% of patients in the MTX group and 44.4% in the non-MTX group, with no significant difference (RR 1.13, 95% CI 0.40-3.10; p = 1.00). Cytopenia was observed only in the MTX group (37.5% vs. 0%; p = 0.08). Other outcomes, including BSI, LPH, UAE, hysterectomy, and suspected intrauterine infection, were similar between groups. The median time to hCG normalization did not differ significantly between groups (66.5 vs. 64.0 days; p = 0.76). CONCLUSIONS:MTX use in conservatively managed PAS was not associated with improved clinical outcomes and may be associated with increased hematologic toxicity. These findings suggest that routine MTX administration does not appear to provide clinical benefit and may increase toxicity.
AIM:To elucidate the neonatal and neurodevelopmental outcomes of infants born via Category 1 cesarean section (CS) in a Japanese tertiary perinatal center. METHODS:Infants born via Category 1 CS from 2015 to 2019 at the National Center for Child Health and Development were included. Neonatal outcomes, including intrapartum/infant death, cord blood pH, and Apgar scores, and neurodevelopmental outcomes assessed using the Kinder Infant Development Scale (KIDS) were examined. RESULTS:A total of 101 children from 95 mothers were evaluated. The median decision-to-delivery interval (DDI) was 16 min. No intrapartum deaths occurred. Three children died during the neonatal period, whereas one died at 5 years of age. Among those who died, two had congenital diaphragmatic hernia, whereas two were preterm. The mean cord blood pH was 7.22; the median Apgar scores were 8 and 9, at 1 and 5 min, respectively. Among the 97 children aged 1 year 9 months to 6 years 5 months who received the KIDS questionnaire, 74 (76%) responded, with a median developmental quotient (DQ) of 110. Two children had a DQ below 70, one of whom had trisomy 21. Poor outcomes, including death and DQ below 70, appeared associated with severe congenital diseases or preterm birth. CONCLUSIONS:In this single-center cohort from a Japanese tertiary perinatal center operating in accordance with national guidelines and established emergency protocols, neonatal and neurodevelopmental outcomes were generally favorable among full-term infants without severe congenital disease who underwent Category 1 CS. Poor outcomes appeared to be related to fetal conditions including prematurity or anomalies.
Intraplacental choriocarcinoma (ICC) is a rare gestational trophoblastic tumor that is often difficult to diagnose and is occasionally associated with fetomaternal hemorrhage (FMH). A 28-year-old woman presented with decreased fetal movements at 38 weeks of gestation. Due to a nonreassuring fetal heart rate pattern, an emergency cesarean section was performed. Severe neonatal anemia (3.2 g/dL) and markedly elevated maternal serum alpha-fetoprotein levels suggested FMH, despite normal maternal hemoglobin F levels. Initial placental pathology was unremarkable. Thirteen days postpartum, the patient developed massive vaginal bleeding requiring uterine artery embolization (UAE). Elevated serum β-hCG levels and multiple pulmonary nodules led to a clinical diagnosis of choriocarcinoma. Placental re-evaluation confirmed ICC. Chemotherapy with methotrexate, etoposide, and actinomycin D resulted in complete remission. In conclusion, ICC should be considered in cases of unexplained FMH or postpartum hemorrhage. UAE did not appear to impair the efficacy of subsequent chemotherapy in this case.
