Objective: Human papillomavirus [HPV) is a leading cause of cervical cancer [CC) worldwide. There is growing interest in the potential role of HPV vaccination as adjuvant measure in patients with active infection. This study aimed to assess whetherthe nonavalent HPV vaccine [9vHPV) promotes faster disease clearance in women with low-grade [LGD) and high-grade disease [HGD). Methods: Retrospective study including women aged 25-60 years who began follow-up in 2018 at a central Portuguese hospital after referral through organized CC screening. A total of 126 patients with HGD [69 vaccinated, 57 unvaccinated) and 277 with LGD [131 vaccinated, 146 unvaccinated) at baseline were followed with HPV cotesting [HPV test + cervical cytology) at 12, 18, 24, 36, and 48 months. Disease clearance was defined as the first negative cotest result. Kaplan-Meier curves and the Log Ranktest were used to compare time to clearance between groups. Results: Among HGD patients, the vaccinated group showed a shorter mean time to disease clearance [17.4 months; 95%CI:14.88-19.93) compared to the unvaccinated group [20.2 months; 95% CI:17.07-23.34), although the difference was not statistically significant [p=0.228). In the LGD group, both vaccinated and unvaccinated patients had similar mean clearance times [25.9 months; 95% CI: 23.44-28.43 vs. 26.9 months; 95% CI: 24.41-29.37), also lacking statistical significance [p=0.637). Conclusion: Main findings suggest a negligible effect of 9vHPV in significantly reducing time to clearance in patients with active infection. Further research is needed to clarify its role in secondary prevention strategies.
Objective:This meta-analysis aimed to assess the ASD risk in offspring exposed to prenatal acetaminophen compared to non-exposed offspring. Methods:A systematic search was conducted across PubMed, Embase, and Cochrane Central Register of Controlled Trials databases up to October 2025. Studies were included if they involved pregnant women, compared exposed versus non-exposed groups, were RCTs or cohort studies, and reported ASD outcomes. Data was extracted independently by two authors, with discrepancies resolved by consensus. Statistical analyses used odds ratios (ORs) with 95% confidence intervals, Cochran Q, and I² statistics with a random-effects model. Study quality was appraised using the ROBINS-E tool. Results:Eight studies, involving 2,560,208 patients, were included. Pooled results showed an 18% increased risk of ASD diagnosis (p <0.0001) and a non-significant 16% increase for ASD symptoms (p=0.1719). Dose-response relationships and gender-specific effects were reported by studies, while familial confounding and "some concerns" to "high" risk of bias were identified. Conclusion:A consistent, albeit modest, association was found. These findings emphasize the necessity for careful benefit-risk assessments and informed dialogue with expectant mothers regarding pain and fever management during pregnancy.PROSPERO: CRD420251160888.
Objective:Evaluate the effectiveness and safety of adding metformin to insulin (M+I) versus insulin alone for pregnant women with type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (GDM), focusing on stillbirth as the primary outcome. Sources of data:PubMed, Embase, and Cochrane Central were searched. No date limits. Last search: January 2025. Eligibility criteria:Randomized clinical trials including women with T2DM or GDM were eligible. Trials restricted to type 1 diabetes were excluded. Data collection and synthesis:Two reviewers extracted maternal and neonatal outcomes and assessed risk of bias with the Cochrane RoB 2 tool. Evidence certainty was graded using GRADE. Data were pooled with random-effects models and reported as risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals. Results:Nine RCTs (2,420 women) were included, most with GDM and some with T2DM. Moderate-quality evidence indicated reduced stillbirth risk with M+I (6 RCTs, 2,196 participants; RR 0.36, 95% CI 0.14-0.90; NNT 111). Low-quality evidence suggested lower risks of gestational hypertension (4 RCTs; RR 0.68, 95% CI 0.48-0.97) and neonatal hypoglycemia (7 RCTs; RR 0.49, 95% CI 0.30-0.80). No significant differences were found for cesarean section, preterm delivery, or other neonatal outcomes. Heterogeneity, baseline imbalances, and small samples limited certainty. Conclusions:M+I may reduce stillbirth and some adverse outcomes compared with insulin alone, but most evidence remains low certainty. Further high-quality RCTs are needed.Registered in PROSPERO: CRD42024617330.
Objective: Recurrent pregnancy loss [RPL] is known as a significant reproductive issue globally, which affects almost 5% of couples. Various factors contribute to the incidence of RPL. Considering the crucial role of male factors in the incidence of RPL, this study investigates the relationship between sperm parameters and RPL. Methods: This cross-sectional study was performed on 253 infertile couples who were eligible to participate and referred to the infertility center of BentolHoda Hospital from February 2022 to March 2023. The information was collected through demographic, medical, and infertility assessments, as well as laboratory examinations. Participants were categorized into two groups: couples experiencing RPL and couples facing primary or secondary infertility, which served as controls. Data were analyzed using descriptive statistical tests, the chi-square test, and logistic regression. Variations in different sperm parameters, as well as other demographic factors, were investigated between the two groups. Results: According to the findings, 32.4% of infertile couples had a history of RPL. The Chi-Square test results demonstrated a statistically significant association between motility and viscosity in couples with a history of recurrent pregnancy loss [p < 0.05]. The results of the logistic regression analysis showed that the variables age [B = 0.103], drug therapy for infertility [B =-2.826], sperm viscosity [B =-1.440], and sperm motility [B = 1.113] could significantly relate to the PRL. Conclusion: The findings of this study suggest that low sperm motility, female age, and high sperm viscosity are factors that influence the occurrence of RPL.
Objective: To translate and culturally validate the VALue of the UteruS (VALUS) instrument in Brazilian Portuguese language and to identify predictors for VALUS score. Methods: A cross-sectional study (February to November 2024) at a tertiary, academic hospital was performed with 164 women presenting symptomatic uterine fibroids (UF) (n=139) or endometrial polyps (n=25) that underwent hysterectomy or myomectomy/polypectomy. The VALUS instrument was translated and culturally validated first. Psychometric variables (internal consistency, test-retest, discriminant validity) were calculated. Women completed the VALUS instrument prior to the decision-making process to undergo surgery. The Uterine Fibroid Symptoms-Quality of Life (UFS-QOL) was also completed for women with UF. Uni-and multivariate linear regression was calculated to seek for associated factors with the VALUS total score. Results: Women that underwent hysterectomy were older, with higher education, higher parity and frequency of abdominal/pelvic surgeries than the non-hysterectomy group. VALUS scores were statistically higher in the non-hysterectomy for some questions and total score. Internal consistency of the VALUS instrument was excellent (alpha=0.890) and test-retest analysis did not differ between the groups (p=0.891). The UFS-QoL quality of life score presented a negative correlation with VALUS instrument. Multivariate linear regression demonstrated that the presence of abdominal/pelvic surgeries was associated with a lower VALUS score. Conclusion: VALUS demonstrated adequate internal consistency and reliability, but with low discriminant validity for the prediction of hysterectomy versus uterine-preservation in women with UF or endometrial polyps. Presence of abdominal/pelvic surgery is associated with a lower VALUS score.
Objective:To evaluate the association between high Anti-Müllerian Hormone (AMH) levels and key outcomes of In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) in women with Polycystic Ovary Syndrome (PCOS). Data sources:A systematic search was performed in MEDLINE (via PubMed), Web of Science, and Scopus, on September 17, 2024. Selection of studies:We included observational studies in PCOS patients stratified by AMH levels that reported any of the IVF/ICSI outcomes of interest, namely: live birth rate, clinical pregnancy rate, miscarriage rate, oocytes retrieved, MII oocytes and fertilization rate. Data collection:Two reviewers independently extracted data and assessed risk of bias using the National Heart, Lung, and Blood Institute Study Quality Assessment Tool. Discrepancies were resolved by consensus. Data were pooled using meta-analysis when appropriate. Sensitivity analyses were conducted using a leave-one-out approach. Data synthesis:Thirteen studies met the inclusion criteria. Ten were rated as low risk of bias, two as unclear, and one as high risk, indicating overall fair to strong methodological quality. Women with high AMH levels had a lower live birth rate (odds ratio [OR]: 0.85; 95%CI: 0.71-1.02), which became significant after leave-one-out analysis (OR: 0.80; 95%CI: 0.64-0.99). Clinical pregnancy rates were 2% lower in women with elevated AMH levels (OR: 0.98; 95%CI: 0.82-1.17). Miscarriage rates showed a non-significant 25% increase in women with high AMH levels (OR: 1.25; 95%CI: 0.88-1.76). High AMH levels were associated with more retrieved oocytes in the overall meta-analysis (mean difference: 3.52; 95%CI: 1.70-5.33), with consistent findings in sensitivity analyses. There was no significant difference in fertilization rate between the two groups. Conclusion:While high AMH levels indicate greater ovarian reserve, they negatively influence reproductive outcomes in PCOS patients. These findings highlight the need for individualized ART strategies and further research to clarify underlying mechanisms.PROSPERO: CRD42024596056.
Objective: The aim of the study was to analyze the role of the neutrophilto lymphocyte ratio (NLR) as a prognostic factor in metastatic breast cancer (MBC). Methods: A retrospective cohort study including 359 recurrent MBC patients was performed. Clinical and pathological attributes were retrieved from patients' medical files and their importance in the overall survival were evaluated using the Cox univariate and multivariate proportional hazard models. A confidence interval of 95% was used to select significant variables and the Wald test was used to infer the best NLR cutoff value to discriminate into low and high categories. Results: In univariate analyses, the variables estrogen receptor (ER) and progesterone receptor (PR) expressions, previous treatment with adjuvant chemo, NLR, PLR (platelet-lymphocyte ratio), age at diagnosis and the main metastatic site (bone/lymph node, visceral or central nervous system) variables were significant to determine the hazards. After filtering the collinear variables, the final model was tested with 6 variables based on 339 patients and the NLR at the time of the recurrence diagnosis (NLR_rec), the hormone receptor (ER or PR) status and the age at diagnosis were considered significant. The best NLR_rec value to discriminate against patients was 4.43 (Wald test= 51.7) and there were 239 patients categorized as low and 111 as high NLR category. The median overall survivaltime was 18 and 4 months in NLR-low and NLR-high groups, respectively (p< 0.001). Conclusion: NLR is an independent prognostic factor in recurrent MBC patients.
Abstract Objective: To compare the prevalence of diagnostic hysteroscopies for endometrial cancer, the prevalence of endometrial cancer diagnoses, and the staging of endometrial cancer at the time of diagnosis before and during the COVID-19 pandemic. Methods: Retrospective observational study included 631 women who underwent diagnostic hysteroscopy at a tertiary hospital in Campinas. Medical records were analyzed from two periods: two years before the COVID-19 pandemic (2018 and 2019) and two years during the pandemic (2020 and 2021). Results: The frequency of hysteroscopies before the pandemic was 59.9%, compared to 40.1% during the pandemic. There were no significant differences in average age, body mass index, or cancer prevalence between the two periods. Among women who underwent hysteroscopy during the pandemic, a lower prevalence of comorbidities and postmenopausal status was observed (p = 0.029 and p = 0.004, respectively). During this period, the primary indication for hysteroscopy was abnormal uterine bleeding (p = 0.004). Conclusion: The pandemic led to a reduction in the number of women with comorbidities undergoing hysteroscopy and an increase in indications due to abnormal bleeding. This scenario may suggest that women at higher risk of COVID-19 complications were less likely to seek medical care.
The National Endometriosis Expert Committee of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) and the Brazilian Society of Endometriosis endorse this document. The content is based on scientific evidence regarding the subject matter, and the findings presented contribute to clinical practice.
Objective: To evaluate the clinical differences in the presentation of vulvar lichen sclerosus in pre-and postmenopausal women, aiming to provide insights to improve disease management and promote the health and well-being of affected patients. Methods: This was a retrospective analytical study involving 287 women diagnosed with vulvar lichen sclerosus, conducted between January 2009 and December2023 at Erasto Gaertner Hospital, in Curitiba, Brazil. Clinical, epidemiological, and therapeutic management aspects were assessed and compared between pre-and postmenopausal patients. Results: Most cases [87%] occurred in women over 50 years of age, showing a strong association with menopause. Systemic arterial hypertension and type II diabetes mellitus were the most frequent comorbidities. Complaints of vulvar atrophy and anatomical deformities predominated among women over 50 years. Pruritus was the most common symptom in both groups, while dyspareunia was more prevalent among younger women. High-potency topical corticosteroid therapy was effective in more than half of the patients in both groups. Additionally, contrary to previous literature, 2% testosterone cream showed significant clinical improvement in the younger group. Progression to in situ neoplasia was observed in 11 cases, and progression to invasive neoplasia occurred in 6 cases. Conclusion: Differences in clinical presentation according to hormonal status reinforce the importance of individualized management strategies. Further studies with larger samples are necessary to optimize treatment approaches and improve quality of life for women affected by this chronic, mutilating, and often neglected dermatosis.
The National Specialized Commission on Obstetric Emergencies of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) endorses this document. The content is based on scientific evidence on the proposed topic, and the results presented contribute to clinical practice.
Objective: Maternal pro-inflammatory responses have been implicated in pregnancy complications. This study examined the association of maternal serum IL-2, IL-4, and IL-13 levels with intrauterine growth restriction (IUGR) and umbilical artery Doppler indices. Methods: This case-control study was conducted at Alavi Teaching and Referral Hospital, Ardabil, Iran, from August 2024 to June 2025. Sixty singleton pregnant women (30 with IUGR and 30 with normal pregnancies) between 28-36 weeks of gestation were included. Umbilical artery resistive (RI) and pulsatility (PI) indices were assessed by a single sonographer, and serum cytokine levels were measured using ELISA. Statistical analyses (t-test, chi-square, Pearson's correlation, logistic regression) were performed with SPSS v25. The study was approved by the Ethics Committee of Ardabil University of Medical Sciences (no. 1403.049). Results: Compared with controls, the IUGR group had higher IL-2 and lower IL-4 and IL-13 levels, as well as increased PI and RI (all P<0.05). Elevated IL-2 (OR=1.027; 95%CI: 1.011-1.044; P=0.001) and reduced IL-4 (OR=0.963; 95%CI: 0.929-0.999; P=0.042) and IL-13 (OR=0.978; 95%CI: 0.962-0.995; P=0.009) were independently associated with IUGR. IL-2 correlated positively, while IL-4 and IL-13 correlated negatively, with both Doppler indices (all P<0.05). Conclusions: Pregnant women with IUGR exhibited a pro-inflammatory Th1-biased cytokine profile, characterized by increased IL-2 and decreased IL-4 and IL-13, which correlated with elevated umbilical vascular resistance. These findings suggest an immunologic contribution to placental dysfunction. However, given the observational design and small sample size, causal inferences cannot be made, and confirmation in larger multicenter studies is warranted.
Objective:To describe genital hiatus area, pelvic floor muscle (PFM) function, pelvic floor dysfunction symptoms and sexual function characteristics of transgender women submitted to gender-affirming surgery. Methods:Six participants were included in this case series conducted in a referral hospital which treats transgender individuals in Brazil. An individual assessment was performed with sociodemographic variables, clinical symptoms, PFM function, neovaginal depth and genital distances. Two and three-dimensional translabial ultrasound were used to measure hiatal dimensions. The results were shown with absolute and relative frequencies, mean and standard deviation. Results:The genital hiatus area had an average of 11.09 (SD 3.49) cm² at rest and 14.36 (SD 3.00) cm² during the Valsalva maneuver. The mean distances of clitoris-vagina, genital hiatus and perineal body were 9.30 (SD 1.57) cm, 6.60 (SD 1.43) cm and 4.00 (SD 1.90) cm, respectively. The mean vaginal depth was 9.50 (SD 3.51) cm. Most volunteers had satisfactory PFM strength and tone. Transgender women reported an increase in daytime urinary frequency (100%), nocturia (83.3%), sensation of incomplete evacuation (66.7%), straining during defecation (50%), flatal incontinence (16.6%), dyspareunia (50%) and anodyspareunia (16.6%). There were no reports of urinary or fecal incontinence, vaginal bulging, perineal pain or dysuria. Conclusion:This is the first study reporting genital hiatus area by translabial ultrasound in transgender women. Adequate levator hiatal area and neovaginal depth were found, preserved PFM tone and strength, preserved urinary and fecal continence, increased daytime urinary frequency, nocturia, sensation of incomplete evacuation, dyspareunia during vaginal sex and moderate vaginal sexual satisfaction.
