BACKGROUND:Preterm birth is a leading cause of perinatal morbidity. While transvaginal cervical length (CL) is the standard screening tool for symptomatic women, its low specificity frequently leads to overtreatment and unnecessary hospital admissions. Although the uterocervical angle (UCA) and phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) are recognized as strong independent predictors, the clinical value of integrating these biomechanical and biochemical markers into a single triage model remains unclear. OBJECTIVE:To investigate the predictive accuracy of a combined model incorporating UCA, CL, and the phIGFBP-1 test for spontaneous preterm delivery, and to evaluate its clinical utility and association with neonatal outcomes. STUDY DESIGN:A cohort study was conducted on 130 pregnant women presenting with symptoms of threatened preterm labor. The latency period (time-to-delivery) was analyzed using Kaplan-Meier survival curves and a multivariable Cox proportional hazards regression model. Diagnostic accuracy was compared utilizing receiver operating characteristic curves. Clinical utility was evaluated by the number of preventable hospitalization days, and neonatal outcomes were compared based on the phIGFBP-1 test results. RESULTS:The combined predictive model significantly improved diagnostic accuracy, achieving an excellent area under the curve of 0.776 compared to 0.731 for CL alone (P<.001). Multivariable Cox regression identified a positive phIGFBP-1 test as the strongest independent factor accelerating preterm delivery (hazard ratio=1.675, P=.006), whereas CL (< 25 lt; 25 mm) and cervical funneling lost statistical significance. Kaplan-Meier analysis demonstrated that the longest latency period belonged to the lowest-risk group (narrow UCA and negative phIGFBP-1). Utilizing this combined model as a triage tool could have helped low-risk patients avoid 34 unnecessary hospital bed days and unwarranted exposure to tocolytics and corticosteroids. Furthermore, a positive phIGFBP-1 test was closely associated with adverse neonatal outcomes, including a significantly lower birth weight (2582.98±518.52 g vs 2899.26±400.57 g, P<.001) and reduced 1- and 5-minute Apgar scores (P<.001 and P=.002, respectively). CONCLUSION:Integrating the UCA and the biochemical marker (phIGFBP-1) provides superior predictive accuracy for preterm delivery compared to the traditional CL measurement. This protocol not only optimizes healthcare resource allocation by safely reducing unnecessary hospitalizations but also effectively identifies pregnancies at risk for adverse neonatal outcomes. More importantly, it empowers physicians to confidently triage low-risk groups, thereby restricting medication overuse, minimizing unnecessary admission rates, and mitigating the economic burden on both families and the healthcare system.
Background Serum human chorionic gonadotropin (hCG) testing performed 12-15 days after embryo transfer (ET) is the standard method to confirm pregnancy, and hCG levels are widely used to predict subsequent pregnancy outcomes. However, the earliest reliable time for pregnancy detection using urinary hCG testing after frozen embryo transfer (FET) and its prognostic value remain undefined. Objective To determine the earliest time that pregnancy could be reliably detected by urinary hCG test following FET and to identify its influencing factors as well as the predictive value for pregnancy outcomes. Study Design This was a prospective cohort study conducted in an academic center for reproductive medicine between September 2024 and May 2025. A total of 120 patients undergoing frozen single blastocyst transfer were recruited. All participants performed daily urinary hCG tests from the 3rd day after FET until the 11th-14th days when serum hCG levels were measured. Results In patients without exogenous hCG administration before FET, the earliest positive urinary hCG results could be detected on the 4th day after FET. Among patients with pregnancy demonstrated by serum hCG measurement, 100% could be detected on the 9th day after FET by urinary hCG test. In patients with exogenous hCG administration, 28.3% had a positive urinary hCG test on the 3rd day after FET, and all pregnancies were detected on the 9th day after FET. Compared with the late positive group, the early positive group exhibited a higher ongoing pregnancy rate (92.6% vs. 68.4%, P = 0.015) and a lower risk of pregnancy loss (7.4% vs. 31.6%, P = 0.015). Conclusions Urinary hCG test performed on the 9th day after FET was reliable for the earliest detection of pregnancy. An earlier positive urinary hCG result was associated with a higher ongoing pregnancy rate compared with a later positive result.
Background The SARS-CoV-2 pandemic, declared in March 2020, has affected over 570 million people worldwide. The impact on pregnant women and fetuses remains unclear, particularly with the Omicron variant, which appears to increase infection rates. This retrospective study describes fetal-maternal complications and placental features in Omicron-variant SARS-CoV-2 infections during pregnancy, and compares them with other variants and non-infected controls from published studies examining the association between SARS-CoV-2 infection and placental pathology Methods We analyzed all consecutive placentas referred to our hospital from May 2021 to March 2023, associated with proven Omicron-variant SARS-CoV-2 maternal infection during pregnancy. Results Among 315 placentas studied, fetal-maternal complication rates were comparable to the general population, including pre-eclampsia (0.6%), intrauterine growth restriction (5%), small for gestational age (9.1%), and preterm birth (3.1%).We observed a significant lower rate of hypotrophic placentas below the 10th percentile (4.1% vs. 15.0%, p < 0.001), chronic deciduitis (3.8% vs 10.5%, p < 0.01), MVM (49.2% vs 58.8%, p < 0.01) and FVM lesions (7.6% vs 14.5%, p < 0.001) in Omicron cohort versus published data from studies of individuals with non-Omicron variant SARS-CoV-2. We did not observe an increased incidence of chronic inflammation nor SARS-cov-2 placentitis histologic triad in comparison to control cases from published data. A high rate of acute histological chorioamnionitis was observed, without increase incidence in preterm deliveries. The interval between infection and delivery did not alter placental features. Conclusion This large Omicron-variant placentas cohort highlighted clinically, an overall good outcome, and histologically significantly less vascular malperfusion and chronic deciduitis than in non-Omicron SARS-Cov-2 variants.
BACKGROUND:India lacks an organized national cervical cancer screening program, and while the World Health Organization (WHO) recommends human papillomavirus (HPV) deoxyribonucleic acid (DNA) testing as the primary modality, large-scale evidence on implementation via decentralized treatment pathways in India is limited. We evaluated the effectiveness of opportunistic high-risk HPV (hrHPV) DNA screening, assessing prevalence, genotype distribution, self-testing acceptance, and the diagnostic performance of a community-based "see-and-treat" approach. OBJECTIVE:To evaluate the prevalence and genotype distribution of hrHPV and assess the diagnostic accuracy, treatment compliance, and clinical viability of a decentralized "see-and-treat" approach within a large-scale opportunistic screening program across 20 Indian states. STUDY DESIGN:In this retrospective cross-sectional study (January 2022-December 2025), 62,868 women aged 25 to 65 years were enrolled across 20 Indian states via community outreach (75.1%) and hospital-based network (24.9%). Screening utilized clinician-collected or self-collected (10.5%) samples tested via the Cobas 6800 system. hrHPV-positive women were triaged by colposcopy and managed through a decentralized "see-and-treat" approach using thermal ablation (TA) or Large Loop Excision of the Transformation Zone (LLETZ). Primary outcomes included HPV prevalence, diagnostic accuracy (AUC), and treatment compliance. RESULTS:Overall HPV prevalence was 8.5% (5,354/62,868), with significant regional variation (11.3% in Delhi NCR to 4.7% in Kerala). Non-16/18 high-risk genotypes accounted for 54.6% of infections. Positivity peaked at ages 26 to 30 years (10.1%) and had a minor peak at 51 to 55 years (8.4%). The see-and-treat modality demonstrated high diagnostic accuracy (AUC 0.95; sensitivity 0.98; specificity 0.91) with a program efficacy of 81.2% with 16.3% overtreatment and 21.1% undertreatment. Treatment compliance in the community sub-cohort was 51.3% (1,957/3,813). We identified five women with invasive cancers and 7.8% CIN III (28/357), 9.0% CIN II (32/357), and 26.3% CIN I (94/357) of the histopathology sub-group. CONCLUSION:Opportunistic hrHPV screening integrated with decentralized "see-and-treat" is a clinically robust strategy for LMICs. Significant regional heterogeneity requires tailored, state-specific policies and digital linkage-to-care frameworks to overcome compliance barriers and meet WHO 2030 cervical cancer elimination goals.
Background Human papillomavirus (HPV) vaccination is central to cervical cancer prevention, but uptake depends on communication as well as access. Teachers can shape how adolescents and families understand school-linked vaccination, although communication style has been studied less than clinician recommendation. Objective To examine whether teacher advice and communication style were associated with adolescent HPV vaccination and whether associations differed between younger and older adolescents. Study Design We conducted parallel cross-sectional surveys among parents or legal guardians and adolescents aged 13-17 years in 10 Bangkok secondary schools. The primary analysis used parent-reported data. Of 687 parent forms submitted, 30 respondents declined consent and were excluded, leaving 657 consenting records; 604 had complete data for regression. The study-specific Thai-language questionnaire was not a previously validated psychometric instrument. It assessed respondent characteristics, clinician and teacher advice, communication style, information sources, vaccination status, beliefs, and barriers. Multivariable logistic regression evaluated receipt of at least 1 HPV vaccine dose. A post hoc sensitivity analysis used 882 consenting adolescent surveys to compare ages 13-14 and 15-17 years while accounting for clinician advice, sex, and perceived peer influence. Results Among 657 consenting parent respondents, 69.6% (457/657) reported that their adolescent had received at least 1 HPV vaccine dose. In the advice-exposure model, teacher advice was associated with vaccination (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.31-3.14; P=.001), as was clinician advice (OR, 3.64; 95% CI, 2.44-5.42; P<.001). In the fully adjusted model, teacher shared decision-making was associated with vaccination (OR, 4.06; 95% CI, 1.58-10.42; P=.004), whereas teacher advice exposure alone was not (OR, 1.04; 95% CI, 0.57-1.90; P=.889). In adolescent sensitivity analyses, shared decision-making communication was associated with vaccination in both age groups (adjusted OR, 3.32 for ages 13-14 and 6.10 for ages 15-17); the age-by-communication interaction was not statistically significant (P=.151). Conclusion Teacher communication quality may be an actionable component of school-linked HPV vaccination. The findings extend prior teacher-perception literature by linking distinct communication styles with individual-level vaccination behavior, while also showing the need for validated instruments and prospective studies that measure age-specific access, autonomy, and peer networks.
Reversible cerebral vasoconstriction syndrome is a rare but potentially life-threatening neurological disorder that may occur during pregnancy and the postpartum period and represents an important diagnostic challenge because of its overlap with other obstetric neurological emergencies. We report the case of a 35-year-old woman with a dichorionic diamniotic twin pregnancy who developed severe preeclampsia requiring cesarean delivery at 30 weeks of gestation. On the fifth postpartum day, she experienced thunderclap headache, generalized seizures, and refractory cerebral vasospasm complicated by subarachnoid hemorrhage, cerebral ischemia, and intracranial hypertension. She was managed in a specialized maternal neurocritical care unit using a multimodal strategy that included continuous neuromonitoring with transcranial Doppler ultrasonography, cerebral oxygenation and metabolic monitoring, electroencephalography, intracranial pressure monitoring, serial cerebral angiography with selective intra-arterial milrinone infusion, and, ultimately, ultrasound-guided stellate ganglion block as rescue therapy. Progressive neurological recovery followed, allowing liberation from mechanical ventilation, initiation of rehabilitation, and hospital discharge with a favorable functional outcome. This case highlights the importance of considering reversible cerebral vasoconstriction syndrome in postpartum women presenting with acute neurological deterioration. Early diagnosis, multidisciplinary management, and multimodal neuromonitoring may facilitate individualized treatment and timely therapeutic escalation in patients with refractory cerebral vasospasm. Further prospective studies are needed to better define the role of advanced neuromonitoring and rescue therapies in this rare condition.
Background Preterm birth is a leading cause of perinatal morbidity. While transvaginal cervical length (CL) is the standard screening tool for symptomatic women, its low specificity frequently leads to overtreatment and unnecessary hospital admissions. Although the uterocervical angle (UCA) and phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) are recognized as strong independent predictors, the clinical value of integrating these biomechanical and biochemical markers into a single triage model remains unclear. Objectives To investigate the predictive accuracy of a combined model incorporating UCA, CL, and the phIGFBP-1 test for spontaneous preterm delivery, and to evaluate its clinical utility and association with neonatal outcomes. Study Design A cohort study was conducted on 130 pregnant women presenting with symptoms of threatened preterm labor. The latency period (time-to-delivery) was analyzed using Kaplan-Meier survival curves and a multivariable Cox proportional hazards regression model. Diagnostic accuracy was compared utilizing Receiver Operating Characteristic (ROC) curves. Clinical utility was evaluated by the number of preventable hospitalization days, and neonatal outcomes were compared based on the phIGFBP-1 test results. Results The combined predictive model significantly improved diagnostic accuracy, achieving an excellent area under the curve (AUC) of 0.776 compared to 0.731 for CL alone (p < 0.001). Multivariable Cox regression identified a positive phIGFBP-1 test as the strongest independent factor accelerating preterm delivery (HR = 1.675, p = 0.006), whereas CL (< 25 mm) and cervical funneling lost statistical significance. Kaplan-Meier analysis demonstrated that the longest latency period belonged to the lowest-risk group (narrow UCA and negative phIGFBP-1). Utilizing this combined model as a triage tool could have helped low-risk patients avoid 34 unnecessary hospital bed days and unwarranted exposure to tocolytics and corticosteroids. Furthermore, a positive phIGFBP-1 test was closely associated with adverse neonatal outcomes, including a significantly lower birth weight (2582.98 ± 518.52 g vs. 2899.26 ± 400.57 g, p < 0.001) and reduced 1- and 5-minute Apgar scores (p < 0.001 and p = 0.002, respectively). Conclusions Integrating the uterocervical angle (UCA) and the biochemical marker (phIGFBP-1) provides superior predictive accuracy for preterm delivery compared to the traditional CL measurement. This protocol not only optimizes healthcare resource allocation by safely reducing unnecessary hospitalizations but also effectively identifies pregnancies at risk for adverse neonatal outcomes. More importantly, it empowers physicians to confidently triage low-risk groups, thereby restricting medication overuse, minimizing unnecessary admission rates, and mitigating the economic burden on both families and the healthcare system
OBJECTIVE:To map peer-reviewed evidence across four linked functions of digital and AI-assisted preeclampsia care-risk prediction, patient education, remote blood pressure monitoring, and clinician-directed escalation-and determine whether these functions have been evaluated together as an integrated clinical service. DATA SOURCES:PubMed, Scopus, and ScienceDirect were searched for records published from January 2010 to May 11, 2026. STUDY ELIGIBILITY CRITERIA:Peer-reviewed original empirical and technical studies of artificial intelligence, machine learning, clinical decision support, telemedicine, mobile health, remote monitoring, digital education, or care escalation for preeclampsia or hypertensive disorders of pregnancy were eligible. Reviews, protocols, conference abstracts without a full report, editorials, and opinion articles were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS:The review followed PRISMA-ScR and Joanna Briggs Institute guidance. Two reviewers independently screened records. One reviewer charted data and a second independently verified them. Findings were organized by the four predefined functions and synthesized thematically. Formal critical appraisal was not performed; the synthesis therefore describes the evidence map rather than certainty or implementation readiness. RESULTS:The searches identified 1396 records. After 313 duplicates were removed, 1083 records were screened, and 320 full-text articles were assessed; 286 full-text articles were excluded, and 34 studies conducted in diverse single- and multicountry settings were included. Prediction models reported favorable discrimination estimates, but calibration, independent validation, and equity assessment were inconsistent. Remote monitoring findings were mixed: BUMP 1 did not show earlier clinic-recorded detection of hypertension, whereas some replacement-care models reduced visits or admissions without an observed increase in adverse outcomes. Education studies mainly examined hypothetical responses or communication gaps rather than measured behavior change. Adoption surveys and qualitative implementation studies did not establish clinical effectiveness. No study prospectively evaluated all four functions as a coordinated service; this was treated as a descriptive observation, not evidence of effectiveness or novelty. CONCLUSION:Component evidence supports staged study, not routine implementation of an integrated pathway. Searching three electronic information sources, excluding gray literature, and not performing formal appraisal may have omitted relevant implementation evidence. Future codesigned prospective studies should evaluate calibration, safety, workload, equity, and maternal and perinatal outcomes.
The traditional World Health Organization (WHO) partograph has been used globally for decades as a standard tool for intrapartum labor monitoring. However, accumulating evidence has challenged its underlying assumptions, particularly the use of rigid cervical dilatation thresholds, and highlighted the need for a more individualized and woman-centered approach to childbirth care. In response, the WHO introduced the Labor Care Guide (LCG) in 2020, aligned with the 2018 WHO recommendations on intrapartum care for a positive childbirth experience. This narrative review aims to examine the scientific rationale, global implementation experience, and policy implications of the WHO LCG, with a particular focus on its relevance and application in the Republic of Moldova. A narrative review of peer-reviewed literature, WHO normative documents, International Federation of Gynecology and Obstetrics position statements, and international implementation studies was conducted. National policy documents and clinical guidelines from the Republic of Moldova were analyzed to contextualize local adoption. International evidence demonstrates that the WHO LCG supports individualized labor monitoring, reduces unnecessary obstetric interventions, and promotes respectful, woman-centered care without compromising maternal or neonatal safety. In 2025, the Republic of Moldova approved a new national guideline on intrapartum care, aligned with WHO principles and the conceptual framework of the LCG. This policy shift reflects a strategic effort to improve the quality of intrapartum care and address ongoing challenges in maternal health outcomes.The transition from the classical WHO partograph to the principles underpinning the WHO LCG represents a significant evolution in intrapartum care. The Republic of Moldova’s experience illustrates how countries with a long tradition of structured labor monitoring can adopt WHO-aligned, woman-centered approaches through national policy reform. Ongoing evaluation of implementation, including assessment of healthcare providers’ preparedness and perceptions, will be essential to ensure sustainable integration and to maximize potential benefits for maternal and neonatal health.
BACKGROUND Many countries in South America and the Caribbean face an unacceptably high maternal mortality rate and a shortage of Obstetrician Gynecologists. OBJECTIVE Our objective was to address both challenges in Guyana with the development of an in-country Obstetrics and Gynecology (OBGYN) residency training program. STUDY DESIGN A four-year OBGYN residency program began in Guyana in 2012 using curriculum formalized at US academic institutions and modified to suit local needs and capabilities. Partnerships between multiple academic institutions have allowed for participation of faculty across North America in educating the first in-country specialty trained OBGYN physicians in Guyana. RESULTS A total of 32 physicians have completed the OBGYN training program in Guyana and 30 of these graduates are currently practicing in-country. There are 18 residents currently enrolled. Full time staff are present in Guyana with support from visiting faculty members from collaborating academic institutions. Evidence-based clinical guidelines specific to this setting were developed and institutionalized to improve quality of care and patient safety. The maternal mortality ratio at program inception was 135 in 2012 and the most recent measurement has fallen to 75 in 2023. Program success was due in large part to the shared vision of local institutions, establishment of partner organizations, investment in resident leadership development, and concomitant infrastructure change and systems-based improvement. CONCLUSION Guyana’s first OBGYN residency program can be used as a model for future academic partnerships in low- and middle-income countries. Creation of sustainable training programs in Obstetrics and Gynecology is key to decreasing global maternal mortality.
BACKGROUND:In the United States, the Dobbs v. Jackson Women's Health Organization (Dobbs) decision has implications not just for patient care, but for abortion training. Consequently, training programs in states with abortion bans are developing out-of-state training rotations by partnering with programs in abortion-accessible states. It is unclear what barriers exist for trainees, sending and receiving site faculty as they develop and manage out-of-state training rotations. OBJECTIVE:This study aims to understand the perspectives of trainees and faculty as they navigate the post-Dobbs landscape and develop out-of-state training relationships. STUDY DESIGN:This qualitative study interviewed trainees, faculty from states with abortion bans considering sending trainees for abortion training ("Sending Sites") and faculty from states supportive of abortion that are receiving trainees ("Receiving Sites"). Interviews were conducted over Zoom, transcribed, and interview transcripts were analyzed utilizing Nvivo software for thematic qualitative analysis. RESULTS:We interviewed 9 trainees, 8 sending sites faculty and 5 receiving sites faculty across the country. Faculty in states with abortion bans noted many barriers to establishing an out-of-state rotation including funding and legal support. Receiving sites were worried about integrating outside trainees and making sure they got enough experience without negatively impacting their home trainees' training. Regardless of rotation length and level of participation, all trainees reported positive experiences with out-of-state training. CONCLUSION:Despite barriers to developing out-of-state training rotations, trainees value the opportunity to obtain abortion training. Efforts should be made to improve facilitation of out-of-state training opportunities in the post-Dobbs medical landscape.
BACKGROUND:Most women with epithelial ovarian cancer present with advanced-stage disease and have poor survival outcomes. However, the factor associated with long-term survival and the prognostic impact of histologic subtype in this population remain incompletely characterized. OBJECTIVE:To identify factors associated with long-term survival and to compare survival outcomes across histologic subtypes in advanced-stage epithelial ovarian cancer. STUDY DESIGN:We conducted a retrospective cohort study of 359 women with stage III to IV epithelial ovarian cancer. Multivariable logistic regression analysis was used to identify independent predictors of long-term survival, defined as overall survival of 5 years or longer. Cox proportional hazards models were applied to evaluate survival outcomes. RESULTS:Among patients with advanced-stage epithelial ovarian cancer, 109 patients (30.4%) achieved long-term survival. Median follow-up was 111.8 months. BRCA mutation status was independently associated with improved long-term survival (adjusted OR 8.11, 95% CI 2.46-26.67; P<.001). Optimal surgical cytoreduction and good performance status were also independently associated with long-term survival. In contrast, clear cell carcinoma was a negative predictor of long-term survival and associated with inferior oncologic outcomes, including a 5-year overall survival of 13.1% and an approximately twofold increased risk of mortality compared with high-grade serous carcinoma (adjusted HR 2.01, 95% CI 1.37-2.95; P<.001). A landmark analysis among 5-year survivors showed that the BRCA survival advantage did not persist beyond 5 years (P=.661). CONCLUSION:Long-term survival in advanced-stage epithelial ovarian cancer is independently associated with BRCA mutation status, optimal surgical cytoreduction, favorable performance status, and histologic subtype. Clear cell carcinoma is linked to significantly worse outcomes. These findings highlight the importance of universal genetic testing and maximal surgical cytoreduction.
Background Spontaneous preterm birth (PTB) remains a leading cause of neonatal morbidity and mortality, yet accurate prediction in asymptomatic women during early gestation remains a critical unmet clinical need. Cell-free DNA (cfDNA) obtained through the same maternal blood collection used for routine first-trimester non-invasive prenatal testing (NIPT) represents an underutilized substrate for early PTB risk identification. Objective To develop and validate a cell-free DNA (cfDNA) fragmentomic classifier for the early prediction of spontaneous preterm birth (PTB) using routine first-trimester non-invasive prenatal testing (NIPT) data. Study design A case-control study was conducted within a multicenter Vietnamese cohort comprising 286 pregnancies, including 82 spontaneous PTB cases and 204 term controls. Maternal plasma cfDNA collected during routine first-trimester NIPT (median gestational age, 12 weeks) was sequenced to a depth of approximately 20 million reads per sample. Five fragmentomic feature categories including copy number alterations, end-motif composition, nucleosome distance, fragment length, and joint fragment-length × end-motif were evaluated for PTB prediction. Machine learning classifiers were developed in a training cohort (n = 228, 65 PTB vs 163 TB) and tested in an internal held-out validation cohort (n = 58, 17 PTB vs 41 TB). Results Among the five fragmentomic feature classes evaluated, 4-mer end-motif (EM) profiles exhibited the most pronounced differences between PTB and term control samples. Consistent with these findings, the EM-based classifier demonstrated the highest discriminative performance in the internal validation cohort, achieving an AUC of 0.970 (95% CI, 0.912–1.000). At a specificity >90%, the model achieved a sensitivity of 94% (95% CI, 78–100%). Conclusion These findings demonstrate that cfDNA EM signatures derived from routine first-trimester NIPT can accurately identify pregnancies at risk of spontaneous preterm birth, using only a routine maternal blood sample, supporting the potential to extend the clinical utility of existing prenatal screening infrastructure pending prospective validation at production sequencing depths.
BACKGROUND:Long-acting reversible contraceptives (LARCs), including intrauterine devices and implants, are highly effective in preventing unintended pregnancies. Despite their benefits, utilization remains low across many Sub-Saharan African (SSA) countries. OBJECTIVE:This study aimed to predict LARC utilization and identify key determinants among women of reproductive age in SSA using advanced machine learning techniques. METHODS:A secondary analysis was conducted using the latest Demographic and Health Survey (DHS) datasets from eight SSA countries, yielding a weighted sample of 29,016 women aged 15-49 years. Data preprocessing included cleaning, feature engineering, variable selection, and class balancing with SMOTE. Twelve machine learning models were developed, and the best-performing model was optimized using Bayesian methods. Association rule mining (Apriori algorithm) was applied to uncover hidden patterns among predictors. RESULTS:The pooled prevalence of LARC use was 29% (95% CI: 21%-38%), with high between-country heterogeneity (I²=99.67%). Random Forest achieved the best performance after optimization, with an accuracy of 87.1%, AUC of 81.0%, and F1 score of 85.0%. Major predictors included country, education, parity, marital status, and age. Association rule mining showed that rural, uneducated, poor, and married women in Senegal and Burkina Faso had a higher likelihood of LARC use (Lift =2.25). CONCLUSION:Machine learning identifies potential predictors of LARC utilization and identifies key determinants in SSA. Targeted interventions focusing on rural, low-income, and low-education groups may improve LARC uptake and reduce unmet family planning needs.
BACKGROUND: Black birthing individuals experience worse perinatal outcomes compared to White counterparts, yet within-group differences among Black populations remain understudied. The U.S. Black population is heterogeneous, encompassing long-established U.S.-born communities and immigrants from across the African diaspora, whose health profiles may differ. Somali immigrants represent the largest African-born population in many U.S. communities and face documented challenges including cultural adaptation and language barriers. However, severe maternal morbidity (SMM) has not been specifically studied in this population. OBJECTIVE: To compare severe maternal morbidity and neonatal birth outcomes between Somali and non-Somali Black birthing individuals. STUDY DESIGN: This was a retrospective cohort study from 2016 to 2024, in which Somali and non-Somali Black individuals were identified within an academic-community health system. Somali individuals were identified using self-reported Black/African race combined with documented primary language (Somali) and/or country of origin (Somalia); individuals meeting either language or country criterion with Black/African race were classified as Somali regardless of birthplace. SMM was defined using CDC 21-indicator criteria (excluding blood transfusion) and assessed during birth hospitalization and through 6 weeks postpartum. Neonatal morbidity was defined as a composite of respiratory distress syndrome, transient tachypnea of the newborn, retinopathy of prematurity, bronchopulmonary dysplasia, sepsis, 5-minute Apgar ≤7, hypoxic-ischemic encephalopathy, NICU admission, or neonatal death. Comparisons were performed using chi-square, Fisher’s exact, and t-tests as appropriate. Logistic regression estimated adjusted odds ratios (aOR) controlling for parity, mode of birth, insurance type, maternal age, and hypertensive disorders of pregnancy. RESULTS: Among 63,435 index births, 7403 (11.7%) were to Black birthing individuals, including 2427 (32.9%) Somali and 4976 (67.1%) non-Somali Black individuals. Somali individuals were older, more frequently multiparous, more likely to have public insurance, and had lower epidural and cesarean birth rates (all P≤.001). SMM during birth hospitalization was similar between groups. Six-week postpartum SMM was lower among Somali births (0.5% vs 1%, P=.021; aOR: 0.53, 95% CI: 0.26–0.99). Neonatal composite morbidity was modestly lower among Somali births compared to non-Somali Black births (15.0% vs 18.7%, P=.001; aOR: 0.85, 95% CI: 0.74–0.98). Subgroup analysis demonstrated no differences in SMM or neonatal composite outcomes between Somali individuals who used interpreter services and those who did not. CONCLUSION: In this single health system study, SMM during birth hospitalization was comparable between Somali and non-Somali Black birthing individuals, whereas postpartum severe maternal morbidity and neonatal composite morbidity were lower among Somali births. This within-diaspora comparison underscores the importance of examining heterogeneity within Black populations and suggests that maternal and neonatal outcomes may differ across Black subgroups despite shared structural disadvantage.
BACKGROUND: Female genital mutilation/cutting (FGM-C) affects more than 230 million women and girls worldwide and carries increased risk of adverse obstetrical outcomes, including obstetrical anal sphincter injury (OASIS). With growing global migration, obstetrical care providers may increasingly encounter individuals affected by FGM-C in historically low-prevalence settings such as the United States. Therefore, it is essential to understand the association between FGM-C and adverse obstetrical outcomes in settings such as the United States to inform evidence-based practice. OBJECTIVE: To estimate the association between FGM-C and OASIS, among inpatient, singleton, vaginal deliveries among people delivering in-hospital in the United States. The secondary objectives were to estimate the association between FGM-C and postpartum hemorrhage and prolonged second stage of labor in this population and the role of episiotomy in mitigating risk of OASIS in this population. STUDY DESIGN: We conducted a population-based, retrospective cohort study of pregnant individuals delivering singleton fetuses in the United States using the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) database (2016-2019, inclusive). Exposure and outcome variables were derived using International Classification of Diseases-10 disease and procedure codes. Weighted multivariate logistic regression models were used to estimate the odds ratio (OR) for the association between FGM-C and OASIS and secondary outcomes. RESULTS: During the study period, 2020,780 delivery-related discharges were captured, representing an estimated 10,168,193 singleton vaginal deliveries nationwide using the complex survey design of the NIS. A total of 795 (0.03%) individuals were diagnosed with FGM-C and 39,668 with OASIS (1.4%) during the study period. After adjusting for potential confounders, vaginal deliveries affected by FGM-C had 3.02 times the odds of sustaining OASIS (95% CI: 2.23-4.07), 1.99 times the odds of experiencing postpartum hemorrhage (95% CI: 1.45-2.73), and 2.33 times the odds of a prolonged second stage of labor (95% CI: 1.23-4.39) compared to unaffected individuals. Performance of episiotomy attenuated the risk of OASIS (aOR 1.12, 95% CI: 0.59-2.11). CONCLUSION: Singleton vaginal deliveries complicated by FGM-C have significantly increased odds of experiencing adverse obstetric outcomes, including OASIS, postpartum hemorrhage, and prolonged second stage of labor. Episiotomy may be protective against OASIS in this population.
BACKGROUND: Uterine fibroids (UF) are commonly associated with heavy menstrual bleeding (HMB) and anemia; however limited data are available on the prevalence of anemia in women with UF, with or without HMB, and the additional incremental burden of HMB and anemia in women with UF and the associated costs of care are unclear. OBJECTIVES: To describe the clinical and economic burden of anemia in women diagnosed with UF, including those with HMB, compared with a control cohort of women without UF or HMB. STUDY DESIGN: This was a retrospective observational study using claims data from the Merative MarketScan Commercial Database. The study included women aged 18-55 years newly diagnosed with UF. The first UF claim served as the index date, and women were followed over 12-month preindex and postindex periods. Patients with UF were categorized into cohorts based on the presence and order of HMB claims: UF only, UF then HMB (UF-HMB), and HMB then UF (HMB-UF). UF cohorts were then matched 1:1:1 on age. A control (non-UF/non-HMB) cohort comprising women with no claims for UF or HMB during the study period was identified and matched 5:1 to the 3 UF cohorts based on age. Cohorts were additionally classified based on the presence of anemia. Demographics were assessed at index; clinical characteristics, treatment characteristics for the UF cohorts, healthcare resource utilization, and cost outcomes were assessed during the preindex and postindex periods. RESULTS: The study included 22,057 women in each UF cohort and 110,285 women in the control cohort. After age-based matching, mean (SD) age was 43.5 (5.9) years for all cohorts. Postindex anemia was most common in women in the UF-HMB (32.0%) and HMB-UF (35.3%) cohorts compared with the UF only (14.3%) and control (4.4%) cohorts. During the postindex period, procedures including hysterectomy and blood transfusions were more common in women with anemia (UF only: 13.4% and 1.8%, respectively; UF-HMB: 37.8% and 7.9%; HMB-UF: 40.8% and 5.7%) compared with women without anemia (UF only: 11.1% and 0%; UF-HMB: 28.1% and 0.1%; HMB-UF: 30.3% and 0%). Allcause and obstetrics/gynecology-related total costs were generally higher in women with anemia compared with women without anemia in all cohorts in both the preindex and postindex periods. CONCLUSIONS: This analysis underscores the significant clinical and economic burden of anemia in women with UF, as well as women with UF and HMB. The findings highlight the necessity for early detection and proactive management of UF and associated anemia to mitigate severe complications and reduce healthcare costs.
OBJECTIVE Radical hysterectomy is widely performed for stage IB cervical cancer; however, a substantial number of patients require postoperative adjuvant therapy, resulting in dual-modality treatment. This study evaluated the predictive value of tumor size measured on magnetic resonance imaging (MRI) and serum squamous cell carcinoma (SCC) antigen levels for the need for postoperative adjuvant therapy. METHODS We retrospectively analyzed 191 patients with stage IB cervical SCC who underwent radical hysterectomy. Patients were also analyzed in a stage IB1 to IB2 cohort. The cut-off values of preoperative tumor size measured on MRI and serum SCC antigen levels for the need for postoperative adjuvant therapy were determined using receiver operating characteristic curve analysis. RESULTS A total of 104 patients (54.5%) received postoperative adjuvant therapy. Large tumor size measured on MRI and elevated serum SCC antigen levels were predictors of the need for postoperative adjuvant therapy. The optimal cut-off values were 3.2 cm and 2.3 ng/mL in the overall cohort, and 2.4 cm and 2.3 ng/mL in the stage IB1 to IB2 cohort. Patients were stratified into three risk groups according to the number of predictive factors. In the low-risk group (no predictors), 20 of 86 patients (23.3%) required postoperative adjuvant therapy. In the intermediate-risk group (one predictor), 46 of 64 patients (71.9%) required adjuvant therapy. In the high-risk group (two predictors), 38 of 41 patients (92.7%) received adjuvant therapy. Similar trends were observed in the stage IB1 to IB2 cohort, with increasing rates of adjuvant therapy across risk groups. CONCLUSION Preoperative tumor size measured on MRI and serum SCC antigen levels are useful predictors of the need for postoperative adjuvant therapy in stage IB cervical SCC. Their combination could assist in treatment planning and patient counseling.
