Abstract Background The Coronavirus Disease 2019 (COVID-19) pandemic disrupted the capacity of healthcare systems. This study aimed to provide a better understanding of the impact of the COVID-19 pandemic on sexual and reproductive healthcare (SRH) services. Methods We conducted a mixed-method cross-sectional study at the SRH services of the tertiary care university hospital of Verona, Veneto region, Italy. Questionnaires based on WHO validated tools were administered to all consecutive clients once per month for 11 months (December 2021 to November 2022) to assess SRH services availability and readiness. In-depth interviews (IDIs) have been used to understand participants’ perspectives. Results The questionnaire was completed by 100 clients (average age 35.34 years; sexually transmitted infection care service: n =49; abortion service: n =24, family planning and contraception service: n =16, and anti-violence service: n =11). All SRH services continued to operate without a shortage of supplies, although some facilities had relocation of staff and a location change. IDIs involved 25 clients at the abortion and family planning services, and 5 clients at the sexually transmitted infection care service. Most clients self-referred to SRH services and sought information online, which was described as helpful, clear, and informative. Remote consultation was the primary access method, allowing planning for in-person attendance after initial triage. This approach was appreciated and considered time-saving and facilitating. Slight delays or longer than anticipated waits were reported by some clients, although mainly in the initial pandemic phase. The relocation of facilities and the restriction of supportive persons were significant barriers to some SRH services. The risk of COVID-19 was perceived as low or less relevant than the reason for accessing SRH care, and it did not limit the decision to access. Conclusions Results of the present study reflect the importance of maintaining SRH services for clients during health emergencies. Expanding pre-existing remote services and innovations in SRH care delivery had a key role and were appreciated by clients. Telemedicine for initial triage or online consultations and prescriptions should be implemented in regular practice or predisposed for rapid implementation in emergencies, along with ensuring up-to-date information, particularly online.

BACKGROUND:Transgender and gender-diverse (TGD) people assigned female at birth (AFAB) increasingly seek reproductive and gynecologic care, yet evidence and clinical pathways remain variable across health systems, including in Europe. OBJECTIVES:The objective of this study was to synthesize evidence on fertility, pregnancy, gynecologic care, and access to care in TGD populations and to highlight practical implications for gender-affirming clinical practice, with attention to European settings. METHODS:A narrative review supported by a structured PubMed/MEDLINE search (January 1, 2014-May 31, 2025). Two reviewers screened 146 titles/abstracts; 58 full texts were assessed; and 31 publications were included. Nine primary studies reported quantitative pregnancy and/or assisted reproduction outcomes after prior testosterone exposure in AFAB TGD individuals. OUTCOME:Available data, largely small retrospective cohorts and case series, suggest that pregnancy and assisted reproduction are feasible after prior testosterone exposure, typically after temporary cessation. In studies with cisgender comparators, oocyte yield and embryology metrics appeared broadly comparable, but evidence remains heterogeneous and underpowered for robust safety conclusions. Survey-based studies indicate that more than half of pregnancies may be unintended. Barriers to fertility preservation (FP) and preventive gynecologic care include financial and structural constraints, limited provider training, and avoidance of pelvic examinations and cervical cancer screening. CONCLUSIONS AND OUTLOOK:Reproductive counseling, FP, contraception, and organ-based screening should be integrated into gender-affirming pathways using trauma-informed, patient-centered communication. Prospective multicenter studies and standardized outcome reporting are needed to better define safety, effectiveness, and equity of care.

Background and Objectives: Intrapartum clinical chorioamnionitis at term is a complication associated with adverse maternal and neonatal outcomes. We aimed to identify factors independently associated with severe histological chorioamnionitis in women with clinical chorioamnionitis at term and with severe histological chorioamnionitis accompanied by neonatal intensive care unit (NICU) admission, considered the most severe end of the spectrum. Materials and Methods: We retrospectively identified all women with a diagnosis of clinical chorioamnionitis during labor at term between 2017 and 2022. Maternal characteristics and maternal and neonatal outcomes were extracted from medical records. The study population was stratified by the presence or absence of histological chorioamnionitis. Results: Out of 12,332 women, 171 (1.4%) singleton pregnant women had an intrapartum diagnosis of clinical chorioamnionitis at term. A total of 96 (56.1%) were confirmed with severe histological chorioamnionitis. Thick meconium-stained amniotic fluid (MSAF) (OR = 5.88; 95% CI 1.12-30.86, p = 0.035) and advanced maternal age (OR = 1.14, 95% CI 1.01-1.29, p = 0.024) were independently associated with severe histologic chorioamnionitis. In women with severe acute histological chorioamnionitis, we observed a higher prevalence of neonatal NICU admission and longer NICU stay. Factors independently associated with severe histologic chorioamnionitis accompanied by adverse neonatal course (NICU admission) were maternal age, fetal tachycardia and thick meconium-stained amniotic fluid. Conclusions: The diagnosis of clinical chorioamnionitis has a low positive predictive value for intra-amniotic infection or inflammation. Factors such as maternal age, thick meconium-stained amniotic fluid and fetal tachycardia may help identify patients with underlying intra-amniotic infection and those at risk of worse perinatal outcomes. Improved identification may help avoid both over- and undertreatment and guide interventions aimed at preventing adverse neonatal outcomes.

OBJECTIVE:To evaluate the clinical impact of Sentinel Lymph Node (SLN) biopsy in women with preoperative diagnosis of Atypical Endometrial Hyperplasia/Endometrial Intraepithelial Neoplasia (AEH/EIN), focusing on surgical safety and feasibility and adjuvant treatment decisions. METHODS:Multicenter retrospective study which included 411 patients with preoperative diagnosis of AEH/EIN who underwent total hysterectomy between 2014 and 2025. Demographic, preoperative, surgical, pathological and adjuvant treatment data were collected from prospectively maintained databases and outcomes were compared between patients who underwent SLN biopsy and those who did not. Descriptive statistics were used. RESULTS:Occult endometrial cancer (EC) was diagnosed in 47% of overall patients at final pathology; of whom 16% was classified within the intermediate to high-risk cases. SLN mapping was associated with slightly longer operative time. SLN metastases were found in 4.7% of patients with EC. SLN assessment modified treatment decisions in 11 of 22 patients (50%) receiving adjuvant therapy within the SLN cohort. Positive SLN findings led to chemotherapy escalation in 5 patients, while negative SLN status supported chemotherapy omission in 6 high to intermediate risk cases. No patients in the non-SLN group received chemotherapy. CONCLUSION:SLN biopsy in AEH/EIN is a feasible and safe procedure that provides staging information in the subgroup with occult EC. Regardless of metastasis frequency, SLN status provides actionable prognostic information. Whether positive or negative, SLN findings refine risk stratification and may guide the escalation or de-escalation of adjuvant therapy, supporting the consideration of SLN biopsy in AEH/EIN patients.

End-of-life care raises complex ethical and legal questions shaped by national frameworks, cultural contexts, and personal beliefs. This comparative study explores how fifth-year medical students in Verona (Italy) and in Halle (Germany) understand and evaluate key end-of-life practices, including advance directives, withholding or withdrawing life-sustaining treatment, palliative care, medically assisted suicide, and life termination through drugs. The study also examines whether religiosity influences ethical orientations. A structured questionnaire consisting of 16 closed-ended items and one open question was administered to fifth-year medical students at the University of Verona and the University of Halle during the 2024–2025 academic year. Items assessed knowledge of legal frameworks, ethical attitudes, personal experiences with dying patients, and perceived educational preparedness. Descriptive statistics, cross-tabulations, and chi-square tests were used to compare cohorts, with statistical significance set at p < 0.05. A total of 259 valid responses were analyzed. Students in both countries showed strong consensus regarding the legitimacy and clinical usefulness of advance directives and the central role of palliative care. Acceptance of withholding or withdrawing treatment was high in both cohorts, though slightly higher in Germany. Marked differences emerged regarding life termination through drugs, with Italian students expressing more permissive and polarized positions and German students showing more moderate and cautious responses. Attitudes toward medically assisted suicide were broadly permissive in both groups, with religiosity emerging as a consistent predictor of more restrictive positions, particularly in Italy. While future physicians in both countries share core commitments to patient autonomy and palliative care, significant differences persist in their evaluation of practices intended to hasten death. These findings suggest that ethical orientations at the end of life are shaped not only by shared professional principles but also by national cultural environments and personal belief systems. Comparative research among medical students offers valuable insight into how medico-legal contexts and education influence emerging professional ethics.

BACKGROUND:In laparoscopic surgery, specimen retrieval can require enlarging abdominal incisions, reducing the minimally invasive benefits. Transvaginal specimen extraction (TVSE) can offer a safer, more cosmetic alternative for women. This systematic review and meta-analysis evaluated the safety and outcomes of TVSE compared with transabdominal extraction, regardless of surgical indication. METHODS:EMBASE, Scopus, PubMed, MEDLINE, Web of Science, and the Cochrane Library were searched from inception to April 2025. Studies were grouped by design, surgical specialty, and extraction method (port enlargement versus mini-laparotomy) to explore heterogeneity. RESULTS:Twenty-five studies were included for 2751 patients (1144 TVSE, 1607 transabdominal extraction) in general, urologic, or gynecologic surgery. TVSE was associated with lower postoperative pain (mean difference -0.98, 95%CI -1.30 to -0.66), rescue analgesia use (OR 0.38, 95%CI 0.28 to 0.51), postoperative complications (OR 0.55, 95%CI 0.34 to 0.89), shorter hospital stays (mean difference -1.04, 95%CI -1.77 to -0.30), and higher cosmetic satisfaction (mean difference 0.91, 95% CI 0.46 to 1.35), especially versus mini-laparotomy. Blood loss, intraoperative complications, and dyspareunia did not differ. CONCLUSION:TVSE is associated with improved postoperative outcomes when it replaces mini-laparotomy, whereas less benefit is observed versus laparoscopic port-site enlargement. Further randomized controlled trials are needed to confirm these findings.

Intimate partner violence (IPV) during pregnancy causes serious harm to both the mother and the child. The magnitude of the problem is likely underestimated due to the sensitive nature of the topic and lack of consensus on screening practices, including frequency, tools, and whether screening should be systematic or risk-based. This scoping review aimed to map existing screening tools and healthcare-based screening programmes for detecting IPV in European countries within antenatal and postpartum care. Joanna Briggs Institute methodology was used and reported following PRISMA-ScR guidelines. Seven databases (Embase, PsycINFO, SocINDEX, PubMed, Web of Science, Scopus, and CINAHL) were searched up to June 2025 to identify screening tools used in European countries. A quality assessment was conducted. To identify current screening programmes within antenatal and postpartum healthcare systems, representatives from 46 European countries were consulted. Twenty-four studies were included, and methodological quality ranged from low to serious risk of bias. Thirteen screening tools for physical, emotional, and sexual IPV were identified. No tools for stalking or digital violence were found. Most studies were cross-sectional. Data were received from 22 of 46 European countries (48

BACKGROUND:Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are rare neoplasms with unpredictable clinical behavior. Optimal management, particularly in reproductive-aged women, remains controversial, with limited data comparing the safety of fertility-sparing versus hysterectomy. METHODS:This multicentre retrospective cohort study included women aged 18-85 with histologically confirmed STUMP treated at 17 Italian gynecologic oncology centers from 2010 to 2023. Patients underwent either fertility-sparing surgery (myomectomy or hysteroscopic resection) or definitive surgery (hysterectomy ± salpingo-oophorectomy). Kaplan-Meier and Cox models were used to compare recurrence-free survival (RFS) and overall survival (OS). RESULTS:Median (range) follow-up was 51 (1-291) months. Among 401 women, 106 (26.4 %) received fertility-sparing treatment (mean [± SD] age: 35.3 ± 6.8 years) and 295 (73.6 %) underwent definitive surgery (mean [± SD] age: 47.7 ± 9.2). At total follow-up, recurrence occurred in 12.5 % of patients, predominantly within the pelvis. Median RFS was longer after definitive surgery than after fertility-sparing procedures (50.0 vs 42.5 months; HR 2.39 [95 % CI 1.36-4.19]), although this difference disappeared when benign (leiomyoma) recurrences were excluded (HR 1.74 [95 % CI 0.90-3.34]). At last available follow-up, 97.5 % of patients were alive, with no significant OS difference between treatment groups (HR 0.22 [95 % CI 0.27-1.79]). Outcomes were comparable across menopausal status and concurrent adnexal removal. CONCLUSION:Definitive surgery reduces recurrence risk, but long-term survival is similarly excellent after fertility-sparing surgery in appropriately selected women with STUMP. Conservative management represents a reasonable option for patients desiring fertility, provided they receive counseling regarding recurrence risk, diagnostic uncertainty, and the need for long-term surveillance.

To compare the da Vinci® X™ (Intuitive Surgical), Versius® (CMR Surgical), and Hugo™ RAS (Medtronic) robotic platforms for the procedure of hysterectomy. Prospective single-center non-randomized study. Referral center for gynecologic surgery. All consecutive adult women scheduled for elective laparoscopic hysterectomy between January and December 2024 were eligible. Enrolled patients were assigned to one of the three robotic platforms (1:1:1) based on the availability on the day of surgery, with a maximum of 50 procedures per platform. Optimal hysterectomy (composite outcome for performance), perioperative outcomes, and costs. The overall performance did not differ, with an optimal hysterectomy achieved in 29, 32, and 24

OBJECTIVE:To evaluate the detection rate, sensitivity, and negative predictive value (NPV) of sentinel lymph node (SLN) biopsy in patients with apparently early-stage epithelial ovarian cancer (EOC). METHODS:A systematic search of multiple electronic databases was conducted from inception to October 31, 2025. Studies reporting detection rate, sensitivity, and NPV of SLN biopsy in apparently early-stage EOC, with completion pelvic and para-aortic lymphadenectomy as reference standard, were included. Study selection, risk-of-bias assessment, and data extraction were independently performed by four reviewers. Pooled estimates with 95 % confidence intervals (CI) were calculated using random-effects models on a per-patient basis and by anatomical site. Heterogeneity was assessed using the I2 statistic. RESULTS:Fourteen studies comprising 365 patients were included. Most studies used indocyanine green injected into the infundibulopelvic ligament for para-aortic mapping and the utero-ovarian ligament for pelvic mapping. The pooled para-aortic detection rate was 79.9 % (95 %CI 66.1-91.4 %; I2 = 74 %), while the pelvic detection rate was 42.7 % (95 %CI 28.5-57.3 %; I2 = 71 %). Pooled NPV was 100 % in both para-aortic and pelvic regions (I2 = 0 %). Sensitivity was 97.8 % (95 %CI 84.0-100 %) in the para-aortic area and 100 % (95 %CI 75.3-100 %) in the pelvis. CONCLUSIONS:In apparently early-stage EOC, SLN biopsy shows acceptable para-aortic detection but limited pelvic detection. Nonetheless, sensitivity and NPV indicate high diagnostic accuracy. Further studies are needed to optimize pelvic mapping strategies and confirm these findings. At present, sentinel lymph node mapping in apparently early-stage epithelial ovarian cancer should be regarded as investigational and not as standard of care.

BACKGROUND:The freeze-all strategy has been increasingly adopted in in vitro fertilization (IVF) to improve endometrial receptivity and reduce the risk of ovarian hyperstimulation syndrome (OHSS). However, its benefit in women predicted to be hyper-responders who ultimately exhibit a moderate ovarian response remains unclear. METHODS:This study retrospectively included 197 IVF cycles between January 2021 and December 2025 in women with anti-Müllerian hormone (AMH) > 3.4 ng/mL and ≤ 14 mature oocytes retrieved after hCG triggering. Patients were stratified into fresh embryo transfer (n = 129) and freeze-all (n = 68) groups. Primary outcomes were OHSS incidence, biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate and live birth rate after the first embryo transfer. Multivariable logistic regression analysis was performed adjusting for potential confounders. RESULTS:AMH levels and ovarian stimulation parameters were significantly higher in the freeze-all group. No cases of OHSS were observed in either group. Reproductive outcomes did not differ significantly between groups. Biochemical pregnancy rate was 38.5% in the freeze-all group versus 49.6% in the fresh group (p = 0.20), clinical pregnancy rate was 29.2% versus 39.1% (p = 0.24), and live birth rate was 20.0% versus 27.8% (p = 0.32), respectively. Miscarriage rates were similar (9.2% vs 10.4%, p = 1.00). Multivariable analysis confirmed that the freeze-all strategy was not significantly associated with clinical pregnancy, live birth, or miscarriage. CONCLUSION:In women predicted to be hyper-responders but exhibiting a moderate ovarian response, no statistically significant differences in reproductive outcomes or OHSS incidence were observed between the freeze-all and fresh embryo transfer strategies. These findings suggest that fresh embryo transfer may represent a reasonable option in carefully selected patients.

OBJECTIVE:The main objective is to investigate the association between periconceptional or pregnancy exposure to hair dyes and obstetric and pediatric outcomes. METHODS:A systematic literature search was conducted in Scopus, PubMed/MEDLINE, Web of Science, and CINAHL Ultimate from database inception to August 31, 2024. Studies were included based on PECO criteria: pregnant women and their newborns (population), exposure to hair dyes during periconception or pregnancy (exposure), no exposure (comparator), and any obstetric or pediatric complication (outcome). After screening 311 records and removing duplicates, 179 abstracts were reviewed, 29 full texts assessed, and 20 observational studies included. Four reviewers assessed bias and extracted data. Meta-analyses were performed using a random-effects model when appropriate. RESULTS:Few studies distinguished hair dye types or exposure timing. Periconceptional or pregnancy hair dye exposure was reported to be associated with stillbirth, low birth weight (Pooled OR 2.30; 95% CI 1.24-4.25), and low hormone levels; in the offspring, with allergic rhinitis, leukemia, neuroblastoma (pooled OR 1.79; 95% CI 1.20-2.68), Wilms tumor (pooled OR 6.00; 95% CI 1.22-29.46), germ cell tumors, and membranous ventricular septal defect. No association was observed with asthma (pooled OR 1.19; 95% CI 0.86-1.65), childhood brain tumors (pooled OR 1.06; 95% CI 0.88-1.28), or mental retardation. Based on the GRADE assessment, the certainty of evidence was low or very low. CONCLUSIONS:Current observational evidence suggests a potential association between periconceptional or pregnancy exposure to hair dyes and some adverse obstetric and pediatric outcomes. However, given the low and very low certainty of evidence and the retrospective nature of most included studies, these findings are hypothesis-generating and preclude causal inference. Further prospective studies are needed to confirm these preliminary associations and define the specific chemicals involved.

BACKGROUND:We evaluated if the number of days of exposure to a hemodynamically significant patent ductus arteriosus (hsPDA) is associated with bronchopulmonary dysplasia (BPD) and/or mortality in preterm infants. METHODS:We conducted a retrospective cohort study of preterm infants (birth weight ≤ 1500 g or gestational age < 30 weeks), admitted between January 2017 to December 2022. HsPDA was defined using Neonatologist Performed Echocardiography criteria. Logistic regression was used to assess the relationship between the duration of hsPDA and BPD/death. Additional analyses explored non-linear associations using penalized splines and quadratic functions. RESULTS:We included 424 neonates: 204 developed BPD/death. The duration of hsPDA was associated to increased risk of BPD/death (OR = 1.67, 95% CI 1.17-2.56, p < 0.001), adjusted for birth weight, 5' APGAR score, IVH, durations of mechanical and non-invasive ventilation. We found a progressive increase in the OR for BPD/death during the first week of exposure, followed by a plateau. CONCLUSION:The duration of exposure to hsPDA is associated with adverse neonatal outcomes, (BPD/ death). The risk progressively increases during the first week of exposure followed by a plateau. These findings suggest that the first week of exposure may represent a critical window of opportunity. IMPACT:The duration of exposure to a hemodynamically significant PDA is associated with an increased risk of BPD/death. This risk progressively rises during the first week of exposure and then plateaus thereafter. This study explores the association between BPD/death and the duration of exposure to a hemodynamically significant PDA, longitudinally assessed using a comprehensive echocardiographic protocol. The findings suggest the first week of exposure to a hemodynamically significant PDA is a critical window for interventions to impact outcomes. Future research should focus on identifying high-risk population and developing targeted treatments during this pivotal period.