OBJECTIVE: To assess racial and ethnic disparities in preterm delivery in the US and evaluate whether insurance type modifies these associations. METHODS: We analyzed National Center for Health Statistics natality data (...OBJECTIVE: To assess racial and ethnic disparities in preterm delivery in the US and evaluate whether insurance type modifies these associations. METHODS: We analyzed National Center for Health Statistics natality data (2018-2024) comprising 24,918,700 singleton live births. Preterm delivery was defined as birth before 37 completed weeks of gestation. Multivariable logistic regression with robust variance was used to estimate adjusted odds ratios, predicted probabilities, and absolute risk differences across race/ethnicity and insurance categories, adjusting for maternal sociodemographic, clinical, and obstetric factors. RESULTS: Overall, 2,134,329 of 24,918,700 singleton live births (8.6%) were preterm during the study period, with annual rates remaining stable between 8.23% and 8.75%. In multivariable-adjusted analyses, non-Hispanic Black women had the highest odds of preterm delivery (adjusted odds ratio [aOR], 1.40; 95% confidence interval [CI]: 1.39-1.40), compared with non-Hispanic White women. Racial and ethnic disparities persisted across all insurance strata; among uninsured women, non-Hispanic Black women had the largest absolute risk difference relative to non-Hispanic White women (5.74 percentage points; 95% CI: 5.52-5.96), which was attenuated but remained significant among Medicaid (2.38 percentage points; 95% CI: 2.33-2.43) and privately insured women (2.66 percentage points; 95% CI: 2.60-2.73). Insurance coverage attenuated but did not eliminate these disparities. CONCLUSION: Racial and ethnic disparities in preterm delivery persist in the US despite insurance coverage, underscoring the need for policies that address both healthcare access and structural determinants of maternal health.
OBJECTIVE: This study explores pain at intrauterine device (IUD) placement in a large Brazilian cohort. METHODS: We undertook a cross-sectional analysis of health records from individuals aged 18 to 45 years who underwen...OBJECTIVE: This study explores pain at intrauterine device (IUD) placement in a large Brazilian cohort. METHODS: We undertook a cross-sectional analysis of health records from individuals aged 18 to 45 years who underwent IUD placements between 2022 and 2024 at the Department of Obstetrics and Gynecology, Universidade Estadual de Campinas Faculty of Medical Sciences, Campinas, Brazil. Insertion pain was measured immediately after the procedure using a 10-cm visual analogue scale (VAS). Scores were classified as no pain (0), mild pain (1-3), moderate pain (4-6), and severe pain (≥7). Pain relief included analgesics, antispasmodics, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids. We used multivariable regression to assess the association between pre-insertion pain relief and pain during placement. RESULTS: We evaluated 6974 individuals. Of 7259 fittings analyzed, 228 (3%) occurred with no pain, 1121 (15%) with mild pain, 2003 (28%) with moderate pain, and 3907 (54%) with severe pain (median [interquartile range] pain score of 7.0 [5.0-8.0]). Clinicians provided pain relief in 429 (6%) of insertions (largely antispasmodics and NSAIDs). After adjusting for age and parity, antispasmodics were associated with moderate to severe pain (adjusted odds ratio [aOR] 1.75; 95% confidence interval: 1.15; 2.68). CONCLUSION: Our findings suggest that moderate to severe pain was experienced in 5910 (81%) of IUD insertions, in contrast with the 5% estimate in national guidelines. We also found evidence that pre-insertion antispasmodic medication was associated with higher moderate to severe pain. Our findings emphasize the need to update guidelines to recognize IUD insertion pain and provide options to manage discomfort.
BACKGROUND: Intraoperative ureteral injury, although uncommon, can result in significant morbidity and medicolegal consequences, particularly during complex gynecologic procedures such as endometriosis excision and prola...BACKGROUND: Intraoperative ureteral injury, although uncommon, can result in significant morbidity and medicolegal consequences, particularly during complex gynecologic procedures such as endometriosis excision and prolapse repair. Conventional ureteral identification techniques, including stents and methylene blue, have recognized limitations. Indocyanine green (ICG) with near-infrared fluorescence (NIRF) imaging enables real-time ureter visualization, but clinical evidence remains scattered. OBJECTIVE: To systematically evaluate the feasibility, safety, and outcomes of intraureteral ICG for ureteral identification in gynecologic surgery. SEARCH STRATEGY: A systematic literature search of multiple databases was performed for studies published between 2000 and 2025 using keywords related to ICG, ureter, gynecologic surgery, and intraoperative fluorescence. SELECTION CRITERIA: Studies reporting intraureteral ICG use for ureteral identification during gynecologic surgery were eligible. Studies involving fewer than 10 patients were excluded. DATA COLLECTION AND ANALYSIS: Data were extracted on ureter visualization success, ureteral injury, ICG-related complications, and operative outcomes. Risk of bias was assessed using the ROBINS-I, and certainty of evidence was evaluated using GRADE. RESULTS: Of 778 records identified, seven studies comprising 299 patients met the inclusion criteria. All studies reported successful ureter visualization, with no ureteral injuries or ICG-related complications. Secondary outcomes, including estimated blood loss and operative time, were inconsistently reported, with very low certainty of evidence. CONCLUSIONS: Intraureteral ICG appears to consistently enable safe, real-time visualization during gynecologic surgery, including complex cases. Although safety and visualization outcomes are encouraging, the evidence is limited. Prospective observational studies with standardized outcome reporting are needed to inform future practice. PROSPERO REGISTRATION: CRD420251110017.
OBJECTIVE: While cardiometabolic comorbidities have been well established in adults with polycystic ovary syndrome (PCOS), it remains unclear whether the early signs of cardiovascular morbidity emerge during adolescence....OBJECTIVE: While cardiometabolic comorbidities have been well established in adults with polycystic ovary syndrome (PCOS), it remains unclear whether the early signs of cardiovascular morbidity emerge during adolescence. This study aimed to investigate whether metabolic and cardiovascular alterations begin in adolescents with PCOS. METHODS: The study included adolescents with PCOS and age and body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) matched healthy controls who were further grouped based on weight status as overweight/obese and normal weight. All participants underwent metabolic assessment through physical examination, laboratory tests, conventional echocardiography, tissue Doppler imaging, strain echocardiography, and 24-h Holter monitoring. RESULTS: The PCOS group (n = 33) consisted of 19 overweight/obese and 14 normal-weight participants, while the control group (n = 43) included 20 overweight/obese and 23 normal-weight participants. Compared to controls, the PCOS group exhibited higher waist-to-hip ratio, liver enzymes, triglycerides, triglyceride-glucose index, and lower high-density lipoprotein cholesterol (P < 0.05). Among BMI subgroups, overweight/obese PCOS group had the highest insulin and homeostasis model assessment of insulin resistance levels compared to all other groups. The PCOS group showed higher left atrial (LA) end-systolic diameter, LA/aortic ratio, and lower left ventricular global peak longitudinal strain in the apical four-chamber view than controls (P < 0.05). Among BMI subgroups, the combination of PCOS and overweight/obesity was associated with the most unfavorable metabolic and cardiovascular profiles. The markers of LA diameter, LA/aortic ratio, and left ventricular mass were highest in the overweight/obese PCOS group. CONCLUSION: Selected metabolic and echocardiographic markers showed modest differences when PCOS coexisted with obesity, suggesting a potentially higher cardiometabolic risk compared with PCOS or obesity alone. Early identification and targeted management are essential to mitigate long-term cardiometabolic complications in this high-risk group.
OBJECTIVE: To determine the incidence of relaparotomy after cesarean delivery in a tertiary referral center, and to evaluate its indications, timing, and association with maternal morbidity. METHODS: This retrospective s...OBJECTIVE: To determine the incidence of relaparotomy after cesarean delivery in a tertiary referral center, and to evaluate its indications, timing, and association with maternal morbidity. METHODS: This retrospective study included women who underwent relaparotomy within 30 days following cesarean delivery between June 2020 and October 2025 in a tertiary center managing high-risk obstetric cases. Baseline maternal, obstetric, and operative characteristics were recorded. Relaparotomy indications were analyzed according to timing and primary cesarean indication. Maternal morbidity, hospital stay, and intensive care unit (ICU) admission were assessed. An exploratory Poisson regression analysis was performed to evaluate potential associations between baseline variables and repeated relaparotomy. Multivariable linear regression was used to analyze factors associated with perioperative hemoglobin change. RESULTS: Among 44 486 cesarean deliveries, 83 women required relaparotomy (0.19%). Uterine atony and hemorrhage were the most common indications for relaparotomy in the early postoperative period, whereas infectious complications became more frequent later. Bladder injury and intra-abdominal abscess were associated with longer hospitalization, while ICU stay did not differ significantly by indication. Repeated relaparotomy occurred in 15.7% of patients; no baseline maternal or operative variables were significantly associated with this outcome in exploratory analysis. Relaparotomies for non-atony bleeding were associated with greater hemoglobin decline, longer operative duration, and increased transfusion requirement. Maternal morbidity occurred in 20.5% of cases, and one maternal death was observed in a patient with placenta accreta spectrum complicated by hemorrhage. CONCLUSION: Relaparotomy after cesarean delivery, although rare, represents a severe postoperative event associated with substantial maternal morbidity. It is not limited to technically complex index procedures and may follow apparently uncomplicated surgeries. The predominance of hemorrhagic causes early and infectious causes later underscores the need for extended postoperative surveillance. Effective hemostatic control, early recognition of infection, and management in experienced tertiary centers are central to improving maternal outcomes.
OBJECTIVE: Gynecologic examinations often provoke anxiety, embarrassment, and a perceived loss of control. Valid, patient-focused tools that specifically quantify examination-related anxiety remain limited. This study de...OBJECTIVE: Gynecologic examinations often provoke anxiety, embarrassment, and a perceived loss of control. Valid, patient-focused tools that specifically quantify examination-related anxiety remain limited. This study developed and validated the gynecologic examination anxiety scale (GEAS). METHODS: In a methodological study conducted in Turkey (October 1, 2023-April 1, 2024), women aged 18-65 years with prior gynecologic examination experience completed an online survey disseminated via social networks. Item generation yielded 44 candidates. Content validity was assessed by 17 experts using the Lawshe approach; four items were removed and minor edits followed a 10-person cognitive pretest, producing a 40-item draft. Psychometric evaluation comprised exploratory factor analysis and confirmatory factor analysis, plus reliability testing. RESULTS: Data from 400 participants were analyzed. Sampling adequacy was acceptable (Kaiser-Meyer-Olkin (KMO) = 0.835; Bartlett's test of sphericity p < 0.001). Iterative refinement produced a 20-item, five-factor solution-healthcare personnel approach (4 items), healthcare personnel experience (5), negative experiences (5), hygiene concerns (3), and individual attitudes (3) explaining 60.18% of variance. Model fit was acceptable (chi-square/degrees of freedom [χ/df] = 2.722; goodness of fit index [GFI] = 0.903; adjusted goodness of fit index [AGFI] = 0.872; comparative fit index [CFI] = 0.905; Tucker-Lewis index [TLI] = 0.908; root mean square error of approximation [RMSEA] = 0.066; standardized root mean square residual [SRMR] = 0.080). Internal consistency was good for the total scale (α = 0.867) and adequate across subscales (α = 0.685-0.818). Temporal stability was excellent (ICC = 0.897; n = 105 retested ≥2 weeks). CONCLUSION: The GEAS is a brief, valid, and reliable instrument that captures anxiety specific to gynecologic examination and is suitable for clinic-level screening/triage, tailoring of trauma-informed care, and quality-improvement efforts.
OBJECTIVE: To assess maternal infection following prelabor rupture of membranes (PROM) at term in a setting where active management is recommended, and to identify associated risk factors. METHODS: A retrospective cohort...OBJECTIVE: To assess maternal infection following prelabor rupture of membranes (PROM) at term in a setting where active management is recommended, and to identify associated risk factors. METHODS: A retrospective cohort study was conducted including pregnant women admitted to a Portuguese tertiary care center where immediate induction of labor is recommended following term PROM. Women with singleton term pregnancies complicated by PROM, who delivered between January 2020 and July 2023, were included. The primary outcome was intrauterine maternal infection, defined as clinical chorioamnionitis and/or endometritis. A comparative analysis was conducted between groups, based on latency to delivery (≤12 h vs. >12 h). A multivariable logistic regression model was used to evaluate the influence of confounding factors on the association between latency and the primary outcome. RESULTS: A total of 759 patients with singleton term pregnancies complicated by PROM were included, corresponding to a prevalence of 9.7%. Chorioamnionitis and/or endometritis occurred in 40 patients (5.3%), with significantly different rates between the up to 12 h and the more than 12 h latency groups (0.9% vs. 7.3%, P < 0.001). Latency of more than 12 h was independently associated with maternal infection (odds ratio 9.0; 95% confidence interval 2.1-39.2). Group B streptococcus colonization status was not associated with increased maternal infection risk. Neonatal outcomes were similar between groups. CONCLUSION: This study demonstrates the increased risk of maternal infection when latency exceeds 12 h following term PROM, supporting the rationale for active management strategies and highlighting the need to evaluate additional prophylactic measures.
High dose valacyclovir treatment of pregnant women has become a common treatment for primary CMV infection, to prevent vertical transmission to the fetus. We present a case of a healthy young pregnant female with primary...High dose valacyclovir treatment of pregnant women has become a common treatment for primary CMV infection, to prevent vertical transmission to the fetus. We present a case of a healthy young pregnant female with primary CMV infection during the first trimester who was diagnosed with acute kidney injury secondary to valacyclovir treatment. This case serves as a reminder to clinicians that prescription of high dose valacyclovir, to prevent vertical transmission of CMV to the fetus, carries a risk of approximately 1% of AKI.
OBJECTIVE: To detail the attendance of female Irish Travellers at the national Sexual Assault Treatment Unit (SATU) network. METHODS: Retrospective cross-sectional study examining the attendance of female patients who id...OBJECTIVE: To detail the attendance of female Irish Travellers at the national Sexual Assault Treatment Unit (SATU) network. METHODS: Retrospective cross-sectional study examining the attendance of female patients who identified as members of the Irish Traveller community at the national SATU network between 2017 and 2023 and comparing them with all other female attenders. RESULTS: There were 5942 female attendances during the study period, of which 54 were Irish Traveller women with a mean age of 25.9 ± 11.5 years; with 35 (64.8%) presenting within 7 days of assault. Most attended with police involvement (40, 74.1%), assaults most commonly occurred in the victim's home (14, 25.9%) or outdoors (13, 24.1%), and perpetrators were frequently family members (13, 24.1%), intimate/ex-intimate partners (12 combined, 22.2%), acquaintances of more than 24 h (8, 14.8%), or strangers (9, 16.7%). Compared with other female attenders, Irish Traveller women were significantly less likely to present within 24 h (24.1% vs 39.7%; odds ratio [OR] 0.48 P = 0.02) and to report alcohol use in the preceding 24 h (OR 0.33, P < 0.001), but were significantly more likely to report a family member (OR 8.25, P < 0.001) or an intimate/ex-intimate partner (OR 2.04, P = 0.03) as the assailant. CONCLUSION: This study provides the first national analysis of Irish Traveller women attending SATU in Ireland and highlights distinct differences in the patterns of perpetrator relationship and timing of presentation compared with other female attenders.
OBJECTIVE: To compare pain, menstrual flow, and quality of life (QoL) between women undergoing surgery for endometriosis only compared with women with endometriosis and coexisting adenomyosis. METHODS: A cross-sectional...OBJECTIVE: To compare pain, menstrual flow, and quality of life (QoL) between women undergoing surgery for endometriosis only compared with women with endometriosis and coexisting adenomyosis. METHODS: A cross-sectional study, set in two tertiary hospitals, of reproductive-aged women (18-50 years) with a preoperative imaging diagnosis of endometriosis and/or adenomyosis and clinical indication for laparoscopy; all diagnoses were confirmed histologically. Groups were divided into pure endometriosis (n = 60) and endometriosis plus adenomyosis (n = 59) groups. Women responded to standardized questionnaires about demographics, gynecologic, history, and symptoms. Pain was graded by visual analog scale. Menstrual blood loss was assessed using the Pictorial Blood Loss Assessment Chart (PBAC). QoL was measured by the 36-Item Short Form Survey (SF-36) questionnaire. Surgical findings and the American Association of Gynecologic Laparoscopists classification were recorded. MAIN RESULTS: We measured pain intensity, PBAC score and bleeding duration, and SF-36 domains. The adenomyosis group was older (42.3 vs. 37.7 years, P = 0.001), reported longer menstrual bleeding duration (10.5 vs. 6.7 days), and had more cyclical bowel changes (55% vs. 28%). The groups did not differ in overall pain scores, infertility, PBAC categories, or SF-36 domains. In multivariable analysis, older age at laparoscopy (odds ratio [OR], 1.15 [95% confidence interval (CI), 1.06-1.26]; P = 0.002) and longer menstrual bleeding duration (OR, 1.09 [95% CI, 1.02-1.17]; P = 0.010) independently increased the odds of adenomyosis; partial cul-de-sac obliteration was also associated with adenomyosis, whereas complete obliteration was more frequent in pure endometriosis. CONCLUSION: In patients with endometriosis, coexisting adenomyosis did not add to pain or worsen QoL but was linked to longer bleeding and increased bowel symptoms. Management should be individualized and guided primarily by symptom burden and life impact rather than imaging labels alone.
OBJECTIVE: To assess the concordance between pre- and postoperative pathology in patients with endometrial intraepithelial neoplasia (EIN) undergoing hysterectomy, and identify predictors of malignancy, including samplin...OBJECTIVE: To assess the concordance between pre- and postoperative pathology in patients with endometrial intraepithelial neoplasia (EIN) undergoing hysterectomy, and identify predictors of malignancy, including sampling method, progestin therapy, and surgical timing. METHODS: A retrospective cohort study was conducted at a tertiary care academic center in Montreal, Canada, from January 2010 to July 2023. Patients undergoing hysterectomy for EIN were included. Demographics, progestin therapy, sampling method, time from biopsy to surgery, operative details, and final pathology were collected. Logistic regression was used to identify factors associated with malignant or benign outcomes. RESULTS: A total of 319 patients were included; 76 received preoperative progestins (medicated group), and 243 did not (unmedicated group). Pathology concordance was 71.2% overall (72.8% unmedicated, 65.8% medicated). Malignancy was found in 11.6% (12.8% unmedicated, 7.9% medicated); benign pathology in 17.2% (14.4% unmedicated, 26.3% medicated). Sampling method was not associated with concordance. In progestin-naïve patients, lower body mass index (BMI) (odds ratio [OR] 2.91, 95% confidence interval [CI]: 1.18-7.13) and premenopausal status (OR 2.20, 95% CI: 1.06-4.58) were associated with benign pathology. In progestin-treated patients, older age (OR 1.10, 95% CI: 1.01-1.22) and menopausal hormone therapy use (OR 16.85, 95% CI: 1.85-218.46) predicted malignancy, while longer time to surgery was associated with benign pathology (OR 2.50, 95% CI: 1.04-6.41). CONCLUSION: Concordance between preoperative EIN diagnosis and final hysterectomy pathology was 65.8%-72.8%, depending on progestin therapy. These findings highlight the importance of personalized management strategies in patients with EIN, with attention to patient preference, their risk factors, and treatment response.
OBJECTIVE: To evaluate the gestational weight gain (GWG) in normal pregnancy and pregnancy-related morbidities in a cohort of South Indian pregnant women in order to address the lack of data on population-specific Indian...OBJECTIVE: To evaluate the gestational weight gain (GWG) in normal pregnancy and pregnancy-related morbidities in a cohort of South Indian pregnant women in order to address the lack of data on population-specific Indian GWG ranges. METHOD: This observational study included pregnant women who delivered in KAHER's Dr. Prabhakar Kore Charitable Hospital, Belagavi. A univariate regression model was used to study the association of excess and suboptimal GWG with the occurrence of morbid outcomes in pregnancy. RESULTS: Among 3603 deliveries, 2003 women were screened for eligibility, and 350 participants were included based on the inclusion criteria. Participants were categorized into two groups: normal outcomes (104; 29.7%), and outcomes with morbidities (246; 70.3%). Excess GWG was observed in various morbidities: macrosomia (15.40 ± 5.35 kg), diabetes in pregnancy (12.96 ± 5.86 kg), pregnancy-induced hypertension (12.91 ± 4.97 kg), maternal intensive care unit (ICU) admissions (12.16 ± 4.2 kg), and emergency lower segment cesarean (11.21 ± 4.75 kg) compared with GWG in women with normal outcome. Suboptimal GWG was observed in other morbidities: low birth weight (10.24 ± 4.23 kg), stillbirth (9 ± 5.77 kg), neonatal ICU admission (8.58 ± 3.34 kg), and fetal growth restriction (8.71 ± 3.15 kg). CONCLUSION: The mean GWG in the South Indian cohort of pregnant women was lower than the IOM (Institute of Medicine) recommendations. India-specific GWG guidelines are needed to optimize maternal and neonatal health through evidence-based prenatal care strategies.
OBJECTIVE: To study perioperative and postoperative complications of a standardized ultrasound-guided hysteroscopic treatment for complete septate uterus with duplicated cervices and non-obstructive longitudinal vaginal...OBJECTIVE: To study perioperative and postoperative complications of a standardized ultrasound-guided hysteroscopic treatment for complete septate uterus with duplicated cervices and non-obstructive longitudinal vaginal septum, and to evaluate operative time, symptom changes, and reproductive outcomes. METHODS: Between January 2021 and May 2025, patients diagnosed with complete septate uterus, duplicated cervices, and non-obstructive longitudinal vaginal septum at a tertiary referral center underwent hysteroscopic resection of the uterine and vaginal septum using a 15 Fr bipolar mini-resectoscope under real-time ultrasound guidance, with preservation of the duplicated cervices. Primary outcomes were perioperative and postoperative complications. Secondary outcomes included operative time trends over consecutive cases, symptom changes before and after surgery, and reproductive outcomes (clinical pregnancy rate, live birth rate, miscarriage rate, and pregnancy-related complications). RESULTS: Twenty-eight patients were included. Surgical correction was successfully completed in all cases, with no perioperative or postoperative complications. Median operative time was 61.5 min (range 21-94 min) and decreased modestly over consecutive procedures. At follow up, all patients showed a regular triangular uterine cavity on three-dimensional transvaginal ultrasound. Median follow up was 24 months (range 3-54 months). Symptoms improved in nearly all patients; only one patient (3.5%) reported persistent dyspareunia. Among the 11 patients who attempted conception, the clinical pregnancy rate was 100% (11/11). The live birth rate per pregnancy was 63.6% (7/11), with two pregnancies ongoing at last follow up. CONCLUSION: This standardized ultrasound-guided hysteroscopic approach using a 15 Fr bipolar mini-resectoscope for the treatment of complete septate uterus with duplicated cervices and non-obstructive longitudinal vaginal septum appears safe and reproducible, with favorable anatomic, symptom, and reproductive outcomes.
OBJECTIVE: This study aimed to determine the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in women with cervical cancer infected with HIV. METHODS: This retrospective cohort study included women with cervical...OBJECTIVE: This study aimed to determine the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in women with cervical cancer infected with HIV. METHODS: This retrospective cohort study included women with cervical cancer with HIV infection who underwent primary treatment at a tertiary hospital in southern Thailand between 2005 and 2019. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to determine the independent factors associated with OS and PFS. RESULTS: Among 100 patients (median follow-up time 37.63 months), the 5-year OS and PFS rates were 64.5% (95% confidence interval [CI]: 55.0-75.6) and 58.2% (95% CI: 48.6-69.6), respectively. In the multivariate analysis, high NLR (hazard ratio [HR]: 3.53, 95% CI: 1.58-7.91, P = 0.002) and low equivalent total dose in 2 Gy fractions at point A (HR 2.14, 95% CI: 1.02-4.49, P = 0.045) were independent predictors of worse OS, while poor performance status (HR 6.73, 95% CI: 1.93-23.56, P = 0.003), adenocarcinoma histology (HR 3.32, 95% CI: 1.43-7.72, P = 0.005), and high NLR (HR 4.04, 95% CI: 1.87-8.73, P < 0.001) were independent predictors of worse PFS. CONCLUSION: High NLR independently predicts poor OS and PFS in women with cervical cancer with HIV.