Assisted reproductive technology (ART) protocols can lead to a serious and potentially life-threatening complication known as ovarian hyperstimulation syndrome (OHSS). The present study investigated and compared the effects of gonadotropin-releasing hormone (GnRH) antagonist (GnRH-ant) administration over 3-day and 7-day periods in women at high risk for OHSS.

In this prospective randomized controlled pilot trial, an antagonist protocol was employed as part of ART in 41 patients aged 18 to 40 who were referred to the Infertility Center. After egg retrieval, subjects in group 1 received cabergoline in combination with 7 days of cetrorelix (one subcutaneous ampoule of cetrorelix once daily), while participants in group 2 received cabergoline along with 3 days of cetrorelix (one subcutaneous ampoule daily). Upon enrollment, participants were administered cabergoline tablets (Cabergolex 0.5 mg) at a dose of 0.5 mg orally at bedtime for 8 consecutive days. Ultrasound and clinical examinations were performed on the day of oocyte retrieval and on days 4, 8, and 14 thereafter to detect the occurrence of OHSS. Data were analyzed using SPSS version 22, with independent samples t-test and Chi-square test conducted at a significance level of <0.05.

The patients in the 3-day treatment group were aged between 30.30 ± 6.46 years, while those in the 7-day treatment group were between 29.09 ± 5.59 years, with no statistically significant difference between themean groups (p = 0.528). No hospitalizations were necessary in either the 3-day and 7-day treatment groups, and no cases of severe OHSS were observed. Moderate OHSS occurred in 6 patients (20%) in the 3-day treatment group and 5 patients (23.8%) in the 7-day treatment group, with no statistically significant difference between the groups (p = 0.768).

A 3-day treatment appears to be as effective as a 7-day treatment in preventing OHSS.

This study is registered on the Iranian Registry of Clinical Trials (IRCT) at https://trialsearch.who.int/Trial2.aspx?TrialID=IRCT20201126049497N1 (registration number: IRCT20201126049497N1).

Intrauterine adhesions (IUAs) are primarily addressed through hysteroscopic surgery, and the clinical application of self-cross-linked sodium hyaluronate gel has progressively gained traction to prevent postoperative recurrence, alterations in uterine morphology, and menstrual irregularities. Clinicians frequently employ sodium hyaluronate gel in combination with an intrauterine device (IUD) or balloon; however, the precise effectiveness of these combined approaches warrants further investigation. Accordingly, this study aimed to synthesize the outcomes of various treatment modalities reported in existing research and summarize the outcome measures employed, thereby providing valuable insights and references for the field.

Our findings indicate that using self-cross-linked sodium hyaluronate gel alone significantly reduces the severity of adhesions in patients with uterine adhesions, but has no considerable effect on those with mild adhesions. The postoperative recurrence rate of adhesions was significantly lower in patients who received a combined therapy of a gel and a uterine balloon or IUD, compared to those treated with the gel alone. Additionally, the combined gel and electrophysiological techniques enhanced local blood circulation in the pelvic floor and mitigated scar tissue formation in the uterus, reducing IUAs. However, none of the three treatment modalities demonstrated a significant impact on the final pregnancy outcomes of the patients.

Self-cross-linked sodium hyaluronate gel proves effective in preventing postoperative recurrence in patients with IUAs; however, further research is required to elucidate the impact of these gels on patients with mild versus severe adhesions. Future studies should consider conducting high-quality, large-scale randomized controlled trials to compare the therapeutic efficacy of these approaches, thereby advancing their clinical application.

Depression during pregnancy can have serious negative effects on the health of both the woman and the fetus. Therefore, studying the risk factors associated with depression in pregnancy is important for timely interventions and prevention. This study aimed to comprehensively identify the risk factors of depression during pregnancy and construct and verify the effectiveness of a prediction model to provide a basis for early prevention and intervention of depression during pregnancy.

A total of 630 pregnant women who underwent regular prenatal checkups at Jinshan Central Hospital Affiliated to Shanghai University of Medicine & Health Sciences from January 2020 to October 2023 were included. The Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder (GAD-7) were utilized to assess the presence of depressive disorders in mid-pregnancy. A risk prediction nomogram model was constructed using the R program, and validation was performed using the Bootstrap method. The calibration curve chart was produced, and diagnostic efficacy was evaluated using the receiver operating characteristic (ROC) curve.

The prevalence of mid-pregnancy depression was found to be 19.37%. Moreover, no statistically significant differences were observed between the two groups in terms of age, gravidity, parity, pre-pregnancy body mass index (BMI), cultural level, smoking or drinking alcohol, and work cessation due to pregnancy (p > 0.05). However, statistically significant differences were noted in the incidence of spousal disharmony, discordant relations with parents, changes in sleep and diet, work-study stress, adverse maternal history, dissatisfactory living environments, assisted reproduction, unplanned pregnancy, adverse life events, lack of maternity knowledge, family income, and pregnancy comorbidities (p < 0.05). A nomogram model was developed based on the multifactor analysis, showing a mean absolute error of 0.011 in the calibration curve, indicating good predictive accuracy. The ROC analysis demonstrated an area under the curve (AUC) of 0.806 for the joint prediction model, with a sensitivity of 66.4% and a specificity of 83.5%, suggesting a strong clinical diagnostic value. The study sample was drawn from pregnant women in our hospital, which may have led to a limited representative sample. The timeframe of the study may also have led to the exclusion of specific periods of pregnant women.

A nomogram model, which incorporates indicators such as spousal and parental disharmony, changes in sleep and dietary habits, work-study stress, adverse maternal history, unsatisfactory living environment, assisted reproduction, unplanned pregnancy, interference from adverse life events, and lack of maternity knowledge, can effectively predict depression during pregnancy.

Placenta accreta spectrum (PAS) is a condition associated with high maternal mortality and morbidity rates due to intraoperative massive bleeding. There is currently no consensus regarding the optimal gestational age at which elective surgery should be performed to reduce the potential complications of PAS. In PAS disorders, the optimal gestational week for intervention is carefully determined to improve neonatal survival and health outcomes while minimizing maternal mortality and the risk of complications associated with surgical treatment. The aim of this study was to evaluate the surgical outcomes of patients who underwent caesarean hysterectomy for PAS in our clinic, according to the timing of the procedure, to be able to predict potential complications and plan delivery time.

Following a retrospective review of patients who underwent caesarean hysterectomy for PAS in our clinic, a total of 117 cases were included in the study. The patients included in the study were divided into five groups based on gestational age at the time of surgery: Group 1 (<34 weeks), Group 2 (≥34 weeks–35 weeks<), Group 3 (≥35 weeks–36 weeks<), Group 4 (≥36 weeks–37 weeks<), Group 5 (≥37 weeks). The groups were compared in terms of demographic data, hematological parameters, histopathological classification, surgical approach, early and late maternal complications, and neonatal outcomes.

No significant differences were observed among groups regarding demographics, intraoperative and postoperative blood transfusions, or maternal complication rates. Neonatal outcomes, excluding asphyxia, significantly improved with advancing gestational age, with the best results after 37 gestational weeks. However, maternal clinical complications increased beyond 37 gestational weeks. No significant association was found between histopathological classifications and transfusion requirements. Emergency surgeries were associated with longer intensive care unit (ICU) stays and higher transfusion needs. No significant differences in complication rates were found between the groups including between patients who underwent planned (elective) and unplanned (emergency) surgeries.

This study demonstrated that PAS surgeries performed up to the 37th gestational week significantly improved neonatal outcomes without increasing maternal complication rates. Although neonatal outcomes were optimal after 37 weeks, a clinically significant rise in maternal complications was observed. Moreover, emergency surgeries were associated with longer ICU stays and higher blood transfusion requirements compared to elective procedures. These findings suggest that, in appropriately selected patients, postponing PAS surgery until 37 weeks of gestation, under close surveillance and multidisciplinary management, can enhance neonatal outcomes without increasing maternal morbidity.

Postpartum hemorrhage (PPH) is a major cause of maternal mortality, and uterine fibroids are a common condition that may contribute to this risk. This study aimed to determine the risk factors for PPH following cesarean myomectomy and to evaluate their predictive value.

We conducted a retrospective analysis of 1002 women with fibroids ≥4 cm in diameter who underwent cesarean myomectomy at the Shenyang Women’s and Children’s Hospital from January 2014 to November 2022. The PPH and non-PPH groups consisted of 109 and 893 patients, respectively. Patient, clinical, and surgical data were collected from medical records. Factors associated with PPH were identified through univariate and multivariable logistic regression analyses. A receiver operating characteristic (ROC) curve analysis was used to assess the predictive value of independent risk factors for PPH. Propensity score matching analysis was used to determine whether bilateral uterine artery ligation before myomectomy and the use of potent uterotonic drugs during this procedure protected against PPH.

Independent risk factors for PPH included multiple fibroids, specific sites of fibroids (located in the lower segment of the uterus, cervix, uterine cornu, or adjacent to the uterine vessels or the interstitial part of the fallopian tube), a longer surgery duration, and a larger fibroid size (diameter >7.5 cm for single fibroids and total diameter >14.5 cm for multiple fibroids). The results of the propensity score matching analysis indicated that bilateral uterine artery ligation and the administration of potent uterotonic drugs before myomectomy were protective factors against PPH. ROC curve analysis showed that both the maximum diameter of a single uterine fibroid and the sum of the maximum diameters of multiple uterine fibroids are predictive of PPH risk.

Cesarean myomectomy is relatively safe for fibroids located at non-specific sites with a diameter ≤7.5 cm (single) or a total diameter ≤14.5 cm (multiple). The duration of surgery should be minimized. In high-risk cases, bilateral uterine artery ligation and the administration of potent uterotonic drugs before myomectomy should be considered.

The application of artificial intelligence (AI) in medicine has advanced significantly, particularly in obstetrics, where it plays an increasingly prominent role in predicting modes of delivery and assessment of maternal risks. AI-assisted prediction of delivery modes, a cutting-edge field at the intersection of medicine and computer science, aims to support clinicians in making more accurate and safer delivery decisions by utilizing advanced AI technologies and big data analytics. With increasing individual variability among pregnant women, traditional clinical experience is often insufficient to meet the requirements of personalized medicine; therefore, establishing a scientific prediction model is particularly crucial. This systematic review aims to evaluate the current state of research on AI-assisted prediction of delivery modes, compare AI predictions and traditional statistical methods, and propose future research directions.

A comprehensive literature search was conducted in the PubMed, Web of Science, and ScienceDirect databases, encompassing publications up to November 2024.

Analysis of existing studies demonstrates that AI models outperform conventional statistical methods in predicting delivery modes, highlighting their potential as valuable tools in obstetric diagnosis and clinical decision-making. However, several critical limitations persist in current research, including: (a) the absence of real-time decision support during dynamic labor progression; (b) insufficient multi-center collaboration and a lack of external validation frameworks; and (c) inadequate standardization of clinical parameters (e.g. inconsistent definitions of cervical dilation thresholds and fetal descent metrics). These methodological gaps limit the clinical applicability and generalizability of AI-driven predictive systems across diverse obstetric populations and care settings.

Future research should prioritize data standardization and sharing, enhance the generalizability of prediction models, address ethical considerations, and ensure the fairness and transparency of AI algorithms to improve clinical trust and applicability.

The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD420251068005).

To explore the necessity for prenatal diagnosis and evaluate related diagnostic methods for fetal visceral situs abnormalities.

A retrospective analysis was performed to examine the clinical data and pregnancy outcomes of 43 cases of fetal visceral situs abnormalities diagnosed at our hospital between May 2018 and September 2023, using prenatal ultrasound consultation as the diagnostic standard.

Among the 43 cases of fetal visceral situs abnormalities, 46.51% (20/43) were diagnosed as situs inversus, of which 95.00% (19/20) had no associated cardiac structural abnormalities. Heterotaxy syndrome accounted for 53.49% (23/43) of cases and was associated with cardiac structural abnormalities (100.00%, 23/23) of these patients. The most common cardiac abnormalities involved a single atrium and a single ventricle (56.52%, 13/23), followed by double-outlet right ventricle (34.78%, 8/23), and pulmonary artery stenosis (30.43%, 7/23). Amniocentesis was performed in 21 (48.84%, 21/43) cases, with both chromosomal karyotyping and chromosomal microarray analyses yielding negative results. Among these cases, 15 underwent whole-exome sequencing (WES), which identified 5 with suspected pathogenic gene variants related to primary ciliary dyskinesia (PCD) and 1 with Holt–Oram syndrome (HOS).

Prenatal ultrasonography is a reliable method for diagnosing fetal visceral situs abnormalities. Moreover, for fetuses diagnosed with visceral situs abnormalities and pregnant women with normal chromosomal results, WES remains essential to improve the detection rates of PCD or other genetic abnormalities.

Patients with cervical insufficiency are at a higher risk of preterm birth or recurrent cervical dysfunction in a subsequent pregnancy. Exploring key risk factors and developing predictive models is of great clinical significance.

Patients diagnosed with cervical insufficiency during their first pregnancy were included and categorized according to whether they experienced preterm birth during their second pregnancy. Lasso regression was used for feature selection, followed by logistic regression (LR) and eXtreme Gradient Boosting (XGBoost) models to analyze the factors influencing the two outcomes. Model performance was evaluated through metrics such as area under the curve (AUC), accuracy, and recall rate. Model interpretation was performed using SHapley Additive exPlanations (SHAP) values, and a risk scoring model was constructed based on the core features to evaluate predictive performance.

The XGBoost model demonstrated the best performance in predicting preterm birth (AUC = 0.745), whereas the LR model achieved a higher AUC (0.777) for predicting cervical insufficiency. The risk model based on core features demonstrated an AUC of 0.711 for predicting preterm birth and an AUC of 0.686 for predicting cervical insufficiency.

Cervical length at 16–18 weeks and 22–24 weeks, along with preterm birth and cervical laceration during first pregnancy, are key predictive factors of second-pregnancy preterm birth and cervical insufficiency. The risk model derived from multi-model analysis can effectively identify high-risk pregnancies.

The incidence of endometrial cancer is steadily rising worldwide. Although surgical interventions, particularly comprehensive lymphadenectomy, have improved survival rates, postoperative lymphoceles formation remains a significant clinical complication adversely affecting patient recovery and quality of life. In recent years, the estimation of physiologic ability and surgical stress (E-PASS) scoring system has emerged as a valuable tool in perioperative risk assessment. This system provides a comprehensive evaluation by quantifying patients’ physiological reserves and surgical stress. Although this scoring method has demonstrated value across various surgical disciplines, its potential utility in gynecological oncology remains to be thoroughly explored.

In this retrospective cohort study conducted at Dongyang Hospital affiliated with Wenzhou Medical University, China, we analyzed 180 patients with endometrial cancer who underwent radical surgery between 2012 and 2023. We evaluated the predictive performance of E-PASS components: preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS).

Lymphocele developed in 62 patients (34.4%). The CRS demonstrated superior predictive performance (area under the curve [AUC] = 0.930; 95% confidence interval [CI]: 0.893–0.966) with 0.806 sensitivity and 0.915 specificity. Multivariate analysis identified CRS (odds ratio [OR] = 1.161; 95% CI: 1.110–1.214) and advanced International Federation of Gynecology and Obstetrics stage (OR = 3.211, 95% CI: 1.262–8.172) as independent risk factors.

The E-PASS scoring system, particularly the CRS, effectively predicts postoperative lymphocele formation in patients with endometrial cancer undergoing radical surgery, potentially facilitating early risk assessment and guiding preventive interventions.

Colonization of the lower genital tract by Ureaplasma urealyticum (UU) and Mycoplasma hominis (MH) has been associated with adverse pregnancy outcomes, including preterm birth, but evidence remains inconsistent. This study aimed to assess the association between UU/MH colonization and preterm birth in singleton and twin pregnancies among Korean women.

This single-center observational study reviewed electronic medical records of pregnant women who attended the obstetrics clinic at Gyeongsang National University Changwon Hospital from January 2017 to December 2020. A total of 1614 pregnant women with available UU and MH test results were included. Both singleton (n = 1298) and twin pregnancies (n = 316) were analyzed. Vaginal swab samples were tested using culture methods, and obstetric outcome data were collected. Statistical analyses included Student's t-test and chi-square (χ²) test, with p-values calculated for statistical significance.

The prevalence of UU and/or MH colonization in the lower genital tract was 36.6% (n = 590/1614). In singleton pregnancies, UU/MH positive women had a higher incidence of preterm birth compared to the negative group (24.6% vs. 16.8%, p < 0.001), with an odds ratio (OR) of 1.62. Late preterm birth (34⁺⁰ to 36⁺⁶ weeks) constituted the majority of preterm births in singleton pregnancies. There was no significant difference in the proportion of small for gestational age (SGA) neonates between the two groups. In twin pregnancies, UU/MH colonization did not significantly affect preterm birth rates (p = 0.443). Bacterial vaginosis was significantly associated with UU/MH colonization (p < 0.001), but was not associated with increased risk of preterm birth (p = 0.189).

UU and MH colonization is prevalent in pregnant women in South Korea and is associated with an increased risk of preterm birth in singleton pregnancies. However, this association is not observed in twin pregnancies. Further multi-center studies utilizing both culture-based and polymerase chain reaction (PCR) methods are necessary to evaluate neonatal outcomes and to refine clinical management strategies.

The incidence of endometriosis-associated malignancies (EAMs) is approximately 1%, with the majority occurring in the ovaries. This condition is often referred to as endometriosis-associated ovarian cancer (EAOC). However, the EAMs are rarer occurrences at other sites, such as the rectovaginal septum, abdominal wall, or perineal incision.

This case involves a 51-year-old female hospitalized at Zhuhai Integrated Traditional Chinese and Western Medicine Hospital with abdominal pain and constipation. Colonoscopy revealed a rectal mass, and histopathological analysis indicated adenocarcinoma, suggesting endometrial cancer metastasis. However, following total laparoscopic hysterectomy, rectal resection, and lymph node dissection, pathological examination confirmed a final diagnosis of rectal endometriosis-associated malignancy (EAM) combined with endometrial cancer. Following surgery, chemotherapy, and radiotherapy, the patient remained disease-free during a 2-year follow-up period.

This case is rare and noteworthy, involving EAMs of the rectum combined with EC. Surgical intervention followed by adjuvant treatment could improve survival outcomes. Therefore, an accurate diagnosis is critical for effective management.

Endometrial thickness is a key factor in determining the suitability for embryo transfer (ET) and influences the success of assisted reproductive technology (ART) outcomes. The aim of this study is to compare endometrial thickness in patients undergoing frozen-thawed embryo transfer (FET) who received platelet-rich plasma (PRP) injections alongside standard estrogen therapy with those receiving standard estrogen therapy alone.

In this randomized controlled trial (RCT), a total of 30 infertile women from Siriraj Infertility Clinic undergoing FET were enrolled and randomly assigned to three groups. Group 1 (PRP-1 group) received a single intrauterine PRP instillation on day 8 (D8) of the cycle prior to ET; Group 2 (PRP-2 group) received two intrauterine PRP instillations on D8 and D10 before ET; and Group 3 (Control) received standard estrogen therapy alone. Endometrial thickness, chemical pregnancy rate, clinical pregnancy rate, abortion rate, and cycle cancellation rate were recorded.

The mean differences in endometrial thickness on D8 and D12 were compared. The PRP-1 group showed the greatest increase in endometrial thickness compared to the other groups; however, the difference was not statistically significance (1.52 ± 1.10 in PRP-1, 0.72 ± 0.72 in PRP-2, 1.43 ± 0.88 in the Control group; p = 0.153). Chemical pregnancy rates were comparable across groups, with 33.34% in PRP-1 group and 42.85% in the control group. Similarly, clinical pregnancy rates were 16.67% in PRP-1 group and 42.85% in the control group; (p = 0.790 and p = 0.585, respectively). However, the cancellation rate was significantly higher in the PRP-2 group (77.78%, p = 0.015).

Single intrauterine PRP instillation on D8 prior to ET in a frozen-thawed cycle may improve endometrial thickness, although without statistical significance. In contrast, repeated PRP administration was associated with a higher cycle cancellation rate.

The study has been registered on https://clinicaltrials.gov/ (registration number: NCT06234540; registration link: https://clinicaltrials.gov/study/NCT06234540?cond=NCT06234540&rank=1).

The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective contraceptive and non-surgical treatment for various gynecological conditions. However, its high expulsion rate remains a concern, particularly in women with a history of prior expulsion. This study aimed to evaluate the effectiveness of non-absorbable suture fixation under hysteroscopic guidance to reduce expulsion rates.

A total of 73 women with a history of LNG-IUS expulsion were enrolled between August 2022 and August 2023 at the Women's Hospital, Zhejiang University School of Medicine. All participants underwent hysteroscopic suture fixation of the LNG-IUS. Postoperative assessments were conducted on days 1, 3, and 7 using electronic questionnaires, along with outpatient follow-up and ultrasonography at 1, 3, and 6 months.

All 73 procedures were successfully performed as outpatient (day) surgeries, with a mean duration 37.81 ± 14.90 min, without encountering any complications. Follow-up was conducted for all 73 patients at 6 months, with 70 patients undergoing postoperative imaging, primarily using ultrasonography. Low rates of expulsion (4.29%) and downward-shift (7.14%) were observed. Decreased menstrual bleeding or amenorrhea was reported by 68 patients (93.15%). Among the 47 patients with preoperative dysmenorrhea, complete symptom relief was achieved in 39 cases (82.97%).

In patients with a history of LNG-IUS expulsion, hysteroscopic suture fixation of the LNG-IUS not only lowers the rate of re-expulsion but also alleviates associated symptoms.

Chromosomal abnormalities constitute the predominant genetic etiology of early pregnancy loss; however, conventional karyotyping analysis fails to detect submicroscopic genomic imbalances or regions of homozygosity (ROH). This retrospective cohort study utilizes chromosomal microarray analysis (CMA) to systematically investigate chromosomal abnormalities associated with early pregnancy loss.

A cohort of 1006 specimens from products of conception (POCs) was collected and subjected to DNA extraction and CMA. Relevant clinical records were also reviewed.

Among the 1006 cases, CMA identified chromosomal abnormalities in a total of 596 cases (59.24%, 596/1006), including 529 cases (52.58%, 529/1006) with chromosomal numerical abnormalities, 58 cases (5.77%, 58/1006) with genomic imbalance, and 9 cases (0.89%, 9/1006) with ROH. The univariable analysis demonstrated that maternal age ≥35 years, paternal age ≥35 years, pregnancy loss at 8–9 weeks, and a history of live birth were significantly associated with an increased risk of numerical chromosomal abnormalities in pregnancy loss. A history of more than two pregnancy losses, pregnancy loss after 10 weeks, and conception via in vitro fertilization-embryo transfer (IVF-ET) were associated with a reduced risk of numerical chromosomal abnormalities. Multivariable regression analyses demonstrated that paternal age ≥35 years and history of live birth did not show a significant correlation. Euploid pregnancies with pathogenic or likely pathogenic copy number variations (CNVs) were not correlated with maternal or paternal age, pregnancy loss history, gestational age, IVF-ET conception, or live birth history.

Numerical chromosomal abnormalities are the leading cause of early pregnancy loss, demonstrating significant associations with maternal age, pregnancy loss history, and gestational age. Furthermore, pathogenic or likely pathogenic genomic imbalances may contribute to euploid pregnancy loss, although the incidence of CNVs does not correlate with clinical characteristics. The potential impact of ROH on pregnancy loss warrants further investigation.