Downregulation of the hypothalamic/pituitary axis is a critical step in patients undergoing controlled ovarian hyperstimulation (COH). The aim of this study was to compare clinical pregnancy rates between gonadotropin-releasing hormone-analogs (GnRH-a) and ethinylestradiol/cyproterone acetate (EE/CPA) downregulation protocols in assisted reproductive technology (ART).
A total of 392 patients received EE/CPA, while 392 patients were treated with Triptorelin Acetate (0.1 mg) or Diphereline as the control group. 1–2 embryos were transferred, and the primary outcome measure was the clinical pregnancy rate. Secondary outcomes included the number of oocytes, mature oocytes, fertilized oocytes, good-quality embryos, mature oocyte rate, fertilization rate, cleavage rate, viable embryo rate, good-quality embryo rate, implantation rate, and the incidence of ovarian hyperstimulation syndrome (OHSS). In addition, the economic cost was compared between groups.
There were no significant differences in the clinical pregnancy rates between the EE/CPA and control groups (50.4% vs. 51.9%, p = 0.630). In the EE/CPA group, the numbers of oocytes retrieved (14.67 vs. 14.78, p = 0.809), mature oocytes (12.95 vs. 13.24, p = 0.459), fertilized oocytes (11.59 vs. 12.11, p = 0.154), viable embryo rate (47.5% vs. 49.2%, p = 0.099), good-quality embryos (4.98 vs. 5.19, p = 0.311), good-quality embryos rate (43.0% vs. 42.8%, p = 0.846), as well as the implantation rate (37.0% vs. 38.0%, p = 0.741), were comparable to those of the control group. The mature oocyte rate (88.3% vs. 89.6%, p = 0.023), fertilization rate (89.5% vs. 91.5%, p < 0.001), number of viable embryos (5.51 vs. 5.96, p = 0.026) were lower than that in the control group, while the cleavage rate (98.0% vs. 96.8%, p < 0.001) was higher. The incidence of OHSS was significantly lower in EE/CPA group (0.0% vs. 2.0%, p = 0.008). The economic cost of the EE/CPA group was significantly lower than that in the control group.
Compared with the GnRH-a downregulation protocol, the EE/CPA protocol yielded comparable outcomes. Thus, EE/CPA may represent a viable alternative for COH, offering greater flexibility and lower cost.
The study has been registered on: https://www.chictr.org.cn/ (registration number: ChiCTR2100048310; registration link: https://www.chictr.org.cn/showproj.html?proj=125733).
The incidence of gestational diabetes mellitus (GDM) has increased in China in recent years. Evidence suggests that gut microbiota composition plays a role in the development of GDM. This study aimed to characterize the gut microbiota in pregnant women with GDM using high-throughput sequencing methods.
A total of 60 pregnant women, comprising 30 diagnosed with GDM and 30 healthy controls, were enrolled at our hospital in this study, conducted from September 2021 to August 2022. Fecal samples were collected for DNA extraction, followed by amplification through polymerase chain reaction (PCR). High-throughput sequencing was then performed to analyze the 16S rDNA V3–V4 fragments in the fecal samples.
The diversity of the gut microbiota showed that the Ace, Chao, and Sobs indices were higher in the GDM group compared with those in the healthy control group (p < 0.05). The Shannon index was also significantly higher in the GDM group (p < 0.05). At the phylum level, the gut microbial communities in both groups predominantly comprised the following four phyla: Firmicutes, Actinobacteria, Proteobacteria, and Bacteroidota. Compared with the healthy control group, the relative abundance of Firmicutes and Bacteroidota was significantly higher in the GDM group (p < 0.05), whereas Actinobacteria and Proteobacteria were significantly lower (p < 0.05). At the genus level, the profusion of Shigella, Romboutsia, Paraprevotella, unclassified Clostridium UCG-014, and Trichospira increased significantly in the GDM group (p < 0.05).
During the third trimester, the intestinal microbial communities of diabetic pregnant women differ significantly from those of healthy pregnant women. In the intestinal flora of patients with GDM, the abundance of Firmicutes and Bacteroidota increased significantly, while that of Actinobacteria and Bifidobacterium decreased significantly. These findings suggest that the occurrence of GDM is accompanied by a reduction in the beneficial bacterium Bifidobacterium.
Fetal growth restriction (FGR) and placental insufficiency (PI) are major contributors to adverse perinatal outcomes, and early identification remains clinically challenging. This study aimed to evaluate the utility of artificial intelligence (AI)-based fetal magnetic resonance imaging (MRI) for early screening of FGR and PI.
A retrospective analysis was conducted on 120 pregnant women with a gestational age of 24–36 weeks who underwent fetal MRI examinations at the Second Hospital of West China, Sichuan University, from September 2024 to May 2025. Participants were divided into an FGR group, defined by an estimated fetal weight (EFW) below the 10th percentile for gestational age based on the Hadlock growth chart (n = 60), and a non-FGR group, defined by an EFW at or above the 10th percentile for gestational age (n = 60). MRI examinations were performed using a 3.0-T MRI Premier scanner with a 32-channel Head GE AIR™ Coil body coil, acquiring T2-weighted single-shot fast spin-echo (SSFSE) sequences of the fetal abdomen and placenta. Accelerated protocol images were reconstructed using the AIR™ Recon Deep Learning (DL) algorithm. FGR assessment relied on EFW, calculated from U-Net-segmented fetal abdominal volume combined with ultrasound-measured fetal femur length (FL) using the Hadlock formula, and compared with birth weight. EFW below the 10th percentile for gestational age served as the criterion for FGR. Segmentation performance was evaluated using the Dice similarity coefficient (target >0.85), diagnostic accuracy via the area under the receiver operating characteristic (ROC) curve (AUROC), and EFW error via mean absolute error (MAE, target <150 g). Ultrasound FL measurements were performed using a GE Voluson E10 system by certified sonographers, following the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines, within 3 days of MRI to ensure consistency.
AIR™ Recon DL-reconstructed images achieved a signal-to-noise ratio (SNR) of 59.5 ± 7.1 and a contrast-to-noise ratio (CNR) of 26.9 ± 4.8, significantly higher than non-reconstructed images (p < 0.05). The Dice coefficient for placental and fetal structure segmentation was 0.892 ± 0.021, the EFW MAE was 148.2 g, and FGR diagnostic accuracy was 91.7% (AUROC = 0.938), outperforming manual assessment (84.5%, AUROC = 0.864; p = 0.032). In the FGR with PI subgroup, diagnostic accuracy reached 93.4%, with an MAE of 135.6 g (p = 0.016).
Fetal MRI combined with the AIR™ Recon DL algorithm shows significant clinical value in assessing FGR and PI. This system enhances image quality, accelerates scanning, and reduces artifacts, thus improving the accuracy of FGR and PI diagnosis in early screening. This technique also offers reliable support for early screening and the development of individualized treatment plans in the context of high-risk pregnancy.
Prompt diagnosis of preeclampsia in pregnant patients with new-onset hypertension is critical, and shorter urine collection intervals may offer a practical alternative to 24-hour urine testing for detecting proteinuria.To evaluate the predictive value and clinical utility of 8-hour urine samples for the diagnosis of preeclampsia, using 24-hour urine collection as the gold standard for detecting proteinuria in pregnant patients with new-onset hypertension.
This prospective study enrolled 99 pregnant women with new-onset hypertension, defined as blood pressure ≥140/90 mmHg on two occasions at least 4 hours apart after 20 weeks of gestation, between December 2022 and April 2023 at the Obstetrics and Gynecology Clinic of Istanbul Training and Research Hospital. Participants were consecutively recruited before confirmation of proteinuria to reflect real-world diagnostic challenges in distinguishing gestational hypertension from preeclampsia. Patients were evaluated based on protein levels in their 24-hour urine samples, which served as the gold standard, and these values were compared with protein levels obtained from three consecutive 8-hour urine collections.
The mean age was 29.7 ± 6.0 years, and the mean gestational age was 33.5 ± 4.2 weeks. Based on the area under the curve (AUC), proteinuria measured in urine collected between 8 AM and 4 PM demonstrated the highest diagnostic accuracy for preeclampsia (AUC = 0.95). All 8-hour urine collections showed a statistically significant strong positive correlation with the 24-hour gold standard. Optimal cut-off values for 8-hour urine protein excretion for the diagnosis of preeclampsia were as follows: >121 mg/8 hours (8 AM to 4 PM), >81 mg/8 hours (4 PM to 12 AM), and >71 mg/8 hours (12 AM to 8 AM).
Prompt diagnosis is critical in patients with new-onset hypertension during pregnancy. Our findings demonstrate that 8-hour urine protein measurement, particularly the 8 AM to 4 PM collection, provides a reliable alternative to 24-hour urine collection for detecting significant proteinuria in this population, offering a practical approach to expedite preeclampsia diagnosis and improve patient compliance.
To assess the diagnostic value of a nomogram that integrates ultrasound and clinical features to differentiate uterine sarcoma from uterine fibroids.
In this retrospective analysis, data from 60 uterine sarcoma patients and 60 uterine fibroid patients confirmed by surgical pathology at the Affiliated Hospital of Putian University (August 2024–June 2025) were examined. Clinical variables (age, disease duration, menopausal status, postmenopausal bleeding), laboratory markers (carbohydrate antigen 125 [CA125], lactate dehydrogenase [LDH]), and ultrasound characteristics (maximal diameter, margin, echogenicity, cystic change, calcification, and Adler blood flow grading) were collected. Independent predictors were determined through both univariate and multivariate logistic regression analyses. Predictive models were constructed and evaluated via receiver operating characteristic (ROC) curves, with model robustness further assessed through tenfold cross-validation and bootstrap validation.
The groups were successfully matched for key baseline characteristics (age, disease duration, menopausal status; all p > 0.05). Multivariate analysis revealed that age, postmenopausal bleeding, LDH, CA125, echogenicity, and tumor margin were independent predictors. The combined model demonstrated enhanced diagnostic ability with an area under the curve (AUC) of 0.902 (95% CI: 0.847–0.935), outperforming individual models based on clinical (AUC: 0.764), laboratory (AUC: 0.651), and ultrasound (AUC: 0.804) data. The model’s generalizability was confirmed by internal validation, showing strong maintained performance (tenfold cross-validated AUC: 0.885; bootstrap-corrected AUC: 0.887).
A nomogram based on combined clinical, laboratory, and ultrasound features provides high accuracy for differentiating uterine sarcoma from fibroids, supporting clinical decision-making.
TomoDirect (TD) and intensity-modulated radiotherapy (IMRT) are advanced techniques used in hypofractionated radiotherapy with simultaneous integrated boost (HFRT-SIB) for patients undergoing breast-conserving surgery. This study evaluates the dosimetric impacts of TD and IMRT on the target volume areas and organs at risk (OARs).
This study is a retrospective dosimetric comparison. Thirty patients were enrolled. Computed tomography (CT) images were acquired with a slice thickness of 5 mm. The CT data were subsequently exported to the Pinnacle treatment planning system. IMRT plans were developed using Pinnacle. The TomoHDTM planning station was used for TD planning. For each patient, three treatment plans were generated: TD (field width [FW] = 2.5 cm), TD (FW = 5 cm), and IMRT. The HFRT-SIB prescription was administered as follows: a cumulative dose of 43.5 Gy was delivered to the planning target volume (PTV); a cumulative dose of 49.5 Gy was delivered to the planning gross target volume (PGTV).
For both the PGTV and PTV, the homogeneity index (HI) values were lowest with TD (FW = 2.5 cm). The conformity index (CI) values were highest with IMRT for both the PGTV and PTV. Mean target volume coverage met the requirements for the PGTV and PTV across TD with a FW of 2.5 cm, TD with a FW of 5 cm, and IMRT. For the left lung and heart, V5, V10, V20, V30, and the mean dose (Dmean) were the lowest with TD (FW = 2.5 cm). The maximum dose (Dmax) and Dmean for the left anterior descending coronary artery (LAD) were also lowest with TD (FW = 2.5 cm). TD (FW = 5 cm) provided slightly less protection for OARs than TD (FW = 2.5 cm). The average treatment time was 5 minutes for TD (FW = 5 cm) and 9 minutes for TD (FW = 2.5 cm).
Compared with IMRT, TD provides better protection of cardiopulmonary function while maintaining target area quality. Overall, when employing TD for HFRT-SIB, a FW of 5 cm is recommended.
This study aimed to elucidate the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C), total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C), low-density lipoprotein cholesterol to high density lipoprotein cholesterol (LDL-C/HDL-C), and triglyceride-glucose (TyG) indices in patients with polycystic ovary syndrome (PCOS). Moreover, we aimed to determine whether the TyG index and traditional lipid parameters could serve as indicators of insulin resistance (IR) in Turkish women.
68 patients diagnosed with PCOS who presented to the gynecology outpatient clinic of our hospital between January 2020 and June 2023 were examined retrospectively. Patients were diagnosed according to the 2003 Rotterdam criteria. Anthropometric measurements and laboratory parameters (glucose, total cholesterol, TG, HDL-C, LDL-C, glycated hemoglobin (HbA1-c), and homeostasis model assessment of insulin resistance (HOMA-IR)) were obtained from hospital records.
Receiver operating characteristic (ROC) curve analysis was performed to examine patients’ differential effects on body mass index (BMI), TyG index, TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C values. A HOMA-IR value of ≥2.5 was considered a reference during these calculations. The area under the curve (AUC) and limit values for the other parameters were as follows: the TyG index was 83.8% and >4.41, the TG/HDL-C ratio was 81.7% and >1.44, and the TC/HDL-C ratio was 62.2% and >3.29. BMI and TC/HDL-C demonstrated moderate discriminatory power (AUC 70%–80%), whereas TyG index and TG/HDL-C showed strong discriminatory power (AUC 80%–90%). LDL-C/HDL-C was not statistically significant in predicting IR.
TyG index, TG/HDL-C ratio, and TC/HDL-C ratio may serve as useful indicators of IR in patients with PCOS.
Sperm DNA fragmentation index (DFI) has emerged as a critical factor affecting male fertility, while the associations between DFI, conventional semen parameters and in vitro fertilization (IVF) embryo culture outcomes remain inconsistent in clinical studies. To investigate the impact of sperm DFI on embryo culture parameters in IVF treatment cycles.
A comprehensive retrospective analysis was conducted on couples undergoing IVF treatment at the Reproductive Medicine Center of Wenzhou People’s Hospital between January 2019 and April 2024. Correlation and regression analyses were performed to evaluate the associations between sperm DFI and male partner characteristics, including age, semen volume, sperm concentration, total motility, and progressive motility. Based on established clinical thresholds, sperm nuclear DNA integrity was categorized as optimal (DFI ≤15%), moderate (15% < DFI < 30%), or compromised (DFI ≥30%). To control for confounding variables, propensity score matching (PSM) was performed twice, using DFI cutoffs of 15% and 30, respectively. Following PSM, the first matched cohort comprised 36 couples in Group A (DFI ≤30%) and 36 couples in Group B (DFI >30%). The second matched cohort comprised 265 couples in the normal group (DFI ≤15%) and 135 couples in the abnormal group (DFI >15%). Differences in fertilization rate, cleavage rate, high-quality embryo rate, usable embryo rate, and blastocyst formation rate between the two groups were compared using the chi-square test.
Correlation and regression analyses revealed a significant positive correlation between sperm DFI and male age (r = 0.244, p < 0.001) and significant negative correlations with total motility and progressive motility (r = –0.290, p < 0.001; r = –0.272, p < 0.001). No significant correlation was found between DFI and semen volume or sperm concentration. The fertilization rate in Group B (60.48%) was significantly lower compared to Group A (66.93%) (p < 0.05). Additionally, the fertilization rate in the abnormal group (64.69%) was significantly lower compared to the normal group (68.35%) (p < 0.05). There were no statistically significant differences in cleavage rate (96.93% vs. 97.62%; 97.58% vs. 98.15%), high-quality embryo rate (38.60% vs. 44.64%; 35.46% vs. 35.63%), usable embryo rate (68.42% vs. 67.86%; 65.69% vs. 62.01%), and blastocyst formation rate (59.38% vs. 60.66%; 60.63% vs. 62.32%) (all p > 0.05) between Group B and Group A, as well as between the abnormal group and the normal group.
Sperm DFI was positively correlated with male age and negatively correlated with sperm motility, but showed no association with other semen parameters. Elevated sperm DFI was associated with reduced fertilization rates in IVF cycles. In contrast, subsequent embryonic development parameters were unaffected by DFI levels, suggesting that sperm DNA damage primarily affects early fertilization events rather than later embryonic development stages.
Severe fetal growth restriction (sFGR) and preeclampsia (PE) are major pregnancy complications that often share placental dysfunction. This study aimed to compare maternal and neonatal outcomes among sFGR cases with or without gestational hypertensive disorders (GHD), with particular emphasis on PE.
A retrospective analysis was conducted on 371 singleton pregnancies with sFGR delivered at Suzhou Municipal Hospital between January 2020 and December 2024. Patients were categorized into three groups: sFGR with PE (sFGR-PE; n = 69), sFGR with gestational hypertension (sFGR-GH; n = 15), and normotensive sFGR (n = 287). Maternal characteristics, pregnancy complications, and neonatal outcomes were compared using Analysis of Variance (ANOVA), and chi-square tests, as appropriate. Multivariate logistic regression was used to obtain adjusted odds ratios (aORs).
The patients in PE group were older, and had higher body mass index (BMI), higher rates of gestational diabetes mellitus (GDM), and preterm delivery (p < 0.05). Neonates in the PE group had significantly lower gestational age and birth weight, and higher incidences of metabolic acidosis, and respiratory complications (p < 0.001). Multivariable regression analysis revealed that, compared with normotensive sFGR, the other two groups showed no significant increase in the risk of adverse neonatal outcomes but had a significantly higher risk of cesarean or instrumental delivery.
Although sFGR with hypertensive disorders showed increased crude risks of adverse outcomes, multivariable analysis indicated that most adverse effects were mediated by earlier delivery and lower birthweight. Only the risk of operative delivery remained independently elevated, highlighting the importance of optimal delivery timing in these pregnancies.
Despite many reported pretreatment prognostic factors in cervical cancer patients, no integrated model has been established. This study aimed to evaluate the prognostic significance of established pretreatment factors in cervical cancer patients undergoing concurrent chemoradiotherapy (CCRT) and to develop a simple and practical model for pretreatment risk stratification.
Fifty-one patients with cervical cancer treated with CCRT between September 2009 and July 2022 were retrospectively analyzed. The median follow-up period was 74.6 months, and the median patient age was 58 years. Clinicopathological and hematological factors, including age, body mass index (BMI), pathology, hemoglobin (Hgb), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), squamous cell carcinoma antigen (SCC-Ag), and International Federation of Gynecology and Obstetrics (FIGO) stage, were collected. Radiological and metabolic factors were assessed using magnetic resonance imaging (MRI), computed tomography (CT), and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT), from which the primary tumor volume (pTV) and the maximum standardized uptake value (SUVmax) were measured. The prognostic significance of factors for progression-free survival (PFS) and overall survival (OS) was evaluated using the Cox proportional hazards models.
The 5-year OS and PFS rates were 75.5% and 72.6%, respectively. In univariate analyses, BMI (p = 0.020) and FIGO stage (p < 0.001) were associated with PFS, while age, pathology, Hgb, NLR, PLR, SCC-Ag, pTV, and SUVmax were not. Multivariate analysis identified FIGO stage as the only independent prognostic factor for PFS (hazard ratio [HR]: 4.385; 95% CI: 1.865–10.310; p < 0.001). For OS, Hgb (p = 0.044), BMI (p = 0.024, and FIGO stage (p < 0.001) were significant in univariate analyses, whereas BMI (HR: 3.207; 95% CI: 1.157–8.893; p = 0.025), and FIGO stage (HR: 3.604; 95% CI: 1.559–8.334; p = 0.003) remained significant in the multivariate analysis. The optimal BMI cut-off, determined by the receiver operating characteristic (ROC) analysis, was 21.2 kg/m2.
FIGO stage and BMI were the most influential pretreatment factors associated with survival in cervical cancer patients undergoing CCRT. These findings support a straightforward pretreatment risk-stratification approach based on readily obtainable information, intended to assist baseline risk communication rather than guide treatment decisions. External validation in larger, multicenter cohorts is needed to confirm its clinical reliability, but these findings suggest a practical approach to identifying patients with distinct prognostic risks before treatment.
This case-control study explored circulating endothelial cell-specific molecule-1 (endocan), a marker of vascular impairment, in women diagnosed with missed abortion and compared the findings with those of healthy pregnant controls. In addition, the associations between serum endocan levels and two oxidative stress markers, malondialdehyde (MDA) and nitric oxide (NO), were assessed.
A total of 83 participants were divided into two cohorts: the missed abortion group (n = 44) and the control group (n = 39), each comprising of women with a singleton intrauterine pregnancy. Serum levels of endocan, MDA, and NO were quantified using enzyme-linked immunosorbent assay (ELISA).
Women with missed abortion exhibited significantly elevated serum concentrations of endocan (p = 0.029), NO (p = 0.011), and MDA (p = 0.021) compared with the control group. Endocan levels showed strong positive correlations with NO (r = 0.795, p < 0.001) and MDA (r = 0.685, p < 0.001). A similar positive correlation was observed between NO and MDA (r = 0.685, p < 0.001). In multivariate regression analysis, both MDA (β = 0.26, t = 3.00, p = 0.004) and NO (β = 0.61, t = 6.94, p < 0.001) were significant predictors of serum levels.
Serum levels of endocan, NO, and MDA were higher in women diagnosed with missed abortion than in healthy pregnant controls. These findings support the presence of endothelial dysfunction in missed abortion.
The study has been registered on https://zenodo.org/ (registration number: zenodo. 17910736; registration link: https://zenodo.org/records/17910736).
This review summarizes global advances in antibody-drug conjugate (ADC) research for the treatment of gynecologic cancers and highlights China’s rapidly evolving role in developing these agents, aiming to contextualize their growing impact on future therapeutic standards.
ADCs represent a transformative class of targeted therapies, coupling monoclonal antibodies with potent cytotoxic payloads through linkers, thereby enabling selective drug delivery to tumor cells while minimizing systemic toxicity.
Globally, ADCs such as mirvetuximab soravtansine and tisotumab vedotin have demonstrated significant clinical benefits in platinum-resistant ovarian and recurrent cervical cancers. Parallel progress in other ADCs has expanded therapeutic options across ovarian, endometrial, and cervical cancers. In China, ADC development is accelerating, with several domestically developed agents targeting folate receptor alpha, human epidermal growth factor receptor 2, trophoblast cell surface antigen 2, cadherin-6, nectin-4, B7 homolog 4, and epidermal growth factor receptor/human epidermal growth factor receptor 3 advancing into phase II and III trials. Early results show encouraging efficacy and safety, underscoring China’s emergence as a key contributor to global anticancer innovation. Nevertheless, variability in biomarker assay, regulatory differences, and future challenges related to pricing and equitable access remain important considerations.
ADCs are redefining the treatment landscape for gynecologic cancers. China’s expanding pipeline, supported by domestic innovation and international collaboration, is poised to significantly influence future standards of care. Continued progress in clinical validation, regulatory alignment, and the development of diagnostic and reimbursement infrastructures will be essential to ensure that these novel therapies achieve meaningful and equitable global impact.
The incidence of endometrial cancer (EC) has been rising annually, and many young patients wish to preserve their reproductive potential. This study aims to evaluate the impact of a whole-course management model on treatment adherence and efficacy among patients with early-stage EC and atypical endometrial hyperplasia (AEH) seeking fertility preservation.
This retrospective cohort study involved 162 patients diagnosed with EC or AEH who underwent fertility-preserving treatment at Peking University People’s Hospital between July 2010 and December 2023. Patients were divided into two groups: the control group (n = 80; diagnosed from July 2010 to June 2019) received conventional disease management, while the experimental group (n = 82; diagnosed from November 2022 to December 2023) received a physician–nurse collaborative whole-course management model. In the experimental group, each patient was assigned a dedicated nurse responsible for monitoring treatment, ensuring protocol adherence, and promptly reporting any abnormalities or disease progression to physicians. Data from both groups were collected over a one-year follow-up period.
No statistically significant differences in baseline characteristics, including residence, income, occupation, education, and treatment regimens, were observed between the two groups (p > 0.05). The experimental group exhibited significantly higher follow-up rates at 3 months (91.5% vs. 93.8%, p = 0.578), 6 months (64.6% vs. 46.3%, p = 0.019), and 1 year (64.6% vs. 30.0%, p < 0.001), as well as greater patient satisfaction (68.3% “very satisfied” vs. 17.5% “very satisfied”, p < 0.001). The median time to complete remission was shorter in the experimental group (6.2 months vs. 10.4 months, p = 0.007), and no disease progression was observed.
The physician–nurse collaborative whole-course management model is effective for patients with EC and AEH undergoing fertility preservation. It significantly enhances treatment adherence, patient satisfaction, and clinical outcomes.
Umbilical artery blood gas (UABG) parameters serve as critical indicators of metabolic and oxygenation status in newborns at birth, including base excess (BE), pH, and lactate (LAC). In high-altitude hypoxic environments, the factors that influence these parameters in indigenous populations may be unique. This study aimed to identify the factors affecting UABG parameters among a low-risk, physiological Tibetan population at high altitude.
This retrospective study analyzed data from 524 Tibetan women and their newborn babies who gave birth vaginally at a high-altitude hospital between January 1, 2024, and December 31, 2024. BE was the primary outcome, while pH and LAC were exploratory outcomes. Maternal and neonatal characteristics were categorized according to median pH, BE, and LAC values. Statistical methods, including t-tests, Mann-Whitney U tests, chi-squared tests, and linear regression models, were employed to identify factors influencing UABG.
The median (interquartile range [IQR]) values for UABG were pH: 7.28 (7.22, 7.33), BE: –8.00 (–10.00, –7.00) mmol/L, and LAC: 4.37 (3.47, 5.40) mmol/L. In univariate analyses, a lower pH (≤7.28) was associated with primiparity, shorter maternal height, longer second and third stage of labor, and neonatal length. A lower BE (≤–8.00 mmol/L) was associated with primiparity and longer first and second stages of labor. A lower LAC (≤4.37 mmol/L) was associated with multiparity, less frequent premature rupture of membranes, shorter second and third stages of labor, lower immediate blood loss, and total blood loss within 2 hours postpartum. Multivariable linear regression revealed maternal height as a positive predictor for pH (β = 0.002, p = 0.016), while the second stage duration was a negative predictor for pH (β = –0.001, p = 0.001) and BE (β = –0.017, p < 0.001), and a positive predictor for LAC (β = 0.003, p = 0.003). Neonatal length was a negative predictor for pH (β = –0.037, p = 0.005). Parity was a positive predictor for BE (β = 0.500, p = 0.045). Robust regression validated these associations. Significant differences were observed in pH, BE, and LAC between primiparous and multiparous women (p < 0.05). Significant differences were observed in BE between epidural anesthesia and non-anesthesia groups (p < 0.05).
In this low-risk Tibetan population, pH was influenced by maternal height, the duration of the second stage of labor, and neonatal length. BE was influenced by parity and the duration of the second stage of labor. The duration of the second stage of labor is a factor influencing LAC. These results should not be generalized to high-risk pregnancies or complex delivery scenarios, as the study cohort was restricted to women with physiologically normal pregnancies who delivered vaginally.
Recurrent ipsilateral ovarian torsion is uncommon; extreme recurrence (≥7 episodes) is exceptionally rare. Herniation of the adnexa through a broad ligament fenestration may precipitate torsion but is seldom reported. Optimal prevention of recurrence remains debated.
A 27-year-old woman with two prior vaginal births presented with acute right-lower-quadrant pain. Ultrasound showed an enlarged right ovary with absent color Doppler flow. She had seven prior right-sided torsions (2020–2024) managed surgically. Laparoscopy revealed a broad ligament fenestration on the right; the ovary had passed through this fenestration twice and undergone two 360° rotations on its axis. The ovary was delivered back through the window (reduction), detorsed, and oophoropexy was performed to the posterolateral uterine serosa; the broad ligament defect was closed. Pain resolved. At the 1-week and 3-month follow-ups, color Doppler ultrasound demonstrated normal perfusion, with no recurrence by 3 months.
In recurrent torsion with a broad ligament fenestration, reduction + detorsion + closure of the defect with uterine oophoropexy may represent a pragmatic, fertility-sparing strategy, although longer follow-up is needed to confirm durability. To our knowledge—considering prior reports of up to seven ipsilateral recurrences—this represents the first report of 8 right-sided torsion episodes.
Endometriosis may have diverse impacts on patients’ quality of life due to the heterogeneity of its symptoms. The aim of this study was to assess the impact of endometriosis on quality of life based on determinants such as age, education level, place of residence, parenthood status, current disease stage, and disease duration.
This study included 100 Polish women with endometriosis. The research tool used to assess the impact of endometriosis on women’s quality of life was a newly developed, non-validated questionnaire, administered electronically via Google Forms and distributed through social networks and support groups for women with endometriosis.
Women under 30 years of age (p < 0.001), without children (p < 0.001), with stage I endometriosis (p = 0.03), and those who had suffered from the disease for less than 5 years (p = 0.001) were significantly more likely to report no difficulty conceiving due to endometriosis. Most women (42%) assessed their quality of life as “positive”, with 38% reporting it as “good” and 4% as “very good”. However, 40% of respondents indicated that their quality of life was “neither good nor bad”. Only 16% of reported “poor” quality of life, and 2% reported “very poor” quality of life.
Endometriosis is a condition that affects all aspects of a woman’s life. Our findings indicate that its negative effects are complex and multidimensional, with most participants reporting sadness and depressive feelings rather than happiness, and nearly half reporting dissatisfaction with their sleep quality. Although validated instruments offer greater objectivity, they are often time consuming. Non-validated instruments, such as global assessments, are easier to administer but may be more subjective.
Cesarean delivery rates have increased substantially worldwide, raising concerns regarding the maternal and neonatal risks associated with multiple repeat procedures. This study aimed to quantify the maternal and neonatal morbidity associated with multiple repeat cesarean deliveries (CDs).
In this retrospective cohort study, we included women with 2 or more prior CDs who gave birth at ≥20 weeks’ gestation at King Saud University Medical City between January 2016 and December 2019. Participants were categorized by number of prior cesareans: 2 (n = 967), 3 (n = 708), 4 (n = 297), or 5 or more (n = 129). Maternal and neonatal outcomes were compared across these groups. Adjusted odds ratios (AORs) were calculated using multivariable logistic regression, with 2 prior cesareans as the reference.
Among 2101 women with multiple repeat cesareans, a dose-response relationship was observed between the number of prior surgeries and maternal morbidity. For maternal outcomes, the AORs of unplanned hysterectomy increased from 11.1 (95% confidence interval [CI]: 1.0–123.7) for 3 prior cesareans to 102.7 (95% CI: 15.0–400.0) for 5 or more (p-trend < 0.001). Significant graded increases were also observed for postpartum hemorrhage (PPH; p-trend = 0.02) and placenta previa/accreta. Neonatal morbidity followed a similar pattern. In women with 5 or more prior cesareans, the AORs were 2.0 (95% CI: 1.1–3.5) for a low Apgar score at 5 minutes and 2.2 (95% CI: 1.4–3.2) for neonatal intensive care unit (NICU) admission compared with the reference group (p-trend ≤ 0.003).
The findings demonstrate that multiple repeat CDs are associated with a progressive increase in maternal and neonatal morbidity, with a significant escalation in risk observed following the third procedure. These findings highlight the importance of individualized risk counseling and delivery planning for women with multiple prior cesareans.
Stillbirth is among the most severe adverse pregnancy outcomes. Over the past three decades, the global number of stillbirths has steadily declined. Despite this progress, the overall burden remains high, with rates ranging from 2.9 to 22.8 per 1000 births. This underscores the need for improved clinical care to further lower stillbirth rates. Identifying risk factors and implementing etiology-based clinical management remain challenging.
This review summarizes recent evidence on risk factors, causes, and active intervention measures for stillbirth. This narrative review is based on a search of Ovid MEDLINE and EMBASE (Excerpta Medica Database) databases conducted in October 2025.
Most stillbirths (~77.4%) occur in low-resource regions such as South Asia and sub-Saharan Africa. Strong associations link stillbirth to modifiable factors in these regions, including lower maternal education, out-of-hospital delivery, limited access to antenatal care, vaginal instrumental delivery, and cesarean section. Nonmodifiable or potentially modifiable risk factors, such as pre-existing hypertension, obesity, excessive gestational weight gain, smoking, and alcohol consumption, are more commonly associated with stillbirth in high-income countries. More than 80 classification systems are currently in use worldwide to categorize the causes of stillbirth, yet many cases remain unclassified. Pathological evaluation of the placenta, umbilical cord, and fetal membranes is one of the most valuable tools for investigating the etiology of stillbirth in all settings. Genetic testing also plays an essential role in identification of underlying causes when accessible. A stratified framework for risk identification and etiological classification, along with an individualized preventive approach tailored to specific circumstances and available resources, should be implemented to address modifiable risk factors before conception or throughout pregnancy. Genetic counseling and reproductive planning should be provided for cases of fetal genetic abnormalities.
Active identification of potential risk factors for stillbirth and management of modifiable factors are essential in all pregnancies. A multidimensional evaluation can help determine the underlying cause of stillbirth, including detailed review of obstetric records, gross and pathological examination of the fetus, placenta, associated tissues, and genetic testing when available. Therefore, a tailored, tiered approach based on local etiological classifications could be implemented to reduce the risk of recurrent stillbirth.
This study aimed to investigate the role of nicotinamide adenine dinucleotide (NAD+) in endometrial decidualization prior to embryo implantation and to elucidate the underlying mechanism.
In this study, primary human endometrial stromal cells (hEnSCs) were isolated and cultured in vitro. Decidualization was induced under three conditions: an experimental group (EG) treated with nicotinamide mononucleotide (NMN) alongside the standard decidualization cocktail to increase intracellular NAD+ levels; a control group (CG) that received only the standard decidualization cocktail; and a blank group (BG) that received no decidualization stimuli. Decidualization was evaluated by examining morphological changes and by measuring the secretion of specific markers, prolactin (PRL) and insulin-like growth factor binding protein-1 (IGFBP-1) using an enzyme-linked immunosorbent assay (ELISA). To explore the underlying mechanisms, transcriptomic sequencing and bioinformatics analysis were performed on cells from all three groups, followed by experimental validation.
The results indicated that increased intracellular NAD+ enhanced endometrial decidualization, as evidenced by higher secretion of the decidual markers PRL and IGFBP-1. Transcriptomic analysis revealed significant differences between the decidualized groups (CG and EG) and the nondecidualized group (BG), which reflect major cellular reprogramming. However, transcriptomic differences between the EG and CG groups were minimal. This finding suggests that NAD+ elevation does not initiate decidualization via broad transcriptional reprogramming but instead provides a fine-tuning, supportive effect on the already induced decidual state. Gene Set Enrichment Analysis (GSEA) indicated that NAD+ supplementation may influence decidualization through modulating DNA replication and cell cycle pathways. In addition, NAD+ effectively reduced apoptotic activity in decidualizing hEnSCs compared with the CG.
This study establishes that increasing intracellular NAD+ level promotes decidualization of hEnSCs. Rather than causing widespread changes in gene expression, NAD+ appears to refine and support the decidualization process, likely through effects on DNA replication and cell cycle pathways and by reducing apoptosis. These early findings provide insight into how cellular metabolism may regulate decidualization and suggest a potential supportive role for NAD+ modulation.
Recurrent pregnancy loss (RPL) affects 1–5% of females of reproductive age, yet nearly half of these cases remain unexplained. This review synthesizes recent advances in understanding the immune-related causes of RPL and highlights how emerging technologies and precision medicine may help improve the diagnosis and treatment of RPL.
Increasing evidence implicates immune dysregulation at the maternal–fetal interface as a cause of RPL, including aberrant uterine natural killer cell activation, Th17/Treg imbalance, impaired macrophage polarization, and disrupted cytokine signaling. These alterations compromise immune tolerance and increase the risk of miscarriage. Autoimmune disorders such as antiphospholipid syndrome and systemic lupus erythematosus, as well as alloimmune intolerance to paternal antigens, further contribute to pathogenic immune responses.
Advances in single-cell RNA sequencing, spatial transcriptomics, and proteomic profiling have refined the understanding of decidual immune-cell states and identified candidate biomarkers—including human leukocyte antigen G (HLA-G), programmed death-ligand 1 (PD-L1), interleukin-10 (IL-10), and interleukin-17 (IL-17)—that distinguish tolerant from inflammatory microenvironments. Therapeutic approaches are shifting from the empirical use of glucocorticoids and anticoagulants toward mechanism-guided immunomodulation, incorporating calcineurin inhibitors, biologic agents, and emerging cellular therapies informed by immunophenotyping and molecular endotyping.
Integrating immunology, multi-omics technologies, and artificial intelligence offers a pathway toward precision immunotherapy in RPL. This convergence supports the development of safer, personalized, and more effective diagnostic and therapeutic strategies for females with immune-mediated reproductive failure.