Ny forskning om jente- og kvinnehelse

This report describes the case of a 37-year-old woman (G5P1041) with Asherman syndrome who failed both medication and procedural abortions. Her medical history included recurrent pregnancy loss, postpartum hemorrhage, and multiple suction and sharp dilation and curettages. She was found to have intrauterine adhesions and while awaiting lysis of adhesions, she became pregnant and desired termination of pregnancy. The patient's clinical course was as follows: unsuccessful vacuum aspiration at 6 weeks 0 days due to inability to reach the gestational sac, failed medication abortion, unsuccessful hysteroscopic abortion with morcellation at 6 weeks 5 days, and successful hysteroscopic removal of retained products of conception one month later. Clinical guidance is lacking for patients with intrauterine adhesions that fail procedural and medication abortions. This single case suggests that management modalities to consider include comprehensive preoperative planning, ultrasound guidance, hysteroscopic removal of the products of conception, use of second-look hysteroscopy, and close postoperative follow-up.

Reactive hypoglycemia (RH) or low oral glucose tolerance test (OGTT) value has been linked with polyhydramnios and SGA, which is possibly due to placental dysfunction and glucose dysmetabolism. This study aims to investigate the perinatal outcomes associated with placental dysfunction and first-trimester uterine artery resistance in pregnancies with RH or a low 2-hour value on OGTT. Pregnant women undergoing OGTT screening after 24 gestational weeks between 2021 and 2023 in maternity units in Indonesia were retrospectively evaluated. Women with multifetal pregnancy, pre-pregnancy diabetes, chronic hypertension, and fetal anomalies were excluded. GDM was diagnosed according to NICE criteria. RH was defined as a 2-hour OGTT value lower than or equivalent to the fasting value. First-trimester uterine artery pulsatility index (UtA-PI) and mean arterial pressure (MAP) were also recorded. Sensitivity analysis was performed using the other definitions of low OGTT values (2-hour OGTT value < 4 mmol/l and < 5 mmol/l). Of 343 pregnancies, 26 (7.58%) had RH whilst GDM was diagnosed in 70 (20.41%). Compared to women with normal glucose tolerance (NGT), women in the RH group were slimmer, had higher fasting glucose, and higher incidence of abnormal uterine artery resistance (left, right, sum, MoM), low birthweight (15.38% vs 4.05%), neonatal intensive care unit (NICU) admission (11.54% vs 3.24%), and preterm birth (11.54% vs 1.62%). The GDM cohort had higher fasting glucose than either RH or NGT; and a higher incidence of NICU admission (7.14% vs 3.24%) and preterm birth (8.57% vs 1.62%) than NGT, but not as high as women with RH. Abnormal uterine artery resistance and high incidence of adverse outcomes persist in the sensitivity analysis using definitions of 2-hour OGTT value < 4 mmol/l and < 5 mmol/l. RH may be another clinical presentation of glucose dysmetabolism in pregnancy, prone to adverse pregnancy outcomes, and an even higher frequency of low birthweight babies. The increased first-trimester uterine artery resistance in RH or low OGTT value implies the adverse outcomes may be placenta-driven.

SMARCA4- deficient undifferentiated uterine sarcoma (SDUS) is a rare, highly aggressive SWI/SNF-deficient malignancy that can morphologically overlap with undifferentiated endometrial carcinoma (UDEC). Although prior targeted sequencing studies have suggested that SDUS often has a "quiet genome," exome-wide corroboration remains limited. We report a 23-yr-old woman who presented with a >15 cm uterine mass and underwent hysterectomy with bilateral salpingo-oophorectomy, followed by rapid peritoneal dissemination and para-aortic metastases within 2 mo. The disease was refractory to gemcitabine/docetaxel and the patient died 6 mo postoperatively. Histologically, the tumor consisted of sheets of monomorphic undifferentiated epithelioid cells with rhabdoid features, focal phyllodes-like architecture entrapping benign endometrial glands and stromal hyalinization, and no identifiable carcinomatous component. Immunohistochemistry demonstrated complete loss of SMARCA4 (BRG1) and SMARCA2 (BRM) with retained SMARCB1 (INI1), a wild-type p53 pattern, intact mismatch repair protein expression, and negativity for claudin-4 and SOX2. Whole-exome sequencing with copy-number analysis of paired tumor and nontumor tissue identified biallelic SMARCA4 inactivation (somatic frameshift deletion c.3717del, p.W1239fs; VAF 0.89) with loss of heterozygosity at 19p13.2, microsatellite stability, and low tumor mutational burden (0.70 mut/Mb), without additional canonical driver mutations; notably, no TP53 mutation was detected despite hemizygous 17p loss. A focal copy-number gain involving the BRCA1 locus was also identified; however, its biological significance remains uncertain. This case provides exome-wide support for the "quiet genome" concept in SDUS and underscores its biological distinction from UDEC. Comprehensive genomic profiling may assist diagnosis in this aggressive malignancy.

To determine the influence of preoperative uterine artery (UtA) Doppler abnormalities on disease severity, intertwin fetal-size discordance and perinatal outcomes in cases of twin-twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery. This was a retrospective cohort study of TTTS pregnancies that underwent fetoscopic laser surgery using data that had been collected between August 2014 and July 2025. Inclusion required prelaser UtA Doppler examination and available neonatal outcomes. Preoperative ultrasound biometry, maternal and fetal Doppler data and Quintero staging were reviewed. UtA pulsatility index (PI) Z-scores were calculated; abnormal UtA Doppler was defined as mean UtA-PI ≥ 95 th percentile and/or UtA notching. The primary outcome was the distribution of UtA Doppler abnormalities across TTTS stages. Secondary outcomes included the relationship between UtA Doppler findings and survival, gestational age at intervention, intertwin fetal-size discordance and intertwin birth-weight discordance. Analyses included non-parametric tests and regression models to identify predictors of intertwin size discordance. Of 509 treated cases, 378 pregnancies were included. Abnormal UtA Doppler occurred in 23.5% of pregnancies and was most frequent in those with Stage-III TTTS (32.4%; P = 0.004). Abnormal UtA Doppler findings were associated with lower maternal age, Stage-III TTTS and greater intertwin size discordance. Patients with UtA Doppler abnormalities had earlier laser surgery (median, 18.4 vs 19.4 weeks; P = 0.008) and exhibited greater prelaser intertwin fetal-size discordance (median, 23.9% vs 18.9%; P = 0.012), with higher proportions of intertwin discordance ≥ 25% before laser surgery (49.4% vs 33.2%; P = 0.006) and at birth (28.4% vs 13.9%; P = 0.004) compared to those without abnormal UtA Doppler. However, immediate post-laser survival and overall perinatal survival did not differ by UtA Doppler status. Multivariable linear regression analysis identified umbilical artery Doppler parameters as the primary determinant of intertwin size discordance, while abnormal UtA Doppler remained independently associated with intertwin size discordance both at the time of laser surgery and at birth. However, receiver-operating-characteristics-curve analysis showed that abnormal mean UtA-PI Z-score alone did not predict intertwin birth-weight discordance of ≥ 25%. Abnormal preoperative UtA Doppler was not a principal determinant of TTTS severity, but was most frequent in Stage-III TTTS. Abnormal UtA Doppler was associated with intertwin fetal-size discordance before laser treatment, with discordance persisting at birth despite successful surgery. Although abnormal UtA Doppler was independently associated with intertwin fetal-size discordance, elevated mean UtA-PI was not a clinically useful independent predictor of intertwin size discordance at birth. UtA Doppler and umbilical artery Doppler may be complementary in predicting fetal growth effects of placental dysfunction, independent of the acute cardiovascular effects of TTTS. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.

To compare outcomes after barbed versus monofilament uterine closure strategies at primary term caesarean delivery. Retrospective, single-centre, 1:2 matched cohort study. Tertiary university hospital in Genoa, Italy. Women with at least 36 months of follow-up after caesarean delivery for a term singleton pregnancy. Women receiving continuous, unlocked, double-layer barbed closure were matched 1:2 to women receiving monofilament closure by labour, second-stage caesarean, and temporal proximity. Records and structured interviews provided long-term outcomes. Cox models stratified by matched set evaluated time from the reported start of active attempts to conception. The primary outcome was time to first conception from the start of active attempts; secondary outcomes included conception, live birth, and subsequent pregnancy and delivery outcomes. The cohort comprised 486 women (162 barbed; 324 monofilament). Among 205 women attempting conception, 62/73 (84.9%) and 114/132 (86.4%) conceived; median time to conception was 11 and 9 months. The adjusted hazard ratio for time to conception was 0.72 (95% CI 0.39-1.31). Confidence intervals for conception within 12-24 months and live birth all included the null value. Among 148 subsequent deliveries, gestational age, trial of labour, vaginal birth after caesarean, and other maternal and neonatal outcomes showed no consistent pattern across groups. Placental and uterine-scar complications were infrequent, resulting in imprecise between-group estimates. Barbed closure was not clearly associated with different reproductive or obstetric outcomes. Operator-strategy confounding and imprecision limit interpretation; equivalence and comparative safety remain unestablished.

Approximately 100 million people worldwide use tampons to manage their menstruation. Tampons have been shown to contain toxic metals, which may contribute to cumulative exposure risk. It is unclear whether metals leach from tampons or how changes in vaginal pH during menstruation affect leaching. To quantify in vitro metal leaching from tampons under physiologically relevant conditions. We assessed metal leaching from 22 tampon products by saturating them in simulated vaginal (pH 4.2) and menstrual fluids (pH 7.4) for 8 hours at 37°C on a shaker. Extracted supernatants were analyzed for 15 metals by inductively coupled plasma triple quadrupole mass spectrometry. Metal leaching was compared across 13 brands and tampon characteristics: organic composition and absorbency. The leaching fraction-percentage of total metal content leached-was calculated using data reported by Shearston et al. We found measurable amounts of 14 metals in leachates from vaginal fluid and 12 metals in menstrual fluid, including lead, arsenic, and cadmium. Most metals leached in greater amounts in vaginal fluid compared to menstrual fluid, such as lead (mean: 40.3 ng, 95% confidence interval around mean value: [6.94, 73.7] vs 15.6 ng, [6.91, 24.3]). The highest average leaching fraction in vaginal fluid was copper (233%, [95% CI: -87% to 553%]), and in menstrual fluid, nickel (53%, 95% CI: 38%-79%]). Metal leaching varied by tampon characteristics. Under simulated physiological conditions, we found that tampons leach metals in both vaginal fluid and menstrual fluid. Since in vitro metal release does not equate to vaginal absorption or systemic exposure, further investigations are required to inform the risk of metal exposure from tampon use.

The vaginal microbiota test predicts the success of in vitro fertilization (IVF), but with no therapy available to improve a low profile, couples must decide whether to proceed or postpone treatment. We aim to examine how couples interpret vaginal microbiome results and make postponement decisions within a shared decision making (SDM) framework. Women undergoing IVF or IVF-intracytoplasmic sperm injection (IVF-ICSI) treatment at 2 Dutch hospitals received the ReceptIVFity test™, which classified the vaginal microbiome as high (52.6% chance of conception), medium (23.6%), or low (5.9%) profile based on predicted implantation success after a fresh embryo transfer. Physicians discussed the results with couples using SDM, after which the couples decided whether to proceed or postpone treatment. The primary outcome was the patients' perceived involvement in shared decision making, assessed with the SDM-Q-9 questionnaire. The secondary outcome was the proportion of couples postponing treatment after a low microbiome profile. Between October 2018 and November 2020, 728 women were enrolled. SDM-Q-9 responses showed high perceived involvement overall but lower scores for "exploring options," reflecting limited alternatives when the choice is to proceed or postpone treatment. A low profile was found in 35.4% (258/728). After the SDM consultation, 49.6% (128/258) chose to postpone treatment, with postponement rates increasing to over 80% among couples in later IVF cycles. Decisions were influenced by personal, emotional, and practical considerations, including the Dutch insurance reimbursement system (3 insured IVF or IVF-ICSI cycles regardless of postponement) and the absence of effective treatment to modify a low profile. These findings demonstrate that couples can understand and use prognostic information when supported by SDM and that the ReceptIVFity test™ facilitated discussion about chances of success, timing of treatment, decisions to proceed or postpone, and personal values.

Emergency cervical cerclage is used to reduce extreme preterm birth in women with advanced cervical dilatation and exposed fetal membranes. Although double-level cerclage has been proposed to provide greater mechanical support than single-level cerclage, evidence comparing these techniques in emergency settings is limited. To compare the effectiveness of emergency double-level versus single-level cerclage, both combined with adjunctive vaginal progesterone, antibiotics and indomethacin in preventing delivery before 34 weeks of gestation. This prospective, multicenter, open-label randomized controlled trial was conducted at 7 tertiary perinatal centers in Poland. Women with singleton pregnancies between 16+0 and 25+6 weeks of gestation, advanced cervical dilatation, and visible fetal membranes were randomized 1:1 to single-level or double-level cerclage. All participants received a standardized management protocol including vaginal progesterone, empirical antibiotics (ceftriaxone, clarithromycin, and metronidazole), perioperative indomethacin, and antenatal corticosteroids when indicated. The primary outcome was delivery before 34 weeks of gestation. Secondary outcomes included gestational age at delivery, latency to delivery, maternal complications, and neonatal outcomes. Time-to-event analyses and Cox regression models were applied. Eighty women underwent emergency cerclage (38 single-level, 42 double-level suture). Delivery before 34 weeks occurred in 27.5% of the overall cohort (23.7% of the single-level group and 31.0% of the double-level cerclage group, P=.53), which was relatively low rate compared with historical reports in women presenting with advanced cervical dilatation and prolapsed membranes. Gestational age at delivery, latency from cerclage placement to delivery, and rates of delivery before 37, 32, and 28 weeks did not differ significantly between groups. Neonatal outcomes, including survival and major morbidity, were comparable. Procedure-related complications were infrequent. In women with advanced cervical insufficiency and exposed fetal membranes, double-level emergency cerclage combined with adjunctive therapy was not found to improve pregnancy prolongation or perinatal outcomes compared with single-level cerclage.

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine-metabolic disorder in women of reproductive age, and is characterized by hyperandrogenism, anovulation, and polycystic ovarian morphology. Emerging molecular evidence has identified dysregulated ovarian steroidogenesis as a major contributing mechanism linking reproductive and metabolic phenotypes in PCOS, acting in concert with neuroendocrine and metabolic dysfunction. This review synthesizes current knowledge on enzymatic and regulatory perturbations driving androgen excess and estrogen deficiency in PCOS, emphasizing their mechanistic, diagnostic, and therapeutic implications. Dysregulated steroidogenic enzymes and associated signaling pathways contribute to androgen excess, impaired folliculogenesis, and metabolic dysfunction in PCOS. Importantly, these steroidogenic alterations are not uniform across all patients with PCOS but vary according to hyperandrogenic, anovulatory, ovulatory, lean, obese, reproductive, and metabolic phenotypes. Particular focus is placed on how these molecular derangements disrupt theca-granulosa cell communication, impair folliculogenesis, and promote hyperandrogenism, oxidative stress, and insulin resistance in the ovaries. This review also discusses therapeutic strategies according to evidence level, distinguishing established PCOS treatments such as lifestyle intervention, insulin sensitizers, ovulation-induction agents, hormonal regulators, and anti-androgens from investigational enzyme-specific inhibitors and speculative precision approaches such as gene editing and exosome-based delivery systems. Collectively, these insights underscore that the pathophysiology of PCOS extends beyond endocrine imbalance to encompass multi-omic alterations in metabolism and signaling. Understanding enzyme-level dysregulation offers opportunities for mechanism-based interventions that can restore steroidogenic homeostasis, improve fertility outcomes, and mitigate long-term metabolic risk. Future research should prioritize enzyme-signal interdependencies and develop personalized therapeutic strategies targeting the biochemical dysfunctions of PCOS.

To evaluate the association between obstructive sleep apnea (OSA) and thromboembolic events among women with polycystic ovary syndrome (PCOS). Retrospective cohort study with propensity score matching. Multicenter electronic health record database (TriNetX US Collaborative Network). Women aged 18-45 years with a diagnosis of PCOS between 2012 and 2021. Women with PCOS were stratified according to subsequent diagnosis of OSA and matched 1:1 with PCOS patients without OSA using propensity scores. Incident pulmonary embolism (PE) and venous thromboembolism (VTE) occurring after a 1-year reference period were assessed using Cox proportional hazards models. Incident pulmonary embolism and venous thromboembolism. After propensity score matching, 20 052 women were included (10 026 per group). All analyses were conducted within this propensity score-matched cohort. PE incidence was higher among women with OSA compared with those without OSA (2.88 vs. 1.48 per 1000 person-years; absolute difference 1.40 per 1000 person-years; incidence rate ratio [IRR] 1.94, 95% CI 1.49-2.53; hazard ratio [HR] 1.95, 95% CI 1.50-2.54). VTE incidence was also increased (3.74 vs. 2.87 per 1000 person-years; absolute difference 0.87 per 1000 person-years; IRR 1.30, 95% CI 1.06-1.60; HR 1.32, 95% CI 1.07-1.61). These associations persisted across clinically relevant subgroups and increased over long-term follow-up. Among women with PCOS, comorbid OSA is associated with an increased risk of thromboembolic events, particularly pulmonary embolism. These findings support consideration of OSA screening and enhanced thromboembolic risk assessment in women with PCOS.

Women with polycystic ovary syndrome (PCOS) exhibit a substantially increased risk of miscarriage, yet the underlying mechanisms remain inadequately understood. This study aimed to investigate whether specific gut microbial dysbiosis and metabolic disturbance are associated with and may potentially contribute to endometrial dysfunction and adverse pregnancy outcomes in women with PCOS. Prospective cohort study integrated with mechanistic experiments. Women's Hospital, School of Medicine, Zhejiang University, China (2022-2024). A total of 110 women with PCOS and 110 age- and body mass index-matched controls were enrolled. We performed 16S rRNA and metagenomic sequencing of gut microbiota, with untargeted and targeted serum metabolomics. Functional validation was conducted using primary human endometrial stromal cells and a PCOS rat model intervened with Parabacteroides merdae (P. merdae) supplementation or faecal microbiota transplantation. Gut microbiota composition, serum metabolites, endometrial senescence markers, and pregnancy outcomes. Women with PCOS exhibited significantly higher miscarriage rates than controls, accompanied by a marked depletion of P. merdae abundance and elevated serum levels of branched-chain amino acids, particularly isoleucine. Exogenous isoleucine induced cellular senescence in human endometrial stromal cells in a dose-dependent manner. Restoration of P. merdae levels in the PCOS rat model resulted in decreased serum isoleucine levels, amelioration of the senescent endometrial phenotype, and reduction in the fetal resorption rate. These findings suggest that P. merdae depletion and the concurrent accumulation of isoleucine may be associated with endometrial senescence and elevated risk of miscarriage, suggesting the possible involvement of a gut microbiota-metabolite pathway in PCOS-related reproductive dysfunction. These results also provide a mechanistic basis for future translational investigations.

Tubulo-squamous polyp (TSP) of vagina is a rare, benign, upper vaginal lesion of postmenopausal women. The origin of TSP is unclear, and the lesion is hypothesized to be arising from misplaced prostate-like vaginal skene glands. We describe the clinical, histological and immunohistochemical features of 6 TSPs we encountered in our routine practice. Histologically, TSPs are characterized by mass-forming, submucosal, cystic metaplastic transitional-type epithelium and prostate-like glands. The histological and immunohistochemical findings in TSP are identical to Mullerian (cervical and vaginal) epithelial metaplastic changes described in a setting of exogenous testosterone exposure.

To evaluate the feasibility and short-term outcomes of Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) High Uterosacral Ligament Suspension (USLS) in patients with advanced apical pelvic organ prolapse (POP). This retrospective case series included 20 patients with Stage III or IV apical prolapse who underwent vNOTES High USLS. Primary outcomes were surgical feasibility, anatomical success defined as postoperative POP-Q Stage 0 or I, and symptomatic improvement defined as absence of bulge sensation or pelvic pressure. Secondary outcomes included operative time, estimated blood loss, and 30-day complications. All procedures were performed under direct endoscopic visualization with ureteral lateralization before suture placement. Anatomical and symptomatic success rates were both 100%. Mean patient age was 62.35 years and mean BMI was 25.2 kg/m². Mean operative time was 128.05 min, including a mean USLS duration of 54 min. Mean blood loss was 86 ml. No intraoperative or postoperative complications, including ureteral injury or hemorrhage, were observed. All patients were discharged within 48 h. vNOTES High USLS appears to be a feasible and safe mesh-free alternative for advanced apical prolapse. Larger prospective studies are needed to confirm long-term outcomes.

Hypertensive disorders of pregnancy (HDP) are a prevalent complication and a leading cause of maternal and perinatal mortality. While vaginal delivery is generally possible for most women with HDP, there is no standardized framework detailing variations in vaginal delivery outcomes across different HDP classifications or identifying the factors influencing emergency cesarean section (EmCS). To explore the vaginal trial outcomes and risk factors associated with emergency cesarean section among women with different classifications of HDP. This was a single-center retrospective cohort study of 894 pregnant women with HDP who underwent a vaginal trial. Of these, 584 were diagnosed with gestational hypertension, 216 with pre-eclampsia, and 94 with chronic hypertension. The study collected and compared detailed maternal and perinatal outcomes. (1) The success rate of vaginal delivery ranged from 85.1% to 90.8% across various classifications of HDP without significant differences. (2) Chronic hypertension was four times more likely to lead to intrapartum poorly controlled blood pressure than gestational hypertension. (3) Factors influencing EmCS in HDP included parity, antepartum BMI, labor induction, intrapartum fever, intrapartum antihypertensive use, and oxytocin during stages of labor. Parity served as an independent protective factor across all HDP classifications. Stratified analysis revealed that for gestational hypertension, risk factors included antepartum BMI ≥ 30 kg/m 2 , labor induction, and intrapartum antihypertensive use. For pre-eclampsia, oxytocin and intrapartum fever were risk factors. In chronic hypertension, antepartum BMI ≥ 30 kg/m 2 and intrapartum fever were identified as risk factors, although the former was not significant. The success rate of vaginal trials across various classifications of HDP is high. Vaginal trial can impact intrapartum blood pressure, particularly for women with chronic hypertension. Tailored management strategies should include encouraging vaginal trial for multiparous women, control of antepartum BMI, judicious use of labor induction, and vigilant monitoring of hypertension and fever, with individualized evaluation and treatment based on HDP classification.

Assisted vaginal birth (AVB) refers to the obstetric procedure commonly performed during the second stage of labor, aimed to expedite delivery after evaluating alternatives options of cesarean birth or expectant management. To evaluate the risk factors for AVB and to compare perinatal factors and outcomes of vacuum extraction when applied to the mid/low cavity versus the perineum. Retrospective observational monocentric study conducted on the cohort of women with singleton pregnancies who delivered vaginally in 2023 at the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan. Multivariable logistic regression was used to identify factors independently associated with AVB. A secondary analysis compared maternal and neonatal outcomes between perineal and mid/low cavity vacuum applications. A total of 3455 vaginal births were included: 3090 spontaneous vaginal births and 365 AVB. After adjusting for all factors considered, maternal age (OR 1.04, 95% CI: 1.01-1.07), mode of conception (OR 1.58, 95% CI: 1.07-2.33), epidural analgesia (OR 6.25, 95% CI: 3.05-12.80), gestational age (OR 1.48, 95% CI: 1.31-1.67), and newborn male sex (OR 1.35, 95% CI: 1.06-1.73) were positively associated with AVB, whereas parity (OR 0.20, 95% CI: 0.14-0.29) was inversely associated. Compared to perineal applications, mid/low pelvic applications were associated with greater blood loss ( p < 0.01), higher episiotomy rate (95.5% vs 88.2%, p = 0.03), and increased ultrasound use (62.4% vs 23.5%, p < 0.01). In this real-world cohort, AVB was mainly associated with well-established factors, confirming previous evidence. Mid/low cavity applications showed greater maternal morbidity than perineal applications, underscoring the importance of careful case selection and procedural planning.

Recent mpox outbreaks have shown a predominant transmission through sexual contact. Replication-competent virus has been detected in seminal fluid, while in female patients, vaginal lesions, vertical transmission, and miscarriage risk have been reported. This study explored the susceptibility of the lower female genital tract (LFGT) to monkeypox virus (MPXV) infection, the role of sex-hormones in modulating viral replication, and host-virus molecular interactions. Human vaginal (VK2/E6E7) and ectocervical (Ect1/E6E7) epithelial cells were exposed to MPXV clade IIb, and viral replication was assessed. The influence of sex-hormones was evaluated after pretreatment with physiological concentrations of 17-β-estradiol or progesterone. Cellular genes' expression was determined by RT-qPCR and RNAseq, and ELISA was used for protein release analysis. Both cell lines supported productive MPXV infection. 17-β -estradiol and progesterone slightly reduced viral replication in Ect1/E6E7. At 48 hours post-infection, compared to uninfected control, 216 differentially expressed genes (DEGs) were identified in MPXV infected VK2/E6E7 and 11 in Ect1/E6E7, with nine shared DEGs involved in protein folding (HSPA6), chemotaxis (CXCL3, ARC), inflammation and lymphoproliferation (IL11, IL1RL1, MMP-1), and tissue remodeling (IGFN1, MMP-1). MPXV infection significantly increased MMP-1 release in both cell lines, and MMP-1 inhibitors reduced infectious virus production. IFN-β and IFN-λ1 were induced earlier and more pronouncedly in Ect1/E6E7 which also showed slower viral replication than VK2/E6E7. Our analysis demonstrated the MPXV-mediated modulation of common and tissue-specific cellular pathways in the LFGT. The perturbation of tissue remodeling and inflammation in this district has the potential to affect reproductive health and susceptibility to sexually-transmitted-infections.

To investigate safety, risk and perinatal outcomes of vaginal delivery in women with active coronavirus disease 2019 (COVID-19) infection. Three hundred and fifty-one women who gave birth between 7 December 2022 and 31 December 2022 were recruited. Women with a COVID-19 infection were considered to be cases (COVID-19 group), and those without COVID-19 infection were controls (non-COVID-19). The maternal demographic characteristics, intrapartum parameters, and perinatal outcomes were compared between both groups. There was no significant difference regarding maternal demographic characteristics within two groups ( p > 0.05). The rate of multiparity was significantly higher in non-COVID-19 group compared with COVID-19 group ( p < 0.05); a prolonged first stage and total labor duration were more frequently seen in COVID-19 group ( p < 0.05). Higher rate of fever during delivery was noted in the COVID-19 group as compared with non-COVID-19 group ( p < 0.05). Generalized linear model analysis demonstrated that COVID-19 infection status was not correlated to the risk of a prolonged first stage and total labor duration; Multivariate logistic regression analysis found that COVID-19 infection was associated with an 8-fold increased risk of fever during delivery. Vaginal delivery is an appropriate delivery option and associated with favorable outcomes among COVID-19-infected asymptomatic or mild individuals in late pregnancy who underwent vaginal birth; COVID-19 status alone is associated with increased risk of fever during delivery for COVID-19-infected women, and pregnant women would benefit from increased monitoring during delivery management.

Congenital cervical agenesis is a rare but important obstructive cause of primary amenorrhoea. Initial diagnosis is often delayed. With advances in reconstructive surgery, fertility restoration is now a realistic option for some women. We present a case of complete cervical and vaginal agenesis diagnosed in a 16-year-old girl who presented with cyclical pelvic pain and primary amenorrhoea. Following successful vaginoplasty and direct uterovaginal anastomosis, regular, pain-free menses, and later, uncomplicated sexual intercourse was achieved. Following a 10-year period of primary infertility and unsuccessful assisted reproduction treatment, natural pregnancy was achieved with the birth of a healthy male infant by caesarean section at term. This report aims to highlight the potential complexities of both natural and assisted conception following corrective uterine surgery. The importance of an individualised, multi-disciplinary approach to care is also highlighted.

Warkany syndrome, or mosaic trisomy 8, is a rare chromosomal disorder characterized by craniofacial dysmorphism, skeletal anomalies, and urogenital malformations, with no previously reported association with solid mesenchymal neoplasia. Angiomyofibroblastoma is an extremely rare benign mesenchymal tumor of the lower female genital tract with a largely uncharacterized cytogenetic background. We describe a 27-year-old nulliparous woman with constitutionally confirmed mosaic trisomy 8, established in childhood by peripheral blood karyotype, who presented with a protruding vaginal mass. Magnetic resonance imaging demonstrated a well-defined, homogeneously enhancing mid-vaginal mass and incidentally revealed uterus didelphys and bilateral ureteral ectopia, both recognized urogenital features of this syndrome. Complete surgical excision was performed, and histopathology with immunohistochemistry confirmed angiomyofibroblastoma. This is, to our knowledge, the first reported co-occurrence of angiomyofibroblastoma and Warkany syndrome. Chromosome 8 status of the tumor was not evaluated, so any biological or causal relationship between constitutional trisomy 8 and tumor development remains hypothetical, and the co-occurrence may be coincidental.

To compare surgical outcomes and recurrence-free survival (RFS) among laparoscopic sacrocolpopexy (LSC), laparoscopic colposuspension sec Shull (LCSS), and vaginal colpohysterectomy and colposuspension (VCH) for pelvic organ prolapse involving the apical compartment. This retrospective observational study included patients undergoing surgery for pelvic organ prolapse involving the apical compartment. Patients were divided into three groups according to surgical technique: LSC, LCSS, and VCH. The primary outcome was prolapse recurrence. Secondary outcomes included operative time, postoperative complications, and reoperation rate. RFS was analyzed using Kaplan-Meier curves and Cox proportional hazards models, with LSC as the reference. A predefined subanalysis was performed in patients with severe pelvic organ prolapse (Stage III-IV). A total of 204 patients were included. Median follow-up was 25 months (IQR 16-43) after LSC, 24 months (IQR 15-29) after LCSS, and 31 months (IQR 29-48.25) after VCH. Twenty recurrences occurred: five after LSC, nine after LCSS, and six after VCH. Operative time differed significantly among techniques, while postoperative complication rates were comparable. Kaplan-Meier analysis showed worse RFS after LCSS. In Cox analysis, LCSS was associated with a higher recurrence hazard than LSC (HR 17.20, 95% CI 3.67-80.57; p < 0.001), whereas VCH was not (HR 0.86, 95% CI 0.26-2.85; p = 0.80). Concomitant anti-incontinence procedures were performed in only five patients and were not associated with recurrence or reoperation (both Fisher's exact p = 1.00). LCSS showed significantly worse RFS than LSC, despite similar complication rates and intermediate operative times. These findings may suggest reduced short- to mid-term RFS; however, they should be interpreted with caution given the retrospective, non-randomized design and potential treatment allocation bias. VCH showed the shortest operative times and no significant differences in recurrence risk compared with LSC.