Ny forskning om jente- og kvinnehelse

Mycoplasma genitalium (MG) frequently co-infects women with Chlamydia trachomatis (CT), but the epidemiology and clinical significance of this association remain poorly understood. This study assessed MG positivity, antimicrobial resistance, mgpB genotyping and bacterial load in paired self-collected vaginal and anal swabs from 426 women with urogenital CT infection, and assessed the risk factors for CT/MG coinfection compared with CT monoinfection. MG detection and quantification were carried out using an in-house quantitative PCR targeting the MgPa adhesin gene. Macrolide and fluoroquinolone resistance-associated mutations were determined by sequencing the 23S RNA gene and the parC gene, respectively. The mgpB types were determined by sequencing a 281-bp region of the mgpB gene. Clinical, demographic, and behavioural characteristics were compared between women with CT monoinfection and CT/MG coinfection. MG was detected in 22.8% of women, more frequently in vaginal than anal specimens (18.5% vs 12.9%, p = 0.03). Among MG-positive women, 43.3% had vaginal-only infection, 18.6% anal-only infection, and 38.1% infection at both sites. Macrolide and fluoroquinolone resistance were detected in 16.7% and 9.1% of evaluable cases, respectively. Anal MG was usually asymptomatic and unrelated to reported anal intercourse. MG bacterial load was significantly higher in vaginal than anal samples, and paired specimens shared identical mgpB genotypes, supporting the hypothesis of secondary anal colonization from the vagina. Being born in France was the only factor associated with CT/MG coinfection, compared with CT monoinfection in the multivariate analysis. MG coinfection did not influence the CT bacterial load. MG coinfection was common among women with CT infection but was not associated with higher CT bacterial load, more severe clinical manifestations, or distinct behavioural characteristics. Further studies are warranted to clarify the biological interactions between these two pathogens in women.

Primary vaginal leiomyosarcoma is a rare malignancy characterized by similar histologic features as uterine leiomyosarcomas. Previous studies of uterine leiomyosarcomas have shown specific molecular alterations, including frequent alterations in TP53, RB1, ATRX, PTEN, MED12, CDKN2A, and MDM2. Similar alterations have been found in primary vaginal leiomyosarcomas as well as an alternative tumorigenic pathway associated with HPV. Herein, we describe a primary vaginal leiomyosarcoma in a 46-yr-old patient. The tumor was located in the vaginal wall without involvement of the uterus or cervix. Morphologically, it was composed of atypical, spindled cells, with a mitotic rate of 25 mitotic figures per 10 high-power fields and tumor type necrosis. Immunohistochemistry showed positivity for h-caldesmon, SMA, desmin, and ER, along with p53 null pattern expression and loss of ATRX and Rb. Next-generation sequencing analysis revealed mutations in ATRX and PTEN, along with homozygous deletions of RB1, and deep deletions in TP53 and NCOR1 tumor suppressor genes. High-risk human papillomavirus (HR-HPV) E6/E7 mRNA in situ hybridization was performed and showed no staining.

Vaginal infections, including bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV), are common gynecologic disorders in reproductive age women. Accurate differential diagnosis remains challenging due to overlapping symptoms and limitations of conventional microscopy and biochemical assays. Surface-enhanced Raman spectroscopy (SERS) provides label-free molecular fingerprints of complex biological fluids and may support automated classification when combined with machine learning. The problem addressed here is the lack of a label-free analytical strategy for patient-level discrimination of healthy controls (HC), BV, VVC, and TV using vaginal fluid samples. SERS spectra were acquired from vaginal fluid samples using citrate-reduced silver nanoparticles (AgNPs). A total of 170 participants were enrolled, with one vaginal secretion sample collected from each participant. Among these samples, 135 samples (HC = 40, BV = 40, VVC = 40, TV = 15) were used for model construction and 35 independent samples (HC = 10, BV = 10, VVC = 10, TV = 5) were used for independent blind validation. Although the average SERS spectra of HC, BV, and VVC showed substantial overlap, spectral deconvolution revealed subtle class-related features. Thirteen machine-learning and deep-learning models were evaluated using a patient-wise strategy. The one-dimensional convolutional neural network (1DCNN) achieved the most balanced performance, with an internal hold-out patient-level accuracy of 80.0% and a macro-AUC of 0.92. Independent blind validation correctly classified 31 of 35 participants, corresponding to an external patient-level accuracy of 88.6%. This study establishes a patient-wise SERS and machine-learning framework for four-class discrimination of HC, BV, VVC, and TV. Its novelty lies in combining vaginal-secretion SERS fingerprints, patient-level data splitting, majority-vote classification, and independent blind validation. This label-free and automated framework may provide an objective complement to conventional microscopic and biochemical testing in future diagnostic workflows.

Vaginal anomalies frequently accompany anorectal malformations (ARMs) in females, yet management strategies remain poorly standardized. This study presents our 17-year single-center experience with vaginal reconstruction in ARM patients with documented Müllerian and/or vaginal anomalies, focusing on surgical decision-making, technique selection, and outcomes. This study was conducted retrospectively on all children with ARMs who had documented Müllerian and/or vaginal anomalies who underwent vaginal reconstruction at our tertiary referral center between January 2004 and January 2021. Patient demographics, ARM types, vaginal anomaly types, associated anomalies, surgical approaches, vaginal reconstruction techniques, complications, and long-term outcomes were analyzed. Categorical variables were compared using Fisher's exact test. Eighteen patients underwent vaginal reconstruction: 11 (61%) had persistent cloaca (PC), 6 (33%) had rectovestibular fistula with anal atresia (RVFAA), and 1 (6%) had cloacal exstrophy. Eleven patients (61%) had duplicated vaginas; distal vaginal agenesis was present in 6 (33%). Associated anomalies were highly prevalent: vertebral (72%), gastrointestinal (39%), urinary (39%), cardiac (27%), and VATER/VACTERL association (22%). Mean age at definitive surgery was 2.50 ± 1.53 years. Vaginal reconstruction methods included introitoplasty (28%), vaginal septum excision (33%), and vaginal replacement using bowel segments and/or rectovestibular fistula tissue (33%). Mean achieved vaginal length was 60.56 ± 13.16 mm. Complications occurred in 44% of patients, predominantly wound dehiscence (33%) and fistula formation (28%). Fistula formation was significantly associated with prior wound dehiscence (p < 0.001). Mean follow-up was 7.18 ± 3.66 years (range 2.3-14.3 years). Vaginal anomalies in ARMs require individualized reconstruction approaches. No single technique is universally applicable. The surgical algorithm should prioritize maximal native vaginal tissue use, appropriate replacement tissue selection when needed, protective colostomy for complex cases, and long-term follow-up through puberty.

Simulation is commonly used for applicator placement verification during vaginal brachytherapy (VBT) for high-intermediate risk (HIR) endometrial cancer (EC). We evaluated vaginal recurrence (VR) outcomes in a single-institution cohort treated with VBT without simulation and compared results with those of PORTEC-4a, which mandated simulation. We conducted a retrospective cohort study of women with HIR EC treated with VBT without simulation. VR was analyzed in a competing risks framework. Outcomes were compared with the PORTEC-4a standard brachytherapy arm. A total of 255 patients were included, with a median follow-up of 60.1 months. Eleven VR events were observed. The 5-year cumulative incidence of VR was 3.6% (95% CI = 1.2-6.5%). This was compared with a 5-year VR incidence of 1.6% (95% CI = 0.00-3.32%) in the PORTEC-4a standard brachytherapy arm. No significant differences in VR were observed across clinical subgroups or by applicator type. In this retrospective cohort meeting PORTEC-4a eligibility criteria, VBT without simulation was associated with low VR rates, comparable to those reported with simulation-verified VBT. These findings suggest that omission of simulation may not compromise vaginal control in appropriately selected patients and support further prospective evaluation of verification strategies.

Intravaginal products, including silicon dioxide-based gels, are marketed to support short-term high-risk human papillomavirus (hrHPV) clearance or loss of detectability, but independent randomized evidence testing these short-term claims against observation is limited. We evaluated whether daily intravaginal silicon dioxide-based gel treatment increases the proportion of women with no detectable cervical hrHPV DNA compared with observation alone. This prospective, single-center, parallel-group, randomized, open-label controlled trial included women with PCR-confirmed cervical hrHPV infection and no indication for immediate treatment. Participants were randomized 1:1 to 3 months of self-administered daily intravaginal gel treatment or observation alone. The primary outcome was absence of detectable cervical hrHPV DNA by PCR at 3 months. Secondary outcomes during the randomized study period were patient-reported satisfaction and adverse events. ClinicalTrials.gov, NCT05509413, https://clinicaltrials.gov/study/NCT05509413. Between November 2022 and January 2025, 242 women were randomized, with 121 allocated to each group. Primary-endpoint data were available for 208 women. At 3 months, hrHPV DNA was not detected in 18/99 women (18%) in the gel treatment group and 23/109 women (21%) in the observation group (absolute risk difference -2.9 percentage points, 95% CI -14 to 8; p = 0.60). A reduced post hoc adjusted sensitivity analysis did not materially change the interpretation of the primary comparison. Patient-reported adverse events were more frequent in the gel treatment group than in the observation group (32/99 [32%] vs. 2/106 [2%]; absolute risk difference 30 percentage points, 95% CI 21 to 40; p < 0.001). Satisfaction scores were high in both groups but lower with gel treatment. In this randomized trial, 3 months of daily intravaginal silicon dioxide-based gel treatment did not improve short-term loss of detectable cervical hrHPV DNA compared with observation alone. The trial did not reproduce the large short-term virologic benefit suggested by prior product-related studies. The findings do not support routine use of this intervention solely to promote short-term hrHPV non-detectability in women without an indication for immediate treatment, particularly given the higher frequency of local adverse events.

Treatment of International Federation of Gynecology and Obstetrics (FIGO, 2009) stage II endometrial cancers (ECs) typically involves total hysterectomy and bilateral salpingo-oophorectomy followed by adjuvant radiation and/or chemotherapy. Existing guidelines recommend whole pelvis radiation therapy (WPRT); however, vaginal cuff brachytherapy (VCB) has conditional support as a boost. We sought to evaluate if there is improved overall survival (OS) associated with WPRT + VCB over WPRT alone for patients with FIGO (2009) stage II endometrioid EC and assess patterns of care. We hypothesize that WPRT + VCB will be associated with improved survival. The 2023 National Cancer Database was queried for patients with endometrioid ECs who underwent hysterectomy with complete surgical staging, consistent with T2N0M0, and were treated adjuvantly with WPRT + VCB or WPRT alone. Patients were excluded if risk factor information (eg, lymphovascular invasion, peritoneal cytology, myometrial invasion, and surgical margins) was incomplete. Logistic regression analysis was used to determine the propensity for each treatment method. Kaplan-Meier and landmark analyses for OS and univariate and multivariable (MVA) Cox proportional hazards models were used to evaluate (1) the entire cohort and (2) a propensity score-matched subgroup. Of 1782 patients included in this analysis, 670 received WPRT alone, and 1112 received WPRT + VCB. Median follow-up was 6.5 years. Logistic regression analysis revealed that few demographic or pathologic features were predictive of the adjuvant regimen received. WPRT + VCB was associated with an OS advantage (MVA: hazard ratio 0.68 [95% CI, 0.55-0.83]; P < .001). After propensity score matching, the OS benefit associated with WPRT + VCB was maintained (MVA: hazard ratio 0.61 [95% CI, 0.47-0.79]; P < .001). This National Cancer Database analysis suggests that adjuvant treatment with WPRT + VCB is associated with improved OS compared to WPRT alone in patients with FIGO 2009 stage II endometrioid EC. Given the limitations of such database analyses, further exploration in molecularly defined cohorts is warranted.

To determine whether periurethral estrogen application is noninferior to intravaginal estrogen application for the prevention of urinary tract infections (UTIs) in postmenopausal individuals with laboratory-proven recurrent UTI. The TAPER (Techniques of Applying Vaginal Estrogen for Prevention of Recurrent Urinary Tract Infections) trial was a single-center, nonblinded, randomized noninferiority trial that compared outcomes after a twice-weekly intravaginal estradiol applicator instillation of 1.0 g cream (intravaginal) compared with periurethral digital application of 0.5 g cream (periurethral) in postmenopausal individuals with recurrent UTIs. The primary outcome was the proportion of UTI-free participants at 6 months postintervention. Secondary outcomes included number of UTIs, the amount of time elapsed to the first UTI, vaginal pH, PGI-I (Patient Global Impression of Improvement) scores, patient experience with the study drug, study drug adverse effects, and urinary and sexual function. To achieve 80% power with a type 1 error of 5% and to account for loss to follow-up, 114 participants needed to be randomized based on a noninferiority margin of 25%. Of 270 eligible individuals, 114 consented and were randomized (57 intravaginal, 57 periurethral). Participants were predominantly White (92.1%) with a mean age of 71.1 years (range 52-93). Participants reported a median of three UTIs in the 12 months before enrollment. Individuals randomized to periurethral estrogen application had a similar proportion of UTI-free participants at 6 months as those randomized to intravaginal estrogen application (50.9% vs 52.6%; risk difference, -1.75 percentage points; 95% CI, -20.0 to 17.0 percentage points). Both groups experienced a decrease in vaginal pH at 6 months; the decreases did not differ by application method (-1.2 intravaginal vs -0.8 periurethral, P =.30). Participants assigned to intravaginal estrogen were more likely to experience vaginal itching after 3 months of use than those assigned to periurethral application (24.0% vs 2.4%, P <.01). Other outcomes did not differ by route of estrogen application. For postmenopausal individuals who are experiencing recurrent UTI, periurethral application of estradiol cream is noninferior to intravaginal application for UTI prevention. Both application methods resulted in approximately half of the participants being UTI-free at 6 months. ClinicalTrials.gov , NCT05472779.

Endometrioid endometrial carcinoma (EEC) is the most common type of endometrial carcinoma. A small subset recurs exclusively in the vagina. Data on this group remain limited due to its low incidence and study heterogeneity, combining different histologies and recurrence sites. We describe 20 patients with isolated vaginal recurrence of EEC, focusing on tumor characteristics, treatment, time to recurrence, and outcomes. Vaginal recurrences occurred between 2015 and 2024. Patients with positive margins at primary surgery or persistent disease were excluded. Medical records and slides were reviewed. Median time to vaginal recurrence was 2 yr (range, <1->16 yr), with 85% occurring within 4 yr. Most recurrences were unifocal and at the vaginal apex, and all retained the primary tumor grade. High-grade EEC recurred 19 months earlier than low-grade ( P =0.0227). Time to vaginal recurrence was not associated with other tumor features or postsurgical management. Complete remission was achieved in 65% of evaluable patients; among complete responders, 82% received radiotherapy (RT) alone. Second vaginal-only recurrences were uncommon (10%), and half were successfully salvaged. Five-year overall survival (OS) after primary tumor diagnosis was 89% (95% CI: 75%-100%) and after vaginal recurrence was 84% (95% CI: 66%-100%). Median follow-up after recurrence was 3.7 yr (95% CI: 1.0-5.7 yr). OS was associated with FIGO stage ( P <0.0001) and lymphovascular invasion ( P =0.0081). Five-year postrecurrence disease-free survival (PR-DFS) was 68% and was shorter in high-grade tumors ( P =0.043) and in patients receiving adjuvant RT ( P =0.013).

BackgroundHydrometrocolpos secondary to congenital vaginal atresia is a rare neonatal anomaly, usually diagnosed during puberty, resulting from obstructed uterovaginal secretions under maternal estrogen influence, which rarely leads to urinary tract compression, obstruction and renal dysfunction.Case presentationWe report a preterm 33-week neonatal Asian female delivered by normal vaginal delivery. Antenatal ultrasound revealed bilateral enlarged kidneys, ascites, and polyhydramnios. Postnatally, she developed sepsis, and elevated serum creatinine levels. Abdominal ultrasound and magnetic resonance imaging showed a cystic abdominopelvic mass with enlarged kidneys. Exploratory laparotomy confirmed congenital vaginal atresia. Following surgical intervention, the patient stabilized, with marked improvement in renal function.ConclusionAlthough congenital vaginal atresia is usually diagnosed at puberty, it can present in the neonatal period; early diagnosis and appropriate management are crucial to prevent complications and achieve favorable outcomes.

Antibodies against HPV proteins can provide pre-diagnostic information about cancer development. We described the prevalence of antibodies to proteins of oncogenic HPV types prior to diagnosis of HPV-related cancers. We analysed pre-diagnostic blood from 1700 participants with incident HPV-related cancers (anal = 387, cervical = 274, oropharyngeal = 788, penile = 168, vaginal = 83) and 6221 controls from nine prospective cohorts in Europe, North America and Australia in the HPV Cancer Cohort Consortium. We measured antibodies against E6, E7 and L1 proteins for 6 HPV types, and additionally against E1, E2, E4, E6, E7 and L1 proteins of HPV16 and 18. We described seroprevalence by lead time from blood draw to cancer diagnosis (range: 0-43 years). We found that among oropharyngeal cancers, seroprevalence increased approaching diagnosis for HPV16 E1, E2, E4, E6, E7, L1 and HPV18 E1, E2, L1 (HPV16-E6: from 10.4% at > 20 years to 35.8% at 0-5 years, vs. 0.3% in controls). Anal cancer showed similar patterns for HPV16 E1, E2, E4, E6 and L1 and HPV18 E2 (HPV16-E6: from 3.8% at > 20 years to 29.8% at 0-5 years). No trends were observed for cervical, penile, or vaginal cancers. In a multivariable model fit among cases, HPV16-E6 seropositivity was higher at shorter lead times and more recent calendar periods, lower among US non-Hispanic Blacks, and varied by cancer type (highest in oropharyngeal followed by anal, vaginal, penile and cervical) (all p < 0.03). In conclusion, pre-diagnostic HPV antibody responses vary by cancer type, with seroprevalence of 6-9 HPV proteins increasing approaching diagnosis for oropharyngeal and anal cancers, but not cervical, penile or vaginal cancers.

To describe the pre-procedural planning and demonstrate the intra-procedural technique of transrectal ultrasound-guided oocyte retrieval (TROR) in a patient with vaginal cancer. Video article. University-affiliated fertility center. A 19-year-old virginal female with primary clear cell cancer of the vagina presented for fertility preservation. She was unable to tolerate a pelvic examination or transvaginal ultrasonography (TVUS) due to significant pain and bleeding. Her antral follicle count (AFC) and anti-mullerian hormone (AMH) was 37 and 67 pmol/L (9.38 ng/mL), respectively. Controlled ovarian stimulation (COS) was initiated with 150 units of recombinant follicle stimulating hormone (FSH) in a gonadotropin-releasing hormone (GnRH) antagonist protocol. Transabdominal ultrasonography (TAUS) on the 10th day of COS revealed 11 follicles measuring 17 mm or larger in both ovaries. TAUS also demonstrated access to only the lateral portion of the right ovary; access to the left ovary was limited significantly by the uterus and intervening vasculature. Given the short notice, a laparoscopic oocyte retrieval was not possible, and both transabdominal and transrectal retrieval of oocytes was proactively discussed. Bowel preparation was implemented the day before the retrieval. The patient gave consent for publication and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. TROR 36 hours after ovulatory trigger. Total and mature oocyte yield after TROR. A 7 mHz vaginal transducer with diameter of 23.8 mm, covered with a sterile cover, and copious lubrication was gently introduced into the rectum. Both ovaries were visualized easily. A 17 G, 25-cm single lumen needle was used for follicular aspiration. Twenty nine oocytes were retrieved, of which 28 mature oocytes were cryopreserved. The patient was prescribed oral levofloxacin and metronidazole for 5 days post-TROR. She had an uneventful postoperative course and began her oncologic treatment shortly after. TROR is a viable alternative to the transabdominal and/or laparoscopic approach in patients with vaginal or cervical cancer. Despite its novelty, TROR should be performed only when transvaginal, transabdominal or laparoscopic oocyte retrieval is not safe or feasible.

Endometrial hyperplasia (EH), a common precursor lesion to endometrial carcinoma, represents a major gynecological challenge. Current noninvasive vaginal treatments are severely hampered by poor retention and inadequate mucosal adhesion. Herein, we developed a novel thermosensitive hydroxybutyl polyvinyl alcohol (HBPVA) hydrogel for efficient localized vaginal delivery of progesterone. By grafting hydrophobic hydroxybutyl groups onto the hydrophilic PVA backbone, the resulting HBPVA hydrogel exhibited good flowability at 4 °C and a rapid sol-gel transition at 37 °C. Progesterone microcrystals were directly incorporated into the HBPVA solution via simple physical mixing, yielding a stable formulation (Pro@HBPVA) without the need for organic solvents or purification. The thermosensitive hydrogel, once gelled at body temperature, leveraged its abundant surface hydroxyl groups to achieve superior mucoadhesion compared to commercial F127 hydrogel (mucosal adhesion duration >10 times that of the F127 control). Ex vivo fluorescence imaging revealed that the fluorescein-labeled HBPVA hydrogel was retained in the vaginal tract 4-fold longer and at significantly higher levels than a fluorescein sodium solution. Furthermore, the HBPVA formulation enabled preferential uterine accumulation with prolonged therapeutic exposure (>24 h). In an estrogen-induced EH rat model, Pro@HBPVA demonstrated superior therapeutic efficacy to intramuscular progesterone oil injection (positive control), effectively reducing uterine wet weight, restoring endometrial thickness and apoptosis balance, suppressing excessive endometrial angiogenesis and proliferation, and attenuating local inflammation to levels comparable to healthy controls. Collectively, with proven biocompatibility, this mucoadhesive platform offers an effective and noninvasive strategy for EH treatment.

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder associated with reproductive dysfunction and increased cardiometabolic risk. Conventional diagnostic phenotypes may not adequately capture endocrine-metabolic variability, particularly in young women. We aimed to identify data-driven endocrine-metabolic phenotypes in young women with PCOS and assess their associations with selected cardiometabolic risk markers. This cross-sectional study included 1032 women aged 16-25 years with PCOS diagnosed according to the Rotterdam criteria, selected from 1300 consecutive patients evaluated at a tertiary gynecological endocrinology center in Poland between 2018 and 2025. Principal component analysis (PCA) followed by Gaussian mixture model clustering was used to identify latent endocrine-metabolic subgroups. Cardiometabolic outcomes included impaired glucose tolerance (2-hour plasma glucose ≥ 140 mg/dL), elevated triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio, elevated non-high-density lipoprotein cholesterol (≥ 130 mg/dL), and a composite endpoint. PCA retained 10 components explaining 81.9% of total variance. The optimal clustering solution identified two subgroups: a predominant mixed endocrine-metabolic subgroup (n = 954; 92.4%) and a smaller thyroid/autoimmune-enriched subgroup (n = 78; 7.6%) characterized by higher anti-thyroid peroxidase antibody and thyroid-stimulating hormone levels. Cluster assignment certainty within the selected model was high, although sensitivity analyses suggested that the latent structure was partially driven by thyroid/autoimmune-related variables. The thyroid/autoimmune-enriched subgroup showed a higher prevalence of an elevated TG/HDL ratio, whereas differences in glucose tolerance and non-high-density lipoprotein cholesterol were less pronounced. These findings suggest the presence of exploratory endocrine-metabolic subgroup structure in young women with PCOS, including a thyroid/autoimmune-enriched subgroup associated with modest differences in lipid-related cardiometabolic risk markers. The observed heterogeneity extends beyond conventional diagnostic classifications, although external validation and longitudinal studies are required to determine clinical relevance and reproducibility. CLINICAL TRIAL REGISTRATION: This study was not registered as a clinical trial, as it was an observational cross-sectional analysis.

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder in women that is characterized by a complex pathogenesis involving multiple mechanisms, including hyperandrogenism, ovulatory dysfunction, insulin resistance (IR), and chronic inflammation. Recent studies have demonstrated that the gut microbiota acts as an important metabolic regulator and may play a pivotal role in the onset and progression of PCOS. Patients with PCOS frequently exhibit gut microbiota dysbiosis, which is characterized by reduced microbial diversity, decreased levels of beneficial bacteria, increased levels of pathogenic bacteria, and altered metabolic byproducts. This imbalance may contribute to IR and ovarian dysfunction by activating the toll-like receptor 4/nuclear factor kappa B inflammatory pathway, inducing oxidative stress, and disrupting Wnt/β-catenin signaling. The Wnt/β-catenin signaling pathway, a key regulator of follicular development, is frequently aberrantly activated in PCOS. In this narrative review, we summarize the recent advances in understanding the roles of the gut microbiota and the Wnt/β-catenin signaling pathway in the pathogenesis of PCOS. To this end, we conducted a comprehensive literature search across PubMed, Web of Science, Embase, and Cochrane Library databases, covering publications from January 2012 to March 2026. Ninety-eight articles were included after screening. We further explored therapeutic strategies based on microbiome modulation and signaling pathway targeting, including probiotics, traditional Chinese medicine, ginsenosides, puerarin, fecal microbiota transplantation, and nanoparticle-based ginseng-derived exosomes, thereby providing novel insights into potential therapies for PCOS.

Background: Episiotomy is considered a protective intervention when used selectively rather than routinely. Although current obstetric practice no longer recommends routine episiotomy, data on its use remain limited, particularly in Lebanon. Objective: This study evaluated the prevalence, predictors, and maternal outcomes of episiotomy in low-risk vaginal deliveries and compared its use between a hospital-attached birth center (BC) and a delivery suite (DS). Methods: A retrospective observational study was conducted using data from Rafik Hariri University Hospital (RHUH) BC and DS between January 2024 and September 2025. A total of 333 patients were included. Data were analyzed using SPSS v23. Binary logistic regression identified predictors of episiotomy, while associations with maternal outcomes were assessed using risk ratios and number needed to treat. Results: The episiotomy rate was 28.5%, with no significant difference between BC and DS. Rates were higher among primiparous women. Episiotomy was associated with lower rates of perineal injury overall (NNT = 4 for both parity groups). Among primiparous women, those without episiotomy had significantly higher rates of paraurethral injury (41.2 vs 12.3%, p = 0.011) and first-degree tears (35.3 vs 11.0%). On multivariate logistic regression, independent predictors of episiotomy included primiparity (aOR = 39.18, 95%, CI 18.42-83.33), private patient status (aOR = 21.72, 95%, CI 3.33-141.64), older age (aOR = 0.93, 95% CI: 0.86-0.99), and greater cervical dilation at admission (aOR = 0.74, 95% CI: 0.60-0.91). Conclusion: Episiotomy use varies by case and remains common in low-risk pregnancies, especially among primiparous women. Predictive and preventive factors associated with its use were identified. Episiotomy is a small surgical cut made between the vagina and the anus during childbirth. It is done in order to help the baby pass through more easily. It was once done routinely for almost all women giving birth for the first time, but health organizations now recommend using it only when truly necessary.This study looked at how often episiotomy was performed at Rafik Hariri University Hospital (RHUH) in Beirut, Lebanon. The hospital has both a midwife-led birth center and a standard delivery suite. We included 333 women with low-risk pregnancies who delivered vaginally between January 2024 and September 2025.We found that about 1 in about 3 women received an episiotomy. Women giving birth for the first time were much more likely to have one. There was no notable difference in the rates of episiotomy between the birth center and the delivery suite.Women who had an episiotomy were less likely to experience perineal tearing or injury around the urethra, particularly among first-time mothers.The study also found that younger age, being a first-time mother, having less cervical dilation on arrival, and being a private patient were the strongest predictors of receiving an episiotomy.Overall, the episiotomy rate at RHUH is lower than older Lebanese data and lower than most neighboring countries, which can suggest progress toward evidence-based practice. However, the rate remains above the World Health Organization’s recommended level of 10%.All in all, this study is one of the few to examine episiotomy in Lebanon, which has a large refugee population. The findings of this study can help inform better and more individualized obstetric care.

Trial of labor after cesarean (TOLAC) has reemerged as an important strategy to lower rising cesarean rates and provide women with a safe alternative to repeat surgery. Successful vaginal birth after cesarean (VBAC) may also reduce long-term complications associated with multiple cesarean deliveries. Despite this growing interest, data from high-fertility regions remain limited. This study evaluated outcomes of TOLAC in secondary-level hospitals in Türkiye and compared them with elective repeat cesarean section (ERCS). This retrospective multicenter cohort included women with ≥1 prior low-transverse cesarean delivery between January 2020 and January 2026. Eligible patients underwent either ERCS or attempted TOLAC, which resulted in VBAC or emergency cesarean. Maternal characteristics, peripartum variables, and neonatal outcomes were assessed. Crude risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Of 19,768 women with a previous cesarean, 2,185 (11.1%) attempted TOLAC and 17,583 (89.0%) selected ERCS. VBAC was achieved in 1,464 women (67.0%), while 721 (33.0%) required emergency cesarean. Compared with ERCS, VBAC was associated with lower risks of gestational diabetes (RR 0.68; 95% CI 0.52-0.89) and pregnancy-related hypertension (RR 0.62; 95% CI 0.44-0.89). Emergency cesarean was linked to higher transfusion requirements (RR 1.36; 95% CI 1.02-1.82). Uterine rupture was rare across groups. Neonatal outcomes were broadly similar, although fetal acidosis appeared more frequent after failed TOLAC. VBAC success rates in this cohort aligned with contemporary international benchmarks and demonstrated favorable maternal outcomes in appropriately selected patients. Emergency cesarean following failed TOLAC represented the highest-risk pathway, emphasizing the need for meticulous intrapartum monitoring and timely surgical readiness. Expanding safe TOLAC programs may reduce unnecessary repeat cesarean deliveries in high-fertility settings.

Childbirth can be experienced as traumatic and lead to posttraumatic stress symptoms. The evolution of childbirth-related posttraumatic stress symptoms remains poorly documented. We aimed to characterize posttraumatic stress symptom trajectories after vaginal delivery and identify associated risk factors. Ancillary cohort of the TRanexamic Acid for Preventing postpartum hemorrhage after vaginal delivery trial in 15 French university hospitals (2015-2016) including women delivering vaginally after 35 weeks' gestation. After randomization, characteristics of the labor and delivery were prospectively collected. Posttraumatic stress symptoms were assessed at day 2 and 2 months postpartum using the self-administered Impact of Event Scale-Revised questionnaire. Four trajectories were defined: asymptomatic (Impact of Event Scale-Revised <22 at both time points), recovered (≥22 at day 2; <22 at 2 months), emerging (<22 at day 2; ≥22 at 2 months), and persistent (≥22 at both). Prevalences were corrected for nonresponse using inverse probability weighting. Risk factors were assessed using multivariable logistic regression. Among 3891 women, 2344 (60.2%) completed the Impact of Event Scale-Revised at both assessments. Corrected prevalences were 83.4% (81.8-85.0) asymptomatic, 11.0% (9.7-12.4) recovered, 2.1% (1.6-2.8) emerging, and 3.5% (2.7-4.4) persistent. Among women with posttraumatic stress symptoms at day 2, persistent symptoms compared with recovery were associated with younger age (adjusted odds ratio, 0.8; 95% confidence interval, 0.6-0.9), non-European origin (adjusted odds ratio, 1.8; 95% confidence interval, 1.2-2.6), psychiatric history (adjusted odds ratio, 1.9; 95% confidence interval, 1.2-2.4), bad memories of delivery (adjusted odds ratio, 2.4; 95% confidence interval, 1.3-4.6), and hemoglobin <9 g/dL at day 2 (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-2.7). Among women without posttraumatic stress symptoms at day 2, emerging symptoms compared with asymptomatic trajectories were associated with previous abortion (adjusted odds ratio, 2.6; 95% confidence interval, 1.6-3.9), hospitalization during pregnancy (adjusted odds ratio, 2.8; 95% confidence interval, 1.4-4.7), labor induction (adjusted odds ratio, 1.7; 95% confidence interval, 1.1-2.8), bad memories of delivery (adjusted odds ratio, 3.7; 95% confidence interval, 1.4-5.6), and fatigue at day 2 (adjusted odds ratio, 2.2; 95% confidence interval, 1.4-3.5), while epidural analgesia reduced the risk (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.7). About 1 in 20 women present an unfavorable posttraumatic stress symptom trajectory up to 2 months after a term vaginal delivery. The risk factors for a persistent trajectory were notably preexisting vulnerabilities, bad memories of delivery, and postpartum anemia at day 2 postpartum, whereas emerging trajectories were more closely associated with obstetric risk factors. These findings may help inform potential postpartum posttraumatic stress disorder screening strategies and highlight targets for preventive efforts.

Adverse childhood experiences have been associated with several long-term health outcomes, yet their relation to polycystic ovary syndrome-renamed as polyendocrine metabolic ovarian syndrome in 2026-is understudied. Adverse childhood experiences may influence polycystic ovary syndrome risk via disruption of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes. We used cross-sectional data to evaluate the association between early life adversities and self-reported polycystic ovary syndrome in Pregnancy Study Online, a North American preconception cohort of females aged 21 to 45 years enrolled during 2013 to 2025. At enrollment, participants completed a baseline questionnaire to ascertain sociodemographics, behavioral factors, and medical history. Thirty days after enrollment, participants completed a supplemental questionnaire that included the Behavioral Risk Factor Surveillance System's 8-item adverse childhood experience module and Brief Trauma Questionnaire. Participants reported physician-diagnosed polycystic ovary syndrome on baseline and follow-up questionnaires during preconception. We fit modified Poisson regression models to estimate prevalence ratios and 95% confidence intervals, adjusting for age, race, ethnicity, childhood financial hardship, and highest level of parental education. We used inverse probability weights to account for supplemental questionnaire nonresponse. Among 10,856 participants, 52% and 26% reported 1 to 3 and ≥4 adverse childhood experiences, respectively; 1169 (10.8%) reported a polycystic ovary syndrome diagnosis. Self-reported polycystic ovary syndrome prevalence ranged from 7.4% (no adverse childhood experiences) to 14.2% (≥4 adverse childhood experiences). Weighted and fully adjusted prevalence ratios for 1 to 3 and ≥4 (vs 0) adverse childhood experiences were 1.33 (95% confidence interval, 1.11-1.60) and 1.64 (95% confidence interval, 1.33-2.01), respectively (per 1-adverse childhood experience increase, prevalence ratio=1.08; 95% confidence interval, 1.05-1.11). Specific adverse childhood experiences associated with the largest increase in polycystic ovary syndrome prevalence included sexual abuse (prevalence ratio=1.82; 95% confidence interval, 1.45-2.29), parental interpersonal violence (prevalence ratio=1.68; 95% confidence interval, 1.29-2.17), emotional abuse (prevalence ratio=1.54; 95% confidence interval, 1.28-1.86), physical abuse (prevalence ratio=1.52; 95% confidence interval, 1.21-1.90), household mental illness (prevalence ratio=1.46; 95% confidence interval, 1.21-1.77), and parental separation/divorce (prevalence ratio=1.43; 95% confidence interval, 1.15-1.77). Results based on Brief Trauma Questionnaire‑derived measures of childhood sexual and physical abuse were consistent with those based on adverse childhood experience measures. In this North American cross-sectional study, higher exposure to early life adversities was associated with a higher lifetime prevalence of self-reported physician-diagnosed polycystic ovary syndrome. These findings add to growing evidence that childhood adversities may have lasting effects on gynecologic health and underscore the need for attention to early life stressors in understanding polycystic ovary syndrome.

This study aimed to describe antimicrobial resistance profiles, temporally proximate polymicrobial co-detection patterns, and clinical characteristics of Group B Streptococcus (GBS) in pregnant women, and to explore potential factors related to multidrug resistance (MDR) and pregnancy outcomes. A retrospective analysis was conducted on 508 pregnant women (gestational age ≥28 weeks) who underwent vaginal culture and antimicrobial susceptibility testing between January 2020 and December 2023 at a tertiary hospital in southern China. Pathogens were identified using the VITEK 2 system, and susceptibility testing was interpreted per CLSI 2023 criteria. Polymicrobial co-detection was operationally defined as the detection of ≥2 pathogens from the same anatomical site in the same specimen, on the same day, or within a predefined ±7-day interval. Clinical data and pregnancy outcomes were extracted from medical records. GBS was detected in 23.6% (120/508) of participants. Based on the operational definition, 75.8% of GBS-positive women had temporally proximate detection of at least one additional pathogen, most commonly Candida albicans , Ureaplasma urealyticum , and Mycoplasma hominis . GBS isolates showed high susceptibility to penicillin (≥95%), whereas resistance to erythromycin (35.0%) and clindamycin (33.0%) was observed. Among isolates with complete susceptibility data, 9.0% (6/67) met the MDR definition. In exploratory analyses, gestational diabetes mellitus showed an elevated but imprecise association with MDR, while no robust evidence of association was observed for polymicrobial co-detection. Unadjusted comparisons indicated higher rates of cesarean delivery and premature rupture of membranes in GBS-positive women. GBS colonization in pregnancy is frequently accompanied by temporally proximate detection of additional vaginal pathogens and macrolide/lincosamide resistance. MDR-related findings and clinical associations should be interpreted as exploratory and hypothesis-generating, and require confirmation in larger prospective studies.

Forceps delivery often leads to increased maternal and neonatal complications, primarily attributed to the rigidity of traditional steel forceps, a major contributor to birth injury. This study aims to develop obstetric forceps with reduced rigidity and assess the safety and effectiveness of the newly designed pliant forceps. Pliant forceps with varying materials and shapes were produced by three-dimensional printing, and a pilot simulation determined the optimal design. Three fetal mannequins were developed to measure force changes exerted on the fetal head. Simulated births with several resistance intensities, were conducted to compare the real-time force between pliant forceps and Simpson forceps. Perineal distension was assessed by recording maximum perineal distention during a simulated forceps delivery using pliant forceps and Simpson forceps. The pliant forceps, constructed from polylactic acid with solid blades and angled shanks, featured foam tape on the fetal sides. In simulation studies on term fetal head model, pliant forceps achieved successful assisted vaginal delivery across all resistance levels. Compared to Simpson forceps, pliant forceps consistently exerted lower force on the fetal head during assisted vaginal delivery. The maximum force applied by pliant forceps occurred at RA1 site on fetal head (67.11 ± 4.35 N, Simpson forceps: 99.12 ± 10.53 N, p < 0.001), and Simpson forceps reached its peak at RP2 site (177.37 ± 19.28 N, pliant forceps: 12.87 ± 5.11 N, p < 0.001). Similar results were obtained in simulation experiments on large and small fetal head models. Perineal distension was determined to be smaller in births with pliant forceps compared with that in births with Simpson forceps (lateral perineal distension: 76.6 mm vs. 92.6 mm, p < 0.001). The three-dimensional-printed pliant forceps demonstrated reduced force on the fetal head and less perineal distension compared to Simpson forceps in simulated births, which holds potential for decreasing birth injuries and maternal birth canal injuries during forceps delivery. Further research is required to ensure the safety and efficacy of pliant forceps before clinical application.