Placenta accreta spectrum (PAS) is a high-risk obstetric condition associated with hemorrhage, urologic injury, and peripartum hysterectomy. Rising cesarean delivery rates continue to increase its prevalence. Variation in surgical management and limited multidisciplinary involvement may contribute to adverse maternal outcomes. To evaluate whether the implementation of a multidisciplinary team (MDT) protocol for PAS was associated with improved perioperative outcomes. This retrospective cohort study included 417 women diagnosed with PAS from 2011 to 2022 at a tertiary center. In 2019, a structured MDT protocol was adopted, incorporating standardized imaging, preoperative conference, routine bilateral ureteral catheter (UC) placement, and on-site urologic support. Outcomes of MDT-managed patients (n = 108) were compared with pre-MDT patients (n = 309). Multivariable logistic regression and generalized linear models adjusted for maternal age, gravidity, prior cesarean delivery, placenta previa, PAS grade, surgical urgency, gestational age, and year of delivery. After adjustment, MDT care was associated with lower odds of urologic injury (aOR 0.34; 95% CI 0.12-0.82), surgical complications (aOR 0.39; 95% CI 0.18-0.78), transfusion (aOR 0.41; 95% CI 0.14-0.93), and hysterectomy (aOR 0.22; 95% CI 0.05-0.91). Adjusted estimated blood loss decreased by 260mL (95% CI - 480 to - 70), and length of stay was reduced by 0.9days (95% CI - 1.4 to - 0.3). Results remained consistent in sensitivity analyses limited to 2017-2022. Implementation of an MDT protocol was associated with reduced perioperative morbidity, supporting multidisciplinary management as a potentially safer strategy for high-risk PAS surgery.

This study was conducted to investigate the changes in the uterine biophysical profile (UBP) before and after intrauterine administration of Autologous Blood Cell Derivatives (ABCD). This prospective observational study investigates endometrial receptivity in frozen embryo transfer (FET) cycles. It focuses on patients with thin endometrium (TEM), a basal serum FSH below 10IU/L, and good-quality frozen embryos. The study utilizes the UBP to evaluate endometrial receptivity both before and after the ABCD procedure. The study involved 33 women with TEM undergoing FET cycles. ABCD was administered during the first, second, and third or later FET cycles in 21.21%, 45.45%, and 33.33% of patients, respectively. Following ABCD administration, significant improvements were observed in UBP scores (from 9.06 to 14.85), EMT (from 6.6mm to 8.67mm), blood flow to zone III (from 0.85mm to 3.36mm), and uterine artery pulsatility index (PI) (from 0.7 to 0.97). Odds ratio analysis showed an association between pregnancy and endometrial layering (OR = 2.12), though it was not statistically significant. Multivariate analysis revealed that the UBP score predicted pregnancy with 68% accuracy, while the ROC analysis yielded an accuracy of 54%. A UBP threshold score of 20 offered 100% specificity, making it a potentially reliable predictor of successful implantation. This study demonstrates that ABCD growth factors significantly enhance endometrial development in women with TEM, resulting in improved UBP scores, reduced EMT, lower uterine artery PI, and increased uterine blood flow. A UBP score cutoff of 20 demonstrated 95% sensitivity, highlighting its potential as a reliable prognostic tool in infertility treatment.

Preeclampsia is a major obstetric disorder. Machine learning (ML)models incorporating angiogenic biomarkers show promise in predicting related adverse outcomes, but refinement is needed for clinical use. This study aimed to reduce features to a clinically meaningful set and to develop and validate predictive endpoints for preeclampsia-associated outcomes. A model with a reduced feature set was derived from a training cohort of 1,634 patients (2, 412 visits) and then tested on a validation cohort of 402 patients (540 visits). Three machine learning models were developed to predict (1) adverse outcomes overall, (2) delivery within 14days before 34weeks of gestation, and (3) delivery within 7days after 34weeks, using 13 features versus 114 originally. Reduced-feature models demonstrated comparable accuracy to original models across all endpoints. Model 1 (any adverse outcome) achieved an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.92 (95% CI: 0.88-0.96) in training and 0.89 (95% CI: 0.84-0.93, p = 0.31) in thevalidation cohort, respectively. For delivery within 14days, theAUROC was 0.92 (95% CI: 0.87-0.96) in training and 0.85 (95% CI: 0.78-0.92) in validation (p = 0.13). Delivery within 7days showed AUROCs of 0.79 (95% CI: 0.70-0.87) and 0.80 (95% CI: 0.75-0.85) (p = 0.78). A machine learning model with a significantly reduced number of features can accurately predict clinically relevant preeclampsia outcomes. The identified endpoints (timing of delivery and adverse events) could support clinical decision-making and help reduce maternal and neonatal morbidity and mortality.

Insulin autoimmune syndrome (IAS), or Hirata disease, is a rare autoimmune disorder characterized by the presence of autoantibodies targeting insulin, leading to episodes of postprandial hypoglycemia. First identified in Japan, the condition was historically seen primarily in the Asian population, but with global recognition and improved diagnostic tools, its prevalence has expanded. While IAS is often self-limiting and resolves with dietary modifications and discontinuation of triggering medications, its management in the context of assisted reproductive technology (ART) remains understudied. This case report discusses a 28-year-old female diagnosed with IAS who underwent oocyte cryopreservation following a fertility assessment revealing low serum AMH levels. Despite a history of severe hypoglycemia, which was managed with rituximab and resolved within a month, and the presence of elevated insulin and insulin autoantibodies, she successfully completed ovarian stimulation without experiencing hypoglycemic episodes. Close monitoring of glucose levels and insulin autoantibody concentrations was essential for successful oocyte retrieval. This case underscores the importance of careful monitoring and individualized care for patients with IAS undergoing ART as autoimmune flare-ups and hypoglycemia can still occur even when the disease is in remission. A multidisciplinary approach involving reproductive endocrinologists and fertility specialists is critical for safe management of such patients.

To evaluate the acceptance of micronutrient therapy in women with symptoms related to a pathological neurostress profile and to explore its association with patient-reported outcomes such as perceived efficacy, side effects, compliance, and perceived lack of information. This retrospective observational study included women aged ≥ 18years who underwent neurostress testing followed by micronutrient therapy. The study was conducted at the Department of Obstetrics and Gynecology, University Hospital Bern. Patients were invited to complete the validatedACCEPT© questionnaire to assess their level of treatment acceptance. Descriptive statistics and non-parametric tests were applied, and correlations were analyzed using Spearman's rho. Eighty-one women participated. Overall treatment acceptance was high, with a median ACCEPT© score of 88.9 (Q1 = 66.6, Q3 = 100). Acceptance of drug-related constraints scored high (median = 100), whereas acceptance of treatment duration was lower (median = 66.6). Side effects were well tolerated (median = 100), and perceived efficacy was rated positively (median = 100). General acceptance correlated significantly with perceived efficacy (p < 0.001) and side effects (p < 0.001), but not with compliance (p = 0.084). A negative correlation was found with the perceived lack of information (p = 0.043). Micronutrient therapy in women with a pathological neurostress profile was highly accepted, particularly regarding treatment-related constraints and side effects. Acceptance was closely linked to perceived efficacy, highlighting the importance of patient-centered communication and expectation management.

This study evaluates treatment intensity, tolerability, and survival outcomes in early breast cancer patients with high body surface area (BSA) receiving capped chemotherapy doses. We retrospectively analyzed 730 patients with early breast cancer who received neoadjuvant or adjuvant chemotherapy with anthracycline/cyclophosphamide and taxane-based regimens at the University Hospital Tübingen between 2014 and 2021. Institutional policy capped dosing at BSA 2.0 m2. To identify patients with clinically relevant dose reduction (≥ 5%), we classified those with BSA > 2.1 m2 as the high-BSA group. We assessed relative dose intensity (RDI), adverse events leading to treatment modifications, and survival outcomes using Kaplan-Meier analyses and Cox proportional hazards regression. Among 730 patients, 61 (8.4%) had BSA > 2.1 m2. High-BSA patients received significantly lower median RDI (83.9% vs. 92.6%, p < 0.001). Consistent with reduced dose intensity, treatment tolerability was good: blood and lymphatic system disorders (8.2% vs. 24.5%, p = 0.006) and gastrointestinal disorders (0.0% vs. 11.1%, p = 0.002) occurred less frequently, and fewer patients required subsequent dose reductions (37.7% vs. 58.3%, p = 0.008). Despite this favorable tolerability profile, 5-year overall survival (85.5% vs. 94.3%, p = 0.015) and disease-free survival (74.3% vs. 91.0%, p = 0.008) were inferior in the high-BSA group. This association persisted in multivariate analysis (OS: HR 3.25; DFS: HR 2.17), though obesity-related effects could not be separated due to collinearity. In this cohort with consistent dose capping at BSA 2.0 m2, patients with high BSA represent an at-risk population with reduced chemotherapy intensity, inferior survival, but good treatment tolerability. Lower rates of blood and lymphatic system disorders and gastrointestinal disorders and fewer dose reductions suggest these patients may have tolerated full weight-based doses. While the contributions of obesity-related prognostic factors and potential underdosing could not be separated, these findings support ASCO guideline recommendations against routine dose capping in curative settings.

Preterm delivery (PTD) has been a significant cause of neonatal morbidity and mortality. Maternal serum ferritin, a biomarker of both iron stores and systemic inflammation, has shown inconsistent associations with PTD risk in individual studies. This systematic review and meta-analysis aimed to clarify the relationship between maternal serum ferritin levels and the risk of PTD. Following the PRISMA guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar up to August 2025. Twenty-four observational studies with more than 10000 participants were included. Pooled standardized mean differences (SMDs) and odds ratios (ORs) were calculated using random-effects models. The ROBINS-1 tool was used to assess the quality of the studies and the risk of bias. Ferritin levels were significantly higher in pregnancies ending in PTD (random-effects SMD 0.82, 95% CI 0.28-1.36; I2 = 97.3%), with the strongest association observed in the second trimester (SMD 1.18, 95% CI 0.74-1.63). No independent predictive role for ferritin was shown (random-effects OR 1.05, 95% CI 0.97-1.13). High heterogeneity and evidence of publication bias were noted. Hemoglobin levels did not differ between groups. Elevated levels of maternal serum ferritin, especially during the second trimester, are linked to PTD. However, the adjusted OR estimates have not shown statistical significance. There is considerable variability among the studies and a risk of bias that warrants cautious interpretation. Additionally, the diagnostic thresholds reported differ greatly and lack sufficient validation for clinical application. It is essential to conduct standardized prospective studies before ferritin-based clinical decision-making can be endorsed.

To evaluate the association between ultrasonographically measured umbilical coiling index (UCI) at 18-24weeks of gestation and adverse perinatal outcomes in primigravid pregnancies. This prospective study included 461 primigravid women with singleton pregnancies. UCI was measured at 3 cord segments and classified as hypocoiled (< 0.20), normocoiled (0.20-0.40), or hypercoiled (> 0.40) using percentile distribution and ROC-derived thresholds. Maternal characteristics, delivery outcomes, fetal well-being, placental measurements, cord blood gas values, and neonatal outcomes were compared using Kruskal-Wallis, Mann-Whitney U, and chi-square tests (p < 0.05 was significant). Of the 461 patients, 72 (15.6%) were hypocoiled, 244 (52.9%) normocoiled, and 145 (31.5%) hypercoiled. No significant differences were found in maternal age, BMI, gestational age at delivery, hypertension, diabetes, or placental abruption. Birth weight was lowest in the hypocoiled group (p < 0.001). Umbilical artery pH was significantly lower in the hypercoiled group (p < 0.001). Both hypo and hypercoiled groups showed significantly reduced placental weight/thickness (p < 0.001) and higher rates of non-reassuring non-stress tests (34.7 and 28.3% vs. 9.0%, p < 0.001). Meconium-stained amniotic fluid (p = 0.003), oligohydramnios (p < 0.001), and intrauterine growth restriction (p < 0.001) were more common in abnormal coiling groups. Five-minute Apgar scores were significantly lower in both abnormal groups (p < 0.001). No association was found with fetal death (p = 0.575). Both decreased and excessive umbilical cord coiling in the second trimester are associated with impaired fetal growth and adverse perinatal outcomes. Routine second-trimester UCI assessment may help identify high-risk pregnancies.

Transcervical radiofrequency ablation is a low-risk, uterus-preserving option for symptomatic fibroids in women with obesity with significant improvement of bleeding disorder, including ≥ 40 kg/m2. Obesity should not preclude offering TFA. To evaluate the safety and effectiveness of transcervical radiofrequency ablation (TFA) for uterine fibroids in women with obesity. Retrospective multicenter cohort at two German Fibroid Centers. From 574 consecutive TFA cases, we included patients with BMI ≥ 30 kg/m2 and ≥ 6-month follow-up; those with incomplete data were excluded. Fibroids were characterized by ultrasound. TFA (Sonata®) was performed per instructions for use. Outcomes were perioperative complications and patient-reported improvement in abnormal uterine bleeding (AUB). Sixty patients were analyzed (age 43.59 ± 6.52 years; BMI 35.72 ± 6.72 kg/m2). Mean operative and ablation times were 33.65 and 9.91 min, respectively. One intraoperative bleeding event (1.7%) was controlled with a balloon catheter; no postoperative complications occurred. Mean follow-up was 17.08 months (6-54). Overall, 42/60 (70.0%) reported AUB improvement. By BMI category: 30-34.9 kg/m2 25/39 (64.1%), 35-39.9 kg/m2 5/7 (71.4%), ≥ 40 kg/m2 12/14 (85.7%) (p = 0.3168). Considering the initial assessment, 48/60 (80.0%) improved; six later recurred, yielding 42/60 (70.0%) at last follow-up. TFA showed a very low complication rate and clinically meaningful bleeding improvement in women with obesity, with comparable outcomes across BMI strata, including ≥ 40 kg/m2. Obesity is not a barrier to safe, effective TFA. Prospective, BMI-stratified studies with validated bleeding measures and objective endpoints are warranted.