This study aimed to investigate the acute effects of pelvic floor muscle training (PFMT) on vaginal dryness in postmenopausal women using an objective measurement method within the framework of a randomized controlled trial. This randomized controlled pilot study included postmenopausal women who were allocated into two groups: a PFMT group (n = 45) and a control group (n = 58). The PFMT group performed a single set of exercises in the lithotomy position, consisting of 10 slow and 10 fast pelvic floor muscle contractions. The control group received no intervention. The primary outcome was vaginal dryness, assessed objectively using the Vaginal Lubrication Kit (VLK). Secondary outcomes included Visual Analog Scale (VAS) scores for vaginal dryness, burning, and dyspareunia, as well as smear test results. Associations of baseline VLK and VAS scores with smear test findings were analyzed. Pre- and post-treatment differences, as well as between-group comparisons, were evaluated using parametric and non-parametric tests, with a 95% confidence interval. Of the 105 women randomized, 103 completed the study. Baseline characteristics did not differ significantly between groups (p > 0.05). Following the intervention, the PFMT group demonstrated statistically significant improvements in VLK scores (p < 0.05). Baseline VAS scores were statistically significantly negatively correlated with the initial VLK score (VAS vaginal dryness, VLK r: -0.571, VAS vaginal burning, VLK r: -0.451, VAS dyspareunia, VLK r: -0.460, p < 0.05). In addition, the presence of atrophy in the pre-treatment smear test was found to be statistically significantly negatively correlated with the initial VLK score (r: -0.346, p < 0.05). PFMT significantly reduced vaginal dryness in postmenopausal women compared with the control group. It may be considered a potential treatment option for vaginal dryness. The VLK appears to be a promising objective tool for both assessing vaginal dryness and monitoring treatment outcomes in postmenopausal women. Although these findings are promising, they should be interpreted with caution given the pilot design and the short follow-up. Larger randomized trials are needed to confirm the long-term efficacy of PFMT and to validate the VLK as an objective outcome measure.

This report describes a 32-year-old primigravida diagnosed with bilateral anterior sacral meningoceles without bony defect of the sacrum during pregnancy. The patient remained asymptomatic throughout the pregnancy, with regular monitoring via transvaginal ultrasound and MRI. An elective cesarean section was planned at 38weeks. However, the patient presented in obstructed labor at 42weeks and underwent an emergency cesarean section, resulting in the birth of a healthy infant. This case is unique as it involves bilateral anterior meningoceles without sacral anomalies. Anterior sacral meningoceles are rare findings in pregnancy. Anterior sacral meningoceles are either congenital with bony defect of the sacrum or acquired lesions due to connective tissue disorders characterized by the herniation of the meninges through the sacral foramina. In pregnancy, these lesions pose unique challenges due to potential complications such as rupture, infection, or obstructed labor. Management strategies vary, and individualized approaches with close monitoring and patient counseling are crucial in determining the appropriate mode and timing of delivery.

This study investigated adherence to vitamin and dietary supplement intake, satisfaction with healthcare-provided information, and knowledge of essential micronutrients among women seeking fertility treatment and pregnant women in Germany. An anonymous online survey (34 questions) assessed sociodemographics, supplement intake, knowledge and motivations. Adherence and satisfaction were measured by MARS-D (Medication Adherence Rating Scale) and SIMS-D (Satisfaction with Information about Medicines Scale). Among 254 participants, 93.7% reported supplement use, and 86.6% began intake preconceptionally. On average, participants consumed two (2.0 ± 1.36) supplements concurrently. Most multiple micronutrient supplements (MMS) contained folic acid (100%) and iodine (86.2%) at recommended doses, other nutrients varied considerably. Participants knew two (1.81 ± 1.43) out of six micronutrients prior to information provision, increasing to three (2.94 ± 1.65) afterwards. Satisfaction with information (SIMS-D: 7.46 ± 5.92) was low, whereas adherence was high (MARS-D: 27.16 ± 3.06). Higher information satisfaction was associated with pregnancy (p = 0.007), younger age (p = 0.009), and lower educational level (p = 0.024). Adherence was linked to trimester (p = 0.007) and region (p = 0.013), with higher MARS-D scores in the first trimester and among participants from North Rhine-Westphalia. Key motivations were protecting the child and preventing deficiencies; main barriers included lack of awareness and feeling overwhelmed by preparation oversupply. Despite high adherence, knowledge and satisfaction with information remain limited. The wide variability in MMS formulations may pose risks of over- or underdosage. Combining personalized consultations with trustworthy media resources is essential to assess individual needs and provide detailed recommendations.

Pyrroluria is a proposed metabolic condition that remains controversial and insufficiently supported by empirical evidence within conventional medical practice and research. The present study evaluates patient acceptance of micronutrient therapy prescribed for pyrroluria in a clinical setting. The aim is not to validate the condition but to document patient experiences with a therapy commonly used in complementary practice. This retrospective cohort study was conducted in the Department of Gynecology at the University Hospital of Bern in 2022/2023. The study included patients who tested positive for pyrroluria and received micronutrient therapy. The primary outcome was the overall acceptance of therapy, assessed using the validated ACCEPT© questionnaire. The mean score for overall therapy acceptance was 74 ± 34 out of a maximum of 100 points, indicating a high level of acceptance. Micronutrient therapy was also well accepted in terms of side effects (85 ± 27), treatment constraints (71 ± 24), long-term use (85 ± 20), and therapy regimen (84 ± 21). The perceived efficacy of the therapy received a score of 63 ± 34, which did not reach statistical significance (p = 0.7). Micronutrient therapy was well tolerated and accepted by patients with pyrroluria, underscoring its potential as a low-risk adjunctive intervention. However, the perceived treatment efficacy was modest, and no conclusions about the biological validity of pyrroluria or the effectiveness of the therapy can be drawn. Rigorous, placebo-controlled trials are needed to evaluate the therapeutic value of micronutrients in this context. Furthermore, substantial scientific investigation is required to determine whether pyrroluria constitutes a valid clinical entity within conventional medicine.

Cesarean delivery (CD) has been linked to increased long-term infectious morbidity in offspring, potentially due to limited exposure to the maternal vaginal microbiome, which may influence immune development. We hypothesized that the degree of exposure to vaginal microbiota during labor would be associated with differences in long-term infectious morbidity. We conducted a population-based cohort study including 348,332 singleton deliveries. Offspring were classified into four groups: vaginal delivery (VD, reference), CD for non-progressive labor in the first stage (NPL1), CD for non-progressive labor in the second stage (NPL2), and elective (pre-labor) CD. Infectious-related hospitalizations up to age 18 were assessed. Kaplan-Meier curves compared cumulative incidence between the groups and a Cox proportional hazards model adjusted for various potential confounders. Of the cohort, 89.2% were VD, 1.4% NPL1, 0.6% NPL2, and 8.8% elective CD. Infectious-related hospitalization rates were higher for NPL1 and elective CD (26.2% each) compared to NPL2 (24.3%) and VD (23.8%) (p < 0.001). Kaplan-Meier analysis demonstrated a dose-response pattern, with the lowest cumulative incidence in VD, followed by NPL2, NPL1, and highest in elective CD (log-rank p < 0.001). In adjusted analysis, NPL1 (aHR 1.10) and elective CD (aHR 1.13) were associated with increased long-term infectious morbidity, whereas NPL2 was not significantly different from VD. Reduced exposure to vaginal microbiota, as in elective CD and NPL1, is associated with increased long-term infectious morbidity in offspring, while exposure during the second stage of labor (NPL2) may confer immunological benefits.

The question of how to deal with a pregnancy, whether desired or unwanted, is a complex biological, ethical, social, and medical issue going back for millennia. Every form of regulatory approach to this issue is culturally and temporally specific and is therefore subject to continuous change. Our look at its history and the medical, legal, and religious background begins in ancient times, progresses through history, and ends with a focus on the second half of the nineteenth century and especially the twentieth century in Germany. These ethical, moral, and medical questions are likely to have been discussed in a similar way in other parts of the Western world.

PurposePolycystic ovary syndrome (PCOS) is recognised as a potential risk factor for chronic non communicable diseases (NCD). Although international guidelines recommend proactive NCD risk prevention, actual practice may be suboptimal. This study aimed to identify unmet clinical needs regarding information, risk assessment and satisfaction with care related to NCD risk factors among women with PCOS.MethodsAn eight-domain questionnaire was developed based on the 2018 ESHRE guideline, covering demographics, PCOS diagnostic criteria, aesthetics, metabolism, reproduction, mental health and NCD prevention /monitoring. The present analysis focused on metabolic disorders, guideline-recommended risk screenings, patients’ satisfaction with care and overall satisfaction with management by healthcare providers (HCPs).ResultsOf 2029 respondents, 1943 answered metabolic-related items. 66.3% without known metabolic disease (MD) reported never having undergone screening for MD. 34.3% received advice from gynaecologist, 58.9% from general practitioner (GP) concerning MD. 41.1% (n = 271) did not receive counselling. Among 1839 respondents, 32.5% reported gynaecologist-led risk discussions. Annual screening occurred in 30.5% (body weight), 46.8% (blood pressure), 5.8% (gynaecologist) to 21.4 (GP) for serum cholesterol and 25.4% for diabetes. 1.0% had been consulted on obstructive sleep apnoea (OSA), 17.5% on endometrial cancer. Satisfaction with gynaecologist counselling was low (Mean 34.7), 79.4% expressed a desire for more advice.ConclusionWomen with PCOS remain at high risk for NCDs (CVD, diabetes, endometrial cancer, OSA), yet experience substantial gaps in risk awareness, monitoring, and counseling. Addressing these deficiencies through improved clinical practice, education and adopting holistic PCOS management that balances NCD prevention with infertility concerns, is essential for safeguarding long-term health.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00404-025-08287-x.

PurposeTo evaluate the incidence of associated structural anomalies, chromosomal/genetic abnormalities, infections and outcomes of fetuses with ventriculomegaly (VM).MethodsRetrospective multicenter cohort study of 627 pregnancies with fetal VM. VM was classified as mild, moderate, or severe and isolated or non‐isolated. Genetic, obstetric and outcome data were collected and compared according to VM categories.ResultsThe incidences of associated structural anomalies were 21.9%, 53.1% and 63.9% in mild, moderate and severe VM, respectively (p = 0.032 mild vs. moderate-severe). The incidences of genetic abnormality and fetal infection of the total VM group were 16.1% and 0.8%, respectively, with no significant differences between the VM categories (p > 0.05). The incidences of pathogenic genetic variant in the mild, moderate and severe VM were 13.5% (5/37), 16.7% (3/18) and 38.1% (8/21), respectively (p = 0.032 mild vs. severe). Fetal MRI identified additional CNS anomalies in 5.6% of cases. The incidences of surviving babies with neurological morbidities were significantly higher in fetuses with non-isolated VM groups than in isolated VM groups (p < 0.001).ConclusionThe prognosis of fetuses with VM mostly depends on the severity and the associated anomalies. In all types of fetal VMs additional genetic investigations are valuable.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00404-025-08279-x.

ObjectiveOverweight and obesity are associated with adverse pregnancy outcomes, yet higher body mass index (BMI) has paradoxically been linked to reduced risk of perineal lacerations, including obstetric anal sphincter injury (OASI). The role of gestational weight gain (GWG) in this context is not well established. The objective of this study was to evaluate the association between GWG and perineal injury among overweight and obese primiparous women.MethodsA retrospective cohort study was conducted at a tertiary center between 2012–2023, including primiparous women with singleton, term (≥ 37 weeks), vertex vaginal deliveries and pre-pregnancy BMI ≥ 25.0 kg/m2. Women were categorized by GWG based on Institute of Medicine guidelines: below (Group A), within (Group B), or above recommendations (Group C). Exclusion criteria included cesarean delivery, diabetes, multiple gestations, stillbirth, preterm birth, non-vertex presentation, and maternal age < 18 or > 45 years. Perineal injury was defined as any perineal laceration or episiotomy. Univariate and multivariable logistic regression analyses were performed.ResultsAmong 5,082 deliveries, 13.1% were in Group A, 28.2% in Group B, and 58.7% in Group C. Episiotomy rates were higher in Group C versus Groups A/B (38.7% vs. 34.7%/34.5%; p = 0.011), while overall perineal injury (87.2%–88.5%, p = 0.652) and OASI rates (0.5–1.0%, p = 0.428) did not differ. In multivariate analysis, GWG was not associated with perineal injury. Independent risk factors included epidural analgesia (OR = 1.39, 95% CI 1.10–1.75), vacuum-assisted delivery (VAD) (OR = 2.83, 95% CI 2.07–3.86), higher birthweight (OR = 1.06 per 100 gr., 95% CI 1.03–1.08), and advanced gestational age (OR = 1.13, 95% CI 1.04–1.23).ConclusionGWG was not associated with perineal injury, whereas VAD, epidural analgesia, increased birthweight, and advanced gestational age were independent risk factors.