Introduction/BackgroundThe C‐reactive protein (CRP)–albumin–lymphocyte (CALLY) index is a new prognostic biomarker combining CRP, serum albumin, and lymphocyte count that can be associated with the survival of cancer patients by assessing immune, nutritional, and inflammatory status as an important immune indicator. The association of CALLY index as a marker predicting survival of cancer patients with cervical cancer (CC) remains unclear. This study aimed to evaluate the prognostic value of the CALLY index with overall survival (OS) and recurrence‐free survival (RFS) in patients with early‐stage CC after radical hysterectomy.MethodologyIn this multicenter retrospective cohort study, we examined the medical profile of 806 women with early‐stage CC who underwent Type II/III radical hysterectomy and bilateral pelvic lymphadenectomy at three centers affiliated to our center between 2012 and 2022. The CALLY index was calculated before treatment. OS and RFS were the primary endpoints. Kaplan–Meier and Cox models assessed the association between CALLY index and outcomes, adjusting for age, histology, tumor size, FIGO stage, grade, extent of lymphadenectomy, and adjuvant therapy. A CALLY index cutoff of 3 maximized discrimination (AUC 0.822; 95% CI, 0.75–0.90).ResultsFive‐year OS was higher with CALLY index ≥ 3 vs. < 3 (82.1% vs. 71.2%; log rank p = 0.009), as was 5‐year RFS (76.4% vs. 64.2%; p = 0.001). Multivariate analysis showed that CALLY index ≥ 3 was independently associated with improved OS (HR 0.87; 95% CI, 0.78–0.96; p = 0.001) and RFS (HR 0.86; 95% CI, 0.78–0.95; p = 0.001). In addition, age ≥ 45 years, nonsquamous histology, tumor size ≥ 3 cm, FIGO stage > IB, grade > G2, and LNR > 40% were significantly associated with poorer OS and RFS, whereas receiving adjuvant therapy was associated with a better prognosis.ConclusionsPretreatment CALLY index is an independent, readily obtainable prognostic biomarker for OS and RFS after radical hysterectomy in early‐stage CC. This index can be useful as a predictor of the prognosis for patients with CC.

This study evaluated whether an online mindfulness-based stress reduction (MBSR) program could reduce psychological distress and improve pregnancy rates in women undergoing in vitro fertilization (IVF). A total of 133 infertile women were randomized to an online MBSR intervention or a control group. The intervention included twice-weekly mindfulness sessions over 3 months. Primary outcomes were anxiety and depression, and the ultrasound-confirmed intrauterine pregnancy rate was a secondary outcome. The intervention group showed significant reductions in anxiety and a significant borderline decrease in depression compared to controls. Participation in MBSR was also associated with a higher rate of ultrasound-confirmed intrauterine pregnancy. Online MBSR may effectively reduce psychological distress in women undergoing IVF, with potential benefits for pregnancy outcomes. This study suggests that online MBSR may serve as an effective complementary approach for alleviating emotional distress and potentially enhancing pregnancy outcomes in women undergoing IVF. Online MBSR programs appear to be a valuable tool for supporting women in managing infertility-related psychological challenges. Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20241002063238N1.

BackgroundNonepithelial ovarian cancers (NEOCs) comprise a group of uncommon malignancies which can be challenging to treat. This broad term includes germ cell tumors, sex cord–stromal tumors, and rare types of ovarian cancer, such as small‐cell carcinomas and sarcomas. It is imperative that these rare tumors are managed with accurate diagnosis, staging, and treatment in order to optimize patient outcomes. The aim of this study was to describe the prevalence, pathology, and therapeutic interventions for NEOC in a Sub‐Saharan African setting.MethodsThis is a 5‐year retrospective review of NEOC cases managed at St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia, from September 2016 to September 2020. Data on NEOCs including clinical presentation, pathology, therapeutic interventions, staging status, type of surgery, histological subtype, and current disease status were extracted from patients’ records. Data were collected using a structured data extraction format. Data were analyzed using Stata release 15 (College Station, TX: StataCorp LLC).ResultsThe prevalence of NEOC was 17.3% (80 out of 264 cases of ovarian cancer). Among the types of NEOC, sex cord–stromal tumors were most common (46.2%) followed by germ cell tumors (43.8%). Of the germ cell tumors, yolk‐sac tumor was the common histologic subtype, representing 15% of all NEOC cases. Sixty‐five percent of cases were managed with staging surgery while 27% underwent fertility sparing surgery. There was no statistically significant association between patients’ age and type of tumor (p = 0.08).ConclusionIn this study, the prevalence of NEOC was 17.3%, which is higher than in other previous reports in the literature. Yolk‐sac tumor was the most common histologic subtype among germ cell tumors.

Uterine fibroids are the most common anatomical cause of heavy menstrual bleeding. To which extent clinical practice variation is present in the treatment of fibroid-related heavy menstrual bleeding at the hospital level remains unclear. The aim of this study was to identify and evaluate the clinical practice variation in the treatment of fibroid-related heavy menstrual bleeding. In this multicenter, retrospective database study, pseudonymized real-world data were collected from electronic health records using a natural language processing and text-mining data collection tool. Women ≤ 55 years, who presented as new patients at the gynecology outpatient clinic in 2019 with heavy menstrual bleeding and fibroids, were selected. Data were extracted from the first appointment in 2019 throughout December 2022. The primary outcome was the number of treatments initiated. Secondary outcomes were the type of treatments initiated, treatments initiated prior to hysterectomy, and time to hysterectomy. From four hospitals, 623 women were included. The median age was 46 (range: 23-55) years. Overall, a median of one treatment (range: 1-4) was initiated, which significantly differed between hospitals (p < 0.01). Pharmacological treatment was initiated most frequently, which differed significantly among hospitals (392/623 [62.9%], range: 49.1%-70.5%, p = 0.02). Minimally invasive therapies were initiated in 51.2% (319/623, range: 40.6%-58.9%, p < 0.01). Only 30/319 patients (9.4%) received a minimally invasive uterus-sparing treatment. Hysterectomy was performed in 123/319 patients (38.6%), with Hospital 1 being an outlier as 52.3% underwent hysterectomy, compared to 23.9%-36.4% in the other hospitals (p < 0.01). Clinical practice variation is present in the treatment of heavy menstrual bleeding in Dutch women with fibroids. Organizational factors could partially explain clinical practice variation. Sharing data can aid in identifying, explaining, and acting on (un)warranted practice variation between healthcare clinics. While clinical practice variation remains inevitable, unwarranted practice variation should be limited by ameliorating guideline adherence, educational interventions, and patient counseling, to improve the quality, efficiency, and equity of care.

Endometriosis is a complex, estrogen‐dependent disease with limited effective treatments that often focus on symptom management rather than addressing the underlying pathology. Current therapies, such as progestins and GnRH agonists, have significant side effects (weight gain, mood changes, decreased bone mineral density, and menopausal symptoms) and fail to prevent disease recurrence or address fertility concerns. The current study is the first to demonstrate the therapeutic potential of combined treatment with dydrogesterone (a progestin) and letrozole (an aromatase inhibitor) in a preclinical mouse model of endometriosis. Our results revealed that the dydrogesterone–letrozole combination reduced the volume of endometriotic lesions, suppressed cell proliferation, and decreased inflammation relative to the disease control, with trends suggesting greater effects than those observed with individual agents or standard treatments such as dienogest and leuprolide. The dydrogesterone–letrozole combination also exhibited a reduction in fibrosis, indicating a potential role in managing chronic endometriosis and associated symptoms such as pelvic pain and adhesions. These findings suggest that the dydrogesterone–letrozole combination may offer a broader therapeutic approach for endometriosis. Based on existing literature, dydrogesterone is thought to counteract estrogen‐driven endometrial proliferation through progesterone receptor activation, while letrozole is believed to reduce estrogen biosynthesis by inhibiting aromatase, which may collectively influence lesion growth and inflammatory processes. Additional long‐term studies are warranted to thoroughly assess the safety profile, clinical effectiveness, and overall therapeutic relevance of the dydrogesterone–letrozole combination for the treatment of endometriosis.

There is a lack of studies on lipid levels in Vietnamese pregnant women. Our study aimed to describe serum lipid levels of healthy Vietnamese women in the third trimester and identify factors influencing these levels. A cross-sectional study on 1022 healthy females with singleton pregnancy intended to deliver at Bach Mai Hospital recruited from April 2023 to June 2024. Measure fasting serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides at 28-40 weeks of gestation by enzymatic colorimetric assays. Assess factors associated with maternal lipid levels by multivariable linear regression. Median (95% reference range) of TC, LDL-C, HDL-C, and triglycerides were 6.48 (4.39-8.88), 3.33 (1.59-5.52), 1.81 (1.25-2.53), 2.90 (1.65-6.06) mmol/L, respectively. Complicated pregnancy (n = 377) had higher triglycerides and lower cholesterol levels than the uncomplicated pregnancy (n = 645). Factors associated with TC were prepregnancy BMI and gestational age. For LDL-C: prepregnancy BMI, gestational age, and gestational diabetes mellitus (GDM). For HDL-C: prepregnancy BMI and GDM. For TG: prepregnancy BMI, gestational age, GDM, a history of hypertensive disorder in pregnancy, and a history of macrosomia. We presented 95% reference range for the third trimester serum lipid levels in healthy Vietnamese women. Obstetric complications were associated with decreased LDL-C and HDL-C and increased TG, along with gestational age and prepregnancy BMI.

Hydrodissection (HD) is used in surgical blunt dissection covering its two types. The first one is volumetric with application of neutral fluids to obtain exclusive separation of tissue planes. The second one is hybrid with additional effect by addition of some pharmaceutics like vasoconstrictors to neutral fluid. In most reports dealing with ovarian endometrioma stripping, the hybrid HD is used. To assess application of volumetric HD in endometrioma stripping in respect to intraoperative and postoperative data including reproductive outcome. The prospective observational study was conducted in a group of 53 women qualified for laparoscopic enucleation of endometrial cysts. The patients were operated with two methods according to surgeon choice. First method was the enucleation proceeded by volumetric HD, and in the other one, classic stripping was performed. The patients operated with these methods constituted two groups accordingly. All the patients were asked to fulfill the questionnaires dealing with their reproductive data. Volumetric HD was not found to reduce surgery time, to diminish the frequency of ovarian stitching, and to reduce postoperative pain. Decrease in the AMH was lower in Group I, but it did not reach statistical significance (p = 0.19). Evacuation of intact endometrial cyst and removal of reduced resected tissue through endobag were more frequent in Group 1 (69.2% vs. 22.2%, p = 0.0006; 46.2% vs. 7.4% p = 0.0039, respectively). Very important fact was absence of mature ovarian cortex in all samples coming from Group 1. We did not observe the differences between the groups in reproductive outcome. Spontaneous conceiving was 63.1% in Group 1 vs. 63.6% in Group 2, and in-time deliveries were 47.3% in Group 1 vs. 50.0% in Group 2. There are some positive postoperative changes after application of volumetric HD in endometrioma stripping, but it did not cause better reproduction outcome.

BackgroundEquitable access to maternal healthcare hinges on overcoming logistical and socio‐economic challenges in many low‐ and middle‐income countries (LMICs).ObjectivesThis study examines the association of travel time to health facilities and residential areas with the use of antenatal care (ANC) and institutional delivery services in Afghanistan.MethodsWe used data from the Afghanistan Health Survey 2018, focusing on 1051 ever‐married women aged 15–49 who had recently given birth and had ≥ 1 ANC session. The study measured the association of travel time and residential location, along with sociodemographic characteristics, on two primary outcomes: institutional deliveries and ANC service frequency. A generalized linear model facilitated the multivariable regression analyses.ResultsThe study found that travel time to health facilities and residential locations significantly influenced ANC utilization and institutional deliveries. Women with travel time of 0.5–2 and < 0.5 h to health facilities received 78% and 65% more ANC visits, respectively, than women with travel time of > 2 h to health facilities. Women who lived in rural areas received 50% fewer ANC visits compared to women who lived in urban areas. Women with travel time of 0.5–2 h were more likely to have institutional deliveries (odds ratio [OR] = 2.56, 95% confidence interval [CI]; 1.43–4.59) than those with travel time of > 2 h to health facilities. The likelihood of institutional deliveries was lower among rural resident women (OR = 0.62, 95% CI; 0.40–0.97) than their urban counterparts. Other predictors of ANC visits were women’s education level and women’s knowledge of complicated pregnancy, and other predictors of institutional deliveries were women’s education level, decisions made for women about birthplace choice, and women’s access to media.ConclusionWe have shown for the first time that access to health facilities and geographic disparities significantly influence maternal health service utilization in Afghanistan.

This study aimed to determine the relationship between isometric exercise test, roll-over test, levels of PAPP-A and β-hCG, and NLO in the early diagnosis of preeclampsia. The 580 pregnant women filled out the personal information forms and performed the roll-over test and isometric exercise test. The roll-over test and isometric exercise test used in the diagnosis of preeclampsia had high levels of sensitivity and specificity and negative predictive values. Thus, roll-over test and isometric exercise test, pregnancy-associated plasma protein A levels, and neutrophil-lymphocyte ratio are useful parameters for the early diagnosis of preeclampsia.

Background and AimsPermanent contraception (PC) is a safe and cost‐effective irreversible method of preventing unwanted pregnancy and reducing maternal morbidity and mortality. Only 0.2% of women use PC in Nigeria. This study aimed at assessing women’s knowledge, their desire for spousal and future uptake of permanent contraception.MethodsA cross‐sectional survey conducted among 256 antenatal attendees at University College Hospital, Ibadan, Nigeria, using semistructured self‐administered questionnaire. Logistic regression analyses were used to determine factors associated with women’s desire and spousal uptake of PC at 95% confidence interval (CI) with a p value of ≤ 0.05.ResultsAll were aware of PC and majority (180 [70.3%]) had good knowledge of it. About a quarter (26.5%) of the women wish to use PC once they complete their family size with more than half (52.6%) of them willing to use it after four or more children. Only 28.9% will allow their spouse to have vasectomy. Commonest reasons for PC future uptake are completed family size (88.9%) and economic challenges (45.5%). Those with one living child were less likely to have a good knowledge of PC (AOR = 0.527 and 95% CI = 0.278–0.998) and those with fertility issues were twice more likely to have good knowledge (AOR = 2.373 and 95% CI = 1.030–5.466). Respondent’s perception of PC (p < 0.001) and “ever had pregnancy complications” (p = 0.014) are associated with their desire for spousal uptake.ConclusionsThere is a high level of awareness and good knowledge of PC; however, just a few will use it or allow their spouse to use it in future. There is a need to strengthen counselling and maternal education on PC with the aim to improve its uptake.