Polycystic ovary syndrome (PCOS) affects about 5% to 20% of women worldwide in their fertile years and often combines with infertility. Ovulation induction is often needed for those who want to get pregnant. To review the research advances of letrozole for ovulation induction in women with PCOS. The papers are searched in Cochrane libraries, SinoMed, PUBMED, and EMBASE till June 2024 and reviewed. Letrozole, one of the third-generation of aromatase inhibitors, is increasingly recommended as a first-line agent for ovulation induction in anovulatory PCOS women due to better pregnancy and live birth rates, especially in those with clomiphene citrate (CC) resistance (CC is an earlier contacted and frequently used ovulation inducer). In this review, we focus on the usages, advantages, and disadvantages of letrozole for ovulation induction in PCOS, and show that different timing of initiation, extending treatment duration, stair-step protocol, and letrozole combined with other drugs such as FSH, ethinylestradiol and cyproterone acetate, metformin, aspirin, dexamethasone, and N-acetylcysteine. Letrozole is effective for inducing ovulation and achieving pregnancy in patients with PCOS, and report variations in letrozole treatment protocols. Better understanding of letrozole for ovulation induction is important for gynecologists and women with PCOS to achieve better pregnancy and live birth rates.

Trauma and childbirth-related posttraumatic stress disorder (c-PTSD) are underrecognized possible consequences of birth and obstetric care that may affect maternal well-being, parent-infant bonding, and future reproductive decisions. Despite a growing body of research, gaps remain in the implementation of robust screening, timely diagnosis, and trauma-informed practices to prevent and address c-PTSD. Review our current understanding of psychological birth trauma and c-PTSD, emphasizing provider roles in prevention, identification, and management. PubMed and Google Scholar literature search from 2000 to 2024. Birth trauma is a subjective experience, often driven by factors such as poor communication, lack of informed consent, and perceived loss of control. Only a subset of individuals with traumatic births develops c-PTSD. Prior trauma, mental health conditions, obstetric complications, and inadequate support exacerbate risk. c-PTSD affects approximately 3% to 6% of low-risk, postpartum individuals and up to 18% of postpartum individuals in high-risk populations. Diagnosis requires assessment of associated symptoms with validated tools. Interventions range from psychosocial support, medications, and trauma-focused therapies. Preventive strategies include maternal mental health collaborative models and trauma-informed care that emphasizes respectful communication, autonomy, and continuity of care. Obstetric providers are key actors in shaping a positive childbirth experience through respectful communication and shared decision-making. Early follow-up, mental health screening, and collaborative, trauma-informed care may help mitigate long-term psychological sequelae of birth trauma and c-PTSD to improve outcomes for birthing individuals and families.

Penicillin allergies are commonly reported in pregnancy, yet patients are rarely truly allergic. Identification of pregnant patients who would benefit from penicillin allergy testing is an important public health initiative to reduce alternative antibiotic usage and reduce associated adverse outcomes. This article reviews the epidemiology of penicillin allergy, the pathophysiology of allergy in general, in addition to penicillin allergy, the safety of penicillin allergy testing in pregnancy, the impact of penicillin allergy testing on maternal and neonatal outcomes, and considerations for quality improvement interventions. Original research articles, review articles, and professional society guidelines on penicillin allergy evaluation in pregnancy were reviewed. Penicillin allergy in pregnancy is associated with increased risks of adverse neonatal and maternal outcomes. The reviewed literature demonstrates that penicillin allergy testing in pregnancy is efficacious, with the majority of individuals undergoing penicillin allergy delabeling with low rates of allergy testing complications. In addition, penicillin allergy testing has been shown to be associated with a reduction in second-line antibiotic usage, although future studies are required to elucidate the full reduction in adverse outcomes associated with delabeling. Penicillin allergy in pregnancy is associated with increased risk of adverse outcomes. Given that the majority of individuals can be safely delabeled, efforts to explore opportunities for increased penicillin allergy assessment should be an ardent goal.

Preeclampsia (PE) remains a leading cause of maternal mortality worldwide. Research has shown multifactorial contributions to its pathophysiology. With recent evidence suggesting that humoral autoimmunity plays a crucial role, autoantibodies targeting vascular and immune pathways contribute to disease progression. Further research into the role of humoral autoimmunity in the etiology of PE and potential treatments could significantly improve maternal and fetal health. This study aims to provide an overview of current research on the role of autoantibodies in humoral autoimmunity and their contribution to the pathophysiology of PE. A comprehensive search was conducted in the PubMed database using the keywords "preeclampsia" and "autoantibody" to identify potentially pathogenic autoantibodies in preeclampsia. We performed follow-up searches with the keywords "preeclampsia" and identified autoantibodies such as "AT1-AA." Autoantibodies, particularly angiotensin II type 1 receptor autoantibodies (AT1-AA) and endothelin-1 type A receptor autoantibodies (ETAR-AA), play a crucial role in PE by directly modulating vascular tone and promoting inflammation through mechanisms such as vasoconstriction and oxidative stress. Preeclampsia is also associated with other autoantibodies, including anti-beta-2-glycoprotein and lupus anticoagulant. Emerging research suggests that targeting these autoantibodies or their downstream receptors may be a promising therapeutic strategy for reducing disease severity. Humoral autoimmunity plays a significant role in the pathophysiology of PE, offering novel diagnostic and potential therapeutic avenues. Emerging treatments targeting these pathways show promise in alleviating PE symptoms. Further research into autoantibody mechanisms and targeted interventions is essential for improving outcomes in PE-affected pregnancies.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, is characterized by fatty deposits in the liver, with histologic features like alcohol-induced liver injury, without associated alcohol misuse. This condition is associated with other metabolic comorbidities, particularly obesity and insulin resistance. MASLD is also associated with the development of pregnancy-related complications such as gestational diabetes mellitus and hypertensive disorders of pregnancy. MASLD is one of the most common liver diseases today, with a prevalence of 14% in pregnant individuals. The goal of this review was to explore the topic of MASLD with a discussion of its pathophysiology, diagnosis, clinical management, and complications related to pregnancy. A literature search was conducted utilizing Rayyan to review 180 articles published between 2000 and 2024 for inclusion or exclusion in the review. MASLD is an increasingly prevalent disease process likely underdiagnosed in pregnancy. Evidence suggests a synergistic pathway between obesity and the physiological changes of pregnancy, which can initiate or exacerbate liver steatosis. MASLD is associated with adverse outcomes in pregnancy and in the offspring of affected pregnancies. Further research is needed to demonstrate optimal screening, diagnosis, and management in pregnancy. If detected early, early diabetes screening and low-dose aspirin may be appropriate, given the significant association with gestational diabetes and gestational hypertensive disorders. Patients should be counseled on the increased risk of maternal morbidity, preterm birth, miscarriage, macrosomia, pregnancy-induced hypertension, cesarean delivery, gestational diabetes, and metabolic disease in the offspring.

Furcate umbilical cord insertion is a rare anomaly in which the umbilical vessels separate and lose Wharton jelly before placental insertion. This condition increases the risk of complications such as vessel avulsion and intrauterine fetal demise (IUFD). Despite these risks, data on this condition are limited, and no formal management guidelines exist for prenatally diagnosed cases. To provide an overview of abnormal umbilical cord insertions, with a focus on furcate cord insertions, as well as the evidence for the management of patients with furcate cord insertions. Articles were identified through a PubMed and OVID literature search and reviewed for relevance. We identified 158 cases of furcate cord insertion. Prenatal diagnosis occurred in only 20 cases (12.7%). IUFD was reported in 6 cases (3.8%), all where furcate cord went undiagnosed prenatally and nearly all (5/6) occurring after 37 weeks' gestation. Cesarean delivery was frequently performed when furcate cord insertion was detected prenatally, especially when co-occurring other comorbidities. Cord avulsion was reported in all cases of labor after 37 weeks, underscoring the risks associated with vaginal delivery. Furcate cord insertion is a rare placental anomaly associated with significant perinatal risk. Improved prenatal recognition may support evidence development and guide peripartum care. According to the limited available evidence, early-term cesarean delivery may be a reasonable option in prenatally diagnosed cases, though further research is needed. This review offers an overview of the evidence for the detection and management of furcate cord insertions.

The administration of corticosteroids before anticipated preterm delivery represents a crucial antenatal intervention that enhances fetal lung maturity and reduces neonatal morbidity and mortality. This review aims to evaluate and compare the most recently published influential guidelines on the use of antenatal corticosteroids (ACS). A comparative review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the International Federation of Gynecology and Obstetrics (FIGO), the European Association of Perinatal Medicine (EAPM), the World Association of Perinatal Medicine (WAPM), the World Health Organization (WHO), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) was carried out. All the reviewed guidelines recommend the use of ACS between 24+0 and 33+6 weeks of gestation, when preterm delivery is anticipated and endorse the consideration of their use at the periviable period. In addition, there is an overall agreement regarding the recommended regimens and the use of ACS in case of pregnancies with existing comorbidities, such as preterm prelabor rupture of membranes, obesity, multiple pregnancy, fetal growth restriction, and diabetes. In contrast, the recommendations for the use of ACS in the late preterm period, in women with chorioamnionitis and in cases of recurrent or persistent threatened preterm delivery vary. Moreover, RCOG is the only medical society supporting that the administration of ACS in case of planned cesarean delivery should be considered up to 38+6 weeks of gestation. The favorable role of corticosteroids in improving the outcomes of preterm neonates is clearly outlined. However, the explicit articulation of the potential benefits and harms stemming from their use at different stages of pregnancy and in different delivery contexts is yet to be elucidated. Thus, it seems of paramount importance to develop consistent recommendations for the use of this antenatal intervention to maximize its beneficial effects and eliminate the associated risks.

Non-neurogenic voiding dysfunction is a common lower urinary tract condition that affects both pediatric and adult patients. Normal bladder physiology requires complex coordination of the brain, spinal cord, bladder, and surrounding pelvic floor musculature. Abnormalities in this cycle can lead to symptoms of voiding dysfunction. The pathophysiology of voiding dysfunction can be multifactorial and influenced by different clinical settings, such as the perioperative or post-obstetric care periods. The goal of this review is to review the definitions, pathophysiology, and treatments for pediatric and adult female non-neurogenic voiding dysfunction. A literature review using PubMed of relevant randomized clinical trials on treatments for voiding dysfunction in adults and children from 2000 to 2024 was completed. Of the 3397 abstracts initially reviewed, 97 full-text manuscripts were screened, and a total of 31 articles met the criteria for inclusion. These manuscripts were reviewed, and their findings were reported within the manuscript. Voiding dysfunction can present as inadequate functioning of the emptying stage of micturition. It can present in children and female adults and has overall similar management strategies in both populations. For clinicians, it is important to understand the definition, relevant physiology, and the current evidence for treatment approaches for voiding dysfunction.

Preeclampsia affects ~8% of pregnancies and is a leading cause of maternal and neonatal morbidity and mortality. From 2007 to 2019, rates of hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, doubled in the United States. This trend coincides with a rise in maternal mortality, which is now the highest among high-income nations. These statistics support the need to develop risk stratification tools that help to prevent and treat preeclampsia. Efforts to develop these risk assessments have not been successful in reproductive medicine, especially for preeclampsia. The US Preventive Services Task Force (USPSTF) has recommended a risk-based approach using clinical and demographic factors and, for individuals at increased risk, treatment with low-dose aspirin prophylaxis (AP) starting at 12 weeks of gestation. The aim of this study was to assess the proportions of a racially and geographically diverse population classified as low, moderate, or high risk for preeclampsia according to USPSTF criteria. This was a prospective cohort study conducted at 11 medical centers across the United States or through direct recruitment via social media. Included were individuals with singleton pregnancies who were 18 years or older and enrolled in the study before 22 weeks' gestation between July 2020 and March 2023. Participants were classified as high risk if they had at least 1 high-risk condition based on the USPSTF criteria. Participants were classified as moderate risk if they had ≥1 moderate risk factors but no high risk factors (moderate +1 risk category); this group was further subdivided into 2 categories: moderate 1 risk (defined as those with only 1 moderate risk factor) and moderate 2+ risk (those with ≥2 moderate risk factors). Those in the low-risk category had no high or moderate risk factors. AP recommendation with or without a prescription was the effect modification. The primary outcome was preeclampsia. A total of 5684 people were included in the analysis. The study population was identified as Asian (4.7%), black (21%), Hispanic (17.4%), white (48.6%), and other (8.3%). About 12% and 11% of participants were diagnosed with preeclampsia and gestational hypertension that progressed to preeclampsia, respectively. There were 18.5% in the high-risk category and 11.2% in the low-risk category. Approximately 70.3% were in the moderate +1 risk category, which was subdivided into the moderate risk 1 category (34.4%) and the moderate risk 2+ category (35.9%). While the incidence of preeclampsia varied by race, limited information was gleaned for sensitivity and specificity. A significantly increased risk of preeclampsia was observed in those with prior preeclampsia [risk ratio (RR), 1.44; 95% CI, 1.25-1.65; P<0.001] or chronic hypertension (RR, 1.26; 95% CI, 1.10-1.44; P=0.001). Much of the statistical significance was lost for moderate risk factors, and none of the racial categories were associated with increased risk. About 47% of participants with ≥1 risk factor received an AP recommendation. Those with a history of preeclampsia, chronic hypertension, diabetes, or a combination of these conditions before pregnancy were more likely to receive an AP recommendation. In conclusion, the USPSTF criteria for assessing the risk of developing preeclampsia were found to be associated with an increased risk of preeclampsia. The USPSTF risk assessment, examining the moderate risk for preeclampsia, was more weakly associated, and recommendations for AP were more effectively initiated in both high- and low-risk categories. (Abstracted from JAMA Network Open. 2025;8:32521792.).