Management Of Women Research Articles

Utility of colposcopy for the screening and management of cervical cancer in Africa: a cross-sectional analysis of providers’ training and practices

IntroductionCervical cancer is a public health issue in Africa with devastating socioeconomic consequences due to the lack of organized screening programs. The success of screening programs depends on the appropriate investigation and management of women who test positive for screening. Colposcopic assessment following positive screening results is a noteworthy issue in Africa. This study aimed to assess the utilization of colposcopy by providers in the region.MethodsA cross-sectional study was conducted in 2021–2022 among healthcare providers involved in cervical cancer prevention activities in Africa. They were invited to report prior colposcopy training, whether they performed colposcopy and the indications of colposcopy in their practice.ResultsOf the 130 providers from 23 African countries who responded to the survey (mean age [SD]: 39.0 years [9.4]), half were female (65 [50.0%]), and 90.7% reported working in urban areas. Overall, only 12.6% of respondents indicated having received prior training on colposcopy, and 11.7% reported that they were performing colposcopy in their current practice. Among the providers who reported performing colposcopy in their practice, colposcopy was indicated for routine cervical cancer screening in 21.2% of clinicians, to better visualize the transformation zone in 15.2% of respondents, to further assess the vascularization of cervical mucosa in 33.3% of respondents, and to determine the appropriate treatment modality in 12.1% of respondents. Providers who performed colposcopy in their practice reported a median number of 30 (interquartile range: 19-65) colposcopic procedures in the past 6 months.ConclusionProviders’ training and practice of colposcopy for cervical cancer screening remain suboptimal in Africa. To increase utilization of colposcopy in the region, further training is needed to improve providers’ knowledge and engagement. With the development of lower-cost and portable colposcopes, efforts to equip cervical cancer prevention programs and facilities with colposcopy should be enhanced to ensure that women can be screened and managed appropriately in the clinical setting and communities.

Update on diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) - recommendations of Section of Multiple Sclerosis and Neuroimmunology of Polish Neurological Society.

An expert panel of the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society has developed principles for the management of neuromyelitis optica spectrum disorders (NMOSD). These principles are based on expert opinion and data from the literature published up to May 2023. Recommendations were developed based on the results of the most recent clinical trials, guidelines of foreign and international scientific societies, and the authors' clinical experience. The principles for diagnosing NMOSD are discussed, with particular emphasis on serological and neuroimaging diagnosis. Recommendations for the treatment of relapses and chronic immunosuppressive treatment, including the most recent methods of immunotherapy, are also presented. Additionally, the principles of monitoring treatment efficacy and safety are included. Therapy regimens are completed with recommendations for symptomatic treatment. The paper also includes an algorithm for vaccination in patients with NMOSD. Therapeutic management in pregnant women with NMOSD is discussed.

Long term follow-up of women treated for screen detected atypical ductal hyperplasia or lobular neoplasia in a large UK screening centre

BackgroundAtypical ductal hyperplasia (ADH) and lobular neoplasia (LN) increase subsequent breast cancer (BC) risk. However, optimal surveillance and risk reduction regimes remain uncertain. We report management and outcomes of women with ADH and LN to provide data on potential screening/prevention strategies.MethodsWomen diagnosed with screen detected ADH and/or LN between 2010-2018 at our institution were identified and demographic data, MDT decisions and BC diagnoses extracted from electronic patient records in 2019 and 2023.ResultsOf 107 women, 74 were discharged to the NHS Breast Screening Programme and 33 were offered enhanced screening (ES). The proportion offered ES increased significantly over time (p = 0.037). 15/105 (14.3%) developed BC (median follow-up 117 months), 9 screen-detected and 6 symptomatic, with 3 interval cancers diagnosed 12–25 months following their last screen. 3/15 were lymph node positive and 13/14 invasive cancers were estrogen receptor (ER) positive. BC incidence rate was 1499.6/100,000 women/year (SIR = 4.7), lower in the first 5 years of follow-up compared with post 5 years.ConclusionsIn women with ADH/LN most BCs occur beyond 5 years. ES regimens should therefore extend to at least 10 years and be at least biennial. Preventative therapy should be considered given the high BC SIR and ER positivity of subsequent tumours.

FIGO-GCH joint consensus statement on the current status and recommendations for the use of blind intrauterine procedures in the evaluation and management of women withsuspected intrauterine pathologies.

Historically, blind intrauterine procedures such as dilation and curettage (D&C) and blind endometrial biopsies have been the primary approach for diagnosing and managing intrauterine pathologies. However, these techniques lack direct visualization, leading to diagnostic limitations, incomplete treatment, and increased complication rates. Despite substantial advances in hysteroscopic technology, including high-definition imaging and minimally invasive instruments, blind procedures remain widely used. This paper examines the limitations of blind intrauterine procedures, underscoring the advantages of hysteroscopy, which provides real-time visualization and allows for more accurate, targeted interventions. With the adoption of the "See and Treat" philosophy, hysteroscopy enables nearly 90% of procedures to be performed in an office setting, enhancing both patient convenience and outcomes. FIGO and GCH advocate for the gradual replacement of blind procedures with hysteroscopic approaches whenever feasible, noting that hysteroscopy improves diagnostic accuracy, reduces risks, and minimizes the need for repeat interventions. Recommendations include expanding access to hysteroscopy through targeted training, especially in low- and middle-income countries, where financial and logistical barriers limit access to advanced gynecological care. Furthermore, this paper emphasizes the importance of patient-centered care, encouraging transparent counseling to support informed decision-making.

Awareness, attendance, and attitudes toward cervical cancer screening among HIV-positive Chinese women in Yunnan province: a cross-sectional study

BackgroundCervical cancer is a major health threat in the female population. Human immunodeficiency virus (HIV)-positive women encounter a higher risk of cervical cancer. It is significant to promote cervical cancer screening attendance among HIV-positive women. Little is known about the awareness, attendance, and attitudes toward cervical cancer screening, as well as the associated factors, among Chinese HIV-positive women.MethodsA cross-sectional study was conducted among 411 HIV-positive women attending a large ART clinic in Yunnan, an HIV-endemic province in China. Participants were recruited using the convenient sampling method from January 2019 to August 2020. An interviewer-administered semi-structured questionnaire was utilized to collect information on socio-demographic and behavioral characteristics, clinical characteristics related to HIV infection, awareness, attendance, and attitudes toward cervical cancer screening. Binary logistic regression analyses were used to determine factors associated with awareness, attendance, and attitude toward cervical cancer screening.ResultsSome 69.8% (287) of the participants were aware of cervical cancer screening, but only 27.7% (114) had attended screening within 3 years. After receiving a brief health education, 72.3% (297) of the participants exhibited a positive attitude toward cervical cancer screening. Participants with a higher education background and longer duration of antiretroviral therapy were more likely to be aware of cervical cancer screening and have up-to-date screening. The up-to-date screening attendance was also influenced by age, smoking status, and health insurance. Single participants were less likely to show a positive attitude toward cervical cancer screening compared married or cohabiting counterparts. The main facilitators to attending cervical cancer screening were health promotion activity and well-organized programs, while the main barriers were high costs of the service and inadequate awareness.ConclusionsAlthough most HIV-positive women attending a large ART clinic in Yunnan were aware of cervical cancer screening, the up-to-date attendance was low. It is crucial to conduct health education and promotion through efficient channels to improve awareness and attendance. The discrepancy between awareness and attendance also emphasized the importance of adopting appropriate screening strategies and powerful health policies that can foster the attendance of cervical cancer screening among HIV-positive women. Efforts should be devoted to constructing a comprehensive healthcare system with high accessibility in China for cervical cancer prevention and management for HIV-positive women.

The association among fetal head position, fetal head rotation and descent during the progress of labor: a clinical study of an ultrasound-based longitudinal cohort study in nulliparous women.

To elucidate the effects of the timing of fetal head rotation on the labor progress and outcomes. A paired ultrasound measurement was performed at each of the three stages of labor: latency stage, active stage, and full-cervical-dilatation stage. The measurements included fetal head position, head-perineum distance (HPD) and the angle of progression (AOP). A total of 46 pregnancy women were included and a total of 102 effective measurements were collected. The cases in occipital anterior position were all eutocia. The rate of cesarean section in the left transverse occipital group was the highest (15.7 %, 3/19). There were 13 cases (37.1 %) with fetal head rotation occur during active phase, changing from occipital transverse to anterior. Ten cases (28.6 %) rotated in the second stage of labor. The average rotation degree of occipital transverse to anterior position was 62.6°. When AoP <95°, 100 % of the women were occipital transverse; When AoP≥125°, 66.7 % was occipital anterior. The rate of oxytocin utilization and epidural analgesia in the occipital posterior group was higher than that in the other groups (71.4 and 85.7 %, respectively). Occipital transverse is the most common fetal head position in the early stage of labor and fetal head rotation occurs mostly in the active phase and the second stage of labor. Sufficient time should be given in labor management for women that who tried vaginal delivery without contraindications.

High level of satisfaction with care related to mastectomy and breast reconstruction as measured by the BREAST-Q in a Brazilian Tertiary Cancer Center

Optimizing patient experience is a central pillar in oncological care. The objective of this study is to evaluate satisfaction with care in two groups: women undergoing mastectomy and women undergoing late breast reconstruction using a Portuguese version of BREAST-Q questionnaire. The authors applied postoperative mastectomy and reconstruction questionnaires regarding “satisfaction with care” scales. Obtained scores were transformed into a 100-point scale. 150 women with breast cancer were included; of these, 122 were evaluated after mastectomy, 17 were re-evaluated after post-mastectomy late reconstruction, and 28 were only evaluated after late reconstruction. Mean scores in mastectomy group were 87.3, 94.9, and 91.5 for satisfaction with the surgeon, medical team, and office staff, respectively. Mean scores in reconstruction group were 90.4, 91.4 and 97.0 respectively. The scores suggest that the women had high satisfaction with the care team. The present evaluation may help to improve mastectomy management and breast reconstruction process in women.

Melanoma in pregnancy

The melanoma incidence is rising. Among pregnant women, melanoma is one of the most common cancers accounting for approximately 30% of all cancers. Timely diagnosis is critical, but management of pregnant women with melanoma lacks international consensus, and uncertainties may arise. Changes in an existing mole or the appearance of new suspicious moles during pregnancy warrant prompt evaluation, similar to moles in non-pregnant women. Our review summarises current knowledge and proposes a strategy for management.

Reply to letter to the editor regarding article, “Efficacy of aquatic vs land-based therapy for pain management in women with fibromyalgia: a randomised controlled trial”

Reply to letter to the editor regarding article, “Efficacy of aquatic vs land-based therapy for pain management in women with fibromyalgia: a randomised controlled trial”

Intramural myomas and fertility: To operate or not?

Intramural uterine myomas are very common among women of reproductive age, but their impact on natural and assisted fertility remains controversial. Although international federation of gynecology and obstretrics type 3 myomas may have the most negative impact on receptivity, available data are still not convincing. Surgical removal of these myomas is encouraged when they are symptomatic, but myomectomy for fertility-only reasons cannot be offered in daily clinical practice before in vitro fertilization treatment, as data are still inconclusive. Moreover, myomectomy is strongly associated with short and long-term complications, some of which may also affect the fertility outcome. A better understanding of the association between intramural myomas and fertility may open up new perspectives for the individualized management of infertile women with uterine myomatous masses.

Health-Related Quality of Life in Women With Metastatic Breast Cancer: An Integrative Review.

To examine current evidence on health-related quality of life and its associated factors in women with metastatic breast cancer over the past 10 years. An integrative review. We conducted a comprehensive search across five databases: CINAHL, EMBASE, MEDLINE, PsycINFO, and Web of Science, for studies published between January 2013 and June 2023. Following the integrative review guideline, we screened full-text papers based on the inclusion and exclusion criteria. The quality of the studies was assessed using the Joanna Briggs Institute's appraisal checklist, and the data were extracted and synthesised. Of 7316 articles, 25 studies met the inclusion criteria. Most of the participants were non-Hispanic white women from the United States or Europe. Various instruments were used to assess health-related quality of life. The key factors included sociodemographic and clinical characteristics, physical symptoms and function, disease stability and progression, and psychological attributes. Although targeted agents and immunotherapy are common therapies today, data on their side effects and health-related quality of life remain limited. Literature gaps included a lack of racially diverse samples, an absence of data on protective factors, and limited insights into symptom experience with novel therapies. Physical and psychological symptoms were still the major influencing factors. Clinicians should prioritise symptom management in women. Future research is needed to increase racial diversity in the study and explore novel agents related to symptoms and protective factors that may improve health-related quality of life. Women with metastatic breast cancer experience compromised health-related quality of life. Understanding which factors influence their quality of life, particularly those on novel therapies is critical for providing high-quality, individualised care and developing targeted interventions to improve their well-being. PRISMA. This integrative review does not need patient or public contribution.

The SARS-CoV-2 (COVID-19) pandemic and diagnosis and treatment of women with abnormal uterine bleeding: findings from Brazil

Objective To determine practice patterns in the diagnosis and management of nongestational abnormal uterine bleeding (AUB) in women in reproductive years during the SARS-CoV-2 (COVID-19) pandemic in Brazil. Materials and methods A web-based survey was conducted to determine the impact of the COVID-19 pandemic on the diagnosis and management of women with AUB. Survey elements included treatment location, the use of ultrasonography, laboratory evaluation for iron deficiency and some hormone determinations, and endometrial evaluation by histopathology, as well as the practice of hysteroscopy, hysterectomy and medical therapy including the placement of the 52 mg levonorgestrel-intrauterine system (LNG-IUS52). The survey was completed electronically at scientific meetings or sent by e-mail to Brazil-based OBGYNs between April and September 2021 during the COVID-19 quarantine. Results Fully completed questionnaires were received from 541 physicians aged (mean ± SD) 46.6 ± 12.5 years. Whereas the overall number of AUB-related visits decreased (p < 0.001) compared to the pre-pandemic period, the reduction was in office-based encounters; AUB-related visits at emergency facilities did not change. Telehealth-based AUB consultations increased from 1.3% at pre-pandemic to 34.3% (p < 0.001) during the pandemic. There were significant reductions in the use of diagnostic hysteroscopy (p < 0.001), endometrial biopsy (p < 0.001), therapies with the LNG-IUS52, combined oral contraceptives and hysterectomies (p = 0.002, p = 0.006 and p < 0.001, respectively). Conclusions In Brazil, during the COVID-19 pandemic, there was a decrease in AUB-related consultations, a slight increase in telehealth visits and a reduction in the use of procedures and treatments.

Machine learning approach to predict postoperative pain after spinal morphine administration during caesarean delivery

BackgroundA major barrier to optimal pain management is the difficulty in predicting and assessing patients at high risk for significant pain across multiple locations within the institution in a timely manner. This is compounded by the fragmented display of clinical information on enterprise clinical platform, which further hinders delay the reviews and hence the increased risk of untreated pain. We evaluated and compared the predictive performance of six modelling techniques in predicting significant pain, defined as the maximum pain score of 3 or more on movement at the 13th to 24th hour after spinal morphine administration during caesarean delivery. MethodsWe retrieved medical records from women who underwent caesarean delivery and received postoperative spinal morphine in a single specialist maternity hospital in Singapore between Aug 2019 and Aug 2022. We extracted 120 clinical variables from the medical records of eligible patients and further selected 23 to improve algorithm accuracies. The dataset was split randomly, with 80 % of patients (n = 5248) used for training the models, and 20 % (n = 1313) reserved for validation. ResultsThe study cohort comprised 6561 patients with an incidence of significant postoperative pain of 7.9 %. Ridge regression demonstrated the best performance with both the full (AUC: 0.649) and selected (AUC: 0.719) feature sets. By reducing the number of features, Ridge regression, LASSO, Elastic net, and XGBoost showed similar in AUC (0.704–0.719), sensitivity (0.644–0.695), specificity (0.644–0.705), positive predictive value (0.155–0.179), and negative predictive value (0.949–0.955) in predicting significant postoperative pain. These were attributed to the top three variables, mainly the last recorded postoperative pain score (on movement) before the prediction point, mean and standard deviation of the hourly maximum postoperative pain score (at rest) at 0th to 12th hour. ConclusionsFuture research will aim to refine these models and explore their implementation in clinical settings to enhance real-time pain management and risk stratification for women after caesarean delivery.

When pulmonary arterial hypertension and pregnancy meet: a multidisciplinary clinical experts review.

Pulmonary hypertension (PH) is a rare condition characterized by elevated pulmonary arterial pressure and pulmonary vascular resistance, potentially leading to right ventricular failure. Pulmonary arterial hypertension (PAH) is the most common type of PH in women of childbearing age and, as per the modified World Health Organization (mWHO) classification of maternal cardiovascular risk, it falls into mWHO class IV and pregnancy is contraindicated. These patients face an exceptionally high risk of maternal mortality and morbidity, with estimated maternal cardiac event rates ranging from 40 to 100% during pregnancy, because physiological changes happening in pregnancy exacerbate the disorder. Despite these recommendations, there is a growing incidence of pregnancy among women with PAH. Early referral to specialized centers, personalized therapies and expert multidisciplinary care involving pulmonary hypertension specialists, obstetricians, critical care specialists, anesthesiologists, and neonatologists are crucial steps to ensure positive outcomes for both mother and fetus. This review aims to examine the current understanding of pregnancy in patients with PAH, drawing on the experience of our center in the multidisciplinary management of pregnant women with this condition. In particular, we want to focus the attention of clinicians on the following aspects: early referral of pregnant patients to specialized centers, detailed counseling on the implications of pregnancy, initiation of therapy in treatment-naive patients and potential adjustment of therapy in non-naive patients, periodic risk assessment, evaluation of the appropriate timing of delivery, multidisciplinary management of the most critical periods, which are delivery and the post-partum phase.

Hereditary breast and ovarian cancer genetic testing in unselected patients: example of private supplementation of public healthcare service.

In the Emilia-Romagna region (Northern Italy), the identification and management of women at familial/hereditary risk of breast and ovarian cancer is guided by a well-established regional protocol. Here we report the results of the experience of private supplementation of public healthcare service in offering the possibility to undergo BRCA1/2 testing and/or multigene panel testing (MGPT) within a well-defined pathway to women unfulfilling regional criteria. Out of 177 patients referred to our center who underwent BRCA1/2 testing, 175 tested negative while two (1.1%) resulted carriers of pathogenic variants in BRCA2; 69 patients also underwent MGPT, and in four cases (5.8%) a pathogenic variant were found (two in ATM and one in CHEK2 and RAD51C, respectively). Overall, this private supplementation of territorial public healthcare system has made it possible to confirm the validity of regional criteria for genetic testing access (concordance: 98.9%), but also to identify carriers of pathogenic variants of BRCA1/2 that would have escaped regional protocol, to support the effectiveness of MGPT for the identification of rare cases (not BRCA) at mild/high risk, and to provide reassurance to women who were found to be non-carriers of pathogenic variants, who may benefit from a more accurate assessment of their risk.

Improvement effect of insulin resistance in one-day outpatient service by reducing stress adaptation disorders in patients with gestational diabetes mellitus.

Conducted a one-day outpatient service for GDM patients, analyzed the relationship between stress adaptation disorder and insulin resistance in GDM patients after intervention, and tried to provide some new clues for the prevention and treatment of GDM, provide some theoretical basis for the multidisciplinary diagnosis and treatment model of GDM patients. 240 GDM women were included in this study, 120 women were included in one-day diabetes clinic management for GDM women as GDM Intervention Group, and 120 GDM women receiving regular dietary education as GDM Control Group. One-day diabetes clinic management including disease knowledge and dietary education, sports education and blood sugar monitoring and personalized issues and follow-up visits, and intervention time lasting for 1 month. After intervention, the concentration of 2-h postprandial blood glucose, and HOMA-IR were decreased in GDM Intervention Group, while weekly weight gain rate and insulin application rate were significantly lower than GDM Control Group (all p < 0.05). Cortisol and MDA in GDM Intervention Group were significantly lower than GDM Control Group (both p < 0.01). HOMA-IR was positively correlated with weight gain, E, NE and cortisol (r = 0.249, 0.242, 0.663, 0.313, all p < 0.01), E and HOMA-IR were negatively correlated with SOD in GDM Intervention Group (r = -0.306, -0.213, both p < 0.01). The intervention model in our study was based on the one-day outpatient comprehensive management model of diabetes, which improved the insulin resistance of GDM patients. The possible mechanism was related to the implementation of one-day outpatient intervention measures, which reduced the stress adaptation disorder and oxidative stress injury of GDM patients. At the same time, the implementation of intervention measures reduced the rate of weight gain, which can also alleviate insulin resistance to a certain extent. One-day outpatient treatment has a positive effect on improving insulin resistance in GDM women, which can reduce the risk of maternal and fetal complications.

Management of detected syphilis in pregnancy adheres to guideline recommendations, but the crisis of congenital syphilis persists.

Infectious syphilis among women of reproductive age continues to rise in many countries including Australia, with a resultant increase in congenital syphilis. In response, new guidelines for management of syphilis in pregnancy were published in Queensland, Australia in 2018. This study evaluates the management of women diagnosed with syphilis in pregnancy in South-East Queensland (SEQ) after release of this guideline. This retrospective review of notification data identified women in SEQ who had a positive syphilis serology during pregnancy, without evidence of adequate treatment prior to the pregnancy, between January 2019 and December 2021 inclusive. Maternal demographics and pregnancy details including syphilis staging, testing and management were extracted, with management assessed against the 2018 Queensland syphilis in pregnancy guideline. Of the 42 women identified, 79% were diagnosed in the first or second trimester, 69% had early-stage syphilis at the time of diagnosis and 86% were asymptomatic at the time of diagnosis. All, including the eight (19%) Aboriginal and/or Torres Strait Islander women identified, completed stage-appropriate treatment with penicillin, 83% completed treatment four weeks prior to delivery and 60% achieved a four-fold reduction in rapid plasma reagin at time of delivery. Our findings suggest compliance with syphilis in pregnancy management recommendations has improved in SEQ since release of the 2018 guidelines. However, congenital syphilis rates continue to rise; further initiatives addressing barriers to timely testing and management of syphilis in pregnancy are urgently needed at both healthcare system levels and for individual women.

The Influence of Financial Literacy and Self Control on Women's Personal Financial Management in Konawe District, Southeast Sulawesi Province

The purpose of this study was to determine the influence of financial literacy and self-control of women on their personal financial management. The study was conducted on women in Konawe Regency, Southeast Sulawesi Province. The type of data used in this study is quantitative data. The data source comes from secondary data. The population used in this study were women in Konawe Regency with various different backgrounds. The sampling method used Random Sampling. With a sample size of 100 women. The test results stated that the financial literacy variable had a positive and significant effect on women's financial management and the self-control variable had a significant positive effect on women's financial management.

Clinical Efficacy and Prognostic Factors of McDonald Cervical Cerclage in Pregnant Women with Cervical Incompetence

Background: This study aimed to evaluate the clinical efficacy and prognostic factors associated with McDonald cervical cerclage in pregnant women with cervical incompetence. Methods: We retrospectively reviewed medical records of 100 pregnant women with cervical incompetence who underwent prophylactic or therapeutic McDonald cervical cerclage between January 2021 and December 2022. The participants were divided into two groups: good prognosis (n = 37) and poor prognosis (n = 63). Baseline characteristics and pregnancy outcomes were compared between the two groups, and multivariate logistic regression was used to identify associated prognostic factors. Results: The good prognosis group showed lower rates of miscarriage and preterm birth and higher rates of full-term birth compared to the poor prognosis group, but these differences were not statistically significant. Multivariate logistic regression identified various independent risk factors influencing clinical outcomes of McDonald cerclage, including gravidity (odds ratio [OR] = 1.75), having more than two previous births (OR = 2.44), assisted reproductive technology (OR = 1.52), history of cervical conization (OR = 1.88), complete uterine cavity curettage (OR = 1.67), prolonged second stage of labor (OR = 2.19), cesarean section (OR = 1.48), cervical laceration (OR = 1.80), polycystic ovarian syndrome (OR = 1.60), and prophylactic cerclage (OR = 0.73). These factors demonstrated good predictive performance for the prognosis of patients with cervical incompetence, with an area under the curve of 0.793 and sensitivity and specificity values of 0.750 and 0.850, respectively. Conclusions: The identified risk factors, particularly having more than two previous births, prolonged second stage of labor, and a history of cervical conization, should be considered in the clinical management of pregnant women with cervical incompetence. The protective effect of prophylactic cerclage emphasizes the importance of early detection and timely intervention to improve pregnancy outcomes.

A cohort study of the occurrence of post-term births and its association with perinatal mortality in a rural area in Bangladesh.

We aimed to evaluate the trend of post-term births over time and their association with perinatal mortality based on prospective pregnancy cohorts in a rural area in Bangladesh. This cohort study included 72 373 singleton births with gestational ages ≥28 weeks recorded by a health and demographic surveillance system from 1990 to 2019 in Matlab, Bangladesh. We expressed the gestational age as X (weeks) + Y (days)/7 weeks, where X indicated complete weeks, and Y presented the number of completed days out of seven days or a week. Using Poisson regression with robust variances, we estimated the population-based proportion of post-term births and assessed the association between gestational age categories and perinatal mortality. We presented results by adjusted relative risk (aRR) with 95% confidence intervals (CIs). Post-term births declined from 5.8% in 1990 to 2.8% in 2019. Perinatal mortality declined from 58 to 27 per 1000 births from 1990 to 2019. Compared to full-term births (39 + 0/7 to 40 + 6/7 weeks), the aRRs of perinatal mortality were 1.39 for late-term (41 + 0/7 to 41 + 6/7 weeks) and 1.93 for post-term (≥42 + 0/7 weeks) births. The population-attributable fraction of perinatal mortality was 15% for births at ≥41 + 0/7 weeks out of the total perinatal deaths occurring at ≥39 gestation weeks. In this rural setting in Bangladesh, we observed a decline in post-term birth proportions from 1990 to 2019. We found increased perinatal mortality when pregnancy continued beyond 40 + 6/7 weeks of gestation. This implies that planning the management of pregnant women approaching the post-term period may be needed to further improve perinatal health outcomes.