Objective::To evaluate the early pregnancy loss (EPL) rates in women with and without low molecular weight heparin (LMWH) treatment during early pregnancy.Methods::A retrospective, non-randomized study was conducted at Guangzhou Women and Children’s Medical Center between June 2019 and March 2022, involving women diagnosed with polycystic ovary syndrome (PCOS). All participants conceived following standard preconception care and voluntarily chose either the control group or the LMWH intervention group during the first month of pregnancy. The intervention was administered throughout the entire first trimester. Early and final pregnancy outcomes were recorded, with a particular focus on EPL rates. In addition, venous blood samples and clinical data were collected to compare hormonal profiles, blood lipid levels, and anthropometric parameters between the two groups. Statistical analyses included the two-tailed unpaired Student’s t-test, Mann–Whitney U test, Chi-square test, and Kaplan–Meier survival analysis. A value of P < 0.050 was considered statistically significant. Results::Thirty-eight women in the LMWH group and 102 women in the control group were included. The EPL rates in the LMWH and control groups were 5.3% (2/38) and 26.5% (27/102), respectively ( χ2 = 7.582, P = 0.006, odds ratio ( OR) = 0.154, 95% confidence interval ( CI): 0.035-0.685). The age ( P = 0.005), PCOS subtype ( P = 0.012), and levels of total cholesterol ( P = 0.003), and high-density lipoprotein ( P = 0.018) were significantly different between these two groups. Continued follow-up was performed to observe the long-time effects of LMWH treatment in early pregnancy. Seventy-three patients were successfully delivered, 23 patients in the LMWH group and 50 patients in the control group. There was no significant difference between the LMWH and control groups in gestation length, bleeding during delivery, birth weight, gender of the newborn, or mode of delivery. In addition, Kaplan-Meier curve analysis revealed that LMWH treatment may decrease the risk of EPL in PCOS patients in the first trimester ( χ2 = 4.144, P = 0.040). Conclusion::LMWH treatment during early pregnancy may reduce the EPL rate in women with PCOS.

Objective::To assess the impact of maternal physiological and pathological factors on fetal birth weight in pregnancies in Kazakhstan.Methods::This retrospective cross-sectional study was conducted from January 2016 to December 2021 at Aksu City Hospital, Atyrau Regional Perinatal Center, Altai Interdistrict Hospital, Abay Regional Perinatal Center of the Health Department, and Astana Multidisciplinary City Hospital No. 3, in the Republic of Kazakhstan using the stratified randomization grouping method. The study involved two maternal ethnicity groups, Asian (5101; 77.91%) and European (1446; 22.09%). All statistical analyses were performed using Stat Tech version 3.0.9 and SPSS 26.0.Results::This study involved 6547 pregnant women. Fetuses weighing < 2500 g were more common in the Asian group than in the European one ( P = 0.001), while large fetuses (> 4000 g) were more common in the European group ( P = 0.001). Multiple linear regression analyses revealed that a history of arterial hypertension and preeclampsia leads to decreased fetal weight, while gestational diabetes mellitus (GDM) was associated with increased fetal weight. In the Asian ethnic group, maternal physiological factors and a history of arterial hypertension, preeclampsia, and GDM significantly influenced fetal birth weight. In the European group, a history of hypertension and GDM did not affect birth weight. Conclusion::Stillbirth and perinatal death were more likely among women of the Asian ethnic group when compared with women of the European ethnic group. Therefore, it is necessary to account for the maternal physiological and pathological factors that may influence fetal birth weight when assessing optimal fetal birth weight.

Objective::To evaluate the diagnostic efficacy and clinical application of the Obstetrical Chinese Disseminated Intravascular Coagulation (DIC) Scoring System (OCDSS).Methods::This study is a retrospective study that collected 1063 cases from Wuhan Union Hospital, Yichang Central People’s Hospital, and the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture between July 2017 and June 2024. These cases were divided into DIC and non-DIC groups based on score standard. Diagnosis of DIC, the rate of hysterectomy, neonatal mortality, and severe asphyxia are the main outcome measures. All the laboratory indicators are all determined by clinical laboratory department of the hospital. Data were expressed as mean ± standard deviation or median (interquartile range) and frequencies. Independent sample t-test or non-parametric test were used to compare measurement data, while the chi-square test was used for count data. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to test the predictive accuracy. Using univariate and multivariate logistic regression analysis to study the high-risk factors. P < 0.050 indicates a statistical significance. Results::Of 1063 participants in this study, 29 participants (2.73%) were diagnosed with obstetrical DIC by OCDSS score standard, and all the participants were diagnosed as DIC with underlying disease. When the Takao, Clark, and Erez score standard is the "gold standard", the OCDSS score standard always shows good sensitivity and specificity, with all the AUC over 0.75. OCDSS score standard also has better predictive of hysterectomy (68.18%, 91.07%, 0.872), severe neonatal asphyxia and death (79.17%, 75.07%, 0.842) than the other three score standards. All the indicators included in the OCDSS score standard contributed to the DIC diagnosis (all the P < 0.001). The indicators in the DIC group were more abnormal than the non-DIC group (all the P < 0.001). Conclusion::OCDSS is a first score standard, especially for pregnancies, it considers the underlying disease, clinical symptoms, and laboratory results. This score system shared a good diagnosis performance for DIC in the Chinese population and may help clinicians make timely decisions.

Objective::To compare pregnancy terminations for two reasons: intrauterine fetal death (IUFD) and fetal anomaly, focusing on obstetric data and termination processes to optimize clinical management.Methods::This retrospective, single-center study included singleton pregnancies terminated for intrauterine fetal death or fetal anomaly (≥ 10 weeks’ gestation) between January 2020 and December 2021. Demographic, obstetric, and procedural data were collected. Termination methods included misoprostol, balloon catheter, curettage, and hysterotomy, following FIGO guidelines. Feticide was performed when indicated. Statistical analysis was conducted using t-test, chi-square test, and Pearson correlation; significance was set at P < 0.050. Results::A total of 173 termination cases (104 IUFD, 69 fetal anomalies) were analyzed. Mean gestational age was 16.6 ± 4.2 weeks. Termination and hospitalization times were longer in anomaly cases ( P < 0.001). Gravida and parity were lower in the anomaly group ( P = 0.005, P = 0.011). Misoprostol use showed a positive correlation with termination time ( r = 0.251, P = 0.001); parity was negatively correlated ( r = –0.175, P = 0.021). Balloon, curettage, and feticide rates were higher in anomaly cases (all P < 0.001). Complications occurred in 4 patients (2.3%). Conclusion::Clinical approaches to pregnancy termination differ based on the underlying condition. Obstetric history and fetal pathology influence the methods and timing of the procedure, emphasizing the need for individualized care to improve patient outcomes.

Objective::To evaluate the safety and effectiveness of intermittent bolus administration of ephedrine, norepinephrine, and phenylephrine in the treatment of maternal hypotension during spinal anesthesia for cesarean sections in preeclamptic women.Methods::This PRISMA-based systematic review included English random control trails (RCTs) of women with singleton preeclampsia (American College of Obstetricians and Gynecologists (ACOG) criteria) undergoing cesarean delivery with spinal anesthesia, excluding chronic hypertension or systemic disease. Interventions were intermittent bolus phenylephrine, norepinephrine, or ephedrine, with outcomes on maternal hemodynamics, neonatal status, and adverse events. Searches of PubMed, ScienceDirect, Google Scholar, and Cochrane (to December 2024) plus reference screening identified eligible studies. Two reviewers independently selected studies, extracted data, and assessed risk of bias (Cochrane RoB 2.0). Due to heterogeneity in vasopressor regimens and outcome measures, results were synthesized narratively.Results::Of 2333 records screened, six RCTs (sample sizes 20-166) were included, all in preeclamptic women undergoing cesarean delivery. Overall risk of bias was low. Norepinephrine better preserved maternal hemodynamics than phenylephrine or ephedrine, with higher cardiac output (6.31 ± 1.08 vs. 5.45 ± 1.21 L/min; P = 0.009) and lower uteroplacental resistance (0.04 ± 0.02 vs. 0.06 ± 0.03; P = 0.002). Ephedrine caused higher heart rates (84.9 ± 7.1 vs. 76.6 ± 6.9 bpm; P < 0.05) and more nausea/vomiting. Neonatal umbilical artery pH was higher with norepinephrine or phenylephrine than ephedrine (7.32 ± 0.02 vs. 7.31 ± 0.03; P < 0.050), while Apgar scores did not differ. Adverse events favored norepinephrine, which reduced bradycardia versus phenylephrine (5.1% vs. 20.5%; relative risk ( RR) = 0.25; P = 0.042) and tachycardia versus ephedrine (16.1% vs. 36.4%; RR = 0.54; P = 0.020). Conclusion::Intermittent bolus administration of norepinephrine offers superior maternal cardiac output and neonatal safety, making it optimal for preeclamptic cesarean deliveries. Phenylephrine is effective for blood pressure control but may induce bradycardia, while the use of ephedrine is limited by its association with neonatal acidosis. Tailored vasopressor selection is thus essential for optimal outcomes.

Advances in prenatal screening have significantly improved the early detection of fetal anomalies and chromosomal abnormalities. Among these, first-trimester soft markers have emerged as valuable indicators of potential adverse outcomes. This review explores the clinical relevance of key markers—including increased nuchal translucency (NT), nasal bone hypoplasia, tricuspid regurgitation, aberrant right subclavian artery, and abnormal ductus venosus flow—and their associations with aneuploidy, structural malformations, and pregnancy complications such as preeclampsia and fetal growth restriction. We emphasize the importance of interpreting soft markers within a comprehensive clinical context, rather than in isolation, and examine their underlying pathophysiological mechanisms and associated statistical risks. Particular attention is given to the integration of soft marker findings with advanced screening techniques, including cell-free DNA (cfDNA) testing and maternal serum biochemistry, to improve diagnostic accuracy. In addition, we review current recommendations for clinical management, such as the use of follow-up diagnostic procedures like chorionic villus sampling or amniocentesis, and the role of multidisciplinary counselling in high-risk pregnancies. Future research should aim to validate novel soft markers and promote the standardization of screening protocols to enhance maternal and fetal outcomes.

Preterm birth (PTB), predominantly induced by intraamniotic inflammation, stands as the foremost contributor to neonatal morbidity and mortality globally. Fetal inflammatory response syndrome, stemming from the activation of the innate immune system, signifies the occurrence of funisitis or chorionic vasculitis. Maternal-fetal complications associated with infection-related PTB encompass maternal sepsis, fetal demise, neonatal sepsis, neonatal neurological impairment, and chronic lung disease. The inflammatory cascade is initiated when Toll-like receptors present on immune cells within the fetal membranes and the female reproductive tract encounter pathogen-associated molecular patterns derived from infectious agents. Subsequently, the nuclear factor kappa-light-chain-enhancer of activated B cells facilitates the transcription of cytokines. The accumulation of neutrophils compromises the tissue integrity of the fetal membranes, leading to membrane rupture via the secretion of matrix metalloproteinases. Elevated prostaglandin levels prompt uterine contractions and cervical remodeling, resulting in progressive cervical effacement and dilation, ultimately culminating in fetal delivery. The diagnosis of PTB should encompass three pivotal criteria: gestational age, uterine activity, and the consequences of that uterine activity. The diagnosis of chorioamnionitis is established through a combination of clinical manifestations, laboratory findings, identification of infectious microorganisms, and placental pathology. Fetal monitoring involves antenatal ultrasonography and non-stress testing. The management of infection-related PTB involves controlling and treating the infection, timing delivery to coincide with optimal fetal lung maturity, and optimizing outcomes for both the mother and neonate. Current preventive strategies for PTB primarily focus on inhibiting myometrial contractions that arise from the inflammatory cascade initiating PTB. An understanding of these pathways serves as the cornerstone for the development of therapeutic interventions aimed at preventing PTB.

Objective::To compare the analgesic effects of ibuprofen administered orally via two modes combined with a conventional, patient-controlled intravenous analgesia pump on maternal pain after cesarean section (CS).Methods::This prospective, randomized, controlled study enrolled females who underwent CS from August 2022 to August 2023 at Peking University First Hospital, Beijing, China. Participants were randomly assigned to either an as-needed ibuprofen group (300 mg orally upon request) or a scheduled ibuprofen group (300 mg every 12 hours for 48 hours). The primary outcomes assessed were postoperative pain levels using the Wong-Baker Faces Pain Scale-Revised and cumulative oxycodone consumption at multiple time points up to 48 hours post-delivery. Secondary outcomes included recovery parameters (time to first flatus, ambulation, and lactation initiation), patient satisfaction with pain control, and postpartum depression scores evaluated by the Edinburgh Postnatal Depression Scale on postoperative day 3. Normally distributed data analyzed with t-tests; non-normal data with Mann-Whitney U tests; categorical variables with chi-square or Fisher’s exact tests (SPSS 26.0, P < 0.05). Results::After excluding 61 non-eligible cases, 339 patients were included (171 as-needed vs. 168 scheduled). The scheduled group showed significantly better pain control at 12 hours (4.00 (2.00-5.50) vs. 4.00 (4.00-6.00), P < 0.001), 24 hours (4.00 (2.00-4.00) vs. 4.00 (2.00-6.00), P < 0.001), and 36 hours (2.00 (2.00-4.00) vs. 4.00 (2.00-4.00), P < 0.001), and 48 hours (2.00 (2.00-4.00) vs. 2.00 (2.00-4.00), P = 0.004) post-delivery and lower levels of oxycodone consumption at 36 hours (10.20 (8.20-13.35) vs. 11.00 (8.80-14.40), P = 0.042) and 48 hours (12.40 (10.40-15.95) vs. 13.80 (11.00-16.00), P = 0.020) postpartum compared with those in the as-needed group. Additionally, the time to the return of bowel movements was shorter in the scheduled group than in the as-needed group (23.50 (16.94, 31.47) vs. 27.00 (19.88, 35.97), P = 0.004). Differences in post-delivery ambulation, lactation initiation, satisfaction levels, and depression scores were not significantly different between the two groups. Conclusion::The results of this study promote the use of ibuprofen (scheduled oral administration) combined with a conventional, patient-controlled intravenous analgesia pump for achieving better post-CS pain control than an as-needed dosage regimen.Registration::Chinese Clinical Trial Registry, ChiCTR2400082474.

Objective::To assess the adverse maternal and neonatal outcomes of anemia among pregnant women in primary hospitals in Southern Ethiopia.Methods::This institution-based prospective cohort study was conducted from March 1 to October 30, 2022, in three primary hospitals in the Hadiya zone of Southern Ethiopia. Participants were categorized into exposed (Hb < 11 g/dL) and non-exposed (Hb ≥ 11 g/dL) groups based on hemoglobin levels measured before delivery. Baseline characteristics were comparable between groups. Maternal and neonatal complications were considered as outcomes. Data were analyzed using STATA version 15. Descriptive statistics summarized baseline characteristics, and Chi-square tests assessed associations. Generalized linear models with a log link calculated adjusted relative risks (a RRs) with 95% CIs. Statistical significance was set at P < 0.05. Multivariable models adjusted for confounders, and sensitivity analyses evaluated robustness using multiple imputations for missing data. Results::A total of 490 participants were enrolled in the study, with 245 in each of the exposed and non-exposed groups. Due to loss to follow-up, 220 participants in the exposed group and 239 in the non-exposed group were assessed for outcomes. Prolonged labor (adjusted RR (a RR)= 3.235; 95% CI: 1.658, 6.312; P = 0.003) and postpartum hemorrhage (a RR = 2.901; 95% CI: 1.202, 7.910; P = 0.045) were identified as adverse maternal pregnancy outcomes of anemia. We observed low birth weight (a RR = 3.020; 95% CI: 1.233, 6.010; P = 0.002) and respiratory distress syndrome (a RR = 4.820; 95% CI: 2.901, 9.012; P = 0.001) as neonatal complications. Furthermore, having no previous history of anemia reduced the risk of prolonged labor (a RR = 0.078; 95% CI: 0.033, 0.188; P = 0.015) and low birth weight (a RR = 0.480; 95% CI: 0.370, 0.592; P = 0.001). Conclusion::Mothers who have experienced maternal anemia in the past or present face serious consequences for both themselves and their children. Preventing anemia should thus start before conception and continue through pregnancy.

Alternative splicing (AS) is a crucial process that produces functionally distinct proteins from a single gene, depending on the developmental or physiological state of cells in multicellular organisms. It plays a significant role in cellular proliferation, survival, and differentiation, including embryonic development, spermatogenesis, and a broad spectrum of diseases. However, the precise involvement of AS in embryo implantation is still unclear. In this review, we summarize the potential roles of AS in regulating mesenchymal-epithelial transitions during embryo implantation, specifically in epithelium regeneration and decidualization initiation via the mesenchymal-epithelial transformation process. Overall, this review emphasizes the impact of AS and splicing variants on embryo implantation and offers novel insights into the potential application of alternative splicing in the treatment of female infertility.