Objective: Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting during pregnancy that can have significant physical consequences for the pregnant individual. However, studying affected patients often reveals an additional dimension of impact—specifically, the psychosocial effects on their quality of life.
Materials and methods: This literature review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Relevant articles were identified through a systematic search across three major databases on May 18, 2024: Google Scholar, Cochrane, and PubMed.
Results: 19 full-text articles met inclusion criteria. Across all studies, HG was consistently associated with poorer psychiatric health, strained social relationships, and broader psychosocial burdens.
Conclusion: This particular review highlights the importance of appropriately taking a psychosocial history with patients at obstetric appointments. In addition, it encourages the practicing physician to delve further into the psychosocial health of each of their patients during these visits. Lastly, this review provides definitive evidence from a number of sources that these patients are truly suffering and calls to action investigation into new treatments and treatment methodologies to provide benefits for these needy patients.

Objective: Recurrent implantation failure (RIF) remains a multifaceted challenge in assisted reproductive technology (ART), affecting a subset of in vitro fertilization (IVF) patients despite transfer of high-quality embryos. Conventional diagnostics often require invasive procedures that may disturb endometrial receptivity. This narrative review critically synthesizes the evidence on liquid-biopsy strategies for RIF screening, emphasizing biofluids such as uterine fluid (UF), spent embryo culture medium (SCM), peripheral blood, cervicovaginal fluid (CVF), and seminal plasma.
Materials and methods: Literature searches covered PubMed, Scopus, and Web of Science through August 2025, with inclusion of pivotal pre-2022 studies. Eligible works included observational studies, clinical trials, multi-omics analyses, and systematic reviews reporting molecular biomarkers relevant to endometrial receptivity or embryo competence.
Results: UF-derived microRNAs (miRNAs) and extracellular vesicle (EV) cargo during the window of implantation (WOI) consistently differentiate receptive from nonreceptive endometrium, with predictive accuracies (AUC 0.75–0.90) in small validation studies. SCM-based noninvasive PGT-A (niPGT-A) shows moderate concordance (~65%) with trophectoderm biopsy PGT-A, constrained by contamination and low cfDNA yield; recent advances include blastocoel fluid integration and methylation-based decontamination. Peripheral blood, CVF, and seminal plasma biomarkers remain exploratory due to lower specificity. Pre-analytical standardization and harmonized outcome definitions are critical for translation.
Conclusion: UF-miRNA/EV profiling holds the strongest promise for noninvasive RIF screening, whereas niPGT-A may serve as an adjunct for embryo competence assessment when biopsy is not feasible. Both approaches require multicenter validation and prospective trials demonstrating improved live-birth rates before routine clinical adoption.

Objective: Given the invasive and costly nature of reference diagnostic methods like hysteroscopy , this study aimed to compare the diagnostic accuracy and the dimensional measurement agreement of uterine cavity lesions between two-dimensional saline infusion sonography (2D SIS) and three-dimensional saline infusion sonography (3D SIS) against the gold standard of hysteroscopy and histopathology.
Materials and methods: This cross-sectional study was conducted on 283 female patients who were candidates for hysteroscopy. Prior to surgery, all patients underwent blinded evaluations via 2D SIS and 3D SIS performed by experienced radiologists, and the type, number, location, and size of the lesions were recorded. Subsequently, all patients underwent diagnostic hysteroscopy and tissue sampling for pathological evaluation as the gold standard. Diagnostic performance metrics were calculated, and the dimensional agreement of the lesions between the modalities was statistically evaluated using the Intraclass Correlation Coefficient (ICC) and Bland-Altman analysis.
Results: The mean age of the patients was 35.9 ± 8.1 years. Histopathological examination confirmed endometrial polyps in 20.5% and leiomyomas in 17.3% of the patients. Compared to 2D SIS, 3D SIS demonstrated higher sensitivity (83.15% vs. 78.65%), higher specificity (93.30% vs. 91.75%), and higher overall diagnostic accuracy (90.11% vs. 87.63%). In the dimensional agreement analysis, 3D SIS showed an excellent correlation (ICC = 0.927) and a negligible mean systematic error (mean bias: -0.26 mm; 95% limits of agreement: -7.77 to 7.25 mm) compared to hysteroscopy. In contrast, 2D SIS systematically overestimated lesion dimensions compared to hysteroscopy (mean bias: 2.21 mm) and exhibited the widest limits of agreement when compared with 3D SIS (-8.76 to 13.70 mm).
Conclusion: 3D SIS is an accurate, non-invasive tool that lacks systematic bias in measuring uterine tumors, offering superior performance compared to the 2D SIS method. Given its high overall accuracy, 3D SIS can be utilized as a reliable first-line diagnostic tool, significantly reducing the necessity for unnecessary diagnostic hysteroscopies and the associated financial burdens on the healthcare system.

Objective: Anxiety disorders during the perinatal period, or perinatal anxiety (PNA), occur at rates comparable to perinatal depression and often go undetected. Obstetric providers are perfectly positioned to identify PNA; yet, most literature focuses on informal supports as primary protective factors the prevention and detection of PNA. This study aims to contribute to this gap by exploring the relationship between perceived support from medical providers and the detection of PNA.
Materials and methods: The current study asked postpartum women to reflect on their levels of anxiety, perceived social support from obstetric care providers, help seeking behavior, and factors influencing their decision to disclose symptoms of PNA to their obstetric care provider during their perinatal period. Participants were recruited via an electronic flyer posted in social media groups for mothers. They completed an online survey consisting of a demographic questionnaire, Perinatal Anxiety Screening Scale (PASS), Modified Multidimensional Scale of Perceived Social Support (MSPSS), Subscale 1, Subscale 2.
Results: Totally 98 postpartum women participated in this study. A Spearman correlation demonstrated a significant positive relationship between levels of perceived social support from obstetric providers and perinatal women ranking their obstetric provider as a barrier, neutral or motivating factor in help seeking behavior for PNA. A chi-square test of independence indicated a significant relationship between rankings of a provider as a barrier, neutral or motivator in help seeking behavior and the disclosure of PNA directly to obstetric care providers. It was found that levels of perceived social support reported on the Multidimensional Scale of Perceived Social Support (MSPSS) significantly predicted ranking obstetric providers as a barrier, neutral or motivating factor in the decision to disclose symptoms of PNA to their obstetric care provider.
Conclusion: The results of this study indicate a missed opportunity in more effective detection of PNA. Specifically, the role of obstetric providers in detection of PNA and potential to serve as a protective factor or motivator in the disclosure of PNA is mentioned.

Objective: The global prevalence of smoking among women of reproductive age is significant, and the impact of tobacco on assisted reproductive technologies requires evaluation. This study aimed to determine the association between cigarette or hookah smoking with in vitro fertilization (IVF) outcomes.
Materials and methods: In this cross-sectional study, we enrolled 200 women undergoing their first
IVF cycle at Arash Infertility Center (Tehran, Iran). Ovarian response, oocyte maturity (Metaphase I (MI) and II (MII), embryo quality, and pregnancy outcomes were compared between cigarette smokers and non-smokers, as well as between hookah users and non-users.
Results: Among the 200 participants, cigarette smokers (n=100) had significantly fewer mature (MII) oocytes than non-smokers (6.72±2.90 vs. 8.63±6.20; P = 0.036).  Hookah users (n=100) did not show a significant decrease in the number of MII oocytes compared to non-smokers (8.06±5.81 vs. 8.73±6.12; P = 0.512). There were no significant differences in MI oocytes, embryos obtained, embryo quality, or chemical and clinical pregnancy rates between cigarette smokers and non-smokers. Hookah users had more MI oocytes compared to non-users (7.88±5.63 vs. 6.05±4.44; P = 0.010). The chemical pregnancy rate was higher in the hookah-user group than in non-users (P = 0.036). Logistic regression analysis showed no link between cigarette smoking, hookah smoking, age, or BMI and pregnancy rates.
Conclusion: Cigarette smoking may impair oocyte maturation, while hookah use showed inconsistent associations with IVF outcomes. These findings should be interpreted cautiously due to the limited sample size and cross-sectional design.

Objective: Varicella (chickenpox) is a highly contagious disease, and its vaccine was incorporated into the Brazilian National Immunization Program in 2013. Objectives: (i) To analyze trends in hospitalization rates for severe chickenpox by age; (ii) To assess the impact of the interventions “anti-vaccine movement/vaccine hesitancy” and “COVID-19 pandemic” on hospitalization rates.
Materials and methods: Classical Time Series (CTS) and Interrupted Time Series (ITS) methods were applied to estimate the impact of the anti-vaccine movement/vaccine hesitancy (intervention-1) that occurred in 2016 and the COVID-19 pandemic (intervention-2) that began in 2020 on hospitalization rates among children under 5 years old, stratified by groups based on vaccine-ineligible (< 1 year old) and vaccine-eligible (1-4 years old) children.
Results: CTS results supported the potential for herd immunity effects, showing an annual decline of
-17% and -14% in hospitalization rates for vaccine-eligible (1-4 years) and vaccine-ineligible (< 1 year) groups, respectively. The ITS model for vaccine-ineligible children showed an upward trend (coefficient 0.35) after intervention-1(isolate) (p=0.001), as well as after intervention-1 (coefficient 0.42; p 0.011) adjusting for intervention-2 (p=0.135). For vaccine-eligible children, the ITS model revealed an upward trend (coefficient 0.14) only after intervention-1 (isolate) (p=0.006).  
Conclusion: The decline in varicella hospitalizations indicates a herd immunity effect among vaccine-ineligible children. ITS analysis reveals that the anti-vaccine movement/vaccine hesitancy contributed to increased hospitalizations in both vaccine-eligible (1-4 years) and vaccine-ineligible (<1 year) groups, while the COVID-19 pandemic had no discernible impact.

Objective: Maternal hemoglobin concentration during pregnancy is a key indicator of placental–fetal oxygen delivery and may influence neonatal outcomes. Despite existing evidence, prospective cohort data in the Iranian population remain limited. This study aimed to investigate the association between maternal hemoglobin concentration and neonatal outcomes while controlling for potential confounding factors.
Materials and methods: This prospective cohort study was conducted over a six‑month period.  A total of 263 eligible mother–neonate pairs were included in the analysis. Maternal hemoglobin concentration was measured at 28 weeks of gestation, and participants were categorized into two groups: Hb < 11 g/dL (anemia) and Hb ≥ 11 g/dL. Neonatal outcomes were investigated in two groups. Statistical analyses were performed using independent t‑tests, chi‑square tests, and univariate and multivariate linear and logistic regression models, adjusting for gestational age, mode of delivery, parity, maternal conditions, and iron supplementation.
Results: The incidence of RDS was calculated 56% (33 neonates) and 26% (48 neonates) in mothers with anemia and normal, respectively. Neonates born to mothers with Hb ≥ 11 g/dL had a significantly lower risk of RDS compared with those born to anemic mothers (adjusted OR = 0.64; P < 0.01). No significant association was observed between maternal anemia and either birth weight or birth length in multivariate analysis.
Conclusion: Adequate maternal hemoglobin concentration is associated with a reduced risk of neonatal RDS. Timely screening and appropriate management of maternal anemia may play an important role in improving neonatal respiratory outcomes.

Objective: To report a rare case of Edwardsiella tarda bacteremia in early pregnancy complicated by maternal sepsis, sepsis-induced coagulopathy, acute kidney injury, and intrauterine fetal demise.
Case Report: A 32-year-old woman at 13 weeks of gestation presented with sudden-onset high-grade fever, abdominal pain, and vaginal bleeding shortly after consuming freshwater fish. She had no preceding diarrhea or vomiting. During hospitalization, she developed persistent fever, anemia, thrombocytopenia, acute kidney injury, and coagulopathy, with a sepsis-induced coagulopathy score of 5. Obstetric ultrasonography confirmed absence of fetal cardiac activity, and emergency vacuum aspiration was performed. Blood cultures grew Edwardsiella tarda, while stool cultures were sterile. She was treated with intravenous piperacillin-tazobactam, fluid resuscitation, oxygen supplementation, and blood transfusion. Her fever subsided, renal function and coagulation parameters normalized, and she was discharged in stable condition.
Conclusion: Invasive Edwardsiella tarda infection during pregnancy is extremely uncommon but may cause severe maternal sepsis and adverse fetal outcome even without gastrointestinal symptoms. Recent freshwater fish exposure may provide an important diagnostic clue. Early blood culture sampling, prompt antimicrobial therapy, and supportive care are essential for maternal recovery.

Objective: Myonecrosis is a complication of severe endometritis. The usual management of uterine incisional necrosis with dehiscence is hysterectomy. Conservative surgery, which involves wound debridement and resuture, presents a strong alternative to hysterectomy.
Case Report: In this study, a 27-year-old woman underwent an emergency cesarean section at 37 weeks due to fetal distress after labor induction for severe preeclampsia and intrauterine growth restriction. Five days after cesarean section, the patient developed purulent discharge from the incision, followed by tachycardia, leukocytosis, and fever. Imaging revealed endometritis with peritonitis symptoms. Her condition deteriorated in spite of broad-spectrum antibiotics, requiring an urgent exploratory laparotomy. Necrotic tissue was excised during surgery, and the uterine incision was effectively healed without necessitating a hysterectomy. She exhibited a satisfactory recovery, and a three-month follow-up revealed an unblemished uterus.
Conclusion: Uterine incision necrosis can be lethal if not appropriately recognized and treated. Conservative therapy can be a good alternative for properly chosen patients, even though hysterectomy is frequently required. Successful outcomes depend on early diagnosis, cautious patient selection, careful infection management, and surgical debridement. The long-term safety and reproductive implications of conservative treatment require further investigation.

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