Frontiers in reproductive health最新文献

Introduction: Risky sexual behaviour (RSB) among adolescents in Zimbabwe is a major public health issue, contributing to high rates of HIV, STIs, and unintended pregnancies. Interventions have been ineffective, especially in urban areas like Bulawayo, where "Vuzu parties" worsen the situation. This study aims to assess the prevalence of RSB among high school students in Bulawayo, identify influencing factors, evaluate awareness of sexual health issues, and examine the accessibility and effectiveness of sexual health education from various stakeholders' perspectives.

Methods: The primary study is a school-based, convergent mixed-methods design that includes a quantitative cross-sectional survey and a qualitative key informant study, conducted concurrently. A preliminary systematic review will inform the study's framework and instrument development. The quantitative phase will survey 400 students, selected through stratified random sampling from five schools in Bulawayo, using a self-administered questionnaire. The qualitative phase will consist of in-depth interviews with 10-15 teachers and healthcare workers. Quantitative data will be analysed with descriptive statistics and chi-square tests in SPSS version 28, while qualitative data will undergo thematic analysis. A joint display table will integrate the findings to identify areas of convergence, divergence, and complementarity.

Discussion: The study will provide comprehensive data on the prevalence and drivers of RSB in Bulawayo's adolescents. Findings will inform the development of targeted school-based interventions and policies aimed at reducing RSB and improving sexual health outcomes. The study findings will be reported back to the public and health officials through community meetings and workshops.

Background: Postpartum haemorrhage (PPH) is a preventable yet leading cause of maternal death, demanding urgent attention and action. Every year, tens of thousands of women die from postpartum haemorrhage a tragedy that is both preventable and unacceptable. Each maternal death represents a systemic failure. This umbrella review consolidates global evidence on burden, disparities, and determinants of postpartum haemorrhage (PPH) to inform policymaker's evidence decision making.

Methods: A comprehensive literature search was conducted between July 30 and August 15, 2025, across PubMed, Scopus, Science Direct, Web of Science, Cochrane, and related review databases to identify systematic reviews and meta-analyses on the prevalence, disparities, and determinants of postpartum haemorrhage among women who gave birth. Study quality was assessed using the AMSTAR tool. Heterogeneity was examined with Cochran's Q and I², publication bias via Egger's test and funnel plots, and pooled effect sizes estimated through random-effects meta-analysis using Stata 19. The review protocol was registered in PROSPERO (CRD420251121022).

Result: This umbrella review included 17 systematic reviews with sample size of over 21 million women to estimate the global pooled prevalence of postpartum haemorrhage (PPH) at 9.97% (95% CI: 6.90%-13.04%), with (p < 0.001). Based on studies using objective blood loss measurement (≥500 mL per 100 women giving birth), the prevalence increased to 11.25% (95% CI: 8.78%-13.72%) with p < 0.001.Globally pooled prevalence of severe postpartum haemorrhage is estimated at 4.52% (95% CI: 2.47%-6.57%) with p < 0.001, indicating that nearly 1 in 20 women experience life-threatening bleeding after childbirth.This study identified key risk factors for postpartum haemorrhage, including maternal age, lack of antenatal care, obstetric complications, and rural residence. These determinants highlight the need for targeted prevention strategies to reduce PPH-related morbidity and improve maternal health outcomes.

Conclusion and recommendation: The study underscores postpartum haemorrhage (PPH) as a critical global health issue, with approximately 1 in 10 women experiencing PPH worldwide and 1 in 20 affected by severe PPH, highlighting the urgent need to address persistent disparities. An immediate policy action is essential to guarantee timely, effective care and to uphold maternal health as a fundamental human right. As the global call reminds us: "No woman should die giving life."

Systematic review registration: [https://www.crd.york.ac.uk/PROSPERO/view/CRD420251121022], identifier CRD420251121022.

Background: Although azithromycin has demonstrated potential therapeutic efficacy in the treatment of chronic endometritis (CE), comprehensive studies on the optimal timing of administration are lacking. Our study aims to evaluate the impact of different timing of azithromycin treatment on cure rates and pregnancy outcomes in patients with CE.

Methods: A retrospective cohort study was conducted involving infertile women diagnosed with CE via hysteroscopy during the proliferative phase. Participants with mild CE were assigned to either: immediate treatment (500 mg oral azithromycin daily for 5 days within the same cycle), or delayed treatment (identical treatment dosage and duration in the subsequent cycle). Follow-up endometrial biopsy with CD138 immunohistochemistry was performed during the secretory phase. Cure rates and pregnancy outcomes were compared between the two groups.

Results: No significant differences in cure rates were observed between the Immediate treatment group (88.40%) and the delayed treatment group (93.63%) (P > 0.05). The average time from initial diagnosis to follow-up was significantly shorter in the Immediate treatment group (14.80 ± 3.23 days) compared to the delayed treatment group (44.20 ± 7.00 days) (P < 0.0001). Additionally, there were no significant differences in biochemical pregnancy (80.90% vs. 86.39%), clinical pregnancy (70.91% vs. 76.87%), ongoing pregnancy (88.46% vs. 89.38%), or early miscarriage rates (11.54% vs. 8.85%) between the two groups (P > 0.05). To further elucidate the relationship between treatment timing and pregnancy outcomes, we performed multivariate regression analysis. This analysis demonstrated that the different treatment timings for CE were not identified as independent risk factors for biochemical pregnancy [1.44 (0.77-2.68), P = 0.25], clinical pregnancy [1.35 (0.80-2.28), P = 0.264] and ongoing pregnancy [0.83 (0.36-1.88), P = 0.65].

Conclusions: In patients with CE, same-cycle treatment offers the advantage of a significantly shorter follow-up time, which may be beneficial for patients undergoing assisted reproductive technology (ART) cycles. Our analysis confirmed that same-cycle treatment significantly accelerates the entire ART process. Furthermore, although the effect of azithromycin treatment timing in chronic endometritis patients did not reach statistical significance, the observed positive trends of pregnant outcomes justify further investigation with larger sample sizes to determine its clinical efficacy.

Objective: To evaluate the predictive value of hematologic inflammatory indices derived from complete blood count (CBC) parameters for in vitro fertilization (IVF) outcomes in women with unexplained infertility, and to determine their potential role as biomarkers of subclinical inflammation affecting reproductive success.

Materials and methods: This retrospective cohort study included 430 women with unexplained infertility who underwent IVF/ICSI cycles at Ege University Hospital between January 2020 and January 2025. CBC parameters and derived systemic inflammatory indices-including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV)-were measured on the ovulation trigger day. Patients were divided into pregnant and non-pregnant groups according to clinical pregnancy outcomes. Demographic, hormonal, hematologic, and embryologic variables were compared using appropriate statistical tests, and logistic regression and ROC analyses were performed to identify independent predictors of pregnancy.

Results: None of the CBC-derived inflammatory indices showed significant differences between pregnant and non-pregnant groups (all p > 0.05). ROC analysis revealed poor discriminative ability for predicting pregnancy (AUC values 0.48-0.52). In contrast, embryologic variables-particularly the number of two-pronuclei (2PN) embryos and total embryos-were independent predictors of clinical pregnancy (p < 0.05), while excessive oocyte yield was inversely associated with pregnancy (p = 0.028).

Conclusion: Systemic inflammatory indices derived from CBC parameters, including NLR, PLR, MLR, SII, SIRI, and PIV, do not predict IVF/ICSI outcomes in women with unexplained infertility. Embryologic parameters, especially 2PN and total embryo counts, remain the most reliable predictors of clinical pregnancy.

Background: Menopause is a universal biological event whose experience is shaped by cultural and ethnic factors. The available literature reveals a wide range of perspectives across contexts and population groups, including women from diverse ethnic backgrounds. However, differences persist in how symptoms are conceptualized, expressed, and managed according to sociocultural environments. This scoping review aims to map the existing evidence on menopausal experiences among different ethnic groups and to identify recurring thematic patterns.

Methods: The review followed the Joanna Briggs Institute methodology for scoping reviews and was reported in accordance with PRISMA-ScR guidelines. Articles were retrieved from seven databases-Medline/PubMed, Web of Science, and Scopus-using database-specific search strategies. No language or time restrictions were applied. Studies were analyzed descriptively, and quality appraisal was conducted following the interpretive criteria proposed by Dixon-Woods et al.

Results: Out of 446 initial records, 374 remained eligible for title and abstract screening after duplicate removal; 63 full texts were assessed, and 20 studies met the inclusion criteria. Ethnic differences were observed in both the prevalence and interpretation of symptoms: African American and Hispanic women exhibited a greater emotional and vasomotor symptom burden, whereas Asian and Indigenous women tended to frame the menopausal transition as a natural or developmental process.

Conclusion: This scoping review highlights that menopause is not merely a biological phenomenon but a culturally embedded experience shaped by ethnicity, belief systems, and social position. Substantial ethnic differences exist in the perception, reporting, and meaning attributed to menopausal symptoms.

Objective: To characterize a rare fetal complex chromosomal rearrangement (CCR) derived from a maternal balanced translocation using integrated G-banding and CNV-seq analysis.

Methods: Integrated G-banding and CNV-seq enabled precise karyotypic determination in the fetus, with familial verification confirming its derivation.

Results: Karyotype analysis confirmed that the pregnant woman was a carrier of a balanced translocation, 46,XX,t(10;13)(p15;q22), while her husband had a normal karyotype. Combined G-banding and CNV-seq analyses diagnosed the fetal karyotype as 47,U,t(10;13)(p15;q22)mat,+der(13)t(10;13)dmat, resulting from 3:1 meiotic segregation of the maternal balanced translocation.

Conclusion: This case confirms the pivotal role of integrated G-banding and CNV-seq in diagnosing complex chromosomal rearrangements. For families with a high recurrence risk, PGT is a mandatory intervention to prevent subsequent adverse reproductive outcomes.

Introduction: Due to long-standing systemic xenophobia in the Dominican Republic (DR), women of Haitian descent are underrepresented in national health data. This study examined menstrual hygiene management (MHM) and other reproductive health concerns in a migrant-dense community to inform future health studies and potential interventions.

Methods: An anonymous cross-sectional survey was offered in a low-income community near Santo Domingo over two, one-week periods from October 2023 to April 2024. Eligible participants were at least 14 years old. Reproductive health-related factors were assessed among participants who had menstruated in the last 12 months. Multivariable adjusted modified Poisson regression was used to identify factors associated with sub-optimal MHM, defined by lack of water and/or soap, privacy, or safe menstrual products.

Results: Among 148 participants who menstruated in the past 12 months, over half (53.0%) reported that menstrual materials were unaffordable sometimes (43.5%) or always (9.5%), and more than one-third (38.1%) reported menses interfering with regular duties. Overall, 21.6% had sub-optimal MHM; although 94% of women reported using disposable pads to manage menses, 14.2% were also using cloth (n = 19) or underwear/diapers (n = 2). Other factors contributing to sub-optimal MHM were lack of privacy (4.1%) and lack of soap (8.7%). In analyses adjusted for age, educational attainment, employment status, and menstrual product affordability, Haitian-born women were more likely to have sub-optimal MHM (aPR = 7.25; 95% CI 4.23-12.4). Compared to women with optimal MHM, women with sub-optimal MHM were more likely to report "Poor" general health (46.9% vs. 19.8%, p = 0.004) and menses interfering with regular duties (56.3% vs. 32.8%, p = 0.015), and were less likely to report reliable contraceptive use (43.3% vs. 68.5%, p = 0.011) and prenatal care at last pregnancy (79.3% vs. 95.3%, p = 0.005). Haitian-born women were also more likely to have intersecting sub-optimal MHM and contraceptive gap or lack of prior prenatal care (20.4% vs. 2.2%, p = 0.001).

Conclusions: Sub-optimal MHM and its association with other reproductive health concerns was common in this migrant-dense community, notably appearing more frequently among Haitian-born women. Our preliminary findings suggest opportunities for future research and context-appropriate approaches addressing structural barriers to menstrual and reproductive health-particularly for migrant populations.

Background: Assisted reproductive technology (ART) is widely used, yet potential effects on androgen-sensitive male genital development remain a concern. Anoscrotal distance (ASD), a validated marker of prenatal androgen exposure, may differ in ART-conceived infants. This study compared ASD and urogenital anomalies among male newborns conceived via frozen-thawed embryo transfer (FET) using natural-cycle (tNC) or hormone-replacement therapy (HRT) protocols versus natural conception (NC).

Methods: In this retrospective cohort of 432 singleton male births (156 NC, 132 FET-tNC, 144 FET-HRT) delivered between 2021 and 2023, neonatal outcomes, including ASD, hypospadias, and undescended testes (UDT), were assessed. Group comparisons were performed using standard statistical tests, and exploratory modelling was conducted to identify variables most strongly distinguishing conception groups.

Results: Median ASD was significantly longer in NC infants (26.2 mm) than in FET-tNC (24.9 mm) and FET-HRT (24.6 mm) infants (p < 0.001), with no difference between FET protocols. Hypospadias was less frequent in FET-HRT than FET-tNC infants (p = 0.031), while UDT was more common in NC than FET-tNC infants (p = 0.041). Exploratory modelling identified ASD as the strongest discriminator across conception groups.

Conclusions: Male infants conceived via FET consistently exhibited shorter neonatal ASD than naturally conceived infants, suggesting subtle alterations in androgen-sensitive genital development. These findings underscore the importance of incorporating careful genital assessment and ART-specific counseling into neonatal care.

Objectives: This study aimed to assess the content and reliability of videos discussing the oral contraceptive pill (OCP) on TikTok, the popular social media platform amongst adults aged 18-24, to gauge the dialogue surrounding birth control on TikTok.

Methods: We conducted a quantitative content analysis. The top 100 TikTok videos in English under each of the six hashtags related to OCPs were collected. Video content, engagement metrics (likes, comments, shares), and creator attributes were analyzed by two independent reviewers, with a third to arbitrate discrepancies.

Results: 307 videos were included in the final data set with an average of 134,891 likes, 1,080 comments, and 7,483 shares. Healthcare providers created 27% of videos and 85.5% of these videos were educational. The majority of videos (73%) were created by non-healthcare providers and 54.4% discussed OCPs in a negative tone. Side effects were mentioned in 79% of videos, and 64% of these videos carried a negative tone regarding OCP side effects. Discontinuing OCPs was discussed in 24% of videos, and 83% of these videos carried a negative tone.

Conclusions: The most frequently discussed topic was the side effects of OCPs, with the majority framed negatively. Approximately one quarter of videos addressed discontinuing OCPs, often portraying cessation as beneficial. In the post-Roe v. Wade era, understanding how OCP experiences are portrayed on TikTok highlights the importance of physician-patient collaboration to support informed contraceptive decision-making and move beyond narratives that focus primarily on negative experiences.