This narrative review focuses on the disproportionate impact of climate change on women’s health and outlines practical strategies and interventions that healthcare professionals (HCPs) and healthcare workers (HCWs) can implement to improve health literacy, inform women, and integrate climate-health awareness into care. Through these actions, HCPs and HCWs can support and empower women in managing climate-related health risks and reducing health inequities.

Bilateral ovarian torsion is an exceptionally rare condition, especially in postmenopausal women, and presents a diagnostic challenge due to its nonspecific clinical features. Prompt diagnosis and surgical intervention are crucial to prevent ischemic complications. Here, we present the case of a 52-year-old postmenopausal woman who presented with acute abdominal pain and was found intraoperatively to have bilateral ovarian torsion due to the presence of large cysts in both ovaries. Emergency laparotomy was performed, revealing ischemic, necrotic ovaries, necessitating bilateral salpingo-oophorectomy. This case highlights the importance of considering ovarian torsion in the differential diagnosis of acute abdomen in postmenopausal women, especially in those with adnexal cysts, and underscores the role of early surgical intervention.

Tubo-ovarian abscess (TOA) is a serious complication of pelvic inflammatory disease, characterized by purulent collections in the fallopian tubes and/or ovaries. It primarily affects women of reproductive age and can lead to infertility, ectopic pregnancy, or chronic pelvic pain if not promptly managed. Although broad-spectrum antibiotics are the first-line therapy, many cases require surgical or radiologic intervention. We report three women aged 32–48 years with TOA, each presenting with distinct clinical features. All initially received intravenous antibiotics, but surgical management was necessary in all cases: laparoscopic drainage in one patient, laparoscopic drainage with ureteric stenting in a second, and salpingo-oophorectomy followed by image-guided drainage in the third. Microbiological analysis identified Escherichia coli in the first case and Streptococcus constellatus in the third. The second patient developed severe complications, including iliopsoas myositis and ureteric obstruction. These cases highlight the variable presentation of TOA and the potential for complications despite antibiotic therapy alone. Early recognition, multidisciplinary collaboration, and timely escalation to surgical or radiologic intervention are critical to optimize patient outcomes.

Background:

Congenital uterine anomalies (CUA) are often diagnosed during infertility evaluation and may be associated with infertility and obstetric complications, although their impact remains controversial.

Objective:

To describe the prevalence of CUA and evaluate reproductive and obstetric outcomes in a population of infertile women with these anomalies.

Method:

We conducted a retrospective cohort study between January 2014 and December 2023, including patients with CUA (n=50) and a control group (n=40) who underwent assisted reproductive technology (ART). Baseline characteristics, reproductive outcomes, and obstetric complications were recorded and compared.

Results:

The prevalence of CUA was 1.6%. No significant differences were observed between groups in the number of oocytes, mature oocytes, fertilization rates, embryo development, or pregnancy and live birth rates. In the first IVF-ET cycle, pregnancy (28.5% vs. 14.3%, p=0.102) and live birth (25.7% vs. 9.5%, p=0.081) rates were similar between women with CUA and those with a normal uterus. Likewise, cumulative pregnancy (42% vs. 35%, p=0.552) and live birth (36% vs. 22.5%, p=0.247) rates did not differ. Obstetric outcomes, including first-trimester miscarriage, preterm delivery, fetal growth restriction, low birth weight, and cesarean delivery, were also comparable. Descriptive analysis by CUA subclass showed the lowest pregnancy rate in women with hemi-uterus (25%). Live birth rates were higher after septoplasty in women with complete septate uterus, but not in those with partial septate uterus.

Conclusion:

Pregnancy and live birth rates after ART were not significantly different between women with CUA and those with a normal uterus.

Objective:

Assess the effect of estetrol/drospirenone 15 mg/3 mg (E4/DRSP) on menstrual symptoms and health-related quality of life (HRQoL) in adolescents aged 12–17 years.

Methods:

This was a phase 3, open-label, six-cycle trial. We measured menstrual symptoms using the Menstrual Distress Questionnaire–Short Form (MDQ), focusing on bothersome symptom domains. We assessed HRQoL with KIDSCREEN-27. Participants completed both instruments at baseline, Cycles 1, 3, and 6. We compared Cycle 6 outcomes versus baseline using the Wilcoxon signed-rank test.

Results:

Eighty-nine adolescents completed treatment; 51 completed both MDQ and KIDSCREEN-27. E4/DRSP reduced MDQ t-scores for menstrual Pain and Negative Affect, and premenstrual and menstrual Water Retention (p<0.05). Impaired Concentration did not change. Overall, shift analysis revealed that most adolescents improved to milder categories, often to no symptoms, with minimal worsening. Largest shifts occurred for menstrual cramps, backache, general aches and pains, painful or tender breasts, mood swings, crying, tension, and feeling sad or blue. Baseline KIDSCREEN-27 t-scores indicated reduced HRQoL in Physical Well-being, Psychological Well-being, Social Support & Peers, and School Environment compared to European norms, while Autonomy & Parent Relations was within the normal range. Following treatment, all domains improved, with significant gains in Physical Well-being and Autonomy & Parent Relations (p<0.05). By Cycle 6, all domains initially below the normative range had reached the normative range.

Conclusions:

E4/DRSP reduced menstrual symptom burden and improved health-related quality of life in adolescents. Its native estrogen and progesterone-like progestin profile may support acceptability and adherence in this population.

Background and Purpose:

Management of minor vaginal bleeding due to placenta previa remains largely supportive, as targeted pharmacological options are limited. This study evaluated the efficacy of intravenous tranexamic acid (TXA) in reducing recurrent vaginal bleeding and improving perinatal outcomes.

Methods:

In this multicenter, randomized, double-blind clinical trial conducted from December 2022 to December 2023, 149 women with placenta previa and minor recurrent painless vaginal bleeding were recruited from four maternity teaching hospitals in Iraq and one in Egypt. A total of 149 women were randomized and 146 participants were included in the final analysis. Participants were randomly assigned (1:1) to receive either intravenous TXA or Dextrose 5% in water (placebo). Outcomes included cessation of bleeding after recurrent interventions, gestational age at delivery, and perinatal outcomes.

Results:

TXA was associated with a higher rate of vaginal hemostasis after recurrent intravenous administration compared with placebo (91.8% vs. 53.4%, p<0.001). The TXA group also showed higher rates of live birth with normal Apgar scores (91.8% vs. 42.5%) and normal birth weight (89.0% vs. 49.3%) (p<0.001 for both). Improved hemostasis was accompanied by more favorable gestational outcomes, with higher rates of term delivery (24.7% vs. 2.7%) and lower rates of total preterm delivery (75.3% vs. 97.2%) in the TXA group (p<0.001). Factors significantly associated with hemostasis included TXA use (OR=5.2; 95% CI=1.7–15.5), BMI <25 kg/m² (OR=6.3), and late preterm (OR=20.6) or term delivery (OR=4.5) compared with very preterm delivery.

Conclusions:

In women with placenta previa and minor vaginal bleeding, TXA was associated with higher rates of vaginal hemostasis, longer gestation, and improved neonatal outcomes. Larger studies are needed to confirm these findings and inform clinical practice.

Parkinsonism is rare in individuals younger than 40, making its coexistence with pregnancy exceptionally uncommon and clinically challenging. This case report describes the management of a 33-year-old woman with autosomal recessive Parkinson’s disease (two PARK2 gene mutations) who conceived through in vitro fertilization (IVF) due to unexplained subfertility. Her partner tested negative for the mutation. She continued levodopa throughout pregnancy and required a carefully coordinated multidisciplinary approach. She developed pregnancy-induced hypertension, which was controlled with beta-blockers. Her Parkinson’s symptoms worsened toward the end of pregnancy, requiring increased levodopa doses. Due to subfertility, impaired coordination, and mental health concerns, an elective Caesarean section was performed at 38 weeks under spinal anesthesia, resulting in the birth of a healthy baby. She received strong support from neurology, occupational therapy, and physiotherapy teams during pregnancy and the postnatal period. Although postnatal depression had been anticipated, bonding with the baby was good. This case underscores the importance of multidisciplinary, individualized care to achieve favorable maternal and fetal outcomes.

Conjoined twins are a rare complication of monozygotic pregnancies resulting from incomplete separation of the embryonic disc after day 13. Early antenatal detection is essential for appropriate prenatal management and timely obstetric intervention. This case report describes the early detection of a conjoined twin pregnancy during a dating ultrasound. It presents the clinical findings and documented images of a rare presentation, particularly given the very early gestational age at diagnosis. The patient presented for a first dating ultrasound in her first pregnancy. The examination revealed an enlarged fetus with multiple anomalies highly suggestive of conjoined twinning. Once the diagnosis was established, a detailed discussion regarding the pregnancy prognosis was held with the couple. They subsequently opted for medical termination of the pregnancy. Anatomopathological examination confirmed the diagnosis of conjoined cephalopagus twins. Karyotypic analysis revealed no chromosomal abnormalities. The application of a rigorous and systematic diagnostic approach, combined with careful attention to detail, enabled the early detection of this sporadic condition. Early diagnosis allows for timely clinical management and may reduce the risk of both obstetric and psychological complications.

Background:

Female sexual interest and arousal disorder (FSIAD) is the most prevalent sexual dysfunction in postmenopausal women.

Objective:

To systematically review and summarize the existing evidence on the efficacy and safety of testosterone, mainly in transdermal formulations, for the treatment of FSIAD in postmenopausal women.

Method:

A systematic review was conducted, including randomized controlled trials, systematic reviews, and meta-analyses. The eligibility of 105 articles was assessed, and 13 were ultimately included in the synthesis following the PRISMA procedure.

Results:

Compared with placebo, testosterone was associated with significant improvements in the frequency of satisfactory sexual activity, orgasm, sexual desire, and personal distress related to low desire. Most adverse events were mild and well tolerated. No data indicated severe short-term adverse effects, although long-term safety data remain limited.

Conclusion:

The short-term efficacy in improving sexual function and safety of testosterone (especially transdermal) in naturally or surgically menopausal women with FSIAD, either with or without estrogen +/- progestogen hormone therapy, has been demonstrated in this systematic review. Testosterone use was associated with an increase in androgenic adverse effects such as acne or hair growth, but was not associated with any serious adverse effects.

Background:

First-hand accounts of female ejaculation frequency are scarce in the medical literature. This study presents self-reported experiences from a segment of well-educated, sexually active women in their 20s.

Objective:

To determine how often young, sexually active adult women experience some form of fluid release before, during, or immediately after orgasm, and to explore their practical and emotional reactions.

Method:

Fifty-three female medical students at the University of Oslo, aged 19–29 years, were interviewed by a fellow female student. Forty-four reported heterosexual orientation, while the remaining described themselves as “bisexual,” “open,” or “pansexual”; none reported “lesbian” or “queer” identity. Individual interviews were conducted at the university, without recording, and with minimal intervention from the interviewer. All participants reported sexual experience through self-stimulation and with male partners; fifteen also had experience with female partners. The number of previous sexual partners ranged from one to 60, with a median of nine.

Results:

Fifty-two participants had experienced orgasm through self-stimulation, of whom four had never experienced orgasm with a partner. Twenty-six reported some form of fluid release before, during, or immediately after orgasm, with ten describing it as a visible squirt from the genital area. The likelihood of ejaculation during orgasm depended on the duration of sexual stimulation. Unlike orgasm itself, ejaculation provided little additional pleasure.

Conclusion:

Female ejaculation is common among young, sexually active adult women.

Clinical Decision Support Systems (CDSS) have shown considerable potential in reducing medical errors, yet a persistent gap remains between their technical capabilities and their real-world impact on diagnostic and management errors in the high-stakes environment of Obstetrics. This paper addresses a critical question in the current state of the art: why has the promise of error reduction through CDSS not been fully realized? We argue that the primary obstacles are no longer technical but arise from a complex interplay of human and organizational factors. While sophisticated algorithms for pre-eclampsia prediction and fetal monitoring are increasingly robust, their effectiveness is often undermined by pervasive issues such as alert fatigue, poor workflow integration, automation bias, and lack of trust in the system. This review synthesizes current literature to provide a comprehensive analysis of these non-technical barriers. We then propose a human-centered design and governance framework, arguing that to transition CDSS from a technically sound tool to a reliable, error-eliminating partner in Obstetrics, the focus must shift from algorithm development to a deep understanding of the socio-technical context in which these systems are deployed.