Gynecology Obstetrics & Reproductive Medicine

Young Women and Burden of Unsafe Abortion: 2023 Estimates from Two Hospitals in Yaoundé, Cameroon

2026-04-13T14:25:35+03:00

OBJECTIVES: Adolescent girls and young women (AGYW) are particularly vulnerable to unsafe abortion (UA). The study aimed to describe the distribution of women with complications of abortions, determine the frequency of complications and deaths, and estimate measures of disease burden in 2023 at two hospitals.

STUDY DESIGN: The study employed a cross-sectional design, utilizing retrospective hospital record review, and lasted 12 months. We included all recorded cases of abortion complications managed at two referral hospitals of Yaoundé in 2023. Data on all complications of abortion, live births, and maternal deaths were collected and used to make estimates for the incidence of infertility due to UA, based on recognized assumptions in the literature, and to calculate disability adjusted life years (DALYs).

RESULTS: We identified 324 cases of complications of abortion in 2023; 235 were declared spontaneous abortions (SAs) and 89 (27.5%) UAs. Adolescents and young women (AGYW) accounted for 60,7% of UAs. There were 15 deaths (Case-fatality 16,900/100,000) in the UA group and none in the SA. The UA mortality ratio (per 100,000 live births) was 174. The proportion of maternal deaths due to UA was 16.0%. DALYs were 738.16 (Equivalence: 8,567/100,000 livebirths).

CONCLUSION: UAs were very common, especially among AGYW, and associated mortality was high at the study hospitals in 2023. They contributed to a great proportion of maternal mortality, and the associated DALYs for 2023 are substantial. There is a need for a nationwide assessment and to improve access to contraception to reduce unwanted pregnancies, address stigma to favor timely consultation, and improve the quality of management.

APRI, FIB-4, and FIB-5 Scores and Their Association with Late-Onset Preeclampsia

2026-03-31T11:07:44+03:00

OBJECTIVES: Late-onset preeclampsia (LO-PE) is a major cause of maternal–perinatal morbidity. Noninvasive liver fibrosis indices, the AST-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4), and Fibrosis-5 (FIB-5), may capture subclinical hepatic injury in preeclampsia. We assessed the association of these indices with LO-PE and their diagnostic performance.

STUDY DESIGN: In this single-center, retrospective, case-control study, we compared pregnant women with LO-PE (defined as preeclampsia onset at or after 34 weeks of gestation, with no chronic hypertension; n=84) with healthy pregnant controls matched by gestational age (n=84). Demographics, obstetric features, and laboratory parameters (AST, ALT, ALP, platelet count, and albumin) were obtained from medical records. APRI, FIB-4, and FIB-5 indices were calculated using standard formulas. Differences between groups were assessed using statistical tests. For normally distributed data, parametric tests (such as the independent-samples t-test) were used. For nonnormally distributed data, we used nonparametric tests (such as the Mann-Whitney U test). The ability of each index to distinguish between cases and controls was evaluated using ROC curve analysis. ROC analysis plots sensitivity versus 1-specificity to assess diagnostic performance.

RESULTS: ALT, AST, ALP, FIB-4, and APRI levels were significantly higher, whereas FIB-5, platelet, and albumin levels were significantly lower in patients with preeclampsia than in controls (p<0.05). APRI, FIB-4, and FIB-5 values were found to be important parameters affecting disease status (p<0.05). When APRI and FIB-4 values increase by 1 unit, the risk of disease will increase 23.683 and 59.402 times, respectively. In contrast, for each additional unit increase in the FIB-5 score, the risk of disease decreases by 13.3%.

CONCLUSION: APRI and FIB-4 are independent predictors of LO-PE and provide robust discrimination between affected and unaffected patients. While FIB-5 offers limited diagnostic accuracy, APRI and FIB-4, available from routine antenatal labs, can be leveraged for timely risk stratification and early detection of LO-PE. However, prospective validation and clear thresholds are needed to enable effective clinical implementation.

Hemogram-Derived Inflammatory and Oxidative Stress-Related Indices in Second-Trimester Pregnancy Loss

2026-03-04T10:30:12+03:00

OBJECTIVES: To investigate hemogram-derived inflammatory indices in women with spontaneous second-trimester pregnancy loss and to compare these parameters with those of the women who achieved term delivery.

STUDY DESIGN: This retrospective case–control study included women aged 18–35 years. There were two groups: women who experienced spontaneous second-trimester pregnancy loss between 14+0 and 23+6 gestational weeks (Group A), and women who achieved term delivery (≥37 weeks) (Group B). We excluded pregnancies terminated for medical or fetal indications, multiple gestations, chronic systemic or blood (hematological) diseases, active infection, and pregnancy complications. Complete blood count (CBC) parameters, which are laboratory measurements of different types of blood cells—such as white blood cells (WBCs), red blood cells, and platelets—were obtained during the second trimester. We calculated hemogram-derived indices, including the neutrophil-to-lymphocyte ratio (NLR, the ratio of neutrophils to lymphocytes) and the systemic immune-inflammation index (SII, calculated as platelet count multiplied by neutrophil count, then divided by lymphocyte count). Multivariable logistic regression models—statistical analyses that account for several influencing factors at once—were adjusted for maternal age, parity (number of previous pregnancies), previous abortion history, and gestational age at sampling. An additional adjustment for total white blood cell (WBC) count was done in hierarchical analyses. Receiver operating characteristic (ROC) curve analysis, a statistical method to evaluate how well a test distinguishes between groups, was performed to assess discriminative performance.

RESULTS: A total of 439 women were included—218 with spontaneous second-trimester pregnancy loss and 221 with term delivery. Women in the pregnancy loss group were older and more often had a history of previous abortion (p<0.001). White blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) values were significantly higher in the pregnancy loss group (all p<0.001). In a multivariable analysis adjusted for maternal age, parity (number of pregnancies), previous abortion history, and gestational age at sampling, both NLR and SII were significantly associated with second-trimester pregnancy loss. However, after additional adjustment for total WBC, these associations were reduced (attenuated). ROC (receiver operating characteristic) curve analysis, which assesses how well a test differentiates between groups, showed limited discriminative performance with area under the curve (AUC) values ranging from 0.61 to 0.63. SII had the highest AUC.

CONCLUSION: Hemogram-derived inflammatory indices, particularly NLR and SII, are elevated in women with spontaneous second-trimester pregnancy loss. These indices are associated with this outcome after adjustment for key clinical factors. However, their discriminative performance is modest. These parameters are readily available. They should be considered adjunctive markers rather than standalone predictive tools in this clinically heterogeneous setting.

Longitudinal Arterial and Venous Doppler Changes in Late-Onset Fetal Growth Restriction

2026-04-14T10:48:00+03:00

OBJECTIVE: This study aimed to evaluate longitudinal changes in arterial and venous Doppler parameters in late-onset fetal growth restriction and to investigate their association with NICU admission.

STUDY DESIGN: This prospective cohort study included singleton pregnancies diagnosed with LO-FGR at or beyond 32 weeks of gestation and followed at a tertiary perinatology center between August 2025 and February 2026. Serial Doppler assessments included measurements of the umbilical artery (UA), the middle cerebral artery (MCA), and the ductus venosus (DV). DV waveform-derived parameters, including pulsatility index for veins (PIV), preload index (PLI), peak velocity index for veins (PVIV), S/a ratio, and time-averaged maximum velocity (TAmax), were evaluated together with arterial Doppler indices and the cerebroplacental ratio (CPR). Neonatal intensive care unit (NICU) admission was used as the primary outcome.

RESULTS: Fifty-two pregnancies with LO-FGR were included. Longitudinal evaluation showed a significant decrease in MCA PI between the first and second examinations (p=0.026). In contrast, no significant changes were observed in DV Doppler parameters, including DV PIV, PLI, PVIV, S/a ratio, and TAmax. UA Doppler indices and CPR also remained stable over time. NICU admission occurred in 21.2% of neonates. Longitudinal changes in DV PIV and CPR were not significantly associated with NICU admission. In multivariable analysis, weekly change in CPR showed a borderline association with NICU admission (adjusted OR 0.04, 95% CI 0.002–1.08, p=0.056).

CONCLUSION: In LO-FGR, arterial Doppler parameters, particularly MCA PI, may show longitudinal change, whereas venous Doppler parameters remained relatively stable. These findings suggest that fetal adaptation in LO-FGR primarily manifests in the arterial circulation.

Intrahepatic Cholestasis of Pregnancy: A Narrative Review

2026-03-31T21:36:41+03:00

This narrative review synthesizes the current literature on the pathogenesis and management of Intrahepatic Cholestasis of Pregnancy (ICP). ICP is a multifactorial liver disorder characterized by intense pruritus and elevated serum bile acids (SBA) and/or liver enzyme levels, typically emerging in the second or third trimester and resolving postpartum. Its etiology involves a complex interplay of genetic factors, hormonal influences (e.g., elevated estrogen and progesterone levels), and environmental factors, supported by varied global prevalence (9.2–15.6% in South America vs. 0.1–0.5% in Europe) and high recurrence rates (45–90%). Diagnosis requires the exclusion of other hepatobiliary diseases and the presence of pruritus with a random peak SBA concentration ≥10 μmol/L (or ≥19 μmol/L, depending on the specific guideline used).

Ursodeoxycholic acid (UDCA) (10–20 mg/kg/day) is the first-line treatment, reducing maternal symptoms and transaminase levels, though its effect on stillbirth is debated. Vitamin K supplementation is advised for a prolonged prothrombin time. Antenatal surveillance includes monitoring liver function and SBA every 1–2 weeks. Fetal monitoring, while necessary, has limited predictive value for sudden fetal death. The risk of stillbirth correlates strongly with SBA levels (3.44% for ≥100 μmol/L).

Management focuses on risk-stratified delivery timing: ≥100 μmol/L warrants delivery at 35–37 weeks; 40–99 μmol/L suggests 37 weeks; and <40 μmol/L may continue to 39 weeks. Postpartum, SBA, and liver function should be reassessed at 6–8 weeks.

Fumarate Hydratase-Deficient Leiomyomas: A Retrospective Case Series with Clinical and Familial Findings Suggestive of Hereditary Leiomyomatosis and Renal Cell Carcinoma Syndrome

2026-04-01T21:26:58+03:00

OBJECTIVES: Fumarate hydratase (FH)-deficient uterine leiomyomas are a rare variant of smooth muscle tumors that may signal underlying hereditary syndromes like HLRCC, making their recognition crucial for gynecologists and pathologists.

STUDY DESIGN: This retrospective case series included ten patients who underwent surgery for uterine fibroids (benign smooth muscle tumors) between November 2015 and October 2023. Immunohistochemistry (IHC)-a lab technique using antibodies to detect specific proteins in tissue-was performed to confirm fumarate hydratase (FH) deficiency. After confirmation, patients underwent renal ultrasonography (kidney ultrasound) and had available imaging reviewed (CT and MRI, both advanced modalities). Each patient also underwent skin assessment for cutaneous leiomyomas (skin tumors) and received counseling for FH deficiency. Demographic, clinical, surgical, and familial data were collected and analyzed descriptively.

RESULTS: The mean age of patients was 40.2 years (range: 27-52), and the mean BMI was 26.9 ± 3.8 kg/m². Five patients underwent myomectomy, including one laparoscopically. The remaining five had a hysterectomy via Pfannenstiel incision. All diagnoses of FH-deficient leiomyomas were confirmed by immunohistochemistry. Two patients exhibited notable co-pathologies: one with adenomyosis and the other with a low-grade appendiceal mucinous neoplasm (LAMN). Family history findings included one patient with a sibling diagnosed with renal cell carcinoma, one patient with a sibling diagnosed with endometrial cancer, and another patient with first-degree relatives affected by uterine leiomyoma and endometrial intraepithelial neoplasia. Germline FH mutation analysis was not performed for any patient. Fertility-preserving procedures were offered to women of reproductive age, but no pregnancies were recorded during follow-up.

CONCLUSION: FH-deficient leiomyomas (fibroids lacking fumarate hydratase activity) should be considered in patients with large, multiple, or early-onset fibroids. Histopathology (examination of tissue under a microscope) and IHC (immunohistochemistry, a specialized lab technique for identifying proteins in tissue) are essential for diagnosis. Germline FH testing (testing for inherited mutations in the FH gene) was not systematically performed in our cohort. However, genetic referral (to a genetics specialist) was offered to 5 patients in the most recent year. This reflects a shift toward integrating molecular assessment into clinical practice. Our experience highlights the need to incorporate genetic counseling, routine renal imaging (regular kidney scans), and dermatologic evaluation (skin checks) into follow-up, especially for patients with features suggestive of a syndromic condition (that is, symptoms that could indicate a genetic syndrome).

Utilizing the Prognostic Nutritional Index to Predict Chemotherapy Toxicities in Ovarian Cancer Patients: Long-Term Tertiary Center Experiences

2025-12-15T11:06:02+03:00

OBJECTIVE: Our aim was to clearly evaluate the Prognostic Nutritional Index's ability to predict chemotherapy-induced toxicity in ovarian cancer patients undergoing platinum-based chemotherapy.
STUDY DESIGN: This retrospective cohort study of 158 patients with epithelial ovarian cancer treated with carboplatin-paclitaxel after surgery at a university hospital from 2010 to 2020 decisively investigates the Prognostic Nutritional Index (PNI) as a predictor of chemotherapy-related toxicities. PNI was calculated using pre-treatment serum albumin levels and lymphocyte counts.
RESULTS: The findings clearly demonstrate that patients with a PNI ≤34.10 experienced higher overall and severe hematologic toxicities compared to those with a higher PNI. Dose reductions and treatment delays were markedly more frequent in the low PNI group.
CONCLUSION: This study establishes that PNI is a valuable tool for assessing patient risk, though further validation will enhance its clinical utility.

A Dual Diagnosis in the Puerperium: Severe Endometritis Complicated by Leptospirosis-Induced Weil's Syndrome

2025-11-12T19:36:38+03:00

Endometritis is defined as the inflammation of the endometrium and myometrium. Social factors can predispose to concomitant tropical infections, and diseases such as leptospirosis can have overlapping symptoms. We present the case of a 19-year-old female who had an urgent cesarean section, had a poor clinical course with jaundice, acute kidney injury, and coagulopathy requiring a second surgical time, and underwent an urgent hysterectomy for severe and irreversible endometritis. Additionally, leptospirosis-induced Weil’s syndrome was confirmed by serology (positive IgM) due to the presence of systemic alterations that could not be explained by a gynecologic condition alone. Endometritis has identifiable risk factors, and a typical antibiotic regimen is usually sufficient to prevent complications. However, severe cases can still occur despite treatment. This case highlights the diagnostic challenge of differentiating severe sepsis due to obstetric syndromes and zoonotic diseases such as leptospirosis, which can mimic gynecologic diseases and delay diagnosis and treatment. Analyzing each case is crucial to identifying unusual pathologies in pregnant patients and preventing adverse outcomes.

Urethral Resection and Neo-Urethra in Invasive Vulvar Cancer

2025-12-15T11:37:48+03:00

Vulvar cancer is a significant gynecological malignancy. It often invades surrounding organs at the time of diagnosis. In cases of urethral invasion, lack of effective reconstruction may result in serious micturition disorders. We performed a urethral resection (surgical removal of part of the urethra) on a patient undergoing vulvar cancer surgery. Urethral invasion was detected during resection. We then created a distal neo-urethra (reconstructed lower urethra) using a vaginal flap (section of vaginal tissue reconstructed as the urethra). During the 1-year follow-up, we observed no complications. These included no urethral stenosis (narrowing), fistula formation (abnormal connection), atrophy (tissue wasting), dysuria (painful urination), or urinary disorders. When urethral invasion is found in vulvar cancer, a multidisciplinary approach is needed. Distal urethral resection and neo-urethral reconstruction are linked to good recovery and few complications.