Almost 10% of all pregnant women are diagnosed with placental location abnormalities (PLA), including placenta previa and low-lying placenta; however, most of PLA resolve as pregnancy process. Despite of placental migration, postpartum hemorrhage (PPH) is often experienced in those cases. The association between the timing of placental migration and the risk of PPH has remained unclear. The aim of this study is to investigate the relationship between the timing of placental migration and the PPH, and to establish a cutoff value to accurately predict the risk of PPH in cases who underwent the placental migration during course of pregnancy. This was a retrospective cohort study using electronic medical records in Osaka University Hospital (Japan). Patients diagnosed with PLA after 22 gestational weeks using transvaginal ultrasonography were eligible for inclusion. All patients delivered at our hospital between 2009 and 2022. Focusing on the cases in which placental migration (more than 2 cm away from the internal cervical os) were observed, the association between the timing of placental migration and the PPH was investigated only in vaginal delivery using the multivariate analyses with collecting covariates that could affect the PPH. Based on the results, receiver operating characteristic curves were generated to determine the optimal cutoff for the number of weeks of placental migration to predict PPH. One hundred and forty-five patients were diagnosed with PLA after 22 gestational weeks and delivered at our hospital between 2009 and 2022. Seventy-six after-placental migration cases with successful vaginal delivery were analyzed. The median gestational age of placental migration was 32 weeks, and the median amount of hemorrhage during delivery was 777 mL. PPH (500-1000 mL) occurred in 34 cases (44.7%), >1000 mL in 26 (34.2%). In the univariate analysis, a positive correlation was observed between the timing of placental migration and the amount of hemorrhage (r=0.365, P<.01). Furthermore, multivariate analysis showed that the timing of placental migration is the most strongly influential covariate (standardized partial regression coefficient: 0.31, P=.0036) for predicting the amount of hemorrhage. In addition, the timing of placental migration was a significant risk for PPH (more than 500 mL) (adjusted unit OR 1.26 [95% CI: 1.07-1.49]). The receiver operating characteristic curve indicated that the moderate cutoff of the timing of placental migration to predict the risk of PPH (more than 500 mL) was 29 gestational weeks. In comparison between the groups in which placental migration was confirmed before 29 gestational weeks (n=19) and after 30 gestational weeks (n=57), the incidences of PPH (more than 500 mL) were significantly higher in the group in which placental migration was confirmed after 30 gestational weeks (52.6% vs 87.7%, P=.0012). The timing of placental migration is positively correlated with the occurrence of PPH. In particular, cases in which placental migration is confirmed after 30 gestational weeks should be monitored carefully as high risk for PPH, as the risk of PPH is not eliminated.

ObjectiveTo describe fertility-sparing management of atypical polypoid adenomyoma (APA) in two premenopausal women and to review the relevant literature on treatment strategies aimed at preserving fertility.Case ReportA 39-year-old nulliparous woman presented with heavy menstrual bleeding and was diagnosed with APA via hysteroscopy and histopathology. Rapid recurrence prompted a second-look hysteroscopy and complete lesion resection. The second case involved a 30-year-old nulliparous woman with prolonged bleeding and a suspected submucosal fibroid; hysteroscopic resection confirmed APA. She received a levonorgestrel-releasing intrauterine device and regular follow-up. Both cases highlight diagnostic and therapeutic challenges in managing APA while preserving fertility.ConclusionThese cases illustrate the diagnostic and therapeutic challenges of APA while preserving fertility. Based on our cases and a review of the literature, complete hysteroscopic resection, combined with hormonal therapy when appropriate, may be effective. Close follow-up is essential due to the risk of recurrence and potential malignant transformation, and individualized management is recommended to optimize fertility outcomes.

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) combines vaginal surgery with single-port laparoscopy, providing a minimally invasive technique designed to overcome the challenges in traditional vaginal surgery. Several authors have now described techniques for performing these procedures with robotic assistance (R-vNOTES). We aim to evaluate the surgical outcomes and the safety of R-vNOTES hysterectomy in patients with benign diseases. We searched six major databases from their inception through October 2024 for studies analyzing the surgical outcomes of hysterectomy by R-vNOTES in cases with benign gynecologic diseases. We included all primary research studies that included at least one of our selected outcomes and did not include surgeries for malignant conditions. Study quality was appraised using the National Heart, Lung, and Blood Institute quality assessment tools. Data synthesis was accomplished using OpenMetaAnalyst and RevMan software. Mean difference and 95% confidence intervals were used for continuous outcomes following inverse variance analyses. Dichotomous outcomes were analyzed using an odds ratio and 95% confidence intervals. Ultimately 10 eligible studies were included in our synthesis, including two studies that compared the R-vNOTES technique to robot-assisted laparoscopic hysterectomy (RALH) performed for the same indications. Our overall pooled analysis demonstrated that the operation time of R-vNOTES was 142 minutes, with an estimated blood loss of 67 mL. The overall length of hospital stay among the included studies was 2.04 days. We found an approximate decrease of 1.4 grams of hemoglobin after surgery. The incidence of conversion was 1.3%, and the complication rate was 13.3%. We found, R-vNOTES was to have a shorter operative time (P<.001) and lower blood loss than RALH (P=.002), with no significant differences seen between the cohorts in total hospital stay (P=.29) or complication rates (P=.98). Initial data shows that R-vNOTES seems to be a feasible minimally invasive technique with comparable outcomes and a favorable safety profile. Compared to RALH, R-vNOTES was associated with a shorter operation time and less blood loss.

BackgroundThe evidence of husband’s involvement in maternal antenatal care (ANC) is scant and inconsistence across each study. Therefore this systematic review and meta-analysis will be to examine (1) the characteristics of published studies on husband involvement in maternal ANC; (2) estimate the nationwide magnitude of husband involvement in maternal ANC;(3) show the significant association between husband involvement in maternal ANC and reported associated factors in published articles.MethodThis systematic review and meta-analysis will be conducted by publishing and unpublishing articles, which will be searched online through Google Scholar, PubMed, Cochrane Library, EMBASE, HINARI, and Africa Journals. The Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) guideline will be used to review articles. Repeated articles will be removed by EndNote version X7.1. The data will be extracted by using the 2014 Joanna Briggs Institute Reviewers’ Manual data extraction. Critical appraisal of the studies will be done by the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) for cross-sectional studies tool. Begg-Mazumdar rank correlation tests and Egger’s regression tests will be used to check the presence of publication bias. The presence of heterogeneity will be assessed by Cochran’s Q statistics.DiscussionThis systematic review and meta-analysis will be the only study that investigates the magnitude and associated factors of husband’s involvement in maternal ANC. Through gathering information, the possible outcome will be to investigate and show those interested to utilize it.