Uterine niches (isthmoceles) are myometrial defects commonly occurring after caesarean sections and may lead to abnormal uterine bleeding, pelvic pain and impaired fertility. Robotic-assisted surgical approaches have emerged as a minimally invasive option for their management, yet data on their efficacy remain limited. To evaluate the efficacy of robotic-assisted laparoscopic repair of uterine niches in improving clinical symptoms and fertility outcomes. A retrospective observational study conducted at a tertiary university hospital. All patients who underwent robotic-assisted laparoscopic repair of uterine niches between 2013 and 2023 were included. Preoperative assessments included transvaginal ultrasound and hysterosalpingo-ultrasonography to evaluate residual myometrial thickness (RMT) and niche morphology. The surgical procedure entailed isthmocele resection followed by double-layer myometrial suturing using the Da Vinci Robotic System®. Pre- and postoperative RMT measurements were compared to assess myometrial restoration. Symptom resolution and postoperative fertility outcomes were also evaluated. Fifty-one patients underwent robotic-assisted laparoscopic repair during the study period. The mean RMT significantly increased from 1.75 ± 1.4 mm preoperatively to 4.9 ± 3.4 mm postoperatively (p < 0.001). While niche diameter reduction was not statistically significant, the healing ratio demonstrated a significant improvement (p < 0.001). Among symptomatic patients with postoperative symptom assessment (n = 28), 20 (71.4%) reported complete or partial symptom resolution. Among patients desiring conception postoperatively (n = 36), 26 conceived; among pregnancies, 17/26 (65.4%) resulted in live birth, 1/26 (3.8%) was ongoing at last follow-up and 3/26 (11.5%) had an unknown outcome. Robotic-assisted laparoscopic repair was associated with improvement in symptoms related to uterine niches. The technique significantly improves myometrial thickness and supports favourable reproductive outcomes. Further prospective studies are warranted to establish standardised treatment guidelines and assess long-term efficacy. Not applicable.

Companionship-based care is essential for enhancing maternal and neonatal health services. Despite its importance, studies have shown inconsistent findings regarding the utilization of companionship during childbirth in developing countries, including Ethiopia. To evaluate the pooled utilization of companionship and identify the factors influencing this practice among women giving birth. A systematic review and meta-analysis. We conducted our review by searching common databases, including PubMed, Scopus, Wiley Online Library, ScienceDirect, and Epistemonikos, between February 1, 2025, and April 1, 2025. In addition, Google Scholar and unpublished theses from Ethiopian university research repositories were included. Data extraction was performed using an Excel data extraction form and subsequently imported into STATA version 11 for analysis. We employed forest plots, Cochran's Q tests, subgroup analyses, sensitivity analyses, and meta-regression models to assess the heterogeneity among the included studies. Publication bias was evaluated through funnel plots and Egger's regression tests. A random-effects model was used to estimate the pooled utilization of companionship. From the 13 studies analyzed, which included a total of 8100 participants, we found that the utilization of companionship during childbirth was 28.86% (95% CI: 22.23, 35.48). Factors associated with higher utilization included the following: higher education level (prevalence and odds ratio (POR): 2.87, 95% CI: 1.81, 4.57), being primiparous (POR: 2.21, 95% CI: 1.82, 2.67), expressing a desire for companionship during delivery (POR: 2.77, 95% CI: 1.79, 4.28), having a history of obstetric complications (POR: 2.77, 95% CI: 1.79, 4.28), access to comfortable healthcare facilities (POR: 2.66, 95% CI: 1.97, 3.59), and possessing good knowledge about companionship care (POR: 2.35, 95% CI: 1.25, 4.41). The utilization of companionship during childbirth in Ethiopia remains low. The factors influencing this practice include higher education levels, being primiparous, the desire for a delivery companion, experiences of complications during pregnancy and labor, access to adequate healthcare facilities, and awareness of the benefits of having a birth companion. To improve this situation, healthcare management teams and providers should prioritize educating expectant mothers about the advantages of companionship during antenatal care. PROSPERO registration: CRD420251020204.

Levonorgestrel-releasing intrauterine systems (LNG-IUS) are considered off-label and investigational in the United States for treating non-atypical endometrial hyperplasia (NAEH), atypical endometrial hyperplasia (AEH), and early-stage endometrial cancer (EC), though evidence suggests potential benefit. To summarize the available evidence regarding the use of LNG-IUS, with or without other therapies, for the treatment of NAEH, AEH, and early-stage (FIGO I/IA) EC. Systematic literature review and meta-analyses. MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews (CDSR) were searched from database inception through May 2022. Data from studies reporting complete outcome definitions and study populations that were aligned with the 2014 World Health Organization (WHO) endometrial hyperplasia classification criteria or were defined as FIGO grade 1 stage I/IA EC were extracted and assessed in random-effects meta-analyses. A risk of bias assessment was completed using recommended study-design-specific tools. 1085 unique records were reviewed; 80 publications were included, with data from 30 assessed in meta-analyses: NAEH, n = 14; AEH, n = 21; EC, n = 5. Complete response (CR) rates at 12 months were high: 86.3% (95% confidence interval (CI): 78.50%-91.55%; n = 342) of patients with NAEH, 83.9% (95% CI: 71.95%-91.34%; n = 196) of patients with AEH, and 51.1% (95% CI: 16.30%-84.90%; n = 20) of patients with EC. LNG-IUS was associated with significantly greater odds of CR at 12 months compared to oral progestins in NAEH and AEH populations, with odds ratios ranging from 2.16 (95% CI: 1.38-3.36) to 4.56 (95% CI: 2.57-8.09). No comparative data were available for EC. Safety information was consistent with that of approved LNG-IUS indications. Risk of bias varied across study designs. The findings suggest that NAEH, AEH, and early-stage (FIGO I/IA) EC can be effectively treated with LNG-IUS, with the evidence being strongest for NAEH and weakest for EC. Greater availability of LNG-IUS treatment could provide meaningful benefit to these patients. Not applicable.

Background:Understanding women’s intention to shift from short-acting methods to long-acting reversible contraceptive methods (LARCMs) in diverse settings, including socioeconomic, behavioural and multicultural contexts, is crucial for improving contraceptive utilization. While short-acting methods are widely used, shifting to LARCMs remains a challenge in resource-limited settings like Ethiopia. Previous studies in Ethiopia either lack theoretical framework or focus on intention spanning a year with theoretical incoherence.Objective:Guided by the theory of planned behaviour, this study aims to assess the intention to shift from short- to long-acting methods in 6 months and identify associated factors among women attending public health facilities in Hossana Town, Central Ethiopia.Design:A facility-based cross-sectional study was conducted in public health facilities of Hossana town, Central Ethiopia Region.Methods:The 336 reproductive-age women who were using short-acting contraceptive methods were included. The data were collected through face-to-face interviews using a pre-tested structured questionnaire. A generalized linear model (GLM) with a Gamma distribution and log link function was applied to model the positively skewed intention scores. Adjusted exponentiated beta coefficients (Exp(β)) and their corresponding 95% confidence intervals were used to quantify associations and declared statistically significant at p-value < 0.05.Results:The proportion of women who intended to shift from short-acting contraceptives to LARCMs was only 42.3%. In the multivariable GLM, primary education (Exp(β) = 1.10; 95% CI: 1.033–1.170), secondary education (Exp(β) = 1.15; 95% CI: 1.078–1.227), and tertiary education (Exp(β) = 1.19; 95% CI: 1.061–1.329) were significantly associated to shift from short- to LARCMs. Additionally, attitude (Exp(β) = 1.011; 95% CI: 1.007–1.015), subjective norm (Exp(β) = 1.007; 95% CI: 1.001–1.013), and perceived behavioural control (Exp(β) = 1.012; 95% CI: 1.004–1.020) were also positively and significantly associated with the intention to shift.Conclusion:These findings suggest that enhancing educational access, improving service delivery through informed decision-making support, addressing social influences and strengthening psychosocial factors such as attitude and self-confidence could improve the intention for uptake of long-acting contraceptive methods.

Background: Preterm premature rupture of membranes (PPROM) is a significant risk factor for perinatal morbidity and mortality. It is the main cause of preterm birth and affects approximately 10% of all pregnancies. The occurrence of PPROM has recently increased significantly. However, there is limited data on the determinants of PROM in the study area. Objective: To assess the determinants of PPROM, among pregnant women admitted to maternity wards of public hospitals in the Sidama Region. Design: An institution-based, unmatched case–control study Methods: The study was conducted in public hospitals in the Sidama Region from March 1st to May 15th, 2023. The consecutive cases were recruited until the required sample size was reached, and controls were randomly selected. Face-to-face interviews were used to collect data from 69 cases and 207 controls. Binary logistic regression analysis was used to identify determinants of PPROM. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported to show the strength of the association. The significance of the association was declared at a p value &lt;0.05. The goodness-of-fit model was checked by the Hosmer–Lemeshow test. Results: A total of 69 cases and 207 controls were included in the study. Pregnancy-induced hypertension (AOR: 2.65; 95% CI: 1.12–6.27), a history of abortion (AOR: 3.1; 95% CI: 1.41–7.08), a history of abortion (AOR: 3.78; 95% CI: 1.75–8.15), a history of cesarean section (AOR: 2.57, 95% CI: 1.10–5.99), a mid-upper arm circumference &lt;23 cm (AOR: 2.1; 95% CI: 1.02–4.54), a history of urinary tract infection (AOR: 2.42; 95% CI: 1.10–5.32), and a hemoglobin level &lt;11 mg/dl (AOR: 2.68; 95% CI: 1.15–6.23) were determinants of PPROM. Conclusion: Past obstetric history, nutritional status, and risks in the index pregnancy have an association with PPROM. Therefore, strategies to reduce the occurrence of PPROM should target women in rural areas and emphasize the early identification and treatment of urinary tract infections, anemia, and pregnancy-induced hypertension.

Background:Adverse birth outcomes associated with grand multiparity are more ambiguous than those linked to multiparity. The primary literature on this issue reveals inconsistent findings across various studies. A paucity of data is evident in systematic reviews and meta-analyses that assess adverse birth outcomes specifically for African grand multiparas.Objectives:To address the pooled adverse birth outcomes and their associated factors among African grand multiparas.Design:Systematic review and meta-analysis.Data sources and methods:Studies were systematically searched from April 20, 2024, to June 15, 2024, using Scopus, Web of Science, PubMed, Science Direct, African Journal Online, and the Wiley Online Library. The Joanna Briggs Institute tool was used for a quality assessment of each primary study. Data were extracted using Excel and analyzed with Stata 11 software. A random-effects model was employed to calculate the pooled estimates. The paper employs appropriate statistical techniques to assess publication bias and heterogeneity, such as the symmetry of the funnel plot, Egger’s test, and Cochran’s Q test. The study addresses a critical public health issue in Africa, contributing valuable data that could inform policy and healthcare practices aimed at reducing adverse birth outcomes among grand multiparas. A subgroup analysis was performed based on the publication years.Results:The pooled prevalence of adverse birth outcomes among African grand multiparas was 24.97%; 95% CI: 19.97–31.99. Pregnancy-related complications (AOR: 3.17; 95% CI: 2.35–4.28), a history of home births (AOR: 3.30; 95% CI: 1.70–6.40), and rural residence (AOR: 4.12; 95% CI: 3.12–5.44) were significantly associated with adverse birth outcomes among African grand multiparas.Conclusion:Overall, the pooled prevalence of adverse birth outcomes among grand multiparas was comparably high. Variables such as rural residence, previous pregnancy-related complications, and a history of home births were significantly associated with adverse birth outcomes. Strengthening institutional births, providing high-quality prenatal care, and early pregnancy follow-ups are recommended to reduce adverse birth outcomes in grand multiparous women. In addition, improving the availability of comprehensive contraceptive options for rural-residing African grand multiparous women is essential.PROSPERO registration:CRD42024569768.

In 2020 in sub-Saharan Africa, 25% of new human immunodeficiency virus (HIV) infections occurred among young women (15-24 years). In Uganda, the HIV prevalence is three times higher among young women at 2.9% compared to 0.8% among their male counterparts. HIV status disclosure is a gateway to preventive services. We set out to estimate the prevalence of HIV status disclosure to current male partners, and the predictors among the adolescent girls and young women living with HIV (AGYWLHIV) in a semi-rural northern Uganda. In a cross-sectional study design, a consecutive sample of the AGYWLHIV was recruited from six antiretroviral therapy clinics between November 2022 and April 2023. Participants were administered an interviewer-guided questionnaire. They were asked whether they have ever disclosed their HIV status to their current male partners. They were also asked about their socio-demographics, sexual and reproductive health profiles, knowledge and perceptions of dual protection, and safer conception methods for AGYWLHIV. Percentages to estimate prevalence, Chi-square tests to assess associations, simple and multivariate modified Poisson regression to identify predictors at p < 0.05 and 95% confidence intervals (CI) were considered. Overall, 423 participants with a median age of 22 (IQR 4) years participated in the study. The prevalence of HIV status disclosure to the current male partners was found at 73.3% (95% CI 69.0-77.5). The predictors for HIV status disclosure were found to include the women's knowledge of their HIV status (APR 1.1 (95% CI 1.0-1.2), p 0.032), knowledge of their male partner's HIV status (APR 0.8 (95% CI 0.7-0.9), p 0.003), and the male partners' disclosure of their HIV status to the women (APR 0.7 (95% CI 0.5-0.9), p <0.016). About three-fourths of the AGYWLHIV in semi-rural northern Uganda disclosed their HIV status to their male partners. The predictors of disclosure included the women's knowledge of their HIV status, knowledge of their male partner's HIV status, and the male partner's reciprocal disclosure of their HIV status. To enhance disclosure rates, post-test, and disclosure counseling for both individuals and couples is recommended as part of the routine HIV testing, treatment, and care programs.

Reproductive health emergencies, such as postpartum hemorrhage, contribute significantly to maternal and neonatal morbidity and mortality in Uganda due to knowledge and skills gaps. Medical interns, intern midwives, and nurses are crucial as frontline healthcare workers in responding to these emergencies. Our proposed hands-on strategy involves comprehensive simulation-based training (SBT) to equip these healthcare workers with the essential knowledge to manage common reproductive health emergencies and procedures in the country. The study aimed to assess the effectiveness of comprehensive SBT in improving the knowledge of interns and fifth-year medical students on reproductive health emergencies and procedures at Gulu University and its Teaching Hospitals in Uganda. A before-and-after study. A 4-day SBT was conducted for fifth-year medical students and interns (nurses, midwives, and doctors) at Gulu University Teaching Hospitals, focusing on reproductive health emergencies. Pre- and post-tests with 40 multiple-choice questions were used to evaluate knowledge enhancement, the scores were summarized as medians and interquartile ranges. Paired sample t-tests was used to test the difference in pre- and post-test scores. Independent sample t-tests compared median post-test results between interns and students, with a p-value <0.05 considered significant. A total of 153 participants were enrolled, the majority being males (78.4%, n = 120) and medical students (73.9%, n = 113). Among the 40 interns, 55% (n = 22) were doctors, 30% (n = 12) were midwives, and 15% (n = 6) were nurses. The study participants showed an increase in knowledge, with median post-test scores higher than pre-test scores for all participants [63% (interquartile ranges, IQR: 57-71%) versus 49% (42-54%), with a median difference of 14% (8-23%), p < 0.001]. The SBT effectively imparts key knowledge competencies to the interns and fifth-year medical students. We recommend that SBT be included as part of the course units that students should take and for continuous medical education for qualified healthcare workers in resource-limited settings.

The vaginal contraceptive ring is very effective and user dependent. In this article, we will discuss the different types of vaginal contraceptive rings, namely, the etonogestrel/ethinyl estradiol (ENG/EE) ring (NuvaRing, Merck, Rahway, NJ, USA) and the segesterone acetate (SA)/EE (Annovera, Mayne Pharma, Raleigh, NC, USA) ring. The details of dosing and administration, indications, advantages, disadvantages, and cost-effectiveness are presented. This literature review was conducted using PubMed and Google Scholar. The search terms included ‘vaginal contraceptive ring’, ‘etonogestrel/ethinyl estradiol ring’, and ‘segesterone acetate/ethinyl estradiol ring’. The search was then sorted by year from 2000 until present, and the most recent articles were reviewed. The purpose of this article is to provide a comprehensive reference on the two vaginal contraceptive rings widely used in the United States for clinicians to guide management. Both vaginal contraceptive rings are combination of hormonal contraceptives that suppress ovulation and create physiologic conditions unfavorable for pregnancy. The ENG/EE ring is designed to be replaced monthly, while the SA/EE ring is a single device used over the course of 1 year. Common side effects of both devices include headaches, nausea, vomiting, and vaginitis. Serious adverse reactions can occur with the vaginal contraceptive rings including venous thromboembolism, psychiatric events, and hypersensitivity. Both devices are contraindicated in patients at high risk for arterial or venous thrombotic events, patients with a history of breast cancer or other estrogen/progesterone cancers, and patients with severe liver disease. Overall, the vaginal contraceptive ring is well tolerated and liked by patients. Patients should be well counseled on known severe adverse reactions. The vaginal contraceptive ring is more expensive than other forms of contraception and this should be an important point of discussion with patients.