Unexplained recurrent pregnancy loss affects many fertile couples who want to conceive. Possibly, the maternal immune system is involved in the underlying mechanism of such unexplained cases and immune-suppressing corticosteroids can be used to modulate this system and improve pregnancy outcome. As a high quality, sufficiently powered randomized controlled trials in the unselected unexplained RPL population is currently lacking, the PREMI (Prednisolone administration in patients with unexplained REcurrent Miscarriages) trial was designed. Here, we discuss the rationale for the administration of prednisolone, including its potential mechanisms, safety, administration protocol and study population.

Advanced maternal age (AMA) is associated with reduced fertility and higher risks of adverse pregnancy outcomes. Iron deficiency, a leading cause of anemia, has been associated with pregnancy loss. However, the iron deficiency-related burden among AMA women remains poorly quantified. This study aimed to quantify the global burden and geographical inequalities of abortion and miscarriage related to iron deficiency among AMA women. We utilized data from the Global Burden of Disease Study 2021. Trends from 1990 to 2021 in the age-standardized disability-adjusted life years rate and age-standardized mortality rate were quantified globally, across 5 Socio-demographic Index (SDI) regions and countries. Age-stratified analyses were performed. The association between SDI and age-standardized disability-adjusted life years rate/age-standardized mortality rate was evaluated using Spearman correlation analysis. Sensitivity analyses were also conducted. Globally, the iron deficiency-related burden of abortion and miscarriage in AMA women declined markedly, yet pronounced disparities persisted. The high-middle SDI region exhibited the most substantial decrease in disease burden, while the low SDI region continued to have the highest burden and showed slower improvement. A distinct pattern was observed in the low SDI region, where the peak burden shifted to the 45 to 49 age group, unlike all other SDI regions. A significant inverse correlation was observed between SDI and burden metrics, with a steeper inverse association at lower SDI levels and attenuation at higher SDI levels. The burden of iron deficiency-related miscarriage and abortion in AMA women decreased globally from 1990 to 2021, yet inequalities persist, especially in low SDI areas. The inverse correlation between SDI and disease burden suggests that regions with lower socioeconomic development may carry a disproportionately higher burden. These observations should be interpreted as population-level associations rather than causal relationships.

Pregnancy fundamentally reshapes maternal immunity, creating a state of immune tolerance that simultaneously increases susceptibility to infections. In women with rheumatic diseases (RDs), this vulnerability is further amplified by underlying autoimmune dysregulation and immunosuppressive therapies. Infectious comorbidities in this population represent a major challenge as they may precipitate rheumatic disease flares, contribute to maternal morbidity, and adversely affect pregnancy, including miscarriage, preterm birth, fetal growth restriction, and neonatal complications. This review aims to overview current evidence on infectious comorbidities in pregnant patients with RDs, with a focus on rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and primary Sjögren syndrome. Disease-specific infection patterns and their impact on maternal and fetal outcomes are discussed. Literature searches were performed in Medline/PubMed, Scopus, Web of Science, and Directory of Open Access Journals (DOAJ) to identify documents on infections, prevention, and outcomes in pregnant women with RDs published up to September 2026. The influence of pregnancy-related immune modulation and immunosuppressive treatments, including corticosteroids, disease-modifying antirheumatic drugs, and biologic agents, on infection risk is examined. Preventive strategies, including preconception counseling, vaccination, targeted screening, and multidisciplinary management, are also addressed. Available evidence suggests that infectious comorbidities remain underrecognized in pregnancy counseling for women with RDs. Early risk stratification, individualized adjustment of immunosuppressive therapy, and close collaboration between rheumatologists, obstetricians, and infectologists are essential to optimize maternal and fetal outcomes.

Chronic pelvic pain remains a challenging clinical problem due to its diverse underlying causes and often nonspecific presentation. Although common conditions account for most cases, rare postoperative or inflammatory cystic lesions within the vesicouterine space may mimic more common pelvic pathologies and create significant diagnostic uncertainty. These lesions may demonstrate imaging features that overlap with those of chronic hematomas and endometriotic cysts, further complicating the preoperative diagnosis. A woman in her mid-30s, gravida 3, para 1, with two previous miscarriages, presented with a several-month history of left lower abdominal and pelvic pain. Pelvic ultrasound demonstrated a cystic lesion with internal echoes located anterior to the lower uterine segment. MRI revealed an ovoid lesion adjacent to the anterior lower uterine segment, with imaging characteristics suggestive of a chronic hematoma. Due to persistent symptoms, laparoscopic exploration was performed. Intraoperatively, dense adhesions were identified between the uterus, cervix, and bladder. Following adhesiolysis and bladder dissection, a cystic lesion containing dense, friable, whitish-yellow material was identified within the vesicouterine space, and the visible cyst wall and its contents were excised. Histopathological analysis demonstrated a fibrous wall without epithelial or mesothelial lining, accompanied by chronic fibro-inflammatory changes, consistent with a pseudocyst. The patient had an uneventful recovery, with significant improvement in her symptoms. This case demonstrates the imaging overlap between chronic hemorrhagic collections and fibro-inflammatory pseudocysts and highlights the diagnostic challenge posed by uncommon lesions of the vesicouterine space. In this symptomatic patient, despite imaging findings suggestive of a chronic hematoma, a definitive diagnosis was established through surgical exploration and histopathological examination. The report contributes to the limited literature describing pseudocysts involving the vesicouterine space and emphasizes the need to consider postoperative fibro-inflammatory pseudocyst formation in the differential diagnosis of a non-enhancing vesicouterine lesion.

Rubella infection during pregnancy poses significant risks, including congenital rubella syndrome (CRS), miscarriage, and fetal death. Vaccination programs have reduced rubella incidence globally, but regional differences in coverage and immunity persist. The objective of the study was to assess the seroprevalence of anti-rubella IgM and IgG antibodies among pregnant women in South-Western Romania, with a focus on temporal trends, demographic factors, and the impact of vaccination eligibility.

Non-invasive preimplantation genetic testing for aneuploidy (niPGT-A) can detect embryo chromosomal aneuploidy by analyzing the cell-free DNA in embryo culture media. However, evidence for its clinical efficacy is insufficient. In this investigator-initiated, multicenter, double-blind, randomised controlled trial, women aged 35-42 who agreed to single frozen-thawed blastocyst transfer with at least two blastocysts were enrolled from 13 fertility centers in China. Eligible participants were randomly assigned (1:1) to the niPGT-A(n = 594) or morphology group(n = 595) using a computer-generated block randomization list, stratified by participating center. In the niPGT-A group, embryos were selected for the first transfer cycle based on niPGT-A results, whereas in the morphology group, embryos were selected according to standard morphological criteria. The primary outcome was the ongoing pregnancy rate (OPR) (pregnancy beyond 12 weeks). Secondary outcomes included clinical pregnancy, miscarriage (pregnancy loss before the 28th week, with those before the 12th week as early miscarriages), and live birth rates. The trial has been completed. The modified intention-to-treat population(mITT) contained 581 couples in the morphology group and 571 in the niPGT-A group. Among 1152 randomised patients, OPR was 38.7% (221/571) in the niPGT-A group and 36.8% (214/581) in the morphology group (adjusted p = 0.49). There were no statistically significant between group differences in the rates of clinical pregnancy (47.6% vs 49.9%, adjusted p = 0.49), miscarriage (21.0% vs 27.6%, adjusted p = 0.06) and live birth (37.0% vs 35.5%, adjusted p = 0.59). Early miscarriage was significantly lower in the niPGT-A group compared with that of the morphology group (18.0% vs 25.2%, adjusted p = 0.03). Maternal and neonatal outcomes did not differ significantly between groups. No serious adverse events were reported in either group. The results indicated that there was insufficient evidence to establish a statistically significant difference in OPR between the two treatment arms. The results of this trial do not provide a basis for recommending routine use of niPGT-A in this good-prognosis population (NCT04339166).

Rift Valley Fever Disease (RVFD) causes substantial economic losses via livestock abortion storms, yet community-based abortion reporting for early warning remains suboptimal in endemic settings. This study analysed the behavioural determinants of livestock abortion reporting to inform RVF surveillance interventions in Uganda. We conducted a cross-sectional study using qualitative data collection methods in Isingiro District, Uganda, employing the Capability, Opportunity, Motivation-Behaviour (COM-B) framework. We conducted 29 key informant interviews with national/district policymakers and technical officers and 17 focus group discussions involving livestock owners, abattoir operators, and local leaders. Transcripts underwent deductive thematic analysis using NVivo-12, with independent coding verification and member checking. Barriers and facilitators were ranked by frequency and thematic emphasis, and a comparative analysis was conducted across participant groups. The most frequently cited barrier was poor community knowledge about RVF, while the most powerful demotivator was the absence of post-reporting feedback. Key facilitators included mobile phone platforms, community governance structures, and fear of economic and cultural loss. Our study recommends that sustainable abortion reporting requires simultaneous intervention across capability, opportunity, and motivation domains. Priority interventions could include: integrating reporting into Uganda's electronic surveillance platforms, co-developing local RVF names with communities, establishing reliable feedback mechanisms, addressing veterinary staffing gaps in remote areas, and implementing no-blame reporting protocols. Effective RVF surveillance depends on reinforcing existing community structures while ensuring responsive feedback that validates reporters' contributions.

Obesity is increasingly understood as a reproductive-metabolic condition that can affect female fertility across the continuum from natural conception to assisted reproductive technology (ART). Excess adiposity may disrupt hypothalamic-pituitary-ovarian regulation, insulin signaling, inflammatory pathways, ovarian function, oocyte competence, embryo development, and endometrial receptivity. This review synthesizes current evidence linking obesity with infertility, reduced ART efficiency, implantation failure, miscarriage, and reduced live birth, while emphasizing that these associations vary according to reproductive and metabolic phenotype. Particular attention is given to polycystic ovary syndrome, advanced age, diminished ovarian reserve, recurrent implantation failure, and recurrent pregnancy loss. Pre-treatment weight-loss strategies, including lifestyle intervention, glucagon-like peptide-1 receptor agonists, tirzepatide, and bariatric surgery, are also considered in relation to reproductive benefit, treatment delay, and pregnancy safety. Overall, obesity should not be treated simply as a body mass index category, but rather as a phenotype-dependent reproductive-metabolic condition that requires individualized fertility-treatment planning.