Affecting approximately 85% of expectant mothers during the first trimester, nausea and vomiting of pregnancy (NVP) are frequently reported symptoms. Despite numerous existing systematic reviews and meta-analyses (SRMs), findings remain inconsistent. Consequently, this study assesses the quality of these prior SRMs and investigates the efficacy of ginger as a treatment for NVP. A comprehensive search was conducted across PubMed, Scopus, Cochrane, and Web of Science from their inception through December 30, 2024. This review includes peer-reviewed English-language SRMs investigating ginger as a therapeutic intervention for pregnancy-related nausea and vomiting. Methodological rigor was evaluated using the AMSTAR-2 checklist, while evidence quality was assessed via the GRADE approach. Findings are synthesized narratively through content analysis. The study protocol was prospectively registered in the PROSPERO database. This study analyzed 18 systematic reviews, of which eight (44%) incorporated meta-analyses. The Rhodes Index of Nausea and Vomiting (RINV) emerged as the primary tool for evaluating outcomes. Regarding study reporting and transparency, seven studies registered their protocols in PROSPERO, while eight adhered to the PRISMA checklist. Overall, the included reviews demonstrated low methodological quality, with a mean score of 11.77. Specifically, 28% (n = 5) were rated as high quality, 28% (n = 5) as moderate, 22% (n = 4) as low, and 22% (n = 4) as critically low. Taking ginger supplements (usually between 450 and 1950 mg daily) significantly decreases the severity and occurrence of nausea and vomiting compared to a placebo. This benefit is more noticeable for nausea than for vomiting, where the results are less consistent. Numerous studies have shown that ginger does not raise the risk of adverse effects, such as spontaneous abortion or side effects like heartburn and drowsiness, when compared to a placebo or vitamin B6. Current evidence clearly shows that ginger is a safe and effective treatment for nausea and vomiting during pregnancy, with effectiveness similar to vitamin B6 and some traditional medications, and it has a good safety profile. Ginger can be recommended as a dependable medicinal herb for women dealing with NVP, though more research is needed to determine the best doses and confirm long-term safety.

Recurrent spontaneous abortion (RSA) involves complex and often unexplained pathogenesis. This study investigated metabolic reprogramming in RSA to identify diagnostic biomarkers. We integrated GEO datasets (GSE26787, GSE165004), identified metabolic reprogramming-related differentially expressed genes, and intersected them with WGCNA modules. Module genes were refined using logistic regression, SVM-RFE, and LASSO to construct a diagnostic model validated by ROC, nomogram, calibration, and decision curve analysis. The role of SREBF2 was explored by PCR, western blot, CCK-8, and transwell assays in vitro. Immune infiltration (ssGSEA, CIBERSORT) and single-cell RNA sequencing (GSE214607) explored immune-metabolic crosstalk. Results demonstrate critical involvement of metabolic reprogramming in RSA. Four model genes (SREBF2, PPARG, SQLE, UCP2) were upregulated in RSA and enriched in lipid/cholesterol pathways. Experimental validation confirmed SREBF2 upregulation in RSA decidua. Its overexpression in endometrial stromal cells impaired cell proliferation, decidualization, and trophoblast migration. Immune infiltration revealed correlations between model genes and specific immune subsets. Single-cell analysis identified altered immune cell proportions and cell-type-specific expression patterns, predominantly in macrophage subsets. This study indicates that lipid-centric metabolic remodelling may concurrently affect decidual function, trophoblast behaviour, and immune tolerance in RSA, offering diagnostic and therapeutic insights.

ObjectiveUnexplained recurrent spontaneous abortion is a multifactorial condition with an unclear etiology. This study aimed to investigate the relationship between liver function biomarkers and unexplained recurrent spontaneous abortion and explore interactions with tobacco exposure and body mass index.MethodsA retrospective case-control study was conducted on 2126 pregnant women, including 602 with unexplained recurrent spontaneous abortion and 1524 who served as controls. Liver enzyme indicators (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and alkaline phosphatase) were assessed, and multivariate logistic regression models were applied to analyze their association with unexplained recurrent spontaneous abortion. Interaction analyses were performed to evaluate combined effects of liver enzyme abnormalities, tobacco exposure, and body mass index.ResultsLiver enzyme abnormalities (alanine aminotransferase level >32 U/L or aspartate aminotransferase level >28 U/L) were significantly associated with increased unexplained recurrent spontaneous abortion risk (adjusted odds ratio = 2.15, 95% confidence interval: 1.68-2.76). A significant interaction between alanine aminotransferase elevation and tobacco exposure was observed (p < 0.001). Among non-exposed women, elevated alanine aminotransferase levels were associated with an odds ratio of 1.8 (95% confidence interval: 1.2-2.7), whereas among tobacco-exposed women, the odds ratio was 5.2 (95% confidence interval: 3.1-8.7) (p for interaction <0.001). However, these interaction results warrant cautious interpretation due to the absence of quantitative tobacco exposure metrics. The alanine aminotransferase-body mass index interaction was not significant (p = 0.179).ConclusionsElevated alanine aminotransferase and aspartate aminotransferase levels are independently associated with unexplained recurrent spontaneous abortion, and tobacco exposure significantly strengthened this association. These findings suggest that liver function abnormalities and tobacco exposure are associated with unexplained recurrent spontaneous abortion risk. However, given the limitations associated with tobacco exposure measurement, these findings should be interpreted with caution.

Background Retained products of conception (RPOC) constitute a clinically significant complication following spontaneous abortion, induced termination, or postpartum delivery, representing a notable contributor to maternal morbidity in resource-limited settings. Timely and accurate diagnosis is paramount to prevent life-threatening sequelae, including hemorrhage, sepsis, and intrauterine adhesive disease. This study aimed to evaluate the diagnostic accuracy of transvaginal sonography (TVS) in detecting RPOC among women of reproductive age, utilizing histopathological examination as the reference gold standard, with stratified analysis across age, gestational age, and symptom duration. Methodology This cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Bolan Medical Complex Hospital (BMCH), Quetta, Pakistan, over a six-month period from October 2022 to April 2023. A total of 205 women aged 15-49 years presenting with clinically suspected RPOC were enrolled through consecutive non-probability sampling. Following thorough clinical evaluation, all participants underwent transvaginal Doppler sonography utilising a 5-7 MHz endovaginal probe. Definitive diagnosis was established through histopathological examination of uterine curettings. Diagnostic performance indices - including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy - were calculated from the 2×2 contingency matrix and stratified across demographic and clinical subgroups. Intergroup comparisons of diagnostic accuracy across age, gestational age, and symptom duration strata were performed using the chi-square test, with a p-value of less than 0.05 considered statistically significant. Results Histopathological examination confirmed RPOC positivity in 195 participants (95.12%), while transvaginal sonography yielded positive findings in 168 participants (81.95%). The 2×2 contingency analysis identified 164 true positives, 6 true negatives, 31 false negatives, and 4 false positives. Overall, TVS demonstrated a sensitivity of 84.10%, specificity of 60.00%, PPV of 97.62%, NPV of 16.21%, and diagnostic accuracy of 82.93%. Stratified analysis revealed superior diagnostic performance among younger women aged 15-30 years (accuracy 84.03%), participants with gestational age exceeding 27 weeks (sensitivity 85.52%, specificity 75.00%, accuracy 85.00%), and those presenting within 48 hours of symptom onset (specificity 75.00%, accuracy 84.52%); however, none of the intergroup differences across age (χ² = 0.093, p = 0.7602), gestational age (χ² = 0.274, p = 0.6006), or symptom duration (χ² = 0.312, p = 0.5765) strata attained statistical significance on chi-square testing. Conclusion Transvaginal sonography demonstrates clinically acceptable sensitivity and diagnostic accuracy for RPOC detection, with performance optimised at advanced gestational ages and acute symptom presentation. However, the critically low NPV confirms that TVS cannot function as a standalone exclusionary diagnostic tool, necessitating mandatory histopathological corroboration in all sonographically negative yet clinically symptomatic cases within high-prevalence clinical settings.