Vaginal examination is an essential component of maternal assessment during pregnancy, performed to evaluate cervical status and monitor the progress of labor. Despite its clinical importance, this procedure may provoke fear, anxiety, and pain in pregnant women. Immersive Virtual Reality has emerged as a safe, non-pharmacological intervention that enables patients to interact with a device that delivers a simulated environment during medical procedures. By creating an engaging, immersive experience, VR can divert pregnant women's attention away from the immediate clinical setting of the examination, thereby alleviating psychological distress and discomfort. This study aimed to investigate the effect of immersive VR on fear, anxiety, and pain among pregnant women during clinical training of vaginal examination. This randomized controlled trial was performed in a teaching hospital in Mashhad, Iran. (IRCT20220704055367N7). The participants of this trial were 70 pregnant women who were in the latent or active phase of labor and required vaginal examination as part of routine intrapartum care. The participants were randomly assigned to either an immersive VR intervention group (n = 35) or a standard-care control group (n = 35). The participants who were assigned to the VR group used a head-mounted display with a relaxing virtual environment during the entire vaginal examination conducted by medical trainees. The state of anxiety was assessed by using the State-Trait Anxiety Inventory (STAI) before and immediately after the vaginal examination. Pain was assessed by using the Visual Analog Scale (VAS), McGill Pain Questionnaire (MPQ), and the fear of pelvic examination checklist immediately after the vaginal examination. A total of 70 pregnant women were randomized into VR and control groups. Post-intervention analysis revealed significantly lower state anxiety in the VR group compared to controls (34.31 ± 9.07 vs. 45.66 ± 13.03; p < 0.001). Pain intensity measured by VAS was also significantly reduced in the VR group (3.43 ± 2.13 vs. 6.29 ± 2.18; p < 0.001). The McGill Pain Questionnaire showed significantly lower scores across all pain dimensions in the VR group (p < 0.05). Furthermore, fear during all stages of the vaginal examination was significantly lower in the VR group than in the control group. (p < 0.001). Immersive VR serves as an effective non-drug treatment that delivers safe patient results while maintaining high user satisfaction because it decreases fear and anxiety and pain levels during vaginal examinations conducted by trainees on pregnant women. The routine in intrapartum care and medical education for midwives will enhance maternal satisfaction and deliver high-quality clinical education.

Amniotic fluid embolism (AFE) and placental abruption represent two of the most catastrophic obstetric emergencies, sharing a common pathway of severe coagulopathy while differing fundamentally in their underlying pathophysiology. AFE is characterized by sudden cardiovascular collapse, respiratory distress, and disseminated intravascular coagulation (DIC), likely triggered by an anaphylactoid-like reaction to fetal antigens entering maternal circulation. The condition manifests with both consumptive coagulopathy and hyperfibrinolysis, with platelet counts frequently falling below 50,000/μL and precipitous drops in fibrinogen levels. Management requires immediate advanced cardiac life support and aggressive hemodynamic support, mechanical ventilation, and massive transfusion protocols guided by viscoelastic testing. Emerging therapies include extracorporeal membrane oxygenation for refractory cardiopulmonary collapse and recombinant factor VIIa for intractable hemorrhage. Placental abruption results from premature placental separation and presents vaginal bleeding, abdominal pain, and fetal compromise. The condition arises from chronic uteroplacental ischemia and decidual arteriopathy, with retroplacental hematomas serving as massive sources of tissue factors that trigger the coagulation cascade. Abruption-related DIC primarily manifests consumption coagulopathy. Unlike AFE, urgent delivery of the fetus and placenta can eliminate the source of thromboplastic material, often resolving the coagulopathy. Both conditions demand, among others, institutional preparedness with established massive transfusion protocols and multidisciplinary teams trained in obstetric critical care. While advances in viscoelastic testing, targeted factor concentrates, and life support technologies have improved outcomes, AFE and placental abruption continue to challenge even experienced obstetric teams.

Pneumorrhachis, defined as the presence of air within the spinal canal, is generally regarded as a benign radiological finding. In obstetrics, it is most frequently associated with use of the loss of resistance (LOR) to air technique during neuraxial procedures. We present a unique case of symptomatic pneumorrhachis after inadvertent dural puncture using the LOR to saline technique. The patient developed severe, refractory neck pain that precluded effective maternal Valsalva efforts during the second stage of labor, ultimately necessitating an operative vaginal delivery. This case illustrates that pneumorrhachis, while typically asymptomatic, can produce significant morbidity capable of altering obstetrical management.

Incidental findings on 18F-FDG PET/CT may mimic pathologic processes, making recognition of imaging pitfalls essential. The eye-black sign, a rare finding characterized by bilateral symmetric FDG uptake in the lower eyelids, has mainly been reported in patients receiving systemic oncologic therapy. We present a 53-year-old woman with endometrial adenocarcinoma treated surgically and with adjuvant vaginal brachytherapy, without systemic therapy. Follow-up PET/CT 18 months later showed bilateral lower eyelid uptake (SUVmax: 9.7) without recurrence. Biopsy revealed chronic inflammatory changes. This case demonstrates that the eye-black sign can occur without systemic therapy and should be recognized as a benign imaging pitfall.

This study explored the development of salicylic acid-conjugated chitosan nanoparticles (SACNs) and their effectiveness in enhancing the cryopreservation of buffalo sperm. The assessment focused on post-thaw sperm quality and kinematics, microbiota profiles, oxidative stress markers, acrosome integrity, apoptosis, and docking analysis. Semen was collected from eight fertile buffalo bulls via an artificial vagina. Samples were diluted with a Tris-based extender and supplemented with SACNs at concentrations of 0 μM (SACNs0), 5 μM (SACNs5), 10 μM (SACNs10), 20 μM (SACNs20), and 40 μM (SACNs40). Following a standard freezing procedure, sperm quality and kinematic parameters significantly improved in the SACNs10, SACNs20, and SACNs40 groups, with the greatest improvement in the SACNs40 group (p < 0.05). Acrosome integrity was significantly improved in all SACNs-treated semen samples compared with the SACNs0 treatment (p < 0.05). Additionally, total antioxidant capacity and catalase activity were improved, while hydrogen peroxide and MDA levels were noticeably diminished in all SACNs-treated groups (p < 0.05). Although all SACNs concentrations markedly reduced apoptotic markers, caspase-3 activity, and reactive oxygen species, it showed the lowest levels in the SACNs40 group (p < 0.05). Salicylic acid exhibited strong docking interactions with key regulators of mitochondrial function and sperm motion, including UCP1, HSP70, cytochrome c, and the tubulin-colchicine complex, suggesting a multi-target mechanism of action. Furthermore, supplementation with SACNs at 10, 20, and 40 μM significantly declined coliform and total bacterial counts compared with the SACNs0 treatment (p < 0.05). These findings show that SACNs, acting as nano-antioxidant additives, enhance the cryoresistance of buffalo sperm, suggesting their potential to improve assisted reproductive technologies.

In children presenting with prolonged irregular vaginal discharge, colposcopic evaluation should be performed, and the possibility of a malignant tumor must be considered in the differential diagnosis. Surgical excision remains the cornerstone of treatment to prevent recurrence. Long-term follow-up is mandatory.

Hydranencephaly (HE) is a rare congenital condition characterized by near-total absence of the cerebral hemispheres, replaced by cerebrospinal fluid, most commonly resulting from in utero bilateral internal carotid artery occlusion; although maternal alcohol consumption is associated with fetal neurodevelopmental abnormalities, its direct role in HE remains unclear. We report a case of a 42-year-old multiparous woman with chronic alcohol use throughout pregnancy who delivered a female neonate at 40 + 5 weeks via spontaneous vaginal delivery. The neonate presented with facial asymmetry and a boggy parietal swelling, while maintaining intact reflexes and normal muscle tone. Third-trimester ultrasonography had suggested hydrocephalus, and postnatal cranial ultrasonography confirmed extensive cerebral destruction with fluid replacing most brain structures. Laboratory investigations, including TORCH screening, were unremarkable. The infant was managed with supportive care and parental counseling. Hydranencephaly is typically associated with early childhood mortality, although rare cases of prolonged survival have been described. Neuroimaging is essential for differentiating HE from severe hydrocephalus and porencephaly, and management remains largely supportive, with ventriculoperitoneal shunting considered in selected cases. This case highlights the importance of early prenatal detection, multidisciplinary management, and increased awareness of potential alcohol-related fetal brain abnormalities to guide counseling and optimize outcomes.