Bassel Hamameeh Al Wattar

Polycystic ovary syndrome (PCOS) has been formally renamed as polyendocrine metabolic ovarian syndrome (PMOS). This has followed a global consensus exercise that engaged more than 14,000 patients a...

Background: Immersive virtual reality (VR) technology offers a non‐invasive, non‐pharmacological approach to reduce pain perception in patients undergoing diagnostic or interventional procedures. Objective: To systematically evaluate the efficacy of immersive VR technology in reducing pain perception during obstetric and gynaecological procedures. Search Strategy: We searched MEDLINE, EMBASE, CENTRAL, and CINAHL databases from inception to January 2025. Selection Criteria: We included randomised controlled trials (RCTs) evaluating VR interventions in women undergoing obstetric or gynaecological procedures. Data Collection and Analysis: We performed meta‐analyses using random‐effects models and assessed risk of bias using the Cochrane risk‐of‐bias tool for randomised trials. Main Results: 49 RCTs (5355 participants) were included. Due to clinical heterogeneity, data were analysed separately. VR resulted in a larger, consistent reduction in pain scores compared with standard care in labour (11 studies; SMD −0.93, 95% CI −1.25 to −0.60) compared to minor procedures (29 studies; SMD −0.64, 95% CI −0.97 to −0.32). VR also significantly reduced anxiety scores in both labour (8 studies; SMD −1.13, 95% CI −1.80 to −0.45) and minor procedures (17 studies; SMD −0.74, 95% CI −1.18 to −0.29). Our analysis was limited by high levels of heterogeneity and variability in procedural protocols. Conclusion: Immersive VR technology appears effective for reducing pain and anxiety during obstetric and gynaecological procedures, particularly during childbirth, despite substantial statistical heterogeneity. Further research is needed to optimise implementation strategies and establish clinical practice guidelines.

In the last two decades, we have consolidated our knowledge of the epidemiology and risk factors for ectopic pregnancies. Minimally invasive surgical skills are now widespread, and laparoscopic surgery is recognized as the best and safest operative treatment for extrauterine ectopic pregnancies. Based on the evidence from randomized trials published a decade ago, laparoscopic salpingectomy is accepted as the optimal surgical treatment for tubal ectopic pregnancy. However, with recent advances in surgical techniques and improvement in surgical skills, the appropriateness of tubal removal versus conservation is under increasing scrutiny. Improvements in the organization and provision of care for women presenting with early pregnancy complications, in conjunction with better quality and wider use of ultrasound imaging, have resulted in an increased ability to detect small failing ectopic pregnancies, which were impossible to diagnose in the past. Many of these pregnancies are destined to resolve spontaneously without the need for any intervention. The necessity to avoid overtreatment and the potential for iatrogenic harm in such cases has facilitated the introduction of expectant management into mainstream clinical practice. This represents one of the key developments in the care for women with ectopic pregnancies. By contrast, the efficacy of medical management with methotrexate has been questioned. Another important development in recent years has been a rapid rise in the prevalence of ectopic pregnancies that are located outside the uterine cavity but within the confines of the uterus, the largest burden of which is from Caesarean scar ectopic pregnancies. This has promoted the development of new terminology and classification of ectopic pregnancies, with the aim of raising awareness of these increasingly prevalent types and minimizing the risk of misdiagnosis. In comparison to ectopic pregnancies outside the uterus, uterine ectopic pregnancies are more difficult to diagnose and manage, and are also associated with increased maternal morbidity, mortality, and adverse reproductive outcomes. Another challenge, which is peculiar to uterine ectopic pregnancies, is their potential to progress to reach foetal viability, albeit with a high risk of extreme prematurity. This requires women and clinicians to make difficult decisions about whether these pregnancies should be terminated to protect maternal health, despite some possibility of a good foetal outcome. Herein, we provide a comprehensive review of published literature to summarize new evidence and explore emerging themes with respect to ectopic pregnancy. Our aim is to provide an overview of modern classification and diagnosis, to summarize available treatment options and recommendations, and to emphasize longer-term outcomes, including the potential psychological impact of ectopic pregnancy. We examine current knowledge gaps and outline priorities for further research.

Importance: There is a need for interventions that employers and employees can adopt to optimize the health, safety, and productivity of women with menopause at the workplace. Objective: We conducted a structured scoping review to summarize the literature and identify effective interventions that could help women manage menopausal symptoms at the workplace. Evidence review: We searched electronic databases (MEDLINE and EMBASE) until July 2024 for all studies that evaluated any non-hormone interventions used among women with menopause at the workplace and reported as per PRISMA-ScR. We used a standardized data extraction tool to capture relevant data and conducted a thematic analysis to identify the prominent themes. Findings: Out of 4,284 potentially relevant citations, we included seven studies, including four randomized trials and three observational studies. Four studies evaluated cognitive behavioral interventions showing improvement in hot flushes, workability, presenteeism, and quality of life, though results varied between studies. One randomized study examined the impact of a structured aerobic exercise program on menopausal symptoms and work-related outcomes showing slight improvement in workability and mental strain. Raja Yoga meditation combined with sleep hygiene education was evaluated in one randomized study showing improvements in insomnia, sleep quality, and menopausal symptoms. Offering regular consultations at an outpatient menopause clinic for managing symptoms through lifestyle modifications improved menopausal symptoms and workability at 3 months after adjusting for potential confounders. Conclusions and relevance: Several behavioral and lifestyle interventions can help to optimize the health, productivity, and quality of life of women with menopause at the workplace. However, there is limited high-quality evidence on the best available intervention with wide variation in reported outcomes and measurement tools.

Objective: To assess the effect of interpregnancy interval on the odds of recurrence of tubal ectopic pregnancy (TEP) following expectant or surgical management. Methods: This was a retrospective cohort study conducted at a tertiary early pregnancy unit (EPU) in London, UK. Patients diagnosed with TEP following spontaneous conception, who had expectant or surgical management and who attended the EPU between December 2008 and January 2021 were included. Univariate and multivariate regression analyses were conducted to explore the association between the odds of recurrence of ectopic pregnancy and various factors, including maternal history, interpregnancy interval and management method of the index TEP, and analyses were adjusted for confounders. The main outcome measure was the odds of recurrence of extrauterine ectopic pregnancy in women presenting with a subsequent pregnancy. Results: A total of 1386 women with TEP were included, of whom 626 (45.2%) presented with a subsequent pregnancy. Fifty‐nine of these women were excluded, as their subsequent pregnancy was conceived via in‐vitro fertilization. From the remaining 567 women, 59 (10.4%) were diagnosed with recurrent extrauterine ectopic pregnancy. An interpregnancy interval of 6–18 months was associated with four times the odds of recurrence compared with an interval of ≤ 3 months (odds ratio (OR), 4.05 (95% CI, 1.37–12.03)). Women with two or more previous TEPs had more than three times the odds of recurrence compared to those with one previous TEP (OR, 3.27 (95% CI, 1.13–9.42)). Surgical management of the index TEP was associated with similar odds of recurrence as expectant management (OR, 1.26 (95% CI, 0.72–2.20)). Conclusions: Rapid conception after TEP is associated with low odds of recurrence. Therefore, purposeful delay to conception after TEP, including those managed expectantly, should not be recommended. Women with conception delay or a history of more than one ectopic pregnancy are at high risk of recurrent extrauterine ectopic pregnancy. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The Coronavirus Disease 2019 (COVID-19) pandemic disrupted maternity care, highlighting the need for rapid, high-quality clinical practice guidelines (CPGs) to ensure safe care for pregnant women. We assessed the quality and recommendations of CPGs related to COVID-19 in pregnancy. Following prospective registration (PROSPERO number: CRD42022346031) we searched Medline, Web of Science, and UpToDate from inception until July 2024. The methodological quality was appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). A total of 27 CPGs were included. High scores were achieved in scope and purpose (21/27, 78%) and clarity (17/27, 63%). The most poorly addressed domains were rigour of development and applicability to clinical practice (18/27, 67% and 19/27, 70% scored low quality, respectively). Overall, only four (15%) guidelines were recommended. Most CPGs (25/27, 93%) addressed COVID-19 screening and transmission prevention, but few covered psychological care (3/27, 11%) or maternal delivery preferences (4/21, 19%). Consensus was found on timing and mode of delivery (16/17, 94%), but there was disagreement on delayed cord clamping and virus transmission interventions. Evidence-based practice requires health care providers, patients and stakeholders to be aware of variations in both the quality and recommendations of CPGs, especially during times of uncertainty.