Shaghayegh Moradi Alamdarloo

Neonatal mortality remains a leading contributor to under-five deaths, yet early, individualized risk prediction is hampered by the rarity of the outcome and by limited attention to calibration and interpretability in prior models. We developed and stress-tested machine learning (ML) models for neonatal mortality prediction in a large, population-based cohort, integrating probability calibration, explainable AI, and exploratory unsupervised phenotyping. The development cohort of 61,517 neonates (131 deaths; class imbalance 1:469) was used to train L2-regularized logistic regression (LR) and LightGBM models on 60 routinely available perinatal features. performance was assessed by discrimination (AUROC, AUPRC), calibration, and decision-curve analysis, while SHAP and four unsupervised methods (UMAP, K-means, Isolation Forest, Apriori) characterized the underlying risk structure. Locked models then underwent a one-time case-only external stress test on 604 deceased neonates from a separate center and later period. LR achieved an AUROC of 0.955 (LightGBM, 0.944); at the optimal threshold (τ*=0.004) it captured 87.8% of deaths at 97.3% specificity, and positive net clinical benefit. In the external stress test, LR flagged 69.5% of deaths. Exploratory unsupervised analyses, fitted without outcome labels and evaluated post hoc against mortality, described a single high-risk phenotype; a K-means cluster comprising 6.7% of neonates contained 89.3% of all deaths. In this large, heterogeneous cohort, well-regularized ML models provided calibrated, interpretable, and early neonatal mortality risk stratification. The case-only design of the external cohort permits assessment of sensitivity only; external discrimination and calibration remain to be established, and prospective evaluation is warranted before clinical deployment.

Background and Aim: This study assessed the prevalence, patterns, and risk factors of urologic injuries in patients with placenta accreta spectrum (PAS) undergoing cesarean hysterectomy, aiming to help clinicians identify high‐risk cases and optimize surgical planning. Methods: In this retrospective cohort study with a 6‐month postoperative follow‐up, patients with a diagnosis of PAS referred to Namazi Hospital for treatment between January 2015 and December 2024. These patients were monitored for 6 months after their cesarean section for long‐term urologic complications, and their demographic information, obstetric history, hospitalization course, and operation detail were collected. Results: A total of 115 patients (23.09%) had urologic injuries during cesarean section hysterectomy. Severe intraoperative blood loss (≥ 3000 mL), as a marker of surgical complexity, was strongly associated with urologic injury (adjusted OR 7.10, 95% CI 3.73–13.53; p < 0.001). Regarding pathology, placenta accreta was associated with a significantly lower risk of urologic injury compared with placenta percreta (adjusted OR 0.52, 95% CI 0.29–0.93; p = 0.03), whereas placenta increta was not significantly associated (adjusted OR 0.90, 95% CI 0.50–1.60; p = 0.71). Conclusion: Approximately one‐fifth of pregnant women with PAS undergoing cesarean hysterectomy develop urologic injuries. This emphasizes on having a multidisciplinary team of surgeons with adequate experience in the field of abnormal placental tissue involvement. Besides, efforts should be taken preoperatively with the use of sufficient diagnostic means to optimize the surgical planning and management to reduce the amount of blood loss and prevent surgical morbidities such as urologic damage.

Placenta accreta spectrum (PAS) is an increasingly prevalent condition in women, often necessitating cesarean hysterectomy, which can significantly impact various aspects of life. This study aimed to evaluate the quality of life and postpartum depression in women with PAS and compare them with women who underwent repeated cesarean sections. In this case-control study, we conducted interviews with women after delivery. The SF-36 questionnaire was used to assess quality of life, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess postpartum depression. Data on demographics, neonatal outcomes, complications, rehospitalization, blood loss, ICU admission, and neonatal NICU admission were collected from hospital records. All data were entered into SPSS and analyzed using descriptive statistics, the Kruskal-Wallis test, Spearman's Rho correlation, the Mann-Whitney U test, and post hoc tests. Among 62 cases with PAS and cesarean hysterectomy and 75 control subjects with repeated cesarean sections, there was a significant difference between the groups in the physical function and pain domains of the SF-36, with lower scores observed in the case group (p-value < 0.001). Significant relationships were found between blood loss and both physical function (p-value = 0.005) and pain (p-value = 0.003). NICU admission was also significantly associated with bodily pain (p-value = 0.01) and physical function (p-value = 0.005). Maternal ICU admission significantly affected physical function (p-value = 0.016), and surgical complications were related to role limitations due to emotional problems (p-value = 0.028). Probable depression was observed in 37 cases and 39 controls(p-value = 0.89). Women with PAS face meaningful postoperative limitations-particularly in physical function and pain-that extend beyond surgical morbidity and highlight the need for specialized perioperative counseling, proactive rehabilitation strategies, and multidisciplinary follow-up. Despite these physical burdens, postpartum depressive symptoms were comparable between groups, indicating that mental health outcomes may depend on factors other than PAS alone.

Placenta accreta spectrum (PAS) is a severe obstetric condition associated with substantial maternal and neonatal morbidity. This study aimed to evaluate a

Cognitive Behavioral Therapy (CBT) is a non-pharmacological intervention that may reduce anxiety during pregnancy. This study aimed to evaluate the effect

A short cervical length (CL) in placenta accreta spectrum (PAS) may be associated with adverse outcomes. This study aimed to evaluate the impact of CL on m

Severe polyhydramnios occurs in 1%–2% of pregnancies and may be associated with maternal diabetes, fetal structural anomalies, genetic disorders, or remain idiopathic. Among the rare etiologies is Bartter syndrome, a renal tubular defect causing impaired salt reabsorption. We report a rare case of severe polyhydramnios secondary to antenatal Bartter syndrome to emphasize clinical and biochemical features that aid in early diagnosis. A 36‐year‐old primigravid woman developed severe polyhydramnios at 26 weeks (AFI 30 cm, moderate polyhydramnios), which progressed to 44 cm (severe polyhydramnios) despite two therapeutic amnioreductions. Amniotic fluid analysis showed markedly elevated chloride (104 mmol/L). A male neonate was delivered at 36 weeks with normal birth weight and Apgar scores. At 3 months, he presented with polyuria, dehydration, hypokalemic hypochloremic metabolic alkalosis, confirming Bartter syndrome. The presence of severe polyhydramnios, together with elevated chloride levels, may be supportive in the diagnostic evaluation. Incorporating biochemical analysis and targeted genetic testing in the prenatal assessment may facilitate earlier recognition and improve neonatal outcomes. Prompt diagnosis can prevent morbidity, guide management, and reduce delay in the treatment of affected infants.

Purpose The main purpose of this review is to examine the outcomes of pregnancy following different metabolic and bariatric surgical procedures. Methods A comprehensive literature search was conducted in PubMed for studies published between 2014 and 2024, focusing on pregnancy outcomes after bariatric surgery. The review analyzed outcomes across different surgical procedures: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric banding (AGB), and biliopancreatic diversion with duodenal switch (BPD-DS). Results Metabolic and bariatric surgery demonstrates significant benefits in reducing obesity-related pregnancy complications, including decreased rates of gestational diabetes and hypertensive disorders. However, procedure-specific risks were identified: RYGB showed increased risks of internal herniation and nutritional deficiencies; SG demonstrated more stable glycemic profiles with lower rates of complications; AGB required ongoing adjustment during pregnancy; and BPD-DS presented the highest risk of nutritional deficiencies. Small-for-gestational-age births were more common after malabsorptive procedures compared to restrictive ones. The traditional recommendation of waiting 12–24 months before conception appears oversimplified, with evidence suggesting procedure-specific timing considerations may be more appropriate. Conclusions While all bariatric procedures improve pregnancy outcomes compared to untreated obesity, the choice of procedure for women of reproductive age should carefully consider the balance between metabolic benefits and potential risks to maternal and fetal health. Individualized, procedure-specific approaches to post-surgical care and pregnancy timing are recommended.

Placenta accreta is a serious condition during pregnancy often leading to cesarean hysterectomy. This study aimed to investigate a novel hysterectomy metho

In this case report, we present a 43-year-old man (XY) with azoospermia and typical male appearance, at Tanner stage 5 of sexual development, who presented with severe colicky abdominal pain accompanied by nausea. A pelvic CT scan revealed a pear-shaped structure in the pelvic cavity, located entirely behind the bladder, measuring 106*44 cm with fluid accumulation inside it, extending into the right inguinal canal. There was also evidence suggesting the formation of the upper and mid-third part of a vagina, terminating in the prostatic gland. The patient underwent laparoscopic surgery for the removal of the uterus and the left gonad. The patient had a uterus with hematometra and a blind vaginal pouch measuring 4 centimeters at the end of the uterus, extending posteriorly behind the bladder to the apex of the prostate, containing old blood. Hormonal analysis showed serum estradiol < 5.0 pmol/L (11-44pg/mL), free testosterone at 1.57 ng/ mL(male reference range: 2.5–20 ng/mL), testosterone at 0.56 ng/mL (2.27–10.30),FSH at 44.8 mIU/L (0.95–11.95 mIU/L), LH at 20.4 mIU/L(0.57–12.07), and DHEA-SO4 at 199.0 µg/mL (139.7–484.4 µg/mL). Currently, the patient is under the care of a urologist and is receiving weekly treatment with hCG medication. He reports normal sexual function, including intercourse, orgasm, erection, and ejaculation.