Salvatore Mola

Objective: To evaluate long‐term gynecological symptoms and reproductive and ultrasound outcomes among women originally enrolled in a randomized controlled trial (RCT) comparing monofilament and multifilament sutures for uterine closure after Cesarean delivery. Methods: This was a secondary analysis of a RCT including women who underwent Cesarean delivery, who were originally assigned to monofilament or multifilament absorbable sutures for uterine closure. In this secondary analysis, participants were contacted 4–6 years after delivery and invited to a follow‐up evaluation, comprising a clinical interview and a voluntary transvaginal ultrasound examination. The primary outcome was the presence of postmenstrual spotting at long‐term follow‐up. Secondary outcomes were other gynecological symptoms, reproductive outcomes and ultrasound outcomes. Analyses were performed according to the original randomized allocation. Effect estimates are reported as relative risk (RR) with 95% CI. Results: Of the 300 women included in the original RCT, 117 (39.0%) were included in the long‐term follow‐up analysis, comprising 51 in the monofilament group and 66 in the multifilament group. There was no significant difference in the primary outcome of postmenstrual spotting between the monofilament and multifilament groups (23.5% vs 22.7%; RR, 1.04 (95% CI, 0.53–2.01)). Similarly, no significant differences were observed between groups for other gynecological symptoms. Ultrasound data were available for 21 women, of whom 13 had a Cesarean‐scar defect. The overall prevalence of Cesarean‐scar defects was similar between groups, although defects ≥ 4 mm were more frequent in the multifilament group (RR, 0.42 (95% CI, 0.18–0.97); P = 0.04). Most reproductive outcomes, including infertility and pregnancy outcomes among women who conceived, were comparable between groups. However, subsequent pregnancy occurred more frequently in the monofilament group (29.4% vs 12.1%; RR, 2.43 (95% CI, 1.12–5.27)). Conclusions: In this long‐term follow‐up of a RCT, monofilament and multifilament sutures for uterine closure were associated with similar long‐term gynecological symptoms. Differences observed in selected ultrasound and reproductive outcomes should be interpreted cautiously because of the limited sample size and exploratory nature of these analyses. Further studies are needed to better evaluate the potential impact of suture material on long‐term reproductive outcomes and sonographic Cesarean‐scar characteristics. © 2026 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 objective of the study is to compare the hematologic response to three oral iron regimens during pregnancy and to evaluate differences in treatment efficacy across distinct obstetric populations. Specifically, we compared ferrous sulfate 100 mg once a day with two doses of Iron Hydroxide Adipate Tartrate (IHAT^TM), 30 mg once a day and 60 mg daily (i.e., 30 mg twice a day) after 24 weeks of supplementation. This retrospective observational study was conducted at the Department of Public Health, University of Naples Federico II, Naples, Italy. We analyzed clinical data retrospectively collected from 60 pregnant women with iron deficiency anemia managed between September 2025 and March 2026, who completed 24 weeks of oral iron therapy and distributed across five predefined population clusters: singleton low-risk pregnancy, multiple gestation, increased surgical risk, high-risk pregnancy, and gastrointestinal disorders affecting iron absorption. Each cluster included 12 participants equally allocated to three treatment groups: ferrous sulfate 100 mg (arm A), IHAT^TM 30 mg (arm B), and IHAT^TM 60 mg (arm C). The primary outcome was the change in hemoglobin concentration from baseline to 24 weeks after treatment initiation. Subgroup analyses were performed according to population cluster. A total of 60 participants were included (20 per treatment group). Hemoglobin levels increased progressively during follow-up in all treatment arms. At 24 weeks, the mean hemoglobin increase from baseline was 0.87 ± 0.29 g/dL in the ferrous sulfate group, 1.48 ± 0.34 g/dL in the IHAT^TM 30 mg group, and 1.96 ± 0.41 g/dL in the IHAT^TM 60 mg group (p < 0.001). Ferritin levels increased by 7.4 ± 2.7 ng/mL, 14.6 ± 3.3 ng/mL, and 21.3 ± 4.6 ng/mL in the three treatment groups, respectively (p < 0.001). Gastrointestinal adverse events were more frequent with ferrous sulfate (55%) compared with IHAT^TM 60 mg (25%) and IHAT^TM 30 mg (0%) (p = 0.0004). Subgroup analysis across the five population clusters showed a consistent pattern, with greater hemoglobin increases observed with IHAT^TM compared with ferrous sulfate, including among women with gastrointestinal conditions affecting iron absorption. In this retrospective observational study, oral IHAT^TM demonstrated greater improvement in hemoglobin and iron parameters compared with conventional ferrous sulfate after 24 weeks of treatment, with the largest effect observed with the 60 mg dose. This pattern was consistent across the predefined obstetric populations and was accompanied by fewer gastrointestinal adverse events.

Objective: To evaluate the real-world effectiveness and tolerability of Iron Hydroxide Adipate Tartrate (IHAT^TM) in women with iron deficiency across three common obstetric and gynecologic clinical settings: pregnancy, the postpartum period, and abnormal uterine bleeding. Methods: This prospective multicenter observational real-world study included women with iron deficiency managed in routine clinical practice across Italy. Participating gynecologists collected data using standardized case report forms. Patients received IHAT^TM according to routine clinical practice and were followed for approximately three months. Baseline demographic and hematologic parameters were recorded, including hemoglobin and ferritin levels. The primary outcome was the change in hemoglobin between baseline and follow-up. Secondary outcomes included changes in ferritin levels, treatment adherence, and tolerability. Results: A total of 517 women was included in the analysis. The study population included pregnant women (N = 287, 55.5%), women with abnormal uterine bleeding (N = 161, 31.1%), and women in the postpartum period (N = 69, 13.3%). Improvements in hemoglobin were observed across all clinical settings, with hemoglobin increasing from 10.35 g/dL at baseline to 11.63 g/dL at three months, corresponding to a mean increase of 1.28 g/dL. Mean ferritin levels increased from 22.50 ng/mL to 37.74 ng/mL in three months. Treatment adherence was high or moderate in 93.4% of patients. Gastrointestinal adverse events were infrequent, with constipation (9.7%) and nausea (4.8%) among the most reported. Conclusions: In this prospective real-world multicenter study, treatment with IHAT^TM was associated with meaningful improvements in hemoglobin and iron stores in women with iron deficiency across pregnancy, postpartum, and abnormal uterine bleeding. The treatment showed good adherence and a favorable tolerability profile in routine clinical practice.

Objective To evaluate the real-world effectiveness and tolerability of Iron Hydroxide Adipate Tartrate (IHATTM) in women with iron deficiency across three common obstetric and gynecologic clinical settings: pregnancy, the postpartum period, and abnormal uterine bleeding. Methods This prospective multicenter observational real-world study included women with iron deficiency managed in routine clinical practice across Italy. Participating gynecologists collected data using standardized case report forms. Patients received IHATTM according to routine clinical practice and were followed for approximately three months. Baseline demographic and hematologic parameters were recorded, including hemoglobin and ferritin levels. The primary outcome was the change in hemoglobin between baseline and follow-up. Secondary outcomes included changes in ferritin levels, treatment adherence, and tolerability. Results A total of 517 women was included in the analysis. The study population included pregnant women (N=287, 55.5%), women with abnormal uterine bleeding (N=161, 31.1%), and women in the postpartum period (N=69, 13.3%). Improvements in hemoglobin were observed across all clinical settings with hemoglobin increasing from 10.35 g/dL at baseline to 11.63 g/dL at three months, corresponding to a mean increase of 1.28 g/dL. Mean ferritin levels increased from 22.50 ng/mL to 37.74 ng/mL in three months. Treatment adherence was high or moderate in 93.4% of patients. Gastrointestinal adverse events were infrequent, with constipation (9.7%) and nausea (4.8%) among the most reported. Conclusion In this prospective real-world multicenter study, treatment with IHATTM was associated with meaningful improvements in hemoglobin and iron stores in women with iron deficiency across pregnancy, postpartum, and abnormal uterine bleeding. The treatment showed good adherence and a favorable tolerability profile in routine clinical practice.