Artem A. Aksenenko, Tatyana A. Kodyleva, Polina O. Patskova, Alla A. Gavisova, Gennadiy T. Sukhikh
Monochorionic triamniotic triplet pregnancy following single embryo transfer is an exceptionally rare outcome of assisted reproductive technology. We report a monochorionic triamniotic triplet pregnancy following transfer of a single vitrified-warmed blastocyst. Fertilization was performed by intracytoplasmic sperm injection, with no assisted hatching, trophectoderm biopsy or preimplantation genetic testing. Initial transvaginal ultrasound 21 days after embryo transfer demonstrated a singleton intrauterine pregnancy. At 8 weeks and 1 day of gestation, three viable embryos were identified within a monochorionic triamniotic pregnancy. The pregnancy remained uncomplicated, with appropriate growth of all three fetuses, and three live female infants were delivered at 35 weeks of gestation. This case adds to the limited number of reported monochorionic triamniotic triplet pregnancies following single embryo transfer and is distinguished by transfer of a day-6 vitrified-warmed blastocyst that re-expanded from grade 2BB after warming to 6BB before transfer, without assisted hatching, trophectoderm biopsy or preimplantation genetic testing.
Advanced maternal age (AMA), commonly defined as maternal age ≥35 years, has been associated with adverse pregnancy outcomes. However, evidence from Libya and the wider North African region remains limited. This study examined maternal and neonatal outcomes associated with AMA in a Libyan cohort. This retrospective, record-based cross-sectional study included deliveries at Benghazi Medical Centre between 1 April 2017 and 25 December 2019. A systematic random sample of 450 singleton delivery records was selected from 9,450 eligible deliveries. After excluding six women aged 17–19 years, the final analysis included 444 women aged 20–45 years. Firth penalized-likelihood logistic regression was used to adjust for parity, body mass index, and pre-existing diabetes mellitus. Of the 444 women included, 243 (54.7%) were aged ≥35 years. AMA was associated with higher crude odds of preterm labour (OR 2.01, 95% CI 1.09–3.68) and preterm birth (OR 2.08, 95% CI 1.12–3.86). After adjustment, these associations were attenuated, and the confidence intervals included the null (aOR 1.76, 95% CI 0.93–3.31 and aOR 1.87, 95% CI 0.98–3.56, respectively). Pre-existing diabetes was observed only among women aged ≥35 years. Meconium aspiration was less frequent in the AMA group, although this finding should be interpreted cautiously because of the small number of events. In this predominantly multiparous Libyan cohort from a tertiary referral centre, adjustment for baseline maternal characteristics reduced the strength of the main crude associations with maternal age. These findings suggest that maternal age should be considered alongside parity and maternal medical history when assessing antenatal risk.
Digital access may influence how women obtain health information, communicate, and navigate healthcare, but it is also strongly shaped by socioeconomic and geographic disadvantage. We examined associations between recent digital access and maternal healthcare utilization among women in Pakistan and assessed whether these associations differed by socioeconomic position. We analyzed 2024–25 Household Integrated Economic Survey data from 10,723 ever-married women aged 15–49 years who reported a live birth during the preceding three years in Pakistan's four provinces. Recent digital access during the three months before interview was classified into four mutually exclusive nominal categories: fully disconnected, offline device use, Internet use without any of 11 specified ICT activities, and Internet use with ≥1 recorded ICT activity. Primary outcomes were ≥4 antenatal-care contacts (ANC ≥4), facility delivery, and maternal postnatal care (PNC) within six weeks. Survey-weighted modified Poisson models estimated adjusted prevalence ratios (aPRs), with maternal age modeled using linear and quadratic terms and lifetime live births continuously. Marginal standardization estimated adjusted prevalences and absolute differences. Fully disconnected women had lower adjusted prevalence of ANC ≥4 than women reporting Internet use with ≥1 recorded ICT activity (aPR 0.75, 95% CI 0.67–0.85), corresponding to standardized prevalences of 47.2% and 58.6%, respectively (difference −11.4 percentage points, 95% CI −13.9 to −8.9). The association with ANC differed across household consumption quintiles (interaction P = 0.004). Among women in the poorest quintile, 19.2% reported Internet use with ≥1 recorded ICT activity, compared with 84.2% among women in the richest quintile. Associations were smaller for facility delivery (aPR 0.94, 95% CI 0.89–1.00) and maternal PNC (0.87, 0.76–0.99) and were less consistent across sensitivity analyses. The ANC association remained evident after additional social-context, temporal, missing-data, and finer-geographic analyses. Complete digital disconnection was consistently associated with lower antenatal-care utilization and was concentrated among socioeconomically disadvantaged women. Associations with facility delivery and maternal PNC were weaker and more context-sensitive, indicating that recent digital access does not relate uniformly to all stages of maternal care. Because digital status was measured near the survey interview and may have changed after the index pregnancy, these findings are associational and do not establish a causal effect of digital access on maternal healthcare use.
Fanourios Makrygiannakis, Thomas Vrekoussis, Maria Marmara, Aikaterini Berdiaki, Antonis Makrigiannakis
Repeated implantation failure (RIF) remains a significant challenge in assisted reproductive technology, with approximately two-thirds of cases attributed to impaired endometrial receptivity. This review highlights the role of autologous platelet-rich plasma (PRP) as a regenerative adjuvant for rehabilitating the uterine environment. Molecular mechanisms and clinical evidence are presented. It is evident that the concentrated growth factors in PRP—such as VEGF, PDGF, and TGF-beta—promote cell proliferation, angiogenesis, immunomodulation and tissue remodeling. Α consistent statistical trend is recognized toward improved clinical pregnancy and live birth rates across multiple meta-analyses. However, a critical methodological-clinical gap is identified, noting that the current evidence base is compromised by a high risk of bias, non-standardized preparation protocols, and inconsistent diagnostic criteria for RIF. While PRP shows significant biological promise in transforming a hostile uterine environment into a receptive one, its routine clinical application is currently cautioned. Until large-scale, properly blinded randomized controlled trials -utilizing standardized ESHRE definitions- are conducted, PRP should be regarded as an experimental tool rather than a validated standard of care.
Fertility is a key demographic and public health phenomenon reflecting actual childbearing within a population. It can be characterized using several measures, including total fertility rate, age-specific fertility rates, children ever born, and the number of births occurring within a defined reference period. These measures capture different dimensions of reproductive experience and are associated with a complex interplay of socioeconomic, demographic, cultural, biological, and policy-related factors. By dividing the nine regions into urban and rural categories, twenty-one sampling strata were created. The survey employed a two-stage stratified cluster sampling design. In the first stage, 305 enumeration areas (EAs) were selected from the national sampling frame using probability proportional to size. A total of 8,885 women were included in the descriptive analysis, while the primary multivariable analysis was restricted to 6,585 ever-married/partnered women. A survey-adjusted Poisson regression model was used to examine associations between explanatory variables and the number of live births during the five years preceding the survey. Statistical significance was assessed using a two-sided p -value of <0.05. The mean age of the participants was 27.6 years. More than four-fifths of women had either no formal education (40.4%) or primary education (41.7%). Compared with women aged 15–19 years, the expected number of recent live births was higher among women aged 20–24 years (aIRR = 2.129, 95% CI: 1.759–2.577). Women residing in Amhara had a lower expected number of recent live births than women residing in Tigray (aIRR = 0.765, 95% CI: 0.658–0.890). Lower expected counts were also observed in Addis Ababa (aIRR = 0.818, 95% CI: 0.684–0.979) and Dire Dawa (aIRR = 0.792, 95% CI: 0.659–0.952). An inverse association was observed between household wealth and recent live-birth counts. These findings highlight the multifactorial nature of recent live births in Ethiopia and suggest that fertility patterns are associated with a combination of individual, household, and contextual factors. These insights may help inform evidence-based reproductive health and family planning policies tailored to the Ethiopian context.
