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A new study published in the journal of BMC Pregnancy and Childbirth revealed that postpartum hemorrhage (PPH) is not well predicted by the HEMSTOP bleeding score.

In high-income nations, postpartum hemorrhage affects 5% of births and continues to be the primary cause of maternal morbidity and death globally. In order to start active management of delivery and early detection and treatment of PPH, it is imperative to identify women who are at greater risk. Inherited mild-to-moderate bleeding disorders (MBDs) are one of the maternal risk factors for PPH that may be identified and treated.

High percentages of MBDs were identified in 2 recent studies examining hemostasis in women following severe PPH (23% and 56%, respectively). The women in these studies were sent to hemostasis specialists due to an unusual PPH course. The function of MBDs in PPH, particularly in unselected parturients, is therefore little understood. This study was to ascertain the predictive usefulness of the HEMSTOP bleeding score for the incidence of PPH in unselected parturients using prospective data and various adjusted analyses.

Women who completed the HEMSTOP questionnaire before to delivery and had no known bleeding disorders or antithrombotic medications were included in a prospective cohort research that was carried out in a tertiary maternity hospital between 2014 and 2016. Primary PPH > 500 mL after birth was the main result. This research looked at the bleeding score, which ranges from 0 to 7, as an ordinal and continuous variable. They adjusted for PPH risk variables in our multivariable analysis. Also, this study calculated the prognostic accuracy metrics for the bleeding score.

Out of 2,536 women, 116 (4.6%) experienced PPH. When compared to a score of 0, elevated bleeding scores were linked to increased PPH risk, showing a progressive increase in risk along with score escalation (adjusted RR = 1.58; 95% CI, 1.01 to 2.46 for a score of one, adjusted RR = 2.11, 95% CI 0.86 to 5.20 for a score of two, and adjusted RR = 7.20, 95% CI 2.54 to 20.41 for a score of three; P < 0.001).

The accuracy of the bleeding score in predicting PPH had an area under the curve of 0.56. Overall, the evaluation of main PPH risk benefits from the computation of the HEMSTOP bleeding score in pregnant women who are not chosen.

Reference:

Deleu, F., Nebout, S., Peynaud-Debayle, E., Mandelbrot, L., & Keita, H. (2025). A high HEMSTOP bleeding score is a major independent risk factor for postpartum hemorrhage: a prospective cohort study. BMC Pregnancy and Childbirth, 25(1). https://doi.org/10.1186/s12884-025-07281-0

A new study published in JAMA determined that the addition of sugemalimab to chemotherapy enhances overall and progression-free survival in patients with previously untreated, unresectable, locally advanced, or metastatic gastric or gastroesophageal junction adenocarcinoma. The GEMSTONE-303 phase 3 trial, which was carried out at 54 centers in China, proved that patients treated with sugemalimab in combination with capecitabine and oxaliplatin (CAPOX) achieved a median overall survival of 15.6 months. This study was conducted by Xiaotian Z. and colleagues.

Diagnostic tests and treatments for infertility must be accessible to all individuals requiring these services. Discrepancies in infertility rates and obstacles to obtaining assisted reproductive technology should be recognized and tackled within the context of reproductive justice. Drawing from the guidelines established in this Committee Statement, the American College of Obstetricians and Gynecologists (ACOG) presents recommendations and insights concerning infertility within historically marginalized and deliberately excluded communities.

Disparities in Accessing Infertility Services

The paper focuses on the disparities in accessing infertility services and the importance of addressing these inequities within a reproductive justice framework. It highlights the need for diagnostic testing and treatment for infertility to be available to all individuals in need. The paper emphasizes that health care professionals should identify specific populations at risk, advocate for insurance coverage for infertility services, policy changes, and evidence-based, affordable treatment options.

Infertility as a Medical Disease

The paper stresses that infertility is a medical disease and not merely a social condition, urging health care professionals to provide medically and ethically sound care tailored to the patient’s diagnosis. Obstetrician-gynecologists are recommended to inquire about reproductive planning and attempts at pregnancy, refer patients to subspecialists when necessary, and understand the specific barriers different populations face in accessing infertility care.

Disparities Highlighted in Infertility Care

Furthermore, the paper highlights disparities in both infertility prevalence and access to services. It mentions that certain racial and ethnic groups, such as Black women and Asian American patients, may have higher rates of infertility. It also discusses lower utilization of infertility services among Hispanic women and American Indian/Alaska Native populations. The paper points out the need for continuing research to improve outcomes, particularly in communities facing obstacles in accessing infertility services.

Reproductive Justice and Fertility Options

Reproductive justice, developed in the 1990s, emphasizes reproductive autonomy and the right to fertility options. Health care professionals are encouraged to address social determinants of health, mitigate biases, collaborate with support agencies, offer patient education on fertility, and advocate for insurance coverage for infertility services. The paper underlines the importance of recognizing and addressing biases in health care delivery, especially related to systemic racism and cultural beliefs affecting access to care.

Economic Barriers in Infertility Treatment Access

Moreover, the paper discusses economic barriers hindering infertility treatment access, particularly for marginalized communities. It calls for comprehensive insurance coverage for fertility treatment and the promotion of evidence-based, cost-effective treatment options. The importance of patient education on fertility, addressing health literacy disparities, and the need for inclusive research reporting to better understand disparities in infertility care are also highlighted.

Promoting Equitable Infertility Care

Overall, the paper emphasizes the significance of promoting access to infertility services, advocating for policy changes, and ensuring equitable care for all individuals, regardless of race, ethnicity, socioeconomic status, or gender identity, to achieve reproductive justice in the realm of infertility care.

Key Points

1.*Disparities in Accessing Infertility Services**: The paper highlights the importance of addressing inequities in accessing infertility services within a reproductive justice framework. It advocates for diagnostic testing and treatment to be available to all in need and stresses the role of health care profess*ionals in identifying at-risk populations and advocating for insurance coverage and policy changes.

2. Infertility as a Medical Disease*: Infertility is depicted as a medical disease rather than solely a social condition. The paper urges healthcare professionals to provide ethically sound care tailored to each patient’s diagnosis. Obstetrician-gynecologists are recommended to inquire about reproductive planning, refer patients to subspecialists as needed, and understand the unique barriers different populations face in accessing infertility care.

3. *Disparities Highlighted in Infertility Care*: Disparities in infertility prevalence and service access are discussed, with certain racial and ethnic groups, such as Black women and Asian American patients, identified as having higher infertility rates. Lower utilization of infertility services is noted among Hispanic women and American Indian/Alaska Native populations, emphasizing the need for further research to improve outcomes, especially in communities facing barriers to infertility services.

4. *Reproductive Justice and Fertility Options*: The concept of reproductive justice, emphasizing reproductive autonomy and the right to fertility options, is introduced. Health care professionals are encouraged to address social determinants of health, mitigate biases, collaborate with support agencies, provide patient education on fertility, and advocate for insurance coverage for infertility services. Recognizing and addressing biases in healthcare delivery, particularly related to systemic racism and cultural beliefs impacting care access, is highlighted.

5. *Economic Barriers in Infertility Treatment Access*: Economic barriers that hinder access to infertility treatment, particularly for marginalized communities, are discussed. Comprehensive insurance coverage for fertility treatment, promotion of evidence-based and cost-effective treatment options, patient education on fertility, addressing health literacy disparities, and inclusive research reporting to better understand disparities in infertility care are emphasized.

6. *Promoting Equitable Infertility Care*: The paper underscores the importance of promoting access to infertility services, advocating for policy changes, and ensuring equitable care for all individuals regardless of race, ethnicity, socioeconomic status, or gender identity. This inclusive approach aims to achieve reproductive justice in infertility care, emphasizing the need for fairness and equality in accessing and receiving infertility services.

Reference –

Infertility: Disparities and Access to Services: ACOG Committee Statement No. 14. Obstet Gynecol. 2025 Jan 1;145(1):e51-e57. doi: 10.1097/AOG.0000000000005769. PMID: 39666991.

Dongqing Wang, an assistant professor of Global and Community Health at George Mason’s College of Public Health, is pioneering research in prenatal nutritional interventions. His latest report identifies prenatal supplements that reduce health risks to small and vulnerable babies. This research was published in the prestigious The Lancet Global Health journal and funded by the Bill and Melinda Gates Foundation.

Wang found that compared to folic acid and iron alone, a multiple micronutrient supplement led to a 27% lower risk of giving birth to “small vulnerable newborn types,” or babies who suffered from preterm birth, low birthweight, and small-for-gestational-age birth-the three groups most likely to result in infant death.

In the past, these birth outcomes were all treated as separate conditions. Wang, however, delves into emerging science to look at different combinations across the three outcomes. Low birthweight, for example, can occur because of a short pregnancy, and growth restrictions can lead to babies born too small for their developmental age.

“Small vulnerable newborn types may have distinct mechanisms, health impacts, and intervention strategies,” says Wang. “This work is the first to examine the effects of prenatal multiple micronutrient supplements and small-quantity lipid-based nutrient supplements on the emerging outcomes of small vulnerable newborns.”

Folic acid and iron have been used to support prenatal health since the 1970s. Wang explored the effects of two additional types of prenatal supplements on women in low- and middle-income countries: prenatal multiple micronutrient supplements (MMS), similar to a common multivitamin, and small-quantity lipid-based nutrient supplements (SQ-LNS), which provide caloric nutrition and fatty acids in addition to vitamins.

He found that nearly all of these vitamins conferred some type of benefit-and some of them were hugely beneficial.

“This study underscores the important promise of nutritional supplements in prenatal care in low- and middle-income countries,” says Wang. “In particular, the protective effects of prenatal multiple micronutrients on most small vulnerable newborn types, particularly those with the greatest mortality risk, strongly supports switching from iron and folic acid supplements to MMS as the standard care.”

Combining 16 different studies, Wang analyzed how prenatal nutrition correlates to the occurrence of small vulnerable newborns. He believes that the right prenatal supplements can help mitigate them. Since more than 90% of pregnancies resulting in low birthweight occur in low- and middle-income countries, including those in sub-Saharan Africa and South Asia, Wang focused this work on those regions.

Reference:

Wang, Dongqing, Adu-Afarwuah, Seth et al. The effects of prenatal multiple micronutrient supplementation and small-quantity lipid-based nutrient supplementation on small vulnerable newborn types in low-income and middle-income countries: a meta-analysis of individual participant data, The Lancet Global Health.

Researchers have found in a new study that radiographs are effective in detecting pulp stones. However, further research is needed to evaluate their potential as a screening tool for early detection of systemic diseases.