Stress urinary incontinence affects a large proportion of women in their lifetime. The objective of this review was to describe and compare the latest surgical trends in urinary incontinence and focus on the literature advantages, disadvantages, complications and efficacy of surgical procedures regarding this pathology. Using network meta-analysis, we have identified the most frequently used procedures (Burch surgery, midurethral sling and pubovaginal sling), and we have described and characterized them in terms of effectiveness and safety. Midurethral procedures remain the gold standard for surgical treatment of stress urinary incontinence, although the potential of serious complications following this procedure should be taken into consideration always. There is a clear need for a much more unified evaluation of possible complications and postoperative evolution. This process will help practitioners to adapt and individualize their strategy for each patient.

Background: The human fetal adrenal gland is a unique endocrine organ with distinct morphology and functional dynamics, which is significantly different from the postnatal adrenal. Its rapid growth and vital steroidogenic role during gestation have positioned it as a key regulator of fetal development and pregnancy maintenance. Objectives: To provide a comprehensive overview of the morphogenesis, function, regulatory mechanisms, and clinical implications of the human fetal adrenal gland, highlighting recent advances in understanding its development and its role in prenatal and postnatal health outcomes. Methods: A systematic review was conducted, including original research articles focused on human fetuses or validated animal models, examining the genetic, molecular, and hormonal mechanisms underlying adrenal development and function. Studies were excluded if they were editorials, case reports, focused on adult adrenal physiology, had small sample sizes, or were non-English publications. Study quality was evaluated using PRISMA guidelines. Results: The fetal adrenal gland develops from both mesodermal and ectodermal origins, forming three primary zones: fetal, transitional, and definitive. Each zone has distinct functions and developmental pathways. The fetal zone, which predominates, is responsible for producing dehydroepiandrosterone sulfate, DHEA-S, which is crucial for placental estrogen synthesis. The adrenal gland undergoes rapid growth and functional maturation, regulated by ACTH, placental CRH, IGF, and the renin–angiotensin system. Disruption of adrenal function is associated with conditions such as preterm birth, adrenal hypoplasia, congenital adrenal hyperplasia, and intrauterine growth restriction. Emerging evidence suggests that fetal adrenal hormones may influence long-term health through fetal programming mechanisms. Conclusions: The fetal adrenal gland plays a critical and multifaceted role in fetal and placental development. This gland influences placental development via steroid precursors (DHEA-S → estrogen synthesis), while also being regulated by placental factors such as the corticotropin-releasing hormone. Understanding its complex structure–function relationships and regulatory networks is essential for predicting and managing prenatal and postnatal pathologies. Future research should focus on elucidating molecular mechanisms, improving diagnostic tools, and exploring long-term outcomes of altered fetal adrenal function.

Introduction Identifying a marker that is highly sensitive, specific, noninvasive, and cost-effective for predicting preterm labor remains a critical clinical priority. We propose that ultrasound assessment of fetal adrenal gland morphometry, especially measurement of adrenal gland volume, may help discriminate pregnancies at higher short-term risk of delivery among women presenting with threatened preterm labor. Objective The objective of the study is to evaluate the short-term discriminative performance of ultrasound-derived fetal adrenal gland morphometric parameters, particularly the fetal zone depth-to-total gland depth (d/D) ratio and corrected adrenal gland volume (cAGV), in identifying the risk of delivery within seven days in patients with threatened preterm labor. Methods This retrospective study included 52 singleton pregnancies between 28 and 35 weeks' gestation. Fetal adrenal gland dimensions and the fetal zone were measured via transabdominal ultrasound. Logistic regression and receiver operating characteristic (ROC) analysis were used to assess predictors of preterm birth within seven days of ultrasound evaluation. Results Both d/D ratio and cAGV were significantly higher in the early delivery group (p < 0.0001). Multivariable logistic regression identified d/D ratio as the strongest association with delivery within seven days. The model yielded an area under the curve (AUC) of 0.88. At the optimal probability threshold of 0.59, sensitivity was 85.7%, specificity 79.2%, positive predictive value (PPV) 82.8%, and negative predictive value (NPV) 83.3%. Conclusion Fetal adrenal morphometry, particularly d/D ratio and cAGV, can serve as valuable predictors of imminent preterm delivery and should be integrated into clinical assessment tools for symptomatic patients.

Background Fetal growth restriction (FGR), also referred to as intrauterine growth restriction (IUGR), results primarily from placental insufficiency and is associated with chronic fetal hypoxemia and adverse perinatal outcomes. Doppler surveillance traditionally focuses on umbilical artery and middle cerebral artery (MCA) indices to identify cerebral blood flow redistribution (“brain sparing”). However, these markers reflect only part of the fetal adaptive response and may not fully capture the systemic and chronic nature of fetal compromise. Objective To evaluate ophthalmic artery (OA) Doppler indices in fetuses with FGR, to examine their relationship with established MCA Doppler markers, and to describe fetal adrenal gland enlargement as a complementary structural marker of chronic intrauterine stress in the same cohort. Methods This observational study included 32 singleton pregnancies diagnosed with FGR in the third trimester. All fetuses underwent standardized Doppler ultrasound assessment of the MCA and OA. OA waveforms were analyzed for peak systolic velocity of the first and second systolic peaks, and the OA peak systolic velocity ratio (PSV2/PSV1) was calculated. MCA pulsatility index (PI), resistance index (RI), and cerebroplacental ratio (CPR) were interpreted using gestational age-specific reference ranges. In addition, fetal adrenal gland size was assessed using two-dimensional ultrasound, and whole adrenal gland volumes were calculated and corrected for estimated fetal weight. Results Fetuses with FGR demonstrated consistent alterations in cerebral and carotid-related hemodynamics, characterized by reduced MCA PI and CPR and increased OA PSV ratios, indicating cerebral redistribution and altered distal carotid vascular resistance. A significant inverse association was observed between OA PSV ratio and MCA PI. In parallel, corrected adrenal gland volumes were generally higher than values reported in published studies of normally grown fetuses, consistent with structural endocrine adaptation to chronic intrauterine stress. A qualitative trend was observed suggesting that fetuses with more pronounced cerebral redistribution may exhibit larger adrenal gland volumes, suggesting concurrent vascular and endocrine adaptive responses to chronic intrauterine hypoxia. Conclusion In fetuses with growth restriction, ophthalmic artery Doppler and fetal adrenal gland enlargement reflect complementary aspects of fetal adaptation to placental insufficiency. While OA and MCA Doppler indices characterize cerebral hemodynamic redistribution, adrenal gland enlargement represents a structural marker of sustained endocrine stress. Integrating vascular and structural markers may provide a more comprehensive evaluation of fetal adaptation in IUGR than cerebral Doppler assessment alone.

Cervical ectopic pregnancy is the rarest kind of ectopic pregnancy, and it is known as the implantation of an embryo into the cervical mucosa. It is commonly associated with complications such as hemorrhage from the cervix and can lead to severe consequences if it is not treated early. For this reason, the treatment for a cervical pregnancy often requires an abdominal hysterectomy. To avoid such radical management, several conservative methods of termination have been used. In this paper, we report a complex management of one of our ectopic cervical cases, which includes embolization of the uterine arteries, treatment with methotrexate and mifepristone, evacuation of the pregnancy followed by local hemostatic sutures and application of a balloon in the cervix. The post-operative period was uneventful. After a three-day postoperative stay, the patient was discharged. The management options employed in the presented case achieved the goal of preserving fertility for our patient. There are no specific guidelines for the treatment of cervical pregnancies in advanced gestational age.