Background: Recurrent pregnancy loss (RPL) is a complicated reproductive disorder with underlying genetic and immunological causes. RPL may be influenced by hereditary thrombophilia, a class of blood clottingrelated genetic abnormalities, via the vascular and immune systems. This study examines the immunological characteristics that hereditary thrombophilia patients have in common with RPL. Methods: A prospective cohort study included 300 patients split into two groups: a control group without hereditary thrombophilia and a group with the condition. Interleukin-6 (IL -6), tumor necrosis factor -alpha (TNF-alpha), and interferon -gamma (IFN-gamma) levels were measured, along with demographic specifics, antiphospholipid antibodies, natural killer (NK) cell counts, and other cytokines. Group differences were found using statistical analysis. Results: Antiphospholipid antibodies were significantly more common in the thrombophilia group (42% testing positive, p=0.001) compared to the control group (12% testing positive), despite demographic factors being similar between groups (p=0.372 and p=0.093). When body mass index (BMI) was taken into account, the study found a statistically significant difference (p=0.046), with the thrombophilia group having a higher mean BMI (26.3 kg/m2, standard deviation (SD): 2.8) than the control group (24.7 kg/m 2, SD: 3.1). IL -6 (14.8 pg/mL, SD: 3.2, p=0.029) were higher than the control group (12.4 pg/mL, SD: 2.1), and TNF-alpha levels were higher in the thrombophilia group (10.5 pg/mL, SD: 2.0, p=0.012) compared to the control group (8.9 pg/mL, SD: 1.5), but NK cell counts did not differ significantly (p=0.213). Conclusion: This study emphasizes the role of elevated pro -inflammatory cytokines (IL -6 and TNF-alpha) and antiphospholipid antibodies in RPL among people with hereditary thrombophilia. In this population, early detection and immunomodulatory interventions may improve pregnancy outcomes. To fully comprehend these mechanisms and create customized treatments, collaborative research is required.

From the time of conception until the time of labor, a woman's body and mind undergo a variety of hormonal and other changes. Patients may also experience vertigo and a lack of balance during this period. Disabling and physically painful, these symptoms may strike at any moment. Pregnancy-related vertigo has been the focus of several studies. We looked at the research on vertigo in pregnant women in detail. This narrative review aims to examine the causes, pathophysiology, and current treatments for vertigo during pregnancy. Vertigo during pregnancy has a diverse etiology, with typical causes including hormonal changes and modifications in vascular dynamics. Vertigo may start to appear due to pathophysiological mechanisms involving vestibular and central nervous system adaptations. Numerous alternatives for treatment are available, including dietary changes, vestibular therapy, medicines, and surgical procedures. The thorough assessment of the current research on vertigo during pregnancy provided by this narrative review will help medical practitioners make wise clinical decisions.

Objective. To investigate the impact of thrombophilia on pregnancy-associated plasma protein A (PAPP-A) and human chorionic gonadotropin (hCG) and the nuchal translucency (NT) during the first trimester of the pregnancy. Material and Methods. A case-control research study was conducted at a prenatal outpatient unit of a tertiary referral hospital in Burgas, Bulgaria, between January 1st, 2021 and March 31st, 2023. A total of 309 pregnant women patients with congenital thrombophilia took part in the experimental research of the study, while 150 healthy pregnant women patients without evidence of thrombophilia were the control sample. Results. A statistically significant difference in the pregnancy-associated plasma protein A (PAPP-A), t(369) = 1.028, p < 0.05 between the two groups, with the experimental group reporting lower multiples of median (MoM) values as compared to the control group. The results showed statistically significant differences in the median values of PAPP-A and NT between the different types of inherited thrombophilia but no statistically significant difference in the median values of HCG. The results showed no statistically significant difference in age, gravidity, or parity between the experimental and control groups. Conclusion. The first trimester combined aneuploidy screening parameters are important in prenatal detection of the pregnancy status for identification of any variations in terms of chromosomal and fetal structural anomalies. Inherited thrombophilia adversely impacts the aneuploidy screening parameters during the first trimester of pregnancy.

Background: Vitamin D is essential for maternal health, fetal development, and pregnancy outcomes. Despite its importance, vitamin D deficiency is highly prevalent among pregnant women, increasing the risk of gestational diabetes mellitus (GDM), preeclampsia, preterm birth, and fetal growth restriction. Objective: This article explores the impact of maternal vitamin D deficiency on pregnancy outcomes and evaluates current strategies for its management and prevention, and supplementation. Methods: We onducted a comprehensive literature review of clinical trials, meta-analyses, and systematic reviews, focusing on the association between vitamin D levels and pregnancy complications and the effectiveness of supplementation and public health interventions. ]Results: Studies suggest that vitamin D deficiency is linked to poor pregnancy outcomes, including hypertension, GDM, low birth weight, and neonatal health complications. Vitamin D supplementation (600–4,000 lU/day) has shown potential benefits in reducing these risks, but the optimal dosage and screening strategies remain debated. Food fortification and sunlight exposure may be complementary approaches to improve maternal vitamin D status. Conclusion: Managing vitamin D deficiency during pregnancy requires a multifaceted approach, including early screening, appropriate supplementation, dietary interventions, and public health policies. However, further large-scale clinical trials are needed to establish standardised guidelines for universal supplementation. Addressing vitamin D deficiency can significantly enhance maternal and neonatal health outcomes, making it a crucial public health priority.

The current article aims to provide an analytical review of the aetiology, pathophysiology, diagnosis, and treatment of recurrent pregnancy loss (RPL) with a focus on Bulgaria. RPL has become an important reproductive health issue worldwide and affects 2%–3% of reproductive-aged women. The findings showed that the etiological factors can be biological, hereditary or environmental, and in approximately 50% of RPL cases, these factors remain unknown. In relation to pathophysiological processes associated with the condition, the findings showed that different etiological factors affect different gestational processes, such as alteration of the structural and nanomechanical abnormalities of the platelets and disruption of the ANXA5 protective shield that prevents adverse pregnancy outcomes. Also, acquired uterine structural defects such as submucosal uterine leiomyomas, endometrial synechiae, and polyps disrupt the implantation and embryonic development processes, which can result in recurrent miscarriages. A common factor for diagnostic approaches to recurrent pregnancy loss is the examination of historical medical records of patients who have experienced the condition and the identification of possible etiological and risk factors. The management and treatment of recurrent pregnancy loss are often based on the results of the diagnostic tests used to determine the underlying etiological factors associated with the condition.

Background and Objectives: The rising rate of cesarean delivery worldwide has led to an increasing number of women considering their options for birth after a previous cesarean section. Vaginal birth after cesarean (VBAC) offers potential maternal benefits but remains associated with concerns regarding maternal and neonatal safety. This systematic review and meta-analysis aimed to evaluate VBAC success rates and compare maternal and neonatal outcomes associated with trial of labor after cesarean (TOLAC) and elective repeat cesarean delivery (ERCD). Materials and Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines. PubMed/MEDLINE, Embase, and CENTRAL were searched for studies published between January 2010 and January 2026. Pooled proportions were calculated for VBAC success rates, while pooled risk ratios (RRs) with 95% confidence intervals (CIs) were used to evaluate comparative outcomes when sufficient data were available. Results: Thirty-one studies, including one randomized controlled trial and thirty observational studies, were included. The overall VBAC success rate was 67.7% (95% CI 61.8–73.6%), although substantial heterogeneity was observed across studies (I² = 98.7%). No evidence of significant small-study effects was identified. Women undergoing TOLAC had a higher, although imprecisely estimated, risk of uterine rupture compared with those undergoing ERCD (RR 6.86, 95% CI 0.72–65.07). No statistically significant differences were found for maternal transfusion (RR 2.08, 95% CI 0.43–10.14) or postpartum hemorrhage (RR 1.47, 95% CI 0.04–55.03). Neonatal outcomes were reported inconsistently and could not be reliably pooled. Conclusions: VBAC may be an appropriate option for carefully selected women after individualized assessment of the likelihood of successful vaginal birth and the potential risks associated with TOLAC. However, the available evidence is based predominantly on observational studies, and the certainty of evidence for most comparative outcomes remains low or very low. These findings support individualized counselling and shared decision-making while highlighting the need for larger, well-designed comparative studies with standardized outcome reporting.