Background: Preoperative differentiation between uterine mesenchymal tumors and benign uterine fibroids remains challenging in postmenopausal women. This study aimed to develop an exploratory risk-stratification model for uterine mesenchymal tumors and to characterize complementary molecular features of uterine leiomyosarcoma using a public transcriptomic dataset. Methods: A retrospective case–control study was conducted in postmenopausal patients with uterine masses who underwent surgery between 2011 and 2021. A total of 23 uterine mesenchymal tumor cases and 92 frequency-matched fibroid controls were included. Clinical variables were analyzed using univariable and multivariable logistic regression to develop an exploratory risk-stratification model. Model performance was evaluated using ROC analysis, calibration analysis, decision curve analysis, and confusion matrix assessment. Exploratory transcriptomic analysis was performed using the GEO dataset GSE64763 to characterize molecular differences between uterine leiomyosarcoma and fibroid tissues. Results: Pelvic pressure, abnormal uterine bleeding, and tumor diameter were independently associated with uterine mesenchymal tumors. The model achieved an apparent AUC of 0.859 and an optimism-corrected AUC of 0.846 after 1000 bootstrap resamples. Exploratory transcriptomic analysis revealed distinct expression patterns and upregulation of proliferation-associated genes, including CCNB1, BUB1B, PRC1, TOP2A, and FOXM1, with enrichment of cell cycle–related pathways. Conclusions: An exploratory model based on routinely available preoperative variables demonstrated preliminary discriminatory ability within the development cohort. Independent external validation in representative prospective cohorts is required before any assessment of clinical utility.

Objective: To identify the high risk factors associated with postpartum hemorrhage (PPH) after selective cesarean delivery of twins. Methods: This retrospective cohort study included all women with twin gestations who choosed an elective cesarean delivery after 28 weeks of gestation at Women's Hospital of Zhejiang University School of m from September 2014 to April 2019. The Women with an intrauterine fetal demise one or both of twins were excluded.A total of 532 wemen were analysed,they were classified as PPH group(n=70) and No PPH group(n=462). Estimated blood loss greater than or equal to 1000 ml was defined as Postpartum hemorrhage(PPH).Univariate and multivariate logistic regression analysis were performed to assess the independent risk factors.Results: Of the 532 twin pregnant women, PPH occurred in 13.2% (n=70). There were statistically signifcant diferences in preeclampsia (P=0.005), premature rupture of membranes(P<0.001), placental adhesion (P<0.001), placenta previa (P<0.001), hemoglobin (Hb)< 100 g/L（P=0.003)）, hematocrit (HCT)< 0.39（P=0.004）.However, the indepedent risk factors for PPH after selective cesarean delivery for twin pregnancy were preeclampsia (OR3.538, p < 0.05), premature rupture of membranes (OR17.9, P < 0.05), placental adhesion (OR5.71, p < 0.05) and placenta previa (OR10, p < 0.05). Conclusions: preeclampsia , premature rupture of membranes , placental adhesion and placenta previa were risk factors for postpartum hemorrhage after elective cesarean section for twin pregnancy. Risk factor identification and prevention should be a priority.