Preeclampsia affects 2–8% of pregnancies globally and remains a leading cause of maternal and perinatal morbidity, with limited preventive options beyond low-dose aspirin. Low-molecular-weight heparin (LMWH) has emerged as a promising therapeutic candidate due to its pleiotropic effects extending beyond anticoagulation, including anti-inflammatory, pro-angiogenic, and placental-protective properties. This comprehensive narrative review examines LMWH’s effects on preeclampsia-associated biomarkers and evaluates clinical evidence for its preventive efficacy. LMWH exerts multifaceted effects on disease pathophysiology, including restoration of angiogenic balance through sFlt-1 reduction and PlGF preservation, attenuation of inflammatory responses via decreased TNF-α and IL-6 production, normalization of coagulation parameters, and enhancement of trophoblast invasion and placental vascularization. Clinical trials reveal heterogeneous results, with meta-analyses suggesting significant benefit primarily in high-risk subgroups. Women with previous severe placenta-mediated complications demonstrate relative risk reductions of 40–60% for recurrent preeclampsia with LMWH prophylaxis, particularly when initiated before 16 weeks’ gestation. Combination therapy with low-dose aspirin appears to enhance protective effects. However, larger trials in unselected populations have failed to demonstrate significant benefit, highlighting the importance of appropriate patient selection. Current international guidelines reflect this evidence heterogeneity, with most recommending against routine LMWH use while acknowledging potential benefit in selected high-risk populations, particularly those with antiphospholipid syndrome or previous severe early-onset disease. Future research should focus on biomarker-guided patient selection, optimal dosing regimens, and integration with multimodal preventive strategies to maximize therapeutic benefit while minimizing unnecessary interventions.

Background/Objectives: Endocrine-disrupting chemicals (EDCs) interfere with hormonal homeostasis and have been implicated in gynecological malignancy pathogenesis. This narrative review synthesizes current evidence regarding EDC exposure and breast, endometrial, ovarian, and cervical cancers, examining molecular mechanisms, epidemiology, and diagnostic and clinical implications. Methods: We conducted a literature review using PubMed/MEDLINE, Embase, Scopus, and Cochrane databases through April 2026, including systematic reviews, meta-analyses, prospective cohorts, case-control studies, and mechanistic investigations examining EDC-cancer associations. Methodological quality was appraised using the Newcastle-Ottawa Scale and AMSTAR-2, with overall certainty of evidence rated using the GRADE framework. Results: Major EDC classes—bisphenol compounds, phthalates, polychlorinated biphenyls, organochlorine pesticides, and per- and polyfluoroalkyl substances—demonstrate carcinogenic potential through estrogen receptor modulation, epigenetic alterations, oxidative stress, and oncogenic signaling disruption. Breast cancer shows the strongest evidence, with prenatal and early-life DDT/DDE exposure associated with up to a 3.7-fold increased risk. Endometrial cancer demonstrates associations with xenoestrogen mixtures exhibiting non-monotonic dose-responses, whereas ovarian and cervical cancers show emerging but limited associations. Common mechanisms include receptor crosstalk, epigenetic dysregulation with transgenerational effects, oxidative genomic instability, metabolic reprogramming, and cancer stem cell enrichment. Conclusions: Evidence supports EDC contributions to gynecological malignancy through convergent pathways, though causal inference remains constrained by observational epidemiology, long latency periods, and challenges in characterizing real-world mixture exposures. Diagnostic and prevention strategies should integrate EDC exposure into risk-prediction models, leverage multi-omics biomarkers for early detection, and emphasize exposure reduction during critical developmental windows alongside regulatory reform.

Introduction: Membrane prolapse represents a severe manifestation of cervical insufficiency, occurring in 0.3–1.0 % of pregnancies and posing significant risks for extreme prematurity and perinatal mortality. Despite decades of clinical experience, optimal management remains controversial. Content: This narrative review synthesizes current evidence on pathophysiology, diagnosis, and management of membrane prolapse. We examine biomechanical and inflammatory mechanisms, diagnostic criteria, including cervical length assessment and amniocentesis, as well as therapeutic strategies, such as emergency cerclage and expectant management. Evidence-based perioperative care includes prophylactic antibiotics (cefazolin plus azithromycin), tocolytic therapy for uterine quiescence, antenatal corticosteroids (betamethasone or dexamethasone) between 24 and 34 weeks, and magnesium sulfate for fetal neuroprotection before 32 weeks. Summary: Emergency cerclage achieves fetal survival rates of approximately 73 % in carefully selected patients presenting between 16 and 24 weeks with cervical dilation of 2–4 cm and absence of intraamniotic infection. Amniocentesis is critical when cervical dilation exceeds 2–3 cm, as infection represents the strongest predictor of treatment failure. Outcomes vary significantly based on clinical presentation, with negative amniocentesis associated with 70–80 % survival vs. 20–30 % with positive results. Outlook: Future research priorities include prospective randomized trials comparing emergency cerclage to expectant management, validation of biomarkers predicting infection and treatment success, optimization of perioperative protocols, and further development of innovative therapeutic strategies such as anti-inflammatory agents.

The value of postoperative critical care in gynecologic oncology surgery is crucial for the patient’s further postoperative course. For that reason different levels of postoperative care should exist, in order to identify in an early stage the possible complications and handle them properly . Strict indications of who should be admitted or not, should be defined and surgeons as well anesthesiologists should be aware of them. On the other hand, longer stay in hospital increases the likelihood of complications such as nosocomial infections and late ambulation, increasing morbidity and mortality. Therefore, longer stay in critical care units should be avoided, by predicting if patients are able to move to the general ward and later exit from the hospital. The next step is to set strict protocols for the indications of admission and decreased hospitalization by an accepted scientific team. These protocols should be applied universally in order to achieve the best possible outcomes in patients’ postoperative course.

Pre-eclampsia, a major obstetric syndrome with an estimated global incidence of 2–8% of all pregnancies, ranks among the foremost causes of adverse maternal and perinatal outcomes worldwide. The Systemic Immune-Inflammation Index (SII)—derived as the product of platelet and neutrophil counts divided by the lymphocyte count—is a composite hematological parameter first established in oncological research that simultaneously captures neutrophil activation, lymphocyte dysfunction, and platelet alterations—three immunohematological disturbances implicated in pre-eclampsia pathophysiology. This narrative review synthesizes the current evidence regarding SII in pre-eclampsia, examining the biological rationale, clinical study findings, comparative performance against established inflammatory biomarkers, practical advantages, and limitations. A comprehensive literature search encompassing PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar was conducted, covering all available records up to January 2026. The available data reveal substantial heterogeneity in both the direction of association (elevated versus paradoxically decreased SII in pre-eclampsia) and diagnostic performance across populations. While some studies report significantly elevated first-trimester SII values in women who subsequently develop pre-eclampsia, others demonstrate lower values or no significant predictive capacity. The only available meta-analysis reported non-significant pooled results for the pre-eclampsia-specific subgroup. Although SII’s derivation from routine complete blood count testing presents the advantages of cost-effectiveness and universal accessibility, methodological limitations—including retrospective study designs, the absence of standardized thresholds, the inconsistent discriminatory performance, and the conflicting directionality of association—preclude clinical implementation at present. Integration within multiparametric prediction models may optimize SII’s clinical utility. Future research should prioritize prospective validation studies across diverse populations, mechanistic investigations, and randomized controlled trials to establish evidence-based clinical translation.

Background/Objectives: Cervical insufficiency affects 1–2% of pregnancies and represents a significant cause of second-trimester loss and spontaneous preterm birth. This review synthesizes current evidence across the clinical spectrum of cervical insufficiency, providing evidence-based management guidance and identifying areas requiring further investigation. Methods: We conducted a comprehensive review of the current literature, evidence-based clinical guidelines, and landmark randomized controlled trials examining diagnostic frameworks, therapeutic interventions, and clinical outcomes across different presentations of cervical insufficiency. Our analysis incorporated data from major obstetric databases, professional society recommendations, and recent comparative effectiveness research. Results: Cervical insufficiency diagnosis encompasses three primary categories: history-based, ultrasound-based, and physical examination-based. Vaginal progesterone achieves a 31% reduction in preterm birth before 33 weeks (RR 0.69, 95% CI 0.55–0.88; NNT= 14). Ultrasound-indicated cerclage achieves a 30% relative risk reduction for delivery <35 weeks. The landmark SuPPoRT trial (n = 386) demonstrated no statistically significant differences among cerclage, pessary, and progesterone (p = 0.4), though formal equivalence trials have not been conducted. Multiple gestations show no benefit from singleton-derived interventions (RR 0.99–1.04). Conclusions: Optimal cervical insufficiency management emphasizes individualized approaches based on comprehensive risk stratification and objective cervical assessment, with vaginal progesterone and cervical cerclage serving as cornerstone therapies supported by robust clinical evidence.