Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disorder in women of reproductive age, often associated with low-grade chronic inflammation. This study aimed to investigate the relationship between composite inflammatory markers—Neutrophil-to-Lymphocyte Ratio (NLR), Systemic Immune Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)—and clinical phenotypes of PCOS, including oligo-/amenorrhea, hyperandrogenism, and polycystic ovarian morphology (PCOM). In this retrospective cross-sectional study, women with PCOS were categorized into subgroups based on clinical phenotypes. Composite inflammatory markers were calculated from complete blood count parameters, and their association with clinical, hormonal, and ultrasonographic findings was analyzed. ROC analysis assessed the discriminatory value of each marker. Inflammatory markers were significantly higher in the oligo-/amenorrhea and PCOM groups. In oligo-/amenorrhea, NLR (2.42 vs. 1.96, p = 0.028), AISI (282.16 vs. 188.73, p = 0.005), SII (664.59 vs. 519.86, p = 0.008), and SIRI (0.97 vs. 0.70, p = 0.005) were elevated. In PCOM, NLR (2.85 vs. 2.25, p = 0.025), AISI (323.15 vs. 262.78, p = 0.049), SII (738.52 vs. 641.27, p = 0.030), and SIRI (1.10 vs. 0.90, p = 0.046) were also higher. AISI showed the best discrimination for oligo-/amenorrhea (AUC = 0.652), while NLR was most predictive for PCOM (AUC = 0.617). Composite inflammatory markers are elevated in specific PCOS phenotypes, especially oligo-/amenorrhea and PCOM, and may reflect low-grade inflammation. These markers may help identify patients at higher cardiometabolic risk and guide preventive strategies.

To evaluate the impact of fibroid size on maternal and neonatal outcomes, determine whether a dose–response pattern exists across size categories (< 5 cm, 5–10 cm, > 10 cm), and identify a threshold at which pregnancy risk increases significantly. This retrospective cohort study included 651 pregnant women with sonographically confirmed uterine fibroids. Participants were stratified into three groups based on the maximum diameter of the largest fibroid: 10 cm. Outcomes assessed included preterm birth, PPROM, malpresentation, caesarean delivery, postpartum haemorrhage (PPH), fetal growth restriction (FGR), NICU admission, miscarriage, surgical outcomes such as operative time and blood loss, and a composite adverse perinatal outcome (CAPO). Logistic regression analysis was performed to identify variables independently associated with CAPO. Adverse events rose stepwise with fibroid size. Preterm birth occurred in 12.3%, 24.1% and 36.1% of the size groups (p < 0.001); PPROM in 2.5%, 10.6% and 13.9% (p < 0.001); malpresentation in 13.3%, 28.6% and 47.2% (p < 0.001). Caesarean deliveries were 56.6%, 67.3% and 92.1%, while PPH rose from 1.3 to 30.6% (both p < 0.001). Operative blood loss and time likewise increased with diameter. Neonatally, mean birthweight declined (3150 g, 2995 g, 2870 g; p = 0.003); NICU admission rose from 13.5 to 34.1% (p < 0.001), and CAPO from 14.8 to 35.1% (p < 0.001). Multivariate analysis showed that fibroids > 5 cm independently predicted CAPO (aOR: 1.84 for 5–10 cm; 3.78 for > 10 cm), while maternal age, parity, IVF were not significant. Descriptive subgroup analysis revealed longer operative times and greater blood loss in women with multiple, cervical, or combined-type fibroids. Fibroid diameter emerged as a key determinant of obstetric and neonatal risk. Lesions > 5 cm, particularly > 10 cm, were associated with markedly increased rates of maternal haemorrhage, preterm birth, and neonatal morbidity. Such pregnancies should be managed as high-risk, with enhanced antenatal surveillance and individualized delivery planning.

This study aimed to evaluate the clinical and prognostic value of various inflammatory and metabolic indices in identifying of early-onset (EO-PE) and late-onset preeclampsia (LO-PE) and in predicting composite adverse maternal outcomes (CAMO), composite adverse perinatal outcomes (CANO), and disease severity. This retrospective cohort study included 625 singleton pregnant women followed at a tertiary center between January 1, 2023, and January 1, 2025. The study group comprised 320 preeclamptic women (170 EO-PE < 34 weeks, 150 LO-PE ≥ 34 weeks), while 305 gestational age-matched healthy pregnancies served as controls (155 early controls, 150 late controls). Preeclampsia cases were further classified into 155 severe and 165 mild cases. The indices analyzed included uric acid/albumin ratio (UA/Alb), fibrinogen/uric acid ratio (Fib/UA), uric acid/creatinine ratio (UA/Cr), creatinine/body weight ratio (Cr/BW), AST/platelet ratio (AST/PLT), AST/ALT ratio, and fibrosis indices (FIB-4 and FIB-5). Composite adverse maternal outcomes (CAMO) include the presence of at least one of the following maternal outcomes: thrombocytopenia, renal dysfunction, hepatic dysfunction, HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count), disseminated intravascular coagulation (DIC), pulmonary edema, eclampsia, and admission to the maternal intensive care unit (ICU). Composite adverse neonatal outcomes (CANO) include the presence of at least one of the following adverse outcomes: transient tachypnea of the newborn, respiratory distress syndrome, need for continuous positive airway pressure, need for mechanical ventilation, need for phototherapy, neonatal hypoglycemia, intraventricular hemorrhage, necrotizing enterocolitis, neonatal sepsis, 5th minute APGAR score < 7, neonatal intensive care unit (NICU) admission, placental abruption, and preterm birth. The UA/Alb ratio and Fib/UA ratio were the most strongly associated with EO-PE and LO-PE, with high discriminative accuracy (AUC = 0.831 and 0.888, respectively). These indices also showed strong associations with CAMO, CANO, and disease severity. In contrast, the AST/ALT ratio was not significantly associated with PE discrimination, severity, CAMO, or CANO. The AST/PLT ratio and FIB-4 were significantly associated with both EO-PE and LO-PE, while FIB-5 was only associated with EO-PE. Both FIB-4 and FIB-5 were significantly linked to CAMO and CANO in EO-PE cases, but not in LO-PE. Both indices were also associated with severe preeclampsia. Although the Cr/BW ratio was associated with disease severity, it showed limited value in distinguishing EO-PE or LO-PE from the control group and was only related to CAMO and CANO in EO-PE. Our study identified UA/Alb and Fib/UA ratios as the most informative indices for classifying EO-PE and LO-PE, assessing CAMO and CANO risk, and evaluating disease severity. The high AUC values support their potential clinical applicability. Conversely, the AST/ALT ratio was not significantly associated with preeclampsia diagnosis, disease severity, differentiation of CAMO or CANO.